When a patient first entered a medical institution, they were classified based on perceived intelligence and mental grade. These determinations were made through various I.Q. tests and assessments that were often subjective and skewed to privilege standards based on an Anglo American, middle-class background and education. As a result, many of the patients in these facilities were people of color, in various states of poverty, and/or were seen as individuals that violated traditional standards of living and moral expectations. A woman who had a child out of wedlock, for example, could be institutionalized and classified as “feebleminded.” This catch-all diagnoses implied that the patient was not mentally fit based on perceived intelligence, socioeconomic background (which was thought to be linked to heredity), and lifestyle.
A diagnosis of “feebleminded,” and other classifications of mental grade such as “moron” often resulted in a recommendation by the institution to sterilize the patients. This eugenic measure, in part, was seen as a therapeutic measure to help the patient, but it was also a way to control the reproductive lives of these individuals. According to Alexandra Stern, these practices were “as much ... about hereditary control, [as] it was also about social control. … So [eugenic sterilization] sought to control ... and then deprive the reproductive ability [of] those who are identified as problem people in society.” Sometimes, patients were even required to be sterilized before they could be released from the institution, while others who were sterilized during institutionalization had little say in the matter.