ChapterPDF Available

From Kraepelin to Karadzic: Psychiatry’s Long Road to Genocide

January 2012

January 2012

DOI:10.5130/978-0-9872369-7-5.d

In book: Genocide Perspectives IV (pp.122-165)

Authors:

Robert M Kaplan

Graduate School of Medicine, University of Wollongong, Australia

Content uploaded by Robert M Kaplan

Content may be subject to copyright.

FROM KRAEPELIN TO KARADZIC: PSYCHIATRY’S

LONG ROAD TO GENOCIDE

ROBERT M KAPLAN AND GARRY WALTER

…it is always a simple matter to drag people along whether it

is a democracy, or a fascist dictatorship, or a parliament, or a

communist dictatorship. Voice or no voice, the people can

always be brought to the bidding of the leaders. All you have

to do it tell them they are being attacked, and denounce the

pacifists for lack of patriotism and exposing the country to

danger. It works the same for every country.—Herman Göring,

Commander-in-Chief of the Luftwaffe, at Nuremberg

The twentieth was the century of mass murder, as Niall

Ferguson,

Eric Hobsbawm,

and others have pointed out.

The rate of civilian deaths rose from less than 5 per cent

before World War I to over 80 per cent by 1980, with women

and children a significant majority. The death toll from

genocide, mass murder, forced starvation, ethnic cleansing

and expulsion exceeded 170 million. In 1990, Michael Burleigh

could say that the chance of events such as the Holocaust

occurring again were remote; after 11 September 2001, he

stated that humankind faced an existential threat to its

future.

Gilbert, G M (1947), Nuremberg Diary, New York, Signet.

Ferguson, Niall (2006), The War of the World: History's age of hatred,

London, Allen Lane.

Hobsbawm, Eric (1994), The Age of Extremes: The short twentieth

century 1914–1991, London, Penguin.

Hobsbawm, Eric (1992), Nations and Nationalism since 1780:

Programme, myth, reality, Cambridge, Cambridge University Press.

Burleigh, Michael (2008), Blood & Rage: A cultural history of terrorism,

New York, Harper Perennial. Also review by Stuttaford, Andrew

(2008), ‘Sacred monsters. On Blood & Rage: A cultural history of

123

In a Europe that had been [relatively] peaceful since 1945,

the wars that followed the collapse of Yugoslavia in 1990

caused dismay at the rapid rise of extreme nationalism.

Images of gaunt prisoners in Serbian concentration camps

between 1992 and 1995 raised the spectre of genocide.

Between 150,000 and 250,000 people were killed and a million

made homeless. By 1995, when hostilities came to an end

following the Dayton Agreement, there were reports of

atrocities on all sides—Serbian, Croatian and Muslim

Bosnians—but the chief perpetrators were the Serbian

Bosnians. Led by Dr Radovan Karadzic, and under the

military command of General Ratko Mladic, the Serbs

committed genocide to render 70 per cent of the territory of

Bosnia free of non-Serbian inhabitants.

Many aspects of the Bosnian genocide were deeply

disturbing. But one startling feature emerged—the role of

psychiatrists. They were leading figures in the Bosnian Serb

political party, the Serb Democratic Reform (SDF). Serbian

psychiatrists adopted a public role to promote their

nationalist aims, justify the behaviour of the military forces,

and denigrate the opposition in psychological terms. The

unique spectacle was that of a practising psychiatrist, Dr

Radovan Karadzic

—in his role as President of Republika

Srpska—actively directing the military activities, notably the

siege of his home town of Sarajevo.

terrorism by Michael Burleigh’, The New Criterion 27, 68, republished

2009 on-line: www.newcriterion.com/articles.cfm/Sacred-monsters-

3924, accessed 20 March 09.

Niebuhr, Robert (2007), ‘Yugoslavia: The final showdown’, Small

Wars & Insurgencies, September, 18, 3, 380–96.

Cigar, Norman (1995), Genocide in Bosnia: The policy of 'ethnic

cleansing', College Station, Texas, Texas A&M University Press.

Kaplan, Robert M (2003), ‘Dr Radovan Karadzic: Psychiatrist, poet,

soccer coach and genocidal leader’, Australasian Psychiatry, 11, 74–78.

124

At this time of writing, Karadzic is on trial before the

International Criminal Court in The Hague. His case should

shed light on how he used his psychiatric training to devise

terror tactics for dealing with the enemy. It may also answer a

key question: how does the profession of psychiatry lend itself

to such extraordinary state abuse? Decades earlier, in the

Nuremberg Doctors’ Trial,

it became apparent that the

medical profession contained within itself the necessary

ingredients for much of its own ruin. And in this regard the

psychiatric profession, so often regarded as marginal to the

medical mainstream, set the agenda for the rest of the

profession [see the Dudley and Gale chapter in this volume].

The path from marginalisation to acceptance in

mainstream medicine and the use of modern technology in

psychiatry goes back to the early years of the nineteenth

century. Psychiatry unerringly allied itself with the dominant

social agendas of the day. That the model arose in Germany

meant that eugenics, racism and nationalism were allied to an

academic approach in which the individual was readily

submerged by the doctrine of the greater good of the nation.

From Sigmund Freud and Emil Kraepelin, reductionist or

vulgarised psychological concepts were used as a tool for

ideological pursuits. These tendencies surface recurrently

whenever psychiatry becomes involved in abuse of human

rights by the nation-state. The terminus of this path, the

Bosnian genocide, illustrates this theme.

‘The doctors’ trial’, Jewish Virtual library,

http://www.jewishvirtuallibrary.org/jsource/Holocaust/doctorstoc

.html. Accessed 26 November 2011.

125

The rise of psychiatry

Insanity…provides us with the proper scale for

comprehending the numerous intellectual, moral, religious,

and artistic currents and phenomena of our social life. —Emil

Kraepelin

Psychiatric illness has been recognised since antiquity. There

are credible descriptions of schizophrenia in the

Mesopotamian Assyrian Codex.

Until the nineteenth

century, psychiatry—its practitioners often referred to as

‘mad-doctors’ or ‘alienists’—was mostly a custodial business,

looked down upon by the medical profession and feared by

the public. The Enlightenment led to new attitudes. Phillipe

Pinel (1745–1826), a fervid revolutionary, believed in an

illness model of symptoms and treatment.

The belief that the

root cause of mental illness lay in the environment led to

more humane psycho-social methods of management in what

was known as 'moral treatment'. Pinel’s work led to the

removal of chains and shackles for the ill, liberation from

dungeons, and to the rise of the asylum. Thus began

institutionalised psychiatry and the process of organising its

practitioners into a professional discipline.

By the second half of the nineteenth century one condition

came to dominate and define psychiatry: neurosyphilis,

Decker, H S (2004), ‘The psychiatric works of Emil Kraepelin: A

many-faceted story of modern medicine’, Journal of the History of

Neurosciences, 13, 3, 248–76.

Jeste, Dilip, del Carmen, R, Lohr, J B and R J (1985), ‘Did

schizophrenia exist before the eighteenth century?’, Comprehensive

Psychiatry, 26, 6, 493–503.

Pinel, Phillipe (1806), A Treatise on Insanity, translated from French

by D D Davis, Sheffield, Cadell and Davies.

http://books.google.com.au/books?id=4snWNO11ETAC&printsec=

frontcover&source=gbs ge summary

r&cad=0#v=onepage&q&f=false

126

known as Generalised Paresis of the Insane, or GPI.

Psychiatry had found its grand cause, its defining illness, and

it was not until the middle of the twentieth century that GPI

ceased to play a part in the daily life of doctors in psychiatric

wards. GPI was a uniformly fatal disease that affected men

more than women. A middle-class illness, it struck at the

heart of the class interests—property. The patient would have

a change in personality, a sense of self-importance and an

expansive tendency leading to wild spending, investing and

drinking. This wrecked the family business and distressed

relatives. The victim could ruin the family fortunes, making it

‘a disease that had everything to do with property and little to

do with sex’.

Patients became demented and unable to care

for themselves, often dying in lunatic asylums.

As the twentieth century loomed, the syphilis organism

showed its adaptability. Neurosyphilis became, as it were,

more egalitarian. Previously an illness of predominantly

upper-class men, it went ‘down market’, affecting women as

commonly as men.

Syphilis occupied such a dominating role

in the pantheon of diseases that it was accorded 113 pages in

the 1893 Index Catalogue of the Surgeon General; tuberculosis, a

much more prevalent condition and one with a greater

morbidity, was given a mere 55 pages.

Prevalent in all this was an especially malignant idea,

namely, hereditary syphilis. First raised in 1595, this was to

become a leitmotif of the times. How could a third generation

Shorter, Edward (1997), A History of Psychiatry: From the era of the

asylum to the age of Prozac, New York, John Wiley and Sons.

Hare, E H (1959), ‘The origin and spread of dementia paralytica’,

Journal of Mental Sciences, 105, 594–626.

Silverstein, Arthur M and Ruggere, Christine (2006), ‘Dr Arthur

Conan Doyle and the case of congenital syphilis’, Perspectives in

Biology and Medicine, 49, 2, 209–19.

127

of a family be so afflicted unless the disease was inherited?

Arthur Conan Doyle, creator of the fictional Sherlock Holmes,

graduated as a doctor in 1881, a period when the Lamarckian

theory of acquired characteristics featured prominently in

medical education. Doyle chose the topic of complications of

tertiary syphilis for his MD thesis. In 1894, his short story ‘The

Third Generation’, illustrated how syphilis could affect

several generations of a family, leaving havoc in its wake.

The idea of hereditary syphilis had remarkable persistence.

Despite the discoveries of Louis Pasteur and Robert Koch, it

endured, fitting perfectly into the theory of degeneration. It

coursed through psychiatry like a septic stream into the

twentieth century. It attracted an obscure youth living in

Vienna. Coming from a rural background rife with

intermarriage, mental handicap and ancestor confusion, Adolf

Hitler was convinced that hereditary syphilis, ‘spread by the

Jews’, would destroy the German race, his obsession fuelled

by persistent rumours that he had a Jewish grandfather. Hitler

did not understand the difference between congenital syphilis

(the organism can cross the placental barrier, which

distinguishes it from other sexually transmitted diseases) and

hereditary syphilis. Years later, it was to surface in Mein

Kampf where 13 pages were devoted to explaining how the

syphilitic taint, (allegedly) spread by Jews, passed down the

generations.

In a Europe that was growing in wealth and creating a

large bourgeoisie, nationalists seized on middle-class fears of

being outbred and losing their privileged status to a surging

proletariat. In response, an alliance arose between two

Silverstein and Ruggere, op. cit.

Hitler’s obsession with syphilis led to inevitable accusations that

he suffered the disease. Despite heroic efforts to prove this there is

no evidence to support the claim. See Redlich, Fritz (1998), Hitler:

Diagnosis of a destructive prophet, New York, Oxford University Press.

128

unlikely forces: nationalism (with the Catholic church in close

association) and ‘respectability’. Nationalism represented an

unrepentant swing back to the past, but with significant

differences. The cities, hotbeds of liberalism and modernism,

encompassed everything that was wrong with the nation.

Marginal groups like Jews, Romani and Slavs were perceived

as a threat to the social order through their birth rates and

their values. They were said to propagate anti-clerical

philosophies like abortion, sexual perversion and breakdown

of the traditional family unit. The countryside, including

regions of appalling backwardness, poverty, ignorance, and

devotion to the irrational, was idealised as the völkisch culture

which represented a glorious and unsullied past.

The nation was divided along faultlines of race and an

extraordinary dichotomy in the private and public life of the

individual. State policy ensured a ‘polite’ society in which

sexual activities were directed to childbirth within marriage.

Sex began to be regulated for the wellbeing of the greater

society. The medical profession duly stepped forward,

providing a forensic basis for state regulation. The

'classification' of sex was initiated by psychiatrist Baron

Richard von Krafft-Ebing. A believer in the theory of

degeneration, he wrote Psychopathia Sexualis, probably the

only medical book to have pornographic status. In the

process, he gave the world the term ‘sado-masochism’, but he

focused mainly on homosexuality. The state now had the

legal basis to prosecute aberrant individuals. ‘Perversions’

such as masturbation, homosexuality and trans-sexualism

were deemed precursors to moral insanity. Krafft-Ebing's

book was published in 1886 and by 1871 the German Criminal

Code (in its notorious Paragraph 175) had made

homosexuality a criminal offence. These outlooks created a

breach into which not only Freud but many others surged.

The medical profession, including psychiatry through its

desire to explain, classify and 'own' many different forms of

behaviour, was now in a position to pass judgment on all of

129

society, a role that was deeply antipathetic to the ancient and

sacred role of treating the individual without fear or favour.

To pass from healing the person to the role of healer of society

was an opportunity that some could not resist.

Kraepelin and the German eugenics movement

There are two sorts of psychiatrists, those by inclination, and

those by chance; those entering psychiatry by chance are

sometimes reasonable. —Emil Kraepelin

An indication of the age is that the three of the most

important figures in twentieth century psychiatry were born

almost simultaneously—Emil Kraepelin and Sigmund Freud

in 1856 and Eugen Bleuler a year later. Compared to the rest

of Europe, German psychiatry had a significant advantage. It

was practised by academicians who perceived themselves as

scientists and saw their patients as research material.

Emil Kraepelin (1856–1926)

qualified in medicine at the

University of Leipzig in 1878 and, unusually, wanted to study

psychiatry from the start.

His intention was to establish a

discipline based on findings that could be proved,

abandoning speculative theories from romanticism. Like all

psychiatrists of the day, Kraepelin learnt his craft through

clinical encounters with syphilis, writing what is probably still

the best book on its psychopathology and predicting

Boroffka, Alexander (1990), ‘Emil Kraepelin (1856–1926)’,

Transcultural Psychiatry, 27, 228–37.

Engstrom, Eric (2003), Clinical Psychiatry in Imperial Germany: A

history of psychiatric practice, Ithaca, New York, Cornell University

Press.

Shepherd, Michael (1995), ‘Kraepelin and modern psychiatry’,

European Archives of Psychiatry and Clinical Neuroscience, July, 245, 4–5,

189–95.

Meyer, A (1994), ‘In memoriam, Emil Kraepelin. 1927’, American

Journal of Psychiatry, 151, 6 Supplement, 140–43.

130

(correctly) that GPI arose from Treponema pallidum infection.

Kraepelin was the organising principal in modern

psychiatry. His findings became the paradigm for twentieth

century psychiatry. He had deeply bureaucratic instincts, he

developed training programs, and constantly lobbied the

government for mandatory syphilis testing and alcohol

control.

In 1917, he founded the German Institute for

Psychiatric Research, a centre that came to dominate

psychiatric research.

The eminent psychoanalyst and historian Gregory

Zilboorg

described Kraepelin as an ‘academic man’ who

lacked human interest in the individual. He was unreservedly

antisemitic, describing Jews as ‘a very great danger’ to the

German ‘race’ through a tendency to forge ahead. Among the

races and classes, he believed that Romani, swindlers, poets

and ‘psychopathic Jews’ were prone to hysteria.

Kraepelin’s psychiatry was dominated by a somatic or

biological perspective in which biographical, social, cultural

and psychological dimensions were marginalised. He was the

first to apply these terms not solely to individuals but to social

groups and institutions. Behaviour that did not correspond

with his outlook was attributed to the theory of degeneration.

Jablensky, Assen (1995), ‘Kraepelin’s legacy, paradigm or pitfall for

modern psychiatry?’, European Archives Psychiatry and Clinical

Neuroscience, 245, 4–5, 186–88.

Zilboorg, Gregory (1957), ‘Eugen Bleuler and present-day

psychiatry’, American Journal of Psychiatry, October, 114, 4, 289–98.

Shepherd, op cit, 193.

Decker H S (2004), ‘The psychiatric works of Emil Kraepelin: a

many-faceted story of modern medicine’, Journal of the History of the

Neurosciences, September, 13, 3, 248–76.

Lomax, Elizabeth (1979), ‘Infantile syphilis as an example of

131

Preoccupied with the ‘will’, Kraepelin appeared indifferent to

the problems of shell-shocked soldiers or hysterics.

In 1915, psychiatrist Professor Albert Hoche described the

end of individualism and the transformation of the nation into

a higher organism, the Volk.

Eugenics, arising from the

practice of pedigree in veterinary science, became a dominant

theme in German medicine and science. Prominent eugenicist

Ludwig Woltmann, who drew on Charles Darwin and Comte

Arthur de Gobineau for inspiration (with some Karl Marx

thrown in for good measure), made race a central concern.

German eugenics was a vulgarised form of Social Darwinism,

portraying the struggle for survival in simplistic racial terms,

constantly raising the threat to the German people from

‘other’ groups. Preaching Germanic supremacy, he regarded

the struggle for existence as a racial conflict in which

Germany would eventually predominate. Three prominent

disciples were anthropologists Otto Ammon and Eugen

Fischer, the latter then based at the University of Freiburg,

and Professor Ludwig Schemann.

Schemann translated and

introduced into Germany the Frenchman Comte de

Gobineau's four-volume essay on The Inequality of the Human

nineteenth century belief in the inheritance of acquired

characteristics’, Journal of the History of Medicine and Allied Sciences,

January, 34, 1, 23–39.

Kraepelin, Emil (1919), ‘Psychiatric observations on contemporary

issues’, first published in Süddeutsche Monastshefte, June xvi, 2, 171–

83. Translated by Eric J Engstrom (1992), History of Psychiatry, June, 3,

10, 253–69.

Kaldjian, Lauris (2000), ‘Eugenic sterilization and a qualified Nazi

analogy: the United States and Germany, 1930–1945’, Annals of

Internal Medicine, February 15, 132, 4, 312–19.

Weikart, Richard (2003), ‘Progress through racial extermination:

Social Darwinism, eugenics, and pacifism in Germany, 1860–1918’,

German Studies Review, May, 26, 2, 273–94.

Weikart, op cit

132

Races, the doctrine of degeneration and decline and, above all

to eager German ears, the 'science' of racial purity.

The trail from the gas chambers and ovens of Auschwitz

can be followed back to the hitherto forgotten but first

genocide of the century—the Herero and Nama slaughter in

German South West Africa (now Namibia) between 1904 and

1906. The first demonstration of the malign consequences of

biological racism resulted in the annihilation of over 80 per

cent of the Herero nation, the effects of which are still being

felt today.

This event was largely assisted by the efforts of

Eugen Fischer. In 1908 he studied (or rather, he did a series of

pseudo-scientific measurements) of 310 children of a mixed

race group arising from cohabitation of the settlers and native

women in German South West Africa, a people known as the

Rehoboth Bastards or Basters. He argued that the physically

strong and healthy Basters should initially be allowed to

increase in numbers to provide labour to the settlers;

thereafter, one should only grant them the minimum

protection they needed ‘as a race inferior to us’ and for as long

as these physically strong but mentally inferior mongrelised

people were useful. Then nature should take its course

through 'free competition, which in [Fischer’s] opinion, means

[their] demise'.

The Herero genocide was driven by the racial theories of

such physical anthropologists. The influence of these men on

German medicine, especially psychiatry, was considerable

and set the tone for what was to follow. After Germany was

defeated and excluded from the colony, the Herero genocide

subsided into obscurity [until a decade ago], but its lessons

Weikart, op cit, 288.

Olusoga, David and Erichsen, Casper (2010), The Kaiser’s Holocaust:

Germany’s forgotten genocide and the colonial roots of Nazism, London,

Faber.

133

were well learned. The terms Lebensraum [need for living

room] and Konzentrationslager [concentration camp]

established the pattern of state organisation of genocide by

biological means, largely run by doctors.

It is no coincidence

that a number of leading Nazis had close connections with

German South West Africa and acted as ‘conduit’ for these

concepts. Of these, Herman Göring was the most notorious.

Fisher’s study, published in Germany in 1913, must be

regarded as one of the precursors of the Holocaust. In 1919,

Entente troops, mostly French, occupied the Rhineland.

Children born out of wedlock (known as Rhineland Bastards)

arose from relations between local women and the soldiers.

After 1937, Fisher created a medical unit, Commission

Number 3, to secretly sterilise 400 children of ‘Rhineland

Bastards’. In 1927, Fischer became Director of the new Kaiser

Wilhelm Institute for Anthropology, Human Heredity, and

Eugenics in Berlin, supervising academics who became

leading figures in providing justification for Nazi

antisemitism and developing laws which then excluded Jews,

Rom people and other ‘non-Aryans’ from German citizen-

ship. By training SS doctors and medical students in eugenics

and racial hygiene, he supported physicians directly involved

in mass murder and crimes against humanity. Fischer used

his scientific authority to justify colonial exploitation and

racial extermination. His disciples were equally influential in

anthropology, sociology, medicine and eugenics. Fritz Lenz

became the first professor of ‘Race Hygiene’ at the University

of Munich in 1923. Setting the tone for the medical

involvement in genocide, in a 1917 article Lenz, Fischer's close

colleague, proposed putting the interests of one’s race above

Madley, Benjamin (2005), ‘From Africa to Auschwitz: How

German South West Africa incubated ideas and methods adopted

and developed by the Nazis in Eastern Europe’, European History

Quarterly, 35, 3, 429–64.

Madley, op cit, 450.

134

all ethical considerations.

To what extent psychiatrists were the driving force in

devising biological solutions to racial ‘problems’, or were

easily encouraged to do so,

may be debatable, but there can

be little doubt about their enthusiasm to become involved. In

the lead-up to World War I, eugenics as the dominant

paradigm flourished in Germany, America, Great Britain,

Sweden and elsewhere, with Fischer at one point hailed as

heading an international eugenics organisation. Eugenics had

a considerable influence on research, planning and the quest

for effective treatments. Other influences were also beginning

to establish themselves, notably the rise of psychoanalysis.

Initially concerned with establishing his movement, Freud’s

testimony to the commission of inquiry on war neurosis led to

growing interest. In the decades before his death, Freud began

to stray from strictly technical issues, writing instead about

the application of psychoanalysis to the condition of

humanity as a whole. Reacting to the rise of fascism, Freud

came to hold a pessimistic view of human nature as

dominated by the death instinct. Religion was merely an

illusion. He was not alone in this: Kraepelin wrote about

Bismarck, describing Weimar republican society as hysterical

and the socialist leaders as psychopathic. Yet soon the medical

profession itself came to be caught up in horrific abuse and

widespread death in the Armenian genocide. That genocide

and its biological thrusts set the stage for what was to be the

precursor to the Holocaust.

Doctors and the Armenian Genocide

If a physician presumes to take into consideration in his work

Friedlander, Henry (1995), The Origins of Nazi Genocide: From

euthanasia to the final solution, Chapel Hill, University of North

Carolina Press.

135

whether a life has value or not, the consequences are

boundless and the physician becomes the most dangerous

man in the state. —Christopher Willhelm Hufeland

The 1914–1923 Armenian, Pontian Greek and Assyrian

genocide was in so many ways the template for the

Holocaust: forced emigration, expulsions, property

confiscations, forced labour, public torture and executions,

medical experiments, elementary gassings, starvation, and

death marches. It was largely directed and carried out by

doctors, leading members of the Ittihadist Party who came to

power in a coup in 1908.

Dr Behaeddin Sakir and Dr

Mehmett Nazim, held responsible in part for the deaths of at

least 1.5 million Armenians, 350,000 Pontian Greeks and

perhaps 250,000 Assyrian Christians, played a pivotal role in

the establishment and deployment of the Special Organ-

isation units, extermination squads staffed by violent

criminals released from prisons to undertake killings. Sakir

had worked as chief physician of Soloniki Municipal Hospital

and Nazim, described as ‘a doctor by profession and not

without promise’, in what must be regarded as one of the

most misguided appointments in the history of medicine, was

designated Professor of Legal (Ethical) Medicine at Istanbul

Medical School.

Many of their collaborators, mostly governors of the

Anatolian provinces where the Armenians lived, were

graduates of the Imperial Medical School. Medical personnel

did not merely supervise proceedings but were directly

involved in the killings, often participating in torture. Dr

Mehmed Reşid, known as the ‘Executioner Governor’, was

Haas, François (2008), ‘German science and black racism — roots

of the Nazi Holocaust’, Federation of American Societies for Experimental

Biology Journal, February, 22, 2, 332–37.

Dadrian, Vahakn (1986), ‘The role of Turkish physicians in the

World War I genocide of Ottoman Armenians’, Holocaust and

Genocide Studies, 1, 2, 169–92.

136

extraordinarily brutal, smashing skulls, nailing red-hot

horseshoes to victims' chests, and crucifying people on

makeshift crosses. Sadistic cruelty was demonstrated by

ophthalmologists who gave eye drops to children that made

them blind and who performed unnecessary, deliberately

disfiguring ophthalmological procedures, especially on young

girls.

Other doctors, describing their victims as subhuman,

used them as guinea pigs to infect a range of diseases.

Hundreds of victims were injected with blood from typhus

cases.

Dr Ali Said was accused of killing thousands of infants,

adults and pregnant women by administering poison as

liquid medicine. He ordered the drowning at sea of patients

who refused the ‘medicine’ and directed the disposal of their

corpses. Infant victims of Dr Tevfik Rusdü were taken to a

purported steam bath and killed with a toxic gas, an ominous

precursor to the later Judeocide.

The later Kemalist government turned its back on the issue

and the collective (and aggressive) Turkish denial that the

genocide had ever occurred took hold. In the years

afterwards, looking at the issue from radically different moral

standpoints, both Hitler and Churchill noted that everyone

[wilfully] forgot the matter before long and Armenia was

destined to slip into the West's historical amnesia [at least

until the 1980s].

Dr Mehmed Reşid’s suicide note summed up the attitude

of these medical genocidaires:

Even though I am a physician, I cannot ignore my

nationhood. Armenian traitors…were dangerous microbes.

Isn’t it the duty of a doctor to destroy these microbes? My

Dadrian, Vahakn (2003), ‘Children as victims of genocide: the

Armenian case’, Journal of Genocide Research, 5, 3, 421–37.

137

Turkishness prevailed over my medical calling. Of course my

conscience is bothering me, but I couldn’t see my country

disappearing. As to historical responsibility, I couldn’t care

less what historians of other nations write about me.

The Armenian genocide set the groundwork for the most

notorious examples of medical complicity in state abuses: the

Nazi doctors who participated in euthanasia and genocide,

and the Japanese doctors who practiced biological warfare.

Included among the former were psychiatrists, who, in

carrying out Hitler’s euthanasia program on their patients,

appear to have been in a state of complete moral disarray.

Racial psychiatry, sterilisation and the Holocaust

[Hitler] could, if need be, do without lawyers, engineers, and

builders, but not without medical professionals, suggesting in

an early speech before the National Socialists Physicians’

League…’you, you Nationalist Socialist doctors, I cannot do

without you for a single day, not a single hour. If …you fail

me, then all is lost. For what good are our struggles, if the

health of our people is in danger?’ ––Adolf Hitler

Many members of the German medical profession needed no

pushing to accept Nazi ideology after Hitler came to power in

1933. Doctors were the first profession to join and embrace the

Nazi party and had the largest representation of all

occupational groups;

of 15,000 Nazi Party medical members,

3,000 were psychiatrists. Nazi racial theories were accepted

without question. The profession acquiesced in the drive to

expel all Jewish doctors. The Nazi physician was designated a

‘selector’ to improve the health of the nation by removing

Baron, J H (1999), ‘Genocidal doctors’, Journal of the Royal Society of

Social Medicine, 92, 11, 590–93.

Haas, op cit, 332.

Kater, Michael H (2000), Doctors under Hitler, Chapel Hill, NC, The

University of North Carolina Press.

138

‘inferiors’.

Eugenics and racial hygiene were compulsory

subjects in medical schools. This enthusiasm was not

restricted to Germany. Following the Anschluss, Austrian

physicians forced Jewish doctors out of the Vienna Faculty of

Medicine, which more than any other European university

had a huge Jewish presence—78 per cent of the staff,

including some Nobel Prize winners.

The role of psychiatrists in mass murder began in 1938

with their prominent involvement in the sterilisation of

patients said to have incurable physical or mental disease. The

process soon accelerated with the move to exterminate

psychiatric patients. In 1928, jurisprudence professor Karl

Binding and psychiatrist Albert Hoche enunciated their

concept of ‘life unworthy of life’, which quickly became the

raison d’etre of the Nazi biological vision. The ‘Aktion T4

program’ to kill ‘unworthy’ adults on eugenic grounds was

based at six centres in Germany and Austria. Under the sign

of the Red Cross, gas chambers were introduced to dispose of

‘incurables’ from the mental hospitals of the Reich.

Psychiatrists experimented with killing by phenol injections

and carbon monoxide gassing. Tiergartenstrasse 4 was the

address at which the Auschwitz, Belzec, Treblinka, Majdanek

and Sobibor gas chambers had their first trial run.

No coercion was involved. Resistance to participation in

these activities was very limited. Opposition to the T4

philosophy came from men like Bishop Clemens von Galen,

Karl Bonhoeffer, Oswald Bumke and Gottfried Ewald. John

Rittmeister, a Swiss-trained psychoanalyst and Communist

had been involved in underground activities to oppose the

Nazis, ostensibly spying for America; he was the only

Proctor, Robert (2000), ‘Nazi science and Nazi medical ethics: some

myths and misconceptions’, Perspectives in Biology and Medicine,

Spring, 43, 3, 335–46.

139

psychiatrist to be executed—by beheading in May 1943.

Ernst Kretzmer made the observation that whereas in the past

they had treated psychopaths, they were now ruled by

them—and was lucky to get away with his life. Paul-Gerhard

Braune, who was arrested, wrote to Hitler condemning the

very concept of 'life unworthy of life', warning that the moral

foundations of the nation would be undermined.

There was no shortage of supporters of the euthanasia

program. The leading figure, Ernest Rüdin, was followed by

professors Heyde, Carl Schneider, de Crinis and Nitsche. Carl

Jung’s enthusiasm for Nazism went well beyond mere

flirtation but he managed to cover his tracks after the war.

There were at least 275,000 victims of this ‘cleansing’

program. Schneider’s eagerness included grandiose plans for

a vast research institute to study genetic aspects of idiocy and,

while it never materialised, he did experimental work on

brains from euthanased patients.

German doctors unquestioningly shared the values of

Wilhelmine Germany. The loss of World War I came as a

shattering blow, followed by the Weimar Republic, a regime

they rejected. There was also a practical issue: loss of income.

Following the Depression, health funding was significantly

reduced and medical schools were producing far more

graduates than the system could absorb, a situation only

remedied by Hitler’s ascent to power in 1933. That the mass

clearing of all Jewish doctors from practice would inevitably

lead to an improvement also featured in the doctors'

thinking.

From 1927 to 1932, the average annual income of

Hunter, Ernest (1993), ‘The snake on the caduceus: dimensions of

medical and psychiatric responsibility in the Third Reich’, Australian

and New Zealand Journal of Psychiatry, March, 27, 1, 149–56.

Lifton, Robert J (1986), The Nazi Doctors: Medical killing and the

psychology of genocide, New York, Basic Books, 123.

Biddiss, M (1997), ‘Disease and dictatorship: the case of Hitler’s

140

doctors fell by 27 per cent; by 1935 it had increased by 25 per

cent.

The central concept in Nazi ideology was the

‘symbolisation of immortality’. Fritz Lenz (and later Rudolf

Hess) would suggest that National Socialism was nothing but

applied biology.

The German medical profession was

designated the ‘central intellectual resource’ of the New

Order.

In this grotesquely thaumaturgic vision, the doctor

was the final agent in the Nazi myth of therapy by mass

murder. Seduced by the power of utilitarian thought and

arguments, German doctors allied their professional skills

with the annihilating process of a despotic government.

Echoing Turkey's Dr Mehmed Resid, Fritz Klein, a Nazi

doctor, explained to author Robert Jay Lifton that he 'killed in

order to cure'

, and that made him a good doctor. Their

statements at Nuremberg indicated how they lost their moral

bearings in this grotesque Nazi political culture.

During World War II, doctors made ‘selections’ at the

death camps, dividing victims into those destined for

immediate extermination in the gas chambers and those who

Reich’, Journal of the Royal Society of Medicine, June, 90, 6, 342–46.

Sofair and Kaldjian, op cit

Baur, E, Fisher, E and Lenz, F (1931), Menschliche Auslese und

Rassenhygiene (Human Selection and Race Hygiene), Munich,

Lehmanns, 417. Baur, E, Fischer, E and Lenz, F (1931), On Human

Heredity, translated by Eden & Cedar Paul, New York, Macmillan Co.

Proctor, Robert (2000), ‘Nazi science and Nazi medical ethics: some

myths and misconceptions’, Perspectives in Biology and Medicine,

Spring, 43, 3, 335–46.

Lifton, op cit

‘Extracts from final statements of defendants’, in Spitz, Vivien

(2005), Doctors from Hell: Accounts of Nazi experiments on humans,

Boulder, CO, Sentient Publications, 258–62.

141

could do some useful work or could be used in experiments.

The operation of the crematoria, determination of when the

victims were dead and choice of means of killing were done

under medical supervision.

Psychiatric euthanasia centres served as training

institutions for SS doctors who went on to construct the death

camps. These doctors had seven times the membership of the

SS compared to other sectors of the German population.

coercion was required to get doctors to work in experimental

institutes or concentration camps and there was no shortage

of volunteers. Large-scale experimental programs were

conducted by leading medical research institutes using

untermenschen, ‘sub-human’ subjects, from concentration

camps. The only physician to command a death camp

(Treblinka) was psychiatrist Dr Imfried Eberl.

The Nuremberg Doctors Trials in 1946 proved every-

thing—and nothing.

They revealed the role of doctors in

experimenting on human subjects and in running death

camps. The doctors, to a man, lacked any contrition, stating

that they were doing no more than following state policy and

their experiments were all done for ‘the greater good'. It is

perhaps problematic that the trial focus was arguably on

details of warped experimentation rather than the doctors’

role in industrialised mass murder.

The Nuremberg Code established criteria to ensure that

the abuse of human beings for experimentation would not

Zwi, Anthony (1987), ‘The political abuse of medicine and the

challenge of opposing it’, Social Science and Medicine, 25, 6, 649–57.

Strous, Rael D (2006), ‘Nazi euthanasia of the mentally ill at

Hadamar’, American Journal of Psychiatry, January, 163, 1, 27.

Marrus, Michael (1999), ‘The Nuremberg Doctors’ Trial in

historical context’, Bulletin of the History of Medicine, 73, 1, 106–23.

142

occur again.

Alone of German institutions, the medical

profession escaped denazification. No attempt was made to

acknowledge the abuses—let alone even atone for them—and

this continued until well into the 1970s when intense (and

foreign) exposure forced some concessions.

Medical abuse after 1945—a growth industry

There is nothing in the human being that which cannot be

verbalised…What a person hides from himself, he hides from

society. There is nothing in Soviet society that is not

expressed in words. There are no naked thoughts. The

unconscious does not exist because it is not available for the

conscious control. —Joseph Stalin

By the time of Hitler, the distinction between civilian and

military combatants was blurred beyond recognition;

atrocities against the civilian population were regarded as an

essential means of waging war. Murder of civilians was a

feature of World War II; in Yugoslavia, for example, more

civilians had been killed by Chetnik and Ustasa resistance

forces than by the Nazi invaders.

What happened in mid-Europe mid-century gave birth to

the shibboleth 'Never Again!'. The Holocaust, the Nuremberg

and 110,000 other trials that ensued, and the 1948 Convention

on the Prevention and Punishment of Genocide led to this

universal cry. But it wasn't long before we had to witness

genocide yet again in most continents and in diverse domains:

the Soviet deportations of whole nations, the Indonesian

(1996), ‘The Nuremberg Code (1947)’, British Medical Journal,

3131448.1, DOI 10.1136/bmj.313.7070.1448. Available from

http://www.bmj.com/content/313/7070/1448.1.full

Korolenko, Caesar and Kensin, Dennis (2002), ‘Reflections on the

past and present state of Russian psychiatry’, Anthropology and

Medicine, 9, 51–64.

143

massacres, genocide in East Timor, Burundi, Rwanda, the

Chittagong Hill Tribes, the massive death tolls in establishing

first Pakistan, then Bangladesh. Amidst such carnage, there

was the spectre of Soviet psychiatry distorting every ethical

precept of the profession in its role as a slavish agent of the

Soviet regime. If people began to think that postwar genocide

was by now essentially the province of Africa and Asia, they

were wrong. A nightmare in the Hitlerian mould was

awaiting in what was Yugoslavia.

The origins of Yugoslavian medicine and psychiatry

At a time when Germany can expel tens of thousands of Jews

and Russia can shift millions of people from one part of the

continent to another, the shifting of a few hundred thousand

Albanians will not lead to the outbreak of a world war. —

Vaso Cubrilovic, predicting ethnic cleansing

Information on the origin and development of Yugoslavian

psychiatry and psychology is almost nonexistent in the

English literature, and scarce enough in Serbo–Croatian

journals,

but certain conclusions can be drawn. Following

the Enlightenment, Croatian and Latinist writers made

contributions to psychology— Croatian philosopher Marko

Marulic (1450–1542) is credited with first using the term

‘psychology’,

but it took until 1920 before psychology had

an academic place in universities.

Yugoslavian psychiatry, like the rest of Europe, drew

Weine, Stevan (1999), When History is a Nightmare: Lives and

memories of ethnic cleansing in Bosnia–Herzegovina, Rutgers University

Press, London, 87.

Kline, Nathan S (1963), ‘Psychiatry in Yugoslavia’, Psychiatric

Quarterly, April, 37, 245–52.

Starjevic, V, personal communication.

Marinkovic, Ksenja (1992), ‘The history of psychology in former

Yugoslavia: An overview’, Journal of the History of the Behavioral

Sciences, 28(4), 340–51.

144

heavily on the German School, with its emphasis on

Kraepelinian dualism, biological factors and eugenics.

Psychoanalysis had a natural attraction to some individuals

when Vienna, where Freud was based, and the regions that

became Yugoslavia, were still in the Austro –Hungarian Dual

Monarchy. Following World War II, at least in the first few

years, the Communist federated state that appeared under

Marshall Tito was determined to be more ideologically pure

than Stalinist Russia. Yugoslavian psychiatry changed when

psychological testing and psychoanalysis were seen as

politically unacceptable bourgeois indulgences. The emphasis

was on Pavlovian behaviourism, with the addition of

biological treatment. Within a decade, ideological restrictions

were relaxed.

Despite rigid centralisation of control, psychiatric services

varied between the component states and this tended to

influence the approaches taken. The influence of Communism

was regarded as stronger and lasted longer in Serbia than in

Croatia and Slovenia. The result was a greater emphasis on a

clinical and more ‘person-orientated’ psychology in Belgrade,

while there was greater production of academic research-

based work in Zagreb. Possibly because of its long-standing

ties to the Germanic world, Zagreb was the most well-

endowed centre, while Belgrade tended to attract those who

were psychoanalytically orientated.

There was nothing

unusual about this: even in Nazi Germany, where Freud was

considered anathema, a form of analytic psychotherapy

continued at the Göring Institute for the duration World War

II. After 1970, Yugoslavian psychiatrists would regularly

attend international conferences and train at other centres,

such as the Tavistock Institute or the Maudsley Hospital in

London.

Kline, op cit

145

Psychiatrists and the Bosnian genocide

These are truly scenes from hell, written on the darkest pages

of human history. —Judge Fouad Riad (1995), reviewing the

Srebrenica killings

The 1992–1995 Bosnian war arose from the break-up of the

nation state called Yugoslavia. Following the death of Tito

and the fall of Communism, multi-ethnic Yugoslavia was

doomed. Slovenia, after a brief clash with Croatia, was the

first to secede. Transforming seamlessly from their role as

Communist apparatchiks to nationalist leaders, Franjo

Tudjman (Croatia) and Slobodan Milosevic (Serbia) were

determined to expand their territories by expelling other

ethnic groups. Playing on ancient scores, the two states went

to war in 1991, with atrocities on both sides. While both made

gains, the outcome was less than satisfactory for Milosevic,

who then set his sights on the multi-ethnic state of Bosnia–

Herzegovina as his prime goal.

Milosevic used the Serbian

Democratic Party of Bosnia–Herzegovina (SDS) as a proxy for

his goal of creating a Greater Serbia.

An ominous phrase entered the lexicon: ‘ethnic cleansing’,

the use of brutal force to remove Muslims from territories

claimed by the Serbs. Harking back to the atrocities of the

Croatian Ustasa during World War II, it has the same meaning

and intent as clearing Europe of its Jews, Judenrein. Ethnic

cleansing involved individual and mass killing, arbitrary

extrajudicial killings, mass rape, starvation, destruction of

residences, property and religious institutions, and

population expulsion.

It was first used by Slobodan

http://www.guardian.co.uk/world/2005/jul/12/warcrimes.iantray

nor/print, retrieved 24 Nov 2011

Markusen, Eric (2003), ‘Genocide in former Yugoslavia, 1992–1995’,

Journal of Genocide Research, December, 5, 4, 605–15.

Blum, Rony, Stanton, G H, Sagi S, and Richter, E D (2008),‘"Ethnic

146

Milosevic in April 1987 to describe Albanian violence towards

the Kosovar Serbs. The term was then used by the media from

July 1991 and by the United Nations in 1993; recent examples

of the practice and its underpinnings have been thoroughly

examined in Norman Naimark's book, Fires of Hatred.

Serbian psychiatrists were prominent in nationalist

politics. The SDS, including many of its medical members,

was established in 1990 by Zagreb-based psychiatrist Dr

Jovan Raskovic.

He was born in Knin in 1929. With the onset

of war, his family moved to Zagreb. He studied medicine at

the University of Zagreb, qualifying in 1956. He obtained his

psychiatric degree in 1962 and worked in the neuropsychiatric

ward at Sibenik Hospital. A well-known psychiatric figure in

Yugoslavia, he published widely in international psychiatric

journals. His early papers on social and cultural topics give

little indication of his political views. Later books (Narcissism

and Depersonalisation, 1990) were more explicit, and the most

notorious was Luda Zemlja (The Mad Country, 1990).

Raskovic

wrote that Catholics (Croats), Orthodox (Serbs) and Muslims

experienced different neuroses: Serbs were strongly oedipal,

Croats fearful of castration and Muslims anally fixated.

this premise, Croats were psychologically driven to challenge

the power of Serbs, the ‘nation of tragic destiny’. The

connection between heaven and national destiny created

‘conditions for the religious destiny of an ethnical being’. As a

cleansing" bleaches the atrocities of genocide’, European Journal of

Public Health, April, 18, 2, 204–09.

Naimark, Norman (2001), Fires of Hatred: Ethnic cleansing in

twentieth-century Europe, Cambridge, Mass, Harvard University

Press.

Weine, op cit, 91–93.

Weine, op cit, 92.

Weine, op cit, 91.

147

result of ‘laws regarding the hygiene of the anal channel’,

Muslims were disposed to gather property and behave

aggressively. In this fashion, Raskovic used psychoanalytic

jargon to justify Serbian aggression, while simultaneously

dehumanising the Muslim opposition. He claimed

that his

conclusions were derived from decades of psychiatric work at

the borders of the three republics.

Raskovic addressed public meetings. He refused to join

Tudjman’s government because the latter would not

acknowledge Serbian rights. Tudjman made public a tape-

recording in which Raskovic derided Serbians, forcing

Raskovic to stand down. He retired to Belgrade and from any

further involvement in politics.

In 1989, an obscure Sarajevo-based psychiatrist, Dr

Radovan Karadzic, became head of the Serbian Green Party (a

grim irony in view of his later despoiling of large tracts of

Bosnia). The following year he surprised many by replacing

Raskovic as head of the SDS. He immediately adopted a

posture of aggressive nationalism and vicious anti-Muslim

rhetoric, confusing many who had regarded him as

unscrupulous but apolitical until then. The SDS proclaimed a

network of ‘Serb Autonomous Regions’ which

from 1992

orchestrated the removal of all Muslims and Croats in the

Serbs’ path. After a strong vote in the November 1990

elections, the SDS participated in a tri-national Bosnian

government under President Alija Izetbegovic. As Yugoslavia

moved toward dissolution in the following year, Karadzic

warned that if Bosnia and Herzegovina declared

independence, Bosnian Serbs would secede and seek union

with Serbia. After the republic’s electorate voted for

independence, war erupted in April 1992.

Weine, op cit, 99.

Gow, James (2003), The Serbian Project and its Adversaries: A strategy

of war crimes, London, C Hurst and Co.

148

Karadzic became president of the Bosnian Serb Republic

(Republika Srpska) based in the self-proclaimed capital of Palé.

By December 1992, Bosnian Serbs had seized about 70 per

cent of Bosnia and Herzegovina. In the course of the conflict,

Serb forces committed many atrocities, chiefly against

Muslims. Tactics included mass execution, the establishment

of rape centres, torture, and forcible removal of people.

Concentration camps, not seen in Europe since the Nazi era,

were re-established. Karadzic authorised the siege of Sarajevo,

shelling the homes of his colleagues and killing patients in

their beds at the hospital where he had worked until

recently

Sydney psychiatrist Dusan Kecmanovic, who had direct

experience of the events that led to the post-Yugoslavia wars,

described the behaviour of psychiatrists at the time as ‘ethno-

nationalism’—defined as the absolute precedence of loyalty to

one’s own ethno-national group.

This was characterised by

preferential treatment of patients of the same ethnicity, the

disproportionately high numbers of psychiatrists among the

political leadership, and the involvement in ethno-nationalist

studies or statements beyond usual professional interests.

These criteria applied to the ethno-psychological writings of

both the Croatian and Serbian psychiatrists of the period.

Each side used psychoanalytic vocabulary to rationalise the

defects of their enemies.

In 1993, Serbian psychiatrists published The Stresses of

War—in collaboration with government departments—

Kaplan, op cit

Kecmanovic, Dunsan (1999), ‘Psychiatrists in times of

ethnonationalism’, Australian and New Zealand Journal of Psychiatry,

June, 33, 3, 309–15.

149

documenting the effects of the war on the Serbian people.

The book alleged that the international media ‘satanised’ the

Serbian people, preparing the way for genocide against them.

While condemning war crimes and genocide, the authors’ bias

was evident in their discussion of the rape of non-Serb

women. First, they claimed that the number of victims was

greatly understated; second, the tendentious allegation was

posited that rapes could not have been ordered by officers

because soldiers cannot get erections on command. In an

ironic reversal of Dr Raskovic’s writings, the psychiatrists

alleged that psychiatry was being misused to ‘spread hatred

against the Serbian people’, and in their subsequent book,

Sanctions (1994),

it was suggested that growing international

sanctions acted as a prelude to Serbian genocide.

Professor E Klein of Zagreb University wrote that Serbs

were militant, had a warrior culture and tended to form

groups around warrior-leaders. They often had an inferiority

complex because of their ‘lower level of civilisation and

culture’.

Professor M Jakovljevic, at the same institution,

said Serbs had a paranoid political culture manifesting in an

‘almost erotic attitude’ towards weapons, producing a

nihilistic destructiveness. This compared adversely with the

Croatian political culture of peaceful co-existence.

Professor J Maric, at Belgrade University, took a different

tack. Serbs, he stated, were well-intended, peaceful and did

not ‘denigrate other peoples’.

Maric contends that while

Weine, op cit, 133–46.

Kaličanin, Predrag (1994), The Stresses of War and Sanctions,

Belgrade Institute for Mental Health.

Kecmanović, Dusan (2002), Ethnic Times: Exploring ethnonationalism

in the former Yugoslavia, Westport, CT Praeger Publishers, 147.

Kecmanović, ibid.

Kecmanović, Dusan (2002), Ethnic Times: Exploring ethnonationalism

in the former Yugoslavia, Westport, CT, Praeger Publishers, 148.

150

they did not have high level of material wellbeing, they did

not subscribe to the superficial politeness found in the West.

Serbian psychiatrists, while ostensibly presenting their case in

a balanced and objective fashion, were both publicising the

Serbian case and seeking to justify ethnic cleansing practices

in the Bosnian war. By ignoring the aggressive role of the

Serbian government, these psychiatrists acted, in effect, as

genocide apologists.

Milosevic signed the Dayton peace accord on December

1995, effectively shutting the door on the Bosnian Serb

leadership. The accord partitioned Bosnia and Herzegovina

into Serb and Muslim–Croat areas and ended the war. The

political tide turned and many Bosnian Serbs held Karadzic

responsible for their isolation.

In 1995, Karadzic was

indicted by an international War Crimes Tribunal for the

massacre of Muslim and Croatian civilians. He resigned in

July 1996, swearing he would never stand trial. After the fall

of Milosevic, he went underground in Serbia. There he

remained, protected by a network of Serbian loyalists until his

arrest in 2008.

Radovan Karadzic—a psychiatrist’s own story

Why not? It’s all strange here, nothing is normal. —

Psychiatrist Dr Ferhid Mujanovic, after Kosovo Hospital was

shelled by the Serbians.

At 15, Radovan Karadzic moved to student quarters in the

city of Sarajevo, living in a multi-ethnic neighbourhood and

mixing comfortably with Serbian, Croatian and Muslim

neighbours. The young Karadzic was described as naïve, but

http://www.bosnet.org/archive/bosnet.w3archive/9709/msg00036

.html.

Weine, op cit, 106–32.

151

endearing. Neighbours recalled a shy farm boy wearing a

grimy white pullover knitted with wool from his village.

Later, his striking looks—he was over six foot tall with a

Byronic shock of hair—attracted attention, and he became a

serial seducer of women. In 1965, Karadzic, with a high school

diploma from the medical vocational school,

studied at the

University of Sarajevo. He received his medical degree on 19

July 1971 and then qualified in psychiatry.

During this time, Karadzic had joined and left the

Communist Party, became involved in student politics and

dabbled in literary circles. He wrote four volumes of poetry

which he recited in public, accompanied by the gusle (a one-

stringed Serbian instrument), to indifferent response.

Karadzic had no doubt about his talent as a poet, but the

literary circles with whom he associated were dubious,

regarding him as little more than a dabbling amateur. This

did not deter him. He published several volumes of his work,

receiving state-funded prizes for his efforts. He also wrote

children’s stories and composed Serbian folk music, which he

performed on radio.

Analysis of his early poetry reveals prophetic, if not

apocalyptic, visions of the future.

In 1971, 21 years before the

war, he wrote a poem called ‘Let’s go down to the town and

kill some scum’. Another poem of that time, ‘Sarajevo’, speaks

of the city burning in a ‘blood-soaked tide'. His fourth

volume, published in 1990, reveals an obsession with

Wilkinson, Tracey (1995), ‘Bosnians recall Karadzic, a neighbor

turned enemy’, Los Angeles Times, 23 July. Available at

http://articles.latimes.com/1995-07-23/news/mn-27059_1_bosnian-

serb. Retrieved 11 January 2012.

Mezedi, I, personal communication.

Kaplan, op cit

Weine, op cit, 118–25.

152

violence, notably in ‘The Morning Hand-Grenade’.

According to Marko Vesovic,

a writer who knew him from

university days, ‘we had considered his case hopeless as far as

literature is concerned’.

Karadzic married Ljiljana Zelen—a Serbian psychiatrist-in-

training from an upper-class Sarajevo family—who later

practised as a psychoanalyst. They had two children. With

suspicious amounts of money at his disposal, he was thought

to be a police informer for KOS (the Counterintelligence

Agency of the former Yugoslavia)

and was shunned by

many.

Karadzic worked at the Djuro Djakovic Adult Education

Centre. To further his skills, he had Tavistock Group Therapy

training [the Tavistock in London is a highly regarded centre

for education and training in different therapies.] He moved

to the psychiatric clinic in Kosevo hospital, Sarajevo until

1983, spending 1980 training in psychotherapy at the Zagreb

Centre for Mental Health. From 1983 till 1984 he was at the

Vozdovac Health Centre in Belgrade. Karadzic continued to

engage in activities that would fulfil his grandiose self-image,

becoming the psychiatrist for the Sarajevo soccer team, one of

the leading teams in Bosnia, and later for the Belgrade Red

Star team. Despite subjecting the players to mass hypnosis,

Dekleva, K B and Post, J M (1997), ‘Genocide in Bosnia: the case of

Dr. Radovan Karadzic’, Journal of the American Academy of Psychiatry

and the Law, 25, 4, 485–96.

http://www.pbs.org/wgbh/pages/frontline/shows/karadzic/inter

views/vesovic.html

http://www.pbs.org/wgbh/pages/frontline/shows/karadzic/inter

views/vesovic.html

153

the teams fared no better.

Ever enterprising and needing money for investments and

gambling, Karadzic sold fraudulent medical certificates and

prescriptions to those who wanted to avoid military service or

retire early. On 26 September 1985, he was sentenced to three

years in prison and fined for fraud and embezzlement of

public funds. He was charged with using a $100,000 grant

meant for farmers to build his own chicken farm in nearby

Palé. Karadzic spent only 11 months in prison. He later

claimed that he had been a political prisoner and the

experience had hardened him, but it is likely the offences

were criminal, not political, and his government contacts

ensured he did not serve a long sentence.

He returned to psychiatric practice when political pressure

to take him back was asserted on the hospital. He worked at

the Vozdovac Health Centre in Belgrade in 1987 and that year

he presented a paper to a psychotherapy conference analysing

a poem about bizarre bodily mutilation. A much-touted book

on depression never eventuated. The last record of him

working in psychiatry is from February to March 1992 at the

Nedjo Zec psychiatric clinic in Kosevo Hospital, Sarajevo. In

his last year at the clinic, Karadzic was always accompanied

by bodyguards, who caused staff and patients distress by

insisting on body searches. Karadzic’s availability became

increasingly limited, and there were always lines of unhappy

patients outside his office. His supervisor, Dr Ismet Ceric,

eventually requested he take leave. After he went to Palé in

1992, he did not practise psychiatry again.

Karadzic’s possible motivations and mental state

You want to take Bosnia and Herzegovina down the same

highway to hell and suffering that Slovenia and Croatia are

Kaplan, op cit

154

travelling. Do not think that you will not lead Bosnia and

Herzegovina into hell, and do not think that you will not

perhaps lead the Muslim people into annihilation, because the

Muslims cannot defend themselves if there is war—How will

you prevent everyone from being killed in Bosnia and

Herzegovina? —Dr Radovan Karadzic (October 1991),

demonstrating the skills acquired from years of psychotherapy

training

Little is known about Karadzic’s upbringing. His father

would undoubtedly have stoked his nationalism, but died

when Karadzic was young; his reaction to the death is

unknown. His mother spoke glowingly of her son and

supported his political goals once he became President.

know little more of Karadzic the doctor, or why he chose

psychiatry. At best he was regarded as marginally competent,

indifferent to the concerns of his patients, and corrupt. Dr

Ceric described his work as ‘ordinary’.

His colleagues,

regaled with assertions that he would become a famous

psychiatrist or poet, said that he diagnosed everybody with

masked depression, provoked psychotic patients, was always

late and never completed reports.

When a psychopathic

patient with a knife went roaming in the ward, Karadzic

retreated to his room, leaving a nurse to disarm and calm him.

Inevitably questions will be raised about Karadzic’s mental

state. He was reported to drink to excess, spend money and

Judah, Tim (1997), The Serbs: History, myth and the destruction of

Yugoslavia, New York, Yale University Press, 199.

http://www.tnr.com/archive/0698/062998/diarist062998.html.

http://www.pbs.org/wgbh/pages/frontline/shows/karadzic/inter

views/ceric.htm.

Weine, op cit, 79.

155

gamble heavily at casinos.

Dr Ceric said he had

psychosomatic symptoms. In springtime and autumn he was

depressed and ‘a little bit, sometimes euphoric’ during

summer and winter. Selling medical certificates, gambling

and indiscriminate spending are indicative of a grandiose and

reckless nature, with strong elements of opportunism.

Vesovic described Karadzic as a psychopath, ‘a man without a

core’. We cannot exonerate his actions, yet some writers,

noting his extreme pronouncements, would consider

diagnoses like psychopathy, manic-depression or paranoia.

Dr Ceric wrote that ‘at the time there was a joke among

our colleagues and our nurses that one day in the future, it’s

possible that Radovan would come to the clinic early in the

morning and say, “Okay I’m back and I’m not guilty of

nothing—or everything, everyone else is guilty...the

Americans or something...so how about some tea or coffee.”’

Warren Zimmerman, the last American ambassador to

Yugoslavia, regarded him as barking mad, obsessed with

violence and in need of psychiatric treatment

What cannot be denied is Karadzic’s capacity for gross

denial, at times reaching delusional proportions. He alleged

that Muslims destroyed the famous National Library, with its

irreplaceable cultural treasures, because it was a Christian

http://sca.lib.liv.ac.uk/collections/Owen/lists/owencd0.html.

Dekleva and Post, op cit

Robins, R (1986), ‘Paranoid ideation and charismatic leadership’,

Psychohistory Review, 615–55. Redlich, Fritz (2000), Hitler: Diagnosis of

a destructive prophet, New York, Oxford University Press, 334.

http://www.pbs.org/wgbh/pages/frontline/shows/karadzic/inter

views/ceric.html

http://www.pbs.org/wgbh/pages/frontline/shows/karadzic/rado

van/impressions.html, retrieved 21 November 2011.

156

building.

Far from Sarajevo being under siege by his forces

for two years, he blustered that Muslim guns were there to

prevent citizens from breaking out of the city. In the face of

overwhelming evidence of murderous atrocities by Bosnian

Serb forces, he continued to state that there was not one shred

of evidence to support these claims and, once again, the

atrocities had been carried out by Muslims against their own

people.

He never renounced his role as a psychiatrist, even after he

assumed the Presidency of the Republika Srpska. One analyst

stated that the level of violence of combatants was fanned by

Dr Karadzic’s ‘psychobabble’.

Karadzic’s group therapy

training influenced his leadership style and choice of terror

tactics. Allegations have been made that he witnessed and

participated in torture at Bosnian Serb concentration camps.

100

Karadzic’s short reign as President of the Bosnian Serb

Republic left an appalling legacy. The full extent of killing and

destruction wrought by his forces during the war will never

be fully known. The casualties and survivors, many now

dispersed around the world as refugees, will suffer for the rest

of their lives. Although many aspects of Karadzic’s

personality remain deeply enigmatic, he displayed an

extraordinary degree of reckless opportunism in which the

instincts of an extreme gambler were unchallenged by any

Cigar, Norman (1995), Genocide in Bosnia, College Station Texas

A&M University Press, 52.

Kaplan, op cit

Breo, Dennis (1993), ‘Human rights II—Cherif Bassiouni condemns

“psychology” of Balkan crimes’, Journal of the American Medical

Association, 270, 643–44.

100

(1995), ‘Witness from hell’, De Telegraaf [Amsterdam], May 27, in

Deklava and Post, op cit

157

restraint or fear of the consequences. His most enduring

characteristics are his grandiose self-image, reckless and

profligate nature, boundless opportunism and grotesque

capacity for self-deception. If nothing else, they disqualify

him as a candidate for Hannah Arendt’s ‘banality of evil’.

Conclusion

…of all the professions, medicine is one most likely to attract

people with high personal anxieties about dying. We become

doctors because our ability to cure gives us power over the

death of which we are so afraid… —Sherwin Nuland

101

The three facets of the medical role are sapiential,

authoritarian and charismatic. Sapience, of course, comes

from training and experience, while authority is not just

implicit but constantly reiterated by the title ‘Doctor’. The

charismatic role accounts for the fact that doctors are dealing

with powerful and mysterious forces. The basis for medical

involvement in political abuse goes deep into the psychology

of medicine and the personality of the practitioner. At its

heart is an extreme grandiosity, a belief that ‘treating’ (in

reality, extirpating) the illness affecting the nation is merely

an extension of the ancient and honoured role of treating the

sick patient. During the nineteenth century, the belief arose

that it was only a question of degree in moving from healing

the individual to healing the nation. The murder of other

human beings (the emphasis being on those defined as ‘the

other’) was, to some, merely a mental leap from the

adjustment required of the doctors to detach themselves from

the patients in order to treat them.

In 1937, the Serb philosopher and nationalist Vaso

Cubrilovic, who had taken part in the plot to kill the

Archduke Franz Ferdinand, anticipated ethnic cleansing in

psychological terms. He proposed to remove Albanians from

101

Nuland, Sherwin (1995), How We Die: Reflections on life’s final

chapter, 1st Vintage Edition, New York, Vintage, 258.

158

Serbian lands by ‘the creation of a suitable psychosis’, that is,

to drive them away by intolerable terror. It is significant that

the language used to justify racial genocide was derived from

medicine in portraying the enemy in pathological terms. The

concept of cleansing or disinfection, particularly since the

early 1900s, was intended to facilitate the illusion that the

mass murders were intended to promote ‘hygiene’. This

designation of the victim of eugenic or ethnic genocide as

some sort of pathology infecting the society as a whole was a

regular part of the process of legitimising massacre as a public

health measure by using ‘reverse jargon’.

102

Turkey's Dr Nazim referred to his Armenian victims as

dangerous microbes or abscesses; Hitler and his medical

acolytes described Jews, inter alia, as parasites, a plague, lice,

vermin, cancer, tumours, racial tuberculosis and gangrenous

excrescences that had to be eliminated.

103

Stalin and Beria

promoted the term purge to denote the deportation of millions

of ethnic Soviet minorities to Siberia, regardless of the

mortality. Japanese germ warfare referred to the population in

Manchuria as 'logs', whom they used for horrifying

experiments; in Rwanda, the Hutu term for Tutsis was

‘cockroaches’; Albanian commanders called the Roma

‘majutsis’, meaning, lower than garbage.

104

Animalisation and

insectification of people, as Rowan Savage shows in his essay

here, is the 'simplest' form of dehumanisation, and it is that

102

Blum, Stanton, Sagi and Richter, op cit

103

Biddiss, op cit

104

Savage, Rowan (2006), ‘“Vermin to be Cleared off the Face of the

Earth”: Perpetrator representations of genocide victims as animals’,

in Tatz, Colin, P Arnold and S Tatz (eds) Genocide Perspectives III

Essays on the Holocaust and other genocides, Sydney: Brandl and

Schlesinger with the Australian Institute for Holocaust and Genocide

Studies, 17–53.

159

sense of designated enemies as other than human that allows

the ideological perpetrators and their minions to justify their

actions.

Why do some elements of the psychiatric profession ally

themselves with genocide in this way, a way that stridently

contradicts every principle of care and healing to which its

practitioners are dedicated? Of all the medical sub-disciplines,

psychiatry has the most direct link with shamanism, the first

specialised role in hunter-gatherer society. The role of the

shaman was not just healing the individual but ensuring the

harmony of the tribal group by placating the gods, coping

with drought or scarcity and predicting the future. In doing

so, it became an elite and hereditary priestly group. This

tendency continued in the post-Enlightenment decline in

religion and its substitution by psychiatry and psychology.

Of all the sub-disciplines, psychiatry was the youngest and

the last to achieve professional recognition. By virtue of the

terrain in which it operates—the mind—psychiatry is

predisposed to overdetermination, making it especially

susceptible to utopian ideology or irenic fantasies. The first

organiser of the profession, Pinel, driven by the spirit of the

French Revolution, sought to change the environment of the

patient through 'moral therapy'. Full recognition of the

discipline came at the start of the twentieth century from Emil

Kraepelin. There is no denying his organisational genius; this,

coupled with the development of a rational system of

classifying diagnoses, set the profession on track to become a

medical speciality.

German psychiatry’s greatest asset proved its undoing:

academicians perceived themselves as scientists and saw

patients as research material.

105

This was a Faustian pact of

the most ominous nature—it laid the seeds of the total moral

105

Engstrom, op cit

160

collapse of German psychiatry under the Nazis.

106

Kraepelin

has to take credit for the catastrophic effect of the theory of

degeneration on German psychiatry—and ultimately the

lowest point in the history of medicine. More than any of his

colleagues, Kraepelin had the intelligence and vision to see

that degeneration was an ultimately doomed and immoral

proposition. By articulating social facts into an implied threat

to the collective wellbeing of the nation,

107

Kraepelin was the

chief architect of the psychiatric debauchment that followed.

It was no coincidence that Ernst Rüdin, his successor at

Heidelberg, was the driving force behind the Nazi euthanasia

program.

108

Another follower, Robert Gaupp, stated in 1938

that Kraepelin’s work comprised nothing less than ‘the

foundation of all Nazi racial hygiene laws’.

109

English

psychiatrist Michael Shepherd described Kraepelin’s ideas as

proto-fascistic.

110

When Kraepelin died in 1926, Hitler would

have been mostly unknown to him.

Whitely states that psychiatry ‘now constitutes an

amorphous system of beliefs, behaviours and attitudes whose

functions and doctrines are unsettlingly to those held by

106

Hanauske-Abel, Hartmut (1996), ‘Not a slippery slope or sudden

subversion: German medicine and national socialism in 1933’, British

Medical Journal, 7 December, 313 (7070), 1453–63.

107

Engstrom, Eric, Burgmair, W and Weber, M M (2002), ‘Emil

Kraepelin’s ‘Self-Assessment’: clinical autography in historical

context’, History of Psychiatry, March, 13, 49, 89–119.

108

Pilgrim, David (2008), ‘The eugenic legacy in psychology and

psychiatry’, International Journal of Social Psychiatry, 54, 272–84.

109

Engstrom, Eric J and Weber, M M (2007), ‘Making Kraepelin

history: A great instauration?’, History of Psychiatry, 18, 3, 267–73.

110

Shepherd, Michael (1995), ‘Two faces of Emil Kraepelin’, British

Journal of Psychiatry, August, 167, 2, 174–83.

161

conventional religions’.

111

Its practitioners undergo years of

special training to gain access to knowledge inaccessible to the

public (increasingly less so in this age of the internet) allowing

them special powers (enforcing treatment). Their terrain,

despite constant reiteration that they are now brain-based, is

‘the mind’, a territory with as little definition as ‘the soul’ is to

the public.

Canonical texts are regarded as being of unshakeable

authority but lead to intense (and to the public, largely

incomprehensible) disputes. Its ultimate expression, personal

psychotherapy, models itself on sacramental involvement and

sin confession, establishing a ritual practice akin to regular

attendance at Catholic mass. Like any church, psychiatry can

be broken down into diverse parts, with different competing

schools squabbling over ideology but sharing the same goals

and distinguishing itself from opposition, that is, non-

professional or lay competitors. Like other institutions in the

public relations-driven jargon-rich discourse, psychiatric

colleges all have ‘mission statements’.

Consider, as an example, the Royal Australian and New

Zealand College of Psychiatry.

112

It takes a stand on selected

and appropriate public issues, such as child abuse or

detention of refugees; yet it shies away from matters that

would be seen as falling directly into its bailiwick. At times it

appears to take a distinctly moral or censorious approach,

sometimes quite legitimately in relation to issues around

stigma, for example complaining that the Jim Carey movie

Me, Myself and Irene was offensive to mental patients. It is

preoccupied with sexual misconduct by doctors (most

111

Whitley, Rob (2008), ‘Is psychiatry a religion?’, Journal of the Royal

Society of Medicine, December, 101, 12, 579–82.

112

It should be stated that in this regard, the RANZCP is little

different from its counterparts in the United Kingdom or United

States.

162

recently, banning delisted psychiatrists from applying to

rejoin the College), but has never issued any response to the

roles of men like Karadzic and his Serbian colleagues in the

Bosnian genocide.

Are psychiatrists as individuals inherently prone to human

rights abuse? There is nothing to indicate that most

psychiatrists involved in such activities are anything but law-

abiding and exemplary citizens. In the former USSR, it would

appear that the majority of Soviet psychiatrists were reluctant

to participate in state-sanctioned abuse of psychiatric

diagnosis and treatment, and 'wriggled out' of such roles as

soon as it was politically possible.

113

114

The German

psychiatrists who led the genocide were not marginal

characters, misfits or psychopaths, but some of the most

prominent academics. Rüdin and Gaupp, for example, were

leaders in the field. Other academics involved in wide-

ranging abuses included Julius Hallervorden, director of the

prestigious Kaiser–Wilhelm Institute, who collected brains of

euthanasia victims for his neuro-pathological collection, and

Carl Schneider, who studied victims before they were

murdered and then dissected their brains. Colonel Aubrey

Levin, who ran the anti-homosexual Aversion Project in the

South African Defence Force, had extreme right-wing views,

yet was an otherwise unremarkable personality.

Karadzic, in contrast, was an extremely dubious, if not

marginal, character. His work was at best ‘ordinary’, his

attempts to establish himself as an artist (or sporting coach)

close to pathetic and he constantly cast around for a role in

113

Bloch, Sidney and Reddaway, P (1997), Psychiatric Terror, New

York Basic Books.

114

Chodoff, Paul (2009), ‘The abuse of psychiatry’, in Bloch, Sidney

and Green, S (eds) Psychiatric Ethics, 4th edition, Oxford, Oxford

University Press.

163

which he could fulfil his grandiose fantasies. Yet Karadzic the

genocidaire cannot be separated from Karadzic the psychiatrist.

He had no hesitation in shelling his workplace, suggesting

that he had internalised the slights of his colleagues and

wanted revenge. He thrived on the fighting, was a constant

presence at the siege of Sarajevo and used group psychology

to plan tactics of terror and ethnic cleansing. That he worked

as an alternative therapist when he was in hiding indicates

that the genocide was perhaps just another expression, albeit

one with the most terrible consequences, of the quest to

become the comprehensive 'healer', feasibly an aspiration of

genocidal doctors.

In its capacity for overdetermination, does psychiatry have

a fatal flaw? This may well be the case. The involvement with

eugenics only had consequences in Germany, but led to

sterilisation of the mentally ill in countries such as Sweden (as

late as 1965) and the United States particularly between the

two world wars. At the highwater mark of psychoanalysis in

mid-century, American psychiatrists confidently issued

nostrums about disturbed youth requiring counselling to

solve a range of social problems. For decades, there was

suppression of acknowledging child sexual abuse on the basis

of Freud’s oedipal theory (it was all a fantasy), that swung

round to the opposite extreme after 1980 and imprisoned

innocent parents on the basis of repressed memories

‘discovered’ in therapy. Now we see another manifestation of

this tendency towards over-zealous social activism, the

removal of children from mothers (if not their imprisonment)

on the basis of a pseudo-scientific and unproven theory

known as Munchausen’s Syndrome by Proxy.

It has to be accepted that, with the best intentions in the

world, the practise of psychiatry can lend itself at intervals to

a view of society that can be described, variously, as

patronising, paternalistic, Manichean and all-encompassing.

In this scenario, the outcome is inevitable. From the

individual to the profession, there arise those who ally

themselves with the state to use their skills to abuse, if not

164

destroy, other groups of people, driven by an inexorable sense

of rectitude that may, in some cases at least, overlie a surging

torrent of rage that led them to the profession in the first case.

As a result of atrocities committed during the Bosnian

Civil War of 1992–1995, Karadzic stands indicted as a

suspected war criminal for crimes against humanity and

genocide, the first doctor so indicted since the Nuremberg

Doctors’ Trial in 1946. These crimes include killing 68 civilians

in the shelling of the Markale marketplace on 5 February 1994,

the use of 248 United Nations peacekeepers as human shields,

and the murder of up to 7,500 people under UN protection at

Srebrenica.

In 1993, the American Psychiatric Association passed a

motion condemning Karadzic for ‘brutal and inhumane

actions’. The condemnation was issued with ‘particular

offence, urgency and horror because, by membership and

training, Dr Karadzic claims membership in our

profession’.

115

Psychiatrists, alongside other medical and mental health

professionals, have wide reaching moral responsibility.

Prominent psychiatrist Thomas Szasz made the point quite

bluntly: 'It is the moral duty of psychologists and

psychiatrists to safeguard the dignity and liberty of people

generally, and, in particular those with whom they work. If

instead they take professional advantage of the imprisoned

status of incarcerated individuals or populations, they are, in

my opinion, criminals.'

116

115

http://www.psych.org/Departments/EDU/Library/APAOfficialD

ocumentsandRelated/PositionStatements/199301.aspx

116

Szasz, Thomas Stephen (1979), The Theology of Medicine: The

political-philosophical foundations of medical ethics, Oxford, Oxford

165

Regrettably, the evidence thus far suggests that doctors,

regardless of prestige, ability, qualification or training, are

amongst the most willing accomplices of state abuse. They

will play a leading role in perpetuating the system, support

and participate in state abuse and, where circumstances

permit, willingly accede to leadership of repressive regimes.

What cannot be doubted is that this phenomenon is a

beginning, not an end, and will undoubtedly recur in future.

We kill everybody, my dear. Some with bullets, some with

words, and everybody with our deeds. We drive people into

their graves, and neither see it nor feel it. —Maxim Gorky in

Enemies

117

Acknowledgements

Robert M Kaplan and Garry Walter thank Dr Nerissa Soh

for her assistance with sourcing material, and Vicken

Babkenian and Anabell St Vincent for their advice and

encouragement.

University Press, 52.

117

Enemies was first published in 1906 (an English version by Kitty

Hunter-Blair and Jeremy Brooks, published 1972 by E Methuen in

London).

The professional regulation of madness in nursing and social work

Chapter

Nov 2021

The Bizarre Career of Aubrey Levin: From Abuser of Homosexual Conscripts to Molester of Male Prisoners

Article

Full-text available

Aug 2016

Robert M Kaplan

Doctors and the Armenian and Bosnian Genocides

Article

Full-text available

Jan 2016

Robert M Kaplan

The extensive degree of mass murder that occurred throughout the twentieth century saw the rate of non-combatant (civilian) deaths rise by over seventy-five percent in the space of seventy years, amounting to a death toll exceeding 170 million. Where genocides are concerned, the central role of doctors is undeniable. Their participation arose from the preoccupation with eugenics for improving the health of the nation. From here, their belief in nationalism overrode the sacred duty to save lives. These doctors descended into moral anarchy, breaching an ethical code of two millennia. This paper examines the role of doctors in the Armenian genocide and that of psychiatrists (notably Radovan Karadzic), in the Bosnian genocide. That medicine contains the seeds of its own destruction is confirmed by the recurrent involvement of doctors in genocide.

Not a slippery slope or sudden subversion: German medicine and National Socialism in 1933

Article

Full-text available

Jan 1997

Hanauske-Abel Hartmut

The history of medicine this century is darkened by the downfall of the German medical profession, exposed during the doctors' trial at Nuremberg in 1946. Relying largely on documents published during 1933 in German medical journals, this paper examines two widely accepted notions of those events, metaphorically termed "slippery slope" and "sudden subversion." The first connotes a gradual slide over infinitesimal steps until, suddenly, all footing is lost; the second conveys forced take over of the profession's leadership and values. Both concepts imply that the medical profession itself became the victim of circumstances. The slippery slope concept is a prominent figure of argument in the current debate on bioethics. The evidence presented here, however, strongly suggests that the German medical community set its own course in 1933. In some respects this course even outpaced the new government, which had to rein in the profession's eager pursuit of enforced eugenic sterilizations. In 1933 the convergence of political, scientific, and economic forces dramatically changed the relationship between the medical community and the government. That same convergence is occurring again and must be approached with great caution if medicine is to remain focused on the preservation of physical and medical integrity.

Making Kraepelin history: A great instauration?

Article

Sep 2007

This introduction surveys the literature on Kraepelin's legacy and assesses efforts on the part of neo-Kraepelinians to install him as a new, post-Freudian `father' of clinical psychiatry. It argues that in contemporary discourse Kraepelin has become a touchstone of professional loyalties and that he is put to use in the strategic organization and apportionment of disciplinary resources, power and knowledge.

Two Faces of Emil Kraepelin

Article

Sep 1995

Michael Shepherd

Eponymous lecturers are expected to make some reference to the person in whose name the lecture is being delivered. In this case my task has been facilitated by the fact that the first Mapother lecture was devoted to Edward Mapother himself. It was given by his successor, Sir Aubrey Lewis, who, as was his wont, furnished a comprehensive account of his subject, demonstrating how this remarkable man laid the foundations of the institution to which he devoted his professional life. Lewis's lecture, entitled “Edward Mapother and the Making of the Maudsley Hospital” (Lewis, 1969), provides a link with this one via the mention of the visit paid by Frederick Mott in 1909 to Emil Kraepelin's Forschungsanstalt in Munich, where he was so impressed by what he saw that he resolved to use Henry Maudsley's bequest to found a corresponding institution in this country. Edward Mapother was to assume a major responsibility for this large enterprise which he justified as follows: “The only hope for the sort of dispassionate long-term research which psychiatry needs, is the creation of teams of career investigators … most of whom should not be primarily psychiatrists at all, but real experts in various branches of science, who have brought its technique to the service of psychiatry and then received enough training in this to enable them to see its problems … Then we should get progress, not pot-boiling.”

Emil Kraepelin's 'Self-Assessment': Clinical autography in historical context

Article

Apr 2002

Contemporary psychiatrists and historians know very little about the life of Emil Kraepelin. Until recently they had to glean what information they could from his memoirs, which had more to say about his travels to far-flung corners of the world than about his own mental life. Now, however, a unique historical document has been uncovered which opens a window on Kraepelin's own psyche. In a manuscript written shortly after World War I, Kraepelin turned his diagnostic methods on himself and clinically documented his own state of mind. This paper reproduces a translation of Kraepelin's 'Self-Assessment' and places it in its historical context.

The Eugenic Legacy in Psychology and Psychiatry

Article

Jun 2008
INT J SOC PSYCHIATR

David Pilgrim

Assumptions about genetic differences in human mental characteristics can be traced in large part to the eugenic movement, ascendant at the turn of the 20th century. This paper offers historical case studies, of 'innate general cognitive ability' and 'psychiatric genetics', in order to appraise the eugenic legacy in current psychology and psychiatry. Reviewing the work of representatives, Cyril Burt, Franz Kallmann and Eliot Slater, along with their research networks, it is argued that eugenics remains a quiet but powerful background influence in modern-day psychology and psychiatry. At the turn of the 21st century, eugenics remains an important area of inquiry, reflection and education for those in the inter-disciplinary field of social psychiatry.

From Kraepelin to Karadzic: Psychiatry’s Long Road to Genocide

Recommended publications

Doctors and the Armenian and Bosnian Genocides

Genocide and Mass Destruction: Doing Harm to Others as a Missing Dimension in Psychopathology

Madness as a political factor

The Nazi Doctors: Medical Killing and the Psychology of Genocide