The_Holokaust_-_origins,_implementation,_aftermath

PSYCHIATRY, SOCIETY AND NAZI “EUTHANASIA”
year, whereas it cost 1,277 RM to keep one patient for a year in Munich’s Eglfing-
Haar asylum. 9 However, patients in asylums also were not free from the attentions
of the reformers. Depressed by the effects of long-term institutionalisation in
environments effectively bereft of therapy, Hermann Simon decided to use
occupational therapy to engender self-satisfaction and hence repress the
depressed or excitable moods which resulted from enforced idleness. Soon,
asylums were humming with patient activity, with both the complexity of the work
performed, and hence the degree of freedom and responsibility enjoyed, being
the objective indicators of recovery. In many asylums, up to 80 per cent of patients
did some form of work, which made the asylums largely self-sufficient or capable
of generating modest surpluses. Judging by the flood of articles devoted to
community care and occupational therapy published in the professional journals
in the 1920s, psychiatry began to be a more optimistic profession.
Inevitably, there was a downside to these developments. Firstly, as
psychiatrists followed their discharged patients out into the wider world, they
inevitably encountered hitherto unknown ranges of ‘abnormality’. What passed
before them in the asylums was literally the tip of an iceberg. Being of an
increasingly hereditarian cast of mind, they began to construct genealogies of the
patients’ families. 10 Instead of addressing themselves to questions concerning
the socio-economic environment, which in fact they were powerless to affect, they
opted for the control function of registering widespread deviance in primitive data
banks. The sheer scale of illness they encountered engendered a certain pessimism,
and hence enhanced their susceptibility to fashionable and radical eugenicist
solutions. Since experience taught that people they deemed degenerate or feckless
could not be counselled into voluntary low rates of reproduction, many
psychiatrists began to think in terms of compulsory sterilisation. This would enable
the person to return to the productive process without risk of reproductive damage
ensuing to the collective biological substance of the race or nation, in itself a
striking retreat from individual-centred medicine. 11
Secondly, the widespread introduction of occupational therapy in asylums
increasingly meant that patients’ recoveries were measured in terms of their
economic productivity. Unfortunately, not all patients were capable of rolling cigars,
weaving baskets, running errands or answering the telephone. Each asylum
therefore had a quantity of ‘incurables’ languishing in unproductive hebetude,
and conditions were often parlous. The adoption of occupational therapy implicitly
meant separating the able-bodied and willing from the therapy-resistant chaff. In
other words, these reforms were contributing to the creation of a psychiatrically
defined sub-class within a group of people already consigned to the margins of
society. Long before the National Socialist government appeared on the scene,
some psychiatrists advocated, or countenanced, killing this permanent reminder
of the limits of their own therapeutic capacities and permanent burden upon the
nation’s scant resources. This included some of those responsible for running
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