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Psychiatry and the dark side: eugenics, Nazi and Soviet psychiatry

  • Jason Luty
Summary

Psychiatrist Thomas Szasz fought coercion (compulsory detention) and denied that mental illness existed. Although he was regarded as a maverick, his ideas are much more plausible when one discovers that between 1939 and 1941, up to 100 000 mentally ill people, including 5000 children, were killed in Nazi Germany. In the course of the Nazi regime, over 400 000 forced sterilisations took place, mainly of people with mental illnesses. Other countries, including Denmark, Norway, Sweden and Switzerland, had active forced sterilisation programmes and eugenics laws. Similar laws were implemented in the USA, with up to 25 000 forced sterilisations. These atrocities were enabled and facilitated by psychiatrists of the time and are only one example of the dark side of the profession. This article reviews some of these aspects of the history of psychiatry, including Germany's eugenics programme and the former USSR's detention of dissidents under the guise of psychiatric treatment.

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Copyright
Corresponding author
Dr Jason Luty, Borders Addiction Service, The Range, Tweed Road, Galashiels TD1 3EB, UK. Email: jason.luty@yahoo.co.uk
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Declaration of Interest

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References
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Psychiatry and the dark side: eugenics, Nazi and Soviet psychiatry

  • Jason Luty
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eLetters

CTOS- ALSO THE DARK SIDE?

Zekria Ibrahimi, psychiatric patient
19 September 2014

Jason Luty refers to the 'dark side' of psychiatry. He cites the Nazi holocaust as being assisted with cruel zeal by psychiatrists. I believe that he makes some extrapolations into the present from this gruesome past, and psychiatrists are advised to be less authoritarian. For example, there is personality disorder as a potentiallyvague diagnosis that allows psychiatrists to lock up too many vulnerable people.

Luty does not, however, mention community treatment orders (CTOs), yet these are a current example of the human rights of patients being compromised by psychiatrists. A recent paper (1) by Tom Burns at Oxford found them to be ineffective, but psychiatrists seem enthusiastic about them.

Several correspondents in the Lancet and the Psychiatric Bulletin have attacked the Burns article on two fronts.

The first is lack of statistical power. Burns confirmed the null hypothesis - of no difference between intervention (CTO) and control (Mental Health Act Section 17 leave) - with a relative risk of 1.0. The narrow confidence interval (CI 0.75-1.33) seems to imply sufficient power. Of course, one can increase sample size and power ad infinitum; however, the clinical importance may be negligible.

The second front of criticism involves psychiatrists who cite individual cases where CTOs appear appropriate, viz. anecdotal guesswork. In the more primitive days of psychiatry, papers in journals had no statistical analysis. Instead, accumulated case studies were used to justify procedures such as lobotomy. Individual case studies are not as rigorous as randomized controlled studies such as that used by Burns.

CTOs actually put patients at risk. Clinicians mistakenly have faith in CTOs as 'miracle interventions', whereas CTOs in practice mean that severely ill patients are abandoned in the community. Some chronically unwell people with schizophrenia cannot cope without annual stays in hospital as respite. CTOs will never compensate for the catastrophic reduction in psychiatric beds due to short-sighted cost cutting in the NHS.

Given its vicious history, any measure in psychiatry that reduces patients' rights should provoke suspicion.

REFERENCES:

(1) Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. Burns at al. Lancet 2013:381:1627-33.

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Conflict of interest: None declared

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