Before proceeding back in history, we offer these definitions to clarify our use of terms:
condition: a biological, psychological, cognitive or sensory state
impairment: a biological, psychological, cognitive or sensory state that is atypical and publicly acknowledged
diagnostic condition: atypical condition that is publicly asserted by a medical professional
In early western civilizations, the limits of “humanness” were drawn at normal body composition. Thus, the classification of "human" was not extended to infants who were physically deformed. However, impairments such as sensory and mobility deficits, lameness or illness were recognized and described as human variations. Thus, the description of what constituted anomaly was specific to visible sensory and physical functioning. What are labeled today as mental retardation and mental illness were not classified as human inadequacy. These variations in behavior, while often feared because of the belief that they were supernatural, were respected as well.
The explanation for activity limitations in mobility, seeing, hearing and so forth were both moral and supernatural. Descriptive conditions such as "not seeing" or "not hearing" were believed to be caused by the gods for sinful acts, either by the afflicted individual or by an ancestor. Personality traits were often ascribed on the basis of specific impairments (e.g. deafness=lack of intelligence) (Hanson, 1999).
While the explanation for human variation in activity at this time was essentially not scientific, Aristotle's early scientific studies and systematic descriptive ordering of the observable world provided a means to identify what was 'natural,' through what we would consider empirical or at least logical methods. At the same time, Hippocrates' development of medicine and the application of empirical knowledge to treating illness placed rational thought somewhat in opposition to previous mystic explanations of atypical activity (Braddock & Parrish, 2001).
Thus, descriptions and to some extent explanations of atypical human activity moved from supernatural to natural, yet the moral element of "the unnatural" still prevailed. Similar to our art and media today, the value attributed to specific conditions could be inferred from cultural myths. Those with visible conditions were 'marked' with inferior qualities, while those who acted in a manner consistent with what we classify today as mental retardation or mental illnesses were respected as citizens because they were 'possessed' of special knowledge about the will of the gods unknown to the rest of the community.
When atypical activity was explained in moral terms, formal services for people considered immoral not surprisingly were not known to exist. However, when atypical performance resulted from war injury, where the cause was known and considered to be heroic, some cities maintained a pension fund to be made available. (To what extent funds were disbursed to women is not known; however, women were not allowed citizenship status and likely were not eligible for funds.) The "care" provided to those who with severe deformities was exposure to the elements and death. So as far back as ancient civilizations, variations of the human condition were identified in contrast to what was typical, and value-based explanations for extreme variation were supported while others were not tolerated. The limited development of scientific theory coupled with the strong spirituality of ancient Greece was operational in ascribing meanings to what people did and didn't do. The attention and resources given publicly were determined from those meanings.
Atypical activity is not frequently discussed in the literature on early Jewish civilizations (Abrams, 1998). The minimal references to appearance and daily activity that were considered to be flawed reveals that the nature of one's role in the community was in large part what determined what was typical and expected activity. Of particular relevance to this discussion is the prohibition of those who were "blemished" from the Priesthood, because of spiritual beliefs that priests were the direct link between God and the earth. However, congregation members did not carry those same expectations and those with atypical appearance were permitted to be full participants in spiritual activity. Even with the permission to worship, those who were atypical in Jewish communities were in large part viewed as punished by God. The explanation for atypical appearance and activity was therefore spiritual and moral as was the obligation for care of such individuals.
In the Middle Ages, it is interesting to note that the "typical" included human activity consistent with many conditions that today are classified as anomalous. According to historical researchers, so many individuals lived in poverty and squalor that they were the rule rather than the exception. And thus their appearance and activity, resulting from exposure to severe living conditions, were not considered out of the ordinary. Illness, and limitations in mobility and sensation (blindness, deafness and so forth) were not at all unusual in poor communities. Further, given the limited knowledge about disease and nutrition, even the wealthy experienced illness and activity limitation considered preventable today (Braddock & Parrish, 2001).
Scholars have noted the existence of various competing explanations for visible atypical activity. Among them were both religious spiritual explanations and explanations of demonology (Braddock & Parrish, 2001). Reflecting the disparate views of the times, some medieval documents show that "cripples" were viewed as part of a group that included "criminals, the sick, and paupers". However, other works make the distinction between the treatable sick and the untreatable "lepers, lame, one-armed and blind". The small likelihood of survival for those who were unable to thrive at birth eliminated consideration of birth-based atypical activity from the literature or history of medieval times.
Individuals who behaved, communicated or expressed thoughts differently from others were regarded as evil or as demons. This religious explanation for activity that today is classified as mental illness was not surprising, given the Catholic Church's dominance in the western world at the time. However, simplicity in cognitive activity that today would be regarded as mental retardation was explained as the possession of divine inspiration, or a blessing given by God (Winzer, 1997).
Due to the variety of explanations for the occurrences of difference in activity and appearance, treatment and community responses were variable. Of particular note was the growth of institutional and charity approaches (Winzer, 1997). It was not unusual to find members of the clergy involved with providing medical treatment, and thus hospitals were often located near monasteries. (Castiglioni, 1941). In addition, people who could not see or think, among other human differences, were often the objects of faith-healing, a practice which provided concrete evidence of God's love, presence and power. Charity in the form of service and almsgiving exonerated the giver in the eyes of God, once again providing a purposive explanation for the extremes of human difference.
Particularly through the work of St. Francis of Assisi, the suffering of the poor and sick (e.g. lepers) glorified the recipients of care (Stiker, 1999), as well those providing care. However, due to such widespread poverty, those needing protracted care were often forced to beg for survival. This phenomenon is reflected in the artwork of the times in which beggars are depicted as individuals who are blind and lame.
Not all differences were met with charity however. In areas where the population believed in demonology, those who behaved in ways that were considered "mad" were feared and persecuted as witches. Increasing social disorder in part was attributed to such individuals and their murders therefore served as a rallying point for the masses.
In summary, the Middle Ages brought some important changes in the way that atypical human activity was conceptualized, explained and treated. Due to the hegemony of the church, explanations and purposes for human anomaly were anchored in religion and morality. Religion-based institutions were created, in part to segregate "unusual individuals" from the public, and in part to protect, treat and care for them.
As belief in demonology was slowly being replaced by science at the end of the middle ages, views of difference were drastically altered. Advances in knowledge about the anatomy and physiology of the human body contributed to a growing sense that illness and differences in human activity occurred from that which could be observed in the physical world. These views are reflected in the literature and art of the renaissance period. For example, Francis Bacon was particularly important in advancing systematic study of these observable phenomena. In 1605 he published The Advancement of Learning, Divine and Human, in which he refuted the notion of moral punishment as the cause for behavior that was considered to be "mad". Humanism in art emphasizing actual knowledge of underlying physical form (Braddock & Parrish, 2001) also emerged at this time, providing detailed depictions of the human body.
This is not to say that moral explanations of difference in human activity ever disappeared, as philosophers, clergy and others continued to debate the relationship between God and nature. Questions about the purposive or serendipitous nature of anomaly were tackled and many of the competing explanations that were posited remain operative and influential today.
As Stiker (1999) points out, explanations for the distinction between birth-based and acquired human activity conditions were developed during this time and served as platforms for value distinctions as well. For example, birth-based failures in activities necessary for typical growth were explained as 'monstrosity,' while limitations in what individuals did that resulted from observable explanations such as injury were regarded as natural. As in the past, the treatment of people who behaved and did activity in atypical manners was in large part influenced by how these behaviors were explained. At this juncture, we begin to see the emergence of praxis, which introduces the attribution of human activity and change to social and other complex contextual factors.
The extent to which social explanations for human activity ebbed and flowed was and still is associated with scarcity or affluence and order or disruption in communities. For example, the category of “poor” often contained a disproportionate number of individuals who exhibited atypical activity and appearance. Social explanations for these differences were met with resources while explanation seated in individual blame were not.
Those who were not blamed for their unusual behavior or who were not seen as dangers were often supported in the communities. Thus, we see the clear link between explanation and care. Those who were perceived as out of the ordinary were treated differentially depending on how the community viewed the worth of the reasons for, and results of, their differences.
Individuals who were considered atypical but who were born into wealthy families had different experiences than those who required assistance to survive in communities (Stiker, 1999). Access to medical treatments for limitations with medical explanations did exist and was available to those who could pay for them.
Institutions for people who behaved in ways that were considered to be mad proliferated during the seventeenth century. These served to remove unusual behaviors from public view rather than as a means to change behavior. Moreover, the manner in which people were treated in institutions was extremely harsh, clearly indicating the devaluation of institutional residents.
Chapter Two continues on next page.