Mental retardation historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Historical Perspective

The term "Mental retardation" has acquired pejorative and shameful connotations over the last few decades and is now used almost exclusively in in The United States in technical or scientific contexts.

  • In North America the broad term developmental delay has become an increasingly preferred synonym by many parents and direct support professionals. Elsewhere, however, developmental delay is generally used to imply that appropriate intervention will improve or completely eliminate the condition, allowing for "catching up." Importantly, this term carries the emotionally powerful idea that the individual's current difficulties are likely to be temporary.
  • Developmental disability is preferred by most physicians, but can also refer to any other physical or psychiatric delay, such as delayed puberty.
  • The phrase intellectual disability is increasingly being used as a synonym for people with significantly below-average IQ.[1] These terms are sometimes used as a means of separating general intellectual limitations from specific, limited deficits as well as indicating that it is not an emotional or psychological disability. Intellectual disability is also used to describe the outcome of traumatic brain injury or lead poisoning or dementing conditions such as Alzheimer's disease. It is not specific to congenital conditions like Down syndrome.

The American Association on Mental Retardation continued to use the term mental retardation until 2006.[2] In June 2006 its members voted to change the name of the organisation to the "American Association on Intellectual and Developmental Disabilities," rejecting the options to become the AAID or AADD. Part of the rationale for the double name was that many of the members worked with people with autism and Asperger syndrome, also known as pervasive developmental disorders, not all of whom were also mentally retarded.

In the UK, "mental handicap" had become the common medical term, replacing "mental subnormality" in Scotland and "mental deficiency" in England and Wales, until Stephen Dorrell, Secretary of State for Health in England and Wales from 1995-7, changed the NHS's designation to "learning disability." The new term is not yet widely understood, and is often taken to refer to problems affecting schoolwork (the American usage): which are known in the UK as "learning difficulties." British social workers may use "learning difficulty" to refer to both people with MR and those with conditions such as dyslexia.

In England and Wales the Mental Health Act 1983 defines "mental impairment" and "severe mental impairment" as "a state of arrested or incomplete development of mind which includes significant/severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned."[3] As behavior is involved, these are not necessarily permanent conditions: they are defined for the purpose of authorising detention in hospital or guardianship. However, English statute law uses "mental impairment" elsewhere in a less well-defined manner—e.g. to allow exemption from taxes—implying that mental retardation without any behavioural problems is what is meant. Mental Impairment is scheduled to be removed from the Act when it is amended in 2008.

Traditional terms

Several traditional terms denoting varying degrees of mental deficiency long predate psychiatry, but have since been subject to the euphemism treadmill. In common usage they are simple forms of abuse. Their now-obsolete use as psychiatric technical definitions is of purely historical interest. They are often encountered in old documents such as books, academic papers, and census forms (for example, the British census of 1901 has a column heading including the terms imbecile and feeble-minded).

There have been some efforts made among mental health professionals to discourage use of these terms, but as long as intelligence is seen to contribute to social and financial success, children will use any term they believe to mean "unintelligent" as an insult. In addition to the terms below, the abbreviation retard or tard is still used as a generic insult, especially among children and teens. A BBC survey in 2003 ranked retard as the most offensive disability-related word, ahead of terms such as spastic (not considered offensive in America) and mong.[4]

  • Cretin is the oldest and probably comes from an old French word for Christian. The implication was that people with significant intellectual or developmental disabilities were "still human" (or "still Christian") and deserved to be treated with basic human dignity. This term has not been used in any serious or scientific endeavor since the middle of the 20th century and is now always considered a term of abuse: notably, in the 1964 movie Becket (film), King Henry II calls his son and heir a "cretin." "Cretinism" is also used as an obsolescent term to refer to the condition of congenital hypothyroidism, in which there is some degree of mental retardation.
  • Idiot indicated the greatest degree of intellectual disability, where the mental age is two years or less, and the person cannot guard himself or herself against common physical dangers. The term was gradually replaced by the term profound mental retardation.
  • Imbecile indicated an intellectual disability less extreme than idiocy and not necessarily inherited. It is now usually subdivided into two categories, known as severe mental retardation and moderate mental retardation.
  • Moron was defined by the American Association for the Study of the Feeble-minded in 1910, following work by Henry H. Goddard, as the term for an adult with a mental age between eight and twelve; mild mental retardation is now the term for this condition. Alternative definitions of these terms based on IQ were also used. This group was known in UK law from 1911 to 1959/60 as "feeble-minded."
  • Usage has changed over the years, and differed from country to country, which needs to be borne in mind when looking at older books and papers. For example, "mental retardation" in some contexts covers the whole field, but used to apply to what is now the mild MR group. "Feeble-minded" used to mean mild MR in the UK, and once applied in the US to the whole field. "Borderline MR" is not currently defined, but the term may be used to apply to people with IQs in the 70s. People with IQs of 70 to 85 used to be eligible for special consideration in the US public education system on grounds of mental retardation.
  • Along with the changes in terminology, and the downward drift in acceptability of the old terms, institutions of all kinds have had to repeatedly change their names. This affects the names of schools, hospitals, societies, government departments, and academic journals. For example, the Midlands Institute of Mental Subnormality became the British Institute of Mental Handicap and is now the British Institute of Learning Disability. This phenomenon is shared with mental health and motor disabilities, and seen to a lesser degree in sensory disabilities.

References

  1. MENCAP: Website of the UK's leading learning disability charity. Retrieved 28 June 2006
  2. "AAIDD POSITION STATEMENTS". Retrieved 2007-08-23.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  3. "DRAFT ILLUSTRATIVE CODE OF PRACTICE" (PDF). Retrieved 2007-08-23.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  4. BBC (2003). "Worst Word Vote" (HTML). Ouch. Retrieved 2007-08-17. Check date values in: |date= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>

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