Treating the disabled

Throughout the eighteenth and nineteenth centuries the policy of segregating severely disabled people into institutions slowly increased and was subsequently extended to other disadvantaged groups.[1] The term ‘institution’ can refer to a variety of social organisations but refers here to ‘any long term provision of a highly organized kind on a residential basis with the expressed aims of ‘care’, ‘treatment’ or ‘custody’.[2] They included hospitals, asylums, workhouses and prisons. One explanation for this important break with the past links it to the breakdown of early forms of state welfare in the face of large-scale industrialisation and the inevitable spread of poverty that followed.[3] But the impetus to build institutions came before the growth of cities and was more pronounced in rural communities.[4] The widespread incarceration of disabled people is directly attributable to the transition from agriculture and cottage-based industries to the large-scale factory type system: The speed of factory work, the enforced discipline and time-keeping were a highly unfavourable change from the slower, more self-determined and flexible methods of work into which many handicapped people had been integrated.[5] Such arguments tend to play down the general antipathy that surrounded disability before the Industrial Revolution but it is clear that the economic and social conditions created by the new system compounded the difficulties faced by disabled people.[6]

The system of Poor Law relief that had survived since Elizabethan times was directly at odds with the ascending free market economy.[7] Waged labour made the distinction between able-bodied and non-able-bodied poor important since parochial relief to the able-bodied poor interfered with labour mobility. Segregating the poor into institutions had several advantages over domestic relief; it was efficient, acted as deterrent to the able-bodied malingerer and could instill good work habits into the inmates. These conclusions are reflected in the Report of the Poor Law Commission and the Poor Law Amendment Act of 1834. The Poor Law Commission ruled that the workhouses should separate the inmates into four different groupings--able-bodied males, able-bodied females, children, and the ‘aged and infirm’. It was intended that the latter, or those perceived as the ‘deserving poor’, were to be housed in different buildings and accorded different treatment. These categories were later refined.

Poor Law Officials developed four specific categories for dealing with the non-able bodied poor. They were the ‘sick’, the ‘insane’, ‘defectives’, and the ‘aged and infirm’.[8] The term ‘sick’ described people with acute, temporary or infectious diseases who automatically qualified for outdoor relief if it was available. But where incarceration was deemed necessary, separate accommodation was usually provided, although the conditions in these facilities were rarely better than those in the workhouse. The ‘insane’ were singled out for special treatment from the outset. Despite the difficulties of definition and diagnosis, there was already a universal recognition of the ‘problem’ posed by people with mental illness. There were two main strategies for dealing with it. People termed. ‘idiots’,[9] ‘lunatics’, ‘mad’, ‘mentally infirm’, or ‘suffering from diseases of the brain’[10] were either admitted to an asylum or boarded out on contract to families willing to be held responsible for them.

Several private asylums had been established in the seventeenth century. But the public outcry over the atrocious conditions in many of these establishments, brought to light by Evangelical reformers, forced the Government into setting up a state-run system in 1845 under the Lunacy Commission.[11] The cruelty accorded to people perceived as mentally ill inside institutions was often no worse than that which they encountered in the community at large. Until 1871 Poor Law officials had no right to detain citizens in an institution against their will, but this did not apply to people termed insane. Prior to the Lunacy Legislation of 1845, the certification of insanity was the responsibility of local lay officials but confirmation of mental illness was now valid only if a doctor was involved. This change has been attributed to doctors’ assertions that mental illness had physiological causes and was responsive to medical treatment, and their successful struggle for control within private and public institutions.[12] Once defined as mentally ill, individuals could be detained on a doctor’s recommendation and moved from one institution to another against their will.[13]  The term ‘defectives’ was used to describe people with sensory impairments such as blindness, deafness and the lack of speech. After 1903, people with epilepsy and children termed ‘mentally sub-normal’ were also included in this category. Individuals in this group were still liable to be institutionalised and their treatment was no different from that of other inmates but they were frequently singled out for special attention by Victorian philanthropists and charities. Many of the charities that exist today were founded during this period. For instance, the British and Foreign Association for Promoting the Education of the Blind, now known as the Royal National Institute for the Blind (RNIB), was formed in 1863 and the National Institute for the Deaf in 1924.[14] ‘Aged and infirm’, the oldest of the four categories, referred to people with chronic illness and/or permanent impairments. While there was little official controversy over their eligibility for outdoor relief, more often than not they too were directed into an institutional setting.

Towards the end of the nineteenth century, pressures to detain people classified as belonging to one of these categories increased dramatically. First, the transition from relatively light industries such as textiles to the much heavier capital goods industries like iron, steel and the railways, in what has been called the ‘second phase of industrialization’, further emphasised the importance of physical fitness as a condition for finding work among working people. Welfare policies, particularly with regard to outdoor relief, were also severely tightened during the 1870s and 1880s due to escalating costs because of rising unemployment. after a decade of economic depression that began with the severe winter of 1860-1861. This put more pressure on local authorities to apply the ‘workhouse test’ to anyone seeking aid. Thirdly, there was a further expansion of segregated institutions for the non-able-bodied poor following another set of public scandals and government enquiries exposing the appalling conditions in workhouses.

The number of disabled people consigned to these establishments rose and did not fall until the 1950s.[15] Ideological legitimacy for the intensified oppression of disabled people during the eighteenth and nineteenth centuries can be found in contemporary philosophies that stressed the rights and privileges of the individual over those of the group or state in relation to property rights, politics and culture. Charles Darwin’s On the Origin of Species published in 1859  provided ‘scientific’ authenticity placing emphasis on the process of natural selection, the survival of the fittest, the notion that evolution is progress and that progress is inherently beneficial. It was adapted from the biological domain to apply to human societies into what later became known as ‘Social Darwinism’. [16] The Eugenics movement emerged from the general tendency to apply Darwin’s theories to human affairs. Concerned mainly with what they saw as racial degeneration through the birth of disabled children, the Eugenicists reiterated ancient fears that disabled people were a serious threat to British and European society.

The Eugenics Society was founded in 1907 arguing that women were the guardians of the future of the British ‘race’ and that they should be both chaste and fruitful. Although the focus was on the working-classes, there were public denunciations by Rudyard Kipling and others of the debilitating ‘sloth and pleasure-seeking’ of the upper classes. Eugenics, the science of race improvement through human selective breeding saw women largely as mothers rather than as citizens.[17] At its height in the early-twentieth century, the eugenics movement swept up individuals of all political persuasions including H. G. Wells, Harold Laski, John Maynard Keynes, Arthur Balfour, Conservative Prime Minister and the young Neville Chamberlain who looked to this branch of biology to achieve that qualitative improvement in human beings necessary for the advancement of national efficiency.[18] Preventive societies utilised the rhetoric of eugenics and medicine to persuade governments to enact legislation on sexual matters when they were not always willing to legislate on such issues. This was evident in the Mental Deficiency Act of 1913 that gave local authorities powers over pregnant women who were homeless, destitute or immoral and many were admitted to hospitals for the mentally ill, where some became long-term residents.  Most of the policies were dealt pragmatically with particular issues rather than as part of a national strategy. 

The work of Galton,[19] Dugdale[20] and Goddard[21] reinforced traditional myths that there were genetic links between physical and mental impairments, crime, unemployment and other social evils. The stated aim of the Eugenicists was to improve the British race by preventing the reproduction of ‘defectives’ by means of sterilization and segregation. In 1896, the National Association for the Care and Control of the Feeble Minded was set up as a pressure group for the life time segregation of disabled people. During the 1910 General Election it campaigned vigorously on these issues. In the following two decades eugenic fears were further endorsed by the invention and widespread use of Intelligence Quotient (IQ) tests in British schools. Their inventors, the French psychologists Binet and Simon and principal advocates, notably the psychologist Cyril Burt, asserted confidently that intelligence is innate and that the majority of defectives were uneducable.[22] Eugenic fears were prevalent throughout the 1920s and 1930s. For instance, in 1934, the Report of the Departmental Committee on Sterilization chaired by Lord Brock recommended legislation to ensure the ‘voluntary’ sterilisation of ‘mentally defective women’.[23] Although such legislation was never passed in Britain--unlike America, where sterilisation was legalised in 32 states[24]--this did not prevent many such operations being carried out under various degrres of coercion.

The evolution of the welfare state during the 1940s led to official policy to disabled people move in favour of a more overtly paternalistic approach. This can be explained by reference to the humanitarian influence of the Victorian philanthropists, the general concern felt toward disabled ex-servicemen during and after the 1914-1918 and 1939-1945 wars, the changing political climate and the prospect of a buoyant economy.[25] World War One exposed the public to disability on a massive scale and this led to a change in attitude to disability.  The state, wishing to save money, did not take a uniform approach to the disabled and disability. For instance, disabled industrial workers were not considered for pensions, benefits, or rehabilitation in the same way that the war disabled were. Yet, the main funding for many disabled ex-servicemen was left largely to charitable and voluntary agencies, a pattern continued after World War One. An aspect of war disability is mentally disabled ex-servicemen especially those suffering from shell shock.[26] The seeds of cooperation between doctors, charities and government was established during and after the First World War but it was not until World War Two that a modern, organised system of rehabilitation was implemented. An expansion of these and similar facilities was recommended by the Tomlinson Report.[27]

The economic and social upheavals brought about by the depression in the 1930s, in conjunction with the need for national unity during and immediately after the war stimulated a concern for welfare programmes that had previously been absent. This resulted in a flurry of legislation which was to have a significant impact on the lives of disabled people. The first legislation to treat disabled people as a single group was the Disabled Persons (Employment) Act 1944 that attemptied to ensure that employers employed disabled people and made provision for a variety of rehabilitation services and vocational training courses. The 1944 Education Act stated that children should receive education suitable for their age, ability and aptitude and obliged local education authorities to provide special educational treatment for those thought to need it. The National Health Service Act 1946 provided for the acute medical needs of disabled people and made it possible for local authority health departments to provide any medical aids necessary to enable disabled people to live in their own homes. Finally, the National Assistance Act of 1948 made some provision for meeting the financial needs of disabled people, and mandated local authorities to provide residential facilities and services for people who are substantially and permanently handicapped by illness, injury or congenital deformity.

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[1] Eghigian, Greg, (ed.), The Routledge History of Madness and Mental Health, (Routledge), 2017, pp. 1-16, 101-134, Pietikainen, Petteri, Madness: A History, (Routledge), 2015, provide useful overviews.

[2] Jones, K., and Fowles, A. J., Ideas on Institutions: Analysing the Literature on Long-term Care and Custody, (Routledge), 1984,  p. 207.

[3] Mechanic, David, ‘The Influence of Mothers on Their Children's Health Attitudes and Behavior’, Pediatrics, Vol. 33, (1964), pp. 444-453.

[4] Ingelby, David, ‘Ideology and the human sciences: Some comments on the role of reification in psychology and psychiatry’, Human Context, Vol. 2, (2), (1970), pp. 159-187, reprinted in Pateman, Trevor, (ed.), Counter Course: a handbook for course criticism, (Penguin), 1972, pp. 51-81.

[5] Ryan J., and Thomas F., The Politics of Mental Handicap, (Free Association), 1987, p. 101.

[6] Stone, J., Precedent and Law: Dynamics of common law growth (Butterworths), 1985, Borsay, Anne, Disability and Social Policy in Britain since 1750: A History of Exclusion, (Palgrave), 2004.

[7] Mounsey, Chris, (ed.), The Idea of Disability in the Eighteenth Century, (Bucknell University Press), 2014.

[8] For classification see, Martin Duncan, P., and Millard, A Manual for the Classification, Training and Education of the Feeble-Minded, Imbecile and Idiotic, (), 1866.  Bartlett, Peter, The Poor Law of Lunacy, (Leicester University Press), 1999, pp. 151-196.

[9] McDonagh, Patrick, Idiocy: A Cultural History, (Liverpool University Press), 2008, pp. 1-23, 192-230.

[10] Scull, Andrew, Museums of Madness: The Social Organization of Insanity in Nineteenth-century England, (Allen Lane), 1978, and ‘Museums of Madness Revisited’, Social History of Medicine, Vol. 6, (1993), pp. 3-23.  Porter, Roy, Mind Forg’d Manacles: A History of Mandness in England from the Restoration to the Regency, (Harvard University Press), 1987, Scull, Andrew T., MacKenzie, Charlotte, and Hervey, Nicholas, Masters of Bedlam: The Transformation of the Mad-doctoring Trade, (Princeton University Press), 1996, Scull, Andrew, The Lost Solitary of Afflictions: Madness and Society in Britain, 1700-1900, (Yale University Press), 1993.

[11] Smith, Leonard D., ‘Cure, Comfort and Safe Custody’.  Public Lunatic Asylums in Early Nineteenth-Century England, (Leicester University Press), 1999, excellent local studies of asylum management.  See also his Lunatic Hospitals in Georgian England 1750-1830, (Routledge), 2007, pp. 21-48, 137-164.

[12] Scull, Andrew, Decarceration: Community Treatment and the Deviant—A Radical View, (Polity Press), 1984.

[13] Appignanesi, Lisa, Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present, (Virago), 2008, Wright, David, Mental Disability in Victorian England, (Oxford University Press), 2001.

[14] Phillips, G. A., The Blind in British Society: Charity, State and Community c.1780-1930, (Ashgate), 2004, Reiss, Matthias, Blind Workers against Charity: The National League of the Blind of Great Britain and Ireland, 1893-1970, (Springer), 2015, Gooday, Graeme, and Sayer, Karen, Managing the Experience of Hearing Loss in Britain 1830-1930, (Palgrave Pivot), 2007.

[15] Ibid, Scull, Andrew, Decarceration.

[16] Hawkins, Mike, Social Darwinism in European and American Thought 1860-1945, (Cambridge University Press), 1997, pp. 3-60, and Paul, Diane B., ‘Darwin, social Darwinism and eugenics’, in Hodge, Jonathan, and Radick, Gregory, (eds.), The Cambridge Companion to Darwin, (Cambridge University Press), 2003, pp. 214-239.

[17] Richardson, Angélique, Love and Eugenics in the late Nineteenth Century: Rational reproduction and the New Woman, (Oxford University Press), 2003.

[18] Pearson, Karl, Darwinism, medical progress and eugenics: the Cavendish lecture 1912.

[19] Galton, Francis, Hereditary Genius: An Inquiry into its Laws and Consequences, (D. Appleton), 1870, Bulmer, Michael, Francis Galton: Pioneer of Heredity and Biometry, (JHU Press), 2004.

[20] Dugdale, R. L., The Jukes: A study in crime, pauperism, disease, and heredity, (G. P. Putnam’s Sons), 1910.

[21] Goddard, H. H., Juvenile Delinquency, (Dodd, Mead), 1921.

[22] Hearnshaw, L. S., Cyril Burt: Psychologist, (Hodder and Stoughton), 1979, Fletcher, Ronald, Science, Ideology and the Media: The Cyril Burt Scandal, (Routledge), 2017..

[23] L. G. Brock, chairman, ‘Memorandum regarding foreign laws on the subject of sterilisation’, p. 109-130, ‘Memorandum regarding foreign invesigations into mental deficiency’, p. 131-134, Command paper: Cmd. 4485; Whitney, Leon F., The Case for Sterilisation, (Bodley Press), 1935.

[24] Ladd-Taylor, Molly, Fixing the Poor: Eugenic Sterilization and Child Welfare in the Twentieth Century, (John Hopkins University Press), 2017.

[25] Anderson, Judie, War, Disability and Rehabitation in Britain: Soul of the Nation, (Manchester University Press), 2011.

[26] Leese, P., Shell Shock, Traumatic Neurosis and the British Soldiers of the First World War, (Palgrave Macmillan), 2002; Reid, F., Broken Men: Shell Shock, Treatment and Recovery in Britain 1914-1930, (Continuum), 2010; and Holden, W., Shell Shock, (Channel 4 Books), 2001.

[27] Tomlinson Committee on Rehabilitation and Resettlement of Disabled Persons, 1941-1944.