Trial run for mass murder

One-third of the patients in Germany's asylums and hospitals for the mentally ill were murdered with official Nazi connivance during the war years -- a training programme for genocide, writes SUSANNE HELM in Le Monde Diplomatique

(May 2005) -- THE Berlin headquarters of the Nazi Sicherheitsdienst (security service) asked local staff in the spring of 1944 for reports on the public response to a particular issue: the rumour rife throughout Germany that elderly people were dying prematurely (1). They uncovered deep-seated suspicion of the national socialist healthcare system. Much of the German population believed that because the elderly had less to contribute, the state saw them as undesirable and superfluous and that, consequently, they were not getting proper medical care.

There were rumours of doctors using the "appropriate" means to "eliminate" elderly patients to cut costs and save drugs in short supply. Many Germans believed that the authorities had told medical staff to stop treating the most elderly patients and avoid prescribing them prostheses or drugs subject to quotas, such as insulin. In some districts the elderly avoided going to see doctors, preferring to seek the advice of pharmacists or healers; others were not taking drugs that had been prescribed for fear of being poisoned. The rumours were accompanied by accusations that when high-value rationed foods like fruit, vegetables or milk were being distributed and people were being evacuated to escape Allied bombings, priority was being given to the young and women of child-bearing age.

In many parts of Germany, these rumours had persisted for years: the most recent experience of the elimination of "unproductive" people at the state's request was very much alive in the public consciousness. People again talked openly of the killing of patients in asylums and hospitals; they thought that, after the handicapped, it would the turn of the elderly to be given lethal injections.

But knowing about the Nazi policy of euthanasia, people were resigned rather than rebellious. Between January 1940 and August 1944, more than 70,000 patients in German psychiatric institutions had been systematically killed. This mass murder was the work of the innocuously named T4. The authorities used administrative tricks to conceal T4, which became a state secret. At the start of the war Hitler had issued a written authorisation for the deaths, but in deliberately vague terms, leaving it to medical and administrative experts to set up the death plan and define the victims. Although the doctors demanded a legal guarantee, Hitler refused to enact a law on euthanasia, citing the need for secrecy. There is much evidence to show that the leaking of information was no error: it was deliberate.

When the regime had eliminated the mentally ill, it had discovered that the mass murders had not fundamentally shaken the loyalty of the population, an important factor when it came to extending the programme of extermination to prisoners in the camps, in particular Jews and Gypsies (both Roma and Sinti). The administrative structures and staff that had "proved" themselves in that context later took part in the genocide of the Jews.

The preparations for the euthanasia trial run went back a long time. A psychiatric hospital director acknowledged retrospectively in 1947 that, even before the war, the minister of the interior was considering drastic cuts in the rations of mental asylum or psychiatric hospital patients if war broke out. In response to the objection that this would result in slow death from starvation, "cautiously, and for the first time, feelers were put out to establish what approach the Innere Mission (2) would take, if the state considered exterminating some categories of the sick during the war because there was no longer sufficient food available to feed the whole population" (3).

In the summer of 1939 Hitler's personal doctor, Theo Morell, had drawn up an expert report for the same purpose. On the basis of a survey in the early 1920s among the parents of severely handicapped children, he concluded that the majority would accept that "their child's life should be brought to an end without suffering". Some said they would prefer not to take the decision on their child's fate: it was preferable for a doctor to do so. On that basis, Morell advised that relatives should not be asked for express consent in the case of euthanasia, that the killing of the sick should be concealed as far as possible and that it was better to count on the fact that people "did not want to know" (4).

So victims were rapidly transferred from one establishment to another to make it more difficult for concerned relatives to make inquiries, and then dispatched to a killing centre (5). The families were then notified of the death, which was attributed to a fake cause, and informed that their suddenly deceased relative had already been cremated. Despite those precautions, it soon became an open secret that sick people were being killed, particularly among asylum staff and in the areas around the establishments where the killings happened.

In August 1941 the fragile silence was broken when the Bishop of Münster, Count Clemens August von Galen, openly denounced the murders in a sermon. There had already been protests, primarily from Catholic circles. A few weeks after Von Galen's sermon, Hitler called a halt to the euthanasia programme. But that did not mean actually halting the institutional killings. At the time the number of victims had already reached the target the organisers had set in 1939: that is, one psychiatric hospital patient in 10 - a total of about 70,000 people. The statisticians had calculated the savings in clothing and food that would be achieved up to 1951, plus the fact medical staff could be freed for other tasks, beds made available for people who could be cured, and asylums converted into hospitals.

During the first world war the division of the population into different categories to be supplied according to their relative value had led to severe malnutrition in psychiatric hospital patients. The result had been a marked increase in mortality rates (6). But in the second world war systematic selection became the foundation of general social policy, accompanied by state sanctions. And the halt to the euthanasia programme in 1941 had no effect on this. The killing of the sick continued; but it was now decentralised and used other techniques. Victims were no longer transported to the gas chambers of the killing centres; they were eliminated in individual hospitals and asylums by lethal injection, under the supervision of local hospital management. This led to a sizeable increase in the number of people directly involved in the killings and with knowledge of them.

The euthanasia experts who had previously selected patients to be eliminated transferred their activity to other groups of victims. From early 1941 they selected prisoners in the concentration camps, particularly the handicapped and Jews, to be gassed. Then the T4 killers began to operate in the Belzec, Sobibor and Treblinka extermination centres. The commandors and inspectors of all three camps were able to use their expertise in the operation of gas chambers to destroy the Jews.

Besides their practical and organisational skills, the euthanasia experts from T4 used their experience in managing public opinion on euthanasia for the Final Solution. They had been so successful that, by April 1941, the public response to killing the sick was largely positive: "In 80% of cases relatives are in agreement; 10% protest and 10% are indifferent" (7).

The SD reports from spring 1944 can be read as documenting cautious moderation: they sounded out the general mood, provided indications of the possible causes of rumours and advised the authorities how to react to them. This was less a case of manipulating opinion than of gauging just how far it was possible to go.


(1) Former special archives, Moscow, 500/4/330.

(2) Evangelical charitable institution whose leaders had expressed themselves in favour of eugenic sterilisation in 1931. See Ernst Klee, Euthanasie im NS-Staat, Fischer, Frankfurt, 1985.

(3) Ludwig Schaich, Lebensunwert?, cited by Götz Aly and Susanne Heim, Vordenker.

(4) Idem.

(5) Grafeneck, Brandenburg, Bernburg, Hadamar, Harteheim, Pirna.

(6) Heinz Faulstich, Hungersterben in der Psychiatrie 1914-1949, Lambertus, Freiburg im Breisgau, 1998.

(7) Susanne Heim and Götz Aly, op cit.

Translated by Julie Stoker

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