Wednesday, December 04, 2013

Guest Blogger Dr. Ronald Chase on Historical Misuses of Psychiatry

Dr. Ronald Chase is the author of  Schizophrenia: A Brother Finds Answers in Biological Science.   Today, he joins us as a guest blogger to talk about his recent trip to Heidelberg and the atrocities committed by the Nazis under the guise of psychiatry and a reminder for all of the things psychiatry should not be.  Dr. Chase is a biologist who taught neurobiology at McGill and now writes about mental illness.  As per the title of his book, the topic can be very personal.  

A Memorial is a Reminder


To research a book I am writing about the 19th century origins of modern psychiatry, I recently traveled to Heidelberg, Germany. I wanted to see the clinic where Emil Kraepelin and other influential psychiatrists had worked. I met up with Dr. Maike Rotzoll, a psychiatrist and historian who had been a psychiatric resident at the same clinic. She kindly agreed to show me around. As we approached the stately old clinic building, she suddenly turned from the beckoning entry and led me to a small enclosure just opposite. There, surrounded by a ring of small trees, stood a monument. “I want you to see this,” said Dr. Rotzoll.

It is a circular structure made of local sandstone and measuring about 10 feet in diameter. On its topside is an inscription which reads (in translation), “In memory of the victims — for us an admonition. We lament these 21 children, patients of the Psychiatric Clinic of the University of Heidelberg, killed in the name of criminal medical research in 1944.” All around the sides of the memorial are written the names of the murdered children. 

            Dr. Rotzoll explained that the children were killed by Nazis acting under the infamous Aktion T4 program of eugenics and euthanasia. Carl Schneider, then Director of the Psychiatric Clinic, was an active participant. Some contemporaries described Schneider as empathetic and enthusiastic about psychiatric rehabilitation, but he ordered these children killed to further the cause of what he called “National Therapy”. He collected their brains for histopathological research. Altogether, the Nazi euthanasia programs killed an estimated 200,000 persons with mental or physical handicaps, of whom 70,000 were psychiatric patients and 5,000 children.

            Although I learned a lot about late 19th century psychiatry while in Heidelberg, and I found the city beautiful, the thought of those 21 children weighs heavily on my memory. On the one hand, it is reassuring to know that post-war Germans are driven to express their horror and regret about what was done. On the other hand, it leads me to reflect on the dangers lurking even now for all of us. How was it that an institution that had hosted such distinguished psychiatrists as Franz Nissl, Emil Kraepelin, Alois Alzheimer, Karl Jaspers, and Hans Prinzhorn could have become involved in such terrible acts? Clearly, many medical professionals, among whom Carl Schneider, failed to see ethical implications in the prevailing social-political agenda, or their vision was blunted. It’s something to bear in mind as we read of American doctors assisting in the interrogation of prisoners detained as part of the war against terrorism. Especially worrisome is the recent report written by two psychiatrists detailing cases of complicity in the torture of prisoners at Guantanamo and other centers.

            I thank Maike Rotzoll for her contributions to this post.


Ronald Chase is an emeritus professor of biology at McGill University. His book combines, in alternating chapters, a 50-year memoir of his intellectually gifted older brother and an accessible explanation of the science related to schizophrenia.

31 comments:

Dinah said...

A thought-provoking post. Clearly, being a psychiatrist, a doctor, a political or religious leader, a teacher or a coach, does not preclude that any individual may also be evil. I was a bit sad that others who had nothing to do the Nazis or Carl Schneider were even mentioned in the post -- they don't deserve the association in even the loosest of formats.


AnonAnon said...

:( I think doctors have every right to refuse participation in torture, murder, etc and I hope that they exercise that right.

Hank Matthews said...

For a more detailed account of psychiatrists' involvement in the mass killings of the Nazi era, watch the documentary "The Age of Fear" at www.cchr.org.

Anonymous said...

Another historical misuse (or abuse rather) of psychiatry is the Dan Markingson case. Appalling how someone could be threatened with a state hospital unless they join a clinical trial the doctor is profiting from. Hard to believe stuff like this happens.

Pseudo-Kristen

Anonymous said...

P-K,

Thank you for mentioning the Markingson case. And according to Carl Elliott, a psychiatrist who has put his career at great risk to speak out against this situation, this is not an isolated incident.

But yet, this doesn't get the attention on any psychiatry blog which is a big mystery to me.

There are many other examples of abuse in psychiatry I could mention that has nothing to do with being antipsychiatry which some would sadly use as a response. Google Justine Pelletier.

Can these be compared to the Nazi era? Technically no. But this feels to me like saying that being killed by lethal injection is better than being shot to death.

In summary, I realize there are many kind and thoughtful psychiatrists. But when there continue to be so many horrific situations of abuse currently that no one seems to give a darn about, writing about the Nazi era of psychiatry doesn't do it for me.

AA

Anonymous said...

In the previous post, I should have said that the Markinson case doesn't get the attention of most psychiatry blogs. Just remember that the boringoldman blog has done a great job of covering it.

AA

jesse said...

I have a somewhat different view on this, and not just due to my reluctance to talk about what is wrong with "psychiatry" rather than on specific issues and ways of thinking.

To me, the issue with the nazis, or the doctors helping with waterboarding, is that individuals became more committed to the advancement of their own field to the extent that they lost sight of the ends they were serving. The ultimate example of this would be developing a nuclear bomb for Hitler, focussing on whether it will work rather than that it will work over New York (or the V2 over London).

People are capable of this blindness, and we would like to think being a physician protects us from this, or being a priest, or an academic, but sadly we all are subject to the seduction of idealogy and profit.

Rather than castigate the Germans, who indeed have faced how their great society allowed Evil to triumph, we need to look at our own society and ourselves, a much more difficult task than to focus on "psychiatry" as if the problem is within a profession.

Dinah said...

Jesse -- nicely said.

t

Anonymous said...

I hold those who behave unethically responsible rather than psychiatry as a whole.

I mention the Markingson case here because the Nuremberg Code governing informed consent came out of the atrocities committed by the Nazis. It's supposed to protect us, and unfortunately, it's not enough.

I think psychiatry as a profession can and should do something, though, about the not uncommon practice of obtaining informed consent for a "voluntary" hospitalization when the patient has already said no. While the intent may be well intentioned, a patient should not be signing consent under duress or threat of force, and many times they are. The person obtaining informed consent through threat of force is behaving unethically, and they alone are responsible for their behavior. Not the profession.

Those involved in obtaining informed consent (in all areas of medicine) should heed the Nuremberg Code. The Nuremberg Code "establishes that the individual should “have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision.” It's there for a reason.

Pseudo-Kristen

Liz said...

the foster care system is another area in which psychiatry is abusive so much of the time. foster parents get paid a significantly higher per diem for caring for mentally ill children, so they have a strong incentive to take mentally well kids who are under enormous stress to the psychiatrist to get medication, regardless of true need. it's terrible.

Anonymous said...

I don't think it's psychiatry that's to blame when unethical conduct occurs. I think people who behave unethically are responsible for their own behavior. I think the reason we see some of these things happening in psychiatry is more due to the vulnerability of the patients involved, and perhaps they should take the lead in trying to solve some of these problems. Vulnerable people need more protection.

With foster children, they need to take away any financial incentive for having a child diagnosed with mental illness. Instead of providing more money to the foster family, why don't they create an account similar to an HSA. I cannot spend my HSA savings on whatever I want. I have to spend it on medical care, medications, etc. They don't just hand me a check and "trust" that I use the money on health care, rather than using it to redecorate my living room. It wouldn't solve everything, but would remove the financial incentive.

In the situation where patients are signing informed consent for "voluntary" hospitalization under threat, which is not informed consent, then, we provide disincentives for them to behave unethically. Conversely, we make it easier for them to do the right thing. We need increased oversight for patients in these situations. Bring in an outside party to serve as a witness to the informed consent process to ensure that it is being conducted in line with the Nuremberg Code. Take away the ability for those who use threats to get patients to sign informed consent to rationalize unethical behavior.

Pseudo-Kristen

jesse said...

@P-K, Amen, amen, amen.

The solution is to hone laws and regulations in a way that not only encourages ethical behavior but removes incentives for unethical behavior. There was yesterday a NYTimes article which calls for companies not using auditors who are their own employees. Police should not get a cut from the fines they bring in. The IRS does not get a cut from the extra revenue they collect.

One of the problems (and I don't have an answer to it) to urging a person to sign a voluntary to avoid an involuntary commitment is that signing the voluntary might be the much preferable thing, or it might be abuse.

Prosecutors often use the fact that a conviction can bring a life sentence to get an accused person to admit to the charge and therefore receive "only" ten years. This can be terribly abused, but it can also be the fact of the legal system. The accused's understanding of that fact can be perfect, yet he might still admit guilt to a crime he did not commit.

There is no perfect solution: we should work to find it but need to realize human nature makes a definitive solution illusory.

Dinah said...

This is really an aside to the topic of evil, and on a completely different level than the horrors of a Nazi psychiatrist killing children, but I thought of this post and the comments tonight while I was watching a hockey game. A hockey game you ask, why? What could hockey have to do with evil?

Well, we have our cultures and belief systems and our actions are judge within the context of those. Somehow, people bought in to the culture of the Nazis, or if they didn't, some bought into the culture of self-preservation and the idea that if they didn't follow orders and collude with the horrors, they were in grave danger.

So the Bruins were playing the Penguins, and the culture of hockey is that fighting is allowed with certain rules within the context of the game, it's what the players do and the culture allows this. So one player grabs another, throws him to the ground, and brutally and repeatedly punches him in the head. The player on the ground is knocked out, taken off the ice on a stretcher completely unconscious. This was act was not part of the active play, but an aside.

The announcer somehow faulted the guy who had been knocked out-- something about how he should have fought someone earlier in the game. Twitter was a buzz with how the assailant should be suspended. It's now been announced that he will have an in-person hearing with the National Hockey league which will allow for a suspension greater than 6 games.

One man brutally assaults another, grabs him and punches him repeatedly in the head to the point that he goes unconscious, on television, and the talk is of not allowing him to play a game for a while because clearly, tis was outside of the standards for fighting that hockey permits. No where have I seen anyone question whether criminal charges should be pressed against the player who beat the other player. What is wrong with us? How can we tolerate such behavior in any context???

jesse said...

@Dinah, your example is brilliant. That is exactly what happened. There is a blindness that occurs in the group context, people buy into it. It is exacerbated by numbers of factors: wearing a uniform, following orders, etc. there are near infinite rationalizations for the action.

In another place you mention that no one comes into the office and complains to us about sadism. No, but we see it in the way a patient describes his actions to others and in the way he treats us. It does not have to be grabbing another's head and bashing it, but acting in a way that causes another pain, discomfort, or using one's power to force another person to do something he or she clearly does not want to do or have done to him. It takes many forms. It can even be expressed by bringing something up at the end of a session that forces the doctor to extend the hour beyond what the patient knows is the time allotted. There is no simple formula.

So the Nazi functionary did not go into his psychiatrist and say he was concerned because he was sadistic, he said he was just following orders. That rationalization may have allowed him to sleep well.

I do not think this occurs every time there is forced hospitalization, because there may be true altruistic reasons for it, but it is possible that the people who suffered the most from such hospitalizations were hurt more from the sadism that was being acted-out and rationalized to them as "in their interest" than they were from simply having to be in the hospital. Passive-aggressive actions are often loaded with sadism: just think of Nurse Ratched in One Flew Over the Cuckoo's Nest.

In therapy we try to find ways for people to become aware of the feelings behind their own actions and impulses. We do not hit them on the head with them.



Anonymous said...

Regarding the statement: "One of the problems (and I don't have an answer to it) to urging a person to sign a voluntary to avoid an involuntary commitment is that signing the voluntary might be the much preferable thing, or it might be abuse."

I think that rationalizing it's okay to do this because it might be the preferable thing is a dangerous road to go down. If this is allowed, then why not allow this for other doctors? For example, the oncologist decides that it's the preferable thing to get them to join her clinical trial (e.g. we've had great results!), so it's okay that I told them that if they didn't sign the document I would put them on the clinical trial anyway. Or...you need your leg amputated, and if you don't sign this consent we're going to amputate it anyway. Would that be informed consent? I would argue the answer is no. I think if you don't have informed consent, you don't treat the patient as a voluntary patient despite the fact that it might be preferable (preferable for whom is another debate).

When patients are threatened to sign informed consent, they know that what is happening is shady. They know it's not right. I didn't know the first thing about the Nuremberg Code at the time, but I knew what they were doing was wrong. After all, where else is it ok to threaten someone to sign a piece of paper? It's just not okay. It creates additional fear because the patient wonders if the doctor will do this, what else will he do? Where else will the doctor bend the rules to suit his purposes?

I read a journal article about this topic a while back, I don't remember the name of it or who wrote it. But, the argument was that it's a fine line, but it's okay to threaten someone with involuntary hospitalization to get them to sign in as voluntary because you're just providing necessary information. That's rationalization of unethical behavior. Well intentioned, yes, but still wrong. I think if informed consent cannot be obtained (i.e. you cannot get the signature without threatening to do something to them against their will) you don't get the patient to sign. You treat them involuntarily. At least in that situation the patient has legal protections.

I'm going to stay away from the argument about the prosecutor, because I don't know the first thing about the legal system and would be in waaaaay over my head.

I love these type of discussions.

Pseudo-Kristen

Anonymous said...

I should have said,

You treat them involuntarily - IF they meet the criteria.

Joel Hassman, MD said...

To me, it really comes down to the corruptions that power and money inherently create in our species. We seem to crave pleasure and bliss, irregardless of what happens to those around us, and just how did we lose track of respecting and protecting the herd?

Again, to me, it has been a troublesome combination of what the Boomer generation has wrought these past 25 plus years, plus what technology by the net and cell phones has reinforced the self mentality. I mean, really, "Selfies", who even thinks up these term!?

And yes, the poor choices and agendas of human nature has been corrupt before these past 25 plus years, but, hasn't the debauchery and lack of accountability increased near logarithmically of late?

But, for those of you in the profession, the adage "silence is death" persists onward! Especially the silence with what Obamacare will create in health care, psychiatry more specifically. I know, I am ranting now, my bad!

jesse said...

@P-K, you are making strong points. The issue of informed consent is important. The situations I was considering are different: the patient (or accused person) has met all of the criteria for certain action, and the doctor (or prosecutor) is giving a choice. The person completely understands the choice, and the doctor can go either way.

For instance, I would never offer a patient who cannot understand what is occurring the chance to sign a voluntary, but what about the person who made an overdose, is completely alert and the staff is concerned about his safety. Two psychiatrists agree he could well be a danger to himself if he leaves the emergency room. He meets criteria for an involuntary. The doctor explains this to the patient, and says that for his safety they cannot let him leave. The doctor says that if the patient decides to be a voluntary patient that would be in his long term interest. The patient thoroughly understands and is being offered a choice.

This is what happens, I believe, in the majority of cases. It would not be right for the doctors to think, "Ah, this patient meets criteria for involuntary, so we should not explain the situation and offer a voluntary, which he is completely capable of understanding and accepting.

The legal situation, just like the medical, can be subject to abuse. The prosecutor may think that the subject could get life, or know full well that it would be very unlikely. The subject has not even been charged. But the prosecutor tells him that if he does not agree to a lesser charge (which may not be provable) he will charge him with the more serious crimes that carry a mandatory life sentence.

Very much in psychiatry is not black and white. Decisions are made on symptoms and history that may not be certain. I can say proudly, however, that in all my years in practice the vast majority of psychiatrists I've met have been ethical and tried very hard to do what was best for the patient, not what was best for their own interest.

Ronald Chase said...

To my mind, the whole concept of "evil" people is wrong. It implies some kind of tarnish, a religiously flavored blanket condemnation. Yes, some people, some psychiatrists, sometimes do unethical things, but evil is an obsolete term. It went out with the last edition of the bible.

Anonymous said...

Jesse, thanks for debating this with me.

The problem with the example you gave is that informed consent was not obtained. Informed consent requires the ability to say "no" to the choices. Per the Nuremberg Code it cannot be done with threat of force. There is no saying "no" in the case you describe. The patient will be hospitalized against her will. There is no informed consent when a patient said no to hospitalization and signs consent under threat.

This is like someone holding a gun to my head and saying, "If you don't agree to sign this paper then I will shoot you in the head. If you do sign the paper and agree to be shot in the leg, then that's what will happen instead." Guess what I would do? I would sign the paper. Did I consent to being shot in the leg? No, I didn't agree to being shot at all. I didn't want to be shot and said so. I was threatened into signing.

I get that those who coerce and/or threaten patients into signing in as a voluntary patient are well meaning and believe they have the patient's best interests at heart, but it doesn't change the fact that they did not obtain informed consent from the patient who said she did not want to be hospitalized.

Maybe they should call it something else, but they should not call it "voluntary." Voluntary means you agree to the plan, and many do not. They should also not call it informed consent, because it's not informed consent. It's not in line with what the Nuremberg Code requires, i.e. lack of force, etc.

P-K

Anonymous said...

"It would not be right for the doctors to think, "Ah, this patient meets criteria for involuntary, so we should not explain the situation and offer a voluntary, which he is completely capable of understanding and accepting."

Informed consent cannot happen in this case. It just cannot. The person cannot say "no" to hospitalization. They will be hospitalized regardless.

P-K

jesse said...

P-K, I think you understand it correctly, and the problem is in the nomenclature. We have a category of admission which is called "voluntary" and that category fits most hospital admissions. We also have a category in which a patient is admitted psychiatrically on certificates, "involuntarily," in which there is no intimation whatsoever that the patient has a choice.

So, yes, when an examining doctor tells the patient that she meets the criteria for "involuntary" (assuming this is completely accurate and correct) and offers a "voluntary" admission she cannot say, "well then, if we are calling it voluntary I am walking out." It is a misnomer, but it is offered because it is in the patient's long-term interest most often to be placed in that category.

Imagine the opposite: the patient has made an overdose and quite willingly wishes to sign into the hospital, but the admitting doctor says, "No, because you meet the criteria for certificates to be signed I am not going to let you sign a voluntary, because I know that you realize you will be admitted anyway, so it would not really be completely your free will. So I am not going to offer that to you even though we both know it is in your interest. You meet the criteria for involuntary so I and a colleague are going to sign those certificates."

Dinah said...

Gosh, we've gone astray. Having said that, I don't think it's unethical for a psychiatrist to coerce a patient to sign in voluntarily -- I agree with Jesse that this is in the patient's best interest, even if the "voluntary" status is felt by the patient to be coerced, it still alters many interactions with the treatment team so that it is a less adversarial relationship. So "sign in voluntarily or I will certify you" is simply the truth. The law in our state requires that the patient be offered voluntary admission and the doc must sign off that the patient was either unwilling or unable to enter voluntarily. What isn't ethical is to lie to a patient, to say that if they don't sign in the doctor will certify them when they don't meet criteria (in our state: being both mentally ill and dangerous), when the doctor has no intention of certifying the patient and if the patient does not sign in, the doc ultimately lets them leave.

But P-K and Jesse are right: in these coerced cases, there is no choice so "voluntary" is a legal designation, not necessarily a semantic one.

Many of the patients who are certified decide to voluntarily sign in before they get to a hearing. And a "voluntary" patient may have signed in from the ER, gotten to the floor, put in a request to leave, and the floor docs then have 72 hours to decide whether to alter the status to involuntary or to let the patient leave. If it becomes clear that the patient poses no danger, they often allow the patient to leave before the 72 hours are up. Remember, the pressure is on doctors to have the shortest possible length of stay, a situation which may cause it's own ethical issues.

Anonymous said...

Jesse, you're right part of my issue is with nomenclature, i.e. calling it voluntary when it's not, but the bigger issue I have is with pretending like informed consent has been obtained when it clearly has not. That's dishonest.

Disclosure - In the past (I don't any longer) I worked on multiple clinical trials. I took informed consent very seriously. If there was even a hint that the person did not agree with what was going on, they did not sign. We did not pretend we had consent when we did not. As we were told, informed consent is more than a signature on a piece of paper.

What you have in a "voluntary" psychiatric admission when the patient has signed under threat is a signature on a piece of paper. If the doctor does not follow the Nuremberg Code in obtaining consent, they do not have consent. So, why pretend like this patient has consented to hospitalization? That's dishonest, and I believe, unethical. Is it legal, maybe, but if informed consent is required for a hospitalization to be "voluntary," then looks like they ought to really obtain it?

Pseudo-Kristen

Anonymous said...

Sorry, Dinah for going so far off on a tangent.

Back to the topic - I read the author's book the other day and it was really interesting. I liked the mix of science with the personal story.

P-K

Ronald Chase said...


Thanks, P-K. I'm glad you liked my book!

Je Suis said...

"I don't think it's unethical for a psychiatrist to coerce a patient to sign in voluntarily -- I agree with Jesse that this is in the patient's best interest"

It's amazing to me that mental health professionals always know what is in the patients best interest, even if they have never met said patient before. No, what's really meant here is "in their best interests according to my belief system, and whether it conforms to the patients reality is unimportant". This is a very solipsistic point of view, and one that is forced upon a patient regardless of the reality of the situation. After all, from the patients perspective, the world does revolve around you, in a way, since their desires have been suborned by yours.

Let's examine some similar circumstances and see where it leads us, though: given the push for gun control, and the seemingly endless assaults, robberies, home invasions, and other violent crimes occurring daily, it would seem to be in everyone's best interest to know how to defend themselves. Now, let's assume that I am a martial arts instructor, and I teach full contact MMA- style fighting skills. Would you be OK with me forcing you to learn what I have to teach? Even if it involved my attacking you, repeatedly if necessary, in order to force you to fight back - all so that you learn to defend yourself properly? After all, this is clearly in your best interests, I'm trying to give you the skills to save yourself (sound familiar?). Are you OK with my forcing you to spar with me repeatedly, enduring the beatings until you become proficient enough to stand your ground (this can take years, and can cause injuries, by the way)? Why or why not? You cannot use the issue of force, or injury, as a defense, since both of these things occur in your interactions with the mentally ill - what is arrest and imprisonment (and that's what it really is when you take someone against their will and lock them in a facility designed to prevent their exit), as well as injections and restraints, if not force? What do you call it when a mentally ill individual is tasered, or shot, or beaten (sometimes to death) by the police if not injury? And all of this is in their best interests, of course..

So, should I, the hypothetical MMA instructor, be able to force my ideals upon someone who is unwilling to endure the hardships inherent with the training? For their own good? And force them to pay me for the lessons, as well?


Also, "Many of the patients who are certified decide to voluntarily sign in before they get to a hearing" - of course they do, nobody trusts the courts in that situation. The mentally ill is already condemned, a professional has said so, and the courts are rarely interested in what the victim (sorry, patient) has to say in the matter. It's a somewhat weak argument in support of coercion.

One more thing: "floor docs then have 72 hours to decide whether to alter the status to involuntary or to let the patient leave" - not where I work. I have seen a "72 hour hold" run out of time and the papers refiled at least once and sometimes several times on a patient in order to keep them against their will. This has happened more than once that I am aware of. No hearing, just repeated 72 hour holds back to back - in other words, the patient can be held involuntarily and indefinitely it would seem. This may not be the intent of the law, or strictly legal even, but it is being done.

Anonymous said...

Mr. Chase, thank you for responding, and I'm sorry I kind of derailed your thread. In case you haven't noticed I can get a little passionate about things.

One of the things that I noticed as I read your book is that you really tried to understand what it was like for your brother, and you reached out to him. I think both of those things are so important to people who are suffering. I thought of the famous quote by Mother Teresa - "One of the greatest diseases is to be nobody to anybody."

Your brother wasn't nobody to anybody. He was a beloved brother, son, a person who loved literature, he was witty, had an amazing memory, and so much more.

As I read I was reminded of the times my own family reached out to me when things were really bad. I think of a time my dad rang the doorbell of my apartment, and I didn't let him in because I knew if he saw the conditions of myself and my apartment I would probably be hospitalized. And, even though at that time I couldn't respond or reach back, I was glad he came. I know your brother knew he was loved.

Thank you for sharing your family's story.

P-K

Ronald Chase said...

P-K, you write eloquently about the feelings of persons with mental illness or even persons just awkward or retiring. As for my relationship with Jim, my brother described in the book, I certainly did treat him as a person. It's love, I suppose. If I was able to convey that attitude in the book, I will consider myself successful.

I really like your beautiful quote from Mother Teresa, "One of the greatest diseases is to be nobody to anybody."

a psychiatrist who learned from veterans said...

Five Germanys I Have Known by Fritz Stern is partly written in response to the question of how the Nazi period came to be. The question lingers. Various factors are discussed. I wonder if it isn't useful in considering this issue to have lived inside a cultural shift; such a thing happened in the late 60's. There was the suppression of leftist viewpoints in the 50s, the discovery of the pill, the real price of the 'pay any price' anticommunism for a generation raised in part according to the doctrine of tell the child why. Suddenly there was a change; ultimately I think because the youth wanted to go there reorganizing the factors just mentioned. This was like a reorganization of chromosomes in a punctuated equilibrium. Ultimately I think German society wanted to go to the Nazi period out of previous factors in a similar way as a punctuated cultural equilibrium.

jesse said...

@apwlfv: thank you for reminding us to look below the surface in order to see the forces beneath it. A "cultural shift" is a helpful concept. There must always be anxieties, fears, and other strong emotions below the surface that influence the conscious beliefs but don't necessarily want to be identified. We are often blind to the real motives and influences behind what we do.