Nurses in Nazi Germany: Moral Choice in History (review)

Bronwyn Rebekah McFarland-Icke. Nurses in Nazi Germany: Moral Choice in History. Princeton: Princeton University Press, 1999. xvii + 343 pp. $35.00; £21.95 (0-691-00665-2).

I enjoyed reading this book, which in some ways reminded me of Michel Foucault's Birth of the Clinic (1973). But immediately a concern cropped up: although the book is entitled "Nurses in Nazi Germany," it covers only psychiatric nurses, and it devotes more than one-third of its text to the period before the Third Reich--so when the author correctly observes that "nurses remain a relatively understudied group in the history of medicine" (p. ix), does this apply to all nurses? I would argue that it does. Thus Bronwyn Rebekah McFarland-Icke proves enlightening when she seems to make sociohistorical points about nurses in general, such as that women nurses came to prominence as an occupational group when male nurses were called to the front in World War I, or that the subsequent beginnings of the Weimar Republic afforded all nurses better pay and social security and altogether more public esteem (such as it was). Yet other questions remain: What about the restrictions applied to young female resident nurses in mental institutions as described here--do these parallel the oppression that resident assistant physicians (Assistenzärzte) had to suffer at the hands of their Chefärzte in ordinary hospitals, as Ferdinand Sauerbruch and others have reminisced? ¹ There is also the issue of training and social prestige vis-à-vis general nurses; when the author tells us that psychiatric nurses by about 1930 had only elementary education, does this imply that other nurses did not? At the same time, she says that psychiatric nursing demanded much more of the caregiver than general nursing; how would this have been reflected in the field's relative remuneration and standing?

Regarding the latter, according to what we know of the history of institutional psychiatric care, from Edward Shorter and others, ² this medical discipline struggled long and hard to rise above its association with socially ill-regarded madhouses. Now if, as McFarland-Icke writes, even during the Weimar Republic people in the street did not want to be greeted by a psychiatrist, how much worse did recognized psychiatric nurses fare here? We read that many of the male ones stayed in that occupation after the war because they realized that nursing was "physically easier" than many jobs, affording lifelong financial security, however low the absolute value (p. 70). But one of the drawbacks of psychiatric nursing must have been the extremely tight situation for the caregivers--between authoritarian physicians, on the one hand, and often unruly, paracriminal patients, on the other. This authoritarian hierarchy, as has already been shown in studies by Franz-Werner Kersting and Bernd Walter, was much more rigid than in ordinary institutional physician-nurse-patient relationships, given the menacingly paternalistic attitude of the physicians toward the disenfranchized inmates. ³ This meant that whenever extremely dangerous inmates escaped, nurses could be held criminally responsible and severely punished. Hence the analogy to a prison suggests itself (and again conjures up Foucault), but this is not elaborated by the author.

After having waited too long for the story of the Third Reich to unfold, the reader learns of a gradually worsening situation for psychiatric nurses from 1933 to 1945. Much of this was a function of increasing inhumanity in the treatment of the mentally ill starting in the late 1920s (after the relative progress of the post-World War I era). Chancellor Wilhelm Brüning's emergency decrees repeatedly diminished public-health-care funds, resulting, for instance, in staff reductions and an increased burden on health-care providers. Novel psychiatric concepts regarding lives not worthy of living impressed themselves not only on physicians, but also on their nurses in the asylums, with predictable misfortune for the patient population. Skepticism toward eugenics and "euthanasia" had waned...