Exhumed: Reckoning with the History of Eugenics in Marriage and Family Therapy

Abstract

The purpose of this article is to educate Marriage and Family Therapists about the history of the profession and to call attention to the troubling history of eugenics as it pertains to current ethical practice. The eugenics movement sought to increase the marriage and reproduction of healthy, white people, while implementing a system of institutionalization and sterilization to deter the reproduction of people of color, people with disabilities, and anyone determined to be “undesirable” by eugenicists. The helping professions, including Marriage and Family Therapy arose during the years when this took place, and contributed to the implementation of eugenics in a variety of ways. Founders of the field of Marriage and Family Therapy, including eugenicist Paul Popenoe, also known as the father of marriage counseling, played a key role in linking eugenics ideals and practices with Marriage and Family Therapy. While other professions, and indeed other organizations of all types, have worked to understand their participation in the promotion of eugenics ideals, and have issued apologies along with commitments to function ethically in the future, Marriage and Family Therapy has yet to do so. This article is a call to reckon with our history, to understand it, to educate and to practice ethically in the future.

“Those who cannot remember the past are condemned to repeat it”

George Santayana, Spanish Philosopher

Introduction

The helping professions have a troubled history. Marriage and Family Therapy, like the other professions, has ties to the eugenics movement that began in the late 1800's. In 2021, both the American Psychological Association (APA) and the National Association of Social Workers (NASW) have issued letters of apology for their respective professions’ participation in racism (APA, 2021; NASW, 2021). Both organizations acknowledge the harms done by their respective professions and take responsibility for the specific actions taken. The APA and NASW specifically name the eugenics movement and their involvement in it as an important part of the harm perpetrated against many people the movement targeted. In this article we detail the history of the field of Marriage and Family Therapy and its origins in eugenics. We call to action the leaders and practitioners of our profession to acknowledge our history, to take responsibility for our participation in causing harm, and to commit to anti-racist, ethical practice in the future.

The term “eugenics” was coined by Francis Galton, a cousin of Charles Darwin, in 1883 (Farber, 2008). During the late nineteenth and early twentieth centuries, the movement developed in the United States with a melding of quasi-scientific thinking about heredity and a desire to control human reproduction. The goal was to promote the reproduction of “desirable” people and limit the reproduction of less desirable people. People perceived by the eugenics movement as having undesirable characteristics were described in extremely pejorative terms. Categories included those described as imbeciles, n’er do wells, the mentally ill, poor people, sexually promiscuous women, men who could not support a family, prisoners, alcoholics, epileptics, sexual deviants or delinquents, criminals and anyone who was not white (Amy & Rowlands, 2018; Cohen, 2017; Ladd-Taylor, 2001; Novak et al., 2018). Eugenicists believed that the population of healthy, white people was declining, and that undesirable people were reproducing at a higher rate. To combat this, they espoused institutionalization and involuntary sterilization to prevent breeding by populations they deemed undesirable, and marriage counseling and encouragement for people who were healthy and white.

During the time period from 1907 to 1960, over 65,000 people were forcibly sterilized in the United States. Indiana was the first state to pass legislation authorizing involuntary sterilization, in 1907, followed by most other states. The laws were overturned in 1979, however the practice continued until as recently as 2010, in California, for example, where 150 incarcerated women were sterilized between 2005 and 2010 (Page, 2019; Solis, 2021). Although eugenics laws did not specify race as criteria for sterilization, the language of eugenicists was often explicitly racist (Cohen, 2017) and research has shown that Latinos, Native Americans, and African Americans were disproportionately impacted (Amy & Rowlands, 2018; Novak et al., 2018; Page, 2019)

Prominent eugenicist Paul Popenoe was dubbed “the father of marriage counseling” and opened the first marriage counseling clinics in the United States. Popenoe advocated sterilization for those who were deemed unfit to reproduce and marriage counseling for healthy, white couples (Cohen, 2017; Lepore, 2010). Popenoe is quoted as saying “Continued limitation of offspring in the white race simply invites the black, brown, and other races to finish the work already begun by Birth Control and reduce the whites to a subject race preserved merely for the sake of its technical skill” (Lepore, 2010). This statement and others convey the racism inherent in eugenics. Eugenics language used to describe people with other characteristics was also laced with homophobia, misogyny and other forms of hatred and harsh judgment. Popenoe operated the first marriage counseling clinics in the United States, with the purpose of supporting marriage and reproduction of healthy, white couples (Cohen, 2017; Ladd-Taylor, 2001). This early entanglement of the concept of marriage counseling with the racist, homophobic, and misogynistic ideas of the eugenics movement needs to be brought to the awareness of Marriage and Family Therapists so that we can guard against carrying these concepts forward in our work. As a profession, we subscribe to the American Association of Marriage and Family Therapy (AAMFT) code of ethics that specifies non-discrimination and a core value of “diversity, equity and excellence in clinical practice, research, education and administration” (AAMFT, 2015). This means we need to understand the history of our profession and take responsibility for chasing any remnants of eugenics, with its racist, homophobic and misogynistic ideas, out of the profession. To do so will involve including discussion of the history of eugenics in Marriage and Family Therapy by practicing MFTs and inclusion of the topic in graduate studies programs.

History

Paul Popenoe was born at the end of the 19th century in Southern California to parents in the produce industry. As an adult, Popenoe focused on human breeding—specifically the “right kind of humans”. Paul Popenoe was a prominent and outspoken eugenicist. Without finishing college, Popenoe became the editor of the Journal of Heredity. He sat on the board of directors for the Human Betterment Foundation, an American eugenics organization—which he later used as evidence to support his beliefs (Kline, 2018).

The American eugenics movement informed and was acknowledged by the Third Reich in Nazi Germany (Page, 2019). The Nazi's forcibly sterilized over 400,000 people. As Americans became aware of this connection, eugenics fell out of favor in the United States and its American proponents began to alter their language in order to distance themselves from the horrors of the holocaust. They shifted from advocating for limiting reproduction of groups of people to focusing on characteristics of individuals. The underlying ideas, however, remained unchanged. Individuals could be counseled on their fitness to marry and reproduce.

As eugenics fell out of favor in the United States, Popenoe declared himself a marriage counselor to save the “right kind of marriages”, namely the Nordic white, heterosexual, monogamous, able, middle to upper class marriages (Cohen, 2017; Ladd-Taylor, 2001).

With the help of another prominent eugenicist, E.L. Gosney, Popenoe opened the American Institute of Family Relations in Los Angeles in 1930. He became known as Dr. Popenoe or Mr. Marriage, although he had attended only three years of college and had no formal training in psychology or in marital counseling. According to several sources, Popenoe's institute claims to have trained hundreds of marriage “counselors” and averaged over 15,000 client consults a year (McMahon, 2017; Smith, 2017). He influenced thousands of would-be marriage counselors before American Association of Marriage and Family Therapists ever existed. Popenoe had a recurring column in Ladies Home Journal, a syndicated news column, a radio show, a TV show, and was involved in creating one of the first ever computer dating programs.

Early collaborators with Popenoe included colleagues who were “mostly religious conservatives” and many of his assistants were ordained ministers or other devoutly religious people (Popenoe, 2017, p. 236). The eugenics and marriage counseling movements had strong ties with clergy and religious people which began in the early days of the movement and continued (Rosen, 2004). The eugenics movement sought the support of clergy to spread its ideas and religious organizations of virtually all faiths participated out of a desire to maintain an influential voice in the regulation of marriage (Rosen, 2004). The helping professions arose from the collaboration of charitable organizations and clergy and were also involved in promoting eugenics ideas (Rosen, 2004).

None of Popenoe's efforts were done to assist people for their own benefit. Popenoe had widely published his personal views on the need for forced sterilization because of his beliefs in defective and undesirable genes being perpetuated more often those preferred genes (Ladd-Taylor, 2001; Popenoe, 1936, 1937a, 1937b). Popenoe connected eugenics with marriage counseling because the divorce rate in the U.S. had been increasing. Many women were working because of World War I, and many men had died; birth rates of middle- and upper-class whites were lowering (Binyam, 2021; Coontz, 2005). Popenoe saw his ability to perpetuate his eugenics beliefs and intervene in saving the Nordic white race through marriage counseling. He published many disparaging opinions about people of color, same sex oriented folx, those perceived as less than able, and women (Popenoe, & Johnson, 1918). His opinions and ideas pervaded therapy and pop culture for decades; he retired in 1976 (Cohen, 2017; Smith, 2017).

The goal of eugenics was to arrest the perpetuation of “undesirable stock”. The U.S. was the first to conduct involuntary sterilization (Amy & Rowlands, 2018). Some eugenics laws are still technically on the books, even though the U.S. began looking less favorably upon eugenics and forced sterilization by the time World War II began (Cohen, 2017). However, the damage was done, and Hitler appreciated the idea. While many people began to publicly distance themselves from the eugenics movement, others continued to support it. Popenoe waxed poetic about Hitler's use of eugenics (Kline, 2018; Smith, 2017). The theoretical stance of superiority continued through Jim Crow laws against Black folx, interracial relationships remaining illegal until the 1970s, homosexuality remaining a DSM diagnosis until the 1970s. Popenoe and many other eugenicists believed that their methods must expand beyond sterilization to marriage bans, immigration limitations, and euthanasia (Amy & Rowlands, 2018; Coontz, 2005).

Emily H. Mudd formed the Philadelphia Marriage Council (now Council for Relationships/CFR) in 1932 to also train marriage counselors to preserve the right kind of marriages; CFR is still open and training marriage counselors today (CFR, 2021). Mudd also had no degree at the time, and no training; Mudd completed her degree in social work only after working as a director for CFR (Thomas, 1998). She did have a firm eugenics ideology informing her efforts, however. Her inspiration stems from the marriage counseling models and centers of Germany that operated to promote the superior race's progress (Jurczak, 2012). Ernest Groves was a minister and self-declared family sociologist. He, his wife Gladys, and several other people formed the Groves Conference of Marriage and Family (Cole & Cole, 2012). The couple also assisted in the creation of American Association of Marriage Counselors, the precursor to AAMFT (Rubin & Settles, 2012). Ernest Groves was also a staunch eugenicist, arguing in favor of eugenics despite legalities and social opposition (Groves, 1935). According to a historical review of his work in the field, he is also known for setting professional standards for the field of marriage counseling despite having no education or training (Rubin & Settles, 2012). Eugenicists, known for promoting the further development of Nordic white, educated, able, heterosexual, monogamous, married, middle- to upper-class families and population developed the professional standards that inform the American Association of Marriage and Family Therapists (AAMFT).

Eugenics became the rationale, the scientific proof, behind many social failings. Primarily, forced sterilization of people in prisons and institutions became the norm and eventually the law (Amy & Rowlands, 2018; Cohen, 2017; Page, 2019). Eugenic theory expanded to include LGBTQ+, “promiscuous girls”, deviants, and perverts (Amy & Rowlands, 2018). Eugenics informed immigration laws, the Holocaust, and Jim Crow (Cohen, 2017). Social workers used eugenic theory to push through a law in North Carolina allowing social workers to petition for sterilization for people on their caseload (Amy & Rowlands, 2018). Between 1907 and 1921, over three thousand involuntary sterilizations were conducted unknowingly upon folx considered “feebleminded”; over two thousand were conducted annually through the 1930's. Another 40,000 were completed in 30 states by 1944; some 65,000 by 1960 (Amy & Rowlands, 2018). Involuntary sterilization has been conducted as recently as 2010 (Cohen, 2017). The sterilizations throughout the 20th century were done on the underage, people of color, indigenous people, and anyone convicted of a felony (Amy & Rowlands, 2018).

Popenoe and other early marriage counselors returned to the Adam and Eve argument that a woman is solely responsible for the success or failure of the couple and the family (Jurczak, 2012; McMahon, 2017). Positive eugenics, the promotion of the right people contributing to the population, carried sexist, patriarchal messages—if the husband has an affair, if he wants a divorce, if he is failing or flailing in life, the wife is to blame (McMahon, 2017). The very success or failure of the superior race rested solely on the shoulders of the wives—lose some weight, get dolled up, quit emasculating your husband, be more interesting (Lepore, 2010).

Underlying all the eugenics movement is the desire to “save” and “promote” the “right” kind of people. The formation of marriage counseling as the means of accomplishing said endeavor draws to question many underpinnings of our field. Early marriage counselors clearly came to the field with all their values informing their approaches with clients. Racism, sexism, homophobia, ableism, classism were primary motivators for some of the early contributors to what is now the MFT field. The modern theorists of MFT often only saw white middle to upper class families as demonstrated through textbooks or early video recording.

Situation Today

The history of eugenics is embedded in the history of Marriage and Family Therapy. Our very association, AAMFT was originally established by a leading eugenicist under the name American Association of Marriage and Family Counselors. The original goal of the profession was to promote reproduction by the “right” kind of people, white, healthy people, in monogamous marriages between one man and one woman. It is important to identify any lingering effects of these ideas, founded in racism, sexism, homophobia, ableism, and classism, and to look critically at our theory and practice to make sure they are not a part of what we do today. The ideas of eugenics are antithetical to the stated core value of “Diversity, equity and excellence” put forth in the AAMFT code of ethics (AAMFT, 2015, p. 113).

When Paul Popenoe established his marriage counseling clinic many of his colleagues were clergy or religious lay people from conservative religious denominations (Popenoe, 2017, p. 236). Popenoe himself was not religious but believed that the alliance with religious conservatives would further his goals. Interestingly, of the 94 graduate programs in Marriage and Family Therapy, 35 (37%) were housed in colleges or universities with explicitly religious orientations. According to our code of ethics clients should have autonomy in decision making, and make their own decisions regarding relationships, including “decisions about cohabitation, marriage, divorce, separation, reconciliation, custody and visitation” (AAMFT, 2015, p. 115). Since conservative religious denominations often take the position that decisions should be made in accordance with religious doctrine, there may be a conflict between adherence to religious doctrine and the AAMFT code of ethics for MFTs who wish to incorporate religious doctrine into their work as therapists. Furthermore, the AAMFT code of ethics stipulates that we do not discriminate based on age, ethnicity, socioeconomic status, disability, gender, health status, religion, national origin, sexual orientation, gender identity, or relationship status (AAMFT, 2015, p. 114). Again, conservative religious traditions may take positions in opposition to gay relationships or marriages, and to expression of sexual orientation or gender identity that is not cis-gender and heterosexual. MFTs are tasked by the code of ethics with practicing in a way that does not discriminate against people on this basis.

The name of the Marriage and Family Therapy profession conveys the idea that the profession works with marriages rather than with all relationships. Since the AAMFT code of ethics (AAMFT, 2015) stipulates that MFTs do not discriminate and that people have a right to make their own decisions, MFTs need to be able to work with people in married or unmarried relationships, as well as with people who are cohabiting and people in non-monogamous relationships. Our training in systemic work prepares us for work with all these situations—or should—but the name of the profession belies an older idea about what relationships are valued and worth working with.

Eugenics and the marriage counseling that arose from it held that men and women had narrowly defined roles. Paul Popenoe said a “wife should be sympathetic with her husband's work and a good listener, but she must never consider herself enough of an expert to criticize him” (Coontz, 2005, p. 239). David Popenoe wrote that his father expected his wife to take a stay-at-home servant role (Popenoe, 2017). MFTs working with couples need to guard against ideas of women's submission in relationships. Assumptions about how power is held, how decisions are made and how the work of the relationship and the household are distributed need to be challenged.

Eugenics pathologized sexuality any time it occurred outside of marriage between one man and one woman. Women who were sexually active were described as sexual delinquents and lesbian and gay people were described as sexual deviants. It is important for students in MFT graduate programs to learn about sexuality as a healthful dimension of life and be able to provide therapy in a way that is accepting and supportive of sexual expression.

The origins of the field of Marriage and Family Therapy included explicitly homophobic ideas that were embedded in eugenics. Eugenicists included in their plans for sterilization homosexuals and “sexual deviants” (Cohen, 2017). The AAMFT code of ethics states MFTs should not discriminate, however MFTs are not prohibited by the code from recommending, referring for or providing sexual orientation change efforts (SOCE), also known as conversion therapy. Extensive research has been conducted and shown that SOCE is not effective at changing sexual orientation (Haldeman et al., 2019; Ryan et al., 2020; Serovich et al., 2008) and that in fact it causes depression, suicidality, internalized homophobia, decreased self-esteem and other negative outcomes (Bradshaw et al., 2014; Haldeman, 2002; Shidlo & Schroeder, 2002). Although other professions have prohibitions against SOCE (Gamboni et al., 2018), AAMFT has not prohibited this harmful practice. In 2021, this author (LAC) emailed a petition link to the chairs of COAMFTE graduate programs and quickly gathered over 1500 signatures from students, professors and practicing MFT's to change the code of ethics to prohibit SOCE. Similar efforts have been made to have the code of ethics prohibit Gender Expression Conversion Efforts. These efforts were met with resistance by the national organization. An estimated 16,000 LGBT youth will undergo SOCE in the 32 states where it is still legal (Mallory et al., 2019) This should be concerning to all MFT practitioners.

Eugenics practices harmed tens of thousands of people in the United States and the ideas generated here were transferred to other nations. The “father of marriage counseling” advocated marriage counseling but also advocated forced sterilization. By his assessment 10 million Americans ought to have been sterilized (Cohen, 2017; Lepore, 2010). Eugenic sterilization was proscribed in legislation in the United States and upheld by the supreme court of the United States (Cohen, 2017; Page, 2019). The harm done was devastating to individuals and families. That the injustice was legally sanctioned normalized the injustice in our society and made it easier for individuals involved in perpetuating the injustice to do so without considering their own part in the injustice critically and created an environment in which stigmatization of disability and sterilization without consent were normalized (Page, 2019). There is an important lesson for MFTs in this history. MFTs have an obligation to practice ethically. To do so, they must be educated about this difficult history. Once educated we also need to take steps to ensure these old ideas do not creep into our practice.

Action

MFTs can take important steps to educate themselves and make sure that the harmful ideas in the history of the profession are not carried forward in everyday practice. In graduate programs and in supervision we can make sure that students and trainees are educated about this history. Training and supervision should also involve extensive work with social justice concepts for a thorough understanding of how the old ideas are harmful and how to replace them. With a history like ours it is especially important to define and teach practice that is anti-racist, anti-misogynistic and anti-homophobic. MFTs need to learn culturally sensitive practice that is LGBTQ+ affirming and positive toward people from all ethnic and religious backgrounds.

The field of Marriage and Family Therapy would do well to join APA and NASW in evaluating and acknowledging its history of perpetrating harm as a result of racist and eugenic practices. Reckoning with our past brings the opportunity for a renewed commitment to ethical practice that serves clients of all backgrounds with the skill and knowledge we are uniquely qualified to bring to the practice of therapy.

Conclusion

The purpose of this paper is not to throw the whole field out with the proverbial bathwater, but to draw attention to the troubling history of eugenics that was present in the early days of marriage and family therapy, and to call on MFTs to be mindful of that history so that it does not guide practice now or in the future.

This is our call to a public reckoning. As social justice-oriented clinicians agreeing to abide by a code of ethics on behalf of all identities, we cannot stand for those we proclaim to help without acknowledging the field's complicity in the injustices executed against so many. We need to know where we have been so we can work diligently to avoid repeating our mistakes. Not only do we know there were problems, but we actively agree that we see those aspects as problematic. We must endeavor to demonstrate that the field of MFT is better than where we began. That we desire to do better for all clients. That all relationships have merit, worth, and deserve our attention to help them make the wisest decisions possible for their specific circumstance.

A recent article by online news source Jezebel reports that California will pay reparations to the approximate 400 survivors of forced sterilization (Solis, 2021). California was known for conducting the most involuntary sterilizations during the eugenics movement; by 1933 California conducted more sterilizations than the rest of the U.S. (Amy & Rowlands, 2018). According to Solis (2021) California was conducting involuntary sterilizations of women in prisons as recently as 2014. Governors of several states have issued apologies within the last twenty years; North Carolina and Virginia offered reparations within the last decade (Amy & Rowlands, 2018). Multiple organizations, states, countries, academic and research institutions, and professional organizations have all issued apologies, public reckonings, and/or reparations for their respective participation in the eugenics movement (APA, 2021; Beasley, 2021; Chernoguz, 2015; Hasson, 2020, NASW, 2021; Schwarts & Schlenoff, 2020).

While some professions have addressed this problematic past, many spaces, institutions, and organizations have not reckoned with it. No apology issued; no work done to acknowledge the participation in real harm done to so many people. Buildings and foundations still hold names of prominent eugenicists (Hiltzik, 2020; Saini, 2019; Sonabend, 2021). The field of Marriage and Family Therapy is one of those organizations that have yet to produce a statement of acknowledgement, reckoning, or apology (as of the time we are writing this article). Will MFTs repeat their historical mistakes?