In the wake of the horrific slaughter of the First World War, artists struggled to make sense of the tremendous loss and suffering from the brutal industrialized war. Thanks to German psychiatrist and doctor of art history Hans Prinzhorn, many artists found inspiration in the art of mental patients that broke boundaries while expressing psychological pain and unbridled emotion without regard for convention or tradition.

Prinzhorn encouraged his psychiatric patients to draw and paint as a form of therapy, and then he published a groundbreaking collection of their work in 1922. Modern artists such as Paul Klee, Salvador Dali and Max Ernst were influenced by these raw, unfiltered images.

In the 1930s, Adolf Hitler—a megalomaniac who saw himself as a great artist— condemned the work of the artist-patients, as well as most forms of modernist art, as an “insane deviation” from the traditional realism he admired. In the late thirties, Hitler’s Nazis mocked avant-garde artists and compared them with the mentally ill artists in their exhibits of “Degenerate Art.” And, by the early 1940s, the Nazi regime had murdered the more that 70,000 psychiatric patients, including several of Prinzhorn’s patient-artists, in a euthanasia program designed to exterminate so-called “life unworthy of life,” meaning the mentally and physically disabled. Aktion T4, as the program was known, paved the way for the Holocaust.

In his moving and riveting new book, The Gallery of Miracles and Madness: Insanity, Modernism, and Hitler’s War on Art (Random House), acclaimed author Charlie English presents this complex history. He weaves together the life of Prinzhorn, his artist-patients, the rise of failed artist Hitler, eugenics and “The Master Race,” and the horrific Aktion T4 to advance “racial hygiene” and create an Aryan master race by killing those with disabilities.

Based on extensive research, Mr. English’s book takes the reader into the lives of Prinzhorn and talented patients such as Franz Karl Bühler and Agnes Richter, and then illuminates Hitler’s cruel world. The gripping storytelling creates suspense even though the reader knows of the tragedy to come.

The Gallery of Miracles and Madness is an urgent tribute to the creative spirit as it exposes the horrors of totalitarianism. Mr. English provides a humane and timely historical account with cautionary lessons for readers today and into the future.

Charlie English, a celebrated British nonfiction author, has written two previous books, The Storied City (published in the UK as The Book Smugglers of Timbuktu) and The Snow Tourist. He is a former journalist for The Guardian, where he served in several positions including arts editor and head of international news. Also, he has appeared on NPR and the BBC and written for numerous newspapers and magazines including The New York Times, The Telegraph and The Independent, and lectured at the Royal Geographical Society, where he is a Fellow. He lives in London with his wife and children.

Mr. English generously responded by email to a series of questions on his recent book.

Robin Lindley: Congratulations Mr. English on your powerful new book The Gallery of Miracles and Madness. You take a deep dive into art, psychiatry, and the policies of Nazi Germany. This book seems a departure from your previous work. What sparked your interest in this often-neglected history?

Charlie English: Thank you Robin. I realize it seems a long way from The Book Smugglers of Timbuktu, though in fact there are similarities. Both books are about culture under totalitarianism, one being set during Al Qaeda’s rule over Timbuktu, the other in Nazi Germany.

I’m drawn to cultural stories, and when I discovered the Prinzhorn collection some years ago it seemed to speak to me. A history that directly links so many fascinating areas of twentieth century history–from modern art’s interest in insanity to Hitler’s ability as a painter to the Nazi mass-murder programs–was one that I thought that deserved to be told and understood.  

Robin Lindley: Your book begins with a focus on Dr. Hans Prinzhorn, a psychiatrist who collected the art of mental patients in early twentieth century Germany. He was also trained in art history. What are a few things you’d like readers to know about Prinzhorn?

Charlie English: I guess you’d say Prinzhorn was a Renaissance man, a war veteran, a medic, a baritone singer, an intellectual. He achieved something really astonishing in the space of two to three years, rather less time in fact than it took me to write my book. But his brilliance did not lead him to a good place, and he made a lot of poor decisions, not least his support, for a short time, for Hitler, who still seems to me to represent the polar opposite of Prinzhorn’s earlier work, which promoted psychiatric art as valid art. His biography shows, I think, that people are usually flawed and the truth is always complicated.    

Robin Lindley: Why was Prinzhorn interested in inspiring and collecting the art of mental patients?

Charlie English: Several reasons. One is that this was an active field of enquiry for art at the start of the 20th century: Freud had revealed vast hidden depths inside every human being, and modernists saw mental illness or perhaps madness as a way to explore that, while escaping all the hated trappings of the bourgeoisie and so-called civilization.

Beyond that, Prinzhorn was psychologically fragile himself, perhaps a sufferer of PTSD, and an art critic and a medic. The stars aligned for him, you could say. His education meant he was unusually, perhaps uniquely qualified for the task of exploring the art of schizophrenic patients. 

Robin Lindley: Several of the psychiatric patient artists you discuss were already recognized artists. Who are a few of the patient artists that stand out to you?

Charlie English: There are hundreds of artists in the collection, and for the book I needed to focus the story on a handful at most. The hero, if you like, is Franz Karl Bühler, an artisan-blacksmith before he was incarcerated as a schizophrenic. He had been a genius at metalworking, and won a gold medal at the World’s Fair in Chicago in 1893, so he was trained in the design aspects of his craft, but he also managed to teach himself to become a great fine artist after his mental collapse. Others in the collection include Else Blankenhorn, a very great talent whose worked inspired Ernst Ludwig Kirchner, among others. The Surrealists’ favourite Prinzhorn artist was August Natterer, who depicted his psychotic episodes in his work. Like many Prinzhorn images they have an intriguing, uncanny quality. 

Detail of Hexenkopf (The Witch's Head), c. 1915, August Natterer

Robin Lindley: You write about how some of these mentally ill artists influenced surrealists, expressionists and other modernists. What did you learn about the influence of these ill “outsider” artists?

Charlie English: I was astonished by their influence over the major art movements of the time. If you think how substantial Surrealism was, for instance, and then discover how dependent those artists were on psychiatric patients’ art, it gives you a whole new understanding of where certain iconic twentieth century works came from. Evidence for artistic influence is often hard to pin down, as few artists are keen to discuss or write about the people they borrowed ideas from, but the Prinzhorn collection’s influence is really very well documented by dozens of art historians. Prinzhorn’s achievement, you could say, is to have expanded the idea of what art is, and widened the circle of permitted art-makers. 

Robin Lindley: How did other medical professionals view Prinzhorn’s interest in the art of his psychiatric patients?

Charlie English: You have to remember that at the time opinion was highly polarized between arch-conservatives and the avant-garde, rather as I think it is now. Conservative psychiatrists really hated the idea that madness was polluting fine art, which they held up as something spiritual, superior, quasi-religious. The far right realised that they could capitalize on this natural distaste for the “moderns”.

Robin Lindley: Wasn’t Prinzhorn attracted by some aspects of Nazism before his death in 1933?

Charlie English: Yes. During the economic crisis of the early 1930s there was a sense of pending catastrophe, which Hitler did his best to encourage, blaming the Jews and the left and the avant-garde. Prinzhorn, like other conservatives, felt Germany needed a strong leader, and thought Hitler could be that person. It seems very surprising given Prinzhorn’s earlier ideas, but he even offered to work with Hitler on a program of German cultural renewal. He was politically naive, and later realized he had made a mistake. He died soon after Hitler came to power, so we can’t know what would have become of him during the period of Nazi rule. 

Robin Lindley: Hitler also looms large in your book. The young Hitler was a starving artist. You stress that he saw himself as an artist through his life. Some readers may not be familiar with his actual art. How did his contemporaries see his art work and his personality?

Charlie English: As a teenager Hitler was determined to become an artist. He believed he was brilliant, of course, and that it would be “child’s play” for someone of his great talent to get into Vienna Academy of Fine Arts, so when they rejected him, he was devastated and furious. There’s no doubt that he had some ability for drawing buildings, but he was terrible at figures. Read into it what you will, but the people in his paintings just don’t seem to have interested him on any level.

After his rejection, he was homeless for a time, and made a living copying out tourist postcards depicting famous buildings, but even he would later dismiss these works as of no value. His real talent—as observers from Albert Speer to Thomas Mann have pointed out—was for the art of politics, the spectacle, the rallies, the insignia, the speeches, the set designs…

Robin Lindley: How did Hitler’s artist persona play into his leadership style and beliefs about himself?

Charlie English: Hitler came to believe he was an artist-Fuhrer, a mythical Romantic idea for a type of leader that Germany was said to produce in times of crisis. This combined politician and seer would allegedly be able both to envisage the future of the German people and to bring it about, however abhorrent the methods. Hitler’s propaganda consistently presented him in this way.

Goebbels once wrote that for the Fuhrer the people were no more difficult to work than clay was for the sculptor. It seems clear that Hitler took this almost literally, as he would try to genetically reengineer the Germans to fit his Aryan ideal.

Robin Lindley: After a failed putsch in 1923, Hitler was arrested and—as you write—he was examined and diagnosed as a psychopath. What brought evaluators to this conclusion?

Charlie English: I wouldn’t say this was a formal diagnosis, but the prison psychologist Alois Maria Ott spoke with him after he was admitted to the jail and described him much later as ‘prone to hysteria’ and ‘a morbid psychopath’, with flecks of spittle showing around his mouth. Of course, Hitler’s first great political gamble had just gone catastrophically wrong.

The issue of his sanity has been controversial since none of the many formal psychiatric opinions that exist come from people who actually examined him. Also, it used to be argued that calling him “mad” somehow let him off the hook for his crimes. These days, the binary concept of “mad” or “sane” seems less relevant, and I don’t think many people who know his biography would argue that Hitler wasn’t a deeply disturbed individual. 

Robin Lindley: During his year in jail, Hitler wrote his hated-filled screed Mein Kampf. He was already attacking Jews and the weakness of the Weimar state. When did he become acquainted with eugenics and the idea of a German Aryan master race?

Charlie English: Eugenics was already a popular scientific concept at the turn of the twentieth century. A British polymath, Sir Francis Galton, invented the term in the 1880s, and sterilization was enthusiastically practiced in the United States. Hitler is said to have been inspired by some of these American programs.

The idea of an Aryan master race was older: it grew out of mid-nineteenth century concepts of so-called “scientific racism”, which separated people into a hierarchy of races, with the Nordic whites and Aryans at the top and the Jews at the bottom. One of the most bizarre aspects of these theories was that the only people who could have good ideas were the Aryans, and every other world culture could only continue what the Aryans had taught them or else destroy it by their bungling. One conclusion of this theory required that the ancient Greeks be categorized as Aryans, and in fact the Nazis did try to co-opt every “good” thing that had ever happened in history—including classical culture—for the German-Aryans.

You wonder at people’s credulity when faced with this nonsense, but, a bit like QAnon or another conspiracy theory, it didn’t really have to make sense, it was just a labyrinthine way of justifying the emotional prejudices people felt about a particular issue. The Nazis adapted the language to support these racial concepts, promoting words such as “Volksgemeinschaft” (ethnic cultural community), “Rassengefuhl” (racial feeling), and “Kulturbolschewismus” (cultural Bolshevism). 

Robin Lindley: What was the “Degenerate Art” exhibit that Hitler promoted? How did Hitler view works by recognized modernist artists and the mentally ill? Why was Nazi mockery of modern art so important to Hitler? What threatened him about expressionism and other styles?

Charlie English: “Entartung”, or “degeneracy” was another nineteenth century concept that went hand in hand with eugenics and race theory.

Degeneracy theory stated that a people’s racial health could be read in its cultural output, and that a race that had been polluted by “foreign” genetics—i.e., by racial intermarriage, notably with the Jews—produced symptomatic art that no “pure” Aryan could understand. Art, then, was a barometer of cultural health and —surprise, surprise—modern art was an indicator of the excessive Jewish influence on German culture.

It was Goebbels’s idea to capitalize on this theory by organizing “shaming shows” of modern art designed to reinforce the idea that modernism=Jewishness=mental illness. These “Degenerate Art” shows included works from the Prinzhorn collection, as further evidence that madness and modernism were a Jewish conspiracy against the German people. They would be included in the exhibitions alongside professional works with sarcastic captions claiming that a “really sick” patient’s effort was better than that of the professional modern artist.

Josef Goebbels inspects the Degenerate Art Exhibition, February 1938

Photo Bundesarchiv, CC BY-SA 3.0 de

The Degenerate Art shows were vital for the Nazi propaganda effort. They toured the country for years, and are still the most popular art exhibitions of all time in terms of footfall: around four million people are believed to have seen them. 

Robin Lindley: The Nazi’s T4 program, a precursor of the Holocaust, involved destruction of “life unworthy of life,” including those with genetic illnesses, the mentally ill, and others. How did Nazi eugenics evolve from sterilization policies in the mid-1930s to mass murder by 1939?

Charlie English: Once the principle of racial cleansing was established—and Hitler had hinted at such a program in Mein Kampf in the mid-1920s—the question was how to do it without attracting too much public protest.

Months after Hitler came to power, a sterilization law was passed which meant that psychiatric patients with particular conditions could be forcibly neutered. As war loomed, Hitler decided to go further, starting to actually murder the mentally ill, to eliminate them from the gene pool and save the cost of their care. He knew that the conflict would provide political cover for this program, which could be explained as the sort of emergency measure required in times of war. A group of administrators in his private office were tasked with establishing the program, later known as Aktion T4. They brainstormed methods of mass-murder, and came up with the idea of gas chambers. These were put into action from early 1940. These tools and methods would later be used in the Holocaust, often by the same people.

Robin Lindley: It’s heartbreaking that there was little public outcry about the T4 mass killing of disabled people. Did most Germans know of the mass murder? Who cared about it?

Charlie English: A large number of people knew. It was impossible for instance to disguise the smell of burning corpses that emanated from the incinerators, or to stop the soot gathering on people’s houses.

There was some resistance to Aktion T4 but this was entirely insufficient to prevent the murder of 70,000 or so people by the state. Only a few individuals spoke up, including the Bishop of Munster, and Lothar Kreyssig, a district judge in Brandenburg. The propaganda had been highly effective: people mostly either did nothing or tacitly supported the killings.  

Robin Lindley: Your description of the last days of the Prinzhorn’s psychiatric patients is poignant and moving. Karl Bühler, a once prominent artist, was one of victims. How were the T4 victims located and then killed? What did you learn about the killing centers?

Charlie English: One of the most shocking aspects of the story is that the victims were identified, judged and murdered by the medical profession. Asylums were told to report people who had been diagnosed with certain conditions, including schizophrenia and alcoholism, or people who had been in the care system for several years. The names and medical notes of such people were sent to medical reviewers, who then decided if they fit the criteria for murder that Hitler’s office had set out. Most of them did. After that, lists of selected patients were sent back to the asylums, and a special transport squadron came to pick them up on the appointed day. They were taken to the killing centers, which had been designed to look like hospitals, and put in sealed chambers disguised as shower rooms. A doctor turned on the gas and killed them all. The bodies were robbed of gold teeth and burnt.

Robin Lindley: What was you research process? Did you search for resources in museums, galleries, hospitals, and other archives? Did you interview survivors and experts?

Charlie English: I was helped greatly by the Sammlung Prinzhorn, part of the Heidelberg university psychiatric clinic, where Prinzhorn had worked from 1919. They have an archive of art and patient records and letters written by Prinzhorn and others. I found other documents all around the world, from the Library of Congress to the British Library to the small city archive in Offenburg, where Franz Karl Bühler grew up. In all, the research phase lasted around two years.

There are sadly no survivors of Aktion T4 or living eyewitnesses to the story. It all happened too long ago, and many of the patients were already elderly. 

Robin Lindley: Can people still view some examples of the psychiatric art collected by Prinzhorn?

Charlie English: Yes, there is a gallery at the Sammlung Prinzhorn in Heidelberg. I highly recommend a visit.

Robin Lindley: Is there anything you’d like to add for readers about your book and how this history resonates now?

Charlie English: This book is not about the present day, but as I was writing I felt it resonated strongly with the period we are living through now. Readers will draw their own conclusions, but I hope they might recognise some of the parallels. Mostly, though, I want them to enjoy reading it and hope it will inspire them to explore the art.

Robin Lindley: Thank you for your insights and thoughtful comments Mr. English and congratulations on your gripping and humane study of art, tyranny, mass murder, and psychiatry. Best wishes for your new book and future endeavors.

Charlie English: Thank you Robin.

Robin Lindley is a Seattle-based attorney, writer and features editor for the History News Network (history news network.org. His work also has appeared in Writer’s Chronicle, Bill Moyers.com, Re-Markings, Salon.com, Crosscut, Documentary, ABA Journal, Huffington Post, and more. Most of his legal work has been in public service. He served as a staff attorney with the US House of Representatives Select Committee on Assassinations and investigated the death of Dr. Martin Luther King, Jr. His writing often focuses on the history of human rights, conflict, medicine, art, and culture. Robin’s email: robinlindley@gmail.com.