Psychiatrists as a moral community? Psychiatry under the Nazis and its contemporary relevance

Objective: In Nazi-occupied Europe, substantial numbers of psychiatrists murdered their patients while many other psychiatrists were complicit with their actions. This paper addresses their motivations and actions, and with particular reference to Australia, explores issues of contemporary relevance. Methods: The events are reviewed in their historical context using mainly secondary sources. Results: The assumption that the term 'Nazi' denotes a closed and unrepeatable chapter is questioned. As with the Holocaust that followed, medical killing of psychiatric patients was an open secret with gradations of collective knowing. Perpetrators were impelled by pressure from peers and superiors, unquestioning obedience, racist ideology and careerism. Perpe-trators and bystanders' denial was facilitated by use of deceptive language, bureaucratic and technical proficiency, and notions such as 'a greater cause' or 'sacred mission'. Dissociation and numbing were common. Psychiatrists were the main medical speciality involved because Nazi race and eugenic ideology (accepted by many psychiatrists) targeted mentally ill people for sterilization and euthanasia, and because psychiatrists were state-controlled and tended to objectify patients. Few psychiatrists resisted. Implications: Nazi psychiatry raises questions about medical ethics, stigma and mental illness, scientific 'fashions', psychiatry's relations with government, and psychiatrists' perceived core business. Psychiatric resistance to future similar threats should be based on commemoration, broad-based education and reflection on cultural values, strong partnerships between psychiatrists and patients, and willingness to question publicly policies and attitudes that disadvantage and stigmatize groups. The principle fundamental to all these practices is an orientation to people as subjects rather than objects.