Before Auschwitz: Nazi Germany's Silent Extermination of People with Disabilities
Unearthing the terrors of Aktion T4
In Vienna's 14th district, there is a large hospital complex surrounded by tall trees and the sound of birds singing. Amidst this peaceful setting stands an unassuming building that seamlessly blends in with its surroundings. However, a series of lit candles positioned in rows close to it signals that this isn't just any ordinary structure. As you walk towards the candles, you find a plaque that reads: "This memorial commemorates the children and young people who were murdered in the National Socialist euthanasia center 'Am Spiegelgrund' between 1940 and 1945."
My visit was not incidental. Yet, as I stood there last week, the weight of that place's history bore down on me, and everything felt intensely personal.
The location usually does not find its way onto the usual tourist trails of Vienna, a city renowned for its imperial palaces, charming streets, and vibrant culture. It remains a somewhat muted site, overshadowed by more traditional and well-known attractions. Nevertheless, for me, going there was something that held immense significance.
From 1940 to 1945, Am Spiegelgrund served as a children's clinic connected to the Am Steinhof psychiatric hospital (now called Otto Wagner Hospital). It was one of many such facilities associated with the Nazi's secret child euthanasia program - a monstrous campaign aimed at exterminating mentally and physically disabled children, with doctors and staff perpetrating chilling cruelty under the pretense of alleviating suffering. This program, which was, with its progression, named Aktion T4 (after the Berlin address of the office it would eventually operate from, Tiergartenstrasse 4) initially targeted children and young people but later expanded its reach to include adults and elderly individuals living in institutional settings.
A personal reflection
Being "different" bears a distinct weight that is difficult to convey and explain until you've experienced it firsthand. For me, life has always consisted of moments when I feel slightly out of sync, like if I'm listening to a melody that only I can hear. Sometimes, I describe the experience as if I had to navigate the world using a weird map that's got missing bits, maybe a doodle of a dragon, and definitely upside down. Meanwhile, everyone else seems to have the deluxe edition with turn-by-turn directions and a built-in compass.
When your brain is wired differently, there's always a soft yet persistent reminder that you will never fit into society's predetermined ideals and expectations.
I'm autistic. For individuals like me, with an invisible disability, there are even more layers of complexity in the story.
On the one hand, the "invisibility" of my condition offers a shield that allows me to at least try to choose when and with whom I share the big news. I can try and make an effort to navigate some spaces without the immediate label or presumption that often accompanies visible disabilities - though when this happens, it comes with a great cost. Yet, this invisibility also presents its own set of challenges. It means my struggles are often met with skepticism, as the absence of obvious signs leads some people to question the authenticity of my experiences. And while a few people may see some kind of power in deciding whether to disclose or hide, that very fact that 'hiding' sometimes might be the only, wiser choice makes me furious. The fact that I have to choose, by itself, is violent. The essence of who I am is constantly overshadowed by society's eagerness to define or dismiss my reality based on what they can or cannot see.
Visiting the memorial was an overwhelming experience. I was honestly shaken to the core. For the children now represented by candles, their differences, be they obviously visible or not, marked them for a horrifying fate. And, unlike me, they were forcibly stripped of any control over their lives and denied the chance to simply be themselves.
Healers Turned Executioners
Aktion T4 stands out as a particularly heinous chapter in the history of human rights violations. The program was officially authorized by Hitler in 1939, but its origins can be traced back to 1938, when the Nazis initiated an intricate scheme to methodically identify children who did not meet their ideal of the Aryan race. These identifications were made based on the presence of physical or neurological conditions, behavioral peculiarities, or any other unfavorable attribute. The main concept underlying this initiative, as well as the way it was justified, was horrifically twisted: these 'broken' individuals, as they were dubbed, were seen as weakening the Aryan lineage and draining valuable resources from the German Reich. Building on this toxic foundation, the Reich Ministry of the Interior issued an order on August 18th, 1939, requiring all health professionals - physicians, nurses, and midwives - to report babies and children up to three years old who showed any signs of mental or physical “defects”.
Many parents were tricked, persuaded, or coerced into enrolling their children in this program that promised excellent medical care. However, the reality fell far short of this. Once admitted, most of these innocent children would never return home. They endured everything from deadly injections to blatant medical neglect, and some even became subjects for fatal "scientific" experiments. The idea of mercy killing was used to justify these atrocities. “It is better for these children to be dead than to live with their disabilities", doctors used to say. The families remained unaware of what was happening until they received a notification of their child's death, accompanied by a false cause of death written in complicated medical jargon.
The apparatus for carrying out the killings became increasingly powerful, robust, and ambitious, overseen by crucial figures such as Philipp Bouhler, who handled Hitler's private chancellery, and Karl Brandt, Hitler's personal physician. Everyone living in institutional settings, regardless of age, was at risk and became a possible target at some point. Questionnaires were poured into public and private hospitals, mental institutes, and homes for the chronically ill. These questionnaires assessed patients on multiple criteria, including their capacity to work, criminal history, specific conditions such as schizophrenia or dementia, and other psychiatric or neurological disorders. Simultaneously, a committee of medical specialists, some of whom were extremely prominent in their areas, met behind closed doors. These physicians, divided into teams, were tasked with deciding the destiny of countless lives based on these questionnaires. Those who were chosen were taken away from wherever they were and transported in unmarked vans and buses to designated T4 execution sites.
The program spread rapidly into neighboring Germany, as regional authorities, keen on emptying their health facilities - primarily to accommodate wounded soldiers - eagerly embraced this idea.
“Propaganda is a truly terrible weapon in the hands of an expert.” — Adolf Hitler, Mein Kampf (1924)
Understanding the power of narrative and public perception, the Nazis perfected a handful of lies and deceptive tactics to carry out their atrocities while maintaining a facade of normalcy. Creating a feeling of authenticity was crucial: from the official-looking paperwork to the urns with random ashes that were sent to the families, everything was designed to preempt suspicion and ensure the continued flow of victims.
This era was a masterclass in the power of propaganda. The Nazi machinery worked overtime to create a narrative where disability was not just a deviation, but a detrimental flaw. German society was relentlessly bombarded with this ideology. In classrooms, children were taught about the burdens associated with hereditary illnesses and the perceived dangers of allowing disabled individuals to reproduce. Cinemas featured movies where protagonists, often doctors or government officials, grappled with the morally complex decision of ending the lives of those with disabilities, presenting it as an act of mercy. "Ich klage an", a particularly influential film, aimed not only to entertain but also to indoctrinate by portraying the killings of disabled people as not just acceptable but even noble.
One prevalent form of this propaganda was the widespread display of posters in towns and cities. These unsettling images showcased disabled individuals as parasitic entities—either as shadowy figures drawing away resources or as twisted caricatures, juxtaposed against the 'perfect' Aryan specimens. These images weren't just distasteful—they were dangerous, establishing a visual rhetoric that justified mass murder.
The progression from the Aktion T4 euthanasia program to the Holocaust is one of the most chilling examples of how a regime can escalate its atrocities once a foundation of dehumanization is laid. The similarities between these two events are not coincidental. They reflect a deliberate and systematic expansion of the tools, techniques, and personnel that had been 'tested' on the disabled, re-purposed for an equally horrifying end: the extermination of millions of Jews, Romani, Slavs, homosexual people, and other 'undesirables' groups. Gas chambers (some even disguised as shower facilities), for example, which became synonymous with extermination camps like Auschwitz, had their origins in the T4 extermination centers such as Bernburg, Brandenburg, Hartheim, Hadamar, Grafeneck, and Sonnenstein. To address the logistical challenge presented by the remains of the deceased, crematoria were employed. This method of body disposal, which aimed to minimize evidence and streamline the process, was also further expanded upon and implemented on a massive scale in the extermination camps.
Dr. Irmfried Eberl, a trained physician and psychiatrist, had already ascended to the position of medical director at the Brandenburg euthanasia center and gained extensive experience with the use of gas chambers at the age of 29 - knowledge that would later prove invaluable when he was appointed to oversee the Treblinka extermination camp in July 1942. For his ‘wildly unrealistic expectations of the camp's ability to "process" prisoners’, Eberl was soon removed from his post.
When describing the doctor’s leadership, SS-Unterscharführer Willi Mentz said:
“It was said that he ordered more transports than could be "processed" in the camp. That meant that trains had to wait outside the camp because the occupants of the previous transport had not yet all been killed. At the time it was very hot and as a result of the long wait inside the transport trains in the intense heat many people died. At that time whole mountains of bodies lay on the platform.”
By the time the broader objectives of the Holocaust were put into motion, much of the groundwork had already been laid. The public had been desensitized to the idea of mass murder.
“What scientific eugenics does aim for is for the elimination, by restriction, of hopeless hereditary feeble-mindedness and of defects which must condemn one’s posterity to ineffective and joyless lives.” — "Aim of Scientific Eugenics" (1913)
In the medical circles of Nazi Germany, eugenics was not seen as a fringe belief but rather an accepted doctrine. It provided a sense of 'scientific' legitimacy to the regime's racial purification goals. Many doctors truly believed they were paving the road for a new era in human evolution, making difficult but necessary choices for the greater good. However, it is crucial to acknowledge that this concept emerged long before the Nazis came into power, courtesy of Sir Francis Galton, a British polymath who happened to be Charles Darwin's half-cousin. In his influential 1883 publication "Inquiries into Human Faculty and Its Development", Galton introduced the idea of using selective breeding as a means to enhance the human race. He argued that “there is no escape from the conclusion that nature prevails enormously over nurture”, hinting at the prevailing belief in hereditary superiority over environmental factors. This notion became deeply ingrained within global scientific and medical communities during the late nineteenth and early twentieth centuries. Many countries, including the United States, actively pursued eugenic policies and practices during this time period. Numerous states in the U.S. implemented sterilization laws specifically targeting individuals deemed "unfit" for reproduction due to mental illnesses, disabilities, or criminal backgrounds.
One of the most infamous events reflecting America's keen interest in eugenics was the Second International Congress of Eugenics, which took place at the American Museum of Natural History in New York, in 1921. Attracting a large number of influential figures, including Alexander Graham Bell, its mission was clear: to advocate for and support eugenic sterilization and other measures aimed at restricting the reproduction of individuals who did not "fit the mold". Medical institutes worldwide taught eugenic principles, ensuring a continuous supply of new professionals who were ready to carry on this work.
In 1933, the Nazis passed the "Law for the Prevention of Offspring with Hereditary Diseases." This law allowed for compulsory sterilization of German citizens who were believed to have hereditary diseases. The definition of these was quite broad and included conditions such as schizophrenia and manic depression. The list extended further to encompass epilepsy, inherited visual or hearing impairments, severe physical deformities and even chronic alcoholism.
Thousands were forcibly sterilized under this law, subject to invasive procedures without their consent. Hospitals and asylums often collaborated, helping to identify individuals for sterilization. Later, in 1935, the Reich introduced the Nuremberg Laws, which initiated increasingly strict and dehumanizing racial policies, including prohibiting marriages and sexual relationships between Jews and "Aryans" and eventually stripping Jews of their German citizenship. We all know how the story ended.
From Hippocrates to Hitler
The medical community's active participation and endorsement of eugenic practices were fundamental to the atrocities committed. When it comes to Aktion T4, these doctors not only facilitated the program but often sought to "innovate" it by refining methods and expanding its reach. Against this backdrop, some names stand out, such as Dr. Heinrich Gross, a prominent Austrian psychiatrist and neurologist. Dr. Gross started his career at Spiegelgrund in November 1940. By 1942, he had killed more children than any other doctor in the hospital. If that wasn’t enough, Gross took his macabre actions a step further by preserving the brains of his victims for so-called "scientific studies" - a grotesque action that would later underpin many of his 'research' publications. Believe it or not, only in 2002 were these remains released for a proper burial, and the memorial that I visited was erected on the grounds where the clinic once operated.
What's even more astonishing in Dr. Gross' story is that even after the war ended and the horrors of the crimes committed were laid bare to the world, his career didn't seem to be at all affected. On the contrary. He continued his work in psychiatry, rose to prominence, and became an influential voice in numerous Austrian legal cases. But history, it seems, has a way of coming full circle.
In 1975, Gross found himself face to face with Friedrich Zawrel, a survivor from Am Spiegelgrund who had personally endured the atrocities meted out by the doctors at the facility. Recounting this encounter, Zawrel later shared insights from his meeting with the very doctor who had once tormented him:
“Right then, he said to me: Have you ever been in psychiatric care? Then I lost it. I said, Mr. Primarius, for an academic you have an exceptionally bad memory.
— What is it I should remember?
So I said, Oh my God, can you even sleep at night? Are you not haunted by the cries of the small children left to freeze outside on the pavilion at temperatures below zero? That was the devil’s symphony, that doesn’t bother you in the least? Can you still sleep at night? Have you forgotten about Krenek, Jegelius, Hübsch, Türk, Jockel?
I listed the names of all the doctors.
— Have you forgotten all that? How can you live with that?
—What? You were there too?
He leaned back in his chair, and turned as pale as the ceiling.”
You might want a stiff drink for this next bit. The very year Gross encountered Zawrel, he was honored with the prestigious Austrian Honorary Cross for Science and Art for his 'research' using the brains of children he had personally exterminated at Am Spiegelgrund. Yes, seems like someone's moral compass was on a coffee break during that award ceremony. Thankfully, in 2003, this accolade was rightfully revoked. Despite facing trial three times, Gross managed to evade justice. His third trial in 2000 ended with him deemed mentally unfit due to advanced dementia. Yet, upon leaving the courthouse, he was promptly spotted at a local coffeehouse, cheerfully giving interviews and celebrating with friends and family.
“It is only necessary for some secret edict to order that the method developed for the mentally ill should be extended to other 'unproductive' people.” — Bishop Clemens August Graf von Galen
Aktion T4 continued its 'official' operations until 1941. The program's cessation came amidst a backdrop of protests - not from the medical and scientific community, but particularly from sections of the German church and public, who were beginning to find out about the then-secret extermination project. A prominent voice of resistance was Bishop Clemens August Graf von Galen, often referred to as the “Lion of Munster.” In a series of brave sermons, von Galen condemned the Nazi euthanasia program, decrying the state's usurpation of the divine right over life and death. He publicly criticized the regime for its immoral actions, declaring that the value of human life wasn’t for the state to determine. “If you establish and apply the principle that you can kill 'unproductive' fellow human beings then woe betide us all when we become old and frail!... it is only necessary for some secret edict to order that the method developed for the mentally ill should be extended to other 'unproductive' people.”
Unofficially, however, the "euthanasia" killings continued in various forms until the end of the war. In all, at least 250,000 people with mental and physical disabilities were murdered, from 1939 to 1945. At Am Spiegelgrund alone, around 789 children lost their lives. This 'medical' extermination under the guise of therapeutic intent, devoid of any moral compass, showcased the terrifying depths humanity can plummet when blinded by a warped ideology.
Simultaneously, on a much larger scale, the Holocaust was unfolding, targeting millions based on their ethnicity, beliefs, and identities.
“Ableism looks like calling people 'inspiring' for navigating a system that is designed for exclusion, while doing nothing to hold the system accountable." — Carson Tueller
We get very close to a dark abyss when hate and prejudice change the values of society and when people's lives are reduced to numbers and figures on a page. Even today, the experiences of those with disabilities, especially the “invisible” ones like my autism, face skepticism and misunderstanding. Being on the spectrum, I know firsthand how the subtleties of our experiences can be dismissed or underestimated. We constantly have to defend not just our abilities, but also the challenges we face against those who refuse to acknowledge or understand them. I'm sick of witnessing people stubbornly clinging to their narrow-minded beliefs of what is right or wrong, who should be accepted and who should be excluded. It's almost laughable, the sheer hypocrisy of it all. Society parades itself as inclusive, wearing the badge of 'diversity' like it's this season's fashion trend. But scratch beneath the surface and you will find a world still trapped in outdated beliefs, quick to marginalize anyone who does not fit into their stupid definition of 'normal'. They pat themselves on the back for the smallest gestures of acceptance, while in the same breath, pass silent judgments or even voice them aloud. The audacity to claim progress while holding tight to age-old biases is both bewildering and infuriating. Let's not even touch upon the self-proclaimed 'experts' and doctors who often make the most absurd and ignorant remarks, perpetuating stereotypes while hiding behind their credentials. And then there are those who advise patience, suggesting that society just needs time to 'adapt' and 'absorb' this newfound awareness. Well, for someone constantly told to fit into a world that rarely tries to fit around them, my patience has worn incredibly thin. It's funny how those who don't experience the struggle are always quick to preach about endurance, isn't it?
Being stuck on one thought of what is "normal" or "ideal" has led to some of the worst and darkest times in history. This awful way of thinking is exactly what allowed atrocities like Aktion T4, the Holocaust and numerous other tragedies to happen. I know, it's tempting to view history as a collection of isolated incidents, but we must remember that the horrors of Nazi Germany didn't simply emerge out of nowhere. They were the result of years of discrimination, where people chose to shame and disdain anything that didn't fit their own personal ideals.
Finally, here's my closing argument: before we judge, before we decide the worth of someone's life based on a diagnosis, skin color, religion, or any other arbitrary marker, let's remember the past. Let us remember the children of Am Spiegelgrund. Let us remember the millions who lost their lives under the Nazi regime. Every time we let our preconceptions dictate our beliefs and actions, we bring ourselves closer to repeating those same mistakes.
Our call now is not simply to be patient. Our call is to be vigilant, vocal, and unwavering in our pursuit of understanding and acceptance. Because in that pursuit lies not just the well-being of the marginalized, but also the essence of what it means to be human.
Excellent essay. Historically, mass atrocities didn't happen overnight. Bits and pieces are tested over and over again along with a relentless propaganda campaign to test the public's willingness to believe and not interfere. The tragedy of these dead children should remind us of that.
Excellent piece of work Marina, I felt frozen in time with your details, your passion for the innocent victims really shines🙏