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Nazi Extermination of Mental Illness

Year End Reflection on Those Taken From Us

There are certain times of the year such as religious holidays, anniversaries and the New Year where I find myself reflecting on those people who are no longer with us. As we come to a new year and the end of the first decade of the 21st century that is one of those times. As a son, I think about my parents which leads me to remember other relatives and dear friends who have died and whom I miss. As a Jew I think of the Holocaust and the extermination of millions of people who were murdered because they were born Jewish. I know history is filled with other similar events which have occurred even in the recent past and may approach the evil nature and magnitude of Hitler’s work.

People with Schizophrenia Also Targeted by Hitler

As as a psychiatrist, I also find myself reflecting at these times on the systematic murder by the Nazi’s of people because they had a mental illness! This addition to my personal memorial list is relatively new to me since I only recently became aware of the details of Hitler’s systematic singling out mental disease, especially schizophrenia due to recent writing of E. Fuller Torrey, Robert Yolken and others. Yes, I had known how the Nazi’s in their attempt at racial purity were targeting other groups in addition to the Jews but I did not appreciate how people with Schizophrenia were being especially chosen. I was originally alerted to this piece of history by an article in Psychiatric News by Mark Moran in November of this year which also referred to an article by Torrey and Yolken in the September 2009 issue of the Schizophrenic Bulletin

Psychiatrist May Have Given Birth to this Plan

Some further review turned up additional information which suggested that Hitler’s thought process on this may have had it’s roots in events that occurred in 1922. At this time the psychiatrist Alfred Hoche and the lawyer, Karl Binding, published a document titled “Extermination of Life Unworthy Creatures” , using that ominous term for the first time and demanding extermination of persons who constituted “a burden” to the society, ravaged by World War I. They argued, in this document, that excessive humanitarian ideas be abandoned in the interest of what they called “the higher state morality” implying that the existence of an individual is worthless if unfitting to the interest of society. Shortly after Adolf Hitler took power in 1933, an act was passed, translated as “Act on Preventing an Inheritable Burdened Progeny” The act introduced the obligatory sterilization of persons suffering from inheritable diseases, including, among others, mental retardation, schizophrenia, affective psychoses, epilepsy, and alcoholism. Implementation of the act, associated with the sterilization of approximately 350,000 persons in Germany, induced a wide discussion during which only the Catholic Church expressed a negative attitude toward the act.

Physicians Including Psychiatrists Participate in Extermination Plan

The next stage was the elimination of these people as well as the Jews. The approach to the Jews is well documented. However how Hitler utilized physicians including psychiatrists to approach the eliminations of psychiatric patients was not as well understood at least by myself. In July of 1939, an agreement between Hitler, the Reich Chancellory head, Lammers and the leader of the Reich’s physicians, Dr. Leonardo Conti, resulted in the formation of a strictly secret commission for the extermination of patients, directed by Philip BouhIer and called T4 (according to its official address at Tiergartenstrasse 4, in Berlin). The commission included, among others, recognized professors of psychiatry and neurology: Carl Schneider from Heidelberg, Paul Nitsche from Halle, Werner Heyde from Wurzburg. The commission was to choose methods of extermination (at the beginning carbon monoxide was used) and provide opinions on the lists of patients submitted for extermination by psychiatric hospitals, using official questionnaires. This occurred two months before the invasion of Poland. Apparently gold fillings were removied from the teeth of the deceased and used to partially pay for this program. Torrey and Yolken in their analysis of the data estimate that between 220,000 and 295,000 people with schizophrenia were either sterilized or killed which according to them represented all of those people with schizophrenia living in Germany at the time.

Extermination Plan Continued After the Invasion of Poland

After attacking Poland in September, 1939, the Germans began in the very same month a systematic murder of patients in Polish psychiatric hospitals that were situated in the captured parts of the country. The action of murdering these patients took a similar course in all psychiatric hospitals. The schedule was typical of Nazi mass crimes, followed a specific plan, and was performed scrupulously. After taking control of a hospital under a German director, no patient could be released from the hospital under threat of the death penalty. All the patients were counted and transported out in lorries to an unknown destination. Each transport was accompanied by armed soldiers from special SS detachments, who returned without the patients after a few hours. The patients were said to be transferred to another hospital, but circumstances showed that they had been killed.

In October, 1939, approximately 1,000 patients (children and adults) of the psychiatric hospital in Owinska, near Poznan, began to be transported out in an unknown direction. At the same time, a chapel and a rich, 100-year old medical library were destroyed. The hospital was turned into SS barracks and burned at the end of war. Extermination of patients from the hospital in Owinska requires special attention since on that occasion for the first time new methods for the mass killing of people were implemented. Investigations conducted after the war by the Commission for Examination of Nazi Crimes demonstrated that the special Gestapo unit took care of the patient evacuation. The patients, dressed only in worn clothes, were transported out in lorries, each lorry accommodating 25 patients and some armed SS men. Distressed and protesting patients were quieted with injections of narcotics. According to witnesses, the lorries drove first toward Poznan where the patients were crowded into an old fort. Each of the bunkers accommodated approximately 50 persons. The gates were sealed up with clay, and carbon monoxide was fed into each bunker, killing the patients within 10-20 minutes. Corpses of the murdered patients were dragged out by a group of prisoners of the fort, and other prisoners transported them and buried them in a forest close to Oborniki.

On December 7, 1939, approximately 1,200 patients were transported out of the neighboring psychiatric hospital in Dziekanka, near Gniezno. Selection of the patients for the transport was made personally by the hospital director, Ratka, who had just changed his citizenship to German and put on an SA uniform. Later on, the hospital kept providing psychiatric services for patients of German nationality and also served other, peculiar aims. On orders from Berlin, the hospital was disguised to represent a place of burial of the exterminated patients even if most of them had never visited the hospital. Families of the patients were falsely informed that the patients being searched for were buried at the hospital cemetery, and the families were even charged for the care for these graves. After the war, it was found that the psychiatric hospital in Pruszkow near Warsaw played a similar role. Families of the murdered patients were referred to the hospital and told that their relatives had been brought to the hospital, but died natural causes.

The sanatorium in Koscian for neurological and psychiatric patients lost approximately, 500 patients who were murdered and the institution then appropriated for other purposes. Patients in psychiatric hospitals in Warta (approximately 580 patients), Gostynin (approximately 100 patients), and Choroszcz (564 patients) were shot in the neighboring forests while patients of Kochanowka hospital (approximately 540 patients), near Lodz were killed in the sealed lorries using engine exhaust. In the psychiatric hospital of Lubliniec, 194 children were killed with high doses of luminal. The existence of the psychiatric hospital in Kobierzyn, near Cracow ended on June 23, 1942. The hospital was surrounded by soldiers in helmets and SS uniforms, the patients were loaded into lorries and cattle trucks, and the patients were transported to Auschwitz to gas chambers. Severely ill patients were transported to the hospital cemetery and shot there. A total of 566 patients died in that action.

The above data that originated from individual hospitals do not unfor­tunately create a complete image of the extermination of patients. It is difficult to estimate, e.g., how many of the psychiatric patients in the hospitals died due to drastically lowered food rations. Systematic starvation increased the mortality of patients several fold. It should be mentioned that this statistic does not pertain to patients of German origin who were fed better. The numbers of known victims also fail to include crimes which have not been documented. At the end of the war, the Nazi authorities destroyed evidence of their own crimes, as they pulled back from the captured territories. In most cases, extermination of patients was executed with no preliminary formalities (in the Reich it was preceded by filling in of questionnaires) and unexpectedly. The data quoted above originated from hospital registers that escaped destruction or from secretly prepared lists of those patients who were transported out of the hospitals.

Most Psychiatrists Don’t Protest but Two Psychiatrists Chose to Stay with Their Patients

I apologize for somewhat wordy unpleasant detail of this blog but I felt the story had to retold. My source for much of the above detail which I have shortened comes from the previously mentioned reference Project Inposterum.

Torrey made the point of emphasizing how while psychiatrists played a leading role in these horrendous events, he is not aware of any protests against the policy from organized German psychiatry. He notes “if you wanted a bright future in Nazi Germany you would not be enhancing your prospects by saying “we shouldn’t be doing this.” However the above link gives two instances in Poland where psychiatrists chose the path of staying with their patients. Dr. Józef Bednarz, (see date of 1932 in this link ) Director of the Psychiatric Hospital in Swiecie in Wisla, who rejected the chance to escape, did not want to leave his patients, and was shot with them in November of 1939.

How Did This Extermination Effect the Future of Schizophrenia ?

Torrey and Yolken also make the point that the Nazi reasoning for killing patients with schizophrenia was also founded on an erroneous notion that the disease was entirely genetic. In fact the number of existing cases or the prevalence of the disease after the war was low as expected, because of the killings. However the incidence or number of new cases was high suggesting that factors other than genes played an important role in schizophrenia. Studies have found that the incidence rate in Germany 20 years after the last patient was sterilized or killed were 2 to 3 times the rates in the US and England . It was postulated that the most likely explanation is that social conditions after the war produced environmental factor such as famine, illnesses and poverty which led to an increase in new cases of schizophrenia

Of course what ever we can glean from the results of this horrible “experiment “ will never provide any justification for what was done. I do that believe that we are obligated to use any data that emerges from this event to better help people in the future just as we can use the data from other unspeakable Nazi experiments on helpless victims to make people’s lives better in the future. In doing so we need to never forget those whose lives were taken including why and how they were killed.

May This Be A Good Year for All of You

While I chose to write the last blog of the year on a somber topic, I do want to also end with an optimistic greeting to all of you. I appreciate the interest and encouragement that many of you have given me as I have undertaken this weekly blog . I know that there are many people who share my interest and concern about educating the public about all aspects of mental illness.

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