I am going to say it clearly and succinctly: this brand-new book is one of the most important scholarly works of the year. Seeking to understand why some people were poor, homeless, criminally inclined, mentally ill, and in other ways socially inadequate, 19th-century theorists turned to the science of eugenics, the concept of genetically unfit people. This stunning book is an exploration of the profound contemporary resonance of this concept and how it directly contributed to such persecutions as the Holocaust. Certain individuals were judged "degenerate" as early as biblical times, and the condition was viewed as a punishment for religious transgression. Noted author Elof Axel Carlson traces the idea that degeneracy was biologically determined and shows how the social application of the label changed throughout the last century as the new academic discipline of sociology emerged. Carlson describes the failures and abuses of the social movements in the United States and Europe with their sorry history of racism, anti-Semitism, and violations of basic human rights.
Carlson writes beautifully, but I want to warn readers that this is not a book to be looked at lightly. It probably couldn't have the power it does if it did not include the wealth of illustrations and extensive notes, but it is indeed a serious study of this disturbing science. As Carlson writes in his Introduction, "Readers of this book may feel uncomfortable, as I certainly did, when they realize that there is a lot of mythology associated with the origins of the eugenics movement. It is embarrassing to see many strange bedfellows in the development of the idea of unfit people, and it should give us pause if we believe that the Holocaust could have been predicted from its earliest roots." I shivered when I read that statement. --Charles Decker
The Unfit: A History of a Bad Idea is a valuable contribution to historical scholarship relating to the eugenics movements of the 19th and 20th centuries. Carlson recounts some of the familiar episodes described in several other books on eugenics published in the past two decades, but he also provides a broader perspective on the topic. Carlson traces the idea of unfit races from biblical times to European and American laws dealing with poverty, crime, famine, disease, mental illness, and illegitimacy. By showing that the idea of the unfit has social, political, and religious origins and uses outside of the biomedical context, Carlson helps us to understand the broader context of the eugenics movements, as well as the challenges for social policies that attempt to respond to the needs of people who may be deemed unfit. Indeed, one of the more disturbing inferences that many readers will draw from the book is that the conceptual underpinnings of the eugenics movements did not come solely from the philosophies of the wealthy and powerful classes; rather, they were also derived from the attitudes, beliefs, and religious traditions of ordinary people. Carlson shares some relevant biographical information with the reader in the introduction to his book. He had a Lutheran father and a Swedish-American mother, both of whom abandoned their religious backgrounds. He lived in slums during his childhood, had a brother with a congenital heart defect, and had half-siblings who were raised in an orphanage after his mother's first marriage failed. His mother had paranoid schizophrenia and had been institutionalized before she met his father. According to Carlson, his whole family would have been classified as unfit according to many of the standards used in the 19th and 20th centuries. If his mother had lived in a different state, such as Indiana, she would have been sterilized. If his family had lived in Germany or Poland, they might have all perished in the Nazi concentration camps. Given this background, one can see why Carlson has a special concern for the unfit.
Carlson begins his account of the unfit in ancient Israel, going back more than 3000 years. The Israelites regarded the Amalekites, a population that lived in Ashdod in southwest Palestine, as unfit. The town of Ashdod was one of five occupied by the Philistines. According to Carlson, ``the Amalekites were perceived as degenerate people with evil habits, who should not only be shunned but exterminated.'' The Israelites also believed the Amalekites had been created evil and that they had corrupted the Jewish people by marrying and breeding with Jews. Carlson invites the reader to draw an ironic parallel between Israelites' attitudes toward the Amalekites in the 12th century b.c.e. and Nazi attitudes toward the Jews in the 20th century.
From ancient Israel, Carlson leaps ahead in time to the development of the theory of degeneracy in 18th-century Europe. Many Europeans, especially the English, French, and Swiss, regarded masturbation, or onania (after the sin of Onan, discussed in Genesis, chapter 38), as a form of moral degeneracy, or ``self-pollution,'' that could lead to diseases such as stunted growth, abnormal development of sexual organs, and tuberculosis (known at the time as consumption). Although it was initially viewed as a sin, masturbation was soon classified as a disease. The theory of degeneracy soon expanded from its focus on masturbation to encompass vagrancy, crime, poverty, insanity, and mental retardation. In 1857 the physician Benedict Morel published a book that postulated several different causes of degeneracy, including alcohol, narcotics, tobacco, and tainted bread. Morel also suggested that syphilis and tuberculosis could lead to degeneracy.
Others believed that degeneracy was the result of hereditary factors. Cesare Lombroso hypothesized the existence of a separate race of human beings, Homo delinquens, who were born to be criminals. Elisha Harris, a physician who conducted a study of prisoners in New York, traced the lineage of many of them back to a woman he named ``Margaret, mother of criminals.'' Herbert Spencer, who was influenced by Thomas Malthus's Essay on the Principle of Population, opposed public charities for the poor, sick, and disabled and argued that the government should not interfere with the natural laws of survival, which tend to weed out unfit members of the human population. Spencer proposed this idea, which later became known as social Darwinism, almost a decade before Charles Darwin published On the Origin of Species.
Carlson also discusses many of the well-known chapters in the history of eugenics, including the founding of the movement as a ``scientific'' field; the establishment of the Eugenics Record Office in Cold Spring Harbor, New York; the passage of compulsory sterilization laws in the United States; the Supreme Court's infamous decision in Buck v. Bell, which affirmed the constitutionality of sterilization laws; the origins of the Ku Klux Klan; Nazi Germany's campaign to purify the fatherland by killing 6 million Jews; and the eventual dissolution of the eugenics movement.
The unique contribution of this book is that it makes the reader aware of the complexities of the eugenics movement. Carlson shows that long before Francis Galton coined the term ``eugenics,'' scientists, physicians, philosophers, social reformers, and theologians had discussed the idea of an unfit class of people and had proposed solutions to deal with people they regarded as unfit. He also points out that many of those associated with the movement were ``people of good will, many with outstanding credentials as social reformers.'' Carlson further reminds readers that even if societies do not enact eugenics laws, couples planning to have children will still face difficult moral decisions created by the availability of genetic counseling, prenatal genetic testing, and elective abortion.
Although many may regard the eugenics movement as little more than an unfortunate chapter in human history, Carlson's book reminds us that the idea of an unfit group of people is not likely to fade into history, since it is a common strategy for explaining and responding to humanity's moral, physiological, and psychological imperfections. As we learn more about the genetic basis of disease and gain more control over human health and reproduction, we must also learn to deal with human imperfections without stigmatizing classes or races of people as unfit.
David B. Resnik, Ph.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
