A Review of The Devil’s Castle by Susanne Paola Antonetta

In her latest book, The Devil’s Castle: Nazi Eugenics, Euthanasia, and How Psychiatry's Troubled History Reverberates Today, Susanne Paola Antonetta traces over 200 years of history through Germany’s Sonnenstein Castle asylum, uncovering how one of the most enlightened psychiatric care programs in Europe eventually became a site for the Nazi’s eugenic Aktion T4 euthanasia program which murdered hundreds of thousands of disabled people against their will. From the early 1800s through Nazi Germany to the present day in America, Antonetta digs deep into psychiatry’s origins through the stories of two German psychosis experiencers and memoirists, Dorothea Buck and Paul Schreber who gave The Devil’s Castle its name when he was institutionalized there for eight years. Buck and Schreber serve as guides for both the reader and Antonetta as she examines her experiences with psychosis and abusive psychiatric treatment, shining a light to the series of doctors, medical directors, and governments who shaped the medical and social perception of psychosis and madness as a disease to be irradicated rather than another variant of humans’ vast, variable consciousness. Through the writing and advocacy of Buck and Schreber, Antonetta offers a new vision for what mind care and neurodivergence acceptance can look like in modern American psychiatry, in our communities, and in ourselves.

            Antonetta doesn’t shy away from the horrors that disabled people were subjected to at the origins of psychiatry and throughout Nazi Germany. She details the tortures disguised as treatments through Buck and Schreber’s several forced institutionalizations between the 1880s-1950s, who were subjected to electric and chemical shocks, ice baths, beatings, starvation, restraints, and sexual abuse. Buck was forcibly sterilized under early Nazi eugenics laws, and Schreber was held for eight years in Sonnenstein Castle to be financially exploited by the program director. Antonetta shows how these inhumane treatments and conditions pushed patients already in a crisis into a “near-feral state,” dehumanizing disabled people and providing the groundwork for the Aktion T4 program to come. In this program (the only genocide order signed by Hitler himself), an estimated 275,000–300,000 disabled people were murdered in so-called “mercy killings” that first targeted children born with physical disabilities and eventually grew to include disabled and mentally ill adults, before the euthanasia techniques and the eugenics doctors who created it were exported to the Nazi’s genocidal concentration camps. Antonetta draws a subtle but striking parallel between how the Aktion T4 doctors ticked off forms to send mental health patients to their deaths without ever seeing or talking to them, to modern psychiatry’s emphasis on rote symptom box checking with the Diagnostic Statistical Manual (DSM), fifteen minute appointments, routine prescription of medication which reduces people’s life expectancies, and forced institutionalizations in hospitals rampant with abuse, all of which too often ignore engaging with patients in human conversations about their experiences.

            But this treatment of neurodivergence doesn’t have to be this way, Antonetta argues. She examines an alternative history and lineage for psychiatry, looking at two of the fathers of the field, the 18^th century’s Philippe Pinel who believed in humanization and care of patients with “moral treatments,” and 19^th century’s Emil Kraeplin, an antisemite and eugenicist who laid the groundwork for the DSM, today’s leading framework for diagnosing and treating psychiatric conditions. Followers of Pinel’s methodology made Sonnenstein Castle in the late 1800s into a retreat rather than a prison (or the gas chamber it would eventually become), with a piano, library, long conversations, delicious food at nightly dinners attended by the director and his family, and an emphasis on releasing recovered patients back into the community. “Pinel believed the best impulses of humanity are inseparable from its madness,” Antonetta writes, “I cannot call this an idea ahead of its time; the idea has yet to have its time.” Here, she raises an interesting question that haunts much of the book—what could the lives of neurodivergent people look like if Pinel’s ideas and methodologies finally had their time?

            The strongest advocates for understanding psychosis and madness not as a biological disease but another miraculous layer of human consciousness are Buck and Schreber, both who were institutionalized several times in Germany (Buck narrowly escaping Aktion T4), and who fought fiercely for their rights and the rights of others to experience, as Schreber introduced into German law when he litigated his own release from Sonnenstein, “harmless insanity.” Like Antonetta, both were writers of memoirs, Schreber’s Memoirs of a Nervous Illness and Buck’s On the Trail of the Morning Star: Psychosis as Self Discovery, in which they argue for a different way of interpreting psychosis not as a “failing biological processes in the brain” as Kraepelin would suggest, but rather, even when it was frightening or painful, as another state of consciousness to playfully experience, make meaning from and to connect to the deeper spiritual universe and self.

            Through Buck and Schreber, Antonetta arrives at the ultimate question—how can we decide what is normal and what is sick consciousness? ““Mental illness” really means “consciousness illness,” and given what we know about consciousness, the term makes no sense. No one can define “out of touch with reality” when no one knows what the thing being touched is,” she writes. As Antonetta points out, the definitions of who is insane and who is not has always been a blurry one as social taboos morph and change; Schreber was considered insane for his gender transition into “a spirited woman” at God’s calling; homosexuality was listed as a mental illness in the DSM until 1973 and only dropped because of the hard work of gay rights activists. In 1851, an American physician hypothesized a diagnosis he called drapetomania, pathologizing an enslaved person’s drive to escape enslavement. Through these examples, Antonetta poses the question of how valid psychiatric diagnoses are if they can be removed from the DSM and highlights how some psychiatric diagnoses can be used by those in power to villainize, delegitimize, trap, and control people who exist and stray beyond the norm.

            Antonetta’s The Devil’s Castle is a powerful and sobering reminder of the work that is still to be done to improve psychiatric care and the acceptance of disability and neurodivergence in our modern lives—for the millions of people who are suffering and being failed, abused, and exploited by the ableist standards of psychiatric care. As the book concludes, Antonette details a disturbing list of Aktion T4 euthanasia doctors that were not tried until decades after the Holocaust, when one survivor Fritz Bauer finally was able to arrest and prosecute some of them. Even then, many of these doctors were not convicted of their crimes or released after short sentences despite their participation in the murder of up to 300,000 disabled adults and children as, “Germans still didn’t consider euthanasia doctors guilty.” The lives and livelihood of disabled people are still devalued and disregarded in society as psychiatry’s entanglement with eugenics and euthanasia through the Kraepelinian DSM teaches us that our brains and minds are broken, rather than our circumstances and the methods used to treat us. Instead, Antonette follows in the tradition of Schreber and Buck, advocating for a broadening of our understanding of the psychological and social interworking of neurodivergent experiences, concluding with a call to action to end the DSM standard of psychiatry and reimagine mind care that centers the experiences of neurodivergent patients. As Antonette writes of the current psychiatric system that is DSM-centric and economically reliant on people’s illness—“It doesn’t have to remain so.”

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Mialise Carney is a writer whose stories and essays have appeared in swamp pink, Booth, Washington Square Review, and other places. She is a PhD student in creative writing and literature at the University of Cincinnati, where she reads for The Cincinnati Review and teaches writing.