Alfred Hoche

Last updated
Alfred Erich Hoche
Alfred Erich Hoche.jpg
Alfred Erich Hoche sometime before 1923
Born(1865-08-01)August 1, 1865
DiedMay 16, 1943(1943-05-16) (aged 77)
NationalityGerman
OccupationPsychiatrist
Known forEugenics and euthanasia

Alfred Erich Hoche (German pronunciation: [ˈalfʁeːt ˈeːʁɪç ˈhɔxə] ; 1 August 1865 in Wildenhain, Province of Saxony – 16 May 1943 in Baden-Baden) was a German psychiatrist well known for his writings about eugenics and euthanasia.

Mockrehna Place in Saxony, Germany

Mockrehna is a municipality in the district Nordsachsen, in Saxony, Germany.

Province of Saxony province of Prussia

The Province of Saxony, also known as Prussian Saxony was a province of the Kingdom of Prussia and later the Free State of Prussia from 1816 until 1945. Its capital was Magdeburg.

Baden-Baden Place in Baden-Württemberg, Germany

Baden-Baden is a spa town in the state of Baden-Württemberg, south-western Germany, at the north-western border of the Black Forest mountain range on the small river Oos, ten kilometres east of the Rhine, the border with France, and forty kilometres north-east of Strasbourg, France.

Contents

Life

Hoche studied in Berlin and Heidelberg and became a psychiatrist in 1890. He moved to Strasbourg in 1891. From 1902 he was a professor in Freiburg im Breisgau and was the director of the psychiatric clinic there. He was a major opponent of the psychoanalysis theories of Sigmund Freud. Hoche's body of work on the classification system of mental illness [1] had great influence. [2] He also published poetry under the pseudonym Alfred Erich.

Freiburg im Breisgau Place in Baden-Württemberg, Germany

Freiburg im Breisgau is a city in Baden-Württemberg, Germany, with a population of about 220,000. In the south-west of the country, it straddles the Dreisam river, at the foot of the Schlossberg. Historically, the city has acted as the hub of the Breisgau region on the western edge of the Black Forest in the Upper Rhine Plain. A famous old German university town, and archiepiscopal seat, Freiburg was incorporated in the early twelfth century and developed into a major commercial, intellectual, and ecclesiastical center of the upper Rhine region. The city is known for its medieval minster and Renaissance university, as well as for its high standard of living and advanced environmental practices. The city is situated in the heart of the major Baden wine-growing region and serves as the primary tourist entry point to the scenic beauty of the Black Forest. According to meteorological statistics, the city is the sunniest and warmest in Germany, and held the all-time German temperature record of 40.2 °C (104.4 °F) from 2003 to 2015.

Psychoanalysis psychological theory that was founded in 1890 by the Viennese neurologist Sigmund Freud

Psychoanalysis is a set of theories and therapeutic techniques related to the study of the unconscious mind, which together form a method of treatment for mental-health disorders. The discipline was established in the early 1890s by Austrian neurologist Sigmund Freud and stemmed partly from the clinical work of Josef Breuer and others. Psychoanalysis was later developed in different directions, mostly by students of Freud such as Alfred Adler and Carl Gustav Jung, and by neo-Freudians such as Erich Fromm, Karen Horney and Harry Stack Sullivan. Freud retained the term psychoanalysis for his own school of thought.

Sigmund Freud Austrian neurologist known as the founding father of psychoanalysis

Sigmund Freud was an Austrian neurologist and the founder of psychoanalysis, a clinical method for treating psychopathology through dialogue between a patient and a psychoanalyst.

According to Michael Burleigh's book "Death and Deliverance", he was married to a Jewish woman and left his post in Freiburg after National Socialists came to power. He was privately critical of Nazi euthanasia program after it claimed one of his relatives despite its rationale being based on his own ideas. After losing his only son in 1915 he became increasingly taciturn and depressed and his death in 1943 was probably due to suicide. [3]

Michael Burleigh is an English author and historian whose primary focus is on Nazi Germany and related subjects. He has also been active in bringing history to television.

Publications and Ideas

Allowing the destruction of life unworthy of living (life unworthy of life)

Life unworthy of life

The phrase "life unworthy of life" was a Nazi designation for the segments of the populace which, according to the Nazi regime of the time, had no right to live. Those individuals were targeted to be euthanized by the state, usually through the compulsion or deception of their caretakers. The term included people with serious medical problems and those considered grossly inferior according to the racial policy of Nazi Germany. This concept formed an important component of the ideology of Nazism and eventually helped lead to the Holocaust. It is similar to but more restrictive than the concept of "Untermensch", subhumans, as not all "subhumans" were considered unworthy of life.

In Binding and Hoche's book, Hoche calls for the killing of the mentally ill and especially considers those who have been what he calls, "mentally or intellectually dead" since birth or early childhood. [4]

Hoche begins his relatively short text by reminding readers that in the society of the day (1920s Germany) deaths caused by doctors were, in some cases at least, actually taken for granted. He mentions the risk taken by patients during operations and the killing of a child during birth to save the life of a mother. Hoche stresses that none of these killings are actually legal and although a doctor cannot always be sure of escaping prosecution, they are examples of where non-legal killings are accepted by the society of the day.

Hoche talks about euthanasia as proposed by Binding, arguing that if killing a person would lead to other lives being saved, it would be justifiable (Utilitarianism). Hoche believed that the killing of patients which he claimed had neither value for society, nor for themselves should be allowed.

Euthanasia is the practice of intentionally ending a life to relieve pain and suffering.

Utilitarianism is an ethical and philosophical theory that states that the best action is the one that maximizes utility, which is usually defined as that which produces the greatest well-being of the greatest number of people, and in some cases, sentient animals. Jeremy Bentham, the founder of utilitarianism, described utility as the sum of all pleasure that results from an action, minus the suffering of anyone involved in the action. Utilitarianism is a version of consequentialism, which states that the consequences of any action are the only standard of right and wrong. Unlike other forms of consequentialism, such as egoism and altruism, utilitarianism considers the interests of all beings equally.

Hoche was unable to establish an absolute rule for the first group (incurable illness) as they had not all "lost their objective and subjective value of life" and so concentrated on the second group, which he presumed had already done so. It is clear that this group would be substantially larger than the first.

Again Hoche saw an important difference in the people belonging to this group and he split it accordingly. He divided the group into people that have entered this condition later in life after "being mentally normal or at least average for a period of their life" (Dementia Paralytica/ Dementia Praecox) and in those that had either been born in the condition or where this had occurred in early childhood. Hoche argued that anyone born with this condition could never have developed any emotional relationship to their environment or family, whereas a person who had lived normally for most of their life would have had this possibility. This would enable them to display thankfulness or reverence and to connect strong memories to these feelings. This was important to take into account when deciding on a killing, yet it was not to be equated with the killing of another human being.

Hoche argued that the "mentally dead" are easily identified, they have no clear imagination, no feelings, wishes or determination. They have no possibility to develop a Weltbild, or a relationship to their environment. Most importantly, they lack a self-consciousness or even the possibility to become conscious of their own existence. They have no subjective claim to life, as their feelings are just simple elemental ones such as those found in the lower animals.

Hoche criticises the "modern endeavour" that has blocked "our German duty", which wants to "keep the weakest of all alive" and "has blocked attempts at preventing the mentally dead at least from procreating" and he speaks of "elements of less value", "weaklings" or "ballast existences".

Hoche then begins to argue for the killing of the disabled for purely financial reasons. Calculating the "financial and moral burden" on a person's environment, hospital and on the state, Hoche claimed that those who were "completely mentally dead" at the same time weighed heavily on "our national burden".

Binding and Hoche's book along with those by Alfred Ploetz, Rupp and Jost, directly influenced the Nazi T-4 Euthanasia Program of the 1930s. Hoche postulated "that perhaps one day we will come to the conclusion that the disposal of the mentally dead is not criminally nor morally wrong, but a useful act".

Hoche argued that the state can be seen "as an organism, as a human body which - as every doctor knows - in the interests of the survival of the whole, gives up or discards parts which have become valueless or damaging". In the case of the mentally ill these were those who were valueless and were to be discarded.

Hoche believed his ideas would be widely accepted only after, "a change in consciousness, a realisation of the unimportance of a single person's existence compared to that of the entirety... the absolute duty of bringing together all available energy and the feeling of belonging to a greater undertaking". Arguably this was to take place much faster than even Hoche had expected, a little more than a decade later, his ideas became part of German (Nazi) law.

Jahresringe: Innenansicht eines Menschenlebens

In his comments to the second edition of Hoche's "Jahresringe", Tilde Marchionini-Soetbeer, the book's editor, claimed that "out of love to his dead friend of 20 years", "I have taken it upon myself, with the help of understanding critics, to edit or even remove parts of the text which ... (Hoche) would have rejected, are outdated or unjust". These included Hoche's ideas "grouped around the euthanasia problem". Marchionini claimed that by 1950, Hoche would have rejected the idea, "had he experienced the inhumanities which doctors are capable of, if they are given the right to kill".

In his book, Hoche spoke about the "centuries in Germany, in which it was impossible to travel through the country, without seeing a sinner hanging from a gallows; years ago, they had stronger nerves than us and reached to the gallows more quickly. They were times in which a well trained judge was able to undertake interrogations using torture and could face the hanged and their smell as they decayed". (P195)

Hoche was interested in anatomy and took part in autopsies. He preferred people who had faced the guillotine: "because of the importance of the freshest possible material for investigation". Hoche detailed how he had taken part in at least one illegal experiment on such a person. Smuggling himself into an autopsy as an assistant to investigate the effects of electricity on the human central nervous system, Hoche connected a hidden motor to the body to see if he could make it move.

Eventually, after the state prosecution gave him special permission, Hoche was able to experiment on bodies within two minutes of their execution by guillotine. (P197)

Hoche's relevance today

Advocates of euthanasia have been accused of being influenced by Hoche, whether knowingly or not.

In particular, several authors [5] [6] [7] [8] have drawn similarities between the arguments of Hoche and those of Australian philosopher Peter Singer. [9]

Publications

See also

Related Research Articles

Anti-psychiatry

Anti-psychiatry is a movement based on the view that psychiatric treatment is more often damaging than helpful to patients. It considers psychiatry a coercive instrument of oppression due to an unequal power relationship between doctor and patient and a highly subjective diagnostic process. It has been active in various forms for two centuries.

<i>Aktion T4</i> Nazi Germanys "euthanasia programme" with 70,273 victims

Aktion T4 was a postwar name for mass murder through involuntary euthanasia in Nazi Germany. The name T4 is an abbreviation of Tiergartenstraße 4, a street address of the Chancellery department set up in the spring of 1940, in the Berlin borough of Tiergarten, which recruited and paid personnel associated with T4. Certain German physicians were authorized to select patients "deemed incurably sick, after most critical medical examination" and then administer to them a "mercy death". In October 1939, Adolf Hitler signed a "euthanasia note", backdated to 1 September 1939, which authorized his physician Karl Brandt and Reichsleiter Philipp Bouhler to implement the programme.

Racial hygiene

The term racial hygiene was used to describe an approach to eugenics in the early 20th century, which found its most extensive implementation in Nazi Germany. It was marked by efforts to avoid miscegenation, analogous to an animal breeder seeking purebred animals. This was often motivated by belief in a racial hierarchy and the related fear that lower races would "contaminate" a higher one. As with most eugenicists at the time, racial hygienists believed that lack of eugenics would lead to rapid social degeneration, the decline of civilisation by the spread of inferior characteristics.

Viktor Brack SS officer

Viktor Hermann Brack was a German Nazi war criminal, an organiser of the euthanasia programme Action T4, where the Nazi state systematically murdered over 70,000 disabled German and Austrian people. Following this, Brack was one of the men responsible for the gassing of Jews in the extermination camps, and he conferred with Odilo Globocnik about the practical implementation of the Final Solution. Brack was sentenced to death in 1947 and executed in 1948.

Ernst Rüdin Swiss psychiatrist

Ernst Rüdin was a Swiss-born German psychiatrist, geneticist, eugenicist and Nazi. Rising to prominence under Emil Kraepelin and assuming his directorship at what is now called the Max Planck Institute of Psychiatry in Munich, he has long been scientifically honoured and cited internationally as the pioneer of psychiatric inheritance studies. He also argued for, designed, justified and funded the mass sterilization and clinical killing of adults and children.

Werner Catel, Professor of Pediatrics at the University of Leipzig, was one of three doctors considered an expert on the programme of euthanasia for children and participated in the Action T4 "euthanasia" programme for the Nazis, the other two being Hans Heinze and Ernst Wentzler.

Heinrich Gross was an Austrian psychiatrist, medical doctor and neurologist, a reputed expert as a leading court-appointed psychiatrist, ill-famed for his proven involvement in the killing of at least nine children with physical, mental and/or emotional/behavioral characteristics considered "unclean" by the Nazi regime, under its Euthanasia Program. His role in hundreds of other cases of infanticide is unclear. Gross was head of the Spiegelgrund children's psychiatric clinic for two years during World War II.

Bénédict Morel French psychiatrist

Bénédict Augustin Morel was a French psychiatrist born in Vienna, Austria. He was an influential figure in the field of degeneration theory during the mid-19th century.

Karl Binding German jurist

Karl Ludwig Lorenz Binding was a German jurist known as a promoter of the theory of retributive justice. His influential book, Die Freigabe der Vernichtung lebensunwerten Lebens, written together with the psychiatrist Alfred Hoche, was used by the Nazis to justify their T-4 Euthanasia Program.

Nazi eugenics Nazi Germanys racially based social policies that placed the improvement of the Aryan race or Germanic

Nazi eugenics were Nazi Germany's racially based social policies that placed the biological improvement of the Aryan race or Germanic "Übermenschen" master race through eugenics at the center of Nazi ideology. In Germany, eugenics were mostly known under the synonymous term racial hygiene. Following the Second World War, both terms effectively vanished and were replaced by Humangenetik.

Ewald Meltzer was a German director of an asylum in Saxony whose work had an influence on the Nazis to justify their T-4 Euthanasia Program.

Legality of euthanasia

Efforts to change government policies on euthanasia of humans in the 20th and 21st centuries have met limited success in Western countries. Human euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations. As of March 2018, active human euthanasia is legal in the Netherlands, Belgium, Colombia, Luxembourg, and Canada. Assisted suicide is legal in Switzerland, Germany, the Netherlands, and in the US states of Washington, Oregon, Colorado, Hawaii, Vermont, Montana, Washington, D.C., and California. A law legalising euthanasia in the Australian state of Victoria will come into effect in mid-2019.

Gerhard Herbert Kretschmar, was a German child born with severe disabilities. After receiving a petition from the child's parents, the German Führer Adolf Hitler authorized one of his personal physicians, Karl Brandt, to have the child killed. This marked the beginning of the program in Nazi Germany known as a "euthanasia program" – Aktion T4 – which ultimately resulted in the deliberate killing of about 200,000 people with mental and/or physical disabilities.

Action 14f13 campaign of the Third Reich to murder Nazi concentration camp prisoners

Action 14f13, also called "Sonderbehandlung14f13" and Aktion 14f13, was a campaign by Nazi Germany to terminate Nazi concentration camp prisoners. Also called invalid or prisoner euthanasia, the campaign culled the sick, elderly and those deemed no longer fit for work, from the rest of the prisoners in a selection process, after which they were killed. The Nazi campaign was in operation from 1941 to 1944 and later covered other groups of concentration camp prisoners.

Unitary psychosis (Einheitspsychose) refers to the 19th-century belief prevalent in German psychiatry until the era of Emil Kraepelin that all forms of psychosis were surface variations of a single underlying disease process. According to this model, there were no distinct disease entities in psychiatry but only varieties of a single universal madness and the boundaries between these variants were fluid. The prevalence of the concept in Germany during the mid-19th century can be understood in terms of a general resistance to Cartesian dualism and faculty psychology as expressed in Naturphilosophie and other Romantic doctrines that emphasised the unity of body, mind and spirit.

Bernburg Euthanasia Centre

The Nazi Euthanasia Centre at Bernburg operated from 21 November 1940 to 30 July 1943 in a separate wing of the State Sanatorium and Mental Hospital in Bernburg on the River Saale in the German state of Saxony-Anhalt. It was one of several euthanasia centres run by the Nazis under their official "Euthanasia Programme", later referred to after the war as Action T4. A total of 9,384 sick and handicapped people from 33 welfare institutions and nursing homes as well as around 5,000 prisoners from six concentration camps were killed here in a gas chamber using carbon monoxide gas.

The Euthanasia trials were legal proceedings against the main perpetrators and accomplices involved in the euthanasia killings of the Nazi era in Germany.

The Nazi Doctors: Medical Killing and the Psychology of Genocide was written by Robert Jay Lifton and published in 1986, analyzing the role of German doctors in carrying out a genocide. From the viewpoint of a psychiatrist, Lifton dove into detail covering the medical procedures occurring before and during the Holocaust. The book consists of three parts, each with chapters, and recounts the events that led to the holocaust, as well as members that formed part of it. Euthanasia was the term used by the Nazis to describe their killings that had purpose, in reality they committed a genocide. Lifton explores the paradoxical theme of healing killing in which one race was healed by eliminating another; a concept that many used to morally justify their actions. Throughout the book, Lifton provides quotes from interviews he conducted with SS doctors and with victims. In that manner, he is able to retell the story from both sides, and later provide a psychiatric analysis on the manner in which the doctors were able to carry out their experiments.

References

  1. Dening R G, Dening T R & Berrios G E (1991) Hoche and his "The Significance of Symptom Complexes in Psychiatry". History of Psychiatry 2: 329-343
  2. Berrios G E & Dening T R (1991) Alfred Hoche and DSM-III-R. Biological Psychiatry 29: 93-95
  3. Dening R G, Dening T R & Berrios G E (1991) Hoche and his "The Significance of Symptom Complexes in Psychiatry". History of Psychiatry 2: 329-343
  4. https://de.wikipedia.org/w/index.php?title=Datei:BindingHoche_FreigabeCoverAufl22.jpg
  5. Wright, Walter (2000). "Peter Singer and the Lessons of the German Euthanasia Program". Issues in Integrative Studies No 18, pp27-43. Available online
  6. O'Mathúna, Dónal P (March 2006). "Human dignity in the Nazi era: implications for contemporary bioethics". BMC Medical Ethics, March 2006. Available online
  7. Hendin, Herbert. "Euthanasia and Senicide". Available online
  8. Rosenblum, Jonathan (December 27, 2007). "Not a Doctor's Decision". Jerusalem Post. Available online
  9. Singer, Peter (1993). Practical Ethics, 2nd Edition. Cambridge. Extract available online