Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940

This is an interesting book, the result of a lot of hard work and very detailed investigation. Ian Dowbiggin’s claim is that a concern for eugenics among members of the psychiatric profession was a product of their personal experience of the asylum. He argues his point from the biography of G. Alder Blumer, a Canadian psychiatrist who worked mainly in the United States. Blumer’s career in the world of the asylum moved from state-run progressivism in Toronto under C. K. Clarke (mid-1880s-1899), to custodial care of poor patients in a large public asylum in Utica, New York (1899–1902), to Butler Hospital in Rhode Island (1902–21), which dealt with a selected population of “curable” affluent patients. His interest in eugenics—that is, in negative eugenics, with its emphasis on the incurable nature of mental disease and defect, especially among the poor—was at its peak during his Utica years, and faded when his patient population altered. Blumer himself felt that it was his Utica experience that persuaded him of the hereditarian theory of mental disease. In contrast, he found that the paying patients of Butler angrily rejected any suggestions that their ancestry was defective.

Using the rise and fall of Blumer’s eugenic enthusiasm as his model, Dowbiggin then extrapolates to seek a general pattern. Did a grim, overcrowded U.S. state hospital with its increasing numbers of long-stay patients usually have the effect of turning the thoughts of its directors to sterilization for the good of the race? The U.S. sterilization laws of the turn of the century were often supported by the state hospital psychiatrists, whereas the American Medico-Psychological Association, with its more mixed membership, never unequivocally endorsed either sterilization or the eugenic regulation of marriage. Many of its members were keen eugenists, but there were many alternatives to the hereditarian hypothesis. By the 1920s, alarmist hereditarian rhetoric was going out of fashion: as Dowbiggin points out, Freudian analysis, child guidance, psychiatric social work, and outpatient treatment provided more hopeful alternatives, and perhaps more fruitful professional fields to till. Many state hospital psychiatrists, however, continued to support sterilization well into the thirties. It seemed like an effective cost-cutting measure for underfunded institutions.

The main thesis of Keeping America Sane is persuasive: support for eugenics within the American psychiatric profession seems to have had the expected class dimension. It was the poor who were to be sterilized, in the United States as elsewhere. Broadly speaking, those whose patients were poor were for it, while those who treated private patients dared not suggest it, whatever they might feel personally. However, when Dowbiggin extrapolates still further to explain why Canadian psychiatrists continued to endorse eugenic ideas into the thirties, I cannot follow him. Canadian social machinery was generally state-funded, he says, and “wherever government and mental health physicians functioned in close proximity, eugenic measures enjoyed considerable psychiatric approval” (p. 134). This does not explain, however, why the Canadian movement had such spotty support that Canadian sterilization laws did not appear until about thirty years after those in the United States, nor does it square with the fact that in Britain the Eugenics Society, despite campaigning throughout the thirties, could not get any legislation passed at all.