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Issue 6

Editor's note: Behind the Door of Delusion was published in 1932. Its author called himself only "Inmate, Ward 8."

"Inmate, Ward 8" was Marion Marle Woodson. Born in 1883, Woodson came from a prominent family in Oklahoma. His wide-ranging career included heading the Oklahoma Department of Agriculture and serving as president of the Connell State School of Agriculture in Helena, Oklahoma. He was a reporter and editorial writer at the Tulsa World and Tulsa Tribune, as well as a foreign correspondent for the Associated Press. He held a private pilot's license.

By his own account, Woodson had struggled for years with "dipsomania" -- what we would now refer to as advanced alcoholism. The drinking bout that preceded his commitment involved ingestion of paraldehyde and a "bromide solution" (probably potassium bromide). When he was found by a friend, Woodson was delirious. He spent two weeks hospitalized, on the verge of death.

It wasn't hard for friends to convince him that "confinement" for a year or more was his only hope of freeing himself from his compulsion He was admitted to Eastern State Hospital in Vinita, Oklahoma -- the route a fair number of alcoholics took in those days. (It wasn't until 1935 that Bill W. and Doctor Bob S. met and formed Alcoholics Anonymous, a grassroots self-help program that enabled people like Woodson to reach out and help each other free themselves from alcohol addiction and abuse while still working and living in their own homes and communities.)

Woodson was given favored status at Eastern -- and access to a typewriter. With it, he wrote a very readable account of his stay, which was published by the Macmillan Publishing Company.

I happened across his book by accident, one of five or six I grabbed for a dollar on the last day of a university library bag sale. Carefully pasted into the back cover was a letter to a previous owner from the publisher. The letter, dated 1944, revealed the identity of the author and some of the details of his life.

Woodson's story shows a man who slowly grows more and more aware of the true price he will pay for the desperate act of allowing himself to be declared insane. By the end of the book, he concludes he'll be unable to return to the city and the work he loves. His solution, according to the letter from the publisher, was to start a new career as a social worker at Eastern. I can only guess that this allowed him to engage in work that had meaning, and let him relate to a social group in which he'd be viewed as a "success," rather than meet the ostracism he feared awaited him in Tulsa.

The chapter reprinted here, "The Sterilization Spectre," is an exceptional account of a barely remembered piece of our history. During Woodson's stay at Eastern, Oklahoma passed a law authorizing sterilization of inmates about to be paroled, at the discretion of the institution's superintendent. Everyone in the state hospital knew about the new law, but this is the only account I've come across from the point of view of persons against whom the law was directed.

As it turns out, Oklahoma was conservative in applying its law. As of 1938, it had sterilized 49 men and 236 women. California had sterilized over 12,000 people.

Paroled from the hospital in 1932, Woodson didn't get to enjoy his new life very long. In 1933, he died of bone cancer.

-- Steve Drake. Steve Drake is Research Director of Not Dead Yet


Chapter 14:
The Sterilization Spectre

by "Inmate, Ward 8"

From Behind the Door of Delusion, published by The Macmillan Company, NY, in 1932. Reissued in 1994 through the University Press of Colorado, with an introduction by William W. Savage and James H. Lazalier.

The patients on the receiving ward are in seething unrest. The two thousand men and women in the institution are in a foment. I suspect that this is true in every asylum in the state, and to a minor degree in the state school for the feeble-minded, although many of the boys and girls in that institution are not old enough to appreciate the situation.

The spectre of sex sterilization has been thrust over us. The legislature has passed and the governor has signed a measure permitting the desexualization, under certain conditions, of any male or female inmate who is not too aged to procreate.

And the patients are frightened, wrought up, angry and muttering. They know little about the law, therefore they are the more frightened. Men and women fear most that of which they know the least. And the patients know only what the newspapers have told them.

Into every ward of the hospital some daily papers come. Many of the patients are regular subscribers to papers from their home city and religiously read every item in every issue. But the subject of sex sterilization is avoided like a plague by most newspapers. Their editors are afraid of offending some narrow or prudish reader, so such vital facts are largely avoided.

Knowing so little the patients are the more frightened and angry, expecting the worst. They gather in little knots and discuss the fate which may be hanging over them. But they do not do it where the attendants can hear. They are afraid to do that.

"The paper says they can sterilize any male patient under sixty-five years old and any female under forty-seven. That seems nearly all of us, even to the little children," one patient says in helpless anger. "If they do that to me they might as well kill me and be done with it. If they don't I'll kill myself anyhow. I haven't got much to live for as it is but if they do that I won't give a damn what becomes of me." I really think this man means it. I know that he believes he means it.

"Well if they do that to me I'll kill the man who orders it done if it takes me the rest of my life." The patient who says this has always been a quiet man, obedient and likeable. It is difficult to determine that he is insane. Yet I am told that he comes exactly in one of the classifications intended to be reached by the sterilization law. He is abnormally sexed.

"Well I know what I'm agoing to do. I'm not agoing to stay here," another patient says. His sentiments are echoed fervently by numerous others. And that is just one of the reasons why the sterilization law, as passed, will defeat its own purpose. It will lead -- is already leading -- to desperate attempts at escape. Some of these will be successful.

The fear of the law has already led to one successful effort to escape, on this ward alone. A parole man, sub-witted but considered harmless, became so worried that he made a successful break for freedom. He is still at large, capable of fathering children and with that thought indubitably brought uppermost in his mind. "I am going right back to my country girl," he has since written to one of the other patients here. Had he not been frightened by the passage of the law very probably he would still be here where there is no possibility of his even associating with the other sex.

There is another way, far, far more serious, in which the law will defeat its purpose. Many families have members who are idiotic, epileptic, feebleminded, imbecile or even possessed of mental quirks, and under former circumstances they would not have hesitated to have these unfortunates confined; but now they will avoid having them committed, no matter what the cost in deception, risk or hardship to the other members of the family.

Thus many persons who should be confined will be at large with the possibility of bringing about reproduction. And many of them will be of two types that the measure is especially designed to reach -- either suffering from the effects of social diseases, or abnormally sexed. In both of these classes it is extremely difficult for the layman to determine when the point of insanity is reached, so that if the victim does not in some way come under the observation of competent physicians he may remain at large for long periods without his casual associates realizing that he is abnormal. There lies the danger to society.

Personally I am not so seriously concerned about the law. I have studied it and know its provisions. I obtained from the ward physician special permission to obtain a copy, but the permission was granted on the strict condition that I would not discuss it with the other patients or even let them know that I have it. I would not do the latter even if permitted to do so, as the other patients would almost mob me to get an opportunity to read it. Then many of them would not be able to understand it and the frightened discussions would start all over again.

Those patients most deeply steeped in delusions are the worst excited. "The paper says that the superintendent decides whether you are to be sterilized or not. Of course he will pick on me right away. He's always had a grudge against me. He's only keeping me here for spite, anyway," one of them says.

He is right in one thing. The law does leave the decision as to whether or not a patient is to be sterilized to the superintendent, practically alone, although it was not intended to do exactly that. It errs most in its assumption that the men who administer it will be trained, conscientious, and, above all else, infallibly capable in judgment. But are laws always administered by such super-perfect humans?

I am leaving out of all consideration the question of whether society ever has the right to inflict sterilization. I am leaving that question to the churches, and the consciences of the people. Some of the greatest of the churches have taken an unyielding stand against any sterilization. I am not discussing whether it would be right to inflict sterilization for something of which the helpless victim is not willfully guilty. And I admit that at first reading and on first thought the law might appear to be a good one for society at large; but a closer analysis shows it to be as full of holes as a fish net; presenting uncounted opportunities for tragic travesties on rights while giving the perpetrators the protection of being within the law.

The first section of the law provides that the superintendents of asylums "when they are of the opinion that it is for the best interests of society and of the patients, may perform or cause to be performed the operation of sterilization on any such patients afflicted with hereditary forms of insanity, which are recurrent -- idiocy, imbecility, feeblemindedness or epilepsy."

This section contains the gist of the law; remaining sections being devoted to an outline of legal and medical steps required, including legal steps by which the patient, supposedly, may protect himself.

The measure has been intentionally provided with several "legal safeguards" -- but these are such that they can be of use only to those who are mentally and financially capable of taking advantage of them.

These steps include a hearing before the board of control and a possible appeal to the state courts. The patient must bear all the expense and burden of his appeals; the superintendent's "opinion" is supported by the state's attorney general, and the state treasury defrays any court or other expense which the superintendent may incur.

"That's no protection at all to any of us," Borden says bitterly. Borden was an excellent architect while outside. "We are either actual or legal paupers and can't hire attorneys, and we are either insane and can't look out for ourselves, or everybody who might help us believes we are insane because we are here, which has the same effect."

"You're right," says Whitney, a former farmer. "Then we are completely shut in. We can't even send out a letter if they don't want us to." (This is true. Officials have turned down several letters which I have written to outside friends, and I can not guess or discover the reason.)

"We can not use a telephone," Whitney continues. "We can not send out a telegram without special permission, and they never give us that. We are hedged in; practically buried. Then we are flat broke. I have money and property at home but I can't use either one. My wife is my administrator and she is running around with another fellow, and she and my grown son both want my farm. What could I do if they wanted to sterilize me?"

Because I have read the law I can tell him what he can do. He can stay here until he dies, whether he recovers or not, whether he is sane or insane, if the superintendent should decide that he should be sterilized. Unless he submitted to the mutilation, that decision of the doctor's would rob him of all hope of ever going home. Even the reformers who forced the passage of the law realized that there is no possibility of offspring as long as the patient is shut up here; so the measure provides that only patients "about to be discharged" may be forced to submit to sterilization.

Does that mean that a man may be sane enough to be discharged and yet insane enough to be forced to submit to sterilization against his will?

"How are they going to know what forms of insanity can be passed on to the children?" Borden asks. "Even the doctors in this hospital don't agree on that. They are going to let the superintendent's opinion force men to be sterilized, and all superintendents don't agree on what can be transmitted. That law is rotten, but it has been passed and what can we do about it. None of us can go into court and fight it. Most of us haven't a dime and those of us who have estates can't use them. Our administrators wouldn't let us."

Borden is correct in both of his conclusions. The best informed physicians are sharply divided in opinion as to what forms of insanity are transmittable; and administrators, as a rule, will not advance funds for a long and expensive court fight to save the patient from sterilization. They will take the position that "The doctor surely must know what is best."

There is a patient on this ward who owns an estate said to be valued at about $1,000,000. If he were about to be released and the superintendent should decide that he should first be sterilized, would his administrator or his prospective heirs advance money to fight the matter through the courts and thus set him at liberty? Or would they not rather insist that he should not be released without sterilization? They would know that he would resist sterilization and thus be forced to remain in the asylum.

It would tear up their pretty playhouse so rudely if he should be discharged and permitted to resume control of his affairs; especially after the prospective heirs have it all arranged among them just how the big estate is to be divided, and the administrator has decided that his nice, fat job is good for several years.

Such injustices are particularly apt to occur when the husband or wife has been instrumental in having the patient committed. In many such cases the husband or wife does not want the patient discharged.

A lover, sweetheart, the estate or even physical fear may be the reason. But no matter what the reason, the outside spouse seldom will be willing to supply the money to carry on the expensive court fight which would be required to overthrow the superintendent's decision. As for the patients themselves, they have no money except what little is sent to some of them, and even this must be spent under supervision. I have a little money in a bank at home but I can not draw a cent of it, even "tobacco money."

The framers of the law evidently believed it was "fully safeguarded." I am convinced that the men who passed the laws permitting the execution of death sentences on witches and those under which heretics were burned at the stake believed that those laws were "fully safeguarded."

Later knowledge has proved how completely illogical those safeguards were, but that does not return life to the innocent victims. And the person of today who advocates the sterilization of men and women, boys and girls, when no physician can say with certainty what insanities can be transmitted to offspring, may be putting himself in the same class with the burners of witches.

Today the famous Salem witchcraft obsession is referred to by some physicians as a "mass mania or insanity." Their predecessors were no doubt called into court to testify as to whether or not the accused persons were possessed of "witches' minds."

Certain it is that records, still existing, show that among the witnesses in several cases were a "leech and a minister." And now I know from what sources some of the criminal court alienists of today were derived.

The informed medical profession of today is sharply divided on the question of what forms of insanity are the result of heredity. Formerly practically all physicians were agreed that the vast majority of insanity cases were the result of heredity. Even within the last year I have had a bombastic general physician tell me that "ninety percent of insanity can be traced to heredity."

Of course this man was ridiculously wrong. He knew nothing of insanity or insane persons. He had no business talking on the subject. But many people who hear him make such ridiculous statements will believe him, because, "Doctor Pomposity said so; I heard him myself." And a few hundred years ago all of the Doctor Pompositys said -- and so the people believed -- that insane persons were possessed of an evil spirit. So the victims were chained up and starved to, drive out the evil spirits. Those must have been stubborn spirits; they always refused to leave until after their hosts died.

But even those physicians who make a scientific study of insanity, and are in no way kin to Doctor Pomposity, are divided into two classes on the subject of the transmissibility of insanity. One class, which is growing smaller, holds that the majority of insanity cases can be traced to heredity. The other class holds that in many cases formerly ascribed to heredity the transmission certainly can not be proved, and is very doubtful; I while the majority of insanity cases may be due to organic physical ailments, social or other germ diseases, injuries, and a variety of other causes, including nervous shock or tension; as witness the religious maniacs, victims of so-called shell shock or of worry, and women who become demented from the nervous and physical strains of childbirth.

With the best informed doctors failing to agree, can the conscientious person contend that the mere opinion of a physician should be permitted to determine if a lifelong mutilation should be imposed on other persons ? If so, to which class of physicians should we, listen? And is it certain that the superintendent who must pass on the cases will happen to belong to that class? Even physicians in the same hospital often are divided. They are very much so, here.

Regardless of the hazy ideas of such laymen as happen to know what the terms mean, and equally regardless of a very few physicians who are almost as uninformed, vasectomy in the case of males and salpingectomy in the case of females is mutilation; uninformed statements to the contrary notwithstanding. Original claims for these two forms of sterilization, which are the only two permitted under the law, were that sexual association is not eliminated but that procreation is. But calm statistics show that a very high percentage of the operations fail to attain this result and surgeons are beginning to admit that very much of the attraction of a woman for a man or of a man for a woman is irretrievably lost even in the most successful operations. And this attraction is the basis of affection between the sexes which keeps households together and families happy.

The divorce laws of practically every state recognize this when they make sterility of one of the contracting parties a good and sufficient ground for divorce.

As for the provision in the law that the patient must be notified in advance and a hearing held by the board of control before the sterilization can be carried out, that is of little if any protection. The patient can not represent himself successfully; he requires an attorney, alienists and perhaps other witnesses.

The members of the board usually are politicians or business men; they know nothing of insanity, and have had no opportunity to study the patient; they haven't an idea as to what forms of insanity are transmittable. They will naturally and almost unvaryingly rely on the word of the superintendent; the very same superintendent who has already decided that the patient should be sterilized and who will be present to uphold his opinion.

If the members of the board attempted to cross-examine the patient they would be prone to some ludicrous mistakes. Many badly insane persons are apparently sane, rational and keen when they arc not having one of their disturbed periods. At such times they would deceive the very elect, while a harmless person with the mentality of a child would be trapped by the veriest tyro. The board members, knowing,this, would rely on the recommendation of the superintendent, and the superintendent could overbalance any good impression that the patient had made by simply tapping his head or winking significantly. .

After the hearing before the board the patient, although pronounced by the superintendent as sane and ready to go out into the world, would have to remain in the asylum unless he submits to sterilization or appeals to the courts. In not one per cent of the cases would the patient be able to appeal to the courts. He could not obtain the necessary money. He could not communicate with friends if the superintendent did not wish him to do so. Even if he communicates with them they are not apt to come to his aid, in the face of the decision of the superintendent and the board. They would believe the authorities were right. Certainly they would not advance large sums out of their own pocket. Would you, even if it were your brother who had been pronounced insane?

Depending on the opinion of a physician is natural. The most hard headed, and sanest, people do it to a surprising degree. Men frequently give up their positions or sell their businesses and move to a different climate on the advice of their physician. And in mental cases the unquestioning dependence of people on the word of a physician is almost absolute.

Of course the framers of the law contend that the superintendents of the hospitals, who are very often political appointees, will be conscientious in giving their opinion that patients should be sterilized. Unquestionably many of them will. The "leech and minister" were undoubtedly conscientious in giving their opinions that the poor Salem wretches had witches' minds. And even where the superintendent is scrupulously conscientious in giving his opinion the fact remains that it is but an opinion and later knowledge may prove it to have been unjustified.

And the assumption of the proponents of the law that such opinions will be honestly given in all cases can not be justified by past experience.

The human element creeps through all such assumptions of law. Are not judgeships sometimes bought? Are all verdicts uninfluenced!? Do all contracts go to the lowest and best bidder? Is the Volstead law always conscientiously enforced? Are not the gods of money, politics and selfishness some times served ?

Is there not a possibility that some superintendent might be influenced by surgeons coveting the fee which the state will pay to the surgeons performing the operations?

No better refutation of the claim that superintendents will never apply the law except where abundantly justified need be offered than the proved fact that, in the past, superintendents of some hospitals, without a scintilla of law to justify them, secretly have sterilized helpless and hapless patients. They used the barbarous method of removing some of the reproductive organs, just as is done with colts or calves.

Not only was there no law to permit this; the action was directly against the law. But the superintendents evidently depended upon the fact that their word is law within their domains, and patients are helpless.

More than 25 years ago there was an infamous case of this in Kansas where the superintendent of one of the state hospitals sterilized not merely one but a considerable number of patients and endeavored to keep the matter secret.

But some of the patients managed to get out of the hospital and their mutilation was proof of their stories. The brutal superintendent is said to have justified his action on the ground that it was in the interest of scientific knowledge, and that the men and women whom he mutilated were "just crazy people, anyhow."

He was discharged from his position, but did that right the great wrong which he had committed? It has been charged that physicians and superintendents in many hospitals for the insane have used patients, or permitted them to be used, for experimental operations of different kinds. In some instances these charges have been authenticated.

One of the physicians here, with whom I have discussed the law at length, admits the measure has many faults, but is a staunch advocate of a law permitting sterilization in certain cases, provided it is thoroughly safeguarded. Most of the other physicians are in accord with him, and I believe they are conscientious and sincere.

I might agree with them if such a law could be properly safeguarded. But I believe this is impossible under present lack of definite knowledge concerning insanity, and is almost impossible so long as superintendents of hospitals are subject to political appointment.

In this institution there formerly was a physician of such odor that I hold my nose when I think of him. He did not last very long. He was abruptly discharged and kicked up a political row about it.

Yet during the time he was here he stood in the capacity of a hospital physician, and relatives of patients accepted his word unquestioningly. He was culpably incompetent, fundamentally dishonest and constitutionally unconscientious. Yet he could have caused untold injustice by a few words or by merely tapping his head.

But the physician who believes in legal sterilization in certain rare cases has given considerable thought to the subject and has evolved a plan which many good people will endorse.

He would permit no sterilization without a hearing before a board composed in part of legally trained men, in part of laymen, preferably substantial business men, and in part of physicians who are experienced in mental cases but are not connected with the institution in which the patient is confined. The state commissioner of charities and corrections would be, ex officio, defender of the patient, empowered to call witnesses and alienists, at state expense. Such a board might possibly be able to reach a just conclusion and the patient automatically would have some one charged with and empowered to represent his interests.

"There are," says this physician, "some women, excellent wives and mothers, who, due to the nervous and physical strain of childbirth, become mentally deranged. After they are here for a time they recover, mentally and physically. But their next childbirth results in a recurrence of the mental derangement.

"Would it not be better if they should be sterilized and so be able to go home, take care of their children and be useful homemakers than for them to be permitted to bear more children at the expense of dementia on their part, leaving the children uncared for and essentially motherless?"

Right, in some ways, Doctor. But if she again is sane as you claim, if she is mentally competent to go home to her husband and children and be a good homemaker and credit to her family, is she not competent to pass on the question of her own sterilization? Should not that question be left to herself, her husband and her conscience?

And should it not be decided where the threat of having to remain in the asylum, coupled with her yearning for her children, home, husband and freedom, can not beat her down into despairing acceptance?

But the doctor is not through with the presentation of his case. "There are some men in the asylums who are children in mentality, but physically they are adults, capable of procreating children. Their families are able and willing to care for them and support them. Also it is cruel to keep them confined here in association with those who are irrevocably deranged. Would not it be better that they should be sterilized and sent home than that they should be kept virtual prisoners for something for which they are not responsible?"

Right again, in some ways, Doctor. But if your theory that idiocy is always transmittable is correct, should not the other members of his family, his brothers and sisters be sterilized also? They unquestionably must have inherited some of the taint from the same source from which he received his. They come from the same father and mother, the same ancestry. And shall we sterilize his father and mother? They have produced one idiot child, hence may produce another. The idiot, at least has not done this and there is no proof that he may.

If the theory of transmitted idiocy is correct the parents' tendency to produce idiotic children has been proved. Shall we let them go and sterilize the child they brought into the world?

Shall we say that when an idiot makes his appearance in a family all members of that family should be sterilized? Inherited traits sometimes skip a generation. Shall we sterilize his grandfather? And what about cousins, second, third and umpty-fourth cousins? Where does the taint end?

And can those unanalytical reformers who shout vigorously and vociferously for sterilization and who stampede legislatures, be assured that some twenty-second cousin of their own was not born feeble-minded?

Such a logical interpretation of your theory of hereditary idiocy would be apt to cause an awful furor among our best people, would it not, Doctor? Some of the most prominent families in the country have produced feebleminded children. They hide them away with the other family skeletons. And have not many families of apparently low intelligence produced some mental giants? Whence came Lincoln?

How about new blood to bolster up our civilization at intervals. Must it come only from those of our present mental heavyweights who can trace their ancestry back to Noah, including all the family branches and ramifications, to show that no insanity, imbecility, idiocy or feeble-mindedness ever tainted the blood?

Shall we automatically divorce couples when it can be shown that one of the parties is a member of a family which has at some time produced a, child which was not up to mental par? And what constitutes mental par?

There are men who are idiotic or insane from injuries, pre-natal or since birth. How can the physician know? Shall we sterilize them?

But while I have been getting myself all hot and bothered about the matter the other patients on the ward are more than hot and bothered. They are frightened and dreading.

They congregate on the exercising porch and talk about it. Through mysterious grapevine sources we have learned that the women are as wrought up as the men. Perhaps they are more so. Strip from any woman all her overgarments of training, repression, pretension and artifice and you will find that her thoughts are of the other sex. Her dreams and her life are expressed in terms of the masculine gender. Sweetheart, husband, lover or perhaps a son; her real life is wrapped up in these. A man has other interests; he can immerse himself in business or hobbies. He is, often, quite willing to live alone in a club, hotel or even a boarding house. A woman is not, even in this age of flappers and business women.

The modern flapper has thrust aside repressions and is striving for "self expression," which usually includes calling up a boy friend and inviting him on a necking party. If he is "dated up" or not interested she has little hesitancy in calling another one. And all of us here know where the minds of older women swing when their restraints are loosened or erased by mental unbalance. Yes, the women are worried about the sterilization law.

Those here think, talk and dream about little else but men. They crowd to their barred windows and flirt shamelessly with anything in trousers which happens to pass near their wards. Their advances are bold, bald and urging.

And so the fears, the loneliness and the near hopelessness of the Locked-ins have an added terror.

Its poignancy will wear off to some extent as time goes on and the patients learn of no sterilizations; for they will never learn of any which are performed, unless it be through some mischance. Nor will the public.

But, knowing my insane associates, I know that each new patient who may be brought in will be warned of the possible fate which awaits him, and his hopes will be even fewer than were those of us older patients who heard the click of the lock in the heavy door before the sterilization law was passed.

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