Francois Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis: Forced Hospitalization, ECT and Sleep Therapy
Hanfried Helmchen: Some background*
(The personal memories of some events related to psychiatry following the turmoil of 1968 in Germany, particularly in Berlin and Heidelberg.
Events are experienced, reported and interpreted.
If they apply to the reporter and thereby the interpreter himself, or even aim directly at him, his report and, all the more, his interpretation will not be free from the emotions he experienced at that time and now again.)
Binjamin Wilkomirski became known in the 1990s through his autobiography (Wilkomirski 1995). He described his horrible experiences as a child in a concentration camp in such a lively way that he was invited as an expert for infantile traumatization even to psychotherapeutic specialist conferences. Later it was found that he, a native Swiss, had never been in a concentration camp. Thus, by the “Wilkomirski case” it was proven that the mystification of one’s own ego through identification as a victim was provoked not only by a psychotherapeutic treatment but surely also by great public attention and support” (Stoffels and Ernst 2002).
Considering this I dare – neither as a victim nor as identified with one or another aggressive adversary –describe from my personal viewpoint some disturbing events from that time because they have taught me something about the powerful influence of the contemporary socio-cultural atmosphere on the thinking and behavior of many people and, moreover, about the mutual interactions between this power of the Zeitgeist and the possibilities of independent individual thinking.
A 1985 event shows how much mental suppression may play a role:
During the academic celebration of the 80th birthday for Professor Helmut Coper in 1948,as one of the founding students of the Free University in West Berlin I mentioned that he, as the first chairman of the student executive board, thanked General Clay, the father of the Berlin Airlift on the occasion of his return to the USA, for his support of the founding of the Free University. I quoted the following sentences from Clay’s answer: “Dear Mr. Coper. I do not know of any letter which has given me greater pleasure than yours of 13 May 1949. I assure you of my admiration for the will of the students of the Freie Universität Berlin to maintain academic freedom and of any continued interest in your success.” With the change of the Zeitgeist 20 years later, the rebellion of the academic youth against academic and societal structures considered crusty led to such absurdities as a declaration of loyalty to Erich Honecker, the representative of a totalitarian state structure (the East German DDR), from which, from East to West, the preceding generation of students had escaped. After my speech with this comment on the change in the Zeitgeist, Rolf Kreibich, the first and non-professorial president of the Free University (1969-1973), told me that he had never heard of such an event. I answered that he as the universitypresident at this time must have heard about this event because all of the media reported it. Only the former chancellor of the university could remember this event.
The relationship between the individual and the Zeitgeist is not easy to understand. For the Zeitgeist – an undetermined term for the prevailing pattern of thinking and interpreting; the normative framework; the atmosphere and state of mind of an epoch – occasionally changes rapidly, is at the moment never clearly recognizable and, in retrospect, the selection and composition of its manifold manifestations underlie the evaluation of the retrospecting person. Likewise, complex are the conditions of the more or less independent thinking and behavior that rest on any individual’s disposition, actual situation and social function.
In this context I will try to trace how the events – even if today they may appear weird, fancy, unacceptable, partly incredible or trivial – have influenced me and why they were effective: did they confirm my point of view due to the aggressiveness that I experienced as appalling and personally defaming or did they stimulate me to a strengthened confrontation with a rational core that occasionally was recognizable in some deliberate provocations? (Petty 2001). Insofar as my thinking turns out to be a classical product of the Zeitgeist, which is characterized by the “linguistic turn,” i.e. the “aspiration that producing and communicating of historical knowledge,it is mixed inextricably with the epistemological crisis that is linked with the transition from a modern to a ‘postmodern’ condition of culture” (Toews 2001).
1 Tribunals
The student rebellion of 1968 against the “mustiness of a thousand years underneath the gowns” and, more strongly, against specific conceptions that they personalized in individual professors, sometimes took on a shape – such as the impossibility of continuing a lecture against the clamor of the students – that reminded me of the shouting down of Jewish professors by Nazi students in the early 1930s.
At the end of 1970 assistants (some of whom later became my most loyal coworkers) summoned me to a “tribunal” that became “fashionable” at that time. Such tribunals served to attack (alleged) annoyances by personalization. It could not be avoided that such events fueled the memories of the morally accused persons with what they had experienced or heard about National Socialist and Soviet “show” trials. In the 1950s I had reflected intensively on books of Communist renegades such as Arthur Koestler’s “Darkness at Noon,” but also of intellectuals, such as Czeslav Milosz’ “The Captive Mind,” or Hannah Arendt’s “The Origins of Totalitarianism” and George Orwell’s “Homage to Catalonia.” I by no means compared my situation at that time to the deadly threat of those defendants who were brought up, on demand, to stand before “show” trials.Because they fueled my memories, however, I was concerned with the question how much the effective mechanisms of such tribunals are comparable – seen sociopsychologically. Thus, I ignored the “invitation” to the tribunal – and nothing happened.
A similar situation occurred in 1972 when, as a candidate, I was invited to give a lecture by the appointment commission for the chair of psychiatry at Heidelberg University. I also received an invitation – likewise ignored – by the board representing the medical students for a public hearing that was to take place independently from my presentation in front of the faculty commission. Heidelberg colleagues also gave me student pamphlets (“There were enough Schneiders… beware of Helmchen”) that denied my qualification for the Heidelberg chair with the argument that I, as a biologistic psychiatrist, had a naturalistic, reduced, reactionary understanding of psychiatry.
Similarly, the assistants of the Berlin psychiatric department tried to invite candidates for a position to an independent interview in a tavern near the hospital - before the interview with me. After hearing about this I invited the senior physicians and representatives of the assistants to participate in my interviews. After, in one case, an applicant forced through by this group of coworkers proved a miscast, I had no more difficulties having my decisions accepted as the ultimate ones.
During the overheated discussion following my Heidelberg lecture in the overcrowded lecture hall of the psychiatric hospital, I responded to the inquisitorial question of whether, in psychiatry, I preferred the natural or the social sciences.My comment was that, for me, it is decisive whether the applied method is adequate to the question, as well as the quality of the methodical procedure both in the natural and the social sciences; this answer was not understood because it apparently did not correspond with the above-mentioned prejudice.
After a two-hour-discussion the 36 (!) members of the appointment commission retired with me to the conference room of the department in order to debrief me. But this was not possible because the students interrupted in order to “open the meeting to the public.” Therefore, the dean closed the session and I left. Karl-Peter Kisker, also an invited co-applicant and chair of psychiatry at the Hannover Medical School, described this incited, aggressive and noisy atmosphere later on as “the motion of men through the fiery furnace” (Kisker 1971). It was also the time of the Socialist Patients' Collective(SPK) in Heidelberg, a group of patients from the psychiatric department led, indoctrinated and radicalized by an assistant of this department (Pross 2016).
The background was the fierce conflict between politicized students and a faculty that was oriented to a traditional claim of quality and achievement. On the one hand, the students attacked the mode of the non-public procedure of professorial appointments as a “reputable fiddle” and urged openness. On the other hand, the students wanted to establish a psychiatry primarily oriented to societal causes and to change fundamentally the social practice of psychiatry instead of a psychiatry denounced as a descriptive-labeling one. Therefore, they demanded that Erich Wulff should be appointed, who alone in this sense would be qualified for the chair. This happened in the larger context that, at the end of the 1960s, broad concepts of psychiatric reforms arose, such as those that led to the influential enquiry of the German Parliament on the situation of German psychiatry (Deutscher Bundestag 1975), mixed with socialistic concepts that aimed at fundamental societal changes. In this retrospective description over so much time, one can scarcely imagine the difficulties of the stakeholders in such an excited and emotionalized atmosphere to recognize the border between an adequate response to a reasonable criticism or a demand for change and an acceptance of misleading ideas,particularly of behavior, that could be perverted into destructive social pathological manifestations such as the instrumentalization of patients in the SPK at the Heidelberg psychiatric hospital or into excesses of the antipsychiatry movement that was again becoming stronger (Kisker 1979).
In 1998 a professor of the Free University of Berlin invited me to a discussion with his students who wanted to prepare a FoucaultTribunal. In the style of the BertrandRussellTribunals, which had received considerable public resonance, psychiatry was to be indicted. I invited the professor for a discussion in our clinical conference. He came with his students, some of whom I recognized as members of the “crazy offensive” (“Irren-offensive”). This had been founded in 1980 by Peter Lehmann, a former patient of the department, as a self-help organization which cooperated during the past years with the state association of psychiatry-experienced persons.
They asked me whether I was ready to defend psychiatry at the tribunal. I refused by saying that I was not an actor and therefore was not available for this spectacle in the VolksbühneTheatre theater at Rosa Luxemburg Square. But, above all, I made clear that I saw this as an irresponsible act of nonsense because a position paper was to be presented there in which, among other aspects, the health insurance funds were to be urged to be withdrawn from financing psychiatric treatments because there were no mental illnesses.
About the apparently chaotic course of this four-day tribunal, called “power- delusion- sense,” the leading German newspaper,Frankfurter Allgemeine Zeitung (FAZ 1998), reported on half a page under the title “Madness giggles at all corners.” The organizers, the above-mentioned antipsychiatry groups, apparently had learned from this article and were able to attain the RussellTribunal in 2001 for an event called “Freedom of Thought” on the question of human rights in psychiatry. The basis of the accusation, presented by Thomas Szasz, was his thesis that the diagnosis of mental illness produces a state of human submissiveness and thereby constitutes an offense against humanity.
During the fall of 1998 the bronze busts of Karl Bonhoeffer were stolen from the Karl Bonhoeffer Hospital, a large lunatic asylum, and from the Psychiatric Clinic of the Charité where Bonhoeffer had the chair of psychiatry 1912-1938. In 1999 sculptor Igael Tumarkin created an artistically alienated sculpture of the Bonhoeffer busts stolen entitled "Castration thoughts come with angel music" and donated it to the Landesverband Psychiatrie-Erfahrener Berlin-Brandenburg that includes the earlier mentioned “Irren-offensive.” It was then confiscated in 2001 as stolen goods on the occasion of a vernissage of a circulating exhibition at the above-mentioned theater at the Rosa-Luxemburg-Place, the Volksbühne. Presumably organized by the same group (or its antipsychiatry fellow travelers) via the home page of the Free University, a “chair of madness” appeared. On this web site defamation had been disseminated about the geneticist Peter Propping from Bonn that was extinguished by order of the President of the Free University.
2 Media
On March 17, 1980, the Spiegel published the cover story called “The Gentle Murder” (“Der sanfte Mord”). Over 26 pages the magazine described “delusion dampening neuroleptics …[that] provoke severe, often deadly side effects.” Antipsychiatry utterances such as “ever more schizophrenics are killed gradually or driven into suicide by drug treatment – …a clandestine ‘psychiatric holocaust’.” Members of the German Society for Psychiatry and Neurology (DGPN) urged me, as the society’s president at the time, to take steps against the Spiegel by citing numerous factual errors in this article. Although skeptical about the chances of success of such a step, I accepted the challenge after two patients, referring to this article, told me that they wanted to stop all drugs and end their lives – because now they had it in black-and-white that they could not be helped.
Therefore, I requested a counterstatement from Spiegelin order to counteract “the discomfiture of the patients and their relatives, which had been apparently provoked by the article in a widespread way” and to protect “those who are active in the care of the mentally ill against unjustified reproaches.” Spiegelrejected the counterstatement by referring to the Hamburg press law because the “sphere of interest of the psychiatrists” was not touched individually by the allegation that they continuously gradually murder, and thus such an allegation would not be grounds for a counterstatement. The German Press Council, then contacted, responded that the “complaint of the DGPN to the Press Council was not the suitable means to lead the discussion in which the Spiegel had intervened with its report.” Albeit the committee of the Press Council “had discussed whether the title ‘The Gentle Murder’ was an exaggerated formulation.”
Then I called on the appropriate department of public prosecution in Hamburg with a lawsuit “against unknown” for defamation and slander. This request was also rejected for the reason that no individual person was defamed. Moreover, the accusation of murder itself did not seem questionable for the prosecutor, because he narrowed it to the notion that its application was related “only to specific drugs.” After this I called on the Federal Minister of Health, reasoning that she as the Minister responsible for medical education should proceed against articles that could discourage the younger generation from an education in the improperly negatively presented psychiatry. I have published the answer without consequences as an example of a ministerial bureaucracy without content.
The speaker of the Federal President, to whom I finally wrote, answered that the President stood above the parties and did not intervene into daily business. But my comment that it is just the task of the President to state his position on a basic question of journalistic ethics apparently influenced his speech at the 275th birthday of the Hildesheim newspaper.
My conclusion from these experiences at that time was: “Everyone talks around this, always using the same formalistic arguments of lack of direct interest. Formerly such an attack on others who have scarcely a chance to defend themselves was called cowardly; today a behavior that only asserts its own opinion and tries to prohibit discussion and other viewpoints is backed legally, however this is not named as what it is, the legitimation of irresponsible spin, but is praised as freedom of press. Cui bono?” (Helmchen and Degkwitz 1980).
Even today, with repeated readings of the Spiegelarticle, I find its style and particularly some formulations such as the title itself as irresponsible, because it could prevent mentally ill persons from helpful treatment, not the least by stigmatization of the treating institutions, which also abets the stigmatization of the mentally ill. However, I also ask myself today how much some substantial criticism, as was on the agenda of the media, sensitized psychiatrists and their coworkers to shortcomings and particularly to the needs of the patients and thereby contributed to a change of attitude and atmosphere in the treating institutions. Of course, the Zeitgeist articulates itself in the media, which simultaneously manipulate it. In order to achieve this manipulative power, the media overdraw, personalize and emotionalize. It seems not possible to eliminate these social psychological mechanisms; however, it is possible to fight against them, particularly against a demagogic and personal defamatory style if it leads to pressure or even threats for single human beings as well as to counteract derailments of the Zeitgeist. They become dangerous if they rudely simplify and polarize in language and behavior, adopt inhuman features, absolutize the figures of thought behind their actions and thereby can blaze the trail into a totalitarian societal deformation (Welzer 2005).
In his book “The chemical gag” (Lehmann 1990), Peter Lehmann compared a senior physician of the department to the SS-men in a picture of the selection ramp at Auschwitz. Such defamations did not remain without effect. When I introduced myself during a ward round to a new patient she cried: “Alas, you are this pig.” She came from the “crazy offensive” and had been brought by friends to the department due to severe disorders of behavior as a result of an acute delusional psychosis. After successful treatment she showed her appreciation by bringing flowers every year at Christmas for the nurses of the ward.
However, I also had an oppositeexperience when a head physician of a psychiatric hospital called me in order to transfer a patient from his hospital for ECT. When I told him that he, as a psychiatrist, had to master this standard treatment himself, he brushed it off by saying that ECT was no longer used in his hospital. In a radio broadcast the same colleague called our department “the shocker clinic.”
In the middle of the 1990s the Social Democratic and Leftist government of Berlin tried to implement a legal prohibition of ECT. I protested against this illegal intrusion into the physicians’ freedom to treat (“Kurierfreiheit”) according to established standards. Nevertheless, in following this ideological intention the physicians’ parliament delegates of the physicians’ board (Delegierten-Versammlung der Ärztekammer) decided that ECT should be performed only after ethical consulting by the physicians’ board. Again I protested, and after a few weeks the president of the physicians’ board invited the heads of all psychiatric hospitals for consultation on the indication and application of ECT. After the unanimous vote of the leading psychiatrists that ECT was an established and, by narrow indications, a necessary standard therapy, he assured us that he would have the physicians’ parliament vote again in order to revise the former decision. One astonished colleague remarked that the president cannot preempt a vote of the parliament. However, the next session of the parliament reversed its decision.
A patient who had been treated for three months in 1977 wanted, one year later, to consult his case record. His reasoning for this to me was that he needed these documents for his thesis.I refused on the basis of antitherapeutic risks and the threat of the rights of third parties (in this case those of relatives whose statements of the patient’s medical anamnesis had been given only under the premise of confidentiality); furthermore, I argued that the case record served mainly as a memory aid for the physician. Although this reasoning had been used to date, this argument was renounced by the Federal Supreme Court (Bundesgerichtshof - BGH) in 1978 as an expression of an outdated medical approach and the physician was obligated to a documentation as a kind of accountability.
In the following years several courts deduced from this judgement a patient’s right to see “his” own case record. This former patient then also sued the department in front of the regional court. For this lawsuit the patient asked the “assistants of the department of psychiatry” for support, but now by reasoning that he wished “to set a precedent: we as psychiatry patients must have the right to inform ourselves about the diagnosis, therapy, and prognosis. Simultaneously, more than ever, it is in view of known abuses in psychiatric asylums necessary to exercise control”because “the suspicion cannot be excluded that male and female patients are misused as guinea pigs.”
The publicity of this former patient attracted interest insofar as the German Society of Social Psychiatry (DGSP) placed itself behind him and made the case for donations for him (TAZ 1980). The regional court of Berlin found in favor of the plaintiff. During the trial of the university’s dissent the hall of the supreme court of Berlin (“Kammergericht”) was filled with noisy members of the “crazy offensive” (founded by the former patient) who sometimes made it impossible for me, as the expert witness, to answer the questions of the court. Nevertheless, the judges did not call for quiet from the audience.
The Berlin Supreme Court confirmed on June 1, 1981, the judgement of the regional court but allowed for a revision at the BGH. In its judgement on November 23,1982, the Supreme Court took into consideration the reasons propounded from the psychiatric side (DGPN 1982) by which the psychiatrist is not obliged to allow the patient an inspection into his case record; but in each individual case he must weigh how much he will allow inspection, whether the rights of a third party would be an obstacle to such inspection, or whether the patient could be threatened by his inspection.
In the following years additional court decisions broadly removed the still-existing restrictions of the inspection. This probably has contributed to the fact that not only judgmental statements have disappeared from the case reports but also judgments have become much more cautiously formulated. After in 2006 the Federal Constitutional Court (Bundesverfassungsgericht - BverfG) (BverfG 2006) conceded a practically unrestricted right of inspection to a mentally ill patient with a narcissistic personality disorder in forensic commitment, a controversy lasting 30 years that ended in favor of the – however understood – individual right of self-determination.
In retrospect, the controversy around the right of the patient to inspect “his” case record appears as an early beginning of an epoch that since 1990 also legislatively accepted a right of inspection into data collections compiled and administered by public institutions (Schmidt-Assmann 2005). Therefore, it was right legally to clarify the weights and relationships of the touched upon and diverse, but in each case justified, interests, e.g., the right of inspection as opposed to the right of third parties to be protected. The duration of the clarification process over almost three decades may have contributed to an evolutionary change of attitudes and adaptation to the basically new situation of public access to many data collections and to informational self-determination.
I realize that court decisions are not only spoken of as a formula “in the name of the people” but also that judges as individual persons are also exposed as citizens towards the moods and mental states of the population at large (in the media as well as in the court); however, I doubt strongly that the defaming forms of the controversy described above were necessary or even advantageous. After the public hearing in Karlsruhe (the seat of the Federal Court), but before the pronouncement of the court’s decision, I heard by chance from a member of the deciding civil senate that he was glad that there was a large space between himself and the audience because “some wild people had come from Berlin.”
Simultaneously to the processes reported above, the promotion for support of the patients’ demands was intensified into a public campaign, broadened over and above the cause and focused on me. Thus, on July 1, 1982, a whole page article by Götz Aly, a historian, appeared in the newspaperDie Tageszeitung (TAZ), in which patients were encouraged to grab their case records, along with the following statement: “Among his victims, Mr. Helmchen by now has no reputation to lose; he is feared as an electro-shocker. To his psychiatric pupils he recommends the electro-shock, developed in Italian slaughterhouses for pigs, as a very humane treatment. Up to a short time ago he could perform his drug research and drug trials with his patients without being disturbed. But since some survivors of psychiatric abuse have organized themselves in the Berlin “crazy offensive,” a self-help group, and helped in the makeup of the complaint center for psychiatry the pressure has increased on Mr. Helmchen: the Alternative List (later on integrated into the Green Party) has demanded the closure of the research institution.”
In the beginning of 1982 the Alternative List, represented as a party in the Berlin parliament, wanted to know from the Berlin government: “How many cases of death have occurred in the Psychiatric Clinic of the Free University of Berlin under the responsibility of the psychiatrist Hanfried Helmchen…? How many cases of death have occurred….in so-called clinical trials? In how many cases in which patients died under the responsibility of the psychiatrist Hanfried Helmchen has a prosecutor’s investigation been performed?”
For the very time-consuming reply of these questions some coworkers and I searched through the entire archives of case records for cases of death, which we documented precisely. On the basis of this detailed documentation the responsible Minister for Science and Research answered the inquiry on May 25, 1982, by saying: “The assumption that the activity of the psychiatrist H., a broadly approved and scientifically renowned professor of the Free University, could be the cause of fatalities, is rejected with particular emphasis by the government as unfounded and false. The government explicitly regrets this form of inquiry, which is suitable to damage one’s reputation.”
But this was exactly the aim of the initiators of this campaign since the parliamentary inquiry was brought forward at the spring meeting of the Berlin Society of Psychiatry and Neurology by a masked person who charged the stage at the beginning of the meeting. When I (coming from a distance and thereby delayed) entered the hotel in which the meeting took place, three women with whitewashed boughs “for the deaths of psychiatry” came toward me. When I, surprised, asked one of the women, whom I recognized as a former patient of the department, whether she had ever seen dead persons in the department, she said in tears that someone had told her that. These events were filmed by a camera crew of the Second German Television company (ZDF). Legal actions were needed in order to prevent the usage of these illegal shooting of a non-public session.
Many times, coworkers of the department could scarcely recognize their work in media reports and urged me to counteract obviously wrong and defaming publications. Although this sometimes appeared hopeless, it could be seen that, in the long run, factual representations of clinical reality could objectify and differentiate public opinion (as part of the changing Zeitgeist). However, the decisive reason for the change probably was that the great majority of patients appreciated the work of the department, experienced the atmosphere as helpful and could thus contribute to the positive reputation of the department. I also gratefully look back on the helpful and loyal solidarity of my colleagues and coworkers in these bitter altercations.
3 Public discourse
In 1989, together with the geriatric psychiatrist Siegfried Kanowski and the jurist Hans-Georg Koch, I published a work on “Ethical implications of research with demented ill persons” (Helmchen, Kanowski and Koch 1989). The topic seemed to me just as difficult as it was important, so I established an interdisciplinary working group with psychiatrists, jurists and theologians which published the results of our more than two years of work (1991-1993) in 1995 (Helmchen and Lauter 1995).
Friedrich Leidinger, a psychiatrist in the association of all psychiatric hospitals of the Rheinland (Landschaftsverband Rheinland),argued in a review of the book that “Helmchen and Lauter presumably are the first renowned German psychiatrists since the end of World War II who want to move the borders of the allowed” by discussing untenable allegations “in a suggestive and mystifying language. Nowhere is there evidence of an epidemic of dementia or an increasing risk of becoming demented” (Leidinger 1995). That dementias associated with aging would become one of the large care problems in the near future became commonplace during the past decade but was also seen at that time not only by us but was becoming familiar to many. Without our knowledge, at the same time the Council of Europe prepared a “Convention of Human Rights and Biomedicine” and published their report just before our publication. This caused a passionate public discussion, especially in Germany (de Wachter 1997). Particularly, the conditions named specifically in this convention under which the inclusion into a research project of patients without the capacity to consent could be possible were utterly condemned as an assault against the weakest of the weak. From this side I was defamed as a spokesman of a “total biomedical aspiration to power that is recognizably directed against demented persons.” Letters to me from persons completely unknown to me contended: “by human experiments you risk the consequences of somatic damages with patients entrusted to your care. You can deny it as long and as much as you will – it remains the truth.” Or: “In no case can you exclude the risk of health impairments through your crazy human trials.”Meant were legally required drug trials. With the background of my own experience with demented patients and considering the newest historical knowledge of the National Socialist misuse of psychiatry (Helmchen 2001). I have dealt intensely with the ethical and legal implications of these questions and, in discussions with many experts, have tried to define practically the borders of research actions (Deutsches Ärzteblatt 1997).
4 Conclusion
In looking back, I have the impression that I have been urged at least to analyze defined issues (Helmchen and Winau 1986) and, by accepting this, I have perhaps tried to influence the Zeitgeist a little bit, namely in the sense of a more evolutionary-analytic instead of a revolutionary-critical solution of factual problems of psychiatric practice. Whether I would have turned my attention to some of these problems without the provoking, occasionally even inhuman mode of these articulations of problems as intensely as I did, I do not know. I am convinced that my basic attitude toward the patient as a person suffering and seeking help did not change because of this experience. However, the engrossment into the problems (and my increasing experience with many individual fates) made me understand better the individual patient in his illness and made me more sensitive to the expressions of language.
However, this does not change the fact that I have experienced some of these modes of controversy not only as attacks on me personally but also as completely inappropriate in substance, and still see it so today, particularly that the demand of respecting the dignity of the patient was counteracted by distorting and inhuman assaults on psychiatrists and by the instrumentalization of patients as well. Nevertheless, that a dialogue between patient self-help organizations and psychiatrists has begun in the past years in order to counter together disabilities caused by illness is great progress.
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* Translated from the German original into English by Jane Helmchen: Hanfried Helmchen. Chapter 6. Psychiatrists and the “Zeitgeist.” Geschichte der Psychiatrie an der Freien Universität Berlin. Lengerich: Pabst Science Publishers; 2007, pp. 108 -116.