A First-Rate Madness

by Nassir Ghaemi

  TONY BLAIR’S BIOGRAPHY reads like a case from Roy Grinker’s study. He was again sociable but not extremely extraverted (unlike FDR), calm but not overly or insufficiently anxious, curious but not a risk-taker (unlike JFK). Even his earnest attitude to religion is consistent with homoclite psychology.

  In sum, Tony Blair was a mentally healthy, homoclite leader. He rightly objects to assertions, based on stigma attached to mental illness, that he must be mentally unwell: “Friends opposed to the war think I’m being obstinate; others, less friendly, think I’m delusional. To both I may say: Keep an open mind.” To both, I would say, your conclusions are right, but your premises are wrong. His political enemies think there is something wrong with Blair—morally, politically, psychologically. If Blair was politically mistaken, the cause was not any mental abnormality; it was mental health. Tony Blair had many problems, but mental illness was not one of them. His main problem, like Bush, may have been that he was too mentally healthy to handle the crises thrust upon him.

  BLAIR AND BUSH praise each other for their “integrity,” for standing up to popular disapproval, then and now. This may not be unreasonable. Indeed, none other than John Kennedy wrote a book, Profiles in Courage, which argued that political courage meant just this: to do what was right, what was in the people’s best interests, rather than what was popular. But if Bush and Blair are wrong, then their steadfastness is not a measure of integrity or political courage. It is hubris.

  So concludes David Owen, foreign minister in the British Labour government of the late 1970s, founder and leader of the Social Democratic Party in the 1980s, and a trained physician and neurologist. In recent years Owen has published books on the health and illnesses of twentieth-century political leaders, many of whom he met and knew personally. In his book In Sickness and in Power, he recounts having dinner with Tony Blair on December 18, 1998. The two men and their wives gathered at a table in the kitchen of No. 10 Downing Street. It was the third evening of a four-day bombing blitz against Iraq jointly authorized by President Clinton and Prime Minister Blair in which the United States and UK dropped more than 600 bombs and launched 415 cruise missiles on Iraqi targets, killing an estimated 1,400 members of Iraq’s Republican Guard. At the time Congress had passed a resolution calling for the overthrow of Saddam Hussein. Owen recalls a pleasant wide-ranging conversation with detailed discussion on Iraq and the euro currency. Throughout the conversation, Blair was respectful and thoughtful—a good listener.

  In July 2002, the two couples had dinner again in the same surroundings. The people were the same; the room was the same; the food was similar. But the social interaction could hardly have been more different. In the time since their previous dinner, Blair was now a veteran leader, having been in office five years, and he was embroiled in planning for an upcoming war in Iraq. Though the circumstances of the meal were quite similar, Blair himself had changed considerably. He no longer listened; he ignored viewpoints that challenged his opinion on Iraq. An open mind had been replaced by closed neural pathways, it seemed. Owen was struck by the transformation, and his wife summed it up during the drive home by describing Blair as “messianic,” a term later commonplace, but then rarely applied to him.

  The Blair of 1998 was a highly realistic politician who had plumbed the wishes of the British electorate. The Blair of 2002 was a premier living in a world that contrasted sharply with the real one, and yet he could no longer appreciate the discordance, or even be open to hearing about it from allies. What happened to Blair between the two dinners?

  One might have predicted this outcome, based on the Goldilocks principle. Too much illusion is dangerous, and one has to make some effort to avoid sliding down that dangerous slope. Psychologist Shelley Taylor credits the real world itself: the world around us will correct us if we start to become too illusory. We will start to get negative feedback from friends and from harsh reality itself, which will punish us with setbacks: “The world provides sources of physical and social feedback that may keep illusions from becoming too extreme.” Unless you’re prime minister.

  David Owen calls it “Hubris syndrome” and considers it a disorder of power. He has observed leaders at the highest ranks of international politics for decades, and he believes that prolonged exposure to power makes many of them unwilling and even unable to accept criticism or correctly interpret events that diverge from their own beliefs. Hubris syndrome worsens with the duration and absoluteness of one’s rule. Owen has even identified specific features of the syndrome, which is completely independent of depression, mania, or abnormal personality. According to Owen, such leaders become unresponsive to opposing views, speak in the royal “we,” presume the beneficial judgment of history or God, ignore public opinion, demean dissent, and rigidly hold their beliefs against evidence to the contrary.

  Normally, people and events around us prevent us from developing too many illusions about the state of the world. We hear criticism or suffer setbacks that show that our approach to a particular situation is misguided, and we correct our course as best we can. But leaders often lack that useful check on their illusions. Their position gives them the power to ignore negative messages, or—more likely—they’re less likely to get those messages in the first place. Yes-men abound in the corridors of power. Once leaders attain power, the world gives them less and less realistic feedback, and they’re better able to exert their own power to suppress or dismiss such unhappy reactions.

  As we saw earlier in our examination of depressive realism, mentally healthy people are insulated from some of the world’s travails by their positive illusion—the belief that they and the world are actually better than they are. Generally speaking, positive illusion is a good thing, but I believe that power magnifies positive illusion into the Hubris syndrome. In this instance, we might apply the Goldilocks principle again: some illusion is beneficial, too much is dangerous—for the homoclite leader and especially for the society he leads. There are several possible antidotes to Hubris syndrome—term limits and “checks and balances” are two methods many democracies use to limit a leader’s power. But clearly such measures aren’t always effective by themselves. Another possible antidote might be having a leader who is not too mentally healthy. People who suffer from depression also benefit from a depressive realism that should protect them from the illusion-enhancing effects of power.

  In his memoir, Tony Blair [TB] himself indirectly confirms Dr. Owen’s diagnosis:

  The difference between the TB of 1997 and the TB of 2007 was this: faced with this opposition across such a broad spectrum in 1997, I would have tacked to get the wind behind me. Now I was not doing it. I was prepared to go full into it if I thought it was the only way to get to my destination. “Being in touch” with opinion was no longer the lodestar. “Doing what was right” had replaced it.

  But what if you are not right?

  BUSH AND BLAIR were normal; so too, mostly, was Nixon; so too were one last group of leaders commonly assumed to be abnormal: Nazis. I have already discussed Hitler, whose bipolar illness is consistent with the thesis of this book. Helpful initially, it became a detriment when combined with years of intravenous amphetamine treatment. We are left with the other Nazis. Weren’t they sick men?

  In the Nuremberg trials, the Allies subjected about two dozen Nazi leaders to two years of evaluation by multiple psychiatrists and psychologists, with extensive personal interviews and psychological tests. These evaluations concluded that those Nazi leaders were normal men, mentally healthy, not insane. This may seem a banal confirmation of Hannah Arendt’s thesis of the banality of evil. If it is, it at least tells us that no Nazi leader was mentally ill except possibly the three who committed suicide (Hitler, Himmler, and Goebbels). The list of those who were found to be normal is not in itself unimpressive: Hermann Goering (Luftwaffe chief), Joachim von Ribbentrop (foreign minister), Franz von Papen (vice chancellor), Hans Fritzsche (chief deputy to Goebbels), Alfred Rosenberg (editor of the Nazi newspaper), Rudolf
Hess (Hitler’s secretary, his cellmate from the 1923 prison, and a Nazi party leader from its inception), Albert Speer (armaments chief and, more important given Hitler’s original life goal, a prominent architect), and others such as the leader of the Hitler Youth, ministers of justice and economics, and the governors of occupied Poland and Austria. If one believes that the Nazi tragedy reflected the mental illness of much of its leadership, at least some of these Nazi leaders should have been mentally ill. None was.

  The consistency of the mental health of these men especially disturbed one of the psychiatrists who examined them, Dr. Douglas Kelley. Kelley had developed close relationships with the prisoners, and he was convinced they were normal healthy men, which made the whole process of Nazism that much harder to understand. For instance, Goering was Hitler’s second in command and later committed suicide by taking potassium cyanide just before he was to be hanged. After much evaluation, Kelley concluded that the Goering had a “normal basic personality,” although he was “cynical and filled with a mystical fatalism.” (Goering also had an IQ of 138, which is nearly at the “genius” level of 140 or above; even so, he was only third highest in IQ among the Nuremberg Nazi leaders. So much for the nineteenth-century biologist Sir Francis Galton’s thesis that intelligence is the hallmark of greatness.) When Kelley was transferred, Goering gave him a signed photograph as a gift, and Alfred Rosenberg, the intellectual leader of the group, wrote a farewell letter: “Your excellency Major Kelly! I regret the fact that you are leaving Nuremberg, and the comrades imprisoned with me certainly also regret it. I thank you for your human attitude and for your endeavors to understand our motives as well. . . .” Just before his hanging, Goering managed to obtain a potassium cyanide pill and commit suicide. A decade later, Dr. Kelley killed himself the same way.

  TO GIVE READERS a sense of the evidence on which these observations are based, I will now describe briefly the results of the Rorschach tests of the Nazi leaders. Though open to Freudian interpretations, Rorschach tests can be interpreted descriptively, comparing results between different groups. The Nazi Rorschachs were not published for decades, and were first reported to demonstrate mental illness galore: “[The authors] unequivocally conclude that ‘The Nazis were not psychologically normal or healthy individuals.’ . . . With few exceptions, [they] describe the Nazi leaders as vicious psychopaths, opportunistic villains, and morally and emotionally bankrupt bigots who experienced no real guilt for their instrumental roles in the slaughter of millions of Jews and other victims of Nazi terror.” This initial report was discredited when another psychologist “blinded” the tests, hiding the Nazis’ identities and mixing in psychiatric patients and normal controls. Blinded experts could not distinguish the Nazi tests from the other two groups; sometimes Nazi results were judged pathological, but other times they were described as completely normal, even commendably well-adjusted.

  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:

  I have yet to hear one of these men say that he regretted he had a part in starting the war. Their only regret is at losing it. Not one sign of contrition or reform has appeared, either in public testimony or private interrogation of the twenty-one men in the dock. Not one of them has condemned the persecution of the Jews or of the Church—they have only sought to evade personal responsibilities. Not one has condemned the creation of the concentration camps; indeed, Hermann Goering testified they are useful and necessary. Not one has indicated that, if he were free and able, he would not do the same thing over again.

  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 struggle
d 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.