Blood Matters

by Masha Gessen

  “The man from whom I got the most injections was a man with my name, this Heinrich Gross,” Johann Gross told me. Heinrich Gross, a psychiatrist, administered what the Nazis called “euthanasia” to the disabled inmates of Spiegelgrund, and preserved their brains, which he kept studying after the war. He continued publishing on the Spiegelgrund brains into the 1970s.

  Heinrich Gross was tried and convicted by a Viennese court in the late 1940s, and sentenced to two years in prison for his part in killing the children at Spiegelgrund. The Austrian Supreme Court threw out the verdict on a technicality, though, leaving Heinrich Gross free to embark on a second career as a neurological psychiatrist and court expert. In 1968 he became head of a research institute in Vienna. In 1976 he was called on to testify in the case of a man who had been interned at Spiegelgrund, like Johann Gross, as a “hardly reformable” youth. Heinrich Gross quoted from the man’s Nazi file in court—and the man confronted his former doctor. The media exposed Heinrich Gross as a Nazi criminal, but it took another twenty years for the Viennese prosecutor to bring a criminal suit against him. The court ruled that Gross was demented and unfit to stand trial. “They didn’t do him because they didn’t want to do him,” Johann Gross told me.

  The brains of Spiegelgrund were finally buried in the year 2002.

  I took a bus to the scenic outskirts of Vienna to see the hospital named for Otto Wagner, the Austrian Art Nouveau architect, another of the city’s great twentieth-century figures. I entered and climbed up a very steep path in the middle of the vast grounds, punctuated with all manner of signs and arrows, including red plywood temporary-looking signs that pointed to something having to do with “NS Medizin.” The warm autumn sun forced me to squint. The place seemed full of young people, some apparently medical students. Two teenage boys ran down the gravel path toward me, screaming, unable to stop.

  I entered Building V, near the top of the hill, through a lovely sunporch. The room where the Spiegelgrund museum was located was Otto Wagner–stylish: all the whitest of white, sun-drenched, with double-height ceilings and a checkered tile floor. A wispy-haired young man, not much older than the teenagers I had just seen, sat at a little desk in the corner. As it turned out, he knew next to nothing about the exhibit he was overseeing: He was just performing his alternative civilian service to avoid being drafted into the army. This was a shoestring operation that had been recently mounted by a group of enthusiasts, led by a city councillor who failed to get reelected.

  A circular semienclosed wall formed a room within a room. Inside, photographs of children killed at Spiegelgrund were tacked to the wall, captioned with first names, surname initials, and ages, from two to seventeen. Most looked obviously mentally impaired. Some looked terrified. One, Friedel F., looked exactly like my daughter: long thin eyebrows, huge eyes, ears that stuck out, and a bad haircut. Friedel F. had been nine when she died.

  Displays lined the rest of the room, aiming to educate the casual visitor about Spiegelgrund and Nazi medicine.

  “In the late nineteenth century a new discipline developed in Great Britain somewhere between anthropology, medicine, and biology, for which its founder Francis Galton coined the term ‘eugenics,’” explained a printout pinned to one of the stands. “While ‘valuable’ individuals were to be promoted (‘positive eugenics’), carriers of an allegedly inferior genotype should be systematically excluded from reproduction (‘negative eugenics’), which would lead to a genetic improvement of humankind. The idea met with public approval in many European countries and North America.” The rest of the page listed Nazi eugenic efforts—forced sterilization, “euthanasia,” and the fight against intermarriage—while attempting to walk the middle line between two traditional interpretations of the relationship between the science founded by Francis Galton and Nazi eugenic policies. One tradition interprets the National Socialists as enemies of science who perverted the spirit of eugenics. The other tradition, implicitly accepted by all who treat eugenics as a suspect term, has it that Hitler’s Germany was a land where science prospered, and in this fertile environment Galton’s ideas yielded the only fruit they possibly could: crime against humanity.

  Some of the definitions of racial hygiene, a concept that predates Hitler’s rise to power by several decades, sound conspicuously like possible definitions of contemporary medical genetics. One of the founders of the field, Hugo Ribbert, wrote that a goal of racial hygiene was “the prevention and conquest of diseases afflicting the entire human race, diseases from which each of the various races might suffer in similar manner.” His colleagues objected to the contamination of the value-free science of racial hygiene with “vulgar race propaganda.” These concerns notwithstanding, racial hygiene, or eugenics, lent itself extraordinarily well to use by the Nazis, who claimed that “National Socialism [is] the political expression of our biological knowledge.” At the same time, eugenics was perceived as the cutting edge of science not only in Germany but in the wealthy countries of Europe and, perhaps most of all, in the United States. In the period between the two world wars, Germany was far from unique in adopting laws based on eugenic ideas. In 1924 President Calvin Coolidge signed into law a bill that restricted the inflow of immigrants to the United States in accordance with then-dominant eugenic ideas. Coolidge himself had made his views known earlier. “America must be kept American,” he had said. “Biological laws show... that Nordics deteriorate when mixed with other races.”

  In Nazi Germany and annexed Austria, the practical application of eugenics proceeded in rapid stages. First, all forms of social deviance and difference, from Jewishness to Marxism and from homosexuality to criminality, were framed in biomedical terms. (Even the concentration camps and, some years later, the liquidations of the ghettos in Poland, were framed in terms of “quarantine.”) Second, public health policies changed to accommodate this understanding. Medical care for “the weak” endangered the race because it interfered with natural selection by allowing the unfit to survive. Public health had to concern itself with the good of the race as a whole, not just the individual: This was the view of Alfred Ploetz, the man who coined the term racial hygiene.

  The first of the racial-hygiene legislative acts was passed by the Nazi government in July 1933. It was called the Law for the Prevention of Genetically Diseased Offspring, which mandated the forcible sterilization of individuals whom a genetic health court found to suffer from any of a number of diseases then believed to be genetic, including numerous psychiatric conditions, hereditary epilepsy, Huntington’s chorea, genetic blindness or deafness, and severe alcoholism. (By this time, similar sterilization laws were on the books in twenty-eight American states and one Canadian province.)

  Unlike sterilization, Hitler’s euthanasia operations were mandated not by public law but by the Führer’s secret directives, illegal even in Nazi Germany. The body appointed to oversee the child-murder operation, which began in 1939, was called the Committee for the Scientific Treatment of Severe, Genetically Determined Illness. This was a cover name, but a telling one. The doctors who served on the committee, as well as those who carried out its directives, believed that the proper scientific treatment for severely disabled children was death—a mercy death, in their opinion, for their lives were not worth living. The committee did not issue orders; doctors simply received expanded powers, which included the right to commit murder, and acted in accordance with their beliefs. Four years later, the “euthanasia” program expanded to include healthy children of undesirable races, such as the Jews. The adult “euthanasia” program, initiated shortly after the child-murder campaign, claimed the lives of roughly four hundred thousand psychiatric patients.

  After the annexation of Austria, Vienna became the second-largest city of the Third Reich. Its officials raced to catch up with the implementation of racial-hygiene policies. The ground was fertile enough: As elsewhere in Europe, eugenic ideas were popular. Vienna had a city office of marriage counseling, created to stem the tide of anti-Darwinian s
election. Attendance, however, was voluntary, and apparently modest. The new regime acted quickly to streamline Vienna’s health-care system, adding new offices and entire new fields, such as “hereditary and racial health care.” Public health offices were charged with inventorying the city’s population, consolidating records culled from psychiatric hospitals, the police, and the office of youth welfare, to create a list of the genetically suspect. All those defined as inferior would be denied welfare benefits and health care. Public health officers were to pay particular attention to an individual’s potential productivity. This was why Johann Gross, the son of a disabled man, lost his place at the orphanage but ultimately was allowed to live: He was right to tell me that it was his good school grades that saved him.

  ***

  The easiest way to think of medicine under the Nazis is to believe that science was abused, and so, in some way or another, were the doctors who applied it. The problem is, that does not seem to be true. “One could well argue that the Nazis were not, properly speaking, abusing the results of science but rather were merely putting into practice what doctors and scientists had themselves already initiated,” writes Robert Proctor, a scholar of Nazi medicine. “Nazi racial science in this sense was not an abuse of eugenics but rather an attempt to bring to practical fruition trends already implicit in the structure of this branch of science.”

  The line of thinking launched by Francis Galton in the nineteenth century produced the desire to improve the human race, and particular races among humans. As knowledge accumulated, so did the drive to act on it, leading to the policies of National Socialism. That is why my German colleague cringed as I described my research. That is also why the very word eugenics sounds, if not exactly obscene, then at least accusatory. The problem with this view, though, is that it really does make it impossible to mount any credible defense of the contemporary science of medical genetics.

  Where does one draw the line between Nazi eugenics and contemporary genetics? For one thing, many of the racial hygienists went on to second careers as human geneticists, drawing on the experience gained while serving the Nazi regime—just as Heinrich Gross continued his study of disabled children’s brains even after he was no longer allowed to kill them for his research. The hardest place to try to mark a division between the Nazis and us is at the science itself. Many of the enduring obsessions of racial hygienists have either remained germane research topics for geneticists or have been revisited in the last few years. These include the studies of twins to estimate the genetic components of everything; the heritability of behavior, such as a propensity for violence, crime, or alcoholism; and Jewish intelligence. Even the once-ridiculed claim that Jews have a higher incidence of certain genetic diseases has now yet again been affirmed by scientists.

  What makes matters even more complicated is that some of the Nazi public health measures live on: For example, the restructuring of the Viennese health-care system, designed to prioritize public health over individual care, is still in effect. Indeed, it is difficult to object to the basic argument advanced by Alfred Ploetz, who claimed that on a policy level public health trumps individual medical care. In 1936 Ploetz was nominated for the Nobel Peace Prize for his public health work.

  Some researchers have focused on the economic arguments inherent in Nazi public health policies, which calculated the value—and care-worthiness—of human life according to the person’s potential productivity. But economic arguments are extremely important in contemporary public health policy as well. Professional journals regularly publish articles arguing, for example, that widespread testing for certain conditions is economically viable because care for full-blown disease is very expensive. In the mainstream media, discussions on, say, the cost and economic defensibility of life support for hopelessly brain-damaged patients are commonplace.

  A term that used to sound so damning as to provide a potential demarcation line was “lives not worth living.” But in recent years, American legal practice has virtually rehabilitated the concept by allowing so-called wrongful-birth lawsuits, in which plaintiffs argue that they, or their offspring, were born as the result of medical errors or negligence—for example, because a disability was not diagnosed prenatally. The basic premise of such lawsuits is, certainly, that some lives are not worth living. The conditions at the heart of “wrongful-birth” suits—such as severe mental disability, for example—tend to be the same conditions that the Nazis believed rendered lives unworthy.

  Of course, the easiest place to draw a line is at forced medical interventions. Nazi “euthanasia” was actually murder. Nazi sterilizations were involuntary. A basic tenet of contemporary medical genetics, to a degree even greater than in Western medicine in general, is that any tests or resulting care must be chosen by the patient voluntarily. But starting in the early twentieth century, a number of European countries and more than half of all American states enacted forcible sterilization laws. The language of the German law was, in fact, quite scrupulous: It allowed sterilization only in cases where genetically defective offspring was a likelihood and criminalized the sterilization of heterozygous carriers. It seems obvious now that forcible sterilization, no matter how finely defined, is indefensible. But the question remains: Were such laws the first step down a preordained slippery slope, which Germany simply slid down much faster than other countries would have, or was that catastrophic path unique to Germany?

  I wandered the city of Vienna, thinking about this. As a historian, I was less than a dilettante. But I had chosen to write a book on a topic over which a giant historical shadow is cast. I had no other option now than to try to draw my own dividing lines.

  Of the industrialized powers of the twentieth century that could lay claim to serious scientific achievement, the first one conspicuously to reject eugenics was the Soviet Union. Indeed, the Soviet Union banished genetics altogether. That did not serve to prevent the institution of racist policies, including wholesale deportations of entire ethnic groups—it was just that the Soviets, instead of claiming that members of the group were inherently inferior, ascribed to the groups behaviors, such as cooperating with the Nazis, and then laid collective blame. Nor did it prevent nationalism: Even several years after the collapse of the Soviet Union, in the early twenty-first century, more than half of all Russians owned up to supporting “Russia for the Russians.” Indeed, the only thing the rejection of genetics succeeded in doing was holding back Russian medical science: Russia did produce a crop of ambitious young geneticists once the ban was lifted, but in the absence of any institutional support, most of them emigrated. (In fact, about a hundred of them settled in Chicago, where they were doing most pioneering work on improving the human race—see chapter 12.) It serves as a good reminder that even in the twentieth century the rifts and crimes of nationalism existed independently of the science of either genetics or eugenics, perhaps because they resulted from differences that are real. The advances in genetics have served to remind us of these divides, which American culture in various ways and with varying success has tried to obliterate, especially when it came to the Jews, subsuming them into the general Caucasian population and deeming them a religious rather than ethnic or racial group. This time genetics came with a warning label, like cigarettes.

  Cigarettes, doctors will reluctantly tell you, are dangerous only when consumed in large doses: Very light smokers can have the pleasure without the risk of lung cancer. But only a very few people (see chapter 11) are inured to the temptations of cigarette addiction and can go on smoking five or fewer cigarettes a day for years. I was one of those smokers: two or three a day, for nineteen years. Genetic research, like most knowledge, can be like a drug: It leaves most of us wanting more. To separate the knowledge effectively from collective behavior, we must take it in small doses: apply it to individuals and not groups. Once it is used to generalize and create population-wide policies, the risks skyrocket.

  My own task now was to apply my new genetic knowledge to myself.

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nbsp; PART 2

  THE PRESENT

  Chapter 4

  Indecision

  THE TECHNICIAN ASKED ME if I was claustrophobic. I am not. I climbed onto the table and lay facedown, lowering one of my breasts into a specially made hole, and the technician disappeared behind a glass door, from there to pull me into the MRI tube and begin. I lay very still, as instructed. There was a series of loud, rapid-fire bursts, like shots from a machine gun. Then a whistling sound—sniper fire. Then something in the machine churned heavily, signaling the approach of a new series of shots, the way a low-cruising plane announces an imminent bombing with its engine noise.

  I had spent years working as a war correspondent. I had lived this. You lie still as you can, usually surrounded by people you cannot see or feel, and you wait, listening. You name every noise. It is not frightening exactly: There is no adrenaline rush like you get when you run from a threat or stare it down. There is an eerie calm, and it is all in the waiting.

  When I went in for an MRI of my other breast a week or so later, I told the technician the machine reminded me of a bomb shelter. “Oh my God,” she exclaimed. “We had an older woman in here who lived through World War II somewhere in Europe—she said the same thing!”

  Then the technician seemed to breathe a sigh of relief. “Oh, you’ve been to wars,” she said. “Then this is nothing! You’ll be fine.”

  Right. What I have always loved about war reporting—what, I think, generally gets people hooked on that absurd line on work—is that the danger is so clear-cut. You either catch a bullet or you do not. Most journalists, in fact, do not. Then you go home, and you are safe.

  The life of a genetic mutant could not be more different. First, the nature of the risk is fuzzy. The mechanisms by which the vast majority of known deleterious mutations work are unclear to scientists. Mutations are most often identified by comparing epidemiological data with the results of genetic testing. In a 2002 study, for example, researchers set out to find out what role genetic mutations played in the rates of breast cancer in Pakistan—the highest in Asia (with the exception of Jews in Israel)—and ovarian cancer, one of the highest in the world. The study looked at 661 women: 341 had breast cancer, 120 had ovarian cancer, and 200 made up the healthy control group. Forty-two of the women with cancer turned out to have one of six mutations in either the BRCA1 or the BRCA2 genes (most of the mutations seem unique to Pakistan). The researchers concluded that genetic mutations were an important factor in the high rates of cancer, and, in addition, that consanguineous marriages (marriages between relatives) were associated with some of the cancers.