| Summary: | Before the German occupation, mortality in French psychiatric hospitals was comparatively stable, the national annual average ranging from 3 to 10%. During the German occupation mortality rose precipitously to over 30% in some cases and total patient-deaths numbered more than 45,000. How and why this happened and who died is examined through a case study of four psychiatric hospitals: three ‘closed’ institutions in which patients were committed and interned as mentally ill and a Colonie familiale, similar to current community care, in which patients lodged in foster homes. Examination of the history of these hospitals offers an insight into institutions within the Assistance psychiatrique (French welfare system which included mental hospitals) managed by the state and by the Religious Order of the Brothers of Saint-Jean. Normalcy of daily life for inpatients and personnel was disrupted when France joined the Second World War and the mobilisation of able-bodied Frenchmen by France’s subsequent defeat and occupation. Psychiatric hospitals relied essentially on male labour for nursing, discipline and security, general maintenance and building works, internal hospital services, and crucially for food provisioning from their vast farmlands and agricultural production. Disruption of daily life and the intensity of harsh restriction of foodstuffs and raw resources were brought about by the Vichy regime’s rationing system imposed by the German occupiers. Severe malnutrition and ill-health affected the nation. For patients in psychiatric hospitals, already ‘at risk’ of increased mortality due to their mental condition, the consequences of the Occupation were fatal. Psychiatrists administering the target hospitals were unable to act autonomously and although many responded positively to the crisis of limited and ever-dwindling rations and consequent malnutrition suffered by their patients. The Occupation exposed grave and entrenched deficiencies in institutional management and professional practice for mentally ill inpatients.
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