Thomas Foth on the continuities of psychiatric violence

The extermination of heretics on the funeral pyre of Christianity was a theological measure.
The extermination of Jews in the gas chambers of the Nazis was a medical measure.

Source: Thomas Szasz – „The Theology of Medicine“, 1977
The medical historian Thomas Foth presents in a new essay his research on the continuities of psychiatric violence. The essay claims that the murderous violence executed by German doctors between 1933-49 was, although unique, a manifestation of the extremities in a continuous psychiatric  dehumanization process. Focusing his in-depth qualitative analysis research on the role of the psychiatric nurse, Foth demonstrates how the various shock treatments used on a patient were used randomly and primarily as a means of discipline for “bad” behaviour, sometimes leading to the death of patients. Accordingly, his lecture on the same subject at a conference by the German Psychiatric Association (DGPPN) was savagely criticized

This essay was one of the few not included in the conference documentation, as it didn’t serve the profession’s desired whitewash. Thereafter Mr. Foth wanted to publish his lecture as an abridged article but the participants of the workshop, who were approached for the peer-approved reading, all refused to even read his article.
After some back
and forth, the magazine Canadian Bulletin of Medical History published the essay.

Below, as an incentive to read the full essay, is part of the introduction.
Here a pdf of the article can be downloaded.

Thomas Foth can be contacted for radio interviews or lectures and workshops.

Best regards,
Rene Talbot
(IAAPA Secretary)

In an attempt to contextualize German psychiatric practices, this paper will also touch on international discussions among psychiatrists that took place during the 1930s and 1940s on how these therapies were presumed to operate. Although Buller was in these asylums over the period of the Nazi regime, and without denying or downplaying cruelties committed during the Nazi era, I contend, along with some historians writing currently in the field, that German psychiatric practice demonstrates more continuity than discontinuity from the First World War into the post-Second World War era.  Conventionally, historians writing after the Second World War have subdivided the history of German psychiatry into three fairly distinct stages, paralleling German political history.3 Written for the most part by psychiatrists themselves, this traditional historiography was an attempt to create a respectable self-image by distancing themselves from their past and presenting the Nazi era as exceptional and German psychiatry as the victim of political circumstances. The first decades after 1900 were characterized by the development of an academic psychiatric discipline and the development of nosology, classification, and neuropathology based on the work of Emil Kraepelin or Alois Alzheimer. The advent of Nazi rule marked the beginning of the second phase, which lasted from 1933 to 1945, when psychiatrists were purportedly forced to adhere to Nazi racial ideologies. The third stage that began after the Second World War was characterized “by a slow but more or less successful ‘normalization’ of German psychiatry,”4 and German psychiatrists adjusted to international developments in psychiatry…

… Historian Heinz Faulstich’s work points out that psychiatric patients had been killed both before and after the Nazi regime.6 Newer research on the history of military psychiatry in Germany highlights that the treatment of “war neurotics” arose during and after the First World War,7 and heralded the era of “heroic therapies,” where psychiatrists began to search for therapeutic success regardless of the risk that these treatments posed for patients or how much they exposed them to pain or fear.8 And preliminary results from my research on the Ontario Hospital Toronto, Canada, suggest that shock treatments and other chemical and physical measures employed there in the 1930s and 1940s were not that different from those given in German psychiatric asylums. Some nursing practices at the Toronto hospital, and especially the way that nurses perceived their patients, also appear to be comparable to German nursing practices of the same time period.

While my research perspective is much more aligned with that of this new generation of historians of German psychiatry, I assert, nevertheless, that even these newer approaches are not far reaching enough. Although historian Volker Roelcke, for example, suggests that the interests of the profession drove the development of German psychiatry, his focus remains on reasons exterior to psychiatric practice and to psychiatric knowledge as such. In contrast, this article is based on Michel Foucault’s work, which argues that psychiatry at its very core is a discriminatory practice, and that the Nazi exclusionary practices were extreme variants of scientific, social, and political exclusionary practices that were already in place.9 German psychiatrists, whether before or after the extremes of the Nazi era, were following a rationality that was part and parcel of psychiatric practice (termed a practice by Foucault and not a discourse because the asylum cannot be understood by scientific discourses alone). As Foucault notes, these exclusionary practices are necessarily bound to symbolic and physical violence, which begins with the differentiation between those considered “normal” and those defined as “abnormal, and the definition of madness as the absolute ‘other’ of reason.”10 Once these distinctions were in place, lunatics could easily be identified without any doubts by psychiatric experts because of their difference, even if the causes of their lunacy could not always be determined. When the theory of degeneration allowed psychiatrists to link deviant behaviour with theory, and when the idea that the degenerated person was abnormal became the foundation of biological psychiatry, psychiatry was able to extend its power beyond its traditional focus on curing.11 The idea of incurability had formerly represented a kind of psychiatric horizon, since it defined the effective limits of treatment for diseases that had been perceived as essentially curable. However, from this moment on, madness appeared to be more the technology of the abnormal, and when that status of abnormality was fixed by heredity onto the individual, the project of curing no longer made any sense. Foucault also argued that as the pathological content of the psychiatric domain disappeared, so too did the therapeutic dimension of psychiatry.12 The German psychiatrist Kankeleit made this correlation visible in 1925 when he argued that, although it would be easier and less expensive to “re-integrate the inferiors as viable members into society,” the power of psychiatry was insufficient to achieve this goal: “however successful the care, it can only reform but it can never transform inferiors into normal humans.”13

If the insane could not be cured but only influenced by the rationality of psychiatry, then, Foucault argues, psychiatric practices could best be described as disciplinary, aiming to influence the conduct of the patient and basing themselves on a power structure that hierarchically placed the psychiatrist at the top. Admission to the asylum was a demonstration of the medical power that ruled the asylum, conveying to patients that they had entered a specific space where the distribution of power had nothing in common with the “ordinary world.”14 Using a Foucauldian discourse analysis approach to history thus enables one to analyze this very specific distribution of power and the way psychiatrists conceptualised their interventions, in this case, shock treatments. The underlying question is to analyse how humans govern themselves and others through the production of a specific truth.15 This kind of historical analysis can help to decipher the ways in which certain practices were justified as well as the intentions and evidences of these practices.