Psychiatrists as forensic authorities: evaluation of dangerous habitual offenders in West Germany during the 1960s - the Helmut Hoinka case.

Background: Preventive detention for highly dangerous habitual offenders has been in force in Germany for 90 years. The necessity of this measure is hotly debated from a legal perspective. However, the assignment of preventive detention is largely determined by the opinion of medical experts. This article discusses the role of medical experts and the issues they face in evaluating the dangerousness of habitual offenders using the case of the marriage swindler Helmut Hoinka, prosecuted several times in the Federal Republic of Germany in the 1960s. Methods: Helmut Hoinka's case was chosen for analysis because of the rare opportunity to access detailed materials that allowed us to follow in detail the reasoning of the medical experts who evaluated Hoinka: medical reports stored in the Gerd Huber Archive at the University of Ulm, and Hoinka's court case from the State Archive of North Rhine-Westphalia. To examine these sources, we implemented the historical-critical method. Results: The medical experts who evaluated Hoinka were aware of the defendant's criminal record prior to the evaluation, which was a source of bias. In addition, the criteria for classifying the offender as a dangerous habitual offender were open to a wide range of interpretations. Hoinka's high level of intelligence was negatively emphasized. Some test results were considered unreliable because it was assumed that Hoinka had manipulated his answers. Personal value judgments were allowed in assessing Hoinka's personality. Hoinka's criminal behavior was considered a medical symptom of psychopathy because it violated general moral and social norms. The medical reports of both experts showed that the psychiatrists believed in the genetic nature of psychopathy and criminal behavior. Their criminological prognosis was fully supported by the court in imposing the sentence. Conclusion: Challenges to Hoinka's criminological prognosis were the experts' personal biases, their belief in the theory of genetic predisposition to crime, the lack of clear criteria for antisocial personality disorder, and the absence of forensic recommendations for "psychopathic" criminals. The experts' opinion on Hoinka's criminal predisposition was crucial to the imposition of the sentence.

Adolescents' life between violence and discipline. Medical care in the "Jugendhäuser" juvenile detention centers in East Germany in the 1960s-1980s.

Background: In 1952-1989, special juvenile detention centers, called Jugendhäuser, were established in the German Democratic Republic. There, juvenile delinquents had to not only complete their sentences, but they were also supposed to be re-educated into conscious socialist personalities through a system of collective education proposed by Soviet pedagogue Anton Makarenko. Among twelve Jugendhäuser in East Germany, the ones in Halle and Dessau were considered to have the most severe conditions due to the praxis of mental and physical violence. For the first time, based on the personal files of former juvenile prisoners and archival documents of medical services, we reconstruct a picture of the health status of prisoners and medical care in both these Jugendhäuser. Methods: We analyzed personal files of juvenile prisoners from the Archive of the Correctional Facility in Halle and unpublished documents from the Saxony-Anhalt State Archive, Magdeburg Department, the State Archive in Leipzig and the Stasi Records Archive in Halle. For the examination of these sources, we implemented the historical-critical method. Results: The Jugendhäuser had a system of outpatient and inpatient treatment. Although the medical services rated the level of health care as good at those detention centers, numerous complaints from juveniles, as well as cases of failure to provide assistance, indicated certain deficiencies. Cases of violence in juvenile prisons were common, especially in the Jugendhaus Halle. Brawls between inmates led to injuries and sometimes even to deaths. Fear of beatings resulted in desperate acts such as self-harm, suicide and escapes from prison. Conclusion: The health status of young prisoners in the Jugendhäuser in Halle and Dessau was negatively affected by violence and often by lack of medical care. The prevalence of violence can be attributed to challenges of the penal system as well as deficiencies of the medical services. Since repressive means were used to overcome the violence, such efforts were not successful. The medical services did not offer specialized care for juveniles with mental and learning disorders or those who required psychological or even psychotherapeutic support. Physical health issues were also often ignored due to the stigmatization of sick juveniles as malingerers.

50 years of the first ethics commission in Germany: the Ulm Ethics Commission in an international perspective.

Background: The creation of the legal framework to recognize rights of patients and participants in clinical trials began in Germany in the 19th century. However, the ethical review of medical research in terms of the protection of rights and welfare of human subjects has only become a widespread practice since the establishment of ethics commissions. The first ethics commissions emerged at the universities under the influence of the German Research Foundation. The widespread establishment of ethics commissions began in the Federal Republic of Germany in 1979, after the adoption of the recommendation of the German Medical Association for the establishment of ethics commissions. Materials and methods: We analyzed unpublished archival documentation of the Ethics Commission of the University of Ulm and evaluated it based on a thorough review of research works on the history of international and German ethics commissions. For the examination of the sources, we implemented the historical-critical method. Results: The first ethics commission in Germany was set up at the University of Ulm in 1971/72. The reason for that was that the German Research Foundation required grant applications for medical research involving human subjects to be reviewed by an ethics commission. Initially the commission was created at the Center for Internal Medicine and Pediatrics, its authority grew over time until in 1995 it became the central Ethics Commission for the entire University of Ulm. Before the adoption of the Tokyo revision of the Declaration of Helsinki in 1975, the Ulm Ethics Commission developed its own guidelines for the conduct of scientific investigations on humans based on international ethical principles. Conclusion: The Ethics Commission of the University of Ulm must have been established between July 1971 and February 1972. The German Research Foundation played a decisive role in the establishment of the first ethics commissions in Germany. The Universities had to create ethics commissions in order to be able to obtain additional funds from the Foundation for their research. Thus, the Foundation initiated the institutionalization of the ethics commissions in the early 1970s. The functions and composition of the Ulm Ethics Commission were similar to other initial ethics commissions of the time.

Politicization of psychiatry and the improvement of ethical standards in the 1970s.

Background: The Code of Ethics for Psychiatry adopted by the World Psychiatric Association in 1977, also known as the Declaration of Hawaii, was a milestone in the development of ethical standards in psychiatry. The impetus for the development of the code came primarily from the politicization of psychiatry, first discovered in the USSR, and later in other countries of the socialist camp, such as Romania, Yugoslavia, and the People's Republic of China. The purpose of this article is to trace reasons for the lack of consolidation among Western psychiatrists against the politicization of psychiatry and their efforts to improve the ethical standards in this medical field. Methods: We analyzed unpublished documents from the Archive of the German Association for Psychiatry, Psychotherapy and Psychosomatics, the private archives of the West German psychiatrists Gerd Huber and Walter von Baeyer as well as research works. To examine these sources, we implemented the historical-critical method. Results: The World Psychiatric Association made efforts to collect, analyze and discuss materials concerning psychiatric ethics in order to create the Code of Ethics for Psychiatry and establish an Ethical Committee. In general, the reaction of Western psychiatrists to the information about the internment of dissidents in psychiatric hospitals was restrained and focused on attempts to solve the issue together with the Soviet colleagues. Conclusion: The international policy of détente of the time as well as collisions between different medical concepts and ethical dimensions did not allow Western psychiatrists to condemn cases of politicization of psychiatry without proir clarification of the situation. The efforts of the World Psychiatric Association in the ethical field improved the ethical standards for psychiatry.

[The Archive of Gerd Huber (1921-2012) at Bezirkskrankenhaus Günzburg]. / Der Nachlass von Gerd Huber (1921­2012) am Bezirkskrankenhaus Günzburg.

Gerd Huber (1921-2012) was an influential West German psychiatrist and neurologist of the postwar period. Especially his studies with imaging techniques on the question of brain atrophy, the long-term course and the basic symptoms of schizophrenic disorders made a significant contribution to the research of schizophrenia and were discussed internationally. The Huber Archive, which was handed over to Bezirkskrankenhaus Günzburg, is currently being catalogued for research purposes. The archive contains Huber's private and professional papers, his writings, and a small partial archive of Kurt Schneider. These archival records not only reflect the development of Gerd Huber's academic career, but also are significant for research on the history of psychiatry in postwar West Germany, the development of concepts in the fields of schizophrenia research and biological psychiatry, the history of universities and everyday life, and other topics.

Fetal Development in Anatomical Preparations of Ruysch and the Meckels in Comparison.

Anatomical collections have been used for centuries for research and teaching purposes. By the example of selected preparations of fetal development from the Ruysch collection (17th-18th centuries) and the Meckel collections (18th-19th century), this article aims to trace the changing purposes, specifics and methods of creating specimens as well as the development of anatomy during that period. The selected specimens are compared and analyzed implementing the historical-critical method. Regarding the appearance of the preparations, we see a transition from the visually aesthetic specimens (Ruysch) to exact ones (Meckel collections). If Ruysch's preparations were compared in his time to works of art, specimens created by three anatomists of the Meckel dynasty were primarily created for teaching and research purposes. However, Ruysch's preparations tracing fetal circulation were scientific discoveries of the time. As for preparations of fetal development from the Meckel collections, we see both specimens of physiological processes already known at that time and experimental ones. Regarding teratology, Ruysch and Meckel the Younger tried to explain malformations, but their anatomical preparations could hardly give answers to the cause of deviations from the norm. The differences between the collections can be explained by the different stages of development of anatomy of the time and by the research interests of the anatomists themselves.

"My Death Was in a Kiss": Theatrical Propaganda Against Sexually Transmitted Infections in the Early Soviet Union and the United States in the 1920s-1930s.

We analyze key historical anti-sexually transmitted infection (STI) theatrical performances in the Soviet Union and the United States that were staged to disseminate knowledge and awareness of STIs among the population. The phenomenon of theatrical hygiene propaganda emerged in the USSR after the October Uprising of 1917. The so-called sanitary plays, mock trials, revues, and Living Newspapers addressed important public health issues, one of which was STIs. The Soviet experience provided inspiration for the Federal Theater Project in the United States, which produced socially relevant performances during the Great Depression. The Living Newspaper Spirochete, staged in Chicago, Illinois, in 1938 at the beginning of the "war against syphilis," became one of the most often staged Living Newspapers in the United States. We compare discourses of the theatrical propaganda against STIs in the Soviet Union and the United States. We aim to explain the driving forces and motives behind the anti-STI movement in both countries and describe structural and performative differences in the anti-STI theatrical productions. (Am J Public Health. 2022;112(9):1318-1325. https://doi.org/10.2105/AJPH.2022.306933).

Informed Consent in Clinical Studies Involving Human Participants: Ethical Insights of Medical Researchers in Germany and Poland.

Background: The internationalization of clinical studies requires a shared understanding of the fundamental ethical values guiding clinical studies. It is important that these values are not only embraced at the legal level but also adopted by clinicians themselves during clinical studies. Objective: Our goal is to provide an insight on how clinicians in Germany and Poland perceive and identify the different ethical issues regarding informed consent in clinical studies. Methods: To gain an understanding of how clinicians view clinical studies in the countries they work in, we carried out semi-structured problem-centered interviews per telephone in Poland (n = 6) and Germany (n = 6). Our interviewees concentrated on three main topics: an appraisal of the normative framework, challenges in the information process and the protection of all participants in clinical studies. Results: Clinicians generally supported the normative framework, even though they considered it quite complex. In the two study countries, a widely noted dilemma in the information process was whether to overburden participants with extensive information or risking leaving out important facts. Clinicians were ready to exclude larger population groups from participating in clinical studies when the information process could not be carried out with standard procedures or when their inclusion was ethically sensitive. Conclusion: Clinicians need to gain a better understanding of the consequences of excluding larger population groups form participating in clinical studies. They should seek assistance in improving the information process for the inclusion of underrepresented groups in clinical studies.

Hermann Rorschach's (1884-1922) Clinical and Scientific Work as a Psychiatrist in Russia.

ABSTRACT: This year marks the 100th anniversary of the death of the Swiss psychiatrist Hermann Rorschach, the famous creator of an inkblot projective test. This article examines an insufficiently studied period of Rorschach's work in Russia in 1913-1914 and aims to reconstruct his clinical and scientific activities at that time. Rorschach worked in the psychoneurological sanatorium in Kryukovo near Moscow where he treated his patients with psychotherapy. During that period, he came in contact with leading psychiatrists and became a part of the Russian psychoanalytic community. Case histories of Rorschach's patients did not reveal any original approaches in his psychotherapeutic methods. Despite his lack of time for scientific work, he still coedited one of the leading psychiatry journals in Russia, Issues of Psychiatry and Neuropathology , where he published an article on the organization of services for mental health in Switzerland. Moreover, he contributed to the transfer of knowledge by publishing reviews of his Russian colleagues' works in German journals.

Masturbation as a Cause of "Sexual Neurasthenia": Anton Chekhov's Medical Report (1883).

ABSTRACT: In the 18th and 19th centuries, in Europe and the United States, masturbation was seen not only as a deviant form of sexual activity but also as a cause of nervous diseases. Masturbation was originally thought to cause insanity, but with the introduction of George Miller Beard's concept of neurasthenia, it came to be considered a form of nervous exhaustion. In the current article, we analyzed the almost forgotten medical report of a "sexual neurasthenic," written by the famous Russian writer and physician Anton Chekhov (1860-1904). This report gives us detailed information about the treatment of a patient allegedly experiencing the effects of masturbation, and thus reflects the medical discourse on masturbation in Russia in the early 1880s. It shows that although the international debate on the causes of neurasthenia had just begun, the concept of neurasthenia toward masturbation had already been put into practice at the Moscow University Clinic in 1883.

Diagnosis and treatment of lobar pneumonia in the pre-antibiotic era Anton Chekhov's medical report (1883).

In the late 19th century, pneumonia was one of the leading causes of death in Europe and the USA. Although at this time doctors knew about the infectious cause of pneumonia, they were not able to offer patients specific antimicrobial therapy. In the current paper, we translated into English for the first time and analyzed the almost forgotten medical report of a pneumonic patient written by the famous Russian writer and physician Anton Chekhov (1860-1904), which describes the classic stages of lobar pneumonia, now no longer observed in clinical practice due to antibacterial treatment. Despite the limited capabilities of lung disease diagnosis compared to the possibilities of modern medicine, physicians were able to diagnose lobar pneumonia using techniques of percussion and auscultation. Therapy in this case was limited to diet and symptomatic treatment and could only relieve some of the symptoms. This case history shows that in the early 1880s, in the one of the leading university clinics in Russia, despite the transition from humoral theory and ideas of natural philosophy to the concept of cellular pathology, there were still contradictory trends in the treatment of diseases.

Access to Prenatal Testing and Ethically Informed Counselling in Germany, Poland and Russia.

The development of new methods in the field of prenatal testing leads to an expansion of information that needs to be provided to expectant mothers. The aim of this research is to explore opinions and attitudes of gynecologists in Germany, Poland and Russia towards access to prenatal testing and diagnostics in these countries. Semi-structured interviews were conducted with n = 18 gynecologists in Germany, Poland and Russia. The interviews were analyzed using the methods of content analysis and thematic analysis. Visible in all three countries is a connection of prenatal medicine with the politically and socially contentious issue of pregnancy termination. Respondents in Poland and Russia concentrated on the topic of inadequate resources. Quality of information for expectant mothers is an important point in all three countries. Only in Germany was the issue of language barriers in communication raised. With regard to non-invasive prenatal testing (NIPT) respondents in Germany focused on the ethical issues of routinization of testing; in Poland and Russia they concentrated on fair access to NIPT. Challenges in all three countries arise from structural factors such as imprecise and prohibitive regulations, lack of resources or organization of healthcare services. These should be addressed on a political and medico-ethical level.

The "proletarian disease" on stage. Theatrical anti-tuberculosis propaganda in the early Soviet Union.

The present contribution analyses sanitary theatrical performances as a means of anti-tuberculosis propaganda in the early Soviet Union. Starting in the 1920s, sanitary theatrical performances were demonstrated in open-air theatres and clubhouses for workers and farmers. Since 1925, the newly founded Moscow Theatre for Sanitary Culture centrally managed the theatrical hygiene propaganda. It became a role model for other theatres of hygienic enlightenment and numerous sanitary amateur stages. Their anti-tuberculosis repertoire ranged from the so-called "mock trials" where a person or even Koch's bacillus must stand trial for the spreading of tuberculosis, to "living newspapers" which used entertainment elements such as music or acrobatics to provide a mass audience with the hygiene knowledge. The contribution describes in which images, figures and actions knowledge about tuberculosis was presented on stage, which genre traditions and communicative instruments were used and which changing political implications those performances were based on. To achieve this goal, the archive sources, selected texts of theatrical performances, reports and reviews in daily press have been evaluated.