Psychiatric genocide: reflections and responsibilities.

Torrey and Yolken should be commended for adding to the burgeoning reports in the recent psychiatric literature describing the genocide committed by our colleagues during the Nazi era. That it has taken close to 60 years to confront this dark period in the history of psychiatry does not diminish the importance of finally dealing with it. It is painfully shameful that close to 300 000 individuals with schizophrenia were either sterilized or killed at the behest of members of our profession. These include physicians at all levels, from the resident to the senior professor, and including the support of all ancillary staff, from nurses to transport teams to the hospital janitor. In order to ensure that this period never returns, the facts must be made known to newer members of our profession. Of the estimated 600–700 psychiatrists practicing in Germany at the time, it is not known how many refused to participate in this extreme injustice to their patients or protested privately against it. Only a very few were known to protest publicly. These include, most notably, Martin Hohl, Hans Creutzfeldt, Gottfried Ewald, and Karsten Jasperson. Thus, Torrey and Yolken may not be correct in stating that only ‘‘some psychiatrists were fully cooperative.’’ As Torrey and Yolken allude to, the enterprise of mass murder by means of gas chambers, and used so morbidly successfully on Jews, originated in psychiatric hospitals under the facilitation and direction of psychiatrists. Only one physician was appointed commander of a Nazi death camp—and he was a psychiatrist (albeit with minimal training). Dr Irmfried Eberl established Treblinka at the age of 32, and there he was responsible for the killing of approximately 280 000 individuals within a few weeks (considered to be the most ‘‘rapid and efficient’’ murder of Jews during the Holocaust). Eberl earned the position of Treblinka commandant following his success as head of 2 psychiatric hospitals, at Brandenburg and Bernburg, where he coordinated the murder of tens of thousands of mentally ill patients within the context of the euthanasia program. However, few in medicine in general and psychiatry in particular know his name and of the genocidal damage he did to the ethical practice of the profession. Several interesting points emerge from the Torrey and Yolken paper that require comment. First, it would be wrong to suggest that eugenic ideas were limited to those psychiatrists practicing in Nazi Germany. Much of the lead for eugenics originated outside of Germany in the early 19th century, and most of the initial momentum for it among other countries came from Britain, the United States, and Canada. For example, the FrenchAmerican Alexis Carrel, awarded the Nobel Prize for Physiology or Medicine in 1912, wrote in his 1935 book Man, The Unknown, which was later translated into German in 1936, that the criminally insane should be ‘‘humanely and economically disposed of in small euthanasia institutions supplied with proper gasses.’’ In 1938, William Gordon Lennox, the prominent American neurologist who pioneered the use of electroencephalography in epilepsy, recommended euthanasia as a ‘‘privilege of death for the congenitally mindless and for the incurable sick who wish to die.’’ He added in 1950 that mercy killing is advisable for ‘‘children with undeveloped or malformed brains’’ as a way of opening up space in ‘‘our hopelessly clogged institutions.’’ Finally, the British neurologist and chairman of Cornell’s department of neurology, Robert Foster Kennedy, in a 1942 paper published in the American Journal of Psychiatry, stated that ‘‘defective children,’’ ‘‘Nature’s mistakes,’’ over the age of 5, should be euthanized. There were even physicians with ‘‘Jewish blood’’ who were associated with eugenics statements, including the sterilization advocate Franz Kallman, mentioned in the paper. Kallman’s father was Jewish and had to flee Germany to the United States, where he built his prominent academic career. While others advocated euthanasia, it was primarily German doctors during the Nazi era who actualized the ideas by performing euthanasia, thus permitting their philosophical/theoretical constructs to affect patient management. While several Jewish doctors were known to have supported eugenic principles, none were known to have participated actively in the euthanasia program since, among other reasons, by the year Schizophrenia Bulletin vol. 36 no. 2 pp. 208–210, 2010 doi:10.1093/schbul/sbq003 Advance Access publication on February 4, 2010