History of Events Dealing With Mental Retardation

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 by him.

• 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 causes.
• 500-400 B.C. from the Torah
  • Thou shalt not curse the deaf, nor put a stumbling block before the blind.
  • 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 slavery.

• 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 killing kids.

• 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
  • Imagination
  • 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 stomach
  • a fall or blows struck against the stomach of the mother during pregnancy
  • 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 Gheel, Belgium (still in effect). Gheel became a refuge and haven for "the mental afflicted" beginning in the seventh century; primary focus on family care.

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 1930s.

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. Tuke:

"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 was!

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 reasoning.

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. Recognized difference:

"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:

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, KY

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, etc.