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The Death Doctors

In fact, T4 only paused, to continue for the rest of the war on an “informal” basis in which the central bureaucracy was dissolved and the medical staff of the killing institutions were left to carry on the work at their own discretion. The next step had already been taken. Early in 1941, the T4 leaders had agreed to allow Himmler to use their facilities for an operation to rid the concentration camps of “excess” population: “asocial” and invalid inmates.

This was the penultimate step to the death camps. The operation, known in office jargon as “14f13,” for the first time merged the SS empire of the camps with the biomedical purging of society. The doctors were now working closely with the SS; gas chambers were in use; the victims were being selected on grounds that no longer had much to do with any objective health criteria but a great deal to do with racial origin and political attitude. It was for 14f13 that the euphemism “special treatment” (Sonderbehandlung) was first introduced to denote killing. Doctors in white coats appeared in the camps. Collective diagnosis was applied to Jews, and Lifton quotes some of the labels used: “Inflammatory Jew hostile to Germans,” or “Anti-German disposition. Symptoms: well-known functionary of the KPD [German Communist Party],” or “Diagnosis: fanatical German-hater and asocial psychopath. Principal symptoms: inveterate Communist.”

It was not long, however, before camp commandants were dispatching indiscriminate parties of victims chosen by their own guards for “special treatment” in the T4 gas chambers, simply to reduce overcrowding. By now, T4 staff were extracting gold teeth and fillings from corpses and forwarding them to headquarters in Berlin. It is no wonder that Lifton calls 14f13 the “medical bridge to genocide.” (Lifton here adds a detail which, to the best of my knowledge, has never been followed up in Germany. In 1942 a T4 “mission” went to Minsk on the eastern front. Its assignment is not known, but there are strong indications that its task was the killing of wounded German soldiers suffering from severe cerebral or psychological damage. Both Bishop von Galen and Braune had earlier expressed the fear that this would be one of the logical consequences of the program.)

The basis of Lifton’s method in this book is an extensive series of interviews. He spoke to twenty-nine men “significantly involved” in Nazi medical programs, including doctors implicated in T4 and employed at Auschwitz. He also interviewed a dozen old Nazis described as “nonmedical professionals,” and eighty Auschwitz survivors from the medical blocks, many of whom were in the tragic category of “prisoner-doctors” working under the supervision of masters like Eduard Wirths, the chief physician, or Josef Mengele. Lifton, who is himself Jewish, conducted these meetings as he felt a scholar should, restraining although not actually denying his own intense emotions, dissembling to a pardonable extent with some of the Nazi doctors by concealing from them the real extent and aim of his book.

This enterprise has already proved too much for some critics, for whom the idea of a Jewish academic tactfully, even at moments tenderly, addressing questions about their psychological stresses to men who did ramp duty at Auschwitz is—simply—unbearable. Such objections seem to me quite wrong. There is an overriding need to know the process by which highly educated and intelligent people contrived to justify to themselves their participation in acts like those. The alternative is to leave—for instance—Mengele protected behind generalizations about “the beast in all of us” or even “the banality of evil,” observations which hide him and his colleagues from examination as surely as the bulletproof screen shielded Eichmann at his trial.

The second part of Lifton’s book is a study of individual behavior at Auschwitz, primarily of the Nazi doctors but also of the prisoner-doctors. Lifton introduces this section by remarking that the place might well have been named the “Auschwitz Center for Therapeutic Racial Killing,” and emphasizing that Nazi ideologues indeed regarded it as a rather special and secret kind of public health venture. The doctors there referred in jest to “Therapia Magna Auschwitzensis”; shortened to “TM,” the abbreviation came to be their unofficial euphemism for the gas chambers. That was the approach that rendered it necessary that doctors, not other camp officials, should supervise the selection process.

Their responsibilities were arduous. They included not only selection on the ramp and supervision of the killing process, but selections within the camp, direct killing by injections (mostly by phenol), certifying death at individual executions, signing false death certificates, overseeing tooth extraction from corpses, controlling epidemics, performing abortions, observing floggings, offering advice on cremation and other means of corpse disposal, and—very important—general advice on controlling the influx of prisoners into the camp itself, which of course affected the proportion of arrivals sent straight to their deaths.

Here, as Lifton says, the healing-killing paradox was at its most acute. Hard as it is to understand, the medical staff took seriously their obligations to maintain “standards of health” at Auschwitz. However, the price of protecting the inmates’ health (if that is the right expression: their average life expectancy was about three months) was to keep up a high killing rate among new arrivals at the ramp, and often to recommend the gassing of whole blocks of the camp which had become infected with typhus or other diseases, or were otherwise unmanageable.

There also remained the other, broader aspect of healing-killing: the necessities of the biomedical vision which required the curing of the Nordic race by ridding it of Jews and other “poisonous” elements. The doctors, in short, were invited to see their task as a supreme expression of medical responsibility, its value only emphasized by the fact that most doctors initially found it difficult to carry out—and some found it impossible. However, once these physicians had convinced themselves that they were still acting as doctors and not as slaughterhouse foremen, their sense of omnipotent rectitude could become extreme. The tale of the Polish children gassed to protect camp morals is one example. Another is the fact, cited by Lifton, that suicide by prisoners was regarded as a most serious offense and was followed by a careful official inquiry.

By contrast, the prisoner-doctors, most of whom were Jewish, faced their own dilemmas with open eyes. Essentially, they were all dead men and women on furlough; for any reason or none, at any moment, a prisoner-doctor could be dropped back into camp or gas chamber. Nonetheless, they did what they could to save lives, to help the sick in the medical blocks, and to restrain or mitigate the “hobby” programs of research which individual Nazi doctors were carrying out on prisoners. In order to do these things, they were obliged also to enter the awful paradoxes of Auschwitz. They provided lists for selections to the medical block doctors, knowing that the more reliable they were in assisting the death process, the more effectively they could persuade their masters to let them help others. In matters like the distribution of medicine—ten aspirins a day for a block containing thousands—they were again choosing candidates for survival by rejecting other claims to live. As Lifton says, in Auschwitz a rare syringe was worth more than a human life.

Curious, conditional bonds sometimes arose between these prisoner-doctors and the SS physicians; born of expediency, these bonds—as between terrorists and their hostages—could acquire some depth. The ties could be confessional, professional (doctors talking to doctors), sexual, or even scientific, for some of the prisoner-doctors, although appalled at the brutality of the experiments on prisoners, became almost in spite of themselves emotionally committed to their success. A few SS doctors, like the man named here as Ernst B., not only took pains to keep their prisoner-helpers alive and well-fed but even arranged forbidden meetings with their relatives in the main camp.

The extraordinary prisoner-doctor Hermann Langbein, who was in touch with a resistance group in the camp, managed to establish a sort of ascendancy over Eduard Wirths, the chief Auschwitz doctor. As his secretary, Langbein was able to extract concessions from Wirths, to encourage him in his power struggle against the SS political office, and even to dissuade him from resigning in a moment of despair. In three categories, however, the prisoner-doctors killed voluntarily. They killed vicious kapos, as indicated by resistance cells; they killed dangerous maniacs on the medical blocks whose behavior threatened to get the whole ward “selected”; most reluctantly, they also aborted babies or killed them at birth, in order to save their mothers from the gas chamber. As Dr. Olga Lengyel, one of the prisoner-doctors, said: “I marvel to what depths those Germans made us descend.”

Two psychological terms are advanced by Professor Lifton to interpret the adaptation of the Nazi doctors. These are “numbing” and “doubling,” and they have, of course, a validity which can extend far beyond the crimes of the Third Reich into any situation where human beings consent to behave in ways that contradict a previously internalized moral code—including war itself.

Numbing,” a term Professor Lifton has formulated in earlier work, is fairly self-explanatory. Selection duty on the ramp was accompanied at Auschwitz by an almost literal numbing: the doctors drank heavily in what became a carefully observed group ritual, and encouraged shaken or reluctant newcomers to get drunk with them. More generally, the doctors protected themselves against impulses of pity or horror by a battery of mental devices. Racial ideology was the most important. Lifton suggests that the doctors tended to regard Jews not simply as “subhumans” beyond normal human consideration but as people who were in practice already dead by virtue of their presence in the camp. Experiments on living prisoners could thus be experienced by the doctors as a form of autopsy, and some of the contradictions that so horrified outsiders—for instance, careful antiseptically performed surgery on patients, who were then at once killed off—were evaded.

Josef Mengele provided numerous examples of such “extreme numbing,” but so did the doctors of the T4 program, including leading figures like Karl Brandt, an admirer of Albert Schweitzer and a man whom many contemporaries remembered as noble and upright: many decent Germans were bewildered by the revelations at his trial after the war. At the lowest level, “numbing” was only an extension of self-protective attitudes always present in the medical profession: the hardening to horror required in any casualty ward, or the “sawbones” humor common among surgeons. At the “euthanasia” center of Hadamar, a drunken party with music and mock sermons was held in the cremation room to “celebrate” the ten thousandth victim.

Doubling” is a more complex idea. Lifton is defining the construction of a second “Nazi” or “Auschwitz” self. He is not, he insists, talking about the lasting dissociation of “dual personality,” but about a temporary dissolving of psychic glue as “a means of adaptation to extremity.” The second self accepted an entirely different set of criteria within the extreme circumstances. “Conscience” at Auschwitz meant performance of duty, loyalty to the doctors’ and SS groups, the “improvement” of camp conditions (i.e., making Auschwitz function more efficiently). At the same time, the prior self continued to exist, to be entered on leave when a doctor returned to his family: or when Rudolf Höss, the commandant, went home at night to his luxurious house and played lovingly with his children.

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