8-1 | Table of Con­tents | DOI 10.17742/IMAGE.GDR.8-1.7 | Klock­ePDF


Abstract | With­in the con­text of med­ical-his­tor­i­cal research, this arti­cle com­pares the depic­tion of female patients in GDR and post-GDR fic­tion­al texts: Lothar Warneke’s Die Beun­ruhi­gung (1982), Christa Wolf’s Nach­denken über Christa T. (1968) and Leib­haftig (2002), and Kathrin Schmidt’s Du stirb­st nicht (2009). This approach high­lights the idio­syn­crasies of GDR med­i­cine, which demand­ed patients’ col­lab­o­ra­tion in ther­a­peu­tic mea­sures and hid from them the truth about their con­di­tions. This cus­tom, known as the “gen­tle lie,” as well as oth­er top-down prac­tices echo the state’s patri­ar­chal atti­tude towards its cit­i­zens, par­tic­u­lar­ly women, evi­denc­ing that the GDR claim of gen­der equal­i­ty was not prac­ticed in key areas of women’s lives. Fur­ther­more, there is evi­dence that hier­ar­chi­cal struc­tures deny­ing patients’ agency per­sist today in east­ern Ger­many.
Résumé | Dans une per­spec­tive médi­co-his­torique, cet arti­cle com­pare la descrip­tion de patientes dans des réc­its de fic­tion de la RDA et de l’ex-RDA: L’Inquiétude (Die Beun­ruhi­gung) de Lothar Warneke (1982), Christa T. (Nach­denken über Christa T.) (1968) et Le Corps même (Leib­haftig) de Christa Wolf (2002) ain­si que Tu ne vas pas mourir (Du stirb­st nicht) de Kathrin Schmidt (2009). Cette approche met en lumière les idio­syn­crasies de la médecine de la RDA, laque­lle demandait la col­lab­o­ra­tion des patients dans les mesures thérapeu­tiques tout en leur cachant la vérité sur leur con­di­tion. Cette pratique—connue sous le nom de « doux men­songe »—ain­si que d’autres pra­tiques imposées d’en haut reflè­tent l’attitude patri­ar­cale de l’État envers ses citoyens, et tout par­ti­c­ulière­ment envers les femmes, preuve que la revendication—faite par la RDA—de l’égalité des sex­es n’était pas mise en œuvre dans des secteurs clés de la vie des femmes. En out­re, tout porte à croire que les struc­tures hiérar­chiques pri­vant les patients d’initiative con­tin­u­ent de se per­pétuer aujourd’hui dans l’Est de l’Allemagne.

Son­ja E. Klocke | Uni­ver­si­ty of Wis­con­sin – Madi­son

The “Gentle Lie”:
Women and the GDR Medical System in Film and Literature

Loth­ar Warneke’s 1982 film Die Beun­ruhi­gung (Appre­hen­sion, 1982), a low-bud­get, black-and-white All­t­ags­film (every­day film) that fea­tures doc­u­men­tary ele­ments, was among the most pop­u­lar DEFA films of the 1980s.[1] At the GDR’s sec­ond nation­al fes­ti­val for fea­ture films in Karl-Marx-Stadt in 1982, it received sev­er­al prizes, includ­ing the so-called Großen Steiger, the audi­ence prize for the most effec­tive movie screened with­in the pri­or two years.[2] As Andrea Rinke high­lights in “From Mod­els to Mis­fits, “the ques­tion of how indi­vid­u­als cope with ill­ness, pain, depres­sion, and death was at the fore­front of Warneke’s con­tro­ver­sial film” (195). Sur­pris­ing­ly, though, schol­ar­ship large­ly focus­es on how the pro­tag­o­nist, Inge Herold (played by Chris­tine Schorn) takes charge of her life and seeks a ful­fill­ing love rela­tion­ship when she finds her­self in a time of cri­sis. These dis­cus­sions treat the diag­no­sis of breast can­cer as no more than a plot trig­ger for Inge’s actions. This approach may be attrib­ut­able to Eri­ka Richter, the artis­tic advi­sor for Die Beun­ruhi­gung, who spot­light­ed this aspect in her after­word to Hel­ga Schubert’s 1982 script. Richter’s dec­la­ra­tion that the main idea of the film was, “ill­ness inter­rupts nor­mal every­day life and forces indi­vid­u­als to take stock” seems to have been high­ly influ­en­tial (88).

Con­trary to these approach­es, this arti­cle pro­pos­es a read­ing that inves­ti­gates more close­ly the por­tray­al of the GDR med­ical sys­tem in Die Beun­ruhi­gung. It places this inter­pre­ta­tion in the con­text of med­ical-his­tor­i­cal research on GDR health­care prac­tices and exam­ines how this dis­tinc­tive med­ical system—characterized by a lack of patient auton­o­my reflect­ing the GDR’s essen­tial­ly author­i­tar­i­an and patri­ar­chal structure—affects Inge Herold’s abil­i­ty to deal with her ill­ness. By con­sid­er­ing addi­tion­al exam­ples of med­ical treat­ment in GDR and post-GDR fic­tion by Christa Wolf and Kathrin Schmidt—fictional texts delib­er­ate­ly cho­sen to demon­strate that the con­cern for med­ical ethics has played a sig­nif­i­cant role in var­i­ous his­tor­i­cal cir­cum­stances and polit­i­cal systems—this approach achieves two goals: first­ly, it high­lights the idio­syn­crasies of the GDR health­care sys­tem, rang­ing from the effects of a spe­cif­ic doc­tor-patient rela­tion­ship based on a legal sys­tem influ­enced by Marx­ist-Lenin­ist thought to the suc­cess of the GDR’s effec­tive can­cer screen­ing pro­grams; and sec­ond­ly, it demon­strates the extent to which prac­tices spe­cif­ic to the GDR med­ical sys­tem are por­trayed as lin­ger­ing in post-GDR lit­er­a­ture, a por­tray­al that is, in fact, authen­ti­cat­ed by med­ical-his­tor­i­cal research.[3] The cho­sen texts all fea­ture suf­fer­ing female pro­tag­o­nists whose ill­ness­es indi­cate their reluc­tance to be inte­grat­ed into the pre­vail­ing sym­bol­ic order of a patri­ar­chal society—GDR or, in the case of Kathrin Schmidt’s Du stirb­st nicht (You Are Not Going to Die, 2009), post-GDR soci­ety. The inter­est in med­ical ethics and patient auton­o­my sug­gests that the texts’ frame of ref­er­ence extends beyond the his­tor­i­cal para­me­ters of GDR soci­ety and seeks to sit­u­ate the eth­i­cal dilem­ma they explore with­in a more gen­er­al analy­sis of patri­archy and female sub­jec­tiv­i­ty. Yet the fact that all these texts place their pro­tag­o­nists in GDR or post-GDR, i.e., con­tem­po­rary East Ger­man soci­ety encour­ages us to con­sid­er the specifics of GDR-style, top-down prac­tices of med­ical care that, as Schmidt sug­gests, have not yet been over­come in East­ern Ger­many and seem to affect women in par­tic­u­lar. How­ev­er, before delv­ing into a more detailed analy­sis of the fic­tion­al texts, we should reflect on their poten­tial to pro­vide us with his­tor­i­cal insight. Here, film and lit­er­a­ture can hint at every­day life expe­ri­ences in the GDR, specif­i­cal­ly its med­ical sys­tem, which seems to have con­sid­ered patients in gen­er­al and women in par­tic­u­lar inca­pable of han­dling unpleas­ant truths about their health.

Fiction as a Source of Historical Knowledge

Simone Barck’s claim that GDR fic­tion is a more illu­mi­nat­ing source of knowl­edge about GDR soci­ety than schol­ar­ly pub­li­ca­tions by his­to­ri­ans also applies to the med­ical realm and med­ical his­to­ri­og­ra­phy (315). Indeed, in the GDR dis­cus­sions sur­round­ing con­tentious topics—such as ques­tions regard­ing ethics in the med­ical field—tended to take place in small cir­cles, not in pub­lic forums sup­port­ed by the media. In “Ethis­che Fra­gen” (“Eth­i­cal Ques­tions”), physi­cian Susanne Hahn stress­es that, since the GDR mass media pre­dom­i­nant­ly broad­cast experts’ deci­sions, more fine-grained infor­ma­tion and crit­i­cal debates about ill­ness and patients in med­ical insti­tu­tions became avail­able to the gen­er­al pub­lic through lit­er­a­ture and film (77). Fur­ther­more, in Rifts in Time and in the Self, Cheryl Dueck writes, “in a soci­ety in which potent polit­i­cal and social mes­sages were trans­mit­ted by fic­tion, the fates of char­ac­ters in nov­els can be read as a ther­mome­ter of soci­etal health” (112). Die Beun­ruhi­gung exem­pli­fies these aspects as both scriptwriter Hel­ga Schubert—a pro­fes­sion­al psy­chol­o­gist as well as a writer—and direc­tor Lothar Warneke stressed the sig­nif­i­cance of their film and the main character’s sto­ry for cat­alyz­ing an inten­sive dia­logue with the audi­ence. As Eri­ka Richter tes­ti­fies:

A large por­tion of the audi­ence eager­ly takes up this offer to com­mu­ni­cate, as the first expe­ri­ences demon­strate. The film loosens tongues. The audi­ence talks about deal­ing with ill­ness as well as the will­ing­ness to com­mu­ni­cate and the lack of com­mu­ni­ca­tion; about the rela­tion­ship between gen­er­a­tions as well as the man­i­fold prob­lems that come with eman­ci­pa­tion. (100-1)

Richter points to the film’s influ­ence on sev­er­al lev­els: spark­ing com­mu­ni­ca­tion and gen­er­at­ing spe­cif­ic dis­cours­es, for instance, about ill­ness or gen­er­a­tions. Accord­ing to Rose­mary Stott, Warneke, like most DEFA film­mak­ers, “felt a strong affin­i­ty with their audi­ence and a respon­si­bil­i­ty towards them. Because of the lack of a demo­c­ra­t­ic press, the arts could serve the func­tion of rais­ing con­tem­po­rary issues relat­ed to every­day life which were taboo in the print media” (35-36). Die Beun­ruhi­gung thus offers an exam­ple for the many fic­tion­al texts that trig­gered crit­i­cal thought among GDR cit­i­zens and that present a remark­able archive of infor­ma­tion about dai­ly life and issues.[4]

Lit­er­a­ture and film depict­ing ill­ness and the health­care sys­tem reveal cul­tur­al and ide­o­log­i­cal dis­cours­es in med­ical insti­tu­tions as well as social norms—including, but by no means lim­it­ed to, the sig­ni­fiers for pathol­o­gy, since GDR cit­i­zens clear­ly under­stood the med­ical sys­tem as a part of soci­ety that echoed both the prob­lems and the stan­dards gov­ern­ing the GDR. Accord­ing­ly, Thomas Ahbe, Michael Hof­mann, and Volk­er Stiehler’s Rede­frei­heit, a vol­ume that con­tains tran­scripts of all pub­lic debates that took place in Leipzig in the fall of 1989, also includes a chap­ter deal­ing with glitch­es in the health­care sys­tem. Here, the link between dif­fi­cul­ties in the med­ical sys­tem and larg­er soci­etal set­backs is artic­u­lat­ed in the state­ments con­tributed by Dieter Lohmann, Med­ical Direc­tor of the city hos­pi­tal in Leipzig, and Rudolf Wein­er, Med­ical Direc­tor of the dis­trict hos­pi­tal St. Georg, which met with the audience’s strong approval. Both Lohmann and Wein­er empha­size that the health­care sys­tem must be con­sid­ered an inte­gral part of soci­ety, which means its tri­als and tribu­la­tions echo the griev­ances of soci­ety at large (Lohmann 526, 531).

One of the so-called All­t­ags­filme com­mit­ted to “doc­u­men­tary real­ism,” Die Beun­ruhi­gung  illus­trates Warneke’s ide­al of the doku­mentaren Spielfilm (doc­u­men­tary dra­ma), which he delin­eat­ed in his epony­mous master’s the­sis in 1964. With ref­er­ence to Ital­ian Neo­re­al­ism and specif­i­cal­ly to Cesare Zavat­ti­ni, Warneke artic­u­lat­ed the artis­tic posi­tion jus­ti­fy­ing the need for a GDR-spe­cif­ic real­ist doc­u­men­tary film. He aimed for the uni­fi­ca­tion of the “tra­di­tion­al pos­si­bil­i­ties of the fea­ture film to cre­ate live­ly char­ac­ters with doc­u­men­ta­tion [in order to] facil­i­tate a new, deeply real­is­tic way of reflect­ing real­i­ty artis­ti­cal­ly. This pos­si­bil­i­ty is avail­able in the doc­u­men­tary con­fig­u­ra­tion of the fea­ture film. We describe this syn­the­sis as the doc­u­men­tary dra­ma” (238-39).[5] While not chal­leng­ing socialism’s mas­ter nar­ra­tive, such doc­u­men­tary dra­ma would strive to find gen­uine rep­re­sen­ta­tions of real­i­ty in the tex­ture of per­son­al dai­ly expe­ri­ences (Harhausen 102; Fein­stein 199). Yet fol­low­ing the so-called Kahlschlag-Plenum (clean-sweep ple­nary) of 1965—an event of the rul­ing Social­ist Par­ty that was meant to sig­nal an end to any ten­den­cies asso­ci­at­ed with the West (e.g., Neo­re­al­ism) and led to the ban­ning of numer­ous films and books—there was lit­tle space for find­ing “artis­tic truth” like Warneke imag­ined it.[6] Hard­ly sur­pris­ing, then, that the direc­tor only began to explore this cre­do in his tril­o­gy of the ear­ly 1970s—Dr. med. Som­mer II (MD Som­mer II, 1970), Es ist eine alte Geschichte (It’s an Old Sto­ry, 1972), and Leben mit Uwe (Life with Uwe, 1973)—and then much more explic­it­ly with Die Beun­ruhi­gung in 1982.[7]

In Die Beun­ruhi­gung, more than his oth­er films, Warneke strived to attain “the great­est pos­si­ble authen­tic­i­ty in pre­sent­ing the fig­ures and their liv­ing space and con­di­tions ” (qtd. in Richter 92). He insist­ed on using black-and-white film stock in sup­port of a greater sense of real­ism and truth­ful­ness, and on engag­ing Thomas Plen­ert, a young cam­era­man who had nev­er before shot a fea­ture film but was well-versed in film­ing doc­u­men­taries (Harhausen 111; Richter 90-98; Dieter Wolf 136-38). Warneke adamant­ly defend­ed his idea to devel­op each scene at orig­i­nal loca­tions and in dia­logue with all par­ties involved. The locales includ­ed the Berlin Char­ité hos­pi­tal, Inge’s work­place in the Depart­ment of Health and Wel­fare, and screen­writer Hel­ga Schubert’s apart­ment, which serves as Inge Herold’s home in the film. Schu­bert was will­ing to accept rad­i­cal revi­sions to her script pro­vid­ed Warneke respect­ed the basic spir­it of her sto­ry. She also sup­port­ed his desire to work with non-pro­fes­sion­al actors, par­tic­u­lar­ly for those char­ac­ters direct­ly linked to the top­ic of can­cer and health­care. These authen­tic voic­es include an elder­ly lady diag­nosed with breast can­cer whom Inge meets in the Charité’s wait­ing area; a young woman who tells the pro­tag­o­nist about her breast can­cer ther­a­py; and most impor­tant­ly Dr. Rösel­er, an actu­al Char­ité physi­cian who exam­ines Inge and informs her about the nec­es­sary surgery.

Despite Warneke’s strug­gle for max­i­mum authen­tic­i­ty and the well-estab­lished fact that in the GDR fic­tion served the func­tion of dis­cussing taboo issues in lieu of a demo­c­ra­t­ic press, we should not sim­ply take Die Beun­ruhi­gung as the only evi­dence for quo­tid­i­an life as it was expe­ri­enced in the GDR. Still, this film in par­tic­u­lar is well worth exam­in­ing in the con­text of research on the state’s med­ical sys­tem since it can serve as one win­dow onto GDR soci­ety and the health­care pro­vid­ed. It reveals how the med­ical system—which viewed GDR cit­i­zens in gen­er­al and women in par­tic­u­lar as chil­dren too frail to han­dle issues of life and death—affects Inge Herold’s abil­i­ty to deal with her ill­ness and mod­els how she comes to claim agency in her fight against breast can­cer.[8]

 

Fictional Representations of the GDR Medical System

An intel­li­gent and well-edu­cat­ed woman in her late thir­ties, the psy­chol­o­gist Inge Herold works as a mar­riage coun­selor for the Depart­ment of Health and Wel­fare. A sin­gle moth­er, she has a trust­ing if not always easy rela­tion­ship with her teenage son Mike, who dis­ap­proves of Joachim (played by Wil­fried Puch­er), the mar­ried man with whom Inge is hav­ing an affair. When she learns of her poten­tial breast can­cer and the need to under­go a biop­sy and pos­si­bly also breast surgery the next day, she fears the biop­sy that may con­firm the pres­ence of can­cer and pos­si­bly include a mas­tec­to­my. The fol­low­ing 24 hours under psy­cho­log­i­cal stress prompt her to reflect on her life and to see the deci­sions she has made in a clear­er light: she seeks out her son, who proves to be a source of encour­age­ment, breaks up with Joachim, who turns out to be unsup­port­ive when Inge needs him most, and dis­cov­ers a new con­fi­dant in Dieter Schramm, a high-school friend and sin­gle father. Despite the con­stant appre­hen­sion due to her ill­ness, she musters up the ener­gy to start her life anew.

This con­fi­dent if not entire­ly euphor­ic out­come cor­re­sponds with Inge’s char­ac­ter: like most female pro­tag­o­nists in DEFA’s 1970s and 1980s All­t­ags­filme, she is a strong woman who asserts her inde­pen­dence as an indi­vid­ual against social norms and does not com­pro­mise her ide­al of a rec­i­p­ro­cat­ed roman­tic rela­tion­ship.[9] Her resis­tance to soci­etal stan­dards sur­faces par­tic­u­lar­ly vis-à-vis Katha­ri­na (played by Wal­friede Schmitt), a for­mer class­mate and judge who leads a mod­el social­ist life as a mar­ried woman with two chil­dren, an apart­ment, a car, and an active social and polit­i­cal life. Faced with both Katha­ri­na as well as Inge’s dis­ap­prov­ing moth­er (played by Traute Sense), Inge insists that she is hap­pi­ly divorced and active­ly seeks a new part­ner when Joachim proves inad­e­quate.

Giv­en her strength in these sit­u­a­tions as well as her con­fi­dence when she deals with co-work­ers and clients in the Depart­ment of Health and Wel­fare, it is all the more remark­able that the patient Inge Herold does not stand up to the med­ical insti­tu­tion. In one of the film’s most sig­nif­i­cant scenes, the Char­ité physi­cian Dr. Rösel­er informs Inge about the poten­tial­ly malig­nant lump they found in her breast.

In the after­word to the script, Eri­ka Richter draws atten­tion to the remark­able authen­tic­i­ty of this dia­logue: the physi­cian “per­forms” a role that con­forms to his rou­tine busi­ness, includ­ing his attempt to calm down Inge, while the actress “to a cer­tain extent field­ed real cues from her part­ner, cues that a pro­fes­sion­al actor could hard­ly have pro­vid­ed, and she respond­ed with great aplomb to these cues, with no trace of stagi­ness” (Richter 96). In oth­er words, Inge per­forms the reac­tion to be expect­ed from a patient in the Berlin Char­ité in 1982: she does not ques­tion Dr. Röseler’s pro­posed ther­a­py, which com­mences with an oper­a­tion the next day.

As a par­tic­i­pant in the health­care sys­tem, Inge is fun­da­men­tal­ly aware of her posi­tion in the ther­a­peu­tic process as deter­mined by the frame­work of GDR law, which denied patients the sov­er­eign­ty to refuse treat­ment plans pro­posed by doc­tors. The GDR-spe­cif­ic doc­tor-patient rela­tion­ship, in which there was no legal con­tract between a patient and a doc­tor, meant that the respon­si­bil­i­ty for a pre­scribed ther­a­py rest­ed exclu­sive­ly with the physi­cian. Susanne Hahn draws atten­tion to the fun­da­men­tal dif­fer­ence between the East Ger­man med­ical-care rela­tion­ship, the so-called Betreu­ungsver­hält­nis, and legal prac­tice in the Fed­er­al Repub­lic of Ger­many (FRG): “While in the FRG a med­ical inter­ven­tion has been con­sid­ered an inflic­tion of bod­i­ly harm in crim­i­nal law, which can only be sus­pend­ed by means of a patient’s con­sent, a med­ical inter­ven­tion deemed nec­es­sary and car­ried out accord­ing to stan­dard prac­tice was, as a mat­ter of prin­ci­ple, con­sid­ered ther­a­py in the GDR” (75).[10] Accord­ing­ly, with­in the social­ist doc­tor-patient rela­tion­ship, the physi­cian was not required to jus­ti­fy a pro­posed treat­ment or to tell the patient about the true out­come of an exam­i­na­tion. Ulrich Lohmann points out that if doc­tors con­sid­ered a patient unable to come to an “appro­pri­ate deci­sion,” they could even “decide on med­ical mea­sures against the patient’s will” (222). At the same time, patients were legal­ly oblig­at­ed to coop­er­ate and active­ly sup­port the ther­a­py admin­is­tered due to the so-called Mitwirkungspflicht. As Ulrike Seifert explains, this oblig­a­tion was sup­ple­ment­ed by manda­to­ry dis­clo­sure of any aspect of the con­cerned person’s life that might impinge on the ther­a­py, the so-called Offen­barungs- und Infor­ma­tion­spflicht, and the legal com­pul­sion to endure any med­ical mea­sures and any doctor’s direc­tions, named Dul­dungs- und Befol­gungspflicht (271-74).

In this respect, the prox­im­i­ty of Warneke’s 1982 film to Christa Wolf’s nov­els Nach­denken über Christa T. (The Quest for Christa T., 1968) and Leib­haftig (In the Flesh, 2002) is note­wor­thy, par­tic­u­lar­ly since these three fic­tion­al texts were con­ceived at quite dif­fer­ent points in his­to­ry and por­tray GDR hos­pi­tals in dif­fer­ent decades. While Nach­denken über Christa T. focus­es pri­mar­i­ly on the 1950s and ear­ly 1960s, Die Beun­ruhi­gung por­trays the sit­u­a­tion in the ear­ly 1980s and Leib­haftig—look­ing back from the ear­ly-21st century—in the late 1980s. In oth­er words, Nach­denken über Christa T. was writ­ten before the new frame­work agree­ment for hos­pi­tals, the so-called Rah­men-Kranken­hau­sor­d­nung (RKO) of 1979, went into effect, while the oth­er two texts por­tray the sit­u­a­tion after this doc­u­ment was pub­lished. The RKO grant­ed patients the indi­vid­ual right to diag­nos­tic and ther­a­peu­tic elu­ci­da­tion. Ref­er­enc­ing the new law, Lohmann argues that patients now were enti­tled to be informed about their state of health, the moti­va­tion and aim of intend­ed med­ical mea­sures, and the neces­si­ty and poten­tial con­se­quences of med­ical inter­ven­tions and med­ica­tion. Yet GDR lawyers quick­ly point­ed out that, based on the stand­ing GDR-spe­cif­ic doc­tor-patient rela­tion­ship, physi­cians alone retained the pow­er to decide on the con­tent and extent of infor­ma­tion about the patient’s state of health and the man­ner in which it was to be passed on.[11] In oth­er words, law­mak­ers were obvi­ous­ly aware of the intri­ca­cies implied in the legal impli­ca­tions of the doc­tor-patient rela­tion­ship, yet the lack of patient auton­o­my was nev­er effec­tive­ly dimin­ished dur­ing the 40 years of GDR med­i­cine. Accord­ing­ly, Christa T. and the name­less pro­tag­o­nist admit­ted to a hos­pi­tal in the late 1980s por­trayed in Leib­haftig are, like Inge in Die Beun­ruhi­gung, sub­ject­ed to care in a clin­ic and oblig­at­ed to adjust to the rules of an insti­tu­tion that offers no alter­na­tives to the pre­scribed treat­ment. All three texts crit­i­cize the pow­er rela­tions in dis­cours­es sur­round­ing legal and med­ical insti­tu­tions. In par­tic­u­lar, Wolf’s patient in the 2002 nov­el is acute­ly aware of the mech­a­nisms that exact her obe­di­ence (37-38). When the head physi­cian thanks her for her excel­lent coop­er­a­tion, she even feels oblig­ed to reas­sure the pro­fes­sor of his accom­plish­ments (117, 156). Cor­re­spond­ing to GDR law, Leib­haftig por­trays a pro­tag­o­nist required not only to endure but also to par­tic­i­pate in the physi­cians’ pre­scribed ther­a­py, even though she expe­ri­ences it as vio­lent injury and for the longest time does not seem to believe in its suc­cess. In the lat­ter respect, she dif­fers sig­nif­i­cant­ly from both Christa T. and Inge, who clear­ly believe in the progress of social­ist med­i­cine.[12]

Nach­denken über Christa T. informs us that the pro­tag­o­nist knows “that before long peo­ple won’t still be dying of this dis­ease.”[13] Thus, she fore­shad­ows an end of all suf­fer­ing for com­ing gen­er­a­tions. While Die Beun­ruhi­gung is less cer­tain in pre­dict­ing Inge’s chances to sur­vive can­cer, it starts and ends on a decid­ed­ly pos­i­tive note. On the day of one of her sub­se­quent semi­an­nu­al can­cer check-ups, we ini­tial­ly see her in bed with Dieter and short­ly after­wards step­ping in the show­er. In this scene, for which Hel­ga Schubert’s script advis­es that Inge treats her body nat­u­ral­ly and with­out self-pity, she reveals to the view­ers that she only has one breast (12). The sce­nario then jumps back three years to show Inge with Joachim and with both breasts. The audi­ence is there­fore aware that can­cer plays a key role in this film, but since the pro­tag­o­nist is rather optimistic—she stress­es at the end that she has sur­vived the first three years after the surgery and that future can­cer check-ups will be sched­uled annually—the film offers rather good prospects for Inge to be cured.[14]

In fact, the char­ac­ters’ belief in the progress of social­ist med­i­cine is sup­port­ed by med­ical-his­tor­i­cal research that shows the extent to which GDR med­i­cine had improved since the 1950s. From 1978 to 1982, the year Die Beun­ruhi­gung was released, the cen­tral­ized and free health­care sys­tem became more suc­cess­ful in com­bat­ing can­cer than most West­ern Euro­pean coun­tries, includ­ing the FRG, as a vari­ety of inter­na­tion­al stud­ies cit­ed by Gün­ter Baust (117) and Stephan Tan­neberg­er (52-53) dis­close. At least to some extent, this achieve­ment needs to be con­sid­ered one of the pos­i­tive effects of the GDR’s Betreu­ungsver­hält­nis and the patient’s Mitwirkungspflicht. Citizens—physicians and patients alike—were expect­ed to com­mit to the advance­ment of social­ism. There­fore, it was incum­bent upon patients to coop­er­ate in any mea­sure that would advance not only their indi­vid­ual health but also the health of the com­mu­ni­ty. In fact, the two were—in anal­o­gy to per­son­al and soci­etal interests—considered one enti­ty, as Seifert (353) and Gün­ther (“Arztrecht” 89) high­light. Accord­ing­ly, patients had to par­tic­i­pate in any mea­sure sup­port­ing com­mu­ni­ty health, such as vac­ci­na­tion cam­paigns and pre­ven­ta­tive med­ical screen­ings. The cen­tral­ized approach proved very effec­tive and most suc­cess­ful in health­care tech­nol­o­gy assess­ment and in com­bat­ing can­cer. The GDR estab­lished a World Health Orga­ni­za­tion-cer­ti­fied Com­pre­hen­sive Can­cer Cen­ter, which posi­tioned the social­ist state as an inter­na­tion­al leader in can­cer pre­ven­tion, but which was, as Tan­neberg­er laments, dis­man­tled in the uni­fi­ca­tion process (52-55).

On the down­side, these mea­sures did, of course, imply state con­trol, which extend­ed to fields tan­gen­tial­ly relat­ed to the med­ical sphere. Since the pro­tec­tion of indi­vid­u­als’ health was an effort of soci­ety at large, pow­er exer­cised in health­care was tight­ly linked with the judi­cial sys­tem and social wel­fare, and often also includ­ed the sup­port received from a work­ing person’s employ­ment col­lec­tive (Lohmann 223; Seifert 61-62, 64, 305; Gün­ther “Arztrecht” 90). As GDR lawyer Karl-Heinz Christoph explained in 1980: “Fun­da­men­tal­ly, the health­care facil­i­ties ful­fill their mis­sion with­in the frame­work of a spe­cif­ic legal rela­tion­ship with the cit­i­zens for whom they care. A deci­sive fea­ture of the health­care facil­i­ties con­sists in the fact that they not only ful­fill their mis­sion towards the cit­i­zen, but also per­form mea­sures of med­ical and social care on the cit­i­zen” (42-43). Christoph high­lights the patient’s enforced pas­siv­i­ty in GDR law and in med­ical prac­tice: some­thing is done on and to a citizen’s body that is to be under­stood as both med­ical and social rem­e­dy. Since doc­tors were sworn to take respon­si­bil­i­ty pro­fes­sion­al­ly, polit­i­cal­ly, and as mem­bers of social­ist soci­ety, patients were required to accept their physi­cians’ pro­posed treat­ments as the best option for their indi­vid­ual health and, more impor­tant­ly, for the health of the social­ist com­mu­ni­ty. Even the physician’s for­mal oblig­a­tion to inform patients about the pro­posed ther­a­py (Aufk­lärungspflicht) and to seek con­sent could be bypassed with­out legal con­se­quences for the doc­tor (Berndt and Hüller 45; Seifert 162; Gün­ther, “Patien­ten­schutz” 167). A patient’s fail­ure to coop­er­ate could, by the 1970s, have seri­ous legal con­se­quences, e.g., con­cern­ing labour law and rights to social secu­ri­ty, and cause a patient’s doc­tor to ini­ti­ate edu­ca­tion­al reform mea­sures (Seifert 301). Patients’ bod­ies become sub­ject to the state and its legal and med­ical sys­tem in the doc­tors’ deci­sions about the cit­i­zens’ bod­ies, even if the patient expe­ri­ences the exe­cu­tion of a ther­a­py as vio­lent. Giv­en the legal sit­u­a­tion, cit­i­zens’ bod­ies became sub­ject to one body politic, not only metaphor­i­cal­ly speak­ing. Yet while pro­tect­ing one’s health ceased to be a pri­vate mat­ter, and notions of indi­vid­ual choice and doc­tor-patient con­fi­den­tial­i­ty were con­sid­ered sec­ondary to the health of the entire pop­u­la­tion, the indi­vid­ual ben­e­fit­ted from the over­all suc­cess of pre­ven­tive care—an aspect under­lined by Dr. Rösel­er in Die Beun­ruhi­gung when he tells Inge that they are deter­mined to catch any malig­nan­cies as ear­ly as pos­si­ble.

One char­ac­ter briefly por­trayed in Die Beun­ruhi­gung who does not ben­e­fit from can­cer pre­ven­tion but rather from social­ist med­i­cine is the young woman Inge meets imme­di­ate­ly after she received her inter­im diag­no­sis and learns of her immi­nent surgery. Bär­bel Loeper, around five years younger than Inge and one of the non-pro­fes­sion­al actors, tells her own sto­ry: she is a can­cer patient per­form­ing the role of a can­cer patient.

Bär­bel is devot­ed to telling Inge her sto­ry meant as encour­age­ment. Even though she only received radi­a­tion ther­a­py because her case was too advanced for surgery and she was in dan­ger of los­ing her then-unborn child, Bär­bel did not despair. As the appar­ent­ly hap­py eight-year-old daugh­ter is then shown pick­ing up her moth­er from the hos­pi­tal, the film accen­tu­ates the con­fi­dence that social­ist med­i­cine will suc­ceed in com­bat­ing can­cer. As if Christa T.’s 1960s claim that soon nobody would die of can­cer any longer has come true, Bär­bel assures can­cer patients in the 1980s that they too can be opti­mistic. Inge Herold, how­ev­er, rejects that kind of opti­mism and turns away—a sig­nif­i­cant point to which I will return.

The Significance of Generation

In this con­text it is cru­cial to note that Bär­bel Loeper, Chris­tine Schorn, the char­ac­ter she plays (Inge Herold), as well as her antag­o­nist (Katha­ri­na), scriptwriter Hel­ga Schu­bert, and direc­tor Lothar Warneke all belong to the same gen­er­a­tion, name­ly the first post­war and post-Hitler Youth gen­er­a­tion. In “Vom Szenar­i­um zum Film,” Eri­ka Richter points to this aspect sev­er­al times:

From the inter­ac­tion among the actors ensues a plau­si­ble image of this gen­er­a­tion that nev­er had to say ‘Heil Hitler!’ in school […], that could freely decide in favor of cap­i­tal­ism or social­ism. Maybe they are influ­enced more by the soci­etal devel­op­ments of our coun­try than they them­selves influ­enced these devel­op­ments. Hel­ga Schu­bert does not show out­stand­ing pro­tag­o­nists of the soci­etal devel­op­ments. But it is evi­dent that in places where things are actu­al­ly done, […] the rep­re­sen­ta­tives of this gen­er­a­tion work inde­pen­dent­ly. (94)

In con­trast to Christa T.’s cohort—that of Christa Wolf her­self and oth­er so-called 1929ers who expe­ri­enced Nation­al Social­ism and World War II as chil­dren and ado­les­cents[15]—this first post­war gen­er­a­tion was raised free of direct fas­cist con­t­a­m­i­na­tion. Unques­tion­ably respect­ing those who had risked their lives in the fight against fascism—which nat­u­ral­ly includ­ed those who rep­re­sent­ed the GDR at its very top—they grew up with high expec­ta­tions for a social­ist future and sided with social­ism. In the film, the dif­fer­ence between social­ism and cap­i­tal­ism boils down to the ques­tion of hap­pi­ness: when Inge meets her for­mer high-school friend Brigitte (played by Cox Habbe­ma), who now lives in West Berlin, the major dis­crep­an­cy between the two women emerges in their expec­ta­tions for the future. Caught in the cap­i­tal­ist rat race, Brigitte can­not enjoy mate­r­i­al com­forts such as her new BMW. While she seems to look for­ward to her vaca­tion in France, she dis­miss­es any chance for hap­pi­ness and fam­i­ly life and is fix­at­ed on her well-pay­ing job. Inge, on the oth­er hand, focus­es on her desire for inde­pen­dence and a ful­fill­ing rela­tion­ship. For this first GDR gen­er­a­tion, the free­dom to trav­el that Brigitte enjoys can­not make up for the ben­e­fits of social­ism, such as secure jobs that come with­out mer­ci­less com­pe­ti­tion.[16] Like the oth­er rep­re­sen­ta­tives of her cohort in Die Beun­ruhi­gung, Inge is no social­ist hero­ine, but one of the “pret­ty aver­age rep­re­sen­ta­tives of this gen­er­a­tion,” as Richter puts it, who ben­e­fit­ted from the edu­ca­tion­al reforms that allowed for access to high­er edu­ca­tion for those groups who had pre­vi­ous­ly been exclud­ed (94). These peo­ple were, as Dorothee Wier­ling explains, “encour­aged […] to iden­ti­fy with the state and think of them­selves as a bio­graph­i­cal project, as part of build­ing a utopi­an future com­bin­ing tech­no­log­i­cal with social progress” (209). Their mis­sion was, as Wier­ling con­tin­ues, “a spe­cif­ic ‘mis­sion to hap­pi­ness’” (209, which brings us back to Bär­bel Loeper, the can­cer patient set on giv­ing Inge con­fi­dence in her heal­ing prospects.

More than a nice and car­ing human being, Bär­bel Loeper sur­faces as a mod­el social­ist of the post­war gen­er­a­tion. As Udo Grashoff reminds us, the main char­ac­ter­is­tics that dis­tin­guish the social­ist per­son­al­i­ty are opti­mism, health, and the “capa­bil­i­ty to con­scious­ly effect the envi­ron­ment and to alter both this envi­ron­ment and one­self accord­ing to one’s own ideas and goals (84).[17] Bär­bel makes up for per­fect health by fight­ing can­cer, adopt­ing a pos­i­tive atti­tude towards life, attempt­ing to mod­i­fy her envi­ron­ment accord­ing to her social­ist goals––and doing her best to influ­ence Inge to do the same. Med­ical insti­tu­tions were assigned a promi­nent role in in edu­cat­ing patients to embody the ide­al of the pos­i­tive social­ist cit­i­zen who ensures pro­duc­tiv­i­ty and vital­i­ty for the tri­umph of social­ism. Hence, patients such as Bär­bel and Inge have to believe in regain­ing their health. To achieve this goal, Bär­bel even sup­ports Dr. Rösel­er in his role of Inge’s educator—a role that exceeds the realm of the physi­cian and explic­it­ly includes ide­o­log­i­cal edu­ca­tion (Seifert 38-40, 355). Based on the belief that at least some patients devel­oped organ­ic ill­ness from ide­o­log­i­cal insta­bil­i­ty, GDR med­ical spe­cial­ists and pol­i­cy demand­ed that ter­mi­nal­ly ill patients, in par­tic­u­lar, should be treat­ed with­in an ide­o­log­i­cal and eth­i­cal frame­work based on Marx­ist-Lenin­ist phi­los­o­phy and the ide­ol­o­gy of work­ing-class progress (Kirchgäßn­er 25; Löther 14). The under­ly­ing idea that a sick, mal­func­tion­ing body indi­cates ide­o­log­i­cal unre­li­a­bil­i­ty also sur­faces in Hel­ga Schubert’s film script when Inge, reflect­ing on the three years since her surgery, mulls over the physi­cians’ moti­va­tion for the repeat­ed check-ups and con­cludes: “And it some­how also makes you feel safe that they do it so thor­ough­ly. But deep inside you think: so they sup­pose that some­where in your body, some­thing grows per­fid­i­ous­ly, or it could grow. That they do not trust your body any­more” (84). When Inge con­tem­plates the med­ical personnel’s atti­tude towards her dis­eased body, she reveals that her ill­ness is asso­ci­at­ed with per­fid­i­ous results in a body which—like an unre­li­able comrade—cannot be trust­ed any longer. Con­verse­ly, that her body no longer dis­plays can­cer­ous traces indi­cates the suc­cess­ful treatment—both on the lev­el of the body and ide­ol­o­gy. To achieve this goal, the legal sys­tem empha­sized physi­cians’ oblig­a­tions to ele­vate patients’ hope and opti­mism by con­vinc­ing them that their treat­ment was work­ing, even in cas­es of ter­mi­nal ill­ness (Seifert 168). Since the “social­ist per­son­al­i­ty” believes in progress and is sup­pos­ed­ly strong and gen­er­al­ly opti­mistic, the very exis­tence of incur­able dis­eases was denied, even in schol­ar­ly pub­li­ca­tions. Patients could poten­tial­ly be described as “cur­rent­ly not cur­able” (“zur Zeit nicht heil­bar”) or “on the basis of cur­rent knowl­edge incur­able” (“auf der Grund­lage der derzeit erre­icht­en Erken­nt­nisse unheil­bar”), but the notion that—also in the long run—any dis­ease could be incur­able was not to be voiced (Bet­tin and Gade­busch Bon­dio 10-11).[18]

The Gentle Lie

This approach to med­i­cine explains both Bärbel’s desire to cheer up Inge and Inge’s wish to be left alone, as expressed in her body lan­guage when she gives Bär­bel the cold shoul­der. As a par­tic­i­pant in the med­ical sys­tem, Inge is aware of these poli­cies. She knows that doc­tors and nurs­es are like­ly to lie to both women regard­ing their state of health and is clear­ly opposed to such prac­tices. In the GDR, med­ical per­son­nel were not oblig­ed to dis­close the truth about the con­di­tion of ail­ing patients, and it was com­mon prac­tice to dis­cuss the sta­tus of the dis­ease only with close fam­i­ly mem­bers and not with the patient. Par­tic­u­lar­ly in cas­es of adverse prog­no­sis, rep­re­sen­ta­tives of the med­ical and the legal sys­tems embraced the pre­vail­ing prac­tice of con­ceal­ing the hope­less sit­u­a­tion and the prospect of death. Until the very end of the GDR, physi­cians pos­sessed the legal right—and were in most cas­es encouraged—not to dis­close the truth about neg­a­tive prog­noses. Instead, they were to employ what was offi­cial­ly termed the scho­nende Lüge (gen­tle lie): using appro­pri­ate word­ing and an incom­plete descrip­tion to delib­er­ate­ly keep patients in the dark in cas­es of unfa­vor­able prog­no­sis (Seifert 173-78).[19]

In Die Beun­ruhi­gung, the audi­ence becomes privy to a dis­cus­sion about this prac­tice before Inge leaves her work­place for the Char­ité, hop­ing to learn about her own state of health. On her way out, she encoun­ters one of her col­leagues who refus­es to inform his patient about the diag­no­sis of can­cer. Pres­sured by Inge, he explains that he does not want to be held respon­si­ble for the patient los­ing hope and choos­ing to com­mit sui­cide. Inge, how­ev­er, insists on an in-depth dis­cus­sion at a lat­er point, even though she must have been aware that the law was on her colleague’s side and favored unknow­ing, pas­sive patients who were to be treat­ed under the assump­tion that indi­vid­ual desires could be rec­on­ciled with the inter­ests of soci­ety (Seifert 351-52).

While in the scene Inge ques­tions the prac­tice of the gen­tle lie in her role as psy­chol­o­gist, she also lat­er rais­es the issue in her role as patient. After she wait­ed for her part­ner Joachim dur­ing the long, lone­ly night pre­ced­ing her surgery, she informs him when he final­ly arrives in the ear­ly morn­ing hours: “In an hour, I must go to hos­pi­tal, and then you must take me because they said they would tell the per­son who takes me the truth. Yes, that per­son they will tell the truth. And only that per­son they will tell the truth. And they will tell that per­son the truth, and I do not know the truth.”[20]

This cru­cial film scene show­cas­es patients’ help­less­ness vis-à-vis the prac­tice of the gen­tle lie. We have rea­son to believe that Hel­ga Schu­bert incor­po­rat­ed her own expe­ri­ences as a seri­ous­ly ill patient here (Richter 88), akin to writer Max­ie Wan­der, who relates her expe­ri­ences of doc­tors lying to her about breast can­cer in the Char­ité and in the famous Berlin-Buch clin­ic in the 1970s of doc­tors. In her posthu­mous­ly pub­lished vol­ume of diary entries and let­ters, Leben wär’ eine pri­ma Alter­na­tive (Life Would Be a Great Alter­na­tive, 1979), she shares how she acci­dent­ly found out about her con­di­tion when friends and fam­i­ly had known about it for sev­er­al months already (25, 29-30, 60, 271). In a let­ter to Christa Wolf from Jan­u­ary 1969 pub­lished in Sei gegrüßt und lebe (Be Greet­ed and Live), Brigitte Reimann sim­i­lar­ly reveals her stu­pe­fac­tion upon learn­ing that a famous Char­ité physi­cian had lied to her about her ill­ness. Look­ing back at that moment, Reimann expos­es the lie as “worse than the truth, the entire affair, the clin­ic, surgery and so on” (Reimann and Wolf 48).  She clear­ly artic­u­lates that this prac­tice of with­hold­ing knowl­edge about one’s well-being did not, as Ulrich Lohmann points out sim­i­lar­ly, serve to add to the patient’s “feel­ing of secu­ri­ty” and “dignity”—two goals the so-called Rah­men-Kranken­hau­sor­d­nung (RKO) of 1979 had intend­ed to achieve (221). As Reimann’s let­ters reveal, the con­tin­ued lies by med­ical per­son­nel as well as friends and fam­i­ly caused increas­ing anx­i­ety over the course of the next years dur­ing which the writer suf­fered ter­ri­bly. By May 1970, the high radi­a­tion lev­els she received made her sus­pect that once again the physi­cians were not telling her the truth and that “real­ly, she has can­cer or a sim­i­lar hor­rid­ness” (Reimann and Wolf 121). In fact, the doc­tors’ tall tales con­tin­ued. In Decem­ber of the same year, Reimann acci­den­tal­ly over­heard them dis­cussing her case and thus learned that her can­cer had spread to her dor­sal ver­te­bra. Her hus­band had known about this ter­ri­ble devel­op­ment since March but had remained silent (Reimann and Wolf 184-85). In fact, Christa Wolf’s diary entries from 1971 dis­close that her knowl­edge about her friend’s ill­ness exceed­ed that of the patient because at least one of the attend­ing physi­cians revealed the actu­al diag­no­sis and prog­no­sis to Wolf—but not to the sick Brigitte Reimann.[21]

The gen­tle lie occu­pied Christa Wolf all her life, and she repeat­ed­ly brought up the issue in her oeu­vre. Start­ing with Christa T., who over­hears the doc­tors dis­cussing her ill­ness and sub­se­quent­ly insists on know­ing the truth—“Is it that, doc­tor? Tell me the truth, I want to know the truth” (Wolf, Nach­denken 174)—she por­trays char­ac­ters who suf­fer from being left in the dark about their state of health. Thus, she explic­it­ly raised a cru­cial issue and con­tributed to soci­etal dis­cus­sions already in the late 1960s. Not until the mid 1970s did some lawyers, the­olo­gians, and philoso­phers who were opposed to the prac­tice of the gen­tle lie come for­ward with their views. In 1974, Pro­fes­sor Berndt on the oth­er hand voiced his con­cern that patients’ grow­ing lev­el of knowl­edge could lead to a sit­u­a­tion in the future in which a doc­tor might be com­pelled to tell patients the whole truth (4). Yet for years to come, patients were declared incom­pe­tent when it came to man­ag­ing the health of their own bod­ies, and the pre­vail­ing opin­ion in the med­ical and the legal realm sup­port­ed the prac­tice, as med­ical ethics spe­cial­ist Müller’s insis­tence on the gen­tle lie demon­strates: “even if patients repeat­ed­ly […] ask and want to hear the whole truth, even if it should mean death, they real­ly do not want to know it and hope for an opti­mistic and com­fort­ing answer from their physi­cian” (100).[22] What emerges here is the firm belief not only in social­ist opti­mism but also in treat­ing patients like chil­dren because they are deemed inca­pable of deal­ing with the real­i­ties of life and death.

In Wolf’s 2002 ret­ro­spec­tive nov­el Leib­haftig, she por­trays the gen­tle lie as an ongo­ing prac­tice of turn­ing patients into pas­sive objects inca­pable of influ­enc­ing their own ther­a­py in the GDR of the late 1980s. The nov­el stages the physi­cians’ norm of dis­cussing a patient’s life-threat­en­ing con­di­tion exclu­sive­ly with her rel­a­tives. Ini­tial­ly, the patient is hard­ly sur­prised to learn that her hus­band speaks furtive­ly with the doc­tors (16). When she dis­cov­ers lat­er that he knew about her immi­nent oper­a­tion before she was her­self informed—because he had dis­cussed her ther­a­py with the surgeon—she is alert­ed to the seri­ous­ness of her ill­ness (50). The patient, aware of the con­ver­sa­tions but not of their con­tent, accepts the dai­ly clan­des­tine meet­ings her spouse has with the chief sur­geon (77, 103, 119). Even when she has recov­ered at the end of the nov­el, the pro­tag­o­nist sus­pects con­tin­ued pri­vate con­fer­ences based on the evi­dence that her hus­band hap­pened to encounter the physi­cian in the cor­ri­dor (184).

Leib­haftig there­fore reveals that the strat­e­gy meant to sup­port heal­ing by not alarm­ing patients actu­al­ly increased anx­i­eties and con­tributed to doc­tor-patient rela­tion­ships lack­ing trust and deny­ing patients’ agency. Sim­i­lar­ly, Stadt der Engel oder The Over­coat of Dr. Freud (City of Angels, Or The Over­coat of Dr. Freud) con­veys how the protagonist’s friend Emma was forced to trick a nurse into reveal­ing her diag­no­sis of thy­roid can­cer so that she could arrange for her death as she saw fit (244). Absent the legal right to infor­ma­tion about her body and her health, Emma’s only recourse was to out­smart the med­ical staff. In the entry for 1988 in the auto­bi­o­graph­i­cal Ein Tag im Jahr (One Day a Year, 2003), Wolf revealed that the gen­tle lie pre­oc­cu­pied her after her hos­pi­tal­iza­tion in 1988. Here, she recounts that she heard a radio report in which a doc­tor insist­ed that one must not lie to can­cer patients (424). Wolf’s fic­tion­al por­tray­als of and reflec­tions about the gen­tle lie and its effects on patients con­firm those schol­ars and con­tem­po­rary wit­ness­es who assert that the gen­tle lie was prac­ticed in the GDR until its health­care sys­tem was dis­solved. Sim­i­lar­ly, a sym­po­sium on the top­ic of “Information—Truth—Security” that brought togeth­er pro­fes­sion­als involved in med­ical ethics in the GDR in Decem­ber 1988 indi­cates that in the very last years of the social­ist state there was final­ly pub­lic dis­cus­sion about the gen­tle lie, while also con­firm­ing it as com­mon prac­tice.[23]

The gen­tle lie exem­pli­fies a guardian state that wants to pro­tect its alleged­ly incom­pe­tent patients from unwel­come news. While sim­i­lar prac­tices might have exist­ed in the FRG as well, patient docil­i­ty and the gen­tle lie were nei­ther legal­ly defined nor pre­scribed by the state appa­ra­tus there. On the con­trary: since legal prac­tice in the FRG has always demand­ed a patient’s writ­ten con­sent for any med­ical inter­ven­tion, they could hard­ly be left in the dark about their state of health. While the gen­tle lie and the demand for patient cooperation—as enshrined in the Dul­dungs- und Befol­gungspflicht, the Mitwirkungspflicht, and the Offen­barungs- und Infor­ma­tion­spflicht—are indeed char­ac­ter­is­tic of the GDR med­ical and legal sys­tems, this does not imply that these prac­tices van­ished with the GDR. Indeed, Kathrin Schmidt’s Du stirb­st nicht high­lights the post-uni­fi­ca­tion con­ti­nu­ity of pro­ce­dures that lim­it a patient’s agency and com­pares ways of exer­cis­ing pow­er before and after 1990. The patient at the cen­ter of the nov­el, Helene Wesendahl—another psy­chol­o­gist trained in the GDR, just like the author Schmidt, the script writer Hel­ga Schu­bert, and the char­ac­ter Inge Herold in Die Beun­ruhi­gung—expe­ri­ences the pow­er struc­tures and rou­tines of two clin­ics and a rehab cen­ter as she recov­ers from a burst aneurysm. When she declines psy­chother­a­py in the hos­pi­tal and rejects con­traindi­cat­ed epilep­sy med­ica­tion, she is sub­ject­ed to the full force of the med­ical staff. Three doc­tors and two nurs­es assem­ble to inform her, “she was not allowed to do that. […] She had to. Back down. They bore the respon­si­bil­i­ty. Not Helene. What, I bear no respon­si­bil­i­ty?[24] Deny­ing her the right to take respon­si­bil­i­ty for her own body, the mem­bers of the med­ical pro­fes­sion team up against the patient and claim author­i­ty over her disease—behavior that appears bizarre, giv­en the legal sit­u­a­tion in unit­ed Ger­many. Instead of seek­ing a solu­tion in dia­logue, they expect the patient to “back down,” which clear­ly means that she is sup­posed to dis­re­gard her own inter­ests in favor of those expressed by the med­ical pro­fes­sion­als.

These doc­tors and nurs­es appear stuck in an atti­tude towards the patient that is rem­i­nis­cent of GDR law, in which both patients’ ill bod­ies and their behav­ior were to be treat­ed, indi­vid­u­als were sup­posed to be per­suad­ed to “back down” for the greater good, and pas­sive patients had to accept the pro­posed ther­a­py. In oth­er words, cer­tain aspects of GDR med­i­cine seem to live on; Hart­mut Bet­tin and Mari­acar­la Gade­busch Bon­dio explain:

We can assume exten­sive con­ti­nu­ities with regards to staff. […] That means that many who work and research in […] med­ical insti­tu­tions were born, social­ized, and in many cas­es received their aca­d­e­m­ic edu­ca­tion in the GDR. As stu­dents of med­i­cine, physi­cians, […] and nurs­es they worked in GDR med­ical insti­tu­tions, gained expe­ri­ences there, and were shaped in cer­tain ways. (7)

Med­ical-his­tor­i­cal research main­tains that due to obvi­ous con­ti­nu­ities among med­ical staff, behav­ior and eth­i­cal atti­tudes that were spe­cif­ic to the GDR and social­ist med­i­cine per­sist. In oth­er words, while the polit­i­cal state ceased to exist, its cit­i­zens inevitably per­pet­u­ate its prac­tices and norms. Du stirb­st nicht address­es this top­ic repeat­ed­ly by ref­er­enc­ing the GDR’s Dul­dungs- und Befol­gungspflicht—an “oblig­a­tion” the med­ical per­son­nel in Schmidt’s nov­el expect to be ful­filled by Helene and against which the patient rebels.

Lin­ger­ing GDR prac­tices also sur­face in the patient’s alleged oblig­a­tion to coop­er­ate with ther­a­py. In the nov­el, this extends to the reports the hos­pi­tal sends to the rehab cen­ter. They are not lim­it­ed to infor­ma­tion per­tain­ing to the patient’s med­ical sit­u­a­tion, but also assess her per­son­al­i­ty and will­ing­ness to accept the ther­a­py whose suc­cess­ful out­come is con­tin­gent upon her coop­er­a­tion and for which she is held liable. The speech ther­a­pist, for exam­ple, claims that the patient “proved to be a non-coop­er­a­tive patient […] The physiotherapist’s report, how­ev­er, says very coop­er­a­tive” (Schmidt 136-37; ital­ics in orig­i­nal). Employ­ing lan­guage that is char­ac­ter­is­tic of the GDR med­ical sys­tem, both reports explic­it­ly eval­u­ate the patient’s incli­na­tion to coop­er­ate. By ital­i­ciz­ing the rel­e­vant words in the text, Du stirb­st nicht draws atten­tion to what Christa Wolf sim­i­lar­ly con­veyed about her stay in the GDR hos­pi­tal in Leib­haftig and to what we wit­ness in Die Beun­ruhi­gung: the require­ment to par­tic­i­pate in ther­a­peu­tic mea­sures, even if the patient expe­ri­ences them as bru­tal, con­traindi­cat­ed, or futile.[25] While Du stirb­st nicht does not por­tray instances of the gen­tle lie, the med­ical per­son­nel unmis­tak­ably remind the woman of her so-called Mitwirkungs-, Dul­dungs- and Befol­gungspflicht—oblig­a­tions to coop­er­ate and endure that were part of GDR law but not con­tem­po­rary FRG law. The female pro­tag­o­nist can only escape such demands to col­lab­o­rate in painful and even con­traindi­cat­ed and poten­tial­ly dead­ly ther­a­peu­tic mea­sures with the sup­port of her hus­band. In fact, she even depends on his rejec­tion of the idea to sub­mit his wife to a guardian­ship pro­ce­dure, an idea brought for­ward by the med­ical staff to threat­en the patient (313-14). This inci­dent presents yet anoth­er sit­u­a­tion in which the health­care pro­fes­sion­als depict­ed in Schmidt’s nov­el engage in a practice—in Ulrich Lohmann’s terms, the “unex­plained, infor­mal inca­pac­i­ta­tion devoid of a lawyer by the col­lec­tive of physi­cians” (222)—that was com­mon­ly accept­ed in GDR hos­pi­tals.

Conclusion

Pub­lished 20 years after the fall of the Wall, Schmidt’s Du stirb­st nicht points to ongo­ing prac­tices in East­ern Ger­man hos­pi­tals that clear­ly have their roots in the GDR med­ical sys­tem. The med­ical personnel’s repeat­ed refusal to grant the pro­tag­o­nist sov­er­eign­ty over her own body and mind evokes insti­tu­tion­al and every­day prac­tices of patri­archy in GDR hos­pi­tals such as the ones we wit­nessed in the exam­ples of GDR fic­tion­al texts dis­cussed in this arti­cle. In the social­ist state, these cul­mi­nat­ed in the prac­tice of the gen­tle lie, which aimed to pro­tect patients in gen­er­al and women in par­tic­u­lar from harsh truths about their health. Whether such ten­den­cies will sur­vive in the next gen­er­a­tion, one trained entire­ly in post-uni­fi­ca­tion Ger­many, and emerge in fic­tion­al texts in the future remains to be seen.

While it is true that med­ical sys­tems tend to be hier­ar­chi­cal­ly struc­tured in most soci­eties, not least because exper­tise rests with the physi­cians, this is a phe­nom­e­non that will prob­a­bly pro­lif­er­ate with increas­ing spe­cial­iza­tion of med­ical experts in the years to come. Nonethe­less, it seems rather sur­pris­ing that in a social­ist state—one that declared itself to be a class­less soci­ety and offi­cial­ly guar­an­teed gen­der equality—these appar­ent­ly inher­ent dimen­sions of the heal­ing pro­fes­sion were nev­er seri­ous­ly ques­tioned. Fur­ther research that inves­ti­gates whether sim­i­lar prac­tices were com­mon in oth­er East­ern Euro­pean coun­tries under Sovi­et rule would be enlight­en­ing. In the GDR, sev­er­al reforms that aimed to flat­tened hier­ar­chies in hos­pi­tals, includ­ing by reduc­ing the salary dif­fer­en­tials between doc­tors and nurs­es, were indeed suc­cess­ful. The hier­ar­chi­cal rela­tion­ship between health­care pro­fes­sion­als and their patients, how­ev­er, was nev­er ques­tioned.[26] In fact, the suc­cess­es in the GDR’s pro­gres­sive pre­ven­tive care pro­grams depend­ed on hier­ar­chi­cal struc­tures that enforced the belief that one’s health could not be con­sid­ered a pri­vate mat­ter. Because notions of indi­vid­ual choice and doc­tor-patient con­fi­den­tial­i­ty were con­sid­ered sec­ondary to the health of the entire pop­u­la­tion, every­one had to par­tic­i­pate in mea­sures sup­port­ing com­mu­ni­ty health, such as vac­ci­na­tion cam­paigns and med­ical screen­ings, and indi­vid­u­als ben­e­fit­ted from the over­all suc­cess of pre­ven­tive care. Effec­tive­ly, the state’s atti­tude towards its citizens—deemed chil­dren unqual­i­fied to make deci­sions regard­ing seri­ous issues such as life and death—often did pro­tect patients. How­ev­er, the mind­set revealed in prac­tices such as the gen­tle lie and oth­er cus­toms deny­ing patients’ agency, in gen­er­al and for women in par­tic­u­lar, offers yet more evi­dence that East Ger­man social­ists’ claim of gen­der equal­i­ty was not achieved in key areas of women’s lives.

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Richter, Eri­ka. “Vom Szenar­i­um zum Film.” Schu­bert, pp. 87-101.

Rinke, Andrea. “From Mod­els to Mis­fits: Women in DEFA Films of the 1970s and 1980s.” DEFA: East Ger­man Cin­e­ma 1946-1992, edit­ed by Sean Allen and John Sand­ford, Berghahn, 1999, pp. 183-203.

Schieber, Elke. “Anfang vom Ende oder Kon­ti­nu­ität des Arg­wohns 1980 bis 1989.” Das zweite Leben der Film­stadt Babels­berg: DEFA-Spielflme 1946-1992, edit­ed by Film­mu­se­um Pots­dam, Hen­schel Ver­lag 1994, pp. 265-327.

Schleier­ma­ch­er, Sabine, and Udo Scha­gen. “Rekon­struk­tion und Inno­va­tion (1949–1961).” Die Char­ité: Geschichte(n) eines Kranken­haus­es, edit­ed by Johan­na Blek­er and Volk­er Hess, Akademie Ver­lag, 2010, pp. 204-42.

Schmidt, Kathrin. Du stirb­st nicht. Kiepen­heuer & Witsch, 2009.

Schu­bert, Hel­ga. Die Beun­ruhi­gung. Film­szenar­i­um. Mit einem Nach­wort von Eri­ka Richter, Hen­schelver­lag, 1982.

Seifert, Ulrike. Gesund­heit staatlich verord­net: Das Arzt-Patien­ten-Ver­hält­nis im Spiegel sozial­is­tis­chen Zivil­rechts­denkens in der DDR, Berlin­er Wis­senschafts-Ver­lag, 2009.

Sol­dovieri, Ste­fan. “Cen­sor­ship and the Law: The Case of Das Kan­inchen bin ich (I am the Rab­bit).” DEFA: East Ger­man Cin­e­ma, 1946-1992, edit­ed by Seán Allan and John Sand­fort, Berghahn 1999, pp. 146-63.

Stott, Rose­mary. “The State-Owned Cin­e­ma Indus­try and Its Audi­ence.” Re-Imag­in­ing DEFA, edit­ed by Seán Allan and Sebas­t­ian Hei­duschke, Berghahn 2016, pp. 19-40.

Tan­neberg­er, Stephan. “Ethik in der medi­zinis­chen Forschung der DDR.” Bet­tin and Gade­busch Bon­dio, pp. 40-62.

Wag­n­er, Linde. “Polik­liniken – ein gesund­heit­spoli­tis­ches Mod­ell.” Die DDR war anders: Eine kri­tis­che Würdi­gung ihrer sozialkul­turellen Ein­rich­tun­gen, edit­ed by Ste­fan Bollinger and Fritz Vil­mar, Das Neue Berlin, 2002, pp. 226-45.

Wan­der, Max­ie. Leben wär’ eine pri­ma Alter­na­tive: Tage­büch­er und Briefe, edit­ed by Fred Wan­der [1979]. Reprint, dtv, 1994.

Warneke, Lothar. “Der doku­mentare Spielfilm.” Filmwis­senschaftliche Mit­teilun­gen, Son­der­heft 1964.

Warneke, Lothar. Film ist eine Art zu Leben. Aus The­o­rie und Prax­is des Films, no. 3, edit­ed by Her­mann Her­ling­haus, Betrieb­sakademie der VEB DEFA Stu­dio für Spielfilme, 1983.

Wier­ling, Dorothee. “How Do the 1929ers and the 1949ers Dif­fer?” Pow­er and Soci­ety in the GDR, 1961–1979: The ‘Nor­mal­i­sa­tion of Rule’? edit­ed by Mary Ful­brook, Berghahn, 2009, pp, 204-19.

Wolf, Christa. Ein Tag im Jahr: 1960–2000. Luchter­hand, 2003. Trans­lat­ed by Low­ell A. Bangert­er as One Day a Year: 1960–2000. Europa Edi­tions, 2007.

Wolf, Christa. Leib­haftig. Luchter­hand, 2002. Trans­lat­ed by John S. Bar­rett as In the Flesh. Ver­ba Mundi/David R. Godine, 2005.

Wolf, Christa. Nach­denken über Christa T. [1968]. Reprint, dtv, 1993. Trans­lat­ed by Christo­pher Mid­dle­ton as The Quest for Christa T. Delta, 1970.

Wolf, Christa. Stadt der Engel oder The Over­coat of Dr. Freud, Suhrkamp, 2010. Trans­lat­ed by Damion Searls as City of Angels Or, The Over­coat Of Dr. Freud. Far­rar, Strauss and Giroux, 2013.

Wolf, Dieter. “DIE BEUNRUHIGUNG – kon­se­quentestes Beispiel doku­men­tarisch­er Stilis­tik im DEFA-Spielfilm.” Ein­blicke in die Lebenswirk­lichkeit der DDR durch doku­mentare Filme der DEFA, edit­ed by Geb­hard Mold­en­hauer and Volk­er Steinkopff, Bib­lio­theks- und Infor­ma­tion­ssys­tem der Uni­ver­sität Old­en­burg, 2001, pp. 127-42.

Clip Notes

* All Clips will be added by Sep­tem­ber 2017.

Clip 1: Char­ité physi­cian Dr. Rösel­er exam­ines Inge before the surgery.

Clip 2: Can­cer patient Bär­bel Loeper tells Inge her own sto­ry: Bär­bel is a can­cer patient per­form­ing the role of a can­cer patient.

Clip 3: Inge reveals her help­less­ness vis-à-vis the prac­tice of the gen­tle lie in a con­ver­sa­tion with her part­ner Joachim.

Endnotes

[1] DEFA or Deutsche Film-Aktienge­sellschaft was the state-owned film com­pa­ny estab­lished by the Sovi­et Mil­i­tary Author­i­ty in 1946. Unless I indi­cate I am quot­ing from an extant trans­la­tion, all trans­la­tions into Eng­lish are my own.

[2] At the GDR’s sec­ond nation­al fes­ti­val for fea­ture films in Karl-Marx-Stadt in 1982, Die Beun­ruhi­gung received the fol­low­ing prizes: Hel­ga Schu­bert for sce­nario, Lothar Warneke for direc­tion, Chris­tine Schorn for lead actress, Wal­friede Schmitt for best sup­port­ing actress, Thomas Plen­ert for cam­era, and Eri­ka Lehm­phul for edit­ing. The audi­ence jury declared Die Beun­ruhi­gung to be the most effec­tive movie screened with­in the last two years, and the film—a rare instance for the GDR—was invit­ed to the Venice Film Fes­ti­val. See Haas and Wolf, Sozial­is­tis­che Filmkun­st 241; Dieter Wolf, “Die Beun­ruhi­gung” 138-40.

[3] See Bet­tin and Gade­busch Bon­dio, 7.

[4] On this aspect of GDR film and the impact of such “audi­ence forums,” which were habit­u­al­ly held in cin­e­mas, see Gisela Bahr, “Film and Con­scious­ness: The Depic­tion of Women in East Ger­man Movies (Till Death do You Part, Solo Sun­ny, The Dis­tur­bance, Pauline’s Sec­ond Life),” in Gen­der and Ger­man Cin­e­ma: Fem­i­nist Inter­ven­tions. Vol. 1: Gen­der and Rep­re­sen­ta­tion in New Ger­man Cin­e­ma, edit­ed by San­dra Frieden et al., Berg, 1993, p. 131.

[5] Warneke’s “Der doku­mentare Spielfilm” is also par­tial­ly reprint­ed in Warneke, Film ist eine Art zu Leben.

[6] The infa­mous 1965 Eleventh Plenum of the SED Cen­tral Com­mit­tee became known as the Kahlschlag-Plenum after Erich Honeck­er, who lat­er became the Gen­er­al Sec­re­tary of the SED Cen­tral Com­mit­tee (1971–1989), jus­ti­fied the ban­ning of numer­ous films and books by declar­ing that skep­ti­cism and the devel­op­ment of social­ism were mutu­al­ly incom­pat­i­ble. Honeck­er insist­ed on the artists’ com­mit­ment to a par­ti­san approach to polit­i­cal and aes­thet­ic eval­u­a­tions of GDR real­i­ty, an approach that sup­port­ed SED pol­i­tics at all times. The events are doc­u­ment­ed in detail in Agde, Kahlschlag. Soldovieri’s arti­cle “Cen­sor­ship and the Law” high­lights the most notable event of the plenum, the ban­ning of Das Kan­inchen bin ich (The Rab­bit is me), a film by Kurt Maet­zig based on a nov­el by Man­fred Biel­er only pub­lished after the fall of the Wall.

[7] Stott empha­sizes that the “doc­u­men­tary real­ist style, which became pre­dom­i­nant in the 1970s and 1980s was far less cost­ly [than genre films]. Warneke’s Die Beun­ruhi­gung, for instance, […] was made with a bud­get of some 800,000 marks” (28-29). Stott fur­ther empha­sizes Eri­ka Richter’s role as dra­maturg for “Warneke’s remark­able run of cre­ative suc­cess­es in the 1980s” (25).

[8] Since Novem­ber 1989, the image of the GDR as an author­i­tar­i­an, pater­nal­is­tic state that kept its pop­u­la­tion in a pro­longed state of child­hood has dom­i­nat­ed polit­i­cal and cul­tur­al dis­cours­es on the GDR. For ear­ly exam­ples, see, for exam­ple, Hen­rich, Der vor­mund­schaftliche Staat; and Maaz, Der Gefühlsstau. Deb­bie Pin­fold has demon­strat­ed that this image needs to be com­ple­ment­ed by offi­cial rep­re­sen­ta­tions of the GDR as a child who tries to nego­ti­ate its iden­ti­ty vis-à-vis its Sovi­et parental fig­ures. See Pin­fold, “‘Das Mün­del will Vor­mund sein.’”

[9] Harhausen 101; Rinke 183, 189; Fein­stein 210. In “Waren Ost­frauen wirk­lich anders?,” Gräf empha­sizes that start­ing in the 1960s, DEFA films screen women who pre­fer to be divorced than unhap­pi­ly mar­ried (110).

[10] Gün­ther in “Arztrecht” con­sid­ers this spe­cif­ic doc­tor-patient rela­tion­ship unique in his­to­ry (87). See Gün­ther, “Patien­ten­schutz” 161; Seifert 168, 304; Wag­n­er 234. The Bun­des­gericht­shof (Fed­er­al Court of Jus­tice) in the FRG con­sid­ers a med­ical inter­ven­tion, includ­ing a suc­cess­ful inter­ven­tion car­ried out accord­ing to stan­dard prac­tice, as ful­fill­ing the legal cri­te­ria for assault and bat­tery accord­ing to §223 Strafge­set­zbuch (StGB, Crim­i­nal Code). A patient’s con­sent to treat­ment is there­fore indis­pens­able, with the excep­tion of an emer­gency oper­a­tion per­formed when the patient is uncon­scious and there­fore unable to pro­vide con­sent. See BGH judg­ment BGHSt 11.

[11] See Lohmann 221; Juris­tisch-medi­zinis­ch­er Arbeit­skreis der Vere­ini­gung der Juris­ten der DDR 139-40.

[12] For detailed analy­ses of the sig­nif­i­cance of ill­ness and patients in the GDR med­ical sys­tem in Christa Wolf’s nov­els Nach­denken über Christa T. and Leib­haftig see Klocke 34-113.

[13] The Quest for Christa T., 182. The Ger­man orig­i­nal reads: “Ich bin zu früh geboren. Denn sie weiß: Nicht mehr lange wird an dieser Krankheit gestor­ben wer­den” (179).

[14] For a sim­i­lar assess­ment of the end­ing, see Pinkert, 127.

[15] Through­out Dis­so­nant Lives, Ful­brook employs the term “1929ers” in her analy­sis of this generation’s sig­nif­i­cance for the ear­ly years of the GDR. She explains that her research on the 1929ers was ini­tial­ly pro­voked by a joke she heard repeat­ed­ly, “to the effect that ‘Christa Wolf was born in 1929, like every­one else in the GDR’” (252). Ful­brook con­sid­ers Wolf “the ‘clas­sic 1929er’” (293). See Wier­ling, 205-08; Ahbe and Gries, “Gesellschafts­geschichte als Gen­er­a­tio­nengeschichte” 481.

[16] For a sim­i­lar read­ing, see Ger­sch 186-87.

[17] Grashoff empha­sizes the “Fähigkeit, bewusst auf die Umwelt einzuwirken und diese sowie sich selb­st nach eige­nen Vorstel­lun­gen und Zie­len zu verän­dern“ (282).

[18] Red­ing insists on defin­ing “unheil­bar” (incur­able) in rela­tion to ide­ol­o­gy (90). Also see Jahr.

[19] Even though “scho­nend” has a more lit­er­al trans­la­tion of “pro­tec­tive” or “pro­tect­ing,” I chose to trans­late “scho­nende Lüge” as “gen­tle lie” to bet­ter evoke what the prac­tice entails: pro­tect­ing patients from a real­i­ty that the med­ical pro­fes­sion in the GDR obvi­ous­ly con­sid­ered as too harsh for patients to face. Bet­tin and Gade­busch Bon­dio sim­i­lar­ly report that, at least in 1976, the gen­tle lie was still rec­om­mend­ed prac­tice (10-11). Hahn claims that it was grad­u­al­ly aban­doned dur­ing the 1970s (78), but Gün­ther in “Arztrecht” insists that it per­sist­ed until the end of the GDR, par­tic­u­lar­ly in cas­es of incur­able can­cer (89).

[20] “In ein­er Stunde muss ich ins Kranken­haus, und dann musst du mich hin­brin­gen, weil sie gesagt haben, dem, der mich bringt, sagen sie die Wahrheit. Ja, dem sagen sie die Wahrheit. Und dem sagen sie die Wahrheit. Und dem sagen sie die Wahrheit und ich weiß die Wahrheit nicht.”

[21] Christa Wolf’s diaries of Feb­ru­ary 16, 1971, Feb­ru­ary 22, 1971, and March 3, 1971 quot­ed in Reimann and Wolf 153-55.

[22] Man­del and Lange sim­i­lar­ly insist that even when patients ask spe­cif­ic ques­tions, the con­tent and form of the physi­cians’ answers depend on what the doc­tors, not the patient, con­sid­er ben­e­fi­cial for the patient and the ther­a­peu­tic goals. Also see Lohmann 221.

[23] Ernst Gün­ther and Ernst Luther, “Was schafft Gebor­gen­heit? Zu eini­gen Resul­tat­en des Ethik-Sym­po­siums zum The­ma Infor­ma­tion – Wahrheit – Gebor­gen­heit.” Human­i­tas, vol. 29, no. 4, 1989, 9, quot­ed in Lohmann 221.

[24] “Sie dürfe das nicht. […] Sie müsse. Zurück­steck­en. Die Ver­ant­wor­tung trü­gen sie. Nicht Helene. Was, ich trage keine Ver­ant­wor­tung?” (Schmidt 308; ital­ics in orig­i­nal.)

[25] For detailed analy­sis of Kathrin Schmidt’s nov­el Du stirb­st nicht and the sig­nif­i­cance of the GDR med­ical sys­tem in post-uni­fi­ca­tion Ger­many, see Klocke 165-78.

[26] See Hahn 80-82, 84, 74; Festge 97; Schleier­ma­ch­er and Scha­gen 230; Seifert 60-61.


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