Diagnosing Dissent

Hysterics, Deserters, and Conscientious Objectors in Germany during World War One

Rebecca Ayako Bennette

• Publisher: Cornell University Press
• Year: 2020
• ISBN:
  9781501751219
• Topic: History
• Subtopic: World War I
• Index: History

Although physicians during World War I, and scholars since, have addressed the idea of disorders such as shell shock as inchoate flights into sickness by men unwilling to cope with war's privations, they have given little attention to the agency many soldiers actually possessed to express dissent in a system that medicalized it. In Germany, these men were called Kriegszitterer, or "war tremblers, " for their telltale symptom of uncontrollable shaking. Based on archival research that constitutes the largest study of psychiatric patient files from 1914 to 1918, Diagnosing Dissent examines the important space that wartime psychiatry provided soldiers expressing objection to the war.

Rebecca Ayako Bennette argues that the treatment of these soldiers was far less dismissive of real ailments and more conducive to individual expression of protest than we have previously thought. In addition, Diagnosing Dissent provides an important reevaluation of German psychiatry during this period. Bennette's argument fundamentally changes how we interpret central issues such as the strength of the German Rechtsstaat and the continuities or discontinuities between the events of World War I and the atrocities committed—often in the name of medicine and sometimes by the same physicians—during World War II.

Chapter 1

ANTECEDENTS

Psychiatry, the Military, and Pacifism in Late Imperial Germany

“Our psychiatric map of today no longer shows the many dark stretches of space and blurry borders as it used to,” the psychiatrist August Fauser confidently claimed at a 1903 conference held in Stuttgart.¹ Certainly, as the director of the local hospital acknowledged, much remained to be learned, and doctors could not always definitively determine the exact affliction a patient was suffering from. Yet, Fauser touted “the recent developments” in his field that meant practitioners now had a far better understanding of psychiatric disorders.² Indeed, recent advances “guarantee[d]” not only the ability to make specific diagnoses but also a fuller understanding of the causation and prognosis of a variety of afflictions, according to the director.³ Nonetheless, Fauser realized many members of the audience came to the field from a far more traditional background in asylum work focusing on providing a proper environment for patients that often had little in common with the cutting-edge research being carried out in the hospitals and clinics increasingly associated with academic medical faculties.⁴ Because of this, he acknowledged the service such traditional practitioners had rendered to the care of the mentally ill. Yet, the director’s embrace of and emphasis on all the information the latest work in the field had made available—research into etiology, better classificatory systems based on symptoms, and pathological-anatomical findings—made his identification with “the newer psychiatric direction” centered around the universities clear.⁵ This was where the future contributions of psychiatry to society would be found.

Fauser’s confidence stands in stark contrast to the estimation of the noted historian of medicine Erwin Ackerknecht concerning the field at the start of the twentieth century: “The position of the psychiatrist around 1900 was not a particularly happy one.… His patients were prisoners and in a way he himself was a prisoner caught up in the difficulties of the field in which he had chosen to work.”⁶ Ackerknecht lamented the limits of psychiatric knowledge, especially the rudimentary treatment options available to help those gravely suffering. Certainly, one might suggest that Ackerknecht’s interpretation reflected a more general pessimism regarding psychiatry; his low estimation of the field’s progress even decades later found reflection in an aside about his own experiences with the system as a trained physician.⁷ A similar argument could be made about Fauser’s optimism. After all, it was Fauser’s research that made headlines in publications like the New York Times after he confidently claimed at the 1913 conference of the German Psychiatric Association that he had discovered a blood test to determine dementia praecox, an earlier diagnosis largely supplanted by the modern-day term “schizophrenia.” It was a claim that merely a few years later would be completely disproved.⁸

---

While Fauser’s and Ackerknecht’s estimations of psychiatry around 1900 inhabited opposite ends of the opinion spectrum, it is notable that the scholarly literature on the subject has tended to reflect more of the latter’s pessimism concerning the field at the turn of the century. Worsening work conditions in a field already marked by serious problems and the poor standing of psychiatrists within the medical community as well as in society more generally added to the more specific concerns about scientific knowledge and treatment efficacy to produce a situation described as one of multiple “crises.”⁹ Indeed, drawing on the same quote from Ackerknecht, Paul Lerner characterizes the field and its practitioners as “plagued” by a variety of problems.¹⁰ At the same time, one cannot simply dismiss the optimism of Fauser. To an extent, both the pessimism and the optimism reflected different sides of the reality of the situation, akin to seeing the glass half empty or half full. Even though scholars have tended to emphasize the limits of psychiatry around 1900, these very shortcomings were made all the more glaring in light of real improvements and advances over the previous century. As Eric J. Engstrom and Volker Roelcke have noted, finding weaknesses and strengths in the standing of psychiatry at the end of the nineteenth century might not reflect finding one “despite” the other but more a case of being able to see both of them “maybe even because of” the contrast.¹¹

Certainly, Fauser’s optimism would have been understandable when looking at the improvements made in psychiatry—or what passed for it—over the previous century. Part of the more general conceptual shift initiated by the Enlightenment that highlighted reason and progress, a new outlook in the care of those deemed “insane” emerged by the beginning of the nineteenth century that recognized some of those suffering individuals might be treatable. Far from ascribing mental illness to religious or supernatural causes, practitioners—some more quickly than others, of course—increasingly came to view those under their care as afflicted by ailments best addressed by the medical sciences. Instead of merely warehousing the ill alongside other “undesirables” like the poor and women of ill repute, with nary a person with any medical training in sight, institutions began to focus on healing.¹² A prime example was the establishment of the institution in Siegburg (near Cologne, Germany) in 1825. The intake guidelines for Siegburg indicated that only those deemed curable be admitted, an outcome that should be achieved in two years or less. Failure or a change in the prognosis of any individual was supposed to lead to the patient’s immediate discharge or transfer to another facility. Nonetheless, the optimism embodied in Siegburg certainly contributed to its “distinguished reputation” both in Prussia and beyond.¹³ While one would be right to note that not much had changed, especially in the early decades of the nineteenth century in the actual therapies available to cure sick individuals in Siegburg or elsewhere, it would be anachronistic to underestimate the importance of simply recognizing the goal—and a potentially attainable one at that—of curing the “insane.”

Institutions opened up in many places beyond Siegburg as part of a European-wide phenomenon in which newer institutions grew in size and more beds for patients became available. While religious asylums for the mentally ill continued to exist, often properties secularized right before the end of the Holy Roman Empire in 1806 came to serve new purpose as public hospitals for the mentally ill. In Germany specifically, it was the last third of the nineteenth century that saw exponential increases: around 1900 approximately twice as many public institutions for the mentally ill existed as had merely a few decades ago around the founding of the nation in 1871. Indeed, dozens more would be built leading up to the eve of World War I. The numbers of patients tell a similar story of expansion in care. They rose from 33,023 (in 1877) to 111,951 (in 1904) to 239,583 (in 1913). While most of these institutions did not have the sole focus on treatable cases as Siegburg did, and many individuals seen as incurable continued to be housed in these newer institutions as well, efforts to rehabilitate patients continued, a process with some success given the marked difference between patients seen and number of beds available in 1913, which was 164,708. A sizable portion of those who were treated must have required stays of less than a year.¹⁴

Psychiatry not only became less limited by growing its institutional capacity and moving away from the endless confinement of individuals, but also its patients—and by extension the field as a whole—became less liminal over the century. While attitudes toward the “insane” had previously lumped them in with the larger category of the poor, the clientele of institutions became less indigent over the nineteenth century. Of the four levels of care a patient could be placed under in an institution, the least expensive fourth class always made up the bulk of the patients. But the very existence of more well-appointed classes of care indicates the increased presence of those from beyond merely the bottom of the social ladder. (This is not to speak of the wealthy who had long found places in expensive private sanatoria, of course.) It is not surprising in light of the changing social profile of patients that more attention was paid to regulatory oversight and reform. Not only did care come in a variety of classes of comfort, for example, but also it increasingly came without some of the most obvious forms of physical repression. Chains and other restraints began to disappear over the century. However much one—either doctor or patient—may have felt a prisoner in one of these asylums around 1900, the real “prison section[s]” of many a former institution were long gone by then, as Ackerknecht himself noted. Beyond merely the socioeconomic profile of patients in residential institutions shifting, psychiatrists over the century increasingly found better-off individuals turning to them for help with issues related to “nervousness,” which became a highly “fashionable” disorder especially en vogue among the bourgeoisie in Germany and elsewhere.¹⁵

The rising fortunes of psychiatry over the nineteenth century could also be seen in a number of further developments that generally fit into the professionalization of the field, especially in the latter half of the period. Though caution is advised in attempting to pigeonhole all groups into a similar, predetermined path regarding their development into modern professions, the common hallmarks of the process are all visible in the case of German psychiatry (as well as for the medical field more generally). Well into the century, practitioners who ministered to those suffering from mental illness tended to have little specialized training. What knowledge they did gather—something completely devoid of any regulation—often occurred haphazardly and once on the job itself. As already noted, some asylum administrators had no medical background but were instead appointed based on other factors like religious learning. With such a mix of individuals involved in tending to the insane, it is no surprise that little sense of group identity, much less exclusivity, existed.¹⁶

Though unlikely clear at the time, the creation of a psychiatry chair at the University of Berlin in 1864 formed a watershed moment in the rise of professional psychiatry in Germany. The first of its kind, the position was taken up by Wilhelm Griesinger, who also oversaw the establishment of a new clinic at the affiliated Charité hospital. Beginning slowly with only one more such position created at the University of Göttingen that decade, the stream of establishing new chairs flowed by 1900, with sixteen of them and many new clinics linked to universities as well.¹⁷ The research taking place in the universities by a “new generation of psychiatrists,” who firmly associated themselves with these academic institutions as Fauser did, now dwarfed what little investigation those employed in the old-fashioned asylums were conducting.¹⁸ No doubt the shift received a fillip not only from psychiatry’s anchoring in academia but also from Griesinger’s successful efforts to meld neurology—often considered part of internal medicine at the time—to psychiatry. His emphasis on the physical, brain-based origins of disorders allowed psychiatry to enjoy in the second half of the century the prestige not only of university inclusion but also of a connection to the much-esteemed hard sciences of the period.¹⁹

By 1900 “university psychiatry” had clearly won out over “institutional psychiatry.”²⁰ Whatever concern this likely caused for old-style asylum practitioners, it meant a notable rise in the status of psychiatry. By that point, a common identity could be found among psychiatrists that drew on increasingly common training in universities, membership in common professional organizations, and readership of certain field-specific journals. Not only gaining clear demarcation from those outside the profession, psychiatrists became internally distinguished from general practitioners as part of a process that saw specialization among a variety of subfields. The reform of the medical curriculum in 1901 would include psychiatry among the specialties required. By that point, psychiatrists not only enjoyed increased status at home but also formed the forefront of the field internationally.²¹

Psychiatrists not only gained professional “jurisdiction” over the care and treatment of the “insane”; they increasingly expanded their realms of influence beyond this core constituency. In addition to treating patients suffering from “nervousness” and colonizing neurology, psychiatrists began enlarging their area of concern to claim additional individuals who were less gravely ill as potential patients within their purview. Such “borderline” cases involved a variety of perceived abnormalities that often found a home in broad diagnoses like psychopathic inferiority (psychopathische Minderwertigkeit) and claims of degeneracy.²² Indeed, interest in the “grey zone” between insanity and complete mental health only rose as psychiatrists further expanded their purview to another horizon by increasingly considering the health of not merely individuals but entire populations. Concerns for public welfare and social hygiene by psychiatrists increasingly meant a far larger domain of expertise than merely a few decades earlier. It also dovetailed with the function of physicians more generally growing beyond merely being doctors concerned with their individual patients’ welfare to instead increasingly being incorporated into the workings of the social welfare state. There they not only offered treatment but also functioned as gatekeepers to benefits like pension payouts.²³

Psychiatry’s Expanding Influence beyond Medicine

The expansion of psychiatry’s province of expertise occurred not only within the field of medicine itself but also into others as well. One of the most important realms that psychiatrists increasingly played a role in was that of the law. Already dating back to the sixteenth century, judgments in the Holy Roman Empire generally followed a stipulation in the Constitutio Criminalis Carolina recognizing those of unsound mind who committed a crime should not be penalized for their actions. In earlier centuries, the determination normally proceeded without any medical input. By the second half of the nineteenth century, however, courts commonly called on physicians to provide expert testimony on the question of a defendant’s mental state, even though the decision ultimately rested with the judge. Indeed, under German imperial law the field of psychiatry specifically received a boost in the recognition of its competence to make such determinations, as an 1879 law allowed for the accused to be remanded to an asylum for a period of observation. Increasingly, the courts sent defendants for the six-week observation period, and the number of such cases expanded rapidly up to the eve of World War I, far outstripping a rather modest rise in crime during the same period.²⁴

Of course, one should not overestimate this unmistakable expansion of psychiatry’s purview into the courts as an unmitigated triumph. Engstrom is right to caution against overlooking the real limits of psychiatry in the legal realm. Many causes promoted by doctors never came to pass, such as the desire for an official, intermediary category of diminished responsibility (geminderte Zurechnungsfähigkeit) to bridge the hard separation between mental competence and...

Table of contents

• Acknowledgments
• Map of Germany, 1918
• Introduction
• 1. Antecedents
• 2. Hysterics and Other Patients
• 3. Deserters
• 4. Conscientious Objectors
• Epilogue
• Notes
• Bibliography
• Index