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The decades around 1900 were crucial in the evolution of modern medical and social sciences, and in the formation of various national health services systems. The modern fields of psychiatry and mental health care are located at the intersection of these spheres. There emerged concepts, practices, and institutions that marked responses to challenges posed by urbanization, industrialization, and the formation of the nation-state. These psychiatric responses were locally distinctive, and yet at the same time established influential models with an international impact. In spite of rising nationalism in Europe, the intellectual, institutional, and material resources that emerged in the various local and national contexts were rapidly observed to have had an impact beyond any national boundaries. In numerous ways, innovations were adopted and refashioned for the needs and purposes of new national and local systems. 'International Relations in Psychiatry: Britain, Germany, and the United States to World War II' brings together hitherto separate approaches from the social, political, and cultural history of medicine and health care and argues that modern psychiatry developed in a constant, though not always continuous, transfer of ideas, perceptions, and experts across national borders. Contributors: John C. Burnham, Eric J. Engstrom, Rhodri Hayward, Mark Jackson, Pamela Michael, Hans Pols, Volker Roelcke, Heinz-Peter Schmiedebach, Mathew Thomson, Paul J. Weindling, Louise Westwood. Volker Roelcke is professor and director at the Institute for the History of Medicine, Giessen University, Germany. Paul J. Weindling is professor in the history of medicine, Oxford Brookes University, UK. Louise Westwood is honorary research reader, University of Sussex, UK.
'John W. Thompson: Psychiatrist in Shadow of the Holocaust' is the biography of a doctor whose revulsion at Nazi human experiments prompted him to seek a humane basis for physician-patient relations. As a military scientific intelligence officer in 1945, Thompson was the first to name "medical war crimes" as a special category for prosecution. His investigations laid the groundwork for the Nuremberg medical trials and for the novel idea of 'informed consent.' Yet, Thompson has remained a little-known figure, despite his many scientific, literary, and religious connections. This book traces Thompson's life from his birth in Mexico, through his studies at Stanford, Edinburgh, and Harvard, and his service in the Canadian Air Force. It reconstructs his therapeutic work with Unesco in Germany and his time as a Civil Rights activist in New York, where he developed his concept of holistic medicine. Thompson was close to authors like Auden and Spender and inspirational religious figures like Jean Vanier, founder of L'Arche. He drew on ideas of Freud, Jung, and Buber. The philosophical and religious dimensions of Thompson's response to Holocaust victims' suffering are key to this study, which cites accounts of psychiatrists, students and patients who knew Thompson personally, war crimes prosecution records, and unpublished personal papers. Paul Weindling is Wellcome Trust Research Professor at the Centre for Health, Medicine and Society: Past and Present, Oxford Brookes University, UK.
Allied plans for the occupation of Germany and Austria meant that Squadron Leader (S/L) Thompson was briefed about conditions he was likely to encounter—and about war crimes. Disarmament detachments searched for scientific weapons, while military medical teams wanted to know what research the Germans had performed during the war. In October 1944 the RAF asked the Canadians to provide an air disarmament unit, and Canadian units were transferred en bloc to the British to disarm the Luftwaffe. The RAF 84 Group was nominally British but staffed by Canadians. Its mission was to search for German radar, jet-engine technology, and other secret equipment, and to investigate missing aircraft. Thompson joined the 84 Group to assess German oxygen masks and Luftwaffe procedures for offsetting decompression sickness.
S/L Thompson arrived at Greenock, Scotland on October 13, 1944. After passing through the Personnel Reception Centre at the sedate south coast resort of Bournemouth, he worked at the RAF Institute of Aviation Medicine at Farnborough. Moving to the RCAF Headquarters at Lincoln's Inn Fields, London, he gathered records to document the medical work of the RCAF overseas. The British extracted “embarrassing material” before handing over information to Thompson on the RAF collaboration with the RCAF.
Thompson then went back to “school” He attended the Control Commission School (Air) with a group of thirty-seven other RCAF officers from March 14 to 27, 1945. The school was at Stockleigh Hall, Prince Albert Road, Regent’s Park, in central London. The course covered the military organization of Germany: the character and psychology of the German and Austrian peoples, and a history of the Nazi Party and the German police.
I am working with the people liberated from a concentration camp at Belsen. Can you imagine what that means? I myself have seen 8000 women: typhus, starvation, despair. Oh God! God! Give me strength to carry on. I work among them from seven in the morning until far, far into the night. Sometimes my strength gives way and I must fall exhausted into the straw with them. Still I lose each day 20–30. I have scarcely any drugs. The patients are still on the most meagre of food supplies. More than half have open tuberculosis—there is no space to segregate them! I bring the shadow of a smile to some poor suffering one. I feel encouraged but then I turn and see the thousands of others and I need to call on every nerve of courage to continue. It requires courage, Karl. So much courage.
The writer of this letter—Squadron Leader J. W. Thompson, Royal Canadian Air Force Number C21106—saw that the end of Nazism did not mean the end of human suffering. Medicine had to be placed on a humane basis or similar atrocities would recur. A specialist in aviation medicine, he rethought the foundations of medical research and physician-patient relations. The despairing eyes of victims prompted him to assist the suffering, rather than analyze and classify them in terms of neurophysiology or psychology. His life became a philosophy of care for the distressed.
In June 1943, F/L Thompson was sent by Air Commodore and Director of Medical Services J. W. Tice on a tour of duty in the United States. F/L Thompson was to report to the RCAF air attaché in Washington, DC, and to Col. Frank H. Wickhorst, head of Naval Aviation Physical Training. On July 1, 1943, he was at the target destination, the National Academy of Sciences, to represent the RCAF at the Subcommittee on Decompression Sickness of the American Committee on Aviation Medicine. The mission was a chance to visit friends, and—memorably—Wystan Auden. On Thompson's return to the Grant project, Arlie Bock commended the prodigal physiologist: “You never looked so well in your life, and I gathered that you felt that you were in the right spot to help win the war.” A mysterious friend, “Gladys,” presented Thompson with T S. Eliot's newly published Four Quartets on the eve of his presentation in Washington, DC. Here, he could read a motto for his life, for philanthropic medicine, and for the spiritual malaise of his age:
Our only health is the disease. …
The whole earth is our hospital
Endowed by the ruined millionaire, …
(11)
F/L Thompson observed that susceptibility to blackouts was more likely if an airman showed physiological effects of anxiety. At first, he spoke of this in terms of high, medium, and low susceptibility. However, his observations on the prevalence of anxiety met with skepticism. To gain credence for his observations, he had to quantify the notional proportions of those who blacked out.
Thompson wondered how could he be a doctor in a clinic when the whole world was mad! Milton Rosenbaum sensed Thompson was unhappy in Oxford. “I hired Thompson as a poet” was the disarming explanation of Rosenbaum, the founding professor and chairman of the Department of Psychiatry at the Albert Einstein College of Medicine. “I saw him as a very special person. He had a spiritual side—a philosopher, writer, poet.” Thompson was appointed assistant professor on February 1, 1958.
We find Thompson at an institution whose rationale was to remedy the injustice of discrimination. The Albert Einstein College of Medicine was located in the upper reaches of the borough of the Bronx in New York City. Open to students of all religions, this facility allowed a strong Jewish intake at a time when other medical colleges imposed restrictions. Einstein commended the foundation as of “the greatest importance to American Jewry.” Its ambitious president, Sam Feldman, wanted the medical school to be scientific and secular in ethos, although it was part of Yeshiva University, which was (and is) Orthodox Jewish. The college brought together a brilliant group of professors whose work appealed to bright, irreverent students. Thompson appreciated being part of “the Yeshiva here in New York.”
Joseph Berke, then a medical student, remembered Thompson as “a handsome silver haired Scotsman.” This déraciné appeared otherworldly, ethereal, and mysterious, with a slow, measured speaking voice.
By the summer of 1946, Thompson had persuaded the British, the Americans, and the French to recognize “medical war crimes” as a special category for prosecution. The accumulating evidence on medical criminality prompted chief prosecutor Telford Taylor to instigate the medical trial. On August 15, 1947, when the judges delivered their verdict, they promulgated a set of guidelines on human experiments requiring the “voluntary consent” of human research subjects. What was John Thompson's contribution to the momentous code?
Thompson had conceived of an ethical evaluation and statement at an early stage in his campaign to draw attention to medical war crimes. A moral and philosophical analysis to guide scientists and physicians was necessary to prevent future abuses. In January 1946, Edward Mellanby, the physiologist and secretary of the MRC, was visited by “the Scotsman,” Thompson, and noted, “he asked me what I thought about a statement being made on an international plane by scientific men repudiating all this kind of work.”
Thompson's campaign for ethical judgment on Nazi medicine proves that he had recognized the need for an ethical agenda by late 1945. Robert P. Patterson, the U.S. Secretary of War, sent Andrew Ivy (representing the American Medical Association) on a mission to Germany and France from July 18 to August 12, 1946, to study the problem of human experiments, coordinate with the British at FIAT, and attend the July 31 meeting at the Pasteur Institute.
Allied scientific intelligence searched for hidden stockpiles of deadly German atomic and chemical weapons and biological warfare agents. The Canadian Advisory Targets Committee aimed to secure military, scientific, and technical intelligence and offered Canadian technical specialists to the British. These specialists had to make sense of the sprawling German wartime scientific edifice with its branches in medical and weapons research.
S/L Thompson transferred to a military intelligence unit on September 2, 1945 as part of a contingent of Canadian scientists on loan to the British. He became chief of the scientific and technical branch of the British scientific intelligence agency FIAT (an acronym for Field Information Agency Technical). The British Element of FIAT ran parallel branches for the army, navy, and air force as well as for the economy, industry, and science and technology. The main FIAT office was at Hoechst, once IG Farben's center of chemical and pharmaceutical production. This posting brought Thompson into frontline engagement with Nazi scientists. He found a chaos of competing scientific groups mired in destructive Nazi Party, SS, and military structures.
Fiat—“let it be done”—had an appealing religious connotation of the Creator. Thompson used the phrase “fiat voluntas tua” as he pursued his several agendas. He made available the results of German wartime research, investigated unethical experiments on living human subjects, psychologically assessed defendants at Nuremberg, and screened German scientists for their suitability to work in Canada.
When Thompson returned to Edinburgh as a demonstrator in physiology in 1933, he took a circuitous route. He thought of becoming a demonstrator in neurology in Paris and studying for a doctorat ès science. He worked in the laboratories of the pathological anatomist Ludwig Aschoff in Freiburg and the preeminent neurophysiologist Santiago Ramón y Cajal in Madrid. Visiting Berlin, he took an interest in psychoanalysis.
Finally resuming his studies, Thompson became immersed in demanding clinical training. He clerked and examined patients in Ward 19 (the students' ward) of the Royal Infirmary. He worked on the wards for over twenty-seven months. The hours were long and tiring. He learned to communicate with patients as people. Assisting with birth, death, sickness, and recovery made life worth living. His experience bore out the medical humanist Sir William Osler's view of the hospital as a college—a place where learning and healing went hand in hand.
Thompson studied mental diseases with David Kennedy Henderson, tuberculosis under Sir Robert Philip (pioneer of the first TB dispensary) in 1935, and assisted with twelve births at the Rotunda in Dublin—a renowned maternity hospital. He thought of becoming a neurosurgeon (his examination marks in surgery were high), having been supervised and examined by Sir David Wilkie, who approached surgery on a scientific basis. Thompson concluded, “My education was obtained entirely in Edinburgh.”
Thompson looked forward to death as “immersion in the sea, absorbed by the infinity of being.” His wartime sense of existing amid death was indelible. In April 1948, he had asked his sister, Margaret, to think kindly of him “if we do not meet again.” He confided to Sebastian in May 1954 that he hoped to avoid a lingering death: “There is nothing partial either in the crucifixion or the resurrection. … May we live or die but not partially be alive and partially be dead.”
Thompson convinced Père Thomas that the fear of death remained half conscious and unexplained, like an abscess beneath the surface of consciousness. At the Hallucinations Seminar of March 1965, Thompson discussed how in the case of Macbeth, “confusion and unreality fuse as his breakdown becomes complete, ending with depression and virtual suicide.” In April 1965, he spoke of living and dying as a primal dilemma. When we visit someone in hospital we might say, “He is dying,” but be thinking, “He is dying and I am living.” This protects us from the frightening fact that “I am living and I am dying.” Thompson similarly reflected to Yosef Yerushalmi, “Why do we say, we are living when we really mean we are dying?” The insight reflected T. S. Eliot's “Life is death.”
A card in Thompson's wallet had Cardinal John Henry Newman's calming reflection that when
the fever of life is over and our work is done then in His mercy may He give us a safe lodging—and a holy rest and peace at last.
Matthias lived in a small chapel on a hill at Eau Vive, marking one of the stations of the cross. He was studious, sensitive, acutely intelligent—and incorrigibly morose. He took his doubts, uncertainties, and anguish to John, on whom he became increasingly dependent. His introverted, reflective nature contrasted to the extrovertly roguish Sebastian. Natasha Spender remembers Matthias at Eau Vive as a “stretcher case,” entirely quiet and withdrawn.
Matthias Georg Leber was born in Lübeck on April 21, 1931. He was baptized with his sister Katharina (two years older) as a Roman Catholic in 1933, when their father was sent to a concentration camp. Their mother hoped that the Catholic church might give the children some protection. She told them that their father's work had taken him on a journey and that he was writing a book.
Matthias's father, Julius or Jules Leber, was a robustly militant Social Democrat. Julius was born on November 16, 1891 in Biesheim, Alsace, the illegitimate child of the twenty-three-year-old Katharina Schubetzer. He was strongly influenced by Catholicism, his family's peasant background, and a firm sense of his German national identity. His apprenticeship led him to socialist convictions. He passed the Abitur examinations at the end of his secondary education, qualifying him for university studies. In 1915 he interrupted his studies at Freiburg University to volunteer for military service.
In 1935, Blackwood's [Edinburgh] Magazine published a story by Thompson about an unsettling medical expedition in Mexico. The story told a haunting tale about children growing up in the tropical Mexican province of Oaxaca: when they were young, they had full vision, but as they grew older, they progressively lost their sight. Acquiring knowledge meant a narrower perspective on life: children have vision, so the old depend on the young. Twenty years later, the author reflected on how children were the world's largest oppressed group, and yet they had innate wisdom. The child's vision was weighed against the blind accumulation of scientific discoveries.
We know little of Thompson's early childhood, his age of prescient vision. In his military service record, Thompson stated that his father was born in Oregon and was a “mathematical consultant.” His mother was Scottish. He stated that he was educated in Lausanne and Edinburgh before studying at Stanford, Oxford, and Edinburgh. As with the short story, his personal history meshes with the truth, but with elaborations.
His brother, Frank, was born when Thompson was seven, and his sister Margaret when Thompson was ten. Their memories of him date from when their elder brother was being schooled away from home, due to political upheavals in Mexico. Frank and Margaret recollect their parents' deep, serene love. The home for their six children was caring, ordered, and emotionally secure.
