Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Sunday, July 27, 2014

Summer Books

I have a week of work left before my August break, so for me, the summer is just starting, even though it's half over for most people. And I have BIG READING PLANS.

I plan to finish 2 of the 3 books sitting on the shelf in my bathroom: A Confederacy of Dunces, by John Kennedy Toole, and Microbe Hunters, by Paul De Kruif. I started reading both of these books ages ago, and just never got through them.

The third book on the shelf is Psychoanalytic Terms & Concepts, edited by Auchincloss and Samberg. It's described in its Introduction as "a hybrid of dictionary, encyclopedia, annotated bibliography, textbook, and intellectual history". There's no way I'm going to "finish" reading it any time soon, but I do plan to work my way through it slowly, letter by letter, all the way from "Abreaction" to "Wrecked by Success". I guess there are no X, Y, or Z terms.
This book was given to me by my analytic institute as a graduation gift. True, the guy who handed it to me is married to one of the editors, but it was still a generous and meaningful gesture. It's a fascinating book that not only teaches things about psychoanalysis, but gives one a real sense of what a Herculean task it is to create such a lexicon.

Another book I received as a gift about two years ago, and did finish reading, is Robert Jay Lifton's, The Nazi Doctors: Medical Killing and the Psychology of Genocide It's about as far from beach reading as a book can get. Dr. Lifton, who is a psychiatrist, researched the book over the course of many years by interviewing survivors of Auschwitz, other people who knew the Nazi doctors at Auschwitz, and many of the doctors, themselves.
The basic premise of the book is that Germany did not go directly from barely tolerating Jews to The Final Solution. There had to be a more gradual shift in thinking, and this shift, according to Lifton, was facilitated by the medical profession. First there was the "euthanasia" program, in which mentally limited children and adults, not all of them Jews, were quietly done away with, often by slowly starving them into a debilitated state, and then putting them out of their misery. This was done, ostensibly, to create more resources for Germany's finest, who were fighting for their country. And this early killing was performed by physicians, paving the way to Auschwitz.

In Auschwitz, itself, doctors didn't lock the inmates in a chamber and turn on the gas. But they did determine who would be sent to the gas chamber. All the selections were performed by doctors, and the heart of Lifton's book is about an internal process he calls "doubling", which allowed these physicians, trained in the art of healing, to pervert their knowledge, skills, and position into the art of killing.
Many of the doctors, most notably Mengele, also performed cruel experiments on inmates, justifying them as necessary for the furtherance of medical science. Lifton explores how they lived with themselves. Or didn't. One-and only one-doctor refused to participate in selections. Mengele indulged in the power and cruelty. All of them drank heavily. And the medical chief of Auschwitz, Eduard Wirths, was somewhere in the middle. He was a devoted family man, and used his love for his family as a support system to carry out what he believed to be a necessary evil. He was never cruel to inmates, and he occasionally went out of his way to save the lives of a few individuals. But it was he who streamlined the process and turned Auschwitz into the ultimate killing machine. He hanged himself after the war.

I'm sure it won't surprise you to learn that it was a tough read. I could only tolerate a little at a time. I often read chapters, or sections, out of sequence. And I found myself conceptualizing it as, "This is a book about a fictional place called Germany in the 1940s." I couldn't read about it and believe it at the same time. It was my own kind of doubling.

As hard as it was for me to read, it was even harder for Dr. Lifton to write. In 2011, he published Witness to an Extreme Century: A Memoir, in which he describes what it was like for him to do the research for the Nazi Doctors book, including the interviews with the doctors, themselves.

So on that fateful day at the library when I checked out the book I subsequently lost on the subway, I also checked out "Witness", which I didn't lose, and proceeded to read. And the reason I'm writing all this is that I learned a powerful professional lesson from these two books.

Lifton writes about how he prepared himself for the interviews with the Nazi doctors. Steeled himself, really. He resolved not to tell any of them that he is a Jew, although some figured it out. He also resolved to maintain his moral position, which is that these men are evil. They participated in horrors, and nothing can change who that made them.

He politely extracted himself from any appeals to his understanding of their position, as a "fellow doctor". And he was especially uncomfortable with any non-research interactions. The interviews took place over many hours, and he and his German interpreter would take lunch breaks, and go to eat lunch in some local restaurant. But one of the men they interviewed lived out in the countryside, and there was nowhere to go, so he (the interviewee) invited them to stay and have lunch with him and his wife. They did so, but Lifton had tremendous difficulty with this kind of social connection with his subject.

He interviewed Eduard Wirth's daughter, who was a small child when her father died. Growing up, she was not told about his role in Auschwitz, but she gradually became aware of what he had done, and continues to struggle with that knowledge, and the inconsistency with the memories she and her family have of her father. She asked, "Isn't it possible for a good man to do bad things?"
Lifton's response was, "Yes, but then he is no longer a good man."

None of the men he spoke with demonstrated any real remorse. They rationalized, talked about "what it was like back then", minimized, externalized. All kinds of defenses. None of them said, "What I did was terrible. I regret it. It's hard to live with myself."

In reference to Wirths, one of the survivors said, "At least he did the decent thing and killed himself." But Lifton's take on it was that his suicide was an act of cowardice.

I got the impression that Lifton was defending himself in all these interviews. Not in the obvious ways. He's particularly insightful about his feelings of anger, and describes his experiences clearly. My sense was that he would not allow himself to see the humanity in these men. The good father and husband in Wirths. The pleasant company over lunch. The fellow physician.

I had several thoughts about this. I couldn't help wondering if, had he let himself relate more to these men, Lifton could have gotten more from them. As it was, he learned a tremendous amount, and his doubling concept is a powerful conclusion. But I wonder if they would have been more willing to reveal their vulnerabilities if he had let himself be more open to them. More vulnerable, himself.

More importantly, I felt that, in denying their human frailties, Lifton was doing to these men what they had done to the prisoners at Auschwitz. He writes about the Nazi concept of "life unworthy of life", which was the foundation of all the murder. The ability to view another as less than oneself allows one to discount the other's humanity. It felt like Lifton was acting out something these Nazi doctors experienced, but could no longer openly acknowledge.

It made me think about my work with patients, and maybe the take home lesson ought to be that I need to be open to all the awful humanness in my patients. But it seems to me that Lifton was afraid that if he was open in this way, he would understand them and identify with them well enough to realize that he could be one of them. And this was intolerable. It's hard to fault him for that. And maybe there are times when I need to exercise a similar restraint in my work.


  1. I was drawn to Hannah Arendt's "banality of evil" discussion of Nazi war criminals, which to me recalls the "fundamental attribution error" coined a few years later by social psychologists. In essence, we tend to overvalue personality-based explanations for the behavior of others, while undervaluing situational variables. It comforts us to imagine that Eichmann, Mengele, Wirth, etc. had evil personalities, and that we would never act remotely like them regardless of the situation. Unfortunately, a number of classic experiments, e.g., Milgram, demonstrate that average people can act cruelly depending on the circumstances. We may not all be Mengele, but we might be Wirth.

    I long ago concluded that choosing one's social or cultural environment is a powerful way to change oneself.

    1. When I read the books, I had the sobering thought that I would not have fared any better in those circumstances. I agree, Mengele was a rarity, but most of them were just regular people tossed into an extreme situation. I think that may be why Lifton had to steel himself the way he did, to keep from the recognition that it could have been him.