Developmental and Physical Disabilities: The "Blind," "Deaf and Dumb," and "Idiot"
DEVELOPMENTAL AND PHYSICAL DISABILITIES: THE "BLIND," "DEAF AND DUMB," AND "IDIOT"
Physically and developmentally disabled individuals occupied the fringe of modern social history. They represented to contemporaries the margins of society, and have been treated by historians accordingly. Individuals with disabilities come into view only to illuminate the pious endeavors of clerics, the revolutionary experiments of medical men, the unselfish generosity of philanthropists, or the pioneering work of educational theorists. Too often, individuals with disabilities are cast as grateful recipients of alms or helpless victims of the historical drama of industrialization—important not for the social reality that they experienced but rather for the advances that "civilised" society has achieved.
PERSPECTIVES ON DISABILITY
The recent emergence of disability studies in academic circles has helped to promote a gradual, if slow, appreciation of disability as a legitimate area of inquiry. Yet despite recent interest, huge gaps in our knowledge remain. Historians are too often faced with the stock character of the medieval "blind beggar," the ubiquitous "village idiot," or the lamentable "deaf and dumb" child. To compensate, some disability researchers overemphasize the great "self-emancipators" who achieved success "despite their disability" or, like John Milton, during their disablement. Little is known of the great mass of individuals who did not conform to these unrepresentative portraits, individuals who carried out quotidian lives in their local communities.
We also know relatively little about the demography of disability in past time. On the one hand, some researchers suggest that, lacking the intervention of modern medical techniques, disability in the early modern period would have been more common than it is today. Developmental disability (through neonatal complications or lead poisoning) and physical disability (such as smallpox-induced blindness) could have contributed to an overabundance of disability in previous centuries. On the other hand, the bare subsistence level at which most people existed might have meant that the life expectancy of those with disabilities was significantly lower than that of the general population. Child abandonment, or even infanticide, of disabled offspring should not be discounted. This may have depressed the numbers of disabled people in past time. Lastly, there may well have been epochs in which certain types of physical disability would have been particularly relevant, such as during and immediately after the great European wars of the nineteenth and twentieth centuries.
The importance disability gained in popular and elite cultures has also ebbed and flowed over the last four centuries. The ideas of the Enlightenment—with its emphasis on the improvability of humankind—directed sustained attention on the moral and ontological status of disabilities. Disabled children in particular became the subject of novel experiments in education, as new medical and philosophical belief systems interacted and informed each other. The disabled become the objects of experimentation and segregation, important as the antithesis of the self-sufficient, educated, physically perfect modern citizen. Disabilities therefore should not be seen as a constant in either an epidemiological or conceptual sense, but as heavily dependent during certain epochs on transformations in society, culture, the economy, and medical science.
Histories of disability place great emphasis on the "backwardness" of premodern attitudes to the "blind," the "deaf and dumb," and the "idiot." However, it is not clear the degree to which poor agricultural communities would have considered, say, deafness as something that, by its very nature, isolated afflicted individuals from their social surroundings. By contrast, the dramatic transformation of European society during the modern era—from local economies dependent primarily upon small-scale agricultural production and local kinship ties to a more impersonal wage-driven industrial society of factories and urbanization—must have boded ill for those who, by the new definition of efficiency, could not compete as effectively as the newly defined "able-bodied." Certain social and economic changes may thus have made certain conditions more "disabling" than they had previously been. Thus, portraying the history of disability as a great upward march from ignorant superstition and social isolation to enlightened scientific medicine and integration is wholly inadequate. The history of disability must be approached with a consideration of the ambiguities of human actions and social change.
This article will summarize the social history of disability in modern Europe. It will draw upon recent historiography to explore the transformation of social welfare, the educational revolution regarding children with disabilities, the medicalization of disability, and the emergence of disability rights. It will look in particular at three disabilities as defined by contemporary society, namely the "blind," the "deaf and dumb," and the "idiot." Contemporary terminology will be used in order to bear witness to popular methods of describing disability in past time. Language tells us a great deal about the understanding of disability. Rather than trying to erase these terms from collective historical memory, we should address the issues they raise and seek to understand why we no longer consider them acceptable in a current context.
DISABILITY AND THE EARLY MODERN STATE
States in early modern Europe have a long history of regulating the property of, and providing relief to, individuals who were incapable of governing their own affairs due to a permanent disability of mind or body. European statutes regarding "idiots"—those defined as having permanent mental infirmity to the extent that they could not govern their own affairs—date back to the thirteenth century, providing ward status for such individuals and setting out the means by which their property would be managed. "Idiots" were recognized as separate and distinct from "lunatics," individuals who had temporarily lost their reason but could still have lucid intervals. This simple distinction between idiots and lunatics reappears repeatedly in legislation governing mental disorder throughout the early modern period and continues in current usage in the differentiation between the developmentally disabled and the mentally ill.
As European states began to organize social relief during the early modern period, other categories of disability and dependency began to appear on the registers of churches, parishes, and towns. Under the Elizabethan Poor Laws, for instance, parishes in England and Wales were responsible for providing relief to their destitute poor, regardless of the cause. The terms "blind" and "deaf and dumb" were widely used by magistrates and overseers of the poor adjudicating on cases of families petitioning for relief in the seventeenth and eighteenth centuries. Overseers of the poor and local magistrates in the England were experienced, if not enthusiastic, in dealing with cases of disability and adopted local solutions to resolve situations in which family and kin care had broken down. In such situations of household crisis, some parishes paid allowances to families to continue caring for dependent relatives within the home; others hired non-related individuals to care for disabled individuals in other households, a system known as "boarding-out." In countries across Europe, Catholic orders took on many of the responsibilities that had been subsumed by civil parishes in Protestant regions. Clergy considered ministering to the disabled as a sign of Christian piety; parables from the Bible describing Jesus tending to the "lame," the "blind," and the "deaf and dumb" provided moral guidance to those who dedicated themselves to the church. Indeed, many churches ran "hospitals" with a changing, and poorly defined, clientele of the sick, the aged, and the disabled.
Religious denominations in Spain experimented with the first organized system of teaching the "deaf and dumb" to communicate. A sixteenth-century Benedictine monk named Pedro Ponce de León adapted for use with the deaf his monastery's system of communicating by signs and gestures. He did this because the deaf were being prevented from joining the priesthood because of an inability to speak. Such restrictions of religious and civil rights of those with disabilities were widespread within Europe at this time. Thus the new techniques championed by Ponce de León and others became important to the propertied and clerical classes. It is probably accurate to say, however, that apart from the aristocracy, local informal traditions of nonverbal communication persisted alongside new techniques formalized by individuals such as Ponce de León. Fragmentary evidence of travel diaries in early modern Europe, for example, describe encounters with "deaf-mutes" who functioned perfectly well within their communities.
Over the course of the eighteenth century, more secularized institutions were increasingly complementing religious provision. In France, the power and wealth of the monarchy enabled successive sovereigns to establish large medical institutions for their disabled and sick poor, such as the Salpêtrière and Bicêtre hospitals in Paris. Creating hospitals for the sick poor was both a means of signifying the wealth of nation-states and a vehicle for engendering popular sympathy for the benevolent dictatorship of autocrats. In response to the growing commercialization of society, there was also an emerging for-profit sector in the eighteenth century, where lay and medical proprietors operated small homes for disabled members of the prospering middle classes, although the extent of the private sector caring seems to have differed dramatically between regions. The impact of the Enlightenment, however, and the growing wealth of most western European countries provided the basis for emerging charities and educational institutions dedicated to teaching and training the disabled.
EDUCATION AND SPECIAL INSTITUTIONS
The second half of the eighteenth century witnessed an explosion of interest in the teaching of disabled children. Jacob Rodriquez Pereire, a Portuguese teacher who emigrated to France, refined techniques for teaching "deaf-mutes" to speak. He gained notoriety teaching children of the French nobility, launching the audist tradition of instruction (placing emphasis on lipreading and the spoken word). In 1760 Louis XV subsidized the establishment of a school for "deaf-mutes," the Institution Nationale des Sourds-Muets (National Institution for Deaf-Mutes) in Paris. In 1776 the French Abbé deL'Épée published a book on the instruction of "deaf-mutes" by "methodological signs," the other dominant tradition of communication now known as signing, or sign language, which he had used at another famous Parisian school, the Institut National de Jeunes Sourds (National Institution for Deaf Youth). Schools for "deaf-mutes" were also opened in Germany and Scotland in the 1760s and the 1770s as the ideas of the Enlightenment spread throughout the educated elite of Europe. Much competition subsequently arose over the presumed advantages and disadvantages of the two competing systems of deaf communication.
Experimentation was also taking place in the education of the "blind." Valentin Haüy opened the Institution Nationale des Jeunes Aveugles (National Institution for Blind Youth) in Paris in 1784. He pioneered the use of embossed print and promoted the education of blind children, as outlined in his Essai sur l'education des aveugles. Encouraged by Diderot's famous Lettres sur les aveugles à l'usage de ceux qui voient (Letter on the blind for the use of those who see; 1749), Haüy refined the practice of reading embossed characters, each representing individual letters. After the Revolution, Haüy migrated eastward, establishing a school in Berlin before settling in Russia. Simultaneously, similarly minded groups, some inspired by the French example, others emerging independently, established schools for the blind, in Liverpool (1791), Vienna (1804), Berlin (1806), Milan (1807), Holland (1808), Prague (1808), Stockholm (1808), St. Petersburg (1809), and Zurich (1809), Copenhagen (1811), Denmark (1811), Aberdeen (1812), Dublin (1816), and Barcelona (1820).
At approximately the same time, Francesco Lana-Terzi's Prodromo, an Italian treatise delineating symbols of lines and dots representing letters of the alphabet, was published in French. Lana's treatise suggested that the characters could be embossed for blind students, a system that was eventually adopted and refined by the French army as a means of reading coded messages in the dark. An officer, Charles Barbier, sent his system to the French National Institution for Deaf-Mutes for use in teaching. One young adult student, Louis Braille, refined the system of embossed dots into simple two-by-three matrices. It was only one of many different systems in use, but its flexibility and simplicity quickly ensured that the Braille method would succeed as the most important system of reading, being endorsed as the approved European method by the end of the nineteenth century.
The establishment of state or philanthropic institutions for the "blind" and the "deaf and dumb" provided an impetus for the creation of a professional medical discourse on the treatment and training of the developmentally disabled. Shortly before Haüy escaped revolutionary France, Jean-Marc-Gaspard Itard, a physician at the Institution Nationale des Sourds-Muets, commenced educational experiments on hearing acquisition and speech formation. As a young physician, he had been brought a mute boy, captured running wild in the woods. Philippe Pinel, the famous psychiatrist who had "unchained" the lunatics at the Salpêtrière Hospital, declared the boy an "incurable idiot." Itard, we are informed, rejected the pessimism of Pinel and sought to "elevate the boy from savagery to civilization." Although Itard largely failed in his endeavor to render Victor (as the boy was sometimes called) "civilized," he did manage to teach him to identify letters and interpret simple words.
The philosophical and social implications of Itard's experiment, published in De l'éducation d'un homme sauvage (Paris, 1801), were widely circulated by the French Academy of Science and influenced similar experimentation in the large French hospitals, particularly by a handful of French physicians associated with the Salpêtrière and Bicêtre hospitals. In 1837 Edouard Séguin, a student of Itard, experimented with the training of idiot children using "physiological" and "psychological" methods. At the Hospice des Incurables and at the Bicêtre he claimed that he achieved success in training "idiot children" to speak, write, and count. In 1841 he published the first of several treatises on the treatment and education of "idiots," most of which were eventually translated into English and German. The mantra that the "idiot could be educated" reverberated across the European medical and philosophical communities.
The apparent success of Itard and Séguin influenced a young Swiss medical student, Jacob Guggenbühl, who had become interested in "cretins." Frustrated by the lack of educational initiatives for their education and treatment, Guggenbühl persuaded the Swiss Association for the Advancement of Science to fund a demographic study of the prevalence of cretinism in his own country. His numerical findings, combined with his enthusiasm for the French school of training and education, sufficiently impressed the Swiss Association that they agreed to subsidize the construction of a small retreat. Guggenbühl built this institution on the side of Abendberg Mountain, in the miasmatic belief that the "odors" and bad air of the Swiss swamps were part of the reason for the high rate of Swiss cretinism. Thus by the 1830s French and Swiss physicians challenged the "irreversability" and "ineducability" of idiocy and associated forms of developmental disability.
Despite the attention being paid to the training of "idiots," "deaf-mutes," and the "blind" at national institutions, local authorities across Europe were not rushing to establish residential schools at taxpayers' expense. Rather, the concern for public order which had been heightened by urbanization and migration prompted the construction of local institutions for "lunatics" throughout the nineteenth century. Medical superintendents of public asylums were overwhelmed by admissions of individuals with a wide range of physical and mental disabilities. A significant minority of admissions to these new mental hospitals were "idiots" and the "deaf and dumb." The pressure of numbers in state asylums, combined with the growing awareness of educational efforts with the disabled, gradually persuaded charitable organizations and civic institutions to establish specialist hospitals for the "blind" and "deaf and dumb," and asylums for idiots across Europe throughout the latter half of the nineteenth century. Institutionalization, however, was not a foregone conclusion, as class, gender, household structure, occupational background, and geographical location dictated the type of accommodation and support those with disability might receive outside the home.
The construction of teaching and residential institutions for disabled individuals provided subjects for the generation of new medical discourses on the etiology and pathophysiology of developmental and physical disability and led to the advent of new inventions for better diagnosis. Hermann Ludwig Ferdinand von Helmholtz invented the ophthalmoscope in 1850, providing more accurate means of observing and measuring pathological processes of the eye. Thereafter followed the invention of the retinoscope, the slit lamp, and other diagnostic tools for eye examination. The utilization of anesthesia and antisepsis in the mid-Victorian period paved the way for later corrective ear and eye operations, such as cataract surgery. Specialist "eye" and "ear, nose, and throat" hospitals were created in the latter half of the nineteenth century as physicians and scientists incorporated rapidly advancing knowledge in cell biology, physiology, anatomy, and bacteriology. Medical specialization also occurred in the area of psychological medicine, as asylum superintendents proposed increasingly detailed lists of mental ages and psychiatric classifications. As medical ideas gained prominence in most western European societies, a new biologically based discourse of disability crept into popular discussion and social policy in the last decades of the nineteenth and first decades of the twentieth centuries; this would profoundly change attitudes to, and the conditions and treatment of, those with disabilities.
Although the establishment of institutions for the disabled was precipitated and encouraged by great intellectual optimism, this sanguine outlook had changed by the end of the nineteenth century. Several factors account for a new popular and professional belief in the relationship between disability and what was then known as "degenerationism." First, urban middle classes in many European countries were beginning to fear an allegedly uncontrollable and physically stunted lumpen proletariat. Second, there was a growing awareness of hereditarian influence in the pathogenesis of diseases, and many commentators felt that mental backwardness and physical disability resulted from a degenerative "taint" passed down through families. With the proliferation of Darwin's views on natural selection, medical treatises and social commentaries increasingly incorporated hereditarianism into their medical explanations of disease etiologies. Societies were conceptualized as competing with each other for survival, what is now known as "social darwinism." Third, national government statistics seemed to suggest a dramatic increase in the numbers of disabled individuals, those deemed the least "fit" of society, while alerting the public to the decline in fertility of the "successful" members of the new middle class. Alarmist commentators suggested that such a differential fertility rate between the "worst" and the "fittest" of society would inevitably lead to social or "race" degeneration. The ideology that formed the basis for the national eugenics movements of the early twentieth century was thus based upon a revolution in intellectual thought, a transformation in the medical understanding of disease, the growing confidence of doctors to become involved in public policy, and the heightened tensions of arms races between industrialized countries.
The advent of national elementary education in Western countries in the last three decades of the nineteenth century also contributed to the heightened fear of the multiplication of individuals with physical and developmental disabilities. Children who had previously been outside the public view were brought into state classrooms and soon caused problems for school officials. Although the Scottish Education Act of 1872 made provision for the education of blind along with seeing children in public schools, teachers in most other European countries complained that children with disabilities disrupted the proper environment for teaching, and education authorities soon agreed to erect separate day or residential schools for the training of children whose disabilities were considered incompatible with regular teaching. Hence local elementary state schools for the "blind," "deaf," and developmentally disabled arose at the turn of the twentieth century and dominated education provision for "handicapped" children for the next eighty years.
Decisions over who were "mentally deficient" and who were not, prompted educators to debate the boundaries between the mentally "normal" and the mentally "subnormal." Charged with a desire for more "accurate" and quantitative measurement of social phenomena, medical practitioners sought measures to quantify "mental subnormality." The most famous of these were devised by the French lawyer Theodore Simon and his psychiatrist student Alfred Binet, whose names were given to the first standardized mental test developed at the Sorbonne between 1900 and 1905. The Simon-Binet test was supplanted in 1915 by the intelligence quotient (IQ), a mathematical score ranked on a normal distribution curve. The IQ test purported to give medical doctors and educationalists a finer instrument for discriminating between and among populations of children. From then onward, vague social categories, such as "idiot," "imbecile," "moron," "feebleminded," and "backward" were associated with numerical equivalents and increased scientific legitimacy.
Armed with new and apparently more accurate measurements of intelligence, with social surveys purporting to show the link between hereditary mental disability and crime, and with the fear over the differential fertility rate, eugenics movements emerged within intellectual circles in most European countries during the first three decades of the twentieth century. Borrowing their name from Francis Galton's term for "well-born," eugenicists actively encouraged the state to promote what they termed "racial hygiene" through selective breeding. Although national movements took on different characteristics, the common elements were a belief in the hereditarian nature of disability, the close association of mental disability with other social evils, and the belief that the disabled were "breeding" at a rate outstripping more "fit" elements of society. Public policy became centered on the needs of society to segregate and control the "feebleminded" and other disabled individuals. Moreover, campaigns began in many countries to forcibly sterilize disabled women who were thought to be "at risk" of breeding further "degenerates" and to restrict the fertility of disabled individuals who were thought to be likely to pass on their disability to future generations.
In Nazi Germany, the confluence of eugenics, a highly racialized polity, and the heightened extremism of war-torn Europe led first to segregation and later to the sterilization and, ultimately, the murder of thousands of disabled individuals. The 1933 Sterilization Act attempted to advance the cause of racial hygiene by instituting the mandatory sterilization of all people with disabilities linked to heredity, including deafness, "mental deficiency," and blindness. The execution of "mentally deficient," physically disabled, and elderly individuals in hospitals constituted the first, and sometimes forgotten, wave in the Nazi "Final Solution." Although precise figures are difficult to determine, well over a hundred thousand developmentally and physically disabled children and adults were executed by firing squad or gassed in the concentration camps in Germany and Poland between 1940 and 1945. Rather than seeing the extermination of the disabled as a horrific but unique act, it is more sensible to see it as the most extreme consequence of a new professional and popular collectivist discourse on disability that was shared across Western society.
Despite the experience of the Holocaust, many of the interwar policies of segregation and sterilization continued in European countries for decades after the end of the war. Institutions for the "mentally deficient" grew to enormous proportions in the 1950s and 1960s, housing many patients from early childhood until death. Many European countries, particularly the Scandinavian nations, continued to have policies of "voluntary" sterilization and "euthanasia," whereby parents could take their handicapped children to undergo surgery, or where disabled children were not giving life-sustaining treatment due to their disability. The emergence of prenatal screening techniques, such as amniocentesis, permitted family practitioners and obstetricians to counsel parents to terminate pregnancies in the cases of fetuses with genetic abnormalities, such as Down's syndrome. These decisions made about selective procreation, which might have decreased the overall number of those children born with severe disabilities, were counterbalanced by medical and public-health changes that led to increasing life expectancy of those born with disabilities and, by the 1980s, to the survival of significantly premature babies who have developed severe mental and physical disabilities later in life.
Meanwhile residential schools continued to evolve throughout the period 1945 to 1970 into separate communities distinct from and independent of society. Starting from the very beginning of the twentieth century, schools for the "blind" and schools for the "deaf " built additional "sheltered workshops" where the pupils (many of them adults) could work at trades and offset the costs to their families and to the state. A widely accepted public discourse prevailed whereby separate institutions, most often residential, were considered better for the disabled individual and better for the family. Disability became a condition requiring removal from general society into specialized institutions.
This dominant attitude was challenged during the 1960s, when civil-rights movements in North America and Europe addressed the status of social groups marginalized by gender, race, language, or disability. Wolf Wolfensberger, among others, articulated a set of policies, broadly known as the ideology of "normalization," which sought to place the disabled in a "culturally normative" set of social roles and experiences. The focus of his critique was a set of residential facilities and educational policies that sought to segregate the disabled from society, ostensibly for their own benefit. Normalization, by contrast, sought to eliminate special schools and residential facilities and reintegrate the disabled into society. The last three decades of the twentieth century were dominated by the debate over "streaming" versus "destreaming." Gradually many large, long-stay institutions for the "mentally retarded," for the "blind," and for the "deaf " have been closed, or dramatically reduced in size, and replaced by integration in "normal" schools and by accommodation in smaller group homes.
The language used to describe certain types of disability has also changed dramatically. Advocacy groups have argued that older terms such as "the mentally deficient," "the blind," and "deaf and dumb" (and their continental linguistic equivalents) stigmatize the individual concerned and influence negatively the social options open to them. Many groups advocate placing people first, hence people with disabilities, people with developmental handicaps. Others have gone further by arguing for the absence of any disability descriptor and for emphasizing the plurality of abilities which all individuals share. This view has been particularly pronounced in the field of hearing impairment, where some researchers challenge the conceptual framework of deafness as a disability, preferring to see people with hearing and speech impairment as communicating in a visual rather than auditory world. The debate over the role of language in the labeling of individuals and in their possible stigmatization continues to rage throughout society and government.
Just as the language describing disability has changed, so too has the composition of that group of individuals seen or labeled as disabled. The demographic revolution in European countries over the last two centuries, from young societies under siege from infectious diseases to older societies suffering from chronic ailments, has altered the stereotypes of disability. Impairments of hearing, sight, and cognitive functioning are becoming more and more common among an increasingly numerous population of the elderly. In the public mind, a disabled person is more and more likely to be old, rather than the disabled child typical of Enlightenment discourse. Moreover, disability is no longer viewed as an either/or proposition (someone is either blind or not). Advocacy groups emphasize that disability constitutes a spectrum of impairment.
Most recently, disability rights groups have called for access (on all levels) to social programs and activities, with some success. The physical infrastructure of society has been gradually transformed by wheelchair ramps, braille lettering on elevators, and a thousand other minor but important alterations making government and leisure services accessible to those who previously could not use them. Such changes have been hard-won. Advocacy groups have taken their campaign for disability rights to legal as well as political remedies. The European Court, with its own declaration of rights to which all European Union nations are bound, has acted as a vehicle against overt and subtle discrimination against people with disabilities.
The social history of people with disabilities has thus been one of profound ambiguities and contradictions, of real and Pyrrhic victories. Nor has the experience been uniform across different types of disability. Economic changes in European countries toward an "information-based society" pose fewest problems for the hearing impaired and more for the visually impaired. Recent closures of long-stay residential institutions for individuals with hearing or visual impairment have proved successful—less so for the severely developmentally disabled. The emergence in the last two decades of the twentieth century of a culture of extended work hours, a renewed emphasis on individual responsibility and self-sufficiency, and the fragmentation of the nuclear household has left many developmentally disabled individuals alone in the community and as devalued by society as ever. Accommodating the needs and aspirations of people with disabilities in the postinstitutional era remains one of the most demanding challenges facing modern European societies.
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