"Transferred to Another Institution": Clinical Histories of Psychiatric Patients Murdered in the Nazi "Euthanasia" Killing Program
Steger, Florian, Görgl, Andreas, Strube, Wolfgang, Winckelmann, Hans-J, Becker, Thomas, The Israel Journal of Psychiatry and Related Sciences
This study aims to examine the practice of medical reporting in a totalitarian environment including systematic killing of people with mental illness in Nazi Germany. The historical analysis is based on patient documents and administrative files at today's District Hospital, Günzburg, as well as on patient documents of inventory R 179 of the branch office of the Federal Archives (Bundesarchiv) in Berlin/Lichterfelde. The paper describes four patient histories and attempts to reconstruct some aspects of patients' (mostly institutional) histories against the background of the Günzburg State Hospital serving as an assembly institution in the context of 'Aktion T4" There is no certainty regarding the places of death of the four patients whose medical documentation is reported. In the patient records examined, the practice of medical description and reporting was characterized by a mixture of medical terminology, ideological diction and common language. The type of medical description and documentation used is an expression of somatization and discrimination of patients and of traumatizing institutional practice, and it reflects institutional violence. It is an ethical responsibility to reconstruct and commemorate the individual histories of mentally ill patients who were victims of the program of organized mass killings of people with mental illness. Places of death were camouflaged by the 'Aktion T 4," and there is uncertainty for many patients regarding where they were killed.
The "euthanasia" project of National Socialism consisted of five distinct programs of systematic mass killing: 1. Child "euthanasia," 2. the murder of psychiatric patients from the East Prussian Provinces and occupied areas of West Prussia by the SS (1939-1940), 3. the "T 4 Campaign" which refers to the decentralized murder of psychiatric patients by means of poison gas ( 1 940- 1941), 4. the "Special Treatment 14fl3," which refers to the gassing of concentration camp prisoners unable to work, organized by the members of the "T 4 Campaign" and the SS (1941-1943), and 5. the decentralized killing by intentional malnutrition and medical injections in long-term care institutions in the occupied eastern regions from summer 1942 until the end of the war (1). For political reasons, Adolf Hitler refused to initiate a euthanasia law and kept the mass killings secret under the code name "Aktion T4" both for Germany and occupied countries (and based on Hitlers "euthanasia authorization" backdated to September 1st, 1939 in October). The "Aktion T4" (1939-1941) was used to organize the systematic killing of about 70,000 patients from psychiatric institutions (2). This number corresponds to about one fifth of all patients who resided in psychiatric (mental) hospitals at the time. Within the organizational structure of the "Aktion T4" the Günzburg State Hospital was used as a so-called "assembly institution" (Sammelanstalt) to gather patients selected for the program of mass killings (3-5). The Günzburg State Hospital was opened in 1915 due to marked overoccupancy at the earliest Swabian district lunatic asylum in Kaufbeuren-Irsee. The asylum was built according to a pavilion scheme, and it was planned for a maximum number of 400 patients. Outside Germany, the name of the small town of Günzburg is associated with the name of the SS-medical officer Josef Mengele. The Swabian town was home to Mengele, and he found shelter in Günzburg during his flight from Allied forces (6).
The medical staff involved in the patient killing programs were protected from prosecution for their actions. From the beginning of October 1939, the Reich Ministry of the Interior or provincial authorities sent "notification forms" comprising questionnaires regarding criteria for patient selection to all psychiatric institutions (1, 7, 8). These forms were examined by three medical officers (in Berlin), and this panel made a decision on the transfer and killing of each individual patient. …