Autism & The Nazi T4 Aktion Program

In May 1939, seventy-two years ago this month, the Nazi Committee for the
Scientific Treatment of Severe, Genetically Determined Illness was established in Germany to undertake the massive secret killing, first of infants, then later older children and adults with disabilities. Initially the killings focused on children with physical disabilities, such as cerebral palsy, larger or smaller than typical head size or atypically developed arms and hands or legs and feet, or misshapen spinal column. Later, the Nazi doctors in charge of deciding who would be killed, began including any child with a mental disability, which in all probability would have included most children with autism and intellectual disability, though it is possible some higher functioning children with the condition we now call Asperger disorder, escaped the gas chamber, though that diagnosis did not exist yet.
Tiergartenstrasse 4

The organization that was in charge of these killings came to be known as “T4 Aktion” which was an abbreviation of Tiergartenstrasse 4 (shown in this image), the address of a villa in the Berlin borough of Teirgarten which was the headquarters of the Gemeinnützige Stiftung für Heil- und Anstaltspflege, bearing the euphemistic name literally translating as Charitable Foundation for Cure and Institutional Care. We Americans are not the first to use euphimisms to disguise our disgraceful actions. Hitler’s Aktion T4 program was carried out primarily according to the dictates of "racial hygiene" ideology, and secondarily to reduce the cost to the state of maintaining people with disabilities at a time when their financial priority was military. The Hitler regime took pains to attempt to convince the German public that such killings were necessary and in their own interest (See poster). This poster (from around 1938) reads: "60,000 Reichmarks is what this person suffering from a hereditary disease costs the People's community during his lifetime. Comrade, that is your money too.”

At first the killings were by lethal injections, which the authorities decided was too inefficient and costly, which subsequently led to T4 shootings and the poison gas program. In Poland’s Gdansk area, some 7,000 Polish patients in various hospitals and institutions were shot, while 10,000 were killed in the Gdynia area. In October 1939 all German hospitals, nursing homes, old-age homes and sanatoria were required to report all patients who had been institutionalized for five years or more or who had been diagnosed with any of a list of specified conditions, including schizophrenia, epilepsy, Hunginton’s chorea, advanced syphilis, senile dementia, paralysis, encephalitis or other chronic neurological conditions (which could include almost any developmental disability). At that time, an individual with autism would have been described as having childhood psychosis or schizophrenia. Patients were transferred from their institutions to the killing centers in buses operated by teams of SS men wearing white coats to give an air of medical authenticity.

The T4 Aktion program served as the prototype for Hitler’s
“Final Solution,” that included mass gassing and incineration of bodies of Jews, Gypsies, people who were Gay and Lesbian and other minority groups, which was economical and efficient. On August 24, 1941, under enormous pressure from both Catholic and Protestant church leaders and much of the German public, Hitler ordered the public cancellation of the T4 killing program. However the program continued sub rosa until the war’s conclusion in 1945. When gassing was officially stopped, the Nazis reverted to the tried and proven methods employed before the gas chambers, turning off the heat and prolonged exposure to frigid temperatures, simple starvation or lethal injection. It has been estimated that by the end of 1941, 75,000 to 100,000 people with disabilities had been killed under the T4 program, and by the end of WWII, a vastly larger number had perished.

During the Nuremberg Trials, In December 1946, an American military tribunal (commonly called the
Doctors' Trial) tried 23 doctors and administrators for their roles in war crimes and crimes against humanity. These crimes included the systematic killing of those deemed "unworthy of life", including people with intellectual disability, mental illness, and those with physical disabilities. After 140 days of proceedings, including the testimony of 85 witnesses and the submission of 1,500 documents, in August 1947 the court pronounced 16 of the defendants guilty. Seven were sentenced to death and executed on June 2, 1948.

Most of today’s children with autism would have perished under Hitler’s T4 Aktion program, but instead thanks to evidence-based intervention approaches, are growing up as integral members of their families, participating in school and community life along with their brothers and sisters. In his last spee
ch before his death, Hubert Humphrey remarked, “"...the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.” November 1, 1977; Washington, D.C.