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Analyzing Nursing As a Dispositif Healing and Devastation in the Name of Biopower

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Analyzing Nursing As a Dispositif Healing and Devastation in the Name of Biopower Analyzing Nursing as a Dispositif Healing and Devastation in the Name of Biopower A Historical, Biopolitical Analysis of Psychiatric Nursing Care under the Nazi Regime, 1933-1945 Thomas Foth Thesis submitted to the Faculty of Graduate and Postdoctoral Studies In partial fulfillment of the requirements For the PhD degree in Nursing Sciences. School of Nursing Faculty of Health Sciences University of Ottawa © Thomas Foth, Ottawa, Canada, 2011 For Carmen …again and again ABSTRACT Under the Nazi regime in Germany (1933-1945) a calculated killing of chronic ―mentally ill‖ patients took place that was part of a large biopolitical program using well-established, contemporary scientific standards on the understanding of eugenics. Nearly 300,000 patients were assassinated during this period. Nurses executed this program through their everyday practice. However, suspicions have been raised that psychiatric patients were already assassinated before and after the Nazi regime, suggesting that the motives for these killings must be investigated within psychiatric practice itself. My research aims to highlight the mechanisms and scientific discourses in place that allowed nurses to perceive patients as unworthy of life, and thus able to be killed. Using Foucauldian concepts of ―biopower‖ and ―State racism,‖ this discourse analysis is carried out on several levels. First, it analyzes nursing notes in one specific patient record and interprets them in relation to the kinds of scientific discourses that are identified, for example, in nursing journals between 1900 and 1945. Second, it argues that records are not static but rather produce certain effects; they are ―performative‖ because they are active agents. Psychiatry, with its need to make patients completely visible and its desire to maintain its dominance in the psychiatric field, requires the utilization of writing in order to register everything that happens to individuals, everything they do and everything they talk about. Furthermore, writing enables nurses to pass along information from the ―bottom-up,‖ and written documents allow all information to be accessible at any time. It is a method of centralizing information and of coordinating different levels within disciplinary systems. By following this approach it is possible to demonstrate that the production of meaning within nurses‘ notes is not based on the intentionality of the writer but rather depends on discursive patterns constructed by contemporary scientific discourses. Using a form of ―institutional ethnography,‖ the study analyzes documents as ―inscriptions‖ that actively interven in interactions in institutions and that create a specific reality on their own accord. The question is not whether the reality represented within the ii documents is true, but rather how documents worked in institutions and what their effects were. Third, the study demonstrates how nurses were actively involved in the construction of patients‘ identities and how these ―documentary identities‖ led to the death of thousands of humans whose lives were considered to be ―unworthy lives.‖ Documents are able to constitute the identities of psychiatric patients and, conversely, are able to deconstruct them. The result of de-subjectification was that ―zones for the unliving‖ existed in psychiatric hospitals long before the Nazi regime and within these zones, patients were exposed to an increased risk of death. An analysis of the nursing notes highlights that nurses played a decisive role in constructing these ―zones‖ and had an important strategic function in them. Psychiatric hospitals became spaces where patients were reduced to a ―bare life;‖ these spaces were comparable with the concentration camps of the Holocaust. This analysis enables the integration of nursing practices under National Socialism into the history of modernity. Nursing under Nazism was not simply a relapse into barbarism; Nazi exclusionary practices were extreme variants of scientific, social, and political exclusionary practices that were already in place. Different types of power are identifiable in the Nazi regime, even those that Foucault called ―technologies of the self‖ were demonstrated, for example, by the denunciation of ―disabled persons‖ by nurses. Nurses themselves were able to employ techniques of power in the Nazi regime. iii TABLE OF CONTENTS Abstract ............................................................................................................................................ ii Table of Contents ............................................................................................................................ iv List of Tables ................................................................................................................................ viii List of Figures ................................................................................................................................. ix Acknowledgements ......................................................................................................................... xi 1 Introduction ............................................................................................................................. 1 1.1 Research Objectives .......................................................................................................... 3 1.2 Research Questions ........................................................................................................... 4 1.3 Organization and Structure ............................................................................................... 4 2 Historical Background of the Killing of Sick Persons ......................................................... 8 2.1 Historiography .................................................................................................................. 8 2.1.1 The coordinated mass murder of “Aktion T4” and the decentralized patient murders of the second phase ....................................................................................... 8 2.1.2 “Aktion Brandt” ........................................................................................................ 11 2.1.3 Assassinations of sick persons outside Aktion T4, the second phase, and Aktion Brandt ............................................................................................................ 13 2.1.4 Assassinations of sick persons during the Nazi regime before 1939 ......................... 15 2.2 Explanatory Approaches ................................................................................................. 16 2.2.1 “Euthanasia” as “final solution of the social question” .......................................... 16 2.2.2 “Euthanasia” and a “Developmental Biopolitical Dictatorship” ............................ 18 2.3 Deaths in Psychiatric Hospitals before and after National Socialism ............................. 22 2.3.1 World War I and earlier ............................................................................................ 22 2.3.2 Weimar Republic and hyperinflation,1923 ............................................................... 23 2.3.3 Mortality after World War II ..................................................................................... 23 2.4 Nursing Historiography................................................................................................... 24 2.5 Discourse Theory Approach to History .......................................................................... 27 2.5.1 Foucault, social history and discourse...................................................................... 28 2.5.2 Discourses and the production of “truth” ................................................................ 30 iv 2.5.3 A Critique of Social History ...................................................................................... 31 2.5.4 Final remarks ............................................................................................................ 35 2.6 Method and Data Collection ........................................................................................... 36 2.6.1 Method ....................................................................................................................... 36 2.6.2 Sampling Method....................................................................................................... 38 2.6.3 The sample from Hadamar ........................................................................................ 39 3 Biopower and Racism ........................................................................................................... 48 3.1 The Roots of State Racism .............................................................................................. 48 3.2 Biopower and Biopolitics................................................................................................ 54 3.3 Norm, Normalization, and Statistics in the Age of Biopower ........................................ 56 3.3.1 Norm and normalization ........................................................................................... 56 3.3.2 The impact of numbers in biopolitics ........................................................................ 61 3.4 The Paradox of Biopolitcs and the Problem of Racism .................................................. 64 3.5 Nazism ............................................................................................................................ 66 3.6 Potentials
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