Disability History 101 – The Rise of the Institution

by Savannah Logsdon-Breakstone

Institutionalization: a core part of what many think of when talking about our history of disability in the United States. But where did the practice come from?

The origin for institutionalization of people with disabilities isn’t a unified one. For each of the general populations or subsections of disability, there is a different origin. In this post, we will cover Mental Health Disabilities and Intellectual and Developmental Disabilities. These aren’t holistic attempts to cover institutionalization, but simply an introduction to the origins of the practice in these populations.

Institutions and Mental Health Disabilities

The origin of institutions for those with mental health disabilities is a long and complicated one. The institutionalization of some individuals with the most behavioral outbursts dates back to the 13th century, but the history of institutionalization for the reasons in the United States stems more from criminalization than treatment.

In the “colonial era”–that is, pre-revolutionary European occupied America–institutionalization wasn’t an option. Either you were left to your own devices, or you were put into jail as a criminal. The term “committed suicide” comes from this portion of our history. Suicide was not struck from all state’s list of felonies until the 1990s, and even attempted suicide was historically considered as a crime equivalent to attempted murder.

Suicide attempts weren’t the only crimes or “crimes” that a person with a mental health disability might find themselves jailed for. Certain municipalities or towns made laws requiring a license to beg, allowing a wider range of the poor–including those with disabilities–to be put in pauper’s prisons. Others might be imprisoned for petty crimes and then held for longer terms than their fellow inmates without disabilities.

When the idea of treating those with mental health disabilities came, it gave the impression of kindness–in some eyes, unearned kindness–to place individuals in “hospitals” specializing in Mental Health. 1773 marked the opening of the first such institution in the United States. Over the next 100 years, many new such hospitals opened, changing in design based on the latest theories of the time.

It is interesting to note that the transition of mental health disabilities (MHDs) from criminal to illnesses corresponds roughly with political and social unease. There is some evidence to suggest that the changes in thought about the role of the citizen in a democratic republic were at play. As the US worked to define how we would assign the roles and responsibilities of our citizens, new thought was given to those with MHDs as well.

Some even cited people with MHDs as a threat to the new social and political structures rather than the simple public nuisance of the past. That the “insane” might have access to the rights of citizenship to make decisions in our society caused some political thinkers to support the movement towards long term hospitalization. These same thinkers then provided or guided funding as those seeking “humane” and “moral” treatment were building what would eventually become a system of institutionalization.

Institutions and Intellectual and Developmental Disabilities

The use of institutionalization for those with intellectual and developmental disabilities is influenced more by economic factors than the political ones dealt with by those with MHDs. Rather than a protective stance that even jailing those with MHDs came from, it was a fairly utilitarian desire to teach those with intellectual and developmental disabilities that they might work. These ideals would later become restrictive in the name of protection of society from the “feeble-minded menace.”

In the face of a world that was changing economically, certain thinkers in the early 19th century began to advocate educating those who were seen as “feeble-minded” that they might provide for themselves. Economic pressures were making it more and more difficult for families to continue educating or caring for family members on their own. Initially, only those who showed promise for education were waccepted to the schools established for such education. Over time, these became boarding schools.

It wasn’t until the states promised funding that schools for the feeble-minded began accepting those with more extensive care needs. Indeed, the initial motivations of education and placement in employment in the community was slowly being undermined by economic interests. Not only was there more funding for custodial care over time, but economic fluctuations made it more and more difficult to place even trained individuals in the community.

By the time that eugenics and images of the feeble-minded as a threat to society emerged, the idea of custodial and institutional care was already in place. These new images created more pressure to continue the trends, and between 1880 and 1900 the intellectually disabled/developmentally disabled population institutionalized rose from a little over 4,000 to 15,000.

The origins of the practice of institutionalization has varied across types of disabilities.  Here we have given a short history of some of the justifications for these practices.  A familiarity with our history is paramount to understanding where we are today.  De-institutionalization continues today.  For more information on the current de-institutionalization movement, visit ADAPT, an organization which is engaged in civil action in Washington DC this week in the name of de-institutionalization.