Everyday Knowledge, Science, and Psychiatric Committals during Germany’s Age of Extremes

Hans A. was 72 years old and in good shape when he was admitted to the Eglfing-Haar Mental Institution in March 1944.¹ This Bavarian asylum was notorious at the time for its high mortality rate, and Hans A. died there within two months without having shown any signs of serious illness prior to his admission. How and why did he get there? The answers to these questions open up new insights about the relationship among distinct types of knowledge involved in psychiatric committals.

From the patient file we learn that Hans A. was admitted with the consent of his son. The son had first taken his father to the Munich university psychiatric clinic while he was on furlough from northwest France, where he had been stationed as a member of the Luftwaffe. Hans A.’s case history contains a note giving us insight into his son’s rationale:

Today the patient’s son came to see us and further informed us that it is not possible to leave the patient at home. He himself is on active service, and the patient’s daughter-in-law is herself in poor health (pulmonary tuberculosis) so it is impossible for her to care for the patient. The air-raid precautions are a particular source of trouble. There is no air-raid shelter in the home itself, and the patient, who is bedridden, must always be carried across a courtyard fifty meters away. As far as the patient’s relatives are concerned, there is no reason why he cannot be committed to the Eglfing Sanatorium-Nursing Home.²

Hans A.’s family decided to put him in the long-term asylum Eglfing-Haar as the patient could no longer stay at the psychiatric award of the university clinic. At first, the family tried to initiate compulsory committal on the grounds that Hans A. allegedly posed a “danger” in accordance with the Bavarian Police Penal Code. However, the district medical officer (Bezirksarzt) did not approve this pretext and rejected compulsory committal.³ Nevertheless, the university psychiatric clinic transferred the patient to the sanatorium-nursing home with the son’s consent. Strictly speaking, involuntary committals had to be certified by the police or the public health officer. Officially, these regulations could only be circumvented in the case of underage patients. Time and again, however, as in this case of Hans A., adult patients were admitted at their families’ behest and with the consent of their relatives.

The man’s son portrayed a situation in which it was impossible to keep his father at home due to the war. In the medical records of the Psychiatric Clinic of Munich University Hospital, Hans A.’s afflictions were described in more detail. The patient had a “clubfoot” that made it difficult for him to walk. Regarding his mental condition, the physician stated: “Nothing particularly noticeable psychologically. His memory is said to have diminished somewhat recently. Patient feels lonely and has become quieter lately.”⁴ The doctor further noted that the patient had never been in the hospital before and had been working in an office just three weeks earlier. The explanation mentioned for his foot trouble was that Hans A. used to be a salesman and had had to do a lot of walking. ⁵The medical description of his condition and the fact that the public health officer rejected compulsory committal suggests that his admission to Eglfing-Haar was neither urgent nor inevitable and surely not based on medical expertise.

My book Psychiatric Institutions and Society probes how the serious and sometimes fatal decision was made to admit individuals to asylums during Germany’s age of extremes. Even at a time when the Nazis were killing hundreds of thousands of sick and disabled people, everyday knowledge of relatives played a more important role in most committals than the scientific reasoning of doctors or the administrative considerations of the authorities. In light of admission practices, my study traces how notions of and knowledge about illness, safety, and normality changed when the Nazi regime collapsed in 1945 and illuminates how closely power and knowledge configurations in the psychiatric sector were linked to political and social circumstances.

My analysis of admission practices allows us to understand the relationship between state, science, and social practice in mid-twentieth century German history in new depth: During the Second World War and the last years of Nazi Germany, in the early Federal Republic of Germany and in the German Democratic Republic, decisions by non-institutional actors went a long way in determining admissions to psychiatric facilities. Such actors included the patients themselves, their social environment – such as neighbors – but, above all, their own families. Furthermore, the institutional actors who were always involved in admissions, namely, asylum- and clinic-based psychiatrists, were heavily dependent on the cooperation of families and those affected. In addition, an outside initiative was required, and they were subsequently dependent on information from the preceding medical context.

The medical attribution of illness was essential for legitimizing admissions. However, such attribution did not in itself result in an admission. In all three systems, patients had often been psychiatrically diagnosed years before their first stay in an institution. But they were admitted only when their social environment no longer considered them tolerable, or – less often, it should be noted – when they sought this outcome themselves. Medical criteria were necessary but not sufficient for admission. In all three political systems, the influence of non-institutional actors on medical decisions to admit individuals to psychiatric facilities tells us a great deal about the function of psychiatry in modern, industrialized, and planning-based societies. Psychiatric institutions have been described, following Foucault, as symbols of modernity within the framework of rationalized and planning-based societies. From this perspective, the “mad,” unpredictable, and irrational were locked up on the basis of scientific-medical criteria as there was no place for them in “reason-based” modernity.⁶

However, my book shows, first, that access to psychiatric institutions was not primarily determined by scientific actors (physicians) or others who had to justify their actions within the framework of state institutions (such as judges). Second, the representatives of scientific rationality – namely, psychiatrists – described committal decisions and psychiatric diagnoses as being intuitive and, therefore, they were also unscientific. This professional description correlates with my study’s findings on psychiatric practices: more psychiatric knowledge in the form of increasingly sophisticated medical classifications, for instance, did not lead to more a consistent committal practice. In fact, the obligatory diagnostic categorization conducted in the course of admission depended heavily on local medical traditions bound up with the powerful position of asylum and clinic directors. At the same time, this local dimension must be understood as the result of path dependencies in practice. Especially when it comes to the highly application-oriented science of medicine, the results of my study point to a great diversity of committal practices. Without locally imbued tacit knowledge, psychiatric admissions were inconceivable and remain so today. My book does not provide support for the notion of science as an instrument of successful centralized control and standardization of interpretations of bodies and behaviors. Thus, science was not the main mover in the mechanisms of social inclusion and exclusion.

This is remarkable given that the period under investigation in my book falls within an era typically characterized by its faith in science and planning euphoria.⁷ At least in the committal processes I study in my book, we find little of this at the level of practice. It is certainly not possible to identify the scientification – in a way that left traces in practice – of social inclusion and exclusion at the threshold of the asylum. Both the self-description of psychiatrists as experts and practitioners as well as the flow of knowledge from families to “experts” reveal the flaws in such a perspective.

Nevertheless, my book underscores a uniquely modern compulsion to classify and rationalize. This includes the causal classification of illnesses and exceptional psychological situations in the life of the affected person – by the latter and by members of their social milieu – as well as the medical profession’s efforts to perfect diagnostic systems. The sources reflect optimism and a belief in progress and, in this sense, highlight the influence of scientific concepts on people outside the medical profession. However, they do not indicate a scientification of committal practice.

New therapies found their way into the rationales put forward by non-experts in the early FRG and GDR. Women, in particular, acquired knowledge about treatment options: my book demonstrates a strongly gender-specific form of medical expertise in families from the 1940s to the 1960s. But the transfer of medical expertise to broader population groups was largely limited to treatment options. Ideas about the causes and course of illness, meanwhile, diverged between families and psychiatrists. The latter attributed misdiagnoses in part to the fact that it was nearly impossible to obtain all the information they considered relevant. Patients and members of their social milieu, along with physicians from outside the psychiatric field, often failed to focus on the issues that clinical psychiatrists considered crucial. Communication about treatment methods also points to the limits of scientific concepts in practice. Doctors regularly had to explain to their clients that treatments were either not available or had little or no chance of success.

We can discern in the practice of committals two different orders of justification, shaped either by scientific or everyday knowledge. Both served to legitimize committals. Psychiatrists, as widely accepted experts, managed these types of knowledge in their function as the gatekeepers of asylums. This made psychiatrists agents of modernity to a special degree, not because they rationalized social practice with scientific arguments, but because they functioned as a sort of “hinge.” In this role, they coordinated vastly different orders of knowledge and needs for legitimation, translated them into one another, and made them manageable. The social acceptance of the psychiatrist, as well as the increasing demand for psychiatric facilities despite their meager or moderate success in terms of healing, diagnostic categorization, and the assessment of safety risks, point primarily to the great need for regulation and legitimization in all three societies studied in my book. The way psychiatric committals unfolded makes it clear that, if we wish to analyze societies that see themselves as based on knowledge, we need to pay more attention to the relationship among everyday knowledge, scientific knowledge, and practical knowledge. Only by taking other knowledge varieties into account can we make statements about the scope and influence of scientific knowledge. This should help us finally gain a more nuanced sense of how knowledge of various kinds did or did not contribute to specific sorts of social change, and why.

Stefanie Coché is a historian at the Justus-Liebig-University, Giessen. Her research interests are history of psychiatry, history of higher education, religious history, German history, and American history. She heads the research group “The Implementation of Psychology and Life Sciences in Evangelical Colleges in the US since WWII” (funded by the Gerda Henkel Stiftung).

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1. HPA Eglfing-Haar, Patient file sign. EH 778, entry, March 7, 1944, AB Upper Bavaria, EH. ↩︎
2. Ibid., entry, February 29, 1944, in the medical record of the Psychiatric Clinic of Munich University Hospital. ↩︎
3. Ibid, entry, March 7, 1944, AB Upper Bavaria, EH. ↩︎
4. Ibid. ↩︎
5. Ibid. ↩︎
6. Michel Foucault, Psychologie und Geisteskrankheit (Frankfurt/M.: Suhrkamp, 1968), 132. ↩︎
7. On processes of scientification and the knowledge society in this period, see Margit Szöllösi-Janze, “Wissensgesellschaft – ein neues Konzept zur Erschließung der deutsch-deutschen Zeitgeschichte?,” in Koordinaten deutscher Geschichte in der Epoche des Ost-West-Konflikts, ed. Hans Günter Hockerts, 277–307 (Munich: Oldenbourg, 2004). ↩︎

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