[Hans Roemer (1878-1947): committed eugenicist and critic of patient killing]. / Hans Roemer (1878-1947): Überzeugter Eugeniker, Kritiker der Krankentötungen.

Hans Roemer (1878-1947), director of the psychiatric asylum in Illenau/Baden, was one of the few psychiatrists during National Socialism who explicitly turned against the program of systematic patient killing (euthanasia). The article gives an overview of Roemer's biography and sketches his activities in the context of reform movements in the 1920s as a protagonist in the context of the German mental hygiene movement and propagator of eugenic measures including the Nazi law of compulsory sterilization of those classified as suffering from hereditary conditions. The focus is on the beginning of the "Aktion T4", the first phase of the systematic patient killing in 1939/1940. Roemer repeatedly tried to avert the deportation of patients from the Illenau and to find psychiatric allies for coordinated steps against the killing program. Ernst Rüdin, president of the German psychiatric association, as well as leading medical administrators blocked Roemer's initiatives. Nevertheless, Roemer did not experience any harassment or sanctions by representatives of the regime.

[Ernst Rüdin: distinguished scientist, radical racial hygienist]. / Ernst Rüdin - renommierter Wissenschaftler, radikaler Rassenhygieniker.

Ernst Rüdin (1874­1952) was one of the founders of psychiatric genetics. From 1931 until 1945, he was Director of the German Institute for Psychiatric Research (Deutsche Forschungsanstalt für Psychiatrie, DFA) and from 1935 until 1945 President of the German Association of Neurologists and Psychiatrists. The historical knowledge on Rüdin is reconsidered, using new sources, and with a focus on Rüdin's involvement in the Nazi program of patient killings ("euthanasia"). It is documented that (1) it is a misconception to interpret psychiatric genetics as "instrumentalised" by the Nazi regime; (2) Rüdin belonged to the group of psychiatric perpetrators who worked to give the Nazi selection policies scientific authority; (3) Rüdin knew early on about the patient killings and refused to support others in their efforts to stop them; and (4) the research in the context of the patient killings carried out by Julius Deussen, a member of Rüdin's team at the DFA, was initiated and actively supported by Rüdin, and co-financed by the DFA.

[Psychiatry during National Socialism: historical knowledge, implications for present day ethical debates]. / Psychiatrie im Nationalsozialismus : Historische Kenntnisse, Implikationen für aktuelle ethische Debatten.

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.

[Is there a German history of evidence-based medicine? Methodic standards of therapeutic research in the early 20th century and Paul Martini's "Methodology of therapeutic investigation" (1932)]. / Gibt es eine deutsche Vorgeschichte der Evidenz-basierten Medizin? Methodische Standards therapeutischer Forschung im beginnenden 20. Jahrhundert und Paul Martinis "Methodenlehre der therapeutischen Untersuchung"(1932).

The article addresses the history of evidence-based medicine in Germany. Its aim was to reconstruct the standard of clinical-therapeutic investigation in Germany at the beginning of the 20 (th) century. By a historical investigation of five important German general medical journals for the time between 1918 and 1932 an overview of the situation of clinical investigation is given. 268 clinical trails are identified, and are analysed in view of their methodological design. Heterogeneous results are found: While few examples of sophisticated methodology exist, the design of the majority of the studies is poor. A response to the situation described can be seen in Paul Martini's book "Methodology of Therapeutic Investigation", first published in 1932. Paul Martini's biography, his criticism of the situation of clinical-therapeutic investigation of his time, the major points of his methodology and the reception of the book in Germany and abroad are described.

[Mentalities and sterilization laws in Europe during the 1930s. Eugenics, genetics, and politics in a historic context]. / Zeitgeist und Erbgesundheitsgesetzgebung im Europa der 1930er Jahre Eugenik, Genetik und Politik im historischen Kontext.

The laws and related practice of sterilisation in Germany during the Nazi period (1933-1945) were not isolated phenomena. Rather, they have to be understood in the broader context of the eugenic and racial hygiene movement developing internationally during the first decades of the twentieth century. Central conditions allowing its emergence were scientific, sociopolitical, and cultural factors. Fears of biological degeneration, economic considerations, and trust in the future potential of biology and in particular genetics played a crucial role in many western societies. Eugenics and the practice of sterilisation are constitutively linked to scientific justifications, just as - complementarily - the development of genetics, in particular psychiatric genetics, is inextricably associated with eugenics and its funding by philanthropic or state institutions. Parallels and a multiplicity of mutual relations existed on various levels, in particular between Germany, the US, and Scandinavian countries.

[Hereditary psychological research in the context of "euthanasia": new documents and aspects on Carl Schneider, Julius Deussen and Ernst Rüdin]. / Erbpsychologische Forschung im Kontext der "Euthanasie": Neue Dokumente und Aspekte zu Carl Schneider, Julius Deussen und Ernst Rüdin.

Ernst Rüdin (1874-1952), director of the Deutsche Forschungsanstalt für Psychiatrie in Munich, was one of the leading psychiatrists in Nazi Germany. Prevailing historical research on Rüdin's relation to the systematic annihilation of psychiatric patients is dominated by the only hitherto available biographical account which suggests that Rüdin privately disapproved of the "euthanasia" program, but did not make this disapproval public. According to this account, neither Rüdin nor any of his co-scientists were in any way actively involved in the systematic killings. In contrast to this image, a general evaluation of the historical sources on the systematic killing of patients clearly shows that due to the fragmentary character of the evidence, any exculpation of particular individuals or institutions is premature to date. Furthermore, the reevaluation of already known archival material and new documents presented here proves that Rüdin had a genuine interest in research which on the one hand made profitable use of the killings, and on the other hand was aimed at formulating scientific criteria for the systematic selection and "euthanasia" of those supposedly unworthy to live. Julius Deussen (1906-1970), since 1939 head of the department for hereditary psychology at the Deutsche Forschungsanstalt, was also a close co-worker of Carl Schneider (1891-1946) at the University of Heidelberg. He coordinated the research on children carried through in the context of the "euthanasia"-programme between 1943 and 1945. This research sought to systematically correlate clinical and laboratory findings with the histopathological data of the victims' brains. From the beginning, it included the killing of the patients. Central elements of the research programme had been formulated by Deussen already in Munich. Rüdin supported the activities of Deussen in Heidelberg and repeatedly pointed out that they were of importance for the health and population policy of the Nazi regime.

Biologizing social facts: an early 20th century debate on Kraepelin's concepts of culture, neurasthenia, and degeneration.

This paper uses an historical approach to elucidate two alternative modes of conceptualizing the relation between social factors and psychological phenomena perceived as pathological. The core features of Neo-Kraepelinian psychiatric nosology associated with the introduction of DSM-III in 1980 were also at the center of a debate in early 20th century Germany. The protagonists were Emil Kraepelin and Oswald Bumke. Kraepelin's empirical research selectively focused on somatic factors as independent variables, such as alcohol, syphilitic infection, and heredity. The ensuing nosology marginalised social factors which might contribute to the etiology and symptom formation of psychiatric conditions. For Bumke, the disorders in question (including the category of neurasthenia) did not represent qualitative deviations from normal psychological states, but quantitative variations of ubiquitous psychological functions caused by a multitude of somatic, psychological, and social factors. The main arguments of the historical debate are reconstructed, with special regard to the professional and political context. The paper illustrates the importance of context-bound pre-'scientific' decisions for the process of formulating theoretical concepts in psychiatry and related disciplines.

Biologizing social facts: an early 20th century debate on Kraepelin's concepts of culture, neurasthenia, and degeneration.

This paper uses an historical approach to elucidate two alternative modes of conceptualizing the relation between social factors and psychological phenomena perceived as pathological. The core features of Neo-Kraepelinian psychiatric nosology associated with the introduction of DSM-III in 1980 were also at the center of a debate in early 20th century Germany. The protagonists were Emil Kraepelin and Oswald Bumke. Kraepelin's empirical research selectively focused on somatic factors as independent variables, such as alcohol, syphilitic infection, and heredity. The ensuing nosology marginalised social factors which might contribute to the etiology and symptom formation of psychiatric conditions. For Bumke, the disorders in question (including the category of neurasthenia) did not represent qualitative deviations from normal psychological states, but quantitative variations of ubiquitous psychological functions caused by a multitude of somatic, psychological, and social factors. The main arguments of the historical debate are reconstructed, with special regard to the professional and political context. The paper illustrates the importance of context-bound pre-'scientific' decisions for the process of formulating theoretical concepts in psychiatry and related disciplines.

[Innovation and extermination--psychiatric research and "euthanasia" at the Heidelberg Psychiatric Clinic 1939-1945]. / Innovation und Vernichtung--Psychiatrische Forschung und "Euthanasie" an der Heidelberger Psychiatrischen Klinik 1939-1945.

The history of German psychiatry is characterized not only by innovative thought in the tradition of Kraepelin and Jaspers, but also by the "euthanasia" program that resulted in the killing of more than 100,000 psychiatric patients and mentally handicapped people. Exemplified by the Psychiatric Department at the University of Heidelberg, the relation between psychiatric research and the systematic killing of patients during the time of National Socialism is analysed. The first part of the paper summarizes the historical background of the general condition of German psychiatry in the 1930s and 1940s. The second part gives an outline of the biography and work of Carl Schneider (1891-1946), head of the Psychiatric Department at Heidelberg until 1945. It can be shown that the call for intensive therapy for those patients who were to be reintegrated into society was connected with the killing of those who were considered to be beyond reach of any active therapeutic approach. This is also the context of C.Schneider's research program concerning mentally handicapped children. The historical reconstruction of research activities, drawing on the patients' files and other documents, reveals that out of 52 children who had been examined, 20 were killed in the asylum of Eichberg in order that their brains might be examined in Heidelberg. The findings are discussed in view of the ongoing historiographical debate on the relationship between the politics of National Socialism and contemporary science.

[We're moving closer and closer to the insane asylum...": Modern life and nervous system diseases by Johann CHristian Reil (1759-1813)]. / "Wir rücken Schritt vor Schritt dem Tollhause näher...": Das moderne Leben und die Nervenkrankheiten bei Johann Christian Reil (1759-1813).

Johann Christian Reil is usually portrayed as a pioneer in the realm of neuroanatomy and psychiatry, and as a pragmatic physician engaged in contemporary problems of social medicine and hygiene. In this article, the connection between these two fields of interest is focused: Reil's ideas on the relation between the "modern" way of life and the occurrence of diseases of the nervous system. The first part of the paper summarizes Reil's statements on the issue, as laid out e.g. in his "Ueber die Erkenntnis und Cur der Fieber" (1802), and in the "Rhapsodieen über die Anwendung der psychischen Curmethode auf Geisteszerrüttungen" (1803). The second part gives an outline of Reil's neurophysiological model of the interaction between the organ of the soul ("Seelenorgan") and the social environment. In the third part, Reil's conceptions of culture, civilisation, and history are investigated. For Reil, madness is not an alienation from reason, but from a postulated healthy state of nature which is located in the past. Modern life causes and steadily increases a contradiction between the needs of the body and those of the soul, resulting in a concomitant tension and irritability of the nerves. Modern culture is thus criticized for its potentially harmful effects on mental health. The balance between physical and mental activities, and the constitution of a decentralized state would be means to prevent the manifestation of the ensuing diseases.

[Is the psyche antiquated? A typology of psychotherapeutic critique of civilization in the works of Alexander Mitscherlich]. / Ist die Psyche antiquiert? Typen der psychotherapeutischen Zivilisationskritik im Werk von Alexander Mitscherlich.

In the oeuvre of the psychotherapist Alexander Mitscherlich, one of the founding-fathers of psychosomatic medicine in post-war Germany, three basic types of critique of civilization can be identified. They each imply a specific conception of the relation between modernity and psychological disorder. Mitscherlich's ideas on the topic have evolved in a manner consistent with his appropriation of psychoanalysis and his confrontation with the causes and consequences of human behaviour during the time of national socialism.

[Between individual therapy and political intervention: campaigns against "diseases of civilization" between 1920 and 1960]. / Zwischen individueller Therapie und politischer Intervention: Strategien gegen "Zivilisationskrankheiten" zwischen 1920 und 1960.

The concept of "disease of civilization" is commonly used for a variety of conditions. It implies a criticism of the "modern" way of life. This criticism and the strategies put forward to prevent diseases of civilization are correlated to the specific historical context in which they are formulated. The paper analyses three positions characterising different periods in 20th century German history: In the Weimar Republic, representatives of paediatrics and social hygiene asked for the expansion of public health care programmes according to the principles laid down by the Weimar constitution. During the time of National Socialism, more radical measures were propagated by exponents of hygiene and psychotherapy, aiming at a fundamental restructuration of society in accordance with the Nazi ideology. After 1945, strategies focused on the individual: Physical exercise, abstinence, and individual psychotherapy were propagated to prevent or treat the consequences of life in modern society.

[Not Available]. / Die Entwicklung der Medizingeschichte seit 1945.

During the last decades, medical historiography has undergone considerable changes. This review attempts an outline of the developments since 1945. The first section sketches the institutional background of the discipline focusing on the characteristic features which emerged in different national traditions. The following sections - essentially restricted to the German speaking context - describe the development of the fields in research and teaching, ranging from the history of ideas to the social history of medicine, from philological and editorial work to the philosophy and sociology of medical knowledge.