Interview with Lea Münch: A look into psychiatry during the Nazi era
Physician and medical historian Dr Lea Münch looked into psychiatric patients' treatment during the Nazi occupation of Alsace, from the patients' point of view.
The Nazi law on forced sterilisation
On 14 July 1933, the law on the ‘Prevention of Hereditarily Diseased Offspring’ (German: Gesetz zur Verhütung erbkranken Nachwuchses) was passed and printed in the Reichsgesetzblatt on 25 July:
‘The Reich Government has passed the following law, which is hereby promulgated: [...] A person with a hereditary disease may be made infertile (sterilised) by surgical intervention if, according to the experience of medical science, it is highly probable that his offspring will suffer from serious physical or mental hereditary defects.’
“Die Reichsregierung hat das folgende Gesetz beschlossen, daß hiermit verkündet wird:
[...] Wer erbkrank ist, kann durch chirurgischen Eingriff unfruchtbar gemacht (sterilisiert) werden, wenn nach den Erfahrungen der ärztlichen Wissenschaft mit großer Wahrscheinlichkeit zu erwarten ist, daß seine Nachkommen an schweren körperlichen oder geistigen Erbschäden leiden werden."
Those who were to be sterilised were subsequently listed: People with illnesses such as schizophrenia, congenital insanity, hereditary blindness and deafness, physical deformity; but also people who were addicted to alcoholism were considered hereditarily ill under the law. Around 400,000 men and women were forcibly sterilised on this basis.
Purging the "national body": the Krankenmorde1
With the outbreak of war, the plans to kill people with mental illnesses and disabilities became more concrete. In the first phase, from spring 1939 to 1945, at least 5,000 children and young people up to the age of 16 with disabilities were systematically murdered by administering medication and systematically starving them to death. From August 1939, the murder of patients was extended to adults. The murders of the sick in this second phase were organised by a cover organisation directly subordinate to Hitler, a central authority at Tiergartenstraße 4 (known as T4) in Berlin's Charlottenburg district. For the ‘selection’, the inmates of all German sanatoriums and nursing homes were systematically recorded on registration forms. They were then forwarded to the T4 authorities, where experts decided the fate of thousands of patients.
In six killing centres, 70,000 people died by gassing. The surviving relatives received a death certificate with an invented cause of death. Due to increasing public unrest and protests from the church, gassing, also known as ‘Aktion T4’, was stopped again in 1941, but only as a pretence. The killing continued in decentralised form in various murder centres: through neglect, targeted food deprivation, injections, or sedatives overdoses. During this phase, at least another 100,000 people died by the end of the war.
The Hadamar institution, near Limburg, was one of these supra-regional centres. To this day, the name symbolises the murder of the sick - just as Auschwitz stands for the Holocaust.
Dr Lea Münch has meticulously researched the history of some of the patients who experienced psychiatry institutions in Nazi-annexed Alsace.
esanum: Dr Münch, you have written your second dissertation in history of science about psychiatry institutions in Alsace during National Socialism. The title is: ‘Inside views of psychiatry in Alsace during the National Socialist era. Life stories between Strasbourg and Hadamar’2. Why did you choose this topic? What new perspective does your work provide on this dark period in the history of psychiatry?
Dr. Lea Münch: It is true that the research literature on medicine under National Socialism, but also on the history of psychiatry under National Socialism, fills entire libraries. However, there were two clear desiderata. On the one hand, my work deals with the question of psychiatric care in Alsace. This border region between Germany and France repeatedly changed its national affiliation. After the Wehrmacht's Western campaign, the region was annexed in the summer of 1940 in violation of international law. There has been hardly any research on this occupied territory to date. It was not until 2016 that an international historical commission began extensive research into the history of the Medical Faculty of the ‘Reich University’ of Strasbourg (1941-1944). My work was also written in this context.
Much more important for me, however, was the fact that we know a lot about Nazi psychiatry and the history of the murders of the sick, the ideology behind them and the doctors who became perpetrators. However, we still know very little about the everyday history of the patients. Their perspectives and their lives have been severely underrepresented in the literature to date. I wanted to change that with my work. That's why the title of my work emphasises the perspective from within. My aim is to write a history of the individual experiences of illness of those affected and their relatives. What did it mean to be a patient in National Socialist psychiatry?
esanum: You used various documents and sources to retell the life stories of different patients who were treated in one of the three psychiatric institutions in Alsace during the occupation. What insights did you gain about the functioning of the psychiatric institutions through the patients' stories?
Dr. Lea Münch: In addition to patients' experiences, I was interested in the significance of a particular psychiatric institution for those affected. The psychiatric university hospital of the so-called ‘Reichsuniversität’ had a completely different function than the sanatoriums and nursing homes located in the rural periphery. If a chronic illness became apparent, the patients were transferred to either Stephansfeld or Hördt - the names of the two institutions in Alsace.
These institutions could have different meanings for the patients living there. The opera singer Luise Reuss, for example, was in the Strasbourg clinic for a relatively long time and was only transferred to Stephansfeld after the end of the war. For her, the institution was merely a stopover before her release. The young Ukrainian Natascha Smoljarowa, on the other hand, who had been deported from Kharkiv to Alsace for forced labour in 1942, died of tuberculosis there in 1953. For her, the institution became the end of her short life. She died forgotten in a strange place where nobody spoke her language.
Electroshock therapy: a standard in Nazi Germany and beyond
esanum: Could you give any other examples?
Dr. Lea Münch: The psychiatric clinic of the ‘Imperial University’ in Strasbourg was a central point of contact for people with a mental illness or disability in the region. Comprehensive diagnostics were carried out here, new patients were assessed, and treatment was initiated. This could involve tranquillisers or the patients had to take on tasks on the ward as part of so-called work therapy. Electroshock therapy was also introduced in 1942. This corresponded to the widespread biologistic understanding of illness, which was also shared by the clinic director August Bostroem (1886-1944). It was an ambivalent but often effective procedure that still harbours many prejudices today. At that time, however, it was one of the standard therapies, not only in Nazi Germany, which was frequently used for schizophrenia and even depression. This treatment method was also used in the two Alsatian asylums. In contrast to this, however, the institutions had more of a function to keep chronically ill people locked up.
esanum: With which mental illnesses were patients admitted to some of the psychiatric institutions at the time?
Dr. Lea Münch: The illnesses could be of a psychotic nature, such as schizophrenia or organic psychosis. But there were also patients with classic depression. I also found patients with an alcohol addiction in the archives, who were treated for a minimum stay of six months with work therapy in the institutions, often running a garden centre and farm, or other workshops. In addition, there was a smaller proportion with the diagnosis of psychopathy, which denoted a borderline area between healthy and sick, i.e. there was completely different meaning to what we understand by the term "psychopathy" today. Above all, it subsumed socially undesirable behaviour and often represented a social and moral value judgement. This could be a promiscuous woman, a homosexual man, or someone who had committed petty theft out of poverty.
Illness categorisation determined person's life value
esanum: Which patients and illnesses were considered 'curable' under Nazi healthcare policy?
Dr. Lea Münch: Under National Socialism, psychiatric illnesses were strongly linked to a hereditary-biological paradigm, and a number of psychiatric diagnoses were considered ‘hereditary diseases’. The entire family was affected by this stigmatisation, which was still noticeable in the post-war period. The question ‘Will I get out of an institution again?’ was much more important for the reality of people's lives than whether they could be cured. This was decided by whether the illness improved, in the sense that those affected were no longer in need of care. A great deal of attention was given to how fit for work a patient was, within the framework of being economically useful and utilisable within occupational therapy or for the community. Ultimately, the individual's life worth depended solely on this categorisation.
esanum: What did the Nazi Alsace annexation change in terms of management and care in psychiatric institutions for doctors and patients?
Dr. Lea Münch: If you did not have German citizenship but were considered Alsatian or French, you had to submit written declarations of loyalty to the German occupiers in order to continue working as a doctor in Alsace. If you did not do this, you were not given a work permit. This also applied to employees of the former French Université de Strasbourg - from professors to ordinary employees. The entire management team, all the professors of the future German Reich University, were newly appointed - all had at least an NSDAP3 membership card, some were also in the SS. The aforementioned August Bostroem, a renowned psychiatrist and neurologist who had previously worked in Leipzig, became Director of the Psychiatric and Neurological Clinic there. The previous chair holder Charles Buhecker decided against collaborating with the Germans and opened a private practice in Strasbourg.
The full destructive potential was fully understood recently
esanum: To what extent were the ideas of Nazi health policy and ideas on eugenics and racial hygiene put into practice in Alsace?
Dr. Lea Münch: The special characteristics of Alsace meant that the idealised Nazi psychiatry was not implemented in its entirety in this annexed territory. There are a number of differences. For example, the occupation period of four years was comparatively short. The extensive evacuation of Alsatian psychiatric institutions in 1939 created a vacuum, which led to a delayed provision of the already scarce resources for psychiatric patients. In addition, Alsace had already been excluded from ‘Aktion T4’4 in advance, presumably for tactical reasons.
The law on forced sterilisation only came into effect in Alsace in the summer of 1944, meaning that it was practically never applied. It was only in the last year of the German occupation in 1944 that the full destructive potential of Nazi psychiatry became apparent. One in four patients in the Hördt asylum died that year due to structural neglect, food deprivation and possibly also drug overdose. In the winter of 1944, 100 men were deported from the Alsatian institutions to Hadamar, a centre for decentralised euthanasia. This "death transfer", which only three men survived, was, so to speak, the vanishing point of Alsace's ‘integration’ into Nazi psychiatry operations.
esanum: Were you also able to find out something about the ‘doctor-patient relationship’ with the documentation found on the patients' perspective?
Dr. Lea Münch: This could take very different forms. For example, in a medical file of the aforementioned opera singer Luise Reuss (1911-2000), I discovered an exchange of letters between the treating clinic director August Bostroem and her father Wilhelm Reuss, who happened to be an old acquaintance of the clinic director. In the letters, Bostroem also mentioned that the eccentric singer sometimes behaved strangely during visits, that she spoke of her mother's death but did not want to give any precise information about it. It seems that the father told him, in a coded form, that her mother Mathilde had been murdered in Aktion T4. This knowledge naturally influenced Bostroem's image of his patient and is constitutive for Luise Reuss' own experience of illness. Luise Reuss remained in the clinic under Bostroem's protection.
Another example is the medical treatment of the Baden (Germany) domestic servant Mina Schabinger (1905-1944), who was the mother of an illegitimate daughter. She had been living in institutions for over ten years and ended up in Alsace. Her daughter had long since been taken away from her and placed in a home. The family always supported their sick family member and the medical records contain over 30 letters and postcards to the respective institutions. The family begged and urged the doctors in Alsace to allow them to take their daughter and sister home with them. But the doctors rejected this. These attempts were rejected by the medical profession and the family was pathologised under the diagnostic label of "imbecility", which we now put under the modern terms of mental disability.
Narratives without an affective undertone
esanum: The last chapter tells the story of Alphonse Glanzmann. He was one of three Alsatian survivors who returned to Alsace after being deported to the Hadamar killing centre in 1946. What insight do we gain into psychiatric practices from Alphonse Glanzmann's story?
Dr. Lea Münch: Alphonse Glanzmann (1895-1970) was an Alsatian factory worker. He lost his wife at an early age and became addicted to alcohol. Because of his psychotic behaviour, he was sent to the Hördt asylum in Alsace in 1942 and then onto Hadamar in 1944. Against his will, as he was a patient able to work, he became a labourer in the systematic killing machinery. In Hadamar, he saw and experienced things that nobody around him could empathise with after his return. There was no room for him in the post-war atmosphere of optimism, and he was once again admitted to an asylum in Alsace. On admission, the treating French psychiatrist asked him about his life story, as is customary when taking a medical history. Glanzmann told of the atrocities he witnessed, and explained that one of his daily tasks was to carry the bodies of his murdered fellow patients down to the morgue. The doctor noted that Glanzmann recounted this ‘without an affective undertone.’ The doctor took Glanzmann's report as the starting point for his psychopathological assessment, and attempted to organise and summarise what he said using his institutionally-formed, routine medical tools. However, it remained a helpless attempt to support the patient's coping of unimaginable experiences.
esanum: Finally, can you tell us something about the situation of psychiatry in Alsace after 1945? What do the records tell us about the subsequent lives of Alphonse Glanzmann (1895-1970) and the opera singer and patient Luise Reuss (1911-2000)?
Dr. Lea Münch: Alphonse Glanzmann's ‘euthanasia’ experience in Hadamar remained an unheard of, incomprehensible, and alien phenomenon; and was simply ignored from his life story and psychiatric experience. His knowledge of everyday life in a killing centre disappeared in his medical records and behind the walls of the institution. This applies to the French psychiatrist on the one hand, but also to Alphonse Glanzmann's family. It is unknown whether he also reported what he had seen when he returned to his home village of Lutterbach in Alsace in 1946. Alphonse Glanzmann spent the rest of his life in the asylum until his death in 1970. In the course of my research, I was able to locate his two grandnieces, who still live in Lutterbach today. Brigitte and Geneviève Glanzmann only knew about the existence of an uncle in a psychiatric ward, but nothing about his experience of Nazi ‘euthanasia’ programs. Shocked by this family secret that had been kept for decades, they set out in search of clues and came forward publicly as contemporary witnesses.
After her experiences under National Socialism, Luise never voted again
Dr. Lea Münch: Luise Reuss was a different story. She was released relatively quickly after the end of the war. She found a balance, albeit a precarious one, and ways to live a self-sufficient life. In 1946, her son Volker was born, with whom I was able to conduct detailed interviews with contemporary witnesses. He told me that Luise Reuss' life was overshadowed by the murder of her mother. Her mother's fate influenced her relationship with her father, whom she could not forgive for his opportunistic and affirmative attitude towards the National Socialists. Luise Reuss' experiences also resulted in a general mistrust of state institutions, which she never put aside. She never voted again. Forced therapy with electric shocks was another aspect that dominated Luise Reuss' personal experience of psychiatric practice. She also told her son about this. This experience is deeply engraved in her memory and goes far beyond the specifics of Nazi psychiatry.
About the upcoming book
The book by Dr med Dr phil. Lea Münch is scheduled for publishing by the end of 2024.
The historical commission report of the ‘Reichsuniversität’ Strasbourg's medical faculty is available online. (Rapport de la Commission historique pour l'histoire de la Reichsuniversität Strasbourg (RUS) - Université de Strasbourg, unistra.fr). There is also a biographical wiki. The biographies provide an insight into the individual lives of doctors, assistants, professors, patients, and victims in connection with the medical faculty of the Imperial University of Strasbourg. Please visit Commission Historique (unistra.fr).
A short biography of Dr Lea Münch
Dr med. Dr phil. Lea Münch is a research and teaching assistant at the Faculty of Medicine, Otto von Guericke University, Magdeburg, Germany. Her current habilitation project deals with the history of experience in intensive care medicine and nursing. Further information can be found here.
- Literally translates as "the murder of the sick and disabled". Refers to the collective group of crimes during NS times for murdering these populations.
- Original German title: "Innenansichten der Psychiatrie im Elsass zur Zeit des Nationalsozialismus. Lebensgeschichten zwischen Strasbourg und Hadamar"
- The National Socialist German Workers' Party. In German: Nationalsozialistische Deutsche Arbeiterpartei or NSDAP.
- Also known as the T4 Program. This was a campaign of mass murder by involuntary euthanasia in Nazi Germany from 1939 to 1945 with an estimate of 275,000 to 300,000 victims.