History of Events Dealing With Mental Retardation
Guest lecture by Bruce Pacht, 2/22/96
A Very Brief Run Through of Some Significant Historical Perspectives,
People, and Events
Freely adapted from A History of Mental Retardation, R.C. Scheerenberger, Brookes Publishing Co. (Baltimore, 1983).
No differentiation between his words and other's words quoted
Very Early Evidence
- 45.000 years ago - "Shandar I" - Neanderthal, age 40; underdeveloped right shoulder
blade, collarbone and upper right, arm amputation; arthritis,
bone scar tissue right side of face. "The stone heap over his
remains, and the mammal food remains, show that even in death,
his person was an object of some esteem, if not respect, born
out of close association against a hostile outside."
- 12,000 years ago - some modern humans ceased being nomads; began agriculture,
symbiolic reasoning, rural and urban living. Physiological changes:
increased ratio of brain to body weight, enlarged frontal and
temporal lobes, increased number of neural synapses
- 7,000 B.C. - treatment for mental and physical ills:
- empirical practitioner: massages, baths, extractions, blood-lettings,
herbs, "trephination" = removal of small circular sections of
cranial bones then worn as amulets to expel demons
- shamans - fetishes, amulets, talismans
- 2500 B.C. - Hammurabi's code. In general, "Disease and mental disorder
were viewed as a punishment by G-d or a possession by evil spirits
or the devil. Diseases, both mental and physical, were considered
impure or taboo."
- 1500 B.C. - Egyptian papyri. ". . . reflect a practice that was to continue
until the seventeenth century. While wounds arising from external
sources were studies in terms of cause and effect, symptoms without
a wound were usually attributed to a common physiological cause
or to the spirits or gods. All diseases regardless of symptoms
arose from some common disturbance of the body. This attitude
severely hampered not only the advance of medical science, but
also the understanding of mental retardation and its associated
- 500-400 B.C. from the Torah
- Thou shalt not curse the deaf, nor put a stumbling block before
- Cursed be he that maketh the blind to wander out of the way.
- Ye shall not afflict any widow, or fatherless child
- If there be among you a poor man of one of thy brethren within
they gates in thy land which the Lord thy G giveth thee, thou
shalt not harden thine heart, nor shut thine hand from thy poor
brother; but thou shalt open thine hand wide unto him and shall
surely lend him sufficient for his need, in that which he wanteth.
Abortion, infanticide, celibacy and other means of limiting the
population were held in ill repute. Kids could still be sold into
Greece and Rome
- Plato (427-347 B.C.): The best of either sex should be united with the best as often,
and the inferior with the inferior, as seldom as possible; and
that they should rear the offspring of the one sort of union but
not of the other, if the flock is to be maintained in first rate
condition . . . the offspring of the inferior, or of the better
when they chance to be deformed, will be put away
- Aristotle (384-322 B.C.): As to the exposure and rearing of children, let there be a law
that no deformed child shall live."
- Sparta: only the strongest and brightest were to have children; lending
of wives; infanticide.
- Athens: 3rd Cent. B.C. "infanticide became a common practice; most baby girls were automatically
destroyed. Kids sold as slaves.
- Hippocrates (460-370 B.C.) - writings began to show concern for children and a separation
of their illnesses from those of adults. Health involved relationship
of 4 humors: blood (heart), phlegm (liver), yellow bile (spleen),
and black bile (brain). Believe that epilepsy had "a natural cause";
this and his belief that nature was the great healer moved medicine
into humans' hands instead of the gods.
- 500 B.C. early Roman republic - father's power absolute to kill, mutilate or sell kids.
- Augustus a humanitarian - "at one time, over 50 percent of the population
was receiving some form of governmental assistance, usually food."
- 1st century - Slavery and massive poverty resulted in children being viewed
as liabilities instead of assets. Mutiliation to increase value
as beggards (Seneca the elder).
- 138-201 Claudius Galen - The Father of Experimental Neurology: The brain is the seat
of many intellectual functions; accurately described cranial bones,
ascertained that damage to one side of the brain manifests in
disorders on the opposite side.
- "Slow thinking is due to the brain's heaviness. Its firmness and
stability produce the faculty of memory. Imbecility results from
the rarefaction and diminution in quality of the animal spirits
and from the coldness and humidity of the brain.
- 110-130 Soranus - hospital providing humane treatment for people with mental
illness (possibly also some m.r.) Rest, sympathy, reading, and
participation in dramatic performances.
- 2nd century - Any type of defective person became a popular source of household
amusement; Durant: there was a special market where one might
purchase "legless, armless, or 3-eyed men, giants, dwarfs, or
hermaphrodites." 4th cent. Christianity's influence diminished
From Antiquity to the Enlightenment
- Maimonides (1135-1204): The brain of the phlegmatic man, which is too humid, produces
mental retardation. However, phlegmatic persons, if properly instructed,
can make some intellectual progress, even though such learning
would be very difficult.
- Paracelsus (1493-1541) distinguished between mental illness and mental retardation:
Many are those who are ill who are not thought to be mentally
sick. For as fools (simpletons, feeble-minded) are of many kinds,
so also are there many kinds of crazy people not of one sort nor
in one way, but in many ways, of many sorts, in many patterns
and forms. Feeble-minded persons behave in the way of a health
animal, but the psychopathic in the manner of an irrational animal.
- Felix Platter (1536-1614): First described "mental alienation" including both mental retardation
and mental illness. This notion persisted into the early 20th
century with those interested in the practice of psychiatry being
known as "alienists". First described a multi-level description
of mental retardation:
- "Now we see many (foolish or simple from the beginning) who even
in infancy showed signed of simplicity in their movements and
laughter, who did not pay attention easily, or who are docile
and yet they do not learn. If anyone asks them to do any kind
of task, they laugh and joke, they cajole, and they make mischief.
They take great delight and seem satisifed in the habit of these
simple actions, and so they are taught in their homes.
"We have known others who are less foolish, who correctly attend
to many tasks of life, who are able to perform certain skills,
yet they show their dullness, in that they long to be praised,
and at the same time they say and do foolish things.
"Some people have dullness from before birth. Such persons have
deformed heads, or they spoke with a large and swollen tongue
and at the same time with a humorous throat, or they were deformed
in their general appearance."
- Ambroise Pare - Monstres et Prodiges 1573: 13 reasons for such conditions as 2-headed girls, "goat-boys"
and hairy girls:
- G's glory
- G's wrath
- too much semen
- too little semen
- narrowness or smallness of the womb
- unbecoming position of the mother, who, while pregnant remains
seated too long with her thighs crossed or pressed against her
- a fall or blows struck against the stomach of the mother during
- the rotting or the corruption of the semen
- heredity or accidental illnesses
- mingling or mixture of seed
- artifice of wandering beggars
- 1497 Frankfurt-am-Main: Idiots were not only to be kept, but confined by their friends;
and when means failed them, then only did municipal authorites
intervene, though they occasionally assisted the families with
sums of money."
Where did most people with mental retardation live? monasteries, hospitals, charitable facilities, prisons, almshouses,
pesthouses, workhouses, warehouses, and other buildings most of
which had lost their original usefulness.
ONE EXCEPTION: the family-care approach used by the citizens of
Belgium (still in effect). Gheel became a refuge and haven for "the mental
afflicted" beginning in the seventh century; primary focus on
19th cent. commentator: The patients were treated as members of the families in whose
homes they had lived. They had their own bedrooms, ate meals with
the family, and engaged in all family activities. Many were given
responsibilities, such as babysitting and other family chores.
Many were employed in the town and on farms. They could use all
the community facilities. Painting, drawing, and gardening were
encouraged. A change of scence was viewed as beneficial, so picnics
and other outings were organized.
This approach not adopted by other Euorpean countries until the
late 19th cent., and in the US not until Charles Vaux during the
1247 - Sheriff of London gave estate and land to the Bishop and Church
of Bethlem for the purpose of building a hospital. Now believed
to be the oldest providing continuous service in Europe, was converted
to a mental asylum in 1377; first patients (both MI and MR) transferred
from an old store house located much too close to the King's Palace.
Bethlem soon earned the title "Bedlum". 1398 inventory: 4 pair
of manacles, 11 chains of irons, 6 locks and keys, 2 stocks --
for 20 patients.
Dark cells were common and sexes mixed. Few staff and low quality.
"Patients are ordered to be bled about the latter end of May,
according to the weather; and after they have been bled, they
take vomits, once a week for a certain number of weeks; after
that we purge all thepatients."
Until 1770, Bethlem was one of London's favorite tourist spots.
Sir Thomas More:
"For thou shalt in Bedlum see one laugh at the knocking of his
own head against a post, and yet there is little pleasure therein."
1606 The Hotel Dieu ordered by King to tend all mentally ill and idiot
people: The patients were herded together in rooms crowded with
miserable beds in which they were put without distinction of disease;
there were two, four, six, and even twelve people bedded together
in various positions; one can easily imagine how sanitary this
Francis Bacon (1561-1626): knowledge about the world is acquired through sensory experience;
discovery, investigation, and explanations of things could be
accomplished only by controlled observation and experimentation.
Recalls Roger Bacon (1214-1292) - philosophical teachings must
be verified with the facts of experience and experimentation.
Rene Descartes (1596-1650): true understanding of the natural world would come through
the proper application of mathematical principles and deductive
Thomas Hobbes (1588-1679): purpose of philosophy is determined cause and effect relationships.
John Locke An Essay Concerning Human Understanding 1690 - at birth, the
mind is a blank table; no one is born with innate ideas. All ideas
come from experiences, either from sensation or reflection. Man
is rational, and ahumane, enlightened social order is possible.
"Herein seems to lie the difference between idiots and madmen,
that madmen put wrong ideas together and reason from hem, but
idiots make very few or no propositions and reason scarce at al."
Jean-Jacques Rousseau (1712-1778): Key notions: the natural child, self-direction,
and the importance of sensory training and experiences:
In the North American British Colonies and Early United States
1660 - First Almshouse - Boston
1727 - First House of Corrections - All rogues, vagabonds, and idle
persons going about in town or country begging, or common pipers,
fiddlers, runaways, drunkards, wanton and lascivious perons, railers
or brawlers, also persons under distraction and unfit to go at large, whose friends
do not take care for their safe confinement,
1751 - First Hospital in Philadelphia separates a section for people
with mental retardation and people with mental illness; by 1756,
it's int he cellar, puts people on display for a slight fee .
1771 - First Workhouse - Philadelphia
1773 - Virginia - first hospital solely for "these miserable Objects
who cannot help themselves"; 1769 law "to make provision for the
support and maintenance of idiots, lunatics and other people of
unsound mind:. Next one is 50 years later, 1824 in Lexington,
1773 - First Poorhouse
1787 - Benjamin Rush (1745-1813) signed Declaration of Independence,
physician, describes Pennsylvania Hospital:
"Here were both men and women, between went and thirty in number.
Some of them have beds, most of them clean straw. Some of them
were extremely fierce and raving, nearly or quite naked; some
singing and dancing; some in despair, some were dumb and would
not open their mouths; others incessantly talking . . . Everything
about them, notwithstanding the labor and trouble it must have
required, was neat and clean."
1818 - American Asylum for the Deaf and Dumb - Hartford, CT, began
to provide the first recognized residential service intended specifically
for people with mental retardation in the US. After 1820, "all
but the smallest of communities placed a greater reliance of the
almshouse and its derivatives, as well as the mental hospital."
"Bidding out" - the pauper and the person with mental retardation were sold
to someone who would provide cheaply their care and maintenance.
"Warning out" - informing a newcomer that the town would not be responsible
for his misfortunes.
"Passing on" - loading people with mental retardation or mental illness into
a cart, transporting them to another town, and leaving them there.
Alms houses intended for the poor became general holding pens
for all sorts of children, aged and infirm adults, sick people,