Draft:Post-traumatic stress disorder after sterilization

What is Sterilization?
Sterilization is defined as a process of complete elimination or destruction of all forms of microbial life (i.e., both vegetative and spore forms), which is carried out by various physical and chemical methods. Sterilization is a permanent method of birth control. Sterilization procedures for women are called tubal sterilization or female sterilization. The procedure for men is called vasectomy. Sterilization is considered a safe procedure with few complications. In the 1930's, the Nazis began a massive, compulsory sterilization program inspired by eugenics. It was a form of social cleansing that affected a large segment of the German population. During this horrifying era, the German government forced these medical procedures on many people without their consent. The Marital Health Law of October 1935 banned unions between the “hereditarily healthy” and persons deemed genetically unfit. In 1936 the Reich Central Office for Combating Homosexuality and Abortion was established to step up efforts to prevent acts that obstructed reproduction. On July 14, 1933, the Nazi dictatorship fulfilled the long-held dreams of eugenics proponents by enacting the Law for the Prevention of Offspring with Hereditary Diseases (“Hereditary Health Law”), based on a voluntary sterilization  law drafted by Prussian health officials in 1932. Individuals who were subject to the law were those men and women who “suffered” from any of nine conditions assumed to be hereditary: feeblemindedness, schizophrenia, manic-depressive disorder, genetic epilepsy, Huntington’s chorea (a fatal form of dementia), genetic blindness, genetic deafness, severe physical deformity, and chronic alcoholism. Vasectomy was the usual sterilization method for men, and for women, tubal ligation, an invasive procedure that resulted in the deaths of hundreds of women. Doctors were required to report their patients with genetic illness to a health officer, and petition for the sterilization of their patients who qualified under the Sterilization Law. Institutionalized individuals made up 30 percent to 40 percent of those sterilized. The main reason given for sterilization was so that the hereditary illnesses could not be passed on in offspring, thus "contaminating" the Volk's gene pool. Since institutionalized individuals were locked away from society, most of them had a relatively small chance of reproducing. So, the main target of the sterilization program were those people who were not in the asylums but had a slight hereditary illness and who were of reproductive age (between 12 and 45). Since these people were among society, they were deemed the most dangerous.

Why?
Most of these operations were performed before the 1960s in institutions for the so-called “mentally ill” or “mentally deficient.” Some deaf and disabled people were subject to forced sterilisation and abortion and many were murdered by medical professionals in the T4 Euthanasia programme which saw approximately 200,000 disabled children and adults killed in specially created gas chambers. Institutionalized individuals made up 30 percent to 40 percent of those sterilized. The main reason given for sterilization was so that the hereditary illnesses could not be passed on in offspring, thus "contaminating" the Volk's gene pool. Since institutionalized individuals were locked away from society, most of them had a relatively small chance of reproducing. So, the main target of the sterilization program were those people who were not in the asylums but had a slight hereditary illness and who were of reproductive age (between 12 and 45). Since these people were among society, they were deemed the most dangerous. This rapid shift in populations worried powerful, upper-class whites, which led many of them to adopt Eugenics as a way to preserve the American way of life. Eugenics was then embraced by scientists, social activists, and politicians as a progressive social movement aimed at ridding society of undesirable characteristics. Some powerful individuals who chose to adopt Eugenics were Theodore Roosevelt, Andrew Carnegie, and, most notably, Margaret Sanger.

Who created it?
Galton promoted the ideal of improving the human race by getting rid of the “undesirables” and multiplying the “desirables.” The first German sterilization law was enacted on July 14, 1933—only six months after Hitler became Chancellor. The new Nazi law was coauthored by Falk Ruttke, a lawyer, Arthur Gütt, a physician and director of public health affairs, and Ernst Rüdin, a psychiatrist and early leader of the German racial hygiene movement. In the early 20th century across the country, medical superintendents, legislators, and social reformers affiliated with an emerging eugenics movement joined forces to put sterilization laws on the books.At the time, however, sterilization both was countenanced by the U.S. Supreme Court (in the 1927 Buck v. Bell case) and supported by many scientists, reformers, and lawmakers as one prong of a larger strategy to improve society by encouraging the reproduction of the “fit” and restricting the procreation of the “unfit.” Special hereditary health courts lent an aura of due process to the sterilization measure, but the decision to sterilize was generally routine. Nearly all better-known geneticists, psychiatrists, and anthropologists sat on such courts at one time or another, mandating the sterilizations of an estimated 400,000 Germans. These petitions were reviewed and decided by a three-member panel in the Hereditary Health Courts. The three-member panel was made up of two doctors and a judge. ==

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Since it was Created...
After the turn of the century, eugenics movements—including demands for sterilization of people considered unfit—had, in fact, blossomed in the United States, Canada, Britain, and Scandinavia, not to mention elsewhere in Europe and in parts of Latin America and Asia. Eugenics was not therefore unique to the Nazis. It could, and did, happen everywhere. The United States, for instance, had already enacted sterilization laws in half its states by the 1920s which included forced sterilization of the immigrants, Black and Indigenous people, poor people, Puerto Rican people, poor White people, incarcerated people, and those living with disabilities. Of the 60,000 sterilizations in the United States, California performed one-third, or 20,000, of them, making the Golden State the most aggressive sterilizer in the nation. Sterilization rates climbed with the onset of the worldwide economic depression in 1929. In parts of Canada, in the deep south of the United States, and throughout Scandinavia, sterilization acquired broad support. This was not primarily on eugenic grounds (though some hereditarian-minded mental health professionals continued to urge it for that purpose) but on economic ones. Sterilization raised the prospect of reducing the cost of institutional care and of poor relief. Even geneticists who disparaged sterilization as the remedy for degeneration held that sterilizing mentally disabled people would yield a social benefit because it would prevent children being born to parents who could not care for them. The first US state to enact legislation to allow eugenic surgery was Indiana in 1907, emphasized by Doctor Harry Clay Sharp who performed such surgeries on inmates in an Indiana prison as early as 1899. Mixed-race African German and Vietnamese German children were born around 1921, when troops drawn from the French colonial empire occupied the Rhineland. These children were forcibly sterilized in 1937. Racial anthropologists had denounced them as "Rhineland Bastards," collected details on them, and persuaded the Nazi public health authorities to sterilize 385 of them. One of the adolescents later gave public interviews about his experiences. Apart from Hans Hauck, very few are known by name, and little is known about how their sterilization affected their lives. None of the 385 received compensation from the German state, either as victims of coerced sterilization or as victims of Nazi medical research. The concerned human geneticists went unprosecuted. The Nazis enacted a new law providing a basis for forced sterilization of disabled people, Gypsies, and blacks on 14 July 1933. African American women were one of the most targeted populations for forced sterilizations in the twentieth century, especially in the state of North Carolina. James Marion Sims, “the father of modern gynecology,” practiced many of his experimental surgeries on enslaved women without anesthetics during the nineteenth century.

Effects
For a woman or a couple to reach a deliberate, informed decision regarding female sterilization, certain conditions must prevail. The woman (or couple) needs to know about the options among reversible contraceptives and about vasectomy. They must also understand the intended irreversibility of the procedure. She must understand how the sterilization will be performed, the type of anesthesia to be used, and the operative risks. She must also understand that if she experiences the rare complication of pregnancy after the procedure, she must seek a prompt evaluation because of her heightened risk for an ectopic pregnancy. A 1966 study of vasectomy patients and their wives by Dr. Frederick Ziegler found "striking adverse changes and reduced marital satisfaction in husband and wife notwithstanding general satisfaction with the procedure itself." A standard personality disorder test found that over 40% of a vasectomy study group experienced personality disturbances between their first testing and that of a year later, after the operation. It has been suggested that men who believe themselves to be truly sterilized may feel more inclined toward marital infidelity Vasectomy may also play an important part in aggravating the tendency of some middle-aged men to discard their middle aged wives in favor of younger women. Another concern is the implication of viewing one-s body as a machine that can be disconnected if one of its functions is no longer necessary. This has grave consequences. Eugenic sterilization would affect thousands of women of color throughout the twentieth century as a result of racism and xenophobia. The sterilization of Native American women affected their descendants and their tribes for generations. Sterilization especially affected Navajo natives because wealth in Navajo culture is determined by the number of children one has

Kelli Dillon
Kelli Dillon was only 24 when a surgeon at the Central California Women’s Facility in Chowchilla decided that she was not fit to be a parent and intentionally sterilized her without her consent. Dillon had sought medical attention for an abnormal pap smear and told the doctor that should he find cancerous cells, he could operate. After the procedure, Dillon intuitively felt that something was wrong, but the surgical team didn’t tell her she had been sterilized. Dillon fought the prison staff for over a year to gain access to her medical records, and only when a lawyer from Justice Now, an Oakland-based social justice legal advocacy organization, requested the records did Dillon learn the truth. In 2001, Dillon was one of 148 women incarcerated and living inside California’s state prisons who experienced medical abuse in the form of forced tubal ligations or total hysterectomies without their knowledge or consent and without required state approvals.
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Paul Eggert
Paul Eggert was categorized as "feeble-minded." At age 11, he was institutionalized and sterilized without his knowledge. We were thirteen children. My father drank a lot and worked little. My mother barely took care of us. I had to beg a lot for food from the farmers so that my brothers and sisters would have something to eat. My brothers and sisters went to school. I was the only one who didn't. Then one morning I was taken to the city hospital in Bielefeld. I was operated on there. They told me nothing. I really felt crushed. We wanted very much to have children but we could not, because of my operation in Bielefeld.

Helga Gross
Helga Gross attended a school for the deaf in Hamburg, Germany. She was sterilized in 1939, aged 16. They explained to the deaf children that they didn’t want deaf children, that they had to be sterilized because they didn’t want deaf children to have children who would grow up and be deaf as well. We were young, we really didn't understand. Then a man came from the government to our school and told the teacher to choose which children that we should send to the hospital for sterilization. Then as the time became near, I was in the kitchen and I was cleaning. My mother came and said, “Helga, sit down.” And she explained, “You have to go to the hospital in two days.” My father cried. He refused to see me. He didn’t want to hug me before I left home to go to the hospital. Not until later, years later, I saw my baby sister, she had a beautiful baby. And the baby was so beautiful and I got to hold the baby and that morning my sister was feeding the baby and then I realized what I felt when I realized I couldn’t have any children. I started to cry and I, I ran into the bathroom and just cried and cried. When I came back out my sister said, “What’s wrong? What’s the matter?” I said, oh I’m just crying because I’m happy for you because you have a beautiful child.

Klara Nowak
Klara Nowak, a German nurse and activist who led the League of Victims of Compulsory Sterilization and Euthanasia after the war, had herself been forcibly sterilized in 1941. In a 1991 interview, she described what effects the operation still had on her life. "Well, I still have many complaints as a result of it. There were complications with every operation I have had since. I had to take early retirement at the age of fifty-two—and the psychological pressure has always remained. When nowadays my neighbors, older ladies, tell me about their grandchildren and great-grandchildren, this hurts bitterly, because I do not have any children or grandchildren, because I am on my own, and I have to cope without anyone's help."

Han Hauck
Hans Hauck was one of at least 385 people who underwent the operation. Mr Hauck, the son of an Algerian soldier and a white German, appeared in the 1997 documentary Hitler's Forgotten Victims. He spoke about how he was taken in secret to have a vasectomy. He was then given a sterilization certificate, to allow him to carry on working, and he had to sign an agreement saying he would not marry or have sex with people "with German blood". "It was depressing and oppressive," he told the documentary makers, "I felt only half-human". Another victim, Thomas Holzhauser, said on the film: "Sometimes I'm glad I couldn't have children. At least they were spared the shame I lived with. In an interview recorded late in his life, Hauck recalls the day his grandmother took him to the health office of the Department of Racial and Hereditary Welfare, where he would be involuntarily sterilized, receiving a vasectomy without a full anesthetic.


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How it has changed and still continues to present day...
Forced sterilization remains legal today at the federal level in the U.S. because of a 1927 Supreme Court case known as Buck v. Bell. American eugenicists used the case to probe the constitutionality of a Virginia state law that permitted forcible sterilizations to see whether they could take the process nationwide, says Jasmine E. Harris, a professor of law at the University of California, Davis School of Law. An 8-1 decision found that the institutionalization of Carrie Buck for “feeblemindedness” and her subsequent sterilization were both legal and justified. In 2001, Dillon was one of 148 women incarcerated and living inside California’s state prisons who experienced medical abuse in the form of forced tubal ligations or total hysterectomies without their knowledge or consent and without required state approvals. The CIR identified 150 California prisoners who involuntarily underwent forced sterilizations from 2004 to 2013. The Associated Press reported in 2017 that a White County, Tennessee, judge entered an order to “allow inmates to get out of jail 30 days early if they agreed to free vasectomies or long-acting birth control implants. Dozens of inmates took the deal.” The Tennessee legislature enacted a bill in 2018 to stop the practice.