Hess in Britain
Review of The Case of Rudolf Hess. A Problem in Diagnosis and Forensic Medicine. Edited by J. R. Rees, M.D., F.R.C.P. (Pp. 224) London: William Heinemann. 1947.
British Medical Journal, 1 May 1948, p. 836
The main problem presented by this book is whether or not Hess was suffering from a paranoid schizophrenia during his stay in England. The authors conclude, though with reserve, that he probably was. The case is obscured by evidence of a psychopathic personality and by the repeated occurrence and remission ‑ most dramatically during his trial ‑ of a hysterical amnesia. In this account he authors consider these side‑issues to a disproportionate extent and do not adequately discuss the more fundamental question of diagnosis.
Hess flew to England on May 10, 1941, apparently quite impulsively, on the conviction that he personally had only to say a few words to the King for peace to be declared. As soon as May 22 he was saying that he was surrounded by Secret Service agents who would drive him to commit suicide or poison his food. The systematized paranoia so begun persisted ever since. Early on he believed that doors were opened and shut and motor‑cycles kept running to prey on his nerves. He would not eat unless others sampled the food. From time to time he would say he could not concentrate, that his mind went blank. An interview with Lord Simon revealed that the reason given for his flight had no basis in fact. Thereafter he was worse. All the people around him were under an evil influence, hypnotic or chemical, unconscious agents in a conspiracy to destroy him. In the early hours of July 15 he dashed suddenly along a corridor, "his face one of extreme despair, his eyes staring," and flung himself over a second‑floor banister, breaking his leg. After that shifts of nurses watched him day and night, but he was still regarded as "not medico‑legally insane."
In July, 1941, he came under the care o a psychiatrist with mental‑hospital experience and was regarded as a characteristic mental‑hospital inmate. He would lie with his fingers in his ears, smiling to himself, and when questioned would reply, "I am thinking." He hoarded odd bits of paper about the room. and under the couch. In subsequent years, apart from the coming and going of amnesic states, he changed little. Auditory hallucinations were observed. He made a second attempt at suicide by plunging a bread‑knife into his breast. In February, 1945, he handed in a medley of names of august personages and personal attendants under the hypnotic influence of the Jews. In October, 1945, he was transferred to Nuremberg gaol. He took with him a statement meant to be the basis of his case, a farrago of delusional material without relevance to legal or political issues. In it he says that the eyes of the people around him had a glassy look and changed from time to time, the result of an abnormal mental condition caused by a secret chemical; his food was contaminated by secretion from camels' and pigs' glands; his dictionary decayed when he touched it., his apples were injected with "hot poison." In Nuremberg gaol primary delusions were still appearing : "I will look at a piece of bread, and suddenly I feel sure it has been poisoned." Schizophrenic ambivalence was shown : asked for his signature, he would write it and immediately scratch it out, this performance being repeated several times. Nevertheless the medical commissions found him not insane but fit to plead, and the Russian physicians state a definite opinion that he was simulating and that his past paranoid illness was psychogenic. He was, however, then in an amnesic state, and the delusions had for the time receded, though they were to recur.
Hess's illness, therefore, is a chronic paranoid condition, progressive and without tendency to remission. It thus bears no resemblance to a purely psychogenic state. Hardly one of the most characteristic schizophrenic symptoms is lacking primary delusions, systematization of delusions of a highly bizarre type, hallucinations in a clear state of consciousness, thought disorder and incoherence, affective impoverishment, and ambivalence and other gross disturbances of volition.
This analysis, when contrasted with that provided in the book, throws into relief the differences between two schools of psychiatry. Considered in the terms of a psychotherapeutic discipline. Hess's case was one of great difficulty and obscurity. Considered in the terms of a classical psychiatry, it was unambiguously schizophrenic from the beginning. The reason for the authors' doubts and hesitations is to be found in the inadequate theory by which, in common with others of their school, they were bound. They state (p. 212) that they attach relatively small importance to "diagnostic labels." In this they throw overboard a whole field of psychiatric knowledge. The making of a diagnosis of schizophrenia is not a bagatelle, but is fraught with consequences of a prognostic, therapeutic, and medico‑legal kind. It was a fateful circumstance for Hess that a diagnosis of schizophrenia was reached only after several years, and after his trial was over.