“It would be a rare phenomenon if the progeny of two mentally deficient parents were not likewise deficient. Yet in every state there are hundreds such in the pauper class free to bear children of whom a large percentage are certain to have criminal tendencies, murderous proclivities or vicious social traits. The public expense and private property loss they cause is beyond computation, and their presence at large is a menace that grows with the spreading branches of their family tree. What’s to be done? ‘Well’, says Mr. John Average Public, ‘Why not try a safe and sane compulsory human sterilization law conservatively administered as in Wisconsin?’”
—Frank C. Richmond, State Director of Psychiatric Field Services, 1934
People tend to be shocked when I tell them that the last state-sponsored sterilization in Wisconsin took place in 1963. It gives one a lot of cognitive dissonance imaging that some surgeon could have performed a coerced salpingectomy one afternoon and then popped over to the cinema to watch The Birds. But so it was, and the law that permitted such operations actually stayed on the books until 1978. Although estimating the exact number has proven difficult, between 1,500 and 2,000 people were sterilized by the state under the Wisconsin Sterilization Act.
The passage of the act in 1913 was a victory long in the making for proponents of the practice of eugenics. Wisconsin prided itself on using science to guide state policy, and eugenics was endorsed as science by representatives from the University and beyond. Writing a half-century later, Rudolph J. Vecoli documented in fascinating detail how “the congruity between the eugenic doctrines and certain aspects of the Progressive mentality,” including the Wisconsin Idea of connecting university and government, folded neatly into the creation of a law to restrict the freedom of its citizens to reproduce. Nonetheless in the early years of the 20th Century sterilization remained controversial and politically risky. A law preventing the unfit from marrying had been passed in 1907, but it was unpopular and fated to be overturned in the courts the following year. In the intervening years, two bills that would have codified state-sponsored sterilization had been defeated in the legislature. The 1913 bill succeeded in part because it was promoted as a conservative approach that would not take the extreme measures that had been seen in other states (then as now, a lot could be achieved in Wisconsin politics with by rallying around shared distaste for Illinois).
Wisconsin was the eleventh state to legalize compulsory sterilization, but it was not the last. Thirty-two states passed sterilization laws in the 20th century, and five more generated a historical record of involuntary sterilizations without the blessing of the legislature. Wisconsin is an instructive case precisely because it kept the scope of its sterilizations narrow. While other states defined the unfit broadly or loosely, and some used sterilization as a punishment for criminals and sex offenders (in Oregon men could be castrated for having sex with other men), Wisconsin separated the concept of sterilization from punishment. The law outlined only three conditions that justified it: epilepsy, insanity, and “mental deficiency.”
Wisconsin’s law represents one of the least extreme cases of government regulation of fertility, and as such it is among the most instructive. In his book Breeding Contempt: The History of Coerced Sterilization in the United States, Mark Largent notes that in historical debates surrounding sterilization, “Even the most aggressive opponents of coerced sterilization often set aside some particularly problematic group for the procedures,” and the same might be said to be true today. People with cognitive disabilities are often made to occupy that role of the particularly problematic group for whom an exception might be made to the concepts of autonomy and the right to reproduce, opening a back door to legitimization of coerced sterilization. Of the three medical conditions made explicit in the law, mental deficiency provided the rationale for surgery in the overwhelming majority of cases, perhaps because it was the most acceptable. As it was put by one prominent supporter of the law, University of Wisconsin professor of sociology E.A. Ross, “The wedge should have a very thin end indeed. Sterilization should at first be applied only to extreme cases…As the public become accustomed to it, and it is seen to be salutary and humane, it will be possible gradually to extend its scope until it fills its legitimate sphere of application.”
Right about here is where I would like to plunk a picture of Dr. A.W. Wilmarth, M.D., who will be playing the role in tonight’s blog post of Guy on the Wrong Side of History. But since I would have to pay for the rights, here’s a link to the Wisconsin Historical Society’s picture of him instead. Wilmarth was the first superintendent of the Wisconsin Home for the Feeble Minded in Chippewa Falls, which was later called the the Northern Colony and Training Center, and still exists today as the Northern Center for the Developmentally Disabled. The Northern Center was the site of Wisconsin’s state sterilization program. It was created by state law in 1895, under the bureaucratic oversight of the State Board of Control, which administered the prison system as well as institutions for people with varying types of disability, and mental hospitals.
From the first, the Northern Center’s founding was tied to the prevention of procreation. In his first report to the Board of Control in 1898, Wilmarth wrote, “The three objects that prompted the foundation of the ‘Home’ are already being largely realized. First, the relief of over-burdened families…Second, the curtailment of the increase of the feeble-minded and epileptic by the sequestration of feeble-minded women of child bearing age…Third, the education of the imbecile to his highest sphere of usefulness.” Within a few years the number of applications had grown larger than the Center’s capacity, and the Board of Control gave its highest priority to women of childbearing potential.
The sterilization procedures were vasectomies for men and salpingectomies for women. They were performed by the Northern Center’s consulting surgeon, first J.V.R. Lyman and then after his death, S.E. Williams. Lyman and Williams were general surgeons for whom sterilization was only a part of their service at the Center; in the center’s 1932 biennial report Williams is reported to have performed appendectomies, hemorrhoidectomies, herniotomies, a mastectomy, and two leg amputations. In several cases, salpingectomies are known to have failed. Records of the operations, housed at the Wisconsin Historical Society and publicly available through 1935, show that twelve women sterilized before 1935 were subsequently known to be pregnant; of these three underwent the operation a second time.
From the end of the 19th Century to the beginning of the 20th, the concept of feeble-mindedness was shaped into something that overlaps to a great extent with our contemporary concept of cognitive disability. For a thorough history of this topic I recommend James W. Trent’s Inventing the Feeble Mind. I will emphasize just a few relevant points.
Feeble-mindedness was divided into three categories based on mental age or IQ. The most severe was the idiot, followed by the imbecile, and then the highest functioning, the moron. Though these words are still in common usage, few people know their origins as the R-word of their time–knowing makes you not want to use them. In addition to these categories of cognitive ability came the innovative concept of the “moral imbecile,” who was deficient less in cognition than in the sense of right and wrong. The moral imbecile was defined not even by anything as pseudo-objective as an IQ, but by failure to live within socially approved codes. From a diagnosis for aberrant behavior it was a short leap to connect feeblemindedness to societal “ills.” The idea became so entrenched that a Board of Control statistician could claim, “This defect is responsible for more pauperism, delinquency and crime than any other one force.”
Although mental deficiency was understood to arise in some cases from environmental factors such as congenital venereal disease and traumatic brain injury, it was generally acknowledged that hereditary factors were responsible for the majority. “The certainty of heredity has been so thoroughly established,” Wilmarth wrote in the 1918 board report, “That the tendency to transmit mental weakness, or instability, is no more to be disputed than the accuracy of the multiplication table.” The Northern Center routinely published the results of pedigrees tracing familial feeblemindedness alongside with more familiar statistics such as institutional censuses and causes of inmate deaths. Thus sterilization came to be understood as a response to not only intellectual disability, but to depravity and antisocial behavior.
Complex Motives for Sterilization
Sterilization in Wisconsin was first and foremost a eugenics program, but the practice of sterilization at the Northern Center was not entirely consistent with a eugenic rationale. Most glaringly, 91% of the patients who were sterilized were women, despite women constituting 49-55% of the patients in a given year. If mental deficiency were truly a Mendelian trait, then men with mental deficiency had just as much potential to affect the societal gene pool as women. To be fair, that basic genetic fact is frequently forgotten. Wilmarth wrote in 1914, “The women especially, not only carry and scatter loathsome disease, but reproduce and multiply their kind.” Men’s role in procreation and transmission of STIs is minimized in American culture in such a breadth of contexts that it would be surprising if it were otherwise at the Wisconsin Home for the Feeble Minded. Nonetheless, one of the hallmarks of the eugenics movement is its frequent recourse to biology and dismissal of any argument not founded in science. This departure from rational principles is telling.
The concept of the moral imbecile was inherently gendered. In the same screed in which he made reference to women carrying disease and procreating, Wilmarth described the moral imbecile as essentially comprising two categories: male thieves and female prostitutes. “The boys are familiar figures at the juvenile courts,” he tells us. “The girls begin vicious practices early and frequently commercialize their vice. Most careful investigation over a large field demonstrates that the majority of women who gain their living on the streets are of this class.” Although moral imbecility was understood as an inherited condition, to my knowledge, no one in Wisconsin claimed that theft or other male malfeasance was remediable by sterilization. Fertility was, however, considered highly relevant to female promiscuity.
The Board of Control’s Director of Psychiatric Field Services, Frank C. Richmond, wrote an article for the Journal of Criminal Law and Criminology in which he suggested that the discrepancy in male and female sterilization was attributable to men falling through the cracks in the system. “Many more females have been sterilized than males,” he wrote, “Because as a rule only non-delinquents have been sterilized while the mentally deficient criminal population has been exempt from such procedure. Were mentally deficient criminals to be dealt with adequately by way of sterilization the number of males sterilized as compared to females would be evened up or reversed.” Here maleness is constructed as a determinant of criminal behavior, and it is possible that that is what Richmond literally meant. It is also possible, however, that he was not including female promiscuity under the umbrella of criminal behavior because it was a problem that could be solved by sterilization itself–a disease with a cure.
In the earliest days of coerced sterilization, its champions often claimed the operations were of therapeutic benefit, primarily through reducing patients’ sexual desire. Trent cites a letter written by Wilmarth in which he suggest that oophorectomy would reduce sexual desire, but since salpingectomy was ultimately chosen instead, it is not clear that the staff of the Home believed that the operations would directly affect sexual behavior. They were probably exposed to evidence that it was not a bulletproof cure for promiscuity; there is record of at least one patient whose parole was terminated because she “had begun to lead an irregular sexual life”—perhaps that was code for having sex with women, but it is difficult to tell. Whether or not sterilization was considered medically therapeutic, it was often argued that prevention of pregnancy was in female patients’ best interests. “No woman should be allowed to become the mother of nineteen defectives,” Wilmarth wrote in 1906. “The State must protect such women from themselves, and incidentally the public purse and public morality.”
There does seem to have been recognition that women with cognitive disabilities were especially vulnerable to sexual assault, although the historical concept of consent for such women is a complex topic in itself. Viewed from this angle, the sexually indiscriminate, morally imbecilic female became the victim of sexual predators. Most of the time, in fact, the two concepts of sexuality were reconciled. A woman could be simultaneously the victim of a sex crime and the perpetrator of a social crime. “In a feeble-minded person the animal passions are usually present and are often abnormally developed,” wrote Irene Beier in 1938 in The Operation and Administration of the Northern Wisconsin Colony and Training School. “The feeble-minded woman is perhaps the worst offender. She cannot resist the persuasions and temptations that beset her. Society needs to be protected from her…Irresponsible and innocent of intentional wrong, she brings to our very doors the most destructive and insidious of evils.”
Here again it would be most surprising if the Home for the Feeble Minded were found to have been sheltered from the cultural construct of victim blaming. In a world where preventing rape was and is considered the responsibility not of future rapists but of potential victims, where sexual assault was and is treated as a known risk of being born female, and where legal consent to sex was and remains presumed, something less than Olympic-level mental gymnastics are necessary to hold a woman as simultaneously a criminal and a victim of the same crime.
Moreover the capacity to consent to sex and the capacity to consent to surgery are intertwined. It was an aim of the 1913 law and its application that all of the sterilizations be consensual. The Sterilization Act laid out the rules for due process, requiring both the consent of the inmate’s family or guardian and the assent of the patient. Richmond estimated that “Objection is registered in about 20% of the cases by parents, relative or guardian. Perhaps one inmate out of 25 personally refuses to consent to sterilization.” Of course, where consent was withheld, “Detention or segregation continues indefinitely,” making the whole concept something other than consensual. The law also required certain procedures for contacting the patient’s family for this purpose, but if the family could not be found, their consent was presumed. So proponents of this model had motive to insist that where a mentally deficient person failed to prevent incursion into her body, she should be judged a willing participant.
As the Home for the Feeble-Minded evolved into the Northern Colony, its mission came to include rehabilitation and reintegration as an alternative to permanently isolating inmates, and sterilization came to be seen through a new lens, neither eugenic nor moralistic but pragmatic. Trent has written about how the demand for care for the developmentally disabled far outstripped the capacity of state facilities, making parole an increasingly attractive option, and sterilization took on a new role as it was deemed crucial to reintegration. Consistent with that reading, 72% of the Wisconsin inmates whose records are publicly available were at some point paroled or placed in paid positions. On the other hand, that means that more than a quarter of the sterilized inmates were never paroled. Sterilization was not performed on inmates who were slated for parole; rather inmates to be paroled were selected from among those already sterilized.
Richmond’s article suggests another motive for sterilization related to the freeing up of space. “A small number,” he tells us, “Has been transferred to county asylums for the chronic insane whose transfer otherwise would have been objectionable and impracticable since they are prone to escape from and cause complications at the county asylums.” Transfers perhaps represent the mirror image of the parolees—patients whose condition is considered so hopeless that they are unlikely to benefit from continuing at the Northern Center. At this end of the medical classification scheme, too, sterilization is an integral part of the plan of care.
The gender imbalance among the sterilized meant that a man admitted to the Northern Center had a much smaller chance of leaving than did a woman. In the gendered framework of the “moral imbecile,” such a pattern makes sense. An innate proclivity for theft has no cure, but a salpingectomy—well, if it doesn’t prevent promiscuity or sexual assault, it does help to make them invisible.
The Stories of the Sterilized
The sterilization books from the Northern Center, spare as they are, nonetheless hint at the biographies of the patients who underwent these operations. Of the 452 whose records are in the open books, 71% were initially paroled to relatives or placed in employed positions. Of these, 59% were ultimately discharged. Among the remaining parolees, fifteen escaped, five died, 18 were returned to the Center, 19 were ultimately transferred to other facilities, and 86 were still paroled or placed at their last notation. Of those who were not paroled, 67 inmates were transferred immediately after their operations, and three immediately escaped. Twenty-one died before leaving the center, and sixteen are not noted to have left or died, and thus are assumed to have stayed.
Fourteen women were listed in the sterilization books with the title “Mrs.,” presumably indicating that they were married at the time the operation was performed. Titles were not routinely used, so it is not clear that this constitutes a definitive list. Many women were admitted to the facility with their children or while pregnant. A full accounting of these numbers is not possible without access to the full archive, but these mothers are recurring figures in Wilmarth’s laments. Seventy-nine patients, all of them women, are recorded as having been married after their operations. Four of these were escapees who were married within days of running away—one can impose on such a structure narratives of escaping in order to be married or marrying to avoid being returned.
Eugenics, of course, is no longer a mainstream part of science or politics, though many of its precepts persist in other guises and under other names. So what place does sterilization occupy today in the care of the cognitively disabled?
It seems to be a received idea that the practice remains quite common, but empirical estimates of its prevalence are difficult to find. Two peer-reviewed studies estimate that the prevalence of sterilization is 22% among developmentally disabled women in both Belgium and Mexico, but to my knowledge there are no comparable estimates available for women in the United States in general, or for Wisconsin specifically, and there are no estimates for men anywhere.
The official position of the American College of Obstetrics and Gynecology (ACOG) is that, for patients with cognitive disabilities who choose contraception or have it chosen on their behalf, the method that restricts future reproductive choices the least should be preferred. To the extent that ACOG represents the mainstream, medical culture has come a long way from Wilmarth’s heyday. But the mere fact that such a guideline is necessary highlights the ways in which fertility occupies a different place in the lives of people with cognitive disabilities than it does for those without them.
As late as 1997, a mailed survey to special educators in Virginia (a state with its own complex history of coerced sterilization) found that many of the ideas articulated by early 20th Century eugenicists have persisted. “The majority of respondents “felt that sterilization should be encouraged for persons with disabilities,” the author found. One of the reasons cited was “protection from rape or assault.” Moreover, “Another reoccurring subtheme at the center of the issue of sterilization was the ‘burden’ the situation would place on taxpayers and society at large. These respondents …felt that by not enforcing sterilization for persons with disabilities, more special education students would be produced and have a need for financial assistance.”
With the advent of the current generation of long-acting reversible contraceptives, one might wonder why sterilization continues to loom so large in reproductive health for patients with cognitive disabilities. Perhaps it speaks to the depth of what Largent calls, “our ongoing compulsion to locate the source of complex problems within certain citizens’ testicles and ovaries.” It seems that in a time of very real threats to the social fabric of the United States, the prospect of cognitively disabled parents still inspires fear that can only be soothed by permanent intervention.