“Those who cannot remember the past are condemned to repeat it.” – George Santayana.
Professor Elisabeth Binder is vice-president of ECNP and director of the Department of Genes and Environment at the Max-Planck Institute of Psychiatry in Munich. At the 38th ECNP Congress in Amsterdam, 11-14 October, she will speak on the importance of psychiatry and science generally being grounded in a sense of what is right. She recently spoke about this to Tom Parkhill, ECNP press officer.
Tom Parkill: At the ECNP Congress in Amsterdam you will be giving a talk entitled, “Legacies of the past and what the history teaches us about the importance of keeping a strong moral compass”. What made you interested in giving this talk, how did the talk come about?
Elisabeth Binder: It's part of the “ECNP Inspired” session. My talk derives from the history of the institute that I'm working at.
I’m one of the directors of the Max Planck Institute of Psychiatry. This is the institute that was founded by Emil Kraepelin, one of the forefathers of biological psychiatry, with the intent of establishing an interdisciplinary university-independent brain research institute which actually used science-oriented approaches to open up new methods, findings and treatments in psychiatry. This was in 1917.
The directors who initially founded the institute raised questions that are quite similar to what we are interested in now – but their aims and their methods were completely different from ours.
As we are today, they were interested in the inheritance of psychiatric illnesses, but not in improving care for patients. Instead, their main goal was a healthy German “Volk”, which excluded persons in antisemitic or racist categories, but also persons with disabilities or mental illnesses. This world view was present at the institute from the beginning and it enabled its involvement in the medical crimes of the National Socialist era.
Ernst Rüdin, the institute’s director at that time, was interested in genetics and a big supporter of so-called “racial hygiene”. By supporting the “law for the prevention of hereditarily diseased offspring,” he made the forced sterilisation of thousands of people possible. Doctors at our institute recommended their patients for this cruel mistreatment.
And also scientists were involved in the crimes: they did research on brain tissues that originated from people that were killed during the so-called “euthanasia” programme, the National Socialists’ murder of the ill. By doing so, they not only profited from these murders, but also legitimised them.
Even in the decades after the war there were no steps taken to talk about the institute’s involvement in these crimes, nor did the responsible persons think about what to do with the specimens. It was only in 1990, due to international and political pressure, that the brain specimens of “euthanasia” victims at our institute and other institutes were buried. Later, the president of the Max Planck Society, Hubert Markl, took responsibility for the lack of historical reappraisal and apologised to the relatives.
While I was director we re-investigated the remaining historical histological and anatomical brain specimens, prompted by the finding of a colleague, and we again found brain specimens of euthanasia victims that had not been buried back then. Initially, we thought that maybe only a few people had been missed. We had external historians looking at the people and fates behind the specimens, and we know now that specimens of more than 100 victims of the so-called “euthanasia” remained in our archives.
This is how I came to this topic. It is very important to me to make sure that, in interaction with the historians, we actually give some dignity back to the patients, organising a dignified burial with the Max Planck Society and setting up a place of remembrance at our institute. I learned a lot by talking to the historians.
What ethical questions derive from this history for today’s research?
We had one workshop where we invited a historian from Harvard, Sabine Hildebrandt, who gave a very interesting talk. She is an anatomist, and she spoke about how before the Nazi era anatomists were only able to work on dead bodies of people who were old or sick. And then suddenly there were many more bodies which became available, because many more people were executed for all kinds of reasons, such as political reasons, for example. And we see letters from anatomists saying how great it is that now there are so many fresh young bodies that they can actually do research on. So this is the first step, the first transgression where basically, yes, you are excited about your research and then you use the political situation to your advantage. And I guess most knew that it was wrong. But still it benefited their research. And then she showed how these transgressions went further to, for example, “well, maybe if we know who's going to be killed and executed, maybe we can give them compounds so that we can study how it's distributed in the in the body”. So these transgressions take additional steps.
This was quite moving for a lot of people at the institute, because our general research goals are quite similar to what they did back in those times. We are doing genetics, we are looking at postmortem brains. We have different tools now, but how would we react if all of a sudden it would be possible to have a deeply phenotyped patient, and for some reason or another (let’s say, political) it becomes much easier to access their brains? And so my question was, how do we keep this moral compass?
We now try to include discussions on history and ethics into our daily life at the institute. I think it is a time when we need to be aware that this has happened before and not all of these people were monsters from the beginning. They may have just been researchers like us and circumstances changed. It is important to reflect what we would need to do so that these transgressions do not happen again. And this is my motivation.
Obviously, many who voted for the Nazis were not monsters, and they did not think that they would end up in a war and killing millions of people. And so it is a creeping effect. I have seen this in a smaller way, even in places where I work, where employees were more worried about causing a panic than about public safety. People can define themselves through what their work or career seems to be telling them to do.
I agree, and such transgressions are the changing boundaries that we thought society had agreed upon, as the recent developments around DEI show. These things start to happen, and maybe in six months they have become normal, and we take the next step. So it is these stepwise transgressions that we need to be very careful about. Crossing the first line may not seem significant, but maybe that kicks off the chain of events that may lead us to things that we really do not want.
Can you see any practical ways that we can avoid this? Because a lot of the changes that are taking place in science and in medicine or the threats that are coming into science and medicine are coming from society. Is there anything that scientists and clinicians can do to influence this to stop it happening?
Yes. This is a very valid point at this moment. Just recently we were at a retreat organised by our institute where we had a dialogue with a lot of researchers and discussed what we would have done if an authoritarian party had won, say, 35% of the votes, which is not absolutely unrealistic.
And this would have offered them the chance to appoint a chancellor. How would we have reacted? And I think there were two things that came up from the discussion. One is to talk to the public, talk to people you know about how important it is to preserve access to medicine for everybody. But also to make sure that we communicate the importance of science, and make sure that the public has access to science. We need to make sure that everybody understands that science is not a threat, but a benefit for society. And that it is essential for science to have transnational co-operation instead of nationalistic ambitions.
This is politics, and it is very difficult for scientists to influence politics at a high level. I am interested in what you say about communication, not just in terms of communicating the research, but putting it into the context of the effect science has on people’s lives. But this does not happen by chance.; we need to plan these things. We started by talking about what happened under the Nazis. Many people probably thought that what they were doing was on the edge, but maybe permissible in the greater scheme of things. Is there anything that we can do to actually give greater guidance to the people working in science? For example, you are involved in the ALBA Network, which works towards diversity and equity in brain sciences.
As I said, back then the researchers at our institute put the “nation’s health” beyond the rights and wellbeing of individual persons. Today our focus is on contributing to the best treatment for every patient, without anyone being excluded. That is why the ALBA declaration is very important to us, as it stresses the significance of diversity, equity and inclusion in brain science, at every level, but especially the one of the researchers. If a group of scientists is more diverse, the risk of transgressing against under-represented groups may be less, including our patients.
It is very important to remove the stigma of psychiatric disorders, to make sure that patients are considered as people. Perhaps we should be moving to a way of emphasising neurodiversity rather than labelling people with a diagnosis. Where the condition is a spectrum, it is not simply an illness anymore.
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For information on the ALBA Network, click here. 
