"I’ve always been fascinated with the Holocaust," said psychiatrist E. Fuller Torrey, M.D. "It's always seemed to me the most important thing that has happened in my lifetime. And I'm especially intrigued that it happened in the country that had at the time the highest level of education in the world. That's always said something important to me—we think we are civilized, but the truth is that we are only a few years out of the trees. Our veneer of civilization is remarkably thin."
That interest in the Nazi Holocaust recently led Torrey to examine one of the less-publicized aspects of the Nazi Party's murderous quest for racial and genetic "purity"—namely, the systematic murder and sterilization of people with mental illness, especially schizophrenia.
In an article in the September 16 online Advance Access section of Schizophrenia Bulletin, Torrey noted that the project had the participation of individual German psychiatrists and encountered little or no organized resistance from the German psychiatric profession. Culling data from published sources in English and German, Torrey and fellow researcher Robert Yolken, Ph.D., summarized the grim facts: in the years 1933 to 1945, between 220,000 and 269,500 individuals with schizophrenia were either sterilized or killed, representing all of those persons with schizophrenia living in Germany at the time.
Moreover, the systematic killing of patients with schizophrenia appears to have served as a kind of trial for the methods that would later be adopted in the colossal destruction of European Jewry. Torrey and Yolken wrote that in July 1939, two months before Germany's invasion of Poland, Adolf Hitler asked his personal physician to draft a law permitting the killing of mental patients; Hitler signed it into law on September 1 of that year, the day of the invasion.
"The planning and logistics for such mass murder elicited much discussion," they wrote. "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 teeth of 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."
In their article, Torrey and Yolken recount the growing popularity in the early 20th century of the ideas of eugenics and racial hygiene; the dramatic increase in the number of institutionalized psychiatric patients following World War I, when Germany underwent extensive economic hardship, and the subsequent search for ways to decrease their numbers and associated costs; the growing support for "euthanasia" among Nazi leaders and some within German psychiatry; and finally the development of a policy and program for killing mental patients—known as Aktion T-4—and the spread of methods used in the program to the larger project of killing Jews and others in the Holocaust.
The authors acknowledged that the quantity and quality of data on the subject have limitations and that the number of individuals killed in the project is an informed guess based on reasonableness and consistency with related data. They urged more research in this area of the history of psychiatry.
Torrey and Yolken cited 26 sources on the history of the Holocaust, medicine, and racial policies under the Nazis, and epidemiology of schizophrenia before and after the era of Nazi rule. Among these are Death and Deliverance: "Euthanasia" in Germany c. 1900-1945 by Michael Burleigh (Cambridge University Press, 1994); Cleansing the Fatherland: Nazi Medicine and Racial Hygiene by Aly, Chroust, and Pross (Johns Hopkins University Press, 1994); and Racial Hygiene: Medicine Under the Nazis by Robert Proctor (Harvard University Press, 1988).
Torrey told Psychiatric News that the story of the killing of schizophrenia patients is relatively unknown. "I have talked to friends and colleagues about it, and one of the most surprising things is the number of colleagues who have never heard about it," Torrey said in an interview. "This includes people my own age. It's something we don't talk about, but it's very important to realize this happened. Psychiatrists played a leading role in it, and it is part of our history.
"If we forget it, it's at our own risk," Torrey said.
Was there no protest against the policy? "There were individuals who protested certainly," Torrey said. "I'm not aware of any protest from organized German psychiatry. If you wanted a bright future in Nazi Germany, you would not be enhancing your prospects by saying ‘We shouldn't be doing this.’
"German colleagues have said to me, ‘You forget that there were people who were trying to save patients,’ " Torrey said. "I'm sure that happened. Of the degree to which it happened, I've never seen a good estimate."
Torrey and Yolken pointed out that the Nazis' reasoning for killing patients with schizophrenia was also founded on an erroneous notion that the disease was entirely genetic. The number of existing cases—or the prevalence—of the disease after the war was low, as expected, because of the killings.
More surprising was the fact that the incidence, or the number of new cases, was high suggesting that factors other than genes played an important role in schizophrenia.
For instance, the first postwar study of the incidence of schizophrenia in Germany was done in Mannheim in 1965, 20 years after the last patients had been sterilized or killed. That study found an incidence rate of 53.6 per 100,000—which was two to three times as high as the rates in the United States and England; other postwar studies found similar results.
Torrey and Yolken discussed several possibilities for this, but suggested that the most likely explanation is that social conditions after the war produced environmental factors—famine, disease, and poverty—that led to an increase in new cases of schizophrenia.
"An example was the increase in schizophrenia in Holland that followed the Dutch Hunger Winter in 1944-1945," they noted. "The cause of the high schizophrenia incidence rates in postwar Germany is thus not apparent and is an appropriate subject for additional research."
An abstract of "Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrennia" is posted at <http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/sbp097>.