Richard Arwed Pfeifer – a pioneer of ‘medical pedagogy’ and an opponent of Paul Schröder

Abstract

Richard Arwed Pfeifer (1877–1957) was one of the initiators and foster fathers of the renowned child-psychiatric and special needs education workgroup at Leipzig University under Paul Schröder (1873–1941) in the 1920s and 1930s. This paper is an account of their dispute concerning the interrelations between child and adolescent psychiatry and special needs education, as well as their disagreement about whether adolescent psychopaths should be admitted to specialized child psychiatric wards or elsewhere. Moreover, Pfeifer questioned the practical relevance of the separation of constitutional and environmentally-based psychopathy and fought eugenic research, which he found incompatible with the ethics of his profession as a remedial teacher and child psychiatrist.

Keywords

Child and adolescent psychiatry Germany history medical pedagogy Paul Schröder psychopathy in adolescents Richard Arwed Pfeifer

Introduction and starting point: Pfeifer – an unknown figure

Special needs education (SNE) or orthopedagogy and curative pedagogy were regarded as a medical rather than a pedagogical subject until well into the twentieth century. It was not until the middle of the century that it was established as a specific branch of the educational sciences. While this is regarded as common knowledge, it frequently allows us to forget that, in the case of the mentally disturbed or mentally ill, it is not entirely true. For them SNE is tightly, if not inseparably interconnected with child and adolescent psychiatry (CAP). Also in historical terms, special needs education for mentally ill children and adolescents developed from CAP. The Department of Psychiatry at Leipzig University has been acknowledged as a focal point of influence in the development of European CAP and SNE.

The more detailed studies published in German on the history of CAP and SNE for mentally ill children mention the special team that worked there under the department’s head Paul Schröder (1873–1941) in the 1920s–30s (Castell, Nedoschill, Rupps and Bussiek, 2003: 436–42; Steinberg, 1999; Thüsing, 1999). In all these publications, Schröder is referred to as one of the ‘founding fathers’ of both disciplines (Müller-Küppers, 2001: 18–19) and the Leipzig department as the only one in Germany that offered special ‘comprehensive’, yet non-compulsory, tuition in the field as early as 1938 (Castell et al., 2003: 59). Schröder’s impact on the formation of special professional associations, both nationally and internationally, is also mentioned (Castell et al., 2003: 438). The Leipzig team was crucial in founding the German Association for Child Psychiatry and SNE in Vienna in 1940 (Müller-Küppers, 2001: 21), and Schröder was elected its first president; he was also the first president of the International Committee for Child Psychiatry in Paris in 1937 (Nedoschill and Castell, 2001: 228–9). Moreover, Schröder is mentioned among the few German professors of psychiatry and neurology to have promoted the idea of child psychiatry as an institutionally and organizationally separate special discipline, independent of general or adult psychiatry and paediatrics (Nissen, 2005: 454). Chronological historical overviews mention the Leipzig CAP and SNE special unit as being among the first (Nissen, 2005: 500, 503). At least for the German-speaking world, Leipzig University was one of the places where this discipline was first developed and practised. However, these studies make little – or no (Nissen, 2005) – reference at all to a certain individual in Schröder’s department who was a member of the team during its first years, but soon adopted an opposing stance to both the team and Schröder. If he is mentioned at all in the publications mentioned above, Richard Arwed Pfeifer (1877–1957) is merely recognized for having established and having personally conducted SNE counselling – comparable to what is called child-guidance in the English-speaking world – in 1923. Based on this out-patient counselling service, Schröder set up his child-psychiatric unit (including an in-patient ward) in 1925: the ‘Department – or Observation Ward – for Juvenile Psychopaths’¹ (Castell et al., 2003: 439, 527; Müller-Küppers, 2001: 19). Only Laube (1996: 70–1, 100, 104–5, 110–11) refers to Pfeifer’s ideas for CAP and SNE, and Gebelt (1978) makes a few general remarks. The present study seeks to fill the gap in the historiography of CAP and SNE and present Pfeifer’s theoretical and practical work in the field, in particular his proposed SNE concept of a ‘medical pedagogy’ for mentally ill children.

From teacher to doctor

This summary of Pfeifer’s biography is based on his personnel file kept at Leipzig University Archives (UAL PA 48), and Busch (1965a). Pfeifer was born on 21 November 1877 in Brand (now Brand-Erbisdorf) in Saxony in eastern Germany. He was one of several children in a poor miner’s family without the means to send him to college. He was nonetheless given the opportunity to follow his interests and qualify as a primary school teacher at the teachers’ college in Nossen (1892–8). Pfeifer subsequently spent three years working as a supply teacher at St Nicholas School in Meissen. Due to his excellent results in his final teaching examinations, he was accepted at Leipzig University in 1901 to study pedagogy and sciences, despite not having acquired A-levels (German Abitur). There Pfeifer made contact with Wilhelm Wundt (1832–1920) and assisted in his experimental psychological laboratory. The Leipzig psychologist, philosopher and physiologist Wundt also supervised Pfeifer’s philosophical PhD thesis of 1906. Alongside his work in Wundt’s laboratory, Pfeifer also worked at the Institute of Physiology and in the brain-anatomical research laboratory at the Department of Psychiatry under Paul Flechsig (1847–1929) (Steinberg, 2005a). During his time at the latter he encountered neurologist and brain researcher Erwin Gustav Niessl von Mayendorf (1873–1943), who spent days sitting in front of his microscope studying brain preparations (Frauenlob, Schober and Steinberg, 2012; Steinberg, 2009). These meetings were to prove influential for Pfeifer. Flechsig was impressed by Pfeifer’s scientific curiosity and talent and in particular by his outstanding three-dimensional imagination, which Flechsig thought was ideally suited for brain research. He therefore made Pfeifer, now aged 34, consider taking his Abitur and then studying medicine. After marrying Anna Eger (d. 1956), the orphaned daughter of an affluent Dresden family, Pfeifer felt he was in a position to do this, so he sacrificed the income and recognition of his job as head teacher and started his medical studies in 1912. After passing all preliminary and final exams ‘with distinction’, he was awarded his official doctor’s licence in February 1916 (UAL PA 48: 6). Two years earlier he had already begun an assistantship at the Department of Psychiatry, basically following the inclination and approach of his teacher Flechsig. In 1916 Pfeifer went on to defend his medical MD thesis before qualifying as a university lecturer (habilitated) on brain research topics in 1920 (Pfeifer, 1916, 1920).

Pfeifer’s SNE counselling service

Pfeifer was interested in art created by the mentally ill (Somburg and Steinberg, 2008), and from the 1920s he began to explore a second important area of interest that bore a connection with his primary pedagogical studies. This shift to child psychopathology may have been stimulated by Oswald Bumke (1877–1950) taking over as Flechsig’s successor as head of the Leipzig University Department of Psychiatry in 1921. Bumke’s interests lay very much in psychology rather than in brain anatomy, which he ‘would rather have outsourced to the Institute for Anatomy’ – as Pfeifer, still angry about this, said to his employee Busch 25 years later (Busch, 1965b: 158; Steinberg, 2008). In addition, the social deprivation in the aftermath of World War I resulted in many children being neglected, falling into bad habits and becoming disturbed; consequently, they were admitted to psychiatric hospitals, and institutions for general psychiatry throughout Germany had to provide care for these adolescents. Bumke’s clinic admitted children for the first time in 1923, taking on 70 that year and a further 102 in 1924 (Laube, 1996: 104; Uhle and Trenckmann, 1982: 104); having a former teacher among his staff must have seemed more than adequate for Bumke.

To return to Pfeifer’s child guidance or SNE counselling service: archival sources enable us to reconstruct the events and help us to discard widespread falsehoods concerning the events of 1923. They also reveal that Pfeifer had a significant stake in establishing CAP and SNE for mentally ill children at Leipzig University and consequently for the institutionalization of the two disciplines as a whole, a fact not previously acknowledged.

Pfeifer’s own account of the situation, included in a speech given in 1946 on the re-institution and re-foundation of the Department after its complete destruction in World War II, should have raised awareness.

As a university lecturer I was appointed medical consultant for the Youth Welfare Centre in Leipzig in 1920. As such, this was a private welfare organization … Funds came from the Department of Justice for counselling adolescent delinquents, from the City’s Youth Welfare Service for counselling / guiding and safeguarding services, but also from the Welfare Funds of churches, Masonic lodges, the craftsmen’s guilds, the Jewish community, consulates and charitable companies … As a medical consultant I kept one day a week free for counselling parents. The children always came accompanied by their mothers, in certain cases accompanied by a social worker. My written statement was sent to the Centre, in cases of job counselling to the labour exchange’s job counselling office. Everything ran smoothly and to the satisfaction of everyone involved. (Pfeifer, 1946b)

Here Pfeifer himself stated that he had begun this work in 1920, commissioned by the Leipzig Youth Welfare Centre. No explicit reference is made to the location where this counselling took place, but the fact that his reports were ‘sent’ to the Centre rather suggests a geographical distance. Elsewhere, Pfeifer also wrote:

Soon the necessity arose for an observation ward for children, including provision for teaching purposes. This led to the opening of the neurological out-patient department for children and one observation ward each for boys and for girls. I was relieved of the directorship when it was taken over by Prof. Schröder, following my appointment as professor for brain research. (SächsHStA, No. 1520: 97–8)

The observation wards were installed in the hitherto unused isolation barracks on the department’s premises and were opened in June 1925 offering 20 beds for boys and later another 20 beds for girls (Laube, 1996: 106; Schröder and Heinze, 1928: 192). A letter written by Schröder to the Dean allows us to determine the date the out-patient department began its work. Schröder reports that, following a request by the City’s Youth Welfare Centre to the Saxon Ministry of Education, an out-patient counselling and examination service for juvenile psychopaths started at the end of June 1925. This service was open every morning as well as on selected afternoons, by appointment (UAL Med. Fak., B III, No. 19, Vol. 2: 2; see also Laube, 1996: 100). Two other documents written by Pfeifer in 1946 give further information. In a letter to the Healthcare Department of the Soviet Military Administration he clearly claimed this idea as his own: ‘Under Schröder my personal impact as Senior Assistant led to the implementation of a clinical sub-department for child and adolescent psychopathology supplemented by an out-patient counselling service.’ (UAL PA 48: 66b). The second document was an appeal to the Mayor of Leipzig that the city should make contributions to the re-establishment of university-based mental health care and child guidance services for children; in view of the enormous devastation brought about by the war to the town’s child and youth welfare, this would be in the city’s own interest. In particular, Pfeifer expressed his explicit hope that the city’s welfare authority would:

decide to affiliate part of their facilities to the university. The thought of such a cooperation of city authorities and university institutes is not a new one. The paediatric ward at the former Department of Psychiatry had been founded by the city’s Youth Welfare Centre, and the City Council showed a keen interest in the permanent existence of this facility, not least by funding one assistant at the out-patient counselling service and the clinical observation ward for deviant children. (Pfeifer, 1946a)

When Schröder took up office on 1 April 1925 (UAL PA 1601: 112), Pfeifer had already been providing out-patient counselling services for some years, commissioned by the city’s Youth Welfare Centre. Since it can be assumed that Pfeifer provided these services within the facilities of the university department, and since most of the patients cared for in the children’s ward were admitted through or by this counselling service (Schweitzer, 1933), the service became increasingly connected with the clinic. In effect, Pfeifer made the youth welfare counselling service an out-patient department of the University Clinic – in agreement, or at least with the permission of, Schröder. From October 1924, when Schröder had accepted the Leipzig post, until his taking office in April 1925, there was consensus between Pfeifer and his future boss. Then in June 1925 Schröder appointed Pfeifer as head of the newly opened boys’ ward and of what had since become the ‘Out-patient Counselling Service’ (on all this, see Steinberg, 2005b). Prior to this, on 21 November 1924, Pfeifer had been appointed associate professor and promoted to Senior Assistant (UAL PA 48: 14–19). Although the personnel files rather suggest that this promotion had been requested by Flechsig, we may assume that any change in staff or promotion in that interim period was decided in agreement with the future head of department, Schröder. In the files, there is no explicit request that this associate professorship be dedicated to CAP or SNE, yet there is reason to assume that Schröder supported it because Pfeifer worked in one of his key areas of interest. Indeed, despite the professorship having no title, presumably for formal reasons, the Inaugural Speech given on 21 November 1925 left no doubt with regard to Pfeifer’s chief subject of interest: ‘Key Aspects of Psychopathology of Pre-School-Aged Children’ (Pfeifer, 1926). All this could have formed a reliable basis for a fruitful scientific cooperation between Pfeifer and Schröder, so it is incomprehensible that as early as 1926 Schröder removed Pfeifer from the post of head of the children’s wards and that Pfeifer resigned from his job as counsellor for the Youth Welfare Centre.

The dissent surrounding CAP as a ‘fundamental part’ of SNE

Not long after Schröder’s arrival in Leipzig, he and Pfeifer clashed. Soon Pfeifer was no longer a member of the Leipzig CAP/SNE team.²

What were the reasons for the disagreements between Schröder and Pfeifer in 1925/26? Contrary to mere speculations (Ettrich, 2002: 16), archival sources suggest that the main cause was a disharmony in both their characters and their views on the subject of CAP. Pfeifer argued with quite a number of colleagues in his career, the first instance being a minor discord with Bumke. Pfeifer also had ‘serious differences’ (Schmidt, 2000: 35) with August Bostroem (1886–1944), Schröder’s successor in 1938; also, after 1946, Pfeifer’s dispute with Hugo Kufs (1871–1955), whom he had explicitly talked into becoming part of the revitalization of the Brain Research Institute, almost turned violent (Steinberg, 2012). This serves to substantiate the view that the conflict between Pfeifer and Schröder was based not only on ‘technical’ issues, but rather on Pfeifer’s poor interpersonal skills and team spirit, over-inflated self-esteem and eccentricity in research matters.

It appears that their disharmony established a permanent communication barrier between them. More senior individuals became involved in one of their disputes (UAL PA 48: 37–44): on 6 June 1934, Hans Volkelt (1886–1964), head of the Institute of Pedagogy and assistant head of the Teachers’ Examination Board in Leipzig, requested official help from the Dean of the Medical Faculty. Volkelt reported that, without prior agreement, Pfeifer had arranged his seminars to be held at the same time as Schröder’s. Moreover, Pfeifer invited all SNE students to a ‘special meeting’, which turned out to be nothing more than a normal seminar/lecture held by him at the same time as Schröder’s. Volkelt denied attendance credits to students present at Pfeifer’s lecture and ‘reprimanded’ Pfeifer ‘severely’,

making him aware of his inconsideration towards Prof. Schröder and his inappropriate guidance of students of Special-Needs Education, who would have had every reason to attend the seminars offered by Prof. Schröder. There is evidence that Prof. Pfeifer tolerated or even promoted activities which virtually excluded his colleague Prof. Schröder from teaching SNE students. As a result, I no longer consider him acceptable as an examiner in this optional subject. (UAL PA 48: 37–8)

The dean elicited a reply on this matter from Schröder who reported that, soon after taking up his post nine years previously, he had established ‘Prof. Pfeifer’s impropriety’: ‘I soon recognized that his personal disposition made the then assistant Dr. Pfeifer exceptionally unsuitable for clinical work and research, especially in the children’s ward that was established soon thereafter.’ (original emphasis). Pfeifer was instead said to have a distinct talent in brain anatomy, and ‘in extensive negotiations with both the ministry and the faculty, I strove eagerly for’ Pfeifer to be appointed Professor of Brain Research. Pfeifer was also assigned the only single room available in the whole brain anatomical department along with all necessary equipment, books and materials. Requests for the latter had so far been made in memos written by Pfeifer, but even this channel of communication ‘had ceased’. ‘This makes Professor Pfeifer appear completely out of place at the department I am in charge of. He has a rather ridiculous habit of punishing me by pretending not to know me or looking the other way for months on end.’ Moreover, Pfeifer would not report any incidents or results. Hence for him the issue in question was:

nothing more than a link in a longer chain of multiple frictions. I am sure that the Dean has got to know the exceptional, unbalanced personality of our colleague Pfeifer sufficiently and will understand that for me the easiest way to proceed is to continue to find him baffling in many ways but to raise objections only if the consequences of his behaviour prove unbearable; that I reserve stricter intervention to cases where I hope this might produce an effect. Maybe an opportunity will present itself. (UAL PA 48: 41–44)

Besides Schröder’s letter to the dean, the directory of courses held at the university proves that, despite becoming more involved in brain research, Pfeifer continued his activities in the field of CAP and in particular SNE until the mid-1930s. This is supported by the permanency of his theoretical course on ‘Medical Pedagogy (with presentations)’ accompanied by a practical course at the Institute of Pedagogy from winter 1932/33 to summer 1936. In the 1936/37 winter semester, Pfeifer offered joint ‘Medico-pedagogical exercises on the main issues in guidance of the soul’ with theologian Alfred Dedo Müller (1890–1972) and in summer 1937 ‘Pedagogy for Medical Professions’ (Universität Leipzig, Vorlesungs- und Personalverzeichnisse, Wintersemester 1932/33–Sommersemester 1937).

The reasons for the serious dispute between Pfeifer and Schröder have not been explored before. Schröder’s preference for CAP and SNE of mentally ill children as medical sub-disciplines and his primary concern about pathological characters have been suggested as reasons, but without a detailed discussion (Ettrich, 2002: 16, 22). Indeed, Schröder, like many colleagues of the time, tried to ascertain to what degree these ‘degenerations’ were hereditary or environmental in nature. Such an approach necessitated in-patient observation beds, which were supplied when the Department for Juvenile Psychopaths was opened in 1925. Laube (1996: 105) has stated that Pfeifer rejected this approach, although he does not mention the reasons. Again, the problem is reduced to Pfeifer’s complaint that Schröder did not deal with child and adolescent psychopathology until very late and only on the basis of his psychiatric knowledge. This latter fact (i.e. looking on child psychopathology from the point of view of adult psychiatry) is said to have made Schröder overemphasize the degenerative, defective and pathological aspects (SächsHStA No. 1520: 97–8). Gebelt (1978: 259) seems to be the only one to disagree, stating that ‘those who read Schröder’s works attentively will see that this assessment does not touch on the core of the problem’. He also says that the dispute arose because Pfeifer preferred a pedagogical-psychological approach rather than the clinical-psychiatric approach of Schröder (Gebelt, 1978: 259). However, this had already been established by Schröder himself (UAL PA 48: 26b, 41).

Schröder’s works reveal him as both a clinician and SNE pedagogue; besides strictly psychiatric and psychopathogenetic observations, objectives and goals for SNE and care begin to emerge that were very close to Nazi Heredity Legislature and appeared to be guided by the interests of public welfare (Nissen, 2005: 455; Thüsing, 1999). Yet despite his classification of psychopaths and mentally ill adolescents as ‘unworthy of support’ and ‘prone to eradication’, wording which is very close to Nazi ideology, Schröder should be seen as ‘rather moderate’ (Dahl, 2001: 185) compared with his CAP and SNE colleagues.

At the First Convention of the German Association for CAP and SNE in 1940, Schröder (1943) summarized his view on CAP and SNE as follows. Their primary concern should be ‘extraordinary personalities and their responsiveness’, and ‘care for the mental well-being of difficult children, pastoral child care’, so to speak. Within these disciplines, ‘character analysis was of the utmost importance, since it enabled pedagogical evaluation, assessment and prognosis’, relevant for several institutions and authorities: school, youth welfare office and services, juvenile courts, approved schools, Nazi youth organizations for boys (HJ) and girls (BDM). Schröder (1943) put particular emphasis on the fact that:

Child psychiatry is not care for psychopaths. Only a few of them, the genuinely ill, should be in the custody of a doctor. Our objective is much wider: We want to learn to understand and identify non-average children with their distinctive mental constitution, assess and guide them properly, educate and integrate them purposefully. We can only achieve this through careful character-analytical differentiation of every single case. The difficult children, who are ultimately nothing but extraordinary varieties of human character, reward us for the care given to them by providing us with excellent study and teaching material for practical character-analysis, as it is needed in pedagogy everywhere, be it the educator and teacher of average children or the SNE specialist.

He also said: ‘Child psychiatry, as well as SNE, ought to help integrate defective, substandard children (each according to their own capacities) into society and its economy for their own and for society’s good.’ Hence CAP constituted a ‘major component’ of SNE, which on top of that reached ‘far into pedagogy as such’. Finally, CAP should be concerned with the ‘problems of timely or early selection for promotion or guidance’ (Schröder, 1943).

This interconnection between character-analysis as Schröder understood it and SNE had already been emphasized by him in 1939 at the First International SNE Convention in Geneva. Obviously led by Nazi ethics, he had nevertheless established that a proper character-analytical assessment allowed both the family and the state an adequate pedagogic prognosis as to ‘whether the outcome repaid the costs and time needed’ (Hanselmann, 1939). However, so far no text has been identified in which Schröder explicitly promoted the killing of those ‘unworthy’ of support.

Contrary to what has been worked out as stated in Schröder’s publications, Pfeifer kept complaining that his boss only followed a psychiatric approach and therefore overemphasized the degenerative and pathological aspects. However, Schröder had established the following major guideline in his character-analysis and repeated it in many of his works as a starting point: ‘Each description of abnormalities in a child’s character should depend and be based on the character-analysis of normal children and adolescents’ (Schröder, 1931: 5). An overview of the practical clinical work involved can be found in a paper by Schröder and Heinze (1928) on the routines in their children’s wards (in which Pfeifer’s preliminary work in the field is not mentioned), and in Schröder’s introduction to his Kindliche Charaktere und ihre Abartigkeiten (1931). Both texts reveal what has so far been neglected by research on Schröder, and obviously relied solely on Pfeifer’s reproach, namely that Schröder had a clear pedagogic prognostic impetus.

It is reported that to both observation wards, ‘boys and girls … are admitted by both parents and educators seeking advice via the out-patient department, through schools and authorities. In a few cases only, patients with genuine mental or nervous ill-health are admitted, the overwhelming majority being children and adolescents who, actively or passively, constitute an educational challenge or those who have been in trouble. Pupils in welfare are a minority. The observation, which usually lasts over several weeks, aims to advise parents and teachers, and also authorities, in determining adequate educational measures. The wards are not medical, nor are they equipped with nursery staff, but rather with pedagogical staff, relying on a team of dedicated and fully-qualified youth coaches and after-school care teachers. The wards also serve teaching purposes for students (future doctors and teachers), future after-school care teachers, youth coaches, public welfare officers and qualifying doctors and teachers.’ (Schröder, 1931: 8–9)

Schröder’s unmistakable pedagogical approach and a ‘totally and extraordinarily high quality of daily practical work’ and its scientific results were highlighted also by Bürger-Prinz (1941/42).

Pfeifer’s CAP and SNE concepts

Drafting a ‘medical pedagogy’

At the beginning of the 1930s Pfeifer drafted a sophisticated SNE concept comprising ‘medical pedagogy’, i.e. SNE in its strict sense and – his primary area of interest – remedial teaching and ‘late-age pedagogy’ (Pfeifer, 1933). His concept was strongly opposed by remedial teachers (Laube, 1996: 71), mainly because he promoted the notion of radical changes in pedagogy; it was also because he supported a so-called biological movement in remedial teaching that sought to develop educational measures hitherto neglected and, with their help, to use organic factors to modify normal psychology and its restrictive outlook that did not venture beyond the field of psychology (Pfeifer, 1934: 5). Pfeifer’s support for this biological movement becomes clear from his definition of what ‘medical pedagogy’ was meant to achieve, namely ‘the evaluation of biological findings obtained on the living object for the purposes of SNE’, which comprised:

A monographic description of the school child.

Descriptive pedagogy, i.e. description of the child in a form enabling the reader to achieve an appropriate evaluation of a child.

Late-age pedagogy (counselling for expecting and nursing mothers, guidance for teachers, etc.). (Pfeifer, 1933: 8)

‘Late-age pedagogy’ (Spätpadagogik) was conceptualized by Pfeifer as SNE applied to the adolescent or adult or to ‘people who have to raise children’ (parents, teachers, etc.). Pfeifer’s SNE concept is rather introductory, and also deals with the theory and practice of ‘special observation classes’ to which children were sent for a certain time ‘for evaluation purposes’. Finally, he establishes how educational problems could be solved by ‘applying a special range of methodical approaches in education that take into consideration the individuality of each child’ (Pfeifer, 1933: 8). The latter also included bed-wetting, ‘soup-haters’, thumb-sucking, nail-biting, which thus became part of SNE. These and other ‘episodes of digressiveness’ could be overcome in SNE in the strict sense. In contrast, remedial pedagogy could not overcome the condition treated, but rather constituted:

SNE for children showing sick conditions or processes. It is the clinical expansion of SNE for cases of feeble-mindedness and psychopathy, as well as for care in facilities for special purposes, i.e. homes for the deaf and dumb, the blind, remedial schools, approved schools and prisons. (Pfeifer, 1934: 5–6)

Pfeifer’s understanding of medical SNE is summarized in his 1946 letter of request to the Mayor of Leipzig mentioned above (Pfeifer, 1946a). Not only did he emphasize the necessity to re-install in-patient care facilities, but also that:

the tasks of the children’s ward at the Department have widened beyond psychiatry. The Counselling Service is there to help those with stammering and stumbling disorders as well as the bad eater, the fidgeter or the ‘Johnnie-Head-in-the-Air’. Educational presentations are meant to attract the better parents and thus secure guidance of the child through the adults. All this has nothing to do with what is commonly understood by psychiatry. Rather, the new discipline of medical pedagogy bridges the gap between the teacher and the doctor … Large cities need both out-patient and in-patient services to care for psychopathic children and adolescents. Teacher and also parent training are closely connected with this. The Department, both in-patient and out-patient, assists in assessment for juvenile courts or the labour exchanges. It also serves as a reception point for the neglected youth or young offenders. Moreover, it takes proper care of endangered adolescents, including securing proper accommodation – or assists the School Medical Service (e.g. with SNE students). As regards teaching, the Department teaches future doctors in medical pedagogy or helps mothers to understand children better through medico-pedagogical internships. It applies descriptive forms which enable the audience to get a proper understanding of the child and also about the psychopathology of children and adolescents. (Pfeifer, 1946a)

Pfeifer was called back into service after the war due to the shortage of staff and put in charge of the whole Department of Psychiatry. In a speech at the reopening of the children’s wards in 1949, he made it clear that he would not be reintroducing conditions such as those under Schröder, but rather a teamwork CAP including doctors, psychologists and educators; this evidently involved youth coaches and after-school care teachers working hand in hand (see, e.g. Gebelt, 1978: 261). A clear difference from Schröder’s theoretical approach, however, cannot be established, either in Pfeifer’s definition or with regard to the place of psychopaths within his introductory studies on the roles of heredity, everyday life and environment in both normal and, especially, abnormal conditions. His concept included pseudo-psychopathy, which he saw as the result of incorrect upbringing (the single child, the celebrity child, the stubborn, withdrawn, silent or unloved child, etc.). Pfeifer (1933: 8) also regarded much milder conditions such as ‘unlucky children’, stumblers, stammerers and other ‘difficult children’ as cases in which SNE could and should help. As his 1946 letter shows, he was inconsistent and used SNE (‘Sonderpädagogik’) and ‘medical pedagogy’ synonymously (Pfeifer, 1946a). This letter, however, also demonstrates that the milder cases of pseudo-psychopathy and psychopathy were the primary concern in his teaching and his out-patient counselling service.

Pfeifer and racial hygiene: ‘So far no pedagogy has been established based on racial hygiene’

In contrast to Schröder, who found hereditary research useful and who even demanded it, Pfeifer opposed it.

In setting up a diagnosis, the question as to whether the evil has been inherited or acquired has always played a big role. I have never seen any practical relevance for that. So far no pedagogy has been established based on racial hygiene. Instead, hereditary research has not fulfilled the hopes invested in it … However, overemphasizing the hereditary factor implies the danger for the doctor to consider inherited abnormalities as incurable, quite apart from raising fear in the family of the affected. On a closer look, many such cases prove themselves to be unclear. If there is one professional moral standard for SNE, it is that no case should need to be treated as incurable from the beginning. This applies all the more to psychopathic children and adolescents. The diagnosis ‘incurable’ can only be established at the end of a treatment, but by no means in its early stages … Eugenics has very weak foundations, since no doctor can draw conclusions with the slightest degree of probability from merely examining … parents. (Pfeifer, 1929: 112–13)

Contrary to most neuropsychiatrists, Pfeifer assumed a rather constant percentage of psychopaths and feeble-minded, and of mentally ill people in general, in the overall population. His comments were characterized by fundamental optimism and, despite having the eugenicists’ economic arguments in mind, he continued to pursue a deeply human approach to mentally ill and disabled people and called for recognition of their contribution to society. Despite the work involved, SNE was worthwhile.

Those whose feeble-mindedness is hereditary are often fully capable of working and fulfilling the duties of a suitable job with great loyalty, honesty and diligence. There is also proof that psychopaths with a disharmonic disposition can make up for their defects rather well if under proper and purposeful care. In contrast, those who have acquired their defects at a later stage often resist treatment, such as those suffering from the after-effects of meningitis or brain influenza. (Pfeifer, 1929: 112–13)

How did Pfeifer react following the Nazis’ seizure of power? Did he move towards Nazi propaganda as Schröder did? According to biographies (Busch, 1965a: 197–8; Schober, Becker, Schlote and Geiler, 1997: 198), Pfeifer had been threatened with losing all his university posts and even with being imprisoned, which was only avoided by a prompt and effective intervention by the university’s Vice-Chancellor and the Minister of Public Education. Pfeifer had been suspected of political conspiracy during his extensive lecture tours; after this he no longer gave any lectures and instead went into internal exile, dedicating much more time and work to his private practice. He also set up a private network of family care, putting patients into the custody and care of staff formerly employed at the Department. Was he thus helping patients to escape the oppression and threats of the new regime? Another fact underlines Pfeifer’s non-conformism: as head of the Brain Research Institute associated with the Department, he was offered human brains of indeterminate origin for use in experiments; he rejected them. We also have sufficient reason to believe that in private Pfeifer was against Nazi eugenic laws. So it can be assumed that his views were similar to what he said as an expert during the so-called Dresden Doctor Trials against Hermann Paul Nitsche (1876–1948), the medical supervisor of the ‘T-4’ Killing Programme, and 14 other medical professionals on 28 June 1947:

It is in the deep interest of all German doctors … to draw a strict dividing line between the unfaithful doctors with clear criminal inclinations and the vast majority of those with a clear conscience … The decent solution would have been symptomatic occupational therapy, sterilization and charity care … It is … appropriate … to hospitalize children in high need of help in an asylum in order to protect a healthy environment, … (Pfeifer, 1947)

‘The decent solution’ meant the alternative to killing, and in the last sentence ‘the healthy environment’ meant the child’s mother – as becomes clear later from the context.

Pfeifer went on to say that professional ethics do not allow the life span even of severely ill patients to be shortened under any circumstances. Yet it is appropriate to ease the severity of the dying process (Pfeifer, 1947). In Pfeifer’s publications from the 1930s until the mid-1940s, little or no reference can be found to the Nazi system and/or its laws and decrees. We conclude that he would have mentioned them if he had been a keen supporter of the National Socialists. In his 1934 paper on the differences between SNE and pedagogy, Pfeifer makes two short references to the Euthanasia Laws, coming to the conclusion that these will not abolish SNE:

As a result of the Law for the Prevention of Progeny with Hereditary Diseases we expect that no feeble-minded child will have feeble-minded parents. Feeble-mindedness from other causes than heredity will not cease to exist, however. We only need to think of mongolism, which is inborn, but not inherited. (Pfeifer, 1934: 6)

No personal attitude is included: Pfeifer merely refers to the fact that the law will not abolish the problem. He later tackles the economic considerations, a major argument for those promoting the law being that it would save a lot of time and money:

SNE professionals are experts in raising children suffering from permanent endogenous and exogenous damage and as such bear a responsibility towards the state to be economical, rather like trustees … There is no SNE case seen by a teacher without prior treatment by a doctor. Hence it is the doctor who is often to be blamed for improper protraction and leaving such children in the family, thus putting a strain on the healthy environment, as well as for other mistakes. Appropriate and hence cheaper SNE primarily requires pedagogically trained doctors. In the past this seemed unaffordable for the state; now with the Law for the Prevention of Progeny with Hereditary Diseases it is being implemented. (Pfeifer, 1934: 6–7)

The following passage makes it unambiguously clear that, for Pfeifer, killing someone suffering from a hereditary disease was unthinkable, and also that to hospitalize them may not always be the most appropriate and most effective form of care. From the point of view of the costs,

one should not only see the costs for the accommodation, but rather the relief achieved for the unaffected healthy environment. Removing a mongoloid child from a family at public expense can be appropriate, if this enables a family of 10 to regain stability – for it is a well-known fact that such a child requires considerable spending on the part of the family and demands all of his/her mother’s attention … The clinical observation wards for psychopaths and the feeble-minded are the sticking point as regards funding. Their value cannot be assessed by the number of admissions, for in a large town there are countless numbers of them, provided that there are sufficient beds available … The inappropriateness of in-patient care is verified when several weeks of observation reveal no other findings than what was already known, namely that the child was a psychopath. (Pfeifer, 1934: 7)

Are psychopaths to be admitted to an observation ward?

It is not clear, but maybe the harsh assessment above was made with reference to Schröder’s wards? Did Pfeifer think that too many SNE cases were hospitalized there for too long (several weeks) and at too high a cost? If we look at the actual patients being treated in Schröder’s wards in the 12-month period from 15 June 1926 to 15 June 1927 (Schröder and Heinze, 1928), we must indeed assume that their variety gave rise to the discord between Pfeifer and Schröder; the types of cases in the wards obviously contradicted Schröder’s claims in his book that mentally ill patients were only admitted ‘as an exception’ and ‘children in care’ constituted only a ‘minority’ (Schröder, 1931: 8–9). The diagnoses published (Schröder and Heinze, 1928) reveal that Schröder had transformed Pfeifer’s counselling service for child guidance into a high-cost remedial care centre that made little sense. Among the 155 patients admitted during the first year of its existence, 30 boys had suffered from epilepsy, brain influenza, chorea, brain tumours, organic nervous diseases, juvenile paralyses, acute mental conditions or had been injured during birth. Another 30 inmates were feeble-minded; in these patients, Schröder intended to study a variety of causes (inheritance, encephalitis, childbirth injury), special characteristics and above all their differentiation from partial intellectual deficits (congenital alexia, dyslexia, acoustic agnosia, mongoloid idiocy). Moreover, he wanted to gain insight into how ‘character and nervous abnormality’ or pathological conditions could lead to intellectual inferiority. The vast majority of patients, however, were psychopaths, for which he elaborated the following main categories: ‘sensitive, anxious and easily tired, insecure and easily seducible, insensitive, actively brutal and excitable, cantankerously irritable and quarrelsome, hypocritical and fantastic liars’ (Schröder and Heinze, 1928: 192–3). These were not the typical bed-wetters, etc., in need of SNE advice – as pictured by Pfeifer – who were merely going through ‘an episode of abnormality’. Schröder therefore once again had Pfeifer in mind when he wrote this criticism:

often the main share of teachers’ and psychologists’ attention goes one-sidedly to one or a few selected groups of ‘psychopathic’ adolescents, on the basis of whom general guidelines are deduced and the rest of the youth then disqualified as mentally inferior, impervious to pedagogic influence, and referred to the custody of the physician. (Schröder and Heinze, 1928: 193–4)

For Schröder it is clear that merely analysing the less severe cases and deriving too positive an outlook for effective pedagogical influence is a danger to society. All psychopaths need to be considered and analysed as to which characteristics are ‘dealt by fate’ and are ‘not or hardly susceptible to influence and can, at the utmost, only be compensated to a certain degree’. Schröder recommended 58 of the 155 patients he observed to consider hospitalization in an asylum, painfully aware that these facilities could not take proper care of such patients with character disturbances, i.e. psychopaths (Schröder and Heinze, 1928: 193–4).

Apart from their different views on who the observation wards were for and what their purpose was, Schröder and Pfeifer also had different views as to whether or not psychopaths should be hospitalized. Pfeifer clearly advocated the view that hospital should be ‘the last resort, not only due to the high costs … incurred’ but mainly ‘because psychopaths’ lives are most difficult when living among other psychopaths,’ since their problem is mainly due to diminished adaptability (Pfeifer, 1933: 5). In large asylums, staff ‘whose training quality leaves much to be desired’ take care of those psychopaths, providing them with insufficient access to pedagogically trained specialists. It would therefore make more sense, he went on, to set up little ‘holding establishments’ for more serious cases and transfer less serious cases with a favourable outlook to approved schools. These could, just like nursery schools and reformatories, offer out-patient services (Pfeifer, 1929: 114–15).

Basically, however, Pfeifer writes about the milder forms of psychopathy, yet even for these he does not give any clear practical recommendations, guidelines or descriptions that could be based on his own immediate experience. Everything consists of theoretical pedagogy by the teacher, Pfeifer. Schröder’s accounts, on the other hand, show practical insights, providing proof of his constant experience with severely psychotic patients including profoundly psychopathic children and adolescents. They also provide proof of Schröder’s rich clinical experience.

Pfeifer overemphasizes the ‘necessity for early intervention’ in order not to ‘procrastinate’ on cases. On the other hand, he strongly opposed the ‘disqualification’ of children and adolescents who are different from others ‘as inferior’ (Pfeifer, 1929: 111). Early intervention as envisaged by Pfeifer was to be conducted by his medico-pedagogical counselling service, comprising medical and teaching professionals, at least until SNE specialists were available. Medical students performing teacher training would be extremely suitable, Pfeifer thought, to become SNE specialists. Appropriate compensation through the state and the institutionalization of SNE as a special discipline ‘would definitely pay off’, when this means of intervention became medically and psychologically-pedagogically based (Pfeifer, 1929: 114).

So, when we read their works, it becomes clear that Schröder and Pfeifer followed different approaches, and it can only be assumed that the admission of psychopaths for several weeks, and in general Schröder’s more clinical approach, were the most controversial factors in their dissent.

A non-contextualized debate

When analysing the disagreement between Schröder and Pfeifer, a surprising fact emerges: namely, that it was not contextualized, nor was it on a national or international scale. At no point did the two men make specific reference to other child psychiatrists to substantiate their own views as to who should be hospitalized in CAP wards. So it seems as if their dispute was without a wider context. Another question was raised by several psychiatrists: whether CAP wards should be more appropriately attached to paediatric and not to psychiatric clinics.

In the 1920s and 1930s specialized in-patient CAP was an emerging novelty. In Britain and also in the USA, most CAP wards were attached to – and newly established at – asylums and university departments of psychiatry, and only a few to paediatric clinics. Likewise, child psychiatrists were also adult psychiatrists at the same time or at least came from adult psychiatry. Primary sources from international CAP in that period suggest that the advantages and disadvantages of hospitalizing adolescent psychopaths were not really discussed.

In German-speaking countries there is a tradition of close interconnections between CAP and SNE (Stutte, 1980/81). Psychiatrists demanded that reformatory teachers and welfare organizations should refer feeble-minded and mentally ill children to mental health care, even before World War I; an example was Tübingen Professor Robert Gaupp (1880–1953) (Castell et al., 2003: 27; on Gaupp see: Leins, 1991). A second root of German CAP lay in forensic psychiatry, in particular in psychiatric genetic research at the end of the nineteenth century. In the course of industrialization, general neglect and juvenile crime rates had already been on the rise, and World War I had increased this trend among morally and socially deviant young people. Psychopathy thus became one of the most frequently made diagnoses comprising all kinds of deviant and criminal behaviour, which was also typical for CAP in the UK (see below). On the other hand, research on the development of children was thought to provide new insights into the genesis of the entire human race (Haack and Kumbier, 2012).

In her overview of the institutional history of CAP in German-speaking countries, Laube (1996: 7–10) gives dates for observation wards opened at university hospitals that were among the first CAP institutions: Heidelberg (1918), Cologne (1919), Tübingen (1920), Vienna and Berlin (1921). According to her research, the first independent CAP hospital was opened in Bonn in 1926. Castell et al. (2003) suggest that the first CAP ward was at the Department of Psychiatry and Neurology of Frankfurt University in 1914. These authors also show that Tübingen-based psychiatrists Robert Gaupp and Werner Villinger (1887–1961) followed aims very similar to those of Schröder and even put forward similar hygienic arguments, whose racial nature was increasingly radical. For a systematic analysis of children’s mental life and for differentiated care and welfare service recommendations, Gaupp demanded the long-term hospitalization and observation of mentally ill children even before World War I. In 1914 he also promoted the idea of special facilities for ‘non-reformable’ and problem children. In 1920 he opened a children’s ward and appointed Villinger as his assistant. He soon started to promote forced sterilizations of mentally and morally deprived adults (Gaupp, 1925) and to view CAP as an instrument to filter out and select the incurably depraved, especially after 1930 (Castell et al., 2003: 23–33).

Later, in 1938, Villinger strongly promoted the idea of special ‘juvenile observation facilities’ (Jugendbeobachtungsheime), institutions similar to approved schools or borstals in the UK, in order to segregate adolescent psychopaths and admit psychopathic children only to CAP wards. He also initiated a discussion as to whether it would make more sense to attach CAP wards to departments of paediatrics instead of psychiatry (Villinger, 1938). Carl Pototzky (1880–1948), head of the CAP department at the Victoria Haus in Berlin, supported the view that paediatric clinics were responsible for problem children (Pototzky, 1933). The more CAP wards were opened, the more children and adolescents, and among them psychopaths, were admitted and hence pathologized, and after 1933 even segregated for and subjected to ‘eugenic treatment’, i.e. forced sterilization or killing. This increase in admission numbers was also promoted by the new German Youth Welfare Code of 1922 (which also allowed, in ch. 65, juvenile psychopaths to be admitted to psychiatric asylums for observation for up to six weeks) and by the emergence and speedy proliferation of active somatic pharmacological and non-pharmacological treatment options (milieu- and psychotherapy), which made hospitalization a necessity (see Laube, 1996: 60–9). Finally, the First International Convention for CAP in Paris in 1937 proclaimed the setting up of specialized CAP wards for medico-psychological evaluation as a high-priority short-term objective (Laube, 1996: 120).

Anglo-American countries likewise started with an approach similar to Pfeifer’s counselling: child guidance. It emerged in the USA in the 1920s under the influence of the mental hygiene movement and spread in the UK through funding support by the Commonwealth Fund. The first two child guidance clinics (CGC) were the East London CGC, started as a voluntary effort by the London Jewish Health Organisation in 1927, and the Islington CGC, which was opened in 1928 in Islington and became a model followed by others. The main objective of CGCs was to prevent crime and anti-social behaviour (Evans, Rahman and Jones, 2008: 467). After the opening of the Birmingham CGC in 1932, more and more CGCs were established all over the UK. By 1936 there were 46, increasing by 1944 to 95, 22 of which were staffed by mental hospitals and 9 were completely voluntary and did not receive any funding (Wardle, 1991: 56). In addition to these and the university and hospital clinics of child psychiatry (see below), school authorities also awarded funds to visiting psychologists to take primary care of mentally peculiar or disturbed children and adolescents. In the 1930s psychological treatment (and research) was also implemented in British prisons. According to their classification, psychopathy included not only personality disorders, but also a wide variety of other psychiatric disorders (Norwood East and Hubert, 1939: 6). For years, however, active and continuous psychotherapeutic intervention was carried out only at Wormwood Scrubs prison. In the 1930s the prison’s psychotherapists, Jonathan C. Mackwood and Jonathan H. Gould, suggested separating juvenile inmates with mental peculiarities in a new segregated facility, which they proposed should have 300 inmates; this facility should feel as unlike a prison as possible, and the main intervention would be guidance and training (Mackwood and Gould, 1950: 72). Between 1930 and 1945 there were discussions as to which services should be provided for the best care for ‘emotionally disturbed’ children, and this resulted in a reduction of the role of clinical psychiatry (Howells and Osborn, 1980/81: 195–7).

One special form of CAP/SNE intervention for problem children and juvenile delinquents was the UK borstal system for delinquents aged 16–21. This new kind of reformatory school promoted the influencing of problem youths psychologically by practical training and guidance, by school education, and also by implementing a sophisticated discipline and rewards system, all of which was aimed at diminishing the youths’ emotional and mental deficits. These borstals increasingly relied on the help of visiting psychologists, approved mental hospitals and out-patient clinics and, for ‘suitable’ or ‘hopeful’ cases, child-guidance clinics (Fox, 1952: 242–3).

Besides child guidance, the first children’s wards were established as early as 1923 at the Maudsley Hospital and in 1926 at the Tavistock Clinic in London. Following initial hesitation, in the 1930s hundreds of children were referred to these CAP wards by youth welfare and educational authorities, and also by police, prosecution and probation officers and doctors. This substantial rise in referrals to clinical CAP was also seen ‘in relation to novel behaviourist hypotheses and the forging of formal links with local government and charitable bodies’ (Evans et al., 2008: 466). In addition to psychiatrists, psychologists, educators and specialist social workers were recruited to these services, which fostered a multidisciplinary approach including reflexological, psychological and psychoanalytical influences. The main influence, however, was general or adult psychiatry. The Maudsley ward accepted any kind of psychiatric and neurological cases, including morally depraved children. However, the feeble-minded, whose number had increased as a result of the huge encephalitis epidemic, were referred back to educational authorities and approved schools, since they were regarded as incurable (Evans et al., 2008).

At a time of general breakthroughs both in understanding the nature and causes of mental diseases and in developing effective therapies, British CAP saw a number of emerging practical and theoretical approaches, in which psychological and psychoanalytic concepts played a large, maybe predominant, role. In contrast, German CAP was dominated by hereditary, eugenic and environmental thinking, and intervention was basically conceptualized clinically, but not socially.

In the USA, the child guidance movement started in 1909 when William Healys (1869–1963) began working with juvenile delinquents (Snodgrass, 1984). In 1917 the Healy and Bonner Judge Baker Clinic, the first American CGC, was launched in Boston (Evans et al., 2008: 467; Howells and Osborn, 1980/81). Before that, Healy had founded the Institute for Juvenile Research at Cook Country Juvenile Court in Chicago, which basically aimed to guide and influence juvenile delinquents and their families in a social-psychiatric way and to help them cope with potential financial problems (McShane and Williams, 2003: 246)

Child guidance relied increasingly on a multidisciplinary approach, in which doctors, psychologists, social workers, probation and police officers gave expert advice to delinquent and problem children and youths, their parents, teachers and authorities (Evans et al., 2008: 467; Howells and Osborn, 1980/81: 194; Snodgrass, 1984). This very individual and strong psychological approach is in line with Pfeifer’s approach. But Healy opposed genetic research on psychopathic behaviour even more strongly than Pfeifer did, and also relied more on psychoanalysis, in contrast to Pfeifer who was much more of a teacher.

Return to brain research

Leipzig Psychiatric and Neurological University Hospital had been totally destroyed by Anglo-American air raids on 4 December 1943, and the Psychiatry Department suffered devastating conditions (Steinberg, 2005b; Steinberg and Angermeyer, 2002). As already mentioned above, in March 1946 Pfeifer, then aged 69, agreed to the request of the Medical Faculty to return from retirement and take over temporary directorship. After World War II, when Leipzig University was being reorganized (and Schröder was no longer there), Pfeifer seems to have been the only professor in the neurosciences with no clear Nazi record. It was largely due to his organizational skills that in the same year the Department was able to resume practice, admitting its first patients in provisionally reinstalled facilities and also continuing its teaching obligations (UAL PA 48: 87–8; see also Sänger, 1963: 130). All sources point out that, together with the Institute for Brain Research, the issue of reopening of the CAP wards was close to Pfeifer’s heart (Kittler, 1965: 154). His letter of request to Leipzig City Mayor quoted above clearly supports this. In 1947 the out-patient services reopened, and two years later two children’s wards with a total of 50 beds resumed patient admission. For many years, this Leipzig CAP ward was the only one of its kind in southern East Germany (Gebelt, 1978: 261). Archival sources now reveal that in 1952 the state authorities were in a great rush to appoint, as head of the Department, Dietfried Müller-Hegemann (1910–89), who in his early years had been a true Socialist Party follower; in this way they wanted to replace Pfeifer, without the Medical Faculty appearing to be involved (Barch DR 3, B 15124; UAL PA 1516). Pfeifer, who was by now 75 years old, did not oppose this, but he remained true to himself in not becoming a member of any party, either Nazi or Socialist, and concentrated on his scientific and medical interests, which lay in brain research. Although no longer head of the whole Department, he still remained head of the institutionally independent Institute for Brain Research. He also resumed his voluntary educational work in the Kulturbund, the East German cultural association. He was given credit for remaining faithful to and in line with the East German constitution (UAL PA 48: 71). On 1 February 1957 he also resigned from his last university office as head of the Institute for Brain Research. He died only a few weeks later, on 15 March.

Footnotes

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