Polish psychiatry was since its origin deeply influenced by German (Austrian) and Russian psychiatry. As a larger part of the Polish territory had belonged to Germany or Austria before 1918, many institutions and staff in mental health had a German or Austrian history. During the occupation nearly all mental hospitals were taken over by the Germans, sometimes all the patients, sometimes part of them were murdered, and often the staff members were shot together with their patients. Jews were separated from non-Jews and killed. Some institutions continued to work under German rule and with German directors. This paper will explore these issues from a historical and organizational perspective and address how Polish psychiatry attempted to survive during and after the war.