ObjectivesClérambault issued the diagnosis that King Louis XI (1423–1483) was paranoid. The objective of this article is to enumerate the various elements that make it possible to question this “diagnosis”. MethodAfter reviewing the psychiatric literature about the “case” of Louis XI, we consulted historians, and then, considering all of this research, we highlight the king's pathological sense of “distrust” which we then analyze in the light of psychopathology and psychoanalytical orientation. ResultsKing Louis XI was nicknamed “the most suspicious man ever”. Beyond this characterized distrust, he also seems to have manifested a persecution complex and hypochondriac concerns. As far as the diagnosis of “paranoia” is concerned, – a non-triggered, non-deviant paranoia seems to us to be appropriate, especially in view of Clérambault's conception of it. DiscussionThe main discussion is related to the notion of “mistrust” in psychopathology, and the role it can play as a “successful defense” in paranoia. ConclusionGiven that there is a certain consensus – among psychiatric references, but also among historians – it is very likely that Louis XI presented a form of paranoia, with ideas of persecution, tyranny, cruelty, thirst for power, and hypochondriac concerns, All in a sense “contained” by an extreme distrust which seems to have sheltered him from a systematized delirium.