Bang! [Freeze frame].

And the credits roll, over a mesmerizing electronica anthem that periodically populates the sound track of this finely honed political, criminological, medical and human drama. The resulting frissons experienced by the viewer serve as valid omens that the ensuing viewing experience will not fail to satisfy the intellect, the gut, and the soul.

In a brief prologue preceding this arresting opening salvo, the audience is introduced to the film’s protagonist, Dr. Berthold Hoffman (Bruno Ganz), a geneticist working in a Max Planck research institute in Hamburg. His angst is immediately evident as he prepares to meet his wife Ann (Angela Winkler), a social worker, who is having an ongoing affair with a leftist organizer, Volker (Heinz Hoening), at a demonstration outside a local youth center scheduled for demolition. “An American in my position would start shooting out the window”, he declares. Instead, it is Hoffman who is shot in the head after he breaches a cordon of riot police to enter the youth center, fearing that his wife is trapped inside. As he lies in a German neurosurgical unit, paralyzed and unable to speak because the bullet track has traversed his motor cortex and “speech center”, the police assert he was shot in self-defense after trying to attack a policeman with a knife, and are hoping to arrest him as soon as he is fit to leave the hospital. Hoffman’s leftist associates, meanwhile, claim he is an innocent victim of police brutality. It seems that Hoffman doesn’t remember what happened. As the film unfolds, we see Hoffman not only grappling with his right-sided paralysis, aphasia, and impotence (both metaphorical and physical – the bullet injured his hypothalamus), but also desperately searching for the truth. In the end, the tables are finally turned, and Hoffman confronts Schurig (Udo Samel), the policeman who shot him, with a gun, creating a stunning – if ambiguous – tour-de-force finale.

The power of Reinhard Hauff’s Messer im Kopt (Knife in the Head, 1979) comes in large measure from a superbly crafted screenplay, penned by Peter Schneider, which engages the audience on so many different levels (neurological, psychological, political, sociological and aesthetic), while maintaining a high level of dramatic tension throughout. Another element in its impact is the extremely naturalistic and powerful performances of the actors, first and foremost that of Bruno Ganz, graphically characterized as “the poster boy of European angst” by one critic, (1) in part because of his role in this movie. Ganz’s extraordinary portrayal of Berthold Hoffman’s neurological condition is arguably the most realistic enactment of a brain injury ever depicted in the cinema. He manages to evoke enormous empathy, even while engaging in some very disturbing behaviour at times. The rest of the cast, including Winkler, Honig, and Hans Christian Blech as Hoffman’s lawyer, Anlietner, is also superb. The hypnotic sound track by Irwin Schmidt and flawless cinematography by Frank Brühne add greatly to the power of the film.

With this synopsis in mind, let us now turn to a neuropsychiatric analysis of the film, beginning with the character of Dr. Berthold Hoffman, the protagonist in Knife In The Head. His opening line (“An American in my position would start shooting out the window”) suggests not only the protagonist’s desperation over his wife’s affair with Volker, but also his carefully controlled rage. Throughout the film we see further examples: is it the result of a brain injury, understandable anger over his loss of function and control, or is Hoffman a man on the verge of a violent breakdown?

The medical scenes in the film are phenomenally realistic, right down to the last details of the neurosurgical operating room and the intensive care unit (ICU). In the ICU, we see Hoffman beginning to recover consciousness. He has bilateral black eyes, e.g. raccoon signs, suggesting he has sustained fractures at the base of the skull, possibly secondary injuries resulting from a fall, although later we come to suspect these were perhaps from a beating. Later, the possibility of a superimposed traumatic brain injury is explored by his doctors when it becomes apparent that the bullet wound alone does not explain all of his symptoms and signs – or is Hoffman faking it? His right arm is flexed with his fingers tightly clenched, and his right lower face droops, indicating right lower facial weakness. These indicate a spastic right-sided paralysis due to damage of the left motor cortex and/or the corticospinal tract that carries motor information down to the facial nerve nucleus in the brainstem and the motor neurons in the spinal cord. His left eyelid droops, suggesting a palsy of the oculomotor nerve, which may result from a number of mechanisms operative in traumatic brain injuries. He is aphasic, i.e., unable to produce intelligible speech and use language. Later we hear from his neurosurgeon that a bullet entered his skull from behind and lodged behind his left ear, “destroying part of his motor speech centre”. This is the only error I noticed in the medical aspects of the film, the motor speech area being in fact located further forward in the frontal lobe of the brain, not in the posterior superior temporal lobe where Wernicke’s area (which has more of a role in language comprehension and formulation of internal speech than in motor control of the speech apparatus) largely resides. However, a high velocity bullet creates a shock wave when it breaches the skull, creating a tunnel of destruction that damages much more tissue than one would expect from its size and trajectory alone, so even this detail is not necessarily inaccurate.

Because of his aphasia, Hoffman is unable to name objects such as a spoon, producing paraphasic errors, e.g. incorrect words or even nonwords that may contain some acoustic or semantic resemblance to the target word. We see him in the CT scanner, and the corresponding images show the typical pattern of radiating white lines, “artifacts” or noise that would emanate from a metal object in this location. Although unable to speak, Hoffman seems to be able to hum a tune to Volker’s jute harp, indicating that homologous areas of the right hemisphere that mediate pitch perception are intact. Hoffman is somewhat paranoid, “cheeking” his pills in his mouth. While paranoia can be a manifestation of injury to the left temporal lobe, is Hoffman right to suspect that he may be being drugged to keep him in a perpetual state of confusion so that he cannot recall a chronology of events that would validate a charge of police brutality? In the same scene he complains of double, triple, even quadruple vision. While double vision is expected because of an oculomotor palsy, seeing three and four of everything is bizarre and difficult to explain easily on a neurological basis. This leads us to wonder if Hoffman might be joking with his nurse. Or perhaps he is right not to take his anti-seizure medications, recognizing that supratherapeutic doses can produce double vision.

Later, Hoffman starts to recover the ability to name objects. He struggles, bursts into tears, and calls his nurses “bastards” in one poignant bathroom scene. Although this could be seen as a manifestation of depression and disinhibited behavior in a patient with a frontal lobe injury, could it be a “normal” response to the humiliation and frustration one would feel at being infantilized, not even allowed to wipe his own backside after a bowel movement?

As Hoffman begins to speak more and is less confused, a police detective tries to interrogate him, without success. Evidently, Hoffman has a dense retrograde amnesia for the events leading up to his brain injury. This would be best explained by a traumatic brain injury other than his bullet wound. The detective confronts him with the “official” account of events, namely that Hoffman is a terrorist involved in producing subversive flyers, and was trying to keep the police from entering the room in the youth centre where he was shot that contained the printing press. He claims that Hoffman threatened Schurig, the policeman who shot him, with a knife, after Schurig entered the printing room. Hoffman’s response at this point to the intimidating tactics of the detective is to expose himself and play with his genitals. While one could see this neurologically as an example of disinhibited or regressed behavior related to frontal lobe damage, it is interesting that Hoffman’s response is not to yell obscenities, scream, or attack the policeman with his wheelchair (perhaps more plausible scenarios in a patient at this stage of recovery from a frontal lobe injury) but instead to express his anger and contempt in a somewhat more controlled, eloquent but “passive-aggressive” fashion.

As his speech becomes more fluent, it is apparent that Hoffman is also confused. He appears to have developed a Capgras syndrome, the delusion that someone has been replaced by an imposter, accusing Volker on the grounds of the hospital of “resembling” the man who is having an affair with his wife. The Capgras syndrome is usually associated neurologically with recovering traumatic brain injuries, although it can also occur in schizophrenia. (2)Hoffman then regurgitates the police account of events to Volker, who points out that Hoffman never even owned a pocketknife. Volker shows him an old picture that Hoffman doesn’t recognize of the geneticist playing the violin on stage. Clearly, Hoffman still he has a very dense retrograde amnesia, probably extending back some years.

Later, in a scene with his lawyer, he draws a file with a wooden handle when asked to draw a “messer” (knife). The police did not find a knife in the room where he was shot. As we see in the end, this may not be coincidental, as Schurig’ssuperficial abdominal wound could easily have been made by a chisel.

As Hoffman recovers, his situation becomes even more poignant. He is no longer physically disabled, and has recovered a good deal of his memory and his sense of humour. He is even able to plan and execute fairly complex (if naïve) acts of deception, as in his escape from the hospital and visit to his laboratory. Yet his ability to communicate remains restricted, and there is evidence that his thinking is still deranged. Is he psychotic as a result of his brain injury, (3) or merely just confused? Hoffman yearns for his independence, but can he realistically function outside the hospital at this juncture, let alone return to his former job as a genetics researcher? His lawyer, wife, and former boss believe not, but even if they are wrong, Hoffman faces the likelihood of incarceration on attempted murder charges if he tries to do so.

A particularly moving scene follows with Ann in the woods where she rejects him after he kisses her, triggering an outburst of rage in which he threatens her menacingly with a stick, if only to make her feel his own fear and angst in a futile attempt to get her to identify with him. He alludes to the possibility that his hypothalamus is injured. Damage to this structure can in fact lead to rage, but usually of a sort more stereotyped and less situation-dependent than Hoffman’s.

In the interests of brevity, I will not summarize the rest of the movie in detail, but skip to the dramatic climax. The ambiguity which persists throughout the film about Hoffman’s “true” personality structure and the extent to which he is engaged in anti-state activities, and its unsettling ending, lead to criticism of the film by a few German reviewers as “Ausgewogenheit” which apparently translates something along the lines of “a calculated attempt to avoid taking sides”, along with an implication that director Hauff did this for commercial rather than artistic reasons. To this charge, Hauff responded:

“If the viewers haven’t been engaged by then and don’t accept a few of the film’s premises, they probably won’t know what to do with the ending. Whoever followed the premises of the film will be in a position to ‘go on filming’ for himself after this abrupt ending and to reflect”.

This leads us to consider the historical context of Knife In The Head, which was filmed in the late 1970’s, when the Baader-Meinhof Gang, the Red Army Faction, and other extreme leftist terrorist groups were active in Germany and elsewhere in Western Europe. The Red Army Faction engaged in a series of kidnappings, bombings and assassinations of leading German industrialists, including the murder of the CEO of Deutsche Bank in 1989, while his alleged assassin was killed in a police shootout four years later. From the 70’s through the 90’s, over 50 people were killed in Germany in such actions. (4) The reaction of the state in the Federal Republic in the late 1970’s was viewed by many as extreme, with terrorist “witch hunts” being conducted by the security police, roadblocks, and other tactics which created an almost police state atmosphere. A number of other films made in Germany around this time also dealt with terrorism, including Margarethe von Trotta’s Das zweite Erwachen der Christa Klages (The Second Awakening of Christa Klages, 1978) and Die bleierne Zeit (Marianne and Juliane, 1981), Rainer Werner Fassbinder’s Die dritte Generation (The Third Generation, 1979) Volker Schlöndorff and von Trotta’s Die verlorene Ehre der Katharina Blum oder: Wie Gewalt entstehen und wohin sie führen kann (The Lost Honour of Katharina Blum, 1975), and Deutschland im Herbst (Germany in Autumn, 1978) a collective venture by Fassbinder, Alexander Kluge, Schlöndorff, and others, about the real kidnapping and murder of a prominent German industrialist, and the subsequent unexplained deaths of three members of the Baader-Meinhof Gang. (5)

Knife in the Head differs from these other films in its linear narrative structure and fairly conventional, 1970’s Hollywood style story-telling along the lines of the paranoia thriller modelled around a central character with whom the audience can identify. It grossed more than two million deutschmarks at the box office, and won numerous awards, including a German Federal Film award and the Prix de la Critique Internationale and the Prix de L’Antenne d’Or at the Paris Film Festival. Hauff’s later film, Stammheim: Die Baader-Meinhof-Gruppe vor Gericht, dealing with the trial of the Baader-Meinhof Gang, won the prestigious 1986 Golden Bear Award at the Berlin Film Festival. The screenplay was based almost completely on the actual trial transcript. According to one reviewer,

“Like the events themselves, Hauff created a milieu that is lurid and occasionally surreal: a courtroom lit by eerie fluorescent lights and menaced by the whirring of an air conditioner, and prison cells that foretell tragedy.” (6)

Stammheim is remarkable for its apparent objectivity at a time when other filmmakers were making more polemical or one-sided films about European terrorism. The influence of Stammheim and Knife in the Head is exemplified in the choice of Reinhard Hauff as one of two keynote speakers (the other being Andres Veiel, who made the documentary Black Box BRD (2001)) at an annual conference organized by the Interdisciplinary Graduate Student Society at Harvard University in April 2003 entitled “RAF’s Germany: Terrorism, Politics, Protest.” (7)

In the view of Klaus Phillips, whose chapter “Reinhard Hauff: A Cinema of Darwinism” I have drawn on at various points in this discussion, Hoffman

“first has to lose his identity so he can reestablish his real self. A likable idiot savant after his injury, reminiscent of Herzog’s Kaspar Hauser, he instinctively goes after the truth. He is a concrete example of a condition everyone desires, although not under such circumstances. What Hauff demands from his viewers is essentially what is demanded of this film’s protagonist: Learn again how to see, hear, speak, and think, before you take a stand!” (8)

At this juncture it makes sense to consider Reinhard Hauff and his films from a biographical and history context. Hauff was born in Marburg in 1939, into a middle-class Protestant family that was active in church affairs. He studied German literature, dramatic arts and sociology in Vienna, but dropped out before completing his degree after Bavaria Studios offered him a vacation job as an assistant in the light entertainment division. He began his directing career in television, initially making programs about musicians (including one about a European tour by Janis Joplin, who intrigued him greatly). He subsequently made a number of documentary films before shooting his first feature, Die Revolte (The Revolt), in 1969. This film revolved around a man bored with his bourgeois existence as a clerk in an insurance firm, who joins a radical political group. (9) Like many of Hauff’s subsequent works, it has a dramatic and tragic ending. Hauff’s background as a documentary filmmaker likely contributes to the realism of his feature films.

Several recurring thematic elements are common to a number of Hauff’s movies, such as the struggle of an individual against authoritarianism, whether perpetrated by a parent (as in Paule Pauländer (1976)), a community (Mathias Kneissl (1970)), an institution (Die Verrohung des Franz Blum (The Brutalization of Franz Blum, 1974), or the police and security apparatus of the state or society at large (Stammheim and Knife in the Head). Another is the herculean struggle of an individual against adversity (e.g. Desaster (1973)). In several of Hauff’s movies these two dynamics coincide, for example in Paule Paulander, where a conduct-disordered boy is brutalized by his father, who in turn is struggling to defend his farm against a giant industrial concern, and is also facing terrible economic stress. Hauff is generally viewed as a social realist director, and in fact made a documentary about the Indian social realist director Mrinal Sen (Ten Days in Calcutta: A Portrait of Mrinal Sen (1984)), whom he admires greatly. Hauff’s films generally demonstrate considerable empathy for the underdog, even when the protagonist engages in serious antisocial acts such as murder and arson. (We see a minor example of this in Knife in the Head, where audiences easily forgive Hoffman stealing his doctor’s coat and stethoscope, breaking hospital rules, even those which exist for the protection of patients and staff, and confronting and intimidating Schurig in the latter’s own apartment). Without being openly polemical, Hauff’s movies chronicle the oppressive social circumstances and/or abusive backgrounds that are implicitly causally implicated in the genesis of antisocial behaviors enacted by his protagonists. Often these are portrayed with a gritty realism, sometimes in an almost documentary style. In several of his films, Hauff employed individuals with no prior theatre or film training and experience whose life circumstances paralleled those of his characters as actors. This proved disastrous for him when the lead actor in Paule Paulander showed up at his doorstep in Munich after running away from home, apparently hoping that Hauff would take him in. Some years later, Hauff also made a semi-autobiographical film, Der Hauptdarsteller (The Main Actor, 1977), based in part on this incident, with a quite disturbing ending. Hauff is quoted as having said:

“I’m fascinated by people who try to survive and keep their human dignity without having a real chance, with more difficulty than I had in my life”. (10)

In reviewing his filmography, at times it appears that Hauff’s identification with his protagonists goes beyond mere empathy for their dilemmas and trying social circumstances, and may extend to a vicarious identification with their status as rebels. In this regard, he takes after a number of his German colleagues such as Wim Wenders. He is apparently an admirer of the directors John Cassavetes, Martin Scorsese, and American film noir. He made several films in collaboration with Burkhard Driest, who inexplicably robbed a bank only days before he was scheduled to take his law exams, was sentenced to five years in jail, and received a great deal of notoriety in the media since, including a rape charge of which he was acquitted.

Hauff’s career in movie making spans thirty years, from the late 1960s to the early 1990s. He co-founded Bioskop-Films with Volker Schlöndorff (who won an Oscar for Die Blechtrommel (The Tin Drum, 1979)) in the mid-1970s. He stopped making movies in the early 1990s, and between 1993 and 2005, he directed the German Film and Television Academy in Berlin. He is described as an intensely serious, erudite, and personable man. Hauff made films at a much slower rate than many of his more prolific German colleagues, turning out approximately one per year. His style as a director is the antithesis of authoritarian, viewing a film as a collaboration with cast and crew, and assuming a role more as facilitator or “amplifier” rather than as a domineering leader who forces his own artistic vision on the actors. (11) This style must have been apparent to Vincent Canby, who observed in his review of Knife in the Head for the New York Times that

“It is such a closely integrated work of writing (by Peter Schneider), direction and performance that it’s difficult to separate the individual contributions. The only think I’m sure of is that Knife in the Head is another major, very original German movie”. (12)

This brings up a point about the original German title of this film Messer im Kopf, which can be translated in a variety of ways. “Messer” can mean “the one who measures” as well as “knife”, and “Messer im kopf”, in addition to the literal meaning of a physical knife stuck in one’s head, can mean being unable to get an image or thought of a knife out of one’s head (clearly a meaning which makes sense at the level of the surface narrative context of the film). It can also be used idiomatically to mean something unpleasant that one wants to rid oneself of in one’s thoughts. It can even mean, “measuring in one’s thoughts”. Thus the title can be seen as a clever double (or even triple) entendre: Hoffman’s relentless and obsessive pursuit for the truth about himself and what happened to him at the hands of the police is ultimately a question about the “measure” of the man inside. The climactic ending, in which Hoffman appears ready to shoot Schurig, but hesitates when he sees his own fear mirrored in Schurig’s face, has been interpreted by Thomas Elsaesser, the author of a highly regarded reference work on the New German Cinema (13)as epitomizing the ambivalence between aggression against others and aggression against the self, an ambivalence which is resolved in some of Hauff’s other films by murder, suicide, or both.

Phillips concludes his summary of Hauff’s films with the valid generalization that they

“appeal to the exploited, the oppressed, the outsider in all of us. His is a cinema of Darwinism, of individuals struggling to escape from society’s labyrinthine dead ends. As in Knife in the Head, … the films of Reinhard Hauff go on long after they are finished.” (14)

Touché. Unfortunately, this superb film and other worthy creations of Hauff’s, equally unavailable in English-language DVDs, are in danger of slipping into oblivion, as this self-effacing director never promoted his films in the aggressive manner adopted by some of his better-known contemporaries. We can only hope that a company such as the Criterion Collection will see the light, and snatch them from the luring dustbin of film history before they are lost forever.


  1. Keough, P. “Collateral Damage: Domestic Violence Shapes ‘The RAF’s Germany’”. The Phoenix (April 10-17, 2003).
  2. Benson, D. F. and Gorman, D. G. “Hallucinations and Delusional Thinking.” In B.S. Fogel, R.D. Schiffer and S.M. Rao (Eds.), Neuropsychiatry. Baltimore: Williams & Wilkins, 1996, pp. 307-323.
  3. van Reekum, R. , Cohen, T., and Wong, J. “Can Traumatic Brian Injury Cause Psychiatric Disorders?” Journal of Neuropsychiatry and Clinical Neurosciences, 12, 2000, pp. 316-327.
  4. Keough, P. “Collateral Damage: Domestic Violence Shapes ‘The RAF’s Germany’”. The Phoenix (April 10-17, 2003).
  5. Yakir, D. “Terrorism–Europe’s Trend is America’s Trivia.” New York Times (September 7, 1980) p. D19.
  6. Anonymous. (2003). Stammheim from http://www.harvardfilmarchive.org/calendars/03marapr/raf.htm
  7. Wilkins, L. “RAF’s Germany: Terrorism, Politics, Protest.” 2003 Interdisciplinary Graduate Student Conference at Harvard University (April 11-12, 2003), from http://www.fas.harvard.edu/~german/conference.html
  8. Phillips, K. “Reinhard Hauff: A Cinema of Darwinism.” In K. Phillips (Ed.) New German Filmmakers: From Oberhausen Through the 1970s, New York: Frederick Ungar Publishing, pp. 143-167.
  9. Ibid.
  10. Ibid.
  11. Ibid.
  12. Canby, V. “Screen: German Knife in the Head.New York Times (April 23, 1980), p. C24.
  13. Elsaesser, T. New German Cinema: A History. New Brunswick, NJ: Rutgers University Press, 1989.
  14. Phillips, K. “Reinhard Hauff: A Cinema of Darwinism”, p. 166.