Mental Illness and Lethal Medical Neglect

Art by Rob Goldstein
Life in the Age of Aquarius

I saw my first homeless person with mental illness in the spring of 1982 in Honolulu.

I worked at the psychiatric unit on which the homeless man had recently been a patient.

John came to us for a course of ECT treatments in the hope that the ECT would resolve some of the symptoms of his Schizophrenia.

He was psychotic and minimally responsive to medications.

I was on his treatment team and assisted his Psychiatrist with the ECT.

After his treatments we sent John to the State Hospital where we hoped he would remain stable enough to live on an open unit.

When I saw him on Hotel Street a week later digging through garbage for food, I was shocked.

I thought that he was in danger and went to his psychiatrist to report my concern.

Dr. Popenoe: Yes?

Me: I just saw John B. He is disorganized, filthy, and on the street eating trash. I thought you should know.

Dr. Popenoe: Why?

Me: (not getting it) I thought you should know. Shouldn’t John be in the hospital?

Dr. Popenoe: Don’t worry about John.

Me: What?

Dr. Popenoe: Don’t worry about John, He has better survival skills than I do.

Me: (still not getting it) How can that be? You’re married. You have a career. You support a family. John is eating trash.

Dr. Popenoe: (frowning) Don’t worry about John. (He glances at his watch) I’m scheduled to see a patient.

I’m fired a week later.

The President of the United States in the Spring of 1982 is Ronald Reagan.

lethal selection
Lethal Medical Neglect


The American Eugenics Movement

The rich founders of the American Eugenics Movement in the early 1900‘s read Darwin’s Theory of Natural Selection and decided that they were the “fit” who are meant to survive to pass on their genes.

These men believed that civilization and improved medical technology subverted the goal of natural selection which favors the quick and strong.  And the rich.

Common descriptions of people deemed genetically unfit implied moral turpitude.

Madison Grant, president of the Eugenics Research Association and the American Eugenics Society, wrote in The Passing of the Great Race:

 “Mistaken regard for what are believed to be divine laws and a sentimental belief in the sanctity of human life tend to prevent both the elimination of defective infants and the sterilization of such adults as are themselves of no value to the community. The laws of nature require the obliteration of the unfit and human life is valuable only when it is of use to the community or race.”

eugenics 1920s
Mentally Diseased, Sex Perverts, Illegitimate, Paupers, Criminals and Murderers

He goes on to say: ” It is highly unjust that a minute minority should be called upon to supply brains for the unthinking mass of the community, but it is even worse to burden the responsible and larger, but still overworked, elements in the community with an ever increasing number of moral perverts, mental defectives, and hereditary cripples”

The American eugenics movement received extensive funding from the Carnegie Institution, Rockefeller Foundation, and the Harriman railroad fortune.

In 1906 J.H. Kellogg provided funding to help found the Race Betterment Foundation in Battle Creek, Michigan.

A Carnegie funded 1911 Preliminary Report of the Committee of the Eugenic Section of the American Breeder’s Association recommended eighteen solutions to the problem of mental defectives.

Among the recommendations was execution and forced sterilization.

Methods of determining who was fit involved classifying people and their families by degrees of intelligence, material success and conformity to the rules of Social Hygiene.

eugenics - virginia
The New Virginia Law to Preserve Racial Integrity


Four Types of Mental Deficiency

In 1918, Paul Popenoe, an Army venereal disease specialist during World War I, co-wrote the internationally used textbook, Applied Eugenics.

Popenoe observed what he called Lethal Selection at work during the War.

He wrote:

“Poverty becomes rife, and sanitation and medical treatment are commonly sacrificed under the strain. During a war, that mitigation of the action of natural selection which is so common now among civilized nations, is somewhat less effective than in times of peace.”

For Popenoe the primary solution to the problem of mental defectives is execution by Lethal Neglect.

 William Robinson, a New York urologist, published widely on the topic of birth control and eugenics. In Robinson’s book, Eugenics, Marriage and Birth Control (practical Eugenics), he advocates gassing the children of the unfit.

Robinson wrote: “The best thing would be to gently chloroform these children or to give them a dose of potassium cyanide.”

“Society cannot prevent the birth of all the unfit and degenerates, but it certainly has the right to prevent the birth of as many of them as possible…when it comes to distinctly and unquestionably anti-social acts, a human being has no more rights than an animal. We pity the paranoiac, we pity the insane, we pity the degenerate, but none the less we have not only the right but it is our duty to prevent the paranoiac, the insane, and the degenerate from reproducing their kind, from polluting the racial stock, and from being a social and economic burden to the sane, the normal and the healthy.”


A Day in His Life

From the Applied Eugenics:

“…Direct starvation is not a factor of importance in the survival of most races during most of the time at the present day so far as the civilized portion of the world is concerned. But disease and the other lethal factors not connected with the food-supply, through which natural selection acts, are still of great importance. From a half to two-thirds of all deaths are of a selective character, even under favorable conditions.”

The 1927 Supreme Court Buck v. Bell decision upheld the right of the State to impose sterilization on the unfit. Justice Oliver Wendell Holmes wrote: “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…. Three generations of imbeciles are enough.”


With this decision the Mentally Ill and the disabled acquired a deeper and more sinister stigma.

We no longer had the right to live and it was OK to kill us if no one was looking or cared.

The most commonly suggested method of execution was to set up local gas chambers. However, many in the eugenics movement did not believe that Americans were ready to implement a large-scale euthanasia program, so many doctors had to find clever ways of subtly implementing eugenic euthanasia in various medical institutions. For example, a mental institution in Lincoln, Illinois fed its incoming patients milk infected with tuberculosis (reasoning that genetically fit people would be resistant), resulting in 30-40% annual death rates. Other doctors practiced euthanasia through various forms of lethal neglect.  Eugenics in the United States


Lethal Medical Neglect

Art by Rob Goldstein
Lethal Medical Neglect: Discharged to the streets in a hospital gown.

Applied Eugenics devotes a chapter to Lethal Selection: Two forms of lethal selection were distinguished, one depending on starvation and the other on causes not connected with the food supply. Direct starvation is not a factor of importance in the survival of most races during most of the time at the present day so far as the civilized portion of the world is concerned. But disease and the other lethal factors not connected with the food-supply, through which natural selection acts, are still of great importance. From a half to two-thirds of all deaths are of a selective character, even under favorable conditions.

Criminals in power legalize their crimes.

A Short Timeline of Events

In 1907, Indiana passed the first eugenics-based compulsory sterilization law in the world. Thirty States soon passed similar laws.

By 1921, California had accounted for 80% of the mandatory sterilizations performed.

By 1930 the forced sterilization of and segregation of the mentally ill and other people deemed unfit became policy throughout most of the industrialized world.

Art by Rob Goldstein
We deprive our mentally ill of resources and let them die on our streets.

The unfit were the poor, the mentally ill, the blind, the deaf, the developmentally disabled, prostitutes, homosexuals, Blacks, Jews, and anyone deemed degenerate.

By 1938 Jews and other undesirables are detained, starved and gassed to death in Hitler’s concentration camps.

If you think this can’t happen in the United States then may not understand that it has happened.

We don’t use concentration camps in the U.S.

We deprive our mentally ill of resources and let them die on our clean streets.

For some reason, we believe they deserve it.

Rob Goldstein (c) 2016













27 thoughts on “Mental Illness and Lethal Medical Neglect

  1. Eugenics is horrifying. Thank you for sharing the history lesson and applying it to today. We are heartless in how we neglect our homeless and severely mentally ill. Unconscionable.


    1. Thanks Kitt. Even if the connections between the ruthless methods of execution discussed in 1918 and our present day policy of sending the disabled to the streets to die weren’t clear it’s certainly worth asking if there is a connection. The American Eugenics Movement inspired the horrors of Nazi Germany. I think that the citizens of the United States need to understand that defeating the Nazi’s was not the same as defeating Class bigotry, Racism and Fascism. These evils persist and are central to our politics today.

      Liked by 1 person

  2. I agree. Leadership does come from the people. Part of the problem is that too many of us have abdicated that responsibility and remained focused only on ourselves and our own needs. We’ve accepted the idea that some lives are worth less. We need a cultural shift that will not only address inequality in terms of resources but also in our belief systems.

    Liked by 1 person

    1. I agree Karen. The thing about democratic systems is that the people are the leaders. If the people are corrupt their leaders are corrupt. If the people abdicate their role their leaders will take on the role of tyrant.

      But enough of our democracy remains in place so that when we work, it works. We see evidence of it in every election.

      When the people show up at the polls and actively engage in the political life of the country the systems that we create change.

      In this country their used to be an unspoken rule that when the elections are over we accept the vote and re-unite as a nation. We need to get the gamers out of government. Cheating and smear campaigns are fine in VR games; these strategies have no place in government.

      Liked by 1 person

  3. It seems that mental illness have been viewed negatively since the dawn of age. While it is due to the lack of knowledge and understanding of the issue, there are much improvements now. But I felt that more needs to be done to ensure that the stigma is eliminated from the society entirely.

    Liked by 1 person

    1. I agree with you.

      One of the first steps in removing that stigma is on a personal level. You have to remove that part of the stigma that we internalize. For instance, internalized homophobia is still a problem among gay men.

      You must know in your soul that the man or woman you see on the street is fully human and undeserving of the conditions this culture has imposed on her.

      Once you know that to your bones you also know that regardless of the intellectual arguments you may hear for allowing people to suffer it is always wrong and always contrary to the underlying principles of civilized life to impose suffering on those who are ill.

      We will not have a civil society until we restore the human dimension of reason and compassion to our system of governments.

      To do that we have to see how the slow deaths of people on the streets is the same as the violent deaths that draw our attention and cause us to react.

      Abuses if power by the police against African-Americans is the same as abuses of power on the part of Congress toward people with mental illness.

      They stem from the same system of oppression.

      Liked by 1 person

  4. Excellent article. Ronald Reagan certainly did the mentally ill and disadvantaged great harm but, as your discussion of eugenics shows, our attitude toward such people has deep historical roots. We have treated them as throwaway people, lives of no value. One can hope that at some point in the future we will restore the social programs necessary to support all members of our communities. Of course, we need caring and effective leaders to make it happen.

    Liked by 1 person

    1. I agree but with this caveat: Leadership comes from the people.

      The militarization of our police, the random murders of unarmed African-Americans by the police, the presence of a media outlet that presents opinion as fact and the normalization of the presence of gravely disabled people dying from treatable illnesses on the streets of our cities is all part of the same problem.

      If you belong to the 99 percent your live doesn’t matter.

      You may think it does but if something beyond your control happens to you and it causes you to lose your housing you WILL become homeless and maybe you’ll survive and maybe you won’t.

      But if the thing that happened to you is Schizophrenia and you are poor and without family and you become homeless you will most certainly die from lethal medical neglect.

      That’s a crime.

      Liked by 1 person

      1. I’m extremely lucky to have a supportive network of friends and family. There is also the fact that I live in San Francisco and am part of an older network of friends who have Communitarianism values.

        Had one little piece of that network been out of place I would be homeless now.

        Most people say I have a good mind.

        How many minds like mine have died in anguish on our streets since homelessness began in the 1980’s?

        Liked by 1 person

  5. I never want to wish ill on people, or speak harshly of the dead, but sometimes I think Reagan’s final years was karma. Though I don’t really believe in that and feel horrible for feeling that way. It is hard to help when you think about the amount of lives that man destroyed.

    Liked by 1 person

    1. You know… I don’t consider his end Karma at all.

      If it had been Karma he would have died on the streets helplessly ill just like the hundreds of thousands of of disabled people who are still dying on our streets thanks to Reagan and his silent enablers.

      …It’s time to let the gas out of balloon of this allegedly great B-Grade President who deregulated and destroyed the economic system that made this one of the most functional and prosperous democracies in history of our species.

      And that’s without the clever trick of shutting State Hospitals while simultaneously removing funds for the programs that were supposed to take their place.

      I don’t mean to sound mean…but can one really be mean about about a man who cheated his way into office, who abused his power and destroyed the lives of innocent people?

      Two generations don’t know about a United States that did not have mentally ill people defecating on its streets. Welcome to Reagan’s endless night.

      Liked by 2 people

  6. Insanity – the study of the sane, by the insane… I personally think society is insane, sometimes… okay, no, most of the time… but am unsure if that makes me sane or insane? …not that it matters.

    It’s just horrific that people are still treated the same way they have always been treated – at arm’s length.

    Liked by 1 person

    1. I think that were such conflicted creatures that we are all probably insane by the standard of some unknown universal mind that knows why the hell we’re here and whether we will survive long enough to master the use of reason.

      Mental illnesses are cognitive disorders.

      Some of them are caused by neurological misfires and some are caused by violent and abusive childhoods.

      At this point I don’t think we keep people with mental illness at arms length because of their mental illness–I think we keep them at arms
      length because if we really look at them we will be forced to come to terms with the fact that we have allowed our government to target an entire group of people for extermination by a kind of economic embargo, This is a crime against humanity. On some level we know this but changing it means facing the fact that we’ve been an ugly people for a very long time.

      Liked by 1 person

      1. Oooogh Lordy, I faced that fact some time ago for countless reasons. But also, changing it means addressing it head on and the possibility it could happen to any of us.


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