The Holocaust and German psychiatry.

The Holocaust under the Nazi regime is probably the most traumatic catastrophe of our century and even of history in the civilised world. Its deepest abyss consumed the lives of one-third of the world's Jewish population, who were selected and murdered in a cold-blooded industrialised machinery of death in this their †̃¿ Shoa'. The Jewish people represent the victims of the Holocaust more than any other group of human beings who suffered this iniquity. The Holocaust has left in its wake few survivors, and many invalids in body and in mind, who remain compelled to live with a trauma that surpasses any other deliberately caused by fellow humans: and it has left in its wake an entire nation in shame and bewilderment, stigmatised and traumatised by the horrifying crimes that were committed in its name, faced with the task of analysing what happened, so that it may never be repeated, forbidden by the enormity of the horrors from repressing the past, and obliged to integrate deeds that cannot be undone. The vast majority of Holocaust victims were Jews; but many other groups were segregated from society and sent to death or mutilated, tortured, deprived of their human rights because they did not conform to the Nazi ideals of †̃¿ desirable members' of their hypothetical race. The first victim group of the Nazi extermination policy was that of the chronically mentally ill and disabled. How were German psychiatrists involved in these crimes? Did they not even try to prevent them? How has the Holocaust affected German psychiatry? These questions necess arily interest German psychiatrists, and are the subject of this paper. Karl Jaspers had already said in 1945: “¿ We ne d a knowledge of history, of its facts and meaning, in order to see through our moral political position―. Since the end of the war, the process of bringing the facts to light has been continuous, and the evaluation of the data for the past ten years has received wide publicity in the so-called Historikerstreit, that is, the public debate among historians. This general dis cussion among experts, the uncensured inquiry into the moral impact and historical location of National Socialism and the ensuing crimes have been followed with intense interest in Germany. As to psychiatry, there have recently been many publications, some by authors outside the medical field, in both parts of Germany, and abroad. We hope gradually to learn and understand what happened. German psychiatry was involved in the Nazi extermination programme. An estimated 100 000 mentally ill or disabled patients were murdered under the Nazi regime. Only one-fifth of all psychiatric in patients of the time survived. Half a century later, we still ask how psychiatrists could have become an instrument of such inhumane domination, so far removed from all moral and ethical principles, as members of a nation that brought forth philosophers who verbalised these very principles. Recent publi cations have offered various theories. Robert Jay Lifton in his book The Nazi Doctors (1986), in the chapter on the †̃¿ Psychology of genocide' focuses on what he calls “¿ the psychological pattern of doubling―, by which he means “¿ the division of the self into two functioning wholes, so that the part self acts as an entire self'. Hans Walter Schmuhl (1987)has offered what he calls the †̃¿ theory of polycracy', that is, the accumulative effect of autonomous centres of power in Nazi bureaucracy, to explain the radicalisation in which the murders were euphemistically called †̃¿ euthanasia'. Orders came from various ministries, and laws were passed to reinforce as right what normal human conscience considered wrong, pressing doctors into compliance. The first law was the †̃¿ Erb-Gesundheitsgesetz', that is, the law concerning hereditary health, passed in 1933, the first year of Nazi rule. It was declared necessary for the “¿ protection of the race―and became the basis for forced sterilisation, which began in 1936. The unqualified term †̃¿ unworthiness' was first applied to the incurably mentally ill and disabled, and later to all members of society who were considered undesirable by racial criteria. This law was not the first manifestation of racial Darwiism in human society. In Sparta, ill-born or deformed offspring were thrown down a chasm below Mount Taygetus —¿ I quote Plutarch, †̃¿ Life o Lycurgus', Chapter 16— “¿ out f the conviction that the life of that which nature had not well equipped at the very beginning for health and strength, was