Forced Sterilization Once Seen as Path to a Better World

In a basement at Caltech, 59 gray boxes contain thousands of documents that reveal in detail how an influential group of California men once hoped to help direct the fate of the human race.

Within the brittle files is the story of the state’s long and largely forgotten effort to sterilize mental patients. Memos show how California civic leaders helped popularize eugenics around the world, including Nazi Germany. Case histories offer a glimpse of the more than 20,000 people who were, by law, sterilized in state hospitals from 1909 through the 1960s in anticipation of curing an array of social ills -- from poverty and promiscuity to overcrowded institutions.

“One of the giggling dangerous type -- a delinquent sexually, morally. Forged checks, remained away from home nights,” reads the case file of a 16-year-old girl who was sent to the Sonoma State Home, sterilized and released.

The archives of the Human Betterment Foundation, a private, Pasadena-based think tank that promoted sterilization from 1926 to 1942, have been at Caltech for six decades. They were kept in a warehouse until 1968. Only since 1995 has most of the collection been open to researchers.

“California is an enormous story in the history of eugenics,” said Paul Lombardo, a professor at the University of Virginia’s Center for Biomedical Ethics. “What makes California special is the work of the Human Betterment Foundation, how it shaped public policy, and the links between major players in the private sector and state officials who carried out the work.”

When Lombardo lectured in March to a state Senate committee on California’s aggressive sterilization policy, lawmakers were stunned. Most had never heard of this. Within hours, Gov. Gray Davis issued an apology.

Today another hearing on the state’s program is scheduled in Sacramento, at which a historian, directors of state departments and mental health advocates will probably raise the issue of whether the state should try to find and compensate survivors of sterilization.

“Many have cried a great deal,” said Robert Edgerton, a psychiatric anthropologist and director of UCLA’s Center for Culture and Health, who interviewed dozens of former mental patients in the early 1960s for a state-sponsored study of sterilization.

Some still do. They are among the 14 of his subjects who are still alive.

*

To illustrate the fact that no feebleminded girl is safe at large unsterilized ... one might cite the case of a Los Angeles girl 20 years old, with the mind of a three-year-old child. She was also humpbacked and so ugly that it was supposed that she would never be molested, so her parents ... used to leave her alone in the house sometimes. On one such occasion she was raped by the iceman, and gave birth to an illegitimate child. Following this she was sent to Sonoma to be sterilized ...

-- patient summary from the files of the Human Betterment Foundation

In 1909, California became the third state to legalize the sterilization of the feebleminded and insane. Eventually, more than 30 states with such laws would sterilize about 60,000 -- a third of them in California, which repealed its law in 1979. Working hand in hand with state officials, the Human Betterment Foundation served as spokesman and primary scorekeeper for the eugenics movement, collecting data on sterilizations nationwide.

Ezra S. Gosney, the Pasadena financier who started the foundation, was well-regarded for his work in philanthropy and education reform. In 1926, at the age of 71, he quietly began funding studies on how sterilization could combat problems caused by excessive breeding of the “unfit.”

At the time, eugenic sterilization was in the mainstream of science and politics, soon to be upheld by the U.S. Supreme Court and embraced by many social progressives, from Planned Parenthood founder Margaret Sanger to economist John Maynard Keynes. Many doctors at the time thought sterilization had a therapeutic effect on mental patients.

Gosney was about to become the movement’s chief public relations agent.

“Any common man will tell you that a herd of common, long-horn Texas or Mexican cattle can be converted to a high-grade Hereford or white-faced herd in three or four generations,” states a memo with Gosney’s initials contained in the Caltech files. “Man falls under the same laws of heredity. The only difference is that we have mixed the breeds and failed to teach our children to ... select their mates.”

The foundation’s members included a who’s who of California: David Starr Jordan, Stanford University’s first president; Los Angeles Times publisher Harry Chandler; Nobel Prize-winning physicist and Caltech head Robert A. Millikan; USC President Rufus B. von KleinSmid; and Lewis M. Terman, a Stanford psychologist who developed the IQ test.

To spearhead his work, Gosney hired Paul Popenoe, an energetic, self-trained biologist who studied the genetics of dates before turning to humans, and who was also a writer with a knack for translating dense material for the common man.

When Popenoe visited the state’s mental hospitals, he found administrators eager to open their patient files to him. He described two cases to Gosney that would not be published in the foundation’s upbeat reports.

“I found one case, which they didn’t know about, where they had sterilized the same man twice, two years apart,” Popenoe wrote Gosney from Stockton state hospital. “He was an unintelligent Italian, and I suppose he didn’t know enough to tell them that he had been through the mill before, and they missed the fact in their own records.”

One hospital superintendent told him of a convention of the Assn. of Railway Surgeons held at the Mendocino state hospital at which the association’s president was invited to sterilize two women as a “special honor.”

“Both women died in agony a few days later,” Popenoe wrote Gosney. “Autopsy showed that instead of tying the Fallopian tubes, the surgeon had tied up the ureters, so they both died of kidney poisoning from being unable to urinate.”

Popenoe compiled stacks of handwritten charts that correlated the background of thousands of patients sterilized in the 1920s using dozens of measuring sticks -- from IQ, birth rank, number of siblings and whether forceps were used at birth, to the marital status, occupation and “moral rating” of the parents.

He found that men and women were targeted in roughly equal numbers. The average age: 30. Mean IQ: 60. The operation was generally done within a few months of commitment.

A foreign-born patient was far more likely to be sterilized than a native-born patient, Popenoe found. Black patients were more likely to be sterilized than whites; this wasn’t a surprise, he wrote, because “studies show that the rate of mental disease among Negroes is high.”

Those sterilized routinely came from large families with histories of mental illness who were reproducing feebleminded children at a rate “more than half again as great as that of the stock which sends its sons and daughters to Berkeley,” he wrote. They were three times as likely to have come from a broken home; half had fathers who were laborers.

In a 1935 memo to The Times’ Chandler, the foundation estimated sterilization saved the state more than $1 million a year by removing patients from overcrowded hospitals. That year, The Times began a weekly column championing strong sterilization laws that ran for six years.

They were among the sermons that were intended to draw the public to the cause.

“In modern civilizations, where the weak and helpless are protected so carefully, it is not possible to depend on Nature to solve this problem of the survival of the unfit,” Popenoe wrote in one report. “Sterilization was seen to be not a punishment but a protection, alike to the afflicted and their families, to society, and to posterity.

“The man who breaks down mentally and requires hospitalization is a sick man. In most instances his wage-earning capacity is impaired for the rest of his life. Multiplication of his family may be as unfair to him as it is to his family.” For women, the strain of pregnancy “is sufficient to cause a nervous breakdown .... Here, sterilization is a psychological protection.”

A quarter of “first admissions” to state hospitals for the insane and subsequently discharged were sterilized, Popenoe found. Those sent to the Sonoma State Home in Eldridge -- many of them girls as young as 11 who were committed because of their alleged promiscuity -- faced a different policy. “No one is allowed to go out of this institution, even for a short vacation, unless sterilized,” Popenoe wrote.

The Human Betterment Foundation not only promoted the sterilization of the mentally ill, but it also advocated voluntary sterilization at public expense of the blind and disabled, as well as people with cancer, heart and kidney disease and tuberculosis. People who should be sterilized “are numbered not in the thousands, not in the hundreds of thousands, but in the millions,” Popenoe wrote.

When Gosney died in 1942, the foundation was known worldwide. Hundreds of thousands of its studies, pamphlets and books were distributed to policymakers, schools and libraries. Its work informed a wide audience, from government officials developing their own sterilization programs to high school students writing term papers.

“You were so kind to send ... new information about the sterilization particulars in California,” Dr. Fritz Lenz, one of Nazi Germany’s leading eugenicists, wrote Gosney in 1937. “These practical experiences are also very valuable for us in Germany. For this I thank you.”

In a 1934 article for the Journal of Heredity, Popenoe dismissed suspicions that the Nazis were motivated by dreams of racial purity. He lauded Hitler as a visionary, quoted from “Mein Kampf” and concluded that Germany’s effort was in “accord with the best thought of eugenicists in all civilized countries.”

The Germans returned the compliment. When Sacramento banker and Human Betterment Foundation board member Charles M. Goethe visited Germany in the mid-1930s, leaders in the Nazi sterilization movement praised the writings of Gosney and Popenoe.

“You will be interested to know that your work has played a powerful part in shaping the opinion of the group of intellectuals who are behind Hitler in this epoch-making program,” Goethe wrote Gosney. “I want you, my dear friend, to carry this thought with you for the rest of your life, that you have really jolted into action a great government of 60,000,000 people.”

*

Boy from very good family ... committed to Sonoma. Family claimed that feeblemindedness was not inherited and fought sterilization. Allowed to go home on parole. Within a few months the family learned that a very low-grade Mexican girl was pregnant and that this boy was the father.... Family insisted that he marry girl, even though it disgraced them and broke their hearts.

-- patient summary from the files of the Human Betterment Foundation

The Caltech archive contains 16 boxes of patient case histories that will remain closed until 2005. But hundreds of unnamed records offer sketchy profiles of patients and the motives of doctors who operated on them.

Female, 20. Parents not married. Mother drank constantly before conception and during pregnancy. Child was neglected and abused. Consent for operation given by stepfather. Patient’s sexual condition: Passionate. Lived for a time with a man to whom she was not married. Hard to control where men are involved. Might easily become a prostitute.

Female, 20. Mother of low mentality. Mother’s mother also feebleminded. Patient uncontrolled around boys. After operation: One of the few girls with whom sterilization may have done more harm than good, in making her feel free from restraint.

Male, 20. Masturbator. Up to this time mother and stepfather have been able to care for this boy by keeping him closely at home. Now they are afraid that he will do harm to some of the little girls in the neighborhood.

Mothers, fathers, uncles, stepfathers, sisters and husbands are listed as those providing consent for the operations. Many other forms state that there were “no responsible relatives” to give consent; they were either dead, overseas or insane themselves.

The Human Betterment Foundation recognized that loopholes in California’s sterilization law opened doctors and the whole program to the threat of lawsuits and negative publicity over the issue of consent.

Margaret Lee Griffin posed such a threat. She was a 24-year-old married mother of three who was living with another man when she was sent to the Sonoma State Home for sterilization after social workers accused her of neglecting her children.

Griffin escaped in 1940 with her lover’s help. “We will try to apprehend Margaret and arrest the parties who stole her,” said Dr. Fred O. Butler, the hospital’s superintendent, in a letter to the foundation.

Griffin was captured and brought back to Sonoma. But weeks later, Butler changed his mind and let Griffin go -- unsterilized. “There had been so much newspaper notoriety regarding this case,” he wrote the foundation, that “we felt under the circumstances we were not justified in forcing it as it might have some deleterious effect on the whole sterilization program.”

Today, scholars believe consent for many of California’s sterilizations were obtained through coercion. It was something promoters knew at the time and kept hidden.

“Dr. Butler has always had a strong weapon to use in getting consents for sterilization by telling the relatives that the patient could not leave without sterilization,” Popenoe wrote to John Randolph Haynes, a nationally known social reformer and one of Los Angeles’ most powerful civic leaders. The letter is part of Haynes’ papers, archived at UCLA.

Haynes applauded Butler’s efficiency and believed other state hospital superintendents could increase the number of sterilizations by following his example. “It is my opinion,” he wrote Popenoe, “that no woman of child-bearing age and no man capable of propagation should be discharged ... without sterilization.” He offered to help set up a $100,000 defense fund for doctors who were sued by patients.

Gosney didn’t like the idea, saying it “might only serve as an incentive” to lawyers. Instead, the foundation maintained in its studies that consent wasn’t an issue and that sterilization was embraced by patients and their families.

The foundation sent questionnaires to 821 sterilized former patients in 1926 asking how they were doing. The 173 letters they got back formed the basis of a report that concluded the overwhelming majority were satisfied with their new lives.

Only a handful of those letters survive.

“I do not believe I have been benefited mentally by the operation; perhaps my ‘pride’ still resents the thought,” one man wrote. “I did not and do not quite understand the motive or ‘purpose’ for compulsory operation.... Hope you can realize my viewpoint.”

“Doctor, if you write my son do not mention the sterilization operation to him as he does not know it was performed,” wrote another patient’s mother.

“I think such operations is just the finest thing there is for people that not mentally or physically healthy: not only for them, but for all those women who are bearing unwanted and uncared for children,” one woman reported.

“It was all a mistake,” wrote a man who had been sterilized at Stockton state hospital. “I would rather not be sterilized as I do not think there is the slightest danger of myself being responsible for any weak or feeble-minded children, and I shall ever bemoan the fact that I shall never have a son to bear my name, to take my place and to be a prop in my old age.

“My brother is at present a patient at Stockton.... He does not intend to ever marry and does not wish to be operated on and as his brother I hope you will please see to it that he is not.”

*

Sterilization in the United States continued until the early 1970s. Its demise had begun during World War II, and the number of operations slowed in the 1950s. Scientific advances discredited the link between heredity and mental illness. New techniques for treating the mentally ill took hold. And the Nazi abuses drove sterilization promoters underground.

As Gosney wrote to a colleague in 1940: “We have little in this country to consider in [terms of] racial integrity. Germany is pushing that. We should steer clear of it lest we should be misunderstood.”

Popenoe eventually abandoned sterilization, turning his attention to marriage and family counseling, which he had advocated since the 1920s. In the 1950s, he became one of America’s best-known marriage counselors -- a pop psychology guru with best-selling books, a syndicated newspaper column, articles in Ladies’ Home Journal and appearances on Art Linkletter’s “House Party” television show.

What had been done in the name of human progress was all but forgotten.

UCLA’s Robert Edgerton was a young researcher working for a state hospital in Pomona when he and a colleague interviewed 50 former mental patients. Their 1961 study tested the still popular assumption -- propagated by the Human Betterment Foundation decades before -- that sterilized patients accepted their operations as beneficial.

Edgerton found that only a fifth of those interviewed approved of the operation, and most of them were unmarried men who felt freed sexually.

Nearly all of the women were devastated. Many were abandoned by their families. Those who married generally didn’t tell their husbands what had been done to them.

“They said they were going to remove my appendix,” one woman told Edgerton. “I still don’t know why they did that surgery to me. The sterilization wasn’t for punishment, was it? Was it because there was something wrong with my mind?”

Said another: “I love kids. Sometimes now when I baby-sit, I hold the baby up to myself and I cry and I think to myself, ‘Why was I ever sterilized?’ ”

Edgerton attended the funeral of one of his subjects a few months ago. He had an IQ of 52 and couldn’t read or write. Yet he worked, accumulated a fair amount of money and had plenty of girlfriends. He also was bisexual.

Edgerton won’t divulge the man’s name, or those of the 14 other sterilization survivors he has kept in contact with for four decades as part of a long-term study of life after institutionalization.

All are older than 70. One woman attempted suicide. One is an active member of a church and delivers food to the needy. Another was married to man who dominated her every move for 20 years. After he died, Edgerton said, “she took off like a rocket,” went to school, got a driver’s license and joined a bridge and Scrabble club.

Her new friends don’t know her secret.

“Of all the things they endured in the state institutions, what has stuck the longest and most painfully is their sterilization,” Edgerton said of his subjects.

“This scar that they carry is just a symbol of that.”

In 1999, Edgerton interviewed dozens of former mental patients as part of a class-action suit over a Canadian sterilization program. The government of Alberta, which sterilized mental patients from 1928 to 1972, eventually settled and agreed to pay $55 million.

That same year, the Swedish government agreed to pay $21,250 to each person it sterilized from 1941 to 1975.

“What could we do for those people who are still alive?” asked state Sen. Dede Alpert (D-San Diego), whose committee earlier this year renewed interest in California’s effort to sterilize its way to a better society. “What should we do beyond ... issuing an apology?”