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Mengele and Me

by Karl Wallenkampf, 2022 Medical Fellow

They believed in doctors, listened to their advice,
And followed it faithfully. You should treat them
One last time as they would have treated you.
They have been kind to others all their lives
And believed in being useful.

—“Their Bodies,” David Wagoner1

We approach the 75th anniversary of the Nuremberg Medical Trial—also known as the Doctors’ Trial—in an environment of political change. Today, parallels abound with that era of rising inflation, civic mistrust, international conflict, and social strife. Pondering a past that seems so present, I stood in front of a stack of shelves and noticed Mengele: Unmasking the “Angel of Death” by David Marwell.2 I remembered the name and shuddered, taking the book off the shelf nonetheless: considering pathologies of professionalism alongside pathophysiology during my first year of residency might be illuminating. I read about Mengele and reflected on a recent trip to Germany and Poland, on visits to Brandenburg, the Wannsee House, Auschwitz, and others. In my reading I found not a foil for my professionalism but a challenging mirror. I was—in a word—stunned at the similarities between Mengele and me.

I read and learned Josef Mengele was not so peculiar, at least not as one might expect from a man called the “Angel of Death,” who made selections for the gas chambers. He grew up the eldest of three boys to a father who ran a respected local business and a devout mother, and though he was initially intended to take over the family business, an ongoing childhood kidney disease led to one of his brothers taking management.3 His life was not unusual and contained no clear foreshadowing of what was to come. As Marwell writes, “It is difficult to find evidence of the extreme politics, antisemitism, and capacity for murder that would define him.”4 He was a middling student,5 but successful enough achieve a place in medical school in Munich. Once there, Mengele became enamored with learning his profession and came to adore his teachers, including Siegfried Mollier, whom he respected in large part because of his humanistic practices such as approaching dissection labs in human anatomy with the utmost respect.6 In reading this I felt a twinge, remembering a poem handed to me by a professor before I went to medical school, “Their Bodies,” by David Wagoner, which I had subsequently printed for my classmates prior to our first cadaver lab. Reading it Ihad felt inspired, full of awe at the magnitude of trust given to medical students and physicians. Reading that Mengele had likely felt similar emotions gave me pause.

It is difficult to understand how a young student could feel and believe as a “good doctor” should, yet simultaneously join far-right nationalist groups—and ultimately the Schutzstaffel (SS). Yet, Mengele’s medical and scientific convictions about the ethical practice of medicine, those he shared with many physicians of that era, were the foundation for his political activity. His complicity with Nazi crimes—with unconscionable acts—became possible through the formation of a developing Nazi medical ethics

Medical mores were undergoing revision in 20th-century Germany. Nazi medical ethics developed in a time of trust in scientific methods as a form of knowledge generation and a deep conviction that science and all it could discover could solve many social problems.7 Genetics seemed to be the key; many considered criminality to potentially be an issue of inheritance.8 Eugenics achieved popularity across the West, reaching its apogee in Germany as the study of Rassenhygiene—racial hygiene.9 The medical paradigm of helping sick individuals weather illnesses came under scrutiny, because, they reasoned, these sick individuals might pass on their genes. For the Nazis this individual focus jeopardized the health of the race.10 Doctors, as individuals and as a profession in Nazi Germany, began prioritizing populations rather than individuals. Many believed racial hygiene would benefit Germany—and perhaps humanity—in the long term by producing fewer “weaker” human beings, thus creating what they imagined would be a superior gene pool. This drive for racial and genetic purity could not be separated from healthcare more broadly: “[r]acial hygiene—along with social hygiene and personal hygiene—was simply one element in a larger, more comprehensive program of human health care.”11

Defining medical care in this way, as a project that involves genetic counseling and public health in the individual patient encounter, helps us interrogate Nazi medical ethics and notice relevant similar motivations in our contemporary practice of medicine. This paradigm allowed doctors who wanted to help others and “follow the science” to ethically endorse and participate in a new approach through which they could focus on the effects of their work at the level of whole populations. In this way, they could support, das Volk, the German people, even if it meant the terrible extermination of millions. Those targeted included congenitally ill children, Jews, Sinti and Roma, anyone not cis-gender or heterosexual, and anyone who did not adhere to the Nazi paradigm, lumped together under the catch-all term “asocials.”12

Physicians were the profession with the highest proportions of Nazi Party membership, with 45% joining the Nazi Party by one estimate.13 These were not only older physicians who may have wished the world was back in some imagined past, but also young physicians. Indeed, some of the most thorough support for Nazism came from young doctors, specifically those under forty.14 Their motivations, while partly explicable by a desire to remove Jewish and other competitors from positions of prestige, were not merely about advancing their own careers. These medical providers had motivations that feel contemporary to clinicians today, including a wish to turn away from a commercialized view of medicine. The Nazis, for example, criticized insurance companies and the “trade” of medicine and encouraged physicians to consider medicine as a “calling.”15 Physicians in Nazi Germany were encouraged to see themselves as integral members of a flourishing society. In a speech to the National Socialist Physicians League, Adolf Hitler declared, “National Socialist doctors, I cannot do without you for a single day, not a single hour. If not for you, if you fail me, then all is lost. For what good are our struggles, if the health of our people is in danger?”16 What physician could refuse such a position of honor at the center of a society dedicated to purifying medical practice?

In the context of these shifts in medical ethics, Mengele’s career was ascendant. If Nazism was merely applied science, then a devoted physician like Mengele only had to “follow the evidence.” For this reason, he was drawn to the most active areas of research and discussion at the time—anthropology and genetic transmission—and thus began experimentation for his dissertation. Twin Studies was then at the forefront of research, so much so that grants to those working in the field came from major universities and non-profits such as the Rockefeller Foundation.17 Thus Mengele mastered the necessary research methods and positioned himself at the cutting edge of medical anthropology. Two years prior to the war, he started his second doctorate, necessary not to be a community physician, but rather to join the ranks of academic medicine.18 His finished work was met with acclaim. In fact, he published his research in a sufficiently high-impact journal that it received international publicity as a welcome contribution to the field,19 an outcome welcomed by anyone, then or now.

It was in this milieu, after working at the battlefront as a physician, that Mengele received a “serendipitous transfer” to Auschwitz.20 There he stood and made selections on the ramp. There he studied prisoners without their consent and denied them treatment in the interest of scientific discovery. There he earned his reputation, a reputation so terrifying that memories of his actions exceed human capability. Many of those who remember Mengele at Auschwitz describe a person with no resemblance to the man himself. Some describe him as tall and blonde, the Aryan ideal. In reality, he was brown-haired and of average build. Memory has transformed him into something inhuman, peculiar, a beastly aberration responsible for each selection, each experiment.21 Mengele undoubtably committed innumerable evils—this is indisputable. Characterizations of him—including the moniker “Angel of Death”—affirm his responsibility and guilt, but they also distance Mengele from his humanity, which we share. We thus shirk confronting whether we could commit such acts too, as illustrated by a question Robert Jay Lifton was asked by an Auschwitz survivor“‘Were they beasts when they did what they did? Or were they human beings?”22

Rather than being supernaturally evil, he was motivated by discovery and, as a result, abnegated his human responsibility, making way for his cruelty. He had access to the most “unprecedented” concentration of research subjects possible23 without any oversight, allowing him to research noma24 (a disease), twins,25 eye color,26 and various proteins thought to be related to the diagnosis of disease.27 Marwell’s work speaks for itself here: “[Mengele] pursued his science not as some renegade propelled solely by evil and bizarre impulses but rather in a manner that his mentors and his peers could judge as meeting the highest standards.”28 It is this which disturbs me, the thin but real continuity of his motivations and mine.

In this dark context I consider my own inspirations and drives. I remember professors for their respect of patients and reflect on the teachers who taught with profound gravity from our cadavers in anatomy lab. I note my aspiration for a career in academic medicine, the need to publish insightful research in respected journals and receive complimentary editorials and applause at conferences. I maintain a commitment to practicing medicine at the vanguard of science while benefiting public health. Whatever my prior conceptions about Mengele, I realize now that instead of being opposites, there is a sense of mission and conviction that I share with him. Admittedly, there are certain moral barriers I have difficulty imagining I could cross—I cannot imagine selecting those who would be sent to their immediate death; his research methods were patently inhumane. But, if we are unable to imagine ourselves committing such acts, is a lack of such imaginative evidence really an inability to commit evil?

I consider my communication with patients, especially the skills I have developed to help have difficult conversations. I wonder though: what if I nudge them to make decisions that they would not have made otherwise? For example, perhaps I believe that CPR is not in their best interest. Having listened to their values and goals and through my influence, convincing words, tone, and phrases, they then choose not to undergo CPR, dying prematurely because of this decision. Did my encouragement, even well-intentioned and based on respectfully listening to their views, hasten their death? I have, after all, seen patients recover from CPR in ways I never would have imagined before. Further, do we as clinicians, chaplains, and visitors, walk along intensive care units, shake our down-turned heads, and ponder whether those lives are worth living? It takes no great mental leap to land at the concept of Lebensunwertes Leben—life unworthy of life, a principle that propelled so much of Nazi decision-making. Members of my profession have been perpetrators; neither the institution of medicine itself, nor medical education, nor membership in academic communities can stand as an antidote to malformed thinking or complicity with terror. German physicians made this gravely apparent in their rush toward Nazism.

As I read about Mengele, reflected on these truths, and searched other books about Nazi physicians and Nazi medical ethics, I consistently found the same themes again and again. I noticed points of agreement between their motivations and those in my personal statements for medical school and residency. What could this mean?

My complicity in contemporary evils is immediately apparent. In recent years, there has been a necessary and awfully belated effort to reveal the malicious effects of many professions and systems within the United States. The complicity of medicine and physicians in racism has been widely documented and increasingly illuminated, for example, in the methods used to teach the diagnosis of common skin disorders.29 Gender bias in medicine is prolific and continues to require enthusiastic and durable change. I knew about this type of complicity before reading about Mengele. Through these and other readings, workshops, and conversations, I continue to recognize my own active and passive complicity in inequity, and work to align myself with a wholly patient-centered, historically informed, and forward-thinking practice of medicine.

Yet, despite my intentions and efforts, it remains especially unnerving to note similarities I have with a Nazi physician at Auschwitz. I can be on guard, think myself to be doing the best for the best reasons. But might he have thought the same? In our contemporary climate, similarities of different political and social groups—or governmental agencies—to Nazis are frequently identified (some, more appropriately than others). At times, it has seemed a flagrant and inappropriate comparison—simply nothing is comparable to the Holocaust. Still, as the memory of the Nuremberg Trials looms, I think in our attempt to acknowledge the incomparable horrors of that era, we have forgotten how much one comparison can shed light on our actions and guide us each day—what motivations we share with those who perpetrated such incomparable evils—the similarity, that is, between Mengele and me.

Karl Wallenkampf was a 2022 FASPE Medical Fellow. He is an Internal Medicine resident through Barnes-Jewish Hospital and Washington University in St. Louis School of Medicine.

Notes

  1. Wagoner, David, “Their Bodies,” https://www.poetryfoundation.org/poetrymagazine/poems/35293/their-bodies.
  2. Marwell, David G. Mengele: Unmasking the “Angel of Death.” W.W. Norton & Company, 2020, 3.
  3. Ibid., 4, 7.
  4. Ibid., 3.
  5. Ibid., 6.
  6. Ibid., 12.
  7. Proctor, Robert N. Racial Hygiene: Medicine under the Nazis. Harvard University Press, 1988, 13.
  8. Bergen, Doris L. War & Genocide: A Concise History of the Holocaust. 2nd ed., Rowman & Littlefield Publishers, Inc., 2009, 12.
  9. Proctor, 15.
  10. Ibid.
  11. Ibid., 22.
  12. Lifton, Robert Jay. The Nazi Doctors: Medical Killing and the Psychology of Genocide. Basic Books, 2017, 30.
  13. Ibid., 34.
  14. Proctor, 68.
  15. Ibid., 70.
  16. Ibid., 62.
  17. Marwell, 23.
  18. Ibid., 26.
  19. Ibid., 29.
  20. Ibid., 83.
  21. Ibid., 78.
  22. Lifton, 4.
  23. Marwell, 84.
  24. Ibid., 87.
  25. Ibid., 92.
  26. Ibid., 100.
  27. Ibid., 109.
  28. Ibid., 115.
  29. Nolen, LaShyra. “How Medical Education Is Missing the Bull’s-Eye.” New England Journal of Medicine, vol. 382, no. 26, June 2020, pp. 2489–91. Taylor and Francis+NEJM, https://doi.org/10.1056/NEJMp1915891.