Letters to the Editor
Reply: Psychiatry in the Nazi Era
Dear Editor: I am grateful to Dr Pieczanski and Dr Matusevich for commenting on ethical imperatives, such as putting the patient first, that seem often to be neglected in the practice of our profession. They are neglected because of theory (eugenic theory is a disquieting example), because of “evidence” from clinical trials, because patient interests conflict with a hospital's bottom line, because clinicians are misled by pharmaceutical marketing, because of pressure from family or peers, because of a nosologic system into which the patient’s symptoms do not easily fit, because the requirements of research preempt a particular patient’s immediate need, or because the lure of personal gain blinds the clinician to the patient's best interests. Sometimes just “not wanting to make waves” can interfere with our fiduciary duty to our patients.
After researching the article to which Dr Pieczanski and Dr Matusevich refer (1), I discovered that “euthanasia” of patients with psychiatric disabilities was carried out not only in Germany during World War II, but also in the countries occupied by Germany and in the countries allied with Germany. In the Scandinavian countries, as in many other parts of the world, including the US and Canada, involuntary sterilization of disabled patients was common. In countries neutral in the War or allied in the fight against Hitler's regime, psychiatric patients perished because they were last in line for food rations, because their attendants were mobilized, because physicians emigrated, because unhygienic conditions caused fatal infections, and because patients were discharged from hospital into the forest to fend for themselves when food shortages made it uneconomic to feed them.
Ignoring the needs of psychiatric patients is not limited to a particular time in history or to a particular political regime. Under stress, human beings appear to establish “hierarchies of worth,” as we all witnessed on our television screens when Hurricane Katrina hit New Orleans. Psychiatric patients seem always to be at the bottom of these hierarchies, especially if they also happen to be financially destitute. It occurred under the Nazis; it occurs sometimes now. Our charge, as Dr Pieczanski and Dr Matusevich note, is to be vigilant to the possibility that what we do may be dictated not by our patients' needs but by our own. As a society, we have come to realize that, when psychiatrists have sex with patients, they are not doing it “for the patient's good” but for their own. Euthanasia was also thought to be for the patient's good. How many other actions, less lethal than euthanasia but probably more harmful than sex, do we engage in under the guise of helping?
References
1. Seeman, MV. Psychiatry in the Nazi era. Can J Psychiatry 2005;50:218–225.
Mary V Seeman, MD
Toronto, Ontario
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