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Book Forum: Diagnosis and Treatment   |    
Hitler: Diagnosis of a Destructive Prophet
JAMES R. MERIKANGAS, M.D.
Am J Psychiatry 2002;159:1066-b-1068. doi:10.1176/appi.ajp.159.6.1066-b
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By Fritz Redlich, M.D. New York, Oxford University Press, 1999, 448 pp., $35.00.

Adolf Hitler was 11 years old 92 years ago, when Fritz Redlich was born. They lived in Vienna at the same time: Redlich a psychiatrist with a medical degree from the University of Vienna and Hitler a failed art student and draft dodger. Redlich, a Jew and a socialist, left Austria when it became part of Germany. Six of his relatives who did not leave perished in the concentration camps. The two men never met, but as a psychoanalyst, Redlich was moved to attempt to understand what kind of man could rise from humble origins, without an education, to become a mass murderer and the most influential figure of the 20th century. The final impetus for this book was the emergence of Holocaust deniers and the movement that attempted to excuse Hitler’s actions as the result of mental illness, "the insanity defense." As Redlich says, "One of the largely unresolved questions is whether physical illness or mental disorder could contribute to an understanding of his behavior. That is the topic of this book, the only topic to which I—not a historian by profession—could make a contribution."

By separating "physical illness" from "mental disorder," Redlich betrays a bias of his psychoanalytic background, that mental illnesses are not physical but are the result of intrapsychic processes resulting largely from early childhood experiences and parental abuse. Redlich regrets that we know nothing of Hitler’s toilet training or the content of his dreams, but he is quick to formulate the unsupported opinion that Hitler had a congenital malformation of the penis (hypospadias) and spina bifida. At autopsy (by the Russians, not necessarily a reliable source), Hitler was found to have had only one testicle, but this was never reported by any physician who examined him while he was alive.

From hypothetical genital malformations to the invasion of Poland is a giant leap, even for a psychoanalyst. Others have suggested that Hitler had the "encapsulated eldest son syndrome" (1), a "Messiah complex" (2), "borderline personality" (3), or the most well-documented and reasonable psychiatric explanation by Hershman and Lieb (4), who suggested that he was "a paranoid, manic depressive megalomaniac whose illness made him capable of the most monstrous crimes—indeed made him eager to commit them."

There were 802 books listed on the web site of a major publisher when the search term "Hitler" was entered. Do we really need another one? If there were new information, perhaps a previously undiscovered diary or the deathbed testimony of an associate (Hitler had no friends), it would be worthwhile. At least Redlich discloses his motivation. Unfortunately, he does not keep his promise; he does not make a diagnosis. He cannot be blamed, however; even Freud refused to make a diagnosis of Hitler’s pathology because he had never examined him.

The book begins with a chronological account of Hitler’s life and the course of Germany’s rise from the fires of World War I to a powerful world empire. There are many other books that tell the same story, and Redlich refers to many of them. If the reader wants to see what the latest scholarship reveals, the best of the new crop of history books are the two-volume work by Ian Kershaw (5, 6) and The Third Reich by Michael Burleigh (7).

Redlich’s book is scholarly, has a huge bibliography, and is thoroughly researched, but he fails to connect Hitler’s words and acts to the known facts of his medical history. For instance, Hitler missed several months of grade school with a serious pulmonary illness, but it is not clear whether Redlich considers that the simple fact of falling behind can discourage a student. Instead, he argues that the illness was not tuberculosis. Hitler’s brother, Edmund, died of measles encephalitis when Adolf was 11 years old. Redlich dismisses out of hand the possibility that an infection of the same encephalitis may have influenced Adolf’s future life (although he refers to that hypothesis by Johann Recktenwald on page 234). He does not mention that measles regularly produces EEG changes in children when acute. Since Still’s classic descriptions in the 1902 Coulstonian Lectures (8), we have known that encephalitis produces subtle changes in "moral control." According to Still, "The child with only slight intellectual impairment may show far greater moral defect than a child with more impaired intellect." Encephalitis in early life can lead to Parkinson’s disease in middle life, and we know that Hitler had Parkinson’s disease. It would be amazing if this degenerative brain disorder did not affect Hitler’s judgment in the light of the frontal lobe defects and major depression that often accompany it.

This is not to excuse Hitler his anti-Semitism, which was both endemic in Europe and a ticket to his appeal to the masses, but it may serve to explain his violent mood swings, paranoia, and lack of a moral compass. His well-documented amphetamine abuse could have increased his paranoia and impaired his judgment, particularly in the presence of a preexisting organic brain syndrome.

Hitler may have been a product of his times, but he was a great orator, the inventor of the multimedia political campaign, and a man of prodigious memory for detail. He wrote, "I know that men are won over less by the written than by the spoken word, that every great movement on this earth owes its growth to our great orators and not to great writers" (9).

Redlich labels Hitler a "destructive prophet," and Hitler considered himself to be the Messiah. He wrote his manifesto, Mein Kampf(9), while in Landsberg prison. He shares his literary use of prison time with other writers such as Saint Paul, Seneca, Cervantes, Bunyon, Voltaire, Dostoevsky, Solzhenitsyn, Martin Luther King, and Iceberg Slim (Robert Beck). Prison has a way of focusing the mind and allowing the lost to find their way. Little is made of this book, in which Hitler set forth his anti-Semitic and anti-Communist paranoia and his plan for racial "purification" through eugenics.

Hitler won the Iron Cross in World War I. He was not a coward, nor was he a leader in that war. Having Germany’s highest military honor certainly helped his political career. He had an attack of hysterical blindness several weeks after being wounded by poison gas in the trenches. The "miraculous" recovery of his sight and some auditory hallucinations contributed to Hitler’s delusions. Redlich does not connect the episode of psychophysiological reaction to further developments in Hitler’s life except to show how he took steps to cover up the episode. Whether you call this book "psychohistory" or Redlich’s term "pathography," it is an example of the case history method pioneered by Adolf Meyer, Professor at Johns Hopkins, and his wife Mary, the first psychiatric social worker.

Unfortunately, a psychiatric evaluation requires not only a detailed history but also a medical-physical examination, a mental status inventory, laboratory tests, and sometimes brain imaging. Some of this information may be gleaned from historical sources and the medical records that exist, but Redlich, in the end, does not provide the promised diagnosis that the title leads the reader to expect. After 448 pages we learn, "Er war ein schlechter mensch" [He was an evil man].

Nelken M: Hitler Unmasked. Glastonbury, Conn, Darkside Press, 1997
 
Langer WC: The Mind of Adolf Hitler. New York, Basic Books, 1972
 
Waite RGL: The Psychopathic God: Adolf Hitler. New York, Da Capro Press, 1993
 
Hershman DJ, Lieb J: A Brotherhood of Tyrants. Amherst, NY, Prometheus Books, 1994
 
Kershaw I: Hitler 1889-1936: Hubris. New York, WW Norton, 2000
 
Kershaw I: Hitler 1936-1945: Nemesis. New York, WW Norton, 2000
 
Burleigh M: The Third Reich. New York, Hill & Wang, 2000
 
Still GF: Some abnormal psychical conditions in children. Lancet  1902; 4103:1008, 1077, 1163
 
Hitler A: Mein Kampf (1933-1939). Boston, Houghton Mifflin, 1971
 
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References

Nelken M: Hitler Unmasked. Glastonbury, Conn, Darkside Press, 1997
 
Langer WC: The Mind of Adolf Hitler. New York, Basic Books, 1972
 
Waite RGL: The Psychopathic God: Adolf Hitler. New York, Da Capro Press, 1993
 
Hershman DJ, Lieb J: A Brotherhood of Tyrants. Amherst, NY, Prometheus Books, 1994
 
Kershaw I: Hitler 1889-1936: Hubris. New York, WW Norton, 2000
 
Kershaw I: Hitler 1936-1945: Nemesis. New York, WW Norton, 2000
 
Burleigh M: The Third Reich. New York, Hill & Wang, 2000
 
Still GF: Some abnormal psychical conditions in children. Lancet  1902; 4103:1008, 1077, 1163
 
Hitler A: Mein Kampf (1933-1939). Boston, Houghton Mifflin, 1971
 
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