The Eugenic Rubicon: California's Sterilization Stories

The Eugenic Rubicon: California's Sterilization Stories is an interdisciplinary, multimedia collaboration in digital medical humanities. It offers novel and compelling interpretations of the social history of eugenics, as well as glimpses of the potential of archives to serve emerging forms of scholarship. The project is led by two distinguished academics: Alexandra Minna Stern is professor and chair of the Department of American Culture at the University of Michigan and director of its Sterilization and Social Justice Lab. At Dartmouth College, Jacqueline Wernimont is distinguished chair of digital humanities and social engagement, and associate professor in the Women's, Gender, and Sexuality Studies Program. They are joined by a project team that includes students, scholars, and University of Michigan epidemiologists associated with Stern's Sterilization and Social Justice Lab. Eugenic Rubicon is supported by research funding from the University of Michigan and Arizona State University, and a Humanities Collections and Reference Resources grant from the National Endowment for the Humanities.

Eugenics is typically understood as a Progressive-era movement to improve the genetic quality of the human race through controlled reproduction. Conventional historical interpretations maintain that eugenics was abandoned after the exposure of Nazi Germany's abuses.¹ Even those knowledgeable of the history of medicine may be surprised to learn that eugenics laws persisted in the United States long into the twentieth century and that eugenic procedures are still reported in the present day.² Eugenic Rubicon is a strong contribution to new historical research that interprets eugenics within the framework of reproductive justice, focusing on how institutions applied eugenics laws to conduct social control along gendered and racial lines: Stern's own Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America³ is a foundational work in this area.

Like Eugenic Nation, Eugenic Rubicon focuses on California, which had the most aggressive eugenic sterilization program in the United States. From the early to mid-twentieth century, approximately 20,000 patients in state institutions underwent forced sterilizations after being judged unfit to reproduce. The state law that supported this program was only repealed in 1979. Historians are bringing attention to how forced sterilization disproportionately targeted people of color, and children and women whose behavior did not align with social norms. Eugenic Rubicon's focus on patient demographics and experience—rather than on legislative history or public policy—is a valuable effort to understand the impact of forced sterilization and to view these programs through the lens of social justice.

Eugenic Rubicon was developed on Scalar, an open source publishing platform designed for the presentation of multimedia digital scholarship. While the resource is ostensibly presented in an e-book format with a traditional chapter structure and index, its introduction describes “a developing prototype that uses mixed media and digital storytelling methods.” Indeed, the Scalar platform explicitly supports a plurality of scholarly and creative approaches, presenting a resource as readable as a straightforward historical analysis, while also offering nontraditional treatments of the subject matter (a marketing video for Scalar asks, “When does an electronic book become an object to think with?”⁴).

Eugenic Rubicon's chapter structure includes introductory text, an examination of the bureaucratization of human experience through recordkeeping, a historical overview of the Sonoma State Hospital, an invitation for creative engagement with the historical content, and a call for reparations for eugenics survivors. Throughout, multimedia objects, digitized archival materials, and embedded external content augment the text. In fact, several of the chapters consist of text that exists primarily to support embedded content, such as external websites and journalism. The navigation invites the reader to simply proceed through the chapters or take detours to read poems written by a project participant, explore an interactive timeline, or leave the resource entirely in favor of other content. Ideally, this structure should support diverse levels of engagement with the content and target multiple audiences—from medical researchers to creative artists and social historians. However, while the chapter presentation is thematically coherent, one gets lost in the multiple hyperlinked paths (internal and external), which are presented in both the primary text and the site navigation. Working through the Scalar presentation evokes memories of navigating websites in the 1990s, which often presented a labyrinth of internal and external links, with an underlying presumption that the ultimate goal of web design is for the user to explore the interface. Going forward, the Eugenic Rubicon team can enrich the experience of readers by more critically deploying Scalar to serve the goals of the project.

Those who manage medical archives, or conduct research in them, are sure to encounter records protected by the federal Health Insurance Portability and Accountability Act (HIPAA). Under the act, records held by a covered entity (such as most health care providers), and that disclose the individual identity of medical patients, are defined as protected health information (PHI) and are restricted by HIPAA's privacy rules.⁵ At my own institution, a covered entity under HIPAA, most researchers must complete an Institutional Review Board (IRB) process before accessing records containing PHI. Materials subject to HIPAA include not only routine medical records, but correspondence, recordings, and photographs of patients. A few of our patrons are willing and able to undertake the IRB process, but barriers to access deter most and they decide not to pursue this avenue of research. We see that, paradoxically, laws intended to protect the privacy of patients also prevent historians from researching and publishing on their experiences. The outcome, as Eugenic Rubicon notes and attempts to redress, is that the perspective of patients continues to be underrepresented in the history of medicine: “Very little is known about the demographics and experiences of people sterilized, often against their will” (Introduction). Part of Eugenic Rubicon's aim is to demonstrate the work of the Sterilization and Social Justice Lab, which identified a collection of nearly 50,000 patient records associated with California institutions from the 1920s through the 1950s. Currently held on microfilm in the California State Archives and protected by HIPAA, the records constitute an invaluable—yet inaccessible—record of the identities and experiences of institutional patients. Eugenic Rubicon provides a redacted sample of the records and promises that, as the records are digitized and made available within appropriate protocols, the resource will take on expansive new dimensions.

For archivists, the second chapter's observations about recordkeeping will hit home. “Turning People into Paperwork” raises theoretical and practical questions about the dehumanization of individual experience through the maintenance of bureaucratic forms, which “demonstrate how medical paperwork encouraged doctors to understand their patients in terms of boxes to check and pre-defined diagnoses.” Eugenic Rubicon aims to at least make this bureaucratization of the patient experience visible, if not to rehumanize the system. Those of us who manage collections of rote, systematic paperwork would do well to consider this problem and question how formulaic records in our own collections erase personal experiences and dehumanize the subjects they represent. We should also consider the redemptive possibilities of drawing individual experience out of systematic records, whether through our own interpretations or by supporting new scholarship that draws narratives from data.

Eugenic Rubicon provides a case study of the questions raised by new forms of digital scholarship. Because multiple versions of pages have already been developed, and authors advise that the resource's content and structure are subject to further change, it is challenging to review or cite the resource in a traditional manner. The extent to which Eugenic Rubicon's content underwent peer review before publication is also unclear. Do dynamic, mutable resources such as Eugenic Rubicon ever move from prototype into a final, scholarly product? If not, is that a problem, or just a demand for the paradigms of scholarly communication to adapt? And, while print books and e-books can both suffer technological failures, such as a torn page or crashed download, projects hosted on platforms such as Scalar can suffer glitches that potentially impact the scholarship itself: for example, how is the scholar or reviewer to evaluate a digital object that will not load? If embedded external content changes, disappears, or triggers browser security issues, how is the authority and impact of the scholarship affected? The Scalar-supported offering of multiple interpretations and interactive paths presents another communication challenge, which could muddy the thesis of even the strongest scholarship. However, in the case of Eugenic Rubicon, access to the primary subject matter—forced sterilization patients—is so limited that alternative interpretations may be the best options currently available. Both creative writing and well-sanitized multimedia can indirectly illuminate the experience of patients without breaching their privacy or imposing a viewpoint on them that is not their own.

Setting aside scholarly communication questions and the emphasis on external content over original research in some of its chapters, Eugenic Rubicon's scholarly text is novel, approachable, and appropriately academic. As a contribution to new scholarship on eugenics, its topical content and critical approach are relevant not only to historians and archivists working in the health sciences, but also to social historians, students, policymakers, and eugenics survivors. Its critique of recordkeeping offers valuable perspectives to archivists who seek to support researchers in accessing and interpreting sensitive personal data. It is deeply troubling that the first-person experiences of patients have been systematically erased or underrepresented in historical analysis—whether due to bias or the functional problems of HIPAA. Eugenic Rubicon is an imperfect, yet promising, step toward finding those voices.