Desperate Remedies

AMERICAN NEUROLOGISTS EMERGED as subspecialists immediately after the American Civil War. Alongside the mass slaughter, the conflict produced large numbers of casualties who had suffered trauma to their brains, spines, and extremities. Taken together, the wrecked bodies of these soldiers provided a series of naturalistic experiments that elucidated important facets of the human nervous system. War, as always, visited unspeakable horrors on those who fought it, but proved invaluable to the medics who treated them.11

Ref. F656-A

These “hysterics,” as they were popularly known, and “neurasthenics” (suffering from weakness or overtaxing of the nervous system) came to constitute a large fraction of the new nerve doctors’ clientele. In exasperation, Weir Mitchell once referred to hysteria as “mysteria,” but, like most of his colleagues, he could not afford to turn these patients aside.12 Not disturbed enough to warrant confinement in an asylum, the ambulatory neurasthenics and hysterics had the wherewithal to pay for their treatment, and their social standing more closely matched that of the professionals whom they consulted. Their demographic profile contrasted markedly with the population that crowded the wards of the state hospitals, helping the neurologists to escape the stigma that asylum doctors increasingly shared with their patients.

Ref. B63F-B

WEIR MITCHELL’S SPEECH SEEMED likely to reopen old wounds. Striding to the podium, he conceded that what he was about to say violated the usual expectations for such celebratory occasions: “It is customary on birthdays to say only pleasant things,” he began, but those who had asked him to speak had persisted in asking him to do so after he had warned them that he would offer criticism “without mercy.” He had given in to their importunities. “That was a momentary insanity; I have been sorry ever since,” for he now had to face up to “the uncongenial task of being disagreeable.”

Ref. AEC4-C

The medical superintendent was the “monarch” of all he surveyed, but he was an emperor with no clothes. “Where, we ask, are your annual reports of scientific study, of the psychology and pathology of your patients[?] … We commonly get as your contributions to science, odd little statements, reports of a case or two, a few useless pages of isolated post-mortem records, and these are sandwiched among incomprehensible statistics and farm balance sheet.” Asylum case records put on display an appalling state of affairs, an “amazing lack of complete physical study of the insane, … the failure to see obvious lesions,” and a complete ignorance of the diagnostic technologies indispensable to the practice of modern medicine. These problems were as visible in the most prominent and best-endowed asylums for the rich, as in the meanest, most overcrowded state hospital.22

Ref. 0473-D

The upshot of such conditions, Weir Mitchell announced, was what he himself had observed in the wards of an asylum in his home city of Philadelphia, where “the insane, who have lost even the memory of hope, sit in rows, too dull to know despair, watched by attendants; silent, grewsome machines which eat and sleep, sleep and eat.” Nor were they the only victims of prolonged confinement: their captors, the psychiatrists, had fallen into the same sort of paralysis. “The cloistral lives you lead give rise, we think, to certain mental peculiarities.… [Y]ou are cursed by that slow atrophy of the energizing faculties that is the very malaria of asylum life.” Indeed, he concluded, “I cannot see how, with the lives you lead, it is possible for you to retain the wholesome balance of mental and moral faculties.”24

Ref. 042B-E

Some made use of the intervention Weir Mitchell himself was famous for inventing, the so-called rest cure, confining nervous patients to bed for weeks at a time, denying them all mental stimulation or outside company, and feeding them a high-calorie diet to build up “fat and blood” and thereby restore their shattered nerves. Affluent but nervous patients who feared their troubles might lead to consignment to an asylum sought out such treatments, and many professed themselves grateful for interventions later generations saw as profoundly misguided.27

Ref. 5A01-F

A profession once convinced that it could cure had mostly subsided into somnolence, bound by the dull rounds of administrative routine.

Ref. 4646-G

Not so in the closing decades of the nineteenth century, especially with respect to the burgeoning troublesome classes, among whom the insane and feeble-minded (a group that substantially overlapped) loomed large. Charles Darwin’s ideas about evolution, however controversial at first, had popularized the notion of the survival of the fittest as the indispensable engine of progress. But as Darwin’s cousin Francis Galton argued, in civilized societies the operation of this natural law was often suspended, prompting overbreeding by the less fit and underbreeding by the more thoughtful and conscientious, an observation that led him to embrace eugenics.3 It was a theme Darwin himself took up in The Descent of Man and Selection in Relation to Sex, published in 1871: With savages the weak in body or mind are soon eliminated; and those that survive commonly exhibit a vigorous state of health. We civilized men, on the other hand, do our utmost to check the process of elimination; we build asylums for the imbecile, the maimed, and the sick; we institute poor laws; and our medical men exert their utmost skill to save the life of everyone to the last moment.… Thus the weak members of civilised societies propagate their kind. No one who has attended to the breeding of domestic animals will doubt that this must be highly injurious to the race of man.4

Ref. 676E-H

Moral causes wrought physical changes on people’s bodies, and these degenerative modifications were successively “transmitted as evil heritages to future generations: the acquired ill of the parent becomes the inborn infirmity of the offspring. It is not that the child necessarily inherits the particular disease of the parent … but it does inherit a constitution in which there is a certain aptitude to some kind of morbid degeneration … an organic infirmity which shall be determined in its special morbid manifestations according to the external conditions of life.”14 Tuke, whose great-grandfather had founded the York Retreat in 1796, the institution that inspired the construction of reformed asylums in the English-speaking world, was blunter still: “Recklessness, drunkenness, poverty, misery characterise the class,” he insisted. “No wonder that from such a source spring the hopelessly incurable lunatics who crowd pauper asylums, to the horror of the [tax]payers.” They were most emphatically “an infirm type of humanity.… ‘No good’ is plainly inscribed on their foreheads.”15 The implication was that it was positively misguided to attempt to cure the mad and restore them to society. Such apparently humane and well-intentioned efforts “prevent, so far as is possible, the operation of those laws which weed out and exterminate the diseased and otherwise unfit in every grade of natural life.” Irrationally, the insane “are not only permitted, but are aided by every device known to science to propagate their kind.” They are “turned loose to act as parents to the next generation … centres of infection deliberately laid down, and yet we marvel that nervous disease increases.”16

Ref. 27A4-I

To treat their patients’ nervous prostration, these doctors invented an enormous variety of nerve tonics whose ingredients remained trade secrets. Many contained dangerous substances, some of which proved addictive: strychnine, morphine, cocaine, and lithium salts, for example. Others proffered animal extracts designed to fortify the nerves.18 Hydrotherapy was another treatment they frequently employed; while in their consulting rooms, patients connected to elaborate machines received jolts of electricity to provide painful stimuli to the body. Electrotherapy had been popular in some circles from the eighteenth century onward, but for many it had the odor of the charlatan and the quack. As neurologists began to demonstrate the role of electricity in transmitting nervous impulses, however, it was not difficult to persuade themselves and their clientele that electrical charges had healing powers.19 Manufacturers rushed to fill the void.20 The shocks were painful, of course, and were particularly touted as remedies for one of the commonest symptoms of hysteria, a loss or impediment of speech, or hysterical aphonia, where electrodes could directly be applied to the larynx. Few remained mute for long when subjected to these interventions.21 More generally, neurasthenics and hysterics were informed that overuse and overstrain had disturbed the equilibrium of the nervous system. A commonly employed metaphor was that overstimulation and overuse had run down one’s battery, an image that suggested why the application of electricity could have therapeutic effects. Within a generation, though, having originally insisted that electrical treatment worked directly on the nervous system, there was a growing consensus that its efficacy, such as it was, rested on the power of suggestion.

Ref. D1D7-J

For Gilman and Woolf, the experience practically drove them mad. As for men, Weir Mitchell prescribed virtually the opposite regimen. Dubbed the “West cure,” it sent neurasthenic men out West to rope cattle, hunt, and compete in a sturdy contest with Nature. Thomas Eakins, Theodore Roosevelt, and Walt Whitman were among those who tried

Ref. 0D3E-K

It is little wonder that modern feminists have denounced the rest cure as a prototype of Victorian patriarchal oppression. Certainly, these gender-based curative regimes uncannily echo the stereotypes of the broader culture of the time: women subjected to a hyperexaggerated version of domesticity, and men sent forth to strengthen nervous systems that their sedentary lives had enfeebled.24 By the early twentieth century, these earlier interventions were gradually giving way to various forms of psychotherapeutics.

Ref. 074A-L

At the McLean Asylum in Boston, the Butler Hospital in Rhode Island, and the Hartford Retreat in Connecticut, as well as at the Bloomingdale in New York and the Pennsylvania Hospital for the Insane in Philadelphia, continuous efforts were under way to compete for a limited number of wealthy patients whose families could choose where their relations would be confined. Though secure confinement of the mad might be the key requirement for such an establishment, it had the potential to alienate the asylum’s true clientele, the patients’ families, and so these features had to be disguised beneath a veneer of good taste and cheerfulness. Manicured grounds could play a vital role in massaging the impressions of families faced with the difficult task of confining their nearest and dearest.26

Ref. 660F-M

If opulent surroundings did not suffice, families could be reminded that the asylum provided a range of other amenities—French lessons, drawing classes, singing classes, theater, and the like. Staffing levels were high—the McLean boasted that “its sane population is about half as numerous as the insane patients”—and patient numbers remained constrained. If all these amenities meant that these private establishments cost six or eight times as much as their public counterparts, their clientele—the patients’ families—were not disposed to object. In these social circles, the linkage of mental illness and degeneracy was a sensitive subject. Just how carefully these doctors felt they had to proceed is suggested by the intellectual evolution of George Alder Blumer, who had previously been one of the most vocal psychiatrists endorsing eugenic ideas.

Ref. B7F3-N

As superintendent of the Utica State Asylum in Upstate New York, Blumer was intimately familiar with the dire conditions of his state’s hospitals. He grew increasingly frustrated at the attempted micromanagement of his institution by Carlos MacDonald, who had been appointed head of a reconstituted state commission on lunacy in 1889. MacDonald, who previously served as superintendent of three state hospitals, immediately set about enforcing uniform state standards, and in 1893 he endorsed state legislation that sharply cut hospital budgets, from $208 to $184 per patient per year. Instructions to hire a female assistant physician and limitations placed on his ability to admit and charge higher fees for private patients exacerbated Blumer’s frustration. His initial instinct was to challenge MacDonald, whom other asylum superintendents also resented for his interference. In such circles, MacDonald was increasingly viewed as a “Prince of Darkness.”27 But it soon became apparent who had the governor’s ear, and when neither a change of administration nor MacDonald’s resignation brought any relief, Blumer’s disillusionment reached the breaking point. In 1899, he accepted a new position as head of the private Butler Hospital in Rhode Island.

Ref. 4D26-O

At first, Blumer was as vocal as ever about the links between mental illness, vice, and the biological defects that ran in families. In 1903, four years into his tenure at Butler, he was elected president of the American Medico-Psychological Association. He used the occasion of his presidential address to warn once again of the links between inherited biological defect and mental defect, speaking darkly of the “infinite disaster” that awaited society if the mad were allowed to give free rein to their instincts. He added that the insane were “notoriously addicted to matrimony and by no means satisfied with one brood of defectives.”28

Ref. C117-P

When the nineteenth-century neurologist George Beard had popularized the term “neurasthenia,” he had employed similar arguments to suggest that this weakness of the nerves was a condition peculiarly likely to afflict the rich and successful, whose nervous systems were more refined and delicate than those of the poor, and stretched by the stresses of their ultracivilized lifestyles. It was a well-judged piece of flattery that had salutary effects in expanding the market for these nerve doctors’ wares, and Blumer was not slow to recognize that such notions could easily be adapted to placate rich relatives of asylum inmates. He returned to the theme on later occasions, reminding them that “there cannot be complexity of the nervous system without what the world calls nervousness.”30

Ref. F051-Q

FAR FROM THESE MANICURED ESTATES, those shunted off to state hospitals could expect no such tolerant treatment. As the theory of degeneracy acquired a patina of respectability, some began to argue that even lifelong confinement or involuntary sterilization were half measures, the product of a failure of nerve. Attentive readers of the Anglo-American psychiatric literature would have encountered hints that a more robust solution was worthy of consideration. “Every year,” the English alienist Samuel Strahan reminded his audience, “thousands of children are born with pedigrees that would condemn puppies to the horsepond.” Lunatics were waste products of the evolutionary process, “morbid varieties fit only for excretion.”38 On occasion, the euphemism of “excretion” or “extrusion” was dispensed with entirely. Blumer had well-thumbed copies of both Maudsley’s and Clouston’s books, and proved to be an adept disciple.39 “Our modern hospitals for the insane are in some measure responsible for the increase of insanity by promoting, not the survival of the fittest, but the survival of the unfit,” he lamented, “as well as by permitting unstable persons to leave institutions and mate themselves with their kind, instead of allowing an affinity of contrasts to prevail in selecting their wives.”40 The ancient Scots may have been condemned by modern sentimentalists for their “rough and ready method” of burying alive babies and their epileptic or mentally disturbed mothers, but “from the point of view of science the cruel and remorseless Scot was more advanced than his descendants of our day.”41

Ref. FEB2-R

Though McKim’s discussion reads today like a twentieth-century equivalent of Jonathan Swift’s satirical Modest Proposal, it was meant in most deadly earnest. The Nation, in a review published on November 1, 1900, recommended McKim’s book to its readers and to “all good citizens interested in human progress.” Who could doubt that the public had every right to protect itself from “the ravages, one may say the compulsory and automatic ravages, of the physically, mentally, and morally diseased [?] … There seems no logical objection to the absolute removal of those whose unsoundness is complete and irremediable, particularly when they are a public charge.”43 For good measure, McKim’s publisher, Scribner’s, more than a decade and a half later brought out the popular The Passing of the Great Race, by Madison Grant, director of the Bronx Zoo and president of the Immigration Restriction League. Here the proposed “obliteration of the unfit” was extended to an assault on the “inferior races.” Grant complained that the “mistaken regard for what are believed to be divine laws and a sentimental belief in the sanctity of human life tend to prevent the elimination of defective infants and the sterilization of such adults as are themselves of no value to the community.”44 Such well-known progressives as Clarence Darrow joined in the chorus, advocating efforts to “chloroform unfit children” so as to “show them the same mercy that is shown to beasts that are no longer fit to live.”45 As a practical matter, the opposition of religious groups and constraints of a democratic polity meant that the chances of actually instituting such policies were essentially nil. Charles Davenport, the Harvard-trained biologist and member of the National Academy of Sciences, did what he could as head of the Eugenics Records Office in Cold Spring Harbor, New York, to persuade the American public to put aside its concerns, but in the end he could only lament that “it seems to be against the mores to burn any considerable part of our population.”46 It would prove otherwise, of course, in Nazi Germany where, with the enthusiastic participation of German psychiatrists, Hitler’s T-4 program would see mental patients herded into gas chambers in tens, even hundreds of thousands, “useless eaters” who became the first victims of a policy of mass extermination that would soon extend to other groups defined as subhuman and a menace to the purity of the race.47 But the harsh and condemnatory language of these authors and the insistence that mental illness was an irredeemable biological condition were not without serious consequences for American social policy.

Ref. F07C-S

THE THEORIES OF DEGENERACY that psychiatrists had done so much to develop and propagate were seen to justify a whole series of legislative changes. The easiest to pass were attempts to prevent marriage and reproduction among the unfit, first codified into law in Connecticut in 1895, launching the fashion for laws prohibiting the marriage of the defective. If one of the marriage partners was determined to be “unfit”—feeble-minded, epileptic, or an imbecile—both parties could be imprisoned for a term of up to three years. Statutes of this sort proved irresistible to politicians, and by the mid-1930s, as many as thirty-one states prohibited the mentally ill and “feeble-minded” from wedding.48 But if such statutes were politically popular, their practical effects were slight, and even those broadly supportive of the eugenic cause came to see them as symbolic gestures, rather than effective interventions to stem the burgeoning number of defectives.

Ref. 5829-T

Francis Walker, a prominent economist and president of the Massachusetts Institute of Technology, had written in the Atlantic in 1896 of the necessity not just of “straining out from the vast throngs of foreigners arriving at our ports … [the] deaf, dumb, blind, idiotic, insane, pauper, or criminal,” but also of excluding “the tumultuous access of … hordes of ignorant and brutalized peasantry from the countries of eastern and southern Europe.” These were “beaten men from beaten races; representing the worst failures in the struggle for existence”—“foul and loathsome” creatures, whose presence would serve only to degrade and debase America’s culture.49

Ref. 9A9C-U

Two years earlier, the Boston bien-pensants Charles Warren, Robert DeCourcy Ward, and Prescott Hall had founded the Immigration Restriction League. The spread of eugenic ideas among “progressive” elites combined with hostility to competition from the new migrants among the working classes ensured that the agitation to exclude those considered biologically inferior increased in the decades that followed. Ultimately it met with legislative success, a process helped along by the expert testimony of sympathetic psychiatrists and social scientists. Asian immigrants were barred in 1917, and the Immigration Act of 1924 imposed strict quotas on immigration from southern and eastern Europe, inaugurating a system that would remain in place for more than four decades.

Ref. FF1B-V

Two-fifths of the nearly two and three-quarter million immigrants in these years were Irish Catholics, and disproportionate numbers of them soon began to show up in public mental hospitals. This pattern was particularly marked in the major cities: in Boston, New York, Philadelphia, Cincinnati, and St. Louis, where unskilled Irish immigrants clustered in urban slums. Sharing the larger culture’s distaste for the new arrivals, asylum superintendents found them “more noisy, destructive, and troublesome,” “very ignorant, uncultivated people [who] from some cause or another, seldom recover.”50 There was…

Ref. 4B91-W

If the prospect of mingling Irish and other foreign-born patients with the native-born was problematic, mixing white and Black lunatics was unthinkable. In the pre–Civil War North, the African American population was small, those who applied were often turned away, and the few who were admitted to asylums were simply placed in segregated cells. In the South, slaves were largely excluded from the asylums, except where their owners were willing to pay for them, in which case they were separately provided for in grossly inferior accommodation. After 1865, either completely separate provision was made in existing asylums or separate and distinctly unequal “colored” asylums were established in which to confine them. Tennessee (1866), Virginia (1869), North Carolina (1880), Mississippi (1889), and Alabama (1902) opened segregated institutions. Segregated wards were set up in various states, including West Virginia (1864), Missouri (1865), Georgia (1866), and Arkansas (1882).52…

Ref. 9777-X

Just how stark the differences in the treatment of Black Americans were has been detailed in a number of recent analyses of asylums in the South—in Georgia, Louisiana, Virginia, and Washington, DC. Collectively, they show the profound differences in the way African American patients were viewed and treated both by psychiatrists and the staff of these institutions. Martin Summers has helpfully documented the large discrepancies in the use of restraints and seclusion between the Black and white inmates at the federal hospital in Washington, DC.54 And he and Elodie Edwards-Grossi show the equally profound differences in the labor demanded of Black inmates compared with their white counterparts. If most American asylums were massively underfunded and overcrowded, conditions in the “colored” wards and institutions were far worse. Some Black patients sought to resist what they perceived as slave labor.55 The heads of mental hospitals in the South were unapologetic about the differential treatment of the races, insisting that it was “essential” and beneficial to both races. Under slavery, T. O. Powell proclaimed, “there were, comparatively speaking, few negro lunatics. Following their sudden emancipation their number of insane began to multiply, and, as accumulating statistics show, the number is now alarmingly large and on the…

Ref. 0CE4-Y

1914, Mary O’Malley, a junior psychiatrist on the staff of St. Elizabeths in Washington, DC, explained the origins of “psychoses in the colored race” in the pages of the profession’s journal, the American Journal of Insanity: “300 years ago the negro ancestors of this race were naked dwellers on the west coast of Africa … in the depths of savagery and suddenly transplanted to an environment of the highest civilization, and 250 years later had all…

Ref. C8FC-Z

Seven years later, her colleague W. M. Bevis echoed these views. “The colored race,” he contended, were simply too primitive to cope with the stresses of a free society. They were, after all, the descendants of “savages or cannibals in the jungles of central Africa.” Consequently, their “biological development” left them “poorly prepared” for emancipation, though “their talent for mimicry … is remarkable … sometimes sufficiently exact to delude the uninitiated into the belief that the mental level of the negro is only slightly inferior to that of the Caucasian.” Nothing, of course, could be further from the truth.61 Persuaded that their happy-go-lucky nature and…

Ref. E642-A

The early twentieth-century anti-immigrant sentiment thus built on decades of prejudice and unequal treatment that were most deeply embedded in “scientific” beliefs about the biological inadequacies of African Americans. If the Grants, the McKims, and the Davenports directed their ire at Jews, Italians, Greeks, Poles, and Russians, that did not mean that they were not even more convinced of the inferiority of Black Americans. It was simply that those prejudices were so deeply rooted and widely shared in the dominant culture as to be not worth mentioning. Segregation and neglect were seemingly immutable facts of life throughout the asylum era. For the most part, psychiatrists shared the profound racial prejudices of the larger society and even helped give a…

Ref. 0569-B

ASYLUM DOCTORS and their allies had by the early decades of the twentieth century put in place yet another set of policies that derived from their belief in the heritability of mental illness. Sexual surgery to “cure” female patients of their insanity had enjoyed something of a vogue in the last three decades of the nineteenth century. By and large, the operations had been performed on “nervous” cases outside asylum walls, mostly by those associated with the newly emerging field of gynecology. Pioneered by a Georgia physician, the aptly named Robert Battey, some thousands of “normal ovariotomies”—the…

Ref. EF40-C

Margaret Smyth, the superintendent of California’s Stockton State Hospital, was a particular enthusiast. She noted with pride in 1938 that California’s aggressive moves to prevent the reproduction of the unfit had served as a salutary example and been emulated in Nazi Germany: California adopted its first sterilization law April 26, 1909. This law has attracted attention from countries all over the world. The German government applies sterilization systematically in accordance with its law, the total number of operations to date having reached something like 250,000. Investigators agree that the policy there is being enforced in a scientific spirit without racial or political implications and with a minimum of difficulty. The leaders in the German sterilization movement state repeatedly that their legislation was formulated only after careful study of the California experiment.… It would have been impossible they say, to undertake such a venture involving one million people, without drawing heavily upon previous experience elsewhere.69

Ref. F1DF-D

A decade before Smyth spoke so proudly of her state’s place in the vanguard of psychiatric progress, a test case of the constitutionality of involuntarily sterilizing the mentally defective had reached the United States Supreme Court. Carrie Buck was a twenty-one-year-old woman who had been a resident of the Virginia Colony for the Epileptic and Feeble-minded in Lynchburg for three years before, on the morning of October 19, 1927, she was wheeled into the operating theater to have her fallopian tubes severed, cauterized, and tied. She had been pregnant on admission, apparently the aftermath of being raped by her cousin, in whose parents’ house she had lived after her mother had been institutionalized as feeble-minded. Carrie’s out-of-wedlock pregnancy had been the primary reason for her own subsequent confinement in the same Colony as her mother. (Her baby, incidentally, was “disposed of,” as the Colony’s official records put it, by being handed over to her aunt and uncle, who took their grandchild with the understanding that the little girl “will be committed later on if it is found to be feeble-minded also.”)70 Buck was unaware of why she was being operated on, just as she did not know that, months previously, after Virginia had passed a statute permitting involuntary sterilization, she had been carefully selected by the law’s defenders to serve as the test case of its constitutionality. The state had provided her with a lawyer who proceeded to sue the Colony’s superintendent, Dr. John Bell, for operating on her. The original trial was little more than a formality. Buck’s lawyer made little effort to challenge the factual basis of the state’s version of the case, and it passed quickly through Virginia’s state courts before being appealed to the United States Supreme Court. Here the lawyer did finally speak eloquently about the underlying constitutional issue, whether the 14th Amendment provided a guarantee of the individual’s right to bodily integrity. But as the measure’s backers had hoped, the Justices were unmoved. The majority ruled 8–1 that there was no constitutional obstacle to the involuntary sterilization of an American citizen. Oliver Wendell Holmes, Jr., widely regarded as one of the most eminent jurists in the nation’s history, was assigned the task of writing the opinion. He ringingly endorsed the state’s position: “It is better for all the world,” he wrote, “if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting Fallopian tubes. Three generations of imbeciles are enough.”71 In a rich bit of historical irony, the parents of the politician who wrote the Virginia statute, and who subsequently successfully argued its constitutionality before the United States Supreme Court, had both died of insanity in Virginia asylums.…

Ref. 42DC-E

A year later, on July 3, 1932, Buck’s daughter, Vivian, the third-generation “imbecile” Holmes had denounced, died at eight of complications from measles—but not before she had been placed on the academic honor roll at the elementary school she attended in Charlottesville.

Ref. 4698-F

THE ERA OF COMPULSORY MASS STERILIZATION CREATED, for many psychiatrists, a clear ethical dilemma. Nominally, their professional duty was to act in the best interests of their patients. But when psychiatrists made the decision to sever the vas deferens or the fallopian tubes of a patient, the rationale enshrined in the law was that the state had a compelling interest in preventing the multiplication of biologically inferior specimens of humanity. The implication was that the operations benefited society as a whole, but not the individuals these physicians were charged with treating. On its face, that might seem to violate the Hippocratic oath, but fortunately an ideological solution came readily to hand. Sterilization, these doctors argued in increasing numbers, provided hidden health benefits for the patients themselves. Both physically and psychologically, patients were seen as improving post-surgically, thus providing a therapeutic rationale for the operation. It was at best a tenuous fig leaf, but its widespread employment in clinical records is a testament to psychiatrists’ desperate need to see themselves as something other than jailers.1

Ref. 7047-H