Anyone who is under psychiatric care, or loves someone who is, may want to read the book The Devil’s Castle: Nazi Eugenics, Euthanasia, and How Psychiatry’s Troubled History Reverberates Today, by Susanne Paola Antonetta. If you care about history, particularly the history of eugenics, you may be interested as well. The book may offer us more respect for the mind and its diversity.
What psychiatric history do you discuss in The Devil’s Castle?
I describe a euthanasia program in Germany that began in the late 1930s, in which the Nazis targeted people with mental diagnoses and built gas chambers into asylums to exterminate them. Nazi euthanasia targeted different disabilities, but the large majority of victims were adults with psychiatric disorders, like schizophrenia.
Euthanasia in Germany demonstrated how easily a group of people can be othered and targeted through the lens of disease. Jews became coded as ill, psychopathic vectors for bringing disease into the population—the language that condemned the neurodivergent would be extended to condemn others as well.
And how does psychiatry’s troubled history reverberate today?
It’s time to reconsider the influence of Emil Kraepelin on psychiatry, the German psychiatrist who promoted eugenic theories and trained some of the worst in the Nazi medical profession. The Diagnostic and Statistical Manual of Mental Disorders, or DSM, was created by a group of U.S. psychiatrists, many of whom called themselves “neo-Kraepelinians.” They embraced Kraepelin’s beliefs in a biologically based, brain disease model of mental illness, the same one used to isolate and dehumanize German citizens.
Can you describe Dorothea Buck, a major figure in your book?
In 2019, when I was having a psychotic episode, I discovered Dorothea Buck, Nazi survivor and author of On the Trail of the Morning Star: Psychosis as Self-Discovery. I am bipolar, and it wasn’t the first such episode, but a severe one. I took leave from work and became incredibly isolated. I was already on medication and got put on so much more that I was having trouble just walking and talking.
I kept feeling, during the whole period, that I was not ill in the sense of a biologically sick brain, as I was told. I knew I needed help, but not the kind of help I was getting. I knew I needed a completely different way to look at my own mind.
In this period, I happened to read two obituaries of Buck. Both mostly stressed her age (she died at 102) and her sterilization. Buck was a successful artist, though much of her work was lost in the post-war period. I found a foundry that still had a mold of one of her sculptures and got one cast for me. It’s so precious. Buck’s story is what we need right now; a large number of people in psychiatric care find it ineffective.
Can you speak about what has worked in mental health care through history?
In the late 1700s, French physician Philippe Pinel developed a system called the “moral treatment.” Pinel spent a great deal of time getting to know his patients and deeply respected them. He considered it essential that doctors understand patients’ “hopes and dreams.” It worked. Pinel cured patients who had been hospitalized for decades in the abusive, treatment-less asylums of the time.
In 1971, Loren Mosher, head of the schizophrenia project at the NIMH, experimented with elements of the moral treatment, among other modes. He called it “soteria,” and he treated psychotic patients with little or no medication, but with a lot of Pinel-like care. Soteria worked at least as well as the control group he studied, patients treated in hospitals with high-dose medication.
Dorothea Buck developed a method of care she called trialogue. Patients, family members, and clinicians met together, speaking openly and equally. Patients learned to manage, even avoid, their worst episodes. Some used medication contracts, so they could manage problem periods without fear of being over-medicated. Others discovered natural treatments, including sensory work, dialoging with their thoughts, and even herbal remedies.
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In our system, patients mostly see health professionals when they’re in crisis. Buck’s methods help people avoid reaching that point.
The book notes that neurodiversity can be transformational for society. How?
One of Dorothea Buck’s psychotic “delusions,” which she had in 1936, was that Hitler would go to war and the war would be terrible. This was treated as part of her schizophrenic “brain illness,” but of course, she was right. Another historical figure I write about, German judge and diagnosed schizophrenic Paul Schreber, had visions decades before the war and saw the coming deaths at the Sonnenstein asylum.
Schreber described his own condition as “unsound nerves,” but he wrote in his book Memoirs of My Nervous Illness that a person with sound nerves could often be “mentally blind.” What we call sanity, and personal insight and wisdom, aren’t the same things.
I’ve had this experience myself. Neurodiverse thinking uncovers truths that may be shut out from the more neurotypical. Maybe the neurodiverse have some filters off, or maybe the filters are just different. I don’t know.
It would be very healthy to, rather than automatically suppress minds that seem different, invite them to the table and unpack what’s going on. Doing so is transformative for patients—Buck proved this—and maybe it would be for those around them as well. One clinician wrote of his experience in trialogue that he learned psychosis could “say something about our relationship to reality, to the world in which we live.”
Philippe Pinel said of his French patients that their states stemmed from “a vivid sensitivity and from psychological qualities we value highly.” How might care change if we believed this?