Hatred Often Lurks in the Shadows of Mania : Mental illness: Society should understand the role of manic depressive disorder and paranoia in crimes of genocide.

While mental health professionals and patients yearn to see mental illness destigmatized, it is contrary to society’s interests to ignore or minimize the role of emotional disorders in bigotry, hate crimes and genocide.

Consider the perpetrators of the most terrible hate crimes in history. Those who knew or studied Adolf Hitler and Josef Stalin offer vivid descriptions of the paranoid, delusional form of manic depressive disorder both men experienced.

One side of Hitler was despairing, indecisive, isolated, unable to care for himself and had impaired concentration and memory. His speech was hesitant, he was confused, despondent and apathetic and suffered paranoid delusions, especially about Jews. This Hitler was afraid of water, horses and the moon. He washed his hands constantly because of his phobic dread of infection. He survived six suicide attempts before succeeding with the seventh.

The other side of Hitler was egotistical, arrogant, grandiose, loquacious, aggressive and irritable. He had delusions of omnipotence, invincibility and infallibility, violent mood swings, rages, racing thoughts and pressured speech.

At 17, Hitler was twice rejected by the Vienna Academy of Arts. It caused him to fall into a deep, paranoid, delusional depression in which he spewed anti-Semitic hatred. His bigotry became a raging obsession. Unable to admit to himself that his talent or training might be insufficient, he blamed the Jewish members of the academy faculty for keeping him out of the art school. “For this, the Jews will pay,” he wrote to the academy’s director.

During World War II, Theodor Morell, Hitler’s personal physician, had daily contact with him and supplied him with amphetamines and cocaine for his depression. In 1943, the doctor was emboldened to state publicly that the Fuhrer was a manic depressive.

Anti-Semitism is a pathologic state of mind. Why else would it continue to thrive in a country like Poland, with a Jewish population of less than 4,000?

In depression, Stalin was indecisive, anxious, pessimistic, indifferent, gloomy, lonely, paranoid and had low self-esteem. In mania, he had grandiose delusions, rages, paranoia and hypersexuality. He abused alcohol in both phases.

As early as 1919, when Stalin was commander of Tsaritsyn, later called Stalingrad, now Volgograd, Leon Trotsky observed how “a military setback . . . became in his [Stalin’s] mind a product not of error or accident, but of treason.”

Stalin targeted his paranoid, murderous hatred at those who he feared knew more than he did on any subject and people who he suspected of knowing his personal affairs. His paranoid delusions led him to accuse of treason and execute millions for failures of his own making. Any person or group might become a target. No one was safe, not even his own family or his inner circle.

The paranoid delusions of manic depressives are as infectious and as virulent as a deadly microbe and can easily infect those in thrall to the host figure. It is a phenomenon known as “induced psychosis,” and we have seen it operating in Guyana, Waco and Tokyo.

Despite the catastrophic consequences of the paranoid delusions of such manic depressive demagogues as Jim Jones and David Koresh, our modern institutions have made no effort to educate society that the hatred of bigots and demagogues, whether expressed in incendiary language or in deed, is often a symptom of manic depressive disorder.

The classification of manic depressive disorder as a single psychiatric disease was published by the German doctor Emil Kraepelin in 1921. One of the paradoxes of this disease is that while its benign form has given us many of our creative geniuses, its paranoid sister has unleashed bigots and mass murderers.

With the war defeat closing in on him, Hitler committed suicide in 1945. Four years later, Australian psychiatrist John Cade established the therapeutic value of lithium in treating manic depressive disorder. Had lithium been available during Hitler’s time, humanity might have been spared World War II and the Jewish genocide. It is a quirk of fate that should not be lost on anyone interested in preventing hate crimes.