Objectives: To update Canadian psychiatrists on recent information from newly discovered Berlin archives about the actions of physicians, especially psychiatrists, during the era of National Socialism in Germany and to encourage introspection about the role of the medical profession, its relationship with government, and its vulnerability to manipulation by ideology and economic pressures.
Method: This is a selective review of the literature on the collaboration of physicians, especially psychiatrists, in the sterilization, experimentation, and annihilation of patients with mental illness before and during World War II.
Results: Directed to value the health of the nation over the care of individual patients and convinced that a hierarchy of worth distinguished one person from another, German psychiatrists were enlisted to commit atrocities during the Nazi period.
Conclusions: The values of care and compassion can be eroded; this knowledge demands constant vigilance.
(Can J Psychiatry 2005;50:218-225)
Information on author affiliations appears at the end of the article.
* A tension exists between individual care and preventive health.
* Ideological and economic pressures are difficult to resist.
* Constant vigilance is necessary to maintain psychiatric values.
* Only secondary sources were available.
* Others may draw different implications from the historical record.
* This article does not do justice to the complexities of the issues covered.
Key Words: Nazi psychiatrists, history, medical ethics
Richard von Krafft-Ebing (1840-1902), Emil Kraepelin (1856-1926), Sigmund Freud (1856-1939), Eugen Bleuler (1857-1939), Julius Wagner-Juaregg ( 1857-1940), Alois Alzheimer (1864-1915), Cari Jung (1875-1961), Karl Jaspers (1883-1969)-these names attest to the intellectual ferment in German, Swiss, and Austrian psychological circles during the late 19th century. The debt we owe to these pioneers makes it all the harder to understand how, before the new century was 30 years old, German psychiatrists were gassing children with mental handicaps and sterilizing adults with mental handicaps and mental illness or using them as subjects for scientific experimentation before putting them, often brutally, to death (1-10). Psychiatrists who once were much admired-Ernst Rudin, Franz Kallman, Carl Schneider-were complicit in these activities. Devotees of preventive health approved of the practices. Social reformers participated. Disciples of humanism and followers of the holistic medicine1 movement colluded in the atrocities. Academicians and scientists were at the centre of them. Even well-meaning child and adolescent psychiatrists willingly took part.
Physicians were among the first to support National Socialism in Germany. The National Socialist Physicians League was formed in 1929. By early 1933, almost 3000 physicians (6% of the entire medical profession) had joined the League. By late 1933, 11 000 physicians were members. Undoubtedly, some joined not out of conviction but out of occupational necessity. Eventually, 45% of German physicians belonged to the Nazi party, about 7 times the mean rate for the employed male population of Germany. Physicians moved with alacrity from looking after individuals to upholding an idiosyncratic ideal of national health (Volksgesundheif) (1). They seemed to easily accept a hierarchy of human worth that put the infirm, the disabled, and the genetically imperfect on the bottom rung (1). Contemporary evidence suggests that, of the medical specialties, psychiatry was the most involved (4).
Science, statistics, and economics conspired to beget the notion that appropriate sterilization of the genetically disabled would improve the health of the nation. The belief that life needed to be "worthy" to merit government-supported health services caught on among the public. …