Social Interactions, Personality, Bipolar, and Hitler - What Does the Brain Have To Do With It?

Patient Expert

"Hell is other people," said Jean Paul-Sarte, possibly on a bad hair day but most certainly in a rational moment. By the same token, we are also social animals. How to reconcile? That's what brains are for.

This post is about social processes, one of five domains identified by the NIMH in it's quest for "classifying mental disorders based on dimensions of observable behavior and neurobiological measures." The other domains include positive emotions, negative emotions, cognition, and arousal and regulatory systems.

Imagine, if you will, if we could set a match to the DSM and start over. No doubt we would still come up with bipolar and most of the other usual suspects, but perhaps we would view them in refreshingly new contexts. Why don't we start with Adolf Hitler as a case study?

There is a lot of support for the proposition that Hitler had bipolar disorder. Hershman and Lieb, in their 1994 book "A Brotherhood of Tyrants," go so far as to give the illness all the credit for the mad man's appalling legacy. Neither author, however, saw fit to investigate why you and I and millions of others with bipolar never once thought of invading Poland.

Nassir Ghaemi, in his fairly recent "A First Rate Madness," by contrast contends that Hitler's bipolar "seemed manageable" and indeed proved beneficial in his rise to power. (The aspiring Fuhrer got a manic boost in charisma and political creativity, among other things, Ghaemi contends.) Hitler's undoing, according to Ghaemi, was his rampant abuse of amphetamines and barbiturates and other prescription drugs. In 1937, Hitler fell under the spell of a quack doctor. Almost immediately, his associates were noticing changes to his behavior. In 1939, he invaded Poland.

Now we're getting somewhere, but in his book Ghaemi makes the extraordinary claim that Hitler was far more normal than we give him credit for. To the extent that Hitler was a deft politician who navigated tricky social situations all too well, Ghaemi has a point. People who are socially clueless and crazy, after all, don't get invited out a lot. But Barbara Oakley in her 2007 "Evil Genes" offers a much better explanation for Hitler's rise and fall by referring to him (and others with Machiavellian tendencies) as "successfully sinister."

Oakley bases her thesis on an 11,000-page psychological profile prepared during World War II by Walter Langer for the OSS (a forerunner of the CIA). Like others who are successfully sinister, Hitler proved adept as exploiting his sociopathy and other abominable personality traits to his own ends. Oakley uses the term, "borderpath." The unsuccessful borderpaths end up in the criminal justice system or as leading very unhappy lives. The successful ones make everyone else's lives miserable as heads of state, CEOs, your scheming co-worker or abusive boss, or that manipulative back-stabbing family member of yours.

Oakley focuses exclusively on Hitler's personality, and it's easy to see why. Clearing up this man's bipolar and drug abuse wouldn't exactly turn him into a nice guy. To the best of her ability, Oakley avoids psychiatric labels and looks instead to what brain science and behavioral science have to say about human behavior. This is the approach of the NIMH.

The NIMH did not have Hitler on its mind when it identified "social process" as part of its agenda to rethink mental disorders. Nevertheless, it earmarked four constructs for further investigation:

  • Affiliation and attachment, which "require detection of and attention to social cues."
  • Social communication, "essential for the integration and maintenance of the individual in the social environment."
  • Perception and understanding of self, involving awareness, knowledge, and making judgements of one's self.
  • Perception and understanding of others, which includes empathy and other traits.

In addition, the NIMH noted the overlap with the other domains. Maybe you can connect your own dots here: If your emotions get the better of you, your social judgment is bound to be impaired. It may work the other way. If you are socially clueless, you may lack the incentive to reign in your difficult-to-control emotions.

But it is a mistake to think of our emotions as a fire that needs to be dampened. As anyone who has experienced the beneficial side of hypomania knows, bipolar can serve as a huge social enhancer. Moreover, those of us who have survived the hells of depression often emerge profoundly changed, with deeper insights into human nature (Ghaemi cites Lincoln as his Exhibit A in this regard).

Human behavior is immensely complex, the product of an infinitude of genes-environment-biology interactions taking place throughout essentially three different brains, each built on top of the other in seemingly random and unrelated ways yet sharing the same neural networks.

"What piece of work is a man?" Shakespeare asked. That is the question.

Previous posts in this series:

Deconstructing Bipolar - Cognitive Control

DSM-5 Bipolar: Not Much Difference from DSM-IV Bipolar

The DSM-5 Debacle - Same Old Bipolar

Attention and Perception: Two Pieces in the Bipolar Puzzle

Understanding Behavior and Emotions - Let's Look at the Circuitry Beyond the DSM: Thomas Insel and Understanding Mental Illness