It is my considered opinion that at this moment in time we are on the verge of succumbing to elements of the same self-serving propaganda that “legitimised” the mass persecutions of Nazi Germany in the 1930s and early 40s.
It is my belief that the current – almost frenzied – campaign to psychologise M.E. and similar conditions is part of this propaganda and represents a dress rehearsal for the wider application of the psychosocial classification of a new “underclass” of “the undeserving ill”, stripped of some of the very rights the Second World War was supposedly fought for by the Allies.
Being born of a British (soldier) father and German mother (who narrowly escaped the clutches of the Gestapo and SS during the war years), it has long been a personal quest of mine to understand how the crimes of the Nazis could be perpetrated among civilised nations only two generations ago.
For no one can simply build slave labour and extermination camps overnight and expect the general public to accept them unquestioningly. It isn’t necessary here to describe in detail how Nazi Germany and the Communist Soviet Union introduced institutionalised mass murder to their respective populations. This has been comprehensively achieved elsewhere. I present here only a summary of the initial processes as they unfolded.
Before you can enlist the cooperation needed to carry out mass persecution (let alone mass murder), you have to create a climate wherein this seems both acceptable and justifiable.
In Hitler’s Germany an entire generation was educated from childhood in the concept of “racial hygiene”, with identified undesirable elements including not only Jews and Gypsies, but also homosexuals, alcoholics, the physically and mentally handicapped, and the mentally ill.
The concept of “lebensunwertes Leben” – life unworthy of living – was introduced. This provided for the justification of firstly sterilisation of those considered to be unworthy of living or procreating and consequently euthanasia, which was only one small step away from mass extermination – the machinery already being in place, if not with the public’s blessing as such, at least without its active condemnation.
This was more easily achieved because of the added distraction of economic crisis and war. The present government in the UK, seeking to juggle the economic books and embroiled in war overseas, has just announced its five-year plan to remove 1 million claimants from receipt of Incapacity Benefit (indeed, to overhaul welfare benefits to the sick and disabled entirely).
In Nazi Germany and the Communist Soviet Union scapegoats were needed to justify the regimes’ plans for the seizure and redistribution of property and wealth: in the former, the prime targets were the Jews and in the latter, the Kulaks and “bourgeoisie”.
In today’s climate, and precisely because of recent history, there would be no chance of racially- or class-based discrimination becoming legitimised in the UK. Instead, an alternative group needs to be identified as being an unnecessary drain on the state’s resources. I would suggest that this group has already been identified – and is now being presented to society at large as “the undeserving ill”.
I do not propose, of course, that there are plans for the building of new gas chambers, but it is my contention that right here and now in the UK the drive to convince the general public that there exists a sub-class of undeserving “state scroungers” who are not actually physically ill, but victims of their own “aberrant belief systems”, is a calculated attempt to justify the barbaric neglect and abuse that sufferers of M.E., Fibromyalgia, Gulf War Syndrome and other similar conditions are currently being subjected to, as well as to provide an escape route for those who administer health insurance, pensions, compensation and state benefits to deny payment to claimants.
I also contend that if this campaign is successful, its scope will inevitably be widened to encompass anyone the state considers to be fair game for classification as a drain on national funds and resources.
And for those dismissive of the suggestion that there could exist such a move to portray health issues in terms of, not caring and welfare, but economic considerations, I draw attention to the words of Col. J. R. Rees MD, in the summary of an address he gave to the Annual Meeting of the National Council for Mental Hygiene on June 18th. 1940, embodying concepts being echoed today in the words of the psychologisers:
“Many people don’t like to be ‘saved’, ‘changed’ or made healthy. I have a feeling, however, that ‘efficiency and economy’ would make rather a good appeal because there are very few people who would not welcome these two suggestions. It has even crossed my mind whether we ought not to have a subsidiary company called the Social Efficiency Board…It seems to me that in approaching national matters, local government and social affairs we should be on much stronger ground if we were constantly stressing our interest in efficiency and economy, and certainly we can ‘sell’ mental health under these headings as well as under any other.” (1)
Col. Rees also set out his suggestions for the propaganda campaign itself:
“In this field, as in every other, we ought to be thinking ahead and foreseeing events so far as that is possible. We have often been too spasmodic in our work and I feel we need a long-term plan of propaganda…I doubt the wisdom of a direct attack upon the existing state of affairs…that would still raise opposition, whereas the more insidious approach of suggesting that something better is needed – ‘Why shouldn’t we try so and so?’ – is more likely to succeed. The evolutionary process is essentially British, and I think that we should make it a fundamental in our propaganda plan.”
“Why shouldn’t we try so and so?” Today, Col. Rees might be asking, “Why shouldn’t we try Cognitive Behavioural Therapy and Graded Exercise Therapy?” Perhaps he had the Nazi doctors in mind when he declared, “We need vision and courage. We mustn’t merely plan and be theorists, but we must also experiment…”
Just as the Nazis had, in the form of camp inmates, readily available subjects for their medical experiments, so too the psychiatric lobby today has, in the form of M.E. sufferers, guinea pigs of their own, who are being handed to them on a plate through a system which, under threat of benefits being cut or withdrawn, patients are coerced into participating in “trials” involving psychotherapy and physical exercise regimes. Those still in Local Government employment but too ill to continue working and therefore compelled to seek medical retirement find that they must be subjected to “all reasonable treatment options” before qualifying for their pensions. The unspecified “treatment options” referred to in the Local Government Superannuation Scheme (below) are, of course, merely experimental and the advice currently emanating from the Department of Psychological Medicine, Institute of Psychiatry, London is that “Medical retirement should be postponed until a trial of such treatment [ie. ‘cognitive behavioural and graded exercise therapies’] has been given.” (2)
Just as the Nazis brainwashed and conditioned the general population into perceiving the concentration camp inmates as “unworthy of living” and thus beyond the protection of all civilised consideration, so too the psychologising lobby today seeks to portray M.E. sufferers as feeble, self-piteous, “eggshell-personality” neurotics or malingerers who are not worthy of the same rights as “normal, hard-working” citizens – citizens who are not going to take much notice of those being summoned to “medical” examinations by the Department of Work and Pensions, or behaviour-challenging psychiatric treatments at “M.E. centres”.
There are those who believe that the AIDS crisis is not only man-made but was also specifically designed to target “social undesirables” such as prostitutes, drug users and homosexuals. Indeed, mass sympathy for AIDS victims was not really mobilised until the problem seeped into the “normal”, law-abiding, heterosexual community.
A similar pattern can be seen with regards to M.E., whereby the perjorative “yuppie flu” label of the 80s only really began to lose credibility when the general public slowly but surely woke up to the fact that among sufferers were children, adolescents, the elderly and those who were clearly not high-flying financial wheeler-dealers from the City of London.
In “Hitler’s Scientists” (Penguin Books 2004), John Cornwell writes (p.73):
“Friedrich Wilhelm Schallmayer…who was a psychiatrist…called for mental health assessment panels, composed of doctors who, as officials of the state, would sit in judgment on the status of patients and deviants of various kinds.”
This mechanism is already in place in the UK, in the form of the DWP decision makers’ and appeal tribunals’ inclusion of psychiatric reports and judgments on claimants to ill-health and disability benefits.
“Erwin Liek, a medical doctor of Danzig…believed that illness was due to a lack of moral fibre, a conviction that in time would add impetus to the influences within professional medicine that justified the elimination of the sick.” (Cornwell, p.81)
The tactic of blaming illness on “lack of moral fibre” in patients has long been evident with regard to M.E. – take, for example, the argument that sufferers can “recover” by following a course of Cognitive Behavioral Therapy, on the alleged grounds that their ill-health is merely being perpetuated by their own false perceptions about their condition:
“Less fatigue severity at baseline, a sense of control over symptoms and not attributing illness to a physical cause were all associated with a good outcome. Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome. Conclusions: Full recovery from untreated CFS is rare. The prognosis for an improvement in symptoms is less gloomy…there is increasing evidence for the effectiveness of cognitive behavioural and graded exercise therapies. Medical retirement should be postponed until a trial of such treatment has been given.” (2)
“Why shouldn’t we try so and so?…We mustn’t merely plan and be theorists, but we must also experiment…” (Col. Rees)
That this culture is already embedded in the system can be seen in the guidelines for the UK’s Local Government Superannuation Scheme:
“A cognitive-behavioural approach to management of [CFS] is recommended…Psychiatric referral should be considered for those who fail to respond to rehabilitation…The possibility of co-existing mental ill health should be approached in a non confrontational manner as some patients with this illness will be resistant to psychiatric referral…The criteria for Ill Health Retirement Benefits are unlikely to be fulfilled unless all reasonable treatment options have been tried by which time many employers may have terminated employment.”
The PACE trials are only in their infancy, with no recommendations having yet been formulated (or so we are led to believe), so one has to wonder why the policy-makers of the Local Government Superannuation Scheme appear to take it as a foregone conclusion that CBT and “rehabilitation” are valid treatments for “CFS”. Have they already been “got at”? And if so, how? Col. Rees perhaps provides a clue:
“If we are to infiltrate the professional and social activities of other people I think we must imitate the Totalitarian and organise some kind of fifth column activity! If better ideas on mental health are to progress and spread we, as the salesmen, must lose our identity. By that I mean that we cannot help so effectively if speaking for a National Council or any other body as we can when we make a more subtle approach adapted to the particular circumstances of the moment. It really wouldn’t matter if no one ever heard of this Council again provided that the work was done. Let us all, therefore, very secretly be ‘fifth columnists’…Even if our letters are not published, they still produce their effect upon the editorial mind, and some of them certainly will be published and in this way will make people think. Here again we had probably better be secretive and not mention this Council or any other body, but simply write or speak as individuals. Don’t let us mention Mental Hygiene (with capital letters), though we can safely write in terms of mental health and common-sense.”
Parallels with the attitude that M.E. sufferers can, with impunity, be subjected to physical exertion beyond their capabilities (e.g. through Graded Exercise Therapy and the Pathways to Work scheme), regardless of what further detrimental effect this might have on their condition, can be seen in Cornwell’s comments (p.374) on I. G. Farben, the owners of Degesch, the manufacturers of Zyklon B, the pesticide used in the killing chambers of Auschwitz:
“Farben, in complete defiance of all decency and human consideration, abused its slave workers by subjecting them, among other things, to excessively long, arduous, and exhausting work, utterly disregarding their health or physical condition.”
Those deemed fit for work in the camps, while escaping immediate liquidation on arrival, were subsequently, however, worked to death. Those who glibly declare, “Hard work never killed anyone!” should seek the views of the survivors of Auschwitz, Buchenwald, Belsen, Treblinka, Dachau…
When applied to sufferers of M.E. and other disabling conditions, the DWP’s new Pathways to Work scheme brings to mind the slogan which bestrode the gates of Auschwitz: ARBEIT MACHT FREI (Work Sets You Free).
The racial purity and hygiene laws of the Nazis were born of eugenics, the science of race improvement (an area of study which did not originate in, nor was exclusive to, Germany). One of the principle architects of the purification laws was Ernst Rüdin, of whom Cornwell writes (p.90):
“As Hitler’s party made its bids for power, Rüdin became an enthusiastic exponent of eugenic and racial hygiene policies. His high reputation lent respectability to the Nazi policies of enforced eugenic sterilisation. Under his aegis schizophrenia and manic depression were judged categories suitable for sterilisation…The ‘medical’ and ‘scientific’ basis for the notion of eliminating the mentally ill was thus laid in the years following World War 1, preparing Germany for the propaganda that would lament the cost of maintaining the ‘ballast’ of the mentally ill and those with congenital diseases.”
Numbered among the students of Ernst Rüdin were Josef Mengele, who conducted the medical experiments at Auschwitz, and – trained by Rüdin in Munich – one Eliot Slater.
Eliot Slater (d. 1983), erstwhile editor of the British Journal of Psychiatry, was also Director of the MRC Psychiatric Genetic Research Unit, Maudsley Hospital from 1959-1965, and a Vice President or Council member of the Eugenic Society intermittently from 1944-1978. (3)
We should note with some interest, therefore, that in 1994 Prof. Simon Wessley delivered the 9th Eliot Slater Lecture – under the title “Microbes, Mental Illness, the Media and M.E: The Construction of Disease” – which included the comment, “I will argue that M.E. is simply a belief, the belief that one has an illness called M.E.”, stating in his opening remarks:
“I am proud and honoured to be asked and give the 9th Eliot Slater Lecture, and I think my choice of subject is one that Eliot Slater himself might have approved of – he was, of course, no stranger to controversy…” (4)
Since psychiatrists are called upon so readily and so often (sometimes in the most unexpected contexts) for their input on military, medical, social, environmental and political issues these days, it is essential that this be recognised, and the reasons for it rigorously and publicly challenged.
If not, if the continuing campaign to demean and denigrate conditions like M.E. is left unchecked, we may very soon find ourselves faced with the legitimisation of the concept of “the undeserving ill” and what that implies for the future – although it is already too late for those who, through neglect, abuse and inappropriate treatment, have been hastened to an early death or driven to suicide.
But if and when that day comes, those who collaborate with this campaign, especially among politicians, health and social workers, pensions agencies, insurance companies, the Ministry of Defence, the Department of Health, Local Government and the Department of Work and Pensions, will all be judged – and held accountable – for their complicity in this persecution of the sick and disabled.
(Feb. 2005/Oct. 2006)
“Hitler’s Scientists (Science, War and the Devil’s Pact)” – John Cornwell, Penguin Books, London 2004. ISBN 0-140-29686-7
(1) “The Men Behind Hitler”: http://www.toolan.com/hitler/index.html
(2) “A systematic review describing the prognosis of chronic fatigue syndrome” – R. Cairns and M. Hotopf (Department of Psychological Medicine, Institute of Psychiatry, London): Society of Occupational Medicine 2005, Vol. 55 No. 1