From Mental Hygiene—and Its Entanglement with Eugenics—to the Human Right to Health: Brock Chisholm and the Production of the “World Citizen”

Human Rights (HR) are a historical product whose emergence and ongoing transformations have been shaped by scenes of confrontation, regimes of knowledge, relations of domination and resistance, technologies of governance, and historical contingencies involving shifts and continuities within the instituted order. In our contemporary world, the universality of their values—equality, freedom, and dignity—makes them a powerful democratic discourse to which the governed appeal to oppose the exercise of violence and domination by the nation-state. However, HR can also serve to universalise sophisticated mechanisms of domination, and not all HR share the same history or the same anchorage in universality.

In this vein, the first HR formulated in the United Nations (UN) founding process—and the only one endowed with concrete meaning by the UN Charter (UN, 1945)—was the right to nondiscrimination based on “race, sex, language, or religion” (UN, 1945, Articles 1, 13, 55, 76). The genealogy of this right is closely tied to the democratic struggles of oppressed groups who were paradoxically denied the very equality and freedom declared as inherent in human nature during the Enlightenment's formulation of natural law (Laclau & Mouffe, 1985/1987; Lauren, 2013). However, the UN Charter only enshrined the illegitimacy of certain exclusionary distinctions that could undermine the egalitarian applicability of future HR to be defined later by the forthcoming Commission on Human Rights (UN, 1945, Article 68). Under the leadership of Eleanor Roosevelt (Glendon, 2001; Morsink, 1999), this commission worked between January 1947 and December 1948 to produce the Universal Declaration of Human Rights (UDHR; UN, 1948).

Paradoxically, the second HR formulated in the UN founding process was born even before the Commission on Human Rights began its work, following a very different historical trajectory deeply rooted in expert technocratic knowledge. Against all precedents in international law and in the natural law tradition (Tobin, 2012), the World Health Organization (WHO) Constitution—adopted on July 22 1946 and in force since April 7 1948—enshrined the HR to the “enjoyment of the highest attainable standard of health” (WHO, 1946, Preamble), rather than to medical care in case of illness. By defining health positively, not as “merely the absence of disease or infirmity” but as “a state of complete physical, mental and social well-being” (WHO, 1946, Preamble), it established an unprecedented biopolitical link between international democratic law, human nature, and the positive role of states as well as of the medical, human, and social sciences in optimising the population's health and abilities. From a social medicine perspective, the WHO Constitution also advanced welfare state policies by articulating a principle of equality in relation to the Human Right to Health (HRH) which, while omitting references to “sex” and “language” in comparison with the UN Charter, notably broadened nondiscrimination to include “political belief” and “economic or social condition” (WHO, 1946, Preamble).

The UDHR, conceived and adopted as an intercultural consensus condemning the recent atrocities perpetrated by Nazism (Morsink, 1999, p. 37), expanded the right to nondiscrimination—including those introduced by the WHO—to “colour,” “political or other opinion,” “national or social origin,” “property,” “birth,” and the “international status of a person's country or territory”; and, more importantly, left the list open with the phrase “or other status” (UN, 1948, Article 2). This openness has allowed dignity, equality, and freedom to be equivalently displaced to other domains, such as disability and madness, which, as constitutive outsides through which the ideal of “health” is produced, will be central to the perspective adopted by this genealogy. The UDHR includes its only reference to “health” in Article 25 on the right to an adequate standard of living, which is foundational to the crystallisation of economic, social, and cultural HR, particularly regarding social security. Nevertheless, this reference specifically concerns the protection of health (rather than its promotion), that is, “medical care” in case of illness. In 1976, the entry into force of the International Covenant on Economic, Social, and Cultural Rights (UN, 1966) made the HRH legally binding, deriving it from the WHO Constitution as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” (UN, 1966, Article 12), thus omitting the WHO's reference to the social dimension of health while retaining the principle of optimising abilities within the mind–body binary.

The emergence of the HRH has been studied mainly from two perspectives. The legal perspective has emphasised both the controversial and unprecedented nature of this human right and the fact that it originated in the WHO Constitution, drafted by public health rather than legal experts (Learly, 1994; Ruger, 2006; Tobin, 2012; Toebes, 1999). The historiographical perspective has tended to address the constitutive process of the WHO and its broad definition of positive health, in continuity—and disruption—with the practice of social medicine developed by the League of Nations Health Organization (LNHO), paying special attention to conflicts and political controversies on socialism, universalist health policy, and social security institutions (Borowy, 2009; Cueto et al., 2019; Howard-Jones, 1981; Larsen, 2022).

However, a significant gap remains regarding the influence of other contemporary trends, beyond social medicine, on the historical emergence of the HRH. The Rockefeller Foundation exerted enormous influence on the shaping of national and international health policies during the interwar period (Farley, 2004). In addition to paying the salaries of LNHO staff and thus financing social medicine (Paillette, 2010; Tournès, 2014; Weindling, 1997), the Rockefeller Foundation also financed movements such as eugenics, racial hygiene, Mental Hygiene (MH), and the interdisciplinary and technocratic turn in the social and human sciences, which will be addressed here in some depth (Kevles, 1986; Richardson & Fisher, 1999; Thomson, 1995; Weindling, 1988).

In this article, I focus on analysing the influence of MH—and its entanglement with eugenics—on the emergence of the HRH and on the WHO's positive definition of health. As Wu (2021) pointed out, one of the WHO's most significant innovations compared with earlier international health organisations, was, in addition to its global reach, the inclusion of mental health as an area of intergovernmental intervention. Neither the Office International d’Hygiène Publique, which focused on protecting Europe from epidemics (Howard-Jones, 1978), nor the LNHO, which adopted a social medicine approach centred on infectious diseases and malnutrition and had begun to expand its presence beyond Europe (Borowy, 2009; Cueto et al., 2019), addressed this issue.

First, I will trace a genealogy of the main rationalities, turns, and innovations in MH since its early developments, including the individual–environment adjustment matrix, its entanglement with eugenics, and the emergence and drifts of child guidance and the interdisciplinary turn. Second, I will focus on the San Francisco Conference to contextualise the emergence of the WHO and to make visible the different rationalities operating within the mind–body dichotomy in medicine, in connection with the instrumental articulation between population health and world peace that ensured its establishment. Third, I will address the WHO's founding process—where these previous trajectories converge—through the figure of psychiatrist Brock Chisholm and the project of “world citizenship” production, which he embedded in the WHO Constitution and advanced through the consecration of the HRH.

Chisholm is a particularly significant figure for this analysis. He held multiple positions of authority throughout the WHO's foundational process: rapporteur of the Technical Preparatory Committee that led to the WHO Constitution, and thus responsible for drafting its final version; executive secretary of the WHO Interim Commission (1946–1948); and the organisation's first director-general (1948–1953) (Farley, 2008; WHO Interim Commission, 1947). His influence on the WHO has been widely acknowledged—for instance, in the organisation's very name and Constitution, in its social medicine orientation, and in the inclusion and shaping of its mental health policies (Farley, 2008; Wu 2021). From a genealogical perspective, he stands out for leading a project of “human production” and world peace, shared by the Anglophone social and human sciences of his time, and for embodying in his subjectivity and actions, without apparent contradiction, virtually all the dominant currents: social medicine, psychoanalysis, MH, eugenics, and technocratic interdisciplinarity in the social and human sciences.

Theoretically, I draw on the intersection of Michel Foucault's (1976/1978, 1999/2003a, 1997/2003b) and Agamben’s perspectives on the convergence between sovereign (i.e., juridical) power and biopolitics (Pérez-Pérez, 2023). This will lead me to employ concepts such as the state of exception, bare life, and camp, which will be introduced at the relevant moment (Agamben, 1995/1998). Moreover, it will allow me to make visible, in relation to the project of human production underlying the historical emergence of the positively defined HRH, what may be termed its constitutive outside (Staten, 1985, p. 17; Campbell, 2008). That is, in Butler's (1993, p. 8) words, that domain of abject beings relegated to exteriority, illegibility, and uninhabitability, negatively bound to the production of the human, or of the world citizen—within a Western-centric civilisational matrix in which the construction of the human is a differential operation that “produces what is more or less ‘human’”: the subhuman.

Methodologically, I use Foucault's (1971/1977) concepts of emergence (Entstehung) and descent (Herkunft), drawn from his reading of Nietzsche's work, to analytically point to historical “beginnings” and series of events linked by mechanisms of knowledge-power. Emergence designates “the moment of arising. It stands as the principle and the singular law of an apparition,” whether it be a concept, a practice, or a right—an apparition that “is always produced through a particular stage of forces” and leads to a substitution, a replacement, a displacement, or a systematic turning point (Foucault, 1971/1977, pp. 148–149). Descent refers to the innumerable beginnings that historically converge and intertwine in an emergence. Tracing the thread of descent allows us to recognise “under the unique aspect”—in this case, of the HRH—“the myriad events through which, thanks to which, and against which it was formed” (Foucault, 1971/1977, p. 146); here, those linked to MH and its entanglement with eugenics.

Finally, like any genealogy, this work adopts a perspectivist and politically engaged stance that “looks from a certain angle, with the purpose of … following all traces of the poison and finding the best antidote” (Foucault, 1971/1977, p. 54). The “contemporary problematic configuration” (Castel, 2001, p. 67) that animates it stems from the recognition that the UN Convention on the Rights of Persons With Disabilities (CRPD; UN, 2006) has abolished a “state of exception” to universal human rights historically applied through the attribution of deficiency, disability, or illness in the dimension of the mind—constitutive of psychiatric power and of the HRH (Pérez-Pérez, 2023; UN Committee on the Rights of Persons with Disabilities, 2014; Weller, 2017). This radical change is challenging mental health systems globally and reveals the “democratic paradox” characterising the HRH, especially in its mental dimension (Pérez-Pérez, 2023): a right that is claimable and, simultaneously, a global space of systematic state violations of rights through practices such as involuntary commitment and treatment, legal incapacitation, and security measures associated with criminal nonresponsibility (Puras, 2017; WHO & Office of the High Commissioner for Human Rights [OHCHR], 2023).

In other words, how is it possible that the first victims of the Nazi mass extermination (Friedlander, 1995; Lifton, 1986)—against which the UDHR was formulated (Morsink, 1999)—had to wait until the 21st century for equality, liberty, and the dignity inherent to HR to be recognised in an international legally binding way through the CRPD? And why is it still so difficult for disablism (Campbell, 2008; Goodley, 2014), and particularly for sanism (LeBlanc-Omstead & Poole, 2024)—undoubtedly foundational to the colonial, patriarchal, and capitalist “matrix of power/domination” (Espinosa Miñoso, 2016; Hill Collins, 2002)—to be acknowledged as illegitimate and prosecutable forms of discrimination?

MH and Its Entanglement with Eugenics: Constitutive Rationalities, Innovations (Early 20th Century–1945)

The Mental Hygiene Movement (MHM) emerged from the radical shift that Swiss anatomopathologist and psychiatrist Adolf Meyer introduced to the project of Clifford Beers. Beers was a psychiatrised man who intended to end physical abuse, torture, and unpunished killings in asylums by promoting, through his autobiography, a civil movement in defence of inmates’ rights (Beers, 1908; Dain 1980). At the time, Meyer was leading the scientific reform of American psychiatry, with the 13 State Hospitals for the Insane in New York state under his direction (Lamb, 2014). Concerned about the independent investigations into mental hospitals proposed by Beers, Meyer redirected his project towards a preventive, largely extrainstitutional programme he called “mental hygiene,” which soon came under expert dominance (Dain, 1980; Rupke Richardson, 1987; Winters, 1969, p. 429).

Meyer gave content to the practice of MH based on his developments in psychobiology, influenced by pragmatism and Darwinism. The concepts of adjustment/maladjustment and efficiency/inefficiency underpinned his psychobiological conception of health as adaptation (Lamb, 2014). Psychobiology postulated that “mental activity” was an adjustment response of the individual as an anatomical, physiological, and functional whole to the “environment” (Lamb, 2014; Meyer, 1903, pp. 90–103; see also Table 1 in the supplemental material). According to Meyer, the environment was the “existing order of society” (Lamb, 2014, p. 158), shaped by brutal industrial capitalism and its increasing demands for “mental stability and efficiency” (Winters, 1969, p. 433).

For Meyer, “mental health” as an object of MH was not to be protected but promoted, as he made clear to Beers when they cowrote The Mental Health of the Public at Large in 1910 (Winters, 1969, p. 422). Protection suggests the creation of barriers and changes in the environment—social, political, physical—that can limit influences that are detrimental to the health of the individual. In contrast, health promotion is a process of optimisation that places on the individual the responsibility for regulating, through its “mental activity,” his or her efficient adjustment to the existing social order.

Although the main innovation of the MHM was the promotion of mental health through individual–environment adjustment, it soon became deeply entangled with eugenics within the broader matrix of increasing “national efficiency.” The biological and collective body upon which eugenics operated was shaped around notions of race and national efficiency. As a hegemonic rationality, efficiency—whether physical, industrial, or mental—converged in the metaphor of the scientific maximisation of production with minimal “waste” (Miller & O’Leary, 1987; Raitt, 2006; Searle, 1971). For eugenics, the product to be manufactured was the “human race” and a fit, superior national body. In the first two decades of the 20th century, the United States (US) MHM promoted the implementation of a range of eugenic techniques supported by a sovereign model of power, including: the permanent confinement of those deemed “mentally ill” or “defectives” in total institutions, the deportation of migrant bodies labelled as “defective” upon attempting to enter the US, the prohibition of certain marriages, and forced sterilisation (Davies, 1923, pp. 59–71; National Committee for Mental Hygiene [NCMH], 1913; Salmon, 1913).

By then, it had also become eclectically entangled with a variety of innovative “scientific” techniques for controlling and managing the human factor, including: (a) the “psychoanalytic deluge” that followed Freud and Jung's 1909 visit to the US; (b) Taylorism and the efficiency movement; (c) John B. Watson's behaviourism; and (d) the mass expansion of intelligence testing following the entry of the US into World War I (WWI; Pérez-Pérez, 2023, p. 188).

The involvement of the MHM in WWI prompted a major shift in its privileged objects of intervention, which had initially focused on minimising the subject of inefficiency—prevention of “insanity,” “delinquency,” and “mental defect.” This shift towards maximising efficiency (Rose, 1985, p. 159) materialised with the launch of the Child Guidance Movement (CGM) and was made possible by the growing relevance of the concept of “personality” (S. Cohen, 1983), then understood as the individual's overall make-up and “the sum of the facilities for adaptation” (Davies, 1923, pp. 186–197).

In this context, drawing on the eclectic interplay of psychobiology, behaviourism, and psychoanalysis, W. A. White (1921) described childhood as “the golden period” for MH. Despite their differences, these schools of thought agreed that personality development in early childhood was the key stage for fostering individual–environment adjustment. For White, it was clear that

if we are to produce a better race of adults, we must be able to control the influences which go to mold the adult character. A practical program in this field seems to me to be possible, and to offer a decidedly more workable scheme than an effort to go back of the returns with the eugenist and control the material. The more we know of what can be accomplished with the material given us, the better position we shall be in to undertake the control of what that material shall be. (White, 1921, p. 60)

Aspirations to engender a “better race” only deepened the strategy of adjustment to encompass all given “human material.” As J. W. Bridges stated when promoting MHM to Canada: “The development of the best possible type of personality … [that is] ‘positive mental hygiene’ … does not overlook or neglect heredity, and it may be said to include eugenics” (Bridges, 1928, p. 8).

Technologies of segregation and reproductive control were complemented by personality shaping within “normal” schools and families. Child guidance clinics helped in the old task of categorising some children as “mentally defective” and segregating them in special schools or colonies (Davies, 1923; Trent, 1995) while simultaneously addressing behavioural and personality “maladjustments” among those of “normal intelligence” (Horn, 1984, p. 25). In the US, their number expanded rapidly—from 10 in 1921 to over 500 by 1930—under diverse nomenclatures (Rupke Richardson, 1987, p. 260).

In the early 1930s, childhood disorder encompassed various forms of “socially unacceptable behaviour,” “personality reactions,” and failures in “habit formation” (Hart, 1931, p. 528). Cases were typically closed as adjusted or partially adjusted, with “environmental” intervention limited to parenting and education. The mother–child relationship became central to modelling efficient, happy, and socially adjusted citizens, and mothers were routinely blamed for disorders attributed to their children via labels such as “overprotecting” or “rejecting” (Bakker, 2020; Horn, 1984; Jones, 1999).

The “attack on schools” aimed to shift teachers’ focus from curricular subjects to pupils’ emotional needs, replacing “failure” with “success” to prevent “feelings of inferiority,” “undesirable defence mechanisms,” or “maladjustments” deemed to cause delinquency, inefficiency, or “mental illness” (S. Cohen, 1983, 1999; Jones, 1999; Rupke Richardson, 1987). The 1932 White House Conference on Child Health and Protection confirmed the CGM's hegemony, declaring efficiency and adjustment a right under the slogan: “For every child, understanding and guiding their personality is his most precious right” (S. Cohen, 1983, p. 137).

By then, the First International Congress on Mental Hygiene (1930, Washington) had already taken place. According to a shrewd commentator, it showed that MH had become a trope permeating “all fields of human relationship,” leading “some thinkers to go to the extreme of considering every science of mankind as a department of mental hygiene”—an “over-expansiveness” that “cannot but lead to loose thinking, confusion of practical issues, and failure to preserve due balance among the various motives for well-being” (Field, 1930, p. 227). This congress marked the international consecration and expansion of the MHM. It gathered 3,042 participants from over 41 countries, and by then, more than 22 national committees of MH had already been established (Garton, 1994; Gutiérrez Avedaño, 2021; Thomson, 1995).

In his presidential address to the congress, White (1930, p. 80) identified the greatest innovation of MHM as its redefinition of “health” as a “positive, not a negative concept,” extending far beyond “the absence of disease and the postponement of death” to embrace the positive agenda of enabling “people [to] live their lives at their best”—that is, with maximum “social value.” As I will discuss later, this constitutes an important precedent for the WHO's positive definition of health (see Table 1, supplemental material).

Given this dual expansion—both as a focus of the human and social sciences and as an international movement—it is unsurprising that the MHM stood at the core of the interdisciplinary turn in the technocratic human and social sciences. This shift emerged in the US in the mid-1920s with the creation of the Social Science Research Council, which marked the “institutionalisation and global expansion of technocratic social sciences in their present form” (Richardson & Fisher, 1999, p. 12), and first coined the term interdisciplinarity in 1930 (Frank, 1988). One of its earliest interdisciplinary experiments was the Yale Institute for Human Relations (YIHR), founded just before the 1929 crash, with funding from the Rockefeller Foundation and the Laura Spelman Rockefeller Memorial (Bryson, 2015; Capshew, 1999). There, Chisholm—the protagonist of the next section—specialised in child development psychiatry between 1931 and 1933 (Dorothy, 1970; Farley, 2008).

The Yale Institute was conceived as a central node of “correlation” and “synthesis” of knowledge for the “co-operative scientific attack” on the “most urgent problems of personal and social adjustment” (Angell, 1929, pp. 585–586). It promised a “penetrating and usable knowledge of human nature,” integrating “biological, psychological, and sociological viewpoints” and resulting in “a form of human engineering such as had not previously existed” (Angell, 1929, pp. 584–585). Its proponents spoke of increasing efficiency, happiness, and well-being, as if they were equivalent concepts (Human Welfare Group, 1929). As Winternitz argued, happiness ultimately related “to the degree to which the psychophysical organism becomes adapted to its environment” (Winternitz, 1930, as cited in Viseltear, 1984, p. 882).

The YIHR's first triumph in the theoretical “correlation of knowledge” (May, 1971, p. 159) crystallised in 1939 with the publication of Frustration and Aggression (Dollard et al., 1939), coauthored by five scholars working at the intersection of sociology, cultural anthropology, behavioural and developmental psychology, MH, psychoanalysis, and Marxist theory. Its central hypothesis drew on an interwar idea within the MHM: that MH was a key instrument for combatting the causes of war, understood as a form of mental malaise (Dain, 1980, p. 239; Thomson, 1995, p. 283). It translated a simple postulate into the “objective” framework of behavioural science: “aggression is always a consequence of frustration” (Dollard et al., 1939, p. 1). The coauthors illustrated this through the behaviour of a 4-year-old who, upon seeing an ice-cream vendor and hearing his bell (the instigator), expresses a desire for ice cream (the goal-response) and, when frustrated, screams or declares hatred for his mother (aggression). The “infantile tantrum,” widely used by the CGM, became the theoretical paradigm for the frustration–aggression hypothesis, presented as a universal explanation for “such diverse phenomena as strikes and suicides, race prejudice and reformism, sibling jealousy and lynching, satirical humour and criminality, street fights and the reading of detective stories, wife-beating and war” (Dollard et al., 1939, p. 26). The book claimed that the social sciences were on the verge of consolidating sufficient knowledge of human behaviour to end all wars (Seim, 2007), identifying childhood as the critical stage for controlling aggression due to its plasticity (Dollard et al., 1939, p. 1). This technocratic logic—linking MH and personality modulation to the prevention of war and the production of peace—would, as we shall see, inform the UN's founding and underpin Chisholm's advocacy of the HRH.

In 1940s US, the complementarity between eugenics and MH remained starkly evident. A striking example is the 1942 debate on forced euthanasia in the American Journal of Psychiatry: two contributors supported it, one opposed it, and all three agreed on the “necessity” of sterilisation (Joseph, 2005). One participant acknowledged that “Nazi Germany” was “systematically bumping off the mentally deficient people of the Reich,” estimating “100,000 killings” (Kanner, 1942, p. 21). By then, Nazism had not only developed the gas chamber for its first mass extermination under the Aktion T4 programme—targeting adult inmates of psychiatric institutions—but had also transferred it to concentration camps for the genocide of Jewish and Roma peoples (Friedlander, 1995; Lifton, 1986). The editorial concluded the debate in favour of forced euthanasia by posing the “psychiatric problem” MH was to solve: parents’ “excessive fondness” for an “idiot” and their “want” to keep them alive were deemed pathological; “good mental hygiene” involved leading them to a “more dispassionate view”—that is, the “welcoming” of their “merciful” death (Anonymous, 1942, pp. 142–143).

Moreover, after more than 3 decades of MHM, the testimony of WWII conscientious objectors assigned to U.S. State Mental Hospitals drew comparisons with Nazi concentration camps: overcrowding, frequent beatings, patients murdered by attendants, enforced nudity, widespread use of straitjackets and other restraints, starvation, exposure to cold, administration of powerful drugs for control—sometimes to the point of death—and forced labour (Grob, 1991; Maisel, 1946; Pratt, 1947; Whitaker, 2001). This was described as “euthanasia by neglect” and attributed to the lack of medicalisation and curative treatments (Whitaker, 2001, pp. 67–103). The proposed solution was to generalise the “special therapies” (Maisel, 1946, p. 113) already imposed against inmates’ will—lobotomy, electroshock, and insulin shock (Dorcus & Shaffer, 1945; Penrose, 1944)—the most brutal and disabling interventions that ex-patient and former psychiatric inmate movements emerging in the early 1970s sought to abolish in both the US and the United Kingdom (UK; Chamberlin, 1977; Insane Liberation Front [ILF], 1971; Irwin et al., 1972).

The biopolitical project of producing a fit, superior, and efficiently adjusted body–race–nation, where eugenics and MH intertwined, unfolded from a “constitutive outside” that simultaneously generated conditions of subhumanity (Butler, 1993). A regime of sovereignty captured these conditions, legally constituting them as “bare lives” and confining them to what Agamben (1995/1998, p. 174) called camps—spaces of exception where the dispossession of rights became the norm and violence could be exercised with impunity. Those constructed as “worthless lives”—“degenerates” threatening the species or race with their degradation—could be permanently confined, forcibly sterilised, abandoned to death, murdered with impunity, or, as in the Nazi case of racial hygiene, directly and massively exterminated. “Forced euthanasia,” also proposed in democratic states such as the US (Joseph, 2005) and France (Carrel, 1935, p. 398), represented the most extreme form of this murderous rationality—one that would reappear, with significant modifications, in the biopolitical project of producing a “world citizen” promoted through the HRH by Chisholm.

Interlude: The San Francisco Conference and the Instrumental Articulation of Health and World Peace

During the negotiations at the San Francisco Conference (April 25 to June 26 1945), the “health clause”—securing the establishment of the WHO—was incorporated into Article 55 of the UN Charter, which enshrined welfare state policies within the section on International Economic and Social Cooperation. This section was expanded beyond the economic, social, and humanitarian fields originally included in the Dumbarton Oaks Proposals (Washington Conversations on International Peace and Security Organization, 1945) to encompass health, culture, and education.

Historians have shown that the inclusion of the health clause in the UN Charter originated in a plan devised by public health experts to create a single intergovernmental health organisation (Borowy, 2009; Burke, 2017; Cueto et al., 2019; Larsen, 2022). Working from a social medicine perspective focused on the physical dimension of health—combatting infectious diseases and malnutrition—these experts first operated within the LNHO and later within the UN Relief and Rehabilitation Administration. The memorandum presented by the Brazilian Delegation at the San Francisco Conference initiated the process (Brazilian Delegation, Commission II General Assembly, 1945), but the plan was built on earlier documents that LNHO leaders circulated. The failed attempt to bring the Office International d’Hygiène Publique under the League of Nations’ authority, and the problems caused by the coexistence of two intergovernmental health organisations during the interwar period—exacerbated during WWII when the office came under Nazi control—were key contributing factors (Borowy, 2009; Cueto et al., 2019; Larsen, 2022). In any case, as J. Tobin (2012, p. 27) notes, it was the instrumental value attributed by states to health as a means of achieving “peaceful and friendly relations among nations” (UN, 1945, Article 55) that led to the creation of the WHO. This instrumental value might have, at least, two genealogies.

From a physical health perspective, the instrumental link between health and world peace rested on the belief that reducing global suffering from hunger and infectious diseases—thanks to recent discoveries such as penicillin, DDT, and vaccines—together with improving living standards in “underdeveloped” countries, would promote peace by preventing socialist revolutions. ¹ Commercial interests also played a role, as evident in the Brazilian memorandum (epidemic control enabled the exploitation of new regions) and in the U.S. Senate debates preceding the approval of the New York Conference that established the WHO (U.S. products required markets in “underdeveloped” countries; United States Senate, 1945). Paradoxically, even Ludwik Rajchman—the historic leader of the LNHO, forced to resign in 1939 after being branded and persecuted as a “communist” and “pro-Soviet” (Cueto et al., 2019, p. 31)—while advocating for a single intergovernmental health organisation, remarked that “health” was “the greatest good in the world,” with “more than two billion consumers” (Rajchman, 1943, p. 216).

From a mental health perspective, the rationale is completely different. In this vein, the statement “Human Nature and the Peace” (Allport et al., 1945), published on the eve of the opening of the San Francisco Conference by the American Psychological Association—and signed by approximately 2,000 psychologists (van Eck, 2015)—illustrates how this instrumental relationship was being constructed within the Anglo-Saxon social sciences and humanities, in which Chisholm participated. The statement set out a series of principles to be considered in the planning for world peace, warning that failure to do so would lead to future wars.

War can be avoided: War is not born in men; it is built into men … The frustrations and conflicting interests which lie at the root of aggressive wars can be reduced and re-directed by social engineering. Men can realize their ambitions within the framework of human cooperation and can direct their aggressions against those natural obstacles that thwart them in the attainment of their goals.

At the heart of this conception, grounded in the frustration–aggression hypothesis and in democratic thought, war was understood primarily as the product of what Meyerowitz (2010) had termed a biopolitics of child rearing. This conception—which did recognise imperialism, prejudice, and insecurity as evils—psychologised the causes of war, as it presupposed that the preceding world wars had been clamoured for from below, by the very masses mobilised to wage them, die in them, or endure their destructive consequences. The concept of social engineering—conveying a technocratic faith in modelling human plasticity—was central to the personality and culture approach adopted by the YIHR (Meyerowitz, 2010), marking a shift from the earlier notion of human engineering advanced by the mental hygienists who founded it (Angell, 1929; Bryson, 2015).

Engineering the World Citizen: Chisholm, the WHO, and the HRH (October 1945–August 1948)

Conclusion and Final Reflections

Meyerowitz (2010) has shown how the convergence of cultural anthropology and psychiatry shaped the tension inherent in the personality and culture approach. On the one hand, its cultural relativism allowed all cultures to be regarded as equally valuable; on the other, what was deemed normal or pathological within the mental spectrum became the criterion for distinguishing good from evil, thereby legitimising social engineering projects. After WWII, this rationality enabled the translation of the causes of the two preceding world wars into psychiatric disorders and symptoms, understood as the result of a “failed development of personalities.” The biopolitical project of producing a “world citizen”—a “common humanity” characterised as apolitical, fit, efficient, socially adjusted, and fully pacified—which Chisholm inscribed into our HRH, responded to this problem.

We saw how the HRH was born not only from a matrix of social justice within emerging welfare-state policies but also from a supremacist rationality shaped by dis/ablist and sanist logics that subordinated the enjoyment and maintenance of all other freedoms to the condition of health. This rationality was evident in both UN leaders who took part in the mental health and world citizenship project: in Chisholm's arguments for peace, but also in Huxley's philosophy. The first director-general of the UNESCO wrote in an official document that the “principle of democratic equality” needed to be adjusted to the eugenic “fact of biological inequality” and amended to read “equality of opportunity within the limits of aptitude” (Huxley, 1946, pp. 20–21). For Huxley, while variety—in terms of racial groups and human differences—was desirable, and “all attempts at reducing it, whether by attempting to obtain greater ‘purity’ and therefore uniformity within a so-called race or a national group … were scientifically incorrect,” the “existence of weaklings, fools, and moral deficients cannot but be bad” (pp. 19–20). He also stated that the UNESCO should work to make what was then psychologically unthinkable—a “radical eugenic policy”—thinkable in the future (p. 21). Despite innumerable differences, above all, that neither Chisholm nor Huxley openly endorsed racist policies or took part in extermination, both shared with Nazism the view that its first victims, psychiatrised and disabled persons, were worthless lives, disposable to death.

The “value of life” is precisely what marks the crossroads between the sovereign decision over a life that may be suppressed with impunity and the assumption of care over the biological body of the nation, where the sovereign is the one “who decides on the value or the nonvalue of life as such”; and this crossroads constitutes “the point at which biopolitics necessarily turns into thanatopolitics” (Agamben, 1995/1998, p. 142).

Throughout the 20th century, the progressive implementation of the HRH, alongside UN regulations on “disability” and “mental health/illness,” materialised its supremacy by discursively universalising a state of exception to HR, applicable through the attribution of disability, impairment, or illness within the mental spectrum. In such cases, HR could be suspended through legal mechanisms such as involuntary commitment and treatment, legal incapacity, and declarations of nonresponsibility accompanied by corresponding security measures (Pérez-Pérez, 2023; Weller, 2017). As previously stated, these medicalised forms of violence carried out with impunity and legitimised through the rhetoric of “care” and “protection” are now being challenged by the CRPD. This binding HR treaty, reflecting the epistemologies and demands of the disability and psychiatric user/survivor movements, requires the abolition of such legal constructs and the establishment of supports for legal capacity (Article 12 on Equality before de law), together with ensuring de-institutionalisation, supporting independent community living, and offering reparations to survivors of institutionalisation (UN Committee on the Rights of Persons with Disabilities, 2014, 2022).

Institutionalisation and the attribution of lesser value of life to disabled persons continue to produce deadly effects. As shown during the COVID-19 pandemic, the hierarchisation of “life value” based on “health status” operated through a thanatopolitical logic that predominantly abandoned disabled bodies to death in order to save fit and productive ones (Abrams & Abbott, 2020; Adams, 2022). This same logic underlies the WHO's estimations of the global burden of disease, which since the 1990s have relied on the Disability-Adjusted Life Year (DALY) Index. Defined as “one lost year of healthy life,” the DALY constructs disability as a negative value of life, literally added to the negative value of premature death (WHO, 2020, p. 6).

The HRH was born both as a milestone in the pursuit of social justice within the welfare-state matrix—anchored in universal access to medical care and state responsibility for protecting the population’s health—and as a product of technocratic, dis/ablist, and sanist rationalities that continue to reproduce racist, classist, (hetero)sexist, and ageist effects. Recognising this dual genealogy is essential to fully realise the HRH's promise of equality, freedom, and dignity. This requires confronting and remedying the exclusionary and coercive effects historically embedded in its implementation while reaffirming that all lives—including disabled lives—matter equally, and that violence and coercion in the name of (mental) health, particularly psychiatric forced interventions, constitute neither protection nor care but human rights violations.

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