Psychiatric Institutions and Society : The Practice of Psychiatric Committal in the “Third Reich,” the Democratic Republic of Germany, and the Federal Republic of Germany, 1941–1963

Psychiatric knowledge as a foil for the interpretation of social problems 42 Changes during the Nazi era up to 1941 and the incipient murder of the sick 45 2 The state and psychiatric institutions-Parameters and committal decisions 52 The murder of the sick and shortages: the practice of committal during World War II 53 Patients and physicians in cases of committal 55 Initiation of committals by relatives 58 Committal practices in a "society in a state of collapse" (Zusammenbruchgesellschaft), 1945-1949 64 New pathways and lack of places: the practice of committal in the GDR 68 Underfunding and lack of places 68 Changes in committal pathways associated with the role of polyclinics and specialist boards (Fachärztegremien) 72 The contested role of psychiatric institutions and controversial committal practices in West Germany 76 Who belongs in an asylum? Debates on costs and the relationship between security and illness 77 Patients between doctors, relatives, and overcrowded clinics 82 Between voluntariness and coercion, assistance and long-term residential placement: committals from the perspective of patients in the Nazi era, the GDR, and the FRG 85 Summary: framework conditions, actors, and the role of the asylum in comparative perspective 89 3 Danger and security: On the practice of compulsory committal 103 "A threat to public safety"? Compulsory committals during World War II 105 Soldier committals at the front and "home front" 106 The elderly as a threat: the radicalization of committal practices by institutions and the social milieu 109 Security, sexuality, and work: committals of "asocial female psychopaths" 115 Interpretation: compulsory committals during the war 121 vi Contents Unregulated spaces: the new power of doctors and relatives in the GDR 123 The regulation of forcible committal in the GDR 123 Standards and decisions: the coalition of practice encompassing asylum physicians and families 127 Judicial compulsory committal: new regulations and their implementation in the FRG 131 New regulations and their acceptance 131 Informal preliminary decisions by families and physicians 137 Summary: practices of compulsory committal in comparative perspective 139 4 Disease and diagnostics-Medical aspects of committal 151 5 Work and performance-Ability and inability to work in committal rationales 212 Sources and what they can tell us 213 At the threshold: work and institutionalization, 1941-1963 214 Inclusion and exclusion: work in families' committal rationales during the war 214 Restoring capacity for work, safeguarding work processes: familial reasoning about committals in West Germany 219 A double-edged sword: work in East German committal rationales 221 The healthy self during World War II, in the GDR, and in the FRG 226 "Overwork" in wartime and in the early FRG 226 Work capacity as a sign of health during World War II and in the FRG 229 Ability to work and "overwork" in the GDR 232 Interpretation: differing perceptions in East and West 235 The medical perspective on work and performance between 1941 and 1963 238 "Psychopathy" as a diagnosis in the Nazi era 239 Managerial disease, "psychopathy," and "exhaustion" (Erschöpftsein): medical interpretations of "overwork" in the FRG 242 "Overworked" diagnostics: a new scientific discourse with consequences for psychiatric practice in the Soviet occupation zone and GDR 249 Summary: work and performance in comparative perspective 259 ## Conclusion 275 Patient records as a source: the benefits of a combined hermeneutic and functional approach 275 State, science, and social practice 278 Work as a category of difference shaped by the sociopolitical system 282 Freedom (and its limits), society, and statehood 284 Cover Half Title Series Page Title Page Copyright Page Contents Acknowledgments Introduction Topic and period of investigation Object of inquiry Methodology, complexes of theory and research, and the book's structure Operationalizing comparison Complexes of theory and research: state and psychiatry Complexes of theory and research: danger and security Complexes of theory and research: disease and diagnosis Complexes of theory and research: work and performance Sources Source materials and their evaluation: a qualitative study with quantitative underpinnings A social history of medicine that takes account of Science Studies: journals and textbooks as complementary sources for interpreting medical records Notes 1. Historical parameters of committal practice: Psychiatry, state, and society to 1941 Types of asylums and clinics The role of psychiatric institutions Physician and patient: cure, recovery, and quartering Security, the justice system, and the police Psychiatry as supplier of knowledge applied by the state Psychiatrists as providers of expert evaluations Psychiatric knowledge as war-related knowledge Psychiatric knowledge as a foil for the interpretation of social problems Changes during the Nazi era up to 1941 and the incipient murder of the sick Notes 2. The state and psychiatric institutions: Parameters and committal decisions The murder of the sick and shortages: the practice of committal during World War II Patients and physicians in cases of committal Independent physicians (niedergelassene Ärzte) and committal decisions Initiation of committals by relatives Committal practices in a "society in a state of collapse" (Zusammenbruchgesellschaft), 1945-1949 New pathways and lack of places: the practice of committal in the GDR Underfunding and lack of places Changes in committal pathways associated with the role of polyclinics and specialist boards (Fachärztegremien) Summary: state and psychiatric institutions in the GDR The contested role of psychiatric institutions and controversial committal practices in West Germany Who belongs in an asylum? Debates on costs and the relationship between security and illness Patients between doctors, relatives, and overcrowded clinics Between voluntariness and coercion, assistance and long-term residential placement: committals from the perspective of patients in the Nazi era, the GDR, and the FRG Summary: framework conditions, actors, and the role of the asylum in comparative perspective Notes 3. Danger and security: On the practice of compulsory committal "A threat to public safety"? Compulsory committals during World War II Soldier committals at the front and "home front" The elderly as a threat: the radicalization of committal practices by institutions and the social milieu Security, sexuality, and work: committals of "asocial female psychopaths" Interpretation: compulsory committals during the war Unregulated spaces: the new power of doctors and relatives in the GDR The regulation of forcible committal in the GDR Standards and decisions: the coalition of practice encompassing asylum physicians and families Judicial compulsory committal: new regulations and their implementation in the FRG New regulations and their acceptance Figures on compulsory committals and what they tell us New regulations on compulsory committals in Bavaria, Hesse, and North Rhine-Westphalia Resistance to the new regulations on forcible committal Informal preliminary decisions by families and physicians Summary: practices of compulsory committal in comparative perspective Notes 4. Disease and diagnostics: Medical aspects of committal The role of the psychiatrist The relationship between doctor and patient The psychiatrist as expert: diagnostic classifications and the clinical picture of schizophrenia in the Nazi era and early FRG The Würzburg Key as a diagnostic scheme in the "Third Reich" Practice, tradition, and local knowledge: the diagnostics debate in the FRG Continuities and ruptures in diagnoses of schizophrenia in the FRG Between tradition, Pavlov, and the WHO: multiple diagnostic classifications and the clinical picture of schizophrenia in the GDR Medical reactions to diagnostic grids Schizophrenia between tradition and Pavlov Diagnostic practice in the FRG and GDR Psychiatrists among themselves Psychiatrists and other physicians The relationship between doctor and patient The flow of information from family to institution Doctors' and lay diagnoses Correspondence between laypersons and physicians Circulation of knowledge between East and West: lay demands for "Western" treatment standards Summary: disease and diagnostics in comparative perspective Notes 5. Work and performance: Ability and inability to work in committal rationales Sources and what they can tell us At the threshold: work and institutionalization, 1941-1963 Inclusion and exclusion: work in families' committal rationales during the war Restoring capacity for work, safeguarding work processes: familial reasoning about committals in West Germany A double-edged sword: work in East German committal rationales The healthy self during World War II, in the GDR, and in the FRG "Overwork" in wartime and in the early FRG Work capacity as a sign of health during World War II and in the FRG Ability to work and "overwork" in the GDR Interpretation: differing perceptions in East and West The medical perspective on work and performance between 1941 and 1963 "Psychopathy" as a diagnosis in the Nazi era Psychiatric discourse Physicians' diagnostic practice Managerial disease, "psychopathy," and "exhaustion" (Erschöpftsein): medical interpretations of "overwork" in the FRG Theoretical concepts Overwork, "psychopathy," and legitimate exhaustion in diagnostic practice "Overworked" diagnostics: a new scientific discourse with consequences for psychiatric practice in the Soviet occupation zone and GDR Work in the committal: questions about salary and occupation in medical histories "Overwork" in medical diagnostics: from "psychopathy" to organ neurosis Ramifications of Pavlovian theory in psychiatric practice Summary: work and performance in comparative perspective Notes Conclusion Patient records as a source: the benefits of a combined hermeneutic and functional approach State, science, and social practice Work as a category of difference shaped by the sociopolitical system Freedom (and its limits), society, and statehood Notes Appendix 1. Statistical analysis of the committal pathway Tables: Committal pathway from 1941 to end of war Tables: Committal pathway from end of war to 1949 inclusive Tables: Committal pathway, 1950-1955 Tables: Committal pathway, 1956-1963 2. Further statistical analyses Sources and bibliography Sources Unprinted sources Archive of the District of Upper Bavaria Archive of the Hesse Land Welfare Association Bavarian Main State Archive Munich Federal Archive Koblenz Federal Archive Lichterfelde Main Archive of the von Bodelschwingh Foundations Bethel Hesse Main State Archive Marburg Greifswald Land Archive Schwerin Main Land Archive Saxony Main State Archive Dresden Saxony State Archive Chemnitz State Archive Munich Munich City Archive Greifswald University Archive Printed sources Psychiatric journals Psychiatric textbooks and monographs Bibliography Index The book probes how the serious and sometimes fatal decision was made to admit individuals to asylums during Germany’s age of extremes. The book shows that - even during the Nazi killing of the sick - relatives played an even more important role in most admissions than doctors and the authorities. In light of admission practices, this study traces how ideas about illness, safety, and normality changed when the Nazi regime collapsed in 1945 and illuminates how closely power configurations in the psychiatric sector were linked to political and social circumstances.