7 The “Eugenics Paradox” Core Beliefs of Progressivism versus Relics of Medical Traditionalism—The Example of Kurt Goldstein

Frank W. Stahnisch

A discussion of well-known German-American neurologist, psychiatrist, and psychologist Kurt Goldstein (1878–1965) as a prime example of eugenic thought—highlighting the interrelated nature of eugenic issues in the United States, Europe, and Canada at the beginning of the twentieth century—is quite paradoxical in several ways. By many scholars, Goldstein is regarded as an impressive interdisciplinary researcher who made numerous and lasting contributions to the fields of clinical neurology, brain psychiatry, experimental psychology, medical rehabilitation, and philosophical anthropology—in both the German-speaking and North American communities, following his forced emigration to the United States in 1935. Goldstein attempted to combine the analytical approach of classical neurology with a new holistic theory of brain function, while also integrating the insights of the contemporary “Gestalt theory” developed among clinical and experimental psychologists. In his clinical departments at the Universities of Frankfurt am Main and Berlin, Goldstein had educated hundreds of medical and psychology students and residents not only in basic brain research and neuropathology but in broader psychoanalytic and clinicopathological methodologies as well, emphasizing the distinct need for a more humanistic attitude in future generations of medical doctors.¹

SEVERAL EUGENICS PARADOXES

From the perspective of the history of eugenics, one might be quite astonished to find Goldstein an early representative of what later became a drastic and inhumane movement worldwide. This is particularly so given his major achievements in holist neurology just mentioned, but also because of his peculiar biography as a German-born physician-scientist with early eugenicist inclinations who later became a victim of the Nazi regime in Germany. After the seizure of power by the Nazi Party on January 30, 1933, Goldstein—who was perceived as a Jewish physician, psychoanalyst, and medical doctor with socialist inclinations—was forced to leave Germany the same year. As British historian and journalist John Cornwell has pointed out, Goldstein’s holist neurology “was generally criticized by Nazi doctors for its ‘negative features,’² which were described as ‘liberalism, individualism, mechanistic-materialist thinking, Jewish-communist human ideology, lack of respect for the blood and soil, neglect of race and heredity, emphasis on individual organs and the undervaluing of soul and constitution.’ ”³

On April 6, 1933, GeStapo agents pulled Goldstein out of his medical practice at the academic City Hospital of Moabit in Berlin and threw him into the terrible city prison located in the General Pape-Strasse, where he was incarcerated and tortured for half a year.⁴ Through the intervention of his student, and later wife, Dr. Eva Rothmann (1878–1960), he was freed: she was acquainted with Matthias Heinrich Goering (1893–1945), leader of a right-wing voelkisch movement of psychoanalysis and, more importantly, an elder cousin of the prime minister of Prussia, Hermann Goering (1893–1946).⁵ Following this intervention, Goldstein was able to flee to Zurich, before he eventually found exile in Amsterdam for the next five years.⁶

Given Goldstein’s biographical background, at first glance it appears more than paradoxical that this Jewish physician could already be a protagonist of “eugenics”—in its German terminology of Rassenhygiene (racial hygiene), with all its imminent infamous and sinister connotations—in 1913.⁷ He is so well known and his work held in such high esteem by many physicians, scholars, intellectuals, and social workers worldwide⁸—having made numerous and lasting contributions to the communities of neurology, neurorehabilitation, experimental psychology, and psychosomatics, as well as holist philosophy—that this chapter may even appear as a somewhat hagioclastic undertaking, in which a significant “medical role model” is thrown from his pillar.⁹ Methodologically, however, this is done to understand in retrospect how this “intellectual digression” became possible in the first place and to reconstruct the remnants and fragments of Goldstein’s working biography. This historiographical process may help us to follow the transition from the person and work in “Goldstein I” to that of “Goldstein II”—his alter ego, who truly became the appraised advocate of the neurologically handicapped—after having assumed the directorship of the Frankfurt Institute for the Brain Injured in 1919, a position he held throughout most of the interwar period.¹⁰

The explanation for the first paradox—why Goldstein got interested in eugenics at all—which I will furnish after briefly introducing Goldstein’s life and work, is one based on his socialist inclinations toward the early twentieth-century secularist ideal—in the North American tradition often the social-theological ideal—of the “New Man.”¹¹ During his years of study and his residency period, this ideal became for Goldstein paired with nationalist and patriotic values, which was quite typical for many leading physicians, such as human geneticist Franz Josef Kallmann (1897–1965) and well-known neurosurgeon Ludwig Guttmann (1899–1980), assimilated Jews who were very appreciative of the bourgeois liberties offered by the Wilhelminian Empire since 1871 while often also sharing the expansivist politics of the German Kaiser.¹² As such, with respect to the pertinent issues of eugenic motivations and social intentions, even the humanist and socially motivated neurologist Goldstein exemplified a personal modernist and libertarian trait, intrinsically paired with patriotic values, that one could find mirrored in Canada—in the social philosophies and political views not only of a number of early feminist activists such as the “Famous Five” in Alberta, for example, but also in the writings on the relation of the healthy family to eugenics of future Saskatchewan premier Tommy Douglas (1904–86) in the early 1930s, in which he mentioned a system that would have required couples seeking to marry to be certified as morally fit.¹³ Those deemed “subnormal” because of low intelligence, moral laxity, or venereal disease would have to be sent to state farms or camps while those judged mentally defective or incurably diseased would be sterilized, according to Douglas: “Sterilization of the mentally and physically defective has long been advocated, but only recently has it seeped into the public consciousness. . . . [S]terilization seems to meet the requirements of the situation most aptly. For while it gives protection to society, yet it deprives the defective of nothing except the privilege of bringing into the world children who only be a care to themselves and a charge to society.”¹⁴

This was certainly not an isolated affair¹⁵—even though Canadian contextual factors clearly do apply and principal British and American influences in medical, political, and philosophical areas were much more pronounced in Canada than were German and European ones—yet it places the discussion about the political philosophy of eugenics in western Canada in the wider, international British, American, and German contexts, where it likewise needs to be addressed.¹⁶ Other contemporaries—such as the well-known case of Swiss-German psychiatrist Ernst Ruedin (1874–1952), who displayed open socialist inclinations even in the 1920s—continued to promote their eugenics line of thought and laid the ground for the murderous context of the National Socialist health-care philosophy.¹⁷ In considering Goldstein’s 1913 book On Eugenics (Ueber Rassenhygiene) in its wider social and cultural context, I attempt here to untangle some medical and philosophical trends that were based on the opposition of social progressivism versus traditionalism in medicine, along with contemporary eugenics convictions as they emerged from the context of medical modernity during the historical time period.¹⁸

The second paradox concerns eugenics theorizing versus medical holism and social philosophy. At face value, of course, it is inconsistent to see eugenics approaches (such as separation, sexual segregation, marriage rules, and forced sterilization) as associated or even integrated with medical holism and social philosophy ideals. In hindsight, then, how was it possible for Goldstein to theoretically align the assumptions of this dreadful development with the implications of his own neurological approach? Along with such eugenics considerations, there are also systematic reasons why Goldstein’s neurology can be seen as an adequate example to study the marginalization and persecution of the field through protagonists of Nazi medicine and racial hygiene. In the new health and welfare programs in Nazi Germany, cultural and medico-legal views on the neurologically handicapped and mentally ill—first in Germany and later also in Austria and the recently occupied countries—saw an unfortunate evolution of applied eugenics programs comprising family counselling of parents, marriage laws, and eventually forced sterilization regulations (see also chapter 8, by Paul J. Weindling, on the wider implications of the central European eugenics programs and the compensation legacy for victims of coerced sterilization).¹⁹ This further created the background for a transformation of the public mental health system in which psychiatric and neurological patients became the prime targets of racial hygienists and applied eugenicists. The transformation of the health care system through the influences by Nazi philosophies were additionally substantiated by a growing enthusiasm for racial hygiene, forced sterilization, and, later, euthanasia programs for children and the mentally ill. What is crucial to my narrative here is the active expulsion of what the Nazis saw as “Jewish medicine and science,” which included particular areas of psychiatry and neurology along with psychoanalysis, medical sexology (Sexualwissenschaft), and socialist public health.²⁰

The third paradox regards Goldstein’s own becoming a victim of the wider racial-anthropological regimes (in their medical, political, and also social dimensions through the threatening of his own Jewish family), while he had himself not anticipated the scope and radicalism of the “political philosophy” of National Socialism.²¹ On the other hand, this appears to have been the reason that Douglas gave up his eugenics inclinations around 1936, after having visited the Third Reich and seen some of the drastic effects and reverberations that the Nazi racial and sterilization laws had had on contemporary German society.²² With new therapeutic approaches arising, and eventually Goldstein’s and his wife’s forced migration to New York City, the traces of his own early embrace of eugenics regulations were lost, as was most of Goldstein’s overarching holistic medical approach and social theorizing.²³

At least in terms of these three paradoxes, a new look at Goldstein’s earlier work and international story can help us to understand similar paradoxes in the Canadian context of eugenics as well as the discussions and quarrels within the neurological and psychiatric communities on both sides of the Atlantic in a new light. An open dispute about the “eugenics question” was apparently more pronounced in the United States than it was in Canada, particularly in the Canadian medical professional communities.²⁴ However, before looking at each of these three paradoxes in turn, I will first outline some biographical details of Goldstein’s life and career, why he was so important for the international neurological and psychiatric community, and why it is necessary to look at his embrace of Rassenhygiene in different ways.

GOLDSTEIN’S BIOGRAPHY

A pseudo-social organization may be compared with an organism in disease, and we may speak of such a society [in which the normal relations are no longer sustained] as sick. Normal society means a type of organization through which the fullest possible actualization on the part of all individuals is assured. . . . If we acknowledge and utilize social organization as an instrument by means of which all individuals may actualize themselves to an optimal degree, then a genuine social life becomes possible. Only under these conditions is a social organization capable of doing justice to every individual; only this makes it a real organization and secures its duration. . . . Only in this way can we discover the concrete causes of failure in a given situation and the appropriate ways to correct the failure.²⁵

This excerpt from Goldstein’s “William James lectures,” which the German émigré neurologist gave at Harvard University between 1937 and 1938, is indicative of his new apprehension of the direction and future destiny of modern Western societies in the wake of the Second World War.²⁶ As much as it represents his own experiences as a Jewish refugee in Switzerland, Holland, and finally the United States, it can also be seen as an embodiment of his early views as a rehabilitation specialist in neurology and psychiatry.²⁷ The lectures, held during Goldstein’s own exile in the United States, conveyed his broad social ideas and holistic approaches to medicine and psychology—after all, he had been invited by émigré-educator Robert Ulrich (1905–66?) and experimental psychologist Arno David Gurewitsch (1902–74) to Harvard’s Department of Education to talk about his neurological and psychological experiences with brain-injured patients after the First World War.²⁸ The lectures are likewise a testimony of his concern with general social and political issues, in that the neurologist should take an active stance as both a citizen and a professional whose role in early “public health” considerations was a pivotal one.²⁹

It should be emphasized here, for the sake of the argument, that this direction was evident in Goldstein’s theorizing right from the beginning, even though the preconditions of his medical philosophy had changed quite visibly over time.³⁰ Goldstein’s biography and the course of his innovative clinical research work passed through a number of distinctive phases, including, for example, his succession of Ludwig Edinger (1855–1918) as the director of the Frankfurt Neurological Institute in 1918 and the onset of his pioneering work with head-injured World War I soldiers.³¹ When Goldstein later accepted the directorship of the neurological clinic at the Krankenhaus Moabit (City Hospital of Berlin at Moabit), in 1930, he organized the network of his groups of collaborators, contributors, and discussants in Frankfurt and Berlin—such as Max Wertheimer (1880–1943), Wolfgang Koehler (1887–1967), and Kurt Lewin (1890–1947)—according to his new understanding of interdisciplinary neurology.³²

Portrait photo of Kurt Goldstein taken at the International Neurological Congress in 1949.

Goldstein’s biography is altogether far from typical: Born into a Jewish mercantile family in the German province of Lower Silesia, he was educated at the integrative Jewish (Junior) High School, before entering the Humanistische Gymnasium in Breslau (see Figure 7.1). It seems quite important for the understanding of his early eugenics inclinations that in his youth and during his years in school he saw himself as a secular Jew for whom Jewishness was “rather a fate than a mission.”³³ Given his broad interests in the humanities and his love for music and literature, he first decided to study philosophy at the University of Heidelberg. Yet because of strong pressure from his father—a landowner in the Kattowitz district and successful merchant in the Silesian logging industry—Goldstein switched to the study of medicine at the University of Breslau, where he graduated as an MD in 1903. Already with his doctoral thesis, conducted in the psychiatric clinic of Carl Wernicke (1848–1905)—one of the most renowned psychiatric and neurological diagnosticians (particularly of speech and language problems and the aphasias) at that time—Goldstein’s interests were set. Adding to his theoretical preoccupation with neurology and psychiatry, further philosophical inspirations moved into his medical work “through the back door”; cultural philosopher Ernst Cassirer (1874–1945), who later fled Germany for England, Sweden, and the United States, became his cousin and exerted a strong influence on him, specifically regarding Cassirer’s analysis of the cultural context of scientific thought and the interplay of “form” and “function” that he had analyzed in physics, biology, and the arts.³⁴

More details of Goldstein’s further training and early medical career will be described in quite some detail in the next part of this chapter, and the relation of his work to his eugenicist inclinations will also be addressed there. It is more imperative here to summarize several of the major achievements and fundamental contributions for which he became so well known in Europe as well as later in North America. Edinger, an eminent neuroanatomist and neurologist, was particularly aware of Goldstein’s pioneering work on the aphasias and language disorders resulting from brain injuries.³⁵ By offering Goldstein the directorship of the Institute for Research into the Effects of Brain Lesions (Institut fuer die Erforschung der Folgeerscheinungen von Hirnverletzungen) affiliated with the Frankfurt Neurological Institute, he helped to provide the latter’s research program with excellent working conditions and thereby foster his important work with soldiers with head injuries.³⁶ The institute was a clinical subdivision of the Neurological Institute, which in 1914, shortly before the outbreak of the war, was annexed to the newly established, bourgeois University of Frankfurt am Main, and it was here that Goldstein joined the experimental psychologist Adhémar Gelb (1887–1936), who became his closest collaborator for many years.³⁷ The work performed between 1918 and 1930 by Goldstein and his interdisciplinary group at the Institute for Research into the Effects of Brain Lesions is a particularly good example of a closer study of the cultural exchanges and interrelations between neurology and the postwar Weimar Republic through integration of philosophy, social psychiatry, and neuroscientific innovations into the program of “holist neurology.”³⁸ It would, however, be a mistake to regard it as part of the then-mainstream research tradition, as it displayed ambiguities even within contemporary neuropathological views:

At that time [mental diseases] were considered the expression of abnormal brain conditions. The study of the nervous system was taken for granted, and I [Goldstein] became attracted by professors who were occupied with studies in this field: the anatomist, Professor [Edward Albrecht] Schaper [b. 1875], who was interested in the embryonic development of the nervous system; the famous psychiatrist, Professor Karl Wernicke, who tried to understand the symptoms of the patients psychologically and to combine this understanding with the findings on their brains; and Professor Ludwig Edinger, who laid the foundations of comparative anatomy of the nervous system.³⁹

Due to organizational changes in the institute and emerging anti-Semitic undertones in the medical faculty of the University of Frankfurt, Goldstein decided in 1930 to leave for Berlin, where he accepted the directorship of the clinic for neurology at the Charité teaching hospital of Moabit, in Berlin, which was soon to become an important centre of clinical neuroscientific research.⁴⁰ Here, Goldstein established a multidisciplinary research and patient care model that incorporated integrative services of neurology, clinical psychology, neuropathology, and brain histological research on the basis of a considerable group of assistants, collaborators, and contributors.⁴¹ However, with the passing of the Nazi Law on the Re-establishment of a Professional Civil Service on April 7, 1933, Goldstein officially lost his academic position. The law made it so that all state officials understood as being of non-Aryan descent had to be dismissed from office. Nazi ideology deemed it unacceptable for Jews to teach “Aryans,” so university professors, teachers, and doctors in the public health service lost their primary positions, and the law cut deeply into the existing culture of science and medicine of Weimar Germany.⁴² It was only after his flight to and refuge in the Netherlands that Goldstein could finalize his seminal publication, Der Aufbau des Organismus. Einfuehrung in die Biologie unter besonderer Beruecksichtigung der Erfahrungen an kranken Menschen (The Organism: A Holistic Approach to Biology Derived from Pathological Data in Man), for which he would become so well known, with the help of the American Rockefeller Foundation.⁴³

In 1935, Goldstein left the Netherlands for New York, where he continued his clinical work as a neurologist in private practice and lectured at Columbia University until the end of the war. Together with other German émigrés—including social philosophers Max Horkheimer (1895–1973) and Erich Fromm (1900–80)—he even pursued sociopsychology research on the “authoritarian character” at the New School of Social Research, until his death in 1965.⁴⁴ Starting in 1938, Goldstein—already sixty years of age—tried to re-establish a fruitful intellectual exchange, with his cousin, Cassirer; his new postdoctoral fellow, the experimental psychologist Martin Scheerer (1900–61); Cambridge education scholar Robert Ulrich; and phenomenologist Aron Gurwitsch (1901–73); however, this work only gained minor ground in physical therapy and rehabilitative psychology. Being forced to practice medicine for his living and the survival of his family, Goldstein toured and lectured at diverse places, while stretching his research interests increasingly into psychology and sociology.⁴⁵ This is reflected in a description by Harvard psychologist Marianne Simmel (1923–2010), who met Goldstein in 1942 and judged that the forced migration had ruined Goldstein’s career as a clinical neurologist.⁴⁶ As she stated, he did not find the right scientific culture he was looking for, and thus he never seemed to feel at home. Or, as his friend Ulrich cunningly summarized while reflecting on Goldstein’s Harvard lectures, “[Americans] wondered suspiciously about his many-sided interests, which extended from medical research to psychology and philosophy. What was he really, they asked: a physician, a psychologist or a philosopher?”⁴⁷

JEWISH ASSIMILATION, PERSONAL SOCIALIZATION, AND THERAPEUTIC NIHILISM VERSUS NEUROLOGICAL OPTIMISM

As far as we now know—and this is fairly in line with the biographies of many assimilated Jewish physicians of the later Wilhelminian Empire (Goldstein’s long-time mentor Edinger and the clinical neurologist Frederic Henry Lewy [1885–1950] are also good examples)⁴⁸—at the beginning of his medical studies Goldstein had applied for a parallel military education as a reserve officer (in the medical corps) with the Breslau Garrison.⁴⁹ It appears that, particularly from this socializational context, Goldstein developed quite a positive view of the military as a central element of the “organism of the nation,” an integral “training school for the nation,” and an “instrument that channels the struggle of the nations” (as he later used to call it).⁵⁰ The military figures centrally in his 1913 book On Eugenics as well, where he writes,

One cannot underestimate the advantages of the military service. It is beyond doubt, for example, that a considerable number of men will be greatly supported by the military, both mentally and physically. Particularly, the education in social discipline and physical exercises is a remedy against the general nervousness of our times and is also of a great advantage. . . . Another question, which is harder to answer, is that of whether war is assuming a selective role in the general competition among the nations, which would lead to the survival of the fitter races [Rassen] over the unfit races? [Alfred] Ploetz writes for example that war is the best means to secure the white races from being flooded by other races, so that they may further expand and secure their general survival for all times.⁵¹

These emphatic and enthusiastic views of the military and its social role in the Wilhelminian Empire were rather common among many assimilated Jews in the German civil service, economic circles, and the higher-education sector, a circumstance that influential German historian Fritz K. Ringer (1934–2006) analyzed thoroughly in his book The Decline of the German Mandarins: The German Academic Community, 1890–1933, based on available social-historical statistical data: “Higher officials, academics, doctors and clergymen still accounted for 40 per cent of the [German officer] corps, while landowners and officers declined in representation. In the meantime, a full secondary education had actually increased in importance as a criterion of entry into the military profession; . . . 65 per cent of them held graduate certificates in 1912.”⁵²

Comprising nearly 16 percent of all university instructors, Jewish doctors and professors were by far overrepresented in institutions of higher learning in the first two decades of the twentieth century (given their 1 percent proportion in the general population).⁵³ Often enough, academics of Jewish origin thereby needed to prove their value to the wider German society against prevailing anti-Semitic prejudices of university and physician colleagues, many of whom were members of the nationalistic pan-German league and fervent supporters of the military and of imperial naval expansion (so-called Flottenprofessoren).⁵⁴ In part, these steps in the assimilation of Jewish doctors and professors can be understood as concessions to the academic ideology at the time, yet they were also an element of Goldstein’s own medico-psychiatric theorizing:

In a fundamental racial-anthropological sense, we may identify the aim of this [social] development as the emergence of the best race, whichever this will be in the end. It is evident that it is the plan of each race and each nation to survive in the struggle of the fittest. Yet with the demise of its sovereignty, many of the national values would be lost which, beyond doubt, comprise a major part of its potential to sustain the living conditions of each individual and nation as a whole.⁵⁵

To further understand and contextualize the explicitly social-Darwinist undertones of “the survival of the fittest” in these writings, it is very important to note that Goldstein had done his medical rotations as an intern (Klinischer Assistent) not only in Berlin for one year (after Theodor Ziehen [1862–1950] had assumed the directorship of the Department of Psychiatry at the Charité) but—what is very important for the discussion of Goldstein’s eugenics inclinations—for another year in southern Germany with the most ardent supporter of psychiatric eugenics, Alfred Erich Hoche (1865–1943), as chief of the psychiatric department at the University of Freiburg.⁵⁶ Between 1906 and the outbreak of World War I, Goldstein completed his residency there before moving to the University of Koenigsberg in East Prussia, where he graduated for a second time with a Habilitation thesis in neurology. Most of his writing of the thesis manuscript, however, seems to have been done in the psychiatric department of the University of Freiburg im Breisgau. Apart from his endorsement and advocacy of eugenics in the psychiatric community of the German-speaking countries, Hoche had also become infamous as a major opponent of Sigmund Freud’s (1856–1940) psychoanalysis, which he rebutted primarily on brain psychiatric and somaticist grounds based largely on the brain psychiatric approach of his mentor Wilhelm Griesinger (1817–68), in Berlin.⁵⁷

Hoche is known particularly for his drastic postwar views on eugenics and the forced sterilization of the mentally and physically disabled.⁵⁸ At the time that Goldstein entered his clinic, however, Hoche was already teaching eugenics theory to medical students and he interacted with an international network of eugenicists around the Swiss psychiatrist Auguste Forel (1848–1931).⁵⁹ This is apparent, for example, in his 1903 treatise Die Grenzen der geistigen Gesundheit (The boundaries of mental health); in Zur Frage der Zeugnisunfaehigkeit der geistig anormalen Personen (On the question of bearing testimony in mentally abnormal persons), co-written with Austrian lawyer August Finger (1858–1935); and in “Konstitutionelle Psychopathien” (Constitutional psychopathies), Hoche’s contribution in the seminal Lehrbuch der Psychiatrie (Texbook of psychiatry), which Hoche co-edited with eminent psychiatrist Otto Binswanger (1852–1929) from the University of Jena and other colleagues.⁶⁰

The respective sections in Goldstein’s book On Eugenics reveal subject titles and content very similar to those in related publications of Hoche’s writings, such as “Die Koerperlichen und Geistigen Faehigkeiten der Bevoelkerung” (The physical and mental abilities of the population); “Das Erziehungsproblem—Herabgesetzte Zeugungsfaehigkeit bei den Geisteskrankheiten” (The educational problem—On the decreased capability to bear witness in the mentally ill); and “Die so genannte nervoese Entartung—Geisteskrankheit” (On nervous degeneration—Mental illness).⁶¹ Regarding Goldstein’s writing in the book, in various respects it shows a very standardized and abstract narrative, featuring many reasons for the rhetoric used—especially when discussing the ethical views that are put forward: “one should not threaten the lives of the mentally ill”—and standard psychiatric tropes of the time.⁶² It is very likely that Hoche even had a direct influence on the writing process, perhaps editing passages of the book itself; many of the contemporary Ordinarius professors often substantially rewrote the theses they supervised.⁶³ However, this hypothesis would have to be corroborated, though it is unlikely that any documentation or correspondence with Goldstein after his move to Koenigsberg (today Kaliningrad, in Russia) can still be found, as most of the material in the University Archives of Koenigsberg was lost in the destruction of the Second World War.⁶⁴

After the First World War, with its countless casualties and nearly three million mutilated soldiers, Hoche become notorious for his collaborative work with law professor, and later provost of the University of Leipzig, Karl Binding (1841–1920), in which both explored and sanctioned negative eugenics approaches to what they called the problem of “bodily and mental degeneration.”⁶⁵ For psychiatrists and neurologists this was an ongoing research problem since the beginning of the century, when various members of the Deutsche Gesellschaft fuer Nervenheilkunde (German Society for the Nerve Sciences)—including psychiatrists, neurologists, and pathologists such as Hoche, Ruedin, Emil Kraepelin (1856–1926), and Oswald Bumke (1877–1950)—entered into a debate about an assumed increase in “functional nervous disorders.”⁶⁶ Relations between psychiatrists and eugenicists were common at that time and are represented in Kraepelin’s article “On Degeneration” (“Zur Entartungsfrage”) published in 1908, only three years after the Nordic group Gesellschaft fuer Rassenhygiene (Society for Racial Hygiene) had been founded in Munich.⁶⁷ The implication was a major shift in concern away from the social origins of disease as affecting the individual and toward a primarily biologistic perspective that envisaged the “collective culture” or “folk body” (Volkskoerper).⁶⁸

In “On Degeneration,” Kraepelin also identified a number of medically relevant phenomena in modern society to be addressed by psychiatrists: an increased frequency of insanity, a higher suicide rate, greater numbers of epileptics and drug addicts, and a decline in the general birth rate.⁶⁹ He especially emphasized the roles played by alcohol and syphilis, as agents toxic to the “germ plasma”—these themes also feature in one-third of the whole text in Goldstein’s book On Eugenics.⁷⁰ In this regard, as pointed out by Kraepelin’s colleagues Hoche and Ruedin, what could have been more devastating than the Great War, with its millions of casualties “negatively selected” from the germ line?⁷¹ In a way, both had taken up Kraepelin’s legacy after the First World War: Ruedin as director of the Demographic Study Unit (Demographische Abteilung) at the leading and globally renowned German Research Institute for Psychiatry;⁷² and Hoche by explicitly formulating a psychopathology- and neurology-based degeneration thesis, founded on dubious statistical data and fostered by the views of “therapeutic killing”—that is, an assumption that medical remedies were available to decrease the number of the mentally disabled. This position was also shared by Ruedin, when he euphemistically wrote of “below-average material which the softened process of elimination [gemilderte Ausmerze] leaves behind in the arena of humanitarian activity.”⁷³

In response to what they saw as the Darwinian process of “natural selection” being decelerated or even stopped in postwar Germany, Ruedin and Hoche launched severe polemics against the social welfare programs of the Weimar Republic.⁷⁴ In a Kraepelinian vein, the social welfare programs appeared as highly problematic and unwarranted expenditures because they secured the longevity of populations regarded as “of low value” and thus negatively contributed to the deterioration of the “germ plasm,” such as through increasing substance abuse and alcoholism.⁷⁵ During the Weimar Republic this view emanated as a battle credo of the far right, and early Nazi doctors began to marginalize psychiatric and neurological research because it addressed degenerate patients, or “conditions of hereditary or early childhood degeneration of the brain,” as Hoche and Binding formulated in their infamous 1920 pamphlet On the Liberation of the Annihilation of Life Not Worth Living:

For the non-physician, it must be pointed out that conditions of ‘mental death’ have to be faced in [this] group, [further] in the dementia-associated changes of the brain, in conditions that lay people call the softening of the brain, in dementia paralytica, . . . juvenile dementia praecox—in which a great number of patients reaches most advanced states of imbecility—and in the gross morphological changes of the brain.⁷⁶

Along with the emergence of racial hygiene as a respected scientific discipline came a parallel view of the mentally ill and mentally defective in purely economic terms as a national burden.⁷⁷ In their influential work, Binding and Hoche felt that those with severe mental retardation were without a sense of the value of life and put an enormous strain on the gross national income. Binding and Hoche believed that the elimination of such individuals could be construed as a “humane” and “acceptable” gesture.⁷⁸ Later, on the eve of the Second World War, as has been well investigated in historical scholarship, mechanisms put into place for an active euthanasia program targeted first mentally and physically disabled children and then the mentally ill and somatically handicapped adults. Registrations were reviewed by an advisory committee called the Committee for the Scientific Treatment of Severe Genetically Determined Illness and were selected and transported to the appropriate institutions.⁷⁹ Eventually, the same committee, which based its policies largely on the Binding and Hoche treatise, received authorization from Adolf Hitler (1889–1945) to administer an adult euthanasia program under the supervision of physician Victor Brack (1904–48).⁸⁰

In a similar form, though of course with a different political and medical direction, Goldstein’s early functional anatomical interests became interwoven with the cultural discourses of “degeneration” and “exhaustion” in On Eugenics.⁸¹ On the one hand, Goldstein described here his models and theories of brain functioning coupled with deeper clinical insights into intelligence, cognition, and emotional functions, though these ultimately proved to be among the fixed ideas of the period—following his training mentor Hoche—being scientifically questionable and regretfully promulgated alongside racist discourses and imprecise, speculative talk of degeneration and neurodegeneration. On the other hand, the book is hence highly revealing of the culture of the late Wilhelminian Empire on the eve of World War I.⁸² It contextualizes neurological practice even though the state of contemporary knowledge was quite demanding:

The reality of intellect, of self-determination, which even in its most primitive form represents essential characteristics of man, dooms to failure any breeding experiment of the usual type. However, if the relation of hereditary conditions aims not at specific characteristics but aspires to meliorate the human race by eliminating the unfit individuals, such endeavour presupposes a thorough knowledge of the significance of individual peculiarities for human natures. And who would venture any decision in this respect at the present state of research!⁸³

This strongly indicates that even the great holistic neurologist had paid tribute to the demands of contemporary social discourses on “weeding out the unfit” and “mobilizing” the bodies of the German people, on the cusp of the “Great War.” At the same time, Goldstein’s early embrace of eugenics—even if we subtract the influences of Hoche’s mentorship—can also be read as a concession to limited therapeutic options and neurological nihilism at a time when institutionalization, physical therapy, and electrophysiological applications were the only options for treating psychiatric and neurological patients.⁸⁴ Goldstein was quite explicit about this when he discussed sterilization of the mentally ill in relation to the passing in 1907 of sexual sterilization legislation in the state of Indiana: “Following the judgement of a committee of experts and members of the administration an improvement of the mental health condition of the patient cannot be anticipated. In order to prevent offspring from the patient, an operation should be performed, which is the most secure and effective [method].”⁸⁵

CONCLUSION

Rarely has the scholarship on eugenics history explored the fact that German-American émigré neurologist and rehabilitation specialist Kurt Goldstein had profoundly embraced eugenicist and racial-anthropological ideals, as found in his concise publication On Eugenics from 1913.⁸⁶ In this early work, Goldstein pondered, for example, the interdependencies of structural brain anomalies that have clinical neurological symptoms. With respect to On Eugenics, the argumentation becomes somewhat interwoven with elements from the “degeneration” and “exhaustion” discourse, which displays major cultural characteristics of Weimar medicine and science.⁸⁷ Among some of his other claims, Goldstein stated that “the relationship of hereditary conditions” points “not at specific characteristics, but aspires to meliorate the human race by eliminating the unfit individuals.”⁸⁸ With similar biologistic—and in many respects militaristic—formal rhetoric, he came to side with many ardent racial anthropologists and medical philosophers, as they embraced notions of the “hardening of the people’s body” or the “cleansing of the nation’s health system of useless patients.”⁸⁹

At the end of this chapter, we have now come full circle. Beginning with Goldstein’s socialization in the multicultural and open city of Breslau during the last decades of the German Empire, and having seen the emergence of his early interests in philosophy, medicine, and psychiatry, we see the first paradox: how this outstanding interdisciplinary scholar on brain injuries as well as the rehabilitation of psychic and motor disorders could become so drawn to the introduction and advocacy of strong and negative eugenic measures in the area of psychiatry.⁹⁰ In particular, Goldstein’s enthusiasm for the military—being an officer of the reserve himself—as a “character and nation building school” proved pivotal. His early enthusiasm for the military can thus be interpreted as a vital part of his own assimilation process into Wilhelminian society along with the larger process of en-culturing (kulturelle Einbindung) the bourgeois Jewry in Imperial Germany—which also led Goldstein to employ militaristic language and war metaphors in the context of social-Darwinist theorizing.⁹¹ Yet despite his early turn toward these nationalistic stances and ideologies, along with the rather direct influences of Hoche, his medical superior at the University of Freiburg and the central eugenics advocate in German psychiatry, there is another major element—as a second paradox—that combined Goldstein’s progressivism with the restrictive and drastic promotion of eugenics, as psychiatry faced the effects of therapeutic nihilism and hopelessness in the first two decades of the twentieth century, both in central Europe and in North America.⁹² This chapter has contextualized eugenics in German neuropsychiatry and wider psychological science, showing how more vigorous eugenic programs were abetted by emergent conceptualizations of brain structure and mental processes at work in the historical period and intellectual milieu under consideration.

Though much of this explanation would have to be based on the rather implicit statements that Goldstein made throughout On Eugenics, a change of direction nevertheless becomes noticeable with regard to his involvement with the partly successful treatment of the war injured by his multidisciplinary team at the Frankfurt Institute of Neurology after the First World War.⁹³ The respective approaches to physiological experimentation, clinical psychology, and early rehabilitation could flourish only in the particular cultural milieu of the liberal city of Frankfurt am Main.⁹⁴ In Frankfurt we see a contrast to the university settings in the cities of Breslau and Freiburg—the cities in which Goldstein’s eugenic thinking originated—with their garrisons, while the pressures of forced migration in Nazi Germany eventually came to destroy the Goldstein group’s enormous neurological, rehabilitational, and social medical potential.⁹⁵

Montefiore teaching hospital in the Bronx, New York.

The outcome of the reconstruction efforts undertaken by Goldstein at Columbia University and the academic Montefiore Hospital in the Bronx, New York (see Figure 7.2), in no way resembled the interdisciplinary research program that Goldstein had headed in Frankfurt and Berlin in Germany.⁹⁶ Moreover, the North American reception of the work occurred almost solely in specialized rehabilitation communities, with aphasiologists Gordon Allport (1897–1967) and Gardner Murphy (1895–1979), or with psychologists Abraham Maslow (1908–70) and Carl Rogers (1902–87).⁹⁷ As psychologist Hans-Lukas Teuber later recalled, “The incredibly rapid development of our field in the 50’s and 60’s [sic] of this century was bound to make Goldstein into an historical figure, seemingly before his time, but history has a curious way of reaching into the present and of replaying half-forgotten themes in the future.”⁹⁸

The narrative of this chapter does not attempt to relativize Goldstein’s holistic and humanist neurological theory; nevertheless, it seeks to emphasize the important overlap of core social progressivist beliefs and relics of medical traditionalism shared by many psychiatrists, social medical physicians, public health activists, and racial hygienists of the 1910s and 1920s in the German-speaking countries and also in the United States.⁹⁹ This second “paradox of eugenics”—as I have used the term above—haunted many social progressivists of that period. Many of these individualists shared eugenics ideals and were supportive of counselling, sexual segregation, and sterilization means. However, prominent scientists and intellectuals, such as Goldstein after his emigration to North America or Canadian social and health-care politician Tommy Douglas, eventually overthrew and discarded their earlier beliefs.¹⁰⁰ To the contrary, psychiatrists such as Ruedin completely endorsed eugenics and paved the way for the infamous medical context in Nazi Germany, while Ruedin’s own development could be traced from being politically a socialist in the 1910s and 1920s to becoming a National Socialist during the 1930s.¹⁰¹ Ruedin frankly called for the sterilization of so-called Ballastexistenzen (ballast lives) and prided himself not only on running the most extensive research program on psychiatric epidemiology at the time—based on the largest mental health database in the world, on which later applied eugenics programs could draw—but also for being one of the designated commentators on the Law for the Prevention of Hereditarily Diseased Offspring, together with West Prussian physician Arthur Guett (1891–1949) and Halle lawyer Falk Ruttke (1894–1955).¹⁰²

In considering Goldstein’s book On Eugenics in its wider social and cultural context, similar Canadian examples come into focus as well—Douglas’s position, for instance, or that of the “Famous Five.”¹⁰³ It is apparent that all of these intellectuals held very strong beliefs about social progressivism and reformism, which became paired with a parallel belief in technological utopias to reach these goals. More conservative—in the sense of psychological and psychiatric traditionalism—was the approach of John M. MacEachran (1878–1971), psychologist and chair of the Alberta Eugenics Board, whose promotion of biostatistics, advocacy for forced sterilization, and application of racist ideology could in many ways be compared with the position of Ruedin, the protagonist of psychiatric epidemiology and racial anthropology. This chapter has emphasized the ways in which eugenics discourse influenced psychiatric education and governmental policy as well as social attitudes through sterilization conceptions and research practices that are addressed in the introduction to this volume (see also chapter 1 on MacEachran and eugenics in Alberta).

Though many were rather indirect—through participation at international meetings, in the reading of international journals such as the Eugenics Review, and mediated through the American reception of forced sterilization—there were also more direct exchanges that brought Canadian eugenics advocates close to their German counterparts.¹⁰⁴ MacEachran, as an Ontario-born psychologist, had the distinction of being the only Canadian student of German experimental psychologist Wilhelm Wundt (1832–1920). While in Europe in 1909, MacEachran developed a hybrid interest in both philosophy and psychology while also subject to Wundt’s discussions, in his Grundzuege der physiologischen Psychologie, of Galton’s views on the inheritability of mental traits.¹⁰⁵ In addition, one Canadian neuroscientist came to study at Ruedin’s German Institute for Psychiatric Research in Munich: Ardrey W. Downs (1913–66), later head of the University of Alberta’s Department of Physiology and Pharmacology and outspoken critic of eastern European immigration to Canada, visited the German institute for one year, in 1928, to learn neuropharmacological techniques. Downs continued to publish papers on the biological basis of eugenics in relation to his major field, the autonomous nervous system control of bodily glands.¹⁰⁶

Nevertheless, despite the rise of Nazism in central Europe and the massive application of negative eugenics measures resulting in the dreadful mass murder of tens of thousands of mentally handicapped,¹⁰⁷ Goldstein himself remained understandably silent on the issue of eugenics after the end of World War I and embraced the early neurorehabilitation approach along with teaching self-adaptive skills to patients. He thus took a turn to the new therapeutic options to compensate for lost functions—whether mental or physical—as these became available through the interdisciplinary clinical work of his research group.¹⁰⁸ While in the 1920s Goldstein had not anticipated the inhumane and murderous scope of the “political philosophy” of National Socialism—which is often portrayed as having changed Douglas’s personal views on eugenics after a 1936 visit to the Third Reich—he later became a victim of the very same nationalist and racist ideologies that had accompanied German eugenics thought early on, ideologies that he had once deeply embraced himself and that now forced him to leave the site of his prolific neurological and rehabilitational work, in his home country, while being barely able to save his own life after the GeStapo entered his patient clinic in Berlin.

8 Too Little, Too Late Compensation for Victims of Coerced Sterilization