Today we often speak about "dying with dignity", "assisted suicides", "interrupted pregnancy","embryonic reductions", "therapeutic abortion". There is nothing new about this because the twentieth century fertile imagination managed to reach the necessary technology to carry out its ambitions. The eugenicists' clan has not just simply used the means but has manipulated them to achieve its goals. It is from this perspective that we should look at the mass exterminations of the IIIrdReich, specially at "the euthanasia" of mental patients in Germany, which psychiatrists were directly responsible for. Nowadays, both the public opinion and psychiatrists know generally very little about this chapter of their History.

The project

Until then, the treatment of mental patients had been a notable progress for the patients. Besides, Germans had played there an important role.

By the end of 1939, four men, in the presence of a group of physicians and a chemist, were deliberately killed with carbon monoxide. They were not even criminals or troublemakers. They were cooperative and confident. They were ordinary patients in a Public psychiatric hospital, responsible for their welfare.

This "successful" experience led to the installation of gas chambers in many psychiatric hospitals (Grafeneck, Brandenburg, Hartheim, Sonnenstein, Hadamar, Bernburg).

The extermination of mental patients was a great and very well organized project, as any other psychiatric project, and even better. Everything had been prepared and planned. Later they completed the methods. They created a specialized transport agency, built ovens in psychiatric hospitals, etc. An important number of hospitals and psychiatric institutions, professors of psychiatry, hospitals' directors and staff were involved in this organization. Mass elimination became a routine job. Those psychiatrists followed on a voluntary basis, the same principle as the one of the famous concentration camp commander Koch: "In my camp there are no ill people. There are the healthy ones and the dead".

The vocabulary

However, this operation was hidden under different names : "help to dying patients", "liberation through death", "destruction of worthless lives", "euthanasia", "charitable action" or briefly "action".

The biggest mistake that we could make would be to believe that this was a legitimate social, moral and medical program and that only excesses were reprehensible. Actually, there had been no excess. No civil operation had ever been so carefully planned, organized and carried out with so much precision.

With the time, carbon monoxide was prescribed for increasingly less serious reasons: different malformations, incontinence, difficulties to learn, worthless existence, useless mouth, unproductive life, being undesirable. We could find a common denominator: the elimination of the weak. Nowadays, we estimate that the victims reached 275,000 in this hospital context.

The actors

We may think that the people who carried out this extermination were either brutes with bestial instincts or people forced by the nazi system . Neither. They were normal people, who had had a good education, training and were good parents. The physicians who organized this operation did it on a voluntary basis. Those who did not agree to participate had not been disturbed.

The director of Hadamar institution was personally responsible for the murder of "more than 1000 patients". He opened the gas cylinders and watched his patients die through the peephole, children included. He declared: "Of course, that tormented me. But the fact of learning that eminent scientists such as Pr. Carl Schneider, Pr. Heyde, Pr. Nitsche, participated in this program reassured me". To justify himself, Dr. Karl Brandt, medical director of the euthanasia project, says: "Weren´t the academics in favour of this program? Who could be better qualified than them?"And in fact, the most eminent psychiatrists had been the ones who launched this program.

How could this mentality arise and develop ? We should go back to the twenties to find the ideas which triggered all this.

The ideas

There was in psychiatry (not only in Germany) the tendency to make value judgements on the individuals and the groups on the basis of medicine or medical-sociology. Some pieces of writing considered scientific (even today) had prepared the ground. The most significant work is "The Permission to destroy life unworthy of life" published in Leipzig in 1920, written by the renowned psychiatrist Alfred Hoche and the respectful judge Karl Binding. The book had such a success that had to be republished in 1922. This book defended the theory which stated that the elimination of "worthless people" should be legalized. Thus the concepts of "worthless life" or "life unworthy of life" used by the Nazis come from that book. Binding and Hoche speak in that book about"worthless human beings". They plead for "the elimination of those who cannot be saved and whose death is an urgent need". They speak about those who are below the beast level and who do not have "neither the will to live nor to die". They refer to those who are "mentally dead" and who form "a foreign body to the human society".

The authors insist particularly on the economic factor, the "waste" of money and work to look after the retarded. They appeal to a "heroic attitude" supposedly lost.

Hoche was professor of psychiatry and director of the psychiatric clinic in Freiburg from 1902 to 1934. Moreover, his contribution to neuropsychiatry is considered valuable. Many eminent specialists were trained in his clinic (Dr Robert Bartenberg for example). His sane view of the mental illnesses classification had a considerable influence on American psychiatry, specially through Adolf Meyer, professor of psychiatry at John Hopkins. He himself considered The permission to destroy life unworthy of life one of his best works.

The other intellectual current which contributed to the massacre of mental patients was the exageration of the influence of the heredity of mental illnesses. Ernest Ruedin, professor of psychiatry at Bâle University, in Switzerland and in Munich is the best representative of this tendency. He was the one who provided the "scientific" justification for mass sterilizations of handicapped. He was the main architect of the law of involuntary sterilization in 1933.

The results of the studies on the involuntary castrations performed from 1933 to 1945 are still today quoted by the psychiatric literature, in general not in a critical way. We can unquestionably link this intellectual current with the Eugenics Society in London which gave its premises to the Birth Control Society, the English branch of the International Planned Parenthood Federation (I.P.P.F.). The spokeswomen of the eugenic mouvement (Margaret Sanger and Mary Stopes) had in fact a racist language and advocated the involuntary sterilization of the weak.


This story has not ended because there are quite a lot contemporary emulators and we can perfectly link Binding and Hoche to Caillavet or Schwarzenberg. We find, hidden behind the same humanitarian phraseology, the same sordid economic reasons and the same indifference to human beings.

There are in fact just two conceptions of medicine : the first considers human life sacred and will do anything to protect it: research, care, company, etc. We have considered it so far the intrinsic vocation of medecine.

The other approach sees the human being just a material to be managed and its main concern is profitability. Its ideal is mainly the man who evolves towards an improved race; that is what Henri Laborit explains in his book L'homme imaginant (10/18, 1970, p.187-188):

"[The] individual belongs to a species that is in itself the resultant of a very long evolutionary descent. (...) What is an essential characteristic of this species is the fact that it has in its cortex some particularly developed associative zones, and creative imagination relies on their functioning. Finally it seems that very few men today, after millions of years of human evolution, are capable of using these privileged cervical zones. Then we could say that they grow old even before they are born to their humanity. In other words, aren´t they still at the evolutionary stage not of their grand-parents or their ancestors but of the ancestors of their race itself? Aren´t those real old men? Why then prolong the existence, not of dead people in suspension but of representatives of a prehuman race, which cannot finally die out? Wouldn't some reserve be enough to keep the range of samples?".

Libération praises this man by presenting him as an independent mind and an anarchist. [We should notice that he received the Lasker prize, just like Dr. Baulieu, great admirer of Margaret Sanger].

The same newspaper (12 Dec. 1990) opens its columns to Louis Thaler, professor at Montpellier University, Director of the "Sciences of the Evolution Institute":

"I believe it is unquestionable that the man evolves under the effect of what I would call "an inoperative selection". This one of the effects of the progress...of medicine. (...) This inoperation of selection lets us predict an accumulation of genetic defects throughout generations...leading to higher health expenditures. In my opinion, this perspective calls for a reflection on the medical practices, specially on those which concern procreation...".

Euthanasia is being legalized in the United States, Australia, the Netherlands, Great Britain; it is already widely practiced in France, as testified, for example, by Anne Seys(30).

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