A Disability History of the United States

by Kim E. Nielsen

  The desire to maintain the female body needed for a healthy nation is exemplified by William Lee Howard, a prominent physician and author of parental advice books at the turn of the century. In 1909 he warned of rising physical and mental degeneration among women. According to Howard, “the female possessed of masculine ideas of independence,” who proclaimed “her sole right to decide questions of war or religion,” and “that disgusting anti-social being, the female sexual pervert,” embodied “different degrees of the same class—degenerates.” In essence, women who sexually desired other women, women who lived as gender nonconformists, and the mother “quick with children who spends her mornings at the club, discussing ‘social statistics,’” embodied different but related forms of a gender disability caused by a degenerating body and mind. The true tragedy, Howard argued, was that if such a woman had children, “she is then a menace to civilization . . . the mother of physical and mental monstrosities who exist as a class of true degenerates.” The poor children would have no good future, for their “weak, plastic, developing cells of the brain are twisted, distorted, and a perverted psychic growth promoted.”24 It was not enough to isolate the Alice Smiths of the nation; they had to be sterilized.

  Alice Smith’s court-appointed attorney argued against her sterilization in a case that reached the New Jersey Supreme Court in 1913. The court agreed and pointed out that the surgery, salpingectomy, was dangerous. Those affected by the law, the court noted, were poor and institutionalized in public facilities. The law thus violated the Fourteenth Amendment’s equal protection clause, because it was not applied to all. Alice Smith would not be sterilized. The court did not take up the more complicated legal question of whether or not sterilization statutes were constitutional.

  In 1927 the US Supreme Court decided the issue in Buck v. Bell. In his majority opinion, Justice Oliver Wendell Holmes argued that “more than once” the nation’s “best citizens” had given their lives for “the public welfare.” “It would be strange,” he went on, “if it could not call upon those who already sap the strength of the State for these lesser sacrifices . . . in order to prevent our being swamped with incompetence. It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.” Holmes concluded that in the family of plaintiff Carrie Buck, her mother, and her daughter, “Three generations of imbeciles are enough.” The Court decided that sterilization statutes calling for sterilization of the institutionalized did not violate the Fourteenth Amendment’s equal protection clause. The Supreme Court decision of Buck v. Bell has yet to be overturned.25

  Alice Smith remained at the State Village for Epileptics until at least 1930, when she was listed in the federal census. Whether or not she was eventually sterilized, and whether or not she was released or died while institutionalized at the Village, is unknown. One wonders what her later life was like.

  Carrie Buck, however, the subject of the Buck v. Bell Supreme Court decision, was sterilized and then released from the Virginia State Colony for Epileptics and Feeble-minded. Like Alice Smith, she was a young, poor, white girl who bore a child outside of marriage. She then entered the court system, her child was removed from her, and she was institutionalized. After Buck’s sterilization and release she married and remained so for twenty-five years until her husband’s death.

  In the Progressive Era, a period of active governmental and social reform between the 1890s and 1920s, institutions for people considered either insane or feeble-minded transitioned from places where education and assimilation were sought to places that were simply custodial. More institutions embraced an organizational and ideological framework called “the colony plan.” Dr. William Spratling, medical superintendent of the Craig Colony for Epileptics at Sonyea, New York (which many considered an ideal model), described the ideal colony as a beehive: “The innumerable hives picturesquely scattered through sweet smelling fields, or dotting the clover covered ground beneath fragrantly blooming apple trees, stand, in colony life, for contented and happy homes; the ceaseless hum of the wings of the busy little toilers stands for the activity of head and heart and hand of the common inhabitants of the colony, each striving for the common good; while the inevitable drones of the hives find their prototype in the lame, the unteachable and the mentally blind among the colonists, who are driven to seek refuge in such a home.”26

  Spratling’s ideal architectural plans included an administrative building at the center from which paths radiated to various cottages. “Cottage” is a misleading term, for these spaces could house as many as fifty people. Such colonies embodied, as historian Lawrence Goodheart pointed out, an arrangement by which a “superior group rul[es] enclaves of inferior peoples.” It is no historical accident that such language developed at the height of US colonialism abroad, such as that in the Philippines, and in the same period in which Plessy v. Ferguson (1896) ruled that separate was equal and that segregation served the public good.27 In an era of US imperialism abroad, the supposedly inferior peoples at home, epileptics and the feeble-minded, remained segregated within their own geographical places, literally called a colony, and removed from larger society.

  Money could provide one with a more comfortable facility, but money and social position did not remove the stigma from epilepsy, institutionalization, or insanity. Jean Clemens, the daughter of Mark Twain (Samuel Clemens), began experiencing blackouts at the age of fifteen. Seizures began later and doctors diagnosed her with epilepsy. Family resources meant that Jean never entered the court system. Instead she made the decision in her mid-twenties to enter Hillbourne Farms, a “private health resort” for individuals with epilepsy, in Katonah, New York. The decision was one made out of desperation and a lack of other options, encouraged by her doctor. In her diary she noted, “It was desperately hard to leave Father and Clara [her sister] in order to come out to a totally strange place. I tried my hardest not to cry before them, but as the time of departure began to approach I found it growing more and more difficult to restrain myself.” During her fifteen-month stay Jean was aware, with some bitterness, of how difficult family life had been: “While I know that neither of them would admit being glad to have me away & therefore relieved of the presence of an ill person, I am sure that they must feel so . . . I am sure [father] is fond of me but I don’t believe that he any more than Clara, really misses me.”28 While Jean was never threatened with sterilization by doctors, the courts, or her family, her family made clear their strong belief that she should never marry or bear children. And once institutionalized, she was deeply dependent on and controlled by doctors’ orders and her father’s money.

  Institutionalization could be individually devastating, but often it also served larger ideological purposes. The warehousing of those considered deviant in one way or another, combined with the threat of sterilization, policed behaviors and literally controlled the reproduction of social norms. In these cases, the rhetoric of disability, benevolence, and care (both of the individual and of the nation) combined with and sometimes masked broader impulses of social control.

  The Hiawatha Asylum for Insane Indians is an example that is both devastatingly singular and commonplace. Hiawatha operated from 1903 to 1933. It may have begun with humanitarian goals, but even that is questionable. Because tribal peoples were under federal authorities, state institutions had no legal obligation to accept indigenous peoples deemed insane. For South Dakota senator Richard Pettigrew, it was a prime opportunity to bring in money and jobs to Canton, South Dakota. Between its founding and closure in 1933, more than three hundred indigenous people from at least fifty-three different tribes were sent to Hiawatha. It was one of only two federal insane asylums. While the majority of people were from the Great Plains and Midwest nations of the Lakota Sioux, the Dakota Sioux, the Chippewa and Menominee, some individuals arrived in Canton to find that no one spoke the language of their home.<
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  Commitment to the Hiawatha asylum involved virtually no legal safeguards. Reservation superintendents, white agents of the Bureau of Indian Affairs (BIA), could confine someone to Hiawatha, and often included boarding school superintendents in their decision making. Parents who opposed sending their children to boarding schools, individuals who resisted assimilation, those who argued with BIA agents, those too rowdy or bothersome, or those who steadfastly practiced indigenous religions, could be and often were committed to Hiawatha. Standards of insanity, normality, and health literally foreign to indigenous nations were imposed upon them, sometimes quite violently.

  Dr. Harry Hummer, the second director of Hiawatha, believed that levels of “insanity among the Indians” were rising. The arrival of civilized peoples and practices in North America, he believed, were simply too much for those immersed in Native cultures to handle. He also argued that “full-bloods” were more likely to be insane than those with some European heritage. It angered him that Hiawatha residents were “suspicious” of him, stating that they were “much more reticent” than white insane peoples. “Reticence, suspiciousness, superstitions” combined with “the fact that oftentimes our only medium of conversation is the sign language, which with us is very crude,” he complained, made diagnosis difficult.29

  Contemporary indigenous activist and elder Pemina Yellow Bird records that Hummer forbade Native dances and music, even to mourn the dead. Hiawatha staff commonly cut inmates’ hair or shaved it off entirely. Boarding school officials also adopted this practice. Not only did it diminish possibilities of lice and make bathing easier, but it was, in Pemina Yellow Bird’s words, “a form of spiritual murder.” “In many Native belief systems,” she says, “our hair is alive, and has a spirit and power of its own. We do not like others to even touch our hair, let alone shave it off.” The forced cutting of hair also happened at boarding schools, another form of institutionalization. Zitkala-Sa, of the Yankton Sioux nation, chronicled having her hair cut at her first day of boarding school in roughly the same time period. She had tried to run away, and was tied to a chair: “I cried aloud, shaking my head all the while until I felt the cold blades of the scissors against my neck, and heard them gnaw off one of my thick braids. Then I lost my spirit.”30

  Family members and tribal representatives had filed complaints about Hiawatha with the BIA since its beginning, indicating among other things that they tried to maintain contact with their loved ones institutionalized at the facility. Employees had filed complaints against Hummer since his arrival, alleging sexual and monetary misconduct. In 1929 Dr. Samuel Silk arrived in Canton to inspect conditions at the federally funded facility (though this was certainly not the first such inspection). At the end of his six-day stay, he compiled a lengthy, highly critical report. The asylum, he said, was “a place of padlocks and chamber pots” with “intolerable conditions” throughout. Only the “poorest kind of medical care” was provided, and conditions were “very much below the standard of a modern prison.” Straitjackets, metal wristlets, and ankle chains routinely confined people. Few ever went home; most died at Hiawatha and at least 131 are buried in a cemetery within sight of the asylum windows. For those inmates who came from tribal nations who valued being buried near one’s ancestors, or with taboos against dwelling close to burial sites, being confined to a building that overlooked the cemetery, far from home, must have been horrific. One local resident remembered nighttime “wailing” coming from the asylum; likely it was not simply wailing, but the honoring and mourning of the dead with death songs.31

  After Silk’s condemnation of conditions at the facility in 1929, and again in 1933, the federal government closed the Hiawatha Asylum for Insane Indians. Silk’s final report promoted Secretary of the Interior Harold Ickes to charge that the Canton institution remained open only “as a result of the greed and selfish inhumanity of certain interests there” and that conditions remained “sickening and intolerable,” “filthy, inhuman, and revolting.”33

  Despite its brutalities, the Hiawatha experience was not unique, in that even within horrific institutions of terror human beings created community. As historian Susan Burch has shown, people institutionalized at Hiawatha cared for one another to the best of their abilities. They helped one another maintain contact with outside family members, and they sustained tribal relationships when at all possible.33

  At the closing of Hiawatha in December 1933, sixteen patients were deemed lacking “insufficient mental derangement” for further institutionalization. They returned home, wherever that was. Sixty-nine people, apparently considered sufficiently mentally deranged, were transported to St. Elizabeth’s Hospital in Washington, DC, the only other federal insane asylum—and one already segregated between whites and African Americans. It was also where Dr. Harry Hummer, Hiawatha’s superintendent, had begun his career. Few former Hiawatha residents ever left St. Elizabeth’s.34

  At St. Elizabeth’s, the former Hiawatha inmates encountered a staff already arguing about and building treatment regiments around the belief that African Americans lacked mental and physical capacity to handle contemporary and civilized life. In other words, they encountered institutionalized ideologies that already linked being not-white with disability. As Historian Martin Summers smartly notes, medical experts both in the United States and throughout European colonies in Africa thought that those of African descent had “underdeveloped nervous systems, and the more they came into contact with civilization the greater their propensity to become mentally disturbed.” This was not simply an extension of the post–Civil War argument that freedom wrought insanity among former slaves, but part of the larger intellectual framework that justified colonialism abroad and domestically. It supported a segregated social order based on racial hierarchies. As Dr. John E. Lind put it in 1917, Africans as well as African Americans, no matter what pretext of sophistication they embraced, had a “savage heart beneath the civilized exterior.”35 The sixty-nine indigenous people who went by train from Canton, South Dakota, to Washington, DC, may have made a considerable geographic move, but they remained bound within the same ideological framework of subjugation.

  Today a golf course lies on the grounds of the former Hiawatha Asylum for Insane Indians in Canton, South Dakota. What had been the unmarked cemetery is near the fifth tee. Because of the activism of Lakota journalist Harold Ironshield, activism that has been continued by others since his death, a memorial listing the names of those known to be buried in the Hiawatha cemetery now sits nearby. Like the cemeteries of many current and former insane asylums, only recently, if ever, have those buried been remembered by name. Its history is both unique and hauntingly commonplace.

  The federal government provided even more reason for indigenous nations to fear its supposed caretaking efforts by undertaking a federal campaign against trachoma in the 1920s. Trachoma, a highly infectious eye disease also common among immigrant communities, affected nearly one in four Native Americans, and in some tribal nations and boarding schools the rate was as high as one out of every two people. Left untreated, the sometimes painful disease could result in blindness. In 1924 the federal Office of Indian Affairs initiated an anti-trachoma campaign. Instead of the more benign approach of improving sanitation conditions and providing health education, or the widely used strategy of prescribing medications such as silver nitrate, OIA officials endorsed an invasive and debated surgery called tarsectomy. This involved using forceps to turn the eyelids inside out in order to scrape off the infected corneal tissue. Among members of tribal nations as wide-ranging as those in Oklahoma, South Dakota, Michigan, Wisconsin, Montana, and California, over 22,773 tarsectomies were performed between 1925 and 1927.36

  Among other problems, however, tarsectomy often did not work. It remained a controversial medical procedure that was quickly discredited, long before its use was abandoned, and tarsectomized patients “frequently experienced severe complications, which could include an untreatable recurrence of trachoma, entropion, sc
arring, or blindness.” As historian Todd Benson has written, “OIA doctors had caused even more suffering for American Indian patients.” Despite cautions and efforts to conduct small test cases, OIA doctors had gone ahead with their surgical efforts. They then blamed indigenous communities for the medical failures. As one OIA trachoma specialist wrote, “The Indian is a born skeptic anyhow, and must be handled by those familiar with his temperamental vagaries.”37 White racism thus resulted in both painful and ineffective surgical procedures—and in increasing blindness in an already marginalized population.

  TECHNOLOGY, INDUSTRIALIZATION, AND AN “ARMY OF CRIPPLES”

  When President Benjamin Harrison issued his first address to Congress in 1899, and as the nation wrestled with whether to assist or simply ignore disabled Civil War veterans, he warned of the undesirable consequences of industrialization. Railroad workers, he proclaimed, were subject “to a peril of life and limb as great as that of a soldier in time of war.” Railroads were creating an “army of cripples.” In 1910, Samuel Gompers of the American Federation of Labor (a man about as dissimilar to Harrison as could be) proclaimed that “‘compensation for the victims of injury’ stood ‘above all’ other issues in terms of its legislative significance; no other issue was ‘of half the importance.’”38 Industrialization was supposed to usher in both wealth and leisure, but it was disabling American workers in incredibly large numbers. Progressive Era reformers sought to soften the disabling blows of industrialization via protective labor legislation—and they used visuals of the disabled bodies of American workers to reveal the horrors of capitalism unchecked—but it is hard to exaggerate the impact of mines, steel plants, railroad yards, textile factories, lead poisoning, fast assembly lines, and repetitive motion on the bodies of working-class men, women, and children. And industrial accidents that resulted in a laborer’s diminished income capacity, or a lack of income, meant that entire families suffered.