Book Review

Dictators in the Mirror of Medicine: Napoleon, Hitler, Stalin

N Engl J Med 1996; 334:740-741March 14, 1996

Article

Dictators in the Mirror of Medicine: Napoleon, Hitler, Stalin
By Anton Neumayr. 462 pp., illustrated. Bloomington, Ill., Medi-Ed Press, 1995. $34.95. ISBN: 0-936741-09-0

Power is an enticing topic, and the abuse of power a fascinating one. Anton Neumayr is a specialist in internal medicine who lives and works in Vienna. He is also a concert pianist, a writer on European composers of the 18th and 19th centuries (his complete three-volume work on the music and medicine of these composers will be available in English this summer), and he is well known in Austria for his television series, in which he discusses his research and conclusions on the lives and medical histories of famous people. In this new book he surveys the lives of three infamous dictators: Napoleon, Hitler, and Stalin. The life of each is described from birth to death. In these biographies Neumayr provides what he (or his translator) calls a psychograph. Napoleon is depicted, for example, as longing to be loved, yet because he felt challenged by authority he transformed his feelings of social inferiority into ones of calculation and revenge. Neumayr remarks in passing that Napoleon was “mentally and emotionally quite an ideal candidate to participate in the Revolution.” Hitler is described as a “necrophile, a destructive, introverted, extremely narcissistic, sadomasochistic, reclusive and undisciplined person.” Stalin is classified as both a sadist and a narcissistic megalomaniac who failed to establish normal social relations.

All three wreaked havoc on people and the structures of states. How did they rise to power? How did they get away with what they did? How did they carry vast throngs of people with them? These questions infuse the book, which was first published in Austria on the 50th anniversary of Hitler's death. The core question is, What can we learn from these rulers so as not to repeat the patterns?

Neumayr concentrates on the lives, the politics, the victories, and the medical histories of his subjects, including as detailed a depiction of their deaths as current records allow. Napoleon languished for two years on St. Helena before dying. His death generated conflicting medical opinions. Neumayr recounts the various views and autopsy results in some depth, concluding that Napoleon's death was probably the result of an amebic infection and perforation of a stomach ulcer. Hitler, choosing suicide, constructed his own death. Stalin's autopsy found hemorrhage in the brain. It says a lot about the role, power, ruthlessness, and effective, if paranoid, sense of self-preservation of these dictators and about the presence of sycophants as an inner circle of protection that none of the three was killed by a disaffected citizen.

For his sources Neumayr draws on materials that will be familiar to readers with a special interest in the power and personalities of political leaders. He acknowledges the work of many others, including Erich Fromm, Wolfgang De Boor, Bradley Smith, Robert Conquest, and Alan Bullock. This book is designed more for the general medical or nonmedical reader than the specialist. The style is engaging. The lives of these men dramatically and horrifically unfold. There are no footnotes, although there is a bibliography. There are marvelous, well-chosen (and referenced) illustrations. There is little overarching analysis. The lives, medical histories, and deaths of these men are described, and the reader is implicitly asked to draw conclusions about the generality or particularity of these three terrifying persons. Some powerful themes come through: the ability of each of these men to rationalize crimes away; their feelings of omnipotence; the dangerous narcissism of believing one is chosen by fate; the lure of the fanatic at a time of social chaos, whether in 18th- and 19th-century France or 20th-century Germany or Russia.

The most striking if understated theme is the role that specific social, military, and political opportunities have offered — and presumably will offer again — as legitimizing forces for dangerous personalities. Napoleon propelled himself on the wave of the French Revolution. He was a general in his early 20s, already immune to concern about the execution of large numbers of people — 1100 after the capture of Toulon in 1793. Hitler's ability to convey certainty, emotionality, and extremism blossomed in the political and economic uncertainties of Germany in the 1920s. Stalin rose in the maelstrom of the Communist revolution. Although this book concentrates on these men in their social context, the explanation of how dangerous dictators come to exist must in large part center on the social structure and its institutions. Presumably there are many more potential Napoleons, Hitlers, and Stalins (hundreds? thousands?) than actually ever come to power. As Neumayr's biographies show, his three subjects would have been equally plausible as social failures, lost to public scrutiny early in their careers. Instead, social circumstances bore them ahead. The need for continuity and stability in social institutions is, perhaps above all else, the most cautionary aspect of these histories. Napoleon was able to have himself created emperor; Hitler became Führer; Stalin was the “Great Leader of the Soviet People.”

The book lacks the kind of analysis that would blend the opportunistic aspects of the environment with the opportunistic aspects of character formation in a new way. What it does do is bring together materials that may encourage a wider, perhaps younger audience to contemplate the terror of dictatorship and how to prevent it.

Rosemary A. Stevens, Ph.D.
University of Pennsylvania, Philadelphia, PA 19104