Nazi Germany’s killing of the “unfit” began with the systematic murder of psychiatric patients, who were deemed to suffer from defective genes. In an in-depth examination of this history published in Ethical Human Psychology and Psychiatry, John Read and Jeffrey Masson make a case that acknowledging this past—and seeing a connection to elements of biological psychiatry today—should hasten a shift toward a humane, trauma-informed paradigm of care.
“The mental health field seems to have been nudging, for decades, closer and closer to a paradigm shift, from a simplistic, pessimistic, bio-genetic ‘medical model’ of human distress to a more nuanced and evidence-based, psycho-social, trauma-informed approach. But to the present authors, who have, like thousands of other people, been advocating for greater focus on abuse, adversity and trauma for many years, it seems that progress towards that paradigm shift has been excruciatingly slow . . . . Some might argue that what happened in Germany 80 years ago has little to do with how psychiatry operates, internationally, today. We document and discuss these tragic, awful events, again, however, precisely because they so clearly illustrate themes present throughout the history of the treatment of people considered mad and which remain operative today: Social control in the interests of the powerful; damaging and sometimes even violent ‘treatments;’ and the capability of experts’ theories to camouflage what is really happening as being in the best interests of the treatments’ recipients.”
As Read and Masson note, it was the science of “eugenics” that gave rise to the Holocaust. Claims that schizophrenia and other major mental disorders were due to bad genes led first to sterilization programs in the United States, Scandinavian countries, and Germany, and then to the “mentally ill” being the first group targeted for extinction in the Holocaust.
Psychiatrists remembered today as founders of biological psychiatry, including Emil Kraepelin and Eugen Bleuler, helped promote eugenic ideas. Bleuler, who introduced the term schizophrenia in 1908, wrote in 1911 that while castration “is of no benefit to the patients themselves . . . it is to be hoped that sterilization will soon be employed on a larger scale . . . for eugenic reasons.”
The United States was the first to turn eugenic ideas into social policy. In 1907, Indiana became the first state to authorize compulsory sterilization of the mentally ill, and in 1927 the U.S. Supreme Court ruled such state laws constitutional.
A primary author of such legislation in Germany was Ernst Rudin, Professor of Psychiatry at the University of Munich and Basel. Germany enacted its sterilization law in 1933; six years later, 350,000 Germans had been sterilized, with about one-third of this group diagnosed with schizophrenia.
At least a few psychiatrists spoke of killing the mentally ill prior to Adolph Hitler’s rise to power. In 1920, German psychiatrist Alfred Hoche wrote that psychiatric institutions were filled with “empty human husks . . . Theirs is not a life worth living; hence their destruction is not only tolerable, but humane.”
In 1939, a group of prominent psychiatrists at Germany’s most prestigious medical schools helped develop a plan to kill the mentally ill. Six psychiatric hospitals were equipped with killing chambers, with carbon monoxide the gas of choice. By the end of the war, an estimated 250,000 mental patients in Germany had been murdered, and an unknown number of patients in French, Polish and Austrian mental hospitals were also starved to death during this period.
Having reviewed this history, Read and Masson conclude: “Thus, the mass murder of mental patients by psychiatrists provided the ‘scientific’ rationale, the staff, and the equipment, for the Holocaust.”
While officers of the Third Reich faced criminal prosecution at the Nuremberg trials, most of the psychiatrists who promoted the killing of asylum patients “escaped censure or punishment.” Indeed, many returned to practice and rose to prominence in the field, the authors note. Three of the first 12 presidents of the German Society for Psychiatry and Neurology had been organizers of the “euthanasia” program. One German professor of psychiatry involved in the killing of children, Werner Villinger, was invited to a White House conference on children.
For decades, this history was nowhere to be found in psychiatric textbooks or histories of psychiatry, and for the most part, such texts continue to avoid it today. At times, texts have even cited Rudin and other German psychiatrists from this era for their “pioneering work” in the “genetics of psychiatric disorders.” Twin studies dating back to the Nazi era are still cited for providing evidence that there is a strong genetic component to “schizophrenia.”
Genetic theories about schizophrenia and other major mental disorders, Read and Masson write, remain “a cornerstone of biological psychiatry” today. After the war, such notions were promoted in American psychiatry and abroad. From 1947 to 1956, the American Journal of Psychiatry published annual updates of “psychiatric progress” on the issue of “Heredity and Eugenics,” which were written by Franz Kallmann, who had argued in the 1930s, while living in Germany, that not only “schizophrenics” but also their relatives should be sterilized.
In the 1950s, Kallmann began advocating “genetic counseling” as a method for removing defective schizophrenia genes from the gene pool. That practice remains alive and well. Schizophrenia is still touted today as having a strong genetic basis, despite a failure to identify specific genes for the disorder and findings that genetics, in fact, account for only a very small percentage of risk factors. Yet, a 2008 survey reported that U.S. psychiatrists “expressed a strongly positive view of genetic testing,” with a leading U.S. website, schizophrenia.com, stating that “genetic counseling for psychiatric conditions such as schizophrenia is becoming more widespread and its use is being successfully demonstrated.”
Read and Masson write: “This practice, of informing people diagnosed with ‘schizophrenia’ and their relatives that their offspring might inherit the supposed illness, thereby discouraging reproduction, is still with us.”
In addition, they note, today there is forced treatment of mental patients with “drugs that shorten life span, and cause stupor and sexual dysfunction” and the promotion of “electric shocks that often cause memory loss and brain damage.” These are practices that, at least to some, echo the abuses of the eugenic era.
This is a connection of past to present that is not welcomed in psychiatry today. Read and Masson first submitted their article to the journal History of Psychiatry, which rejected it because it was “not suitable for the current objectives and thematic balance of the Journal.”
Read and Masson have explored this dark chapter with the hope of reforming care today. Knowing this past, they write, can help produce a paradigm shift toward a more humane, trauma-informed model of care.
“It is incumbent on all mental health workers, on all of us in fact, to be constantly on the lookout for our own failures to perceive the myriad ways in which humans are harmed by other humans, including—perhaps the hardest of all to acknowledge—by mental health staff themselves.”
Read, J., Masson J. (2022). Biological psychiatry and the mass murder of “schizophrenics”: From denial to inspirational alternative. Ethical Human Psychology and Psychiatry 24(2). https://doi.org/10.1891/EHPP-2021-0006. Link