Sterilize THE UNFIT
CLARENCE M. HINCKS
General Director, The National Committee tor Mental Hygiene (Canada)
Our society is menaced by race deterioration, says this authority. His remedy: Prevent the mentally unfit from having children
SUBNORMALITY and mental unfitness seem to be on the increase in Canada. There is evidence that at the present time about 10% of our population vary in mental health from profound mental disability to a state that might be called marginal disability.
What’s more, we can expect the percentage to mount unless we act soon to improve the mental quality of our stock. For the mentally unfit are apparently breeding faster than the fit, and will continue to : do so until we prevent those with undesirable hereditary traits from passing their disabilities on to their children.
While stronger mental health and welfare programs are necessary for the prevention and treatment of mental disorders, these measures alone will only partially stem the rising tide of mental disabilities. Common sense and scientific judgment dictate a combined attack on mental health problems aimed at both constitutional and hereditary factors and environment. And this means, among other things, selective eúgenical sterilization.
Selective sterilization has the backing of psychiatrists and other technical personnel. But no genuine progress can be made until the general public sees eye to eye with the scientist and is ready to grant approval.
Sterilization does not involve the removal of organs and it produces no physical changes in the body. It does not in any degree unsex the individual, except in making parenthood impossible. Those who have been operated upon report no change in their marital relations.
Whom Should Be Sterilized?
STERILIZATION should be restricted to individuals who have disabilities of a hereditary naturewherein a predisposition to mental ill health may be passed on to succeeding generations. Such disabilities include mental deficiency or stunted mental development; certain psychoses or so-called insanity; certain forms of epilepsy; and certain pronounced cases of neuroses.
Mental defectives are individuals who always retain the minds of children. They constitute two per cent of our total population. Regardless of how well they are trained they cannot get along without supervision and guidance. In the absence of supervision they contribute, out of all proportion to their numbers, to such social problems as delinquency, dependency, illegitimacy and the spread of venereal and other diseases. If they marry and have children it is a foregone conclusion that a proportion of their progeny will
be born with inherent mental defects and that the remainder of their children might just as well be deficient, because they will be warped by uninspiring and unintelligent upbringing. In other words, mental defectives are quite unsuitable for parenthood.
Psychotic (insane) individuals differ from mental defectives. It has been well said by Dr. A. F. Tredgold of England that while mental defectives never possessed an adequate mental bank account, psychotics once had a mental bank account but subsequently lost it, or at least part of it. One and one half per cent of the Canadian adult population is afflicted with psychoses, and half of this percentage requires hospitalization.
One form of psychosis, dementia praecox, is responsible for more chronic invalidism than tuberculosis or cancer, and requires more hospital beds for its treatment than any other form of human illness. Approximately one quarter of all hospital beds in Canada are occupied by cases of this disease. Genetic research carried out on the families of dementia praecox patients forces even the most cautious to admit that this disease occurs in certain families at a rate that can be explained only on a hereditary basis.
Another prevalent form of mental illness is manicdepressive psychosis, wherein the factor of inheritance is most important. One third of the offspring of a manic-depressive parent will show the same disorder (whereas in the average population, the frequency is only 4 in 1,000). Another one sixth of the children will show milder mood disorders. If both parents have manic-depressive illness, two thirds of the children will be manic depressive and the remainder will show milder disturbances.
There are other forms of psychosis that owe their origin in considerable degree to inheritance, and it is a generally accepted dictum among psychiatrists that psychotic individuals should not have children even after apparent recovery.
Convulsive disorders or epilepsy are as prevalent as diabetes. One in 200 of the population is afflicted. Where epilepsy is not caused by brain injury, it has been found that when one parent is affected the condition is transmitted to 10% of the offspring. Aside from the hereditary factor, parenthood is unwise for epileptics because the added burden of bringing children into the world may invite more frequent seizures.
Neurotic individuals suffer from such symptoms as anxiety, hysterical reactions, depressions, extreme fatigue, feelings of inadequacy and so on. One third of all medical practice is devoted to this wide grouping of nervous functional disorders And there is some evidence to indicate that people with a pronounced nervous make-up may transmit to their offspring a mental and physical constitution with a low threshold of resistance to neuroticism. Although this field is admittedly more controversial, it is probable that for individuals with very intense, prolonged and disabling neuroses, parenthood is undesirable because of the danger of creating an
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unsuitable environment for the upbringing of children.
And so, in answer to this question, “Whom should be sterilized?” it can be stated that a considerable proportion of those who are afflicted with pronounced mental and nervous disorders qualify in this regard.
Signs of Race Deterioration
At present Canadian mental institutions are caring for 61,244 patients. In 1932 the number was 35,279. This is a percentage gain of 73.59 in 13 years. But that figure proves nothing, because Canada has never had adequate institutional accommodation for its mentally afflicted. Today we are short 22,419 beds. This is a serious problem, but again, it furnishes no clue whether there is an actual increase in race deterioration, because institutional populations do not necessarily reflect accurately the prevalence of mental disability in the community.
But there are other facts which do prove something.
During the six-year period of the war the flower of Canadian manhood and womanhood served in our armed forces. About 10% of all men medically examined for the Army were rejected because of neurosis or mental or emotional inadequacy. An even greater percentage of all the medical discharges from the Army were for psychiatric reasons. The rejections and discharges for these reasons from the women’s service were even higher.
These unfit men and women have been resident in Canada, for the most part, with a considerable proportion getting married and having children, while their more healthy and robust fellow Canadians were away from home, with fewer opportunities to start a family. After six years of war, with many of our best sons dying in the defense of their country, and with the relatively unfit and inadequate remaining at home to raise an even greater crop of children than ever before, it is obvious that we can expect increasing racial deterioration. Modem war is definitely not a sound eugenical experiment. This is one of the heavy prices we must pay for victory.
We would soon recover from this
disastrous war experience if, in times of peace, we were to allow nature to take its course through the free operation of the law of the survival of the fittest. This universe has been so designed that every species of living thing, if left to itself, tends to eliminate the weak and to perpetuate the strong. And thus, without the interference of man, race deterioration would never become an acute problem. The weak would die off and would play little part in the propagation of their kind.
But man has stepped into the picture and, through public health and welfare measures, has protected and prolonged the life span of the unfit and has made it possible for subnormals to multiply. Indeed it would appear that under existing social and health conditions the average birth rate among subnormals is greater than the average birth rate among the normal elements of our population.
Certainly there are some facts that lend color to this assumption. The families of men listed in Green’s “Who’s Who” for 1931 averaged 2.42 living children. Inmates of the Residential School for Mental Defectives at Orillia, Ont., came from families that average 4.4 living children.
Studies in Nottingham, Liverpool and London show that the families from which defectives come are larger than the average families in the same localities. During one year, while a group of 1,000 was being delayed in gaining admission to a school for mental defectives at Mansfield, Conn., they were responsible for 650 births, legitimate and illegitimate, a record that probably was not exceeded by any grouping of normal people in this same locality.
“Tobacco Road” in Canada
But we do not need to canvass experience in other countries, because we have abundant evidence in Canada that the free propagation of mental subnormals is carrying us far in the direction of race deterioration. Here is a case from an unpublished “Study in Social Inheritance” by the Institute of Child Study of the University of Toronto, under the supervision of Dr. W. E. Blatz and Miss Helena Shepherd:
In 1878, in an Ontario rural community near Toronto, a subnormal man and woman were married. They had many descendants, with a fifth genera-
tion now emerging. Up to date it has been possible to identify, locate and study 31 members of the family belonging to the third generation. Of these 31 members seven are mentally deficient, one is insane, one is epileptic, one is psychopathic and six are addicted to alcohol. Twenty-seven of the 31 have had delinquency records and 10 have been on public relief.
Studies of this kind must be interpreted with caution; nevertheless it must be obvious that in the absence of sterilization the members of this family will keep on multiplying their kind.
Several years ago the National Com! mittee for Mental Hygiene was re| quested by a provincial government in Canada to conduct a survey of mental deficiency in that province. It was discovered that in a number of communities of considerable size there had been intermarriage between mental defectives for several generations, and that the proportion of mental deficiency in those particular localities amounted to as high as 10% as against the average of 2% for the whole of Canada.
In every prôvince in Canada social and health workers can supply long lists of mentally deficient homes, together with family histories that furnish convincing testimony to the fact that mental subnormality is apparently passed on from one generation to another. These same social and health workers will tell you that our present methods of dealing with subnormality are frequently in the nature of attempts to “mop up,” and that we will not institute necessary control until we have thoroughgoing mental health measures and sterilization.
The Alberta Model
Provincial enactment is necessary to have selective eugenical sterilization in Canada. Alberta pioneered this legislation in the Dominion, and its act still remains the model. Since 1928, when Hon. George Hoadley, then Minister of Health, obtained the passage of the Alberta Sexual Sterilization Act, approximately 1,000 sterilizations have been performed. Alberta mental institutions have been able to discharge many mentally ill or deficient persons who, in the absence of the precaution of sterilization, might have been confined for life.
Public health and welfare bodies are solidly behind the Alberta legislation. There have been no objections raised on the part of religious or other groups. Public opinion is so overwhelmingly in favor of selective sterilization that it was possible in 1937 to strengthen the Act.
Here is how it works now:
Suppose a patient in a mental institution has mental deficiency or mental illness which is thought to be hereditary. Before this patient is disi charged the superintendent of the i institution may refer the patient to the province’s Sterilization Board along with his recommendation that the patient be sterilized.
! Prof. J. M. MacEachran, formerly I head of the department of philosophy of I the University of Alberta, is chairman of the board, all of whom serve without pay. Its other members are Dr. E. L. Pope, formerly professor of medicine, Dr. E. G. Mason and Mrs. Jean H. Field.
This board of citizens has the advice of such competent psychiatrists as Dr. Randall R. MacLean, Dr. D. C. McCullough and Dr. W. J. McAlister. Before it will advise sterilization it requires an application from a psychiatrist of the Public Health Service, supported by at least one of his colleagues, and a comprehensive medical and personal history of the case. The
patient is interviewed by the board. Unless he is mentally deficient his consent to sterilization must be obtained.
Surgeon and hospital must have written authority from the board before the sterilization operation may be performed.
Courts may refer criminals they think should be sterilized to the mental hygiene clinics operated by the provincial health department. If the head of the clinic agrees with the court, he is obliged to refer the case to the sterilization Board. Physicians, parents, relatives, teachers (or indeed anyone) may refer a member of the community to a mental hygiene clinic if they have reason to believe he should be sterilized for eugenic reasons.
The provincial Government has appointed qualified surgeons to perform the sterilization operations. Where the patient or their families cannot afford the operations, the Government foots the bill.
What the Surgeon Does
The operation on the male is known as vasectomy. It consists of the division and tying up of the vas, or duct, by which the spermatic fluid is conveyed from the testes. The operation is so slight that it can be performed under a local anaesthetic, although some surgeons prefer a general anaesthetic. Recovery is rapid, and the patient rarely requires more than a day in bed.
The operation on the female is technically known as salpingectomy. It consists of the removal of the whole or a part of the Fallopian tubes, or egg ducts, which convey the ova from the ovaries to the uterus. Salpingectomy involves an abdominal incision, and in severity and the time required for recovery it approximates to a simple, uncomplicated operation for the removal of an appendix. The period in bed is not less than two weeks in the average case, and may be more.
But legislation alone is not enough. British Columbia passed a splendid act in 1933, but to date comparatively little advantage has been taken of it. To achieve results there is need for the appointment of a sterilization board of outstanding leaders in the community, who will assume the responsibility of putting legislation into practical effect.
Sexual sterilization has been legalized in 30 states of the United States and in Denmark, Switzerland and pre-Hitler Germany. Before the war the Ministry of Health of Great Britain appointed a departmental committee on sterilization, which recommended the enactment of a sterilization law.
The most extensive experience in sterilization has been in the United States. Up to Jan. 1, 1944, sterilizations had been performed on 40,608 individuals. Of this number 17,012 had been performed in California. In this state, thanks to the Human Betterment Foundation, studies have been made of the subsequent histories of sterilized individuals. It was found that:
“Two thirds of the feeble-minded patients paroled after sterilization made good outside of the institution.
“Many of the feeble-minded girls have married after sterilization, and these marriages have been reasonably successful in the great majority of cases.
“Three fourths of these feebleminded girls had been sex delinquents before sterilization (a record proving that fear of results is no deterrent to promiscuity with such people). But only one in 12 was a sex offender after sterilization and parole.”
The attitude of religion to sterilization is of great importance, because any marked antagonism on the part of representative religious statesmen
might endanger the success of projected eugenical programs. While Canadian viewpoints are significant, we can also learn from men in other countries, particularly from such a man as Joseph Mayer, a Roman Catholic priest, who before the last world war was associated with the Institute for Social Work at the University of Freiburg.
In 1927, prior to the Hitler regime, Father Mayer wrote the most comprehensive work available in any language on the history, theory and world status of the sterilization of defectives. He concluded, after an exhaustive examination of the facts and the opinions of leading Roman Catholic theologians, that eugenical . sterilization is in principle to be approved in suitable cases. It is recognized, said Mayer, that social work tends to perpetuate human defects and this must be offset by the application of a sound program of eugenics. It is, he said, for the Church to work toward this end; it is for the State to support its efforts to this end. In one section of his 466-page book, entitled “The Legal Sterilization of the Mentally Diseased,” Mayer referred to Thomas Aquinas, who held that even such a drastic operation as the castration of sex offenders was justified for the public good.
The very fact that for 17 years there has been no protest on the part of religious denominations to the operation of the Alberta Sexual Sterilization Act is,significant.
Sterilization is not a cure-all for the problem of mental disabilities. It should be remembered that for every subnormal individual who is capable of transmitting defects to offspring there are probably at least 10 times as many apparently normal people who are “carriers” of defects in their germ plasm and who are capable of transmitting their defect to their children or their children’s children. In a considerable proportion of cases of mental disorder and defect the transmission is * not direct from parent to child, but is indirect.
With this in mind we must realize that the sterilization of all subnormals would not result in the immediate purging of mental deficiency and disorder from the human race. Sterilization will be necessary for many generations to achieve the most satisfactory results. But if we began sterilization in 1946 we would be starting a movement that will pay immediate dividends in the prevention of race deterioration.
Is Your Background Bad?
Some of my respected psychiatric colleagues cautioned me against writing this article because of the danger of alarming those readers who happen to have a background of bad heredity. They reminded me that it was unsound mental hygiene to place fear in the hearts of those with hereditary handicaps who are struggling as best they can to make a go of life. Such an article, I was warned, might actually bring on nervous breakdowns among those predisposed.
You and I must face the fact that we have been born into this world with certain weightings in the direction of good mental health and also in the direction of poor mental health. In other words, neither you nor I can boast of perfect family histories with * no evidences of subnormality, mental disorder or defect.
I am proud of my own forebears. On both the maternal and paternal sides of the family there were splendid, able individuals who contributed their share in making this a better world in which
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to live. And yet, in my own family background, there were three cases of psychoses, one of epilepsy, and several suffering from minor complaints. This, you may say, is a bad family history. Perhaps you are right. But, from my own experience in obtaining family histories when I was in private medical practice, I would say that my family history is average, with many better and many worse.
None of us comes from perfect stock. Does this mean Mendel’s Law in regard to inheritance is bound to operate; does this mean that with mathematical precision there will be bom, among our children or grandchildren, inadequate or mentally ill individuals? The answer here is “yes,” if we neglect to provide our descendants with adequate mental hygiene safeguards in their upbringing and if we fail to take advantage of modem psychiatry and of modem medicine when maladjustments appear to be in the making. We can escape some of the disastrous results of bad heredity by putting mental hygiene and psychiatry to work in education,
public health, social work, religion and industry. It is necessary, for the safeguarding of our civilization, to improve and extend greatly Canada’s mental health services.
But to curb race deterioration in Canada, would it be enough to improve and extend our medical and social services?
My personal answer to this question is “No.” It is my conviction that highly selective eugenical sterilization should be part of our expanding health programs in the Dominion. (I have italicized “highly selective” because indiscriminate programs would be more of a menace than a boon.)
This conviction of mine concerning the need of sterilization may not be entirely shared by the organization that employs me, and I feel that the whole question of sterilization should be thoroughly discussed, pro and con, by Canadians, and that we should not embark upon govemmentally directed undertakings in this field until the majority of the people are in complete sympathy with whatever measures are finally decided upon.