UC Santa Barbara > History Department > Prof. Marcuse > Courses > Hist 133D Homepage > 133D Book Essays Index page > Student essay

Contributing Factors That Led To Genocide Committed by Nazi Doctors

Book Essay on: Robert Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide
( New York: Basic Books, 1986), 561pages.
UCSB: R853.H8.L54

by Emmet Cullen
March 23, 2010

for Prof. Marcuse's lecture course
The Holocaust in European History
UC Santa Barbara, Winter 2010

About the Author
& Abstract
Book available at Amazon.com

About Emmet Cullen

I am a junior history major at UCSB. I became interested in the psychology of killing after witnessing civil war and senseless violence in Iraq from 2004-2007. I am interested in understanding the mental process people undergo allowing them to kill others, the effect of such process placed on our soldiers, as well as the training implements that militaries and governments use to achieve this goal, both past and present.

Abstract (back to top)

In The Nazi Doctors author Robert J. Lifton gives an explanation of the social and psychological process that allowed Nazi doctors to commit mass murder and sterilization prior to and during WWII. This process involved the social integration of German Doctors into the Nazi regiment by controlling the doctrine of medical training, as well as requiring German doctors to report certain medical conditions to the Nazi party. Such patients were later marked for death, in order to protect the German Volk, and subsequently doctors were forced to take part in the process of sterilization and euthanasia either directly or indirectly. Lifton also describes important psychological coping mechanisms that these doctors used which allowed them to commit such acts. These mechanisms include what Lifton refers to as the processes of Doubling, Numbing, and Derealizatoin. The impact of Lifton’s studies is that such heinous behavior is capable within all humans, and not isolated to Nazi Germany. My paper focuses on these processes, and relates the process undergone by these doctors to the United States modern military and relates ties between the two.

Essay (back to top)

In Hitler’s quest for the “Final Solution” millions of innocent men, women, and children were killed at the hands of German medical professionals. In an effort to comprehend what allowed people to kill innocents on a large scale, psychologist and author Robert Jay Lifton conducted years of intensive interviews and studies during the late 1970s and early 1980s. These studies focused on surviving German doctors who practiced euthanasia on German medical patients during the Third Reich, and later SS doctors who participated in genocide upon Jews and others in the notorious concentration camp Auschwitz in the 1940s, in order to understand individual motives that compelled these men. According to Lifton, ordinary doctors came to practice mass murder through a systematic social and mental process of nazification of medicine, doubling, and deralization, in order to support the Nazi ideal of a German Volk and a racially pure society. In his book Lifton outlines this process, beginning with the general Nazification of everyday life of German doctors, to the early introduction of sterilization and “euthanasia” of “life unworthy of life” on a limited scale in medical and psychiatric wards, to outright genocide on a mass scale in Auschwitz. In many ways studying what happened in the sequence of events of ordinary doctors-turned-killers in Auschwitz applies to humanity at large; a large percentage of people have the capability to perform evil deeds. When placed in a very stressful situation the human mind is capable of coping through a behavior referred to as “doubling,” which applies to any person placed in a similar situation.


Doctor supervision of all medical selections and killings under Nazi rule was central to bringing legitimacy to the process. But this process did not begin overnight. Early steps to bring Nazi ideology into the mainstream were introduced gradually and over time by top authorities in the Nazi hierarchy.

Initially, the Nazi party passed laws forbidding German doctors to see Jewish patients, and vice versa, creating concrete separation based on radical ideology. This Nazi ideology was soon forced upon German medical students as well. Professors in universities taught lessons on eugenics, emphasizing the superiority of the “Aryan” or “Nordic” German to lesser peoples, as well as teaching traditional medicine. Professors who spoke out on behalf of reason and against such views at the time were literally heckled in lectures by pro-Nazi students, or reported to Nazi authorities.

Nazi ideology introduced at this time very much stressed a duty to the people, or Volk. In a shift from focusing on aiding individual patients, doctors were taught that the need of the German Volk, was more important than that of the individual. In order to better support the needs of the Volk measures had to be taken to insure racial purity. Support of the German Volk before the individual became the first step toward mass murder.

Many Germans at this time, including doctors, were drawn to the Nazi party out of a sense of duty to their country. They genuinely wanted to make their country a better place, and through the twisted ideology of the Nazi party, that could be accomplished through racial purity.

Sterilization and Euthanasia

Nazi doctors did not simply wake up one morning and begin to commit acts of murder. Through a step by step process. Doctors first began to sterilize hospital patients with perceived genetic defects for the greater good of the Volk. This later morphed into the euthanasia of “life unworthy of life,” or those who the Nazi party deemed as no longer supporting society. Again, this process of euthanasia was not born overnight, but through trial and error. Eventually, the lessons learned from this period of hospital-oriented euthanasia around the T-4 and later, 14f13 projects were spread by medical doctors to concentration camps, with devastating effect.

In an effort to guarantee purity of future generations the Nazi party “introduced the early sterilization law with a declaration that Germany was in grave danger of Volkstod (“death of the people” [or “nation” or “race”])” (Lifton 25). In order to prevent Volkstod, it was necessary to sterilize undesirable persons, keeping their genes from tainting future German generations. With the authority of law and obligation as a professional doctor, killing became sanctioned, as well as expected of medical professionals.

Being professionals and not killers, doctors were given specific guidelines for sterilization. Prerequisites for sterilization included feeblemindedness, schizophrenics, those manically depressed, and even those with epilepsy, hereditary blindness and deafness. At the time, “All physicians were legally required to report to health officials anyone they encountered in their practice or elsewhere who fell into any of the preceding categories for sterilization” (Lifton 25). Thus participation in this process was an obligation, not an option, for all physicians.

Doctors experimented with various forms of sterilization. These ranged from radiation of the genitals, to injecting a substance to block ovarian tubes, and even removing reproductive organs. Patient consent to such operations was not a concern. In fact, in most cases “patients” were not told what procedures were being performed on them.

Early use of mass sterilization of so called undesirables quickly morphed into euthanasia, or medical killing, with pressures brought on by WWII. This added to the sense of national duty felt by doctors at the time. Patients who could not or did not contribute to society were considered “human ballast,” or “life unworthy of life” by the Nazi regime, and it was thus were ok to liquidate them.

Medical killing began with children. Many parents were coerced into giving their children to medical institutions for supposed medical and protective reasons, only to have them executed by the state a few weeks later. Parents were not told what was to happen to their children, and in fact doctors attempted to cover up their actions by signing false death certificates.

Euthanasia spread to mentally and physically deficient adults in what was termed the T-4 project. This followed the same basic guidelines as the killing of children. Those marked for euthanasia included patients with “schizophrenia, epilepsy, senile diseases, therapy resistant paralysis… feeblemindedness from any cause, encephalitis, Huntington’s chorea… neurological conditions” as well as “Patients… institutionalized for at least five years… criminally insane… or are not of German or kindred blood” (Lifton 65). It is striking that one could be earmarked to die in a hospital for being “not of German blood,” but this foreshadows to atrocities that would soon follow in death camps.

Initially doctors performed euthanasia through a phenol injection, given intravenously or directly into the heart. Experimentation eventually brought the use of carbon monoxide gas to the killing of these T-4 patients in order to ease the workload on doctors facing high numbers of euthanasia to perform: “The arrangement included a fake shower room with benches, the gas being inserted from the outside water pipes” (Lifton 71). The negative attention eventually brought to the T-4 program on the part of the German public put pressure on the Nazi government to end it officially. What would take its place became known as the 14f13 project, which was more ruthless and less scrupulous than the T-4 project, and ultimately secret in nature.

Because of their position of leadership, doctors felt a professional obligation to perform their duties in support of the Volk. And although a few doctors did refuse such duty, “Each participant could feel like no more than a small cog in a vast, officially sanctioned, medical machine” (Lifton 55). The major role of doctors up to the point of the 14f13 program was identifying actual medical symptoms through “selections” and to carry out euthanasia on those cases.

With the 14f13 program in 1942, “emphasis shifted almost immediately from the mentally ill to political prisoners, Jews, (and) Poles” (Lifton 137). Gassing continued, as did the emphasis that doctors be in charge of selection as well as the euthanasia process.

Eventually killing became “industrialized” in places such as Auschwitz. Doctors trained in killing with the 14f13 program were directly involved in establishing the gas chambers at camps. Thus the progression from sterilization of limited numbers of people to mass execution is clear. Through this process doctors came to view Jews and others as a gangrenous appendage that needed to be removed. This created what Lifton refers to as the healing-killing paradox, in which a doctor is killing his patient in order to heal the greater German Volk.

False Death Certificates: Proof of Guilt

Contradicting the claim that German doctors were performing killing of innocents to support the greater Volk, is the falsification of death certificates. From the earliest killings of handicapped children German doctors falsified death certificates. The primary means of this falsification was inputting a false cause of death, attributing the death to a believable disease rather than execution. This continued through the T-4 program, the 14f13 program, and even into Auschwitz. While early euthanasia was based on existing medical conditions as well as authority from the Nazi Party, falsifying death certificates shows a clear indication of doctors’ attempts to conceal the true nature of their actions. While doctors justified their actions with reasoning and logic to themselves, viewing those selected for death as “a gangrenous appendage,” they contradicted this justification with a direct lie. Reason dictates that to conceal such action indicates awareness that they were indeed committing a crime, with or without the sanction of the state.

While it is true that doctors were aware they were purposely lying on death certificates, and theoretically aware of committing a crime, there is a second detail that lends itself to this issue. That detail is the perception of the German public. In order to pursue a racially pure Volk in the face of a public objection to the T-4 project, falsifying documents was a necessary evil in the eyes of doctors. Had doctors not preformed this critical task of concealing euthanasia their medical goal of healing the Volk would have been hindered. This offers one of the best explanations of such a heinous action perpetrated by professional doctors.

Coping Mechanisms for Nazi Doctors

Many Auschwitz doctors and inmates who survived said that being inside of Auschwitz was like entering another world that cannot be fully described. In order to cope with this extreme situation, Nazi doctors underwent a psychological transformation. Through what Lifton terms Doubling, doctors as well as inmates created a second self that acted within the expectations of their position at Auschwitz: “The requirements of conscience were transferred to the Auschwitz self, which placed it within its own criteria for good (duty, loyalty to group, ‘improving’ Auschwitz conditions, etc.), thereby freeing the original self from responsibility for actions there” (Lifton 421). In this way doctors were able to commit murder, while maintaining their identity as productive members of society outside of Auschwitz.

Beyond this, doctors developed other coping mechanisms: “The Auschwitz self depended upon radically diminished feeling, upon one’s not experiencing psychologically what one was doing” (442). Lifton refers to this diminished feeling as numbing. With this doctors developed what Lifton calls Derealization, “divesting oneself from the actuality of what one is a part of, not experiencing it as ‘real’” (Lifton 442).

Doctors also turned heavily to alcohol to cope with Auschwitz. In nightly drinking sessions doctors felt free to vent their frustration to one another and speak openly. This proved critical to forming bonds as well as dealing with inner conflict created by the healing-killing paradox. Often doctors would also turn to their work, focusing on the good work they were doing in the camp rather than what they referred to as dirty work, or selections and executions.

Thoughts and Relevance

During the Holocaust Nazi doctors showed the ultimate horrors in the dark capabilities of humankind. In many ways, we have failed to comprehend the lessons learned from this event. In 2004 United States soldiers were uncovered committing horrible atrocities against prisoners of war at Abu Graib prison, Iraq. Public attention immediately called for action, and an answer to what could have possibly happened to allow such a thing to take place. Unfortunately, the answer was under our noses the entire time, while no one wished to admit it. Just as with German doctors at Auschwitz, social pressures combined with anti-Iraqi ideology within the military, as well as an expectation to act as a prison guard within a much larger military system, resulting in sanctioned abuse (although denied by military officials), and behavior outside of normal moral boundaries.

Without a doubt, our soldiers in combat experience a doubling of self when they are presented with dealing with the horrors of warfare. They spontaneously experience numbing, as well as derealization, without being taught of such matters. Without proper knowledge, the events of Nazi Germany as well as Abu Graib will surely be repeated for generations to come. Only through education and understanding can we protect ourselves, as well as those who perform our nation’s bidding, from the negative effects of social pressures and bigoted ideology.


Annotated Bibliography and Links (back to top)(links last checked 11/21/10)

Book Reviews

  • Cocks, Geoffery, Review, American Historical Review 94, no. 2 (1989): 477.

    Cocks' review of The Nazi Doctors gives a basic overview of Lifton’s main psychological process of “Doubling,” as well as a description of Lifton’s interview process. Cocks debates the validity behind the process of “Doubling,” arguing that Nazi Doctors may have simply been acting out of pure motive rather than a systematic psychological process. According the Cocks, Lifton’s methods and assessment of Nazi Doctors is outdated and incomplete.

  • Gellately, Robert, "Medicine and collaboration Under Hitler.", Canadian Journal of History 26, no. 3 (1991): 479-486

    Gellately’s review of The Nazi Doctors covers multiple individual studies that give credit to Lifton’s work, conducted by a number of psychologists. This review gives a strong overview of the history of Nazification under the Third Reich, and attempts to explain the mental process that doctors underwent leading up to mass murder. Gallately gives a broader overview of medical killing from a number of perspectives, that all support the underlying theme of turning doctors into killers.

Books and Articles

  • David A., Groassman, On Killing, The Psychological Cost of Learning to Kill in War and Society (Black Bay Books, 1995) 354 pages

    Lt. Colonel David A. Grossman gives a comprehensive look into the psychology of killing within the United States military. He gives a historical overview of resistance to killing in early U.S. conflict, and covers the process the military had to undergo in subsequent years to train more proficient killers on the battlefield. Grossman not only discusses steps taken to initiate soldiers to kill more proficiently, but also discusses the psychological cost of this training on soldiers. Grossman’s insight relates directly to the studies of Lifton, as you see similarities between the mental processes undergone by Nazi doctors in Germany being repeated purposely to initiate U.S. soldiers to the killing process. A main point that Grossman makes facilitating killing is the process of dehumanization, which I feel that Lifton did not emphasize, or only alludes to in derealizatoin.

  • Viven, Spitz, Doctors From Hell (Boulder CO., Sentient Publications, 2005) 317 Pages.

    In this book the author relates Nazi experimentation and dehumanization of Jews and others in Europe to subhuman treatment of peoples throughout history, and in particular connections to America. It is important to understand that the actions taken by Nazi German doctors during WWII were not isolated events, and Spitz brings that point home. The roots of dehumanization and human experimentation are traced to the U.S. within this book, in a profound way. Doctors From Hell points out that the Unites States also had it’s own sterilization laws, based on eugenics, but for whatever reason, Germany lagged behind the U.S. in doing away with such notions. Doctors From Hell also includes first hand accounts from trial transcripts and accounts from concentration camp survivors. I find this book particularly interesting because it bridges the gap between American racism and Nazi racism, giving clear lineage between the two.

Relevant Websites

  • Multiple authors, Least We Forget “Least We Forget.” 2008-2010.

    Least We Forget is a website dedicated to Auschwitz and the history of Auschwitz specifically. I find it particularly helpful because this site gives biographies, photos, literature, poetry, and even a listing of related books that deal with Auschwitz, personnel, and related topics and events. This is a very good place to start any study of Auschwitz. Unfortunately, this site does not give full biographies on all Auschwitz doctors, though it does give a detailed description of Joseph Mengele, and related documentation regarding Auschwitz.

  • Longerich, Peter, The Nazi Racial State 2009

    This web page gives a broad overview of the history of the Nazi attempt into eugenics and biocracy, creating a “racially pure state,” which are topics specifically addressed in Lifton’s The Nazi Doctors. This site is helpful in giving a description of early steps taken by the Nazi regime to first segregate Jews through racial laws, and later steps taken in euthanasia, killing in the T-4 program, and finally mass execution carried out through lessons learned in the T-4 program.

  • United States Holocause Memorial Museum, “Euthenasia Program”

    The United States Holocaust Memorial Museum site is a very good location for a broad range of articles relating to the Holocaust. This particular article covers medicalized killing by the Nazi regime. It discusses euthanasia in Germany from early beginnings in hospitals administered to “life unworthy of life,” the development of the T-4 program, and discusses mass murder in concentration camps. Beyond this there are related articles that can easily be found discussing the development of gas chambers to be used in killing, a list of concentration camps with figures and descriptions, and an assortment of helpful holocaust related writings and pictures. This is also a very good place to start for someone who is trying to find broad information about the holocaust, or narrow a possible thesis for a paper.

(back to top)

Any student tempted to use this paper for an assignment in another course or school should be aware of the serious consequences for plagiarism. Here is what I write in my syllabi:

Plagiarism—presenting someone else's work as your own, or deliberately failing to credit or attribute the work of others on whom you draw (including materials found on the web)—is a serious academic offense, punishable by dismissal from the university. It hurts the one who commits it most of all, by cheating them out of an education. I report offenses to the Office of the Dean of Students for disciplinary action.

prepared for web by Emmet Cullen on 3/23/10; last updated: 11/21/10
back to top, to Hist 133D homepage, 133B+D Book Essays index page; Prof. Marcuse's Courses page; Professor's homepage