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The Death Doctors

The Nazi Doctors: Medical Killing and the Psychology of Genocide

by Robert Jay Lifton
Basic Books, 561 pp., $19.95

Mengele: The Complete Story

by Gerald L. Posner, by John Ware
McGraw-Hill, 364 pp., $18.95

Auschwitz: An Eyewitness Account of Mengele’s Infamous Death Camp

by Dr. Miklos Nyiszli, translated by Tibère Kremer, by Richard Seaver, with a foreword by Bruno Bettelheim
Seaver Books, 160 pp., $6.95 (paper)

Letters from Westerbork

by Etty Hillesum, introduction and notes by Jan G. Gaarlandt, translated by Arnold J. Pomerans
Pantheon, 156 pp., $14.95

On a winter morning in Frankfurt, when it was still dark, the journalists were taken into a small, well-guarded room to show them the defendants at the forthcoming Auschwitz trial. That was in 1963. I remember staring at those faces, as the photographers scrambled among them, as if physiognomy would begin to unlock the mystery of how human beings—what sort of human beings?—had done those things.

Here and there were the faces of wild beasts, grinning uncomprehendingly: terrible Boger with his yellow eyes, the great skull of Kaduk. There was no mystery about them. When Etty Hillesum saw faces like those as the trains drew into the camp at Westerbork to begin the deportations to Auschwitz, she thought of the line in Scripture which says that God made man in His own image and, for the first and last time, her religious faith was shaken to its roots. But then there were the others. Mulka, the camp adjutant, looking like a bad-tempered old shopkeeper, or Perry Broad, who had been one of the youngest SS guards, still a sleek and youthful man in an immaculate three-piece suit with the expression of somebody accused of parking his Jaguar in a pedestrian zone. Their appearance told me nothing.

And there were the doctors. These men, trained in famous academies and some with high research qualifications, bound by the Hippocratic oath, had carried out selections on the ramp—dividing the incoming torrent from the trains into those who were sent straight to the gas chambers and those who were to be worked to death. Some had killed thousands by injections, or carried out experiments on helpless men, women, and children. Most had taken part in internal selections within the medical blocks, consigning to death those with infectious diseases, those too weak to be worth keeping, and those whose bodies had fulfilled their purposes in research.

If the sight of the doctors answered no fundamental questions, neither did the evidence as the long trial got into its stride. It became clear that the doctors above all had subscribed to an “Auschwitz code of values” which could not be reconciled in their own minds with the charge that they had betrayed all medical or human standards. It was not even as simple as “evil, be thou my good.” Early in the trial, one witness described how a group of Polish children had been brought to Auschwitz after being caught stealing coal. Since there was at the time no separate block for children, they were distributed among different huts. However, a medical decision was taken that “it was morally dangerous for children to sleep among adult men.” So the children were taken to the medical block and given lethal injections. “In this way,” said the witness quietly, “the morals of the camp were preserved.”

More than twenty years have passed since that trial, and it is only now, after reading Professor Lifton’s book, that I have begun to understand the fundamental question, How could they?—the subjective process in the minds of these doctors which allowed them to assimilate killing to the commandment of healing. But the importance and stature of The Nazi Doctors is much greater than that remark suggests. This is not only one of the most important works on medical ethics yet written. It also breaks through the frontiers of historiography to provide a convincing psychological interpretation of the Third Reich and the crimes of National Socialism. No one will be able, in my view, to write perceptively about those times in the future without referring to this interpretation, without bringing into the center of the analysis the dynamic which Lifton calls “the biomedical imperative.”

Rudolf Hess said in 1934 that “National Socialism is nothing but applied biology.” It was an appeal to which a large part of the German medical profession responded with a sense of dazzled, revolutionary liberation. Medicine was no longer just one profession among others, or one of many branches of applied science and research. It had become the profession, the central intellectual resource of the New Order. Doctors acquired a status that engineers, nuclear physicists, even generals could not approach. Doctors were “biological soldiers.” Medicine was breaking away from mere “Christian” or “Judaic” compassion for the individual, and from the passive, remedial job of healing the sick. From now on, medical science would address itself to the “positive” task of actively shaping the future of the human race, to cultivating and pruning genetic stock for the future, to using “biological laws” in the service of a new understanding of the wholeness and interdependence of all life.

Lifton establishes the chronology, the steps that led eventually to doctors—not professional SS officers, but doctors of medicine—performing the supreme sacral rite of National Socialism: the selections on the ramp at Auschwitz. There were five such steps. The first was coercive sterilization. The second was the killing of impaired babies and children. The third was the so-called “euthanasia” program, the killing of impaired adults—cripples and the mentally handicapped—in the gas chambers of special institutes and adapted hospitals. Then came the extension of “euthanasia” to impaired or racially undesirable inmates brought from the concentration camps. Finally came the mass extermination of entire racial groups in the Einsatzkommando operations and then in the death camps.

The ideas of “racial hygiene” or coercive eugenics were circulating widely in the early years of this century, and not only in Germany. By 1920, for example, some twenty states in the United States had laws for the compulsory sterilization of the “feeble minded” and criminally insane. But in Germany, such thoughts were fatally to converge with new concepts about euthanasia. In Anglo-Saxon societies, as Lifton remarks, euthanasia implied on the whole the right of a person to choose death. In Germany, however, it had been argued since the late nineteenth century that the state as the supreme social organism retained the right to impose death on some of its subjects in the interest of the collectivity, the sacrifice of lives in war being only the most obvious precedent. An influential book published in 1920 by Karl Binding and Alfred Hoche, Die Freigabe der Vernichtung lebensunwerten Lebens, put forward the concept of “life unworthy of life,” which was to become central to Nazi thinking and practice. The authors, a professor of law and a professor of psychiatry, declared that the destruction of “unworthy life” was in itself a healing process—a treatment for the social organism; they discussed the “ballast existence” of human beings reduced to empty shells and prophesied “a new age…. [There has been] an overestimation of the value of life as such.”

Hitler and the other Nazi leaders seized upon such literature, adding it to their mental brew of racialist dogma, collectivist theory, and paranoia about “Volkstod” (the dying out of the Germanic race). In 1933, the first year of Nazi power, a compulsory sterilization law was applied to a list of mental and supposedly hereditary afflictions, including schizophrenia, hereditary blindness and deafness, and even inherited alcoholism. The program was intended to sterilize nearly half a million people in its first phase, though Lifton believes that it was applied only to 350,000 at most. A national index of persons with hereditary taints was established, and the infamous Racial Institutes for Hereditary Biology and Racial Hygiene were set up.

Euthanasia”—Professor Lifton rightly uses quotation marks, for this was state killing, and the word is one of the earliest and ugliest of Nazi euphemisms—began in 1939. It was preceded by the Knauer case, the birth in Leipzig of a gravely malformed child whose parents appealed to Hitler for the right to end its life. Hitler’s accord, with an assurance that any possible legal proceedings against the doctors concerned would be quashed by the Führer, led to the establishment of a commission under Hitler’s personal physicians to register “life-unworthy” children and organize their killing.

Here for the first time doctors were dealing with the reality of “biological soldiering”: killing as healing. The deceptions were for the benefit not only of parents but of the medical staff as well. Although parents who refused to surrender their children to these institutions were coerced and threatened, there was much talk of “latest methods for healing”; children were perfunctorily “treated” for some time before being given lethal sedative overdoses, and doctors laid much emphasis on the research value of autopsies.

Already gratuitous cruelty was appearing. The extremes were represented by the abominable Dr. Pfannmüller at one such institution in Bavaria, who introduced “the natural method”: death by starvation. A member of a party of visitors describes how he pulled a dying child from its bed, and exhibited it “like a dead rabbit,” explaining that only a few more days were needed. “The picture of this fat, grinning man, in his fleshy hand the whimpering skeleton… is still vivid in my mind.” Pfannmüller exemplified a syndrome on which Lifton lays much emphasis: the association of sadism with omnipotence fantasies which came to affect many Nazi doctors.

The killing of adults “unworthy of life” began with an order from Hitler in October 1939, after the outbreak of war. “Patients considered incurable” were to be medically killed. But Lifton, in a memorable passage, warns against the temptation of interpreting this as only an aspect of war preparations and emergency measures:

Rather than medical killing being subsumed to war, the war itself was subsumed to the vast biomedical vision of which “euthanasia” was a part. Or, to put the matter another way, the deepest impulses behind the war had to do with the sequence of sterilization, direct medical killing, and genocide.

The program to kill “unworthy” adults, known as T4, after the Berlin address of its headquarters at Tiergarten 4, was a huge affair. Directed by a large medical and ancillary bureaucracy, it was conducted at six main centers in Germany and Austria. Gas chambers were introduced for the first time, as the mental hospitals of the Reich disgorged their “incurables,” and there was a complex coverup system of reassuring letters to relatives and of falsified death certificates. Jewish children had already been killed in the earlier program, and a number of Jewish adults were now sent to T4 centers from the camps—Jews alone required no medical paperwork or phony diagnosis to be murdered.

It is well known that T4 was halted in 1941, as a result of the only serious civilian protest in the history of the Third Reich. The facts leaked out: public demonstrations took place and Count von Galen, the Catholic bishop of Münster, delivered the famous sermon in which he declared the entire program to be a blasphemy against God: “poor unproductive people if you wish, but does this mean that they have lost their right to live?” Less familiar abroad is the resistance, religious and professional, put up by a few physicians. Professors like Karl Bonhoeffer and Gottfried Ewald, both psychiatrists, resisted, and so did several Protestant pastors involved in running mental hospitals. Paul-Gerhard Braune, the only objector who was arrested, wrote directly to Hitler condemning the very concept of “life unworthy of life” and warning that unless the “intolerable” program were halted, the moral foundations of the nation would be undermined.

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