Psychiatry under National Socialism: Remembrance and Responsibility
F. Schneider (&) Klinik fur Psychiatrie, Psychotherapie und Psychosomatik,
, Pauwelsstr. 30, 52074 Aachen,
Ladies and Gentlemen! Under National Socialism, psychiatrists showed contempt towards the patients in their care; they lied to them and deceived them and their families. They forced them to be sterilised, arranged their deaths and even performed killings themselves. Patients were used as test subjects for unjustifiable researchresearch that left them traumatised or even dead. Why has it taken us so long to face up to these facts and deal openly with this dark chapter in our history? Although we are proud that the German Association for Psychiatry and Psychotherapy (DGPPN) is one of the oldest scientific medical associations in the world, for too long now we have been hiding, denying a crucial part of our past. For that, we are truly ashamed. It is also a disgrace that we, the DGPPN, did not even stand up for the victims in the period after 1945. Worse still, we were partially responsible for the renewed The original German text of this speech of the president of the German Association for Psychiatry and Psychotherapy (DGPPN) at the annual convention of the DGPPN from 26 November 2011 was unanimously adopted by the Executive Board of the DGPPN as an Association Document on 23 November 2010. We are very grateful to Carsten Burfeind, MA (Berlin), and Prof. Dr. Volker Roelcke (Gieen) for their comments and suggestions. The German version was first published as: Schneider F (2011) Psychiatrie im NationalsozialismusErinnerung und Verantwortung. Nervenarzt 82:104-120. An extended documentation of the memorial event was published as: Schneider F (2011). Psychiatry under National Socialism. Psychiatrie im Nationalsozialismus. Springer, Berlin.
discrimination that they faced in the post-war period. We
are at a loss to explain why we are only now in a position to
hold an event such as this.
I stand before you today as President of an association
that has taken nearly 70 years to end this silence and recall
the tradition of enlightenment through science in which it
stands. An independent scientific commission is currently
overseeing a research project that is addressing the history
of the association, or rather its predecessors, in the period
between 1933 and 1945.
But this is not enough. Irrespective of any research
results, which we expect to receive in the next few years, I
must offer our sincerest apologiesalbeit shamefully
lateto all the victims and their families who suffered
such injustice and pain at the hands of the German
associations and their psychiatrists.
The German Association for Psychiatry and
Psychotherapy has decided to give a clear signal by holding this
commemorative event as a way of acknowledging and of
standing up for the victims, of coming to terms with our
past and of learning from this bleak period in our history.
Ladies and gentlemen, welcome to this commemorative
event. It is wonderful to see so many of you here and I
would like to take this opportunity to thank you all for
The letters and documents we have just heard at the
beginning of this commemorative event provide moving
testimonials of the pain and suffering that mentally ill
people were subjected to.
Psychiatry under National Socialism is one of the
darkest chapters in the history of our discipline.
Throughout this period, psychiatrists and representatives of
psychiatric associations repeatedly disregarded and heinously
reinterpreted their professional duty to treat and care for
Psychiatry was corruptible and it corrupted, it cured and
it killed. It no longer felt it had an obligation to individuals;
rather, in the name of supposed progressthe liberation of
an entire society from the burden of providing welfare,
improvements in the genetic make-up of an entire nation
and, ultimately, humanitys deliverance from misery1
psychiatrists abused and killed vast numbers of people.
They also saw to it that any undesirable colleagues were
forced out of their jobs.
It is important to remember that between 1933 and 1945
many of the psychiatrists working in academia emigrated
from the Reich.2 They did not leave voluntarily.
Psychiatrists of Jewish descent or those who had the wrong
political views were forced out of their jobs and had to stop
practicing. They and their families lost their livelihoods,
their belongings and all too often their home country.
Driven out of Germany, they had to create new lives for
themselves as strangers in an unfamiliar, foreign land.
Most of those who could not flee Germany or Austria
were deported to concentration or extermination camps.
Few survived, and nothing we do can ever make up for the
fate they suffered.
This was all happening at a time when psychiatric
research in the Reich was becoming increasingly focused
on eugenics and racial hygiene.3 National Socialist
healthcare, social and economic policies favoured those
who would most benefit the nations health and
productivity. The weak were to be eliminated so that the strong
could become even stronger. This devastating approach
was nothing new.
The term eugenics had been in use since the late
nineteenth century,4 and the practice of sterilising mentally
1 Title of a book by E. Mann published in 1922 by Fritz Fink Verlag,
2 Outlined in Zalashik R, Davidovitch N (2009) Professional identity
across the borders: Refugee psychiatrists in Palestine, 19331945.
Social History of Medicine 22:569587; Weindling P (2010) Alien
Psychiatrists: The British assimilation of psychiatric refugees. In:
Roelcke V, Weindling P, Westwood L (eds) International Relations in
Psychiatry: Britain, America, and Germany to World War II.
University of Rochester Press, Rochester/NY, pp 218235.
3 Roelcke V, Hohendorf G, Rotzoll M (2000) Psychiatric science,
Euthansia and the new man: The debate on anthropological
premises and values in national socialist medicine (Psychiatrische
Wissenschaft, Euthanasie und der Neue Mensch: Zur Diskussion
um anthropologische Pramissen und Wertsetzungen in der Medizin im
Nationalsozialismus). In: Frewer A, Eickhoff C (eds) Euthanasia
and the current debate on assisted suicide. The historical background
of medical ethics [Euthanasie und die aktuelle Sterbehilfe-Debatte.
Die historischen Hintergrunde medizinischer Ethik], Campus,
Frankfurt/M., pp 193217.
4 Weingart P, Kroll J, Bayertz K (1988) Race, blood and genes
(Rasse, Blut und Gene), Suhrkamp, Frankfurt/M., p 284; Nowak K
(1980) Euthanasia and sterilisations in the Third Reich
(Euthanasie und Sterilisierungen im Dritten Reich). Vandenhoeck &
Ruprecht, Gottingen, p 39.
ill patients was being promoted in the Scandinavian and
Anglo-Saxon countries as well as in the German Empire. In
the summer of 1914, a proposed Bill on Sterilisation and
Abortion was put forward in the Reichstag. It was only the
outbreak of war that stopped the Bill passing into law.5
On 14 July 1933, not long after Hitler seized power, the
NSDAP passed a Law for the Prevention of Hereditarily
Diseased Offspring. The psychiatrist Ernst Ru din, who was
President of the psychiatric association from 1935 to 1945,
was involved in writing the official commentary6 to the law
when he was director of the German Research Institute for
Psychiatry.7 The law described sterilisationforced
sterilisationas protecting future generations.8 This is a
truly perverse view that offsets one persons pain and
suffering against anothers well-being.
The law classed manic-depressive illness and
schizophrenia as genetic mental illnesses. The same applied to
many other conditions, such as hereditary forms of
epilepsy, blindness, deafness, dwarfism, etc. The idea was to
stop sick people having children so that their supposedly
bad genetic material did not continue to pollute the health
of the Volk.
All doctors were obliged to report hereditarily
diseased individuals to the authorities. Under the law,
doctors forcibly sterilised more than 360,000 people. Over
6,000 died as a consequence of the operations.
Since the concepts of eugenics and racial hygiene were
so popular at the time, many psychiatrists held the
sterilisation law in high regard. As President of our predecessor
organisation, the Society of German Neurologists and
Psychiatrists (GDNP), Ernst Ru din spoke in its favour
several times at the openings of annual congresses.9 Other
countries around the world also supported eugenics-based
sterilisation. However, what set Germany apart was the fact
that its law allowed people to be sterilised against their
5 Ganssmuller C (1987) The Third Reichs sterilisation law policy
(Die Erbgesundheitspolitik des Dritten Reiches). Bohlau, Cologne,
6 Gutt A, Rudin R, Ruttke F (1936) Law for the prevention of
heriditarily diseased offspring of 14 June 1933, with implementing
ordinances (Gesetz zur Verhutung erbkranken Nachwuchses vom 14.
Juni 1933 nebst Ausfuhrungsverordnungen). J.F. Lehmanns, Munich,
7 Roelcke V (2008) Science in the service of the Reich: Ernst Rudin
and the German Institute for Psychiatric Research (Wissenschaft im
Dienst des Reiches: Ernst Rudin und die Deutsche Forschungsanstalt
fur Psychiatrie). In: Hockerts G, Hajak S (eds) Munich and national
socialism (Munchen und der Nationalsozialismus). Metropol, Berlin,
8 loc. cit., p 5, in the preface to the first edition of 1934 (note 6).
9 Rudin E (1939) The importance of research and cooperation of
neurologists and psychiatrists in the national socialist state
(Bedeutung der Forschung und Mitarbeit von Neurologen und Psychiatern im
nationalsozialistischen Staat). Zeitschrift fur die gesamte Neurologie
und Psychiatrie 165:717.
will. For its victims, the legislation was an appalling attack
on the very core of their identityan attack they were
powerless to stop and that permanently robbed them of
their right to physical integrity and to parenthood.
Even once the war had ended, shame and silence
continued to shroud what the victims and their families had
endured. To this day, the Federal Republic of Germany has
still not formally recognised these individuals as victims of
Nazi persecution, despite the fact that the sterilisation law
was an unequivocal expression of National Socialist,
German racial ideology. The commentary to the law makes
this very clear:
What is the aim of measures for the genetic and
racial hygiene adequate for the German Volk? The
existence at all times of a sufficient number of
genetically healthy large families that are racially
valuable to the German people.10
At this point, I would like to express my admiration for
Dorothea Buck. The sculptor and author, who was herself
one of the victims, co-founded the Federal Organisation
of (Ex-)Users of Psychiatry in Germany. She has
tirelessly dedicated herself to raising awareness of the issues
and to ensuring that they are not forgotten. Klara Nowak,
who passed away years ago, was another such person. Ms
Nowaks 1987 initiative resulted in the creation of the
Federation of Those Affected by Euthanasia and Forced
Sterilisation which since then fought for the social
rehabilitation of victims.
Yet the violence did not end at forced sterilisation
people were also murdered. In the 1920s, as a result of the
World War and the Great Depression, disabled people
began to be seen as financial burdens. Psychiatrist Alfred
Erich Hoche published Allowing the Destruction of Life
Unworthy of Living in 1920 in collaboration with the
lawyer Karl Binding. In it, he coined the term human
ballast and drew up a list of allegedly incurable mental
illnesses that rendered sufferers mentally dead.11 This
provided the basis for the call for death to life unworthy
of life! published in 1930 in the National Socialist
10 It continues: However, this goal can only be achieved and
ensured over the long term if the concept of breeding remains at the
core of our concept of racial hygiene. The future keepers of the law
must bear in mind the aim of ensuring the bloodstock of the German
people  remains pure. loc. cit., p 55 (note 6).
11 Binding K, Hoche A (1920) Allowing the destruction of life
unworthy of living. To what extent and in what form (Die Freigabe
der Vernichtung lebensunwerten Lebens. Ihr Ma und ihre Form).
Meiner, Leipzig, 1920 (2nd edition 1922), p 57, cited in Nowak K,
loc. cit., p 51 (note 4).
12 Nationalsozialistische Monatshefte 1, 1930, p 298, cited in Nowak
K, loc. cit. p 43.
Later, Hitler issued a decree to start a euthanasia
programme. It was backdated to 1 September 1939, the
date that Germany invaded Poland and World War II
began. Professor Werner Heyde, chair of psychiatry and
neurology of Wurzburg University, was appointed Medical
Director of the programme that would later become known
as Aktion T4. It is thought that, by the end of the war
and even several weeks afterwardsAktion T4 and the
killings that took place once the programme had officially
ended claimed the lives of at least 250,000300,000
mentally and physically disabled people.13
From October 1939, all psychiatric hospitals and
associated areas in the Reich received registration forms from
Columbushaus on Potsdamer Platz, and as of April 1940
from Tiergartenstrae 4, where the Berlin Philharmonic
stands today. The forms were used to systematically record
all patients and select who should die. Decisions were
mainly based on usefulness criteria, that is, on how
much work a person was capable of.14
Today, at the site of the former central administration
office for the killings, all that commemorates the
euthanasia victims is an indistinct plaque in the ground and a
sculpture that was only dedicated to them upon completion.
There is still no central, national memorial to the victims.
This is a clear expression of the continuing denial
surrounding the events and of the humiliation that the
survivors and their families still endure. It also represents a
blind spot in the collective memory of our country and of
German psychiatry. We at the DGPPN will be supporting
current efforts to establish an appropriate national T4
commemorative and information centre.
Approximately fifty selected assessors, some of them
renowned psychiatrists, evaluated the registration forms
they received from the hospitals and decided who would
live and who would die. Among the assessors were Werner
Villinger, Friedrich Mauz and Friedrich Panse, all of whom
held the office of President in our association during the
post-war period.15 Friedrich Mauz and Friedrich Panse also
later became honorary members. Although membership
13 Faulstich H (2000) The number of Euthanasia victims (Die Zahl
der Euthanasie-Opfer). In: Frewer A, Eickhoff C (eds) Euthansia
and the current debate on assisted suicide. The historical background
to medical ethics (Euthanasie und die aktuelle Sterbehilfe-Debatte.
Die historischen Hintergrunde medizinischer Ethik). Campus,
Frankfurt/M., pp 218234.
14 Rotzoll M, Hohendorf G, Fuchs P et al. (2010) The national
socialist Euthanasia campaign Aktion T4 and its victims (Die
nationalsozialistische Euthanasie-Aktion T4 und ihre Opfer).
15 Schmuhl HW (1987) Racial hygiene, national socialism,
euthanasia: from contraception to the destruction of life unworthy of
living 18901945 (Rassenhygiene, Nationalsozialismus, Euthanasie:
Von der Verhutung zur Vernichtung lebensunwerten Lebens
18901945). Vandenhoeck & Ruprecht, Gottingen, p 192.
ends with the death of the individual, we condemn both
these cases and will formally revoke the honours.
Patients selected for death would be collected from their
hospitals in grey buses that have now come to symbolise the
killings, and taken to one of six mental institutions equipped
with gas chambers. Medical facilities thus became
extermination centres. Healing became destruction. Psychiatrists
watched as the patients entrusted to their care were taken away
to be murdered. In the order they were established, the six
institutions were as follows: Grafeneck, Brandenburg,
Hartheim, Pirna-Sonnenstein, Bernburg and Hadamar.
Aktion T4 lasted nearly 2 years, from January 1940
to August 1941. Within that time, over 70,000 patients
were killed. The public protests that eventually spelled the
demise of the programme did not come from the ranks of
the psychiatric profession, but predominantly from the
Church. The crucial sermon against the killing programme
was delivered on 3 August 1941 by Clemens August Graf
von Galen, Bishop of Munster and Cardinal of the Roman
Catholic Church. Aktion T4 was officially stopped
But the Nazis took the knowledge and experience
gathered during Aktion T4 and applied them to the
concentration camps to murder even more peoplethis
time in their millions.17
At the same time as they were implementing Aktion T4,
the Nazis were also murdering physically and mentally
disabled children in over 30 psychiatric and paediatric
hospitals as part of what is usually called child
euthanasia. Previously, it was thought that approximately 5,000
children had died. This figure was given by the perpetrators
during post-war trials and then generally accepted as true.
We now know that the actual number was far greater.
And yet the killing continued, even after the centrally
organised Aktion T4 was officially stopped. During this
decentralised phase of euthanasia, doctors in psychiatric
facilities seeking to free up beds and save money killed
patientspossibly many 10,000by administering
overdoses or providing them with so little food that they starved
to death.18 In a report on new admissions in 1943, Gerhard
16 Cf. Schmuhl, Racial hygiene (Rassenhygiene), pp 210214.
17 Friedlander H (1995) The origins of Nazi genocide: from
euthanasia to the final solution. University of North Carolina Press,
18 Outlined in Faulstich H (1998) Starvation in psychiatry
19141949. With a topography of Nazi psychiatry (Hungersterben
in der Psychiatrie 19141949. Mit einer Topographie der
NSPsychiatrie). Lambertus, Freiburg/Br.; for a local example, cf.
Schwarz P (2002) Murder by starvation, wild Euthanasia, and
Aktion Brandt at Steinhof during national socialism (Mord durch
Hunger. Wilde Euthanasie und Aktion Brandt am Steinhof in der
NS-Zeit). In: Gabriel E, Neugebauer W (eds) From forced sterilisation
to murder (Von der Zwangssterilisierung zur Ermordung). Bohlau,
Vienna, pp 113142.
Of course I could never accommodate the new
patients without undertaking certain measures to free
up space. The process itself is very straightforward,
but there is a distinct shortage of the necessary
Today, it is hard to imagine that psychiatrists allowed
patients in their care to be killed that they chose who
should live or die and then medically, scientificallywell,
pseudo-scientificallyoversaw the deaths of children,
adults and elderly people.
An entry in a medical file from 1939 on a female patient
suffering from a schizophrenic disorder, which is archived
at the Federal Archives here in Berlin, reads as follows:
As before. Mentally dead. No change can be
expected, so medical record should be closed. The
only entry worth making is the date of death.20
Before they were murdered, many patients were used for
research. This involved ethically unjustifiable
experiments that are far removed from scientific and research
values. One example is the euthanasia-related
experiments on mentally ill children and teenagers by Carl
Schneider, Chair and Professor of Psychiatry at Heidelberg
University, in collaboration with Julius Deussen, an
employee at the German Research Institute for Psychiatry
in Munich. The research involved elaborate experiments on
patients, followed by their killing and autopsies.21 Patients
at psychiatric hospitals were also used as test subjects in
19 Letter of 4 Nov. 1943 from Dr. Wischer to Professor Nitsche, head
of Central Department I, cited in Schmuhl, Racial hygiene
(Rassenhygiene), 1992, p 232 (cf. Aly G (1985) Medicine against the
useless (Medizin gegen Unbrauchbare). Beitrage zur
Nationalsozialistischen Gesundheitsund Sozialpolitik 1:974, specifically p 61); cf.
also Klee E (1983) Euthanasia in the Nazi state (Euthanasie im
NS-Staat). S. Fischer, Frankfurt/M., p 427.
20 Federal Archives Berlin R 179/24884, cited in Rotzoll M, Fuchs P,
Richter P, Hohendorf G (2010) The national socialist Euthanasia
campaign Aktion T4 (Die nationalsozialistische Euthanasieaktion
T4). Nervenarzt 81:13261332, specifically p 1331.
21 Roelcke V (2000) Psychiatric science in the context of national
socialist policy and Euthanasia: The role of Ernst Rudin and the
German Institute for Psychiatric Research (Psychiatrische
Wissenschaft im Kontext nationalsozialistischer Politik und Euthanasie:
Zur Rolle von Ernst Rudin und der Deutschen Forschungsanstalt fur
Psychiatrie). In: Kaufmann D (ed) The Kaiser Wilhelm Society under
national socialism [Die Kaiser-Wilhelm-Gesellschaft im
Nationalsozialismus]. Wallstein, Go ttingen, pp 112150; Roelcke V,
Hohendorf G, Rotzoll M (1998) Research into hereditary psychology in the
context of Euthanasia: new documents and perspectives on Carl
Schneider, Julius Deussen and Ernst Rudin (Erbpsychologische
Forschung im Kontext der Euthanasie: Neue Dokumente und
Aspekte zu Carl Schneider, Julius Deussen und Ernst Rudin).
Fortschritte der Neurologie und Psychiatrie 66:331336.
TB vaccination trials in Kaufbeuren,22 in work on the viral
aetiology of multiple sclerosis in Werneck23 and in
neuropathological examinations on euthanasia victims
who had probably been selected especially for this purpose.
This was the project Julius Hallervorden carried out at the
Kaiser Wilhelm Institute for Brain Research in
BerlinBuch in collaboration with the Brandenburg-Go rden
asylum, which was run by psychiatrist Hans Heinze.24
The murdered patients bodies and individual
histopathological specimens were in high demand among
scientists, and the research findings gained were being published
even after the war ended. The Kaiser Wilhelm Institute for
Brain Research used the brains of at least 295 euthanasia
victims in its work,25 and even until recently, there have
been almost no qualms about using specimens taken from
patients murdered during the Third Reich.26
The research was not confined to mental institutions.
Tu bingen-based psychiatrist Robert Ritter, for example,
did research on Sinti and Roma people. He mainly focused
on genealogical and epidemiological studies, which
contributed to developing identification and selection criteria
for Gypsies, who would then be deported to the Gypsy
camp at Auschwitz.27
22 Dahl M (2002) whom keeping alive would not benefit the
nation (deren Lebenserhaltung fur die Nation keinen Vorteil
bedeutet). In: Disabled children as test subjects and the development
of the tuberculosis vaccination (Behinderte Kinder als
Versuchsobjekte und die Entwicklung der Tuberkulose-Schutzimpfung).
Medizinhistorisches Journal 37:5790; cf. also von Cranach M,
Siemen L (1999) Psychiatry under national socialism: Bavarian
psychiatric hospitals and psychiatric asylums between 1933 and 1945
(Psychiatrie im Nationalsozialismus: Die Bayerischen Heil- und
Pflegeanstalten zwischen 1933 und 1945). Oldenbourg, Munich.
23 Peiffer J (1998) Neurology in the Third Reich (Neurologie im
Dritten Reich). Nervenarzt 69:728733.
24 Shevell MI, Peiffer J (2001) Julius Hallervordens wartime
activities. Implications for science under dictatorship. Pediatric
25 Peiffer J (2000) Neuropathology research on Euthanasia victims
in two Kaiser Wilhelm Institutes (Neuropathologische Forschung an
Euthanasie-Opfern in zwei Kaiser-Wilhelm-Instituten). In:
Kaufmann D (ed) The Kaiser Wilhelm Society under national socialism
(Die Kaiser-Wilhelm-Gesellschaft im Nationalsozialismus).
Wallstein, Gottingen, pp 151173.
26 Peiffer J (1997) Brain research in the shadows: examples of
corruptible science during national socialism (Hirnforschung im
Zwielicht: Beispiele verfuhrbarer Wissenschaft aus der Zeit des
Nationalsozialismus). Matthiesen, Husum; Reports of the commission
to inspect the specimen collections in the medical facilities at the
University of Tubingen with regard to the victims of national
socialism (Berichte der Kommission zur U berprufung der
Praparatesammlungen in den medizinischen Einrichtungen der
Universitat Tubingen im Hinblick auf Opfer des Nationalsozialismus),
issued by the president of the University of Tubingen, Tubingen,
1990; Seidelman W (2010) Academic medicine during the Nazi
period: The implications of creating awareness of professional
responsibility today. In: Rubenfeld S (ed) Medicine after the
Holocaust. Palgrave, New York, pp 2936.
Granted, resistance and attempts to sabotage, the many
wrongs committed in the field of psychiatry during the
Nazi era did exist. Even if over 50% of physicians were
members of a National Socialist organisation, i.e. the party
itself or the SA or SS, which means that almost half of all
doctors were not. So, doctors did have some room for
manoeuvre that they could take advantage of without
sanctions being imposed, and resistance did not necessarily
have negative personal consequences.28
Indeed, some did resist, although they were too few in
number, all too few. Among doctors with private practices, in
particular, there were some who did not report a single case of
possible hereditary disease to the public health authorities
between 1934 and 1939.29 One reason for this might have been
that doctors working outside large hospitals had much more
direct contact with their patients. This fact should serve as a
reminder to us not to lose sight of the patients we care for,
despite the demands and pressures of our everyday work. We
must never allow our professional practice to be guided by
ideology, but only by the well-being of our patients.
Human dignity is always the dignity of the individual
human being. No law may ever be allowed to disregard this.
In 1946, Gustav Radbruch described the conflict between
law and justice. In principle, the law takes precedence over
justice unless the extent to which a positive law contradicts
justice is so intolerable that it must yield to justice as
wrongful law.  When justice is not even aspired to and
when equality, the very essence of justice, is deliberately
flouted when drafting a positive law, such law is not only
wrongful, it is completely devoid of legality.30
After the war ended, much the same occurred in the field
of psychiatry as in many other areas of German society
collective denial. Neither psychiatric societies nor
individual psychiatristswith very few exceptions, such as
Gerhard Schmidt and Werner Leibbrandowned up to
27 Zimmermann M (2007) From education to extermination: policy
towards and research on gypsies in twentieth century Europe
(Zwischen Erziehung und Vernichtung: Zigeunerpolitik und
Zigeunerforschung im Europa des 20. Jahrhunderts). F. Steiner, Stuttgart,
specifically the contributions by A. Cottebrune, M. Luchterhandt and
28 Lifton RJ (1993) Physicians in the Third Reich (A rzte im Dritten
Reich). Klett-Cotta, Stuttgart, p 93ff; Klee E, p 223 ff; Roelcke V
(2010) Medicine during the Nazi period: Historical facts and some
implications for teaching medical ethics and professionalism. In:
Rubenfeld S (ed) Medicine after the Holocaust. Palgrave, New York,
29 Ley A (2004) Forced sterilisation and the medical community: the
background to and objectives of physicians actions
(Zwangssterilisation und A rzteschaft: Hintergrunde und Ziele arztlichen Handelns).
Campus, Frankfurt/M., pp 230303.
30 Radbruch G (1946) Legal injustice and justice beyond the law
(Gesetzliches Unrecht und ubergesetzliches Recht). Suddeutsche
Juristenzeitung 1:105108, specifically p 107.
what had happened. This is a fact that leaves us utterly
incredulous and deeply ashamed today.
The story of Professor Werner Heyde, who has already
been mentioned, is particularly mindboggling.31 Heyde
was the medical director of the T4 program, and an
arrest warrant was issued for him after the war. And yet
from 1950 to 1959, he enjoyed a second career as a
courtappointed medical expert in SchleswigHolstein. Although
he went by the name of Dr. Fritz Sawade, there were those
in the medical and legal professions who were aware of his
real identity yet did not expose him. And many others, both
within our field and beyond, knew about it.
At the same time, early attempts to shed light on the
wrongs committed by physicians during the Nazi era were
impeded and thwarted. When Alexander Mitscherlich and
Fred Mielke released their book Das Diktat der
enverachtung [The Dictate of Contempt for Human Life],32
which documented the trials of medical doctors in
Nuremberg in 1947, many doctors protested because they
were worried that the reputation of their profession would
be tarnished. When the duos second book Wissenschaft
ohne Menschlichkeit33 (Science without Humanity) was
published in 1949, it was ignored.
Professor Gerhard Schmidt, the former director of the
psychiatric clinic in Lubeck, gave a radio talk about the
crimes committed against the mentally ill and the mentally
disabled as early as 20 November 1945 yet he was unable to
find a publisher for his book manuscript on the topic for
20 years, despite numerous attempts.34 I read the book many
years ago, and it had a profound impact on me. But many
psychiatrists in post-war Germany were afraid that
publicising the details of these crimes would endanger efforts to
rebuild their profession and damage its reputation, which they
saw still positive at the time. A grievously misguided view for
the scientific community thus failed to acknowledge its
responsibility. The German Psychiatric Association honoured
Professor Schmidt for his lifes work by presenting him with
its Wilhelm Griesinger Medal in 1986, the first year it was
awarded. One of our organisations prouder moments, even if
it came far too late and has sadly been almost forgotten.
31 Cf. Godau-Schuttke K-D (2010) The Heyde/Sawade affair (Die
Heyde/Sawade-Affare), 3rd edition. Nomos, BadenBaden.
32 Mitscherlich A, Mielke F (1947) The dictate of contempt for
human life: a documentation (Das Diktat der Menschenverachtung:
eine Dokumentation). Lambert Schneider, Heidelberg.
33 First published under the title Science without humanity
(Wissenschaft ohne Menschlichkeit). Lambert Schneider, Heidelberg,
1949; from 1960 on under the title Medicine without humanity:
documents on the Nuremberg doctors trials (Medizin ohne
schlichkeit: Dokumente des Nurnberger A rzteprozesses). S. Fischer
Verlag, Frankfurt/M., 16th edition, 2004.
34 Schmidt G (1965) Selection in the psychiatric hospital 19391945
(Selektion in der Heilanstalt 19391945). Evangelisches
And what about official legislation? The German federal
government enacted the Bundesgesetz zur Entschadigung
fur Opfer der nationalsozialistischen Verfolgung or BEG
(Federal Indemnification Law) in 1956, which provided for
the indemnification of victims of Nazi persecution and
came into force with retroactive effect. After some
revisions, the BEG-Schlussgesetz (BEGFinal Law) was
passed in 1965. Thus, all victims who had suffered
persecution under the Nazi regime due to their race, religion or
political views could file a claim for indemnification by
1969. However, the law did not apply to those who had
been forcibly sterilised or to the families of victims of the
euthanasia, sinceit was arguedthey had not been
persecuted due to their race35a further humiliation of the
victimsand still we did not speak out.
Some of the expert witnesses called on during the
hearings of the West German Bundestags Restitution
Committee in the 1960s were the same psychiatrists who
had justified forced sterilisations and participated in
systematic murder during the Third Reich. Records of 13
April 1961 report that Werner Villinger rejected the idea of
compensation payments on the contemptuous grounds that
the payments might cause victims of forced sterilisation to
develop neurotic ailments and suffering that could
damage not only their current well-being and  their ability
to enjoy life, but also their ability to perform.36
The Law for the Prevention of Hereditarily Diseased
Offspring was not suspended until 1974. Formally, though,
it continued to exist. In 1988, the West German Bundestag
concluded that the forced sterilisations carried out under
the Law counted as Nazi injustices. Ten years later, the
Bundestag passed a law repealing the rulings of the genetic
health courts. Yet it took the Bundestag until 2007 to
finally ban the Law for the Prevention of Hereditarily
Diseased Offspring.37 The reason given was that the Law
contravened the Basic Law anyway, so was effectively
35 Cf. written report of the Restitution Committee, Bundestag printed
paper 2382, pp 12f and p 57; for a good overview on this and the
following cf. Surmann R (2005) What is typical Nazi injustice? The
denial of compensation for victims of forced sterilisation and
Euthanasia (Was ist typisches NS-Unrecht? Die verweigerte
Entschadigung fur Zwangssterilisierte und Euthanasie-Geschadigte). In:
Hamm M (ed) Unworthy of livingdestroyed life. Forced
sterilisation and Euthanasia (Lebensunwertzerstorte Leben.
Zwangssterilisation und Euthanasie). VAS-Verlag, Frankfurt/M., pp 198211;
Scheulen A (2005) The legal status and development of the 1934
sterilisation law (Zur Rechtslage und Rechtsentwicklung des
Erbgesundheitsgesetzes 1934). In: Hamm M (ed) Unworthy of living
destroyed life. Forced sterilisation and Euthanasia (Lebensunwert
zerstorte Leben. Zwangssterilisation und Euthanasie). VAS-Verlag,
Frankfurt/M., pp 212219.
36 Minutes of the 34th session of the Restitution Committee,
Thursday 13 April 1961, p 16.
37 Plenary minutes 16/100, 100th session of the German Bundestag,
Berlin, Thursday 24 May 2007.
suspended at the time that came into force. The DGPPN
supported calls to ban the Law at the time.
The Federal Indemnification Act of 1965, however,
applies to this day, which means that mentally ill people
who were forcibly sterilised or murdered have still not been
explicitly acknowledged as victims of the Nazi regime or
as victims of racial persecution. Lawmakers need to take
action and change this before it is too late. Victims will not
have received due recognition of their pain and suffering,
which continues to this day, until the German government
repeals this injustice as well.
The late 1960s and 1970s saw the first attempts to
publish accounts of what happened in the field of
psychiatry. Hans-Jorg Weitbrecht, Walter Ritter von Baeyer and
Helmut Ehrhardt38 all wrote on the topic, yet all three
presented psychiatry itself as a victim.39 A book
commemorating the 130th anniversary of the German
Association for Psychiatry and Psychotherapy in 1972 says that:
representatives of the psychiatric profession, despite their
apparently far-reaching authority, never supported,
endorsed or aided abuses such as euthanasia ex officio.
This is another reason to reject as objectively unfounded
the repeated attempts to charge German psychiatry with
the misconduct or the crimes committed by individual
psychiatrists at the time.40
This was written by Helmut Ehrhardt, President of the
DGPN from 1970 to 1972, who himself had been a member
of the NSDAP and who had written reports endorsing
forced sterilisation. As late as the hearings for the Federal
Indemnification Act in the West German Bundestag in
1961, he said that the actual content41 of the Law for the
Prevention of Hereditarily Diseased Offspring was
certainly not an invention of the Nazi regime, but rather
something that in its essence reflected and still reflects
38 Ehrhardt HE (1965) Euthanasia and the destruction of life
unworthy of living (Euthanasie und Vernichtung lebensunwerten
Lebens). F. Enke, Stuttgart; von Baeyer W (1966) The vindication of
Nazi ideology in medicine with particular regard to Euthanasia (Die
Bestatigung der NS-Ideologie in der Medizin unter besonderer
Berucksichtigung der Euthanasie). National socialism and the
German university, Free University 1966 (Nationalsozialismus und die
Deutsche Universitat, Freie Universitat 1966). de Gruyter, Berlin,
pp 6375; Weitbrecht H-J (1968) Psychiatry under national socialism
(Psychiatrie in der Zeit des Nationalsozialismus). P. Hanstein, Bonn.
39 Cf. the analysis in Roelcke V (2007) Trauma or responsibility?
Memories and historiographies of Nazi psychiatry in postwar
Germany. In: Sarat A, Davidovich N, Alberstein M (eds) Trauma
and memory. Reading, healing, and making law. Stanford University
Press, Stanford, pp 225242.
40 Ehrhardt HE (1972) 130 years of the German Association for
Psychiatry and Psychotherapy (130 Jahre Deutsche Gesellschaft fur
Psychiatrie und Nervenheilkunde). Wiesbaden, p 15.
41 German Bundestag, minutes of the 34th session of the Restitution
Committee, Thursday 13 April 1961, top of p 25.
current scientific conviction.42 This further mocks and
It is true that the association never officially endorsed
killing patients. However, it is also true that it never
officially condemned the practice either. There was never a
single word of apology or reprimand.
And yet, with just a few exceptions, it appears that the
overwhelming majority of German psychiatrists and
members of our association, whether researchers,
academics or practitioners, took part in planning,
implementing and creating scientific legitimacy for sterilisation and
Research into German psychiatry under National
Socialism only began in earnest in the early 1980s.44 The
main contributions from psychiatrists came from Klaus
Do rnerwho began in 1969 and produced a series of
publications in the 1980sAsmus Finzen and
JoachimErnst Meyer. Among the historians were Gerhard Baader,
Dirk Blasius and Hans-Walter Schmuhl. In 1983, Ernst
Klee published his shocking book, Euthanasia in the
Nazi State, which I read at the time in stunned disbelief.
So, this was another book that deeply affected me.
During an anniversary congress held under the
presidency of Uwe Henrik Peters in Cologne in 1992when the
name of the association was changed to DGPPNthe
General Meeting passed a resolution in which the
association reinforced its feelings of revulsion and sorrow about
the holocaust of the mentally ill, Jews and other victims of
persecution. Back then, there was no mention of the
institutional and personal guilt of psychiatrists and their
representative organisation. However, it was a clear
message that needed to be articulated.
During this years congress, we are showing a revised
and updated version of the In Memoriam exhibition,45
which drew large international audiences when it was first
shown in 1999 at the World Congress of Psychiatry in
Hamburg. A series of symposia accompanied the
exhibition. The decision by the World Psychiatric Association to
select Germany and the DGPPN as the hosts of the World
Congress was a conciliatory gesture from the international
psychiatric communityand it presented us with the
solemn duty to begin commemorating the victims and to make
serious efforts to come to terms with the history of our
Over the past 2 years, the DGPPN has held a series of
in-depth discussions about how to deal with its own
history. These talks were not controversial; they were
conducted by mutual agreement. As a result of the talks, we
amended the DGPPNs Articles of Association exactly
1 year ago. The first paragraph now reads:
The DGPPN recognises that it bears a special
responsibility to protect the dignity and rights of
people suffering from mental illness. This
responsibility is the result of its predecessors involvement in
the crimes of National Socialism, in killing and
forcibly sterilising hundreds of thousands of
Another outcome of the discussions was that, early this
year, the DGPPN Executive Committee established an
international commission to address the actions of the
predecessor associations that existed during the Third
Reich. The commission is made up of four renowned
historians of medicine and science: the chairman, Professor
Roelcke from Gieen, Professor Sachse from Vienna,
Professor Schmiedebach from Hamburg and Professor
Weindling from Oxford. The commission makes its
decisions independently of the DGPPN, as we realise how
important complete transparency is in this type of work.
We are extremely grateful to the members of the
commission for helping us in our efforts to come to terms with
The commission is overseeing the DGPPN-initiated and
financed research projects involving Professor Schmuhl
and Professor Zalashik. They aim to shed light on the
extent to which the DGPPNs predecessor organisations
and their representatives were involved in the euthanasia
programme, in forced sterilisations of mentally ill patients
and in other crimes between 1933 and 1945.
The final report is due to be presented in just under
2 years, after which a second phase will begin the equally
long-overdue task of addressing the post-war period. It will
explore the consequences of the terrible crimes perpetrated
under the Nazis, uncover who was involved, and reveal
what lessons were learned and when. This will replace the
speculation surrounding this period with solid facts.
Mentally dead, human ballast, life unworthy of
livingthese are not easy words to say. They are deeply
upsetting and disturbingand, in the light of the fact that
psychiatrists were actively involved in Gleichschaltung,
forced sterilisation and murder, they fill us with shame,
anger and the greatest sorrow.
Our shame and regret are also rooted in the fact that it
has taken this association, of which I am President today,
70 years to make a systematic effort to come to terms with
its past and the history of its predecessors under National
Socialism, andirrespective of the historical facts that
may come to lightto ask for forgiveness from the victims
of forced migration, forced sterilisation, human
experiments and murder.
In the name of the German Association for Psychiatry
and Psychotherapy, I ask you, the victims and relatives of
the victims, for forgiveness for the pain and injustice you
suffered in the name of German psychiatry and at the hands
of German psychiatrists under National Socialism, and for
the silence, trivialisation and denial that for far too long
characterised psychiatry in post-war Germany.
Many of the victims, even those who were not killed,
and their families are no longer with us today. For them,
this request comes too late. But perhaps it is not too late for
the survivors and for the victims descendantssome of
whom are with us here todayfor mentally ill people
everywhere and for todays psychiatrists and the DGPPN
We cannot undo pain, injustice and death. But we can
learn lessons, and we have learned a great manyin the
psychiatry profession, in medicine as a whole and in
politics and society. And we can commemorate the victims by
coming together to advocate humane, patient-oriented
psychiatry and by working together to fight the
stigmatisation and marginalisation of mentally ill people.
As psychiatrists, we must not pass value judgements on
people. We teach, research, treat, support and cure. When
we speak of the inviolability of human dignity, we mean
the dignity of each and every individual, and no law or
research objective must ever cause us to disregard this
We have learned important lessons from our failures.
This offers hope for current debates on medical ethics,
which, given their focus on topics such as preimplantation
genetic diagnosis and assisted suicide, risk descending all
too quickly into questions of the value of a human life.
These discussions will always be murky, but I believe that
my goal and the goal of the DGPPN as a whole is perfectly
clearwe must ensure we provide humane medical care,
contribute to a more benign future and respect the dignity
of every single individual.
Ladies and gentlemen, thank you for your attention.
This supplement was not sponsored by outside commercial interests.
It was funded by the German Association for Psychiatry and