Journal of Psychosomatic Research 78 (2015) 515–518
Contents lists available at ScienceDirect
Journal of Psychosomatic Research
Use of Rorschach tests at the Nuremberg war crimes trial: A forgotten chapter in history of medicine☆,☆☆ Joel E. Dimsdale University of California, San Diego, United States
a r t i c l e
i n f o
Article history: Received 16 March 2015 Received in revised form 2 April 2015 Accepted 2 April 2015 Keywords: History of medicine Rorschach tests War criminals
a b s t r a c t Seventy years ago, psychiatrists and psychologists had unusual access to the Nazi leaders awaiting trial by the International Military Tribunal in Nuremberg. Early leaders in the field of psychosomatic medicine were instrumental in facilitating these interviews as well as arranging for the administration of psychological testing with the Rorschach inkblot test. These observations were kept under wraps for decades and there remains controversy even now about what these Rorschachs revealed—demonic psychopaths or just morally corrupt individuals. © 2015 Elsevier Inc. All rights reserved.
The Nuremberg trials This history has its roots in a quiet little town in Switzerland where Hermann Rorschach worked. When he died in 1924, he had no way of knowing that the world was careening into another war or that twenty years later the test that he had invented would be used to study the Nuremberg war criminals. The Nazi leaders' Rorschach tests were hidden away for decades while the two Rorschach examiners feuded about their interpretation and release. The city of Nuremberg went through remarkable transformations in the 20th century. It started out as a gorgeous old city, famed for its toy industry and crafts, home to Durer and birthplace of Pachelbel and an extensive publishing industry. By the late 1920s, it had become a stronghold of the Nazi party and in subsequent years was home to throngs of Party faithful during the recurrent party rallies. By war's end in 1945, the city was virtually destroyed. Ninety percent of the inner core was destroyed and an estimated 30,000 bodies rotted in the ruins. Surprisingly, the Palace of Justice and an adjacent prison survived the bombings, somewhat the worse for wear. This building complex became the venue for the International Military Tribunal where the Allies tried the highest-ranking Nazis they could find. As Justice Robert Jackson, the lead American prosecutor noted: “The wrongs which we seek to condemn and punish have been so calculated, so malignant, and so devastating, that civilization cannot tolerate their being ignored, because it cannot survive their being ☆ This paper is based in part on a presentation to the European Association of Psychosomatic Medicine meeting in Nuremberg, Germany in July, 2015. ☆☆ This paper was presented as a special lecture at the third annual conference of the European Association of Pychosomatic Medicine (EAPM) at Nuremberg on July 1st 2015. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.jpsychores.2015.04.001 0022-3999/© 2015 Elsevier Inc. All rights reserved.
repeated. That four great nations, flushed with victory and stung with injury stay the hand of vengeance and voluntarily submit their captive enemies to the judgment of the law is one of the most significant tributes that Power has ever paid to reason.” [[1]] The International Military Tribunal met in Nuremberg for almost a year until its sentences were carried out in October, 1946. There were many subsequent trials at Nuremberg and elsewhere, but this first one was notable, in part because of the role that psychiatric research played and because the trial focused on the Nazi leaders rather than rank and file. The impetus for psychiatric and psychological assessment of the war criminals Psychiatry and psychology were oddly central to the trial in ways that are largely forgotten. First of all, the trial was not so much “who done it” as it was a “why did they do it.” Mass killing is common. The Nazi killing was different from blood lust in terms of its scope, attention to detail, and the modernity and culture of the killers. In their wake, the number of non-combatant deaths in World War II was staggering, and the machinery of destruction consumed the lives of millions of Jews, Roma, Slavs, homosexuals, Jehovah's Witnesses, the mentally infirm, and handicapped children. All of this is well known, but there are two threads in this dark history that are largely forgotten but pertain to the history of psychosomatic medicine. A group of American medical societies were early advocates of psychological study of the war criminals, and a group of psychiatrists and psychologists were indeed very active in the Nuremberg jail, albeit less so in the courtroom per se.
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On June 11, 1945, a group of medical societies wrote Justice Robert Jackson requesting urgently that the psychology of the war criminals be studied. The societies were remarkably diverse, including the American Association on Mental Deficiency, the American branch of the International League Against Epilepsy, the American Neurological Association, the American Orthopsychiatric Association, the American Psychiatric Association, the National Committee for Mental Hygiene, and the American Society for Research in Psychosomatic Problems (which later became the American Psychosomatic Society). The academic societies received a surprising amount of support from the Office of Strategic Services (OSS) whose leader General William J. Donovan was an enthusiast for psychological studies and from Murray Bernys who was in the War Department's Special Branch and – by coincidence – was married to Freud's niece. Excerpts from the Societies' letter follow: “Detailed knowledge of the personality of these leaders … would be valuable as a guide to those concerned with the reorganization and re-education of Germany …. In addition to the psychiatric interviews it would be desirable to make a number of psychological tests such as … the Rorschach …. If and when the accused has been convicted and sentenced to death it would be desirable to have a detailed autopsy. Especially of the brain. Therefore it is urged that the convicted be shot in the chest, not in the head.” [[2]] Two of the Societies' recommendations particularly stand out—that the Nazis should be studied with the Rorschach test and that the Nazi leaders' brains should be studied. It was a decidedly unusual letter. The trial had not even started, but the academics were already recommending that the prisoners be executed in such a fashion that their brains could be studied post mortem. This second recommendation was ignored and the defendants who were condemned to death were hanged and cremated. On the other hand, their first recommendation for psychiatric assessment was honored to a surprising extent. Jails always have psychiatrists on hand who serve diverse purposes. We help assess competence to stand trial and we provide medical services to prisoners, even on death row. Nuremberg was well stocked with psychiatrists, but two extraordinary individuals happened to be stationed at the prison. Douglas Kelley was a young American psychiatrist who was a bit of a polymath. Early in life, he had been identified as a genius and was in the famous Terman study of gifted California children. He was a very experienced psychiatrist, ran innovative programs for soldiers who suffered from what we would call today PTSD and by happenstance was an internationally renowned Rorschach expert. Because he spoke little German, he needed a translator. Gustave Gilbert was a young American psychologist who spent most of his war years interrogating prisoners. His German was flawless, and he was a meticulous observer who kept careful notes, but he had little experience with the Rorschach test. Kelley was the superior officer who interacted with the prisoners from August 1945 through January 1946. Gilbert was his subordinate who was assigned as his interpreter and worked at Nuremberg from October 1945 to October 1946. Kelley claimed to have spent 80 h with each of the prisoners during his time at Nuremberg. Given the cramped quarters in the prison cells, Kelley and Gilbert (or occasionally another interpreter) would conduct interviews sitting on each prisoner's small cot with the prisoner sandwiched between them. What would it have been like to conduct extensive psychiatric interviews in such close proximity to such repellant individuals? Both Kelley and Gilbert left extensive diaries about their experiences [3,4]. The Rorschach test in 1945 Today, the Rorschach test seems “musty,” a relic from an earlier time in psychiatry. In the 1940s and 1950s the Rorschach test was THE
psychological test. Its ability to map what was on a person's mind made it a useful adjunct to psychiatric evaluations at a time when the field focused heavily on the unconscious. Its unstructured nature lent itself to evaluating patients who were noticeably guarded or uncooperative. Thus, its inclusion as a core component in the psychological evaluation of the Nuremberg war criminals was entirely logical. In addition to its ability to tap into the unconscious, the Rorschach test had one other use. It was after all a Gestalt test that examined perception and was thus an early indicator of neuropsychological functioning. Its evocative images in black and white with occasional bursts of color captured the attention of popular culture, and the Rorschach was commonly portrayed in movies of that era. Thus, it comes as no surprise that the intelligence community as well as court prosecutors were already familiar with the Rorschach test. Given the Nazis' obsession with death and violence, it was abundantly clear that there were powerful irrational forces underlying their behavior, and thus a test like the Rorschach seemed a natural for Nuremberg. Hermann Rorschach was born in Switzerland in 1884. As a boy, he loved the game of Klegsographia where players would carefully construct an inkblot and then see who could come up with the most observations or associations about each inkblot. Young Hermann loved the game so much that his high school nickname was “Klex,” (i.e. “blot”). As a young psychiatrist, he developed the inkblot test. Rorschach wasn't the first psychiatrist or psychologist to focus on inkblots. Binet, the originator of the IQ test, also investigated their use in 1895. What Rorschach added was his attention to detail and his artistry. Shakespeare ironically noted the perils of subjectivity in interpreting such tests. In Hamlet, act III, scene 2, Hamlet and Polonius gaze into the clouds and Hamlet keeps persuading poor Polonius to change his mind about the shapes in the clouds. Hamlet Polonius Hamlet Polonius Hamlet Polonius
Do you see yonder cloud that's almost in shape of a camel? By th' mass and 'tis, like a camel indeed. Methinks it is like a weasel. It is backed like a weasel. Or like a whale. Very like a whale.
What Shakespeare pointed out came to haunt psychiatry and psychology centuries later when investigators tried to make sense of the Nuremberg war criminals' ink blot tests. How do you guard against bias if you know whose inkblot answers you are viewing? Will the rater, like poor Polonius, switch from describing the cloud (or inkblot) from a camel to a weasel or a whale—just because he was influenced by someone else's interpretation? What if the rater knew that a particular war criminal described seeing dancers in an inkblot? Interpreting the Rorschach While the Rorschach test looks unstructured, it is a carefully prescribed interaction between tester and patient. The patient is presented with 10 cards and queried, “What does this card remind you of” and, “Can you point out what parts of the card made you say that?” Patients commonly offer several interpretations of each card, and these are carefully recorded. The testing process generally requires about an hour. Rorschachs are typically interpreted in two ways. One approach emphases the content or themes that the patient discloses, and the other scrutinizes technical aspects of how those themes are recognized. Does the patient react to the whole card or just a piece of it? Does the person focus on color or shading in the blot, the black of the ink vs the white space on the card? How decent is the form? Can the examiner perceive how the patient recognized part of a card as dancing bears, for instance, or was the patient's report wildly idiosyncratic? Whether one focuses on content or technical analysis, what really counts is the composite response to all ten cards.
J.E. Dimsdale / Journal of Psychosomatic Research 78 (2015) 515–518
In thousands of records, certain types of reactions are more likely in sundry clinical settings. There is no “reason” for such associations; the test uses a complicated coding scheme that relies on enormous clinical experience. Since the 1970s, coding has been standardized sufficiently so that there is good inter-rater reliability in terms of ratings of form, shading, color, movement, etc. [5] Reliability is lower, however, when clinicians try to decide what these codes actually mean about a patient's personality. There are two distinct problems with Rorschach tests, particularly in the context of testing the war criminals. After thousands of testing sessions, we can distinguish what is an uncommon response. But that appraisal must consider the context of the testing. Who knows what is a strange response in a jailed cabinet minister facing a death sentence? Another key problem with Rorschach interpretation is that the tester can be biased as he or she learns more about the patient. This knowledge can interfere with objectivity. This issue of bias bedeviled the Rorschach data from Nuremberg. If you knew the inkblot record came from a Nazi war criminal, could you possibly interpret it dispassionately? Bitter collaborators Douglas Kelley and Gustave Gilbert were ill-suited collaborators. They were both ambitious men who struggled over issues of primacy in their work with the war criminals. They also differed in terms of their over-all perspective and weltanschauung. Ironically, Kelley, the forensic psychiatrist and expert on psychopathology, viewed the war criminals from a social psychological perspective. He saw them as morally flawed individuals influenced by the society they lived in and was, if anything, concerned that a Nazi-like political party could emerge again anywhere. As he famously pointed out, “(the war criminals) are not rare. They can be found anywhere in the country—behind big desks deciding big affairs as businessmen, politicians, and racketeers.” [6] Gilbert, the expert in social psychology, oddly had the opposite view. He did not see the war criminals as being on a continuum that ranged from normal to criminal; instead, he viewed the war criminals as categorically different—as demonic psychopaths. Between their personal rivalries and their ideological differences, it is no surprise that this collaboration fell apart. Both authored books about their interactions with the war criminals, but the books were largely silent about their Rorschach tests, partially as a consequence of their acrimonious disputes about who “owned” the tests. Gilbert's Rorschach records emerged in 1975 and Kelley's Rorschachs were published posthumously in 1995. These reports were immediately controversial, but it would be appropriate first to take a glimpse at what the war criminals reported. Responses to card II For the purposes of this article, I will provide the responses of four of the defendants to just one of the ten Rorschach cards—Card II. According to Kelley, Hermann Goering (Reichsmarshall and head of Luftwaffe) reported: “Two dancing men. A fantastic dance. Two men, here are their heads, their hands together, like whirling dervishes. Here are their bodies, their feet.” Kelley commented, “These figures are seen extremely well; colors are not used except that they can be part of the costume of the men.”[7] Gilbert's notes are similar, that Goering laughed and said: “Those are the two dancing figures, very clear, shoulder here and face there, clapping hands [cuts off bottom part with hand, including red].1 Top red is head and hat; face is partly white.” [8] Gilbert bequeathed his Rorschach records to Miale and Selzer who asserted that Goering's response about “two dancing figures” reflected a hypomanic defense. They then stated that because Goering saw the 1 The text within brackets contains Kelley's verbatim observations as he tried to determine which features of the blot elicited Ley's responses (i.e. form, color, etc.).
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face in both the blot and the white space, “[it] strongly suggests the emptiness of his being” and that when he reported the hat as red, it “indicates an emotional preoccupation with status.” [9] Kelley examined Robert Ley (head of the German Labor Front) and recorded his numerous responses to the card. “A butterfly. There are colors here. That's funny. It is a funny butterfly. [The whole picture is used and he states that it is a form of a butterfly but the colors are important. The colors actually struck him first.] [An additional response, spontaneous at this point is lamp. This is the center white space form only]. Black and red and white. [He repeats this several times and then moving the card near and far, states the colors look different when you consider the distance. At this point, he brought card close to him and went over the description of the butterfly again.] A stork, or goose would be better. It looks like it was tipped over with its legs pulled in. It seems unique. This top is red. [Form is vague—no movement except perhaps tension.] It is alive. Jaws of the butterfly. [These are the top red details which he described previously as the mouth of the butterfly].” [[10]] Ley was a particularly interesting challenge from a neuropsychiatric perspective. He had a history of a severe head injury that left him with some expressive aphasia and he was notable for his impulsivity and alcoholism. His Rorschach responses were decidedly unusual. Ley perseverated, moving the card back and forth, repeating “black and red and white”, and divulged unusual and unsettling form responses (“jaws of the butterfly”). Kelley reported that Julius Streicher (Editor, Der Sturmer) gave two responses to the card, and seemed fixated on leitmotifs of revolution. Kelley writes: “He looks the card over; discusses it, stating that it is pretty. Waves it about his head and finally states that it is two women in the French Revolutionary times with Jacobean caps. He states that they have red socks and caps and are dancing. He then gives dates of Revolution as 1789 and is about to go into a discussion on the French Revolution in general when he is again attracted by the card. Red wine glass on a porcelain platter. Center red and center space detail. In the inquiry he sees an additional white space response, Two Dutch shoes. Upper white space details. He sees glass as red but form is not important. Color is factor for white platter.” [[11]] When Kelley and Gilbert tested Rudolf Hess (Deputy Fuhrer), they recorded similar findings. Gilbert stated Hess reported: “Also microscopic cross section; parts of an insect with blood spots; a mask.” [12] Kelley observed: “Also microscopic cross-section, parts of an insect with blood spots. The shape of the cross-section of the leg of a fly with red blood spots; space in the middle is the marrow, although I don't know if the leg of an insect has marrow. A mask. Mask of an island savage, like Fiji Islanders, though I don't know them; the opening is for the mouth; it is devilish, that is why the eyes and beard are red. …” [[13]] The content of Hess's response included disturbing images and anatomical allusions. The latter are commonly interpreted as depressive equivalents. Miale and Selzer viewed his color responses as “the remnants of a violent, excitable, unrelated emotionality, which is still intense but is split off from contact with anything real.” They were also impressed that he didn't see the typical clown figures but reported a savage mask. I provided these verbatim responses and interpretations because they give a sense for the unique obstacles to Rorschach interpretation. For reasons that I discuss elsewhere [14], neither Kelley nor Gilbert
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published their Rorschachs. Gilbert released his Rorschachs in 1975 to Florence Miale and Richard Selzer. Kelley's Rorschach were lost until Reneau Kennedy miraculously discovered them in the archives of the Chicago Psychoanalytic Institute, just as they were about to be discarded [15]. Questions about the validity of the Nuremberg Rorschach tests Even if you had the Rorschach responses to all ten cards, how could you be sure that your interpretations of their meaning were unbiased? World-renowned Rorschach expert Molly Harrower devised an ingenious experiment to address this issue [16]. Harrower had an interesting background. She was an accomplished poet and dancer who had trained with Penfield in his classic studies on brain and emotion. She oversaw Rorschach tests on thousands and thousands of individuals across a range of functioning (ministers, prisoners, executives, psychiatric patients, soldiers). She was an editor of books on the Rorschach and was on the editorial board of Psychosomatic Medicine (yet another link to psychosomatic medicine). First, she selected a sampling of Nuremberg Rorschachs that included defendants at all ranges of psychological functioning. Then, she chose as comparison groups Unitarian ministers and psychiatric patients—again, across a range of level of psychological functioning. She stripped off any identifying information and asked a number of Rorschach experts—“do you see any commonalities in some of these records?” The Rorschach experts sorted the records in terms of levels of psychological functioning—healthy, mildly impaired, and moderately impaired. In other words, they did not perceive any unifying characteristics of the Nazi war criminals (or the Unitarian ministers, for that matter). She then gave the experts a second task, informing them that the records came from groups of civil rights leaders, military officers, war criminals, ministers, etc. Could they guess which group the cards came from? Again, the Rorschach experts were not able to guess the identity of the respondents. In other words, with blind testing, there was nothing unique about these Rorschach cards. Defenders of Rorschach testing protested that blinded testing is not done in a testing situation, that instead the examiner closely observes the patient and absorbs information from the testing session itself. Rorschach critics responded by suggesting that the results implied such a degree of subjectivity to the Rorschach interpretations that it was hard to believe they could be usefully employed to shed light on the Nuremberg war criminals. What would we do today? From the vantage point of 21st century clinical trials, this effort at diagnosing the Nazi war criminals with Rorschach tests would be risible. This was an exceedingly small sample—21 defendants in all, and they were tested under highly unusual circumstances. They were defeated
leaders of a country who were kept in solitary confinement and faced possible death sentences. If one were to try to guess about their personalities while in power, this was not the most apt design. Then, of course there was the problem with the lack of blinding and the unreliability of the diagnoses in the first place. That said, this was an enormous and unusual effort in the history of medicine. Never before, have we studied so closely leaders who had steered a country into such an abyss. There are comparatively more studies on the rank and file [17,18], but the fine-grained analysis of leaders is unique. Between the Rorschach tests and extensive psychiatric interviews, Kelley and Gilbert were able to assemble an impressive snapshot, so to speak, of the individuals in power in Nazi Germany. Sadly, mass killings continue in other parts of the world, an infestation and intoxication that our species seems to be unusually sensitive to. It is regrettable that in contemporary War Crimes trials we see no continuation of the efforts at scientifically studying the perpetrators [19].
References [1] Jackson Robert. Trial of the major war criminals, Nuremberg, 1947, vol. ii; November 21 1945[Trial transcript]. [2] Library of Congress, Papers of Robert H Jackson, container 107, serial number 22.872. [3] Kelley D. 22 cells in Nuremberg. New York: Greenberg; 1947[republished by MacFadden, New York, 1961]. [4] Gilbert G. Nuremberg diary. New York: Signet; 1947. [5] Exner J. The Rorschach: a comprehensive system, vols. 1 and 2. New York: Wiley; 1974. [6] Kelley D. ibid, page 171. [7] Kelley D, quoted in Zillmer E, Harrower M, Ritzler B, Archer R, The quest for the Nazi personality: A psychological investigation of Nazi war criminals, LEA, Hillsdale, 1995, p. 203. [8] Gilbert G, cited in Miale F, Selzer M, The Nuremberg Mind: the psychology of the Nazi leaders, Quadrangle, New York, 1975, p. 86. [9] Miale F, Selzer M. The Nuremberg mind: the psychology of the Nazi leaders. New York: Quadrangle; 1975 86–7. [10] Kelley D, quoted in Zillmer E, Harrower M, Ritzler B, Archer R, The quest for the Nazi personality: A psychological investigation of Nazi war criminals, LEA, Hillsdale, 1995, p. 205. [11] Kelley D, quoted in Zillmer E, Harrower M, Ritzler B, Archer R, The quest for the Nazi personality: A psychological investigation of Nazi war criminals, LEA, Hillsdale, 1995, p. 209. [12] Gilbert G, cited in Miale F, Selzer M, The Nuremberg Mind: the psychology of the Nazi leaders, Quadrangle, New York, 1975, p. 102. [13] Archives of the history of American psychology, University of Akron, Molly Harrower Papers, Box M3199, folder 17. [14] Dimsdale J. Anatomy of malice. Yale University Press; 2015[in press]. [15] Zillmer E, Harrower M, Ritzler B, Archer R. The quest for the Nazi personality: a psychological investigation of Nazi war criminals. Hillsdale: LEA; 1995. [16] Harrower M. Rorschach records of the Nazi war criminals: an experimental study after thirty years. J Pers Assess 1976;40:341–51. [17] Zillmer E, Harrower M, Ritzler B, Archer R. The quest for the Nazi personality: a psychological investigation of Nazi war criminals. Hillsdale: LEA; 1995 101–19. [18] Steiner J. The SS yesterday and today: a sociopsychological view. In: Dimsdale J, editor. Survivors, victims, and perpetrators: essays on the Nazi Holocaust. Washington DC: Hemisphere; 1980. p. 405–56. [19] Hakkanen-Nyholm H, Nyholm JO. Psychopathy in economical crime, organized crime, and war crimes. Psychopathy and law: a practitioner's guide. John Wiley; 2012. p. 193.
Contents lists available at ScienceDirect
Journal of Psychosomatic Research
Use of Rorschach tests at the Nuremberg war crimes trial: A forgotten chapter in history of medicine☆,☆☆ Joel E. Dimsdale University of California, San Diego, United States
a r t i c l e
i n f o
Article history: Received 16 March 2015 Received in revised form 2 April 2015 Accepted 2 April 2015 Keywords: History of medicine Rorschach tests War criminals
a b s t r a c t Seventy years ago, psychiatrists and psychologists had unusual access to the Nazi leaders awaiting trial by the International Military Tribunal in Nuremberg. Early leaders in the field of psychosomatic medicine were instrumental in facilitating these interviews as well as arranging for the administration of psychological testing with the Rorschach inkblot test. These observations were kept under wraps for decades and there remains controversy even now about what these Rorschachs revealed—demonic psychopaths or just morally corrupt individuals. © 2015 Elsevier Inc. All rights reserved.
The Nuremberg trials This history has its roots in a quiet little town in Switzerland where Hermann Rorschach worked. When he died in 1924, he had no way of knowing that the world was careening into another war or that twenty years later the test that he had invented would be used to study the Nuremberg war criminals. The Nazi leaders' Rorschach tests were hidden away for decades while the two Rorschach examiners feuded about their interpretation and release. The city of Nuremberg went through remarkable transformations in the 20th century. It started out as a gorgeous old city, famed for its toy industry and crafts, home to Durer and birthplace of Pachelbel and an extensive publishing industry. By the late 1920s, it had become a stronghold of the Nazi party and in subsequent years was home to throngs of Party faithful during the recurrent party rallies. By war's end in 1945, the city was virtually destroyed. Ninety percent of the inner core was destroyed and an estimated 30,000 bodies rotted in the ruins. Surprisingly, the Palace of Justice and an adjacent prison survived the bombings, somewhat the worse for wear. This building complex became the venue for the International Military Tribunal where the Allies tried the highest-ranking Nazis they could find. As Justice Robert Jackson, the lead American prosecutor noted: “The wrongs which we seek to condemn and punish have been so calculated, so malignant, and so devastating, that civilization cannot tolerate their being ignored, because it cannot survive their being ☆ This paper is based in part on a presentation to the European Association of Psychosomatic Medicine meeting in Nuremberg, Germany in July, 2015. ☆☆ This paper was presented as a special lecture at the third annual conference of the European Association of Pychosomatic Medicine (EAPM) at Nuremberg on July 1st 2015. E-mail address: [email protected].
http://dx.doi.org/10.1016/j.jpsychores.2015.04.001 0022-3999/© 2015 Elsevier Inc. All rights reserved.
repeated. That four great nations, flushed with victory and stung with injury stay the hand of vengeance and voluntarily submit their captive enemies to the judgment of the law is one of the most significant tributes that Power has ever paid to reason.” [[1]] The International Military Tribunal met in Nuremberg for almost a year until its sentences were carried out in October, 1946. There were many subsequent trials at Nuremberg and elsewhere, but this first one was notable, in part because of the role that psychiatric research played and because the trial focused on the Nazi leaders rather than rank and file. The impetus for psychiatric and psychological assessment of the war criminals Psychiatry and psychology were oddly central to the trial in ways that are largely forgotten. First of all, the trial was not so much “who done it” as it was a “why did they do it.” Mass killing is common. The Nazi killing was different from blood lust in terms of its scope, attention to detail, and the modernity and culture of the killers. In their wake, the number of non-combatant deaths in World War II was staggering, and the machinery of destruction consumed the lives of millions of Jews, Roma, Slavs, homosexuals, Jehovah's Witnesses, the mentally infirm, and handicapped children. All of this is well known, but there are two threads in this dark history that are largely forgotten but pertain to the history of psychosomatic medicine. A group of American medical societies were early advocates of psychological study of the war criminals, and a group of psychiatrists and psychologists were indeed very active in the Nuremberg jail, albeit less so in the courtroom per se.
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On June 11, 1945, a group of medical societies wrote Justice Robert Jackson requesting urgently that the psychology of the war criminals be studied. The societies were remarkably diverse, including the American Association on Mental Deficiency, the American branch of the International League Against Epilepsy, the American Neurological Association, the American Orthopsychiatric Association, the American Psychiatric Association, the National Committee for Mental Hygiene, and the American Society for Research in Psychosomatic Problems (which later became the American Psychosomatic Society). The academic societies received a surprising amount of support from the Office of Strategic Services (OSS) whose leader General William J. Donovan was an enthusiast for psychological studies and from Murray Bernys who was in the War Department's Special Branch and – by coincidence – was married to Freud's niece. Excerpts from the Societies' letter follow: “Detailed knowledge of the personality of these leaders … would be valuable as a guide to those concerned with the reorganization and re-education of Germany …. In addition to the psychiatric interviews it would be desirable to make a number of psychological tests such as … the Rorschach …. If and when the accused has been convicted and sentenced to death it would be desirable to have a detailed autopsy. Especially of the brain. Therefore it is urged that the convicted be shot in the chest, not in the head.” [[2]] Two of the Societies' recommendations particularly stand out—that the Nazis should be studied with the Rorschach test and that the Nazi leaders' brains should be studied. It was a decidedly unusual letter. The trial had not even started, but the academics were already recommending that the prisoners be executed in such a fashion that their brains could be studied post mortem. This second recommendation was ignored and the defendants who were condemned to death were hanged and cremated. On the other hand, their first recommendation for psychiatric assessment was honored to a surprising extent. Jails always have psychiatrists on hand who serve diverse purposes. We help assess competence to stand trial and we provide medical services to prisoners, even on death row. Nuremberg was well stocked with psychiatrists, but two extraordinary individuals happened to be stationed at the prison. Douglas Kelley was a young American psychiatrist who was a bit of a polymath. Early in life, he had been identified as a genius and was in the famous Terman study of gifted California children. He was a very experienced psychiatrist, ran innovative programs for soldiers who suffered from what we would call today PTSD and by happenstance was an internationally renowned Rorschach expert. Because he spoke little German, he needed a translator. Gustave Gilbert was a young American psychologist who spent most of his war years interrogating prisoners. His German was flawless, and he was a meticulous observer who kept careful notes, but he had little experience with the Rorschach test. Kelley was the superior officer who interacted with the prisoners from August 1945 through January 1946. Gilbert was his subordinate who was assigned as his interpreter and worked at Nuremberg from October 1945 to October 1946. Kelley claimed to have spent 80 h with each of the prisoners during his time at Nuremberg. Given the cramped quarters in the prison cells, Kelley and Gilbert (or occasionally another interpreter) would conduct interviews sitting on each prisoner's small cot with the prisoner sandwiched between them. What would it have been like to conduct extensive psychiatric interviews in such close proximity to such repellant individuals? Both Kelley and Gilbert left extensive diaries about their experiences [3,4]. The Rorschach test in 1945 Today, the Rorschach test seems “musty,” a relic from an earlier time in psychiatry. In the 1940s and 1950s the Rorschach test was THE
psychological test. Its ability to map what was on a person's mind made it a useful adjunct to psychiatric evaluations at a time when the field focused heavily on the unconscious. Its unstructured nature lent itself to evaluating patients who were noticeably guarded or uncooperative. Thus, its inclusion as a core component in the psychological evaluation of the Nuremberg war criminals was entirely logical. In addition to its ability to tap into the unconscious, the Rorschach test had one other use. It was after all a Gestalt test that examined perception and was thus an early indicator of neuropsychological functioning. Its evocative images in black and white with occasional bursts of color captured the attention of popular culture, and the Rorschach was commonly portrayed in movies of that era. Thus, it comes as no surprise that the intelligence community as well as court prosecutors were already familiar with the Rorschach test. Given the Nazis' obsession with death and violence, it was abundantly clear that there were powerful irrational forces underlying their behavior, and thus a test like the Rorschach seemed a natural for Nuremberg. Hermann Rorschach was born in Switzerland in 1884. As a boy, he loved the game of Klegsographia where players would carefully construct an inkblot and then see who could come up with the most observations or associations about each inkblot. Young Hermann loved the game so much that his high school nickname was “Klex,” (i.e. “blot”). As a young psychiatrist, he developed the inkblot test. Rorschach wasn't the first psychiatrist or psychologist to focus on inkblots. Binet, the originator of the IQ test, also investigated their use in 1895. What Rorschach added was his attention to detail and his artistry. Shakespeare ironically noted the perils of subjectivity in interpreting such tests. In Hamlet, act III, scene 2, Hamlet and Polonius gaze into the clouds and Hamlet keeps persuading poor Polonius to change his mind about the shapes in the clouds. Hamlet Polonius Hamlet Polonius Hamlet Polonius
Do you see yonder cloud that's almost in shape of a camel? By th' mass and 'tis, like a camel indeed. Methinks it is like a weasel. It is backed like a weasel. Or like a whale. Very like a whale.
What Shakespeare pointed out came to haunt psychiatry and psychology centuries later when investigators tried to make sense of the Nuremberg war criminals' ink blot tests. How do you guard against bias if you know whose inkblot answers you are viewing? Will the rater, like poor Polonius, switch from describing the cloud (or inkblot) from a camel to a weasel or a whale—just because he was influenced by someone else's interpretation? What if the rater knew that a particular war criminal described seeing dancers in an inkblot? Interpreting the Rorschach While the Rorschach test looks unstructured, it is a carefully prescribed interaction between tester and patient. The patient is presented with 10 cards and queried, “What does this card remind you of” and, “Can you point out what parts of the card made you say that?” Patients commonly offer several interpretations of each card, and these are carefully recorded. The testing process generally requires about an hour. Rorschachs are typically interpreted in two ways. One approach emphases the content or themes that the patient discloses, and the other scrutinizes technical aspects of how those themes are recognized. Does the patient react to the whole card or just a piece of it? Does the person focus on color or shading in the blot, the black of the ink vs the white space on the card? How decent is the form? Can the examiner perceive how the patient recognized part of a card as dancing bears, for instance, or was the patient's report wildly idiosyncratic? Whether one focuses on content or technical analysis, what really counts is the composite response to all ten cards.
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In thousands of records, certain types of reactions are more likely in sundry clinical settings. There is no “reason” for such associations; the test uses a complicated coding scheme that relies on enormous clinical experience. Since the 1970s, coding has been standardized sufficiently so that there is good inter-rater reliability in terms of ratings of form, shading, color, movement, etc. [5] Reliability is lower, however, when clinicians try to decide what these codes actually mean about a patient's personality. There are two distinct problems with Rorschach tests, particularly in the context of testing the war criminals. After thousands of testing sessions, we can distinguish what is an uncommon response. But that appraisal must consider the context of the testing. Who knows what is a strange response in a jailed cabinet minister facing a death sentence? Another key problem with Rorschach interpretation is that the tester can be biased as he or she learns more about the patient. This knowledge can interfere with objectivity. This issue of bias bedeviled the Rorschach data from Nuremberg. If you knew the inkblot record came from a Nazi war criminal, could you possibly interpret it dispassionately? Bitter collaborators Douglas Kelley and Gustave Gilbert were ill-suited collaborators. They were both ambitious men who struggled over issues of primacy in their work with the war criminals. They also differed in terms of their over-all perspective and weltanschauung. Ironically, Kelley, the forensic psychiatrist and expert on psychopathology, viewed the war criminals from a social psychological perspective. He saw them as morally flawed individuals influenced by the society they lived in and was, if anything, concerned that a Nazi-like political party could emerge again anywhere. As he famously pointed out, “(the war criminals) are not rare. They can be found anywhere in the country—behind big desks deciding big affairs as businessmen, politicians, and racketeers.” [6] Gilbert, the expert in social psychology, oddly had the opposite view. He did not see the war criminals as being on a continuum that ranged from normal to criminal; instead, he viewed the war criminals as categorically different—as demonic psychopaths. Between their personal rivalries and their ideological differences, it is no surprise that this collaboration fell apart. Both authored books about their interactions with the war criminals, but the books were largely silent about their Rorschach tests, partially as a consequence of their acrimonious disputes about who “owned” the tests. Gilbert's Rorschach records emerged in 1975 and Kelley's Rorschachs were published posthumously in 1995. These reports were immediately controversial, but it would be appropriate first to take a glimpse at what the war criminals reported. Responses to card II For the purposes of this article, I will provide the responses of four of the defendants to just one of the ten Rorschach cards—Card II. According to Kelley, Hermann Goering (Reichsmarshall and head of Luftwaffe) reported: “Two dancing men. A fantastic dance. Two men, here are their heads, their hands together, like whirling dervishes. Here are their bodies, their feet.” Kelley commented, “These figures are seen extremely well; colors are not used except that they can be part of the costume of the men.”[7] Gilbert's notes are similar, that Goering laughed and said: “Those are the two dancing figures, very clear, shoulder here and face there, clapping hands [cuts off bottom part with hand, including red].1 Top red is head and hat; face is partly white.” [8] Gilbert bequeathed his Rorschach records to Miale and Selzer who asserted that Goering's response about “two dancing figures” reflected a hypomanic defense. They then stated that because Goering saw the 1 The text within brackets contains Kelley's verbatim observations as he tried to determine which features of the blot elicited Ley's responses (i.e. form, color, etc.).
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face in both the blot and the white space, “[it] strongly suggests the emptiness of his being” and that when he reported the hat as red, it “indicates an emotional preoccupation with status.” [9] Kelley examined Robert Ley (head of the German Labor Front) and recorded his numerous responses to the card. “A butterfly. There are colors here. That's funny. It is a funny butterfly. [The whole picture is used and he states that it is a form of a butterfly but the colors are important. The colors actually struck him first.] [An additional response, spontaneous at this point is lamp. This is the center white space form only]. Black and red and white. [He repeats this several times and then moving the card near and far, states the colors look different when you consider the distance. At this point, he brought card close to him and went over the description of the butterfly again.] A stork, or goose would be better. It looks like it was tipped over with its legs pulled in. It seems unique. This top is red. [Form is vague—no movement except perhaps tension.] It is alive. Jaws of the butterfly. [These are the top red details which he described previously as the mouth of the butterfly].” [[10]] Ley was a particularly interesting challenge from a neuropsychiatric perspective. He had a history of a severe head injury that left him with some expressive aphasia and he was notable for his impulsivity and alcoholism. His Rorschach responses were decidedly unusual. Ley perseverated, moving the card back and forth, repeating “black and red and white”, and divulged unusual and unsettling form responses (“jaws of the butterfly”). Kelley reported that Julius Streicher (Editor, Der Sturmer) gave two responses to the card, and seemed fixated on leitmotifs of revolution. Kelley writes: “He looks the card over; discusses it, stating that it is pretty. Waves it about his head and finally states that it is two women in the French Revolutionary times with Jacobean caps. He states that they have red socks and caps and are dancing. He then gives dates of Revolution as 1789 and is about to go into a discussion on the French Revolution in general when he is again attracted by the card. Red wine glass on a porcelain platter. Center red and center space detail. In the inquiry he sees an additional white space response, Two Dutch shoes. Upper white space details. He sees glass as red but form is not important. Color is factor for white platter.” [[11]] When Kelley and Gilbert tested Rudolf Hess (Deputy Fuhrer), they recorded similar findings. Gilbert stated Hess reported: “Also microscopic cross section; parts of an insect with blood spots; a mask.” [12] Kelley observed: “Also microscopic cross-section, parts of an insect with blood spots. The shape of the cross-section of the leg of a fly with red blood spots; space in the middle is the marrow, although I don't know if the leg of an insect has marrow. A mask. Mask of an island savage, like Fiji Islanders, though I don't know them; the opening is for the mouth; it is devilish, that is why the eyes and beard are red. …” [[13]] The content of Hess's response included disturbing images and anatomical allusions. The latter are commonly interpreted as depressive equivalents. Miale and Selzer viewed his color responses as “the remnants of a violent, excitable, unrelated emotionality, which is still intense but is split off from contact with anything real.” They were also impressed that he didn't see the typical clown figures but reported a savage mask. I provided these verbatim responses and interpretations because they give a sense for the unique obstacles to Rorschach interpretation. For reasons that I discuss elsewhere [14], neither Kelley nor Gilbert
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published their Rorschachs. Gilbert released his Rorschachs in 1975 to Florence Miale and Richard Selzer. Kelley's Rorschach were lost until Reneau Kennedy miraculously discovered them in the archives of the Chicago Psychoanalytic Institute, just as they were about to be discarded [15]. Questions about the validity of the Nuremberg Rorschach tests Even if you had the Rorschach responses to all ten cards, how could you be sure that your interpretations of their meaning were unbiased? World-renowned Rorschach expert Molly Harrower devised an ingenious experiment to address this issue [16]. Harrower had an interesting background. She was an accomplished poet and dancer who had trained with Penfield in his classic studies on brain and emotion. She oversaw Rorschach tests on thousands and thousands of individuals across a range of functioning (ministers, prisoners, executives, psychiatric patients, soldiers). She was an editor of books on the Rorschach and was on the editorial board of Psychosomatic Medicine (yet another link to psychosomatic medicine). First, she selected a sampling of Nuremberg Rorschachs that included defendants at all ranges of psychological functioning. Then, she chose as comparison groups Unitarian ministers and psychiatric patients—again, across a range of level of psychological functioning. She stripped off any identifying information and asked a number of Rorschach experts—“do you see any commonalities in some of these records?” The Rorschach experts sorted the records in terms of levels of psychological functioning—healthy, mildly impaired, and moderately impaired. In other words, they did not perceive any unifying characteristics of the Nazi war criminals (or the Unitarian ministers, for that matter). She then gave the experts a second task, informing them that the records came from groups of civil rights leaders, military officers, war criminals, ministers, etc. Could they guess which group the cards came from? Again, the Rorschach experts were not able to guess the identity of the respondents. In other words, with blind testing, there was nothing unique about these Rorschach cards. Defenders of Rorschach testing protested that blinded testing is not done in a testing situation, that instead the examiner closely observes the patient and absorbs information from the testing session itself. Rorschach critics responded by suggesting that the results implied such a degree of subjectivity to the Rorschach interpretations that it was hard to believe they could be usefully employed to shed light on the Nuremberg war criminals. What would we do today? From the vantage point of 21st century clinical trials, this effort at diagnosing the Nazi war criminals with Rorschach tests would be risible. This was an exceedingly small sample—21 defendants in all, and they were tested under highly unusual circumstances. They were defeated
leaders of a country who were kept in solitary confinement and faced possible death sentences. If one were to try to guess about their personalities while in power, this was not the most apt design. Then, of course there was the problem with the lack of blinding and the unreliability of the diagnoses in the first place. That said, this was an enormous and unusual effort in the history of medicine. Never before, have we studied so closely leaders who had steered a country into such an abyss. There are comparatively more studies on the rank and file [17,18], but the fine-grained analysis of leaders is unique. Between the Rorschach tests and extensive psychiatric interviews, Kelley and Gilbert were able to assemble an impressive snapshot, so to speak, of the individuals in power in Nazi Germany. Sadly, mass killings continue in other parts of the world, an infestation and intoxication that our species seems to be unusually sensitive to. It is regrettable that in contemporary War Crimes trials we see no continuation of the efforts at scientifically studying the perpetrators [19].
References [1] Jackson Robert. Trial of the major war criminals, Nuremberg, 1947, vol. ii; November 21 1945[Trial transcript]. [2] Library of Congress, Papers of Robert H Jackson, container 107, serial number 22.872. [3] Kelley D. 22 cells in Nuremberg. New York: Greenberg; 1947[republished by MacFadden, New York, 1961]. [4] Gilbert G. Nuremberg diary. New York: Signet; 1947. [5] Exner J. The Rorschach: a comprehensive system, vols. 1 and 2. New York: Wiley; 1974. [6] Kelley D. ibid, page 171. [7] Kelley D, quoted in Zillmer E, Harrower M, Ritzler B, Archer R, The quest for the Nazi personality: A psychological investigation of Nazi war criminals, LEA, Hillsdale, 1995, p. 203. [8] Gilbert G, cited in Miale F, Selzer M, The Nuremberg Mind: the psychology of the Nazi leaders, Quadrangle, New York, 1975, p. 86. [9] Miale F, Selzer M. The Nuremberg mind: the psychology of the Nazi leaders. New York: Quadrangle; 1975 86–7. [10] Kelley D, quoted in Zillmer E, Harrower M, Ritzler B, Archer R, The quest for the Nazi personality: A psychological investigation of Nazi war criminals, LEA, Hillsdale, 1995, p. 205. [11] Kelley D, quoted in Zillmer E, Harrower M, Ritzler B, Archer R, The quest for the Nazi personality: A psychological investigation of Nazi war criminals, LEA, Hillsdale, 1995, p. 209. [12] Gilbert G, cited in Miale F, Selzer M, The Nuremberg Mind: the psychology of the Nazi leaders, Quadrangle, New York, 1975, p. 102. [13] Archives of the history of American psychology, University of Akron, Molly Harrower Papers, Box M3199, folder 17. [14] Dimsdale J. Anatomy of malice. Yale University Press; 2015[in press]. [15] Zillmer E, Harrower M, Ritzler B, Archer R. The quest for the Nazi personality: a psychological investigation of Nazi war criminals. Hillsdale: LEA; 1995. [16] Harrower M. Rorschach records of the Nazi war criminals: an experimental study after thirty years. J Pers Assess 1976;40:341–51. [17] Zillmer E, Harrower M, Ritzler B, Archer R. The quest for the Nazi personality: a psychological investigation of Nazi war criminals. Hillsdale: LEA; 1995 101–19. [18] Steiner J. The SS yesterday and today: a sociopsychological view. In: Dimsdale J, editor. Survivors, victims, and perpetrators: essays on the Nazi Holocaust. Washington DC: Hemisphere; 1980. p. 405–56. [19] Hakkanen-Nyholm H, Nyholm JO. Psychopathy in economical crime, organized crime, and war crimes. Psychopathy and law: a practitioner's guide. John Wiley; 2012. p. 193.
