Reckoning with Evil

This is my third installment in our conversation on Nassir Ghaemi’s “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” In our previous two pieces, Dr Ghaemi indicated he is no fan of normal, at least not in crisis situations that call for individuals (such as Churchill) with at least some practical experience in crazy

In my second installment - Normal: It Ain’t What It’s Cracked Up to Be - I mentioned a study reported by Dr Ghaemi that found that so-called mentally healthy individuals suffered a bad case of average-itis. These well-adjusted individuals tended to fit in rather than rock the boat. Not that there’s anything wrong with that. It’s just that, in a crunch, you don’t send in a normal person to do a crazy man’s job.

So far, so good. But in our first installment - The Normal Paradox - I also outlined an extremely contentious proposition advanced by Dr Ghaemi, one having to do with “normal” as a strong contributing factor to Nixon and George W Bush making bad decisions. In other words, humans are perfectly capable of exercising appalling judgment on their own account, with no assist from any condition with a DSM pedigree.

But Nixon had to have been crazy, you may well counter. Indeed, maybe he was. But the point is that he didn’t have to be, and neither does anyone else. Normal people have committed the worst atrocities imaginable. Enter Ghaemi’s next case study, Adolph Hitler.

First the black box warning: Reconceptualizing Hitler is bound to raise intense reactions. I totally respect that. I’m not even asking you to keep an open mind.

Way way back, on mcmanweb, I reviewed Hershman and Lieb’s “Brotherhood of Tyrants,” which attributed Hitler’s atrocities to bipolar. No, I said in effect. True, the evidence for Hitler’s bipolar is compelling, but not everyone with a mood disorder invades Poland. It had to have been sociopathy.

Not really, says Dr Ghaemi. We start with impossible-to-ignore documentation of Hitler’s depressions and (hypo)manias, but until 1937, Ghaemi contends, Hitler’s condition “seemed manageable.” That changed when he started to take amphetamines.

In 1937, Hitler began treatment with a new personal physician, Theodor Morell, who stayed on till nearly the end. Dr Morell prescribed amphetamines for depression (and a narcotic and other drugs for GI problems and barbiturates for sleep). Confidantes such as Hess and Himmler immediately noted the change in their boss’ behavior. In 1941, there is evidence Hitler was taking amphetamines intravenously on a daily basis, supplemented by oral doses. By 1943, he was receiving multiple daily injections.

Dr Ghaemi points out that oral amphetamines cause mania in about half of individuals with bipolar, with a much greater certainty with intravenous injections. Rats are deliberately injected with amphetamines to produce an animal model of psychosis. As thoroughly odious has Hitler had been, Ghaemi observes, citing Bullock, he was a realistic and astute politician. Moreover, he hadn’t invaded any countries, nor had he turned genocidal. As Ghaemi describes it: “Morell lit a fuse that exploded the entire world.”

Thus, up to 1937, Hitler’s bipolar benefited him in a way that influenced his rise to power, “fueling his charisma, his resilience, and political creativity.”

Ghaemi acknowledges that Hitler had always been an angry man, but that he had generally been “courteous and proper” in social settings. By 1942 (after the war had turned against him) Hitler was routinely screaming at his generals. Whereas he used to have no trouble delegating authority, now he became obsessed with details. His doctor only made things worse by intensifying the quack treatments.

Okay, so how do we account for Nazism in the first place? Or, for that matter, any evil?  What about Hitler’s henchmen? How sick were they?

After the War, Ghaemi tells us, the Allies put two dozen high-ranking Nazis  (including Goering and Ribbentrop) through extensive psychiatric evaluation and psychological testing, which went on for two years. The evaluations revealed that these men were normal. Goering, for instance, according to one investigator, had a “normal basic personality,” though “he was cynical and filled with mystical fatalism.”

Hitler’s criminals went to their deaths, totally impenitent, very pleasant people to talk to, righteous to the end.

Are we ever going to understand evil? Probably not. Are we making a serious mistake always associating evil with crazy? Definitely so. Evil, unspeakable evil, lurks everywhere. Crazy is not a requirement. Normal works very well with evil. Until we come to terms with this shocking fact of life, evil will continue to flourish, barely contested. That’s been our long past. Our futures may turn out short.