On March 19, 1916, Dr. Arthur Holmes, then-dean of the general faculty of the University of Pennsylvania, presented a talk titled "What of the Backward Child" at Boston's Ford Hall. Already well-known as an authority on "mental defectives" , Holmes was outspoken in his views concerning these children and how common they actually were. While never as famous as some of the other prominent eugenicists of his era, Holmes had worked with Dr. Lightmer Witmer at the University of Pennsylvania's Psychological clinic doing ground-breaking work on measuring intelligence in children. The seminal research he and Witmer did together ensured that Holmes' talks were well-attended, not to mention meriting extensive newspaper coverage. And it also allowed him to make various pronouncements about mental defectives and the terrible danger they posed to society.
Certainly, he had no problem using terms such as "moron", "imbecile", and "idiot" since these were actually accepted medical terms at the time. A moron, for instance, was anyone with an IQ score between 51 and 70 (about the mental capacity of a child between the ages of six and twelve). Anyone with an IQ between 26 and 50 was classified as an imbecile while having an IQ less than 26 earned someone the idiot label. Though intelligence tests were still in their infancy and were often used in ways for which they had never been designed, this didn't dissuade psychologists and social reformers from applying them wholesale to large segments of society, particularly for immigrants, psychiatric patients, prisoners, and the "backward children" that Holmes devoted his life to treating.
Despite his career in treating children with mental disabilities, Holmes had no hesitation in speaking out against the "problem" that they posed to society. "Of feeble-minded people, there are said to be between 200,000 and 500,000 in the United States and these include most criminals", he said in his talk. "One Ohio judge found that from 20 to 40 percent of those applied for divorce are feeble-minded." While he stressed that the overwhelming majority of these "mental defectives" were due to heredity, hence the need for "exercising more care in marriage for in such cases, the sins of the parents are visited on the children."
Still, he magnanimously allowed that heredity wasn't to blame for all of these cases. He also allowed that some problem children were actually too "forward" rather than backwards and that they were simply acting out because of being raised in restrictive environments. Then, there were those children who were mentally impaired because of problems with the adenoids at the back of their throats. According to Holmes, the breathing problems caused by adenoids prevented oxygen from reaching their blood, thus causing an "enfeebling and lethargy of the entire body and mind" which could persist well into adulthood.
He hardly stopped there, though. As far as Holmes was concerned, mental defectives also included "people who have a mania for showy costumes and uniforms; women who in person and adornment conform to the simpering, conventional ideals of beauty; men and women who spend money foolishly, and men and women who wish to be divorced may be either morons, imbeciles, idiots, or they may have adenoids that need to be attended to."
But there was only so much Holmes could say in a talk aimed at the general public. Anyone wanting to see the full range of his views on mental defectives would need to read his book, The Conservation of the Child: a Manual of Clinical Psychology Presenting the Examination and Treatment of Backward Children, which was published in 1912 (and is still available online). In his book, Holmes presented various statistics to prove his claim that one in every 500 children was mentally defective which, given the population of the United States at the time, meant that there were at least 200,000 feeble-minded Americans, all of whom could pass their condition on to their children. While he acknowledged that the total number of institutionalized mental defectives was only around 20,000, the remaining ninety percent were "pursuing their unrestricted way, some at work, some idlers, tramps, loafers or criminals, and some at school, clogging and diverting its energies from their proper channels in a vain attempt to teach the uneducable unteachable things." Even more appalling, from Holmes' perspective, were the countless other mental defectives who "roam the streets at will" and, presumably, posing a terrible danger to the rest of society due to the inferior intellect and risk for violence.
Not only did Holmes' book highlight the dangers posed by these defectives, but he also stressed how easy it was to diagnose them using the tests he described in his book, mainly those intelligence tests used in the University of Pennsylvania Psychological Clinic. While the Clinic provided groundbreaking work in training teachers and health professionals to deal with children with special needs, many of these same teachers were also charged with assigning those familiar "moron", "imbecile", or "idiot" labels to children based on tests they administered themselves. That these labels often followed children for the rest of their lives hardly seemed important at the time.
To be fair, Holmes did distinguish between those children he viewed as "curably retarded" and the incurable ones who could only live in institutions. As he said in his book, "To say that a child is "backward" or retarded should not allege or imply the existence of a physical or mental disease. It may, or nearly always, imply some defect or some lack. But that is not always regrettable." Again, he raised the example of children who acted out because of poor upbringing or having to deal with rigid learning methods.
Unfortunately, this was a distinction that many social reformers, especially those eugenicists looking for a simpler (and cheaper) solution weren't prepared to make. Which is why many of these same eugenicists began arguing for the use of mandatory sterilization with institutionalized children, prisoners, psychiatric patients, and other people deemed "unfit." This was eventually extended to various "problem groups", including immigrants, ethnic minorities, and people from disadvantaged backgrounds.
If anything, Holmes fellow eugenicists were even more explicit about the "danger" posed by genetic undesirables. In 1919, Dr. William Hickson, director of the psychopathic laboratory of Chicago’s municipal court said, “Mental defectiveness is hereditary and constitutional, and consequently, not amenable to our preachings, asylums, hospitals, reformatories, penitentiaries, etc. We must ever bear in mind that each year a new quota of defectives is born with statistical regularity. They pass through the hands of parents, then the pedagogues, the theologians, the physicians, the social workers, the employers, the courts, the prisons and back on society, each one in his turn passing them up to the next, and no one to acknowledge their impotency in the face of mental defectiveness.”
While the first of these forced sterilization programs had already passed in 1907 in Pennsylvania (closely followed by California and Washington), sterilization rates for anyone deemed genetically unfit were relatively low despite the public outrage being generated by Holmes and other eugenicists. Still, the entire issue of forced sterilization remained controversial. That is, until the 1927 Buck vs Bell decision in the U.S. Supreme Court which declared that forced sterilization of anyone deemed unfit was constitutional.
The woman at the centre of that decision, 18-year-old Carrie Buck, had been institutionalized largely due to her "incorrigibility" as well as for having an illegitimate child (later determined to have been the product of rape). Despite appeals by Buck's legal guardian, the court decision, as well as the famous ruling by Oliver Wendell Holmes Jr (yes, another Holmes), sealed her fate and she was sterilized, along with her siblings (none of whom were told what had been done to them).
Following the Buck decision, more than 60,000 people were forcibly sterilized (mostly women) though the entire issue remained controversial. Many potential candidates for sterilization successfully fought back, primarily prison inmates who challenged the idea of their "genetic unfitness". While the United States was far from the only country practicing forced sterilization (including Canada, Sweden and Denmark, to name a few), few other countries went as far
It wasn't until after the end of World War II and the revelations over Nazi atrocities that public opinion eventually turned against forced sterilization. That the Nazis routinely sterilized anyone they deemed genetically unfit (usually through the use of "eugenic courts" Still, the Buck decision was never overturned and forced sterilization continued in many states until well into the 1970s. While some states have since agreed to compensation for people sterilized against their will, most victims of forced sterilization have never been compensated and, in many cases, were never even aware they had been sterilized. Even today, forced sterilization for the institutionalized continue to be advocated on a case-by-case basis (though the arguments are usually couched in terms of protecting a woman's health as opposed to "genetic unfitness"). While the 2011 Istanbul Convention concerning violence against women formally prohibits forced sterilization, human rights agencies report that it still remains common in many countries practicing human rights abuses.
But the legacy of the forced sterilization era remains with us even today. In one sense, this bygone era has changed our very language with terms like "moron", "imbecile", and "idiot" being relegated to the status of insults with none of the medical authority they once had. But a more crucial legacy involves the numerous legal claims that have been and continue to be pursued on behalf of involuntarily sterilized former patients. Despite the sizeable settlements made in many of these cases, it's safe to say that we will never see real justice for thousands of others, many of whom were never even told they were sterilized or who died before they had a chance to make a claim.
Whether we've truly learned a lesson from all this tragedy is something only time will tell.
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