Eugenic concerns,scientific practices: international relations in the establishment of psychiatric genetics in Germany,Britain,the USA and Scandinavia,c .1910–60

Ernst Rüdin and the Department of Genealogy and Demography at the German Research Institute for Psychiatry

Ernst Rüdin (1874–1952), a Swiss citizen, was a pupil of Emil Kraepelin, the dominant figure in German psychiatry during the first quarter of the twentieth century. ⁶ Around 1910, both Kraepelin and Rüdin proposed the idea of a central German research institute to investigate the spread and causes of psychiatric disorders and social deviance, with explicit reference to the need for preserving or even improving the hereditary health of the German population – that is, with a eugenic argument (Kraepelin, 1908; Rüdin, 1909). Kraepelin and a few other university psychiatry professors lobbied for this research institute (Alzheimer, 1911; Sommer, 1910), and eventually they were successful: the DFA was inaugurated in 1917 in Munich, backed by funds from both state authorities and private philanthropic sources (Weber, 1991). Among the new institute’s five departments was one for Genealogy and Demography, which had the explicit aim to investigate the epidemiology and genetics of psychiatric disorders for eugenic purposes. Rüdin was appointed director of this genetic-epidemiological department and remained in this position until the end of World War II.

In 1911 Rüdin had formulated an elaborate research programme to study the genetics of the major psychiatric conditions, drawing on the most advanced methodologies of contemporary sciences, including psychiatry itself, as well as anthropology, genealogy, statistics and various laboratory sciences (Rüdin, 1911). In the following years he turned this programme into practice, focusing on one distinct disease category: dementia praecox/schizophrenia. In doing this, he built on Kraepelin’s nosology and its presuppositions, such as the assumption that psychiatric disorders represent biological entities. Methodologically, Rüdin relied on Wilhelm Weinberg’s concepts of population genetics, in particular his ‘sibling method’ (Weinberg, 1912) ⁷ . Weinberg was himself a social hygienist and a physician of the poor (Armenarzt), though also eugenically orientated (1908/09, 1910). For his empirical research, Rüdin studied all of the approximately 700 patients suffering from dementia praecox in Bavarian asylums, as well as 4800 of their siblings and 1400 parents. This was in contrast to previous investigations that had selectively looked at families with more than one ‘case’ (Rüdin, 1916). Applying further methods of correction, in particular those formulated by Weinberg, Rüdin arrived at results which diverged considerably from previous studies, such as that by Charles Davenport and Aaron Rosanoff at the Eugenics Record Office in Cold Spring Harbor (USA). ⁸

Rüdin’s findings, published in a monograph of 1916, suggested that the incidence of dementia praecox among the offspring of one affected parent was around 6%, and amongst the siblings of an affected patient around 4.5%, in contrast to the much higher rates expected by a recessive mode of inheritance according to Mendelian laws (Rüdin, 2016). The problems of interpreting these data in terms of Mendelian inheritance led Rüdin and his team in the following years to extend the database and methods applied to this material. The aim was to calculate the probability of the manifestation of a mental disorder in an individual on the basis of the manifestation ratio in his/her immediate relatives (empirische Erbprognose), which was highly relevant information in the context of eugenic counselling on human reproduction (see e.g. Schulz, 1926).

Rüdin’s 1916 study received rapid international recognition and remained for decades a standard text in psychiatric genetics. Rüdin and his group, amongst them Hans Luxenburger and Bruno Schulz, refined their methodologies – including the application of the then highly promising study of twins (Zwillingsmethode – twin method) – of medical genetics to hereditary studies in psychiatry, and built up a broad and internationally acclaimed programme in the epidemiology and genetics of psychiatric and neurological disorders (Roelcke, 2002). In the first British handbook on human genetics, published in 1934, Aubrey Lewis (later to be the dominant figure in British psychiatry) evaluated the methodology and practices used by Rüdin and his team in Munich as being at the forefront of international efforts in the field and possessing paradigmatic character (Lewis, 1934: 87).

After the Nazi takeover in 1933, Rüdin and Eugen Fischer, director of the Kaiser Wilhelm Institute for Anthropology, Human Heredity, and Eugenics, became members of the government’s Standing Expert Committee for Health and Racial Policy, which in conjunction with state administrators modified an existing draft version of a sterilization law. The definitive law, which allowed compulsory sterilization, was enacted by the Nazi government in January 1934 (Weindling, 1989). Rüdin was one of three authors of the official commentary to this law. The commentary explicitly referred to the method of empirische Erbprognose which, as pointed out above, had been developed at the Munich institute.

At the end of 1934, the Rockefeller Foundation stopped its institutional funding for the Munich department, due to Rüdin’s heavy involvement in Nazi health and sterilization policies. To make up for this, Rüdin turned to the authorities of the Nazi state, in particular the Ministry of the Interior and the Chancellery of the Führer. From these sources, he repeatedly received large sums of money for his research. This research was explicitly designed to ‘contribute to the genetic foundations’ of the regime’s racial hygiene policies. ⁹ Its core aim was to provide scientifically sound criteria for the selection of those to be sterilized in the context of eugenic or racial hygienic rationality. ¹⁰

In spite of this orientation towards the regime’s political aims, the research by the DFA was still considered as leading the field internationally. The Rockefeller Foundation continued to fund fellowships for young, promising scientists from abroad to do post-doctoral work at the Munich institute, such as Eliot Slater and Erik Essen-Möller. Staff members at the DFA, in particular Hans Luxenburger and Bruno Schulz, were quoted in the international literature of the field until the 1950s and 1960s (see below). Immediately before World War II began, in spring 1939, Rüdin was invited to present one of four plenary lectures in the Human Genetics Section at the Seventh International Congress of Genetics. The invitation was issued by Gunnar Dahlberg, a member of the programme committee of the Congress and director of the State Institute for Human Genetics and Racial Biology at the University of Uppsala. ¹¹

Thus, in the case of Rüdin, an explicit eugenic and (with it) political motivation for his genetic research had already existed more than two decades before the Nazi takeover. After 1933, Rüdin’s department continued to attract scientists internationally, despite its close co-operation with Nazi authorities. After 1945, Rüdin was suspended from office; he died in 1952 aged 78.

Franz Kallmann and psychiatric genetics in the USA

Franz Kallmann (1897–1965) was born in Silesia, with a Jewish family background. ¹² After graduating in medicine, he specialized in psychiatry and neurology and trained under Karl Bonhoeffer in Berlin. In 1928 Kallmann was appointed chief of the neuropathology department at the psychiatric asylum of Berlin-Herzberge. Here, he began to collect files of patients suffering from schizophrenia, dating from the late nineteenth century up to his time. It was his aim to extend Rüdin’s earlier studies on the genetics of this disorder, as well as to analyse the reproduction rates of schizophrenic patients and their relatives. He did all of this with an explicit eugenic motivation, and indeed he was a member of the German Society for Racial Hygiene from very early in his career. To update his methodological knowledge and intensify his research, Kallmann took leave to continue his work at Rüdin’s department in Munich in 1931. Until 1936, he regularly returned to the DFA for a few weeks almost every year to develop his close co-operation with colleagues there. ¹³

Due to his Jewish family background (although he was a baptized Protestant), Kallmann lost his position in Berlin in 1935. For the same reason (and not because of his work in psychiatric genetics, which was completely compatible with the accepted views of the regime), in 1936 he was also excluded from the Society for Racial Hygiene. Kallmann explicitly regretted this exclusion in a letter to Rüdin. ¹⁴ That Kallmann fully accepted the Nazi sterilization law is documented by the conclusions of a paper in which he presented preliminary results of his research to the International Congress of Population Science held in Berlin in 1935. Here, he argued that due to the differential fertility rates among various groups of patients suffering from schizophrenia,

in regard to the recessivity and belated manifestation of the schizophrenic disposition, it is desirable to extend prevention of reproduction to relatives of schizophrenics who stand out because of minor anomalies, and, above all, to realize this intervention for those undesirable from the eugenic point of view at the beginning of their reproductive years. (Kallmann, 1936a) ¹⁵

Thus, he not only accepted the sterilization law, but even recommended that the law should be extended to healthy, heterozygous carriers of the assumed gene for schizophrenia, for which he postulated recessive inheritance. Kallmann thought that the healthy carriers of this gene might be identified by thorough clinical investigations eliciting minor psychological anomalies. ¹⁶

Again because of his Jewish origins, he was not allowed to present a paper in person at the annual congress of the Association of German Neurologists and Psychiatrists in Dresden in November 1935. Instead, Kallmann’s paper on his research was read by Bruno Schulz, a colleague from the DFA. That the contents of the paper – on the fertility of various groups of schizophrenic patients – passed censorship and thus were compatible with the racial hygiene ideas of the Nazi state is evidenced by the fact that it was published under Kallmann’s name in the Proceedings of the congress (Kallmann, 1936b). Later hagiography (e.g. in the obituary by Slater) turned this single instance of not being able to present a paper into the plural, and wrongly claimed that his statistics could only get into print ‘by quotation marks in papers of another’s authorship’, thereby presenting Kallmann as opposed to the regime’s hereditary health policies (Slater, 1965: 1440; similarly in Gershon, 1981).

At the end of 1936, Kallmann managed to emigrate to New York. The anthropologist Franz Boas, himself of German-Jewish origin and an explicit critic of German racial laws as well as racist interpretations of eugenics, helped him find a provisional position and initial funding. To Boas, Kallmann presented Rüdin as a victim of the Nazi regime, since his psychiatric-genetic research programme had allegedly been restricted by political pressure and censorship. In a letter to Boas written immediately after his arrival in New York, Kallmann also constructed a dichotomous image of the situation in Germany according to which the various political institutions of the regime were arguing with ‘pseudo-scientific dogmas’ (pseudowissenschaftliche Irrlehren), whereas he and his colleagues in the field of psychiatric genetics had been doing proper science and fighting against such ideologies (quoted in Cottebrune, 2009b: 303–4). The image of a suppressed scientific field of medical genetics, created by Kallmann himself, and the fact that as a Jew he had to leave Germany, were later used to construct the legend that Kallmann had been opposed to the German programme of racial hygiene and the Nazi sterilization law, ¹⁷ which he definitely was not.

In New York, Kallmann spent a few years on short-term grants devoted to projects on psychiatric and broader medical genetics. From his research in Berlin and Munich, he had concluded that the disposition for manic-depressive disorder was inherited by a dominant gene, and the disposition for schizophrenia by a homocygotic recessive gene. In 1938, two years after his emigration to the USA, he published an English translation of the original, as yet unpublished, German manuscript of his book on the genetics of schizophrenia (Kallmann, 1938a). It was a family study of schizophrenia of 13,851 relatives of 1,087 patients admitted to a Berlin hospital during a 10-year period. He calculated the prevalence of the different forms of schizophrenia in relatives of patients compared with the general population. Whereas the expected prevalence in the general population was 0.85%, in the relatives of patients it was 16.4% (children) and 11.5% (siblings). This implied the hereditary nature of schizophrenia, although socio-educational transmission of the disorder (i.e. transmission by exposure to a specific pathogenic socio-educational environment) was not ruled out. In the preface of the book, Kallmann explicitly acknowledged Rüdin and the Munich group for their scientific inspiration and support. Building on this work, and supplementing the method of family studies with the twin-method, Kallmann then published a number of articles on the genetic component of schizophrenia in the 1940s (e.g. Kallmann, 1946). In a final monograph on this issue, he made use of a combined twin-adoption method drawing on concepts formulated by Luxenburger, his Munich colleague, in the late 1920s and 1930s (Kallmann, 1953; see also Luxenburger, 1928). For many years, these studies were the major evidence for genetic factors in manic depressive illness and schizophrenia (Gershon, 1981: 274).

All of these results were widely received and discussed in the field of medical genetics. Thus, some of Kallmann’s as well as Luxenburger’s results, for example, were quoted and discussed in the Principles of Human Genetics, a standard textbook published in 1960 by Curt Stern, one of the leading American geneticists and himself an émigré from Germany (Stern, 1960: 581–4). Even in the late 1960s and early 1970s, the results of Kallmann’s studies on the genetics of schizophrenia, which he had started in Munich, were cause for a large empirical study to re-evaluate his hypotheses (Shields, Gottesman and Slater, 1967; see also Rainer, 1973).

In the first years following his emigration, Kallmann was in a state of uncertainty regarding his employment. Initially he received funding, for example from the Carnegie Corporation of New York (1938–41) and the Rockefeller Foundation (1945–51) (Cottebrune, 2009b: 312). Finally, from 1954 onwards he managed to get a tenured position that was combined with a full professorship in psychiatry at Columbia University. His research programme developed into the first department of psychiatric genetics in the USA. It was also the second programme in the broader field of medical genetics, preceded only by the one at Ohio State University under Laurence H. Snyder (Herndon, 1962: 247).

In 1948 Kallmann co-founded the American Society of Human Genetics, together with Laurence Snyder and Nobel Prize winner Hermann J. Muller, and from 1952 onwards he acted as its president (Paul, 1995: 121). He was also a founding editor of the American Journal of Human Genetics and served as co-editor of the Journal of Heredity and the Acta Geneticae Medicae et Gemellologiae, a journal of twin studies and medical genetics founded in 1952 by the Catholic eugenicist and medical geneticist Luigi Gedda. In addition, Kallmann was a member of the organization committee of the first and second International Congresses of Human Genetics in Copenhagen in 1956 and Rome in 1961 (Herndon, 1962: 247).Thus, in the 1950s and early 1960s, he was among the most distinguished figures not only in psychiatric genetics, but also in the broader field of human genetics. Upon his death in 1965, the New York Times honoured Kallmann as the foremost representative of psychiatric genetics in the USA (quoted in Cottebrune, 2009b: 297). His colleague and friend Slater (1965) stated that psychiatry had lost ‘one of its most notable pioneers’.

Parallel to serving as president of the American Society of Human Genetics in the 1950s, Kallmann was also a member of the Board of the American Eugenics Society. In fact, five of the first six presidents of the American Society of Human Genetics shared these roles, with Hermann J. Muller being the only exception (Paul, 1995: 121). Throughout his career Kallmann maintained his eugenic concerns. When applying for funding for his projects in the USA, he regularly pointed to the importance of the new medical knowledge to be gained in terms of the genetic constitution as well as the health of the population. Newly arrived in New York, he delivered a paper to the Eugenics Research Association where he repeated the results he had previously presented at the Berlin congress of population science (see above). Now, he talked of the ‘danger of the development of new schizophrenic cases’ arising from the ‘unions’ of heterozygous carriers of the supposed genes:

From a eugenic point of view, it is particularly disastrous that these patients not only continue to crowd mental hospitals all over the world, but also afford, to society as a whole, an unceasing source of maladjusted cranks, asocial eccentrics and the lowest types of criminal offenders. Even the faithful believer in the predominance of individual liberty will admit that mankind would be much happier without those numerous adventurers, fanatics and pseudo-saviors of the world who are found again and again to come from the schizophrenic genotype. (Kallmann, 1938b: 105)

He concluded that ‘there should be legal power to intervene, in addition to the general eugenic program of the biological education of all adolescents, marriage counsel, obligatory health certificates for all couples applying for a marriage license, and the employment of birth control measures’ (p. 105).

Following the same rationale, in another paper Kallmann advocated the sterilization of mentally disabled family members of schizophrenic patients if they were inaccessible to genetic counselling (Kallmann, 1938c: 195–7). A year later he wrote ‘In democratic countries with high standards of ethics and moral discipline, the general public should be educated rather than forced to realize the advisability of submitting to reasonable eugenic measures adopted for the perpetuation of common happiness and security’ (Kallmann, 1939). Here, the reference to democracy is used as a rhetorical means to justify intervention in human reproduction to achieve ‘common happiness and security’, whereas individual well-being is not on the agenda. Also, the use of force is not completely rejected, but educational measures are preferred to achieve what are defined by experts as eugenic aims, whereas the perspective of those concerned is neglected.

What Kallmann dropped after his move to the USA and the end of World War II, however, were explicit references to terms such as race, and to the biological quality of the Volkskörper, or ‘national body’. Thus, his talk of populations could now be interpreted as referring to mankind in general. He also stopped arguing explicitly for laws to enforce regulations on reproduction, especially against the will of those concerned, and instead he appealed for educational measures, the nationwide provision of genetic counselling, and voluntary sterilization. Further, he stressed that his genetic interpretation of schizophrenia was compatible with social and psychoanalytical approaches which, however, only addressed the manifestation of the already pre-existing, genetically caused disorder (Kallmann, 1946: 320).

With the new availability of therapeutic interventions such as psycho-pharmaceuticals, eugenic recommendations as preventive measures did not disappear, although they lost their prime place among Kallmann’s considerations and recommendations (Kallmann, 1948; see also Cottebrune, 2009b).

Even in the context of a 1961 conference at Columbia University on the state of psychiatric genetics, Kallmann elaborated on the dangers of ‘bad mutations’ for the collective gene pool and proposed that medical geneticists should act as ‘expert guides’ for measures to improve the biological quality of the population. All available scientific and technical means should be employed to direct the evolution of the human species towards ‘unimpaired health potentials’. To accomplish this, Kallmann argued, genetic selection had to be controlled. Since the potentially dangerous effects of ‘bad’ mutations could only be partially compensated by a supporting environment, an adequate population policy also had to encompass prenatal selection (Kallmann, 1962: esp. p. 251).

The sick or suffering individual was absent from this programmatic statement. Instead, Kallmann referred to one of the basic ideas of early eugenics, namely that of counter-selection: in contrast to ‘natural’ evolution where ‘bad’ hereditary traits were supposedly eliminated by the ‘struggle for existence’, the social institutions and health care provisions of modern societies preclude this process of selection and thus contribute to a potential deterioration of the collective gene pool. ¹⁸ The definition of what was considered ‘bad’ remained with the medical geneticist, whereas the individuals concerned (the supposed carriers of ‘bad’ genes) had no voice.

In conclusion, it may be stated that throughout his career in Nazi Germany and in the USA, Kallmann maintained his overall eugenic concerns and aims. But by ‘sanitizing’ his rhetoric, excluding references to race and the national body politic, and by propagating educational measures as well as genetic counselling, he adapted to the values and rhetoric of the surrounding American society. For his scientific activities, he continuously developed the methodological reservoir he had acquired at the DFA, while at the same time including newly available concepts and procedures.

Eliot Slater and the Institutionalization of Psychiatric Genetics in the UK

Eliot Slater (1904–83) is today seen as the ‘doyen and founder of psychiatric genetics in Great Britain’ (Gottesman and McGuffin, 1996: 537). After earning a degree in medicine, he joined the staff of Maudsley Hospital in London in 1931. Aubrey Lewis, then chief-of-staff of Maudsley, had himself developed an interest in genetic issues (see e.g. Lewis, 1931). The suggestions and guidance of Lewis, as well as contact with the statistician and population geneticist Ronald A. Fisher, led Slater to choose genetics in psychiatry as the focus of his further scientific career. Both Fisher and Lewis were protagonists in the British Eugenics Society. In the early 1930s Fisher in particular lobbied for the introduction of a sterilization law in the UK, after the Wood Report of 1929 had documented the high and apparently increasing incidence of feeble-mindedness, which was seen as both a genetic and a social condition. In order to obtain data to support the sterilization campaign, the Eugenics Society turned to Rüdin, who was pleased to supply information, including a comprehensive list of references on the inheritance of feeble-mindedness and a number of reprints (Mazumdar, 1992: 196–210). Lewis, however, was critical of the new Nazi law for forced sterilization enacted in July 1933. Already in August of the same year, he had published an anonymous comment on the law in The Lancet, in which he spoke of an ‘irresponsible extremist’ implementation of the ideas of eugenics in Germany, a ‘gross overstatement of our present knowledge of heredity’, and a ‘disregard for the individual human being’ whose interests were subordinated to those of the society (Anon. [Lewis], 1933).

Following the suggestion and support of Lewis, Slater received a Rockefeller fellowship for 1934–35 to become acquainted with modern methods in psychiatric genetics and epidemiology. With this funding, Slater worked for 10 months at the DFA in Munich. ¹⁹ He also went to Berlin to familiarize himself with the principles of mutation genetics at the genetic department of the Kaiser-Wilhelm-Institute for Brain Research under geneticist Nicolai Timofeeff-Ressovsky. In addition, he visited the newly established Institute for Hereditary Health and Racial Hygiene at Frankfurt University directed by Otmar von Verschuer, who was regarded as a pioneer in the twin methodology.

In Munich, Slater began a study of three generations of manic-depressive families. The study consisted of 315 probands with recurrent affective disorders, their parents and their children, using the data collected by Rüdin and his team, and supplemented by his own interviews with children of the subjects (Slater, 1936a, 1936b). As a methodical innovation, he applied three different kinds of age-correcting to the same data sets. He also was the first to use the analysis of variance in psychiatric research (Gottesman and McGuffin, 1996: 543). One result of this study was that manic-depressive disorder was not connected with downward social mobility for the family. This was an important result in the context of eugenic considerations, and confirmed the previous results of Luxenburger.

After his return to Britain, Slater, encouraged by Lewis, prepared the way for further genetic studies by first carrying out an epidemiological study of the incidence of mental disorders in England and Wales. ²⁰ This approach had been established by the Munich group around 1930 (see e.g. Schulz, 1931) and was also followed in various Scandinavian contexts. The rationale was to enable comparisons between the frequencies of various mental disorders in the average population and in the families of psychiatric patients, which would be the starting point for genetic investigations. Slater (1935) made direct use of the methods of Schulz and Luxenburger, and compared his findings from Britain with the results from Germany.

For his further work, Slater received funding from the Mental Disorders Committee of the Medical Research Council (MRC), which until then had mainly supported Lionel Penrose’s study on the heredity of the mentally defective in Colchester. The Committee now sought to extend the scope of genetic work in psychiatry, and found Slater to be the most suitable person to do this. In 1936 he began setting up a genealogical databank of psychiatric patients in Greater London, with a particular focus on twins. This project was closely modelled after the work done by Rüdin and his colleagues at the Munich DFA, which Slater again visited in 1937. ²¹ When he delivered a lecture on ‘The Inheritance of Mental Disorder’ in 1936, more than two-thirds of his references for valid evidence on various disorders were from authors affiliated with the DFA. At the same time, he clearly criticized the methods used in earlier research on the inheritance of epilepsy by Rosanoff at the Eugenic Record Office at Cold Spring Harbor, USA (Slater, 1936c).

It was apparently no problem for the MRC that Slater had received his training at German research institutions, in particular the DFA, which was known for its close co-operation with the Nazi regime. In 1936, a year after the MRC’s decision to fund Slater, he published a report and critique of the German sterilization law, which was used in later historical accounts as supposed proof of his opposition to the political ‘abuse’ of genetic knowledge (Gottesman and McGuffin, 1996: 543). However, a closer look shows that, apart from strong attacks against the Führer’s policies in general and the spirit of compulsion pervasive in German society and culture, Slater did not criticize the law in principle, but rather a number of its technical details, such as the difficulties of making exact diagnoses and shortcomings in the practical implementation of the law. He also discussed the question of whether voluntary sterilization might be preferable to enforced measures:

Against this [i.e. the idea of voluntary sterilization] one must put the opinion of such a well-informed authority as Sjögren of Sweden, who told me that in his opinion the reverse would be the case. Apparently the experience in Sweden with voluntary sterilization has been very disappointing, only a few hundred having been sterilized since the introduction of the law a few years ago. (Slater, 1936d)

Although indirectly argued, this may be understood as a plea for the possibility of enforced sterilization as provided in the German law enacted by the Nazi government.

Slater also pointed to mistaken assumptions: ‘There is no foundation in the idea, sometimes found outside Germany, that the law is administered in a partial way as a punishment for political offenders’ (p. 290). Further, Slater discussed possible expansions of the law, such as including children of two recessive parents, and sterilizing the monozygotic twin of a person already ordered to be sterilized. He argued that ‘this could be taken as an improvement in the justice of the law’, since ‘the phenotypically healthy twin is at least as dangerous eugenically as the sick twin’ (p. 290). Finally, he went to some length to discuss the 1935 Nazi ‘law for conjugal health’. Here, he regarded mandatory marriage certificates as problematic due to difficulties in practicalities, but he found the newly adjusted German income tax system ‘from a eugenic point of view’ much better than the English system (p. 294).

Slater’s moderate criticism of the law in 1936 irritated Rüdin somewhat, as is documented in the correspondence between them. This irritation, however, did not prevent Slater from asking Rüdin to support him in the publication of two lengthy articles in German psychiatric journals (Shrimpton and Slater, 1939; Slater, 1938). He also contributed a methodologically interesting article (on the probability of manifestation of genetic dispositions) to the Festschrift on the occasion of Rüdin’s 65th birthday in 1939, on the eve of the war (Slater, 1939). The birthday celebrations were held in Munich, where members of various political institutions of the regime met with researchers from the DFA and the international scientific community. The contributions were published in a special issue entitled ‘Rüdin-Festschrift’ of the Allgemeine Zeitschrift für Psychiatrie, the journal of the German Association of Neurologists and Psychiatrists of which Rüdin was president. ²² After an introduction by Luxenburger, Herbert Linden, physician and head of the Medizinalabteilung of the Ministry of the Interior, presented a paper on the ‘fight against sexual delinquency with medical means’. Kurt Pohlisch, a close personal friend of Rüdin and Professor of Psychiatry at Bonn University, as well as director of the second-largest research institute on psychiatric genetics in Germany, contributed considerations on the ‘family method’; Rüdin’s and Pohlisch’s pupil Friedrich Panse presented a paper about a new ‘genetic order of human hereditary syndromes’. ²³ The international community was represented by Slater, Essen-Möller and the Swiss pupil of Rüdin, Carl Brugger. ²⁴ Slater made it clear that his own work started out from the concept of empirische Erbprognose developed at the Munich Institute, and concluded that it was Rüdin’s special achievement to have insisted on the necessity of the recurring analyses of thoroughly collected empirical ‘material’ with constantly revised methods (Slater, 1939). As already indicated, this was a paper written in German in 1939, immediately before the beginning of World War II. At the same time, in mid-1939, the Mental Disorders Committee of the MRC decided that work on genetics in psychiatry was of growing importance for the future, and that in particular Slater’s twin studies should be regularly supported for the following years. Apparently, from the perspective of the MRC Committee, the goals and methods of eugenically motivated psychiatric genetics, as pursued by Slater and based on the Munich methodologies, were either not judged as contaminated by Nazi ideology, or else this Nazi association was seen as unproblematic regarding the scientific validity of the knowledge gained.

After the war, Slater was appointed physician in psychological medicine at the National Hospital, Queen Square, London. Here, he observed a number of long-standing paranoid psychoses resembling paranoid schizophrenia in patients suffering from epilepsy. In a combined genetic and clinical follow-up study, the evidence suggested that these psychotic states, although closely resembling schizophrenia, were biologically completely distinct and, rather, were related to an inherited disposition for temporal lobe epilepsy (Beard and Slater, 1962). This finding re-confirmed the biological heterogeneity of clinical cases of schizophrenia, and the necessity already stated by Rüdin of both very careful clinical ‘case’-identification and differentiation of genetic studies, in combination with co-morbidity as a potential clue for further investigations into the inheritance of the disorder.

Slater also continued his work on the genetics of neurotic and psychotic twins, and in the 1950s he formulated an influential theory about the monogenetic origins of schizophrenia. This theory became a theoretical challenge and reference point in the field for many years. The Genetics of Mental Disorders, which Slater published with Valerie Cowie in 1971, remained a standard book on the subject for two decades (Slater and Cowie, 1971). Even in the 1950s and 1960s, his publications included references to the work of members of the Munich Institute, in particular Hans Luxenburger and Bruno Schulz. ²⁵

In 1959 the Medical Research Council decided to establish a centre for psychiatric genetics. This was the first research institution in the field in the UK. Slater acted as its director until his retirement in 1969. From 1961–72 he was also the editor-in-chief of the British Journal of Psychiatry, one of the most prestigious positions in the field of psychiatry in the UK. He was a member of the Royal Commission on Capital Punishment and held honorary fellowships at the Royal Society of Medicine, Royal College of Psychiatrists and American Psychiatric Association. His high esteem in Britain was sealed by receiving the 1966 award of the Commander of the Order of the British Empire (Roth, 1983). He died in 1983.

Parallel and intrinsic to his scientific activities, Slater continued to be a member of the Eugenics Society, which he had joined in 1937 and for which he served as a member of the Council (in part in the office of Vice-President) from 1944 onwards for almost 30 years. He regularly contributed to the Eugenics Review, as well as to the Annals of Eugenics (later renamed Annals of Human Genetics). In a short article on ‘Modern tendencies in eugenics’ which appeared in 1945 immediately after the war, Slater gave an interesting evaluation of the Nazi sterilization programme. Although he did not reject negative eugenic measures in general, he argued that in Nazi Germany negative eugenics ‘was taken to its logical limit, and a good bit beyond’, since individuals suffering from hereditary conditions could not themselves decide to be sterilized, but the decision was forced upon them. Further, he argued ‘the Nazis were in too much of a hurry …. We need to know a great deal more about human heredity than we yet do to lay down any absolute rules’ (Slater, 1945: 182, 183). The implication was that the sterilization law had been imposed by ‘the Nazis’ (suggesting a homogeneous group) in disregard of scientific evidence. In spite of Slater’s knowledge of the contrary, no mention was made by him that the law was drafted, publicly justified and the official commentary authored by eugenically motivated medical geneticists, and that its content as well as its implementation relied on these geneticists’ expertise, with Rüdin as one of the protagonists. Thus, similar to Kallmann in his earlier correspondence with Boas, Slater proclaimed after the end of the war that Nazi sterilization policies had nothing to do with proper science; he completely ignored the close co-operation of scientists with the regime in questions of health and population policies, and the fact that in many instances, such as the sterilization law, the initiative actually came from the scientists. ²⁶

In his 1945 article, Slater also repeated the core eugenic argument of counter-selection as a threat to the genetic health of the population: in contrast to ‘a barbaric state of society … in a civilised society with social agencies to protect the least fortunate children, the mentally and bodily enfeebled may outbreed the others’. In view of this differential birth rate, and since ‘it seems probable that important qualities such as good health and intelligence … have a basis in heredity’, he concluded that social measures such as ‘good feeding and upbringing, good education … could be great forces for good; but they could not compensate for a consistent deterioration of innate endowment’ (Slater, 1945: 184).

In another paper read to the Eugenics Society in December 1947, Slater characterized the Nazi sterilization law as ‘draconian’ and the ‘strictest’ of all implemented eugenic laws, but not qualitatively different from other such measures (Slater, 1948: 64). He also referred to an overview and evaluation of 15 years of the Danish sterilization law (implemented in 1929) by geneticist Tage Kemp. According to Slater, Kemp’s ‘informative paper’ had shown that the eugenic legislation was a ‘humanitarian measure’, but it had also illustrated the ‘limited scope and effect of such measures when we think of the community as a whole’ (p. 66). For the time being, Slater was alarmed that ‘we are confronted with what appears to us a ruinous rate of loss of good genes and so a corresponding rate of increase of bad ones. This is the eugenic problem that far outweighs all others’, including that of mental disorders (p. 67). He concluded that ‘the more intelligent half of the community’ should be encouraged ‘to have more, not fewer, children than the less intelligent’ in order to avoid the imminent deterioration of the genetic preconditions for intelligence in the population (p. 68).

In the Galton Lecture delivered by Slater in 1960, he rejected compulsory interventions in human reproduction, but on the other hand he still advocated the improvement of the genetic quality of human populations through biological methods (Slater, 1960).

Erik Essen-Möller and the Programme in Psychiatric Genetics and Epidemiology at the University of Lund (Sweden)

Erik Essen-Möller (1901–92) received a BA degree in genetics and statistics at the University of Lund in 1926, and a degree in medicine in 1931. ²⁷ Inspired by geneticist Herman Nilsson-Ehle, who also was a fervent racial hygienist, Essen-Möller decided to focus his career on behavioural genetics. With a two-year fellowship from the Rockefeller Foundation (1931–3) and additional contributions from Swedish sources (Essen-Möller, 1935: 3), he studied the fertility of the mentally ill at the DFA in Munich. As Essen-Möller himself stated, this topic had been suggested by Rüdin, who also had supported him in all respects. Essen-Möller admired the ‘generous organization’ of the DFA and its director, whom he perceived as interested both in technical details as well as the ‘big issues’ (große Linien) (pp. 3–4). He said explicitly that his topic was first of all motivated by ‘eugenic-social’ goals, but that it should also contribute to clinical knowledge (p. 7). At the DFA he met Luxenburger, Kallmann and Bruno Schulz, who strongly influenced his methodology (Gottesman, 1993: 4), ²⁸ with all of whom he established close and lasting co-operation.

Essen-Möller published, in German, the findings of his Munich investigation into the fertility of some groups of patients with mental disorders as his doctoral thesis in medicine. The central outcome of this study was that the fertility of schizophrenics was lower than that of the healthy population, so it was of minor concern to eugenicists (Essen-Möller, 1935). At the International Congress of Population Science in Berlin in 1935, chaired by Eugen Fischer, Essen-Möller presented a paper on some implications of this work for population policies. He opened his contribution by stating that for eugenic aims, the knowledge of the fertility of psychiatric patients with hereditary conditions was essential; that his research into the related questions had been initiated by Rüdin; and that the empirical ‘material’ had been supplied by the Munich institute. In principle, the fertility rates of most groups of mental patients (in particular of patients suffering from schizophrenia and epilepsy) were lower than that of the general population, but the relationship between the (declining) fertility rate in the general population and in defined groups was changing over time. By sterilizing all known ‘cases’, he argued, the birth of individuals suffering from manic-depressive disorder might be only very slightly reduced, whereas the ‘eradication’ (Ausschaltung) of the number of schizophrenic patients and epileptics in the population might be considerably accelerated. Thus, the systematic sterilization in the case of the latter two diseases would enhance the process of ‘natural’ reduction due to ‘low’ fertility rates, in particular regarding schizophrenia (Essen-Möller, 1936).

Here, we find the motivation of one of Essen-Möller’s central research programmes: his eugenic concerns and goals – in particular the aim of effective control of the reproduction of patients suffering from supposedly hereditary conditions – led him to elaborated theoretical work which, in retrospect, could well be framed as ‘basic science’. Thus, Essen-Möller began working on what he called ‘differential reproduction’ of psychiatric patients and their family members. This research led him to important methodological developments such as advanced methods devised for correcting statistical biases related to the concept of empirical prognosis of heredity (empirische Erbprognose) developed by the Munich group. This work also led to important contributions to theoretical debates on the mode of inheritance of psychopathological traits and disorders, and the epidemiology of psychiatric conditions.

Like Slater, Essen-Möller participated in the celebration of Rüdin’s 65th birthday in Munich in 1939, and he read a paper about the potentials of the concept of personality diagnosis coined by his Swedish teacher Henrik Sjöbring for the investigation of genetics in psychiatry. Reconfirming the programmatic statement Rüdin had formulated from the beginning of his genetic studies, Essen-Möller (1939) pointed to the necessity of careful clinical delineation of psychopathological states and syndromes as a prerequisite of reliable genetic studies.

After returning to Sweden, he began a twin study of schizophrenic patients based on 10,000 consecutive admissions to four Swedish mental hospitals. A total of 69 pairs of twins were identified and closely investigated both in respect of their psychopathology and family relations, and after differentiating monozygotic from dizygotic twins. This study closely followed Luxenburger’s approach of analysing the genetic and environmental factors contributing to various traits or symptoms in an unselected series of twins. The first results of his analysis were published in 1941 (again in German), but this was only the beginning of a unique 30-year longitudinal study (Essen-Möller, 1941, 1970).

After this follow-up twin study, Essen-Möller also initiated in 1947 another unique community-based longitudinal investigation into the epidemiology and genetics of mental disorder: With his colleagues, he examined 2550 individuals, including 600 children, with the aim of describing and quantifying their psychopathology and personality variants, and analysing their family relationships. The last follow-up analyses were published in 1986 and 2005 (Hagnell, 1986; Nettelbladt et al., 2005).

Like Kallmann and Slater, Essen-Möller continued to use concepts and methods of the Munich school, developed in the 1930s and early 1940s, well into the 1950s and 1960s, and he also explicitly appreciated the conceptual tools and results he had received from the DFA. Thus, in 1955 he devoted a paper to an update of the concept of empirische Erbprognose. In 1958 he wrote a lengthy obituary for his Munich colleague Bruno Schulz, in which he sketched the importance of Schulz’s work for the next generation of psychiatric geneticists (Essen-Möller, 1955, 1958).

Essen-Möller’s first academic appointment was that of an assistant professor of medical genetics at the University of Lund in 1935, which was turned into an assistant professorship of psychiatry in 1939. In 1943 he was appointed Chairman of the Psychiatry Department at the Karolinska Institute in Stockholm, but he returned to the University of Lund in 1944 to become head of the Department of Psychiatry, where he stayed until his retirement in 1967. In Lund he built up a strong programme in psychiatric genetics and epidemiology with a high international profile, and with close co-operation in particular with Slater and his group in London (Gottesman, 1993; Munk-Jörgensen, 2007). He twice served as an expert advisor for psychiatric epidemiology and genetics to the World Health Organization (1959–67, 1981–5), and he was also appointed honorary member of the Royal Medico-Psychological Association in the UK.

Like Slater and Kallmann, Essen-Möller throughout his career stuck to his eugenic convictions. Thus, at the First International Congress of Human Genetics in Copenhagen in 1956, he delivered the most extensive statement of all participants during the final panel discussion, which was devoted to the topic ‘Epidemiological Control of Hereditary Diseases. Genetic-Hygienic Registration’. The terminology here is interesting: the term racial hygienic or eugenic was replaced by genetic-hygienic, but without changing the core content of the concept. Essen-Möller’s contribution argued that genetic expertise needed to be applied for improving the quality of the population in order to lower the number of criminals and increase the proportion of people with socially desirable qualities and behaviour. There was no word on the interests or well-being of individual patients or their suffering (Essen-Möller, 1957).

Conclusion

This study of the four protagonists of psychiatric genetics in Germany, the USA, UK and Sweden documents the international scientific credibility and authority of their respective research programmes and practices. All four were motivated by eugenic ideas in their research, which was intended to contribute to eugenic policies in the various national contexts. For all of them, the respective scientific agenda was intrinsic to the political one, and vice versa. However, the specific research programmes and practices were geared to the prevailing political contexts of their respective national settings. Each of the four continuously adapted his research agenda to problems perceived as intellectually as well as politically interesting and promising in view of broader concerns, which in turn were dependent on the available financial resources and specific political configurations.

For example, after his emigration to the USA in 1936, Kallmann maintained his overall eugenic concerns and aims. But by sanitizing his rhetoric, excluding previous references to race and the national body politic, and propagating educational measures as well as genetic counselling, he adapted to the values and language of American society. Thus, his talk of populations could now be interpreted as referring to mankind in general. In the next few years, he softened his convictions and finally stopped arguing for laws to enforce regulations on reproduction, in particular against the will of those concerned, and substituted this with calls for educational measures, and the nationwide provision of genetic counselling and voluntary sterilization. Furthermore, he stressed that his genetic interpretation of schizophrenia was compatible with social and even psychoanalytical approaches. In order to justify his scientific work before his emigration, and that of the Munich group so essential to him, Kallmann presented Rüdin as a victim of the Nazi regime by constructing an image of the psychiatric-genetic research at the DFA having been allegedly restricted by political pressure and censorship. He thus created a dichotomous image of the situation in Germany, according to which the political entities were arguing with ‘pseudo-scientific dogmas’ (pseudowissenschaftlichen Irrlehren), whereas he and his Munich colleagues in the field of psychiatric genetics had been doing proper science and fighting against such ideologies.

Similarly, Slater argued during the post-war period that the German sterilization law had been imposed by ‘the Nazis’ in spite of scientific evidence. The participation of Rüdin and other medical geneticists in drafting and implementing the law was bracketed out, and instead Slater suggested a contradiction between political entities (‘the Nazis’) and scientific expertise. In his 1936 comments on the sterilization law, he did not criticize the possibility of involuntary enforcement, but only the exact indications and the practicalities of the implementation. However, in the UK in the post-war period, he weakened his statements by characterizing the Danish sterilization law, for example, as ‘humanitarian’ (in contrast to the ‘draconian’ German law), albeit still pointing to the inefficacy of the Danish version.

On another level of analysis, the case of the international institutionalization of psychiatric genetics illustrates that the specific developments in Germany after 1933 may not be explained by the fact that the kind of eugenics and medical genetic practices there remained in a scientifically backward state because of their political ‘contamination’. Rather, the historical evidence amply documents that the Munich group around Rüdin was perceived as leading in the field internationally until the beginning of World War II in 1939, in spite of its close co-operation with the Nazi regime. It was only Slater who, at a relatively early date (1936), moderately criticized the authoritarian application of the results of genetic research to eugenic policies. In the case of Kallmann, as well as Scandinavian medical geneticists such as Essen-Möller, we find such an explicit critique developing considerably later, after the defeat of Nazi Germany, and when working in the context of democratic societies, relying on the resources and rewards provided by the institutions in those countries.

Thus, a simple dichotomic image of ‘mainstream’ versus ‘reform’ eugenics as formulated by Kevles does not fit the historical evidence. Instead, an interpretation is needed that takes into account three historical facts: first, the comparatively early onset of the institutionalization of eugenically motivated human genetics in general, and of psychiatric genetics in particular in Germany, which had already peaked by the late 1920s during the democratic Weimar Republic; second, its high standing in the international scientific community until the second half of the 1930s; and third, the continuation and further development of the Munich research agendas and methodologies in the UK, USA and Scandinavia well into the 1950s. Overall, the example of eugenically motivated psychiatric genetics in Germany documents that there was not a period of politically untainted ‘good science’ up to 1933, followed by a politically tainted kind of ‘mainstream’ eugenics from 1933 onwards.

The historical evidence thus points to the importance of two factors that explain the involvement of physicians and biomedical scientists in matters of public policy, the shaping of their research agendas, and thereby the kind of knowledge they produce; these factors were the authority of scientific expertise in the public sphere, and the availability of career resources for scientists. These aspects may be essential not only for an adequate historical analysis of the relation between eugenics and medical genetics, but also for broader issues related to the integral political dimension in the history of science, as well as for today’s public debate on the role of science in a civil and humane society.