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Review Essay of The Nazi Doctors

Review Essay of The Nazi Doctors
Lifton, Robert Jay. The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Perseus Book Group (Basic Books), 2000. 576 pp. $22.95 U.S. (pb.) ISBN 978-0465049059. Review by Richard A. Koenigsberg.

The renowned psychiatrist’s most powerful and important book—a brilliant analysis and history of the crucial role that German doctors played in Nazi genocide.
Robert J. Lifton is a writer and psychiatrist—one of the world’s foremost thinkers on the psychological causes of political violence.

“Must reading…The book as a whole stands without competition in the English language.”
    —Raul Hilberg, author of The Destruction of European Jews

“This profound study ranks with the most insightful books on the Holocaust.”
    —Publishers Weekly

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In Hitler’s Ideology (1975), I identify a core fantasy that constituted the foundation for Hitler’s thinking, and the actions that followed. Hitler’s ideology grew out of his view of the German nation as an actual organism or body (politic).

“Our movement alone,” Hitler declared in Mein Kampf, was “capable of creating a national organism.” In place of the State must be set “the living organism—the people.” The purpose of politics, Hitler said, was to preserve the life of the German organism, that is, to “maintain the substance of the people, in body and mental health.”

The problem, however, was that the German organism was beset with internal forces threatening to destroy it. Hitler approached politics as a physician, observing that every distress “has some root or another.”

To rescue Germany, Hitler said, he would not behave like conventional politicians who merely “doctored around on the circumference of the disease” and only occasionally tried to “lance the cancerous ulcer.” Rather, it was necessary to “penetrate to the seat of the inflammation—to the cause.” Until one identified and dealt with the cause, “no cure is possible.”

Thus we arrive at Hitler’s identification of the Jew as a “disease within the body of the people.” Jews were identified as a viruses or bacteria—the source of Germany’s disease. If pathogenic Jewish cells were not removed from the body politic, Germany would succumb to a fatal disease. The purpose of the Final Solution was to destroy the cause of Germany’s disease, and thus to save the life of this unique organism.

Hitler’s Ideology focused exclusively on Hitler’s rhetoric. The question then became: did my analysis apply more broadly to Nazi ideology and the history that the Nazis created? Robert J. Lifton’s The Nazi Doctors (1986) provides evidence that the fantasy that drove Hitler’s thinking drove the thinking of other Nazis as well. Lifton spent years interviewing 29 men who had been involved at high levels with Nazi medicine. Lifton’s reconstruction of the deep-structure of Nazi ideology is based upon these interviews, combined with an extensive analysis of written accounts, documents, speeches, diaries and letters.

The central fantasy uncovered by Lifton was that of the German nation as an organism that could succumb to an illness. Lifton cites Dr. Johann S. who spoke about being “doctor to the Volkskorper (“national body” or “people’s” body).” National Socialism, Dr. Johann S. said, is a movement rather than a party, constantly growing and changing according to the “health” requirements of the people’s body. “Just as a body may succumb to illness,” the doctor declared, so “the Volkskorper could do the same.”

The Nazi Doctors focuses on “the euthanasia movement”—the killing project that preceded and led to the Final Solution. This movement revolved around the destruction of “life unworthy life:” the killing of people who were defective and who made no contribution to the nation’s life. Killing defective human beings residing in Germany was conceived as the removal of defective or non-contributing cells from within the national organism.

Lifton examines the ideological roots of the euthanasia movement, tracing its evolution from a 1938 national meeting of leading government administrators, where an SS officer stated that the solution to the problem of the mentally ill becomes easy “if one eliminates those people.”

The euthanasia project began with the killing of children. The occasion that initiated the killing was a petition (from the child’s father) for the “mercy killing” of an infant named Knauer, born blind, with one leg and part of one arm missing, and apparently an “idiot.” Karl Brandt was authorized by Hitler in late 1938 to “inform physicians in Hitler’s name that they could carry out euthanasia,” and that any legal proceedings against them would be quashed by order of Hitler. Brandt reported that the doctors were of the opinion that there was “no justification for keeping such a child alive.”

Brandt was authorized by Hitler to proceed in the same way in similar cases. A Directive of August 18, 1939, read as follows: “For the clarification of scientific questions in the field of congenital malformation and mental retardation,” the earliest possible registration was required of all children under three years old in whom “serious hereditary diseases were suspected.”

A systematic procedure was developed to determine which children should be killed. Three medical experts were required to make judgments. If an expert decided on “treatment”—meaning the killing of the child—he put a plus sign (+) in the left column. Eventually, Lifton says, a network of some 30 killing areas within existing institutions was set up.

Not long after, the project was extended to adults, which required rendering medical killing as an official policy—one Hitler enunciated in his “Führer decree” of October 1939. A few months earlier, according to Lifton, Hitler had called on two Nazi officials and told them that he considered it proper that “the ‘life unworthy life’ of severely mentally ill persons be eliminated by actions (Eingriffe) that bring about death.”

The decree itself was brief: “Reich Leader Bouhler and Dr. Brandt are charged with the responsibility for expanding the authority of physicians, to be designated by name, to the end that patients considered incurable according to the best available human judgment of their state of health, can be granted a mercy death.”

Actually issued in October, the decree was backdated to the date of Hitler’s declaration of war (September 1, 1939). Lifton suggests that there was deep psychological relationship between euthanasia and war, each of them subsumed to a “vast biomedical vision.”

The impulses behind euthanasia, war and genocide, according to Lifton, grew out of a similar fantasy, namely the desire to destroy “inferior elements” that threatened the life of the German body politic. In his Secret Book, Hitler spoke of an “inundation of disease bacilli which at the moment have their breeding ground in Russia.” The Nazi movement—their project of mass-murder—revolved around Hitler’s struggle to destroy destructive cells in order to prevent the death of the national organism.

Lifton documents how the killing of mental patients evolved into the killing of Jews. Genocide represented another dimension of the killing process or project, expanding its scope. The Nazi Doctors focuses on the ideology and thought processes of physicians who were involved in executing both the euthanasia program and Final Solution.

Lifton discusses an influential manual by Rudolf Ramm of the medical faculty of the University of Berlin that proposed that each doctor was no longer to be merely a caretaker of the sick, but was to become a “physician to the Volk.” Physicians were to be concerned with the health of the Volk even more than with the individual’s disease, and were to be taught to overcome the individualistic principle of the “right to one’s own body.”

Ramm’s manual urged the doctor to be a biological militant, an “alert biological soldier” serving under the “great idea of the National Socialist biological state structure.” The manual claimed that National Socialism, unlike any other philosophy or party program, is “in accord with the national history and biology of man.”

Physicians, Lifton said, could thrill to this message. Dr. S., for instance, described joining the Party immediately after hearing Deputy Party Leader Rudolf Hess say at a 1934 mass meeting that National Socialism “is nothing but applied biology.” In his work organizing Nazi medical practice, Dr. S. saw himself as spreading a biological message: “We wanted to put into effect the laws of life, which are biological laws.”

What were these biological laws governing the German nation? In their influential book that laid the groundwork for everything that was to follow, The Permission to Destroy Life Unworthy of Life (1920), German professors Karl Binding and Alfred Hoche advocated euthanasia or state killing. They described the state as an “organism with its own laws and rights, much like one self-contained human organism” which “in the interest of the welfare of the whole—as we doctors know—abandons and rejects parts or particles that have become worthless or dangerous.” Hitler himself plaintively posed the question, “Could anyone believe that Germany alone was not subject to the same laws as all other human organisms?”

In their biological conception of the nation state, these men were referring to the immune system: that mechanism operating within each organism acting to reject and destroy cells identified as foreign or not-self. Defective human beings and Jews were equated with not-self or foreign cells within the German organism. Naturally, the organism would act to destroy these cells. Euthanasia and genocide thus reflected a “law of nature.” The German organism acted—like any other organism—to eliminate destructive cells from within its body.

When Lifton asked Dr. Fritz Klein how he could reconcile the concentration camps with his Hippocratic Oath to save lives, he replied, “Of course I am a doctor and I want to preserve life. And out of respect for human life, I would remove a gangrenous appendix from a diseased body. The Jew is the gangrenous appendix in the body of mankind." Lifton mentioned this phrase "gangrenous appendix” to another Nazi, Dr. B., who quickly answered that his overall feeling and that of the other Nazi doctors was that “whether you want to call it an appendix or not, it must be extirpated (ausgerottet, meaning also “exterminated”, “destroyed”, “eradicated”).

Based on the data presented in The Nazi Doctors, it would appear that the fantasy that I identified in Hitler’s Ideology was enacted as the basis of Nazi culture. Physicians, Lifton said, saw themselves at the “core of the mystical body of the Volk.” The underlying principle of the biomedical ideology was that of a “deadly racial disease, the sickness of the Aryan race; the cure, the killing of all Jews.”

Put somewhat differently, Nazi ideology grew out of the fantasy of Germany as a gigantic organism—an actual body. Contained within this body were diseased cells threatening the life of the German organism. The Nazi’s killing projects (euthanasia, the Final Solution and war) revolved around the struggle to kill cells that were the source of defect and disease—in order to save the life of Germany.

The primary source of disease were Jewish bacteria. The Jewish element threatened—not only Germany—but the entirety of Western Civilization. These bacteria had their “breeding ground” in Russia. Communism was the disease that threatened Civilization. The source of this disease was the “Jewish Bolsheviks” that Hitler tried so desperately to destroy. The Final Solution was not separate from war against the Soviet Union.

Adolf Jost, a theorist of scientific racism who issued an early call for direct medical killing in his book, The Right to Death (1895), argued that control over the death of the individual must belong to “the social organism, the state.” The state had a right to kill. Jost pointed out that the state already exercised these “rights” in war, where thousands of individuals are sacrificed for “the good of the state.” The state must own death—must kill—Jost asserted, in order to “keep the social organism alive and healthy.”

What does this mean to claim that in war thousands of individuals are sacrificed for the “good of the state”? What “good” is brought about by virtue of soldiers’ death? And what does it mean to say that a state must kill in order to “keep the social organism alive and healthy”? These are questions that I explore in Nations Have the Right to Kill (2009).

It would appear that Germany’s preoccupation with killing and death preceded by many years their projects of euthanasia and genocide, and was acted out—in a massive way—during the First World War in which 2 million German soldiers died and millions more were wounded. In the First World War, Germany enacted the fantasy of killing and dying in the name of the nation-state.

Killing German soldiers came before the killing of defective children, mental patients and Jews. War proceeded euthanasia and genocide. Did some Germans experience the First World War as a kind of genocide—as the German nation sacrificed its young men for the “good of the state;” to “keep the social organism alive”?

Lifton suggests that there was a single dynamic linking euthanasia, war and genocide. What’s more, he claims it was no accident that Hitler’s decree authorizing the destruction of life unworthy life was backdated to September 1, 1939—the date of Hitler’s declaration of war. Perhaps the killing of defective human beings, Jews, enemy soldiers, enemy civilians, German soldiers and German civilians represented a single purpose: the sacrifice of individuals for the “good of the state.” Nazism enacted—in a radical way—the idea that states have a “right to kill.”

Dr. Pfannmüller, a fanatical leader of the euthanasia movement, was among a number of Germans who sensed a relationship between euthanasia and warfare. Why did he believe that the killing of mental patients was justified and justifiable? “The idea is unbearable to me,” Pfannmüller declared, that the “best, the flower of our youth, must lose its life at the front in order that feeble-minded and irresponsible social elements can have a secure existence in the asylum.” If the state had the right to require its finest and most productive human beings to die in battle, why wouldn’t it likewise have the right to send its worst, least productive human beings to their deaths?