German Extermination of Psychiatric Patients in Occupied Poland 1939-1945.

The paper was presented by Zdzislaw Jaroszewski, M.D. at the historical session of the Regional Symposium of the World Psychiatric Association in Warsaw, 22-25 November, 1987 (translated by Jan Jaroszewski, M.D.).

Of the many experiences that human culture carried out of World War II, the most far-reaching are those that pertain to the human values represented by medicine and its most humane branch, psychiatry in particular. In contrast to earlier, even more increasingly cruel conflicts, victims of the last World War included not only armed and civil forces but also the most defenseless citizens of the assaulted country: Prisoners of concentration camps, serving as experimental models for cruel medical tests performed by Nazi physicians, and psychiatric patients. The latter were murdered systematically according to appropriate plans for economi­cal reasons, as "unwertes Leben" (worthless living creatures). Cathegorizing human lifeless objects as either valuable or worthless, the Nazis challenged the principle of life sanctity, observed for ages and binding physicians (but not only them) since the times of Hippocrates and providing grounds for a penal code. Challenging the principle resulted not only in murdering tens of thousands of innocent people but also affected the behavior of physicians in such a way that the valuation of the unique, but incomparable to other persons, became occasionally, a criterion of the physician's conduct.

Therefore, we recall the cruel war fate of mental patients not just to reflect upon the condemned crime, but to become aware of its origins and its far-reaching consequences so we can attempt to prevent a reoccurrence.

Course of events

 Origins of the concepts that finally resulted in the Nazi ideology and in its outcomes, the murder of patients and genocide, can be traced back to the XIXth century to theories of pseudo-Darwinism and to Nietzsche's philosophy, which in contempt held everything weak and useless. Let us restrict ourselves to some significant facts to provide landmarks for the development and implementation of these evil concepts. In 1922, eminent German professors, the psychiatrist Alfred Hoche, and the lawyer, Karl Binding, published Die Freiqabe der Vernichtury lebensunwerten Lebens (Extermination of Life Unworthy Creatures), using that ominous term for the first time and demanding extermination of persons who constituted "a burden" to the society, ravaged by the last war. The authors argued that the excessive humanitarian ideas be abandoned in the interest of the "hohere staatliche Sittlichkeit" (the higher state morality), well aware that the existence of an individual is worthless if unfitting to the interest of society. It is easy now to see that the terms approached closely those used later by the Nazis: “Du bist Nichts, dein Volk ist alles" (you are nothing, your nation is everything).

Shortly after Adolf Hitler took power in the Deutsches Reich in 1933, an act was passed, titled Gesetz zur Verhutung erbkranken Nachwuchsrt (Act on Preventing an Inheritably Burdened Progeny). The act introduced the obligatory sterilization of persons suffering from inheritable diseases, including, among others, mental retardation, schizophrenia, affective psychoses, epilepsy, and alcoholism. Implementation of the act, associated with the sterilization of approximately 350,000 persons in Germany, induced a wide discussion during which only the Catholic Church expressed a negative attitude toward the act.

Wide publicity around the act appeared in German medical periodicals as well as appearing as diffused propaganda, and there was induced interest in the act also among psychiatrists and eugenists in Poland. In 1936, the Polish Psychiatric Society chose the problems of inheritance and prevention of mental diseases as a topic of its 16th meeting in Lublin. The best available experts, Professor S.K. Pienkowski, a psychiatrist and a neurologist, and Professor T. MarchIewski, a biologist, presented reports on the subje ct. The discussion pointed out that the contemporary state of knowledge provided no grounds for hopes associated with sterilization. The serious role of mutations in inheritance was thought to indicate that application of sterilization was "a hopeless contest in respect to final results.”

After taking power, the Nazi authorities began intense preparations for the "extermination of creatures unworthy of life" for biological or racial (Jewish) reasons. Extermination of patients was termed "euthanasia". Already at the Party meeting in 1935, Hitler told Wagner, a leader of the physicians in the Reich, that euthanasia was planned to be applied in the case of war. In February of 1939, "the Reich commission for scientific evaluation of severe inheritable diseases" was formed at the Reich Chancellory and aimed at the performing "euthanasia" of children, all of which was kept secret until 1945.

In July of 1939, agreement between Hitler, the Reich Chancellory head, Lammers and the leader of the Reich's physicians, Dr. Leonardo Conti, resulted in the formation of a strictly secret commission for the extermination of patients, directed by Philip BouhIer and called T4 (according to its official address at Tiergartenstrasse 4, in Berlin). The commission included, among others, recognized professors of psychiatry and neurology: Carl Schneider from Heidelberg, Paul Nitsche from Halle, Werner Heyde from Wurzburg. The commission was to choose methods of extermination (at the beginning carbon monoxide was used) and provide opinions on the lists of patients submitted for extermination by psychiatric hospitals, using official questionnaires.

After starting the war with Poland in October of 1939, Hitler signed a letter on the official Reich’s Chancellory form with the following content: "Head of the Reich's Chancellory, Bouhler and Doctor of Medicine, Brandt, are responsible for such an extension of authority of physicians delegated by names, that patients who are incurable by human judgment after a critical appraisal of advancement of their disease could be provided with a generous death."

Extermination of patients in Poland

The preparation before the war to murder mental patients began to be implemented in Poland. After attacking Poland on 1 September, 1939, the German began in the very same month a systematic murder of patients in Polish psychiatric hospitals that were situated in the captured parts of the country.

The action of murdering these patients at the beginning took a similar course in all psychiatric hospitals. The schedule was typical of Nazi mass crimes, followed a specific plan, and was performed scrupulously. After taking control of a hospital under a German director, no patient could be released from the hospital under threat of the death penalty. All the patients were counted and transported out in lorries to an unknown destination. Each transport was accompanied by armed soldiers from special SS detachments, who returned without the patients after a few hours. The patients were said to be transferred to another hospital, but circumstances showed that they had been killed.

The first action of this type was performed in Kocborowo, a large psychiatric hospital in the Gdańsk region, on September 22, 1939. At the same time as the patients, five hospital employees and the Deputy Director, Dr. Józef Kopicz, were murdered by firing squad. Beds of ap­proximately 2,000 patients were transported to an unknown destination and were used by German patients brought from East Prussia. After the war, hidden mass graves of the murdered patients were excavated in the Forest of Szpęgaw, near Starogard Gdański. In October of 1939, the same circumstance happened to approximately 1,000 patients of the neighboring psychiatric hospital in Świecie, near Bydgoszcz. After exterminating the patients, the hospital was appropriated to accomplish other purposes. On October, 1939, approximately 1,000 patients (children and adults) of the psychiatric hospital in Owińska, near Poznań, began to be transported out in an unknown direction. At the same time, a chapel and a rich, 100-year old medical library were destroyed. The hospital was turned into SS barracks and burned at the end of war.

Extermination of patients from the hospital in Owińska requires special attention since on that occasion for the first time new methods for the mass killing of people were implemented. Investigations conducted after the war by the Commission for Examination of Nazi Crimes demonstrated that the special Gestapo unit, under Herbert Lange's command (SS-Sonder­kommando Lange), took care of the patient evacuation. The patients, dressed only in worn clothes, were transported out in lorries, each lorry accommodating 25 patients and some armed SS men. Distressed and protesting patients were quieted with injections of narcotics. According to witnesses, the lorries drove first toward Poznań where the patients were crowded into the old Fort VII, the awesome site of tortures and mass murder of the Wielkopolska population. Each of the bunkers accommodated approximately 50 persons, the gates were sealed up with clay, and carbon monoxide was fed into each bunker, killing the patients within 10-20 minutes. Corpses of the murdered patients were dragged out by a group of prisoners of the fort, and other prisoners transported them and buried them in a forest close to Oborniki.

Following these “successful” tests, the patients were transported then directly to the forest, loaded into a sealed furniture lorry, into which the gas was fed from a bottle or from a car engine.

Gas murders of patients from Owińska hospital preceded murders on patients of other psychiatric hospitals in Poland and in Germany and also the murders in concentration camps.

On December 7, 1939, approximately 1,200 patients were transported out of the neighboring psychiatric hospital in Dziekanka, near Gniezno. Selection of the patients for the transport was made personally by the hospital director, Ratka, who had just changed his citizenship to German and put on an SA uniform. Later on, the hospital kept providing psychiatric services for patients of German nationality and also served also other, peculiar aims. On orders from Berlin, the hospital was disguised to represent a place of burial of the exterminated patients even if most of them had never visited the hospital. Families of the patients were falsely informed that the patients being searched for were buried at the hospital cemetery, and the families were even charged for the care for these graves. After the war, it was found that the psychiatric hospital in Pruszków near Warsaw played a similar role. Families of the murdered patients were referred to the hospital and told that their relatives had been brought to the hospital, but died natural causes.

The sanatorium in Kościan for neurological and psychiatric patients lost approximately, 500 patients who were murdered and the institution then appropriated for other purposes.

Fate was particularly cruel to patients of the psychiatric hospital in Chełm near Lublin. No longer there were any attempts to hide the crime. In front of eyewitnesses, the hospital was surrounded by SS soldiers, and approximately 440 patients were expelled from the hospital buildings and shot in front of everyone with machine guns. Children hiding in the wards were thrown out of the windows. Later, it has been found out that the hospital buildings were scheduled to provide barracks for SS detachments.

Patients in psychiatric hospitals in Warta (approximately 580 patients), Gostynin (approximately 100 patients), and Choroszcz (564 patients) were shot in the neighboring forests while patients of Kochanówka hospital (approximately 540 patients), near Łódź were killed in the sealed lorries using engine exhaust. In the psychiatric hospital of Lubliniec, 194 children were killed with high doses of luminal.

The existence of the psychiatric hospital in Kobierzyn, near Cracow ended on June 23, 1942. A systematic decrease in food rations (to 1,200 calories per day) caused the death of a half of approximately 1,000 patients, and then the Nazis began evacuating the hospital facilities, which were now needed for Hitlerjugend activities. All the patients were counted, and the physicians and the remaining personnel were removed from the hospital. The hospital was surrounded by soldiers in helmets and SS uniforms, the patients were loaded into lorries and cattle trucks, and the patients were transported to Auschwitz to gas chambers. Severely ill patients were transported to the hospital cemetery and shot there. A total of 566 patients died in that action.

The Jewish psychiatric hospital Zofiówka in Otwock near Warsaw was liquidated on 19 August, 1942 in the “usual” manner. One hundred patients and personnel were killed. The Director of the hospital, the well known psychiatrist, Dr. Stefan MiIIer, committed suicide.

The fate of patients in the Polish psychiatric hospitals situated at present in the Soviet Union has not been examined in detail at this point. In general, approximately 2,600 patients were killed in psychiatric hospitals in Wino. A proportion of the patients in the psychiatric hospital at Obrawalde-Meseritz (presently Obrzyce, near Międzyrzecz) were of Polish origin, and the patients were killed personally by the administrative supervisor of the hospital, a fanatic Nazi who injected the patients with toxic agents. Detailed investigation after the war docu­mented approximately 13,000 of his victims.

The above data that originated from individual hospitals do not unfor­tunately create a complete image of the extermination of patients. It is difficult to estimate, e.g., how many of the psychiatric patients in the hospitals died due to drastically lowered food rations. Systematic starvation increased the mortality of patients several fold. It should be mentioned that this statistic does not pertain to patients of German origin who were fed better.

The numbers of known victims also fail to include crimes which have not been documented. At the end of the war, the Nazi authorities destroyed evidence of their own crimes, as they pulled back from the captured territories, and, perhaps remembering the exposure of the Katyń crimes where corpses of murdered Polish officers were uncovered they exhumated and burned the corpses of many Nazi victims. In most cases, extermination of patients was executed with no preliminary formalities (in the Reich it was preceded by filling in of questionnaires) and unexpectedly. The data quoted above originated from hospital registers that escaped destruction or from secretly prepared lists of those patients who were transported out of the hospitals.

On the other hand, the number of psychiatric patients who were exterminated in Germany originated from a peculiar report, entitled Die bisher ge le istete Arbeit der Aktion (The action work performed till now) and provided information that in 1940-1941 a total of 70,273 psychiatric patients were murdered or "underwent disinfection." It is also calculated in the report that, accepting a daily food expenditure of 3.50 DM [deutche mark] per patient, extermination of the patients resulted in a savings of 88,543,980 DM. In comparison, assuming the average length of patient stay in the hospital to be 10 years, the total savings would amount to 885,439,800 DM. The report informs that the extermination would result in 10 years having 33,731,040 additional eggs on the market (savings of 3,710,414 DM and 40 pfennigs) and 88,540,040 kg. of additional vegetables (savings of 13,281,606 DM). The same scenario was calculated for savings in bread, flour, butter, cheese and salt.

Response to the crimes

Information about the extermination of psychiatric patients has everywhere induced the deepest abhorrence. However, with the war progress and against a background of enormous German crimes in Poland, the loss of these thousands of mental patients represents only a small part of several million innocent people exterminated by the occupying power, most of whom were healthy. Gradually, differences between the nature of the victims’ groups vanished into social consciousness, and the society tended to ascribe all the crimes to German hatred of anything Polish, lasting for centuries, and even supposedly specific German traits of character. A vast historical and sociological literature soon clarified the Nazi sources of the crimes.

Apart from the individual reports, the specific topic of patient extermination was dealt with by the Polish Psychiatric Association. The first meeting after the war and the 20th meeting in sequence of the Association in Tworki-Pruszków, in November, 1945, discussed the nature of German crimes committed on psychiatric patients. In more than 10 reports, occupier’s policy toward psychiatry and the patients’ fate in individual hospitals was presented. The murdered patients and staff members were commemorated. Out of a total of 243 members of the Association before the war, approximately 100 psychiatrists were killed. Considering the origins of the crimes, a psychiatrist and criminologist, Professor Stanislaw Batawia showed that any attempt to explain patient extermination by psychopathological manifestations instead of application of sociological and moral criteria involved scientific error. This position pointed to obvious responsibility of the perpetrators. Unfortunately, the perpetrators also included many eminent German psychiatrists who par­ticipated in the patient extermination and cynically called the extermination “euthanasia" and provided "scientific" rationale for the crime.

These psychiatrists included professor Ernst Rudin, Director of the Kaiser-Wilhelm- Institut in Munchen and the author of the Act on Compulsory Sterilization of Patients; Professor Max de Crinis from Berlin, who selected patients for extermination and supervised the so-called T4 action: Professor Carl Schneider from Heidelberg, Professor Werner Heyde from Wurzburg, Professor Hermann P. Nitsche (Sonnenstein); and many psychiatrists working in the hospitals. Some, but very few, responded in penal processes after the war but even if punishing all the perpetrators would be possible, this process cannot constitute the only response to what happened.

Extermination of mental patients involves not only a legal problem, but as mentioned above, horrible results reflected in the attitude toward mankind in general. It disclosed a deep crisis of principles which for ages had provided grounds for care of patients and defenseless ones, a crisis of basic principles of our culture. The response to the attempt against crucial values has to involve not only a proper appraisal and defense of endangered values, but has to include also the development of values regarding deep respect for dignity of each man.