Abandoned to Their Fate: Social Policy and Practice toward Severely Retarded People in America, 1820-1920.

Historians often choose their topics for very personal reasons. Some are perhaps even unaware of what drives them to explore and understand certain facets of the past. Philip Ferguson has few such unconscious impulses. He is passionate about his subject and his motivations. At the heart of the book, he says, is his son, Ian, "who will not read my thanks to him." And there is also Peter, whom Ferguson refers to in the introduction. Fitting the label of "profoundly retarded" or "multiply challenged," Peter at age seventeen could neither walk nor talk nor sit up unsupported. He received nourishment through a tube and was subject to frequent, powerful seizures that could knock him to the ground. "He had a spindly body twisted by muscles that never relaxed, and by years of therapy never received." This book was written for and about Peter and others like him.

Philip Ferguson's work is important because it draws a distinction between mental illness and mental retardation, in today's terminology, and between the idiot and the insane of the past. Insanity was perceived as an "acute" condition, treatable and even curable. Idiocy or imbecility, in contrast, was chronic, lifelong and hopeless. There were those who could be taught to work and to function within society, but the "losers," those like Peter, throughout history and even today have been "abandoned to their fate."

The distinctions made between the idiot and the insane derive not only from biology and genetics, but from society's perceptions and the diverse policies of care instituted for each of these "disabled" groups. Out of step with much of the historical literature, which focuses on the history of policy and treatment toward the insane, Ferguson strives to understand something of the quality of life for people who in the past were labeled as idiots and low-grade imbeciles. Although his argument is somewhat contextual, he follows the chronology of social policy and practice toward the severely retarded from the era of the poorhouse through the peak of Progressivism in the decade of the 1920s. The first half of the book is devoted to the legacy of the almshouse and the rise of the idiot asylum. The remainder of the book expands upon the author's research of the records of the Rome State Custodial Asylum for Unteachable Idiots (later the Rome Developmental Center) in Rome, New York. Unlike much of the standard historical treatment of mental retardation, Ferguson begins his story with the poorhouse rather than the purportedly "enlightened" leadership of such notables as Samuel Gridley Howe and H.B. Wilbur who in the mid-nineteenth century espoused, for a time at least, the educability and even curability of idiocy within specialized institutions. In contrast, Ferguson posits the persistence of custodialism (as opposed to rehabilitation) throughout the nineteenth and early twentieth centuries and finds the source for such policy in the confines of the almshouse. Beginning early in the nineteenth century the contradictory purposes of the almshouse, to care for the truly needy while yet deterring the "undeserving," able-bodied poor, set the stage for the systematic classification of all grades of dependency. And it was in the almshouse, says Ferguson, that "the connection between chronicity and the economics of 'uselessness' became institutionalized."

This is a study of the "history of failure," claims Ferguson, and more precisely, a study of the "professionalization of failure" by means of the social construction and application of the concept of chronicity. Within the cultural milieu of the nineteenth century, "curability" was based on a standard of economic utility. Improvement or reform of the individual was simply not enough. Usefulness and productivity were the key to success. In the end, "chronicity proved more durable than reform," as the category of chronicity itself was used by the professional community to explain away its failures. "Ironically," says Ferguson, "the claims that some could be cured through medical diagnoses and proper education, left those who were still judged incurable ever more bereft of hope than before."

The author contends that a pattern of failed reform pervades the history of the care and treatment of the severely retarded, whether set within the context of the almshouse, the "experimental schools" for the severely retarded of the 1850s and 1860s, or Charles Bernstein's progressive farm and domestic colonies (group homes) of the Rome Custodial Asylum in the early twentieth century. According to Ferguson, the pattern of historical change in the treatment and care of the severely retarded has been neither evolutionary nor revolutionary, but rather, "involutionary." From the era of the county almshouse through the period of congregate care and the centralization of services under the New York State Care Act of 1890, policy initiatives and reform became ever more detailed and intricate, but in the end produced little essential change. At least from the narrower point of view of severe retardation, conditions remained "more elaborately the same."

Ferguson's book leaves one asking a number of questions. He admits as much himself and elaborates on a few "remaining questions" in his concluding chapter. In particular, he makes frequent reference to the amazing number of mentally retarded people who remained in their own communities; living with family or friends. Throughout the nineteenth century, the mentally retarded more commonly were cared for in the local almshouse or within their own homes than in specialized institutions. Ferguson, in fact, questions one of the staples of mental retardation history, that the rise of mental retardation institutions was largely a response to the pleas of parents for the state to take responsibility for their retarded offspring. Ferguson might have done well to explore this issue further, particularly since the records of the Rome State Custodial Asylum appear to provide evidence that even the idiot asylums were places of last, not first, resort for most families. Ferguson suggests, and rightfully so, that there is "a need for historians to break out of the institution and greatly increase our understanding of how families with disabled members, mild or severe, have functioned in their communities, at all levels of society."

Finally, Ferguson maintains the premise that the lives of individuals saddled with multiple disabilities have as yet changed little, even with the supposed advances of de institutionalization of the late twentieth century and recent federal legislation to balance the social inequities suffered by the disabled. His notions of betterment and reform for the severely retarded seem starkly idealistic for a practitioner such as himself. The struggle, he says, is not only to make the disabled appear more normal, but to overturn our culturally enforced notions of "body beautiful" and "individual appeal" and to strike at the utilitarian ethic that lies at the very core of modern society.

The question still remains, how might the lives of the severely retarded been different in the past or even today? If justice and mercy and benevolent care are not enough, what can we expect? What would have been a fulfilling life for Peter - to learn to hold his head up, to respond to sound, to swallow? Is the gift of life enough? Ferguson thinks not. The severely retarded have always been and continue to remain untouched by reform. Perhaps he is correct in his belief that "our society still seems to need a place to abandon its failures."

Judith Dulberger American History Partnership Consultants, Youngstown, OH