Learning Disabilities – A Historical Perspective
‘Learning disabilities’ is a modern term first appearing during the mid 1990s when introduced by Stephen Dorrell, the Secretary of State for Health. This replaced the terms ‘mental impairment’ and ‘severe mental impairment’ introduced by the Mental Health Act of 1983. (The 1983 Act definitions excluded a large number of those with learning disabilities and unless their disabilities included aggressive or seriously irresponsible behaviour, they were not subjected to this new piece of legislation. The Act represented a major shift in how people with learning disabilities were perceived in mental health legislation, and for the first time learning disabilities and mental illness were separated by law). These, in turn, replaced the terms ‘sub-normality’ and ‘severe sub-normality’ used since the Mental Health Act of 1959 (and which also introduced the term ‘psychopathic disorder’). This Act replaced the Mental Deficiency Acts of 1913 and 1927 and abolished the phrase ‘mental deficiency’ and the terms ‘idiot’, ‘imbecile’, ‘feeble-minded’ and ‘moral defective’ previously used to describe the four classes of mental defect. Other early Acts included the Idiots Act 1886 which established a legal definition between idiots and lunatics, and the County Asylums Act and Lunacy Act, both 1845.
The term ‘learning disabilities’ may be defined as ‘a significant intellectual impairment and deficits in social functioning or adaptive behaviour (basic everyday skills) which are present from childhood’ (‘Learning Disabilities the Fundamental Facts’ – The Foundation for People with learning Disabilities, 2001). Similarly the Department of Health in England in 2011 defined learning disability as ‘a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence) along with a reduced ability to cope independently (impaired social functioning). The onset of disability is considered to have started before adulthood, with a lasting effect on development.’ Learning disabilities can be mild, moderate, severe, or profound and multiple, the latter being where an individual has more than one disability, the most significant being a learning disability. The term can also include failure to reach developmental milestones including intellectual, social, emotional and spiritual.
The term learning disabilities is also interchangeable with ‘intellectual disability’ which replaced ‘mental retardation.’ Intellectual disability is characterised by an IQ of less than 70 (although these are only useful for individuals around the age of 18) along with significantly impaired cognitive functioning (memory, judgement and reason) and a deficiency in two or more adaptive behaviours (skills needed to live independently, i.e. daily living skills, communication skills, social skills, etc) that were apparent before the age of 18. The IQ scores can be divided further into:
50 – 69 : Mild learning disability
35 – 49 : Moderate learning disability
20 – 34 : Severe learning disability
Individuals with a score of between 71 and 84 are often considered to be on the borderline. The term ‘profound’ is reserved for those whose complex additional disabilities (i.e. sensory, physical or behavioural) make measuring the IQ difficult.
Severe sub-normality/mental impairment was defined by the Acts of 1959 and 1983 respectively as ‘a state of arrested or incomplete development of mind, which includes sub-normality of intelligence, and is of such a nature or degree that the patient is incapable of living an independent life or of guarding himself against serious exploitation, or will be so incapable when of an age to do so.’ This meant that the individual had an incapacity for independent existence or for protecting themselves against serious exploitation including those previous classed as idiots, imbeciles and a large proportion of the feeble-minded. sub-normality/mental impairment was described by the same Acts as ‘a state of arrested or incomplete development of mind (not amounting to ‘severe sub-normality’) which includes sub-normality of intelligence and is of a nature or degree which requires or is susceptible to medical treatment or other care or training of the patient.’ (Heaton-Ward, p11).
The 1913 Mental Deficiency Act introduced a classification system with individuals graded according to their capacity:
· Idiots – so deeply defective in mind from birth or from an early age as to be unable to guard themselves against common physical dangers. This was the lowest level of intelligence and functional ability, what may be currently thought of as profound and multiple learning disabilities.
· Imbeciles – persons who, although not as defective as idiots, are still incapable of managing their own affairs. These individuals possessed the medium level of intelligence and functional ability, the equivalent of severe learning disabilities.
· Feeble-minded – not as defective as imbeciles, but requiring care, supervision and control for their own protection or for the protection of others. The highest level of intelligence and functional ability, comparative with mild or moderate learning disabilities.
· Moral imbeciles – people who from an early age display some permanent mental defect coupled with strong vicious or criminal propensities, on whom punishment has little or no effect. This was given to those considered a threat to the morals of society such as petty criminals, prostitutes, alcoholics and unmarried mothers. The term was changed to ‘morale defective’ in 1927. This was introduced to segregate those who could not differentiate between right and wrong and who did not understand the morale values of mainstream society. Legally someone with an intellectual impairment was incapable of deliberate intent to harm and therefore any action by that individual could not be considered a crime. Therefore many people with no sort of intellect defect now found themselves living with those with learning disabilities simply because of the way they thought or behaved. The term ‘morale defective’ was used until 1959.
All of these were used to designate a person with a permanent cognitive disability from birth or an early age. The Act, being an example of legislation attempting to use the Law to define learning disabilities, stated that ‘Mental defectiveness means a condition of arrested or incomplete development of mind existing before the age of eighteen years, whether arising from inherent causes or induced by disease or injury.’
The word ‘idiot’ derives from the Greek ‘idiota’, originally meaning a private man, or someone who did not own land or did not hold any public responsibility. An attempt to distinguish idiocy, legally and medically from lunacy, was made by the Lunacy Act of 1845, which stated that an idiot was legally a person ‘whose mind from his birth by a perpetual infirmity is so deficient as to be incapable of directing him in any matter which requires thought or judgement’, while lunatic was legally defined as ‘sometimes of good and sound memory.’ Any other person ‘of morbid condition of intellect’ who did not fit either of these categories was ‘a person of unsound mind.’
The categorisation of idiots, imbeciles and feeble-minded was introduced to determine who was capable of being educated. However, these boundaries could blur as an idiot child could also be taught to become feeble-minded (and vice versa) and therefore move between the categories. The term ‘imbecility’ was used to classify a milder form of idiocy, but there were no set criteria to distinguish between idiots and imbeciles. These categorisations were not based on scientific or medical knowledge, but on the administrative, educational and medical problems caused by the institutions that housed them.Whatever terms are chosen it becomes apparent that each eventually becomes a degrading label or insult. However, these definitions help to define the boundaries between disability and learning disabilities. Notwithstanding, there is a crossover, and the history of one cannot be examined without the other. During the past both client groups were frequently subjected to the same kind of lifestyle and treated in similar ways by society.
People who were previously shunned by society for whatever reason – ridicule, fear, loathing, pity or charity – or considered insignificant and forgotten by society naturally leave less trace of their existence, the same as any marginalised group. This makes it almost impossible to examine their past, their place in society and their daily lives and aspirations. Much like the demolition of many of the former institutions, the non-survival of their corresponding archival records, results in the histories of these people being forgotten or incorrectly portrayed as history tends to avoid negativity and controversy. However, this has changed somewhat bearing in mind the Holocaust exhibition at the Imperial War Museum in 2000 that incorporated Nazi propaganda films portraying their treatment of disabled people, including those with an intellectual impairment. The inclusion of those with learning disabilities is especially relevant in the government’s current policy on social inclusion, as these individuals are still among one of the most socially excluded groups from society.
No separate history of learning disability exists and historians who have previously tackled the subject have always widened their net to include all disabilities and mental and physical impairments including the blind, deaf, dumb (mute), lame, amputees, dwarfism (now termed ‘restricted growth’) scrofula, smallpox down to ‘bearded ladies’ and other ‘freaks of nature.’
There is little mention of disability throughout early history. Archaeological evidence has provided suggestions as to how people with learning disabilities were treated by society. This includes evidence of healed cranial injuries showing that these individuals were cared for at least long enough for the skull to heal. These were probably the result of the crude surgery of trepanning – cutting a hole in the skull to release any evil spirit present, although in reality released any pressure on the brain.
Hippocrates, the Greek physician during the late 5th century BC, believed that any form of disability was caused by an imbalance in the four humors in the body, a conclusion also reached by the Roman physician Galen in the 3rd century BC. The Greeks saw the birth of a child with a disability as a punishment on the parents by the gods. Aristotle recommended both abortion and infanticide if there was a risk of such a child. As it was believed that the age of the mother was a contributory factor Plato suggested that all pregnancies in women above the age of forty should be terminated. He also wrote that society would ‘provide treatment for those citizens whose physical and psychological constitution is good, as for others, it will leave the unhealthy to die, and those whose psychological constitution is incurably corrupt it will put to death.’
In Sparta citizens had to be both physically strong and mentally able. Plutarch wrote that all children (of Sparta) were the property of the State, rather than the father, who was required to present his child to the elders of the community shortly after birth to ensure that it was not deformed. They instigated a legal requirement that any infant showing signs of having a disability were left to perish either on a mountainside or in a chasm called Paotheatum in the belief that the health that nature had failed to provide was of no use and that the rearing of such a child was uneconomical to the State. Unlike the Greeks, early Roman law transferred the rights of children to the father rather than with the State, although the father was still responsible for exposing any deformities or disablements, and like the Greeks, were not granted citizenship.
The Celts introduced a system of supporting the poor and disabled of their communities through taxation on those that held their own land. They were the first known society to build hospitals to cater for such the poor and disabled such as the one at Armagh in Ireland around 300BC. Both Celtic and Nordic philosophy associated learning disabilities with supernatural involvement. Those with learning disabilities were thought to possess some form of supernatural gift such as being a ‘seer’ or having great wisdom. The belief was that giving up an attribute such as one of the senses or a limb was seen as a contract with the supernatural and that individual being endowed with special powers.
The Medieval Period
Responsibility for the disabled, including learning disabilities, lay with the Church who felt that they had a duty of care. They established the first hospitals often near to religious establishments such as monasteries or nunneries. There was no uniformity and hospitals varied enormously in size from large communal dwellings to small cottages. Larger hospitals usually consisted of an infirmary with a large hall, the sides of which contained rows of beds.
The original intention of hospitals was to provide shelter and sustenance to travellers and passing strangers but this slowly evolved into providing charitable relief for the sick and disabled. Travellers and strangers would spend one night at the hospital before moving on again although an exception was made for the sick and disabled who were allowed to stay until they were well again, drawing a parallel with the modern concept of hospitals.
One of the earliest hospitals was at Whitby which by the 7th century was said to have had a separate building ‘to which they used to take those who were infirm, or who seemed to be at the point of death.’ One of the earliest specifically to provide care for those ‘oppressed by various kinds of infirmities’ was St John’s at Canterbury. This was established in the late 11th century by Archbishop Lanfranc. Another early hospital was St James’s in Chichester that catered for ‘six cripples, two people without legs, and two idiots.’ Chatham Hospital in Kent looked after ‘100 blind and epileptic monks and nuns’, and St Mary’s Hospital in Cripplegate, London, catered for ‘100 blind, paralytic and disabled priests.’ By the later medieval period hospitals existed in most of the larger towns and cities.
During the 13th century Simon FitzMary, a crusader and twice-mayor of London, donated a piece of land in Bishopsgate to the bishop of Bethlehem for the building of a hospital. In 1247 the Priory of St Mary of Bethlehem was founded, devoted to healing sick paupers. The establishment became known as the Bethlehem Hospital, often shortened to ‘Bethlem’ and frequently pronounced ‘Bedlam.’ The original location was on a site now occupied by Liverpool Street station. Built to a courtyard design in the centre of which was a chapel, were ‘cells’ for patients, a kitchen, staff accommodation and an exercise yard. It remained on this site until being rebuilt at Moorfields in 1676. The hospital originally catered for physical disabilities although quickly expanded to care for those with mental illnesses and by the 15th century had become England’s first mental institution. This was the first form of institutional care for those with learning disabilities.
During the early medieval period leprosy was prevalent resulting in the building of leper houses and colonies. These were usually built on the edge of towns or in rural areas close to main travelling routes. As an alternative to hospitals and leper houses almshouses were built to provide long-term accommodation for the disabled, aged and infirm, and became a feature in most towns. As well as being founded by religious bodies they were also built by wealthy merchants and local trade guilds. As leprosy began to recede in the late 14th century many former leper houses became almshouses. An example of a medieval almshouse is St John’s at Lichfield.
Disabilities, and learning disabilities, were more widespread, more visible and more accepted in medieval England. The exception to this may have been the upper echelons of society who possibly viewed any disability as a fault of the bloodline and therefore threatened the honourable identity of that family unit. Within a community everyone would have known someone with learning disabilities. ‘Because learning disabilities was far more visible and publically accepted, those individuals were not labelled or marginalised. Only with the introduction of legislation on behalf of those individuals to establish and protect their rights did labelling and marginalisation begin, helping to shape attitudes to those with learning disabilities.’ (Steven King, ‘The Disabled: Fellow Creatures or Charlatans?’). People with learning disabilities would have relied upon family members and relatives for care and support. Even though hospitals had become fairly widespread the majority of people with learning disabilities lived with their families within their communities, which continued well into the 19th century. Those that could work did so, while those that could not were supported by family and friends. Those who had no one relied upon the charity of others, sometimes becoming beggars on the streets.
During the medieval period a common term for someone with learning disabilities was ‘fool.’ A distinction was made between ‘artificial fools’ (people attempting to act foolishly) and ‘natural fools’ (those born foolish). The term natural fool fell into disuse during the 18th century. Other terms in use included idiot, innocent, dull-witted, dumb and simple. Additionally the phrase ‘the falling sickness’ was used as an alternative to describing someone with epilepsy.
‘Malleus Maleficarum’, published in 1486, influenced prejudice against learning disabilities (as well as everyone who was considered different) by suggesting these individuals practiced witchcraft and being in league with the devil. What were originally considered to be gifted individuals in earlier societies now became figures of distrust.
There were mixed attitudes to learning disabilities as it was believed this could be the result of astrological events, witchcraft, demonic possession or supernatural phenomenon. Rituals such as exorcisms, incantations and prayers were used to drive out any evil spirits. Charms, amulets and talismans were used and by the 17th century, often made of brass or tin, with astrological symbols etched on them and supposedly cast at significantly astrological times. These were worn around the neck, as were scraps of Latin liturgy wrapped in paper with a leaf of mugwort or St John’s wort and tied with taffeta. Impaired children were sometimes believed to have been changelings, creatures from a subterranean world inhabited by fairies, elves and demons who had stolen the real infant and replaced it with one of their own.
Another superstition was that any form of disability was a form of punishment for sin, the connection between sin and disability originating in the bible. The passage in Matthew 9:2 reads ‘And behold, some brought Jesus a paralytic lying on a bed and when he saw their faith he said to the paralytic “Take heart my son, your sins are forgiven.” He then said to the paralytic “Rise, pick up your bed and go home” and the man jumped up and went home.’ This probably acted as a catalyst for pilgrimages undertaken by those with learning disabilities to the shrines of certain saints. Leviticus 21:18-21 describes how those ‘who have some kind of imperfection’ are not allowed to offer their God’s food.
If a child was born with learning disabilities the blame of the sin was often associated with the parents rather than with the child itself. This was usually in relation to some form of sexual practice that the church frowned upon such as while a woman was pregnant or menstruating, on Sundays or Feast Days, or during daylight. All of these, as well as many others, could result in a child being born with learning disabilities. However, the majority of people were far more pragmatic than the Church, and those children, along with their parents, did not appear to be stigmatised by their communities.
These individuals had a role in medieval society as their affliction was seen to be that they were suffering purgatory during their lifetime similar to the suffering endured by Christ, and therefore already closer to both God and heaven. Helping these individuals by giving assistance to ease their suffering was seen by both Church and society as tokens which would speed a donor’s passage to heaven after death. The Jewish philosophy, through the Talmud, also expressed disability as a holy state and being closer to heaven, as well as for those who assisted them. Similar to Jewish philosophy Islamic society also maintained that the disabled were closer to heaven, which their mind had already passed to while their physical bodies moved around among ordinary mortals on earth.
Many people with learning disabilities undertook pilgrimages such as to the shrines of Thomas Becket in Canterbury Cathedral and St William at Norwich Cathedral. A 13th century ‘miracle story’ from Norwich Cathedral records how the pilgrims travelled to the shrine, including one individual named Matilda. She was described as being so doubled up due to the curvature of her spine and her legs were so twisted together that she was brought to the shrine of St William ‘laid like a sack across a horse.’ Another tells of a woman who was so lame that every step of her pilgrimage was ‘hardly a finger’s length, she was slower than any tortoise, but at the moment of her entering the cathedral church she felt the soles of her feet pricked as if by thorns.’ These stories were written by the monks as advertisements for cures to increase business, often being variations on a theme of Matthew 9:2 where Jesus demonstrated his power to cure a paralytic, but did reflect the popular belief of the period. Pilgrimages remained popular until the 18th century when the medical profession began to claim to be able to heal various forms of disabilities and thereby replaced the saints as a means of effecting a cure.
From the 13th century the Crown took control over the affairs of those judged unable to look after themselves, including administering their property and assets and investing any profits gained from them. In 1325 ‘De Praerogativa Regis’ was established for the protection of idiots and natural fools. This concerned the importance of inheritance and landed wealth and was the first law defining a difference between mental illness and learning disabilities. Its purpose was to protect the individual during his or her lifetime and that the estate succeeded to the rightful heir.
The law distinguished ‘natural fools’ (people with learning disabilities whose condition was considered to be permanent) and those who were ‘non-compos mentis’ (mentally ill and from which there was a possibility that the sufferer might recover). For those considered to have learning disabilities control of the estate was for life, whereas those suffering from mental illnesses the administration lasted until the person recovered. Control of the estates of those with learning disabilities could, if deemed necessary, be transferred to the family while that person was still alive.
Although it was officially the King’s responsibility to protect those with learning disabilities this was often delegated to others. It was commonplace that individuals would frequently inform the King of such people with learning disabilities in order to obtain custody. They would pay a fine to the King, along with an annual rent, and then enjoyed the revenue from the land and provide the person with their requirements until the estate passed to the heir. (Those considered ‘non-compos mentis’ had to be maintained at an economic level suited to their rank and the guardian was not allowed to have the surplus revenue. If they recovered then the guardian no longer administered the estate). For those considered to be idiots the Law gave the right to the Crown to retain any revenue that was not required for the bare necessities for them and their family. For those deemed to be mentally ill the Law ensured that the Crown returned any revenue that had not been used to maintain them and their family in a standard that equated not just to the bare necessities but also equated to their social rank. This distinction remained until the 16th century when the Law was modified to ensure that the rights of those with learning disabilities equated to those with mental illnesses.
This direct care by private individuals meant that those affected could remain in their own homes and communities. However, it is possible that this system may have led to exploitation of the role for financial gain. This early example of community care existed until the 17th century when control transferred from Crown to Parish.
An Inquisition took place to determine the extent of the learning disability or mental illness. This included for how long, how and in what manner, were there any lucid intervals, what land the person held and who was the next heir and what was their age. The inquisition also included a series of tests for the individual concerned to determine their ability (although these changed over time). Fitzherbert’s Test (1534) asked the person their age, the names of parents and to count out twenty pence. Swinburne’s Test (1591) required being able to name the days of the week and measure a yard of cloth.
Because of this over 80% of cases described the individual as a fool rather than non-compos mentis (of where there was a possibility of recovery) as guardians received more revenue from looking after a fool. When the law changed in the 16th century the number of cases of those with learning disabilities reduced by 30%. This was because it was no longer advantageous financially to cater for those with learning disabilities compared to those mentally ill. (Catherine Slater, ‘Idiots, Imbeciles and Intellectual Impairment’). These courts were only applicable to the landowning classes and were not for the ‘village idiot.’ One of these Inquisitions at the Court of Wards concerns the administration of the estates of Margaret Leveson of Trentham Hall. In November 1606 ‘Dame Margaret Leveson was then become a lunaticke and of none said memorie and not able to governe herself.’ (D593/E/4/3 and D593/P/7/2). These courts later became known as the Court of Wards. James I instructed these courts that ‘lunatics be freely committed to their best and nearest friends that can receive no benefit by their death.’
Natural Fools at Tudor Court
Natural fools were defined by Nicholas Breton in 1616 as being ‘Abortive of wit, where Nature has more power than Reason.’ This may be translated into modern-day terminology as the critera of those with learning disabilites. A visitation of a nunnery in 1535 reported a 13 year old ‘idiot fool’, and Bishop Cuthbert Tunstall writing to Thomas Cromwell in 1538 mentioned ‘an innocent natural fool.’ Shakespeare, in ‘All’s Well that Ends Well’, mentioned ‘a dumb innocent’ who was pregnant because she ‘could not say him nay.’
Henry VIII enjoyed the presence of natural fools at his court. One named Sexton, very probably the fool as known as ‘Patch’ (a soubriquet meaning fool), was given to Henry by Cardinal Wolsey in an attempt to win back the King’s favour. John Heywood noted Sexton’s nonsensical and witty response when reprimand by Wolsey:
‘Master Sexton, a person of known wit,
As he at my Lord Cardinal’s board did sit,
Greedily wrought a goblet of wine,
Drink none (said my lord) for that sore leg of thyne,
I warrant your grace (quoth Sexton) I provide
For my leg: for I drink on t’other side.’
Sexton’s successors were Will Somer and ‘Jane the fool.’ Both these individuals appear in an allegorical family portrait (artist unknown) of 1545 that depicts Henry with his long-dead favourite wife Jane Seymour and his children Edward, Mary and Elizabeth. Somer is dressed expensively in red hose with cropped ginger hair and with a monkey on his shoulder probably checking his hair for lice. Jane is seen bald-headed and richly dressed staring at something out of view. The fact that these two individuals are included in this portrait suggests that fools had a privileged place at Tudor court.
Somer was much loved by Henry VIII and was able to speak openly to him in his own cryptic way where others would not have dared. His natural foolishness was seen by some as making him incapable of sin or wrongdoing. He was fool at Henry’s court from June 1535 and after Henry’s death in 1547 remained in the service of Edward VI and Mary I and died early in Elizabeth’s reign. Somer was well-looked after and in 1551 (four years after Henry’s death) a payment of 40 shillings was made to William Seyton ‘whom his majesty hath appointed to keep William Somer.’ The fact that Seyton had been appointed ‘to keep’ Somer implies that he was not able to look after himself and so may be thought of as someone with learning disabilities [Jarrett, p15, & Lipscombe]. Many nobles also possessed natural fools including the Duke of Buckingham, the Marquis of Exeter, Lady Audley and Lady Kingston.
Somer’s character posthumously appeared in several court plays including John Heywood’s ‘Wit and Witless’ and Thomas Nashe’s ‘Summer’s Last Will and Testament.’ Some have doubted the accounts of clever wordplay and wit attributed to fools such as Somer on account of their disabilities, but the suggestion made in the Oxford Dictionary of National Biography that Somer’s reputation for this ‘probably owes more to posthumous myth than to fact is not consistent with contemporary reports.’ [Lipscombe].
With the dissolution of the monasteries during the 1530s came the closure of the majority of hospitals run by religious bodies. The result was that many individuals now faced life on the streets as beggars. The problem became so noticeable that a petition was sent to Henry VIII in 1538 asking for the hospitals to be reopened due to ‘the miserable people lyeing in the streete, offending every clene person passing by the way.’ This helped to change society’s perception of its obligation towards those with learning disabilities. Before this responsibility had been largely regarded as a religious duty but now become a civic one. Causes for helping those with learning disabilities also changed. Whereas before it was to ensure the speedy passage of a donor’s soul to heaven after death, now it became a way of increasing public self-esteem.
The result of the petition to Henry was the building of new hospitals now run by civic authorities, such as Etwall Hospital in Derbyshire that opened in 1557. All of these were now public rather than religious institutions and were established to look after those who were not able to look after themselves. Those hospitals that did survive the Dissolution also passed to civic authorities such as Bethlem which was now controlled by the Corporation of London. This was now run by a team of medically-qualified staff acknowledging that learning disabilities was now a matter for medical treatment. The hospital moved to Moorgate after the Great Fire of London, as although unaffected by the fire, had now become naturally dilapidated and inadequate through age and use. The great rebuilding programme of the capital also saw the hospitals for disabled soldiers and sailors at Royal Chelsea and Greenwich, and Acts were passed to provide pensions for soldiers who ‘had lost their limbs or disabled in their bodies.’
Towards the end of the 16th century Bethlem’s policy was only to accept those who were ‘raving and furious and incapable of cure or if not yet are likely to do mischief to themselves or others.’ The patients at Bethlem were usually the poor who had no family or friends to support them. Chains, manacles, locks and stocks all appear in the hospital inventory. The shock of corporal punishment was believed to aid recovery while isolation was seen to help patients ‘come to their senses.’ The majority of asylums offered deplorable living conditions and cruelty by the staff. They were frequently seen as places where a family member could be sent to be forgotten about. An etching of what Bethlem was like in 1735 appears in Hogarth’s ‘Rake’s Progress’ (plate VIII). In the picture Tom Rakewell, now insane, is seen sitting on the floor at Bethlem grasping his head and surrounded by other patients. His faithful admirer, Sarah Young, cries at the spectacle while two attendants attach chains to his legs. During the 16th and 17th centuries the nickname ‘Tom o’ Bedlam’ was often applied to someone who was mentally ill or had learning disabilities.
In Norwich in 1570 a Census of the Poor examined 1,400 of the poorest individuals in the city and included 63 disabled people. Amongst the disabilities mentioned were ‘lameness’ or ‘crookedness’ of the arms or legs, missing limbs, blindness and deafness. Although poor many worked. Female occupations included spinners and knitters, some lame men were labourers and there was also a blind baker who was assisted by his wife. Almost all disabled people were married to non-disabled partners and many had children.
The terms ‘impotent poor’ and ‘impotent beggar’ were introduced with Elizabethan Poor Law Acts to distinguish those who could not work either through age, infirmity or disability, from the ‘able-bodied poor’ or ‘sturdy vagabonds’, meaning those who were idle through choice. The impotent poor were seen as those ‘naturally disabled, either in wit or member, as an idiot, lunatic, blind, lame, etc, not being able to work...all these...are to be provided for by the overseers of necessary relief and are to have allowances...according to...their maladies and needs.’ With the increase in social mobility more people began moving from the countryside into towns and begging increased. The Act of 1601 sought to restrict the movement of ‘unattached groups’ such as beggars and invalids who potentially threatened the stability of the establishment by incarcerating them in workhouses and segregating those considered to be an economic burden. Some disabled people were accused of mutilating themselves or exaggerating their level of impairment in the hope of receiving charity.
During the Civil War in 1643 John Dyott, more frequently known as ‘Dumb Dyott’, was a member of the Royalist forces defending Lichfield against the Parliamentarians. From the battlements of the Cathedral’s central tower Dyott fired a shot which killed Lord Brooke, the Parliamentarian commander, resulting in Dyott becoming something of a local hero.
The Age of Enlightenment
During the 17th and 18th centuries those with learning disabilities still saw themselves as part of their community, who, if capable, would work, marry and support themselves but were entitled to the help of the better-off if that proved impossible. This support was seen not as the duty of the State but as the charitable duty of the individual. The parish might intervene with poor relief by paying for keepers or carers after the death of parents but for this to happen disability was not sufficient in itself, the person had to be destitute as well. Disabled people belonged to society and were also subject to its potential for harshness and brutality just like everyone else. [Jarrett, p21].
Many people with learning disabilities became beggars (although many beggars did not have learning disabilities). Disabled beggars were so numerous on the streets around Lincoln’s Inn in London that people were warned at night to be extra vigilant. Some devised ingenious ways of mobilising themselves. ‘Billies in bowls’ recieved their name by sitting in wooden bowls and propelling themselves with two wooden blocks. The most famous of these was ‘Philip in the tub’ who roamed the streets in a wooden tub propelling himself with two small wooden blocks and made a living by selling ballads at weddings. Similarly, ‘Go carts’ were those who used wooden boxes to move around in. ‘Sledge beggars’ was given to those who used to sit on a wooden sledge pulled either by a dog or another person.
Hospitals continued to grow and between 1720 and 1825 150 were built in England to cater for the rising number of sick poor. Guy’s Hospital in London opened in 1721 for incurably sick and chronic lunatics. The Norwich branch of Bethlem Hospital opened in 1750 and allowed curious visitors to pay to see its patients, and like its London namesake, also fell into disrepute. These became large and impressive buildings – at least from the outside. However, some reacted to what they saw as ostentatious displays of wealth and an alternative voluntary asylum movement began based on the belief that those with learning disabilities could flourish in healthy, clean institutional environments.
These private asylums, also known as madhouses, began to appear towards the end of the 18th century and tended to cater for the financially better-off, the smallest ones only housing five or six individuals and charging the highest fees. Some housed pauper lunatics paid for by the parish, and treatments and conditions varied greatly. In 1796 the York Retreat was founded by Quaker William Tuke who believed in treating people with respect and compassion. His large country house offered a domestic lifestyle and allowed patients to live and work in a warm and religious environment. From 1774 the Regulation of Madhouses Act introduced a licensing system following public concern that some non-lunatics, and no doubt some with learning disabilities, were being detained at the impulse of their spouse or families. With the growth of State-managed county asylums during the 19th century these private institutions generally declined.
One such private asylum was established by Thomas Bakewell (1761-1835) at Spring Vale in 1808. Three years earlier, despite having no medical qualifications, he published his first book ‘The Domestic Guide In Cases of Insanity, Pointing Out The Causes, Means of Preventing, and Proper Treatment of that Disorder.’ He believed that insanity was curable if treated properly and early enough, combining a medical approach with ‘moral treatment.’ After some years of difficulty the asylum became commercially successful which Bakewell ran for twenty-seven years. This was a large three-storied house, flanked with two bays of two storeys, accessed by a long driveway, in the grounds of which were pools and a fountain. After his death his son, Samuel Glover Bakewell, continued to run Spring Vale. In 1840 the asylum was sold to the Duke of Sutherland and the institution moved to Oulton (now occupied by St Mary’s Abbey) and eventually to Church Stretton.
Bakewell had built the house for its intended purpose. The bedrooms were 16ft x 12ft and 12ft high and there was a large communal day-room. There were also ‘cells’ 10ft square and 10ft in height, with a bed on each side. The airing ground, which was for use only by the male patients, was 60ft by about 20ft, and called ‘Bethlem’ as it was considered as an area of punishment for those that misbehaved. Most exercise was gained in the spacious grounds that surrounded the house. The patients were only placed under restraint, by the use of a strait-waistcoat, during any convulsions. Others were occasionally restrained by having their ankles chained but this was only as a means of preventing escape.
Bakewell was asked to attend a Parliamentary Select Committee on the madhouses of England on May 24th 1815. He stated that he then had twenty-five patients, sixteen males and nine females, and although this figure could obviously vary, there were always a greater number of males than females. These, he stated, all ‘form part of the family’ and were all of different social classes, including either six or seven parish paupers who were charged at the annual rate of £40 (15s 6d a week). Bakewell employed one keeper for male patients and three for the females, who also fulfilled the duties of servant, housemaid and cook.
Asked by the Committee whether any ‘persons afflicted with insanity have met with bad treatment, either in private houses or in their own families?’ Bakewell answered ‘a great many’ and went on to recount the following example: ‘A patient of mine was taken home, in consequence of an agreement between the parish and his two sons, to keep him for less money than I kept him. Sometime after, in one of the most dreadful evenings of the last winter but two, he came to my house in a most deplorable situation, having been all that day and the night before in a most dreadful fall of snow. His first expression was “I come for you to save me from those devils my sons, who will murder me; they beat me and abuse me till I had like to have lost of life, and I hope you will save me.” In consequence of which I made an application to a magistrate, and had him brought by a regular Order; he afterwards completely recovered, and is now again with his family. His statement appeared credible from what I saw, for they threatened to beat him in my presence, but I told them they had got into the wrong box.’
Bakewell also added a further case where ‘I am convinced that a lady of fashion and fortune withheld the means of cure from an elder sister, in consequence of expense, though that sister’s own income was more than sufficient to procure the best means the country afforded; she is now kept at an obscure place, at a very small expense, and under very improper treatment, as I conceive.’
Bakewell also spoke of others who kept family members with learning disabilities or mental health disorders isolated within their own homes including the following: ‘I have now in the house a woman, who has been confined in a dark garret, without the comforts of a fire, for the best part of twenty years. Her husband confessed to me, that he had not seen her for many years. The servant told me that nobody saw her except herself, and she only to take her food and take away the necessaries. The woman was perfectly inoffensive. He himself was trading at the rate of a thousand pounds a week by his own confession. Upon his bankruptcy he was obliged to provide some means of treatment for her, and he desired me to take her. I have found her very susceptible of good treatment, she seems to take a delight in looking at my children, and the comforts of a good fire, and has some little exercise occasionally walking out in the open air.’ When asked whether he trusted his own children with her Bakewell replied ‘yes, she sits at the kitchen fire with my servants and children, and she attends prayers at night.’
During the 18th century there was a move away from the idea of disabilities as a punishment for sin due to a growing medical understanding. Doctors began professing that they were now able to cure those suffering from various forms of disability. However, some of those with a disability may not have wanted a cure as this would have taken away their livelihood through exploiting themselves in public for financial reward. It is easy to assume that many may have been at the mercy of others who could easily exploit them. However, historian Julie Anderson of the University of Kent has said that ‘during the 18th and 19th century the disabled person was often in control. They controlled their appearance, those around them, and how they exhibited themselves to a level that might seem surprising today.’ [White, ep3]. Rather than being exploited some of these individuals became entrepreneurs controlling both their lives and careers. [It would be easy to include Joseph Merrick here, although he was not LD, only physically disabled, and Matthew Buchinger (1674-1740), who despite being born without hands or legs, was a gifted musician and became a popular performer]. Making a living in this way meant escaping something much worse such as the institution or begging on the streets.
At the beginning of the 18th century those with learning disabilities that could work were still integrated into the workforce. Children who had a mild or moderate learning disability but no physical one may have gone unnoticed in an agrarian society where reading. writing and intellectual ability was not commonplace. With industrialisation and the erection of factories with their need for speed and productivity those with learning disabilities became unable to compete with the more able-bodied. Gradually they became marginalised with the onset of industrialisation as they were unable to compete with the majority of the workforce. This was one of the reasons for the large increase in institutions catering for those now deemed unemployable and thereby ‘began the systematic exclusion of people with impairments from mainstream community life.’ (Allday, p34). To be unable to participate in a waged economy was to be isolated both socially and economically.
The Age of the Institution
The mid-19th century saw more and more people with learning disabilities housed in institutions. At the beginning of the century only a handful of people were in asylums. By 1900 more than 100,000 ’idiots and lunatics’ were living in 120 county asylums with a further 10,000 in workhouses [Jarrett, p28]. However the majority of people with learning disabilities still lived at home within their community.
During the first two decades of the 19th century the Government built twenty publicly-funded asylums for pauper lunatics. From 1845 it became compulsory for counties to build their own asylums and a Lunacy Commission was set up to monitor these. These asylums were a self-contained world surrounded by high walls, largely to prevent escape. Inside were often farms, orchards, workshops, as well as recreational facilities such as bowling greens, croquet lawns and cricket pitches. ‘Airing courts’, or exercise yards, led off the dormitories each capable of housing up to fifty patients with the beds in close proximity. There was usually also a cemetery. Some asylums, such as St Edwards at Cheddleton, also had their own railway station with a branch line going into the grounds. Some also had their own fire engines.
Asylums were often in rural locations for two reasons. Firstly to place inconvenient people out of sight of mainstream society, and secondly because of the arguments of social reformers who claimed that the appalling living conditions in poorer urban areas contributed to crime, delinquency, physical ailments, mental illness and idiocy. Moving to clean, well-spacious accommodation in rural settings with fresh air would help to eliminate their condition.
Following the introduction of the 1834 Poor Law Act which restricted state relief to only the able-bodied poor 350 workhouses were built in England. Originally designed to punish the workshy they soon came to house anybody that was out of work including those with learning disabilities. In 1856 the Lunacy Commission commented that the huge insane wards (specially built in some workhouses) were asylums ‘in everything but the attendance and appliances which insure...proper treatment.’ Asylums were originally intended only for those who could be cured or who were considered to be disruptive. This excluded ‘harmless and incurable idiots’, and by the end of the 19th century 10,000 people with learning disabilities remained in workhouses.
Earlswood Asylum, the first institution for the care of the cognitively disabled in England, was founded by Dr J Langdon Down, (best known as the doctor who identified Down’s Syndrome) in 1847. A visit to the asylum was recorded by an anonymous journalist in 1864 and appeared as an article ‘Happy Idiots’ in Charles Dickens’s weekly journal ‘All The Year Round’ (July 23rd, 1864, p564-569). ‘Descending from the noble terrace by a flight of stone steps, I come upon the whole of the inmates of the asylum, disporting themselves upon the lawn. They number in all 365 – 260 being male and 105 females. They of all ages, ranging from a grey-haired old lady, to a child of five years, and of all ranks, from the sons of prosperous merchants, it may be noblemen, down to the children of the poor clerks and petty tradespeople...Contrary to my anticipation they were all clean, and neat and tidy in their dress. Moreover, the majority of them exhibited an activity of body and cheerfulness of expression which I had never witnessed before in persons so manifestly deficient in mental power...On reception the first step is to inquire from friends the of the case, and to discover the peculiar predilection and repugnances of the individual.
Certain objective facts, as weight, height, shape, condition of the organs of sense, and powers of prehension and locomotion are carefully registered. Then follow personal observation with comparison of habits and propensities with the accounts received from friends. These are the data for treatment and instructions in accordance with them are given to the attendant or nurse. The first efforts are directed to the eradication of bad habits, such as tearing the clothes and wallowing in the dirt. After this, if there exist sufficient power, the pupil has proposed to him, occupations such as unravelling coca fibre for matting, slitting rods for baskets, and the result of this labour, whatever it may be, is always received with praise instead of blame...The asylum is at once a hospital, a school and a workshop within; without, a gymnasium, a garden and a farm. In the workshops the inmates practice tailoring, shoemaking, carpeting, mat-making, and the like. The clothes of the inmates and the attendants are nearly all made by imbeciles, who have learned their trades in the asylum. They all take a great interest in their work and are very proud of the results. Some of the lads act as cooks. On a visit to the kitchen, Mr Sidney found twelve of the pupils, none of who a year previously, could have been trusted near an oven or a fire, neatly dressed in white, helping the regular officials of the kitchen with the greatest order and zeal...It should be observed that the pupils are not forced to engage in occupations which they do not like. Each one is allowed to choose the employment for which he has a fancy. Some of them occupy themselves in drawing, and in making models and toys, simply for their own amusement. One of these, a youth of sixteen, has completed a most beautiful model of a frigate fully equipped and rigged with every rope, sail and spar. The model, of a considerable size, is executed with marvellous neatness and skill. I was informed that the constructor had never seen a ship, and took his first notion from a picture on a pocket handkerchief, being afterwards assisted by drawings in the ‘Illustrated London News.’ In the progress of his work he made a great discovery, namely, that boiling wood rendered it capable of being easily bent. He had never heard of this process, so that the discovery really was his own. With the permission of Dr Down, this pupil took me to his room to show me the model. His articulation was so imperfect, and his vocabulary so limited that I could scarcely understand a word he said. He was, I was assured, a true idiot who could scarcely read or write, yet he could draw admirably and had made this wonderful ship. Though he could measure well, as his work testified, he had no idea of figures, or of money. I asked him how much the ship had cost him. He said “three thousand pounds.”’
‘The girls side of the asylum comprises, besides the dining hall and dormitories, a sewing school and a play room. In the school the girls are taught to read by the aid of large letters chalked on black boards. They are also employed in useful work, in the afternoon they are allowed to make fancy articles which may be seen exhibited in the reception room. In another apartment there is a baby class taught entirely by pictures. In these rooms are stands of flowers and ferns prettily arranged, rendering the place cheerful and attractive. Some of the girls have learned to read and write very well.’
‘The farm, situated at the end of the garden, gives regular employment to twelve of the inmates, and in hay and harvest time brings others from the workshops, who profit greatly by the change. Strolling into the yard I met one of the idiot farmers dressed in a smock-frock and a wideawake hat. He certainly did not look more idiotic than some farm servants, not supposed to be deficient in mental capacity, whom I had seen outside the asylum gates. He took me to the cow-house and showed me the cows. There were twenty of them, all in good condition and well provided with straw, and over each stall their attendant had placed a label bearing the cow’s name in highly ornamental text. The lad who accompanied me was a good farmer, but a perfect idiot. He could not count the pigs in a sty, though there were barely a dozen of them, but he was a most useful member of the establishment for all that. He spoke very imperfectly. I asked him if he were happy there. He said “Yes, very happy, but no money.” I asked him what he would do with money if he had any and he said “buy sweetstuff.”’ (‘Happy Idiots’ in Charles Dickens’s ‘All The Year Round’ (July 23rd, 1864, p564-569).
During this period characters with disabilities began to appear in literature, suggesting a growth towards public acceptance. These included Tiny Tim from ‘A Christmas Carol’ (Charles Dickens, 1843 – Dickens included several other characters with disabilities within his other works such as Smike in ‘Nicholas Nickleby’ being ‘a wretched creature with humble ability’, Maggy from ‘Little Dorrit’, Tom Ping from ‘Martin Chuzzlewit’ and Toots from ‘Dombey and Son’), Mr Rochester in ‘Jane Eyre’ (Charlotte Bronte, 1847) and Signora Madeline Neroni in ‘Barchester Towers’ (Anthony Trollope, 1857). However, these were disabilities rather than learning disabilities. However, one of the most well known disabled figures in 19th century literature is Quasimodo, a central character in Victor Hugo’s ‘The Haunchback of Notre-Dame’ (1834) who is both deaf and deformed and is what may be described as having a learning disability.
By the 1890s the two existing county asylums of St George’s at Stafford and St Matthew’s at Burntwood, in the centre and south of the county respectively, were already overcrowded. So too were the workhouses that admitted patients with learning disabilities. Stafford County Council Lunacy Commission had no alternative but to ‘board-out’ its surplus patients to institutions in other counties willing to accept them.
To combat this a new asylum was built at Cheddleton that opened on August 18th 1899. It was capable of accommodating up to 300 male and 300 female patients (later increased to 400 each). The separate sex wards were divided by the administration block at the entrance, the dispensary, patient’s library, dining hall, kitchen and stores. The dining room was also used as a recreation hall with both a stage and orchestra pit and in which cinema projectors were later installed. At the rear of the complex was the powerhouse, laundry, fire station (the hospital had its own voluntary fire brigade) and workshops. Also at the rear, although detached, was the chapel and mortuary. Later the hospital also had its own burial ground.
There were five wards on either side of the main building – infirmary, recent, acute, epileptic, and quiet and working patients, to which separate day rooms were attached. The wards also had access to airing courts that the patients were encourage to use. There were also padded cells for violent or excited patients, as well as strait waistcoats or jackets. Each ward had its own bath house and changing room. There was also a separate isolation hospital in the grounds for contagious diseases.
Quiet and working patients supplied labour either on the farms or in the workshops. The two farms had been in existence when the estate was purchased and vegetables produced on these helped to decrease the amount purchased. Farming continued into the 1960s but then rapidly declined (Chadwick and Pearson, p54). The workshops included a brush-maker (for brushes used in the asylum as well as selling the surplus), an upholsterer (repairing mattresses), carpenters, bricklayers, plumbers and painters. All the wards had patients that did some work even if it was just sweeping and polishing, which reduced the cost of paid cleaners and auxiliaries.
The main meal of the day was dinner which was served about midday. Supper was at 6pm. Bread from the hospital bakery, along with butter, was served with most meals with tea or cocoa. Those patients employed in the workshops or on the farms were given extra rations at mealtimes, but this was commuted to a monetary payment using an internal currency system during the late 1930s. A series of brass tokens in various denominations, from ½d up to 4s, and of different shapes and sizes to help those who were blind or innumerate, were issued. Another reason for an internal currency system was to prevent patients buying alcohol outside the asylum.
Those patients that were allowed to leave the asylum unescorted had to wear a metal badge two inches in diameter which was stamped with the date and time that they were due back. This could be shown to the police if they were challenged. Any patient seen outside the hospital grounds wearing slippers was taken to be an escapee. (Chadwick and Pearson, p54)
Most patients possessed one best suit of clothing which would be worn on visiting days or social events, such as the regular patient dances that were accompanied by the asylum’s orchestra. For the remainder of the time they dressed in basic hard-wearing garments the majority of which were manufactured in the tailors shop. Most men wore corduroy trousers and protective aprons and overalls while working. (Chadwick and Pearson, p50). The exception was private patients who were allowed to wear their own clothes. Inmates who assaulted staff were forced to wear a red tie.
The most disadvantaged were the mentally deficient or those with learning disabilities, then regarded as being mentally handicapped. Magistrates did not differentiate between the mentally ill and the mentally handicapped who were referred to as idiots or imbeciles. This resulted in people with learning disabilities being kept on the same wards as those with severe mental illnesses. (Chadwick and Pearson, p56). The admissions register during the latter part of the 19th and early 20th centuries records the reasons why individuals were admitted. ‘Chronic lunatic’ referred to an individual with a mental illness for which there was little hope of recovery. ‘Chronic mania, ‘Melancholia’, [expand] etc.
Along with the large expansion in institutions there was also a vast growth in charitable organisations. This was due to a belief in the early 19th century by reformers that lunatics could be cured and idiots taught. By the end of the 19th century this optimism had disappeared and institutions simply became a place of confinement. Asylums were supposed to provide a basic education, such as differentiation of colours and basic word recognition and numeracy, but the majority continued to focus solely on the provision of basic needs such as food, clothing and accommodation. Institutionalism increased dependency rather than to assist with self-sufficiency development skills which it was hoped they would teach.
During the middle of the 19th century there were still numerous disabled beggars on the streets of London. The social investigator Henry Mayhew described those he encountered in 1862 including the ‘idiotic young youth...shaking in every limb’ and the ‘crab-like man without legs strapped to a board (who) walks upon his hands.’ Begging on the streets continued and livings could be made as the Victorians had a strong sense of philanthropy.
Although the 1834 Poor Law Act had acknowledged those with learning disabilities as a financial burden, there was a growing awareness of a threat to society by the propagation of their own kind leading to an increase in social evils and the degeneration of society. Unless checked this would lead to a distilling of the upper and middle classes and a decrease in the intelligence of the British race.
The philosophy of eugenics, being ‘the science of improving inborn human qualities through selective breeding’, was introduced by Francis Galton in 1883. He was a cousin of Charles Darwin and believed that people with learning disabilities were a generic threat to society through gradual degeneration. His ideas led to the thinking that sterilisation and segregation of ‘defectives’ was the solution with selective breeding to reduce intellectual disability. To help influence others those in favour of eugenics began attempting to link learning disabilities with crime, unemployment and other social problems. The philosophy of eugenics was later used by Hitler as the rationale for the mass extermination of intellectually challenged individuals during the Holocaust.
The 20th Century
The Mental Deficiency Act of 1913 introduced a classification system for individuals with learning disabilities (see page 2). This included routine testing for mental deficiency in schoolchildren with the use of physical and mental assessments. Because of this learning disabilities gradually came to be seen as a medical rather than a social problem. The implementation of the Act was delayed until after the First World War.
The Act established a new regime that ‘mental defectives’ should either be closely supervised in the community or maintained in a new type of institution, the ‘mental defective colony.’ This would provide a permanent settlement for both adults and children in isolated, scattered village environments. Admission to a colony could be at the request of the family, or a number of people in the form of a petition, and sanctioned by two doctors one of which was officially approved for the purpose. Diagnosis and classification was based on a number of tests including being able to differentiate between a fly and a butterfly, an egg and a stone, without taking into account their physical disabilities or social history.
This idea of separation and control derived from the theory of eugenics and helped by the Report of the Wood Committee in 1929. Each community was self-sufficient and housed between 900 and 1,500 people living in detached villas that housed up to sixty people. There were kitchens, bakeries, and laundries along with workshops for adults. Many colonies had their own market gardens with livestock, and employed farm bailiffs, firemen, engineers and gatekeepers. Most patients worked (unpaid) in the laundries, workshops or on the farm. The ‘idiots’ stayed within the villas which had verandas to enable them to be taken out into the fresh air even in bad weather. The children attended schools within the colonies where they learnt useful occupational skills for their future life as an adult in the colony. At the beginning of the Second World War some colonists left to do war work or even fight. The colonies lived on until the 1990s[Jarrett, p36] being renamed ‘sub-normality hospitals’ with the introduction of the NHS Act of 1946 and control transferred from local councils to regional hospital boards.
Any intention of employing eugenics was abandoned when almost two million newly-disabled ex-servicemen returned from the First World War. The thought of those who had sacrificed themselves for their country brought about a different opinion. Due to the large number of ex-servicemen there were vast improvements in the design of prosthetic limbs and advances in plastic surgery. Exercise and fitness regimes were introduced to help repair both physical and mental damage. Employers were encouraged to take on disabled ex-servicemen and new housing was built for them ranging from single cottages to entire villages.
These benefits did not always filter down to the civilian disabled population and resources were not evenly distributed. However, they were able to benefit from new lighter artificial limbs. A conference on the care of crippled children in 1920 claimed that provision for the war-disabled had caused ‘an appalling amount of suffering’ among other disabled people.[Jarrett, p35].
Schools for blind, deaf and dumb children began to appear towards the end of the 18th century largely through the efforts of charity movements. However, it was not until the Education Act of 1918 that schooling for all disabled children was made compulsory. In reality they were often taught how to perform low-skilled jobs rather than being provided with a full education. Many were residential with strict discipline and with letters home censored and parental visits discouraged. A group of blind boys from The Mount School for the Blind and Deaf in Stoke in 1915 made a night-time escape because they wanted to contribute to the War Effort by working on a farm. When they returned they were placed with the deaf children as a punishment, each struggling to communicate due to the lack of facial contact with each other. They were prevented from making further escapes by being made to hand in their trousers each night.
Disabled people remained on the margins of economic activity being trained only for menial jobs. However, the labour shortage during the First World War meant that those previously considered incapable of employment now found themselves being useful members of the workforce. In 1941 the Ministry of Labour, once again faced with acute shortages, recruited more than 300,000 previously ‘unemployable’ disabled people into the War Effort. The war itself was responsible for a further 300,000 disabled servicemen and women along with civilians.
The Disabled Persons Employment Act of 1944 introduced ‘sheltered employment’ as well as encouraging employers to recruit a fixed percentage of disabled workers into mainstream jobs. The Act was responsible for a series of ‘British Factories’ that were later renamed ‘Remploy.’ There were also a series of reserved occupations set aside for disabled people including lift operators and car park attendants. The concept of rehabilitation introduced during the late 1940s included both employment and learning daily living skills in an attempt to combat depression through purposeful activity. At the same time a low-key sporting event at Stoke Mandeville Hospital in Buckinghamshire in 1948 set in motion what would later become the Paralympics which grew rapidly in popularity during the following decades.
Campaigning disability organisations during the 1940s and 1950s, and civil rights movements in the 1960s and 1970s, helped to introduce a ‘social’ rather than ‘medical’ model of disability that significantly contributed towards the 1995 Disability Discrimination Act. These organisations included the National Association for Mental Health and the National Association for Backward Children, later becoming MIND and Mencap respectively, the Leonard Cheshire Foundation, the British Epilepsy Association and the Spastics Society (later SCOPE). [Explanatory note: The social model of disability argues that ‘it is not the person with a disability who is defective, but the society that stigmatises physical difference and builds the world around one standard kind of body’ – Mike Oliver, ‘Disability Definitions’, 1983. The medical model of disability has its roots in the 19th century being ‘the social process of disabling arrived with industrialisation and with the set of practices and discourses that are linked to late 18th and 19th century notions of nationality, race, gender, criminality, sexual orientation’ Lennard J Davis, ‘Enforcing Normality’, 1995].
During the 1960s Selwyn Goldsmith campaigned against what he termed as ‘architectural disability.’ He fought against what he termed the ‘institutional discrimination’ of buildings and their accessibility issues, and his results included lowered kerbs, and provisions in public toilets, restaurants, shops and churches.
The late 20th and early 21st century brought a realisation of the institutional neglect of those with learning disabilities and began to influence a change in governmental policy. Even as early as the 1950s sociological studies demonstrated that large numbers of individuals living in institutions at that time had the intellect and social capacities to sustain themselves in the community and that institutional life did little to support personal development (Atherton, p45). Their continued existence owed more to the social attitudes of the time rather than whether that form of accommodation was more appropriate.
Frank Thomas, a nursing assistant at a large sub-normality hospital in 1972 kept a diary that was incorporated into Ryan’s ‘The Politics of Mental Handicap’ (1987). The diary details the demeaning objectification of patients: ‘At arrival all semblance of individual personality was removed – all personal possessions, including clothing were not permitted and daily life was controlled by rules and regulations rather than by personal choice.’ (Allday, p34, quoting Ryan, p31-41).
Degrading media reports and staff whistle blowing concerning conditions lead to an increase in public awareness and pressure. One of the first of these was the report of Ely Hospital in 1969. The ‘better Services for the Mentally Handicapped’ White Paper (1971) advocated a 50% reduction in hospital places by 1991 and an increase in the provision of local authority based residential and day care as well as an end to the custodial methods of those hospitals that remained. This paper was one of the first pieces of social policy since the Mental Deficiency Act of 1913 that dealt specifically with the care of people with learning disabilities.
The idea of care in the community first appeared in the Jay Report in 1979 and followed two years later when the government produced the Care in the Community Green Paper in 1981. The same year O ‘Brien’s and Tyne’s five principles of normalisation/service accomplishments were published being community presence, choice, competence, respect and community participation. These translated into a framework on which to base care for people with learning disabilities.
During the last twenty-five years there has been a number of policies and legislative documents influencing the service provision of those with learning disabilities. These have included ‘Caring For people’ White Paper (DoH 1989), The NHS and Community Care Act (1990), ‘Moving into the Mainstream’ (DoH 1998), ‘Signposts for Success’ (DoH 1998), ‘Once a Day’ (DoH 1999). All of these have been aimed towards independent living for those with learning disabilities. Although not specifically inclusive of those with learning disabilities their rights are also covered in the Disability Discrimination Act (1995) and the Human Rights Act (1998).
Recent government reports include the ‘Valuing People’ White Paper in 2001 and legislation culminated in the closure of all mental sub-normality hospitals in 2003. The four main principles of ‘Valuing People’ (DoH, 2001) are rights, independence, choice and inclusion. Its aim was to assist people to become valued as equal citizens and the introduction of what would become person-centred planning.
The meaning of disability has changed over time, both by society and those who regard themselves as having a disability. Lady Mary Wortley Montagu (1689-1762), the wife of the British Ambassador to Turkey, was a victim of smallpox and considered her ailment a disability, hiding her face in public. Henry William Paget (1768-1854), the first Marquis of Anglesey, and Josiah Wedgwood were both amputees who each wore a wooden leg. Nelson lost both an arm and an eye. However, losing a limb or one of the senses does not mean that the individual has a learning disability as there is no intellectual impairment. Some forms of disablement have virtually disappeared such as leprosy (now known as Hansen’s Disease) which during the early medieval period was the single largest disabling condition and resulted in the first institutional response. New disabilities, such as autism, have been recognised. This raises the question of whether autism has always existed (but unnamed during the past) or a recent phenomenon. In 1799, for example, a five year old boy at Bethlem Hospital was described in a case study. He never engaged in play with other children or became attached to them, but played in an absorbed, isolated way with toy soldiers. Some have speculated that Sir Isaac Newton and Lewis Carroll may both have had autism, as both had difficulty with social interaction, compulsive orderliness and eccentric behaviour. However, the application of modern diagnostic criteria to historical figures can only be speculative. [Jarrett, p51].
Concepts of disability change over time. The behaviour of a young child unable to be distracted from screaming or talking to an imaginary friend would not be considered abnormal today whereas it may have been during the past. (Claire Trenery, PhD Candidate Royal Holloway, University of London).
During the Middle Ages and the Renaissance periods idiocy was a legal term applied only to the landowning classes and used to make decisions concerning property inheritance. In the early to mid-19th century the label of idiocy was used for making decisions of who was eligible for parish relief under the poor law. The late 19th and early 20th century terms of ‘feeble minded’ originally meant a child’s failure to achieve adequate scores during school exams. Later the term became inextricably linked with criminality, immorality, intemperance and deviant sexuality, resulting in measures of segregation to prevent the spread of degeneracy. (Gillian Ray-Barruel).
People with learning disabilities during the medieval period would not have been seen as a group needing specialist provision, but would have lived and, if possible, worked alongside their families within their communities. Because of this there was no marginalisation but acceptance of these individuals.
There is a two-edged sword that ...as legislation dating from the early 1900s begins to enshrine rights for the disabled and duties for society/communities/individuals. The more we legislate in the twentieth century to protect the rights of the disabled, the more marginalised a broadly defined group of ‘the disabled’ become in the public mind. (a society largely without protective legislation, but one in which affection, inclusion and a voluntary recognition of basic obligations, even rights, shaped attitudes towards the physically and mentally disabled). The Acts of the 19th century helped to protect those with learning disabilities but at the same time categorised them and therefore marginalised them.
Labels given to people with learning disabilities are largely the result of cultural categorization. Some disabled activists have argued that disability is actually a political idea claiming that the problem is caused by society’s attitude towards people who are considered different. [Jarret, p50]. ‘Intellectual disability’ is an evolving classification that can be linked to social rationales. Historically there has always been a motive for labelling intellectual impairment. Anyone who does not conform to societal roles can expect to be labelled in some way. In order to be eligible for support an individual has to accept that label. (Gillian Ray-Barruel).
Terminology and the use of labels has in the past served as a way of segregating this group of people from society at large. The history of learning disabilities reveals constantly changing concepts and classifications. The current term learning disabilities is not immune from becoming a derogatory phrase and will likely change at some point in the future.
The correlation between disability and fear that existed during the past is linked with the present when Asda began selling a Halloween costume described as a ‘mental patient’ in 2013, consisting of a blood-stained strait jacket, ghoulish mask and a meat cleaver. Tesco similarly offered an orange boiler suit with a jaw restraint as a ‘physco ward’ costume. After complaints the items were subsequently withdrawn from sale.
Disabled people are a part of everyday life and their story should dovetail into national social history. ‘Historically informed understanding of the past is an essential precondition to change and empowerment’ (Allday, p35).
Kathy Allday, ‘From Changling to Citizen. Learning Disability and its Representation in Museums’ in ‘Museum and Society’ March 2009, p32-49.
Helen Atherton, ‘A History of Learning Disabilities’ in ‘Learning Disabilities – Toeards Inclusion’ (4th ed.), Bob Gates (ed.).
Max Chadwick and David Pearson, ‘A History of St Edward’s Hospital.’ (Churnet Valley Books, 1993)
R B Cornwell, ‘The History of Cheddleton Hospital Railway 1985-1954.’ (Self-published 2012).
W Alan Heaton-Ward, ‘Mental Subnormality’, John Wright and Sons 1967, 3rd edition 1972.
Simon Jarrett, ‘Disability in Time and Place’, English Heritage Disability History web content, 2012.
Steve King, ‘The Disabled: Fellow Creatures or Charlatans?’, Director of the Centre for Medical Humanities, April 2013. http://uolmedicalhumanities.wordpress.com/2013/04/23/the-disabled-fellow-creatures-or-charlatans/
Susan Lipscomb, ‘All the King’s Fools’, article published in History Today vol. 61, August 2011.
Alex McClimens and Malcolm Richardson in ‘Learning Disability: A Life Cycle Approach’, 2nd edition, Gordon Grant, Paul Ramcharan, Margaret Flynn and Malcolm Richardson, Open University, 2005.
Gillian Ray-Barruel, ‘The legacy of Specialist Education in Victorian England’, (Griffith University, South-east Queensland, Australia).
Catherine Slater, ‘Idiots, Imbeciles and Intellectual Impairment.’
Peter White, ‘Disability: A New History’, BBC Radio 4, May-June 2013.