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Under the Nazi regime in Germany (1933-1945) a calculated killing of chronic “mentally ill” patients took place that was part of a large biopolitical program using well-established, contemporary scientific standards on the understanding of eugenics. Nearly 300,000 patients were assassinated during this period. Nurses executed this program through their everyday practice. However, suspicions have been raised that psychiatric patients were already assassinated before and after the Nazi regime, suggesting that the motives for these killings must be investigated within psychiatric practice itself. My research aims to highlight the mechanisms and scientific discourses in place that allowed nurses to perceive patients as unworthy of life, and thus able to be killed. Using Foucauldian concepts of “biopower” and “State racism,” this discourse analysis is carried out on several levels. First, it analyzes nursing notes in one specific patient record and interprets them in relation to the kinds of scientific discourses that are identified, for example, in nursing journals between 1900 and 1945. Second, it argues that records are not static but rather produce certain effects; they are “performative” because they are active agents. Psychiatry, with its need to make patients completely visible and its desire to maintain its dominance in the psychiatric field, requires the utilization of writing in order to register everything that happens to individuals, everything they do and everything they talk about. Furthermore, writing enables nurses to pass along information from the “bottom-up,” and written documents allow all information to be accessible at any time. It is a method of centralizing information and of coordinating different levels within disciplinary systems. By following this approach it is possible to demonstrate that the production of meaning within nurses’ notes is not based on the intentionality of the writer but rather depends on discursive patterns constructed by contemporary scientific discourses. Using a form of “institutional ethnography,” the study analyzes documents as “inscriptions” that actively interven in interactions in institutions and that create a specific reality on their own accord. The question is not whether the reality represented within the documents is true, but rather how documents worked in institutions and what their effects were. Third, the study demonstrates how nurses were actively involved in the construction of patients’ identities and how these “documentary identities” led to the death of thousands of humans whose lives were considered to be “unworthy lives.” Documents are able to constitute the identities of psychiatric patients and, conversely, are able to deconstruct them. The result of de-subjectification was that “zones for the unliving” existed in psychiatric hospitals long before the Nazi regime and within these zones, patients were exposed to an increased risk of death. An analysis of the nursing notes highlights that nurses played a decisive role in constructing these “zones” and had an important strategic function in them. Psychiatric hospitals became spaces where patients were reduced to a “bare life;” these spaces were comparable with the concentration camps of the Holocaust. This analysis enables the integration of nursing practices under National Socialism into the history of modernity. Nursing under Nazism was not simply a relapse into barbarism; Nazi exclusionary practices were extreme variants of scientific, social, and political exclusionary practices that were already in place. Different types of power are identifiable in the Nazi regime, even those that Foucault called “technologies of the self” were demonstrated, for example, by the denunciation of “disabled persons” by nurses. Nurses themselves were able to employ techniques of power in the Nazi regime.

Under the Nazi regime in Germany (1933-1945) a calculated killing of chronic “mentally ill” patients took place that was part of a large biopolitical program using well-established, contemporary scientific standards on the understanding of eugenics. Nearly 300,000 patients were assassinated during this period. Nurses executed this program through their everyday practice. However, suspicions have been raised that psychiatric patients were already assassinated before and after the Nazi regime, suggesting that the motives for these killings must be investigated within psychiatric practice itself. My research aims to highlight the mechanisms and scientific discourses in place that allowed nurses to perceive patients as unworthy of life, and thus able to be killed. Using Foucauldian concepts of “biopower” and “State racism,” this discourse analysis is carried out on several levels. First, it analyzes nursing notes in one specific patient record and interprets them in relation to the kinds of scientific discourses that are identified, for example, in nursing journals between 1900 and 1945. Second, it argues that records are not static but rather produce certain effects; they are “performative” because they are active agents. Psychiatry, with its need to make patients completely visible and its desire to maintain its dominance in the psychiatric field, requires the utilization of writing in order to register everything that happens to individuals, everything they do and everything they talk about. Furthermore, writing enables nurses to pass along information from the “bottom-up,” and written documents allow all information to be accessible at any time. It is a method of centralizing information and of coordinating different levels within disciplinary systems. By following this approach it is possible to demonstrate that the production of meaning within nurses’ notes is not based on the intentionality of the writer but rather depends on discursive patterns constructed by contemporary scientific discourses. Using a form of “institutional ethnography,” the study analyzes documents as “inscriptions” that actively interven in interactions in institutions and that create a specific reality on their own accord. The question is not whether the reality represented within the documents is true, but rather how documents worked in institutions and what their effects were. Third, the study demonstrates how nurses were actively involved in the construction of patients’ identities and how these “documentary identities” led to the death of thousands of humans whose lives were considered to be “unworthy lives.” Documents are able to constitute the identities of psychiatric patients and, conversely, are able to deconstruct them. The result of de-subjectification was that “zones for the unliving” existed in psychiatric hospitals long before the Nazi regime and within these zones, patients were exposed to an increased risk of death. An analysis of the nursing notes highlights that nurses played a decisive role in constructing these “zones” and had an important strategic function in them. Psychiatric hospitals became spaces where patients were reduced to a “bare life;” these spaces were comparable with the concentration camps of the Holocaust. This analysis enables the integration of nursing practices under National Socialism into the history of modernity. Nursing under Nazism was not simply a relapse into barbarism; Nazi exclusionary practices were extreme variants of scientific, social, and political exclusionary practices that were already in place. Different types of power are identifiable in the Nazi regime, even those that Foucault called “technologies of the self” were demonstrated, for example, by the denunciation of “disabled persons” by nurses. Nurses themselves were able to employ techniques of power in the Nazi regime.

This thesis aims to make contributions at substantive, methodological and theoretical levels. First, the findings from three observational studies are combined to identify obstacles to the use of shared decision-making in modern psychiatric practice. Particular attention is paid to how patients' choices about their treatment are facilitated or constrained by the actions of mental health professionals. A typology of pressure is constructed, based on detailed analyses of how pressure is applied and resisted in routine encounters (outpatient consultations) and "crisis' situations (assessments for compulsory admission to hospital, and ward rounds in acute inpatient care). Findings from two ethnographies and one conversation analysis (CA) study are presented. 'Meaning' is central to the write-up of each set of findings, however while the analytic focus of the ethnographies is 'insider' knowledge and meanings, in the CA study it is gn the activities that make those meanings possible in the first place. The methodological contribution of the thesis stems from its demonstration of how to produce a coherent, unified research account from two very different versions of qualitative inquiry. Despite the potential for analytic inconsistency, the thesis arguably has far greater force and persuasiveness as a result of the attempt to combine, compare and contrast findings from three studies. It is contended that a sound theoretical base for sociological research may be created by combining Goffman's micro-sociology with Foucault's analyses of disciplinary power/knowledge in one of a number of ways. A Goffmanian 'home base' is adopted for this thesis, with Foucauldian thinking applied to add a historical, 'macro' dimension to the analysis that Goffman's work so conspicuously lacks. Foucault's work also provides the conceptual tools for examining the more subtle form of control through expertise that would be missed in a purely Goffmanian study.

Under the Nazi regime in Germany (1933-1945) a calculated killing of chronic “mentally ill” patients took place that was part of a large biopolitical program using well-established, contemporary scientific standards on the understanding of eugenics. Nearly 300,000 patients were assassinated during this period. Nurses executed this program through their everyday practice. However, suspicions have been raised that psychiatric patients were already assassinated before and after the Nazi regime, suggesting that the motives for these killings must be investigated within psychiatric practice itself. My research aims to highlight the mechanisms and scientific discourses in place that allowed nurses to perceive patients as unworthy of life, and thus able to be killed. Using Foucauldian concepts of “biopower” and “State racism,” this discourse analysis is carried out on several levels. First, it analyzes nursing notes in one specific patient record and interprets them in relation to the kinds of scientific discourses that are identified, for example, in nursing journals between 1900 and 1945. Second, it argues that records are not static but rather produce certain effects; they are “performative” because they are active agents. Psychiatry, with its need to make patients completely visible and its desire to maintain its dominance in the psychiatric field, requires the utilization of writing in order to register everything that happens to individuals, everything they do and everything they talk about. Furthermore, writing enables nurses to pass along information from the “bottom-up,” and written documents allow all information to be accessible at any time. It is a method of centralizing information and of coordinating different levels within disciplinary systems. By following this approach it is possible to demonstrate that the production of meaning within nurses’ notes is not based on the intentionality of the writer but rather depends on discursive patterns constructed by contemporary scientific discourses. Using a form of “institutional ethnography,” the study analyzes documents as “inscriptions” that actively interven in interactions in institutions and that create a specific reality on their own accord. The question is not whether the reality represented within the documents is true, but rather how documents worked in institutions and what their effects were. Third, the study demonstrates how nurses were actively involved in the construction of patients’ identities and how these “documentary identities” led to the death of thousands of humans whose lives were considered to be “unworthy lives.” Documents are able to constitute the identities of psychiatric patients and, conversely, are able to deconstruct them. The result of de-subjectification was that “zones for the unliving” existed in psychiatric hospitals long before the Nazi regime and within these zones, patients were exposed to an increased risk of death. An analysis of the nursing notes highlights that nurses played a decisive role in constructing these “zones” and had an important strategic function in them. Psychiatric hospitals became spaces where patients were reduced to a “bare life;” these spaces were comparable with the concentration camps of the Holocaust. This analysis enables the integration of nursing practices under National Socialism into the history of modernity. Nursing under Nazism was not simply a relapse into barbarism; Nazi exclusionary practices were extreme variants of scientific, social, and political exclusionary practices that were already in place. Different types of power are identifiable in the Nazi regime, even those that Foucault called “technologies of the self” were demonstrated, for example, by the denunciation of “disabled persons” by nurses. Nurses themselves were able to employ techniques of power in the Nazi regime.

Under the Nazi regime in Germany (1933-1945) a calculated killing of chronic “mentally ill” patients took place that was part of a large biopolitical program using well-established, contemporary scientific standards on the understanding of eugenics. Nearly 300,000 patients were assassinated during this period. Nurses executed this program through their everyday practice. However, suspicions have been raised that psychiatric patients were already assassinated before and after the Nazi regime, suggesting that the motives for these killings must be investigated within psychiatric practice itself. My research aims to highlight the mechanisms and scientific discourses in place that allowed nurses to perceive patients as unworthy of life, and thus able to be killed. Using Foucauldian concepts of “biopower” and “State racism,” this discourse analysis is carried out on several levels. First, it analyzes nursing notes in one specific patient record and interprets them in relation to the kinds of scientific discourses that are identified, for example, in nursing journals between 1900 and 1945. Second, it argues that records are not static but rather produce certain effects; they are “performative” because they are active agents. Psychiatry, with its need to make patients completely visible and its desire to maintain its dominance in the psychiatric field, requires the utilization of writing in order to register everything that happens to individuals, everything they do and everything they talk about. Furthermore, writing enables nurses to pass along information from the “bottom-up,” and written documents allow all information to be accessible at any time. It is a method of centralizing information and of coordinating different levels within disciplinary systems. By following this approach it is possible to demonstrate that the production of meaning within nurses’ notes is not based on the intentionality of the writer but rather depends on discursive patterns constructed by contemporary scientific discourses. Using a form of “institutional ethnography,” the study analyzes documents as “inscriptions” that actively interven in interactions in institutions and that create a specific reality on their own accord. The question is not whether the reality represented within the documents is true, but rather how documents worked in institutions and what their effects were. Third, the study demonstrates how nurses were actively involved in the construction of patients’ identities and how these “documentary identities” led to the death of thousands of humans whose lives were considered to be “unworthy lives.” Documents are able to constitute the identities of psychiatric patients and, conversely, are able to deconstruct them. The result of de-subjectification was that “zones for the unliving” existed in psychiatric hospitals long before the Nazi regime and within these zones, patients were exposed to an increased risk of death. An analysis of the nursing notes highlights that nurses played a decisive role in constructing these “zones” and had an important strategic function in them. Psychiatric hospitals became spaces where patients were reduced to a “bare life;” these spaces were comparable with the concentration camps of the Holocaust. This analysis enables the integration of nursing practices under National Socialism into the history of modernity. Nursing under Nazism was not simply a relapse into barbarism; Nazi exclusionary practices were extreme variants of scientific, social, and political exclusionary practices that were already in place. Different types of power are identifiable in the Nazi regime, even those that Foucault called “technologies of the self” were demonstrated, for example, by the denunciation of “disabled persons” by nurses. Nurses themselves were able to employ techniques of power in the Nazi regime.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-22T17:37:06Z No. of bitstreams: 1 PyetraCutrimDamasceno.pdf: 1114991 bytes, checksum: 11870d808d031aa4a00edfdc5d1bd055 (MD5) / Made available in DSpace on 2017-05-22T17:37:06Z (GMT). No. of bitstreams: 1 PyetraCutrimDamasceno.pdf: 1114991 bytes, checksum: 11870d808d031aa4a00edfdc5d1bd055 (MD5) Previous issue date: 2015-05-27 / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) / This present paper to understand psychiatric theories of the main theorical postulates hat developed on madness as well as understand the main principles of social medicine and eugenic political in the reconfiguration of urban spaces and the remodeling of the population's habits. We discuss the main restriction of actions of the spaces of the subjects considered crazy and how laws aimed at an organization of health care services, from the creation of alloys whose aim was to prevent the population of degeneration. The main problem revolves around the understanding of how these precepts arrived in São Luís and were used in the theory and practice of psychiatric Djalma Marques. The writings of Djalma Caldas Marques, in the "comments" of the journal "Pacotilha" are used as a place of diffusion of medical knowledge about mental illness and major medical discourse delivered in Brazil between the years 1920-1940. / O presente trabalho busca compreender as teorias psiquiátricas dos principais teóricos que desenvolveram postulados sobre a loucura, assim como entender os preceitos da medicina social e da política eugênica na reconfiguração dos espaços urbanos e no remodelamento dos hábitos da população. Discorremos sobre as principais ações de cerceamento dos espaços dos sujeitos considerados loucos e como as leis visavam a uma organização dos serviços de assistência à saúde, a partir da criação de Ligas cujo objetivo era prevenir a população da degeneração. A principal problemática gira em torno do entendimento de como esses preceitos chegaram em São Luís e foram utilizados na teoria e na prática psiquiátrica de Djalma Marques. Os escritos de Djalma Caldas Marques, na coluna “comentários” do periódico “Pacotilha” são utilizados como lócus de difusão de um saber médico acerca da alienação mental e dos principais discursos médicos proferidos no Brasil entre os anos de 1920-1940.