“It is mostly up to us users and survivors to preserve the memory of those murdered in the name of psychiatry in our hearts.”
—Dorothea Buck, survivor of forced sterilization, sculptor and advocate on behalf of the mentally ill
In October of 2019, a German woman and psychiatric activist named Dorothea Buck died at the age of 102. In 1936, at 19, she was sterilized under Nazi law because she was diagnosed as schizophrenic. The procedure was carried out at a Christian psychiatric hospital named Bethel.
Buck lost her lifelong dream of becoming a teacher—under Nazi law, the sterilized could not get a college degree. Rather than give up, Buck fought fiercely, both against psychiatric abuse and the way medicine defines schizophrenia and psychosis. She spoke out publicly until her death.
Much of Bethel’s “treatment” amounted to torture: Buck was trapped in a bathtub for hours, restrained by a canvas cover. She lay immobilized by icy sheets while facing a wall decorated with the Gospel quote, “Come unto me, all ye that labor and are heavy laden, and I will give you rest.” At one point Buck smeared out the words with the only substance she had, her feces. This was not a mad act, but a psychological necessity.
One day Buck found herself on an operating table for what she’d been told was a necessary minor procedure that afterward was dismissed as an appendectomy. A fellow patient told her the truth: She had been sterilized. Buck wrote later that she wondered why, before her operation, her pubic area had been shaved. Heartbreakingly, she said she forgot the question once she got to the hospital, entranced because her room had a window.
Buck had been told she was undergoing a necessary minor procedure dismissed as an appendectomy. A fellow patient told her the truth: She had been sterilized.
Buck was hospitalized after she, quite literally, followed a star. On the evening before her 19th birthday, Buck slept outside. When she woke, she saw a bright star shining in the morning sky and followed her “inner impulse” to run toward it. Buck fell into a mucky riverbed and passed out. She came to in her own bed, carried to her home by local workers. The experience in the riverbed felt to Buck like a rebirth, and upon awakening, she asked for a piece of cake. Buck got her cake, but also a forcible ride to Bethel.
After the war ended, Buck began speaking out, calling on psychiatry to confront its deadly history of not only sterilization but murder. She demanded recognition of Nazi action T4, which killed hundreds of thousands of disabled people on the grounds of their economic drain. Many of these were psychiatric patients gassed in chambers built into six of Germany’s asylums. In 2008, Buck told an audience commemorating T4 that there must be “no second-class victims” of Nazi rule.
Buck also called for a radical rethinking of psychosis itself. Biologically based psychiatry, she believed, would always reduce a condition like hers to something “genetically caused, meaningless, and incurable.” This thinking could only lead to dehumanization and the kind of victimization she experienced at Bethel.
Buck believed that her experience in the mucky bed had been anything but chaotic and fragmented. Rather, it was the breaking in of another, symbolic reality to her daily one, a reality that emerged from the unconscious. She considered the event not an illness but an awakening. Buck believed that psychotic experiences are deeply meaningful, potentially healing, and that probing them is an essential part of recovery. A sculptor until she dropped this work in favor of her activism, Buck connected her psychotic experiences to the shapes and forms that came to her in her art.
Buck wrote an autobiography, a brilliant memoir-cum-manifesto titled On the Trail of the Morning Star: Psychosis as Self-Discovery. She published the book under the name Sophie Zerchin, an anagram of the German word for schizophrenia. Morning Star begins with the episode in the mud and unfolds as a personal history, unspooling her psychoses and their meanings, as well as her experiences in treatment.
“In psychosis,” Buck said in an interview, “I have to be asked what the psychosis means.”
Buck co-founded psychosis seminars that brought together experiencers, caregivers and clinicians in the process of “trialogue”—which re-centered the patients as experts in their own conditions and allowed them to plumb their experiences, as well as shape their own care.
Buck argued that psychiatry must move away from the focus on classification that has shaped it in the modern era, beginning with the “father” of modern practice, Emil Kraepelin, who published his still-influential psychiatric textbooks around the turn of the 19th century. Buck reminded her audiences that Kraepelin was a eugenicist, whose drive to identify mental disease was inextricably bound to his belief in creating a “healthy” society. To Buck, victimization went far beyond the deaths of the war but included ongoing practices like over-medication, restraints and heavy electroshock.
Dorothea Buck would be extraordinary by any means after reinventing her life after the horror of Nazi sterilization. She was also a visionary, a psychiatric patient who called on the profession to put her and people like her at the center of its practice, as the authorities in their own lives. She asked psychiatry to rethink its present in light of its darkest past. Buck received some accolades: the German government gave her an Order of Merit, and a small 2009 documentary, “The Sky and Beyond,” focused on her life and her sculpture.
But Buck’s beliefs about the fundamental nature of psychosis and her call for change have never come close to the mainstream of psychiatric practice. If anything, psychiatry has gone in the opposite direction, with each new edition of the Diagnostic and Statistical Manual of Mental Disorders, psychiatry’s “Bible,” constantly adding dozens of new categories.
Few people in the profession know who Dorothea Buck is; her work is rarely taught in medical schools. And the great majority of Buck’s media attention came through her October 2019 obituaries, focused as much on her age as her activism.
Sadly, Buck herself would not be surprised. In 2007, she was invited to address the annual meeting of the World Psychiatric Association. She denounced psychiatry’s reliance on Kraepelin and his hierarchies of “disease.” Few psychiatrists, she told her audience, have made any effort to use the trialogue model. And as to psychiatry’s past, she put it this way:
“It is mostly up to us users and survivors to preserve the memory of those murdered in the name of psychiatry in our hearts.”
What would happen, Buck asked, “if it weren’t you psychiatrists who had the power of definition, but if that power was ours?” It remains a profound question. She also called on the Association members to listen. This need for listening in psychiatry was a lifelong message for Buck, and one poignant in its simplicity.
“As long as we talk to each other,” she said again and again until the end of her life, “we don’t kill each other.”
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