The following is a guest post from my friend Daniel Goldberg of East Carolina University's Bioethics and Interdisciplinary Studies Department. I hope we'll hear some more from him as the discussion about compensation of victims of North Carolina's sterilization program moves forward:
Thanks much to Al for the invitation to contribute to TFL. I am a peculiar academic creature; about 60% of my work involves public health ethics and population-level bioethics, and about 30-40% of my work is original research in the history of medicine and public health. Although I am no historian of eugenics, my period of the mid-to-late 19th c. (and into the early 20th), and my interest in the history of public health, combined with my work on race, class, inequities, and the social determinants of health means that I cannot afford to be entirely ignorant about the enmeshment of fin-de-siècle and progressive public health activities and eugenics.
Having moved to North Carolina just a few years ago, and now living in eastern North Carolina (which is substantially poorer, sicker, more rural, and more African-American than the Piedmont), I have taken a particular interest in the activities of the sterilization task force and the history of involuntary sterilization here in my adopted fair state and in my region.
I am at heart an intellectual historian, and one of the things I find fascinating is the way in which ideas are social actors. That is, ideas can have a powerful effect on material history, and one of the most obvious ways in which this happens in context of health is the importance of individual agency. The conventional view that American political culture is highly individualist turns out upon close scrutiny to be exactly correct, and there is virtually no doubt that this individualism has had and continues to have a profound impact on our ideas about health, our causal attributions of disease and health, and on our ideas about the remedies we should implement to ameliorate poor health.
Thinking about the sterilization program, and communicating with peers, colleagues, and community members on its history in eastern North Carolina in particular, what has become plain is the complexity of some of the issues underlying it. Not, of course, that this complexity serves to diminish either the horror of involuntary sterilization or its class and race-based applications. But there is ample social epidemiologic evidence showing that single parentage is a significant determinant of all sorts of adverse health outcomes, as is having multiple dependents. Moreover, social disadvantage tends to cluster, which means that across a population, those who are single parents are more likely to suffer from other disadvantages (low income, low educational attainment, exposures to violence, racism, discrimination, etc.) So persons experiencing deleterious social and economic conditions often face the enormous obstacles posed by compound disadvantage.
What interests me about the role of individualism in thinking about the sterilization program is the way in which the problem to be solved -- reproduction that creates all sorts of problems and burdens for the mother, larger family, children, etc. -- is read according the script of that individualism. In other words, the very real problems posed by the deleterious social and economic conditions in which many of the victims of the program lived and worked are reformulated as problems of the individual body, of the woman for whom sterilization was sought. If the social problems for which reproduction is a proxy are in fact recast as pathologies of the individual body, then the obvious remedy is to eliminate the pathology, in this case, surgically.
But note that under this interpretation, the intervention alleviates the pathology on both the individual and the collective level -- through sterilization, the pathology inscribed within the individual woman’s body is eliminated, but so too is the pathology inscribed on the body politic.
Lest this seem far-fetched, we have very good evidence in the history of eugenics that this kind of thinking was critical, that what Robert Jay Lifton terms a ‘biocracy’ had an enormous amount to do with the breadth and social power of scientific racism and eugenicist interventions. Individual ‘degeneracy’ -- a key term of art in eugenicist thought -- was a stain on the society itself, analogized to a lesion which should properly be excised or alleviated in some manner provided through the instrumentarium of biomedicine and science.
But the individualism of American culture is of course contingent. What if a different social imaginary dominated the way we think about health, disease, and disadvantage? What if the problems posed by adverse socioeconomic conditions, single parentage, and multiple dependents were seen as failures in the social safety net, as social problems that were both fundamentally caused by breaches in social and collective policies (whose effects accumulate over generations) and sustained, as Engels might surmise, by continued failures to provide material assistance and break what Madison Powers and Ruth Faden term ‘densely-woven patterns of disadvantage’? If that were the case, and the problem was seen as a social problem than as one of individual bodies and their pathologies, then the solution would hardly seem to be sterilization of any kind, but amelioration of the social and economic conditions that caused and sustained the destitution and suffering the proponents of the program sought to ameliorate.