Volker Roelcke

International Relations in Psychiatry: Britain, Germany, and the United States to World War II.

The decades around 1900 were crucial in the evolution of modern medical and social sciences, and in the formation of various national health services systems. The modern fields of psychiatry and mental health care are located at the intersection of these spheres. There emerged concepts, practices, and institutions that marked responses to challenges posed by urbanization, industrialization, and the formation of the nation-state. These psychiatric responses were locally distinctive, and yet at the same time established influential models with an international impact. In spite of rising nationalism in Europe, the intellectual, institutional, and material resources that emerged in the various local and national contexts were rapidly observed to have had an impact beyond any national boundaries. In numerous ways, innovations were adopted and refashioned for the needs and purposes of new national and local systems. International Relations in Psychiatry: Britain, Germany, and the United States to World War II brings together hitherto separate approaches from the social, political, and cultural history of medicine and health care and argues that modern psychiatry developed in a constant, though not always continuous, transfer of ideas, perceptions, and experts across national borders. Contributors: John C. Burnham, Eric J. Engstrom, Rhodri Hayward, Mark Jackson, Pamela Michael, Hans Pols, Volker Roelcke, Heinz-Peter Schmiedebach, Mathew Thomson, Paul J. Weindling, Louise Westwood Volker Roelcke is professor and director at the Institute for the History of Medicine, Giessen University, Germany. Paul J. Weindling is professor in the history of medicine, Oxford Brookes University, UK. Louise Westwood is honorary research reader, University of Sussex, UK.

Medicine during the Nazi Period: Historical Facts and Some Implications for Teaching Medical Ethics and Professionalism

Since die early 1980s, much historical research has been done on medicine during che Nazi period.1 In general, this research has focused on three issues: 1. The relationship between physicians and the state, with two subheadings: the relationship between German physicians and the new regime and the fate of Jewish and socialist physicians under Nazi policies.2 2. The eugenic and racial health policy, which resulted, among other things, in the compulsory sterilization of at least 360,000 individuals and the killing of almost 300,000 psychiatric and mentally handicapped patients.3 3. The atrocious human subjects research in concentration camps and elsewhere.4

Apologising for Nazi medicine: a constructive starting point.

At long last: in May 2012 the German Medical Association (GMA) has apologised for medical atrocities under National Socialism (appendix). Although overdue, the apology is necessary and highly commendable, not least as survivors of medical atrocities and persecution are still living.

Psychotherapy between medicine, psychoanalysis, and politics: concepts, practices, and institutions in Germany, c. 1945-1992.

Looking back at almost fifty years of psychotherapy in post-war Germany, Annemarie Duhrssen (1916–98), one of the grand old ladies of the discipline, proudly presented a story of success in 1994. In the immediate post-war years, between 1946 and 1950, there were already a considerable number of individuals and groups all over the country active in establishing hospitals or outpatient clinics exclusively devoted to psychosomatic medicine and psychotherapy; in 1950, the first university programme in the subject was set up in Heidelberg; in 1967, psychoanalytically oriented psychotherapy was included in the catalogue of services offered by the statutory health insurance system; and in 1970, psychosomatic medicine and psychotherapy had become obligatory subjects in the curriculum of medical students, resulting in the establishment of chairs in these areas at almost every medical faculty in West Germany.1 According to her evaluation, this development was due to the increasing awareness and willingness of psychoanalysts to prove the efficacy of their approach in “scientific” terms, and to the equally increasing awareness among representatives of health policies of the psychological dimension of disease causation and rational disease management.2 However, a closer look at the period in question shows that all the high points and achievements listed by Duhrssen were the result of complex negotiations between various and shifting groups of physicians, psychologists and politicians, who were heavily dependent on intellectual resources and professional alliances inherited from the first decades of the twentieth century, political attitudes created in public debates following the defeat of Nazi Germany and, finally, financial funds supplied according to political and economic deliberations and in part provided by foreign sources. In this article, I shall reconstruct and contextualize one of the major “events” among these developments and outline its significance for the broader history of psychotherapy in post-1945 West Germany: the establishment of the department of psychosomatic medicine and psychotherapy at the University of Heidelberg, which was the first academic programme in psychotherapy at a German university. The paper is divided into three parts: the first gives an outline of early initiatives towards an institutionalization of psychotherapy and the resources used for these activities; the second part focuses on the establishment of the Heidelberg programme in the late 1940s as a case of conflict involving professional interests and struggles over appropriate answers to the activities of the “doctors of infamy” in the Third Reich; and the third gives an overview of the further developments and features of psychotherapy in West Germany since the early 1950s.

Erbbiologie und Kriegserfahrung in der Kinder- und Jugendpsychiatrie der frühen Nachkriegszeit: Kontinuitäten und Kontexte bei Hermann Stutte

Der Protagonist der Kinder- und Jugendpsychiatrie Hermann Stutte verwendete in der fruhen Nachkriegszeit wissenschaftliche Pramissen, Sprache und Wertvorstellungen aus der eugenisch-rassenhygienischen „Erbgesundheitspolitik“ der Zeit des Nationalsozialismus: Mit Verweis auf Stuttes empirische Forschung aus der Zeit des Nationalsozialismus, die zur eugenischen Optimierung der Bevolkerung beitragen sollte und soziale Normen des NS-Staates mit psychischer Normalitat gleichsetzte, wurden von Stutte auch in Nachkriegspublikationen eugenisch-genetische Deutungen jugendlicher „Dissozialitat“ proklamiert, wahrend psycho- und soziogenetische Interpretationen marginalisiert wurden. Normabweichendes Verhalten wurde nicht als Resultat von Krieg, Entwurzelung und Verlust von Eltern gedeutet, sondern vorwiegend als Ergebnis von Erbfaktoren. Daher konne „dissoziales“ Verhalten kaum durch sozialpadagogische oder psychotherapeutische Methoden beeinflusst werden, sondern aus okonomischen Grunden sollte eine fruhzeitige Diagnostik erfolgen, mit Einweisung von „erblichen“ Zustanden der „Unerziehbarkeit“ in Verwahranstalten.

Book Review: Nazi medicine and the Nuremberg trials: from medical war crimes to informed consent.

During the last decade or so, the relation between medical practitioners, biomedical scientists, and politics has received growing attention in the historiography of medicine. Central issues in this field of inquiry are questions such as the degree of autonomy of the medical profession and of biomedical sciences in different political contexts, or the impact of changing intellectual and material resources, as well as moral frameworks in various political settings on the attitudes, conceptualizations, and practices of physicians and scientists. Obviously, periods of political crisis, totalitarianism, or war may be used as exemplary historical cases to elucidate these interrelationships. The case of medicine during the Nazi period provides a prime example for the examination of the structure and dynamics of such interrelations. Indeed, the recent historiography of Nazi medicine has elucidated that most of the medical practices, health policies, and biomedical research endeavours during this period cannot simply be set aside from the rest of twentieth-century medicine as something entirely different, only to be explained by the arbitrariness of ruthless racial ideologists ruling a totalitarian state. Apparently, there is nothing really specific about Nazi medicine and biomedical science, and strictly restricted only to the limited period between 1933 and 1945. Rather, it is increasingly becoming clear that in many respects the Nazi period confronts us with extreme manifestations of features inherent in modern medicine in general. Much of what was done was not simply the result of state oppression, but rather of the initiative, or at least willing co-operation of medical practitioners or researchers who used the ramifications of the Nazi state to stabilize or increase their status within the medical or scientific community, and to get access to new resources, including funds and human subjects deprived of their rights for research purposes. In his new book, Paul Weindling has addressed these issues through the focus of the Nuremberg Medical Trial. It was organized by the American Military Authorities and ran from December 1946 until August 1947. Of the twenty-three defendants (twenty of them physicians), seven were sentenced to death, nine to imprisonment of various duration, and seven were acquitted. Together with the judgement, the court also formulated the Nuremberg Code, the first attempt at an international level to define the conditions and limits of legitimate research on human subjects, with the principle of “freely informed consent” at its core. The authors account is built on an impressive, indeed extraordinary range of unpublished and published sources, retrieved from archives in the US, the UK, Germany, Israel, and a number of further European countries, and complemented by oral history interviews with a number of the historical actors. As Weindling shows, the developments leading to the trial, and the trials own dynamics were driven by the activities of a wide variety of historical actors. These included surviving victims of atrocious medical experiments, physicians and biomedical scientists on the side of the Allies (such as Leo Alexander, Andrew Ivy, and John Thompson) who acted as investigators and expert witnesses; lawyers both on the side of the prosecution, and of the defendants; judges; observers (e.g. Alexander Mitscherlich, Francois Bayle, etc.); and politicians. All these actors pursued their own interests, sometimes in convergence, often in conflict with the activities of other groups or individuals. In particular, Weindling carves out the tensions between the Allies (in the context of the beginning Cold War), as well as between politicians/civil servants on the one side, and highly motivated lawyers on the other. These conflicts referred to very basic issues such as the kind and range of charges raised, the potential extradition of perpetrators, and the right of witnesses to give evidence. In consequence, it was politics that drove the decision to locate the trial at Nuremberg, and defined its scope and participants—rather than the “nature” of the medical, moral, and legal issues at stake. As Weindling also clearly documents, severe conflicts existed regarding the goals of the immediate post-war investigations, in particular between the aim of exploiting German medical know-how, and prosecuting its criminality. Seen from a somewhat different perspective, there existed a tension between an agenda that aimed at an overview of institutional structures and mentalities (enabling both medical knowledge, and—if let free—medical atrocities), and another agenda focused on the identification of individual perpetrators, as well as proof of their responsibility. During the pre-trial investigations, both the American and the British medical associations, and protagonists of biomedical sciences were soon concerned that releasing news of the German atrocities might undermine public confidence in medical research. This caused medical investigators to attempt to formulate new ethical standards to ensure the future of research-based clinical medicine as early as July 1946, well before the opening of the trial. Thus, the Nuremberg Code was not simply a legal tool for the indictment of Nazi perpetrators, but the result of attempts to draw a clear line between the presumed “politically abused” pseudo-science of Nazi physicians, and “proper” science elsewhere. Such a picture implied that Nazi medicine and science were coerced by a powerful state—a picture both Allied and German doctors cherished in the post-war era, albeit for different reasons. However, Weindling also reconstructs in detail how the discussions during the trial again and again blurred such a presumed clear demarcation. By looking closely at the evidence presented at the trial, Weindling adds substantial knowledge and insight to recent historical research on the biomedical sciences during the Nazi period. He reconfirms the conclusion that rather than being the result of a coercive state, Nazi medicine illustrates how medical researchers and their representative bodies (such as the elitist Kaiser-Wilhelm-Society) co-operated with and even manipulated a totalitarian state and political system relying on expert opinion, in order to gain resources for the conduct of research without any moral and legal regulation. It is a further merit of Weindlings book that it gives a strong voice to the victims, depicting them not as passive historical objects, but as active agents in their specific contexts, for example, by transforming the Allied scientific monitoring operation into a quest for medical war criminals. The book thus paves the way for an agenda of future historical work: to reconstruct the history of Nazi research on human subjects from the victims point of view. In sum, Paul Weindlings Nazi medicine and the Nuremberg trials will be a standard reference on the topic. It is also an indispensable book for anyone concerned with the history of the relation between medicine, politics, and ethics in the twentieth century.