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Bioethics and Defense offers information and commentary on ethical issues arising at the interface between healthcare and warfare. For submissions, contact Griffin Trotter at trotter@slu.edu.
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.
