Psychiatry during the Nazi era: ethical lessons for the modern professional

Abstract

For the first time in history, psychiatrists during the Nazi era sought to systematically exterminate their patients. However, little has been published from this dark period analyzing what may be learned for clinical and research psychiatry. At each stage in the murderous process lay a series of unethical and heinous practices, with many psychiatrists demonstrating a profound commitment to the atrocities, playing central, pivotal roles critical to the success of Nazi policy. Several misconceptions led to this misconduct, including allowing philosophical constructs to define clinical practice, focusing exclusively on preventative medicine, allowing political pressures to influence practice, blurring the roles of clinicians and researchers, and falsely believing that good science and good ethics always co-exist. Psychiatry during this period provides a most horrifying example of how science may be perverted by external forces. It thus becomes crucial to include the Nazi era psychiatry experience in ethics training as an example of proper practice gone awry.

Maltreatment of People With Serious Mental Illness in the Early 20th Century

“…Instead, he planned a secret action to coincide with his invasion of PolandVfeeling that a war would distract people from the plan. In the fall of 1939, Hitler signed a letter on his personal stationary authorizing Brandt to expand the special treatment killing to adults (Benedict, 2003;Burleigh, 2004;Ost, 2006;Strous, 2007). The letter was issued in October but backdated to September to cover any work that had already been done on the project.…”

“…They used the same carbon monoxide gas for most killings until the development of Zyklon B cyanide gasVwhich killed quicker. One of the T-4 psychiatrists, Irmfried Eberl, became the only physician commandant of a death camp: Treblinka (Strous, 2007).…”

“…This resulted in an order that physicians and midwives were to report all births of children with suspected mental retardation, malformations, or paralysis (Burleigh, 2004). Pediatricians in the community were also allowed to refer children for assessment (allowedVnot required; Strous, 2007). The children referred for ''expert care'' were taken from their parents, who were told that they were being transferred to specialty hospitals.…”

Psychiatry and the dark side: eugenics, Nazi and Soviet psychiatry

“…Faked death certificates were intended to disguise the deaths as natural in order to hide the victim's fate from their family and the public (Strous 2007). Between 1939 and1941, 80 000 to 100 000 mentally ill people in institutions were killed, including 5000 children (Lifton 2000).…”

Respect of dignity as an ethical principle in forensic psychiatry. Commentary on ‘not just welfare over justice: Ethics in forensic consultation’

“…Yet it is not clear that the professionalism of German doctors as a group was less robust than our own. And some have suggested that the incorporation of community values into professional ethics implied by ‘robust professionalism’, when applied in the circumstances of Germany in the 1930s and 1940s, may have contributed to medical collaboration (Strous, ).…”