Trauma and Immigration
A detour from the usual subject of my posts on this page…
What follows is a think piece of sorts of my involvement in a grant project led by Raquel E. Aldana (Professor of Law) and Patrick Marius Koga, (Professor of Psychiatry, Public Health Sciences; Director, Refugee Health Research). I have been tasked with researching the involvement of mental health professionals in immigration cases in the late nineteenth and early twentieth centuries.
Prologue–An Ode to Aldana
One of my great fortunes in recent years has been my acquaintance with Raquel Aldana. Raquel was hired in 2017 as the inaugural Associate Vice Chancellor of Academic Diversity in the newly-created office of the Vice Chancellor for Diversity, Equity and Inclusion. As a graduate student researcher in the office at the time and eventually a staff analyst, I was assigned to her portfolio and worked under her supervision for three years. Her academic background is as a ridiculously accomplished law professor and she now teaches at the UC Davis School of Law.
In 2020, in her work as a scholar of law and immigration she invited me to contribute to an article on the Warren Court, “A Look Back at the Warren Court’s Due Process Revolution Through the Lens of Immigrants,” to frame the historical context of the limited due process protections immigrants received, particularly when compared to those afforded criminal defendants, during the Warren Court years. Her mentorship and willingness to share a byline with the likes of me remains one of my most treasured intellectual gifts.
And now, I am again the beneficiary of her generosity, assisting her and a team of psychologists, public health practitioners, and lawyers examining the use of forensic assessments of trauma in humanitarian visa petitions by immigrants. As we note in the description of the project:
Currently, immigration cases unduly rely on a petitioning immigrant’s testimony to satisfy the high burden of establishing requisite trauma or harm in humanitarian visas. Yet, due to legal standards for assessing credibility—such as requiring consistency in the narrative and recollection of details about traumatic events—that are inconsistent with the psychological effects of trauma, immigration petitioners often fare poorly and can be re-traumatized in the process.
Although the project is just getting underway, we have started to chart out a path for a future journal article that describes the current state of those assessments and the ways in which the fields of immigration policy, law, and psychology have developed in their use over the past century. My initial inquiry documented here describes the work of mental health professionals in immigration cases in the late nineteenth and early twentieth centuries.
It will probably come as no great surprise that the role of mental health professionals involved in immigration proceedings reflected the prevailing attitudes regarding strict enforcement of the new federal laws. They worked as agents of the government and not as advocates for immigrants. The evaluation of an immigrant’s mental fitness, once it became a subject of scrutiny beginning in 1891, resided first within a more general medical inspection procedure and gradually, in response to the advocacy of eugenicists, was turned over to specialist trained in the developing field of psychology applying the newest tests of intelligence. Over the course of the thirty years examined here (~1891-1921), the effective role of the mental health professional was to act as another “gatekeeper” of the United States.
Origins of Exclusion
The origins of immigration policy in the United States is a story that has been well told.[1] The impetus for the 1875 Page Law and the more meaningful 1882 Chinese Exclusion Act came from a variety of sources with west coast labor agitators initially as some of the loudest and most violent supporters. At its core, however, the desire to limit Asian immigration, and eventually almost all immigration, was racism. As part of that racist heritage in both the details of the law and its implementation, were procedures that viewed immigrants from non-Northern European countries with suspicion. From the first exercise of congressional authority to legislate on immigration in 1875, the intent has been to limit who could seek residency in the United States. It is with this basic fact in mind that we must understand the early role of public health officials in immigration proceedings.
“An Immigrant Family Comes to America to Find Father. The father ran away to America and married another woman,” one of the many women denied entry into the U.S. under the “likely to become a public charge” provision of the 1891 Immigration Act.
Grounds for Exclusion
The grounds for exclusion began narrow and enforcement required little more than the judgement of a local customs official, but over time widened with each new act of Congress. The 1882 exclusion act prohibited “the coming of Chinese laborers to the United States” and the collector of customs or his deputy were charged with enforcement.[2] In 1891, Congress took the opportunity of renewing the exclusion act for an additional ten years and greatly expanded the grounds for exclusion that reached well beyond the Chinese and for the first time included reference to an immigrant’s mental state. Among others, the new law prohibited granting entry to “All idiots, insane persons, paupers or persons likely to become a public charge, persons suffering from a loathsome or a dangerous contagious disease, persons who have been convicted of a felony or other infamous crime or misdemeanor involving moral turpitude.”[3]
The final act of the early twentieth century prior to landmark immigration restriction acts in 1921 and 1924 came in 1917. In thirty-eight sections over twenty-five pages, the law meticulously detailed a great many new classes of persons to be excluded and the methods of enforcement. The categories expanded the mental health grounds of exclusion to include “All idiots, imbeciles, feeble-minded persons, epileptics, insane persons; persons who have had one or more attacks of insanity at any time previously; persons of constitutional psychopathic inferiority; [and] persons with chronic alcoholism.”[4] Interestingly, the 1917 act did include an exception, buried in the newly-required literacy test requirement, for any immigrant seeking admission that could “prove to the satisfaction” of an immigration officer that they sought admission “to avoid religious persecution…whether such persecution be evidenced by overt acts or by laws or governmental regulations that discriminate against the alien or the race to which he belongs because of his religious faith”[5].
Administration of Exclusion
The first significant immigration law, “To Execute Certain Treaty Stipulations Relating to Chinese,” or more commonly, the Chinese Exclusion Act, faced enforcement problems from the start in that there was no establish federal bureaucracy “and its enforcement fell first to customs officials” as part of the duties of the U.S. Treasury Department.[6] When Congress extended the act in 1891, they also created the office of Superintendent of Immigration, still within the Treasury Department, with inspection officers stationed at various ports of entry across the United States (119 of the service’s 180 officers were assigned to the newly-opened Ellis Island). Along with the new federal inspection officers, the law required medical examinations conducted by “surgeons of the Marine Hospital Service.”[7] In 1903, the Bureau of Immigration was transferred to the newly-created Department of Commerce and Labor.[8]
The 1917 act contained a curious provision with respect to determining the mental health eligibility of an immigrant that required “the master or commanding officer, owners, or consignees” of the vessel that transported immigrants to American shores with providing immigration officials a manifest of all the passengers that included not only basic identifying information but also “the alien’s condition of health, mental and physical” that would “aid in determining whether any such alien belongs to any of the excluded classes.”[9] Subsequent guides published by the U.S. Public Health Service (USPHS), the agency that provided the medical officers, referred to those manifests as a starting point for assessing an immigrant’s mental fitness. Thus, to a certain extent, that work was let out to members of the transportation company. (The outsourcing of a medical exam to the transportation company is doubly curious since restrictionists frequently criticized those same companies for their singular focus on profiting from transporting as many passengers to the U.S. as possible without the slightest regard for the “quality” of those they brought.) Ultimately, however, the 1917 law specified that medical officers of the USPHS were responsible for administering the physical and mental examinations of immigrants and issuing a medical certificate and they were required to “have had especial training in the diagnosis of insanity and mental defects” before being stationed at ports of entry.[10]
Angel Island Immigration Station, 1931
Shortly after Congress passed the 1917 immigration act, the Surgeon General issued regulations governing the medical inspection of aliens by Public Health Service officials. As with every other document I have encountered thus far, the central concern of those regulations was the detection and prevention of physically and mentally undesirable immigrants from landing. The regulations made it clear that the medical professionals–there was no clear or meaningful distinction between those that were charged with determining the physical or the mental status of an immigrant–could only attest to the certification of an inadmissible immigrant in medical terms. An interpretation of an immigrant’s mental or physical condition was “a practical one, and therefore for the immigration officer to determine.”[11] The medical officer could append “an expression of opinion,” about the potential ramifications of an immigrant’s medical/mental state (e.g., how it may have affected their ability to find employment), but it was not binding or sufficient in itself to certify (as inadmissible) an immigrant.[12] In other words, it seems that extenuating circumstances such as what we now recognize as trauma were not considered relevant. This is further supported by the simple fact that in the hundreds of pages of material on immigration policy and implementation published between 1882 and 1920, there was no meaningful consideration of an immigrant’s past circumstances that might assist in a diagnosis of an immigrant’s mental health that was for any reason besides barring entry.
In 1918, the U.S. Public Health Service issued a manual to assist its inspection officers in “determining the mental status of an alien” and implementing the Surgeon General’s regulations.[13] With respect to the conditions of an immigrant’s homeland, the manual explicitly stated such personal history “is unknown and unobtainable. His previous environments can be only estimated or suspected” and, in fact, any statement made by an immigrant about such things “must all be accepted with suspicion.”[14] The role of mental health professionals in immigration proceedings was strictly the “detection of the insane and the mentally defective…and the prevention of their entry.” This, they were assured, had a value to the national welfare that could “hardly be overestimated.”[15]
The 1918 manual provided portraits of immigrants that claimed to identify disqualifying illnesses from facial expressions.
Deportation as Eugenic Self-defense
Further evidence of the role of mental health professionals as agents of exclusion can be seen in the involvement in immigration policy debates by eugenicists. Eugenics was an immensely popular and influential pseudo-science at exactly the period in which immigration policy was formulated and implemented. Eugenicists advocated regulating fertility and applying the “laws” of heredity to check racial degeneration and to breed a nation of citizens suited to the challenges of modern civilization.[16] The policies they supported, “stemmed from a belief that everything from intellect to sexuality to poverty to crime was attributable to heredity.”[17] Historian Nancy Ordover writes its adherents “exerted direct influence on immigration debates…predicting dire consequences for the country's bloodline if immigration of the ‘unfit’ was not curtailed.”[18]
Although eugenicists were also interested in the physical fitness of immigrants, they advocated most adamantly for the use of mental qualifications for admission. Despite increasingly restrictive immigration policies, many complained that the laws were “inadequate to effect the exclusion of the unfit.”[19] One such person was Henry H. Goddard, a prominent American psychologist who advocated for the use of intelligence tests and was widely known for his (flawed) study, The Kallikak Family: A Study in the Heredity of Feeble-Mindedness.[20] In 1910, he was invited to Ellis Island to evaluate the process of screening immigrants and to offer suggestions “as to how the service could be improved in the direction of recognizing and detaining more of the mental defectives.”[21] It appears that, at the time, non-mental health professionals were assigned the task of identifying excludable immigrants and Goddard estimated that properly-trained inspectors would “detect at least ten times as many mental defectives” as were currently caught.[22] Such a result, he thought, could be accomplished by trained officers simply by standing near the line “as the immigrants pass” and identify “with marvelous accuracy every case of mental defect.”[23] Through his advocacy and publications, he called on the public “to demand congressional support for testing facilities at all ports of entry.”[24]
In 1914, Howard A. Knox, an Assistant Surgeon of the U.S. Public Health Service at Ellis Island, published an article in the Journal of Heredity, a favorite venue of leading eugenicists, subtitled “How the Public Health Service Prevents Contamination of Our Racial Stock by Turning Back Feeble-Minded Immigrants” that described the mental screening newly-arrived immigrants received before they could be permitted to land.[25] He claimed that the Service worked very hard to “determine the standards of knowledge of the various races.” As part of this they considered an immigrant’s “previous environment, education and the stress under which he may be laboring,” which came as close to understanding the potential push factors or trauma an immigrant might have faced before departing that inspectors came in these early years. However, he concluded, the information was used exclusively “for weeding out defectives.”[26]
“In that 1914 article, Knox claimed on page 126, “The examining physicians are guided first of all by plain common sense, enthusiasm and personal feelings never entering into the consideration of any case.” At the top of page 127 he continued: “The dull, stupid immigrant is not so entirely because of his previous environment and opportunities. The environment and opportunities are the same now as they have been for countless centuries because of the immigrant’s inability to change them. This country is as it is simply because it has been improved by men from prosperous Northern European countries…The civilization in Mexico is in its present state because of the nature of the people who settled there…They are simply undesirables and can never be assimilated to our advantage.” Sure, “dispassionate professionalism” is a totally accurate way to describe the USPHS.”
The most common charge by medical professionals against immigrants to deny them admission based on mental health examinations was “feeble-mindedness.” And because, as Ordover points out, there was no “legally binding codification for the term,” it could be interpreted and applied in ways that suited the inspector. Howard Knox, assistant surgeon with the U.S. Public Health Service at Ellis Island, celebrated the ambiguity of the designation in a 1914 article in the Journal of Heredity. “Fortunately,” he wrote, “the term ‘feeble-mindedness’ is regarded by most alienists as a sort of waste basket for many forms and degrees of weakmindedness, and since it is incorporated in the law as a mandatorily excludable defect, it is especially suited to the needs of [Ellis Island] examiners.”[27]
For my purposes, the label of feebleminded, was also one that came close to taking an immigrant’s previous circumstances into account; it presented the possibility of inquiring into a traumatic past. For example, the Committee on Immigration of the Eugenics Section of the American Breeders Association noted that it was “a defect where family histories become important.”[28] In his description of the work undertaken by USPHS inspectors, Knox recommended they inquire into the immigrant’s “ordinary occurrences and every-day duties of his previous environment…Further than this ask about conditions as they exist in the town or locality from which the alien came.”[29] Invariably, however, the line of inquiry was designed to confirm the inspector’s presumption that an applicant came from an undesirable locale or whether the immigrant could put together a coherent and believable narrative of their past rather than searching for reasons we might now recognize as the basis for a claim of asylum.[30]
An officer of the USPHS administers an intelligence test; the caption from 1915 describes the test subject as “a mentally defective immigrant woman”
The Great War
As I read the article from Knox, written in 1914, and his references to an immigrant’s homeland, I immediately wondered whether there would be any change or accommodation to the devastation caused by the great European war that began that same year. My early findings of the sources from the post-war era were disappointing but not surprising.
Eugenically-oriented authors, writing well before the end of the war, asked, “what will be the result when the war ends?” They predicted the resumption of immigration and feared a wave “greater than we have ever before experienced.” But they certainly did not contemplate those potential immigrants with any degree of sympathy.
Shall we have an influx of physically and mentally deteriorated men, drawn from among the survivors of the great conflict, and from the non-combatants who are suffering as much from privation as the soldiers are from shot, shell and disease; and what will be the permanent character of the defects which these immigrants will present?[31]
The Commissioner General of Immigration’s annual report from 1920 did immediately make reference to the war and to the failure of the armistice to bring about an immediate cessation of hostilities. And he confirmed the fears of earlier writers when he reported that the previous year had been “an extremely busy one–in fact, the busiest of any since the inauguration of the immigration service.”[32] Nevertheless, the 450-page report made no further mention of the war-torn conditions that compelled some immigrants to seek refuge in the United States and whether the U.S. government should take that into account, except to stress the need to redouble the efforts to keep unwanted immigrants out of the country. By 1917, immigration policy in the United States was “ideologically, if not explicitly, aligned with eugenics goals” that made trauma much more likely to be a hinderance than legitimate claim to admission.[33] Under that 1920 report’s heading “Defective Aliens,” the Commissioner warned “adequate enforcement” of immigration law was “of vital importance… at the present time with the enormous increase in immigration, much of it coming to us from countries which have suffered from the devastation of war.”[34]
And thus summarizes the findings of my early research on the topic. I do not imagine the situation changed in any meaningful way until after the next great world war and the U.S. began to revise its immigration policies, improved the science of psychology, and took a less isolationists perspective in its foreign policy.
[1] Roger Daniels, Guarding the Golden Door: American Immigration Policy and Immigrants since 1882 (New York: Hill and Wang, 2004); Martha Mabie Gardner, The Qualities of a Citizen: Women, Immigration, and Citizenship, 1870-1965 (Princeton: Princeton University Press, 2005); Erika Lee, At America's Gates: Chinese Immigration During the Exclusion Era, 1882-1943(Chapel Hill: University of North Carolina Press, 2003); Mae M. Ngai, Impossible Subjects: Illegal Aliens and the Making of Modern America (Princeton: Princeton University Press, 2004).
[2] An act to execute certain treaty stipulations relating to Chinese, 47th Cong., 1st sess. (May 6, 1882), 59; Hereafter cited as Chinese Exclusion Act. The Page Act of 1875 prohibited the “importation” of Chinese women for “lewd and immoral purposes,” and unfree laborers, both of which were an even smaller subset of Chinese immigrants.
[3] An act in amendment to the various acts relative to immigration and the important of aliens under contract or agreement to perform labor, 51st Cong., 2d sess. (March 3, 1891), 1084.
[4] An Act To regulate the immigration of aliens to, and the residence of aliens in, the United States, Public Law 301, 64th Cong., 2d sess. (February 5, 1917), 874ƒ. Hereafter cited as Immigration Act of 1917.
[5] Immigration Act of 1917, Section 3, 877. Instances of exception such as this are almost always in response to a specific context and I am not aware of what that would be in this case. It does surprise me a little as well that it does not specify Christian persecution. The year this was passed, of course, was the year of the Bolshevik revolution and many Russian Jews fled to the United States but I cannot imagine that there was much sympathy with Jewish immigrants in Congress to include this exception on their behalf.
[6] Daniels, Guarding the Golden Door, 19.
[7] Immigration Act of 1891, 1085. The Marine Hospital Service was established in 1870 and placed under the leadership of the supervising surgeon, today’s Surgeon General. Congress established the US Public Health Service Commissioned Corps within the Marine Hospital Service in 1889. https://www.usphs.gov/history.
[8] US, “An Act to Establish the Department of Commerce and Labor,” 57th Cong., 2d sess., (February 14, 1903), 825. The act included no changes or mentions of the medical inspection of immigrants.
[9] Immigration Act of 1917, section 12, 882-3.
[10] Immigration Act of 1917, section 16, 885.
[11] US Department of Treasury, Public Health Service, “Regulations Governing the Medical Inspection of Aliens” (Washington, Government Printing Office, 1917), 7-8; Hereafter cited as USPHS, “Regulations.”
[12] USPHS, “Regulations,” 8.
[13] US Department of Treasury, Public Health Service, “Manual of the Mental Examination of Aliens” (Washington, Government Printing Office, 1918), 5; Hereafter cited as USPHS, “Manual.”
[14] USPHS, “Manual,” 5.
[15] USPHS, “Manual,” 6.
[16] Excellent works on the history of eugenics in the United States during this period include Daniel J. Kevles, In the Name of Eugenics: Genetics and the Uses of Human Heredity (Cambridge: Harvard University, 1995); Wendy Kline, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkeley: University of California Press, 2001); Nancy Ordover, American Eugenics: Race, Queer Anatomy, and the Science of Nationalism (Minneapolis: University of Minnesota Press, 2003); Alexandra Minna Stern, Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America(Berkeley: University of California Press, 2005); the founder of eugenics described his ideas in an article, Francis Galton, “Eugenics: Its Definition, Scope, and Aims,” American Journal of Sociology 10, no. 1 (July 1904): 1-25. The subtitle is taken from Ordover, 13.
[17] Ordover, American Eugenics, xii.
[18] Ordover, American Eugenics, 5, xiv.
[19] “First Report of the Committee on Immigration of the Eugenics Section,” American Breeders Magazine 3, no. 4 (Fourth Quarter, 1912): 250.
[20] “How Science Created Morons,” Science VS, Gimlet Media, https://gimletmedia.com/shows/science-vs/o2ho5g/how-science-created-morons, May 25, 2018.
[21] Henry H. Goddard, “The Feeble Minded Immigrant,” Training School Bulletin 9, no. 7-8 (November-December, 1912), 110.
[22] Goddard, “The Feeble Minded Immigrant,” 111.
[23] Goddard, “The Feeble Minded Immigrant,” 112.
[24] Ordover, American Eugenics, 13.
[25] Howard A. Knox, “Tests for Mental Defects,” Journal of Heredity 5, no. 3 (March, 1914): 122.
[26] Knox, “Tests for Mental Defects,” 122.
[27] Ordover, American Eugenics, 12.
[28] “First Report of the Committee on Immigration of the Eugenics Section,” American Breeders Magazine 3, no. 4 (Fourth Quarter, 1912): 251.
[29] Knox, “Tests for Mental Defects,” 129.
[30] Knox, “Tests for Mental Defects,” passim.
[31] L.E. Cofer, “Eugenics and Immigration,” Journal of Heredity 6, no. 4 (April, 1915): 173.
[32] US Department of Labor, Bureau of Immigration, “Annual Report of the Commissioner General of Immigration,” (Washington: Government Printing Office, 1920), 5; Hereafter cited as Immigration Annual Report (1920).
[33] Ordover, American Eugenics, 13.
[34] Immigration Annual Report (1920), 14.