Medical Murder

1. German Psychiatry

The participation of physicians, especially psychiatrists, in the Holocaust is unprecedented in history. The crimes of German Psychiatry are unique and unprecedented in the history of mankind. The mass murder of Jews, Gypsies, and homosexuals was prepared and preceded by the medicalized mass murder of mental patients.

2. Prior to the Nazis Period

Long before the Nazis came to power psychiatrists in Germany referred to their "patients" in an inhuman manner, and consequently argued for and used inhuman methods of "treatment".
Emil Kraeplin, 1918: "An absolute ruler who unscrupulously interfered with human habits would, without any doubt, and in the course of only a few decades, effect a decline in memtal debility".
In 1931, Hermann Simon, director of the Anstalt (mental institution) in Gütersloh, precisely defined those categories of people deemed to be inferior. These included: the physically ill, the invalid, the weak, the imbecile, the crippled, and the insane. Simon concludes: "Some must die".
Ernset Rüdin, 1934: "The psychiatrist and healthy people are allies against the genetically defect. The psychiatrist must render his service in the furtherance of a hereditary pure, able and superior race."
Rüdin, who regarded compulsory sterilization as the "most humane act of mankind", says in 1934 about Hitler: "Only Adolf Hitler's political work made it possible to raise and strengthen people's awareness of the meaning and importance of the purity of race. Our dream, which we have had for the past 30 years, has finally become reality."

The Nazis did not need German Psychiatry, German Psychiatry needed the Nazis. (Ernst Klee)

3. Chronological Table

30.01.1933	Appointment of Hitler as "Reichskanzler".
22.03.1933	Opening of Dachau, the first concentration camp.
24.03.1933	Passing of the "Ermächtigungsgesetz". Hitler aquires unrestrictive power.
14.07.1933	Passing of the "Gesetz zur Verhütung erbkranken Nachwuchses" (Law to prevent hereditary disease). Between 1934 and 1939 circa 400,000 persons were sterilised.
18.10.1935	Passing of the "Gesetz zum Schutz der Erbgesundheit des Deutschen Volks" ("Ehegesundheitsgesetz") (Law to protect the genetic health of the German Nation (Marriage Health Law)).
1.09.1939	German troops invade Poland. Start of World War II.
1.09.1939	Decree to end sterilisation.
1.09.1939	Hitler personally signs the "Euthanasie-Erlaß" (Euthanasia Decree)
September 1939	Murder of patients in Polish psychiatric institutions.
October - December 1939	Beginning of "Aktion T 4" · Founding of the central organization (Reichsarbeitsgemeinschaft Heil- und Pflegeanstalten, gemeinnützige Krankentransportgesellschaft, gemeinnützige Stiftung für Anstaltspflege, Zentralverrechnungsstelle Heil- und Pflegeanstalten), located at Tiergartenstraße 4, in Berlin. · Reporting to Berlin of all hospitalised patients. · Establishment of the killing machinery in six psychiatric hospitals.
End of 1939 - 24.08.1941	Murder of 70,000 psychiatric patients within the German Reich.
15.01.1940	Decree to report all Jewish patients, and the beginning of their killing after transferral to psychiatric institutions in the "Generalgouvernement" Poland (primarily Cholm near Lublin).
1940	Beginning of the establishment of 21 children's units. By 1945 circa 10,000 children and youths were murdered in these.
24.08.1941	Conclusion of "Aktion T 4".
17.11.1942	Introduction of the "Hungerkost" (Starvation Diet) in many Reich institutions. Circa 90,000 people died as a result of this.
6.04.1944	Decree to establish "Ostarbeiter-Sammelstellen" (units for forced labour from east European countries) in 11 psychiatric institutions. Beginning of the killing of the "useless" forced labourers.
1942 - 1945	Time of the "wilde Euthanasie" (wild euthanasia). In circa 15 institutions special wards were installed. Here patients were mainly killed with Luminal and Morphium-Scopolamin injections.

4. Action T 4

On 1st September 1939, the "Ethanasieerlaß" (Euthanasia Decree) was disclosed to the directors of psychiatric institutions inside Germany's prewar boundaries. The directors were ordered to send a registration form for each patient to a specifically created administration in Berlin, in order to ascertain if the patient fulfilled the necessary criteria for death. A group of well-know psychiatrists was appointed as "T 4 Gutachter" (T 4 Experts), who re-examined the registration forms. One group of experts travelled from institution to institution in order to check the completeness and correctness of the reports, especially with those few institution directors who tried to delay the reports.

Six institutions within Germany's prewar boundaries were emptied of their patients and gas chambers were installed. A transport company, specially founded for this purpose, brought the selected patients from the psychiatric hospitals to the extermination institutions, mostly in groups of 40 to 120 patients. Immediately on arrival the patients were undressed, photographed, numbered with a stamp on the shoulder or arm, briefly seen by a doctor who checked their identity by means of a file, whereupon they were led into the gas chamber. Carbon Monoxide was introduced into the chamber while a doctor observed through a window.
After death gold teeth were extracted and the bodies burned in crematoriums. Relatives received a report that the person concerned had died of an illness.

It was not possible to keep these proceedings secret. The staff of the hospitals of origin as well as relatives soon became aware of the fate of the patients. There were relatives who protested, and there were staff of hospitals who advised relatives to take patients home in order to save them from this fate. Thereby, a few were able to be rescued from death.
A total of 70,273 people were killed in these six institutions.
Due to increasing public criticism, and for organizational reasons, this action was terminated by a decree on 24th August 1941.

5. Euthanasia of Children

"...möchte ich Sie noch höflichst bitten, mir folgende Fragen zu beantworten:", Beate Passow, 1996.
"...I want to most courteously ask you to answer the following questions:", Beate Passow, 1996.

Children were excluded from Aktion T 4, but by October 1939 a special children's unit was established in Görden, where the killing of children began. After the termination of "Euthanasia Aktion T 4" in August 1941, the euthanasia of children was systematically developed. At least 21 special units were established within Germany's prewar boundaries. The directors of the units were authorised to kill children. Children were transferred to these wards from hospitals and welfare organisations who selected them for the euthanasia programme. They were then transferred to special units after approval by the Central Organisation in Berlin. Children were transferred to these special wards as "observation cases". The doctor responsible then made a report, by which the central office in Berlin decided if the child should continue to be observed, or killed. The latter were given Luminal in tablet form, or mixed with food, wherupon they became unconscious and died after two to five days. Sometimes Morphium Scopolamin was injected.
Circa 5,000 children were killed within Germany's prewar boundaries, for example in Bavaria 695 children were killed.

This programme was scientifically promoted and organised by the universities.
The resistance of psychiatrists to this programme was strongest. So many left their appointments that there became a shortage of doctors. In June 1943 the professors Rüdin, De Crinis, Carl Schneider, Heinze and Nitsche sent a memorandum to the "Generalkommissar des Führers für das Sanitäts- und Gesundheitswesen", Professor Karl Brandt, which contains the following sentence: "There has been an exodus of capable doctors from Psychiatry into other medical areas."

Hamburg:

The mentally handicapped, who were systematically murdered by the Nazis during the war as they were considered to be a burden to society, and not regarded as being worthy of life, are amoung the most frequently "forgotten" victims of national socialism.
Mentally handicapped Jews were especially vulnerable as they had no chance of emigrating.
Such an example in Hamburg was the treatment of handicapped patients in the Alsterdorf Institution. From 1937 onward, Pastor Lensch, the head of the institution, attempted not to admit any more Jewish patients, and to quickly transfer the more than 20 Jewish patients already living in the institution to other mental institutions. He later justified this policy by alleging that the charitable status of the institution was threatened. This was a pretext as the Hamburg authorities wanted to accommodate mentally handicapped patients in Alsterdorf at this time.
On 31st October 1938, 16 Jewish mentally handicapped patients were deported to the state-run Langenhorn institution, and further patients soon followed them there, or were transferred to other state-run institutions such as that in Farmsen.
On 23rd September 1940, the first 150 Jewish patients were deported to Langenhorn nursing home and murdered there. This was referred to as "euthenasia". Amoung those murdered were patients who had been expelled from the Alsterdorf Institution.
A total of over 3,000 handicapped people from Hamburg were murdered in this way during the war.

The Evangelische Stiftung Alsterdorf has since confronted itself with its history during the Nazi period, and has erected a memorial to the deported victims, of whom many were non-Jews, in the institution's entrance at No. 3 Dorothea-Kasten-Straße, 22297 Alsterdorf.

6. Death by Starvation

On 15th November 1942 a conference of directors of all Bavarian psychiatric hospitals was held in the Bavarian Ministry of the Interior. After the war, a participant of this conference reported the following to the American investigating authorities:
"In November 1942 the medical directors of all Bavarian psychiatric hospitals were summonded, by secret letter, to the Health Department of the Bavarian Ministry of the Interior in Munich. The meeting was immediately declared secret. The directors had to justify the number of deaths in their institutions, which had risen in number due to starvation and tuberculosis. Despite this, the chairman explained that far too few patients were dying, and that it was not necessary to treat arising illnesses.
The director of the Heil- und Pflegeanstalt Kaufbeuren gave a short explanation of his personal procedure. Initially, he had been opposed to euthanasia, but when he learnt of the official statistics, he regretted that euthanasia had been stopped. He now gave patients in his institution, that would have formerly come within the euthanasia programme, a completely fat-free diet; he especially stressed fat-free. The patients died of famine edema within three months. He recommended this procedure to all institutions as being what was called for.
The chairman accepted this recommendation, and gave the immediate order that this "starvation diet" be put into practice in all institutions. There was to be no written order, but it would be checked whether the order had been followed or not."

The starvation diet was introduced in many hospitals, first in Bavaria, and later nationwide.
Around 90,000 people died either directly as a result of the starvation diet, or indirectly from a starvation induced illness, mainly tuberculosis.

7. Human Experiments

It is only in recent years that it has come to light that "medical" experiments on humans were also performed in psychiatric institutions. To this date little is known of these experiments. It is also still unclear what the purpose of the I.G. Farben laboratories were, which were installed in many psychiatric institutions.
At the beginning of the 1990s, G. Schaltenbrand's experiments were discussed again. In 1940, in the Werneck psychiatric hospital, he had injected chronic mentally ill patients intradernally and cisternally with spinal fluid from apes, the latter having been previously injected with spinal fluid from multiple sclerosis patients.

8. Forced Labourers in Psychiatry

On 6th September 1944 the Reichsminister of the Interior ordered the establishment of special units for "Ostarbeiter" (labourers from Eastern Europe) in several psychiatric hospitals in the Reich. The reason given was that: "With the considerable number of "Ostarbeiter" and Poles who have been brought to the German Reich as a labour force, their admission into German psychiatric hospitals as mentally ill patients has become more frequent ...
With the shortage of space in German hospitals, it is irresponsible to treat these ill people, who in the foreseeable future will not be fit for work, for a prolonged period in German institutions."

The exact number of "Ostarbeiter" killed in these psychiatric institutions is as yet not known.
189 "Ostarbeiter" were admitted to the "Ostarbeiter" unit of the Heil- und Pflegeanstalt Kaufbeuren; 49 died as a result of the starvation diet, or from deadly injections.

9. The Psychiatrists

These were:
1. Doctors who were active in and primarily responsible for the different euthanasia organisations.
They directed and administered the different euthanasia programmes.
2. The T 4 Experts, psychiatrists in positions of responsibility, mostly clinic directors, who observed and controlled the selection of those to be killed. They advised those who were primarily responsible, and themselves determined killings and carried them out.
3. Numerous doctors in universities, who laid the scientific foundations of the euthanasia programme and used its victims for scientific purposes.
4. Psychiatrists in institutions involved with these actions and who carried them out with conviction by sending the registrations to Berlin, making transferrals to killing institutions, and participating in killings.
There were also:
1. Psychiatrists who refused to participate in the euthanasia programmes, and who withdrew, were transferred, or retired.
2. Some psychiatrists who secretly tried to save patients, who delayed registration, who did not introduce the starvation diet, etc.
3. Some psychiatrists who actively and openly protested.
This protest did not provoke any disadvantageous consequences.

10. Post-Nazi Death by Starvation

On 28th April 1945, the day of liberation, the Brandenburg Anstalt (mental institution) Teupitz, accommodated 600 inmates. By the end of October, the number had declined to a mere 54.
At the Saxon Anstalt (mental institution) Altscherbitz, more people died in 1945 than during Nazi times. The mortality rate in 1945 was 36·5%, i.e. 838 people. In 1947, the rate rose to 38%, i.e. 887 people.
At the Saxon Anstalt (mental institution) Großschweidnitz, 1,012 inmates died in May 1945 alone.
At the Wurttemberg Anstalt (mental institution) Zwiefalten, the mortality rate in 1945 was 46·5%, double what it was in 1944.
At the Pommeranian Anstalt (mental institution) Ueckermünde, the mortality rate in 1945 was 55%.
At the Anstalt (mental institution) Bernburg/Saale, in 1945 the mortality rate doubled.
During Nazi times Schloß Hoym (Hoym Castle), in Saxony, functioned as a "killing institution" for so-called psychiatric patients in need of constant care. Again mass dying only started after liberation. In 1945 it housed 500 inmates, however the "average demand for coffins" was not less than 250.
At the North Rhine-Westphalia Anstalt (mental institution) Düsseldorf-Grafenberg, the mortality rate between 1946 and 1947 was 55%. In 1948/49 it was still 30%. Prior to Nazi times, the Grafenberg mental institution supplied the pharmaceutical company Bayer-Elberfeld with "test objects" for their anti-malaria research.

Heinz Faulstich was one of the first psychiatrists to document murder by starvation. He gives a minimum number of 20,000 deaths due to starvation in the post-war period. It is impossible to obtain an exact number as many of the relevant asylums and homes have destroyed data and relevant documents.

There is one exception: staff of the Wittenauer Heilstätten, in Berlin, have critically investigated and assessed the historical role of their clinic. Between 1938 and the end of the war, on 24th April 1945, 4,607 patients were killed, usually within 20 days of admittance. After liberation 2,500 people were newly admitted, and 1,400 patients "died" within the same year, i.e. around 55%.
In 1957, the institution was renamed the Karl Bonhoeffer Clinic of Neurology. Bonhoeffer played a key part in the "sterilization of the mentally inferior", and, like many others, did so voluntarily. Despite retirement he continued to work for the racial sterilization courts. In December 1941 he examined a Jewish "Mischling" ("half-cast"), who had once been admitted to a psychiatric unit 14 years previously. The NS-Erbgesundheitsgericht (the Court for the Protection of German Blood and Honour) itself hesitated in condemning, as the examined individual showed no symptoms of disease, and worked normally. Nevertheless, Bonhoeffer advised sterilization.

The forcibly sterilized were victims of Nazi Germany's racial policies. However, their victim status has never been legally accepted, thereby preventing these people from being able to claim compensation. They are solely dependent on social support.

The perpetrators were able to further their careers after the war. Further, they shamelessly acted as experts and consultants in cases for compensation, deriding their victims further by declaring that, considering their "inferiority", no signs of emotional damage could be established.
One of the most honoured and respected psychiatrists in post-war Germany was Professor Helmut E. Ehrhardt, from 1937 onward member of the NSDAP (National Socialist Workers Party), i.e. the Nazi Party, and professor of Forensic and Social Medicine in Marburg.
Ehrhardt frequently functioned as a "whitewasher" of Nazi Psychiatry. He gave his expert opinion to the Federal Ministry of Finance: "To regulate compensation claims of those sterilized would, in most cases, only lead to derision, and could not justify the real thought behind reparation."
Ehrhardt was awarded the Paracelsus Medal, the highest honour of the German medical profession. He was also a member of the Mental Health Advisory Board of the World Health Organisation, the Ethical Committee, and the Forensic Section of the World Federation of Psychiatry, of which he eventually became honorary member.

In 1946, the Viennese Professor of Psychiatry, Otto Plötzl, gave medical evidence that poisoning was a particularly humane form of killing because people "slowly drifted" into death.
The Viennese forensic medical expert, Leopold Breitenecker, voiced a similar opinion when, in 1967, he said: "Death by gas is one of the most humane forms of death imaginable." Breitenecker was asked to examine Aquilin in testimonies against medical doctors responsible for gassings. Founder of the Austrian Association of Forensic Medicine, he was a member of various ethical committees.

Psychiatrist's protection of their murderous colleagues has always taken priority over the suffering of their victims. This is the only explanation of how Werner Heyde, Professor of Psychiatry and head of gasings was able to practice under the false name of Dr Sawade, and act as an expert for claims of compensation. This is inconceivable without the knowledge of his colleagues.

Protection lasted until death:
Lower Saxony's General Medical Council's obituary for Dr Klaus Endruweit, responsible for the gassings at the Anstalt (mental institution) Sonnenstein, in Pirna, states: "We will honour and remember him".
The obituary notice of the clinic in Wunstorf for Heinz Heinze, former director of the largest institution for the homicide of children states: "In honoured commemoration".
The obituary notice of Kiel University for Professor Werner Catel, who conducted the mass murder of children reads: "he contributed in many ways, to the welfare and well-being of sick children".
The obituary notice of the Düsseldorf University Clinic of Psychiatry for Professor Friedrich Panse culmnates with: "A life in the service of suffering people ... is completed". Panse was a T4- advisor who "expertly guided" patients into the gas chambers.

Until today, the perpetrators of these crimes are treated more sympathetically than their victims.
Those who honour the perpetrators of these crimes kill their victims a second time. (Ernst Klee)

Literature:

Klee, Ernst: Auschwitz, die NS- Medizin und ihre Opfer, S. Fischer, 1997

Klee, Ernst: Dokumente zur Euthanasie, Fischer

Klee, Ernst: Euthanasie im NS- Staat. Die Vernichtung lebensunwerten Lebens, Fischer, 1985

Klee, Ernst: "Schöne Zeiten", Judenmord aus der Sicht der Täter und Gaffer, Fischer, 1988

Im Memoriam, Catalogue to the Exhibition commemorating the victims of the Nazi Euthanasia Programme on the occasion of the XI World Congress of Psychiatry/Hamburg, 1999.

Faulstich, Heinz: Hungersterben in der Psychiatrie 1914-1949. Mit einer Topographie der NS- Psychatrie. Lambertus, 1997.

Leibbrand, W.: Um die Menschenrechte der Geisteskranken, Verlag Die Egge, Rudolf Tauer Nürnberg, 1946.

Mitscherlich, A. und Mielke, F.: Medizin ohne Menschlichkeit, Dokumente des Nürnberger Ärzteprozesses, Fischer Bücherei KG, Frankfurt an Main und Hamburg, 1960.

Dörner, D./Haerlin, C./Rau, V./Schernus, R./Schwendy, A.: Der Krieg gegen die psychisch Kranken, Nach "Holocaust": Erkennen-Trauern-Begegnen, Rehburg-Loccum: Psychiatrie Verlag, 1980.

Schmidt, G.: selektion in der Heilanstalt 1939-1945, suhrkamp taschenbuch, 1943.

Finzen, A.: Auf dem Dienstweg, Die Verstrickung einer Anstalt in die Tötung psychisch Kranker, Rehburg-Loccum: Psychiatrie Verlag, 1983.

Seidel, R./Werner, W.F.: Psychiatrie im Abgrund, Spurensuche und Standortbestimmung nach den NS-Psychiatrie-Verbrechen, Rheinland-Verlag GmbH, Köln, 1991.

Hinterhuber, H.: Ermordet und Vergessen, Nationalsozialistische Verbrechen an psychisch Kranken und Behinderten, VIP.Verlag, Innsbruck-Wien, 1995.

Faulstich, H.: Hungersterben in der Psychiatrie 1914-1949, Mit einer Topographie der NS-Psychiatrie, Lambertus-Verlag, Freiburg im Breisgau, 1998.

Cranach, M. von und Siemen, H.L.: Psychiatrie im Nationalsozialismus, Die Bayerischen Heil- und Pflegeanstalten zwischen 1933 und 1945, R. Oldenbourg Verlag München, 1999.

Struan Robertson