To the present writer, the conclusion is irresistible that Rudolf Hess had a schizophrenic psychosis, quite typical at the start, and capable of recognition as such within a few days of his arrival in Britain, that is by a psychiatrist with experience of acute psychotic states. It is very difficult to explain the incapacity or unwillingness on the part of the psychiatrist to reach this diag­nosis when the illness reached its most acute stage with the attempt at suicide in the early hours of the 16th June, 1941. The illness remained typical up till November of that year, and even after that though now it was obscured by the appearance of a hysterical amnesia. The psychotic process came in a series of acute attacks (step‑like exacerbations, Schübe), each of them leaving him a little further along the road to schizophrenic personality change.

     This opinion is one which it will be possible to check against follow‑up data, when the psychiatric information from the records of Hess's life in prison from 1946 onwards eventually become available. On the diagnosis of schizo­phrenia the following predictions can be made: a) there will have been no complete recovery with restoration to psychological normality; b) personality deficiencies in the form of cold unresponsive behaviour and lack of affective warmth even to members of his own family will have persisted; c) there will have been other manifestations of schizophrenic autism in the form of manneristic behaviour, sterotypies, thought disorder, perhaps a recurrence of amnesic symptoms; d) from time to time there will have been mild or severe recurrences of states with fresh delusional experiences, perhaps with auditory hallucination, and new persecutory beliefs; e) typical schizophrenic symptoms manifested during the British phase will have been repeatedly observed later on, e.g. hoarding worthless scraps, lying smiling to himself with his fingers in his ears, etc.; f) he will have progressed further downhill as the years of im­prisonment went on. If most of these predictions are falsified, then the present writer will have been proved wrong.

     If the diagnosis of schizophrenia is correct, then there would seem to have been serious deficiencies in the clinical judgment or the openiuindedness of a number of distinguished world psychiatrists, for Hess not to have been recog­nized as a schizophrenic at all, even at a very late stage. The diagnostic blind­ness, the failure to reach an obvious conclusion becomes a problem in its own right) demanding explanation. We may perhaps understand it like this. Bri­gadier J. R. Rees, the only psychiatrist on the British commission, had made up his mind that Hess was a schizoid personality with hysterical symptoms, whose behaviour was to be explained along psychodynamic lines. His two colleagues on the British commission were Lord Morau, a general physician, and George Riddoch, a neurologist, neither of them knowing anything about psychiatry. They would be incapable of forming an independent opinion, and would have to accept that of Rees. When 1‑less was examined by the American and Russian commissions, with whom there was also a representative of French psychiatry, the hysterical amnesia was in the centre of the picture, making the underlying gestalt of the illness much more difficult to recognize, and readily leading to the formation of a misconception. A prepared statement of the British medical and psychiatric observations 1941‑1945 would have been made available to the American, French and Russian psychiatrists, who would already know of the British diagnosis. It is, perhaps, not so very surprising that they took a great deal for granted, and did not look at Hess's illness with fresh and unbiased eyes. The natural and proper safeguard against such a thing happening as did in fact happen would have been to arrange for Hess to be examined by German psychiatrists. It is indeed extraordinary and la­mentable that he never got to talk to psychiatrist who was a fellow‑country­man, and never after his arrival in Germany was able to talk to a psychiatrist who spoke German from birth. It seems likely that, if German psychiatrists had been able to examine him, the riddle of Hess's illness at the time of his trial would have been solved.

     But how was it that the British team of doctors, including a psychiatrist able to speak German with fluency, never recognized Hess's illness for what it was? We get the clue to this when we read, in the final chapter of Rees's book that diagnostic categories are only "neat technical terms" that "have become shopworn and 'degraded currency'." Hess's British psychiatrists were the prisioners of a way of thinking which involves contempt for the medical clinical process of taking a balance which we call diagnosis, and thought noth­ing of the intellectual effort that this task demands, its requirements of judg­ment and experience. Their viewpoint was determined by the belief that all that was necessary was to interpret and understand psychopathological phe­nomena on exclusively psychodynamic lines, i.e. in the terms of a normal and not a psychotic system of reference. In taking the view that diagnosis is a bagatelle, the psychiatrist takes his speciality out of the field of medicine entirely. For a century or more medicine has depended on acquiring the know­ledge necessary to make diagnoses, for the basic purposes of understanding what one is up against in a patient's illness, what can be expected, how fur­ther information can be obtained, what is to be done in order to help. The progress of medicine brings always advances in diagnostic methods and in­creases the momentous significance of the diagnostic task.

     In Rees's record of Hess's illness we see what are the results of grave misconceptions of the task of the psychiatrist, of what constitutes psychiatric knowledge, and of the function of psychiatry as a medical discipline vis‑a‑vis the individual patient. It was these misconceptions which led to a trial which seems now to have been a miscarriage of justice.