“The systematic sterilization and killing of individuals with schizophrenia in Nazi Germany from 1934 to 1945 was influenced by several factors. Perhaps, of greatest importance was a belief that schizophrenia was a simple Mendelian inherited disease, passed down from generation to generation. In Germany, this theory was promoted by Drs Ernst Rüdin and Franz Kallmann, among others.”
— Dr. E. Fuller Torrey and Robert H. Yolken, “Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia,” Schizophrenia Bulletin, 16 September 2009
Let me say right away that I’m not the greatest fan of Dr. E. Fuller Torrey, one of the authors of the quote that appears above. He’s given us a couple of organizations that are supposedly about dealing with the issue of “mental illness,” like the Treatment Advocacy Center (TAC) as well as the much better-known National Alliance On Mental Illness (NAMI) (which I might point out, as the name indicates, is not an organization of the “mentally ill” but an organization that is on the “mentally ill,” as in “we will impose our views and our will on you, whether you like it or not”). These organizations are not only funded in large part by Big Pharma (you need only to look at their donors’ list to see their names), but they also promote the idea of “mental illness” as a biological disorder or a disease or a so-called “chemical imbalance” (or something: the medical narrative constantly changes, in the hopes that sooner or later some kind of justification for thinking that schizophrenia is a medical problem will finally come along and justify the prejudicial bias of biological psychiatry that such a medical cause must exist, regardless of whether there has ever been any actual medical evidence to support this bias or not).
Furthermore, Dr. Torrey appears to be an advocate of the reintroduction of a mental hospital system that would use coercion to force drugs (and possibly other “treatments”) on people. I am completely opposed to all of these measures and to these ideas, and I am stating my own bias now so that you will know what it is as I examine the work that he and a co-author, Robert Yolken, produced in a paper that deals with the Nazi’s destruction or sterilization of most of the schizophrenics in Germany, which was done on the basis of eugenics: the idea that some people are so genetically inferior that they are, essentially, unworthy of life (or of the expense that it takes to support them in an institution which is paid for by the state, such as a mental hospital).
I find this paper to be a very curious piece of work. On the one hand, it explains the Nazi genocide of almost all the schizophrenics of Germany, and it even explains the genetics-based theory behind it all, but then it goes on to ignore the question that, if all the schizophrenics of Germany were either dead or sterilized, how was it possible that the incidence rate (new cases each year) of schizophrenia actually rose to double the rate of most industrialized countries?
This begs the question: if all the schizophrenics were dead, how did they pass on their genes? How was it possible — if Dr. Torrey and Mr. Yolken, and all of biological psychiatry itself were right — for a bunch of people who were either dead or sterilized to produce more schizophrenics? And on just what rational basis do you come around to supporting another baseless gene theory for schizophrenia, even after you have just described how a gene hypothesis was used to justify the murder or sterilization of hundreds of thousands of people? And doing it all while completing ignoring the social context which you have just gone to such lengths to describe?
Let me put it this way: I am not opposed to anyone exploring the possibility that genetics may lie behind schizophrenia. I don’t personally believe that to be the case, but I don’t have a problem with people exploring it. This is science we’re talking about, after all, and I believe that it is only right that we explore every idea. What I have a problem with is when the authors of a supposedly scientific paper ignore the obvious scientific conclusions that their own evidence suggests in favor of another, completely unsupported hypothesis. That’s not science anymore. That’s prejudice.
I would like to review the paper very briefly before examining the authors’ conclusions, just so that people will know the context of what we’re talking about here. Germany was, after all, in a difficult situation at the time of the Second World War, and so this invisible holocaust, and then the very curious resurgence of schizophrenia that followed it, did not take place in a vacuum.
According to the paper, which I have no doubt was carefully researched, psychiatrists were asked by Hitler to design a method for killing the “mentally ill,” or at least those who were currently housed in psychiatric centers, where they created a financial burden on the state of Germany. The psychiatrists complied, and they came up with much of the machinery that would later be implemented in the rest of the Holocaust: the “showers,” which were really gas chambers, the use of drugs (for so-called “euthanasia”), the mass sterilization, and the crematoria for the disposal of the bodies. That’s where it all came from, if I understand it correctly. If you have any reason not to trust my account, please check Dr. Torrey and Mr. Yolken’s paper. They are, after all, on the other side of this imaginary debate.
Here’s what they wrote about it all:
Hitler’s letter authorizing the program to kill mental patients was dated September 1, 1939, the day German forces invaded Poland. Although the program never officially became law, Hitler guaranteed legal immunity for everyone who took part in it. In October 1939, the directors of all German psychiatric hospitals were asked to fill out forms indicating the diagnosis and capacity for useful work of each patient, although they were not told what the forms were for. These forms were then assessed by a committee of selected psychiatrists who targeted approximately 70 000 patients for death, 1 for every 1000 people in Germany, which was the initial goal of the program. The program was known as Aktion (action) T–4, after the address of its headquarters in Berlin on Tiergartenstrasse 4.
As if this were not horrifying enough, there are also the actual details of how this mass murder was planned. All of this was done on the basis of a genetic hypothesis. Here is what the Nazis did with that line of thinking:
The planning and logistics for such mass murder elicited much discussion. The method finally chosen was the release of carbon monoxide gas into a closed room outfitted to look like a shower room and the subsequent burning of the bodies in crematoria. Gold fillings were removed from the deceased and used to partially pay for the program. In early January 1940, the first 20 patients were led into a “shower room” at the Brandenburg asylum and killed. This method was judged to be highly successful and was later adapted for the killing of Jews. Five additional asylums, at Bernburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein, were designated as killing centers, and patients marked for death at other hospitals were transported to these regional centers. By August 1941, 70,273 patients had been killed. Careful records were kept, and the 6 centers competed with each other in efficiency. Hadamar, eg, “celebrated the cremation of its ten-thousandth patient in a special ceremony, where everyone in attendance—secretaries, nurses and psychiatrists—received a bottle of beer for the occasion.”
I want to thank Dr. Torrey and Mr. Yolken — quite sincerely — for bringing this to the world’s attention. I am particularly taken aback by the callous brutality of the last line, but if you have ever witnessed a psych ward in action, the basic constituent parts of the situation should be familiar to you. Many mental health workers, nurses, doctors, etc., do tend to get a little jaded and indifferent.
According to Dr. Torrey and Mr. Yolken’s analysis of the historical situation, there were approximately “132,000 with schizophrenia who were sterilized and 100,000–137,500 people who were killed” out of a total German population of about 70 million.
That’s the general context of it all. Now I would like to talk about the gene hypothesis of schizophrenia. This hypothesis, which is the basis of what used to be called the “social science” of eugenics, once so prominent in the world (not only in Germany but in the United States and other countries), was based on the idea that some people are inferior, which is then the basis for the further idea that those “inferior” people can be exterminated without either moral harm to the people involved or without any significance to the world in terms of the people it’s done to, since, after all, they were supposedly less human or less valuable than the population that had supposedly “superior” genes.
I believe that this idea — the genetic hypothesis of schizophrenia — is completely wrong, as the continuing lack of any established science to prove it shows. And I believe that Dr. Torrey and Mr. Yolken’s own paper actually shows how wrong the genetic hypothesis of the origin of schizophrenia actually is.
Let’s use Dr. Torrey and Mr. Yolken’s own words here, because they are quite succinct and clear. It begins with the context of German society and how badly the mental hospitals were burdened after the First World War. I will also fill in a few historical details on my own, in order to make the historical situation a little more clear.
All you really need to know, historically speaking, is that Germany had been blamed by the Allies for the whole expensive disaster of World War I, at which point it was stripped of all of its most important economic assets (largely in the form of its most industrial, coal-producing region, the Ruhr), and burdened with such massive reparation payments to make up for Germany’s part in the war that the country could never have kept up with them. This caused not only immense poverty and suffering in post-war Germany, preventing economic and social recovery, but also contributed to the rise of fascism (the idea of the state as a military and financial power that is to be obeyed without question) which then led to the rise of the Nazis. It also led to an extreme form of racism, because the Nazis appealed to nativist sentiments about what race you belonged to — which in a part of the world that already had enough ethnic problems of its own then led to people hating other people even more, based on their race, their ethnicity, or their national identity, or even because of another kind of perceived genetic defect, as exemplified by the hatred of those with “mental illness.”
This sentiment even extended to simple physical deformities, or to illnesses such as epilepsy. It was all based on a mere hypothesis — not a proven theory, but a mere hypothesis — of what caused “human inferiority” that was in turn based on a narrow ideology about genetics, which the Nazis exploited to extend their power and to eliminate their enemies so far as was possible (and perhaps to ease their consciences).
So the historical context, as Torrey and Yolken write, is this:
This massive increase in patients in psychiatric hospitals came at a bad time for Germany economically. Following World War I, Germany had been stripped of valuable industrial and coal-producing areas and saddled with onerous reparations. The decade following was marked by strikes, clashes between Communists and nationalists, inflation, bankruptcies, and a severe economic depression. Funding for psychiatric care was sharply reduced even as the number of patients requiring care was rising. In 1931, the German Psychiatric Association organized a prize for the best essay on the topic “How can provision for mental health care be more cheaply reorganized?”
The idea of killing the patients in psychiatric hospitals first surfaced prominently in 1920 in a publication by Karl Binding, a lawyer, and Alfred Hoche, a psychiatrist. Entitled Permission for the Destruction of Life Unworthy of Life, the tract posed the question: “Is there human life which has so far forfeited the character of something entitled to enjoy the protection of the law, that its prolongation represents a perpetual loss of value, both for its bearer and for society as a whole?” The authors’ answer was clearly affirmative and described such individuals as being “mentally dead” and “on an intellectual level which we only encounter way down in the animal kingdom.” The authors emphasized the economic burden of such individuals to Germany. The economic argument was repeated in subsequent discussions of this issue, such as in a 1932 article entitled “The Eradication of the Less Valuable from Society,” in which the author, psychiatrist Berthold Kihn, estimated that mentally ill individuals were costing Germany 150 million Reichsmarks per year.
So, to cut to the chase, the Nazis either exterminated or sterilized almost all the schizophrenics in Germany (as well as other countries, but the authors don’t go into that very much) on the basis of the idea that so-called “inferior genes” were the cause of schizophrenia, and that killing or sterilizing all the schizophrenics would prevent these “inferior genes” from being passed on to the next generation, and that schizophrenia would be more or less eliminated from Germany.
And yet, in Dr. Torrey and Mr. Yolken’s paper, the reality of the situation — which is that the incidence rate of schizophrenia actually increased after the war — is treated only as a bizarre anomaly without any explanation, when, if you actually take the historical situation of Germany at that time into account, it becomes clear that the traumagenic hypothesis (the idea that stress and trauma are what lies at the heart of schizophrenia and psychosis) should be taken very, very seriously.
To put it in other words: The Nazis either killed or sterilized almost all the schizophrenics in Germany — 200,000 to 270,000 of them. And yet there was a resurgence in the population (a rise in the incidence rates of new cases of schizophrenia each year) that showed a doubling of the population of schizophrenics in Germany. And how, if it were really an inherited disease, and all the schizophrenics had either been killed or sterilized, was this possible?
This defies the gene hypothesis, which the authors go to some lengths to explain at the end of their paper.
But to continue with the historical context, they write:
Regarding the incidence of new cases of schizophrenia, no published studies were apparently carried out in Germany prior to World War II. The first postwar study was done in Mannheim in 1965, 20 years after the last patients had been sterilized or killed. Heinz Häfner and Helga Reimann at the University of Heidelberg identified all new cases of schizophrenia reported during the year among the city’s 330,000 inhabitants. They reported an incidence rate of 53.6 per 100,000, which the authors noted was “more than twice as high as the mean of 21.8 per 100,000 calculated in 1965 by Dunham from different studies and two to three times as high as the rates of 23.8 or 15.8 respectively . . . for the U.S.A. and England and Wales in 1969.” The German rate, they added, was comparable to the “rate of 52 per 100 000 given by Walsh for Dublin in 1969.”
I would like to note, regarding this last paragraph, that the one incidence rate they report that is comparable to Germany’s incidence rate belongs to Ireland, which at that time was also a very troubled society.
Häfner and his colleagues subsequently opened a psychiatric case register and recorded the incidence of schizophrenia for each year from 1974 to 1980; it ranged from 48 to 67 per 100,000, averaging 59. In one report, the authors compared the incidence of schizophrenia in Mannheim with 11 studies in the Netherlands, Italy, Denmark, Norway, Iceland, the United Kingdom, the United States, and Australia; the 11 studies averaged 24 per 100,000, less than half the incidence rate for Mannheim, and only one, a 1970 study in Rochester, NY, reported a higher rate than Mannheim. In another publication, Häfner compared the Mannheim incidence rate with that of 8 centers in the World Health Organization Determinants of Outcome Study; only 1 of the 8 centers had an incidence of narrowly defined schizophrenia exceeding that of Mannheim.
The other area in Germany where schizophrenia incidence studies were carried out was in Bavaria. A 1971 study found 102 cases in a predominantly rural population of 424,000 for a 6-month incidence rate of 24 per 100,000. Another study done in the same area in 1974–1975 reported an annual incidence rate of 48 per 100,000, thus being more similar to the rates reported for Mannheim. These high German incidence rates were also confirmed by international comparisons. For example, a review of 55 schizophrenia incidence studies by McGrath et al found the median schizophrenia incidence to be 15.2 (7.7–43.0) per 100,000; few of the studies achieved the high incidence rates reported in Germany.
Which brings us to the trauma hypothesis. My own explanation for the appearance of these high incidence rates in Germany were the conditions of the time. After all, these people had just been bombed almost to extinction, subjected to Nazi terror, and then, in the post-war period, often nearly starved to death. Yes: many people were nearly starved to death, jobs were difficult to come by, and all resources, including money, were tight all over the country. Maybe that would harm some people, and possibly contribute to an altered psychology?
Dr. Torrey and his co-author present some different arguments that might explain the increase in the incidence of schizophrenia. I am presenting all of their arguments (there are four) in order to represent their position fairly. I’m not cherrypicking so I can make them look bad, in other words. I would like to keep my discussion as fair and evenhanded as possible.
I will take these arguments in turn, using the authors’ own words so as not to misrepresent or distort their arguments.
Is there any apparent explanation for the relatively high incidence rates of schizophrenia in postwar Germany? One possible explanation is that the areas in which postwar incidence studies were carried out were less affected by the psychiatric genocide. This seems unlikely because many Bavarian psychiatrists enthusiastically supported the eugenics program, and individuals with schizophrenia in the Mannheim region were killed initially in Grafeneck and later in Hadamar asylum.
Here, Dr. Torrey and Mr. Yolken have themselves discounted one explanation on the grounds of logic and plain good sense, so I don’t need to address it. It does speak in their favor that they included it, but not to have done so would have been scientifically obtuse. On to the next, then.
Another possible explanation is that postwar incidence studies of schizophrenia in Germany included large numbers of non-German immigrants. In fact, 13% of Mannheim’s population in the 1970s were foreign workers. Studies of the incidence of schizophrenia among these workers, however, reported that “when corrected for age, the rates of treated schizophrenia episodes . . . were significantly lower than those of the German population.”
What this means is that the authors have, in essence, now presented an argument against the genetic hypothesis, using a historically informed analysis of the existing data. However, they have not really presented the material in the way that really shows what is happening here. Germany was largely rebuilt, following the war, by bringing in a large number of guest workers — “gastarbeiter” — which is a factor that the authors gloss over by ignoring how Turkey, the origin of a substantial portion of those immigrants, had not been subjected to the same kind of horrible conditions that Germany had been subjected to during the war. In other words, since the Turks came from a much less damaged society, their lower incidence rates for schizophrenia would actually speak against the genetic hypothesis and in favor of some other cause, such as the traumagenic hypothesis (which I would suggest is social, since trauma and its aftereffects are both psychological and social).
On to their next rationalization:
A third possibility is that much broader diagnostic criteria were being used to diagnose schizophrenia in Germany after the war compared with before the war. If this had been the case, one would expect to find high rates in prevalence as well as in incidence studies, but this is not the case. It is difficult to determine what diagnostic criteria were being used in prewar studies. Brugger did not define the diagnostic criteria he used in his 1929–1931 studies, but they were probably the classical criteria of Emil Kraepelin, who dominated diagnostic thinking in Munich psychiatry until his death in 1926. Most studies after the war used the diagnostic guidelines of the International Classification of Diseases, Eighth Revision (ICD-8), and International Classification of Diseases, Ninth Revision (ICD-9), introduced in 1965 and 1975, which use somewhat broader criteria for diagnosing schizophrenia. However, most of the other European studies that were being done at the time and that reported much lower incidence rates also used ICD-8 or ICD-9 criteria.
Again, we have a fairly reasonable argument here, but this time it doesn’t prove anything either for or against the gene hypothesis. It’s just saying that, well, we don’t know if they were counting more (or possibly fewer) schizophrenics before the war than after it, or vice versa, due simply to the ways they used to count them (much the same way that a census might allow you to be called multiracial, rather than only “black” or “Caucasian” or “Latino,” which distorts how many people do or don’t belong to any one group).
So those are the first three arguments, none of which actually supports the gene hypothesis at all and one which is potentially an argument against it.
But in going forward, I would like to point out that there is one thing you should always note about psychiatric articles, which I noticed a while back. It is that all the information that really matters — the information that usually contains the truth of it all — is almost always put last. It doesn’t matter what kind of paper it might be, or what kind of form, or what kind of news article. If it’s a form that describes your rights in a psychiatric hospital, for instance, the number that you need to call to get help in addressing how your rights are being abused is always at the bottom of the piece of paper, in the very last line. If it’s a government press release or an article in the newspaper that describes why schizophrenics die on average about 30 years younger than everyone else does, then the real cause (psychiatric drugs) will be in the last line of whatever paragraph it’s in, or at the very end of the article. And it will be done in a throwaway fashion, as if they wanted to numb your brain out with all the other irrelevant information before they finally throw in what really matters, which will be when you aren’t really paying attention anymore. Everything else — I promise you — will be a lot of smoke and mirrors, largely put out there by the PR divisions of various Big Pharma companies or their psychiatric adherents, and everyone who works in psychiatry (except the naive ones) probably knows this. So the last line in anything written down on paper by a psychiatrist is almost always the one thing on the paper that might matter.
Here’s Dr. Torrey and Mr. Yolken’s last argument about the cause of the high schizophrenia incidence rates in post-war Germany:
A fourth possibility is that social conditions during or after the war produced environmental factors that led to an increase in the incidence of schizophrenia. An example was the increase in schizophrenia in Holland that followed the Dutch Hunger Winter in 1944–1945. The cause of the high schizophrenia incidence rates in postwar Germany is thus not apparent and is an appropriate subject for additional research.
So that is what amounts to the last line in Dr. Torrey and Mr. Yolken’s list of the potential causes of the increase in schizophrenia in Germany after the Second World War. And what does it say? That despite the actual existing evidence, such as the rise in schizophrenia in another severely traumatized country immediately following a disaster (much like what happened in Canada, when there was a rise in schizophrenia in children following a period of exceptional economic hardship and stress), there is no serious arguing being done here at all for the traumagenic hypothesis, despite there being considerable evidence for it. At the same time, there is no evidence at all for the gene hypothesis, and in fact any evidence that is presented here is against it. In the absence of any sort of scientifically established argument for the gene hypothesis, I would argue that it’s time to look very seriously into the evidence for the traumagenic hypothesis — that, if not directly causative, it is certainly an overwhelming factor in what gives rise to psychosis.
Yet the conclusion that the authors provide is telling because of how very weak it is: “The cause of the high schizophrenia incidence rates in postwar Germany is thus not apparent and is an appropriate subject for additional research.” It’s a throwaway line if I’ve ever seen one (practically any scientific paper you’ll ever see ends with the same words about “more research” being needed), and it is especially so when you consider the evidence that was presented in the paper itself about the social conditions of Germany at the time.
I would argue that the whole paper, in fact, is sort of a smoking gun. The paper, in toto, says to me that the only plausible cause of such a high incidence rate, going by the evidence presented, is trauma. Not genes. Not any disease. It says that the only common denominator between all these countries with high incidence rates for schizophrenia is the harm caused by a painful and traumatizing environment, not by a disease or a genetic defect. And that is all we know about what begins the experience known as schizophrenia.
Trauma, pain, and adversity. That’s what some people, like Prof. John Read, have been telling us for years, but the psychiatric establishment doesn’t seem to want to do anything with that information. But it’s not the only time that Dr. Torrey, for one, has been willing to close his eyes and ignore the actual social and historical context of schizophrenia in favor of a physiological hypothesis. And in the usual fashion of a psychiatrist who is unable (or unwilling) to understand what is right before his eyes, what Dr. Torrey and his co-author actually say at the end of the paper is this:
It is hoped that this article will elicit additional, previously unpublished, data that can be used to document and memorialize this reprehensible but important chapter in psychiatric history. In addition, perhaps, the most appropriate response the profession of psychiatry can have to the Nazi eugenics and psychiatric genocide program is to focus additional resources on examining more complex forms of genetic and gene-environmental interactions in order to understand the true genetic contribution to schizophrenia. This knowledge should then be used to develop methods for disease prevention and treatment that can be used ethically in all populations.
They just don’t ever learn, do they? Not even from their own work.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.