A History of Psychiatry in Objects

by Bettina Alavi and Ralph Höger


Using the agency of objects as an approach in university-based teacher training seminar
During the winter semester of 2017/18, students on the teacher training course at Heidelberg University of Education and students at the University of Heidelberg took part in the seminar “A History of Psychiatry in Objects”. This seminar was designed and taught by the history educationalist Bettina Alavi and Ralph Höger, a doctoral candidate at the Heidelberg School of Education. The seminar adopted Disability History (Waldschmidt/Bösl 2017; Bösl 2010) as its approach, focusing in particular on the question of the “agency” of material culture (that is, the agency of things and objects). The seminar enquired to which extent objects both contribute to and constitute 20th- and 21st-century understandings of psychiatry: how are the boundaries drawn between healthy/unhealthy, normal/not normal, socially acceptable/inacceptable? Our underlying assumption was that social ideas and orders are inscribed into psychiatric objects and that the psychiatric objects themselves in turn influence the emergence of social orders. Students’ task was to summarise the findings arising from this specific perspective of psychiatric objects in the form of articles for this specialist blog. The seminar thus gave teacher training students the opportunity to take part in a form of Public History. At the same time, the seminar itself constituted a form of Public History, promoting the themes and concerns of Disability History to educators able to disseminate them more widely across society.

Schmidt, Heinrich, Die Pfälzische Kreis-Heil- u. Pflegeanstalt Klingenmünster, Landau 1926, p.2.

Seminar participants traced the agency of objects in the following historic psychiatric items: restraint belts, injection needles, keys, regulations for nursing staff, a medical file, and a carpet made by patients. The objects all came from the Pfalzklinikum Klingenmünster, a psychiatric and neurological clinic in a remote part of the southern Palatinate near Landau. The clinic served as a local example, providing participants with both a concrete context and previously unstudied objects.

We would like to take this opportunity to thank the Pfalzklinikum staff Andreas Dietz and Christel Flory. Christel Flory worked at the clinic for many years as a laboratory technician and collected the objects we investigated herself.

State of research

Psychiatric history is already an established field of research within social history and forms the subject of several relevant publications. Brink’s Grenzen der Anstalt (2010) was helpful in the context of our seminar, as the concept of boundaries – both between the outside world and the institution and within the institution, between open and closed wards and gardens and buildings, for example – proved particularly stimulating for our object-focused approach.

Excerpt from the construction plan 1867 ©Pfalzklinikum Klingenmünster

Beyer’s Ph.D. thesis (2009), which looked specifically at the Pfalzklinikum Klingenmünster, contained a lot of detailed information on the clinic, which helped to place the objects in context. Previous studies on the agency of objects in the history of psychiatry include Majerus (2017), who looked at pills, walls and room layouts, and Ankele (2017), who investigated hospital beds.

The students’ blog articles

In their sheer materiality, the regulations of 1903 formed the foundations of employment relations between nurses and the clinic, regulating nurses’ entire period of service. The regulations set out the training nurses were to receive and detailed the scope of their duties. They reveal a certain margin for interpretation and highlight their own normativity, for example by setting out the sanctions applied for specific conduct.

The nurses’ keys tell us about power relations, regulating how people were locked in and out of the institution. At the same time, the keys highlight the fluidity of the boundary between “inside” and “outside” the institution. The keys made both temporary openings and unplanned, forced imprisonments possible. The power of the keys thus invested care staff with significant authority. Accordingly, staff needed to be very careful with these power-bestowing objects.

A woman’s medical file from the National Socialist period reveals performative agency. The acts of writing performed in these records led to momentous decisions in a later court case. The diagnosis set down in the medical file became the main grounds for the woman’s forced sterilisation.

Injection needles were ambivalent objects. They were vehicles of therapeutic care on the one hand and medical force on the other. As objects associated both with the hope for a cure as well as with sedation and control, injection needles defined the boundaries in doctor-patient relations.

The restraint belts represent compulsory measures that restricted the patients in their free movement. With the restraint, power is directly transferred to the nursing staff which executes the compulsory measures. Even just the look of the belts might have triggered patients' anxieties.

Nurses’ uniforms are a “social skin”, delineating the boundaries between doctors and nurses, nurses and patients, and doctors and patients. At the same time, these boundaries are subject to negotiation, which can be seen from the fact that in many places, female nurses no longer wear a cap; in some institutions, uniforms have disappeared altogether.

The construction plans reflect the major shifts in child and adolescent psychiatry in the late 1960s and early 1970s. Modern facades sought to express the field’s successful “clinification”. However, it remains doubtful whether this was enough to truly draw a line under its inglorious previous history.

The carpet woven by patients in the 1970s exemplifies the tension between the economic activity required for the clinic’s upkeep and the therapeutic measures structuring inmates’ daily routines, such as art therapy. Thus it reveals the somewhat contradictory aspects of occupational therapy, oscillating between the aspiration for meaningful, useful work and the desire for artistic self-realisation.

Students’ blog contributions were edited to various degrees.

Bettina Alavi is professor for history didactics at the Heidelberg University of Education. Ralph Höger is a doctoral candidate the Heidelberg School of Education.

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References
Ankele, Monika (2017): Wie das Krankenbett zum Medikament wurde.
http://science.orf.at/stories/2847043/ (last accessed 2 May 2018)

Beyer, Christof (2009): Von der “Kreis-Irrenanstalt” zum Pfalzklinikum. Eine Geschichte der
Psychiatrie in Klingenmünster. Neustadt: Institut für Pfälzische Geschichte und Volkskunde.

Bösl, Elsbeth (2010): Was ist Disability History? Zur Geschichte und Historiographie von
Behinderung. In: Elsbeth Bösl, Anne Klein, Anne Waldschmidt (eds.): Disability History.
Konstruktion von Behinderung in der Geschichte. Eine Einführung. Bielefeld: Transcript, pp.
29-43.

Brink, Cornelia (2010): Grenzen der Anstalt. Psychiatrie und Gesellschaft in Deutschland ;
1860 - 1980. Göttingen: Wallstein Verl. (Moderne Zeit, 20). Available online at
http://www.h-net.org/reviews/showrev.php?id=46189.

Majerus, Benoît (2017): Material Objects in Twentieth Century History of Psychiatry. In:
BMGN - Low Countries Historical Review 132 (1). DOI: 10.18352/bmgn-lchr.10314.

Waldschmidt, Anne/Bösl, Elsbeth (2017): Nacheinander/miteinander. Disability Studies und
Dis/ability History. In: Nolte, Cordula/Frohne,Bianca/Halle,Uta/Kerth, Sonja (eds.) (2017):
Dis/ability History der Vormoderne. Ein Handbuch. Affalterbach: Didymos, 40-49.

Recommended citation:

Bettina Alavi / Ralph Höger (2019): A History of Psychiatry in Objects. In: Public Disability History 4 (2019) 1.

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Reclaiming Our History? Creative Responses to the Nazi Persecution of Disabled People, Part II

by Emmeline Burdett¹

My previous post looked at the ways in which organisations and individuals within the British disability movement have used references to, and symbols connected with, the Nazi persecution of disabled people. I argued that early references were intended both to encourage a sense of common identity amongst disabled people, and to demonstrate that they were an oppressed minority. This latter interpretation was radically different from the traditional view of disabled people as suffering exclusively from their impairments. In this post, I am going to discuss Tanvir Bush’s forthcoming novel CULL, and Liz Crow’s 2008 documentary, exhibition, and art installation, Resistance. In their different ways, both of these engage creatively with the Nazi persecution of disabled people and ask what relevance this has today.

Although Bush’s novel Cull is not due to be published until January 2019, she has written an as-yet unpublished article in which she explains the novel’s themes and how the Nazi analogy is used in it. Similarly, Crow’s website contains a number of articles shedding light on various aspects of the creation of Resistance. As Bush explains,

"CULL is a dark, satirical novel that hypothetically asks what could happen if the UK government sanctioned state-sponsored euthanasia as a social cost-cutting exercise?"²

‘Grave and systemic violations of disabled people’s rights’.
Bush explains in an afterword that she was inspired by the publication, in November 2016, of a United Nations report which found that the UK government was responsible for ‘grave and systematic violations of the rights of disabled people in the UK’³. The majority of the violations cited involved the UK government’s cuts to disability benefits and its relentless drive to get disabled people into work and ensure that benefits were not a so-called ‘lifestyle choice’⁴. The UN reiterated its findings in 2017, and Theresia Degener, the head of the UN Committee on the Rights of Persons with Disabilities (CRPD) stated that the government’s ‘fitness to work’ tests ‘totally neglected the vulnerable situation people with disabilities find themselves in’⁵.

Liz Crow in her wheelchair dressed as a Nazi

Liz Crow’s Resistance was motivated in part by similar concerns:

"For disabled people, we find ourselves in the midst of a new system of benefits that has been charged with contributing to the deaths of thirty-two disabled people every week, a tabloid press campaign that is portraying disabled people as fraudsters and scroungers … an associated hardening of public attitudes towards disabled people, and a chilling rise in hate crime. Within these events are knife-edge judgments of our place in the world, a step away from whether we even deserve to exist at all."⁶

Despite these similarities, Crow and Bush take very different approaches to the question of the Nazi persecution of disabled people. Crow tackles it directly, whilst Bush alludes to it, and explores how cavalier dismissals of the value of life may come to develop, and then to become virtually unquestioned ‘facts’. Crow’s installation comprises two short films – one scripted by Crow herself, and telling the story of Elise Blick, a character inspired by an account given by Hugh Gregory Gallagher in By Trust Betrayed: Patients, Physicians, and the Licence to Kill in the Third Reich, his 1990 book about the Nazi ‘euthanasia’ programme.

Elise makes her bid for freedom © Roaring Girl Productions

Gallagher had mentioned a woman whom he referred to as ‘EB’, a patient at an institution in Nazi Germany, who was employed there as a cleaner. Gallagher wrote that ‘EB’ made a bid for escape, going around rather than inside the bus which had arrived to take her to her death.⁷ By the time of her posthumous arrival in Liz Crow’s Resistance, ‘EB’ had morphed into the pivotal character of Elise Blick. As Crow shows, the character’s surname was chosen quite deliberately: 

"EB became Elise Blick, her last name translated from the German for to look, to see. Elise does not speak and the staff assume she does not comprehend, but she watches as the buses filled with patients leave and return empty."⁸

The Importance of Names.

‘Resistance’ is a fictional film, but, being inspired by real events, it offers an interpretation which is radically different from that to be found in the overwhelming majority of history books about the Third Reich. In doing so, it further answers Paul van Trigt's question about whether the investigation of historical violence against disabled people can lead to the emancipation of disabled people.

Elise and her broom outside the institution © Roaring Girl Productions

Crow’s film does – taking its cue from Gallagher’s By Trust Betrayed, it brings the possibility of disabled resistance to a much wider audience, and – crucially – shows disabled people valuing their lives and wanting them to continue. Crow further took the decision to name all the disabled characters in Resistance, while leaving the institution staff anonymous – a further act of reclamation, showing that the people who were killed are more worthy of remembrance, than those who facilitated their murder.

Frontcover of Bush’s novel CULL

Names are also of importance in Tanvir Bush’s novel CULL. Bush includes various references to the Nazi ‘euthanasia’ programme and to the ideas and persons which helped to facilitate it. Two of her characters – a celebrated physician and his daughter, a rising politician – have the surname Binding. This is a reference to Karl Binding, who, with his colleague Alfred Hoche, wrote Die Freigabe der Vernichtung lebensunwerten Lebens (The Granting of Permission for the Destruction of Life Unworthy of Life), published in Leipzig in 1920. Bush describes this tract as ‘the blueprint for the Aktion T-4 Plan and the staunch defence of many of the doctors.’⁹ There is also an incidental character called Dr Julian Hallywooden, whose unusual surname came about because it refers to Julius Hallervorden, the German neuroscientist whose glittering research career was not impeded by his having participated in the Nazi ‘euthanasia’ programme.  Bush states that her aim in doing this was not to test her reader’s historical knowledge, but that "readers who made the connections might receive a jolt of pleasure, like finding a key clue to a crossword"¹⁰. 

The grey ‘murder-box’ bus © Roaring Girl Productions

Bush’s image of finding a key clue in a crossword is apposite, but I wonder if instead of receiving a jolt of pleasure, a reader might be motivated to think more deeply about why Bush had chosen to allude to persons instrumental in the Nazi ‘euthanasia’ programme. The decision was clearly taken to make a point. The same is true of the grey Community Transport ambulance which makes its first appearance at the beginning of the novel, and which Bush writes is "based on the very ones in Germany that had picked up the disabled children and adults for euthanasia … in the 1930s"¹¹.

That Bush’s novel is set in modern-day Britain, but alludes to the Nazi ‘euthanasia’ programme, is particularly striking, showing that there are things for every society – not just Germany – to consider. In fact, both Bush and Crow make this explicit. Bush’s novel shows how policies which make life avoidably harder for disabled people facilitate lack of understanding, foster the growth of stereotypes and hate crime, and allow a cavalier attitude towards the value of disabled lives. The novel also shows that these attitudes would be much harder to sustain without a complicit media, and of functionaries who either actively believe that people from targeted groups are merely representatives of types, or who simply do as they are told without question.¹²

Bush’s novel, then, advocates constant vigilance, and an awareness that seemingly small violations can often be part of something bigger. By contrast, Crow emphasises the need to create a society which is so strongly united that attempts to sow division are doomed to failure. The companion film to her ‘Resistance’ drama begins with two of the actors from the film discussing what visiting the death centres and portraying victims of the ‘euthanasia’ programme meant for them as disabled people. Then it moves on to

"A soundtrack of voices, disabled and not, talking about their experiences of discrimination … they speak of practical and emotional cost, but also describe the elation of being included. Audiences glimpse a starting-point for making that inclusion a reality and are shown the possibility of their own role in this."¹³

The differing approaches of these two works, and the different solutions they offer, makes the idea of seeing them as companion pieces, with each illuminating aspects of the other, attractive. They also demonstrate beyond doubt that the subject of the Nazi persecution of disabled people is one to which is still relevant, and also one to which disabled people are continuing to bring new and important insights.

Emmeline Burdett (emmelineburdett@gmail.com) is an independent researcher.

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^{[1] I would like to thank Pieter Verstraete for his comments on a previous version of this post.
[2] Tanvir Naomi Bush, unpublished article explaining the genesis of CULL, 1.
[3] Ibid.
[4] Ibid.
[5] Quoted in ibid, 2.
[6] Liz Crow, ‘Resistance: The Art of Change’, www.roaring-girl.com/ wp-content/uploads/2014/05/Resistance-The-Art-of-Change.pdf , 4.
[7] Ibid.
[8] Ibid,14
[9] Bush, 5.
[10] Ibid, 7.
[11] Ibid, 8.
[12] Ibid, 4.
[13] Crow, ‘Resistance: The Art of Change’, www.roaring-girl.com/wp-content/uploads/2014/05/Resistance-The-Art-of-Change.pdf.}

Recommended Citation:
Emmeline Burdett (2018): Reclaiming Our History? Creative Responses to the Nazi Persecution of Disabled People, Part II. In: Public Disability History 3 (2018) 15.

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Reclaiming our History? The British Disability Movement and the Nazi ‘Euthanasia’ Programme, Part I

by Emmeline Burdett¹

In a PDH blog post earlier this year, the Dutch historian Paul van Trigt asked whether the investigation of historical violence against people with disabilities can ever serve the emancipation of people with disabilities? I believe that it can, and to illustrate this, I am going to look at the various ways in which the disability rights movement in the United Kingdom has dealt with Nazi attitudes towards, and treatment of, disabled people, and the questions which this continues to pose for contemporary Western societies. As this is a rather large topic, I am going to address it in two blog posts. In this first post, I am going to discuss the various instances of images connected with this being used to cement a sense of group identity amongst disabled people. In my subsequent post, I will be looking more closely at the programme’s wider implications, and discuss how members of the British disability rights movement have engaged with these. I hope that my two posts will provide a comprehensive answer to van Trigt’s question.

The Search for Identity
Early UK texts on the subject of what would become Disability Studies did not include references to Nazi attitudes towards disabled people. An example of this is the 1966 book Stigma: The Experience of Disability, edited by Paul Hunt. The book showed disability as the collective experience of oppression, rather than as the individual experience of bodily deficit, and it contains two references to Nazism, but neither of these is connected to the Nazi ‘euthanasia’ programme, suggesting that at this stage it had not entered into disabled people’s collective consciousness – at least not in the United Kingdom.

The British writer Allan Sutherland dedicated his 1981 book Disabled We Stand to ‘the 100,000 or more people with disabilities murdered by the Third Reich’.² As this dedication is unreferenced, and as the book contains no further information about the programme, it seems likely that his purpose in referring to it was to use it to cement a sense of group identity amongst disabled people. This impression is increased by a talk which Sutherland gave at the University of Durham the following year. During this talk, he explained how he had assumed that his experience of impairment was purely personal:

I myself was diagnosed epileptic at the age of four. Yet it was not until I was in my early twenties that I met anybody else whom I knew to have epilepsy. For twenty years my disability was something I lived with on my own, with no knowledge of other people’s experience of that disability … My epilepsy was part of my identity, but a purely personal part … That is one of the things that has in the past kept disabled people from starting to develop a shared radical consciousness: unlike most oppressed groups … we do not have a cultural identity of our own.³

Allan Sutherland’s comment is an important one, because it links Disabled We Stand to both the concerns expressed in earlier disability studies texts, and also with the reasons why the Social Model of Disability – which has become the cornerstone of the British disability movement – was developed. I also argue that it explains Sutherland’s decision to refer to the Nazi ‘euthanasia’ programme – if it could be shown that disabled people had been subjected to a programme of systematic state murder, the traditional view that they were suffering from their impairments with (almost by definition) no societal problems in sight, became increasingly untenable.

The Black Triangle
To this end, the Social Model of Disability (formulated in 1976) distinguishes between Impairment, which it defined as

Lacking all or part of a limb, or having a defective limb, organ or mechanism of the body;

and Disability, which is

The disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them from the mainstream of social activities.⁴

UK Disability History Month (UKDHM) also refers to Nazi attitudes towards disabled people in order to increase feelings of group cohesion and legitimacy. As shown in the illustration, the UKDHM logo is a black triangle with a yellow circle in the middle. Inside this circle, ‘UK DISABILITY HISTORY MONTH’ is written in black letters. The logo also bears the tagline ‘CELEBRATING OUR LIVES – CHALLENGING DISABLISM – ACHIEVING EQUALITY’.

Logo of UK disability history month

The website tells us about the choice of logo. Beside a black-and-white photograph of five obviously disabled men wearing striped concentration camp uniforms, each with an inverted black triangle sewn onto them, the UKDHM website states:

Disabled people were forced to wear this symbol by the Nazis during the T4 Eugenics Programme which was intended to eliminate them. Between 250,000 – 1,000,000 were murdered by the Nazis’ false hopes of building a master race. The UKDHM Logo has taken this symbol, and in reclaiming our history we have inverted it.

Though this statement raises questions - for example, it makes it appear that the black triangle was specifically associated with disabled people in the same way that the yellow star was specifically associated with Jews, when in fact this is not entirely true⁵ – it is an important development. The juxtaposition of the inverted Nazi symbol and the confident tagline asserting disabled people’s right to live and be part of society are very striking, as is the assertion that the decision to invert the triangle is an act of reclamation, in the same way that gay rights activists have reclaimed the word ‘queer’. The reference to ‘our history’ makes it clear that disabled people are seen as a specific group, with a specific identity and history.

The Black Triangle Campaign in Defence of Disability Rights was founded as a response to the death of the Scottish writer Paul Reekie in July 2010. Reekie took his own life at the age of 48 after receiving a letter informing him that his disability benefits were to be stopped. Reekie’s death was not an isolated incident, but just one of many resulting from the current Conservative government’s overhaul of the benefits system. As will be discussed more fully in the next post, the Campaign uses the Nazi symbol because it wishes to draw specific parallels between the Nazis’ use of the symbol to denote people considered ‘Workshy’, and the current Conservative government and right-wing press’s characterisation of benefit claimants as ‘scroungers’. Thus, although Black Triangle and UKDHM have very similar logos, they use them for strikingly different reasons.

Black triangle campaign’s logo

As shown in the illustration, the Black Triangle Campaign’s logo, like that of UKDHM, makes use of the Nazi symbol of the black triangle – this time, the triangle appears with its point facing downwards, on a circular background of what is clearly intended to be a striped concentration camp uniform. According to Black Triangle’s website, this decision was taken because

The Nazis forced people with mental and other disabilities to wear black triangles in the extermination camps during the Holocaust. 

As in the case of the UKDHM logo, the Black Triangle Campaign makes it appear that the black triangle was specifically associated with disabled people, and makes similar claims regarding the symbol’s reclamation. As shown in the illustration, the Campaign’s tagline reads ‘DISABLED PEOPLE FIGHTING FOR OUR FUTURE – CUSTODIANS OF OUR PAST’, and, significantly, the ‘OUR’ of ‘OUR PAST’ is in red, whereas the rest of the sentence is in black. In a similar way to the inversion of the black triangle on the UK Disability History Month logo, this emphasis on ‘OUR’ history may be regarded as an act of reclamation.

This was the first part of Burdett’s response to Paul Van trigt’s earlier post. The second part of her reaction will follow soon.

Dr Emmeline Burdett (emmelineburdett@gmail.com) is an independent researcher.

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^{[1] I would like to thank Pieter Verstraete for his comments on a previous version of this post.
[2] Allan Sutherland, Disabled We Stand (London: Souvenir Press (Educational and Academic) Ltd., 1981, no page number).
[3] Allan Sutherland, ‘Coming Out Disabled’, talk given at the Approaches to Disability conference held at the University of Durham, Friday, 8 March 1982.
[4] UPIAS, Fundamental Principles of Disability, quoted in Cameron, (ed.) Disability Studies: A Student’s Guide (London: Sage, 2014, 137).
[5] The black triangle was used by the Nazis to denote concentration camp inmates considered Asocial and ‘Arbeitsscheu’ (‘workshy’). Thus, though this category included disabled and mentally ill concentration camp prisoners, it was not specifically associated with them.}

Recommended Citation:
Emmeline Burdett (2018): Reclaiming our History? The British Disability Movement and the Nazi ‘Euthanasia’ Programme, Part I. In: Public Disability History 3 (2018) 14.

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