STERILISATION
OF
MENTAL
Uear Sir,
DEFECTIVES
In your Summer issue you invited correspondence "on this highly controversial subject." As basic issues may vary in different geographical locations in so vast a country as the United States, I submit the following as from the area known here as our "far-West." Your questions are answered in accordance with my experience as Superintendent and Medical Director of a State Institution for Mental Defectives in California,
accommodating
over
3,000 patients where,
under my
supervision,
during the years 1918 through 1949, over 5,000 patients were sterilised. Approximately the first 1,000 of this number were operated on by myself, personally. We have found that the vast majority of both males and females should be sterilised before marriage because of their incapacity to care for children either defective or normal. In two extensive surveys made in 1928, with a follow-up in 1938 by an independent and neutral study group and from my own experience, it was definitely shown to us that sterilisation did not increase promiscuity or venereal disease. The two surveys referred to, covered both the mentally
deficient
and the
mentally
ill.
75
Our experience proved definitely in connection with hundreds of those sterilised who subsequently married, that no resentment arising out of their sterility, resulted. In extremely rare instances we were contacted later by one of this group stating that the spouse wanted children and asking if the
operation could be reversed. Such a query would be answered by a letter explaining in detail the reasons for the operation which almost invariably closed the matter. In only one instance a reversal was performed and our records showed the birth of one child to this couple. The appearance of neurosis is rare in the mentally deficient. Our experience, covering many hundred married individuals, showed quite definitely that the home picture was a very satisfactory one. It was our policy to keep these people under the supervision of a trained psychiatric social worker for a minimum of two years before discharge. Our statistics showed that there was one divorce for every 12 or 13 marriages involving one of our sterilised mental defectives. Among normal people in that locality at that time the ratio was one divorce to every 6 marriages. On the basis of inadequacy to rear a child, we recommended sterilisation before any pregnancy or birth. It is definitely important to sterilise following the birth of the first?or in some few cases, the second child. Personally,
it is my view that if a child cannot be born of normal parents it were better not to be born?for the child's sake. One of my saddest experiences was to see a normal person come to the Institution to visit a defective mother. For defectives capable of education and training which cannot be given elsewhere, the institution should provide the best and earliest possible preparation for life in the community. This class of patient should then be sterilised and released under intelligent supervision for as long as decreed necessary, this to be followed by discharge so that enjoyment may be had of all that the world has to offer. Yours faithfully, r red O. Butler, m.d. 867 Second Street
East, Sonoma, California. We
hope that other readers will be drawn by this letter
to
express their views.?Ed.
OF
MENTAL
Uear Sir,
DEFECTIVES
In your Summer issue you invited correspondence "on this highly controversial subject." As basic issues may vary in different geographical locations in so vast a country as the United States, I submit the following as from the area known here as our "far-West." Your questions are answered in accordance with my experience as Superintendent and Medical Director of a State Institution for Mental Defectives in California,
accommodating
over
3,000 patients where,
under my
supervision,
during the years 1918 through 1949, over 5,000 patients were sterilised. Approximately the first 1,000 of this number were operated on by myself, personally. We have found that the vast majority of both males and females should be sterilised before marriage because of their incapacity to care for children either defective or normal. In two extensive surveys made in 1928, with a follow-up in 1938 by an independent and neutral study group and from my own experience, it was definitely shown to us that sterilisation did not increase promiscuity or venereal disease. The two surveys referred to, covered both the mentally
deficient
and the
mentally
ill.
75
Our experience proved definitely in connection with hundreds of those sterilised who subsequently married, that no resentment arising out of their sterility, resulted. In extremely rare instances we were contacted later by one of this group stating that the spouse wanted children and asking if the
operation could be reversed. Such a query would be answered by a letter explaining in detail the reasons for the operation which almost invariably closed the matter. In only one instance a reversal was performed and our records showed the birth of one child to this couple. The appearance of neurosis is rare in the mentally deficient. Our experience, covering many hundred married individuals, showed quite definitely that the home picture was a very satisfactory one. It was our policy to keep these people under the supervision of a trained psychiatric social worker for a minimum of two years before discharge. Our statistics showed that there was one divorce for every 12 or 13 marriages involving one of our sterilised mental defectives. Among normal people in that locality at that time the ratio was one divorce to every 6 marriages. On the basis of inadequacy to rear a child, we recommended sterilisation before any pregnancy or birth. It is definitely important to sterilise following the birth of the first?or in some few cases, the second child. Personally,
it is my view that if a child cannot be born of normal parents it were better not to be born?for the child's sake. One of my saddest experiences was to see a normal person come to the Institution to visit a defective mother. For defectives capable of education and training which cannot be given elsewhere, the institution should provide the best and earliest possible preparation for life in the community. This class of patient should then be sterilised and released under intelligent supervision for as long as decreed necessary, this to be followed by discharge so that enjoyment may be had of all that the world has to offer. Yours faithfully, r red O. Butler, m.d. 867 Second Street
East, Sonoma, California. We
hope that other readers will be drawn by this letter
to
express their views.?Ed.
