Medical Education and the Harm of ‘Goodly Heritage’

In the 12th essay of the Legacies of Eugenics series, three researchers describe how eugenic ideas linger in the institutions and practices of contemporary healthcare.

By Daniel Martinez HoSang, Marco Antonio Ramos, Alana SlavinFebruary 8, 2026

• Science & Technology

• History

• Politics

This is the 12th installment in the Legacies of Eugenics series, which features essays by leading thinkers devoted to exploring the history of eugenics and the ways it shapes our present. The series is organized by Osagie K. Obasogie in collaboration with the Los Angeles Review of Books, and supported by the Center for Genetics and Society, the Othering & Belonging Institute, and Berkeley Public Health.

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EACH YEAR IN LATE August when the summer humidity in southern New England begins to dissipate, first-year medical students take their seats in a tranquil courtyard at the Yale School of Medicine. There, they take part in a ceremony observed at dozens of medical schools across the country. After listening to speeches by esteemed faculty and alumni on the ethical and humanistic aspects of medicine, they line up to receive a white coat and stethoscope to symbolize their entrance into the profession. And then they rise together as one body to recite the Hippocratic oath, promising to “do no harm or injustice.”

This ancient oath, which is over 2,500 years old, reflects the treasured belief that medicine is a noble and benevolent practice, dedicated to the healing and well-being of patients, their families, and their communities. It assumes as gospel that medicine heals regardless of political or historical context. Should harm nonetheless occur, students are to understand it as an aberration, a mistake by an individual physician owing to improper training or an ethical lapse. Yet in workshops we have led at Yale for medical residents, a different and more complex reality emerges.

When we ask the students “Who here has seen medicine do harm?” the question often floats in the air for a few moments before hands rise across the room, at first slowly and then with gathering momentum. Residents in psychiatry typically share stories of patients involuntarily institutionalized or detained for weeks or months on end awaiting diagnosis and treatment, and of two-tiered systems of care in which uninsured, poor, and often Black or Brown patients access different facilities and care from those with private insurance and resources. They also tell stories of patients who have reason to fear they will not be treated with dignity and compassion.

“I worry for the safety of Black male patients who enter the Psychiatric Emergency Room,” one resident reflected recently during a workshop. “I’ve learned that staff often perceive these patients as ‘dangerous’ and are more likely to call for physical or chemical restraints to ‘manage’ their behavior.”

Most of us who have spent time in these spaces have witnessed some version of what this resident describes. A recent meta-analysis of 10 studies shows that Black adults and children are restrained at disproportionately higher rates in psychiatric and medical settings than their counterparts, and that what appears as a matter of “clinical judgment” is shaped by a history of racialized classification.

The gap between the idealized “do no harm” version of medicine and on-the-ground realities can be unsettling for patients and clinicians alike. For patients, it fuels mistrust, which accelerated during COVID-19. This discrepancy is now recognized as a factor in physician “burnout,” depression, and suicide, outcomes often corresponding with what clinicians describe as a sometimes amorphous, sometimes acute feeling of participating in routinized acts of moral injury. In The New York Times, one physician, Eric Reinhart, argued that burnout is related not only—or even mostly—to the long work hours typical of medical training and clinical work but also to the nature of the job. Trainees, for instance, often feel demoralized when navigating systems that fail to live up to expectations of dignified care for all patients.

Far from being an aberration, harm is baked into medicine’s infrastructure—integrated into the very buildings, training curricula, and clinical norms that structure medical care in our society. Perhaps most obviously egregious here is medicine’s historical entanglement with the American eugenics movement. Beginning in the late 19th century, around the time British scientist Francis Galton coined the term “eugenics” to describe a hereditarian ideal of being “well-born,” physicians in the United States such as Harry Clay Sharp forcibly performed vasectomies on men they classified as socially or mentally unfit. And as historian Paul A. Lombardo and others have shown, prestigious journals, including The New England Journal of Medicine, published hundreds of research articles and editorials on the alleged wisdom of eugenicist practices.

Medical education clearly needs an overhaul to better prepare students and residents for the potential harms they will encounter. To create a better future, we believe the history of medicine needs to be routinely integrated into medical training—particularly into its “didactics,” the structured teaching sessions designed to ensure residents receive systematic exposure to the core knowledge of their field. Only by doing so can educators teach students and residents to guard against their desensitization to harm. In the last several years, the three of us, who are clinical psychiatrists and historians of medicine, have worked as part of a group called the Anti-Eugenics Collective at Yale (AECY), piloting workshops and presentations integrated into these didactics for such purposes.

We urge our students to understand in minute detail the significant contributions made by Yale faculty and administrators to eugenicist practices in the first half of the 20th century. By design, we meet in a conference room a few blocks away from where, as first-year medical students, they proudly donned their white coats, under a beautiful wrought iron gateway adorned with the words “The Institute of Human Relations.”

These words still adorn the main administrative building of the School of Medicine (more on their backstory to follow). We also show the class an image of the building that housed the national offices of the American Eugenics Society (AES) overlooking the New Haven Green, a few blocks from Yale’s main campus. Founded in part by prominent Yale faculty and alumni in the early 1920s, its headquarters remained in New Haven, Connecticut, until 1936. Two Yale faculty members, economist Irving Fisher and geographer Ellsworth Huntington, served as presidents of the AES during this time, and a third, Yale School of Medicine dean Milton Winternitz, served with them on the board of directors.

The AES’s goal was straightforward: to build up the scientific authority of the eugenics movement at a moment when increasing numbers of Americans were dismissing it. In 1926, as documented by Emme Magliato, the group sought to shore up its reputation by establishing an “Advisory Council” of more than 100 prominent and heavily credentialed scientists and doctors from across the country, each drawn to Fisher’s vision of eugenics as the “application of modern science to improve the human race.” Not in any way deemed a “pseudoscience,” applied eugenics arose, rather, from within prevailing conventions of research and clinical practice as one creed among others. In our workshops, we show archival images documenting the “Fitter Family Contests” sponsored by the AES at state and county fairs. To demonstrate that families could be evaluated on a standardized measure of excellence the same way that livestock could, the contest’s winners received a medal that read “Yea, I have a goodly heritage.” As for the AES’s legislative agenda, it included advocacy for nonconsensual sterilization laws—Connecticut was the third state to adopt such a law—and for restricting immigration, banning interracial marriages, and upholding racial segregation.

We emphasize that the story of eugenics was complex. Dissent was ever-present. In the United States, the movement faced a chorus of criticism—for instance, that its work was scientifically unsound, violated individual rights, and would never succeed in practice. Among the dissenters were prominent geneticists including Thomas Hunt Morgan and Herbert Spencer Jennings, journalists such as Walter Lippman, and the anthropologist Franz Boas—who, in a 1916 article, described eugenics as “a dangerous sword that may turn its edge against those who rely on its strength.”

By the late 1920s, Yale president James Rowland Angell, who had approved the hiring of several faculty members with deep ties to the eugenics movement, lamented that “the eugenics movement in this country has suffered somewhat—at least amongst the well educated—from the suspicion of sentimentality and of scientific superficiality.” Angell meant here that the movement was seen as lacking rigor, animated instead by the untested assumptions and lofty moral ideals of its proponents. Yet he himself did not doubt the eugenicist mandate: “[N]o thoughtful person,” he wrote, “can have the slightest doubt that the problem […] of selecting the better and suppressing the poorer stock[s] must be given exhaustive study.”

The aforementioned Institute of Human Relations (IHR) emerged out of this period of growing public ambivalence toward the eugenics movement. It sought, in part, to reframe biological and social inquiry in ways that would preserve proponents’ scientific authority while responding to mounting criticism of eugenic ideology. Launched in 1929 to great fanfare and with the support of a $7.5 million grant from the Rockefeller Foundation, it fostered collaborative research projects, promising to integrate the insights of medicine, child development, sociology, law, psychology, psychiatry, and other fields. It took care not to use the word “eugenics” in any of its materials—the term “human relations” was clearly chosen to seem neutral—and Angell promised that the IHR would “foster no fads and hold no briefs for theories except those which grow out of thorough scientific investigation.”

Critically, this history shows that while the IHR disavowed explicitly eugenicist projects such as involuntary sterilization and the Fitter Family Contests, it nonetheless steadfastly promoted projects rooted in assumptions about genetic determinism that traced social inequality to fixed biological differences. The IHR’s scientists asserted, for instance, that residents of New Haven constituted a ready-to-hand natural “laboratory” that provided ample subjects for studies on genetic and biological markers of inferiority, as Magliato’s scholarship notes. They used local schools as research sites and testing grounds for new “interventions,” and to determine the biological and social basis of alleged delinquency. Arnold Gesell, a towering influence in child development and psychology who taught at Yale for nearly five decades and was a member of the American Eugenics Society, explained:

The primary school is the Ellis Island through which our future citizens pass, native as well as alien, normal as well as delinquent and defective. […] While the public school cannot deport, but must accept its defectives, it can do the next best thing; that is, it can recognize, classify [and] register, all the types of human material which pass its threshold.

Early “mental surveys” of thousands of students in New Haven sought to calculate a student’s “mental age” in order to understand a “child’s home life, school history, social reactions and school attainments.” Teachers reported on students they suspected were “mentally subnormal” and classified them as “(a) Definitely Deficient; (b) Very Probably Deficient; (c) Doubtful; (d) Merely Backward.” These categories are laden with assumptions about social value and intrinsic worth.

“Problems of human personality,” Gesell asserted elsewhere, “have a genetic or developmental aspect which traces back to infancy.” In an early IHR publication, psychiatrist William Healy similarly insisted that, thanks to his recently completed study on youth and delinquency, he could “trace definitely and surely the making of a criminal as far back as the tender age of four years!” He and others like him eventually developed rubrics that could serve as the basis for treatment and policy. Healy categorized the children he observed through his IHR studies according to their ability to become responsible, law-abiding adults. In his “Group I,” he described “defective delinquents” and “confirmed homosexuals” as possessed of inherent pathology and requiring confinement to institutions; they were “hopeless for treatment in the community.” An intermediary group’s pathological nature stemmed from their defective families and homes, which also made treatment outside of institutional confinement difficult. By contrast, a third group who came from “good” families, and whose symptoms could be explained by life events rather than hereditary sources, could be treated without such confinement.

By the early 1940s, the research output of the IHR had slowed. What endured were three practices or habits of thought: the employment of New Haven residents as subjects in research studies; rigid diagnostic categories, determined through the administration of allegedly neutral tests and other diagnostic instruments; and the use of hereditary factors to explain such categories.

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The diagnostic categories of race and class remained important components of psychiatric theory and practice in the second half of the 20th century. While the use of the word “eugenic” dropped out of most psychiatric research, it persisted as a style of reasoning, now adapted to social and community-based approaches to psychiatry that were emerging in the 1950s and ’60s. We emphasize this point in particular to residents in Yale’s psychiatry residency program, who join our workshops through the program’s structural competency initiative, which is known for taking residents out of the classroom and into New Haven to examine the architecture and planning of the city. Community members share with the medical residents how Yale’s construction of “cutting-edge” biomedical clinics and laboratories in the 1960s and ’70s pushed Black and Brown families out of their homes and businesses through practices enabled by “eminent domain.” Couched in the language of scientific progress and “urban renewal,” these practices devastated the health and well-being of poor Black and Puerto Rican neighborhoods. New Haven community organizer and public-school teacher Dr. Pamela Monk Kelley describes how the biomedical complex that displaced her family in the 1960s was a traumatizing site of “community destruction,” not a place of “care.” These histories still fuel patient-clinician mistrust and are surely implicated in disparities in patient satisfaction, health literacy, healthcare engagement, and healing.

We focus on one of these “state of the art” clinics, the Connecticut Mental Health Center (CMHC), which the State of Connecticut and the Yale Department of Psychiatry built on top of Black homes and businesses. Constructed in 1966 in a traditionally poor neighborhood known as “The Hill,” the CMHC was, and still is, meant to provide mental health services to the very community it displaced. Today, all psychiatry residents at Yale are required to train at the CMHC. It was founded by famed Yale psychiatrist Frederick (“Fritz”) Redlich as part of the progressive community mental health movement that shifted care away from psychiatric asylums and toward outpatient community clinics. Redlich, described as a pioneer of social psychiatry, has been praised by practitioners and historians alike for radically departing from the eugenic and often violent practices that had characterized his field. His scholarship and its legacies, however, have closer affinities to eugenics than many mental health professionals realize.

Like Arnold Gesell before him, Redlich saw the New Haven community surrounding the CMHC as an invaluable “laboratory” for producing psychiatric knowledge. In 1958, he published a 10-year study on the mental health of New Haveners. Working with Yale sociologist August Hollingshead, he pioneered a National Institute of Mental Health study that divided the New Haven community into five “social classes.” The two men argued that these “classes” were not only based on socioeconomic status but also grounded in ethnic and racial heritage and cultural identity. To categorize New Haven residents, they therefore used the “Index of Social Position,” comprising over 200 questions on heredity and ethnic and social background, as well as on “values, attitudes, aspirations, standard of living, [and] ideas of the future.”

At one end of Redlich and Hollingshead’s spectrum was a group termed “class I”: individuals who were primarily wealthy white New Haveners of Northern European descent. Understood as upstanding individuals, “proper New Haveners”—or “the better sort”—were “socially responsible for its members and the welfare of the community” Ninety-five percent of psychiatrists in New Haven belonged to this class—and most likely, the same proportion of Yale faculty in general did. Certainly, the two authors did.

At the other end of the diagnostic spectrum were those in “class V”: poor New Haveners with limited formal education who were unemployed or worked “unskilled” occupations with little pay and long hours. They tended to be recent immigrants from Eastern and Southern Europe or else belonged to non-white groups.

Why did these “classes” matter for psychiatrists? Redlich and Hollingshead intended this class-based analysis as a critique of disparities in healthcare access and the structural determinants of mental health. Class I citizens, they believed, should not have easier access to psychiatrists than people in class V did. Unequal access, they argued, contributed to inequities in outcomes. As one of the first large-scale psychiatric studies to describe the relationship between social inequality and mental illness, their research has long been regarded as “progressive.”

But in our workshops, we strive to make the story more complex: we ask residents to consider the ways in which such diagnostic rubrics perpetuated a eugenic understanding of racial difference—not unlike categories of “feeble-mindedness” in the early 20th century. Class V individuals, for example, were described as more inclined to physical violence than those in class I. As Redlich and Hollingshead argued, this was partly because individuals in class V had “defective superegos” (a psychoanalytic term for a deficient moral conscience). Our point is that the old habits of eugenicist thought persisted sub rosa in progressive agendas.

As historian Matthew Smith has detailed, class V people were also described as “individualistic, self-centered, suspicious, and hostile to formal institutional controls.” Anticipating conservative sociological arguments that accused communities of color of perpetuating “cultures of poverty” in the 1960s, Redlich and Hollingshead argued that class V individuals lived for “impulse gratification,” which created “trouble,” as their “police, teachers, and neighbors know.”

For Redlich and Hollingshead, their research was important because doctors in general assumed that they ought to treat people in accordance with their “class.” Classification, they felt, captured scientific reality: people of different classes had different sensibilities and so demanded different interventions. Psychiatrists should, therefore, treat the case of a class I husband “beating his wife […] quite differently from similar occurrences in class V.” A class I instance of intimate partner violence might be due to “external” pressures or circumstances, while the identical behavior in a class V individual surely derived from the inherent psychosocial characteristics of their group.

Redlich’s understanding of class and community persists in the very architecture of mental healthcare in New Haven today. During our workshop sessions, psychiatry residents often comment on the carceral structure of the CMHC. When you walk through its doors, you are greeted by multiple uniformed officers, security glass, and a walk-through metal detector. Our point is that attending to the facility’s historical backstory is a way for medical residents to understand why they feel like they are entering a prison, and why its design and aesthetics are so different from those of the clinical institution right across the street: Yale New Haven Hospital (YNHH). When you enter YNHH, you are greeted by a trickling waterfall, a pianist playing classical music, and a Starbucks serving lattes. This setting tends to serve Redlich’s class I individuals—mostly privileged clients with private insurance. Many of them are Yale students, faculty, and staff.

In September 2021, pastor and community leader Kelcy Steele reflected on the contrast between YNHH and CMHC in an interview with the New Haven Register. He wondered how the presence of carceral technologies in the CMHC would affect the next generation of healthcare trainees and their perceptions of the Black and Brown community in New Haven. “[T]his is likely the only time in their impressionable medical education where they rotate at a site with a prison-like entrance.” It is no accident, he continued, that “the site treat[s] Black and Brown communities with mental illness.” In short, these carceral technologies reinforce stereotypes about poor, non-white people with mental illness as more dangerous than the general population, despite the fact that these populations are far more likely to be victims rather than perpetrators of violence.

Providing historical context is critical. Without context, these stereotypes become encrusted into unconscious biases: trainees conclude that carceral devices have legitimate roles in places of healing for the poor, even though no convincing evidence thus far proves that metal detectors protect doctors or their patients. The only robust review on this topic found that weapons-screening programs in aggregate failed to reduce absolute rates of workplace violence in hospitals. It would seem that they serve only to divert resources from better-quality clinical care.

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One of our archive-based workshops invites participants to examine a series of “behavior cards” originally developed in the early 1940s to assess children’s risk of future “delinquency.” Each card includes a yes/no question to be posed to a child by the examiner.

At first, the trainees find the cards humorous and laugh when a flashcard poses seemingly absurd questions to assess a child’s risk of delinquency—such as whether they had “burned down a barn” or told “dirty stories.” A medical resident recently pointed out that some of the questions resemble screening tools used today by teachers to assess attention deficit disorder (ADD/ADHD) and oppositional defiant disorder (ODD). Typically applied to youth who demonstrate persistent patterns of anger, irritability, and “defiance toward authority figures,” the ODD diagnosis almost invariably, however, leads to misunderstandings about patients’ needs and challenges. When applied to Black and Brown youth, many of whom have significant trauma histories, the diagnosis can trigger punitive measures rather than therapeutic support—such as exclusion from school, involvement in the juvenile justice system, or placement in restrictive settings. “Class I” children typically receive gentler treatment and are more likely to have their behaviors interpreted as signs of trauma, leading to trauma-informed therapy, family-based interventions, and school accommodations. The same clinical presentation, when observed through a diagnostic lens shaped by eugenics, yields sharply different clinical treatments and outcomes.

Such dynamics are not unique to psychiatry. The pediatric diagnosis of “growth faltering” or “failure to thrive,” a pattern in which an infant or child does not gain weight, height, or head circumference at the expected rate according to standardized growth charts, can be the result of poverty-related malnutrition. During our sessions, several pediatric residents mentioned being struck by how frequently parents whose children receive this diagnosis were shamed.

Relatedly, reproductive coercion, a hallmark of eugenics, also continues in subtle and overt forms. One psychiatric trainee recalled a discussion among colleagues in which another healthcare provider joked about covertly inserting an intrauterine device (IUD) into a pregnant patient without her knowledge to prevent future pregnancies. The same device that is framed as autonomy-enhancing for class I women—offering choice, control, and freedom over reproduction—is weaponized against class V women to guard against presumed incompetence.

Posters asking for research participants represent another potential trigger for community mistrust. Uncommon in the affluent neighborhood near Yale, they are commonplace in those neighborhoods long subjected to medical surveillance and experimentation. One trainee mentioned encountering a leukemia patient at YNHH who refused blood draws, fearing that their blood would be used for experimentation. When asked to explain, the patient responded, “I know you all at Yale—always experimenting on somebody. That won’t be me.” At first, the trainee dismissed this as paranoia, but after participating in our workshop, they came to recognize the patient’s refusal as likely grounded in historical and ancestral memories of exploitation. For the trainee, the encounter prompted a reckoning with the ways in which history is selectively told and unacknowledged legacies can shape clinical relationships. “Noncompliance” now became legible as an expression of fear.

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Medical harm, then, is not merely a matter of individual failure—indeed, it is built into the very architecture of American medicine: the design of hospitals, the structure of training programs, the norms of diagnosis and care. Teaching this history is meant not to assign blame but rather to equip future clinicians to recognize how this harm is reproduced through ordinary practice. It is also about imagining different frameworks of care. An anti-eugenics framework rejects the idea that harm results only from bad actors or ethical lapses, instead identifying its structural roots in policies, hierarchies, and professional norms. We believe addressing these legacies is essential not just for the health and well-being of patients and providers but also for the credibility of medicine itself.

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Featured image: E. D. Roth, Institute of Human Relations and Sterling Hall of Medicine–Yale University, 1947. Medical Historical Library, Cushing/Whitney Medical Library, Yale University School of Medicine (16787926). CC0, library.yale.edu. Accessed February 5, 2026. Image has been cropped.