Learning from Medicine’s Complex Past

Gray Matters

Learning from Medicine’s Complex Past

By Alexandra Minna Stern, Ph.D.

Fall 2016
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For the past 20 years, I have studied the good, the bad and the complex of the history of human genetics. I have explored how new modalities of genetic identification developed in the 1980s facilitated the reunion of families torn asunder by the military dictatorship in Argentina from 1976 to 1983. I have traced the development of genetic counseling, which began as a fledgling field in the 1940s and transformed into a profession guided by ethical values and patient-centered communication.

Now, I’m leading a large-scale project to uncover the unsavory history of eugenic sterilization in California. Our interdisciplinary team of faculty members and graduate students at U-M, as well as several other institutions, are reconstructing patterns and experiences related to 20,000 reproductive surgeries carried out by the Golden State between 1919 and 1953. These sterilizations occurred under a law that granted medical superintendents at institutions the authority to sterilize people deemed “unfit” and “suffering from a mental affliction likely to be inherited.”

In order to better understand this largely forgotten history of medical institutions in which vulnerable populations were subjected to procedures we today would find unethical, if not illegal, our team has created a de-identified dataset with 212 unique variables drawn from 50,000 individual records. This resource is allowing us to map demographic trends and understand the relationships among gender, age, race/ethnicity and diagnosis. For instance, using complementary census records, we determined that Spanish-surnamed patients, almost all of Mexican origin, were sterilized at rates 2.65 times higher than the overall institutional population. Strikingly, this rate was 3.96 times higher for Spanish-surnamed females under the age of 15, demonstrating that eugenic sterilization impacted, if not targeted, adolescent girls of color, who often were described in the records as biologically inferior and a drain on public welfare.

California’s eugenic sterilization program performed one-third of the 60,000 operations nationwide in the 20th century. It was compulsory, often relying on the heavy hand of medical superintendents who enjoyed great latitude in how they ran state institutions. Many parents resisted the sterilization of their children, appealing to priests, social workers, legal counsel and consular officials to halt scheduled surgeries. Particularly moving are 60 handwritten letters penned by patients protesting the procedure, which our project has captured and preserved.

In the late 1940s, one patient at the Patton State Hospital wrote that he was “religiously opposed to sterilization,” and another at the same facility explained that she objected “strenuously” because “there is no insanity in my family’s background and I am young enough to remarry and have a normal, happy life with children.” Some of the patients who spoke back to the state successfully forestalled the procedure. Barring surgery, however, patients usually remained institutionalized for years to come.

Despite the numerous appeals, some patients — or their guardians — requested this sanctioned surgery. In 1932, one mother drove 120 miles from the coastal town of Santa Cruz to the Sonoma State Home to drop off her daughter “for the purpose of sterilization.” This mother was exasperated by her daughter’s unwanted pregnancies, which had ended in abortions, and believed that permanent birth control was in her child’s best interest.

In other cases, eugenic sterilization was the only viable route for poor women desirous of an otherwise restricted procedure. In North Carolina, which maintained a similar sterilization program, one scholar has found that approximately 6 percent of the 8,000 women and men sterilized actively sought out operations even though doing so meant being officially labeled “feebleminded” by a county eugenics board.

One of our foremost objectives is to tell humanizing stories about individuals whose lives were altered irrevocably by sterilization. Eventually, these stories, documents and findings will be available online, making this history accessible and offering lessons about a period where misguided scientific ideas deprived many Americans of their reproductive autonomy and bodily integrity.

Alexandra Minna Stern, Ph.D., is director of the U-M Center for Latin American and Caribbean Studies; co-director of the Reproductive Justice Faculty Program in the Institute for Research on Women and Gender; and professor of American culture, of obstetrics and gynecology, of history, and of women’s studies.

Illustration by Karolis Strautniekas