A First-Rate Madness (34 page)

A follow-up analysis in 1976 compared the Nazi results with other control groups: patients with schizophrenia and depression, a 1930s sample of German common criminals, a normal control of Kansas state troopers, and a second normal control group of medical students in the 1970s. The average Nazi leader showed little empathy, much positive emotion (e.g., self-confidence, self-esteem, happy mood), and normal amounts of negative emotion (e.g., sadness, anger). His overall cognitive style was deemed to be “integrative/holistic” (in other words, he tended to interpret the inkblot picture as a whole, as opposed to analyzing its parts). Most important, in comparison with the psychiatric and antisocial controls, the Nazi leaders demonstrated
no
evidence of psychosis at all, and hardly any antisocial personality traits. Indeed, the group that they approximated most closely was the “normal” Kansas state troopers.

The most unusual response, found only in some Nazi Rorschachs (five of them), and never in any of the other groups, was what the researchers called an “eerie” finding. Among animal shapes reported in the inkblots, only Nazis reported seeing a chameleon, suggesting perhaps a tendency to accommodate themselves to the powers that be (four of the five chameleon Nazis were acquitted at trial).

In sum, the Nazi leaders were much more normal than otherwise. They most closely resembled American state troopers, a finding that may say much more about the kind of person who seeks power over others than anything specific about Nazi ideology.

One might ask whether the Nazi leaders fooled the test giver, or consciously provided material that they thought would show them in the best light while on trial. This is possible, but as regards antisocial traits the 1930s German criminals also would have had similar motivations. Also, if one truly has psychosis, it is rather difficult to fake not having it. Depression, and to a lesser degree mania, might have been consciously masked to some extent, but even there, complete success at minimizing all symptoms is difficult.

One aspect of the unfortunate normality of the Nazi evil was that, like most mentally healthy homoclite leaders, the Nazis could not learn from their mistakes, even after their evident failure. Here is how the prosecutor of the Nuremberg trials, FDR's old friend Robert Jackson, described it:

Psychiatrist Robert Lifton, in his many interviews with Nazi doctors, confirms that the highest-ranking leaders were mentally healthy, even in many ways admirable, men. Karl Brandt, for instance, a prominent academic physician, a member of an aristocratic family, educated in the best universities, one of Hitler's close doctors, was a leader of the medical euthanasia of mentally ill patients. Yet he was highly respected even by anti-Nazi leaders. Said one, “You must not picture Professor Brandt as a criminal, but rather as an idealist.” Everyone Lifton interviewed spoke of Brandt as “decent, straightforward, and reliable. One doctor who knew him quite well described him as ‘a highly ethical person . . . one of the most idealistic physicians I have ever met.'” Lifton saw Brandt as the prototype of the “decent Nazi”: ethical in his personal relationships, upright and opposed to the extremism of “crude Nazis.” Yet decent Nazis were Nazis nonetheless, believers in racial hygiene and the tools Hitler used to implement his genocide. Brandt never repudiated Hitler or Nazism throughout his Nuremberg trial, even though at the very end of the war, when Brandt declined to commit suicide, Hitler had repudiated him. Just before his hanging in 1948, Brandt could earnestly say these last words: “I have always fought in good conscience for my personal convictions and done so uprightly, frankly and openly.”

The homoclite leader, suffering from hubris, rarely admits failure. If this kind of evil is banal in the sense of being commonplace, awareness of it is hardly common. Without these homoclite leaders, as Lifton concluded, the Nazi mass murders would never have happened.

 

 

IF THE CONCEPT of homoclites is scientifically correct, then it can be universally applied. All masses of people, including the German populace, are, by definition, homoclites: the average of a statistical mean of psychological traits—which constitutes a scientific definition of mental health. Their main weakness, as explained in the previous chapters, is conformity, which can be manipulated by demagogues; and yet they are hardy, resilient stock, able to survive such manipulation and then create a better world. In contrast, as I've tried to show, most Nazi leaders were not mere followers, nor were they insane; they were true believers, ideologues, rational fanatics—but from a psychiatric perspective they were mentally healthy.

While it is natural for laymen to see Hitler and the Nazis as insane, historians have struggled with the moral consequences of whatever judgments one makes about the mental states of Hitler and the Nazi leaders. The path of least resistance is to just avoid the topic, and this is what many do. They assume that Hitler and the Nazi leaders were more or less normal and thus responsible for their acts, and so too for the German people. If Hitler had a mental illness, then he could be made a scapegoat, or in some sense relieved of responsibility for his crimes—the ultimate insanity defense.

This is a simplistic mistake. To identify presence of mental illness with lack of moral responsibility is an expression of major ignorance about what mental illness is; yet I find this assumption in prominent historical works on Hitler and the Nazis. One can have mental illness, even the most severe, like schizophrenia, and still fall far short of the legal standard of innocence by insanity. In fact, in the vast majority of cases, those with mental illnesses are legally responsible for their actions, even when they commit the most heinous crimes. The
medical
and
legal
meanings of mental illness hardly overlap at all.

Medically, Adolf Hitler was a mentally ill man, with bipolar disorder and many abnormal personality traits, worsened markedly by years of treatment with intravenous amphetamine. Legally, he knew what he was doing, and he intended to do it; thus he was fully responsible for all his actions, despite having a mental illness and taking treatments that worsened that illness. There is no strong legal case in favor of Hitler from a psychiatric point of view as regards his historical crimes, as historian Martin Kitchen describes well. But this fact does not change the reality of his mood episodes or his intravenous amphetamine treatment, nor the effects of that illness and that treatment on his behavior.

No Hitler, no Holocaust, it is said. And yet Hitler did not create and maintain the Nazi regime all by himself. He was helped along by many other Nazi leaders who were, we now know, quite mentally healthy. They were homoclite leaders, devout followers of an ideology that they truly accepted. Banality does not do justice to this fact. Though they were disciples of the dictator, these Nazi leaders enjoyed great freedom of action for most of the Nazi regime. They were indispensable to Hitler, his eyes and ears and arms and hands. Without the second-rank Nazi leaders, no one man could have run such a totalitarian state. We must face the paradox: they were ghastly creatures, but they were mentally healthy, normal homoclites. It might seem that the term “homoclites” should not be used for such monsters, but only for nice, upright people like the students of Grinker's YMCA college. But many Nazi leaders had also been nice, upright people most of their lives, before they became fanatic adherents of a racist doctrine. This disconcerting possibility may hold within it a dangerous wisdom about human psychology: the violence that lurks within even the healthiest of us.

And we can't let the German people off this hook. Most historians would argue rightly that Hitler and the Nazis have to be understood within their wider social context. Here the homoclite masses of Germany become relevant. When the masses yearn for community and conformism, and respond to the charisma of a manic-depressive supreme leader, and are prodded along by second-rank homoclite leaders, in a world where other countries don't respond to what is happening, and where poverty is rampant—one has an explosive mix.

We must not underestimate the dangers of homoclite psychology. It is not a matter of Hitler or the Nazi leaders or the German people just going bananas. The German people were mentally healthy, as were most of the Nazi leaders, and for most of his life Hitler's bipolar disorder was helpful to his leadership and his charisma, despite its drawbacks. There is much more mental health here than illness. Germany and its Nazi leaders were not much different, psychologically, from any nation or any leaders. And that's the scary part.

We are left with a dilemma. Mental health—sanity—does not ensure good leadership; in fact, it often entails the reverse. Mental illness can produce great leaders, but if the illness is too severe, or treated with the wrong drugs, it produces failure or, sometimes, evil. The relationship between mental illness and leadership turns out to be quite complex, but it certainly isn't consistent with the common assumption that sanity is good, and insanity bad.

The thesis of this book runs counter to a deep cultural stigma accompanying mental illness. I suspect that it may be among our species' deepest biases, more so than even racism or sexism. Even those who realize the problem of psychiatric stigma, like doctors, cannot escape their inherent stigma. Some studies show that physicians attach as much stigma to mental illness as the general population. Even mental health professionals, who attach the least stigma to mental illness, have negative attitudes toward some mental illnesses, especially schizophrenia and bipolar disorder. And even some mentally ill people themselves harbor stigmatizing beliefs about mental illness.

This stigma is the basis, I think, for most of the intuitively negative reactions that readers may have to this book's theme. Those who have tried to argue otherwise have always noted this bias. Writing in latenineteenth-century Italy, the psychiatrist Cesare Lombroso noted that a “proud mediocrity” resists the notion that what is common, and thus normal, may not be best. In 1930s Germany, the psychiatrist Ernst Kretschmer observed the same stigma and called it out as a “prejudice” of psychiatric “inferiority”; it is “agreeable” to be sane, he noted, but “a sound mind is possessed by the man who is emotionally in a state of stable equilibrium and who has a general feeling of well-being. Peace of mind and restful emotions, however, have never been spurs to great deeds.” The same held in 1960s England when Lord Moran published his medical diaries about Churchill, revealing the great man's depression. Churchill's wife could not accept it (“It shows Winston in a completely false light”) and she tried to dissuade Moran from publishing it, citing doctor-patient confidentiality. America in the 1990s was no different. Just as the Churchill family blackballed Moran, the Kennedy family criticized Nigel Hamilton's carefully documented evidence for John Kennedy's youthful hyperthymia (even though Hamilton never claimed a psychiatric diagnosis).

Prejudice against mental illness crosses all societies and all historical epochs. Profound intuitive responses and beliefs have grown out of this stigma over millennia, and they will not change easily or soon.

However deep the stigma may be, the indisputable fact remains that the border between health and illness is porous. Some aspects of mental health are found in even the most severe mental illness, and some aspects of mental illness reside in the most mentally healthy person. In this regard, the Freudians were right; we all are mentally ill to some extent. Harvard psychologist Brendan Maher showed that abnormal, illogical thought processes are common in normal, mentally healthy people. They differ in degree but not in kind from the delusional thinking that characterizes schizophrenics. Researchers have identified a slew of irrational thinking habits—called mental heuristics and biases. These include treating familiar ideas less critically than unfamiliar ones, assuming a causal link between events that happen coincidentally, exaggerating the threat from uncommon risks, and many others. (One source identified thirty-one standard irrational thought processes.) The overlaps between normal sadness and clinical depression, and between normal happiness and mania, have also been much examined by professionals and laypeople. So whether we're considering mood states or thought processes, the line between mental health and mental illness is hardly sharp, and the fuzziness at the borders means that some conditions will overlap each other. Mental illness isn't like being pregnant—you are or you are not—it's more like hypertension, or diabetes, or heart disease, all of which involve gradations of abnormality leading, in extreme cases, to specific events like a stroke, coma, or heart attacks.

Part of the stigma accompanying mental illness comes from our desire to view it as something completely “other”—utterly separate from those of us who are normal. But there is some of this “other” in all of us.

 

 

THESE CONSIDERATIONS obviously bear on contemporary politics and psychiatric practice. Regarding politics, recent experience in the United States suggests that stigma is alive and well. The last major national American politician to have admitted to any psychiatric condition was the unfortunate Missouri senator Thomas Eagleton, who was briefly the Democratic nominee for vice president in 1972. Soon after his nomination was announced, word spread that Eagleton had received electroconvulsive treatment (ECT) for depression, a common approach in that era (before most psychiatric drugs became widespread). We now know that he was hospitalized and treated three times between 1960 and 1966. Apparently he also received Thorazine, a medication now used for mania and psychosis (though also for depression in that era; it is similar to the Stelazine that Kennedy briefly received in the White House). Some have concluded that Eagleton may have had not just depression, but mania too, that is, bipolar disorder. After Democratic presidential candidate George McGovern dumped Eagleton from the ticket, despite Eagleton's strong objections, the Missourian returned to the Senate for a long career (1968–1986), during which time he served with distinction and was never known to have been severely depressed or manic. After leaving the Senate, he went on to live another two decades, never once criticizing McGovern in public or seeking retrospective revenge on this critics.