The link between psychosomatics, fascism, and eugenics
Intellectual Influences of 20th century Psychosomatics
While Freudian theories were central to the establishment of psychosomatics, in that their extension from only behaviour and thoughts onto the “soma” (body) were crucial, the influences of psychosomatics lie majoritarily outside of science or medicine.
Flanders Dunbar, sometimes referred to as the “mother” of the 20th century psychosomatics, was deeply influenced by her personal experience with illness and religion. She suffered from a young age with what was diagnosed as rachidic pseudo-paralysis, although she claimed later on in life it had been polio. She visited shrines to learn about how people used the mind to heal disease. She remarked that those that came in “hysterical” states to the shrines did not tend to have their improve, but those that had “deep confidence” in the healing power of shrines did.
She was educated in, among other places, clinical pastoral schools such as the Union Theological Seminary where her mentor was Anton Boisen, co-founder of the Clinical Pastoral Education movement. She believed in the power of “symbols” in medicine, such as religion. She eventually created the laws she called “emotional thermodynamics,” which were:
1. Psychological energy seeks an outlet through physical symptoms when it is not expressed mentally.
2. Permanent faults in personality can lead to disruption of energy and “somatic dysfunction.”
Her research commonly showed correlation but failed to prove causation. She believed psychosomatics would be valuable in all facets of medicine, for example by sketching out a “cardiac type of personality,” which was thought to lead to cardiac problems. She viewed personality defects as leading to specific organic illnesses, which was related to the overstimulation of the ANS and endocrine glands related to too much mental energy (it is worth noting this physical model does not hold with current evidence from neurology and endocrinology).
She founded the American Society of Psychosomatics in 1942 and was the first editor of the “Psychosomatic Journal of Medicine” founded in 1939.
Franz Alexander, sometimes called the father of psychosomatics, had similar beliefs. He viewed organic illness through psychoanalysis, forming a theory of “organ specificity,” where specific psychological stressors evoke specific organic damage to different organs. This was based on studying, among others, peptic ulcers and rheumatoid arthritis (we now know peptic ulcers are caused by bacterial infection).
The popularity did not immediately wane post-World War II
[post-WW2] general practitioners would be receptive to teaching and applying psychosomatic medicine to the many veterans and to patients with “functional disorders” admitted to general hospitals. Although the courses were well attended and full of promise, the impediments to implementation led to disappointing results.
http://turkpsikiyatri.org/arsiv/History_of_Psychosomatic_Medicine_Blumenfeld
Eventually, in the 1950s, the first edition of the DSM (sometimes referred to as the “bible of psychiatry”) contained illnesses under the concept of psychosomatic. This included illnesses like ulcerative colitis and hyperthyroidism. Conversion disorders, however, maintained a specific category to themselves, because they weren’t seen as changing the biological reality of the body, like these psychosomatic illnesses, but only the functional reality of how the body “acts.”
To read more, see Psychosomatic Medicine: A Brief History by Martin (1978):
https://www.sciencedirect.com/science/article/pii/S0033318278709114?ref=cra_js_challenge&fr=RR-1
The takeaway from all this that is relevant to the next section is that 20th-century psychosomatics has pseudoscientific roots, and it seeks not just to explain a few select illnesses as mind-body, but large swaths, and if allowed, the entirety of medicine. Echoes of this can be seen in the 1980s, for example, where cognitive-behavioural therapy was increasingly thought to improve breast cancer outcomes.
Eugenics, Fascism, and Psychosomatics
The eugenics movement was strongly based on genetic determinism, to the point that they saw both biological realities and sociopsychological realities as being caused by genetic factors. They framed criminality, poverty, illness, “deviant states” (queerness), as being caused by hereditary factors.
Many chronic illnesses didn’t fit well into that paradigm. How could someone born perfectly healthy all of a sudden develop a vague and persistent state of disease, especially if that disease doesn’t follow obvious hereditary patterns? The psychosomatic movement offered a simplistic (and therefore “elegant”) solution to the disconnect between many chronic illnesses and eugenic theories.
Explaining chronic illness as a manifestation of personality and behaviours (which they saw as intimately linked with moral failures) meant it could be written off as resulting from defective genetics, which are assumed by eugenics to be the cause of personality and behaviours. Therefore, this state of being “hereditary by proxy” allowed eugenic rationalisation of sterilisations, euthanasia, and general mistreatment of chronically ill people. The reasoning went, just as it did for race-based and sexuality-based eugenics: if they are genetically inferior, it isn’t prejudiced to treat them as societally inferior; in fact, it’s perfectly natural.
Hence, we saw a substantial rise in the psychosomatic movement and psychosomatic medicine in the 30s and 40s. This was coupled with the financial difficulties following the Great Depression, demanding cost-effective medicine, which psychosomatic “rehabilitation” also offered a solution to.
In his 1943 book Borderlands of Psychiatry, Stanley Cobb, Professor of Neuropathology at Harvard Medical School and Chief of Psychiatry at Massachusetts General Hospital, made the following provocative observation:
“A new word has come into medicine. It is quite the rage. One must know about ‘psychosomatics’ to be up with the times.”
(Brown 2023)
The decades of the 1930s to the 1950s saw a fervent embrace of the "psychosomatic movement." By 1942, attesting to the movement's impact on medicine, a most remarkable change had occurred in Christian's 14th edition of
Osler's Principles and Practice of Medicine: The leading first chapter was devoted entirely to "Psycho-somatic Medicine," bringing psychiatry and psychoanalysis to the bedside in a way that had probably never occurred before or indeed since.
Source
In the United States, psychosomatics manifested through the classification of chronically ill individuals as “feebleminded.” These people were then affected by eugenicist laws, leading to consequences like forced sterilisation (
US Gov Fact Sheet), which went on until at least the 1970s.
In Nazi Germany, this concept of “feeblemindedness” (
Schwachsinn) was the primary label approved for forced sterilisation (
Jewish Virtual Library). This broadly included illnesses that were judged by medical professionals to involve “insanity” or “weakness,” from schizophrenic presentations to cerebral palsy, deafness, and blindness. Thus, psychosomatic explanations for chronic illnesses with “somatic” symptoms helped cement them as part of the broader concept of “feeblemindedness.”
An attempt to relieve the overcrowding of psychiatric hospitals, in fact, played a significant role in Germany's decision to institute compulsory sterilisation and, later, the killing of psychiatric patients. [...] Hitler's letter authorising the programme to kill mental patients was dated 1 September 1939, the day German forces invaded Poland. Although the programme never officially became law, Hitler guaranteed legal immunity for everyone who took part in it.
(Source: Quoted in Wikipedia; original source Torrey et Yolken 2011, unconfirmed)
These programmes led more than 400,000 people to be forcefully sterilised (Proctor 1988 p.137) and over 200,000 to be murdered (
Yad Vashem Shoah Resource Center 2017). Despite the killings operating more on a
de facto than
de jure basis, the decisions were highly formalised. The verdict on whether an individual’s life was “dignified,” and thus worth living, was based on a three-person panel of a psychiatrist, doctor, and judge. A negative verdict led to execution (often described as “forced euthanasia”) (Proctor 1988 p.558).
In Greece, eugenics was not implemented as overtly (after all, Greek people were seen as “inferior” according to Northern European and American eugenist movements). However, the regime of Greek dictator Metaxas (1936–1941) introduced strikingly similar theories. These theories focused less on race and more on the “inferiority” of deviants, chronically ill, queer, intersex people, etc.
Importantly, psychosomatic theories were central to the rationalisation of the inferiority of these “deviants.”
While Metaxas’s regime did not implement forced eugenic sterilisation, it introduced a new concept into politics, one which attributed all social ills to psychic disease as well as to political, sexual, and gender identity.
(Tzanaki 2022)
This was not new; the previous Greek social elite and ruling class often presented mental illness as the cause of all social problems, from diseases to poverty (Kouroutzas and Tzanaki). What was new was the scale and centrality of these ideas within their political theories and their use to rationalise oppression carried out by Metaxas’ fascistoid regime.
Moreover, the state now emerged as a ‘new’ endeavour, as a network of interrelationships based not on economic interest and family bonds but on individuals’ capacities, according to their moral, psychic, sexual, gender, and social heredity. As a result, the ‘new’ state propagated its role as neutral and objective, above and beyond political parties, social classes, and political benefits. […] Bio-psychology [was used] with a view to ensure as much control as possible [over those deemed “deviant”]. […] Eugenics discourse established a patriarchal, biomedical, liberal eugenic order.
(Tzanaki 2022)
In the sense that psychiatric traits (caused by unchangeable genetics) are the core basis of every facet of suffering and oppression, psychoabsolutism—a radical form of psychosomatics and psychological determinism paired with eugenics—was central to the fascistoid worldview.
Metaxas’s regime managed to perform what gives the impression of a kind of magic trick: by using psychiatric technocracy on profound economic inequality, it elaborated an authoritarian, patriarchal, biomedical discourse on psychic normality. Therefore, injustice, poverty, and even industrial labour accidents emerged in the dominant discourse as the result of a person’s mental illness. Moreover, parallel to the leading biomedical discourse, the political rhetoric of the time sought to stigmatise communist men and women, accusing them of perversity and abnormality.
(Tzanaki 2022)
Metaxas (who was anti-communist) said:
The anti-communist struggle of the state directed against rebellious and mentally ill people should be based on a psychological foundation.
(Tzanaki 2022)
Conclusion
While the roots of 20th-century psychosomatics lie more in religious and Freudian influences, fascist and eugenicist use of psychosomatics may have led to a large increase in popularity. Further exploring how this has affected modern psychosomatics is crucial.
References
Brown, T. (2023, August 23). Thirty Years of American Psychosomatic Medicine, 1917–1947. Oxford Research Encyclopedia of Psychology. Retrieved 21 Dec. 2024, from
https://oxfordre.com/psychology/vie...0236557.001.0001/acrefore-9780190236557-e-641.
Jewish Virtual Library
https://www.jewishvirtuallibrary.org/nazi-persecution-of-the-mentally-and-physically-disabled
Proctor, Robert (1988).
Racial Hygiene: Medicine Under the Nazis. Harvard University Press.
ISBN 978-0674745780. “Racial Hygiene: Medicine under the Nazis.”
Kouroutzas and Tzanaki, ‘[The work of Konstantinos Gardikas and his biomedical conceptualizations],’ 25–40.
Torrey et Yolken 2011
"Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia". Schizophrenia Bulletin. 36 (1): 26–32.
doi:
10.1093/schbul/sbp097.
ISSN 0586-7614.
PMC 2800142.
PMID 19759092.
Tzanaki, D. (2022). Libido, Psychic Eugenics and Abnormality: Patriarchal Biomedical Rule and Metaxas’s Fascistoid Regime (1936–1941). Fascism, 11(2), 291-314.
https://doi.org/10.1163/22116257-bja10044
US Gov Fact Sheet
https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism?utm_source=
yadvashem shoah resource center 2017
https://www.yadvashem.org/odot_pdf/Microsoft Word - 6303.pdf
