Hitler recognized that the direct takeover of private property provokes powerful emotional and political resistance. One of the secrets of his rise to power was that he managed to portray the National Socialist movement as opposed to such a measure, indeed to Communism itself. As Robert Proctor notes, Hitler understood that there was no need to “nationalize industry when you can nationalize the people.” I want to emphasize here that I regard “right-wing” Nazism and “left-wing” Communism not as two antagonistic political systems, but as two similar types of socialism (statism)—one brown, or national, the other red, or international. Both kinds of statists were very successful in their efforts to undermine autonomy and destroy morality.
The therapeutic state as a type of total state with a sacred and therefore unopposable mission is not a new historical phenomenon. The theological state, the Soviet state, and the Nazi state may be viewed as former incarnations of it. To illustrate and underscore the problems intrinsic to the alliance between modern medicine and the modern state, I shall briefly review the anatomy of National Socialist Germany as a type of therapeutic state.
From the beginning of his political career, Hitler couched his struggle against “enemies of the state” in medical rhetoric. In 1934, addressing the Reichstag, he boasted: “I gave the order …to burn out down to the raw flesh the ulcers of our internal well-poisoning.” National Socialist politicians and the entire German nation learned to speak and think in such terms. Werner Best, Reinhard Heydrich’s deputy, declared that the task of the police was “to root out all symptoms of disease and germs of destruction that threatened the political health of the nation. … [In addition to Jews,] most [of the germs] were weak, unpopular and marginalized groups, such as gypsies, homosexuals, beggars, ‘antisocials,’ ‘work-shy,’ and ‘habitual criminals.’ ”
None of this was a Nazi invention. The use of medical metaphors to justify the exclusion and destruction of unwanted persons and groups antedates Hitler’s rise to power and flourishes today. In 1895, a member of the Reichstag called Jews “cholera bacilli.” In 1967, Susan Sontag, the celebrated feminist-liberal writer, declared: “The truth is that Mozart, Pascal, Boolean algebra, Shakespeare, parliamentary government, baroque churches, Newton, the emancipation of women, Kant, Marx, Balanchine ballets, etal., don’t redeem what this particular civilization has wrought upon the world. The white race is the cancer of human history; it is the white race and it alone—its ideologies and inventions—which eradicates autonomous civilizations wherever it spreads, which has upset the ecological balance of the planet, which now threatens the very existence of life itself.”
Despite all the evidence, the political implications of the therapeutic character of Nazism, and of the use of medical metaphors in modern democracies, remain underappreciated or, more often, ignored. It is a touchy subject, not because the story makes psychiatrists in Nazi Germany look bad. That has been accepted and dismissed as an “abuse of psychiatry.” Rather, it is a touchy subject because it highlights the dramatic similarities between pharmacratic controls in Germany under National Socialism and in the United States under what is euphemistically called the “free market.”
Nazi Pharmacracy: I. Socialist Health Care
The definitive work on pharmacracy in Nazi Germany is Health, Race and German Politics between National Unification and Nazism, 1870—1945, by Paul Weindling, a scholar at the Wellcome Institute for the History of Medicine in London. Unlike many students of the Holocaust, Weindling does not shy away from noting the similarities between the medicalization of politics and the politicization of health in Nazi Germany and in the West. Many of Weindling’s observations and comments about Nazi Germany as a therapeutic state (a term he does not use) sound as if they were addressed to conditions in the United States today. He writes:
• Scientifically-educated experts acquired a directing role as prescribers of social policies and personal lifestyle…. Science and medicine provided an alternative to party politics, by forming a basis for collective social policies to remedy social ills.
• The sense of responsibility of the doctor to sick individuals weakened as awareness dawned of the economic costs of poverty and disease…. Medicine was transformed from a free profession …to the doctor carrying out duties of state officials in the interests not of the individual patient but of society and of future generations. . . . Doctors became a part of a growing state apparatus.
Weindling retraces the political-economic history of modern medicine, reminding us that “in 1868 medicine was proclaimed a ‘free trade,’ open to all to practice … without legal penalties against quackery…. Leaders of the profession such as Rudolf Virchow were convinced that scientific excellence guaranteed the future of the profession.” That was a free market in medicine. Today, in contrast, trade in medical goods and services is stringently regulated by the state.
Long before Hitler rose to power, observes Weindling, physicians “sought to colonize new areas for medicine, such as sexuality, mental illness, and deviant social behavior. What had been private or moral spheres were subjugated to a hereditarian social pathology. … As the medical categories invaded the terrain of social categories, the greater became the potential for creating a society corresponding to a total institution.” Deception and self-deception by medical rhetoric were popular as far back as 1914, when German military service was glorified “as healthier than urban life. The fresh air and exercise of the front meant that it could be avast open air sanatorium. Another indicator of health was the fall in the number of mental patients and a decrease of suicides.” War, indeed, is the political health of the state and the mental health of the individual.
Bedazzled by the myth of mental illness and seduced by psychiatry’s usefulness for disposing of unwanted persons, the modern mind recoils from confronting the irreconcilable conflict between the political ideals of a free society and the coercive practices of psychiatry. Let us keep in mind that psychiatry began as a statist enterprise: the insane asylum was a public institution, supported by the state and operated by employees of the state. The main impetus for converting private health into public health came, and continues to come, from psychiatrists.
In 1933, the year Hitler assumed power, a law was passed against “compulsive criminality . . . enabling preventive detention and castration . . . [for] schizophrenia, manic-depression, [etc.]. . . . The medical profession and especially psychiatrists benefited greatly from the drive for sterilization.” Reich Health Leader (Reichgesundheistfuhrer) Leonardo Conti (1900—1945) stated that “no one had the right to regard health as a personal private matter, which could be disposed of according to individualistic preference. Therapy had to be administered in the interests of the race and society rather than of the sick individual.”
In 1939, medical killing in Germany went into high gear. “Reliable helpers were recruited from the ranks of psychiatrists,” who defined lying for the state as a higher form of morality: “Each euthanasia institution had a registry office to issue the false [death] certificates.” In the case of tuberculosis, modern diagnostic technology was employed as a tool for determining who qualifies for therapeutic killing: “In occupied Poland and the Soviet Union, SS X-ray units sought out the tubercular, who were then shot. It is estimated that 100,000 died in this way.”
The more power physicians exercised, the more intoxicated with power they became. “The doctor was to be a Fuhrer of the Volk to better personal and racial health. . . . Terms like ‘euthanasia’ and ‘the incurable’ were a euphemistic medicalized camouflage with connotations of relief of the individual suffering of the terminally ill.” During all the carnage, the Nazis remained obsessed with health: “A plantation for herbal medicines was established at the Dachau concentration camp.”
Nazi Pharmacracy: II. Waging War for Health
In The Nazi War on Cancer, Robert N. Proctor, professor of history at Pennsylvania State University, remarks on the similarities between pharmacratic controls in Nazi Germany and the United States today, only to dismiss them as irrelevant. “My intention,” writes Proctor, “is not to argue that today’s antitobacco efforts have fascist roots, or that public health measures are in principle totalitarian—as some libertarians seem to want us to believe.” Proctor’s systematic labeling of Nazi health measures as “fascist” is as misleading as it is politically correct. Hitler was not a fascist and National Socialism was not a fascist movement. It was a socialist movement wrapped in the flag of nationalism. The terms “fascist” and “fascism” belong to Mussolini and his movement, and to Franco’s, neither of which exhibited the kind of interest in health or genocide that was exhibited by Hitler and the Nazis.
Proctor steers clear of discussing psychiatric practices in Nazi Germany, such as the following typical episode, although they resemble closely psychiatric practices in the United States today. A father, a retired philologist, complains about the sudden death of his physically healthy schizophrenic son, Hans. He writes to the head of the institution where Hans had been confined, complaining that the explanation for his death was “contrary to the truth” and that “this affair appears to be rather murky.” The psychiatrist replies: “The content of your letter… force[s] me to consider psychiatric measures against you..
. . should you continue to harass us with further communications, I shall be forced to have you examined by a public health physician.” Although Proctor’s apologetics for pharmacracy in America diminishes the intellectual significance of his work, it does not impair the value of his documentation.
As Proctor himself shows, it was principally psychiatry that provided the “scientific” justification and personnel for medical mass murder in Nazi Germany. Nevertheless, he declares: “I should reassure the reader that I have no desire to efface the brute and simple facts—the complicity in crime or the sinister stupidities of Nazi ideology.” To call Nazi ideology “stupid” is like calling a distasteful religious belief “stupid.” It is a self-righteous refusal to understand the other’s ideology on its own terms, as if understanding it were tantamount to approving it. The truth is that the Nazi health ideology closely resembles the American health ideology. Each rests on the same premises—that the individual is incompetent to protect himself from himself and needs the protection of the paternalistic state, thus turning private health into public health. Proctor is too eager to efface the method in the madness of the Nazis’s furor therapeuticus politicus, perhaps because it is so alarmingly relevant to our version of it.
“Nazism itself,” he writes, “I will be treating as … a vast hygienic experiment designed to bring about an exclusionist sanitary utopia. That sanitary utopia was a vision not unconnected with fascism’s [sic] more familiar genocidal aspects. . . .” It was not fascism, which was not genocidal, but medical puritanism that motivated the Nazis to wage therapeutic wars against cancer and Jews. This is a crucial point. Once we begin to worship health as an all-pervasive good—a moral value that trumps all others, especially liberty—it becomes sanctified as a kind of secular holiness.
With respect to the relationship between health and the state, Hitler’s basic goal was the same as Plato’s, Aristotle’s, and the modern public health zealots’—namely, abolishing the boundary between private and public health. Here are some striking examples, all of which Proctor misleadingly interprets as manifestations of “fascism”:
• Your body belongs to the nation! Your body belongs to the Fuhrer! You have the duty to be healthy! Food is not a private matter! (National Socialist slogans.)
• We have the duty, if necessary, to die for the Fatherland; why should we not also have the duty to be healthy? Has the Fuhrer not explicitly demanded this? (Antitobacco activist, 1939)
• Nicotine damages not just the individual but the population as a whole. (Antitobacco activist, 1940)
Hitler and his entourage were health fanatics obsessed with cleanliness and with killing “bugs,” the latter category including unwanted people, especially Jews, Gypsies, homosexuals, and mental patients. Hitler neither drank nor smoked and was a vegetarian. Preoccupied with the fear of illness and the welfare of animals, he could not “tolerate the idea of animals’ being killed for human consumption.” After Hitler became Chancellor, Reichsmarshall Hermann Goring announced an end to the “unbearable torture and suffering in animal experiments.” The medical mass murder of mental patients went hand in hand with the prohibition of vivisection, which was declared a capital offense.98 The fact that the Nazi public health ethic demanded not only respect for the health of the greatest numbers (of Aryans) but also for the health of animals (except “bugs”) illustrates—as does also the work of bioethicist Peter Singer—the connections between the love of pharmacracy and animal rights on one hand, and the loathing of human rights and the lives of imperfect persons on the other hand.
Instead of viewing the Nazi experience with medicalized politics as a cautionary tale illuminating the dangers lurking in the alliance between medicine and the state, Proctor uses it to speculate about what the Nazi war on cancer “tells us about the nature of fascism.” He arrives at the comforting conclusion that “the Nazi analogy is pretty marginal to contemporary discussions about euthanasia” and criticizes “pro-tobacco activists”—as if opposing anti-tobacco legislation made one automatically a “pro-tobacco activ-ist”—who “play the Nazi card.” Our future liberty, and health as well, may depend on whether we dismiss the analogy between pharmacracy in Nazi Germany and contemporary America as “pretty marginal,” as Proctor believes we should, or whether, as I suggest, we view it as terrifyingly relevant and treat it with utmost seriousness.
Thomas Szasz – Pharmacracy