In our Forum discussion "journal club" series, the editors of Schizophrenia Bulletin provide access to the full text of a recent article. A short introduction by a journal editor gets us started, and then it's up to our readers to share their ideas and insights, questions, and reactions to the selected paper. So read on".
Torrey EF, Yolken RH. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2009 Sep 16. Abstract
Background Text By Gunvant Thaker, Professor and Chief, Schizophrenia Related Disorders Program, Maryland Psychiatric Research Center and Deputy Editor, Schizophrenia Bulletin
In a recently published report in Schizophrenia Bulletin (available online), E. Fuller Torrey and Robert H. Yolken review existing data to estimate the extent of Nazi genocide of psychiatric patients during the period of 1939-1945. The report provides an outline of the "scientific" thinking and the societal benefit "logic" that supported the genocide, including horrific details of the methods used to implement the plans. Torrey and Yolken estimate that hundreds of thousands of psychiatric patients were killed or sterilized, including 220,000-269,500 schizophrenia patients. This constituted more than 73 percent of the patients in Germany at that time (calculated based on the studies carried out in 1929-1931 that reported point prevalence rates of 2.0 per 1,000). Postwar studies in Germany reported lower prevalence rates than comparable studies in other Western countries carried out around the same period, whereas the incidence rate, when first studied in Mannheim 20 years after the last genocide, was found to be 53.6 per 100,000. The authors note that this rate is on the higher end of other published studies. Haffner and Reimann, the original authors of the Mannheim study, also noted that the observed incidence rate in Germany in 1965 was two to three times higher than most comparable studies at that time.
In addition to the horror of reading about the systematic killing of patients based on misguided scientific thinking and the participation of clinicians in the process, Torrey and Yolken"s report is a somber and thought-provoking read. As the authors point out, in contrast to the Nazi genocide of Jews during that period, killings of psychiatric patients are not as well known. It is legitimate (as the authors convincingly argue in the report) and important to examine and understand the impact of these killings and sterilizations on subsequent prevalence and incidence rates. The prevalence rates examined more than 20 years after the last genocide were lower, as one would expect, but the incidence rates didn"t decrease, and if anything, were relatively high. This is consistent with the fact that schizophrenia survives in the population in spite of low fertility rates among patients, and suggests that the disorder is caused by common variations in a large number of genes. The relatively high incidence rates point to an important role of the environmental factors that contribute to the etiology of the disease. Finally, the report needs to be a constant reminder of potential pitfalls as we participate in making health policy decisions based on our current scientific findings.
Reference: Hafner H and Reimann H. Spatial distribution of mental disorders in Mannheim, 1965. In: Hare EH, Wing JK, eds. Psychiatric Epidemiology: Proceedings of the International Symposium Held at Aberdeen University 22"5 July 1969. New York, NY: Oxford University Press; 1970:341"354.