Early Medical Explanations for Mental Retardation

In 1690, the English philosopher John Locke published his influential work, "An Essay Concerning Human Understanding," in which he posed a theory that the mind is a blank slate; thoughts, beliefs, and personality were not innate but rather things that were learned by way of the senses and experience. This new understanding was a breakthrough in that it set the stage for a view of people as creatures capable of learning who could benefit from corrective experience and therapies. In many ways, the introduction of this philosophical viewpoint into European society set the stage for the modern conception of therapy and education.

Locke was one of the first thinkers to differentiate between mental retardation and other forms of madness. In Locke's view, "Herein seems to lie the difference between idiots and madmen, that madmen put wrong ideas together and reason from them, but idiots make very few or no propositions and reason scarce at all (Doll, 1962, p. 23)."

By the end of the Middle Ages, most insane people and mentally retarded individuals were confined to poorly run asylums. These large facilities were warehouses that piled the mentally retarded on top of the mentally ill, and offered no useful treatment or education. They served instead to segregate the deformed from normal society. These hospitals were sites of neglect and abuse; the quality of life among institutionalized people was pitiable. It was common practice to detain mentally retarded people indefinitely within these neglectful hospitals; however, some have argued that as bad as they these institutions were, being detained was a better fate than being left to fend for one's self or imprisoned.

Major reforms occurred as the medical causes of mental retardation and other mental illnesses became better understood, and as a culture of psychotherapy and medical advances became the norm of the twentieth century. Before such reforms could occur, however, the cultural understanding of mental retardation had to shift. The first major shift that occurred was that society came to understand mental retardation as a result of medical problems and not of divine justice.

Swiss physiognomists Johann Caspar Lavater wrote "Essays on Physiognomy (1797,)" a book that was very influential during the eighteenth and nineteenth centuries. Physiognomists believed that an individual's appearance provided important information about his personality. Lavater's book included hundreds of drawings of individuals with various physical characteristics and related those characteristics to their inner workings.

Lavater's studies had a huge impact on the treatment of individuals who committed crimes. He believed that criminal behavior was caused by sickness and the individual was not at fault for the behavior. He postulated that the mind had sections that controlled certain aspects of personality and if one section became overdeveloped or underdeveloped, the result might be a lack of control over behavior. A person might therefore engage in criminal behaviors because he lacked understanding and control, and not because he chose to do so. Lavater's idea to relate physical traits to personality did ultimately keep individuals with mental retardation who committed crimes from suffering the harshest consequences, because it helped judges of the day to recognize that they were not firm of judgment in the first place, as was evidenced by the many telltale physical and behavioral signs commonly associated with mental retardation.

Enlightened writings such as those Locke and Lavater produced helped move European society toward a view of mental retardation as a form of illness that could benefit from therapy. This shift did not banish the older, more prejudicial attitudes, however. S.G. Howe's "On the Causes of Idiocy," written in 1846, reflects common misconceptions of mental retardation at the time. He suggests that mental retardation as well as mental illness were caused by an individual's actions. The affected person may have broken the laws of nature, or one or both of his parents have done so. The sources of mental retardation were believed to be an unhealthy lifestyle, marriages between blood relatives, heredity, gluttony, and excessive or questionable sexual activity. Such negative attitudes toward individuals with mental retardation have persisted over the centuries and are still readily detectable within contemporary society.

Though Howe's causal theory of mental retardation was not taken seriously for long, he made a lasting contribution to the way that mental retardation is described by offering one of the first classification schemes for mental retardation that sorted more pronouncedly impaired individuals from less impaired folk. Howe was one of the first writers to classify retarded individuals according to the severity of their impairments. For example, Howe referred to the profoundly retarded as 'heaps of skin and bone in the shape of a human'.

According to Howe, Fools were a subdivision of Idiots, who had some muscle control and some cognitive functioning. This group was thought to have almost no reasoning skills and major delays in speech. The third division was the Simpletons, who demonstrated nearly perfect motor skills and enough reasoning skills to complete daily activities with little guidance, but had difficulty functioning within society.