Mass murder and sterilization
Aktion T4 is the mass murder of the disabled and patients of psychiatric asylums by psychiatrists and the directors of the asylums.
It is one of the most depraved crimes against humanity in human history and directly preceded and then carried forward concurrently with The Holocaust.
Between 1940 and 1945 it is estimated that more than 275,000 disabled and asylum patients – men, women and children – were murdered in Germany, Austria, occupied Poland, and what is now the Czech Republic.
While being described as ‘enforced euthanasia’, mass murder is a far more applicable term as while the first and many died through carbon monoxide gas (70,000), others were given lethal injections or were shot. Yet, demonstrating the utter depravity of those involved, some 100,000 were simply left to starve to death within the asylums. 1
Six ‘killing centres’ were established at the Brandenburg, Bernburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein asylums and initially the disabled and mentally ill were transported to these centres and exterminated. Later and in other countries concerned, the patients were murdered in their asylums.
For example, the Hadamar asylum… “celebrated the cremation of its ten-thousandth patient in a special ceremony, where everyone in attendance—secretaries, nurses and psychiatrists—received a bottle of beer for the occasion.”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia.
In January 1940 the first 20 patients were led into the ‘shower rooms’ at the Brandenburg Asylum and killed. The asylums competed with each other and celebrated achieving targets. For example, the Hadamar asylum:
“…celebrated the cremation of its ten-thousandth patient in a special ceremony, where everyone in attendance—secretaries, nurses, and psychiatrists—received a bottle of beer for the occasion.”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 2
While officially ended in August 1941, after the murder of the first 70,000 selected patients, the program continued unabated until the end of the war in 1945. For example, Russian troops entering Germany in 1945, found one crematorium still under construction in a ‘liberated ‘ mental asylum. 3 4
Aktion T4 merely meant “Action” in German and T4 was the address of the administrative offices of the program in Berlin – Tiergartenstraße 4.
Memorial at the Sonnenstein killing centre: “The Path to the Gas Chamber”
This display on the wall of the memorial is entitled: “The Path to the Gas Chamber”.
The display shows the layout of the killing centre with a waiting room, gas chamber, morgue, crematorium, and chimney room.
It reads:
“Employees drove the patients and residents from mental hospitals and homes to the killing centre by buses. Physicians working for Organization T4, had classified them in terms of the Nazi ideology, as ‘unworthy of living’. Nurses guided them to the commission supervised by doctors on the ground floor of the building. The doctors verified the victims’ identity and assigned them a fraudulent cause of death.”
First, the sterilization of the mentally ill
The majority of those sterilized were in overcrowded psychiatric hospitals, where many patients were quickly operated on so they would not procreate and then released.
In 1933, the first target of German psychiatrists was the sterilization of the mentally ill.
On July 14, 1933. The German Reich (Nazi) government passes the Law for the Prevention of Offspring with Hereditary Diseases.
This preparation of this document and its passing occurred under the direct influence of psychiatrist Ernst Rudin, a pupil and colleague of the ardent eugenicist Emil Kraepelin – ‘the father of modern psychiatry’.
Rudin was the first to consider ‘genetic psychiatry’ based on the false eugenic idea that mental illness was hereditary. In 1932 the Presidency of the International Congress of Eugenics passed to Rudin and possibly emboldened by the acceptance of eugenics in Britain, the United States, and many parts of Europe, he was forcefully implementing eugenics principles in Germany. 5
“Its initial target was individuals with mental retardation, schizophrenia, manic-depressive disorder, epilepsy, Huntington chorea, hereditary blindness and deafness, hereditary alcoholism, and “grave bodily malformation.”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 6
The majority of those sterilized were in overcrowded psychiatric hospitals, where many patients were quickly operated on so they would not procreate and then released.
As a result, it is estimated that 400,000 persons were sterilized between 1934 and 1945:
“A diagnostic breakdown of sterilizations for 1934, the only year for which such figures are available, indicates that 49% of the sterilized individuals had “congenital feeblemindedness,” 26% schizophrenia, 16% congenital epilepsy, and the remainder other diagnoses”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 7
Burgeoning populations of psychiatric asylums
Despite psychiatrist’s efforts to sterilize and release patients, the number of persons in German asylums dramatically increased and in 1929 it was estimated to be 300,000 persons. The maintenance and support of this population was considered to be a severe drain on the country’s resources.
“In 1880, Germany had had 47 228 patients in public asylums, but by 1913, this number had increased to 239 583, a 5-fold increase during a period when the total population had not quite doubled. Despite the fact that 140 234 asylum patients died during World War I, mostly from infectious disease and hunger, they were rapidly replaced by others. Between 1924 and 1929, the number of psychiatric hospital patients increased from 185 397 to over 300 000, despite the fact that the average length of stay had decreased from 215 to 103 days.”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 8
Dementia praecox or schizophrenia
In 1893, Germany’s top psychiatrist, Emil Kraepelin put forth his definition for ‘dementia praecox’ or what became known as schizophrenia. While defined (and even falsely stated to be a genetic disease) no cure was offered and this resulted in further large increases in the number of psychiatric patients, not only in Germany but in other countries as well.
“In the Erlangen asylum, the percentage of patients diagnosed with schizophrenia increased from 42% to 56%, and two-thirds of all new admissions were given that diagnosis. A massive increase of psychiatric patients, especially those diagnosed with schizophrenia, was also being observed in England, the United States, and other countries during these same years.”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 9
Psychiatry receives support from the Nazi government
Eugenic theories of German psychiatrists, among them Emil Kraepelin, Ernst Rudin and Alfred Hoche were considered with interest by the Nazi regime. In July 1939 just as Hitler was about to invade Poland and thrust the world into war, he asked his private physician, Karl Brandt and others to propose a law that permitted the killing of psychiatric patients.
The draft law, a memorandum on “the destruction of life unworthy of life” included the following provision:
“The life of a person, who because of incurable mental illness requires permanent institutionalization and is not able to sustain an independent existence, may be prematurely terminated by medical measures in a painless and covert manner.”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 10
While this law was never published, Hitler put Aktion T4 into effect by direct order and promised immunity for those involved. The order was actually signed in October but backdated to 1 Sept 1939.
The order reads:
“Reich Leader Bouhler and Dr. Brandt are entrusted with the responsibility of extending the authority of physicians, to be designated by name, so that patients who, after a most critical diagnosis, on the basis of human judgment [menschlichem Ermessen], are considered incurable, can be granted mercy death [Gnadentod].
Adolph Hitler
Psychiatry’s plan long before Hitler
“The significance of Rassenhygiene [racial hygiene] did not become evident to all aware Germans until the political activity of Adolf Hitler and only through his work has our 30 year long dream of translating Rassenhygiene into action finally become a reality.”
Ernst Rudin
One could always present a picture of German psychiatry under Rudin being coerced into working for the Nazi regime and yet nothing could be further from the truth.
Fredrick Wertham in his book ‘A Sign for Cain: An Exploration of Human Violence’ explains:
“The tragedy is that the psychiatrists did not have to have an order. They acted on their own. They were not carrying out a death sentence pronounced by someone else. They were the legislators who laid down the rules for deciding who was to die; they were the administrators who worked out the procedures, provided the patients and places, and decided the methods of killing; they pronounced a sentence of life or death in every individual case; they were the executioners who carried out or – without being coerced to do so – surrendered their patients to be killed in other institutions; they supervised and often watched the slow deaths.”
F Wertham. A sign for Cain: An exploration of human violence. 1966. 11
And as psychiatrist, Ernst Rudin explained:
“The significance of Rassenhygiene [racial hygiene] did not become evident to all aware Germans until the political activity of Adolf Hitler and only through his work has our 30 year long dream of translating Rassenhygiene into action finally become a reality.”
Ernst Rudin from William H. Tucker. The Science and Politics of Racial Research. 1994. 12
Those involved in psychiatric eugenics had for years proposed the mass murder of those in their care.
“The idea of killing the patients in psychiatric hospitals first surfaced prominently in 1920 in a publication by Karl Binding, a lawyer, and Alfred Hoche, a psychiatrist. Entitled Permission for the Destruction of Life Unworthy of Life, the tract posed the question: “Is there human life which has so far forfeited the character of something entitled to enjoy the protection of the law, that its prolongation represents a perpetual loss of value, both for its bearer and for society as a whole?”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 13 14
The beginning of Aktion T4.
These forms were then assessed by a committee of selected psychiatrists who targeted approximately 70,000 patients for death…
While set up and supervised in 1939 by Hitler’s personal doctor, Karl Brandt and various within the SS, the selection of those to die was left to the medical officers for the program, psychiatrists.
“In October 1939, the directors of all German psychiatric hospitals were asked to fill out forms indicating the diagnosis and capacity for useful work of each patient, although they were not told what the forms were for. These forms were then assessed by a committee of selected psychiatrists who targeted approximately 70,000 patients for death, 1 for every 1000 people in Germany, which was the initial goal of the program.”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 15 16
Psychiatrist Paul Nitsche, a protege of Emil Kraepelin and avid supporter of eugenics and euthanasia, became the Deputy Director of Aktion T4 in 1940. As the program’s chief medical officer and psychiatrist, Nitsche had the duty of selecting people who were “unworthy of life,” those who were to live or die. He sent thousands to their deaths. In 1941 he was made the Medical Director and oversaw the entire extermination program including at least 60 he personally killed through human experimentation. 17
Unworthy of life, “can you work?”
The poster says:
“60 000 RM is what this person suffering from hereditary illness costs the community in his lifetime. Fellow citizen, that is your money too. Read Neues Volk. The monthly magazine of the Office of Racial Policy of the NSDAP.”
In the time of Aktion T4 and after, the difference between life and death was the determination of one as being “unworthy of life.” And that was determined simply by the answer to the question “can you work?”
In an attempt to make their atrocities acceptable to the German public, the large number of people in psychiatric asylums, unable to work, were presented as an economic burden. 18
The prolongation of their life was determined to be and promoted as a betrayal of the state. And, as psychiatrists had been lobbying for years before Adolph Hitler :
“a perpetual loss of value, both for its bearer and for society as a whole?”
From the 1920 book, Permission for the Destruction of Life Unworthy of Life by Binding and Hocke. From E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 19 20
This same rationale can later be seen in the treatment of those in The Holocaust and other NAZI conquests. If the individual had value as a slave worker then life was granted. If not, then life was not.
While there are many appalling examples of this, to impress upon the English-speaking reader, the NAZI plans for the subjugation of England included:
“The original program developed by Nazi hot-heads included also the genocide of the English, with the provision that the English males were to be used as laborers in the vacated territories in the East, there to be worked to death.”
Doctor Leo Alexander. Medical advisor during the Allied trials of crimes against humanity by NAZI doctors. From ‘Medical Science Under Dictatorship’ July 1949. 21 22
“This is how it would end”
This image from March 1935 reflects the extent to which eugenics had been eagerly accepted and propagated by psychiatry in Germany during this period of time.
The quotes from the poster state:
“This is how it would end. Qualitative population increase with insufficient reproduction of the higher quality”
“This is what will happen when the inferior have 4 children and the superior have 2 children.”
Such ideas were being thrown at the German people, including from the NAZI psychiatrist Ernst Rudin the main proponent of ‘psychiatric genetics’, and as the President of the Society of German Neurologists and Psychiatrists and through his ‘Archives of Racial and Societal Biology’ journal.
“…he [Rudin] reasoned that the medical care for the insane was a distortion of the natural laws of the survival of the fittest and that medicine would be obliged to clean the genetic pool of the Volk in order to prevent ongoing degeneration.”
Brüne M. On human self-domestication, psychiatry, and eugenics. 2007. 23
Schizophrenia an exception
There was only one exception to the “unworth of life” – “can you work” rationale and that was a diagnosis of Kraepelin’s ‘dementia praecox’ or schizophrenia, where enforced sterilization and later euthanasia was guaranteed without recourse.
Kraepelin’s student and successor, Ernst Rudin, had established the subject of “genetic psychiatry” while working under Kraepelin in Munich. ‘Dementia praecox’ diagnosis was a new ‘fad’ and Rudin falsely claimed that it was genetically caused and therefore uncurable. As a result, those who were diagnosed were given particular attention.
Between 1934 and 1945, an estimated 132,000 persons labeled as having schizophrenia were sterilized, and between 100,000 to 137,000 were exterminated. 24
Rehearsal for the holocaust
Leo Alexander, the United States Army representative at Nuremberg, had the following to say regarding psychiatry’s actions with Aktion T4.
“According to the records, 275,000 people were put to death in these killing centers. Ghastly as this seems, it should be realized that this program was merely the entering wedge for exterminations of far greater scope in the political program for genocide of conquered nations and the racially unwanted. The methods used and personnel trained in the killing centers for the chronically sick became the nucleus of the much larger centers in the East, where the plan was to kill all Jews and Poles and to cut down the Russian population by 30,000,000.”
“The original program developed by Nazi hot-heads included also the genocide of the English, with the provision that the English males were to be used as laborers in the vacated territories in the East, there to be worked to death, whereas the English females were to be brought into Germany to improve the qualities of the German race. (This was indeed a peculiar admission of the part of the German eugenists.)”
Doctor Leo Alexander. Medical advisor during the Allied trials of crimes against humanity by NAZI doctors and a contributor to the ‘Nuremberg Code’ that covered human experimentation which was written after the trials. From ‘Medical Science Under Dictatorship’ July 1949. 25 26
The techniques learned from Aktion T4 became the basis of the later extermination campaigns in concentration camps. Some personnel from Aktion T4 were directly transferred to these camps to carry it out.
Reflection
For psychiatry, it had only been some 60 years since Wundt’s pronouncement to establish a ‘science’ of mental health, separate from the great traditions of Western philosophy. Even less time for Kraepelin, with his classification system of mental illnesses and fixation on ‘biological psychiatry.’
It should have been a golden age for German psychiatry, instead, it was a horror.
For all their words and ‘advances,’ what they and others of their time forgot was that the only reason psychiatry exists at all is to cure the patient.
As psychiatry could cure none, all they would offer was death.
Further References:
1. The beginning of ‘modern’ psychiatry – a descent into hell
Emil Kraepelin – prelude to mass murder
- Mary V. Seeman. What Happened After T4?: Starvation of Psychiatrie Patients in Nazi Germany. International Journal of Mental Health Vol. 35, No. 4, The Holocaust and the Mentally III: Part II: Starvation (WINTER 2006-7)
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- H Friedlander The Origins of Nazi Genocide: From Euthanasia to the Final Solution Chapel Hill, NC: University of North Carolina Press; 1995
- Gundula Kösters, Holger Steinberg, Kenneth Clifford Kirkby and Hubertus Himmerich.
Ernst Rüdin’s Unpublished 1922-1925 Study “Inheritance of Manic-Depressive Insanity”: Genetic Research Findings Subordinated to Eugenic Ideology - E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- F Wertham. A sign for Cain: An exploration of human violence. 1966.
- William H. Tucker. The Science and Politics of Racial Research. 1994. University of Illinois Press.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- Ole Hartling. Euthanasia and the Ethics of a Doctor’s Decisions. 2021 Bloomsbury Publishing.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- Michael Robertson Astrid Ley Edwina Light. The First into the Dark: The Nazi Persecution of the Disabled. 2019.UTS ePRESS
- Nitsche, Hermann Paul. Biographical Archive of Psychiatry.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- Ole Hartling. Euthanasia and the Ethics of a Doctor’s Decisions. 2021 Bloomsbury Publishing.
- Medical Science Under Dictatorship. July 1949.
- Pedro Weisleder. Leo Alexander’s Blueprint of the Nuremberg Code. Pediatric Neurology. 2022.
- Brüne M. On human self-domestication, psychiatry, and eugenics. Philos Ethics Humanit Med. 2007;2:21. 2007.
- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
- Medical Science Under Dictatorship. July 1949.
- Pedro Weisleder. Leo Alexander’s Blueprint of the Nuremberg Code. Pediatric Neurology. 2022.