18 Biopsychiatry, Genetic Engineering, and "Euthanasia" Today

The murders committed by Dr. Heinrich Gross and other doctors at the Spiegelgrund clinic were exposed in 1978-81, at a time of fundamental changes in psychiatric practice, institutions, and science . The criticism of psychiatric institutions had reached a peak; "social psychiatry" and "communal psychiatry" were the keywords of a transformation of psychiatry in the Western world.

Since then things have changed. In the last twenty years, "biological psychiatry" has triumphed. New scientific findings and new technological devices (e.g., visual imaging techniques) have directed research into new channels. These new trends promise to supply biological explanations for mental phenomena that seemed unthinkable twenty years ago. "Biological psychiatry" seemed obsolete then - today it seems to represent a utopian hope for cures and possibly even prevention. As yet, however, we cannot assess whether these findings will live up to their promise. The utopia of "healing" has already once ended in the gruesome reality of "annihilation."

On a totally different level, "racial hygiene" (or "eugenics") has paved the way for today's human genetics. While we now recognize that National Socialist crimes were based on a wholly inadequate understanding of heredity and its highly complex mechanisms, modern genetics promises to supply this certain knowledge "at last." The utopia of a "genetically healthy" humankind seems once more within reach.

However, the information promulgated in simplified form amongst the public often does not correspond with the complex findings of science. Our old images of "biology" and "heredity" threaten to direct the new knowledge along the old lines. Were the Nazis right after all? Are we returning to the "biological psychiatry" of the Nazi period? The diverse results of modern research do not indicate that and reveal a much more complex reality. But they are interpreted within the old frames of biologistic thinking. This is where a critical approach and a democratic public debate are urgently needed.

In addition, we are experiencing a new worldwide debate over "euthanasia." Again "mercy killing" is advocated: as critique of artificial life-support medicine, as a means of patients' ultimate "self-determination," but also as a result of scant health budgets. Can we no longer afford what is medically possible and salutary for human beings? These thoughts, too, had their precursors in the Nazi period. Despite all the openness and tolerance toward complex questions of medical ethics, we should not forget the consequences that such thinking once entailed in the past.