I incline my head and contemplate the painful deaths of these children.

May the earth be light in which we let them rest.

Steve Sem-Sandberg, The Chosen Ones.

During the Second World War, the Am Spiegelgrund clinic in Vienna ostensibly served as a reform school and a medical clinic for ill or disabled children. In reality, however, the facility became one of 30 to 40 of Nazi Germany’s euthanasia centers for children. Nearly 800 children were killed at Spiegelgrund from 1940 to 1945.

Spiegelgrund was but a small part of Hitler’s involuntary euthanasia program, Aktion T4, his scheme of advancing “racial hygiene” and eugenics to create an Aryan master race by eliminating all "lives unworthy of life" (Lebensunwertes Leben).

The special Nazi program of euthanasia for “inferior” children initially targeted young people with hereditary illnesses and physical or mental abnormalities, and the criteria widened to include children who were simply misfits, perhaps with behavioral problems, delinquency, or certain non-Aryan physical characteristics. The special children’s clinics for euthanasia were precursors of the mass killing apparatus of the Holocaust.

At Spiegelgrund, children endured brutal treatment and often painful and needless medical treatments or experiments before they were murdered. The brains and spinal cords of the young victims were saved and, after the war, this collection became a treasure trove for Austrian psychiatrist and neurologist Dr. Heinrich Gross who supervised the killing center at Pavilion 15 of Spiegelgrund and specialized in selecting children for medical experiments and murder.

Dr. Gross became a renowned researcher after the war thanks to his extraordinary collection of the remains of murdered children stored at Spiegelgrund. He boasted that he had the largest collection of brains in the world. He received wide praise for his scientific work, and Austria awarded him the Honorary Cross for Science and Art in 1975. His role in war crimes was eventually revealed, and he was stripped of the Austrian honor in 2003. He died two years later. Dr. Gross was never held accountable for the crimes at Spiegelgrund.

In 2002, the remains of several hundred children killed at Spiegelgrund were retrieved from the “memory room” in the cellars under the autopsy unit. The remains were placed in urns and buried in a special private ceremony.

Acclaimed Swedish author Steve Sem-Sandberg brings to life the world of the horrific Spiegelgrund clinic in his recent award-winning novel, The Chosen Ones (Translated from Swedish by Anna Paterson; Farrar, Straus and Giroux).

Based on extensive research, the novel transports the reader to wartime Vienna and explores the lives of the patients and staff at the hospital. The narrative focuses on inmate Adrian Ziegler, a bewildered child of normal intelligence with Gypsy and Semitic features, and nurse Anna Katschenka, a devoted professional who gradually awakens to clinic’s atrocious mission: to execute “unfit” children.

In this unsparing novel, Mr. Sem-Sandberg weaves historical background into situations of injustice and cruelty as he puts a human face on child victims and oppressive captors alike during the mad years of the Third Reich. There are also moments of resilience, absurdity and humanity in this dark tale from a time when unspeakable atrocities were committed by the state in the name of science.

Mr. Sem-Sandberg’s books also include the award-winning novel The Emperor of Lies, as well as Ravensbrück and The Tempest, among others. He has won numerous literary awards including Sweden’s August Prize and the Swedish Academy’s Gerard Bonnier Prize. In 2016, The Chosen Ones won the Prix Médicis Étranger for the best translated fiction in France. He divides his time between Vienna and Stockholm.

Mr. Sem-Sandberg graciously responded to a series of questions by email from his home in Vienna. He discussed his novel, his research, his role as a historical novelist, and more

Robin Lindley: You’ve written acclaimed fiction and nonfiction on Nazi Germany and the Second World War. What prompted your interest in this history?

Steve Sem-Sandberg: I do not think I have a special interest in this history as such. I am a fiction writer, not an historian. What interests me is how people interact, how circumstances beyond their immediate control forces or compels them to make the moral choices they do.

I will give you an example. My novel The Emperor of Lies focused partly on the story of Mordechai Chaim Rumkowski who, in his capacity of chairman of the Jewish Council of the city of Lodz, took it upon himself to administer the ghetto the Nazis set up in this town after invading Poland in 1939. In order to save as many Jewish lives as possible, he had to obey every German command to the letter. In practical terms this meant that he himself was the one who had to make the selection, literally name each and every one who had to be deported, and also had to police the deportation with his own men.

What would you consider such a man? A collaborator, a traitor to his own people? Or as a man trying to save as many people as he could by not "angering" the Nazis? For those (few) who survived he was a hero, and those who would think otherwise, [who saw him as] complicit in killing, are long dead.

However, you choose to look at a man like that, history (or historical facts) will not give any answers.

Robin Lindley: How did you come to write The Chosen Ones? Was it inspired by research on your previous books?

Steve Sem-Sandberg: In the first half of 2008 I got a grant to the IWM (Institut ƒur die Wissenschaften vom Menschen) in Vienna to finish the first draft of what was to become The Emperor of Lies. I had come across the Spiegelgrund clinic before, but only as a small part of the T4 euthanasia program, initiated by Hitler after the Anschluss (annexation) of Austria to the Third Reich. The scale, the magnitude of the euthanasia program in Vienna surprised me. And in my free time, while still working on the Emperor, I started to look up some stories from survivors, which at that time had recently been published in Austria.

One book I came across early was Waltraut Häupl´s extraordinary documentation, Die ermordeten Kinder von Spiegelgrund: a collection of medical records of all the children who were brought to the clinic. Häupl’s book is completely unsentimental. It just takes us through the records, from A to Z, and by doing this it paradoxically gives a human face to this act of heinous murder, committed on an unprecedented scale over the course of five years.

There are photographs of the children too, mostly taken by one of the doctors at the clinic such as Dr. Heinrich Gross, and the images of these young kids smiling into the camera, as children do, full of blind trust and curiosity, moved me. I started to try imagine the personal histories behind each photo, behind the brief medical records, which just basically took down the date of birth (of the child), the supposed illness he or she was suffering from (often just a slight cold), and then - inexplicably a few weeks after! - the sudden death.

That was the starting point of the novel.

After The Emperor of Lies was finished, galley proofs read, etc., I moved backed from Stockholm to Vienna again and set out to write The Chosen Ones. It took me five years.

Robin Lindley: Your book, of course, is set in the horrific confines of the Am Spiegelgrund hospital where children adjudged “life unworthy of life” were euthanized—often after they suffered brutal punishment and horrific experiments. How would you describe the facility and how Nazis established a killing center there?

Steve Sem-Sandberg: Again, I am not an historian. The only answer I can give is the one anybody would give: a combination of fear, opportunism and cowardice.

Robin Lindley: How did Spiegelgrund fit into the warped Nazi dream of a master race and how the killing there provided one template for the eventual Final Solution?

Steve Sem-Sandberg: To simplify matters a bit, I sometimes imagine my two books, The Emperor of Lies and The Chosen Ones, as parts of a two-part novel: a diptych of sorts.

If The Emperor of Lies is about the Nazis fighting against their "outer enemy,” i.e., the Jews, The Chosen Ones describes the Nazi war against "the enemy within," a much harder battle to win because the defects and the dysfunctions that the Nazis wanted to come to grips with and eradicate were a lot more difficult to define. It ran in their own blood. For that reason, it was very much a hidden war, fought in silence in locked rooms, behind hospital walls, and of course it was not (and has not been to this date) as well researched and documented [as the Final Solution].

Robin Lindley: Who were “the chosen ones” and how were they selected by Nazi officials for “treatment” at Am Spiegelgrund? As you describe in your book, many of the child patients had severe physical or mental impairments—but some simply had behavior problems or were misfits.?

Steve Sem-Sandberg: The main protagonist of my novel is called Adrian Ziegler. Apart from having a father who is an alcoholic and a mother who alone has to support the entire family there is nothing "wrong" with him. His parents are just one of many at that time, suffering poverty and destitution, whom the authorities considered unfit to take care of their own children.

The Spiegelgrund clinic was first and foremost what in German is called an "Erziehungsanstalt,” a home for children from dysfunctional families in need of a better and more disciplined upbringing and education. The "euthanasia" clinic was only a small part of the Spiegelgrund, "tucked in" two pavilions (numbers 15 and 17) among close to twenty different pavilions serving mainly as orphanages or a reform schools, and it was administered centrally from Berlin, not (as would normally be the case) by the city of Vienna.

Robin Lindley: What was your research process for this book? Were you able to interview surviving patients and staff of the Am Spiegelgrund Hospital in Vienna?

Steve Sem-Sandberg: The staff, most of them, fled in the chaos that erupted during or soon before the Russian liberation of Vienna in 1945. Even if they were to be alive today, which is extremely unlikely, they would hardly to talk to me, would they?

The patients who survived were a long time very hesitant to step forward and speak out about their experiences. It is a typical phenomenon: the victims feel "ashamed" of what they were forced to go through, of their own victimhood so to speak, instead of anger towards the perpetrators.

I did manage to talk a little bit with one of the former inmates, Friedrich Zawrel, just a year or so before he died. I was happy to do that, but he was an old man at that time and his memory clouded. Most of my research was conducted in archives here in Vienna, at the DÖW (Dokumentationsarchiv des Österreichischen Widerstandes) and at the Wiener Stadt- und Landesarchiv. The DÖW has during the last decade or so managed to collect a quite substantive amount of witness accounts from former patients at the Spiegelgrund.

Robin Lindley: Are hospital records and other archival materials from the war still available? Did you visit the hospital site in Vienna?

Steve Sem-Sandberg: Some of it. Not all. Much was destroyed by the personnel before fleeing. What little exists I have consulted.

The hospital - Steinhof - is still very much in use as a psychiatric ward. There is a small museum in one of the pavilions and a memorial to the victims. I went there quite often when I wrote the novel. It is only a 20-minute drive by car from where I live in Vienna.

Robin Lindley: You create fictional characters in The Chosen Ones but also portray real characters. For example, you view the hospital through the eyes of several patients, most notably the Adrian Ziegler. Was his character based on the account of a real patient or documents you uncovered?

Steve Sem-Sandberg: I have some problem with the distinction between real and fictional characters. Since this is a novel, all characters are fictitious i.e., created by me, even those with "real" names.

It is true that some parts of Adrian Ziegler´s story is based on things that happened to Friedrich Zawrel. It was Zawrel who accidentally, 30 years after the war, met one of the former doctors at the clinic, Heinrich Gross, who at that time worked as a psychiatrist and an expert witness, and thus was able to prosecute and to punish him for a second time; a story which when it broke finally - in the 80´s and 90´s - restarted the process of trying to convict the perpetrators that up until this time had been making careers in postwar Austrian.

But to say that my protagonist is a fictional portrayal of Zawrel is completely wrong, and also to misinterpret how a novel of this length and complexity actually works. For my main protagonist, I used biographical material taken from maybe seven or seven or eight different individuals, and in that sense the character Adrian Ziegler is as much a fictional character as anyone else who figures in my novel.

Robin Lindley: You portray several nurses, some caring and some sadistic. The main nurse character, Anna Katschenka, has complicated feelings for her young charges and can be compassionate, but she becomes complicit in the Nazi program of killing “the unfit.” Is she based on a real character or several medical staff members who you discovered through your research?

Steve Sem-Sandberg: Again, I am not totally convinced about the general usefulness of the terms "real" and "fictional" in this regard. In a novel all characters, even the supposedly "real" ones, are used in a fictional sense to support the general purpose of the story.

Very little is known about the "real" Anna Katschenka, apart from where she was born and lived and when and where she died. I used what little biographical material I came across. I also used some material from the court hearings from when she was put on trial after the war. But that is basically it.

Robin Lindley: The character of Anna, a skilled nurse who gradually is complicit in evil acts, seems to embody the idea of what Hannah Arendt called the “banality of evil.” Is that what you intended?

Steve Sem-Sandberg: What is important to understand in the case of Katschenka is that she was never a Nazi. She came from a traditional working class family in Vienna, and her father was a politically active Social Democrat. When the Nazis came to power all "leftists" were banned from society, and party officials were oftentimes jailed. It would have been extremely hard for a professional with Katschenka´s background to find work during these times. The only work she got as a nurse was at the Spiegelgrund clinic - and she had to support her entire family on her own wages.

To complicate matters even further, she was previously, albeit for a short time, married to a Jewish medical student, a fact she later had to hide and which gave her a sense of guilt she probably felt she had to compensate for.

This doesn´t excuse anything (any crime) she committed during her time as nurse and later head nurse at the clinic. But if you want to understand how evil works, how it can corrupt all parts of a society, it is much more worthwhile to study a character like Katschenka, an ordinary citizen who, under normal circumstances, never would be able to commit the crimes she did, never even imagine that something of that kind would be demanded of her.

Robin Lindley: Your characters include actual doctors who were involved in cruel experiments and the killing of children. You portray Doctors Erwin Jekelius, Ernst Illing and Heinrich Gross. Could you briefly describe the position of each one in terms of the operation of the hospital—and killing center?

Steve Sem-Sandberg: As I said previously, the Spiegelgrund clinic was primarily an "Erziehungsanstalt,"a reform school. Hidden among the dozen or so pavilions where young boys and girls in need of a proper education were housed, was also the pavilions 15 and 17 where the euthanisations were conducted. These two pavilions had their own administration, and were under direct command of the interior ministry in Berlin, i.e., the Tiergarten 4 (T4).

Doctors Jekelius, Illing, and Gross were employed by "Berlin" and were under direct orders from the T4 to carry out these killings, but they also worked (or masqueraded) as doctors at the rest of the Spiegelgrund pavilions, i.e., the Erziehungsanstalt, and anyone who misbehaved or did not "learn" from repeated punishments could at any time be brought from the Erziehungsanstalt to pavilions 15 and 17 to be "supervised" or, as a last resort, killed.

Robin Lindley: Doctor Jekelius is prominent in the book and Nurse Anna is infatuated with him. Can you talk a bit about how you imagine and write about a vile actual character like Jekelius?

Steve Sem-Sandberg: Jekelius plays only a small part in my novel, as the doctor who "motivates" Anna Katschenka to take up a position at the clinic. In "real" history he is perhaps better known as the unlucky suitor of Adolf Hitler´s sister Paula, who at that time lived in Vienna. Hitler didn´t take fondly to their relationship and had Jekelius removed and sent to the East. I don´t tell this story in the novel in order for the readers not to get distracted from the main focus of the novel, i.e., the "work" he was commissioned to do in Vienna before he was removed in 1941.

Robin Lindley: You quote from documents including postwar transcripts from war crimes trials. Are you quoting actual documents or are they edited or imagined to suit the novel? If they are actual documents, could you call your book a documentary novel, perhaps in the vein of HHhH on Reinhard Heydrich by French author Laurent Binet? What is the role of documents in your novel?

Steve Sem-Sandberg: The label "documentary novel" just doesn´t make any sense to me. My novel is based on real events - that is true, but that is true also of a great many novels which would never otherwise be labeled documentary.

The inclusion of documents in the narrative doesn´t make the novel any more or less "documentary.” Documents can lie, or they can serve other purposes in a narrative than to present facts: to insert breathing pauses in the general narrative flow, to create the necessary tension or "friction" that sharpens the reader´s concentration, or just to heighten the tension in the novel by introducing as much detail as possible, thereby making it more convincing, more compelling, more "real.” In my novel documents are mostly used to this purpose.

Robin Lindley: You describe vicious punishment and torture of children at Am Spiegelgrund—even though most were destined to be killed anyway. You also describe cruel experiments, sometimes in wrenching detail, on children who were seen only as “research material,” such as the gruesome and painful procedure “pneumoencephalography” that involved injecting air into the spinal canals and brains of child inmates.

Steve Sem-Sandberg: The pneumoencephalography was part of a private research project conducted by Dr. Illing. He had for a while been studying an illness called tuberal sclerosis, which though hereditary can "skip" one generation, i.e., reappear in the grandchildren of the one(s) suffering from the disease. It is also clinically very difficult (or was at that time, at least) to prove if a patient suffers from this illness. The symptoms are varied and could as well be related to some other illness. Hence the experiments. Doctor Illing had a vast "material" - as he called it - to experiment on. By doing first a pneumoencephalography then an autopsy on a child, he could easily discern if his original hypothesis was right or wrong.

But bear in mind, please, that medical experiments were never the purpose of the T4-program; it was the "weeding out" of lives deemed by the Nazis as unfit-- being a burden (and a cost) to a healthy society, as the Nazis viewed it.

I think that if you focus too much on these "experiments" you will demonize (and trivialize) what was considered at the time, by many, to be a normal, "healthy" process. You have to remember that euthanasia was something that not only the Nazis considered during the early 20th Century.

Robin Lindley: I have read that acclaimed autism researcher Dr. Hans Asperger worked for some time at hospitals for children in Vienna during the war. Did you come across any evidence that Dr. Asperger experimented with children at Spiegelgrund?

Steve Sem-Sandberg: No. But then I did not consciously look for his name in the material I used.

Robin Lindley: Dr. Heinrich Gross, who you portray, helped direct the euthanasia procedures at the hospital and ultimately escaped justice. He continued to work as a doctor and researcher after the war and used the brains and other tissue from hundreds of the children killed at Spiegelgrund. He had one of the largest brain collections in the world from those murdered children and conducted his research until 1990 or so. Was his research on living children during the war and then on this large collection of brains of the children of any benefit to science?

Steve Sem-Sandberg: I think it was a benefit to his postwar career. Most definitely. Since I am not a medical historian, I would not be able to judge how "important" the work he did was for medical science.

Robin Lindley: It must have been difficult to immerse yourself in this story, one of the most horrific in modern history. How did you stay healthy as you researched and wrote your novel?

Steve Sem-Sandberg: I do not see how you can approach material of this kind without feeling a sense of acute pain. I tried to describe it above. But that said, you owe it to the victims not to sentimentalize or trivialize what you describe.

Robin Lindley: How did you decide to write a novel rather than a history of Spiegelgrund? You have a background in journalism and you’re an acclaimed novelist, so you probably could have taken either course?

Steve Sem-Sandberg: No, I was always very conscious of being a fiction writer. Writing novels was what I always wanted to do. I strayed into journalism more as a means to support myself financially during the early years when I was not able to be a full-time writer.

Robin Lindley: Your writing is widely praised. Who are some of your favorite writers or influences as a writer?

Steve Sem-Sandberg: I was always an avid reader, and I think my influences are many and varied. I read William Faulkner at an early age, and still do. I like many writers for whom he was a guiding example, like Carlos Fuentes, or the great Portuguese writer Antonio Lobo Antunes.

I like writers who have a literary "voice,” a distinct style, and who are able to create whole worlds in or through their writing. Both things hold true of Faulkner.

Robin Lindley: How do you see the resonance of your novel today as we see growing right wing and nationalist movements in Europe and the United States? Indeed, the U.S. president-elect demeaned the disabled during his campaign here and frequently called his foes “losers.”

Steve Sem-Sandberg: Yes. This is all very depressing, and distressing. But I do not very much like to comment on political matters. There are too many opinion-makers out doing just that. I am putting all my energy into writing novels. Hopefully these are able stand on their own as literary works without having to be propped up by political interpretations. But readers seeking to find parallels between events described in The Chosen Ones and ideologies being fomented today I am sure will find a lot of stuff to digest, though I would not like to comment on that.

Robin Lindley: Are you working on another book now?

Steve Sem-Sandberg: Yes. But it is slow going. Writing novels (at least writing them the way I do) takes years and years.

Robin Lindley: Thank you for your thoughtful comments Mr. Sem-Sandberg and congratulations on your powerful novel.