Why were there so many Nazi doctors?

Studies have shown that doctors have an unusually high number of authoritarians among them. They were raised that way and expect there to be hierarchy, deference to authority figures (“I tell you, I am the doctor”), obedience, submissiveness to authority, and conformity.

Dr. Bruce Levine:

For several years, I have thought it important to illuminate the authoritarian nature of mental health professionals — especially those who have not rebelled in any way against their professional socialization. In this article, I will summarize a compelling analysis from the Journal of Medical Ethics on the variables in “contemporary medical culture” that produce doctors who are authoritarian and harmful. First, however, some definitions and my personal observations.

Authoritarian is defined as “relating to, or favoring blind submission to authority.” Authoritarians with power demand unquestioning obedience from those with lower rank, and authoritarian subordinates comply with all demands of authorities.

In contrast, anti-authoritarians reject — for themselves and for others — an unquestioning obedience to authority, and they believe in challenging and resisting illegitimate authority. In contrast to authoritarians’ unquestioning obedience, anti-authoritarians assess whether authorities actually know what they are talking about, and whether they are competent, honest, have integrity, and care about those people who are trusting them. And when anti-authoritarians determine an authority to be illegitimate, they resist that authority — no matter whether that authority is their parent, teacher, or doctor.

There is always a tension between authoritarians and anti-authoritarians, and when authoritarians have power over anti-authoritarians, this tension results in various forms of violence.

In that article, I simply reported my observations about how the selection and socialization of mental health professionals breed out anti-authoritarians. I noted that gaining entrance into graduate school or medical school and becoming a psychologist or psychiatrist require much behavioral and attentional compliance to authorities, even to those authorities that one lacks respect for. I pointed out that those with extended schooling have lived for many years in a world where one routinely conforms to the demands of authorities, and it was my experience that most psychologists and psychiatrists are not only extraordinarily compliant with authorities but also unaware of the magnitude of their obedience. I concluded that noncompliant patients create enormous anxiety for authoritarian doctors, and that this anxiety along with doctors’ shame over their own excessive compliance can fuel harmful diagnoses and treatments.

Colaianni begins by reporting, “More than 7% of all German physicians became members of the Nazi SS during World War II, compared with less than 1% of the general population. . . . By 1945, half of all German physicians had joined the Nazi party.” Colaianni points out, “Physicians joined the Nazi party and the killing operations not at gunpoint, not by force, but of their own volition” (there is not a single reported case of a physician who was shot, incarcerated, or penalized in any way for refusing to participate in the killing operations).

However, Colaianni does not merely reiterate the history of how authoritarianism among doctors in Nazi Germany enabled Nazi atrocities. Her original contribution is a description of those variables that continue to exist today in “contemporary medical culture” that result in doctors’ authoritarianism and harmfulness. The following is a summary of those variables:

Hierarchy and Socialization: “Medical culture is,” Colaianni concludes “in many ways, a rigid hierarchy.” The essence of authoritarianism is unquestioning obedience, and Colaianni points out, “Those at the lower end of the hierarchy are used to doing what their superiors ask of them, often without understanding exactly why. . . . Questioning superiors is often uncomfortable, for fear both of negative consequences (retaliation, losing the superior’s respect) and of being wrong.”

Career Ambition: Colaianni notes: “Becoming a doctor requires no small amount of ambition. . . . The stereotypical pre-medical student [is] ruthlessly competitive, willing to do anything to get ahead.” She notes that “there is a fine line between being motivated to succeed and being willing to compromise one’s integrity to attain success.” My experience is that for psychiatrists in training, even if they have trepidations about harmful “treatments” such as electroshock (ECT), they recognize that a refusal to administer ECT can threaten their career. The sad reality is that for many doctors, career ambition — and an accompanying compulsion to please authority — trump their moral apprehensions.

The ‘License to Sin’: Colaianni points out, “Physicians and even medical students are allowed to perform actions that, in other contexts, are taboo.” She reports how, in medical school, she and classmates “dissected the cadaver of a 98-year-old woman, cutting her muscles apart with scalpels and cleaving her bones with a saw.” This “license to sin,” she concludes, can result in harmful arrogance.

Inflicting Pain: Colaianni notes: “Doctors must become comfortable inflicting transient pain and discomfort on their patients for their own benefit in the form, for example, of stitches and biopsies.” Becoming comfortable with inflicting pain can lead to, Colaianni points out, “doctors who do not worry enough about whether they are hurting their patients.” This results in, for example, the overutilization of dangerous and sometimes necessary procedures and treatments.

Medical Terminology and Euphemism: Colaianni notes how medicine and scientific researchers use language that protect them from the realities of suffering. “Scientists use euphemisms and the passive voice in journal articles . . . writing ‘the animals were sacrificed’ at the end of the experiment is less jarring than admitting that ‘I killed 20 mice by holding their necks and pulling their tails until their spines snapped’.” Euphemisms also provide doctors with self-deceptions and deceptions to patients about truths that, when clearly stated, reduce doctor authority; she gives these examples: “We routinely use the words ‘idiopathic’ or ‘cryptogenic’ to mean ‘we don’t know,’ and ‘iatrogenic’ or ‘nosocomial’ to mean ‘we caused it’.”

Detachment: Colaianni discovered that “the medical profession requires unflappability in the face of things that others would consider disgusting, horrific, or otherwise overwhelming.” She reports being warned against getting too emotionally invested in her patients; and she was taught to have a clinical detachment or ‘detached concern, which means “showing empathy and caring, but not so much that you burn out emotionally.” Colaianni reports, “It is well documented that medical students become less empathetic and even less ethical as we progress through medical school.”

While there are doctors such as Colaianni who have angst over their professional socialization, many do not.

Among psychiatrists, psychologists, and other mental health professionals, there are a handful who risk their career to resist harmful authority, but most do not; and I believe that anti-authoritarian patients should be especially concerned with authoritarian psychiatrists and psychologists — perhaps even more so than with other authoritarian doctors. While an authoritarian cardiothoracic surgeon may be an abusive jerk for a nursing staff, that surgeon can still effectively perform a necessary artery bypass for an anti-authoritarian patient. However, authoritarian psychiatrists and psychologists will always do damage to their anti-authoritarian patients because anti-authoritarian noncompliance creates anxiety and often even shame for authoritarian doctors, and their anxiety and shame fuel harmful diagnoses and treatments.

What is especially troubling is that in Germany doctors were some of the earliest members of the Nazi Party, and were instrumental in helping the Nazis rise to power, despite their profession of helping people. The reality of it is horrifying. This is especially true when we hear about the experiments done on people that were inhuman by Nazi doctors, experiments involving live dissection, freezing to death, poisoning, amputation, etc. And children were experimented on, particularly twins.

The medical society may have self-selected in joining the Nazi Party based on a variety of major vulnerabilities and factors; these include: 1) Professional vulnerabilities among physicians in general, 2) Economic factors specific to German physicians, and 3) Nazi ideological and historical factors. The causes of the brutalities committed by the Nazi doctors with such self-righteous, methodological efficiency — acts that have reverberated for years since — continue to elude many historians and psychologists. Nevertheless, identification and analysis of the web of vulnerabilities and other factors that fueled this behavior can guide us toward prevention of future abuse by highlighting the conditions that make physicians susceptible to misapplications of medical research, medical practice, and medical ethics (Mileck, 1954). Such analyses also provide vital case studies for teaching medical ethics more effectively. To the extent that we can understand and teach about the context and motives that surrounded physician’s abandonment of the Hippocratic Oath in favor of Nazi ideology and inhumanity, the teaching of bioethics can cultivate essential practical insight. Such insight is necessary to identify one’s own vulnerability to seductions of abandoning the Hippocratic Oath, as well as principles such as beneficence and respect for the autonomy of the “other” (Ries and Wald). Alas, such seductions arise with some regularity in the ever-changing biopsychosocial (not to mention economic) landscape of clinical practice. Moreover, thorough analysis of these vulnerabilities and factors provides lessons in what has been termed ethicogenesis, i.e., harm caused under the banner of self-righteousness, in the name of such ethical values as public health or even medical ethics itself (Bursztajn, 1986). Unimaginable as the Nazi medicalization of genocide may seem today, the perversion of ethical principles is no more confined to the historical past than are demoralization, economic insecurity, a need to belong and conform, and the search for a quick fix to existential problems. George Orwell’s admonition in 1984 that “He who controls the past, controls the future” is well worth remembering, so that education in medical ethics will not omit the pitfall of invoking ethics themselves as a rationalization for perpetuating crimes such as those that were enabled by the German Medical Society (Granick, 2009). Our initial analysis raises a variety of questions we look forward to exploring in future work, including the fundamental question of the relationship between professional authority, authoritarianism, and the avoidance of awareness of dependency and individual fragility.

Attitudes toward Jewish doctors

The self-righteous persecution and marginalization of Jewish physicians by early Nazi members of the German Medical Society were greatly facilitated by caricaturing Jewish physicians as unethical. For example, in 1935 Hans Lohr lauded the remarks of Reich Physician Leader, Gerhard Wagner, “[Jewish physicians have]…debased the concept of professional honor and undermined the ethics and morals intrinsic to our racial stock” (Löhr, 1935, in Mosse, 1981). By attributing to Jewish physicians the ethical failings of early Nazi Party physician joiners, German Medical Society members could wrap themselves with the flag of moral and ethical purity while enthusiastically victimizing their Jewish physician colleagues. This was an important, perhaps essential, move in the process of rationalization, since a conception of ethics — of doing good — has animated the profession of medicine since antiquity. Id.

Support for Nazi Ideology

Examining Nazi ideologies through the looking glass of German medical practitioners of that era calls attention to factors that may have made physicians especially open to and interested in Nazi rationalizations. Through a Social Darwinist ideology, Nazism explicitly framed its methods and aims in biological terms. As Hitler’s deputy, Rudolph Hess, claimed: “National socialism is nothing but applied biology” (Lifton, 1986). Through sacralizing the social whole over the individual, Nazism promised partial solutions to existential problems that physicians confront daily. 4.1. Social Darwinism and eugenics The pseudoscience of Social Darwinism served as the philosophical justification for “eugenic cleansing” of Jewish populations across Germany and eventually Europe. The Social Darwinist model in its most volatile form drew its inspiration from what was, at the time of its inception, the greater economic, governmental and technological advancement of the “White European” in comparison with other populations. Extending this observation, the model reasoned that this greater advancement was manifest reality of “survival of the fittest” at work, thereby concluding that the White European race must be self-evidently superior to other races (Hofstadter, 1992). The Nazi regime needed merely to bend this philosophy to its own needs, preaching German supremacy and destiny for rule over what it deemed to be impure or unfit races. This skewed philosophy directly motivated the Action T4 eugenics program, run by some 50 physicians, who sent surveys out to hospitals, urging their colleagues to nominate candidates for euthanasia (Proctor, 2001). Victims were typically injected or starved to death in psychiatric hospitals, or transported to specialized facilities to be poisoned or gassed to death, and then cremated. Action T4 was, essentially, “medically supervised murder,” and the majority of participating physicians gaining experience through the program also became supervisors of the infamous ‘Final Solution’ plan to annihilate all European Jews (Proctor, 2001). Medical professionals were highly influenced by Social Darwinist ideas. According to one estimate, over 90 per cent of the members of the medical profession at the highest level were involved in one way or another in work … [involving] … experiments … carried out on human beings in which…the subject was either sacrificed or permanently wounded…in German hospitals, universities and concentration camps (Drobniewski, 1993). The Nazi medical experimentation, with its veneer of a research program progressing to benefit the nation — and, by extension, all of humanity — was an easy subsequent step for the regime to implement. After all, the Nazis would certainly need biomedical knowledge to be able to face the many challenges they would confront in the upcoming war years. A eugenic movement provided a direct means of conducting the kinds of research that could address these problems while cutting the efficiency costs that typically accompany humane treatment of experiment subjects. Not the least of the war challenges Germans faced, for example, was that of the many hostile thermal environments in which their soldiers would have to fight and survive. This problem, and others like it, inspired cruelly creative experiments into the prevention of hypothermia and into the general prolongation of life in cold weather and water, in which countless Jews and Russians either drowned or froze to death (Pozos, 2002). The importance of biological research to the Nazi war effort provided a utilitarian justification for these atrocities, which were framed as necessary goods in the aim to create an immortal species of humans, “Übermenschen.” Since such a vision required important, salvific roles for medical scientists as creators and implementers of socially useful knowledge, physicians could easily be taken up by this ideological narrative. 4.2. The social organism as sacred The idea that the social whole has precedence over the individual was very clearly encapsulated in the sayings propagated by Hitler: “Gemeinnutz geht vor Eigennutz” (What is useful for the community has priority over what is useful for the individual) and “Du bist nichts, dein Volk ist alles” (You are nothing; your people [nation] is everything) (Reich, 2001). Hitler was advocating social unity at all costs, including dehumanization of internal minority citizens. In more typical circumstances, such collectivist ideas can serve to moderate extreme individualism. However, post-WWI Germany suffered a deteriorated standard of living, a loss of community spirit, subsequent feelings of loneliness in the German citizen, and a rising potential for rebellion and disorder– circumstances that may have made a collectivist ideology especially attractive (Ferguson, 1975; Mileck, 1954; Weiss, 1987). The Nazi Party promised to quell this social insecurity and loneliness by dissolving individuality and freedom into the single-mindedness of the group. The German people would be one unified organism. Hitler’s ideas were popularizations of earlier, more abstract philosophical ideals. In German philosopher Johann Fichte’s Addresses to the German Nation (1808), one encounters these ideals of salvific collectivism germinating, at least among intellectuals, with full candor: The means of salvation, which I have promised to disclose, consists in cultivating a completely new self, … a universal and national self, and in educating the nation, whose former life has been extinguished and become the appendage of a foreign life, to a wholly new life … the interest of the whole to which he belongs is indissolubly bound by the motivating feeling of approval or disapproval to the interest of his own extended self, which is aware of itself only as part of the whole and can only bear itself when the whole is agreeable… Through the new education we desire to form the Germans into a totality that in all its individual parts is driven and animated by the same single interest… [it] would consist precisely in this, that, on O.S. Haque et al. / International Journal of Law and Psychiatry 35 (2012) 473–479 477 the soil whose cultivation it takes over, it completely annihilates freedom of will, producing strict necessity in decisions and the impossibility of the opposite in the will, which can now be reckoned and relied on with confidence (Fichte, 1808/2009, p. 23–24). It is not surprising, therefore, that one would later come across these ideas in the tremendously influential figure of German politician and Reich Minister of Propaganda Joseph Goebbels, here at a political rally in 1938: Our starting-point is not the individual, and we do not subscribe to the view that one should feed the hungry, give drink to the thirsty or clothe the naked — those are not our objectives. Our objectives are entirely different. They can be put most crisply in the sentence: we must have a healthy people in order to prevail in the world (Burleigh & Wippermann, 1991). These collectivist, totalitarian ideals were also expressed by popular medical theorists at the time. During the rise of the Nazi Party, the ideas of the extremely influential medical theorists Erwin Liek and Karl Kotschau were gaining popularity. Liek and Kotschau argued that commitments to care of individual sick persons had to give way to a preventative care that respected emerging needs of the entire society (Reich, 2001). These ideas were particularly potent because they manipulated not only medical practice, but also the very definition of medical care. By viewing the social organism as sacred and the individual as dispensable (as manifested in the ideas of Liek and Kotschau), physicians could see themselves as saving a sick society in the service of the larger enterprise of creating a stronger, healthier Germany. The Nazi regime also formed a strange connection between healing and killing, in which the latter was construed as a type of the former. Psychiatrist Robert J. Lifton explains how the regime framed eugenic killings as a form of healing, a cleansing for the Aryan population and post-WWI body politic. In short, the doctors believed that by destroying lives they were paradoxically saving the ones that most mattered amid the entire society (Lifton, 1986). Id.

Desensitizing of Doctors

Having emerged from the horrors of WWI, many men had been in war and seen human beings ground to hamburger and blown up by machines guns and bombs. WWI was a carnage fest, and this desensitized doctors. Id.

Economic Advancement and Upward Mobility

Many doctors were incentivized by increased pay and respect, desiring upward social mobility and saw the Nazis as a way to gain that status. Before the Nazi rise to power the economy was in shambles, with hyperinflation. Id.

Militarization of Society

German society had become increasingly authoritarian prior to WWII. A military style organization of social status developed. Doctors that resisted this organization were treated with contempt. Id.

Authoritarianism

This was described above, and authoritarian parenting was incredibly popular in Germany at this time, which enhanced the effect.

Sources cited in the above article:

Conclusion:

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