Psychiatrie und Krieg

Zu Beginn des 20. Jahrhunderts befand sich die psychiatrische Anstalt in Haina in einer Phase des Umbruchs, deren zahlreiche Bestrebungen im Geiste von Fortschritt und Modernisierung durch den Ausbruch des Ersten Weltkrieges jäh beendet wurden. Wie sich der Krieg auf die Geschehnisse, das Personal und insbesondere die Patienten des Landeshospitals Haina auswirkte, ist die zentrale Fragestellung der vorliegenden Arbeit, welche hauptsächlich auf der Auswertung von Archivalien und deren Kontextualisierung anhand weiterer Quellen beruht.
Die unmittelbarste Folge des Krieges für das Landeshospital war die Einberufung von beinahe der Hälfte des Personals zum Heeresdienst. Bei unveränderter Patientenzahl war deren Versorgung und Überwachung nun maßgeblich erschwert, und schon kurz nach Kriegsausbruch finden sich Berichte über vermehrten Aufruhr und Entweichungen. Spätestens ab Herbst 1915 kam dann die für das Landeshospital gravierendste Auswirkung des Krieges zum Tragen: Durch Fehlplanung, Missernten und eine Handelsblockade war die Versorgung mit Nahrungsmitteln erheblich erschwert. Durch die Verbreitung der Infektionserkrankungen Ruhr, Typhus und Tuberkulose verschlimmerte sich die Situation nochmals erheblich. Insbesondere die ab Mitte 1916 einsetzende Ruhr-Epidemie forderte viele Todesopfer unter den mangelernährten Patienten. Dass in Haina aufgrund des damaligen Status als Pflegeanstalt viele ältere Menschen untergebracht waren, begünstigte den verheerenden Verlauf zusätzlich.
Von einer Inkaufnahme des Hungersterbens der Patienten, wie sie der Mehrzahl damaliger Psychiater nachgesagt wird, konnte in Haina keineswegs die Rede sein. Während zu Beginn des Krieges auch in Haina eine patriotische Grundhaltung vorherrschte – hierfür spricht unter anderem die Errichtung eines Vereinslazaretts auf dem Gelände des Landeshospitals, in dem zwischen Oktober 1914 und Mai 1917 verwundete Soldaten versorgt wurden –, unternahm man spätestens ab dem Zeitpunkt, als die gesundheitlichen Folgen für die Patienten sichtbar wurden, vieles, um deren Situation zu lindern, und patriotische Motive rückten in den Hintergrund.
Vor dem Krieg deutlich erkennbare Bestrebungen nach Teilhabe am wissenschaftlichen psychiatrischen Diskurs und fachliche Überlegungen in Haina wurden durch den Krieg erheblich eingeschränkt, da dieser die Einrichtung und Patienten insbesondere durch die Hungersnot und den Personalmangel vor eine existenzielle Bedrohung gestellt hatte. At the beginning of the 20th century, the psychiatric hospital in Haina was in a phase of upheaval with numerous aspirations in the spirit of progress and modernization, which was abruptly ended by the outbreak of the First World War. How the war affected the events, the staff, and especially the patients in Haina is the central question of the present work.
The most immediate consequence of the war for the hospital was the conscription of almost half of the staff for military service. With the number of patients remaining unchanged, their care and supervision was now considerably more difficult, and shortly after the outbreak of war there were reports of increased turmoil and escapes. All requests for reclamation on the part of the management were unsuccessful, and the recruitment of auxiliary staff also proved difficult, which is why the staffing situation remained problematic throughout the war period. The emergency situation was significantly aggravated by the sudden death of the then director, Dr. Schürmann, on February 17, 1916. The provisional management of the hospital was taken over by Dr. Giese, who had been working as a senior physician until a successor for the director's post was found in Dr. Gerling at the beginning of 1917 and thus almost one year later.
From the fall of 1915 on, the most serious effect of the war on the hospital in Haina came to bear: due to poor planning, crop failures and a trade blockade, the supply of food was considerably hampered. In addition, a new distribution hierarchy had emerged with the start of the war, with the military at the top of the hierarchy. Initially, the bread ration for patients in Haina was reduced voluntarily, but in the course of time malnutrition became increasingly problematic. About a year after the outbreak of the war, almost all of the patients lost weight, and the patients' ability to work diminished considerably – a vicious circle in view of their urgent need to work in the affiliated estate administration. The spread of infectious diseases such as dysentery, typhus and tuberculosis further aggravated the situation. In particular, the dysentery epidemic that began in mid-1916 claimed many lives among the malnourished patients. The fact that many elderly people were housed in Haina due to its status as a nursing home at the time further favored the devastating course of events.
Due to the lack of personnel caused by the war, it was very difficult to make correct diagnoses, to carry out the necessary isolations and to treat those affected adequately. Thus, from January 1916 to March 1918, 134 patients in Haina fell ill with dysentery, 89 of whom died. Since typhus and tuberculosis were also often fatal and some patients simply starved to death, the First World War claimed numerous victims in Haina in this way, far away from the frontline. While the annual mortality rate in the regional hospital had been 7.5% in peacetime, it was 24.5% in 1918.
In Haina, there was no question of accepting that the patients would die of hunger, which is what the majority of psychiatrists is said to have acted like. While a patriotic attitude prevailed in Haina at the beginning of the war – this is evidenced, among other things, by the establishment of an association hospital on the grounds of the state hospital, where wounded soldiers were cared for between October 1914 and May 1917 – much was done to alleviate the situation of the patients at the latest from the time when the health consequences became apparent, and patriotic motives receded into the background. However, several requests for better care and more food for the patients were unsuccessful, so that the situation remained catastrophic until after the end of the war, despite great efforts on the part of those responsible.
While the effects on patient care are undoubtedly the most significant consequences of the war on events in Haina, it was possible to show in many ways how the war was involved in the development of the mental illnesses of some patients in Haina. However, gaps in the documentation of medical histories meant that only a few cases could be traced in detail. Clearly recognizable efforts to participate in scientific psychiatric discourse and professional considerations in general before the war were considerably restricted by the war, since the war in particular had posed an existential threat to the institution and patients, especially due to famine and staff shortages.