Augusta Rasmussen – psychiatrist, pioneer and the scientific truths of the time

Erlend Hem, Per E. Børdahl About the authors

In 1934, senior registrar Augusta Rasmussen (1895–1979) published a study of 77 cases involving sexual offences. She found that the women involved had suffered no mental injury from the abuse. In 1947, she published a study of the intelligence level of 310 Norwegian women who had formed relationships with German soldiers during the occupation. She found that nearly all of them were more or less retarded. Her conclusions, however, were not scientifically valid. Here we present Rasmussen’s biography, academic background and scientific activity.

In the autumn of 1932, senior registrar Gunhild Augusta Rasmussen was awarded the Skjelderup gold medal for a medical study that foreshadowed a topic which is highly relevant today (1). The title of the award-winning study was The impact of sexual assaults on children under 14 years of age for the development of mental disorders and character anomalies. The gold medal was presented at the university’s annual celebration in the University Aula, before an audience that included the prime minister, the minister of church affairs and the minister of justice.

The Aftenposten daily quoted in detail from the recommendation submitted by the selection committee, which consisted of senior consultant Sigurd Dahlstrøm (1882–1933) and professor Georg Herman Monrad-Krohn (1884–1964). They noted that the study had involved great difficulties, but that the work was well planned, thoughtful and sober, ‘one may be tempted to say overly sober’.

The descriptions of the patients were very scant, so scant that the jury might have wished for more detailed information. Moreover, it would have been advantageous if the author herself had conducted a more detailed examination of the women in question. However, the committee expressed their understanding of the practical difficulties this would have presented – it might have been so upsetting for the patients that Rasmussen rightly would have been reproached for doing so. The committee found that the author’s conclusions were formulated with sound judgement and criticism.

Rasmussen’s reflections were also ‘very sparse, fairly slender’, but in return refreshingly free from speculation. ‘In sum, although somewhat slender, the work is nevertheless so meritorious that we recommend that it be rewarded with the gold medal’ (2).

Material

In recent years, Augusta Rasmussen has been referred to on several occasions, especially in terms of her investigation of women who had formed relationships with German soldiers during World War II. Today, she has been forgotten by the medical community. We wished to find out who she was and identify her academic background and scientific activity.

For this article, we have used databases that provide access to newspapers, books and medical material: Retriever, bokhylla.no, Oria, PubMed, Web of Science. We have also contacted some of Rasmussen’s colleagues. We have searched through the archives of the Faculty of Medicine, University of Oslo, in the National Archives for the years 1932–35, to find information on the assessment of the study that won the gold medal.

The article is restricted to Rasmussen’s academic works, but it has been impossible for us to undertake comprehensive archive studies; for example, we have not reviewed the archive from the Hovedøya camp. We have made no attempt to penetrate into Rasmussen’s clinical activities.

The award-winning study

Rasmussen had reviewed 77 sexual offence cases from all over Norway. They had been retrieved from the archive of the Forensic Commission from verdicts passed in the years 1902–14. The cases involved 105 girls; in 22 cases the perpetrator had assaulted more than one. At the time of the offence, 87 of them were younger than 14 years. The perpetrators were from 17 to 73 years old. ‘Very many of them are married. They come from various professions and social classes. In many cases, the person involved has been previously convicted of sexual or other crimes. Here are exhibitionists and all shades of sexual offenders. In many cases, the crime took place while in a state of drunkenness,’ Rasmussen summarised (3).

She collected information on the situation of 54 of the 105 girls later in life. She received her information mainly from doctors, but this information was sparse, as noted also by the committee. She did not indicate the methods of measurement that she had used, and we may get the impression that she relied on discretionary judgement.

The news about the award was published in several newspapers, but none looked into the content of the study. Only 20 years later did the Arbeiderbladet daily revisit the matter. How do children who have been sexually abused fare later in life? was the title of a large feature in January 1951 (Figure 1) (3). The answer was provided in the subheading: A follow-up study shows that most of them have suffered no bodily or mental injury. The newspaper explained that Rasmussen had used only sexual offences that had led to criminal charges and convictions. ‘After all, I needed cases in which I could be certain that something had happened,’ she said. ‘And one cannot be more certain than in cases that have ended in a conviction.’

Figure 1 ‘How do children who have been sexually abused fare later in life?’ was the title of a lengthy feature article in the Arbeiderbladet daily on 29 January 1951 (3).

She explained that in order to ‘avoid fabricated stories, which are common when it comes to children with poor mental faculties – imbeciles, hysterics and psychopaths’, she had used the forensic examinations and archived cases from the Forensic Commission. ‘When reading through the records of these cases, I was struck by the amount of knowledge these children had about sexual matters,’ Rasmussen stated. ‘I believe that they would have suffered a greater mental shock had they been ignorant. Young people can be provided with a certain protection through properly facilitated sexual education.’

Initially, Rasmussen had considered including only the ‘more serious cases’, but these turned out to be too few. The study includes only one case of rape. This involved a seven-year-old girl who had been assaulted by a boy of seventeen. After he had abused her, he had let her run away. She came home sobbing uncontrollably and revealed what had happened. The boy was sentenced to 18 months imprisonment with hard labour. Not even in this case did Rasmussen find that the girl had suffered any mental injury from what had happened. ‘It seems as though her parents had the good sense to play down the incident to her, so that it never mattered. She is married, healthy and has children,’ Rasmussen said.

‘Very often, the public believes that any child who has been exposed to such incidents has been as good as completely mentally destroyed. However, in none of the cases that have been examined here has the incident prevented the child from later having a normal sex life and bearing children,’ Rasmussen said. ‘No morbid effects whatsoever on the psyche as a result of what has happened can be identified in this data set,’ she concluded. Most of the children fared well in life, nor did it seem as though they were branded in other ways by the affair. However, as with any other experience that is retained in the memory, this should not be taken to mean that it did not have or continue to have an effect on them,’ Rasmussen believed. ‘But it does not appear that what happened has devastated them, as the public so often loudly claims.’

In conclusion to its report, the newspaper brought a happy-ending story that Rasmussen had included. An infatuation had developed between a 13-year-old girl and a 19-year-old boy, and it ended in a punishable offence. The boy was sentenced to one year, later reduced to 60 days of imprisonment, which he served. ‘They married, have many children, and the couple has an excellent relationship. Their finances are solid, and she is a very capable housewife – bodily and mentally healthy and well,’ Rasmussen explained.

The reception

Rasmussen’s study was noticed. A recurring point was that ‘the notion that a sexual experience in childhood as a rule will leave harmful traces in the mind is considerably exaggerated,’ as the psychiatrist Johan Scharffenberg (1869–1965) wrote in a newspaper op-ed in 1934 (4).

By the early 1920s, public opinion had started to demand that sexual offenders be sentenced to more severe punishment, especially those who had abused children. The provisions in the General Civil Penal Code had to be amended (5). A thorough revision of the legislation on public morality was undertaken in 1927, which included an increase in the minimum sentences for rape and sexual intercourse with children under 14 years. This sharpening of the penal sanction was widely debated in the years that followed. At a meeting of the Norwegian Criminalist Association in 1935, Scharffenberg stated that a main argument in this campaign was the assertion that children who had been abused suffered lifelong moral and mental injury, but he reiterated that Rasmussen’s thesis had shown this notion to be greatly exaggerated (6, p. 113).

In 1951, one of Norway’s leading psychiatrists and director of Gaustad Hospital, Ørnulv Ødegård (1901–83), referred to Rasmussen’s study, just as Scharffenberg had done nearly 20 years previously. He too noted that the study had shown how abuse in childhood did not ‘lead to any kind of unfortunate mental condition whatsoever’. He found it to be quite encouraging to see that children are not as easily harmed as we may have been led to believe. ‘The question is whether we sometimes think more with our hearts than with our heads’ (7).

At the same time, the lawyer Anders Bratholm (1920–2010) wrote that Rasmussen’s study seemed ‘to indicate that the harmful effects are surprisingly minor, even when violence has been used’ (8, p. 460). The comprehensive American Kinsey Report on women’s sexuality, published in 1953, notes how the study showed ‘little evidence of ill effects’ (9).

In the context of a revision to the General Civil Penal Code in 1960, the Penal Code Commission raised the issue of possible mental injury caused by sexual violations of children. The commission noted that ‘among the public, the notion appears to prevail that children who have been exposed to such violations as a rule will suffer a serious and permanent mental injury. Recent studies appear to show that this general notion is considerably exaggerated – and that in a number of cases no mental ill effects can be determined. This applies in particular to cases where the child has not been subjected to violence or brutality.’ The commission also referred to Rasmussen’s thesis (5).

For the first 30 years after its publication there were few who questioned her conclusions.

Long before, Sigmund Freud (1856–1939) had described harmful effects of sexual abuse of children. In the mid-1890s he described Katharina, who had been subjected to sexual abuse, and the serious mental injury she had suffered as a result. Shortly after, however, Freud abandoned this view. Instead, he emphasised the child’s desire for a sexual relationship with the mother or father (10). When Rasmussen undertook her study, this issue was far from clarified. For example, Melanie Klein (1882–1960), one of Freud’s students, claimed in the early 1930s that sexual abuse could entail serious consequences for the child (11).

Although knowledge of the harmful effects of sexual abuse gradually spread, some voices continued to claim the opposite (12). For example, the well-known Swedish child psychiatrist Gustav Jonsson (1907–94) wrote in 1970 that to the extent that any conclusions could be drawn from the information provided by women and their later social adaptation, ‘the risk is unlikely to be significant’ (13, p. 98). Well into the 1900s, abuse of children was often presented as a benign experience. Some even indicated that sexual abuse might have positive effects (14). Many were of the opinion that there was no scientific evidence that it might be harmful (15). This was the climate in which Rasmussen presented her findings. The mental injuries resulting from sexual abuse were not fully acknowledged until the 1970s (16). At that time, more solid research methods had become available to document the harmful effects.

Criticism

Criticism of Rasmussen’s study was first seriously addressed by the Danish psychiatrist Emma Vestergaard (1908–86) in 1960 (17). She believed that Rasmussen’s conclusions were flimsily substantiated and too far-reaching. She herself undertook one of the other early Nordic studies on the harmful effects of father-daughter incest. In a follow-up study of 13 women whose fathers were sentenced, she found that they were strongly affected by the abuse to which they had been subjected (17).

We have not been able to find Rasmussen’s award-winning thesis from 1932. It is not available in the archives of the Faculty of Medicine in the National Archives. Two years later, she published a comprehensive article in German in the journal Acta Psychiatrica et Neurologica (18). It is cited to some extent in the academic literature but is little known outside the academic community. Over the course of time, the assessment of Augusta Rasmussen’s study grew less favourable (10). Today we would say that the study has little scientific value – the results measurements were unclear, there was no personal follow-up study, she had insufficient information on the situation of 49 % of the girls, and she had no control group.

Regrettably, the thesis had unfortunate consequences – it helped make it possible to claim for several decades that sexual traumas are not especially harmful (16, p. 44).

‘The German whores’

Some years later, Augusta Rasmussen undertook another study which has been much more widely referred to and criticised – the study of the so-called ‘German whores’. It was published in Norwegian in 1947, covering barely four pages, and was based on a study of 310 women who had formed relationships with German soldiers during the occupation (19). The women were interned on Hovedøya island in Oslo, and the study, which was conducted from November 1945 to summer 1946, was initiated by Karl Evang (1902–81), Director of Health.

Rasmussen found that only nine of these women were of normal intellect, 112 had to be considered retards, and 182 were even more feeble-minded. The psychologist Ragnar Christensen (1922–2011) wrote in 1953 that the study confirmed the clinical impression ‘that the vast majority were intellectually subnormal’. In Mr Christensen’s opinion, the figures were so clear that it ‘appears to be a tenable conclusion, even though the tests used are not particularly suited to the examination of adults’ (20, p. 147–8).

When the Arbeiderbladet daily interviewed Rasmussen about the study in April 1947, the headline read Approximately all the ‘German girls’ were more or less retarded (21). And it was this interpretation that generally prevailed in the post-war period.

The article lacked a discussion and a conclusion, containing only a short list of the findings. Again, it appears that the conclusion fell victim to methodological problems. The women she studied were highly selected and were not representative of Norwegian women who had had sexual relations with Germans. In addition, the examinations were performed under unfavourable conditions in an internment camp. However, Rasmussen appears to have placed little emphasis on such weaknesses. In the interview with Arbeiderbladet, she stated that ‘It is a study that is sound. It is not a subject for discretionary judgement’ (21).

She should have known what she was talking about. As a school psychiatrist in the 1930s, she had been involved in the development of intelligence tests for schoolchildren (22, 23). At that time, many people had considerable faith in objective measurements of ability. For example, she was engaged by the Norwegian Mission for the Homeless to measure the abilities of children in the mission’s children’s homes every second year from 1950 (24, p. 561).

Unfortunately, the results from the ‘German girls’ study also had unfortunate consequences. They provided a clinically untenable basis for giving the children and their mothers a stigma that was difficult for many to erase later in life (25). Once again, few protested.

In 1943, the exiled doctor and member of the Resistance Movement Ole Jacob Malm (1910–2005) had described them as ‘our female dregs’. ‘In their emotional life they are so entirely stunted and indifferent that what others normally feel as an unbearable shame, leaves them unmoved. This “emotional detachment” is the same as one sees in the mentally ill and in mentally retarded patients, morons and idiots,’ wrote Malm, adding that some were so mentally subnormal that they had not reached the mental age of eight years (26). Leading psychiatrists such as Ørnulv Ødegård and Gabriel Langfeldt (1895–1983) also fostered prejudiced and unscientific views (25). Rasmussen’s results conformed to a prevailing paradigm.

Rasmussen’s last work

As far as we know, Augusta Rasmussen subsequently wrote nothing on the subject of sexual abuse or ‘German girls’. However, she most likely had other ambitions. In the interview with Arbeiderbladet in 1947, she said that alongside the studies on intelligence, she had undertaken in-depth investigations of the girls’ environment and way of life. ‘I have tried to obtain a picture of their lives. Unfortunately, I have not yet had time to prepare the data set’ (21). The study was never forthcoming.

Like a number of other Norwegian psychiatrists, Rasmussen was concerned with the notion that many Nazis were mentally deviant – a hypothesis which it has not been possible to confirm (27, 28).

In 1966 she published her final article: On mentally ill arsonists (29). She used the same methodology as in 1932 – a data set from the Forensic Commission’s archive. In the period 1901–61, altogether 88 perpetrators arrested for arson were judicially observed and declared insane. This study also gained attention. For example, it is cited in Andenæs’ textbook on general criminal law (30).

Rasmussen had no schooling in science, and this imposed limits on the studies she undertook. She presented case series in detail, but scarcely attempted any analysis, discussion or conclusion. The absence of analysis demonstrated by leading psychiatrists when subsequently referring to her work seems extraordinary.

Pioneer

Augusta Rasmussen was a pioneer in many areas. Although in the 1920s it was no longer so unusual for women to study medicine, she was one of only four women from a cohort of 29 students who took a medical degree (31) (Figure 2). After graduating, she worked at Aker and Ullevål hospitals and in 1926 she became junior registrar in the department of psychiatry. In the period 1930–33, she was senior registrar at Gaustad asylum (22, 23), where her father had been a chaplain in the years 1900–19 (32) and where she had grown up at the vicarage.

Figure 2 Student cohort photo taken outside Rikshospitalet’s Department of Gynaecology in the spring semester of 1923. Augusta Rasmussen is sitting to the left of the director of the Department of Gynaecology, Professor Kristian Brandt (1859–1932). Photo from the Department of Gynaecology’s photographic collection, National Museum of Medicine, Norwegian Museum of Science and Technology.

Her greatest professional contribution undoubtedly consisted of her work as a school psychiatrist in Oslo, a position she held for 32 years (1933–65), which one newspaper described as ‘her most distinguished life’s work’ (33). In the 1930s, she was involved in the introduction of ability measurements in schools. It was considered a mark of great progress to be able to assess children’s abilities on a more objective basis. She also worked as a prison doctor, was a permanent expert on forensic issues, and ran a private specialist practice in Oslo. Her background was solid (Figure 3).

Figure 3 Augusta Rasmussen, probably photographed in 1941 outside the Department of Psychiatry, Vinderen, where she was an outpatient clinic doctor from 1938–42. Photo: Private.

When she was awarded the Skjelderup gold medal in 1932, she was the second and last woman doctor to receive this accolade during the years that it was awarded (34). Thematically, the investigation of sexually abused girls was a pioneering study.

In 1933, she was the second woman in Norway to become a specialist in psychiatry (35, p. 124) (36). At that time, the specialty was called ‘mental illnesses and nervous disorders’ and there were in total only 16 recognised specialists in this discipline (37).

Conclusion

It is thought-provoking that ‘scientific truths’ can persist for such a long period once they have the backing of professional authorities. They almost become urban legends. The same mechanism holds true today. Use of common sense and analysis of scientific methodology should make it possible to challenge ‘scientific truths’ before several decades have elapsed.

Augusta Rasmussen’s gold medal-winning study from 1932 had drawn erroneous conclusions and had unfortunate consequences. It contributed to the notion that sexual abuse of children did not lead to harmful consequences. When we add to that the study of ‘German girls’ after the war, we may arrive at a negative assessment of her work.

However, such a conclusion is biased. The gold medal-winning study was undoubtedly a pioneering piece of work. Little literature existed before on this topic, and the study had a high degree of originality. Moreover, throughout her career she showed an interest in research – she observed phenomena in clinical practice that she attempted to explore scientifically. Our assessments of these studies today must be viewed in light of the medical research being conducted at that time. An example of this is the assessment by her peers, Dahlstrøm and Monrad-Krohn, of her thesis, which was awarded the Skjelderup gold medal.

This article is based on a lecture given at a psychiatry seminar at Gaustad Hospital, arranged by the National Medical Museum Foundation on 13 October 2016.

We wish to thank Anders Taraldset for statistical information, Øivind Ekeberg for help with the manuscript, and Hans Christofer Børresen for useful information and loan of the photograph.

One of the authors is an editor of the Journal of the Norwegian Medical Association. The manuscript has therefore been handled externally by Magne Nylenna, external editor.

The article has been peer reviewed.

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