By 1933, the golden days at Emmendingen had passed. The psychiatric system seemed to have fallen through a time warp, slipping back to the immediate postwar years, when food was short and costs were only ever cut. In the general economic emergency, with millions unemployed and mental illness spiking, many destitute families were unable to support relatives who needed care and were forced to send them to institutions. At the same time, budgets were being slashed, nurses laid off, and premises rented out or shut, leaving the asylums that survived overcrowded and understaffed. The more prestigious university clinics could at least argue for funding on the grounds that they would treat and discharge cases more rapidly than before, but this meant long-term-care establishments such as the Heil- und Pflegeanstalten, which housed “incurable” patients, suffered disproportionately. Here, the ambition was simply to spend as little as possible on keeping residents alive.
Whatever pittance was given over to psychiatric care, it was too much for the promoters of racial hygiene. In their rhetoric, Germany was being overwhelmed by a wave of useless individuals “unworthy of life,” and caring for such “ballast existences” was a luxury Germany couldn’t afford. Psychiatry congresses and academic journals recalled Binding and Hoche’s theories, and explored ways to eradicate the “less valuable” from society, but even some of the most hawkish party members recognized the difficulties “euthanasia” presented. There were legal and ethical challenges, and the reputation of psychiatry, never high, would be tarnished, possibly for good. There was a less radical option, however. Sterilization had been practiced legally in the United States since 1907, and by 1932 the debate around this draconian solution had advanced enough in Germany that the Prussian Health Council had drafted legislation to allow the neutering of certain genetically “defective” individuals, with the subject’s consent. In the chaotic political climate of that year, the Prussian law was never passed, but the following summer, as the Nazis moved to turn their racial ideology into government policy, they found the ground well prepared.
The Nazi belief that refashioning the race was an artistic enterprise for Hitler had been clear at least since 1931, when Goebbels had pronounced that “only under the hand of an artist can a people be shaped from the masses, and a nation from the people.” In 1933, a cartoonist for the rightwing Kladderadatsch magazine precisely captured this idea in a four-panel strip: A Jewish-looking artist is shown molding a squabbling mass of small figures from clay; Hitler moves in to smash it angrily with his fist, then reworks it into a towering Aryan Adonis. The caption reads: “The Sculptor of Germany.” Of course, the sculptor-Führer would need someone else to do the actual work, so he handed the project to his regular enforcer, the new interior minister, Wilhelm Frick. Barely four months into Hitler’s reign, Frick convened an “Expert Committee on Questions of Population and Racial Policy” to move the eugenic scheme forward. Frick appointed Schultze-Naumburg to the committee, where he would sit alongside the likes of Himmler and the race ideologues Walter Darré and Hans Günther, to advise on the all-important cultural aspects of the Nazi plan. As the architect had written, art made visible both the Volksgemeinschaft’s genetic health and its spiritual direction. It fell to art, therefore, to establish what the future race should look like, to define the Zielbild, the target image of the pure-blooded supermen who would deliver German salvation.
Every lever of the totalitarian state was thrown into the resculpting project: political speeches, films, posters, magazines, newspapers, and radio. Exhortations for racial hygiene were pushed out on all channels, demonizing Jews, Bolsheviks, and the Weimar Republic, and promoting the spectre of degeneracy. Rassenkunde, or racial science, became an essential part of the newly militarized school curriculum, and laws were introduced forbidding marriage between Jews and Aryans. But the first piece of race legislation was aimed at those Hitler had described in Mein Kampf as “whoever is not bodily and mentally healthy and worthy”: the country’s psychiatric patients and the disabled.
Frick set out the committee’s aims at their first meeting, in June. He explained that while the country was being swamped by large numbers of immigrant Jews, Germany had seen its birth rate decline and its population age. The result, he said, was a huge rise in “degenerate” offspring. At least 500,000 Germans exhibited genetic defects, and there were probably many more: Some experts considered the true figure to be around 13 million, or 20 percent of the German population. Caring for the “asocial, inferior, and hopelessly genetically diseased” was a drain on the exchequer, he said. They needed a population policy that would eliminate these threats to the health of the Volk.
The committee quickly produced the “Law for the Prevention of Genetically Diseased Offspring,” which Hitler passed on July 14. The legislation was based on the Prussian government’s draft from 1932, but with one crucial difference: The new version stipulated that those it targeted could be forcibly sterilized. Nine categories of supposed hereditary afflictions were listed: congenital feeblemindedness, schizophrenia, manic-depressive psychosis, hereditary epilepsy, Huntington’s chorea, hereditary blindness, hereditary deafness, severe hereditary physical deformity, and alcoholism. Applications for sterilization could be made either by people with these conditions or by doctors, psychiatrists, and directors of hospitals, nursing homes, and prisons. Cases were to be decided by a network of “hereditary health courts,” each made up of a judge and two physicians; the presence of the candidate was not deemed necessary at these hearings. The procedures would take the form of vasectomies for men and tubal ligations for women. If a subject refused, the police were empowered to use force to bring them to the operating table.
The law came into effect on January 1, 1934, and quickly led to a rush of referrals: 388,400 in 1934–1935 alone, almost three-quarters of which came from the medical profession. The hereditary health courts were overloaded: They processed 259,051 cases in the following three years, and in more than 90 percent of cases they ruled in favor of the procedure. Over the duration of the Third Reich, doctors would sterilize around 400,000 people, most of whom were judged to be “feebleminded,” schizophrenic, or epileptic, though the categories were vague enough to sweep up large numbers of people who were simply regarded as antisocial and had no risk of passing on their “defects”: moderate drinkers, reformed abstainers, criminals. Complications caused by the operations would kill hundreds of people, mostly women, as their procedure was more invasive. Many found the process traumatic, with some of the most vulnerable individuals attempting suicide rather than face the surgeon. One man was so scared he tried to castrate himself with a bread knife.
Wilhelm Werner, a patient in the Werneck asylum in Bavaria, documented his own sterilization in more than forty pencil drawings that are now in the Prinzhorn collection. He may have been deaf or autistic, but in 1919, at the age of twenty-one, he was given the diagnosis of “idiocy,” the lowest form of “congenital feeblemindedness,” which in the thinking of the time meant he would only ever reach the intellectual development of a toddler. In 1934, a new director arrived at Werneck who diligently implemented the Law for the Prevention of Genetically Diseased Offspring, overseeing the sterilization of 284 of the asylum’s inmates.
Werner had no artistic training, but he developed a sophisticated cartoonist’s style, which gives the lie to his diagnosis. He drew marionette-like figures who enacted a series of humiliating medical procedures in a Punch and Judy–style pageant. Like other Prinzhorn artists, he was fascinated by mechanisms, showing whole pages of terrifying medical tools and implements: syringes, drips, saws, catheters, gauges, and strange and sinister machines. He depicted himself as a friendly but passive clown, sometimes in a dunce’s cap. Stripped naked in the drawings, he submits meekly as his genitals are manipulated or pulled out with sharp hooks by scowling nurses wearing swastika armbands. Some of his cartoons show an expensively dressed man with a monocle, a mustache, and a bow tie: This is “Director Weinzierl,” Werner tells us, a reference to the chief surgeon of a hospital where many sterilizations took place. Another drawing shows patients sitting on a double-decker Nazi propaganda bus. A banner along the side reads “Sterelation”—Werner’s own word for the procedure. A nurse sits on the roof of the bus with a gramophone and a plate bearing two testicles, while people are shown smoking and chatting on the lower deck: such is the new normal in Germany, the artist seems to say.
Werner is the only victim known to have recorded the procedure visually. His pathos-filled drawings capture the helplessness and bafflement hundreds of thousands must have felt in the hands of the medical practitioners who robbed them of their fertility.
The hereditary health court for the town of Emmendingen ordered 216 sterilizations in 1934, mostly on inpatients at the asylum, and by 1939, doctors would operate on 2,500 people in the local area. Bühler, who was in his early seventies, was probably too old and isolated to be targeted, but a rare correspondence at the end of 1935 gives us a glimpse of the precariousness of his situation. His father had passed away some years before, and the courts had made him the ward of an Offenburg councilor, Ferdinand Friedmann. Friedmann’s role came with few responsibilities, it seems, since after the councilor’s death in 1931 the city didn’t bother to replace him until November 1935. The new guardian, Wilfried Seitz, at least showed some interest, because the following month Emmendingen’s director, Viktor Mathes, wrote him a brief note explaining Bühler’s situation:
Franz Karl Bühler has been in the local institution since April 17, 1900. Since the death of his parents, no relatives have cared for him. His board is paid for by Freiburg County Council.
Any inheritance that had come to Bühler, in other words, had already been spent on his care; his living costs were now paid by the state, and the only person with an interest in his welfare was Seitz, a civil servant who likely had never met him. This was a dangerous situation in Nazi Germany.
Two years later, another exchange of letters sheds light on Bühler’s growing peril. In 1936, the regime launched a program to create a database of genetic information on everyone in the Reich. Psychiatric institutions were ordered to sweep their geographic catchment areas for the relatives of those designated erbkrank (genetically ill) in the expectation of finding more “defective people” to send before the sterilization courts. Eugenicist doctors and psychiatrists prioritized this “weeding out” over medical care, and the quality of treatment plummeted, particularly in outpatient departments. Hermann Pfannmüller, who ran the outpatient provision at Kaufbeuren-Irsee, saw it as an excuse to pick up anyone he disapproved of from the lower echelons of society, including “asocial drinkers, grumblers, refractory parasites and work-shy psychopaths,” and send them either to concentration camps or for sterilization. Local administrators would refer vulnerable but perfectly healthy individuals to Pfannmüller, including single mothers and illegitimate children, to save the cost of their care.
As a schizophrenic inpatient designated erbkrank, Bühler was a person of interest to this new racial offensive. On October 19, 1937, Dr. Mathes wrote to Seitz in Offenburg requesting personal details about Bühler’s relatives, “for the purposes of hereditary biology”:
It would be of particular interest to me to find out whether members of [Bühler’s] family were sick with illness or were housed in an institution (health and nursing home, district nursing home, correctional center, penal institution, etc.), or if there was any known mental disorder, drunkenness, neglect, antisocial behavior in the family.
The asylum director enclosed a “genetic inventory” questionnaire. Seitz was to note any relevant details and then return the form to Emmendingen. There is no evidence that Seitz did this; he may have struggled to find other close family members to report. In any case, he was transferred away from Offenburg the following month, leaving the question of Bühler’s guardianship open once again. Town officials noted that the patient was now seventy-three and had no assets. They advised that the role “be taken over by the local office, so that larger administrative work does not develop.” Cost, once again, was paramount.