Death in the community

Michael Burleigh on the reaction of German health professionals and relatives to the murder of their mentally ill by the Nazis.

My work on Nazi Germany began with a book on the supine involvement of economists, geographers and historians with a pernicious dictatorship. Then, I dec-ided to look at expert professionals, those doctors and psy-chiatrists who organised and operated the Nazi "euthan-asia" programme in which as many as 200,000 people died.

Early into this project, the prospect of demonstrating yet again the rather obvious amorality of the Lumpenintellektueller lost its previous appeal. Instead, I embarked on the more daunting task of combining the history of ethics, psychiatry and health policy, with the archivally-based study of victims, perpetrators and bystanders, although in this case the last two categories proved to be more fluid than originally anticipated. Along the way, the research led to a Channel 4 film, Selling Murder, which used hitherto unseen footage discovered in Potsdam to convey the aberrant logic that informed and justified these policies to wider constituencies.

Last but not least, I forsook the North American way of jetting into archives with laptop ready, reading "all", oddly encapsulated from the society in which these things happened, in favour of spending weeks traipsing round practically every asylum discussed in the book, usually in the company of either someone whose relatives were murdered there, or in some cases, the people who had carried out the killing, secure now in their surrogate role of "objective" living witnesses. Repulsion permanently jostled uneasily with natural sympathy for the aged.

Occasionally, amid the chat about physical decline, the war, Wurst, the local history of their region, football or Olympics on television, there would be some new undocumented fact or insight, or even a visible shudder as something very dark that they had once done momentarily resurfaced. They, after all, shepherded people into gas chambers, peered through the apertures, and then humped corpses up to a makeshift, multi-layered cemetery. The context of these curious activities warrants further explanation.

Calls for the selective elimination of "life unworthy of life" proliferated amid the multiple crises that hit Germany after Versailles. Originating with academics,they involved the relativisitic subversion of the Christian doctrine of the sanctity of human life; the denial of human attributes to the severely disabled and chronically mentally ill; and appeals to the selfishness of the majority through utilitarian "costings" of the burden represented by a growing army of the mad, allegedly enjoying the life of Riley in luxury asylums.

Worryingly, informal opinion-sounding on these questions in 1925 by an asylum director utterly opposed to "euthanasia", revealed that 73 per cent of the parents of handicapped children would approve the death of theirincurable offspring, including measures carried out surreptitiously, or involving falsifying the official cause of death. This intelligence proved to be useful to the Nazis a decade later.

Psychiatrists, whose image was traditionally poor, responded to an austere Weimar budgetary climate by introducing a form of ramified care in the community (including novel forms of paid family fostering) for acute cases, while countering the obvious ill-effects of long-term institutionalisation with a regime based on occupational therapy. The downside of both reforms was an enhanced awareness of the full extent of mental illness in the population at large, and an asylum culture which created non-workingsub-groups among the already marginalised patient population.

The advent of a Nazi government in 1933, and with it health adminstrators explicitly bent on killing those entrusted to their care, led to a steady worsening of conditions in the asylums, ie, dangerously low doctor:patient ratios, compulsory sterilisation, the cessation of independent inspection, a reversion to guided public tours of what amounted to freak shows, and last but not least, a massive propaganda campaign which criminalised the insane, dilated on the cost of their upkeep, and generally insinuated that they would be better off dead. Some true believers needed no such convincing, like the young SS men who after visiting an asylum, came out suggesting setting up machine guns at the entrance to mow down the inmates. Actually the matter was well in hand.

In the autumn of 1939, a covert, prerogative, bureaucracy began organising the killing ofabout 5,000 infants and children, with the programme being rapidly escalated to encompass adult psychiatric patients. In occupied Poland, the SS did not bother medicalising murder, preferring to shoot entire asylum populations into trenches. Up to August 1941, just over 70,000 adults were gassed in six asylums, with the cause of death being picked from a list to match age, sex or prior symptoms. Strokes were no good for the under forties; but pneumonia was serviceable for all age groups.

Detailed statistical charts established how much money, bread, butter, coffee or marmalade would be saved as a result, with the sums extrapolated down to 1951. Although asylum patients continued to be killed down to 1945, the gassing expertise was redeployed to kill "sick" concentration camp inmates, and then redirected against Europe's Jewish population in the death camps -- Belzec, Sobibor, and Treblinka -- which were run by 90-odd former "euthanasia" programme personnel. They trawled out much material gained from an ocean of human loss. Clearly having developed a taste for the work, the same grim crew headed south to Trieste to murder about 5,000 Italian Jews and putative "partisans" in a disused rice warehouse before going on the run to evade Allied retribution.

This cursory outline does not really convey the individual tragedies behind the incomprehensible statistics, for that one has to go to families or patient files; nor the complex moral dilemmas faced by doctors, nurses, relatives, judges, lawyers and churchmen when confronted by policies of the sort described. The staff of every asylum,whether confessional, state or private, (assuming that they did not agree with murdering their own patients), had to make day-to-day decisions about where to draw the line in the pathetically small space left open to their determination, in itself, a deliberate device to spread collusive involvement. Was it better to sift out 50 or a 100 "useless" patients oneself, rather than let others do it more indiscriminately? Here, the economistic reform climate of the l920s returned to haunt the psychiatrists, as capacity to work became the key criterion for selection. Did one risk closure by protesting, or prosecution by falsifying diagnoses on patient records? Did one tip off relatives to take people away?

What of the perpetrators? Very few of the young doctors said "no", usually being overawed by big academic names and grand places. Nurses did what they were told, quickly losing what vestigial sensitivity they may have once possessed.

The relatives present a more complicated picture. Some parents were ready to offload a problem child, to remove a hereditary taint at a time when such things mattered, or were just unable or unwilling to care; some families clearly deliberately decided not to take the hint that something was very wrong in the asylums, missing the chance to have a patient decommitted. As for those who protested,unless they were well-connected,their protests quickly faded out, amid a silent bureaucratic void.

With one honourable exception, the judges and lawyers acquiesced in policies which lacked proper legal sanction; while the higher clergy, again with a few exceptions, tried networkingand equivocal persuasion, with men who were fundamentally contemptuous of them, rather than direct confrontation. One Roman Catholic bishop did protest openly, but another negotiated with those responsible to exclude sick priests and to ensure the administration of the last sacraments to the victims.

We are left then, wondering not about the perpetrators, who repel rather than fascinate,butrather about the maths student who hubristically thought he could take on Einstein in a dissertation; the 11-year-old hydrocephalitic child who related his dreams; the sailor who bestrode the wards wrapped up in sheets convinced he was God; or the lame youth with rickets whose main achievement was negotiating steps on crutches, and who was murdered just as he had begun to discover girls. Restoring their lost voice, rather than counting how many of them were killed, or speculating on the mind-set of careerist, couth or uncouth, bullies, made a gloomy project worthwhile, although it is for others to develop it. Michael Burleigh is reader in international history at the London School of Economics and author of Death and Deliverance: 'Euthanasia' in Germany c.1900-1945, published on October by Cambridge University Press.