The State of Health: Illness in Nazi Germany by Geoffrey Campbell Cocks (review)

In The State of Health, Cocks examines a set of compelling and interlocking themes in the social history of medicine and in the history of Nazi Germany. Principally, the book's subject is illness and health in the Third Reich, but Cocks also aims to contribute to the history of the modern self. This forthrightly interpretive work is not an attempt to treat any one topic exhaustively. It likely will, and indeed should, inspire further research.

Cocks begins by laying out some of his conceptual and historical starting points. Views of aging, illness, and death fundamentally shifted during the nineteenth century from a "pre-modern resignation" toward an increasingly medicalized "search for treatment and cure" (21). This change, he argues, brought a "preoccupation with . . . the newly medicalized body and mind of the self" (103), which was concomitant with the creation of a new subjectivity, grounded—as Cocks frequently asserts—in individuals' self-knowledge of their morbid, mortal, and sexual bodies. Cocks links this development to Germany's industrialization and unification—in short, its "modernization," which he finds to have been "peculiar in degree and kind" (4): "The social, economic, and political organization of material interests in modern Germany was a vital condition determining individual and social experience" (19). The corporatism of German society set the stage for this "peculiar" German modernity, one both productive of and at variance with the needs and dictates of the "individual self."

As the location of this self, the body was constantly challenged in Germany by illness, hunger, and death. But nothing made the fragility and mortality of human bodies more evident or more troubling than the technologized warfare of the years between 1914 and 1918. In Chapter 3, "The Body Politic," Cocks offers a fascinating, psychoanalytically inflected reading of Adolf Hitler's wartime experience of being gassed. That experience had powerful effects, laying bare how "questionable if not meaningless the cultural association of masculinity with will and power" became with the onset of industrial killing. Having experienced his own mortal weakness, Hitler spent the rest of his life projecting that frailty outward, and onto the "Other—as unfit und unworthy" (36)— with devastating consequences for Jews, handicapped persons, homosexuals, and other groups. At the same time, the Nazi state's "shrill and endlessly repeated insistence on health" touched almost everyone, terrifying the great along with the small (104). The State of Health is, in one sense, a portrait of social pathology as governmental form.

Yet the book does not always follow up on the methodological or substantive promise of Chapter 3. Many of the chapters take a less adventurous social-historical look at "the state of health" for various populations of Germans—women, workers, and soldiers. Drawing upon a considerable body of evidence, Cocks shows how profoundly unhealthy the Third Reich was not only for the explicit victims of the regime but also for many Germans who did not suffer persecution. Mental illness, nervousness, and depression resulted from the pressures to continue to work despite the war and the terror unleashed by Allied bombings. Germans also suffered from disease, a lack of adequate or proper food, and a lack of access to care and medicines. When they could get a doctor's appointment, they feared their doctors, feared being sterilized, and feared needing medication. They also feared pain, but they probably feared being weak, or being wounded, even more. At the same time, Cocks offers relatively little discussion of what illness (and health) meant to Germans, besides being a source of anxiety. Surely it is true that illness is a "negotiation of fact and discourse" (66), but the culture of sickness—of the meanings of health/illness, and what these looked, felt, smelled, and sounded like for Germans in the Third Reich—also deserves attention.

The central explanatory category of The State of Health is modernity, as embodied in particular state forms and economic relationships, which determined and produced the "individual self." Modernity...