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The beginning of the 20th Century marked a major step in the history of medicine and the status of persons with disabilities. Plagues were mostly gone thanks to better public health, improved hygiene and basic preventive medical care. However, there were still influenza epidemics, infant mortality was high, deadly infections often accompanied surgery, and many diseases were still untreatable. But many people were surviving who once would have died.

These are U.S. veterans wounded in World War I. Throughout history, nations have honored injured soldiers, trying to make up for their personal losses in the defense of their country. World War I was the first time a large proportion of battle victims survived - often with visible or invisible scars. Disabilities included the amputations pictured above, reduced lung capacity from being gassed, "shell shock", head injuries, and the myriad of other reminders of the horrors of war.

Men and women were returning to their communities with physical and mental limitations that restricted their ability to work. "Affirmative Action" began with preferences for these veterans. In 1918, Congress passed a Soldiers' Rehabilitation Act providing vocational retraining for veterans with physical impairments that limited their career choices. This was a way to "make up" for these unintended consequences.

These are residents in an institution for the "feeble minded" in a mid-western state. Large institutions like this existed in every state to care for persons with mental retardation or mental illness. The institutions were usually in rural areas and had large campuses, similar to a university campus but even more comprehensive.

By this time, treatment for mental illness had become activity based - "Idle hands are the Devil's workshop." Institutions had their own farms, dairies, wood and metal working shops, police and fire departments, and housing for staff. Inmates did the vast amount of work needed to keep the institution running, including cooking, custodial work, and even personal services for resident staff.

The general philosophy of the first half of the century was to provide adequate, if primitive, care for people with mental disabilities. Others made decisions for them and everyone assumed "inmates"/patients needed life long care. The inmates got uniforms and work assignments to provide them an orderly life. This segregation from the "normal community" was rationalized on the basis of safety for the residents. They were being cared for where they were "comfortable".

This picture of women institutionalized for mental illness is not from the early part of the century but from the late 1950's - well within the lifetime of many people alive today. The families of institutionalized people were often ashamed of them and sometimes even denied they existed.

This photograph from the early 1960's shows dramatically the quality of institutional care. According to typical promotional pamphlets for such institutions, these patients are getting "individualized care", "close medical supervision", and a "therapeutic environment". Despite the good intentions of society, the reality of institutional care was very bleak. The back wards of institutions were often holding areas for a person's entire future. By its very nature, this kind of segregation led to inadequate care, poor facilities, and loss of dignity. There was no chance for independence or productivity.

During the mid-1960's a radical "deinstitutionalization revolution" began. It was supposed to end the often cruel and inadequate care of institutions. The idea was that individuals would live in their communities and have a "normalized" life. Group homes, residential care facilities, and rooming houses were developed, where persons with similar disabilities could live together. The problem was that, although the residents were now in their neighborhood communities, there were no supports to help them be part of the communities. The new living facilities, in effect, became "mini-institutions".

Until persons with significant disabilities could get supports for meaningful employment and community participation, they would still be an invisible part of society. Integration and inclusion were still dreams, and mini-institutions were not the way to realize them.

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