Author: Robert Jay Lifton
How could doctors ever be active participants in systematic evil? This unsettling question forms the background to this book’s forensic investigation of the medicalised killing that came to symbolise the brutality of Nazism (page 502). With direct interviews and extensive research, the author was able to establish the motivations for the transformation of highly trained physicians from healers to killers, and thereby becoming the driving force behind the Nazi ‘biomedical vision‘ which culminated in the mass murder of millions of Jews. On a wider perspective, the author hoped that his careful examination of the atrocities of Nazi doctors will help all societies to understand and counter ‘the human susceptibility to evil’ which motivates doctors to engage in a deplorable range of despicable schemes, from torture to genocide (pages xii, 501, xi-xiii). In a most dispassionate approach to a clearly disturbing subject, the author observes, rather disquietingly, that most doctors have the potential capacity to do what the Nazi doctors did ‘if the destructive ideological and behavioural pressures are sufficiently great’, and ‘under certain conditions’ anybody can become evil, murderous, or genocidal (pages 4-12, 427, 498 and 500).
At the heart of the book is the Nazi biomedical vision, the philosophy that elevated mass murder to the exalted position of a ‘therapeutic imperative‘ aimed at purifying Germany of the Jews – people who had been wrongly characterised as a danger to the country, and compared to the threat a gangrenous appendix posed to the whole body and requiring that it be aggressively expunged (pages 14-15, 24 and 204-206). In exploring this egregious idea which eventually attained a status as heroic as that of the war itself, the author traced its ideological foundations to the anti-semitic ideas of several philosophers, scholars, and religious leaders such as Ernst Haeckel, Paul de Legarde, and Martin Luther. The book also explored how the eugenic movement which started in the United States greatly influence the Nazi euthanasia programme – the forerunner to the holocaust (pages 441-442, 478 and 479). The book systematically charted the evolution of the biomedical project from its initial beginnings as coercive sterilisation and the ‘mercy killing‘ of those considered ‘unworthy of life‘, to its eventually depraved genocidal embodiment as the Final Solution (pages 63-64 and 143). It is instructive that this ghastly attempt to murder ‘every single Jew the Nazis could lay their hands on’ culminated in the killing of more than twenty thousand Jews in a single day (pages 147 and 493).
The most enlightening, and equally the most alarming, aspect of the book is how it describes the transformation of physician to killer. The author graphically painted the picture of the process whereby ‘normal’ doctors eventually became capable of engaging in all stages of the killing process – from selecting victims for the gas chambers to overseeing the burning of their bodies after death – an arrangement that brought ‘the greatest degree of medical legitimation to the widest range of killing’ (pages 4, 138, 18, 148-149 and 186). In a very detailed analysis, the author chronicled how otherwise upright doctors were able to suppress their ‘moral revulsion‘ and ‘feelings of discomfort, unhappiness, anxiety, and despair‘, and, by a process of ‘socialization to Auschwitz‘, actively participate in the ‘genocidal bureaucracy‘ of the camps. The camps also ‘diminished the emotional and intellectual tones associated with the killing’ by conferring ‘collective feelings of inevitability‘, and a ritualistic nature to the killing (pages 195-198, 495-496, and 432). Other mechanisms that overcome the doctors’ inhibitions towards killing included the psychological distance of not directly witnessing the dying taking place in the gas chambers; the invocation of ‘pride in the assumption of increasing responsibility’; the provision of a sense of ‘professional busyness‘ which gave the doctors a ‘statistically based aura of efficiency‘; and the use of detoxifying euphemisms which routinised the killing (pages 432, 140, 14-15, 199, 150, 136 and 202).
In addition to the camp processes which mitigated the impact of killing, the doctors themselves employed a range of psychological defences to deal with the emotional discomfort and sense of guilt that accompanied their horrendous work; by deploying these psychological defences, the doctors were able to resolve their internal contradictions and perform their tasks by achieving what the author called the ‘healing-killing balance‘. Perhaps the most important defence mechanism the book explored in this regard is psychological doubling, the unconscious process whereby the doctors created an ‘opposing self‘ which freed their ‘original self‘ from the responsibility of carrying out the despicable acts (pages 73, 4-5, 150, 202, 211-2113 and 418-421). Another important psychological mechanism was derealisation, the psychic numbing process in which ‘one could not believe what one was doing, even as one was doing it’. Other measures the doctors deployed to avoid psychological distress included immersing themselves in the scientific aspect of the killing; transferring responsibility for the killing to higher authorities; believing what they were doing was serving ‘a liberating therapy for the race’; and even blaming the victims for their predicament (pages 442-447, 61, 106, 8, 69, 105-110, 76, and 444-461).
A very compelling part of the book is the author’s insightful portrayals of the psychological profiles of individual Nazi doctors, demonstrating as they did the attitudes different doctors brought to their killing duties (page 193). The author focused particularly on those doctors who approached their tasks with enthusiasm; most prominent at this villainous end of the spectrum was Josef Mengele, a man whose actions ‘so well articulated the camp’s essence’, and whose cruelty manifested in lethal injections, shootings, and beatings, including killing and dissecting the bodies of the victims of his infamous twin experiments (pages 355, 379, and 341-351). Belonging in the same class as Mengele were Friedrich Entress and Josef Klehr, two of the most prolific killers in Auschwitz whose sadism the author depicted as symbolic of people who are found in every society who use any opportunity to ‘wallow in the omnipotence of their powerful positions‘ (pages 261-267). Other prominent and notorious doctors included Irmfried Eberl, ‘the ultimate healer-turned-killer‘ who was the only physician to command a death camp because of his enthusiasm in killing Jews; and Karl Brandt who ‘epitomizes the elite, highly educated, and dedicated healer joining actively in the medical killing’ – the prototype of ‘the decent Nazi‘ on whom the whole mass killing project depended on (pages 123-124 and 114-117).
The approach of many Nazi doctors to their work was however surprisingly often restrained, manifesting as reluctance, avoidance, resistance, and even refusal (page 193). Representative of this less sadistic end of the spectrum of Nazi doctors are those the author depicted as ‘decent killers‘ – doctors who either curtailed their killing to the barest minimum, or brought some degree of compassion to their work (page 268). The most symbolic doctor in this context is Ernst B, ‘a human being in SS uniform‘ who treated inmates with humanity and saved many of them in the process (pages 303 and 329-330). Other doctors brought a more ambivalent attitude to their work, and Eduard Wirths stood out in this context for fully manifesting the Auschwitz ‘healing-killing conflict‘ whereby ‘conscience gave way to conscientiousness, and saving lives became associated with killing’ (pages 384- 394). It was however very reassuring that many doctors rejected the killing philosophy altogether partly because of the influence of psychiatrists and neurologists such as Karl Bonhoeffer, Gottfried Ewald, and Hans Gerhard Creutzfeldt; it is based on their perspectives that the author forged his own recommendations on avoiding the trap of evil forces. For example, he advocated for developing an ‘embodied self‘ as a strategy to avert the ‘doubling of the genocidal direction’, and he promoted the ‘critical examination of ideologies and institutions’ as a way to ‘hold on to universal healing principles in the face of ideological pressures to the contrary’ (pages 80-87 and 500).
The subject of this book is a critical social and healthcare problem, and the contents are a cautionary tale for all doctors on the real tendency for social and political circumstances to erode the high moral and ethical standards of medicine. It is a warning that the ingredients that gave rise to the killings are inherent in society and in human nature. The author’s recommendations to physicians to avoid the pull of genocide, and to protect themselves from the situational forces that facilitate this, are essential for every physician to consider. The lessons of the book apply equally to other unethical practices that may tempt doctors away from the high standards of their work. The book is a graphic lesson for health care, and I strongly recommend it to all doctors.
Publisher, Place, Year: Basic Books, New York, 1986
Number of chapters: 21
Number of pages: 561
Star rating: 5