Living and Dying in Hungary : Jewish Psychiatrist looks back
Find out more about sending content to Google Drive. Psychiatrist Thomas Szasz fought coercion compulsory detention and denied that mental illness existed. Although he was regarded as a maverick, his ideas are much more plausible when one discovers that between and , up to mentally ill people, including children, were killed in Nazi Germany. In the course of the Nazi regime, over forced sterilisations took place, mainly of people with mental illnesses.
Other countries, including Denmark, Norway, Sweden and Switzerland, had active forced sterilisation programmes and eugenics laws. Similar laws were implemented in the USA, with up to 25 forced sterilisations. These atrocities were enabled and facilitated by psychiatrists of the time and are only one example of the dark side of the profession. This article reviews some of these aspects of the history of psychiatry, including Germany's eugenics programme and the former USSR's detention of dissidents under the guise of psychiatric treatment.
The objective of this article is to familiarise mental health professionals and lay readers with the rather colourful and disdainful history of psychiatry, particularly the political abuses of mental health legislation. Some psychiatrists have abused power in general.
However, Thomas Szasz controversially argued that there is something inherent in psychiatry, particularly the power to restrict liberty, that tends towards abuse if not regulated by the legal or political system. Eugenics and forced sterilisation programmes tend to be associated with Nazi Germany. However, other countries had active forced sterilisation programmes and eugenics laws, among them the USA, Denmark, Norway, Sweden and Switzerland Weiss Havelock Ellis was a British physician and psychologist who actively promoted eugenics, although these programmes were never enacted in the UK.
Eugenics was supported by many leading psychiatrists, such as Emil Kraepelin, Eugen Bleuler and especially the Swiss psychiatrist Auguste Forel, who pioneered the first sterilisations without consent in German-speaking nations in Kuechenhoff Psychiatrists were particularly active in the eugenics field and were often directly involved in identifying victims for forced sterilisation. In , the Journal of the American Medical Association published a lengthy report on the German eugenics law and its many expected benefits. Indeed, the prosecution at the Nuremberg Trials of — felt unable to classify forced sterilisations as war crimes, because similar laws had been implemented in the USA, where up to 25 such sterilisations took place Cocks ; Mottier The Nazi regime considered that life was a matter of survival of the fittest.
Poverty and disease were thought to arise from hereditary defects due to non-Aryans contaminating the gene pool and also to misguided ideals of welfare and equality. Psychiatrists in Germany and abroad had been enthusiastically promoting eugenics programmes involving sterilisation of the mentally ill decades before Hitler came to power. Many German psychiatrists collaborated eagerly with the Nazis from the very beginning, including enforcement of the Law for the Prevention of Hereditarily Diseased Offspring, which required sterilisation of people with many illnesses, including schizophrenia, manic depression bipolar disorder and alcoholism.
Pre-war propaganda emphasised the financial demands of these patients on the state Fig. The procedures devised in eugenics programmes, such as psychiatric assessment of competence and disability, were crucial predecessors of the euthanasia programmes for the murder of mentally ill people in Germany. Eminent German psychiatrists were actively involved in the T-4 euthanasia programme at all stages, including selection and execution. Again, propaganda was used to promote the programme. Under the T-4 programme, hundreds of euthanasia forms, completed by two doctors at the mental institution or hospital in question, were sent to Berlin for approval by one of fifty experts, including several professors of psychiatry.
The patients were then collected from the institutions in the now infamous grey buses, and brought to six psychiatric institutions in which gas chambers had been installed Grafeneck, Brandenburg, Hartheim, Pirna-Sonnenstein, Bernburg and Hadamar. Psychiatrists supervised the transport and the execution of their patients. The presence of physicians and other health professionals in the euthanasia centres gave a false sense of security to the victims, who did not realise their fate until the very end.
FIG 2 Nazi propaganda poster supporting the sterilisation or euthanasia of people with mental disabilities. Between and , 80 to mentally ill people in institutions were killed, including children Lifton Figures for murders committed under the T-4 programme outside institutions vary, from estimates of 20 according to Dr Georg Renno, the deputy director of one of the euthanasia centres to according to Frank Zeireis, the commandant of Mauthausen concentration camp Cocks Hitler ordered the cancellation of the T-4 programme in August , following protests from the Catholic and Protestant Churches.
Although public opposition ended these quasi-legal killings, they continued in secret in asylums and hospitals until the end of the war. Psychiatrists and doctors often poisoned or starved mentally ill hospital patients to death Breggin Although the Law for the Prevention of Hereditarily Diseased Offspring did not require these patients to be killed, it did permit doctors to kill them.
However, equipment, including gas chambers, was moved to the concentration camps and staff from the mental hospitals, including psychiatrists, advised and staffed the camps. Medical observers from the USA and Germany at the Nuremberg Trials concluded that the Holocaust might not have taken place without the involvement of psychiatrists in the T-4 programme Breggin Although none of these four was subsequently punished for their involvement, at least three other professors of psychiatry were eventually captured.
Karl Brandt Fig. Unfortunately, the German Psychiatric Association and its successor organisation refused to acknowledge the involvement of their members for 65 years Focus FIG 3 Karl Brandt. He was sentenced to death at the Nuremberg Trials. Although psychiatrists were not the only health professionals involved in abuses of mentally ill people in Nazi Germany, many reports indicate it was not a minority activity among them. Indeed, it is likely that a majority of practising psychiatrists in Germany at the time supported the Nazi regime and a large proportion identified their patients for the T-4 euthanasia programme.
The editorial suggests a public education campaign to overcome emotional resistance to such euthanasia. Under the Nazi regime, psychiatric patients were subject to ruthless programmes of sterilisation and eventually murder.
By contrast, the regime did not have the same attitude towards patients of psychotherapists. Hence, there was a great incentive for patients, and families of patients, with psychiatric disorders to be treated by psychotherapists to avoid the dreadful consequences of receiving a psychiatric diagnosis. In , the General Medical Society for Psychotherapy was created in Berlin and it quickly became one of the major organisations in Central Europe for teaching and research in psychotherapy Cocks At the time, many German doctors and medical students supported National Socialism, not least because its plans to prevent foreigners, Jews and women from practising medicine promised to reduce competition for scarce jobs.
Psychotherapy was surprisingly well tolerated in Nazi Germany. Indeed, it was encouraged by the regime. Psychotherapy was able to expand as a professional discipline and it was subject to much less oppression and restriction than many other disciplines such as psychiatry, history and even physics. However, Jews were banned as patients from As the Third Reich expanded, psychoanalysis moved from Vienna and became centralised in Berlin.
Of course, psychoanalytic psychotherapy had been established by a Jewish psychiatrist Sigmund Freud and had many Jewish practitioners. Most Jewish psychoanalysts in Germany emigrated, although 15 who did not were tortured and murdered in Nazi concentration camps. However, other forms of psychotherapy, including Jungian and Adlerian psychotherapy, became well established in Nazi Germany despite the fact that these variants were based on Freudian psychoanalysis.
Political abuse of psychiatry has been defined as the misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society, especially political dissidents van Voren From the s, Soviet psychiatric hospitals were used by the authorities as prisons in order to isolate thousands of political prisoners from the rest of society, discredit their ideas and punish them both physically and mentally van Voren Psychiatry, unlike many areas of medicine, allows doctors to deprive people of their liberty to protect them from coming to harm themselves or to protect society.
Although this form of detention is carried out on the basis that these individuals are mentally ill and unable to reason, the power that detention gives psychiatry can be perverted into a form of social control. Psychiatric detention often allows society to by-pass cumbersome legal procedures such as proof of guilt in public courts.
This became particularly popular in the USSR from the late s as a more convenient alternative to sending dissidents to the Gulag the system of Soviet prison camps in Siberia. One of the first Soviet psychiatric hospitals to imprison political dissidents was in the city of Kazan van Voren It came under control of the Soviet secret police in The psychiatric detention of dissidents became much more common from and the practice gradually expanded to involve hundreds of mental hospitals throughout the Soviet bloc.
Snezhnevsky was actively involved in the detention of political dissidents.
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The diagnosis of sluggish schizophrenia was based on the idea that people who opposed Communism were mentally ill since there was no other logical reason why anyone would oppose the Soviet system. Although psychiatric detention of dissidents was instigated by the Soviet secret police, many Soviet psychiatrists sympathised with the idea that dissidents may be deluded: why else would someone abandon their happiness, family and career for a belief that contradicted what most Soviet people claimed to believe?
Antisocial behaviour, anxiety, poor social adaptation, ideas about reforming society, religious convictions and confrontation with the authorities could be used as diagnostic features of sluggish schizophrenia. Clinical features also included the capacity to behave normally for considerable periods, thereby allowing the diagnosis to be made in people who showed no overt signs of mental illness or people who did not express politically dissenting opinions at the time of examination.
Patients with sluggish schizophrenia were considered to be able to function almost normally in social circumstances. The defendants had to admit in public to their wrongdoing and several were dismissed from their posts. Some were also imprisoned and tortured. Many of their accusers were scientists themselves and several were subsequently promoted. Under this policy, psychiatrists could fabricate a diagnosis and detain political dissenters indefinitely without any court proceedings Possony : pp.
The majority of dissenters who were detained were examined at the Serbsky Central Research Institute for Forensic Psychiatry in Moscow. Between and , Viktor Rafalsky was three times committed to psychiatric hospitals, for belonging to a Marxist group, for writing anti-Soviet prose and for possessing anti-Soviet literature. By the time of his final release he had spent a total of 24 years in detention. Between and Alexander Esenin-Volpin, later a Professor of Mathematics at Boston University, was also detained in mental hospitals on three occasions, for writing anti-Soviet poems.
He was detained on a fourth occasion in but released and permitted to emigrate to the USA following protests by mathematicians and other Soviet scientists. Vladimir Borisov was detained in mental hospitals for a total of 9 years in the s and s as a human rights activist and leader of the Free Interprofessional Association of Workers. In January , the Soviet psychiatrist Semyon Gluzman wrote a psychiatric report that refused to diagnose a political dissident as having a mental illness. For this he was eventually sentenced to serve 7 years in a labour camp.
Later that spring, Gluzman was instrumental in the smuggling to the West of case reports on the use of psychiatric hospitals in the USSR to detain political dissidents. But when the practice was exposed at the World Psychiatric Association WPA meeting in Mexico in November , members of the Soviet delegation were said to have outmanoeuvered the leaders of the WPA and no action was taken, possibly owing to a reluctance to alienate Soviet members.
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However, the first voices had been heard and by the late s protests were more widespread among psychiatrists in the USSR. Circulated unofficially in the USSR, it contained lists of people detained in Soviet mental hospitals and the names of over medical staff and doctors who took part in detaining political dissenters. Podrabinek had also been instrumental in setting up the Working Commission to Investigate the Use of Psychiatry for Political Purposes.
Between , the year of its establishment, and the Commission reported details of 50 dissidents and non-conformists who were wrongly given a psychiatric diagnosis.
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This information was instrumental in convincing psychiatric associations in the West of political abuses in the Soviet psychiatric system. These activities were denounced by Communist governments. During its World Congress, the WPA made a declaration that a psychiatrist must not take part in compulsory psychiatric treatment in the absence of mental disease Declaration of Hawaii.
The declaration did not specifically identify detention of political dissidents as its primary objective. Similarly, the terms of a WPA Review Committee, created at the Congress, were subsequently widened to include any unethical practice by psychiatrists — not just detention of political dissidents. Furthermore, the Committee was to examine only specific abuses by individual psychiatrists, not systematic abuses by governments. Thankfully, the ascent of Mikhail Gorbachev in the USSR in and the political freedoms that followed ended the period of widespread political abuses of Soviet psychiatry.
Still, it was not until that a delegation of US psychiatrists was allowed to interview victims of alleged political abuses of psychiatry. The All-Union Society of Neurologists and Psychiatrists was controversially readmitted to the WPA in , on the understanding that it cooperated sincerely with investigations of political abuse of Soviet psychiatry. Psychoanalysis shares several common themes with Marxist theory. Marxists suggest that there are no economic accidents or coincidences and that all social and political events are deliberately determined to oppress and exploit the worker.
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Similarly, the idea that everything should be conscious, planned and intellectually controlled is similar to Marxist ideas that behaviour and belief are socially determined primarily so that the bourgeoisie could control and exploit the worker. Nothing should be spontaneous, random or unconscious. Marxists in Russia recognised that psychoanalysis was a tool that could be used to address this. The founders of psychoanalysis had been intimately concerned with discussions of Bolshevism and Marxist politics.