CHAPTER TWO
2.3 Intellectual disability
2.3.1 History of intellectual disability
Harris (2006) gives a historical account of intellectual disability in his book, titled Intellectual disability: understanding its development, causes, classification, evaluation, and treatment. He sheds light on the development of the concept, institutionalisation, the legal rights of PWID, and de-institutionalisation.
31 According to the author, the history of intellectual disability dates back to 1300 B.C.-476 A.D., when Greeks practised infanticide due to a belief among ancient Greeks and Romans that congenital deformity was a sign that a god was displeased with the parents. He further notes that this era witnessed marginalisation and exclusion of PWD, with those with intellectual disability being denied their rights due to the perceived severity of their disability. During the Middle Ages (476 A.D.-1500 A.D.), both positive and negative perceptions of intellectual disability were recorded. Some thought that disabilities were demonic in origin and required cures from the clergy, whereas another line of thought was more sympathetic and adopted community support of PWD. The idea of institutionalisation of persons with intellectual impairment also started in the Middle Ages, with the establishment of religious hospices in countries like France, Syria and Turkey. In addition, this era marked the beginning of biological aetiology of intellectual disability and the distinction between intellectual and mental disability, though this was for the purpose of property law, which did not favour PWID.
The scientific approach that emerged at the beginning of the seventeenth century paved the way for the systematic study of intellectual disability (Harris, 2006). This new approach opened people‘s eyes to poverty among PWD, and the English Poor Law subsequently made provision for them. Though accompanied by stigma, the administration of welfare was no longer principally the responsibility of families but rather relied on community support. Hence the development of institutions for PWD in the United States (US) started in 1652 and continued slowly until the 1820s.
He states further that the eighteenth century witnessed a greater trend towards institutionalisation as a result of intellectual revolution associated with the Renaissance and the Enlightenment periods. Human beings had opportunities to become educated and it was widely believed that humankind was capable of altering the natural order. The development of professions then led to the establishment of more schools and institutions in Europe and US.
In the nineteenth century the first attempt to educate somebody with intellectual disability occurred. Jean-Marc-Gaspard Itard showed that it was indeed possible to educate somebody with intellectual disability by using specialised education and behaviour treatment. His action led to more organised education for the intellectually impaired, first in Switzerland, and later in Europe
32 and the US. Following Itard, Seguin developed a physiological method to prove that intellectual disability is a condition that starts at an early age and is irreversible. He also proposed that severely intellectually disabled children could benefit from normal classroom education through institutionalisation.
Institutions for the training of individuals with intellectual disability proliferated in the nineteenth century in Europe and the US. The first institution specifically for intellectual disability opened in the US in 1848. This was the solution proffered for the management of social problems and changes that accompanied urbanisation and the influx of immigrants to the US at that time. However, many of the PWID trained in these institutions had been productive in their communities and became unemployed following the Civil War and the economic recession.
Consequently, less emphasis on education and return to the community by the institutions and the negative attitudes of the general population towards those with intellectual impairment led to the suggestion of lifelong institutionalisation. Despite Howe‘s and Seguin‘s support for community living for this category of people, the governments were adamant in supporting lifelong institutionalisation, emphasising the institutions‘ economic viability.
Furthermore, new techniques for diagnosis, treatment and education for all types of disability were developed. Those with similar types of disability began to identify with each other and formed groups. The first classification of intellectual disability was produced by scientists who established multiple aetiology, as well as different levels of the condition.
Harris (2006) refers to the twentieth century as the era of intellectual testing. By this time, it had been documented that there were 21 countries that operated 171 institutions for PWID all over the world. Psychometric tests were developed in 1905 by two French physicians, Alfred Binet and Theodore Simon, because a means to select children for specialised education based on their abilities was needed. The tests were introduced in the US in 1912 by Henry Goddard, specifically for diagnosing intellectual disability. The intelligence tests soon replaced the individualised clinical evaluation due to their objective and scientific nature. Later, a tripartite classification: idiots (mental age < 2 years), imbeciles (mental age < 7 years), and morons (mental age < 12 years) was proposed by the Committee on Classification of the Feeble-Minded of the American Association of Mental Deficiency.
33 This new development, coupled with an interest in eugenics, gave rise to more emphasis on the study of the heredity of intellectual disability. The eugenics movement proposed that intellectual disability was hereditary and reportedly higher among criminals and the poor. Therefore, intellectual disability was concluded to be the cause of antisocial behaviour. The interface between intelligence and life experiences like poverty, neglect, early mistreatment and limited cognitive capacity and their relationship with antisocial behaviour was overlooked. Intelligence tests developed after 1900 were said to serve both positive and negative purposes: they were used to place children in special education classes and to discriminate against immigrants entering the US on a class basis. The negative stereotypes applied to PWID climaxed with Goddard‘s study of the Kallikaks. The study linked antisocial behaviour to intellectual impairment, and proposed that it was hereditary rather than socially transmitted. People with mild intellectual disability were then declared dangerous to society and a reservoir of even more intellectually disabled persons due to their sexual promiscuity. This marked the introduction of sterilisation of PWID in institutions.
A few researchers like Fernald and Wallace carried out studies that dispelled the misconceptions surrounding deviance in PWID (Harris, 2006). They showed that only about 8.0% of children with intellectual disability had behavioural problems and also disputed the assumed link between intellectual disability and criminality. Some inmates of institutions were thus discharged to live in communities, under the guardianship of relatives, friends and volunteers.
Harris (2006) relates further that scientific studies flourished during this time despite eugenics and the abuse perpetrated in institutions, which led to the finding that phenylketonuria is a metabolic disorder that results in intellectual disability and is reversible through proper diet.
Efforts to research other aetiology of intellectual disability were then intensified. Parents began to advocate remedial programmes for their wards with intellectual disability, and came together to form the National Association for the Retarded Children in the US (now The Arc of the United States). President J.F. Kennedy‘s interest in PWID, brought about through the intervention of his sister, Eunice Kennedy Shriver, was a major breakthrough for PWID in the US. This culminated into legislation to improve the standard of living of PWID in all 50 states.
The principle of normalisation was introduced. With better access to education and treatment,
34 residents of institutions were allowed to live in the communities, and many of the institutions closed down. President J.F. Kennedy set up University Affiliated Research Centres for the study of intellectual disability in all 50 states, which are still in existence today.
With the advent of international legal instruments, the barriers preventing PWD from leading prosperous lives were broken down. Even though there are still a few institutions in some states in the US, the living conditions therein have improved tremendously over the years.