Healers as Killers

The Nazi Doctors: Medical Killing and the Psychology of Genocide.
by Robert Jay Lifton.
Basic Books. 561 pp. $19.95.

The barbarism of the Nazis stops most people cold. Many admit to an emotional incapacity for any but a brief and partial glimpse into Nazi cruelties. Some maintain that the Nazis and their deeds are beyond rational analysis and comprehension. Others argue that even if we could understand them, we should not try to—as if, by treating as human those for whom the term “inhuman” might have been coined, we would deny the singularity of the Holocaust or, possibly, threaten our faith in our own humanity.

For those who believe otherwise, and who can endure a tale of ultimate horrors, The Nazi Doctors is a welcome addition to the literature of the Holocaust. Robert Jay Lifton, a leading practitioner of “psychohistory,” has written previously on a wide range of topics, including the survivors of the bombing of Hiroshima, the Chinese cultural revolution, Vietnam veterans, and nuclear weapons. Now Lifton brings his psychoanalytic approach to bear on the German doctors who participated in Nazi crimes.

The result is of mixed quality. The strength and originality of this book derive from the extensive interviews Lifton conducted with former Nazi doctors and nonmedical professionals, as well as with eighty former Auschwitz prisoners who worked under the Nazi doctors. By weaving together their accounts with archival and secondary material, Lifton has produced a persuasive narrative of the development of the Nazis’ extermination practices and of the ease with which healers became killers. Moreover, he demonstrates convincingly a point frequently lost in scholarly and popular treatments of the Holocaust: before coming to Auschwitz, the Nazi doctors, like many of the other executioners, were of very different backgrounds and personalities, held widely ranging attitudes to Nazism, and were infected in varying degrees by anti-Semitism. They were ordinary Germans.

The book is divided into three parts. In the first and best part, Lifton examines Nazi racism, which was informed by a biological determinism, and demonstrates its prevalence in German society, particularly in the medical community. Here Lifton chronicles the origins of the application of “negative eugenics,” namely, the mass sterilization program, begun already in the summer of 1933, which sterilized between 200,000 and 350,000 people deemed unfit for propagation. He then analyzes the implementation of a still more radical version of “negative eugenics,” the so-called “euthanasia program” of 1939—the secret killing by assorted means (including phenol injections, gassing, and starvation) of mentally and physically infirm children and adults. Before this program was officially halted in 1941, in the face of great popular protest, it had claimed over 100,000 victims. Most shocking and telling was the cavalier acceptance of these programs by the overwhelming majority of the German medical community. Doctors, whether Nazified or not, understood the need to do away with “life unworthy of life.”

The second part of the book, containing the heart of Lifton’s analysis, explores the role of doctors in the greatest death factory, Auschwitz. Here he discusses the doctors’ pervasive anti-Semitism, their central role in selecting who would live and die, and their often ambivalent relationships with the prisoner doctors (many of them Jews) whom they supervised. He analyzes with insight the difficult process whereby the Nazi doctors were socialized into their roles as murderers, and the bizarre, unreal quality of life within an institution devoted to extermination. He also examines the pseudo-scientific, heartless, and cruel experimentation on prisoners (Mengele’s experimentation on twins being the most infamous instance), and finally, in detail, the psychology of three Nazi doctors of varying dispositions and behaviors.

Perhaps the best single chapter consists of an analysis of one of these doctors, Ernst B. Still alive, he continues to be a paradoxical figure. He was an anti-Semite, and an admiring friend of Mengele, who today admits to having looked upon the extermination with understanding if not approval. Given the opportunity to transfer from Auschwitz, he chose to remain. Yet despite his views, he treated Jewish prisoners with solicitude, and adamantly refused to participate in the extermination. The behavior of this man sympathetic to mass murder was indeed so commendable that at his postwar trial he was acquitted, chiefly owing to the testimony on his behalf by former Auschwitz prisoners.

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Throughout his thorough and informative discussion in the first two parts of The Nazi Doctors, Lifton develops his major themes. He argues that it was a “biomedical” conception of society which produced Nazi extermination policies. The German people, conceived as a sacred organic whole called the Volk, could be strengthened or weakened depending on the biological constitution of its members. A person of an inferior “race” or of a defective mental or physical constitution was deemed a malignant tumor within the biological stock of the Volk. Such defective individuals had to be excised from the social body, as cancerous cells must be from individuals. This was the case for all Jews, who were racial polluters par excellence, not only of the German Volk but also of humanity. One Auschwitz doctor summed up this biomedical vision when he explained to a prisoner doctor that his participation in the extermination of the Jews was not the repudiation, but indeed the consummation, of his Hippocratic oath: “Of course I am a doctor and I want to preserve life. And out of respect for human life, I would remove a gangrenous appendix from a diseased body. The Jew is the gangrenous appendix in the body of mankind.”

Lifton argues further that the Nazis employed physicians in the extermination program because their participation would lend an aura of science and expertise to this unprecedented form of “social cure.” “Among the biological authorities called forth to articulate and implement ‘scientific racism’ . . . doctors inevitably found a unique place. . . . [As] contemporary practitioners of mysterious healing arts, it is they who are likely to be called upon to become biological activists.” Lifton emphasizes throughout that doctors were not peripheral actors in the attempt at collective regeneration. Rather, they were central and crucial to the running of Auschwitz as well as to the evolution and fulfillment of the broader extermination policies.

How could doctors, devoted to healing, partake in the evil that was Auschwitz? Lifton believes that they necessarily underwent a psychological metamorphosis after arriving at Auschwitz, developing two psychodynamically whole and distinct “selves”—the “Auschwitz self,” operative for all matters concerning their evil deeds, and a prior, normal self for their non-Auschwitz existence. This psychological state, which Lifton calls “doubling,” allowed the individual to compartmentalize each aspect of his dual existence: “The individual Nazi doctor needed his Auschwitz self to function psychologically in an environment so antithetical to his previous ethical standards. At the same time, he needed his prior self in order to continue to see himself as humane physician, husband, father.” The individual doctor developed, in other words, a psychological self appropriate for living and functioning in each of two radically different environments which together made incompatible psychological and moral demands. Doubling permitted healers to become killers.

After developing these themes in the first two parts of the book, in the third part Lifton amplifies and draws on them—particularly on his understanding of the biomedical vision, and the theory of doubling—to form the basis of a model of genocide. He explains: “The model I propose includes a perception of collective illness, a vision of cure, and a series of motivations, experiences, and requirements of perpetrators in their quest for that cure.” The impulse to commit genocide results from the notion that killing can heal the weakened organic community. The participation of doctors and other professionals often inspires genocide, and its enormous evil is made possible psychologically by doubling. Though Lifton’s model has more detail and nuance, this is its essence.

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What are we to make of Lifton’s argument? In my view, his analysis of the Nazi doctors, and the model of genocide which emerges from it, are each deeply flawed.

It is certainly true that a biomedical vision, a metaphor of the diseased social body requiring radical surgery to restore its health, informed the Nazis’ decision to undertake the extermination of the Jews (although Lifton overstates its prevalence and importance). But Lifton’s assertion that this was the source of the Nazis’ partial extermination of other groups, like the Poles and Russians, is simply erroneous and indicates a fundamental lack of knowledge on his part. These killings were, in fact, motivated by an imperial power’s desire to subjugate its conquered territories.

Furthermore, it is a fundamental mistake to extrapolate from the Nazis’ extermination of the Jews, as Lifton does, and to discuss the resulting model as if it were widely applicable, as if a biomedical vision were a major source of genocides. (To be fair, Lifton indicates at one point that his model is not relevant to all genocides; yet he proceeds to discuss it as if it were, not mentioning other possible models or providing us with a way to discern his model’s range of applicability.) In fact, few if any other genocides, including the ones he mentions, have conformed to Lifton’s model. Even the Turkish mass murder of the Armenians in 1915-16, which Lifton adduces as an exemplar of his model, is incompatible with it. The Turkish leadership’s decision to massacre the Armenians was not a mystical effort toward collective regeneration but a calculated attempt to preempt a future secessionist problem by killing those perceived to have such political aspirations.

Of the other genocides—in Cambodia, Bangladesh, Nigeria, Paraguay, and the Soviet Union—which in Lifton’s view share the “collective patterns” of his model, each diverges from the model in the most fundamental of ways. Since Lifton only lists these genocides and provides no analysis of them, it is not even clear how he believes they fit the model. Lifton’s discussion of genocide is insufficiently grounded in comparative evidence; his model of genocide, for the most part, is misleading.

Also problematic is Lifton’s casting of doctors as major rather than minor actors in the Holocaust. Doctors were indeed crucial to the sterilization and euthanasia programs, and they were prominent at Auschwitz. Yet this is a highly selective set of examples from which to generalize. Had Lifton written a study of other aspects of the Nazis’ extermination program, such as the Einsatzgruppen—the mobile killing squads responsible for the massacres at Babi Yar and a million other Jewish deaths in the Soviet Union—doctors would hardly have been mentioned, let alone accorded a central role. Even at Auschwitz, they were ultimately marginal to the extermination. Had doctors not participated in the killings, the gas chambers and crematoria would have operated no differently. This was the case at Chelmno, the first extermination camp, where doctors were of very little consequence, as Lifton acknowledges, but only in passing.

Lifton’s focus grossly magnifies the doctors’ importance, leaving the unwary reader with a fundamental misconception of the Holocaust. Although to us the doctors’ role in the extermination is rightly of great intellectual and moral significance, historically the Nazi doctors are but an interesting and troubling footnote. Without them, the central features of the Holocaust would have remained the same. The part played by doctors in other genocides, moreover, has been virtually nonexistent.

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Finally, Lifton’s theory of doubling, although it does seem plausible when applied to the Nazi doctors, is, I believe, wrong. The theory is wholly dependent on the assumption that the doctors understood that what they were doing was evil, an assumption Lifton not only fails to justify, but one which he also undercuts. As his analysis of the Nazi biomedical vision and of Nazi anti-Semitism makes clear, the Nazis understood the extermination of the Jews to be necessary, just, and good. Since the Nazi doctors failed to conceive of their deeds as fundamentally evil, why would they need to double?

Moreover, the theory of doubling posits a radical discontinuity in the psychological organization of the Nazi doctors’ minds before and after their murderous deeds began. This seems at odds with the material on which the theory of doubling is based. It is precisely because the killings accorded with their anti-Semitic “prior selves” that so many people could quickly and easily be turned into executioners. This is not to say that being in Auschwitz did not require of the doctors all sorts of psychological stratagems to make bearable their gruesome tasks. (Lifton’s discussion of these stratagems, by the way, is generally good.) But the systematic creation of two psychodynamically separate selves in each doctor seems unlikely. Lifton has certainly not succeeded in sustaining such a speculative assertion.

Problematical as the theory of doubling is for understanding the Nazi doctors working in the unique environment of Auschwitz, Lifton strains credulity even more when he applies the theory to different environments and to more general subjects. Thus he asserts that doubling characterizes other participants in the Holocaust besides the doctors, but he barely mentions whole classes of killers, like the men of the Einsatzgruppen. Moreover, since he hardly examines other genocides, his discussion of doubling as an integral process in the creation of the “genocidal self” is at least equally suspect. Finally, as if this already extended use of the theory were not enough, Lifton proceeds to unearth further applications of it. We are told, for instance, that a “nuclear-weapons self” is created for those involved with such weapons, and that “in the process of doubling, in fact, lies an overall key to human evil.” These extrapolations from an analysis originally meant to explicate the deeds of Nazi doctors are simply reckless.

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The Nazi Doctors is thus a greatly disappointing book. Lifton has failed in his self-proclaimed task, to uncover “the psychological conditions conducive to evil.” His model of genocide appears to be constructed in an empirical vacuum, derived wholly from dubious psychological theories which themselves are based on the study of one narrow and highly unusual case. Even more distressing, these theories permeate his entire discussion of the Nazi doctors themselves.

Despite these severe shortcomings, The Nazi Doctors remains of heuristic value. It is one of the few sustained attempts to interpret the psychology of the Nazi executioners, and it contains many insights into their lives. The new and illuminating empirical material with which it is filled, though often in need of reinterpretation, will be of service to those who do not shrink from the intellectual and emotional struggle of understanding the Holocaust.

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