Die nationalsozialistische „Euthanasieaktion T4“

[Psychiatry and NS euthanasia. Facts, transgenerational effects and work with the relatives in Carinthia/Austria]

OBJECTIVE

This article describes the current state of research concerning the fate of mentally ill people in the psychiatric hospital of Klagenfurt am Wörthersee during the era of National Socialism (NS). Sterilization based on the "Erbgesundheitsgesetz" (genetic health law) deportation to the Castle of Hartheim near Linz, transport to Klagenfurt and killing in the departments of the hospital are documented. This knowledge is to be given to the relatives.

METHOD

Encouraged by diverse public work activities relatives of victims of NS euthanasia sought contact with the department to discover the fate of relatives. Touching meetings with the relatives took place.

RESULTS

Since January 2011 the contacting relatives, their motives and the meetings have been protocolled and in this study an attempt is made to give an initial characterization of these people.

CONCLUSION

This approach of a reconstructive biographical work together with relatives of the victims is presented as a proactive duty of psychiatric institutions.

Previously not recognized deletion in presenilin-1 (p.Leu174del.) in a patient with early-onset familial Alzheimer's disease

We report on a previously not recognized mutation in exon 6 of presenilin-1 (PSEN1) (c.520_522delCTG) in a male patient with early onset familial Alzheimer disease. The mutation results in the deletion of a leucine at amino acid position 174 of the protein. The index patient presented with progressive memory loss at 50 years of age. Initially, depression was the only ancillary symptom. At age 53 clinical diagnosis of early Alzheimer disease was made based on neuropsychological, neuroimaging, and CSF findings. The patient's father and his paternal grandmother also suffered from memory loss and cognitive decline. The clinical findings in the patient are similar to signs and symptoms in previously reported patients with missense mutations at codon 174 of PSEN1.

[Murdering the sick in the name of progress? The Heidelberg psychiatrist Carl Schneider as a brain researcher and "therapeutic idealist"]

The biography of the Heidelberg Professor of Psychiatry Carl Schneider (1891-1946) represents a combination of a quest for psychiatric reform, pronounced interest in brain research, and commitment to the first systematic extermination of a minority during the Nazi era, the murder of psychiatric patients. Guided by a biological concept that included the individual and his environment and thus interpreting the interactive and social sphere from a purely biological viewpoint, Schneider considered cure and extermination as two sides of the same coin. Psychiatric patients should receive intensive "biological" therapy, but if they were incurable and could not be integrated into society, they lost their reason for existence also in the biological sense. This can be illustrated by Schneider's research department in Heidelberg (1943/1944) where 52 children and adolescents were subjected to an extensive diagnostic program. Twenty of these children were murdered in the name of research at the Eichberg psychiatric asylum.

[Psychiatry during National Socialism: historical knowledge, implications for present day ethical debates]

This contribution is a synthesis of the results of historical research on psychiatry during the Nazi period and some implications for present day debates in medical ethics. The focus is on three issues: the relationship between physicians and the state, the impact of eugenically and economically motivated health and social policies for psychiatry (e.g. forced sterilization, patient killing/euthanasia) and psychiatric research. Three myths are deconstructed: 1) that medical atrocities were imposed from above by Nazi politicians on apolitical physicians, 2) that mass sterilization and patient killing had nothing to do with contemporary state of the art of medical reasoning and practice and 3) that ethically unacceptable research on psychiatric patients had nothing to do with the contemporary state of the art of biomedical sciences. It is argued that the findings on these issues of Nazi medicine are not specific to Germany and the period between 1933 and 1945 but they were the extreme manifestations of some potential problems implicit in modern medicine in general.