Ethical Human Psychology and Psychiatry Volume 7, Number 2, Summer 2005 pp. 111-124
The implementation by the President's New Freedom Commission (NFC) to screen the entire United States population - children first - for presumed, undetected, mental illness is an ill- conceived policy destined for disastrous consequences. The "pseudoscientific" methods used to screen for mental and behavioral abnormalities are a legacy from the discredited ideology of eugenics. Both eugenics and psychiatry suffer from a common philosophical fallacy that undermines the validity of their theories and prescriptions. Both are wed to a faith-based ideological assumption that mental and behavior manifestations are biologically determined, and are, therefore, ameliorated by biological interventions. NFC promoted the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan. The impact of TMAP is evident in the skyrocketing increase in psychotropic drug prescriptions for children and adults, and in the disproportionate expenditure for psychotropic drugs. The New Freedom Commission's screening for mental illness initiative, is, therefore, but the first step toward prescribing drugs. The escalating expenditure for psychotropic drugs since TMAP leaves little doubt about who the beneficiaries of TMAP are. Screening for mental illness will increase their use.
The catalyst for my article is the United States government's plan to implement an involuntary mental illness screening initiative as recommended by the President's New Freedom Commission on Mental Health. In no other democratic country has the government adopted a policy to screen the entire population - children first - for presumed, undetected, mental illness. According to the British Medical Journal, President Bush instructed more than 25 federal agencies to develop an implementation plan to begin screening America's 52 million schoolchildren and 6 million school personnel for hidden mental illness (Lenzer, 2004).
The rationale behind this mind-boggling initiative is, in part, evidence of America's abiding faith in science and technology to provide solutions for complex human and societal problems. The "pseudoscientific" methods of screening for mental and behavioral abnormalities are a legacy from the discredited ideology of eugenics. Eugenics and psychiatry suffer from a common philosophical fallacy that undermines the validity of their theories and prescriptions. Both have adopted a faith-based ideological assumption that mental and behavior manifestations are biologically determined, and are, therefore, ameliorated by biological interventions.
The diagnosis of mental illness is neither scientific nor objective - inasmuch as it relies on the subjective assessment by mental health professionals using checklists and the catchall dragnet for mental disorders, the admittedly flawed DSM-IV. The subjective methodology for diagnosing mental illness was acknowledged by the U.S. Surgeon General Report on Mental Health: "Mental health is not easy to define. . . . what it means to be mentally healthy is subject to many different interpretations that are rooted in value judgments that may vary across cultures" (U.S. Surgeon General, 1999).
Screening will most likely inflate the number of American children (and adults) labeled with a mental illness. The New Freedom Commission (NFC) promoted the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan that (the NFC report claims) "illustrates an evidence-based practice that results in better consumer outcomes" (p. 68). TMAP was a pharmaceutical company-sponsored pilot program whose flow charts guide mental health professionals on which psychotropic drugs to prescribe. TMAP has been adopted by at least 12 states, Ohio among the first. Ohio's director of the Department of Mental Health is Michael Hogan, PhD, chairman of NFC, who is an enthusiastic promoter of TMAP.
The impact of TMAP is evident in the skyrocketing increase in psychotropic drug Prescriptions for children and adults, and in the disproportionate expenditure for psychotropic drugs. The New Freedom Commission's screening for mental illness initiative is, therefore, but the first step toward prescribing drugs. The escalating expenditure for psychotropic drugs since TMAP leaves little doubt about who the beneficiaries of TMAP are. Screening for mental illness will increase their use. The number of psychotropic drug prescriptions for American children under 18 is staggering - the FDA estimates 11 million in 2003. A MEDCO report found that prescriptions for behavioral drugs is eclipsing all other categories for this age group: in 2003, there was a 49% rise in use of psychostimulants in children under 5 diagnosed with attention deficit hyperactivity disorder (ADHD); 21% rise in antidepressant use; 71% rise in psychotropic drugs for autism and conduct disorders; and the most shocking news is that psychotropic drug prescribing for preschool children rose 369% (Freudenhaim, 2004). The Massachusetts Behavioral Health Partnership reported that almost two thirds of children in state care were treated for behavioral disorders in 2003 (Vascellaro, 2004).
The unprecedented increase in children being diagnosed with psychiatric conditions and prescribed psychotropic drugs can be traced to the collaborative efforts of the drug industry, organized psychiatry, and the government. A series of federally sponsored "mental health" initiatives promoted the idea that children's mental health is in a crisis, and early intervention is essential (U.S. Surgeon General, 2001). Doctors and parents were persuaded that children's mental health was a big problem and that psychotropic drugs were "safe and effective" and were "well tolerated in children." In fact, the drugs have failed to demonstrate a benefit for children and there is credible evidence of severe drug-induced adverse effects, including a twofold increase in suicide risk. The deception was a collaborative effort by drug manufacturers, industry-supported leading opinion shapers in academic psychiatry, and government officials.
Investigative news reports in Texas reveal that Pfizer contributed $232,000 to state Officials for promoting TMAP, and charged Texas Medicaid $233 million for its psychotropic drugs such as the antidepressant Zoloft (sertraline); Janssen contributed $224,000, and charged the state $272 million for the antipsychotic Risperdal (risperidone); and Eli Lilly contributed $109,000, and charged Texas $328 million for Zyprexa (olanzapine) (Wilson, 2004). Furthermore, in the last 2 years, 107,000 children in Texas have been prescribed psychotropic drugs at a cost of $167 million. Another investigation by a Dallas Fort Worth television network found that in November 2003, just 40 doctors prescribed a third of the total psychotropic drugs children in foster care are forced to take. The average prescriber wrote 105 prescriptions valued at $11,000. Dr. Sharon Igelehart, a Houston psychiatrist, wrote 486 prescriptions that month worth more than $46,000. She wrote at least 20 prescriptions of Zyprexa (olanzapine), a powerful antipsychotic that induced diabetes, for foster care children.
The reporter noted that Dr. Igelehart indicated in an e-mail: "I am often pressured by providers to aggressively medicate children in an attempt to control their behavior" (Koffer, 2004).
As a public health policy initiative, the New Freedom Commission report is highly Suspect and given to a large margin of error. An evaluation by the authoritative U.S. Preventive Services Task Force (USPSTF) concluded that the evidence for screening for suicide failed to demonstrate any benefit at reducing suicide (U.S. Preventive Services Task Force, 2004). The report noted that the accuracy of the instruments used for screening has not been validated. Furthermore, the USPSTF "found insufficient evidence that treatment of those at high risk reduces suicide attempts or mortality." The USPSTF found no studies that directly address the harms of screening and treatment for suicide risk" (USPSTF, 2004).
Screening for mental illness serves no medical or societal purpose - screening will, however, do much to increase the profit margins for drug manufacturers and the mental health provider industry. A label of mental illness all too often signifies loss of autonomous decision-making authority for parents who may be reluctant to give permission for their children to be treated with psychotropic drugs. Nationwide, state agents intervene, imposing their authority over parental objections. During the heyday of the eugenics movement in the US, state eugenics boards approved the involuntary sterilization of 72,600 people who had been classified (often arbitrarily) as "mental defectives."
An examination of the American eugenics movement, and its extraordinary influenceon public policies during the first half of the 20th century, reveals important ideological and methodological parallels between eugenics and psychiatry and their inordinate influence in shaping public health policies. Eugenics was promoted as a cure-all for criminal behavior, disease, physical and mental afflictions, tuberculosis, and epilepsy - all were declared genetically transmitted "defects." Eugenicists' subjective classifications were broadly applied, much as psychiatric diagnoses are broadly applied today. Modern psychiatry is treading down the same slope, armed with a similar arsenal of unproven biological-genetic theories and assumptions about possible faulty brain chemistry. Psychiatrists like eugenicists impose interventions against the will of the targeted individuals. Eugenicists and psychiatrists have done incalculable harm - especially when government provided the mantle of legitimacy.
EUGENICS: A HISTORICAL BACKGROUND
From its earliest beginnings, in the first part of the 20th century, eugenics was not just an academic exercise of scientific inquiry - Francis Galton, an Englishman, and a cousin of Charles Darwin, defined eugenics in 1883 as "the science of improvement of the human race . . . through better breeding" (which is the title of a book by Charles Davenport, 1912). Eugenics applied Darwin's theory of "survival of the fittest" to establish policies that determined who, among humans, should not survive. Eugenicists concluded that mental, emotional, and creative qualities were hereditary and could be perfected through breeding. By dubbing itself as the "science of improvement," eugenics provided the theoretical "pseudoscientific" underpinnings for medicalizing social problems and offering biological interventions for the prevention of naturally occurring disease, abnormalities, and complex human/societal problems. At its core, eugenics is an arrogant ideology of elitism and exclusion.
In 1880, there were 15 million people in the United States - most identified themselves as Anglo-Saxons, and most lived in rural areas. Within a 50-year span, 28 million immigrants arrived mostly from Southern and Eastern Europe, settling mostly in northern urban centers. This extraordinary influx of foreigners, plus the migration of thousands of African Americans and poor Whites from the rural South, changed the fabric of American society. Foreigners, whose differences in appearance, custom, culture, not to mention economic competition, were seen to be a threat to the "natural" order. Anglo Americans abhorred the urban squalor of overcrowded unsanitary cities, were fearful of crime, poverty, and the spread of infectious disease, and regarded the newcomers as morally inferior. America's gospel of success was threatened by class polarization, social and economic change, and dislocation prejudice against foreigners who poured into the country bringing infectious diseases, crime, labor unrest, political radicalism - all of which posed a threat to their values, their economic and social status, and their way of life.
Eugenics took shape as a sociopolitical movement with scientific pretensions that became a dogmatic prescription for ranking human worth. The dubious "scientific" claims of eugenics rested on the single-trait Mendelian heredity laws. So-called "positive eugenics" (Social Darwinism) sought to improve the human race by encouraging the fittest to reproduce and discouraging the "unfit" from bearing children - thereby preserving the supremacy of White Anglo-Saxons. Eugenics appealed to the progressive reformer's quest for perfecting the social order and improving the Anglo American race. Although first embraced by conservatives and denounced by social liberals, over time, support for eugenics alternated between progressive reformers on the political right and left. British Socialists - including George Bernard Shaw and Bertrand Russell - supported it (Paul, 1994).
Eugenics appealed to the American ethos and its rosy optimism about scientific and technological progress and its ready-made "scientific" solutions. Eugenics provided "scientific" confirmation that those regarded as purveyors of society's ills - African Americans (Negroes), foreigners, rural poor Whites - were "biologically inferior." Eugenicists embraced Galton's ambitious aspirations: He envisioned the development of eugenics from science to policy, to a religion. The eugenics prescription for controlling destiny was through birth control. The goals of "positive eugenics," however, can't be achieved without resorting to "negative eugenics." To prevent the "unfit" from reproducing, eugenicists resorted to forced birth control, sterilization, and ultimately, in Germany, genocide. The history of eugenics - and for that matter, all social engineering schemes - demonstrates that the dire consequences of treating humans as means to an end far outweigh the anticipated societal benefits.
Historians classify the American eugenics movement into three phases: Phase I: 1870-1905; Phase II: 1905-1930; and Phase III: 1930 onward. During Phase I, the idea Developed among intellectuals that heredity, rather than environment, held the key to improving the social order. In 1875 Richard Dugdale wrote The Jukes: A Study in Crime, Pauperism, Disease, and Heredity, lending "scientific" support to the theory that disease, poverty, immorality, and failure in society were determined by one's genes. Although Dugdale maintained that environmental factors contributed more to his study of "degeneracy" than heredity, public opinion was that the poor classes were poor and immoral because of their bad genes.
In America and Germany, the eugenics movement endorsed negative eugenics. Racism was a major factor among upper- and middle-class White Anglo-Saxons in America and Aryans in Germany. The rallying cry was: "good blood" must control the social order. The remedy offered by eugenics, "to protect the blood of the nation from contamination of inferior racial strains," was forced sterilization. Its scientific justification rested on two premises: that mental disabilities and "degeneracy" are passed on through heredity, and that the mentally "defective" are producing large numbers of "defective" offspring (DeCorte, 1978).
The most influential promoter of eugenics was Charles Davenport who, in his day, was the best known and most influential biological scientist in the world. He was president and vice president of 10 of 64 societies to which he belonged, was on the editorial board of eight scientific journals, and directed three institutions at Cold Spring Harbor, NY, for over 30 years: the Biological Laboratory; the Station for Experimental Evolution - the largest and best-funded research station; and the Eugenics Record Office (ERO) (1910), with its highly influential bulletin. Davenport sat on dozens of scientific and governmental committees. He secured substantial funds from the Carnegie Institute and Mrs. Mary Harriman, and distributed millions of dollars in research grants. Under Davenport's leadership, eugenicists organized the Eugenics Research Association, the American Eugenics Society, The National Conference on Race Betterment, The Galton Society, The Aristogenic Association, the Tax Payers' League, and the National Committee for Mental Hygiene. These actively lobbied for immigration restriction and sterilization of "undesirables" (Largent, 2002).
In 1910, Harry Laughlin joined Davenport to become superintendent of the ERO, And associate editor of the Eugenical News. They worked side by side furthering the eugenics agenda - in particular he concentrated on eugenical sterilization and anti-immigration. Before the eugenics movement, sterilization was a medical term for killing germs. Eugenics promoted killing reproductive "germ plasm." Cold Spring Harbor was the foremost center for eugenics research. During its years of operation, 1910 - 1939, the ERO collected data from questionnaires and from insane asylums, prisons, orphanages, and homes for the blind. They identified the "defective" traits in family groups, recorded the ethnic makeup of institutionalized dependents, and calculated the cost of maintaining them at public expense. The data were collected and tabulated for the purpose of proving a genetic cause for "feeblemindedness," and to identify groups of carriers.
PSEUDOSCIENTIFIC BIOLOGICAL CONCEPTS
Early American eugenicists had an agricultural background and were members of the American Breeders Association, the first American organization to sponsor the investigation and promotion of eugenics. Accordingly, their favored model was agricultural genetics: They promoted negative eugenics, which held that humans (like animals) had to be weeded of their least productive members, with only the fittest specimens allowed to reproduce. Davenport's motto: "better humans through better breeding." Both positive and negative eugenicists opposed philanthropic outreach and charity to the poor because it interfered with survival of the fittest by encouraging the "unfit" to live. To undo the damage done by social welfare policies, eugenicists sought to replace the mechanism of natural selection by imposing artificial selection through forced sterilization.
The dubious "scientific" claims of eugenics rested on the misapplication of single-trait Mendelian heredity laws and the manipulation of statistics. They treated complex human expression - mental, emotional, behavioral personality traits - as if these were simple, easily defined discreet physical traits. And, they argued that criminality, intelligence, pauperism, and mental illness - including epilepsy, schizophrenia, manic depression, and "feeblemindedness" - were passed down in families as simple dominant or recessive hereditary traits. They studied family trees in an attempt to identify, measure, and trace these undesirable human traits and illnesses within families. They collected data pooled from insane asylums, prisons, orphanages, and homes for the blind to calculate the ethnic makeup of the "unfit" to make the case that their genetic makeup is the root of the problems they bring to society.
Eugenic premises and the criteria for defining dysgenic (bad) traits were suffused in racial and blatant ethnic prejudice and flawed methodology. Despite the eugenics lexicon with references to humans as "weeds" and "defectives," the veneer of scientific legitimacy was ensured by the ascendance of eugenics courses in academia. Indeed, prominent scientists served on the board of scientific directors of the ERO, including Alexander Graham Bell, David Starr Jordan (then president of Stanford University), and other highly regarded scientists from Harvard, Yale, and Columbia. Eugenical News, published by the ERO from 1920 to 1938, was the dominant promoter for the racist agenda of eugenics (Micklos & Carlson, 2000).
Margaret Sanger, founder of Planned Parenthood, was a racist and staunch eugenicist whose writings were imbued with the eugenics lexicon: "Birth control," she wrote, "is nothing more or less than the facilitation of the process of weeding out the unfit [and] of preventing the birth of defectives" (McCann, 1945, p. 107). She referred to Slav, Latin, and Hebrew immigrants as "human weeds . . . dead weight of human waste" (Senander, 1993).
Beyond the fallacy of deducing that a single genetic trait resulted in complex, even multiple ill effects in families, eugenicists twisted reality to further their agenda. For example, in 1911, Aaron Rosanoff, a physician at Kings Park State Hospital in New York, charted family histories of 72 hospitalized mentally ill patients and their 1,097 relatives. According to Mendelian laws, a (3:1) genetic link should have identified at least 359 mentally ill relatives. However, he found only 43 who had ever been hospitalized for mental illness - thereby disproving the genetic determination of mental illness. Instead, Rosanoff concluded that his definition of insanity was too narrow. He broadened it to include relatives whom he classified as "neuropathic" - including those who were "cranky, stubborn, nervous, queer, [or ] restless" or were "suspicious of friends and relatives" or "worried over nothing" or acted like "religious cranks." Using these criteria, Rosanoff determined that 351 relatives of the 72 hospitalized patients were neuropathic. He then concluded: "The hereditary transmission of the neuropathic constitution as a recessive trait, in accordance with the Mendelian theory, may be regarded as definitely established" (quoted in Whitaker, 2001, p. 50). By including normal relatives who were classified as carriers of the recessive insanity gene, Rosanoff calculated that 30% of the American population was tainted (Rosanoff, 1911).
Eugenicists also manipulated statistics and IQ tests to impose ethnic/racial discriminatory policies based on eugenicists' biologically determined theories. Eugenicists regarded intelligence as a fixed, single inherited trait of the brain that can be measured by an IQ test. Henry Goddard, the father of IQ testing in the US, was a psychologist and leading eugenicist who claimed that the "chief determiner of human conduct is a unitary mental process which we call intelligence: that this process is conditioned by a nervous mechanism which is inborn: that the . . . consequent grade of intelligence or mental level for each individual is determined by the kind of chromosomes that come together with the union of the germ cells: That it is but little affected by any later influences" (Goddard, 1920, p. 1).
Eugenicists misapplied a test whose intended purpose was to identify children who needed extra help to improve their learning skills, and converted it into a segregationist tool for labeling and blocking children (and adults) from different cultural backgrounds from achieving their potential. Alfred Binet, the inventor of the IQ test, was horrified when he learned of its misuse. In 1910, he wrote: "Some recent philosophers appear to have given their moral support to the deplorable verdict that the intelligence of a child is a fixed quantity . . . . We must protect and act against this brutal pessimism" (Binet, 1909, p. 101). Eugenicists, who have no faith in the creative human genius, used IQ tests to establish intellectual and class boundaries.
The Kallikak Family: A Study in the Heredity of Feeblemindness, by Goddard, was a widely publicized, influential eugenics study. Goddard invented the classification "moron" which he defined as "high grade defectives" who possess low intelligence, but appear normal to casual observers (Goddard, 1912). He characterized morons as lacking self-control - "restless," "fidgety," "cannot keep still," "worrier," "odd," and "very quiet disposition." These traits, he inferred, make them "susceptible to sexual immorality and vulnerable to other individuals who might exploit them for use in criminal activity" (pp. 54-56). By his definition, "morons" fit the diagnostic criteria of psychiatry's current catch-all diagnosis: attention deficit hyperactivity disorder. Goddard thought morons posed a greater problem than the severely impaired, who were incapable of functioning. Morons, he reasoned, were likely to reproduce, therefore they needed to be identified, segregated, and carefully monitored.
The classification of "normal-minded" or "feebleminded" or "defective" was made according to whatever assumption was necessary to bring the facts into accord with the eugenics theory. Goddard traced 480 descendants of an immigrant retarded girl, finding 214 individuals who exhibited what he called moral depravity - prostitution, alcoholism, criminal behavior, and retardation. In 1921, when the Second International Congress of Eugenics convened at the Museum of Natural History in New York, eugenics gained momentum.
It was funded by the Carnegie Institute and the Rockefeller Foundation, and its purpose was to galvanize support for sterilizing mentally defectives. The session was opened by the Museum president, Henry Fairfield Osborn (nephew of J.P. Morgan), declaring that science must "enlighten government in the prevention of the spread and multiplication of worthless members of society, the spread of feeblemindedness, of idiocy, and of all moral and intellectual as well as physical diseases" (Chase, 1977, p. 278). Scientists from the nation's most prestigious universities presented papers on "racial deterioration," the financial burden of caring for defectives, and the low birth rate of the elite. Davenport and Osborn formed the American Eugenics Society, and established a scientific advisory council whose members were educated by elite universities - nearly 40% at Harvard, Yale, and Columbia. Eugenicists promoted the idea that the unfit must be prevented from passing on hereditary degeneracy. These views were endorsed by editors of The New York Times in 1921 and 1923: "It is certain that the marriage of two mental defectives ought to be prohibited" (Editorial, 1921, 1923).
Eugenicists explained away evidence contradicting their theories and invalidating the single-gene Mendelian model for predicting intelligence. For example, according to the single recessive gene theory, it would be impossible for "feebleminded" couples to produce normal offspring, yet they were found (Spencer & Paul, 1998). Goddard explained away their existence by arguing: "Either there is a mistake in calling them normal, or a mistake in calling the parents feeble-minded; or else there was illegitimacy somewhere and these children did not have the same father as others in the family . . ." (Goddard, 1912). Similarly specious arguments are currently made by leading psychiatrists when confronted with evidence refuting their claims about the efficacy and safety of antidepressant drugs. They claim that negative trial results don't prove the drugs are not beneficial. They also claim that evidence showing an increased suicide risk in those who tested antidepressant drugs compared to those on placebo doesn't mean the drug is at fault. But isn't the purpose of a clinical trial to test whether a drug is safe and effective within a scientifically controlled setting?
Eugenicists sought to control destiny by setting up barriers to prevent the foreigners and the poor from gaining access to privileges enjoyed by middle- and upper-class White Anglo-Saxons. Goddard asserted that most of the immigrants arriving at Ellis Island were mentally deficient. For example, he indicated that 83% of all Jews tested were feebleminded, as were 80% of the Hungarians, 79% of the Italians, and 87% of the Russians. The public accepted the verdict as they were to accept the entire eugenics agenda: Immigrants designated "feebleminded" were turned away and sent back to Europe (Goddard, 1917).
Other proponents of IQ testing were Lewis Terman from Stanford (whose revised IQ test is the Stanford-Binet), and Harvard psychologist, Robert Yerkes, who persuaded the U.S. Army to test 1.75 million recruits during World War I in order to find suitable officers. Hundreds of psychologists were hired to administer two tests: alpha, for those who could read, and beta, for illiterates. The tests indicated the average mental age of the recruits was 13. At the time, no one questioned the validity of the tests, which were culturally biased, favoring the American-born Anglo-Saxons. Subsequently, critics such as Stephen Jay Gould noted that IQ scores among military recruits correlated to the number of years in America (Gould, 1996). Yerkes' disciples claimed the poor results demonstrated that a lower class of immigrants was arriving. When critics have similarly challenged psychiatry about its poor recovery outcomes of patients treated compared to earlier recovery rates, their answer has been that today's patients are more difficult. Although their methodology was flawed, and their subjective assessment biased and unreliable, testing of the military helped legitimize the validity of IQ tests. The poor results were used as evidence for the need to restrict immigration, and IQ tests were used to identify candidates for sterilization.
Eugenics was very influential politically: The congressional testimony by Laughlin, who cited ERO statistics, was instrumental in the passage of the draconian Immigration and Restriction Act of 1924, which restricted immigration to northern Europeans only. Perhaps the most enduring influence of eugenics was in education. After 1914, courses on eugenics were offered at some of America's leading universities, including Harvard, Columbia, Cornell, and Brown. In the 1920s, the National Education Association's Committee on Racial Well-Being sponsored programs to help college teachers integrate eugenic content in their courses. By 1928, eugenics was a topic in 376 separate college courses, which enrolled approximately 20,000 students. A content analysis of high school science texts published between 1914 and 1948 indicates that a majority presented eugenics as legitimate science. High school students were trained that the "scientific" solutions recommended by eugenics were worthy policies for maintaining American culture.
The public was led to believe that laws mandating racial segregation, sterilizing the "feebleminded," and closing the nation's borders to "inferior hordes of degenerate peoples" were supported by research - after all, they were endorsed by scientists at leading universities. Critics of eugenics were mostly ignored, as the nation led the world in implementing draconian policies on the basis of eugenics doctrines. The eugenic ideology of genetic determinism was deeply embedded in American popular culture during the 1920s and 1930s - just as psychiatry's myth of a "chemical imbalance" in the brain has led to the acceptance of chemical solutions for mood and behavioral problems. Despite the proven fallacy of the single-gene theory for intelligence, despite scientific discoveries linking exposure to lead (Needleman & Gatsons, 1990; Needleman & Schell, 1990) or exposure to low-level radiation (National Research Council, 1990) to mental retardation and birth defects, eugenics is not dead. In 1961, a psychology text by Columbia University psychologist Henry Garrett (1961) offered an embellished overview of the Kallikak study to bolster his eugenicist arguments (Garrett & Bonner, 1961). In 1994, Richard Herrnstein and Charles Murray reignited the IQ debate once again with The Bell Curve.
EXPERIMENTS IN SOCIAL ENGINEERING
Eugenics and psychiatry have a common cause - improving human behavior. Both have an unshakable belief in unproven, biologically based theoretical concepts, but lack precise or measurable definitions of traits, or objective diagnostic criteria. Eugenics and psychiatry suffer from flawed methodology relying almost entirely on subjective assessment without verifiable, objective empirical evidence. They define individuals and groups as genetically tainted or suffering from "a broken brain," or they presume that those who don't conform to the norm have a genetic marker, or a "chemical imbalance" of the brain. Eugenics and psychiatry are of one mind in their rationale for screening populations to ferret out mental "defects," today referred to as "mental disorders." Their methodology and their application of radical interventions to contain, and if detected, to prevent the spread of mental illness are remarkably similar. Archival documents uncovered by historian Ian Robert Dowbiggin reveal that U.S. and Canadian psychiatrists collaborated closely with eugenicists in promoting public policies that imposed restrictions on marriage, reproduction, and immigration, sterilization and permanent institutionalization of "mental defectives" (Dowbiggin, 1999).
The dubious "scientific" claims of psychiatry rest on presumed brain abnormalities and unproven "chemical imbalances" in the brain. Their methodology remains flawed inasmuch as psychiatry lacks well-defined criteria for what's normal and abnormal human behavior, or normal versus abnormal individual thought patterns, or normal versus abnormal emotional expression. In the absence of any objective, verifiable diagnostic tools, psychiatry relies on the subjective assessment by psychiatrists who are known to err. As any psychiatric patient's medical record reveals, diagnoses shift as psychiatrists or practice modalities change. Notwithstanding the absence of well-defined mental illness criteria or reliable diagnostic tools; notwithstanding the controversy surrounding the false claims about the clinical effectiveness and safety of the psychotropic drug interventions that psychiatry relies on; American psychiatry seems bent on revisiting the same slippery slope as it promotes mass screening of the population with diagnostic tools not much more reliable than the questionnaires used by eugenicists who screened for the same traits/conditions.
Eugenics and psychiatry have a predilection for embarking on bold large-scale experimental public health policies, applying their unproven, often radical interventions on an involuntary basis - on the theory that these interventions are prevention measures. Under the influence of eugenicists, Americans were screened for "bad blood" or "bad germ plasm" and those deemed to be "carriers" were labeled "unfit" - 7,600 were forcibly sterilized. In his 1920 book, Human Efficiency and Levels of Intelligence, Goddard noted that schools are "the perfect organization of the hive" and, therefore, the best testing laboratory (Goddard, 1920). He said that standardized testing was a way to make lower classes recognize their own inferiority. Schools are also the focus of the New Freedom Commission's screening for mental illness initiative, which will, no doubt, increase the number of healthy children who will be labeled as having, or at risk of developing, a mental illness and who will be forced to ingest psychotropic drugs. The drug industry, in collaboration with psychiatrists and bioethicists, is working to counteract "noncompliance" in patients prescribed psychotropic drugs. They are experimenting with long-acting injectable drugs. At the University of Pennsylvania, a team is experimenting with a surgically implanted antipsychotic drug delivery device with approval of its bioethicists (Wolpe & Sharav, 2004).
Eugenics equated morality to intellect and attributed behavioral problems and social maladjustment to low intelligence, whereas psychiatry links the same problems to mental illness. Both use the mantle of science without the substance of science to further an agenda. Psychiatry's claims and interventions resemble those of eugenics: Both are couched in pseudoscientific terminology but lack scientific validity. Neither developed objective criteria for diagnosing or defining normal and abnormal traits; neither could withstand independent critical analysis; but both have been immensely successful at promoting their objectives by popularizing unsubstantiated claims.
FORCED STERILIZATION, THEN; FORCED MIND-ALTERING DRUGS, NOW
Eugenicists in Germany and the United States favored the negative approach to improving the human race - the cornerstone of that approach was forced sterilization (Carlson, 2001) American eugenicists have the dubious distinction of leading the charge: Americans were first to develop and implement draconian public policies to expunge the carriers of "defective" hereditary traits. Those labeled "unfit" were segregated; subjected to forced birth control; and had restrictions placed on them regarding marriage and immigration. Those who were labeled "mentally defective," either retarded or mentally ill, were the first to be forcibly sterilized to prevent them from reproducing.
Even before the enactment of any laws permitting sterilization, 58 children at the Kansas Home for the Feebleminded were castrated by Dr. Hoyt Pritcher in the 1890s. The first forced sterilization law anywhere in the world was enacted in 1907 in the state of Indiana. By then, Dr. Harry Clay Sharp had castrated 206 inmates at the Indiana Reformatory. David Jordan, president of the University of Indiana, referred to paupers as "parasites" in his lectures. In 1914, Harry Laughlin published a model eugenical sterilization law that cast a wide net to include the "socially inadequate," those "maintained wholly or in part" at public expense, the mentally and physically disabled, criminals, "orphans, ne'er-dowells, tramps, the homeless and paupers." In the United States (and later in Germany), sterilization was promoted as "eugenics in the service of public welfare for the prevention of progeny with hereditary defects" (Muller-Hill, 1988, p.10 ) "and as a medically appropriate, cost-cutting measure."
Widely publicized books like The Kallikak Family and Madison Grant's 1916 book The Passing of the Great Race sounded the eugenics alarm, contributing to a growing hysteria about hereditary degeneracy and the menace of "morally depraved," "feebleminded" people (Goddard, 1919; Grant, 1916). Theodore Roosevelt inveighed about the need to protect Anglo-Saxon society from "racial suicide." By 1924 approximately 3,000 people had been involuntarily sterilized in America; the vast majority (2,500) in California. That year, Virginia passed a eugenical sterilization act based on Laughlin's model. At least 17 states had passed forced sterilization laws before the German program began.
In 1927, the Supreme Court upheld the sterilization of Carrie Buck in Virginia. Justice Oliver Wendell Holmes, who wrote the decision, sealed not only Carrie Buck's fate but the fate of tens of thousands when he declared: "Three generations of imbeciles are enough!" Like many women who were sterilized, Carrie was designated "feebleminded" because she became pregnant out of wedlock. Carrie was raped, but that did not matter, either to the prominent eugenicists who supported her sterilization, or to all but one dissenting Supreme Court Justice (Justice Pierce Butler). That decision marks the lowest moral watershed in Supreme Court history.
Before 1927, few of the 23 states that had passed sterilization laws implemented them: California was the exception in having sterilized 4,636 people by then. After the Supreme Court ruling in Buck versus Bell, and Justice Holmes' stinging words, the sterilization floodgates were opened: The rate of sterilizations jumped to 2,000 to 4,000 per year - half were performed in California. Even after World War II, sterilizations continued in the US - one third were performed in California. By January 1957, 35,519 women and 23,667 men were sterilized. California led the way, with two fifths of the total, or 19,985 (Black, 2003).
Between 1936 and 1960, two prominent American neurologists, Foster Kennedy, Chief of neurology at Cornell, and William G. Lennox of Harvard, wrote and spoke widely In favor of eugenics (Offen, 2003). These influential clinicians urged their colleagues and the public to adopt a program of sterilization for the "feebleminded" and euthanasia for the "hopelessly unfit." Kennedy wrote "Euthanasia: To Be or Not To Be" in Colliers (1939), and in May 1941 he delivered a talk, "The Problem of Social Control of the Congenital Defective: Education, Sterilization, Euthanasia" at an American Psychiatric Association (APA) luncheon. Both called for killing "defectives."
A Cincinnati University report, "Studies on the Use of Refrigeration Therapy in Mental Disease with Report of Sixteen Cases," was published in 1943 in the Journal of Nervous Diseases:
Sixteen mental defectives were placed in refrigerated cabinets to study the effect of frigid temperatures on mental disorders. The temperature was dropped to subfreezing 30 degrees Fahrenheit for periods lasting as long as 120 hours. Body temperatures declined to as low as 81.8 degrees. (Goldman, 1943)
According to the scientists' clinical observations,
The chief complications resulting from the treatment were skin injuries from ice and respiratory infections . . . Five patients . . . had bronchitis and bronchopneumonia following treatment. These patients with two exceptions recovered after varying periods, but prolonged mental retardation and physical decay bordering on cachexia occurred in the survivors . . . Two deaths occurred as a direct result of the treatment. Both these patients suffered from mental illness of long standing which quite justified the risk associated with treatment. Another patient died two months after the treatment without apparent cause.The researchers considered the risks involved "quite justified" because "these patients suffered from mental illness of long standing."
In 1942, The American Journal of Psychiatry published Kennedy's remarks, calling for expanded sterilization and "kindly killing": "[W]e are undoubtedly breeding from the bottom . . . [T]here are five or six times as many cases of minds somehow disordered, outside institutions as in them. If we could devise a fitting standard for feeblemindedness, that is if we can catch the feebleminded and properly christen them . . . In time, sterilization of the feebleminded, if done largely and thoroughly, would, I believe, aid our civilization." Kennedy recommended "relieving" the defective "of the agony of living." A passionate rebuttal by the child psychiatrist Leo Kanner of Johns Hopkins challenged Kennedy about his assessment of the "feebleminded" as worthless. An unsigned American Journal of Psychiatry editorial is revealing:
Dr. Kennedy advocates euthanasia; Dr. Kanner opposes this procedure. Both writers are agreed as to the existence of the group in question and the hopelessness of their condition; one proposes a method of disposal which he believes would bring relief to all concerned, the other prefers to let the situation remain as it is . . . (Kennedy) offers strong arguments in support of his position. Dr. Kanner opposes this position but in his paper presents no arguments beyond the statement: "An idiotic child may have fond parents who want him alive" (Unsigned, 1942)
Of further note, Louis Offen notes in his illuminating 2003 article, while Kennedy and Lennox "wanted to legalize euthanasia for the 'defectives' who could not give consent, Kennedy and Lennox differed on legalizing it for those seeking assistance in ending their own lives. Lennox was in favor, whereas Kennedy was outspoken in opposition on practical and philosophical grounds" (p. 3).
FINANCING OF EUGENICS
Throughout the 1920s and 1930s, German eugenicists worked closely with their American counterparts - especially Davenport and Laughlin at the Eugenics Record Office, and Paul Popenoe, a leader in the American Eugenics Society in California. In 1903, the widow of E. H. Harriman, the railroad tycoon, financed the American Breeders Association, followed by the Carnegie Institute, which established the Station for Experimental Eugenics, and the Rockefeller Institute for Medical Research, in 1904. The American eugenics movement was supported by the most prominent corporate donors in America: the Ford Foundation, the Kellogg Foundation, J. P. Morgan, E. B. Scripps, Procter and Gamble, among others. The Rockefeller Foundation bankrolled the Kaiser Wilhelm Institute whose research in psychiatry, anthropology, and brain research focused on eugenics. The Carnegie Institute and Rockefeller Foundation were the major sources of funding for German eugenicists - including Dr. Otmar Freiherr von Verschuer, who was Josef Mengele's mentor before the Nazi Holocaust, and his collaborator on the twin studies during the Holocaust (cited in M¨ller-Hill, 1988)
In 1933, Germany enacted the Law for the Prevention of Congenitally Ill Progeny, based on Laughlin's model law. In 1935 the Nuremberg laws codified racial hygiene by stripping Jews of their German citizenship and prohibiting marriage and sex between Germans and Jews. In 1936 Laughlin proudly published a translation of the German law in The Eugenical News, and he was awarded an honorary degree from the University of Heidelberg as a tribute for his work in "the science of racial cleansing." The American Medical community continued to praise Verschuer's work. The Nazi laws were reported in the Journal of the American Medical Association as if they were routine health care measures - like vaccines.
The Depression brought home the fact that both the biologically "fit" and the "unfit" shared in misfortunes, and failure didn't seem to hinge on individual weakness, lack of ability, or moral failure. Sterilization lost ground as its scientific claims unraveled and the political climate changed. In North Carolina, sterilizations peaked in 1938 (202) and fell in 1945 (117). But from 1947 through 1974, the Eugenics Board of North Carolina ordered the sterilizations of more than 7,600 people - more than 2,000 were under 18. Most of the operations were done against the patients' wishes, and some were performed on children as young as 10. In 1947, James Hanes (hosiery fortune) formed the Human Betterment League (HBL) with a group of prominent wealthy eugenicists: Alice Shelton Gray, a trained nurse and a member of the local elite; Dr. C. Nash Herndon, a leader in the medical-genetics department at the Bowman Gray School of Medicine; Dr. Clarence Gamble, the Harvard-educated heir to the Procter & Gamble fortune and an important figure in the fledgling birth-control movement; and Dr. A. M. Jordan, a professor of psychology at the University of North Carolina at Chapel Hill. The group had money, political connections, and a conviction it was doing the right thing. Hanes was a master salesman; he brought a fortune and a top New York public relations firm to the enterprise. He also chaired the Forsyth County Board of Commissioners for 20 years. This highly influential elite group set about to convince North Carolina that sterilization was "incredibly valuable," and should be expanded, rather than scaled back.
Hanes and Gamble paid for massive IQ testing of 10,000 students in the Winston-Salem school system. The results suggested that alarming numbers of the children were "feebleminded." Editorials soon appeared suggesting that there was a problem across the state. The HBL set about "selling" sterilization through a massive publicity campaign. The Winston-Salem Journal reports that an HBL document notes that a mailing list of circulation 40,000 has been prepared, consisting of upper-class college students, faculty members, physicians, nurses, ministers, public officials, etc., who had been sent 110,000 items. In part, the motivation was cost saving: As the program grew, those targeted for sterilization were not just the institutionalized. The eugenics board approved more than 90% of the sterilization petitions that it received - serving somewhat like institutional review boards that approve human research proposals - continuing to order sterilizations until 1974. Toward the end of the program, 99% of the operations were on women and more than 60% of those on Black women (Begos, 2002).
Stefan Kuhl, author of The Nazi Connection, wrote that many Americans were intrigued by the notion of a "panacea that will cure human ills." They were seduced into believing that draconian measures - such as racial segregation, sterilizing the "feebleminded," and immigration restrictions - were the right solution to complex social problems (Kuhl, 1994). After all, they thought, they were supported by enlightened social reformers, scientists at leading universities, and public officials, and they were backed by science! The history of eugenics is one of error breeding error breeding tragedy. Screening for mental illness will, no doubt, lead to similar errors and tragedies.
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