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Updated 12 April 2010 E-mail discussion
Printable version

Forum Discussion: Psychiatric Genocide—Nazi Attempts to Eradicate Schizophrenia

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In our Forum discussion “journal club” series, the editors of Schizophrenia Bulletin provide access to the full text of a recent article. A short introduction by a journal editor gets us started, and then it's up to our readers to share their ideas and insights, questions, and reactions to the selected paper. So read on….

Torrey EF, Yolken RH. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2009 Sep 16. Abstract

View Comments By:
John McGrath — Posted 26 September 2009
Ezra Susser — Posted 13 January 2010
James MacCabe — Posted 22 January 2010
Linda Chafetz — Posted 22 January 2010
Tadeusz Nasierowski — Posted 5 March 2010
Rael D. Strous — Posted 14 April 2010
Sanjeev Jain — Posted 20 August 2013

Background Text
By Gunvant Thaker, Professor and Chief, Schizophrenia Related Disorders Program, Maryland Psychiatric Research Center and Deputy Editor, Schizophrenia Bulletin

In a recently published report in Schizophrenia Bulletin (available online), E. Fuller Torrey and Robert H. Yolken review existing data to estimate the extent of Nazi genocide of psychiatric patients during the period of 1939-1945. The report provides an outline of the “scientific” thinking and the societal benefit “logic” that supported the genocide, including horrific details of the methods used to implement the plans. Torrey and Yolken estimate that hundreds of thousands of psychiatric patients were killed or sterilized, including 220,000-269,500 schizophrenia patients. This constituted more than 73 percent of the patients in Germany at that time (calculated based on the studies carried out in 1929-1931 that reported point prevalence rates of 2.0 per 1,000). Postwar studies in Germany reported lower prevalence rates than comparable studies in other Western countries carried out around the same period, whereas the incidence rate, when first studied in Mannheim 20 years after the last genocide, was found to be 53.6 per 100,000. The authors note that this rate is on the higher end of other published studies. Haffner and Reimann, the original authors of the Mannheim study, also noted that the observed incidence rate in Germany in 1965 was two to three times higher than most comparable studies at that time.

In addition to the horror of reading about the systematic killing of patients based on misguided scientific thinking and the participation of clinicians in the process, Torrey and Yolken’s report is a somber and thought-provoking read. As the authors point out, in contrast to the Nazi genocide of Jews during that period, killings of psychiatric patients are not as well known. It is legitimate (as the authors convincingly argue in the report) and important to examine and understand the impact of these killings and sterilizations on subsequent prevalence and incidence rates. The prevalence rates examined more than 20 years after the last genocide were lower, as one would expect, but the incidence rates didn’t decrease, and if anything, were relatively high. This is consistent with the fact that schizophrenia survives in the population in spite of low fertility rates among patients, and suggests that the disorder is caused by common variations in a large number of genes. The relatively high incidence rates point to an important role of the environmental factors that contribute to the etiology of the disease. Finally, the report needs to be a constant reminder of potential pitfalls as we participate in making health policy decisions based on our current scientific findings.

Hafner H and Reimann H. Spatial distribution of mental disorders in Mannheim, 1965. In: Hare EH, Wing JK, eds. Psychiatric Epidemiology: Proceedings of the International Symposium Held at Aberdeen University 22–5 July 1969. New York, NY: Oxford University Press; 1970:341–354.

Comments on Online Discussion
Comment by:  John McGrath, SRF Advisor
Submitted 25 September 2009 Posted 26 September 2009

Apart from collating the best available estimates of the incidence and prevalence of schizophrenia in pre- and postwar Germany, this article outlines the circumstances related to the systematic sterilization and murder of hundreds of thousands of Germans with schizophrenia during World War II. It is a sobering read.

View all comments by John McGrath

Comment by:  Ezra Susser, SRF Advisor
Submitted 13 January 2010 Posted 13 January 2010

Comment by Ezra Susser and Rebecca Smith
The authors and the editors are to be commended for publishing this paper. To our knowledge, this is the first paper to appear on this topic in the Schizophrenia Bulletin. For more than half a century, the Bulletin has been open to a wide variety of opinions and perspectives on schizophrenia from mental health professionals, consumers, and other interested groups. It is difficult to think of any (other) topic regarding schizophrenia that has not been addressed.

Fuller Torrey and Yolken draw our attention to a fact not widely known, even among mental health professionals: Hitler’s massive program for systematic slaughter of the six million Jews was in fact developed and piloted in mental patients. Before their use on a massive scale in concentration camps across occupied Europe, the gas chambers were one of several killing methods first tested in mental hospitals. This took place with the political and practical support of a dishearteningly large proportion of psychiatrists as well as other physicians.

Since the 1980s,...  Read more

View all comments by Ezra Susser

Comment by:  James MacCabe
Submitted 22 January 2010 Posted 22 January 2010

I agree with Ezra that it is important to discuss this subject openly and to learn from it. In that spirit I want to share some potentially relevant findings from Sweden.

I recently studied lifetime fertility in a birth cohort of 14,000 individuals born in Uppsala, a picturesque university town near Stockholm, between 1915 and 1929 (MacCabe et al., 2009). In this cohort, we found the expected reduction in the number of offspring born to males with schizophrenia, with a fertility ratio of 0.41. However, we were surprised to find that the fertility in females with schizophrenia was reduced to the same extent as that of males. In previous studies, the reduction in fertility in females has consistently been only about half that in males (Bundy and MacCabe, submitted).

To my surprise, one of our collaborators in Sweden suggested that the explanation for this may be the forced sterilization of women with schizophrenia. I had not previously been aware that a eugenics program existed in Sweden, so I researched the subject in greater detail.

Between 1935 and 1975,...  Read more

View all comments by James MacCabe

Comment by:  Linda Chafetz
Submitted 22 January 2010 Posted 22 January 2010

In 2003, Susan Benedict published in a nursing journal a description of the "killing programs" at Haldamar. While her report would not add materially to the impressive historical information provided by Drs. Torrey and Yolken, it may interest readers who are trying to fathom how nurses in this hospital could implement such a program. It includes some chilling personal testimony from five of these nurses, much of it obtained from records of their trials for war crimes.

Susan Benedict (2003). Killing While Caring: The Nurses of Hadamar. Issues in Mental Health Nursing, 24:1, pp. 59-79.

View all comments by Linda Chafetz

Comment by:  Tadeusz Nasierowski
Submitted 5 March 2010 Posted 5 March 2010

Genocide of the Mentally Ill and the Holocaust
Note: Supporting evidence for the claims in this comment are provided in the commentator’s book cited below (see reference).

Edwin Fuller Torrey and Robert H. Yolken’s article, “Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia,” could benefit from additional information. Specifically, the authors stated that, "The Nazi genocide of psychiatric patients was the greatest criminal act in the history of psychiatry." However, Fuller Torrey and Yolken focus exclusively on events that occurred in Germany, which is typically the framework used in discussing this topic. It’s important, though, to look at Nazism not only in Germany, but in all of Europe. This wider view enables us to fully understand the genocide of the mentally ill and its importance for the next actions taken by Nazis, that is, the promulgation of the Holocaust.

Along with the German invasion of Poland, the implementation of Adolf Hitler’s homicidal program began with the systematic killing of mentally ill individuals. The units responsible...  Read more

View all comments by Tadeusz Nasierowski

Comment by:  Rael D. Strous
Submitted 14 April 2010 Posted 14 April 2010

Reprinted courtesy of Schizophrenia Bulletin
Rael D. Strous. Commentary on Torrey and Yolken: "Psychiatric genocide: Nazi attempts to eradicate schizophrenia." Schizophr Bull. 2010;36:26-32.

Psychiatric Genocide: Reflections and Responsibilities
Torrey and Yolken should be commended for adding to the burgeoning reports in the recent psychiatric literature describing the genocide committed by our colleagues during the Nazi era. That it has taken close to 60 years to confront this dark period in the history of psychiatry does not diminish the importance of finally dealing with it. It is painfully shameful that close to 300,000 individuals with schizophrenia were either sterilized or killed at the behest of members of our profession. These include physicians at all levels, from the resident to the senior professor, and including the support of all ancillary staff, from nurses to transport teams to the hospital janitor. In order to ensure that this period never returns, the facts must be made known to...  Read more

View all comments by Rael D. Strous

Comment by:  Sanjeev Jain
Submitted 29 July 2013 Posted 20 August 2013

These discussions are extremely valuable, as they illustrate what the "logical" solution to reduce the "burden" of mental illness was not so very long ago (Aziz, 1976).

However, enough information about the incidence and prevalence of mental illness, and fluctuations caused by the death of a large proportion, was available by the turn of the twentieth century, and thus the theoretical premise of the Nazi experiment was inherently flawed even at the beginning.

The prevalence of mental illness, and in general those who needed institutional care, had been a feature in many census operations across the world ever since formal demographics began in the early nineteenth century. Thus, estimates and variations in the prevalence of severe disabilities had been reported from the time formal census reports began in India in 1851. The severe famines in the late nineteenth century provided a natural experiment about the consequences of a significant reduction in numbers of mentally ill over a short period. These famines in southern India reduced the numbers of mentally ill often...  Read more

View all comments by Sanjeev Jain
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