1 Introduction
Seventy-seven days before the outbreak of the Second World War, the German-language neurological and psychiatric journal Zentralblatt announced ‘a new, revolutionary method in the shock therapy of schizophrenia coming from Rome’.Footnote 1 A method, as well as suitable apparatus, had apparently been found which superseded the ‘convulsive therapy’ of schizophrenia, which had been introduced by Ladislas Meduna (1896–1964) in 1934 and relied on epileptic seizures triggered with camphor or pentylenetetrazol (Cardiazol).
That same year, the new treatment was indeed introduced in many countries in Europe, and in Japan,Footnote 2 Latin America and the USA.Footnote 3 With regards to Europe, however, it is assumed that National Socialism played a decisive role in the introduction of this new shock therapy. The research literature not only emphasises the flight of doctors and scientists of Jewish descent or faith from National Socialism,Footnote 4 but particularly supports the thesis that the introduction of the new technology in the Third Reich had drawn special interest from high-ranking officials of the Nazi regime. ‘Electroshock therapy’ (now known as electroconvulsive therapy (ECT)) ‘was swiftly integrated into the dialectics of healing and killing typical of medicine in Nazi Germany.’Footnote 5
Since Szasz’s article ‘From the Slaughterhouse to the Madhouse’, the invention of electroshock therapy has generally been regarded as ‘modern therapeutic totalitarianism’.Footnote 6 Social histories such as Braslow’s Mental Ills and Bodily Cures seem to have reinforced the view popularised by One Flew Over the Cuckoo’s Nest of electroshock therapy as a ‘treatment’ to enforce discipline inside the repressive regime of a psychiatric hospital.Footnote 7 Furthermore, it is frequently assumed that if electroshock therapy was indeed a disciplinary medical therapy, then its introduction and application in the Third Reich must have been particularly cruel. Indeed, such highly regarded historical research on the Third Reich and the ‘euthanasia’ murders as Henry Friedlander’s The Origins of Nazi Genocide: From Euthanasia to the Final Solution claims that during the Nazi period, electroshock was no therapy, but rather a treatment used to ‘inflict torture’.Footnote 8 Within the Third Reich, it had ‘finally’ been the ‘bureaucratic apparatus for organising the mass murder of mentally disabled and mentally ill people which under the conditions of war economy provided German psychiatric hospitals with the apparatuses necessary for electroconvulsive therapy’ and which considered the establishment of institutes for investigating the new technology.Footnote 9
Although most histories of electroshock therapy failed to engage with the complexities of the existence of electroshock therapy in the Third Reich,Footnote 10 preliminary investigations on the chronology of the introduction and implementation of the new therapy in Europe and especially in Germany raise doubts as to whether National Socialist health policy favoured the introduction of the new shock therapy for the German Reich, or whether it in fact delayed it.Footnote 11 Following this line of enquiry, our article proposes a chronological analysis of the invention and subsequent introduction of electroshock therapy in the Third Reich and occupied territories. The extent to which there was a special ‘therapeutic enthusiasm’ concerning electroshock within the Third Reich is queried, as well as the existence of state-subsidised research institutions with the explicit purpose of studying and promoting electroshock therapy.
Our analysis relies on an exhaustive review of contemporary international publications as well as on archival records, including medical files from several countries in Europe and the USA.
Methodologically, a ‘social construction of technology’ perspective is taken to show how medical science worked relative to its social context. The ways in which new scientific knowledge was acquired and put into practice were many-faceted, and dependent on the diverging interests of physicians, industrial companies, mental health politics and the exigencies of total war. Our article describes how the changing medico-political and economic context during the Third Reich and the Second World War not only shaped the design of the devices for electroshock therapy but actually reversed their function as tools of medical therapy.Footnote 12
2 The Italian Invention of ‘Electroshock Therapy’: From a Science of Epilepsy to a Therapy of Schizophrenia
In the spring of 1936, Ugo Cerletti (1877–1963), director of the psychiatric–neurological university hospital in Rome since 1935, sent his assistants to Vienna to study a new therapy for schizophrenia which had been recently introduced there, Meduna’s ‘convulsive therapy’. Its principle was the injection of a pharmacological substance able to provoke a generalised epileptic seizure, the hypothesis being that this had a healing effect on schizophrenia.
Cerletti, with his longstanding research on epilepsy, immediately responded to the report of his assistants on their Vienna observations with the idea of modifying Meduna’s procedure with the use of electricity instead of a pharmacological substance. In his epilepsy experiments on dogs, Cerletti had already used electrical provocation to study histopathological brain changes following multiple epileptic seizures. However, until then, he had been reluctant during these experiments to attach the electrodes to the head of the dogs ‘in view of the fact that the passage of an electric current through the brain several times might also produce some histological alterations’.Footnote 13 Yet the method with one electrode in the mouth and the other in the rectum was relatively dangerous as the current passed the heart and led to the death of several of Cerletti’s dogs. Therefore, still in October 1936, Cerletti entrusted his technically experienced assistant, Dr Lucio Bini (1908–64), with further studies on examining the possibility of safely causing epileptic seizures by applying electric current to the head. The initial results of these tests in dogs, utilising equipment designed by Bini, were presented in May 1937 at an international conference in Switzerland on ‘The Therapy of Schizophrenia: Insulin Shock, Cardiazol, Permanent Sleep’.
In contrast to the intravenous pharmacologic induction of epileptic seizures, electricity promised to be simpler, more reliable and less terrifying for the patient, as the application of the electric current immediately resulted in a loss of consciousness.Footnote 14 Motivated by this therapeutic concern, Cerletti wished to change a technique initially developed to study the neurohistopathology of epilepsy into a therapy of schizophrenia; the technique constructed for medical research was reshaped to enable medical therapy. It is evident, therefore, that the ‘electroshock’ idea was not born in the Roman slaughterhouse and it was not primarily tested on pigs as Szasz suggests with his ‘From the Slaughterhouse to the Madhouse’ story.Footnote 15 On the contrary, Cerletti had been quite reluctant to proceed to a clinical application:
This possibility [of using electricity to induce convulsions in people as they were then produced by cardiazol] was often discussed at our Institute and particularly when observing, after cardiazol injections, the painful reactions which shook fully conscious patients for over a minute – as a result most of them refused the subsequent treatments. However, the idea of submitting man to convulsant electric discharges was considered utopian, barbaric, and dangerous: in everyone’s mind was the spectre of the ‘electric chair’. And I myself found in the literature on electrology reports on death in man caused by electric currents of lower voltage than that used on our experimental dogs.Footnote 16
However, there is some truth in the slaughterhouse myth. Indeed, Cerletti continued in his autobiographical notes to say that it was ‘a chance occurrence’ involving some new electrical equipment at the slaughterhouse in Rome that allowed him to make the next step. Having been told at first that here ‘hogs were killed by electric current’, Cerletti first saw this information ‘confirm’ his ‘doubts regarding the danger of electric applications in man’. However, having gone to the slaughterhouse ‘to observe this so called “electric slaughtering” ’, he realised that it was a technique for anaesthesia; the pigs were killed by other means while unconscious.
Illustration of pig’s anaesthesia with the electrode holder. Source: excerpt from a French brochure by Lotterschmidt & Weinberger, without any date, Siemens MedArchives, Erlangen, Germany.
In fact, the Roman slaughterhouse was equipped with a new innovative electrical anaesthesia for pigs that had been developed between 1927 and 1930 and which in 1934 was already being sold throughout Europe, especially in Italy and the Nordic countries (see figure 1).Footnote 17
Realising the astonishing similarities between this procedure and his experiments with dogs,Footnote
18
Cerletti realised ‘that the hogs of the slaughterhouse could furnish the most valuable material’ for his investigations, which he again put in Bini’s hands as soon as Bini had returned from the schizophrenia conference in Switzerland. The chief veterinarian, Professor Ettore Torti, indeed allowed Bini further experiments to study the safety margin of the applied current. The result of these tests on pigs was that ‘there was a clear difference between the time necessary for a current to provoke a “fit” (
${<}1$
s) and the time necessary to provoke the death of an animal (60–150s)’, a safety margin big enough to make Cerletti dare to undertake the first clinical applications.Footnote
19
The story of these first trials on sick people in the Roman Clinic has been written several times.Footnote 20 Remarkably, the first trial was conducted in secret for fear of a major incident.Footnote 21 Cerletti was already 60 years old and a renowned authority in the field of neurology and psychiatry, and he was cautious of losing his reputation. In any case, the ‘Maestro’, as he was called, did not need to discover something ‘new’ that would grant him his first academic position. The fact that Cerletti did choose a newly admitted patient, instead of a well-known patient of his own, has been widely critiqued; however, in the light of the history of human experimentation in medicine, it appears neither as a feature exclusively characteristic of psychiatry and neurology, nor even of medicine in the Third Reich or in Europe.Footnote 22
The new ‘electro-convulsive’ method proved so convincing that Cerletti dared to present the results as early as 28 May 1938 to the Royal Medical Academy in Rome; they were published in Italian professional magazines as ‘electric shock’ (l’elettroshock). The method was geared initially to apply a weak calibration current to two electrodes fixed with a special supporting structure to the patient’s head, to be able to measure the so-called head resistance. On the basis of this value, a suitable voltage could subsequently be selected so that the electricity flowing through the patient’s head via the same electrodes for fractions of a second would cause an epileptic seizure. Bini’s construction was patented and the production of the ‘electroshock’ apparatuses taken over in exclusive licence by the Milanese Company Officine Elettrotecniche Italiane Ing. Vittorio Arcioni S.a.s. (Arcioni) (see figure 2).Footnote 23
Illustration: Italian manual ‘Apparecchio per l’elettroshock – brevetto Prof. Bini’, 1939. Source: Collection Dolhuys, Museum van de Geest, Haarlem, The Netherlands.
However, in the first half of 1939, the new method ‘hardly attract[ed] any interest’, as Max Müller (1894–1980), who had organised the Swiss conference on the pharmacological shock therapies, later remembered. The apparatus developed by the Italians was a trade secret of the company Arcioni and ‘difficult to get so that nobody was really keen on this apparently risky and still little tested method’.Footnote 24
Max Müller was nevertheless to apply ‘electroshock therapy’ for the first time outside Italy and launch it in Switzerland as early as November 1939. What motivated him to do so was an advertising visit by a German emigrant of Jewish origin, Lothar Kalinowsky (1899–1992), and a follow-up letter written by him from the Italian clinic.Footnote 25
Two months after Müller, in French-speaking Switzerland, Oscar Louis Forel (1891–1982) started to administer regular treatments to patients in Prangins at the psychiatric hospital which he had founded. After the first 262 sessions, within eight months, he highly recommended the therapy.Footnote 26 Consequently, with Italy’s entry into the war, Müller wanted to avoid the possibility that the supply of the devices he required for this very promising therapy might be threatened, and so he gave his Arcioni apparatus to Purtschert & Co. in Luzern for reproduction.Footnote 27
3 The Way to the First German Experiences and the Siemens Konvulsator
Only a few days before the German invasion of Poland, Bini and Cerletti presented their research results from already 3000 cases of artificial inducement of epileptic seizures in humans at the Third International Congress for Neurology in Copenhagen in August 1939 in a special section on epilepsy.Footnote 28
This announcement of electroshock therapy did not remain without consequences.Footnote 29 Young psychiatrists such as the German Adolf Bingel (1901–82) or the Danish Arild Faurbye (1907–83), who had taken part, were enthusiastic about this new area of research and the excellent opportunities it offered for a scientific career. Immediately upon their return from Copenhagen, they sought support from engineers to construct a device with which they could examine the promising Italian work on ‘electroshock’. Faurbye started his first treatments in November 1940:Footnote 30 Bingel, who had been senior physician at the university psychiatric and mental hospital in Erlangen since 1937,Footnote 31 began in December 1939. This early German start in Germany was made possible because Erlangen had the head office of the electro-medical research laboratory of Siemens–Reiniger–Werke (SRW), the leading company for medical technology in the German Reich. Its head, the physicist and mathematician Johannes Pätzold (1907–80), had already developed an interest in the method and its apparatus by the time of the Copenhagen Congress, although he was himself more concerned with high-frequency therapy techniques.Footnote 32 Indeed, by the summer of 1939, SRW had requested a report about the medical usefulness of the new ‘convulsion’ therapy and the Arcioni device.Footnote 33 SRW had asked Oswald Bumke (1877–1950), the director of the psychiatric clinic at the Ludwig Maximilian University of Munich, who was also editor of the reference work Handbook of Mental Diseases, for an expert opinion, because Munich had obtained an Arcioni apparatus as early as July 1939 thanks to Lothar Kalinowsky. However, it was not until October 1941 that Bumke stated that, despite his predictions, the new convulsive therapy did produce positive results with those suffering from schizophrenia and other mental illnesses and that the treatment was therefore to be recommended.Footnote 34
Bingel’s boss, the medical director and chair of the Erlangen clinic, Friedrich Meggendorfer (1880–1953), had been less sceptical about the new therapy. On 3 February 1940, Bingel and Meggendorfer could thus describe their treatments as ‘the first German tests’, started in December 1939 with an apparatus produced by SRW.Footnote 35
Following this, Bingel was appointed ‘Adj. Professor’ in 1940. Meggendorfer, who had been appreciated in the early 1930s for his genetic studies on Huntington’s disease and his eugenic thinking on ‘moral insanity’, or personality failures, saw in the official congratulations on his sixtieth birthday that the ‘success’ of having been the first German psychiatrist to embrace the new therapy was not mentioned at all. The congratulations were written by Ernst Rüdin (1874–1952), who at this time viewed electroshock therapy, like both insulin coma and cardiazol-convulsive therapies, as a contradiction of the genetic view of endogenous psychoses, especially with regards to schizophrenia.Footnote 36 Rüdin had been the major proponent of the Expert Committee on Questions of Population and Racial Policy that had prepared the scientific justification for the Law for the Prevention of Hereditarily Diseased Offspring passed in 1934.Footnote 37 The law enabled forced sterilisation in over 400 000 cases of schizophrenia, epilepsy, Huntington’s disease, hereditary blindness or deafness, congenital mental deficiency or manic depressive illness until the end of the Third Reich.
In spite of this initial reluctance towards the new therapy due to the preponderance of genetic thinking in German psychiatry and Nazi mental health politics, SRW were able to present a genuinely German electroshock apparatus under the name Konvulsator at the end of June 1940 (see figure 3). In the light of some patent queries because of Bini’s application for a German patent, the patent department of SRW had consciously chosen the name Konvulsator to distinguish their equipment from the Italian l’elettroshock.
Illustration: Konvulsator. Source: advertising brochure 1942, Siemens MedArchives, Erlangen, Germany.
Pätzold had succeeded in changing the construction in such a way that the elements of Bini’s device which were most relevant for the patent had in any case been avoided; the circuit omitted the preceding resistant measurement and also enabled the direct adjustment of the current in mA.Footnote 38 Additionally, and in contrast to the Italian electrode clip or forceps ‘maximally compressing the electrodes together and pressing them strongly against the skin’, SRW’s electrodes were to be ‘simply rested on the head’ – as Bingel and Meggendorfer had proposed. A similar construction was used by an English apparatus also developed in 1939.Footnote 39
Having bypassed Bini’s ‘electroshock’ patent, SRW saw themselves confronted with another competitive construction built by the Vienna-based company Reiner & Co. It was developed by a graduate technician and psychiatrist at the Vienna University Psychiatric Clinic, Wolfgang Holzer (1906–80), who had been given the order to scrutinise the Arcioni device and to adapt it to the needs of the Vienna clinic. Elkra I, a large standalone unit with an additional electrode holder, was constructed, and then Elkra II, where the entire apparatus was directly attached to the forceps (see figure 4).Footnote 40
Illustration: Elkra I and Elkra II. Source: Bundesarchiv R 96 I-12.
Holzer had regarded it as ‘established’ that ‘suitably sized electrode holders proved to be considerably better than electrode appliances attached by means of headbands’ because the latter ‘frequently could not even be attached to unsettled patients’.Footnote 41 Moreover, with Holzer’s Elkra II, the treating physician was able to position the electrodes on the patient’s head and simultaneously activate the treatment current without requiring additional staff.
This advantage ‘to enable shocking even the most unsettled patients in a comfortable manner’ had quickly piqued the interest of psychiatric hospitals even if ‘due to the war events it was difficult to get such an apparatus’.Footnote 42 For example, the Heilanstalt für Kopfverletzte und Nervenkranke, another Viennese clinic, which since the 1930s had distinguished itself through a special commitment to new therapies including ‘convulsion therapy’,Footnote 43 bought an Elkra II in spite of having been one of the first clinics to own a Konvulsator produced by SRW.
Within the Elkra II design, the ‘electrode forceps’ was an integral part of the overall device. This made SRW find a remarkable way to protect themselves against Elkra II as competitor in the sales area of electroshock therapy in the German Reich, to which Austria officially belonged since the ‘Anschluss’ of 1938. SRW claimed to have a patent on the ‘electrode forceps’: the Deutsche Reichspatent (D.R.P.) 578 532 for ‘the forceps form of the anaesthesia device’ – for the electrical anaesthesia of animals to be slaughteredFootnote 44 – precisely the technique that Bini had studied in the Roman slaughterhouse to test the safety margin of the application of electricity to the head.
As SRW turned to Reiner & Co. to assert claims from this patent on the holder electrode of Elkra I and II, Holzer responded with indignation:
the subordination of electroshock under the broader term anaesthesia and of patients under animals to be slaughtered […] shall represent a unique curiosity for a leading electromedicine company. It does not apply for the patients in my sphere of influence.Footnote 45
In March 1941, Reiner & Co. nevertheless began to consider a contractual agreement with SRW for a ‘simple non-transmittable licence’ ‘regarding a “device for anaesthetizing animals to be slaughtered” ’. In turn, Reiner & Co. committed themselves to pay a licence fee to the amount of one per cent from the list price of the apparatus for all electroshock devices produced and sold by Reiner & Co.
Meanwhile, SRW got help from Anton Edler von Braunmühl (1901–57), at the mental hospital Eglfing-Haar, to also develop more comfortable electrodes, which were pressed to the patient’s head and which enabled the current release at the same time (see figure 5). Braunmühl had been the main protagonist of insulin coma therapy and cardiazol-convulsive therapy in the Third Reich. As early as 1939, he had urged SRW to give him a Konvulsator prototype for testing the new therapy which he had learnt about on a trip to Italy. In 1944, Braunmühl gained his postdoctoral qualification (Habilitation) in Munich thanks to his clinical research into shock therapies.Footnote 46
Holzer’s career became frozen. Although his electroshock developments as well as his comprehensive book Physikalische Medizin in Diagnostik und Therapie would have met by far the requirements to qualify for a Habilitation, this did not happen during the Nazi period.Footnote 47 Still, in September 1944, Holzer tried to get support for his research in electroshock therapy; however, his idea of a whole scientific institute for investigating electroshock was never realised.Footnote 48
Illustration: Siemens’ new electrodes relaying on Braunmühl’s recommendations. Source: picture dated 1955, used in an advertising brochure in 1957, Siemens MedArchives, Erlangen, Germany.
4 National Socialist Austerity Plans: The Timeline of the Introduction of Electroshock Therapy
By the end of June 1941, SRW had delivered only fifty Konvulsatoren, most of them abroad, including twenty-three devices to the occupied Netherlands. Just eighteen devices had been sold to psychiatric institutions in the ‘Großdeutsches Reich’, of which only five had gone to mental asylums (including Eglfing-Haar). Remarkably, the SRW referred all other interested parties to the beginning of the assembly-line production.Footnote 49 This was the experience of, for example, Gottfried Ewald (1888–1963), who had been desperately looking for a device for the university psychiatric hospital in Göttingen and had finally been able only as a result of personal initiative to acquire a device from Switzerland, from Purtschert & Co., in the summer of 1941.Footnote 50
The low sales figures of the Konvulsator were not least the consequence of a politically desired radical policy of austerity in psychiatry in the German Reich, intended to lead to the starvation of patients with ‘lives unworthy of living’.Footnote 51 What was financed was the so-called ‘euthanasia’ T4 campaign which Paul Nitsche (1876–1948) organised on behalf of the Reich Working Party for Mental Asylums. From its start in October 1939, until its official discontinuation in August 1941, the construction of gas chambers on former hospital grounds and a bureaucratic procedure of camouflaging was funded to murder more than 700 000 patients with diagnoses such as schizophrenia, mental deficiency, epilepsy, dementia or Huntington’s disease.Footnote 52
Crucially, the consequences of another budget cut in psychiatry contributed to an increase of interest in convulsive therapy and particularly electroshock therapy in the spring of 1942.
With the responsibility for mental hospitals passing to Herbert Linden (1899–1945), the beginning of new insulin coma cures had generally been forbidden as insulin was scarce and insulin coma therapy could ‘not be regarded as a specific therapy’ for schizophrenia as ‘there were also other methods (such as Cardiazol and electroshock) available’.Footnote 53 Indeed, the cherished genetic theory of endogen psychoses and especially of schizophrenia implied that insulin coma, cardiazol or electroshock therapies could only have unspecific impacts similar to ‘states of shock’ induced by means of cold showers or a swivelchair;Footnote 54 a real ‘therapy’ of the ‘core group’ of schizophrenia was only conceivable by prevention, namely sterilisation.Footnote 55
These genetic views and the consequent Nazi sterilisation policy had at first considerably delayed the introduction of insulin coma therapy in Germany in the mid-1930s and also caused an initial restraint towards electroshock therapy in well-known clinics.Footnote 56 The university mental hospital of the Charité in Berlin, run by Maximinian de Crinis (1889–1945), a key actor in the preparation and implementation of the national socialist ‘euthanasia’ murders, had not begun testing until winter 1941/42. In contrast, the small evangelical private clinic ‘Waldhaus’ am Nikolassee, which became famous for employing those physicians and carers ‘who have not received any employment in state facilities for political and racist reasons’,Footnote 57 had started with the new therapy by the spring of 1941. Its medical director, Heinrich Schulte (1898–1983), recommended electroconvulsive therapy as an alternative to the pharmacological convulsive therapy as early as June 1941, including at the conference of the Berliner Gesellschaft für Psychiatrie und Neurologie, since it was less stressful for the patients, simpler, cheaper and also suitable for ambulant treatment.Footnote 58 However, the ‘horrifying’ sight of his ‘demonstration of the electroconvulsion on two patients’ caused ‘several listeners [to] leave the room’.Footnote 59
That the circle of leading National Socialist psychiatrists, based around, amongst others, Ernst Rüdin, Maximinian de Crinis, Paul Nitsche and Carl Schneider, finally began to advertise convulsive therapies was the result of a shift in Nazi mental health politics;Footnote 60 to counter the public opinion that psychiatry ‘is becoming more and more superfluous since mentally ill people would soon become extinct due to the racial hygienic laws’,Footnote 61 the convulsive methods, including prominently electroshock therapy, promised to justify a future eugenic National Socialist psychiatry of sterilisation, ‘euthanasia’ and therapy. Probably with a view to introducing this ‘new way’ for psychiatry in the Third Reich, a number of lectures on electroshock therapy, among them lectures by Meggendorfer and Bingel, Max Müller and also Wolfgang Holzer, had appeared on the agenda of the sixth annual assembly of the Gesellschaft Deutscher Neurologen und Psychiater scheduled for 5–7 October 1941.Footnote 62 Yet, the whole conference was cancelled due to the war.
While deaths from medicine overdoses and through starvation continued after the termination of the ‘official’ T4 campaign in August 1941,Footnote 63 financial means for equipping the mental hospitals with therapy techniques were thus granted upon Linden’s mediation and an educational film on electroshock therapy was produced.Footnote 64 Facing continuing complaints, which also spread into public discourse, that ‘the difficulties of material procurement do not favour the spreading of electroconvulsive treatment’,Footnote 65 ninety-five devices were finally ordered from SRW at the end of February 1943 with a collective order by the management of the Reichsauschusses zur wissenschaftlichen Erfassung von erb- und anlagebedingten schweren Leiden (State Committee for the Scientific Assessment of Severe Hereditary Disease), who had also organised the T4 programme.Footnote 66
5 Therapeutic Enthusiasm? Electroshock Therapy’s Sales Markets during the War
Such a collective order had become necessary after SRW, upon Linden’s request, had made clear that the production of electroshock apparatuses would only be worthwhile for the company if higher quantities were sold. Because technology central to the war effort, such as X-ray diagnostic devices, took priority with regards to the use of materials and production processes,Footnote 67 the collective order had to be a formal ‘Wehrmacht’ order. Those clinics which missed this order, offered by Linden, were informed by SRW that the delivery period for the device would be ‘at least one and a half years’.Footnote 68 Yet, even the delivery of the devices of the ‘Wehrmacht’ order happened ‘drop by drop’.Footnote 69 One simple ‘technical’ reason for the delays was the fact that many clinics did not have any alternating current available, since the in-house electricity grid was exclusively supplied with direct current. Under such circumstances, a direct current converter was necessary for the Konvulsator. Although SRW did not itself produce it, they had promised to include the accessory device in the delivery of the Konvulsator, although ‘special convertors could not be obtained in the foreseeable future’.Footnote 70
Remarkably enough, however, a Konvulsator produced by SRW had been in constant use in France at the Paris Hôpital des Enfants–Malades as early as February 1942.Footnote 71 The psychiatrist who used it was Georges Heuyer (1884–1977). Heuyer, known as the founder of French child psychiatry, had been another participant in the Copenhagen Neurological Congress of 1939; it was here that he had learned about the new therapy from Cerletti’s and Bini’s lectures. Although Heuyer had even announced an export of Konvulsatoren to France, at the occasion of the presentation of the initial dog experiments for a French apparatus at the conference of the Société Médico-Psychologique in April 1941,Footnote 72 most psychiatric hospitals in the occupied France, as, for example, the Hôpital du Vinatier near Lyon, known from the study by Isabelle von Bueltzingsloewen on starvation in French psychiatry during the German occupation, used equipment from Purtschert & Co.Footnote 73
On German territory – against widespread assumptions to the contraryFootnote 74 – the war-related production bottlenecks meant that many of the psychiatric hospitals without university affiliation did not receive an apparatus before 1944, and some, only after the war.
In the later French occupation zone, for example, during the Third Reich, none of the big psychiatric asylums in Bad Schussenried, Zwiefalten or Weissenau had an electroshock apparatus in use. The French psychiatric commissioner sent to inspect the situation in the psychiatric hospitals at the end of the war in 1945 noticed with astonishment:
This method has never been practised in these three institutions and this fact appears monstrous to the psychiatrist that knows of the remarkable results of electroconvulsive therapy in the treatment of acute psychosis.Footnote 75
The minor diffusion of electroshock therapy was not solely the result of an inadequate supply or inadequate diffusion of electroshock devices;Footnote 76 most of the ordered Reichsausschuss Konvulsatoren had finally been delivered to hospitals and asylums.Footnote 77 However, few of the hospital asylums which did receive one appear to have been particularly eager to use it, if one believes the report of Curd Runckel (1913-?),Footnote 78 who was working with Nitsche at the T4 unit. Runckel had been sent into the hospitals and asylums to learn the reasons for the reluctance to the new therapies and ‘euthanasia’. In the summer of 1944 he wrote:
In many places the electroshock apparatus is still regarded with certain scepticism. Especially in Lower Silesia the treatment method is frequently belittled; otherwise it would barely be possible, I think, that a huge asylum like Lüben sells its newly acquired electroshock apparatus…. I continuously try to convince the medical directors …that the modern methods are, concerning nursing care, surely greatly relieving.Footnote 79
Especially in comparison with the older insulin coma therapy, electroshock therapy was dismissed. Also Braunmühl had claimed that electroshock combined with insulin was to be preferred to electroshock alone,Footnote 80 and the use of insulin for psychiatric therapy – outlawed in February 1942 due to the lack of insulin – was finally again permitted only in 1944.Footnote 81 Indeed, the notion of a quick and extensive introduction of electroshock therapy in the Third Reich seems to be nothing more than a myth; a ‘cliché’, as Heinz Faulstich has argued in his major work, Starvation in Psychiatry 1914–1949: a historically mistaken, if widely cherished, idea that psychiatrists during the time of National Socialism were widely enthusiastic about ‘euthanasia’ and shock therapies.Footnote 82
Correspondingly, historical studies that have relied on patient files have found that electroshock was seldom used. In Saxony, for example, in the psychiatric hospital Altscherbitz, an analysis of 1400 patient files, including 497 with the diagnosis of schizophrenia, found a single case of electroshock treatment.Footnote 83 The supposed reason is the ‘surely disastrous shortage in financial means and staff due to the fascist war’. For the Saxon psychiatric hospital Großschweidnitz, the finding was similar: ‘only with May 1942 are there a handful of treatment trials of the quite cheap treatment documented in the patient files; however, it never achieved greater significance’.Footnote 84 In contrast, the asylum Eglfing-Haar near Munich had a high incidence of electroshock therapy, as here Anton von Braunmühl, the most ardent proponent and defender of the somatic therapies in the Third Reich, had done everything to convince SRW to give him the second prototype for clinical use.Footnote 85 But besides the university hospitals and asylums with psychiatrists specifically interested in the treatment, the diffusion of electroshock therapy remained minimal in the daily practice of the mental institutions in the German Reich until the end of the war.Footnote 86
In psychiatric hospitals that had a special focus on electroshock therapy, sometimes explicit consent for shock therapy was required from the family. For this, at the university psychiatric and mental hospital Erlangen for example, a letter was sent with the following wording:
Insulin- or Cardiazol- and Electroconvulsive treatment gives the possibility to approach mental diseases in a healing manner today. Therefore we think it our duty as physicians to propose this treatment and we ask that you give us your consent for this treatment at your earliest convenience. As the treatment is invasive and may result in complications, we are informing you of our intentions. If you agree with the treatment, we ask that you sign and return this letter.Footnote 87
On the other hand, psychiatric hospitals whose clinical directors completely subscribed to the ideology of schizophrenia as a genetic disease – such as the Wittenauer Heilstätten in Berlin – changed the diagnosis in the case of a successful electroshock treatment, for example, to ‘reactive psychosis’.Footnote 88 It fits that an increasing number of reactive disorders, especially in soldiers, were treated with electroshock.Footnote 89
In conclusion, the ‘dialectics of healing and killing’, as promoted in the 1943 ‘Denkschrift’ letter ‘Thoughts and suggestions concerning the future development of psychiatry’ written by the elite of the Nazi psychiatrists, remained a pure ‘ideal’, unattained until the end of the Third Reich. Regarding the everyday practice in most of the mental institutions of the German Reich, there was no ‘dialectics of healing and killing’ but a prevailing policy of starvation, leaving people to die and murder.Footnote 90
6 Doing Research in Wartime? ‘Prevention of Vertebral Fractures with Convulsive Shock’
The Munich Research Institute for Psychiatry (Deutsche Forschungsanstalt) run by Rüdin had no interest in research into electroshock therapy; its clinical unit had in any case been closed in 1942 because of the war. However, even SRW reacted with restraint to hints that a ‘model institution for research into electroshock treatment’ was to emerge in southern Germany, in co-operation with the Heidelberg University Hospital and under the direction of Carl Schneider and the mental hospital at Wiesloch.
Actually, the Reich Working Party for Mental Asylums, represented by Linden and Nitsche, had been planning the establishment of a psychiatric research institution with its main pillar in Heidelberg–Wiesloch since the spring of 1942. Yet this was intended less as a ‘model institution for the research of electroshock treatment, as the SRW branch in Mannheim had understood from the discussions in Heidelberg with Linden and Schneider,Footnote 91 but rather for enhancing Schneider’s own genetic, constitutional and neurobiological examinations of ‘mentally deficient children’.Footnote 92
Whatever the potential plans concerning research into electroshock, Pätzold explicitly pointed out that because of its extensive involvement in the war economy, SRW ‘had practically been deprived of all possibilities for more extensive development work for the duration of the war so that currently collaboration can only be in exchanging experiences and discussing pending problems in this field’.Footnote 93
However, SRW did not want to make the same mistake as its predecessor companies during the First World War, when work on developments for civilian and medical- technology use had been considerably limited for reasons of war economy, with the consequence that SRW had, after the end of the war, been left behind compared to the international competition. SRW were therefore striving to avoid a repeat of this situation and to maintain developmental activity for civil commodities as far as possible.Footnote 94
The company needed, in fact, to justify their already existing scientific collaboration with Anton von Braunmühl via nested lines of argument as ‘relevant to the war’ in order to avoid seriously jeopardising their continuity.
In this way, it had been alleged that the help offered by SRW in procuring a Purtschert & Co. apparatus for Anton von Braunmühl, who was planning some major research comparing all apparatuses available on the market, was ‘about a question irrelevant to the war for which an enormous amount of work was not justified’. On the part of SRW, the response to this was that ‘mainly sick soldiers were treated with electric convulsion at Dr von Braunmühl’s and hence ‘comparative experiments for determining the reasonable method …are thus also part of looking after sick soldiers and must also be regarded as relevant to war.’ The scope which the technical development department of SRW was trying to create with this argument was, without doubt, extremely narrow. However, they took the position that ‘tests for improving the apparatuses, whose production is not forbidden, are also allowed’, and, beyond the ‘wording of any regulations’, it must be left to the company to decide ‘which of the works will be postponed and which will not’.Footnote 95
Yet, the conditions of total war in 1944 made any further research impossible.
As for the Heidelberg efforts in Wiesloch, Schneider was in any case resigned to the fact that after two attempts ‘the war did not [allow] the realisation of the extensive projects planned at that time’ and that ‘the implementation of total warfare after the disaster of Stalingrad brought about the dissolution of the newly started Wiesloch department again in 1944’.Footnote 96
Some research had nevertheless been done on electroshock at the Heidelberg Clinic, and then also at the partner institution in Wiesloch.
As Bingel had already warned in 1940 that the ‘electroconvulsive treatment’ is ‘not as free of complications as it seemed according to first reports by the Italian authors’,Footnote 97 Schneider’s chief Heidelberg physician, Fritz Schmieder (1911–88), had started to examine the frequency of vertebral fractures under ‘electroconvulsive therapy’ since February 1942.Footnote 98 The question whether a ‘medicine affecting the muscle apparatus would be able to decrease the danger of a fracture’, had already been internationally discussed in relation to pharmacological convulsion therapy since 1939; from 1940 onwards, it was also considered in relation to electroconvulsive therapy.Footnote 99 Consequently, studies on ‘preventing vertebral fractures with convulsive shock’ were also planned for the research department, especially for Schmieder’s position here from July 1942 until the end of March 1943. Ernst-Adolf Schmorl (1906–64), a leading assistant to Nitsche with extensive experience in pharmacological convulsion therapy,Footnote 100 meanwhile carried out experimental studies ‘on the differences of induced and spontaneous convulsion in humans’.Footnote 101
For the studies on the prevention of vertebral fractures, Schmieder had asked SRW in November 1942 for technical as well as material support. Schmieder wanted to carry out ‘a series of tests with electroshocks on cats or rabbits using the Konvulsator for this purpose’ – the facilities were unfortunately inadequate for the housing of dogs.Footnote 102 Although SRW did not yet have any experiences available from their own animal studies, Pätzold was able to advise Schmieder on the electrodes to be used for cats and the necessary device settings. Thanks to this scientific collaboration, Heidelberg ranked among the first clinics besides Eglfing-Haar that were not only lent the Konvulsator II in May 1943 as a simplified and handy (although not battery-driven) device for testing, but whose criticisms were taken into consideration in the future technical design.Footnote 103
Meanwhile, the problem of vertebral fractures had not remained of purely scientific or medical significance, as it influenced decisively the choice for Linden’s collective device order for the clinics and mental hospitals of the German Reich and thereby consolidated SRW’s position on the electroshock market. It was precisely because of the claim that vertebral fractures were few with the SRW apparatus compared to the competing devices that the collective order went to SRW in spite of the Konvulsator being the most expensive device (955 RM against 390 RM for Elkra II, for example): a claim that was pure advertising, as its author, Meggendorfer, in Erlangen, did not posses any clinical experience with the other devices.Footnote 104
7 A Therapy in Auschwitz or a Solution to the ‘E’-Problem?
In the Third Reich, the distinctive conditions of National Socialism and total war meant a particular interest in electroshock therapy. To this end, an electroshock apparatus was constructed at the concentration camp Auschwitz III, the working camp of the IG Farben-Werk in Monowitz, in 1944. With the unofficial agreement of the SS camp physicians Eduard Wirths (1909–45) and Horst Fischer (1916–66), the Polish detainee physician Zenon Drohocki (1903–78), helped by a Dutch engineer detainee, wanted to treat sick detainees with the apparatus in the neuropsychiatric department which he had established inside the Monowitz camp detainee hospital.Footnote 105 As part of his neurological and psychiatric education, Drohocki had done research in Berne, Brussels and Paris on electro-encephalography, and had also gained practical experience in ‘electroconvulsive therapy’ in Grenoble.Footnote 106 During his attempt to flee to Switzerland from France, then occupied by the Germans, Drohocki was arrested and deported to Auschwitz with a ‘design of the apparatus for generating electroshocks’ in his rucksack.Footnote 107
The ‘senseless luxury’ of such a state-of-the-art healing method in view of the gas chambers, as Drohocki retrospectively put it,Footnote 108 had not least been the most prestigious project of the SS physicians Wirths and Fischer.Footnote 109 Thus, when the leading physician of the concentration camp, Enno Lolling (1888–1945), visited at the end of 1943, Fischer demonstrated the therapy on a prisoner ‘to demonstrate that electroshock can make emotionally disturbed people fit for work again’.Footnote 110 In his position, Lolling was directly under the control of the head of ‘Amtsgruppe D’ at the SS-Wirtschafts-Verwaltungshauptamt (SS Head Office for Economic and Administrative Affairs), who constantly emphasised the optimisation of work amongst those prisoners employed in the German war effort.
In fact, it seemed that the SS Head Office for Economic and Administrative Affairs developed an enduring interest in the introduction of the method after the presentation, because in the spring of 1944 electroshock therapy was addressed again within a discussion amongst all the SS physicians employed in the concentration camps in Auschwitz. Prior to this, Drohocki had received the order to write a scientific ‘lecture about electroshocks in general, with particular reference to research in Monowitz’,Footnote 111 which was subsequently presented by Fischer.Footnote 112 Yet again, it concerned healing the mentally ill in order to ‘reincorporate them into the working processes’.Footnote 113 While Drohocki, because of a widespread shortage of anaesthesia, was himself testing electroshock as an anaesthetic method for surgical means, the SS’s interest was in utilising humans as resources in the service of the nation and warfare.
During the criminal proceedings against Fischer in 1966, many of the other detainee physicians who had, like Drohocki, been involved in the electroshock therapy emphasised that they would have been able to save ‘many a human life’ thanks to the device, in the future, if only their own at the time.Footnote 114
After the war, however, it became known that in Austria, part of the German Reich, an electroshock device had indeed been used for ‘euthanasia’ murder. Psychiatric inpatients had been personally killed by physician Emil Gelny (1890–1961),Footnote 115 who had been medical director for the Lower-Austrian mental hospitals Gugging and Mauer–Öhling since October 1943. In GuggingFootnote 116 and Mauer–Öhling,Footnote 117 Gelny had used an Elkra II, which he had himself converted, on a total of around three hundred occasions.
Even if Gelny had not developed this method of murder on the orders of the T4 organisation, he had nevertheless turned to them, and specifically to Nitsche, in February 1944 with his ‘euthanasia’ suggestion.Footnote 118 This was at a time when the T4 had long been looking for a new solution to the ‘e-problem’, as it had been labelled in the correspondence of Karl Brandt (1904–48), Hitler’s general commissioner for the medical and health system, in the sense of a ‘centrally planned but locally conducted “euthanasia” ’.Footnote 119 As a result, a meeting of doctors and the heads of those institutions directly involved in ‘euthanasia’ took place in Vienna in the summer of 1944, on which occasion Gelny demonstrated the use of the apparatus and the method with the murder of a mental patient in Gugging.Footnote 120 With regards to this demonstration, it also seemed ‘very valuable’ to Nitsche to be present at the ‘inspection of the electrical method by Dr Gelny’ planned by Brandt.Footnote 121
However, Gelny might not have been the first to develop the idea of using electroshock therapy for the explicit purpose of ‘electrocution’.
Dr Elisabeth V., a young psychiatrist at Eichberg between 1942 and 1945, remembered discussions on the topic of killing mental patients at Eichberg:
When he acquired an electroshock apparatus, Director Mennecke raised the question of whether one could effect their deaths through high levels of electric current passed through their brains.Footnote 122
Friedrich Mennecke (1904–47) had been director of the psychiatric asylum in Eichberg since 1939; during the Nuremburg trials, Mennecke was especially condemned for the murder of children in Eichberg as part of Schneider’s research project in Heidelberg.Footnote 123
Gelny’s criminal case remains the only officially known murder of patients using a converted electroshock therapy device. In 1946, Holzer was appointed as an expert in the connected criminal case before the national court in Vienna against the employees of the hospitals in Gugging and Mauer-Öhling, tasked with explaining the changes made by Gelny to the Elkra II in order to exploit the therapeutic device to discreetly continue murdering patients.Footnote 124 As, in the late summer of 1944, Holzer had contacted Nitsche, the medical leader of the T4 campaign, to advertise for a research institute dedicated to electroshock therapy, it has been questioned as to whether Holzer had himself been involved in the deliberations over the use of his Elkra apparatus for ‘euthanasia’ murders.Footnote 125 Holzer had requested the foundation of a research institute, reasoning that his application was timely because of the legal issues surrounding the ‘euthanasia question’. These attempts, according to Holzer, ‘forced the psychiatrist to arrive at a decision.’ However, Holzer did not make an allusion to a ‘chance’ presented by ‘euthanasia’,Footnote 126 but stressed instead that ‘efforts around the basic problems of psychiatry and the development of therapies must be increased a thousand-fold in order to approach the euthanasia problems around psychoses at all’.Footnote 127
8 Summary
Myths, prejudices and clichés have prevailed in many accounts of the history of electroshock therapy in the Third Reich. However, the clinical introduction of the new shock therapy in the German Reich and occupied territories between 1936 and 1945 was neither especially swift nor ‘radical’.
At the beginning, high-ranking members of the Nazi academic and state elite saw electroshock therapy, like the preceding shock therapies, insulin coma and cardiazol convulsive therapies, as a contradiction of the genetic dogma of schizophrenia. ‘Core schizophrenia’ was a recessively inherited disease whose only causal treatment was primary prevention by sterilisation. In 1942, however, the war-related shortages in insulin forced the commander responsible for the mental hospitals, Linden, to forbid insulin coma therapy and propose electroshock therapy as an alternative. Only after the end of the official ‘euthanasia’ murder operation T4 in August 1941, and increasingly confronted with the unexpected clinical successes reported by Bumke in Munich or Braunmühl in Eglfing-Haar, did the National Socialist Psychiatry officials start to promote electroshock therapy as a modern ‘unspecific’ treatment. Their wish was indeed to reframe psychiatry as an ‘honorable’ medical discipline that sought to relieve suffering, through either therapy or ‘euthanasia’. However, war-related shortages even hindered the now politically supported production of electroshock devices. Conferences that might have had a promotional effect were cancelled due to the war. Moreover, clinics or asylums that received a device – with the exception of scientific centres and psychiatric hospitals especially interested in the new therapies and electroshock (Eglfing-Haar, Erlangen, Göttingen etc.) – often made very limited use of it, occasionally changing the diagnosis of schizophrenia after successful treatments to ‘reactive psychosis’. Of course, further analysis of medical files from different clinics is necessary if we are to draw a definite picture.
There never was a special research institute for electroshock therapy in the Third Reich. The psychiatrist that indeed proposed the implementation of such a specialised institute, Holzer, was not one of the Nazi officials; in fact, he was not even given his medical post-doctoral qualification (Habilitation) until after the war and the fall of Nazism. Finally, the research done under Carl Schneider in Heidelberg focused on the problem of vertebral fractures, and thus the clinical safety of electroshock therapy, research which was shared internationally.
Industrial companies like SRW were decisive participants in the development of the electroshock technology, including in the solution of the therapy’s safety issues. Ultimately, they pursued their own interests. While designing their own devices and electrode holders, SRW used the patents of slaughterhouse devices to protect themselves against competitors in the new electroshock therapy market. Indeed, ‘the subordination of electroshock under the broader term anaesthesia and of patients under animals to be slaughtered …shall represent a unique curiosity for a leading electromedicine company’: thus Holzer had deplored it in 1941.
With regards to the use of a self-made electroshock device in the Monowitz detainee hospital Auschwitz III, the working camp of the IG Farben, there is no evidence of dubious experimentation or ‘misuse’. The therapy was ‘allowed’ with a view to reintegrating sick prisoners into the working process, and ‘accepted’ as a replacement for anaesthetic medication.
In conclusion, the introduction of electroshock therapy in the Third Reich is not adequately conceptualised under the paradigm of a ‘dialectics of healing and killing’. It did admittedly have the potential to become a very special version of that dialectic, where the difference was in the ‘dose’, and where anaesthesia was paired with the possibility of a healing convulsion or killing, both caused by electric current. This was Cerletti’s insight from the slaughterhouse studies, an insight that gave him justification to proceed to a clinical application, since the security margin was significant. Cerletti was, however, not the last person to realise this. While scientists and technicians made great efforts to make ‘electroshock therapy’ safe for patients and physicians, the officials of the ‘euthanasia’ murders reflected in 1944 on the possibility of utilising electroshock therapy devices as killing instruments. It was this horrifying scenario which was indeed realised in southern Austria.
On a theoretical level, the analysis of electroshock therapy in the Third Reich demonstrates mechanisms in the introduction of a new medical therapy that went far beyond questions of therapeutic efficacy. The design of the devices, the medical procedure and even the ‘meaning’ of ‘electroshock therapy’ were established in a highly flexible social process. Medical and clinical needs played only a subsidiary role when confronted with the commercial interest of the major industrial companies involved, who came to redefine ‘electroshock therapy’ as a problem of patent law. Under the peculiar conditions of National Socialism, Fascism and the Second World War, the process was in fact so flexible that it not only made electroshock therapy a state-of-the-art healing method utilised in proximity to the gas chambers of Auschwitz but also perverted it into an instrument of ‘euthanasia’ murder.
