The Nazi Doctors: Medical Killing and the Psychology of Genocide by Robert Jay Lifton (Basic: $19.95; 561 pp.)

There was a time when the world was widely regarded as flat, and it was thought dangerous to sail to its extremities for fear of falling off into some dreadful chasm. Nowadays, with round certainty, we go pretty much where we please and manage to come back.

In terms of moral rather than physical geography, the roundness of our planet was thrown seriously into question by the Nazi Holocaust. It is no longer universally taken for granted that our understanding should properly navigate wherever it can. There are those who argue that efforts to understand or explain the perpetrators is to risk, not condoning them, certainly, but reducing an unparalleled horror into a mediated one.

"I was by no means without fear of what I was getting into," Robert Jay Lifton writes at the beginning of this monumental study of the doctors who were so intimately involved with the death camps. The argument was put to him that "psychological study in particular . . . ran the risk of replacing condemnation with 'insights.' "

The risk, if it was one, was more than justified. "The Nazi Doctors" is a full, sometimes unbearable account of the horrors that went on. That is not its point nor its originality; but these horrors, in which Lifton immersed himself during years of research and interviewing--and in which we, as readers, now find ourselves immersed--make possible the book's real achievement.

This can be encapsulated in a phrase. Lifton interviewed 28 former Nazi doctors, including five who worked in the death camps; and he also interviewed about 80 Auschwitz survivors, including many who worked as prisoner-doctors along with a German medical staff. One survivor asked him what kind of men the Nazi doctors were.

"Neither brilliant nor stupid," Lifton sums up his reply, "neither inherently evil nor particularly ethically insensitive, they were by no means the demonic figures--sadistic, fanatic, lusting to kill--people have often thought them to be." And the survivor interjects: "But it is demonic that they were not demonic."

This is the book's major thesis, as Lifton traces the gradual brutalization of German medical practice. It went from involuntary sterilization, to state-ordered euthanasia of deformed babies, to the elimination in hospitals of a gradually widening range of adult mental patients and incurables--being Jewish soon qualified--to the death camps themselves.

Simply to write about the doctors, and their varying degrees of regret and almost invariable degree of rationalization, would have more or less documented one more aspect of the banality-of-evil theme. But to place the doctors against the unflinching account of what they did is to go beyond banality and to juxtapose inextricably the survivor's "demonic" and "not demonic."

The book is an ordeal, it is only fair to note. I felt physically ill as I went through the last couple of hundred pages of Lifton's deadly reporting. It was, of course, much worse for him to confront the two dozen doctors, now in their 70s and 80s and respectable civilians, with the record; and to hear them talk about it. (He had nightmares afterwards; and his survivor-friend, hearing about them, remarked: "Good. Now you can do the work.")

The arrangements were made through a prominent German medical figure, and the doctors were flattered to be asked, as colleagues, to collaborate with the eminent American Prof. Lifton. Once a Herr Doktor always a Herr Doktor. There was anxiety, of course; but it was held in check by a peculiar psychological manipulation. Though often frank, detailed and even regretful, the doctors did not place themselves emotionally inside their accounts. They talked in the third person. "The narrator, morally speaking, was not quite present," Lifton writes.

Nazism regarded itself as a great biological and spiritual cleansing and healing of a nation contaminated by decadence, weakness and the Jewish presence. "The health of the Volk" justified everything; and when you say health, you naturally think of doctors.

The Nazis did; and many doctors were honored to be in the front ranks of the biological warriors. It was only when confronted by what they would actually have to do--inject phenol in newborn babies and select out the weaker among the concentration camp inmates for gassing--that more complex reactions set in.

Some gave brutal evidence of relishing their role. A few resisted, despite their Nazi convictions. Some of the book's most fascinating accounts are of such men as Gottfried Ewald, who in the '30s refused to participate in the euthanasia program and campaigned openly against it; and Dr. Ernest B.--Lifton withholds the surnames of those he interviewed--who, alone among the Auschwitz medical staff, made a point of taking no part in the gas chamber selections.

Survivors unanimously credit Dr. B. with a humanity that approached the heroic; and yet, as Lifton discovers in his interviewing, Dr. B. essentially admired Nazism and considered Josef Mengele as the most decent man in Auschwitz. Lifton's is not a simple journey; a number of surviving prisoners had at least mixed feelings about the man later known as "The Angel of Death."

The great majority of doctors were somewhere between a Mengele and a Dr. B. They took part in the gas chamber selections, supervised the administration of the gas pellets and helped organize the cremations. At night, they would get drunk and, in drunken companionship, curse "this dirty business." And some would participate in the grotesque experimenting on living inmates.

To the doctors, of course, they were not living; they were the pre-dead. Every prisoner in Auschwitz was marked to die, they reasoned. There was nothing they could do about it. To experiment was at least to get some good out of the advance cadavers. To select the old and weak for the gas chambers was to spare them starvation, and to give the younger people a little better chance to survive.

So much for rationalization. Some of the most painful parts of the book are the voices of these old doctors talking about reasons.

Lifton suggests various explanations for the ability of men who regarded themselves as healers to administer death. There was, of course, the ideology of social cleansing; for us, at least, a special case, and a remote one.

But there were other factors, closer and more troubling. Bureaucracy, which breaks down a deadly purpose into smaller, relatively innocuous parts. Technology, which divorces the act from its results. (Killing Jews by shooting them produced a high incidence of nervous complications among the special squads assigned the job. Gassing was much calmer.)

Disassociation is hardly unknown in our own country. "I am only doing my job" is infuriating, but it is not genocide. Professional blinkers may allow a nuclear physicist to develop death weapons out of the pleasure of scientific achievement and independent of any moral questioning, but it is not genocide. Yet with his German doctors, Lifton shows us the uncomfortable linkage between such recognizable attitudes, and utterly unrecognizable actions.

I wish he had explored such implications at greater length. I also felt that the final, theoretical section of the book tends to be murky, jargon-prone and repetitive of concepts that had already been woven into the material, and more deftly.

Even as Lifton records the valor of a few figures in standing against the general dehumanizing, he treats them severely. Of a young doctor, just out of medical school, who took part in the euthanasia program for one month and then quit, he asks why he stayed that long. It is a valid question, though one can certainly see the answer.

But that, finally, is the point. We can see the answer. We might say we can almost see ourselves giving the answer.

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