Bryn Spielvogel Professor Eghigian History 103U 6 April 2012 During the first half of the 20th century,

psychiatrists and neurologists used pain, the destruction of body parts, and even killing to treat mental illness. Explain how they used and how they justified using pain, body part destruction, and killing as forms of therapy and treatment. Do the ends justify the means? This is a timeless question, brought into relevance with nearly every moral dilemma. Not only is it especially prevalent when considering the ethics of war, murder, and lies, but it also emerges in the fields of science, medicine, and psychiatry. While these disciplines are largely focused on the advancement of humanity, this advancement sometimes comes at a cost, and oftentimes that cost is called into question. In the first half of the 1900s, psychiatrists and neurologists sometimes treated mentally ill patients with painful, destructive, or deadly methods, justifying these measures by calling on a consideration of the greater good, whether of an individual or of society on the whole. Despite its painful nature, Fritz Kaufmanns electric current therapy was used to alleviate soldiers shellshock, being justified by its quick success and thus its practicality for the patient, the doctor, and society. Developed during World War I, Kaufmanns treatment focused on the idea that innervation that has derailed because of a mental shock quite frequently is put back on the right track by a new mental shock, (Eghigian 235). In other words, the only way to cure an ailment caused by wartime trauma was to bring about a new trauma. In this case, Kaufmann used strong alternating currents to create this reviving mental shock, and it was stressedeven to the patientthat it would not be a pleasant experience (Eghigian 236). However, for psychiatrists like Kaufmann, the painful nature of this procedure was counterbalanced by its
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supposed success, not only in treating the symptoms of the disorder, but also in providing benefits to overall society. In commenting on patients treated with an alternative method, convalescence and exercise, Kaufmann stated that: A large portionare eventually released as unfit for service, many with high pensions, some who still require outside attention and careThis leads to unhappy consequences for the families; it also leads to the loss of human labor power for the state; another, not insignificant, consequence is the considerable burden on the military budget. (Eghigian 235) In making these judgments, Kaufmann suggested that his method of therapy alleviated at least some of these issues. However, it must be noted that even Kaufmann recognized that some of his patients were released unfit for any military duty, and that they could easily relapse (Eghigian 238). However, his insistent demand for a cure in one session, even at the cost of a more painful experience for the patient, meant that his treatment might have, in fact, been superior to others in terms of money and time, which are both precious during war (Eghigian 136). While Kaufmanns treatment might not have been more successful in treating shellshock than other, less painful methods, its use was justified because it was seen as a more efficient method, costing less for the military and for society overall. Validated for psychiatrists by its apparent success, insulin coma therapy was yet another painful treatment used on the mentally ill. The treatment was characterized by injections of insulin, which brought on a coma, which was overcome with large quantities of sugar (Eghigian 275). One asylum patient that underwent this treatment was eager to promote it, although she acknowledged that she had little technical understanding of mental illness (Eghigian 276, 277). However, her account of this therapy demonstrates just how painful the experience really was for

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a patient, as she stated that because of these treatments, my mornings were hell, (Eghihian 279). But while insulin coma therapy was not a treatment to be desired, it was still used; in fact, the treatment was even promoted by the patient that underwent it, despite her hatred of it. She conceded that soon after her last dose of insulin was administered, I felt well, I liked what I saw, and I was happy. That state of mind never left me, (Eghigian 281). It cannot be concluded for certain that this patients euphoria was a result of a successful insulin treatment, but what can be deduced is that if a patient with such a hatred for insulin coma therapy believed it had cured hershe stated insulin did make me well (Eghigian 282)then the psychiatrists treating her would likely have much faith in this treatment as well. For most people involved, the apparent success of this treatment probably overshadowed the temporary pain that accompanied it. But while this kind of temporary pain was not terribly difficult to justify, the destruction of body parts for the sake of treatment was a whole new issue. The prefrontal lobotomy, a last resort procedure that involved destroying a part of a patients brain tissue, was accepted, even with its damaging quality, due to the belief that it made the patient better on the whole. In the physical sense, a lobotomy meant that the surgeon incises the white matter in both frontal lobes in such a way as to sever the connections between the thalamus and the frontal lobe, (Eghigian 285). However, this physical destruction was nothing compared to the mental changes that came about as a result of it. Among the alterations in most patients personalities were a detachment of emotion to inner experience, outspokenness, lack of motivation, distractibility, immaturity, unselfconsciousness, and a disconnect between foresight and insight and emotion (Eghigian 285-286). Freeman and Watts, the primary experts on prefrontal lobotomy in the United States, did not ignore these changes; rather they worked to justify the procedure in spite of them. They described the procedures merits, saying:

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[The prefrontal lobotomy] relieves the symptom of mental pain. In temporarily abolishing foresight and insight, the operation breaks the vicious circle of preoccupation, emotional tension and imagination that makes the suspected disease or persecution much more serious than any reality could be. It brings the patient back to earth and the enjoyments thereof. (Eghigian 287) For neurologists and psychiatrists, the use of the lobotomy was better than the alternative; rather than letting an extremely mentally ill patient suffer through emotional turmoil, a detachment of emotion meant no worry for the future or obsession with the present would consume the victimthey could be happier thanks to the operation. Furthermore, Freeman and Watts stated that the surgeon would be entirely justified if it could be shown that the patient became psychotic because of perversions of these same functions of foresight and insight, together with the attachment of an abnormal emotional state, (Eghigian 283). This further demonstrates the fact that the neurologists believed lobotomies were doing more good than harm, given that they believed the basis for the patients illness was the very thing they were destroying. Finally, Freeman and Watts stated that prefrontal lobotomy is an operation of last resort, and that it should only be used under very specific conditions where no other alternative was available (Eghighan 287). It was understood that destruction of the brain was a very unfavorable option, but when left with no alternative, it was seen as superior to taking no action. In the case of the lobotomy, justification for such destruction of the brain and the personality was found in the fact that it seemed to provide improvement in quality of life for the patients. However, in some areas the greater good of society overshadowed the greater good of the patient, and a much fartherreaching form of destruction was introduced.

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Justified on the grounds of promoting a healthier, superior population, sterilization, a procedure that destroyed ones reproductive capabilities, was used to treat mental illness in society. As described by the decision in Buck v. Bell, sterilization meant vasectomy in males and salpingectomy in females, which, while not extremely painful or dangerous, was certainly destructive to the body (Eghigian 257). Although it cannot be said that these were the exact procedures used for sterilizations worldwide, the injury to reproductive organs was unquestionable in all cases. In the 19th century, a fear of degeneracy had spread throughout society, and this sentiment did not wane quickly (Eghigian Lecture 2/26). In fact, it provided the breeding ground for eugenic thinking, and that thinking turned into policy. Both the German Law for the Prevention of Hereditarily Ill Offspring and the United States Buck v. Bell decision stated that sterilization of the hereditarily ill should be utilized (Eghigian 257, 300). The justification for these seemingly immoral laws was heavily dependent on the idea that sterilization of the mentally handicapped would support the greater good of society. The Buck v. Bell decision expressed this sentiment, saying that the health of the patient and the welfare of society may be promoted in certain cases by the sterilization of mental defectives, (Eghigian 257), a defense that pointed to the fact that it was in the best interest of the patient and society to disable the reproduction of certain people. This idea was rooted in societys fear of degeneracy, which can also be seen in Buck v. Bells decision which stated that: Many defective personsif now discharged would become a menace, but if incapable of procreating might be discharged with safety and become self-supporting with benefit to themselves and to society. (Eghigian 257-258) By claiming that sterilization saves a mentally ill person from becoming a menace and transforms that person into a beneficial part of society, this statement reiterates the idea that

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sterilization is for the greater good of everyone. In accordance with this sentiment was the idea that psychiatrist and neurologist Lundborg expressed, which stated that the science of eugenics, which is a real patriotic movement according to the true meaning of the words, has for its object the strengthening and improvement of our people both bodily and mentally, (Eghigian 256). In the eyes of those involvedpsychiatrists and lawmakersit was beneficial to society and the patient to sterilize those deemed hereditarily ill as it would eliminate degeneracy from the states future, thus creating a strengthened population and saving those potentially ill offspring from having a terrible fate by being born. However, simple sterilization was not enough for some people. Taking eugenics to a whole new level, the Nazis employed a euthanasia practice that called on killing those unfit for life to provide for a healthier, more productive nation overall. While largely founded on the same principles of the sterilization movement, the euthanasia efforts of Nazi Germany proved to be much more controversial and were therefore much more secret (Eghigian 304). While the methods of euthanasia varied, the term that emerged to describe itused by both lawmakers and suspicious patientswas removal, (Eghigian 308, 310). The use of this ambiguous word was likely meant to help shroud the movement in secrecy. The clandestine nature of the euthanasia program meant that it was likely unnecessary to convince society of its merits, but justification was obviously still necessary for those involved. Again, this justification came from the same ideas of racial health that started the sterilization movement, although they were taken to a greater extreme in this case. According to Lundborg, a strong advocate of sterilization, social swamps ought to be drainedThe necessary supervision and care is not yet given to individuals who are really degeneratethey are allowed to influence the race in an obstructive and dangerous manner, (Eghigian 255). By associating the mentally ill

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with a swamp, Lundborg implied that they were polluting the cleanliness of society. Although he was not advocating for euthanasia here, his belief that there was a lack of proper care for the mentally handicapped since they were still allowed to reproduce (and therefore pose a threat to racial hygiene) was one that helped justify such programs. Fritz Lenz, author of Human Selection and Race Hygiene, saw care in a different light, saying among native people today, one happens upon the mentally ill far more seldomly than with us, where the insane are cared for and protected, (Eghigian 295). Viewing the issue from the natural selection standpoint, he believed that there was actually an immense amount of care for mentally ill patients in the civilized world, which might slow down the evolutionary process. While Lenz also did not openly encourage euthanasia here, his work was still important in justifying it; it implied that perhaps natural selection was being impeded by too much care, so it would only be right to counteract previous intrusion on natural selection by helping it along. However, the question of why sterilization was not enough must be raised. Dr. Irmfriend Eberl, a Nazi doctor, stressed that those being removed were capable of no or only mechanical occupational activity, no longer capable of productive work, or made no notable contributions to the benefit of the people or the nation, (Eghigian 305-306). This sentiment varied from that presented in Buck v. Bell, which implied that once a patient was sterilized they would no longer threaten society. For those involved in euthanasia, this must not have been the case. This most likely had to do with the wartime atmosphere in Germanyif a person was not a productive part of society, their life was not worth sustaining. However, it should be mentioned that the Nazis did utilize sympathetic appeals as well, claiming that ending a hereditarily ill persons life was a charitable action since that person was in suffering (Movie 3/28). In other words, they too justified their harmful program by maintaining that it would relieve the victim of the illness as well. But like earlier

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eugenics programs, Nazi euthanasia was majorly focused on looking towards societys best interests, which for Germany meant ridding the nation of the unproductive, thus helping along the inevitable process of natural selection. In the first half of the 20th century, many psychiatric treatments and therapies came at considerable cost to the patients; psychiatrists and neurologists justified these means by looking for favorable end results. Naturally, as the ends varied so did the means; some psychiatrists committed themselves to achieving a greater good for an individual patient, with costs ranging from temporary pain to irreversible destruction of parts of the body, while others focused on treating mental illness in society overall, which oftentimes required an even greater sacrifice on the individual scale. It is easy to look back at such treatments and be shocked by their immorality, but it must be remembered that at the time, much of societyat least everyone directly involved with treatmentswas convinced that these means were justified. And perhaps in 50 years our children will look back and wonder about the morality of the measures we take to achieve certain ends.

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Work Cited Eghigian, Greg, ed. From Madness to Mental Health. New Jersey: Rutgers University Press, 2010. N. pag. Print.

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