The Hadamar Clinic and humanity

In the summer of 1941, the staff of the Hadamar Psychiatric Clinic in Germany held a party with beer and wine to celebrate the 10,000th patient they had murdered. Initially, the doctors and nurses of the Clinic killed their patients by lethal injections. However, this proved far too slow a process, and so they devised the more cost-effective system of using carbon monoxide in fake shower rooms to kill large numbers at once. The people they murdered were a diverse group of disabled and mentally-ill people, but most had an intellectual disability (called ‘learning disability’ in the UK) and were thus deemed a threat to the efficient survival of the German ‘race’.

The policy of mass murder of people with an intellectual disability by the Nazi regime was an extension of a widely-approved public policy of eugenics. In the first part of the 20th Century, eugenics attracted support from left and right, and from leading intellectuals. Indeed, it was the more socially-progressive societies like Sweden and Canada which at that time most ardently promoted the eugenic policies of the compulsory sterilisation of people with an intellectual disability, and their incarceration in mental handicap hospitals. Eugenics became discredited by its association with the Nazis, and public policy in almost all countries today favours the integration of people with an intellectual disability into the day-to-day life of society. The old hospitals have closed, the rights of disabled people are increasingly protected, and strenuous efforts are made to improve their employment opportunities.

It is tempting to see these changes as marks of ‘progress’, in the sense of an incremental improvement of civilised values from barbarism to humanitarianism. But this would be historically inaccurate. The harsh policies associated with the eugenics movement replaced those influenced by more humane ideas in the 19th Century, which had emphasised the potential of all people with an intellectual disability for learning and social improvement. Rather than a march of progress, our recent history has been a struggle between two views of humans and their worth. Eugenics represented the idea, popularised in the Enlightenment, that human beings are distinguished from other species by their rationality. Rationality then becomes the measure by which people can be ranked, but also a means of determining the general arrangements of society. This legitimises ‘social engineering’, or the application by those in power of measures to shape the lives of those deemed less rational than themselves. A fear in the early 20th Century that the less rational sections of the population were increasing in numbers compared to the more rational created support for eugenic ideas, and led to the ultimate Nazi social engineering project at both the Hadamar Clinic and the mass industrial-scale killings that followed.

There is another and older view of humankind: that each of us possesses an essential essence or soul, that gives us our human character and by which we can be judged. The quality of our souls is unrelated to our physical strength, our intelligence, or our rank in society: a person with an intellectual disability can have a soul more worthy than that of a scientist that sneers at him. This is of course a fundamentally religious outlook, which should make us very troubled by attempts to drive out religion in the name of science. What, therefore, should be the duty of the scientist and the intellectual according to this older view of mankind? It should be to find out the truth and tell it to others, to maintain knowledge in society from one generation to another, to help people reflect deeply on their values and choices, and to do all this with humility.

The curse of the generic

I became an (unqualified) social worker in the early 1970s, just after the creation of social services departments in England. These merged three former organisations, each of which comprised professionals skilled and experienced in work with distinct groups of people: children’s departments employed children’s officers who dealt with child protection and adoption and fostering; welfare departments employed welfare officers who maintained long-term contact with disabled people; and mental health sections of local health departments had their mental welfare officers who supported people with a mental illness living outside hospital.

The decision to merge these departments followed the ‘Seebohm Report’, which correctly noted that some families were involved with two or three of these agencies, and incorrectly proposed that it would be more efficient to have a single generic ‘family’ service. The resulting merged social services departments were large and had management hierarchies rather than being led by a senior professional. The commitment to ‘generic’ social work, in which each member of staff dealt with the full range of clients, became departmental orthodoxy. Both these trends led to a rapid exit of the most skilled and senior staff. They were replaced during my first year as a social worker by people like me: well-meaning, untrained and incompetent.

The results across the country were a radical decline in the quality of child protection, and support for disabled and mentally-ill people. The first indicator of this was the avoidable death of the child Maria Caldwell. The subsequent official enquiry identified that a major cause of institutional failure was the confusion among social workers about whether their primary responsibility was to the child or to the ‘family’ (ie her parents). This was the first of many such enquiries, which led to a succession of management ‘solutions’, from inter-agency committees, registers of children at risk, centrally-imposed targets, inspections, child databases, and repeated re-organisations. No-one in power paid much attention to enhancing the professional skills of social workers involved with children, enabling them to develop specialist skills, or setting up the kind of small specialised and professionally-run departments that had been a success in the past. When specialism did arrive, it was implemented as part of a bizarre governmental reform which merged local authority child protection services with local education departments.

Why this resistance to specialism? I think it is a product of the managerial control that arises with the creation of large public organisations. In small organisations, staff are known as individuals, and there is an awareness of their different strengths. Staff can be assigned to different work informally, and their supervisors can generally assess their performance by observation and informal meetings. Large organisations see staff as a block of people to be matched with some quantitative indicator of workload. It is easier to move people around if they are supposed to have generic responsibilities rather than diverse specialist skills.

The drive to generic work and consequent de-professionalisation arises in many large public organisations. This can occur even in organisations in which specialist professional skills are regarded by almost everyone as being essential. The National Health Service has attempted to grade all its diverse professions on a single ‘knowledge and skills framework’ - a spectacular example of the kind of ‘blue skies’ (crackpot) thinking that occurs in very large organisations. At the same time, the government has attempted to reduce the time spent in specialist medical training. There are similar trends in universities. These value their most highly skilled staff, at least as long as they attract large research grants, but post-doctoral researchers and academic staff who specialise in teaching are sometimes treated as classes of helots, interchangeable and disposable.

The curse of the generic partly explains an apparent paradox: as public organisations get larger and employ more managers, the less competent they are in delivering effective public services. There are other explanations for this paradox: the conversion of previously-autonomous professionals into highly-regulated functionaries produces the alienation familiar in industrial process work. Also, long management hierarchies move decision-making further from the organisations’ customers, who usually encounter junior members of staff with limited authority to adapt procedures to meet individual needs.

We therefore need revolutionary change - towards small-scale public services, with a re-assertion of professional specialism and autonomy. We need to down-size schools with thousands of pupils, so-called ‘local’ authorities which cover wide areas of the country and multiple and formerly self-governing towns, and large welfare departments which fail to protect children at risk or adequately support the disabled. Of course, some public agencies will always need to be large: big cities need governments, and the large numbers of students in higher education will probably require large universities. However, authority can be devolved within cities to community councils (as in Scotland and Wales), while universities can operate more on the Oxbridge model, with academic staff working in semi-autonomous colleges. After all, Oxford and Cambridge Universities have hardly been failures despite lacking the benefits of centralised management.

Disneyfying the body

People have probably always regarded animals as being versions of themselves, albeit devoid of everyday speech and with some enhanced senses (smell, vision) or physical abilities (strength, speed). People develop deeper relationships with animals, relying on them as workmates, regarding them as personal friends: their grief at the loss of a favoured pet matches what they would experience at the loss of a child or sibling.

This tendency seems to be an extension of our innate ability to empathise with each other - an ability said to be lacking among people with Autism. It is one step from understanding animals as if they are human to telling stories of them as humans, speaking and wearing clothes. I call this process ‘Disneyfication’ after Walt Disney, who set up theme parks full of humans pretending to be animals, to resemble cartoon characters of animals resembling humans.

Disneyfication does not stop with animals. Genes can be Disneyfied too: Richard Dawkins has sold a lot of books called ‘The Selfish Gene’. I went to a presentation this week on techniques for regenerating cells in the Central Nervous System. The researcher spoke unselfconsciously about neural cells ‘choosing’ between options, and ‘preferring’ one binding site to another. I am sure a Disney or Pixar cartoon of neural cells, dressed as people, falling in love, and plotting with each other to rebuild a brain will arrive soon at local cinemas.

Surviving school

My parents were very ill-advised about my secondary education. I was raised in Shirley, a suburb just outside the Birmingham City boundary. At the time I was in primary school, Shirley fell within Warwickshire Education Authority, regarded as one of the worst in the country. Children from Shirley who passed the ‘11 plus’ exam had the option of going to grammar schools in Birmingham, and many took advantage of this. However, by the time I was eleven, Shirley came within the new Solihull Education Authority, which set up its own grammar schools. The whole of my ‘A stream’ class in primary school went to the new Tudor Grange Grammar School, while my parents sent me, alone, to King Edward’s Camp Hill Grammar School in Birmingham. At 13, I passed to King Edward’s School, which at that time was a direct grant school, with a combination of fee-paying students of well-off parents and scholarship boys from ordinary families. So all my social connections and friendships were disrupted twice in two years, and I moved to a school where I knew no-one and with an ethos I found incomprehensible. To make matters worse, I needed to take three buses each way to get there, with a commute of over an hour.

The ethos of the school was incomprehensible because it involved a strange nostalgia for an imagined mediaeval England. The headmaster renamed his post ‘chief master’ to revive some supposed tradition, and the school was organised into ‘houses’ to mimic private schools. The school’s sports teams only ever played private schools such as Bromsgrove School, Malvern College and the like, and never the oiks of such schools as King Edward’s Camp Hill. Around the school were boards with the names of old boys who had gone to various Oxbridge colleges. London University was given a board on its own, and there was one for ‘other universities’. Classics was the most esteemed academic subject, and there was a sneering approach to anything practical. I completed a science project on computers (then in their very early days), and the teacher dismissed it for being too technological. There were endless petty distinctions and grades among the students, all to create a world of dull conforming hierarchy. So a school in a metal-bashing city famous for its inventiveness and outspokenness produced students equipped to thrive in a synthetic medieval nostalgia.

I left the school with relief at the age of 18 and went to Handsworth Technical College and completed three social science A levels in a year. My life opened out: I enjoyed the chance to learn as an adult, study things I enjoyed, and meet people from different cultures. I then went to the London School of Economics and studied at a time when English universities were at their peak, full of new ideas about education and the world, taking students from a wider social background than before, but not yet swamped by the vast numbers who come to university now. In those days, undergraduates were tutored by professors and the leading academics of the day: mine included Alexander Irvine (later Lord Chancellor); Edward Mishan (the first economist to challenge the worship of growth); and an American lawyer William Letwin (father of the Conservative politician).

Now my life has come full circle. I work in a university about a quarter of a mile from King Edward’s School. It takes me a long commute of an hour to reach work from home. The University is thankfully more aware than King Edward’s School of the need to be in the forefront of knowledge and to engage with its City. But I miss the intellectual challenge I encountered at the London School of Economics, and the hope for a better future which inspired me when I was a younger man. I was unhappy with the synthetic mediaeval nostalgia of King Edward's School, but I can now see that, for its teachers, it was an attempt to maintain the continuity of the human spirit after the terrible years of war they had experienced. Their beliefs, however old-fashioned, were in any case superior to morality of money and power that eventually triumphed in England.