IN 1937, Hitler began using amphetamines. Before then, his bipolar disorder seemed manageable; either his moods didn’t affect him much in the 1930s, or they only added to his productivity and creativity. After that date, a gradual decline began, with worsening manic and depressive episodes that impaired his leadership. Hitler’s psychotropic treatment history, his amphetamine use, combined with his bipolar disorder, has not been adequately described in previous attempts to “explain” him.
(This story was first fully revealed by the psychiatrist Leonard Heston, a prominent researcher in the genetics of schizophrenia, who along with his German-speaking wife, Renate, published a complete medical study of Hitler in 1980. At that time, the Hestons not only reviewed all available documentation of Hitler’s medical records, but they also interviewed his still living doctors and many other people who knew about Hitler’s medical care. Their personal interviews are important sources of documentation that, with the passage of time, will only increase in value.)
The year 1937 was when Hitler began treatment with the man who would remain his personal physician until his final days, Theodor Morell. Morell’s exclusive practice catered to wealthy Berliners with nonspecific neurotic complaints who loved the doctor’s magic injections. We now know these injections sometimes literally were placebos (diluted sugar—20 percent glucose in medical terms), and frequently were potent “natural” tissue extracts, like adrenal glands or ground bull testes. Morell liberally injected not only Hitler but many of the Nazi elite, such that Hermann Goering jokingly titled the doctor “Herr Reich Injektion Minister—the Injection Minister of the Reich. After he was captured by American forces, Morell admitted to giving Hitler twenty-eight different treatments, though he probably understated how frequently. A few stand out (and are similar to the injections that John Kennedy would later receive from Max Jacobsen): “Orchikrin,” described as “a combination of all hormones of males. Potency is increased by the addition of extracts of testis, seminal vesicles and prostate of young bulls . . . to combat fatigue and depression”; “Prostakrimum,” “an extract of seminal vesicles and prostate. Used to prevent depressive moods”; and a steroid derived from ground-up adrenal glands, “Cortiron,” “Desoxycoticosteronacetate [sic] . . . used for muscle weakness.” These descriptions are further proof, based on treatment, that Hitler experienced depression.
In the 1930s, Hitler (again like Kennedy) was racked with horrible gastrointestinal problems: eating produced sudden pain, followed by diarrhea. In retrospect these symptoms are consistent with gastritis, possibly ulcers, or perhaps irritable bowel syndrome (all of which are common in mood disorders). Hitler had already restricted his diet, becoming completely vegetarian, without avail. He called Morell, who eventually prescribed synthetic opiate narcotics and anticholinergic drugs, known to slow diarrhea. (The narcotic given was Eukodal, which is oxycodone, the same ingredient in the highly addictive drug Oxy-Contin.) Hitler improved, and Morell became part of the Führer’s inner circle.
Hitler’s chronic insomnia was the next target. With constant anxiety and frequent mood episodes, he had developed, like Churchill, reversed sleep cycles. He stayed awake late into the night, talking and working inordinately, but slept each morning until noon. Hitler wanted morning pep and evening sleep. Morell had just the thing.
The insomnia was easy to treat. Barbiturates were used extensively (Churchill also received them); in his American interrogation, Morell admitted to prescribing a barbiturate for sleep (Brom-Nervacit, which contained a bromide sedative, and Barbital, also called Veronal, the first commercially marketed barbiturate). He likely prescribed it to Hitler for nightly use from 1939 onward.
Morell had made progress: Hitler’s stomach was quieted with an opiate; his sleep improved with a barbiturate. Now there was only the problem of pep. Amphetamine would be the solution.
AMPHETAMINES, first marketed in 1928 as Benzedrine (dl-amphetamine), were quite popular. Prescribed initially for narcolepsy, they quickly became the first widely used psychiatric treatment for depression. (By 1971, there were over thirty-one amphetamine preparations marketed in the United States, mostly used for depression.) Morell saw that his patient suffered from depression, anxiety, and insomnia—the kinds of symptoms he frequently saw in his rich Berlin clientele. He decided to prescribe a new antidepressant, methamphetamine.
Heston believes that Hitler’s use began in 1937, based on the first reported changes in his behavior. Hitler was less friendly, more withdrawn, more suspicious of others. These changes weren’t brief, as in his past depressive episodes, but more consistent. They were especially noted by Albert Speer, the Führer’s confidant and a consultant to the Hestons, and by Heinrich Himmler, Hitler’s close deputy, who, convinced that Hitler must have neurosyphilis, began collecting a medical file on him. (Hitler had repeated negative tests for syphilis.) Even the Italian king, Victor Emmanuel III, wondered aloud to his court, after seeing Hitler in May 1938, whether he was taking amphetamines.
More definitive evidence that Hitler received amphetamines dates to late 1941, right after the Germans’ defeat at Stalingrad, when he became markedly depressed. In the 1970s, the Hestons interviewed Hitler’s valet, Heinz Linge, who served him from 1935 onward, and who still admired his old leader. Linge described a daily morning intravenous injection, given by Morell, documented in Linge’s appointment books. Morell admitted giving Hitler injections of “Vitamultin-Ca,” a mixture of vitamins. Linge describes results never associated with vitamins, though: “The effects were instantly apparent—not minutes later, but while the needle was still in the arm. The effect on Hitler was obviously alerting: he felt ‘fresh,’ alert, active, and immediately ready for the day.” By the middle of 1943, Hitler began to have the injections, according to Linge, multiple times daily, with the same results. The Hestons interviewed other Hitler aides who described similar effects: Hitler was immediately rendered “extremely alert and talkative,” a “rejuvenating” effect; after the injections, he was “cheerful, talkative, physically active, and tended to stay awake long hours into the night.”
Morell kept the ingredients a jealously guarded secret; despite Himmler’s repeated entreaties, Morell cited confidentiality, saying only that it was “a mixture specially compounded for the Führer.” Due to his link to Hitler, Morell now ran numerous pharmaceutical factories. Hitler’s preparation was secretly made to Morell’s specific order, with oral tablets wrapped in gold foil and intravenous injections delivered to Morell himself.
Hitler’s other physicians were suspicious of Morell. Dr. Ernst-Günther Schenck, a nutrition inspector for the Waffen-SS, interviewed by the Hestons in the 1970s, reported that in 1943 he managed to obtain a gold-foil-wrapped tablet prepared for Hitler. He analyzed its chemical contents and found, besides vitamins, methamphetamine. Schenck gave the report to his superior, the Reich health minister, who showed it to Himmler. Schenck said that Himmler ordered him to drop the matter. Later assigned to the bunker after the Führer dismissed Morell in the final days, Schenck would be the last physician to see Hitler alive. After ten years in a Russian prison camp, Schenck revealed the story about methamphetamine, which he repeated in his own memoirs and in interviews until his death in 1998. According to Linge, Hitler took about five of these gold-foiled methamphetamine tablets daily, supplemented by continual sucking on over-the-counter candy, called “Cola-Dalmann,” which contained appreciable doses of caffeine. (Hitler did not drink alcohol, coffee, or tea, however.) Like Kennedy’s doctors, some of Hitler’s, such as the highly regarded Karl Brandt, tried to act to restrain the use of harmful drugs, attempting a medical coup d’état against Morell; unlike Kennedy’s doctors, they failed.
In sum, Hitler was constantly taking three kinds of psychoactive drugs: opiates, barbiturates, and amphetamines, of which the amphetamine use was most potent since it was given both intravenously and orally. We don’t know how much intramuscular anabolic steroids (from the ground-up bull testes, prostate, and adrenal glands) were gi
ven, but it is plausible that (like John Kennedy in 1961–1962) Hitler also received anabolic steroids regularly. Kennedy’s doctors were able to get his psychopharmacological mix under control after banishing his quack Dr. Jacobsen; Hitler’s doctors were never able to oust Morell. If Kennedy’s mix eventually became a “spectacular psychochemical success,” Hitler’s was a much more spectacular disaster.
GIVING AMPHETAMINES every day, intravenously, to a man with untreated bipolar disorder is likely to have a grave effect on his decisionmaking processes. Even oral amphetamines, being powerful antidepressants, cause mania in about half of people with bipolar disorder, especially if mood stabilizers like lithium (which weren’t available in Hitler’s time) aren’t given as well. If such is the case with oral amphetamines that are less potent than what Hitler took, then the chances someone with bipolar disorder would become manic with intravenous amphetamine are much higher than 50 percent, so high that we can’t even test the notion: no contemporary hospital ethics committee would ever allow such a risky study; it would be blatant abuse of patients’ rights. Yet Adolf Hitler took such abuse every day. Rats treated this way, with daily intramuscular amphetamine for months, are used as an animal model of psychosis. In sum, these are dangerous drugs, especially when given to people with severe mental illnesses.
Hitler had relatively severe bipolar disorder, like Churchill or Sherman; but unlike them, he received daily intravenous amphetamine treatment for the last four years of his life, supplemented with oral amphetamines and caffeine (and mixed with consistent barbiturates and opiates, and intermittent anabolic steroids). A normal person would have a tough time remaining sane with this concoction. (In contrast, Churchill’s amphetamines came only in pill form, and not consistently. Kennedy never received intravenous injections of steroids, to our knowledge, only intramuscular, and he did not have full-blown bipolar disorder, but hyperthymic personality, which would make him less susceptible to mania or psychosis. Also, his amphetamines were always oral and low-dose.) To call Hitler a time bomb would be to understate matters. Morell lit a fuse that exploded the entire world.
Hitler changed in those final years in many ways. Though he had always been an angry man, especially when manic, he had been generally courteous and proper in social settings, able to exercise good self-control when needed. But by 1942 he routinely screamed at generals during military meetings. Many observers noted that his rages were much worse than they had been in the 1930s. On one occasion in December 1942, he shouted nonstop for three hours. That anger was not limited to military matters. Once, for instance, after the death of an opera singer (Hitler loved opera), he was indignant at what he thought was insufficient newspaper coverage and exploded in “a frenzy of rage against the press. His fury lasted for hours and made him literally incapable of work for the rest of the day.” By December 1943, Himmler, convinced that Hitler had a “sick mind,” disobeyed some orders, such as one to execute all prisoners of war. On at least two occasions (in 1938 and 1942) several generals tried to persuade prominent psychiatrists to commit Hitler to a mental asylum. (The doctors refused.)
Speer notes that whereas Hitler used to ask intelligent questions of his generals and then listen to their responses, the Führer increasingly refused to listen to anyone. “No retreat” became his mantra, whatever the specific military circumstances. For instance, Hitler previously had enjoyed reports of General Erwin Rommel’s successes in North Africa, especially his tactic of the “fighting retreat and counterattack.” But in November 1942, in the great battle of El Alamein, Hitler refused to allow Rommel to move his troops as he wished; no retreat, came the orders. Rommel was demolished. On July 20, 1944, military plotters failed in their attempt to bomb Hitler. Some of the plotters eventually confessed that Rommel was an ally, and as Hitler tracked down and executed officers implicated in the plot, Rommel concluded that his Führer was insane. (“That pathological liar has gone completely mad!” he told an aide.) By October, the regime gave Rommel two options: quietly commit suicide or be executed along with his family. The Nazis said he had died of a heart attack, and arranged a solemn burial with full military honors.
EARLIER IN HIS CAREER, Hitler had no trouble delegating authority. He set broad policies and let his domestic and military advisers enact them. Now he became obsessed with details, telling his commanders what to do at every turn. No order could be given without Hitler’s specific approval. Said Field Marshal von Rundstedt, “The only troops I could move without permission were the sentries outside my door.” Here too amphetamines may be relevant. Hitler likely had, as previously noted, obsessive tendencies, reflected in his fixation on personal hygiene and cleanliness. This trait may have worsened with amphetamine use, which is well known to cause or worsen symptoms of obsessive-compulsive disorder.
While he was taking amphetamines, Hitler’s moods cycled more quickly and severely than before. When he was depressed, he slept longer, refusing to talk about the war as much as possible. He ate alone, he couldn’t concentrate, he was indecisive, and, unusually for a man famous for his great memory, he was absentminded. In 1943, Morell even publicly revised his prior diagnosis from (only) depression to manic depression. Morell was no psychiatric expert, but he was correct if he truly said and meant this. (The source for this citation is from a contemporary book by a Swedish journalist.) Morell intensified the amphetamine treatments, which probably only worsened Hitler’s mania. Speer reports that from then onward, Hitler never seemed depressed again until the final days in the Berlin bunker. Instead, he was increasingly unrealistic and overoptimistic: “The more inexorably events moved towards catastrophe, the more inflexible he became, the more rigidly convinced that everything he decided on was right.” Linge, Hitler’s valet, told the Hestons that this was correct, except that Hitler had brief depressive periods, usually lasting days to weeks, when he would get tearful and wish that he would die. The Hestons date such brief periods to August 1944, February 1945, and again at the end of Hitler’s life in April 1945. It is probable that the extensive intravenous amphetamine injections, perhaps augmented by steroids, were causing Hitler to “cycle” into and out of his manic and depressive episodes more and more quickly. In his final two years, Hitler probably never experienced a day of normal mood.
His world was collapsing; his mind already had.
WAS HITLER PSYCHOTIC? That is, did he have hallucinations or delusions? This question is worth considering because it reflects a common assumption among both historians and the rest of us. As noted above, it’s natural to believe that atrocities as extreme as Hitler’s could only be the products of a thoroughly deranged mind—one that has abandoned reality and inhabits an unreal world of delusion and hallucination. This assumption is bolstered in Hitler’s case by some evidence that could be viewed as indicative of psychosis.
Hearing voices (auditory hallucination) is one symptom of psychosis, and in 1918, when he was in a military hospital, Hitler heard a voice telling him that he was to be Germany’s savior. (Some think his experience occurred under hypnotic suggestion, and that he actually was hearing the voice of his psychiatrist, Dr. Edmund Forster.) Throughout his career, Hitler frequently spoke of following his “inner voice”; but then again, so did Gandhi. Using the word “voice” metaphorically is not the same as hearing an actual voice. During World War II, Hitler claimed to hear orders from God, but such voices were less likely the result of inborn psychosis than years of IV amphetamine use.
As for delusions, psychiatrists sometimes define them as involving fixed false beliefs held against incontrovertible evidence to the contrary, with markedly illogical thought processes. For instance, I might believe the world will end tomorrow because Martians have begun to eat my entrails. That is a clear delusion. But Hitler’s extreme anti-Semitism is not delusional, partly because he belonged to a culture where anti-Semitism was hardly unusual. Such an attitude was undoubtedly wrong—both morally and factually—but it was common enough to fall within the realm of normal behavior for Hitle
r’s time. And while he was paranoid toward a world of enemies, his paranoia wasn’t necessarily delusional, because he in fact had many enemies. He was paranoid about the German military, but that was not irrational, because German generals repeatedly tried to remove him from power. He had grandiose ideas. He thought he alone would save Germany, but this was not a delusion: many other people thought he could too. He also had a constant phobia about syphilis, fearing that he might have contracted it. But he had many obsessions, including a strong desire to be clean and a fear of germs. This abnormal thinking is more consistent with obsessions than delusions. Toward the end of World War II, he may have had delusions; he was known to issue orders to nonexistent armies. But again, by then he’d been taking intravenous amphetamines for several years, which alone or in combination with his underlying bipolar disorder could produce delusions.
So Hitler wasn’t just plain crazy, in the sense of outright psychosis, though he may have been made crazy by a nightmarish mixture of drugs and mania.
AS I DISCOVERED, the literature on Hitler’s psychiatric condition is immense, and it offers up a welter of theories about his mental state. We should examine those theories in light of the evidence we’ve gleaned about his symptoms and drug use.
The most common psychiatric diagnosis given to Hitler is antisocial personality disorder, but this condition involves such features as cruelty to animals, breaking the law, and complete absence of empathy. Yet Hitler loved animals, never broke the law before his political activities, and clearly had much empathy for his mother, his childhood friend Kubizek, his half niece Geli, and others. Other personality disorders, such as borderline personality, also don’t correspond with Hitler’s life. (There is no evidence he was sexually abused, for instance, and he never cut himself or otherwise attempted suicide before his death—all of which are cardinal features of borderline personality.)
A First-Rate Madness Page 20