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Art and Images in Psychiatry
October 2006

The Würgengel

Author Affiliations
 

JAMES C.HARRISMD

Arch Gen Psychiatry. 2006;63(10):1066-1067. doi:10.1001/archpsyc.63.10.1066

If it is once admitted that men have the right to kill “unproductive” fellow-men—even though it is applied only to poor and defenseless mentally ill patients—then the way is open for the murder of all unproductive men and women . . . Who could then have confidence in a doctor? . . . It does not bear thinking of, the moral depravity, the universal distrust which will spread even in the bosom of the family, if this terrible doctrine is tolerated, accepted and put into practice.

—Bishop von Galen, Münster, Germany, August 3, 19411(p191)

In 1938, Carl Schneider (1891-1946), professor and chairman of the department of psychiatry and neurology of the University of Heidelberg, Germany, provided the National Socialists (Nazis) with works from the Prinzhorn collection2 of artistry of the mentally ill. These works were to be displayed along with those of modern artists, especially German Expressionists such as George Grosz3 and Otto Dix,4 in the traveling exhibit Entartete Kunst (Degenerate Art).5 His goal and theirs was to illustrate the similarity of the artistry of mentally ill people to that of modern artists in an attempt to further discredit modern art as degenerate. “Degenerate” modern art was contrasted with the “heroic art” in Adolf Hitler's House of German Art, the first building erected by the National Socialists. Thus Hitler, who had twice failed the entrance examination for the Austrian Academy of Art, began a massive campaign of aesthetic politicization, not only in the visual arts but also in literature, music, and film. By this means, condemning and ridiculing the inner life and the creative imagination, he sought to instill his racial ideology and set the stage for his campaign against “degeneracy.” Hitler's focus was increasingly on societal racial hygiene at the expense of the individual, especially those deemed biologically inferior, “life unworthy of life.”

Franz Karl Bühler (1864-1940), German. Der Würgengel, 1909. Crayon on paper, 29 × 40 cm. Reproduced from Hans Prinzhorn, Artistry of the Mentally Ill, Frontispiece. ©Verlag von Julius Springer, Berlin, Germany, 1923.

Franz Karl Bühler (1864-1940), German. Der Würgengel, 1909. Crayon on paper, 29 × 40 cm. Reproduced from Hans Prinzhorn, Artistry of the Mentally Ill, Frontispiece. ©Verlag von Julius Springer, Berlin, Germany, 1923.

Carl Schneider (not to be confused with his prominent successor Kurt Schneider) oversaw the adaptation of psychiatry to National Socialist health and social politics in Heidelberg. His predecessor, Professor Karl Wilmanns (1873-1945), along with 3 lecturers of Jewish descent, was dismissed in the spring of 1933 because of his political beliefs when Hitler came to power. According to his daughter Ruth Wilmanns Lidz, MD,6(p388n29) he had told medical students in 1932 that Hitler was an example of male hysteria, hysterical blindness after mild mustard gas exposure at the end of World War I.

Wilmanns recruited art historian and psychiatrist Hans Prinzhorn to establish a collection of drawings and artistry of patients with mental illness that is now known as the Prinzhorn collection.2 Prinzhorn's task was to extend an earlier collection of art started by Emil Kraepelin. He was asked to study scientifically works (drawings, paintings, collages, textiles, sculptures) by long-term patients generally diagnosed with schizophrenia. Prinzhorn stated that anyone who equated drawings by people with schizophrenia with modern art was simple-minded and should not be taken seriously. He wrote that psychotic experiences were gruesomely imposed on the patient while images produced by modern artists were freely chosen through exploration of the psyche. Most of the artistry (a term he used to distinguish these works from professional art) was completed between 1880 and 1920. When he left in 1921, the collection included more than 4500 works by about 450 patients; the collection is currently on display at the University of Heidelberg.

Prinzhorn proposed that there is an instinct for self-expression, an inborn creative drive whose goal is to communicate a person's experiences. He suggested that this instinct might be explored in the art of children, indigenous people, and people with mental illnesses. Following an introductory section, Prinzhorn provided case histories of 10 patients; each was given a pseudonym. One was Franz Karl Bühler (pseudonym Pohl), an industrial arts teacher and prizewinning locksmith and metal worker7(p140) who had won a medal at the 1893 World's Fair in Chicago. Four years later, he was released from his job because of eccentric behavior. He had become increasingly paranoid, changing residences multiple times because he believed that people were listening to him through his keyhole, and he ate very little for fear of being poisoned. Relatives had reported that Bühler had reported auditory hallucinations as early as age 16 years, which now worsened, leading to his hospitalization.2 By the time Prinzhorn met him in 1920, Bühler had been institutionalized for 22 years at Emmendingen, Germany; had a severe thought disorder; and was socially withdrawn and verbally uncommunicative. The fact that he persisted in his drawing despite the complete deterioration of his personality intrigued Prinzhorn.

Bühler's Würgengel (1909) is the frontispiece to Prinzhorn's book.2 Although usually translated as “avenging angel” or “death angel ” (Thomas Röske, personal communication, July 2006), Würgengel literally means “choking angel.” It is likely that, thinking concretely, this is the meaning intended by Bühler. A pale green angel with a yellow radiant headdress holds a sword and stands with its left foot on the neck of the victim being choked by its weight; the victim is attempting to push the foot away and escape. A frightened face appears on the angel's left sleeve just above the hand. The angel's coarse features, lack of facial affect, and apparent indifference to suffering are frightening. The image conveys the paranoid terror that Bühler must have experienced and reflects the delusional experience of the artist. It is an image that has personal meaning, reflecting his detachment from ordinary human reality. Prinzhorn was uncertain about what is specifically schizophrenic about The Würgengel but asked if this figure could arise only from schizophrenic emotions (psychotic terror, annihilation anxiety). He concluded that perhaps its aesthetic value might lie “within the work itself.”2(p228) Overall he found that the painting of hallucinations among patients is rare. Although it is not known if The Würgengel was included in the artistry sent with Schneider's approval for the Degenerate Art exhibit, it is definitely known that Bühler's work was provided for the exhibit. The painting is now lost. Many of the works lent for the exhibit were never returned and are presumed destroyed.

Carl Schneider and other psychiatrists were leaders in promulgating the National Socialist forced sterilization law, the Law for the Prevention of Genetically Diseased Offspring (July 26, 1933); schizophrenia, manic-depression, severe intellectual disability (mental retardation), and severe alcoholism were among the disorders listed. Aubrey Lewis provided a contemporary review.8 In the United States, the legality of compulsory sterilization of those with intellectual disability was upheld by the US Supreme Court in 1927. In Buck vs Bell, Justice Oliver Wendell Holmes, Jr, unfortunately concurred with a Virginia law and concluded, “3 generations of imbeciles is enough.” But the Nazis did not stop at sterilization; by 1939 they had accepted the view that there is life unworthy of life (the phrase was introduced in 1920 in a German book coauthored by psychiatrist Alfred Hoche titled Authorization of the Destruction of Life Unworthy of Life) and began the notorious Aktion T-4 involuntary “euthanasia program,” a euphemism for clandestine killing. Carl Schneider, who was against therapeutic nihilism and a leader in the movement for active treatment for the mentally ill who could work productively, was appointed research director of the T-4 program. Schneider exploited the involuntary “euthanasia program” for his own research; following comprehensive assessment at Heidelberg, 21 severely intellectually disabled children were involuntarily “euthanized” (murdered) and their brains sent back for histopathologic examination.9,10 Thus Schneider became known for both “innovation and extermination.”9(p293) A memorial to these victims was established in Heidelberg in 1998.

There was never an involuntary “euthanasia” law passed in Germany; the program was never really legally sanctioned. Hitler had been told that it would be difficult to carry it out, even in wartime, without some authorization from him. What Hitler did was write a note on his personal note paper, not his official stationery, as follows:

Reich Leader Bouhler and Dr Brandt are charged with the responsibility for expanding the authority of physicians, to be designated by name, to the end that patients considered incurable according to the best available human judgment of their state of health, can be granted a mercy death.10(p112)

This served as the justification. The letter was written in October 1939 but was backdated to September 1 to the day of the outbreak of the war against Poland. Hitler felt that a wartime atmosphere would make people less resistant to this project; hospital beds freed by killing incurables could be used for the war wounded. Mental hospital directors were asked to complete questionnaires that could be used to systematically identify unproductive patients; after a bureaucratic procedure, they were sent to facilities to be gassed and cremated. This was the fate of Bühler.7(p140) On March 5, 1940, he was transported from the psychiatric facility at Emmendingen, where he had lived for 40 years, to Grafeneck, Germany, one of 6 Nazi killing centers. There, his Würgengel made its final appearance in the form of National Socialism when he suffocated to death from carbon monoxide poisoning in a gas chamber as a life unworthy of life. His body was cremated “to prevent infection” and his ashes returned to his guardian with a message that he died because of a weak heart muscle. Lessons learned from the use of gas at Grafeneck and similar facilities were the basis and a precursor for its later use at Auschwitz and other concentration camps. In 1990 a memorial was placed in Grafeneck to commemorate the 10 654 who were killed.

Carl Schneider initially escaped the invading American army in Heidelberg by dressing as a mental patient but was eventually captured and imprisoned in Frankfurt, Germany, awaiting charges. On December 11, 1946, he committed suicide by hanging (death by strangulation). In his farewell letter to his wife, he was unrepentant. He wrote that his actions regarding “euthanasia” were “strictly a matter of legal priority! . . . I have spent my life solely for the sake of the sick. Farewell. I’ll see you on the other side.”11(p478) The Nazi experiments on wartime involuntary medical experimentation on humans led to the adoption of the Nuremberg code (1947) requiring voluntary informed consent for human research and to the United Nations' adoption of the Universal Declaration of Human Rights (1948).

The Catholic Bishop von Galen in Münster (epigraph) heroically spoke out against the killing of adult psychiatric patients and the intellectually disabled. The German people responded (the Allies air-dropped his sermon throughout Germany); their public outcry and political considerations were important in ending the centralized killing program. By the time it was officially stopped in late August 1941, more than 70 000 had been killed. von Galen survived the war and afterwards was made a cardinal; he was beatified on October 9, 2005, in St Peter's Basilica of Rome, Italy.

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