World War II and Western Medicine (1939-1945)

Summary

World War II did not merely shake Western medicine: it reorganized it. The war drove Freud and his circle from Vienna to London and New York, reconstituting psychoanalysis as an Anglo-American institution and forcing a theoretical contest between Viennese ego psychology and the British object-relations school. It mobilized American medical schools into an accelerated wartime curriculum and, in the postwar decade, redirected the resulting infrastructure toward federal funding, specialization, and the expansion of academic medicine. It generated wartime biophysics research (including the X-ray crystallography work at King’s College London) that fed directly into the discovery of DNA’s structure in 1953. And it produced, through Nazi medical experimentation, the Nuremberg Code of 1947: the first international statement that human subjects in medical experiments must give voluntary, informed consent. One historian of medicine has characterized the period during and after the war as the high noon of medical modernity: Western bodies were standardized, normativized, and routinized to a degree never before experienced in history, with individual metabolisms and physiologies now surrendering to ideal body weights and population norms.(Jackson (ed.), 2011) Few events in the twentieth century altered the institutions, ethics, and intellectual geography of Western medicine as thoroughly.

Background

The Interwar Institutional State

By the late 1930s, psychoanalysis was a Central European institution centered on Vienna, Berlin, and Budapest. Its international organization, the International Psychoanalytic Association (IPA), had its administrative gravity in the German-speaking world, where Freud’s circle had its densest concentration of analysts, its training institutes, and its publishing infrastructure. Erich Fromm, writing in 1941 as one of the émigré social scientists who had already fled to America, could look back and observe that millions in Germany had been “eager to surrender their freedom” rather than fight to preserve it: not through coercion or ignorance, but from a psychological flight from the isolation and anxiety that modern individuation imposed.(Fromm, Erich, 1941) Fromm’s analysis was shaped by the experience of watching fascism take root in a society that had produced the world’s most sophisticated psychological science, a paradox that drove the social-psychology of the Frankfurt School and defined the intellectual preoccupations of the émigré generation.(Fromm, Erich, 1941)

The organizational crisis of the IPA in those years was as much about professional politics as about ideology. At the August 1938 Paris congress, which proved to be the last IPA gathering for over a decade, Ernest Jones revealed that the American Psychoanalytic Association had sent a dossier demanding the IPA dissolve as an administrative body and exist only as a scientific congress, primarily to settle the long-running dispute over lay analysis in America’s favor.(Makari, George, 2008) The question of who could practice analysis, and under what institutional arrangements, was unresolved at the moment the war began.

Freud’s Death and the End of the Viennese Era

Sigmund Freud had fled Vienna for London in June 1938 following the Nazi annexation of Austria. He was eighty-two, in constant pain from the oral cancer he had battled for fifteen years. On September 23, 1939, three weeks after Germany’s invasion of Poland, his physician Max Schur administered a lethal dose of morphine at Freud’s request, with Anna Freud’s prior knowledge.(Makari, George, 2008) The date was not coincidental as symbol: psychoanalysis lost its founder in the first weeks of the war that would determine what it would become. As George Makari frames it, “psychoanalysis was born in Europe,” the child of Geisteswissenschaft and Naturwissenschaft, neo-Kantian philosophy, and sexual reform movements, and “the world that nourished psychoanalysis had disappeared.” The question after 1939, Makari argues, was not whether psychoanalysis would survive but “what form it would take after losing so much.”(Makari, George, 2008)

Psychoanalysis Displaced: The Anglo-American Reception

The Viennese Arrival in London

The arrival of the Viennese analysts in London created institutional upheaval within the British Psycho-Analytical Society. Melanie Klein had dominated British psychoanalysis through the 1930s, developing her object-relations approach with little reference to Freud’s later metapsychology and considerable divergence from it. When the Viennese analysts emigrated, bringing Anna Freud and the ego-psychology tradition, they constituted a substantial minority within the British Society, staring, as Makari describes it, “across the aisle as members of the same institute.”(Makari, George, 2008)

The war itself produced a bizarre institutional consequence. When the London Blitz began in 1940, Klein and Ernest Jones and other British-born analysts fled to the countryside. The Viennese immigrants, lacking freedom of movement as alien nationals, could not follow. They attended British Society meetings, where “bizarrely, they were at times a majority.”(Makari, George, 2008) The theoretical controversies between Kleinian and Viennese positions, about the role of phantasy, the timing of the Oedipus complex, the nature of early object relations, were conducted partly under aerial bombardment, by analysts who had survived political catastrophe and now survived military one.

W.R.D. Fairbairn, the Edinburgh psychiatrist who had worked independently of both London factions, contributed to these debates from his wartime clinical work as a visiting psychiatrist to an Emergency Medical Service hospital. Fairbairn’s work with war neurosis patients led him to a fundamental reformulation of psychoanalytic theory: he argued that all psychopathological developments in adults are ultimately grounded in an exaggerated persistence of infantile emotional dependence, and that “all psychoneurotic and psychotic symptoms must be interpreted as essentially either effects of, or defences against, the conflicts attendant upon a persistent state of infantile dependence.”(Fairbairn, W. Ronald D., 1952)

War Neurosis as Clinical Laboratory

Fairbairn’s most direct contribution from his wartime clinical work was his analysis of war neurosis. Against the common assumption that war neuroses constituted a distinct diagnostic category produced by the exceptional conditions of combat, Fairbairn argued that “there is now fairly general agreement among psychiatrists that, so far as symptomatology is concerned, the war neuroses possess no distinctive features differentiating them sharply from the various psychoneurotic and psychotic states which prevail in time of peace.” The distinctive factor was not symptom type but the precipitating role of military conditions in activating pre-existing latent psychopathological factors rather than producing disorders from nothing.(Fairbairn, W. Ronald D., 1952)

The clinical specificity of this insight was considerable. Fairbairn documented that traumatic experiences in war neurosis show a high degree of individual specificity: the incident that constitutes the trauma is the one that activates a specific unconscious conflict, not necessarily the most objectively dangerous event a soldier faced. He illustrated this with the case of a maritime gunner who had survived multiple lethal engagements without breakdown but broke down when, in a desperate act of self-preservation, he struck a drowning Chinese crewman who was pulling him under. The investigation revealed that this specific act had crystallized a long-repressed and guilt-laden hatred of his father. Not the preceding dangers, but this particular moment of violence, activated the breakdown.(Fairbairn, W. Ronald D., 1952)

Fairbairn identified separation-anxiety as “the greatest common measure of all forms of war neurosis — the only symptom invariably present in every case.” The popular view that war neurotics broke down from fear of danger was, in his analysis, systematically misleading: “the truth would appear to be, not so much that he craves to go home because he is ill as that he becomes ill because he craves to go home.”(Fairbairn, W. Ronald D., 1952) A case that Fairbairn found equally instructive was Driver J.T., a psychopathic personality whose extreme childhood insecurity had prevented any safe dependence on a parental figure. He had “capitalized his insecurity” by renouncing all intimacy, until the sea itself came to represent the untrustworthy mother, an illustration of how pseudo-independence functions as a denial of deeply repressed infantile dependence rather than genuine emotional maturity.(Fairbairn, W. Ronald D., 1952) Fairbairn argued that the incidence of war neurosis within units was inversely proportional to unit morale, and that “the war neurosis problem is fundamentally a problem of morale” rather than of individual psychotherapy.(Fairbairn, W. Ronald D., 1952)

The wartime experience also had direct institutional consequences for the development of group psychotherapy. Fairbairn drew a distinction that wartime clarified. “Treatment” in the medical sense is technical assistance the physician provides for a patient seeking relief from personal distress, while “rehabilitation” is the restoration of social capacities in the interests of society. The war neurotic required rehabilitation rather than treatment, because his problem was failure of group membership rather than individual pathology.(Fairbairn, W. Ronald D., 1952) Certain army psychiatrists, working in military hospitals, shifted from individual therapy toward cultivating group spirit, with the explicit aim of restoring their patients’ relationship to the Army as a group. Concurrently, other army psychiatrists developed the technique of leaderless discussion groups as an aid to officer selection, and Fairbairn observed that “post-war group psychotherapy for psychoneurotics emerged from these innovations, offering a method partaking more of rehabilitation than treatment.”(Fairbairn, W. Ronald D., 1952)

The Americanization of Psychoanalysis

The emigration reshaped the IPA’s center of gravity beyond recognition. At the 1949 IPA congress in Zurich, the first full gathering after the war, Ernest Jones confronted a memorial list “far too long for individual memorials”: at least fifteen members murdered by the Nazis, along with many prewar leaders who had died during the war years.(Makari, George, 2008) Of the original group that had met in Salzburg in 1908, only Jones himself and Eduard Hitschmann survived. Yet the IPA had grown: by 1949 it had 800 members, over half of them American, with nearly three-quarters from English-speaking countries. Five new American institutes were sanctioned, in Detroit, Los Angeles, Topeka, San Francisco, and a second New York institute. Four of the five largest psychoanalytic communities in the world were now American.(Makari, George, 2008)

The sociological interpretation of fascism that Fromm and the Frankfurt School developed from the émigré experience fed into this Americanization in complex ways. Fromm argued in 1941 that the human automaton, the individual who had given up genuine individuality and conformed to anonymous social expectations, was “fertile soil for the political purposes of Fascism,” because despair and meaninglessness created readiness to accept any ideology and leader who “promises excitement and offers a political structure and symbols which allegedly give meaning and order to an individual’s life.”(Fromm, Erich, 1941) This analysis both described the European catastrophe and, in the postwar years, pointed toward the character-structure concerns that would preoccupy American social psychology and clinical psychiatry through the 1950s.

Wartime Biophysics and the Road to Molecular Biology

The Crystallography Pipeline

One of the less visible medical legacies of World War II ran through the physical sciences. The war mobilized a generation of British physicists and chemists into research that, while not immediately aimed at biology, built the technical infrastructure and trained the researchers who would make the molecular biology revolution of the 1950s.

Rosalind Franklin’s trajectory illustrates the pattern. During the war, she left Cambridge, where women received only “decrees titular” rather than actual degrees until 1948, and worked at the British Coal Utilisation Research Association from 1942 to 1946.(Maddox, 2003) At BCURA, young researchers were given the opportunity to do original work that would not have been possible in peacetime, and Franklin developed the hypothesis of “molecular sieves,” that different coals have porous properties to varying degrees, as well as foundational techniques for studying the internal structure of carbonaceous materials.(Maddox, 2003) Her first published paper, co-authored with D.H. Bangham, appeared in 1946 in the Transactions of the Faraday Society.(Maddox, 2003)

This wartime work opened a postwar trajectory. Franklin’s coal research brought her to the attention of French crystallographers, and in 1947 she joined the Laboratoire Central des Services Chimiques de l’État in Paris under Jacques Mering, where she learned X-ray diffraction of disordered materials, a French specialty not widely used elsewhere at the time.(Maddox, 2003) Mering himself, a Russian-born Jewish crystallographer, had survived the Nazi occupation of Paris by not declaring his Jewishness and living without proper identity papers, having been relocated by the French Ordnance Ministry to Grenoble to protect its Jewish scientists.(Maddox, 2003) Franklin’s Paris years (1947-1950) produced the technical expertise in X-ray crystallography of biological molecules that she brought to King’s College London in 1951, contributing directly to the DNA crystallography work culminating in the 1953 structure determination.

The same wartime mobilization that shaped Franklin’s career produced other consequences for the biophysics of the 1950s. J.T. Randall, who directed the Medical Research Council biophysics unit at King’s where Franklin worked, was “something of a war hero” through his invention (with H.A.H. Boot) of the cavity magnetron, the device that enabled radar detection of submarines and night bombing. President Roosevelt called it “the most valuable cargo ever to reach these shores.” The institutional resources, prestige, and technical culture that Randall commanded at King’s in the early 1950s were direct products of his wartime standing.(Maddox, 2003)

The gendered structure of wartime science was another thread Maddox traces. In Britain, the proportion of women at Cambridge rose during the war as men were called up, and Newnham and Girton graduates served in military intelligence, code-breaking, and engineering; this pattern of female scientific mobilization was, the Newnham historian Gillian Sutherland observed, “one of the social features most sharply distinguishing Britain from Germany.”(Maddox, 2003) The contrast was partly obscured by formal exclusion: Cambridge did not grant women actual degrees until 1948, and in the same year Germany’s allied power was losing the war that had depended partly on the exclusion of its Jewish scientists from the research enterprise.

American Medical Education in Wartime and After

The Wartime Curriculum

World War II forced a radical compression of American medical education. The country entered the war facing a shortage of physicians relative to the military’s needs. The response was an accelerated “9-9-9-9” curriculum of four consecutive nine-month terms rather than the standard academic year, which graduated approximately 25,000 doctors during the war years, about 5,000 more than in peacetime, with some 80 percent entering military service directly after internship or residency.(Ludmerer, 1999) The production was genuine but costly. At some medical schools, up to 60 percent of the clinical faculty served in the military; from Harvard alone, more than 300 doctors ultimately saw active war service.(Ludmerer, 1999)

The educational consequences were acknowledged at the time. Because too few instructors were available for the enlarged classes, lectures substituted for laboratory and clinical work, and faculty had less opportunity for individualized instruction or Socratic dialogue. One contemporary observer described the result as “greater superficiality in learning, less tenacity of retention of what was learned, and a minimum of that contemplation and discussion from which spring habits of independent thought.”(Ludmerer, 1999) Residency positions were cut to 50 percent of prewar levels, research fellowships were discontinued, and the country emerged from the war with what Ludmerer describes as a shortage of young medical teachers and investigators.(Ludmerer, 1999)

One institutional change that would prove permanent was coeducation at some of the most prestigious schools. Harvard Medical School finally admitted women during the war, driven by manpower shortages, and Massachusetts General Hospital noted that “throughout the hospital women are appearing in the intern and resident ranks in steadily increasing numbers.”(Ludmerer, 1999) The emergency that produced this opening did not produce a principled commitment to women’s inclusion, but the precedent was established.

The Specialization Turn

The war’s most lasting structural effect on American medicine was a decisive shift toward specialization. Military policy played a direct role: physicians with specialty certification received higher rank, better pay, and preferred assignments, regardless of seniority. This was a departure from the civilian world’s lingering preference for experience and age, and it sent a clear signal about what the medical profession valued.(Ludmerer, 1999) By 1959, 80 percent of graduates at major medical schools were seeking specialty residencies rather than entering general practice.(Ludmerer, 1999) The percentage of doctors identifying as full-time specialists jumped from 24 percent in 1940 to 37 percent by 1949, then continued upward to 69 percent by 1966.(Starr, 1982)

Alongside specialization came the postwar funding revolution. The National Institutes of Health budget grew from $180,000 in 1945 to $4 million in 1947, then to $81 million in 1955 and $400 million by 1960, driven by the Lasker lobby’s disease-by-disease advocacy strategy.(Starr, 1982) This transformation in federal research support reshaped academic medicine structurally: the average medical school income tripled during the 1940s from $500,000 to $1.5 million annually, then reached $3.7 million by 1958-59 and $15 million by the late 1960s. Full-time faculty increased 51 percent between 1940-41 and 1949-50, then doubled nationally in the following decade.(Starr, 1982)

British Herbal Medicine Under Wartime Conditions

Herb Mobilization and the 1941 Act

The war pulled British herbal pharmacy in two distinct directions. On one hand, the same pattern that had emerged in the First World War recurred: with German herb suppliers cut off, domestic collection was organized and expanded. The Ministry of Agriculture and Fisheries, Kew Gardens, herbalists, and the Pharmaceutical Society appealed to schools, Girl Guides, Scouts, Women’s Institutes, and the Women’s Royal Voluntary Service to gather specific medicinal herbs including foxglove, valerian, henbane, and stramonium. By 1942, 250 drying sheds were in use nationwide, a substantial mobilization of volunteer labor for pharmaceutical ends.(Stapley, 2024)

On the other hand, the wartime legislative environment proved hostile to organized herbal practice. The Pharmacy and Medicines Act of 1941 was passed with speed, “depriving herbalists of the legal right to supply medicines directly to their patients.” Herbalists objected and continued to practice, supplying medicines through Association membership rather than as direct suppliers — a legal workaround that maintained the practice while underscoring the profession’s precarious regulatory position.(Stapley, 2024)

The Nuremberg Code and Medical Ethics

Nazi Medical Experiments and the Bioethics Inflection

] (parallel agent page) when it exists.]

What the current corpus does establish is the sociological-psychological context. Temkin’s comparative analysis, written in 1977, observed that the transformation of Western medicine into global medicine since World War II, combined with the rise of non-Western national consciousness, was producing a comparative medical historiography in which “Western scientific medicine appears as a system on a par with other, indigenous, systems” rather than as the culmination of development.(Temkin, 1977) The ethical cataclysm of Nazi medicine was one driver of this destabilization: if scientific medicine could produce Auschwitz, the triumphalist narrative of medical progress required fundamental revision.

Szasz’s analysis of the 1953 Soviet “doctors’ plot” connects to this theme indirectly. Prominent physicians, many of them Jewish, were accused of murdering Soviet officials, and Szasz reads the episode as a symptom of the structural position in which physicians become both co-architects and scapegoats of the state they serve, a position that Nazi medicine had made visible in its most extreme form.(Szasz, Thomas, 1960) The war did not merely produce the Nuremberg Code; it produced the recognition that medicine, without principled ethical constraints, could become an instrument of organized atrocity rather than of healing.

The Psychiatric Legacy: Stigma, Normality, and the Expansion of Mental Health

The war contributed to the expansion of psychiatric authority into the general population through a specific mechanism. Lawlor’s account of this development identifies the key move: soldiers were not to be stigmatized as diseased but “merely reacting to combat fatigue just as one would with a physical injury.” Treating such soldiers, who were normal people rather than extreme psychiatric cases, made psychiatrists appear equivalent to other physicians. “If they could treat soldiers … then they could treat the general public.”(Lawlor, 2012) The framing of breakdown as a normal stress response rather than constitutional weakness created a stigma-reduced model of mental vulnerability that generalized beyond the military context into postwar civilian psychiatry.

Fairbairn’s observations on the limits of this model deserve note. He argued that malingering accounts for no more than 1 percent of war neurosis cases reaching hospital — genuine symptomatology was present in the overwhelming majority.(Fairbairn, W. Ronald D., 1952) At the same time, he observed that totalitarian states had shown an alternative model for managing the infantile dependence that produces separation-anxiety. By weaning soldiers from family ties and substituting dependence on the state, they created high morale under conditions of success that collapsed catastrophically under failure, as occurred in Germany in 1918.(Fairbairn, W. Ronald D., 1952) The psychological analysis of both Nazi psychology and military morale generated by the war was absorbed into the postwar social science of conformity, authority, and the psychology of freedom that shaped American clinical culture through the 1950s and 1960s.

Scholarly Assessment

The historiography of WWII’s medical legacies is distributed across several distinct scholarly literatures that have not, for the most part, been integrated. Makari’s Revolution in Mind (2008) provides the strongest account of the psychoanalytic displacement and reconstitution in Anglo-American institutions. Ludmerer’s Time to Heal (1999) is the standard history of American medical education’s wartime and postwar transformation. Maddox’s biography of Rosalind Franklin (2003) traces the wartime scientific mobilization that fed molecular biology, though from a biographical rather than institutional frame. The Nazi medical experiments and the Nuremberg Code lack adequate representation in the current evidence corpus and constitute a significant gap.

The transformation of medical historiography itself was one consequence of the war. Temkin, who had fled Leipzig for Baltimore in 1933, observed in 1977 that Western medicine’s postwar encounter with resurgent non-Western medical traditions (Ayurvedic, Yunani, traditional Chinese) was producing a genuinely comparative historiography in which scientific medicine appeared as one system among several rather than as the self-evident culmination of human progress.(Temkin, 1977) The war’s role in delegitimizing Western triumphalism, through the Holocaust, through Nazi medical science, through the colonial dismantling that the war accelerated, was as significant for the intellectual history of medicine as any of its specific institutional reforms.

See Also

• dna-structure-determination-1953 (direct downstream consequence)
• rosalind-franklin (wartime crystallography career)
• sigmund-freud (death in 1939; end of Viennese era)
• melanie-klein (Kleinian-Viennese conflict during Blitz)
• william-fairbairn (war neurosis clinical work)
• erich-fromm (émigré social psychology)
• flexner-report-1910 (context for wartime acceleration)
• founding-of-johns-hopkins-medical-school-1893 (institutional background for American specialization)
• holocaust (sister page; Nazi medical experimentation context)
• paris-clinical-school (European predecessor to the Anglo-American shift)

Sources

• Makari, George. (2008). Revolution in Mind: The Creation of Psychoanalysis. HarperCollins. (source_id: makari-revolutioninmind-2008)
• Fairbairn, W.R.D. (1952). Psychoanalytic Studies of the Personality. Tavistock/Routledge. (source_id: fairbairn-psychoanalytic-studies-1952)
• Fromm, Erich. (1941). Escape from Freedom. Farrar & Rinehart. (source_id: fromm-escapefromfreedom-1941)
• Maddox, Brenda. (2003). Rosalind Franklin: The Dark Lady of DNA. HarperCollins. (source_id: maddox-rosalind-franklin-dark-2003)
• Ludmerer, Kenneth M. (1999). Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. Oxford University Press. (source_id: ludmerer-time-to-heal-1999)
• Starr, Paul. (1982). The Social Transformation of American Medicine. Basic Books. (source_id: starr-socialtransformation-1982)
• Stapley, Julie. (2024). A History of Plant Medicine and Herbal Practice. (source_id: stapley-history-of-plant-2024)
• Temkin, Owsei. (1977). The Double Face of Janus and Other Essays in the History of Medicine. Johns Hopkins University Press. (source_id: temkin-doublefacejanus-1977)
• Lawlor, Clark. (2012). From Melancholia to Prozac: A History of Depression. Oxford University Press. (source_id: lawlor-from-melancholia-to-2012)
• Szasz, Thomas. (1960). The Myth of Mental Illness. Hoeber-Harper. (source_id: szasz-mythmentalillness-1960)

Editorial Notes

Gaps the encyclopaedia compiler flagged for future evidence work, collected from inline markers in the body and frontmatter.

Nazi Medical Experiments and the Bioethics Inflection

Scholarly Assessment