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The Royal College of Psychiatrists Improving the lives of people with mental illness

International Congress: Exhibition

It’s time for the blog for our May newsletter. I was going to write again about the junior doctors dispute. But the problem is that even with our swift and efficient communications set up, several days need to elapse between finishing my draft and it arriving in your in boxes. So it is likely that whatever I say will be out of date by the time you read it. So I have decided to instead to turn to our forthcoming International Congress.

For the last two years I have written a fairly breezy forward look at what is on offer – and I can promise you that the standards, spread and quality of the presentations and guest speakers is as good, if not better (if that is possible) than ever before. But today I want to concentrate on just one part of the Congress, something which does not lend itself to the usual style I have adopted when talking about previous congresses.

This year delegates will be able to see a major exhibition, never before been seen in this country. Normally I would now write phrases that “I am delighted to welcome” and then go on to describe what it is that we are delighted about. But there is nothing in this exhibition from which one can take any delight.

The exhibition is called “Registered, Persecuted, Annihilated: The Sick and Disabled Under National Socialism” (“Erfasst, verfolgt, vernichtet. Kranke und behinderte Menschen im Nationalsozialismus”). It was created by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGGPN), and I thank them and in particular Professor Frank Schneider for their assistance in making it possible for us to host the exhibition here in London. Originally opened by the German Federal President, it received widespread praise, and has had a substantial impact in Germany. Here in London it will be opened by the German Ambassador. As the name suggests, it concerns the murder of 70,273 children and adults with either mental disorder or learning disabilities by what was known as the Aktion T4 programme (so called because the office that administered the programme was based in Tiergarten 4 in the centre of Berlin) between 1939 and 1941, although historians agree that the total death toll of the mentally ill during the Third Reich might be closer to 200,000.

This programme could not have taken place without the active participation of many (but not all) psychiatrists. It is to the credit of the DGGPN that they have taken the lead in bringing attention to the darkest period in their history, in keeping with the dignified, rigorous and mature way in which modern Germany has approached its recent past. At the same time the exhibition raises uncomfortable questions about how all of us approach the subject of mental illness and learning disability, both in the past and present.

In this country we should be reminded that eugenics and racial hygiene was also very influential during the first half of the last century, even if a different political situation meant that we did not pursue such a radicalised path as happened under National Socialism. Historians are largely dismissive of the idea that what happened there could only have happened in Germany, and nowhere else – the so called “sonderweg” or “special path” of German history. Rather like the criticisms of Daniel Goldhagen’s “Hitler’s Willing Executioners”, popular with everyone except historians, and which basically stated that Germans killed Jews because they wanted to – the “special path” hypothesis also explains very little. The eminent historian George Mosse once said that if he had gone to sleep in 1914 and been awoken in 1945 with the news that “they have killed all the Jews” his reaction would have been “I never thought the French would go that far”.

So this exhibition concerns us all. The terrible events of the T4 programme which led to the mass murder of the mentally ill and learning disabled, happened in Germany and modern day Austria but is not solely a German issue.

And the recent debates on assisted dying, which in some countries is permitted for those with mental disorders (something that was never contemplated here) shows that whilst it is often both easy and sometimes facile to make comparisons with National Socialism, nevertheless, it is always salutary to be reminded of what can happen when professions such as medicine or the law lose their moral compass and compassion. It is also the sign of a mature profession, which is what I believe we are, that it does not shy away from, or turn a blind eye, to an uncomfortable past.

I am therefore proud of our College for making it possible for you to see this exhibition. It blends historical scholarship of the highest standard with powerful images of the humanity of those with mental disorders or learning disability, and allowing for the first time their own personal stories to be heard from the grave. It is ironic that one of the responses to the National Socialist period made by the post war Federal Republic was to protect the identities and privacy of those with mental disorder or learning disability by enacting a series of measures that made it next to impossible to share any data, or compile any records or statistics in which there was any possibility of the authorities learning the identities of those with mental disorders without their consent. The irony is that these laws meant that the identity of those who had perished in the T4 programme remained hidden for decades. It is only now that it has been possible to see who they were, what their illnesses were, what they looked like, and what backgrounds they came from. It is only now that they have ceased to be statistics, and have become human again.

We pay tribute to our colleagues at the DGGPN and in the German historical profession for creating this exhibition, but most of all we pay tribute to the memory of those who lost their lives solely because they suffered from mental disorder or learning disability. I hope that all of you will take time to view this exhibition when you attend the International Congress.

Professor Sir Simon Wessely

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Re: International Congress: Ex
Hi Simon, This exhibition on the practical aspects of Eugenics - the move from the Darwinian survival and reproductive potential of the fittest, to the survival of the economically productive and the purest - is timely for British Psychiatry. I wonder if this should be made a permanent display at Prescott Street.

The seminal article ‘Allowing the destruction of life unworthy of life’ was co-authored in 1920 by the then Professor of Psychiatry at the university of Freiburg. This discussion was followed by restricting nutrition and physical healthcare of older people with Learning Disability and Psychosis.
However, it is a mistake in my opinion, to see this as a German historical phenomena; perhaps better seeing Weimar Germany being the unwitting host to the parasitic virus of Nazi eugenic ideology. Arguably the virus won, suggested by operation paperclip and the creation of multinational unions across the world (part of the post war Nazi plan)

From an English perspective, the financially driven adaptation of the Liverpool Care Pathway (LCP) for ‘managing’ care of frail elderly in Mid Staffs and other hospitals comes to mind. It is likely that the non-cancer elderly placed on LCP were incapacitious due to delirium, dementia and depression. I wish there was research looking at the pre mortem diagnoses of non-cancer LCP deaths could be carried out to confirm or discount this suspicion. Perhaps the widespread adoption of liaison services for elderly would be a safeguard.
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Professor Wendy Burn

Professor Wendy Burn FRCPsych


Professor Wendy Burn became a consultant old age psychiatrist in Leeds in 1990 and now works fulltime in a community post. Her main clinical interest is dementia.

She has held a regional leadership role in this area from 2011 and was co-clinical Lead for dementia for Yorkshire and the Humber Strategic Clinical Network between 2013 and 2016.