The majority of sterilizations in the United States and Canada occurred within prisons, hospitals, and – above all – homes for the feebleminded. By the heyday of the coerced sterilization movement, from the 1920s until the late 1950s, there were dozens of mental health institutions in the United States, Canada, and Scandinavia performing the procedures. Some of the chief North American institutions included the Provincial Training School in Red Deer, Alberta; the Sonoma State Home in Eldridge, California; the State Hospital at Raleigh, North Carolina; Fairview Hospital and Training Center in Salem, Oregon; the Utah State Training School in American Fork, Utah; the Virginia State Colony for Epileptics and the Feebleminded, Lynchburg, Virginia; and the Northern Wisconsin Colony and Training School, Chippewa Falls, Wisconsin. In the 1950s, all of these institutions were performing eugenic sterilizations under the procedural arrangements that concentrated the decision to sterilize in recommendations from superintendents followed by approval by boards of eugenics. Because sterilization cannot be understood without an account to these public institutions, it is necessary to devote some attention to their origins and development and to the rules and norms governing them.

The distinction we make today between mental illness and mental disability was less sharply drawn in the nineteenth century, and the discipline of psychiatry itself was a by-product of the establishment of mental hospitals. The treatment of both groups – the mentally ill and the feebleminded (“people with mental disabilities” now) – began with many good intentions and a desire to learn from and avoid the errors and injustices associated with past efforts. The institutions in which these people were housed were to a degree segregated, although many institutions continued to mix groups of the mentally ill and the mentally handicapped, along with epileptics, the crippled, those suffering brain tumors, severe alcoholics, young criminals, and sexual deviants. And, in any case, the care of all these patient groups followed a similar trajectory. The professionals responsible for their care were, from the first quarter of the nineteenth century onward, optimistic about their capacity to care for their patients, and they saw institutions as the setting for doing so. Their optimism was encouraged by initially generous state funding. The superintendents governing the institutions were convinced that residence at the institution would be temporary or cyclical and that the purpose of the institution would be educational.