Psychiatry and Immigration in 1904

Psychiatry was a relatively new form of medicine in 1904. Its practitioners, largely confined to the system of mental hospitals and asylums established in the 19th century, struggled to establish themselves as a field. Psychiatric coursework did not constitute a significant part of medical education at any medical school in the country, and Freudian psychoanalysis had not yet penetrated American psychiatric thought to revolutionize the way American psychiatrists conceived of mental illness. 

Psychiatrists sought to confront these pressures in a variety of ways. To elevate the status of the profession, professional societies, like the American Medico-Psychological Association, the forerunner of the APA, promulgated standards for psychiatric practice and brought consistency to the field through conferences, journals, and awards. To secure funding and facilities, psychiatrists in New York State engaged in a decades-long battle with the government to campaign for control of psychiatric institutions, the exclusion of bureaucrats from public health-related positions, and increased subsidies from the federal government to pay for state hospitals. 

As immigration picked up after 1890, psychiatrists, especially in New York State, began to notice more and more immigrants entering psychiatric institutions. Many could not speak English, and psychiatrists often lacked knowledge of the many languages immigrants spoke, creating an immense barrier to care and resulting in longer hospital stays. With budgets stretched, psychiatrists sought ways to manage their growing population of patients. Many of them turned to the immigrants in their facilities, who they termed the “alien insane”.

Arguments offered by psychiatrists about the “alien insane” followed a similar line of logic: 

Firstly, the number of “alien insane” was rapidly increasing in psychiatric institutions, disproportionately with the rates of mental illness in the non-immigrant population.

Secondly, this disproportionate increase strained the financial resources of psychiatric institutions and the states that supported them, forcing taxpayers to spend inordinate sums on non-citizen foreigners.  

Proposed solutions to this problem took a variety of forms: 

• Advocating for restrictions on immigration, as this would reduce the number of potential patients coming into the country 

• Advocating for increased screening of immigrants at ports of entry, like New York’s Ellis Island 

• Advocating for new tests of mental capacity on immigrants at ports of entry 

While psychiatrists had claimed immigrants, poverty, and mental illness were connected in the past (1), the volume of immigration at the turn of the century further attuned psychiatrists to immigration-related topics. 

Highlighting the plight of the “alien insane” offered psychiatrists an issue through which they could address all of the problems confronting psychiatry. To substantiate their claims, psychiatrists conducted statistical studies of hospital conditions, identifying the predominance of non-native patients and the prevalence of different nationalities within the immigrant population. Some, such as Edward C. Spitzka and James G. Kiernan, took this even farther, attempting to single out different ethnic groups as exhibiting higher rates of mental illness, or having an increased predisposition to particular mental illnesses (2). Such findings, if substantiated, would empower psychiatrists with facts they could use to advocate for new, scientifically informed immigration legislation. Spitzka and Kiernan’s efforts produced contradictory results and failed to consider age as a clinical factor. By getting involved in a topic of growing relevance to American society, psychiatrists could also raise their profile both to other medical professionals and to Americans more generally.  

The conclusions psychiatrists like Spitzka and Kiernan had hoped to reach about the “alien insane” lined up with the priorities of American nativists and immigration restrictionists, such as the American Breeders Society and the Immigration Restriction League. These organizations embraced eugenics, claiming that ancestry rendered some people undesirable as citizens of the United States. Eugenic thought, alongside a growing concern with heredity, had been permeating American psychiatry since the 1880s. Some psychiatrists would experiment with the concept, and the APA created a Committee on Applied Eugenics in 1912 (3). 

Psychiatrists, on the whole, however, ignored eugenic formulations of heredity in discussing immigration (4). Reasons for restriction were to be grounded in psychiatric principles, substantiated through observations of hospital patients, and presented in statistical surveys. Heredity was biological, and for them, verging on the unscientific. It did not help that major eugenic associations, like the Immigration Restriction League, were founded by laypeople (5). 

For the psychiatric community, the goal of immigration discourse was fundamentally to improve psychiatry’s position, to empower psychiatrists with the ability to decide who should and who should not enter the US. Psychiatrists could, should their methods be endorsed, act as immigration inspectors, receive more resources from the state, and acquire a greater say in deportation decisions (6). Armed with statistical methods and trained intuition, psychiatrists could take on a premier role in defending America from European immigration.  

It is key to understand that even where psychiatrists and eugenicists differed, the framework they applied to immigration and racial difference was deeply Darwinian. In this system, ethnic groups competed for scarce resources in a “survival of the fittest”: signs of difference exhibited different levels of fitness, and in time, one group would come to dominate the others. This conception primed psychiatrists and eugenicists to accept the possibility that some ethnic groups may pose a significant threat to American society due to their cultural or mental differences. While in 1912 Adolf Meyer rejected a report penned by the American Eugenics Society supporting ethnic-based immigration quotas, he acknowledged the validity of concerns around the ethnic makeup of immigrants:

“It would not quite do to say publicly that we are afraid that we have too many Catholics, and Hebrews, and Greeks, and Turks to suit ourselves, which of course any group of people have a right to say... [The report gives] the appearance of scientific support to matters which after all are just a little bit too frankly human and not strict science.” (7)

He also concluded that the mentally ill could be weeded out through a blanket increase in the strictness of admission conditions for all immigrant groups: 

“One might for instance say that to meet these so-called undesirables the whole system of requirements could be raised for the whole number.” 

Psychiatrists and eugenicists could differ greatly in their beliefs and commitment to scientific practice, but, on immigration, they both drew from the same toolbox, eager to harness the power of legislation to make mental difference a factor in everyday life.