Looking Back: Mental deficiency – changing the outlook

The year 1908 saw the consolidation of the predominant public and scientific views towards people with learning disabilities, then known  as 'mentahad led to the founding of the Earlswood Asylum in 1847, then the first philanthropic asylum for idiot children in Britain, had well and truly faded. It was replaced by a eugenicist preoccupation with fears of national decline, because of what was seen to be a link between mental defectiveness and criminality (see Thomson, 1998; Wright & Digby, 1996). Mental defectives were seen as genetically tainted; they should be both separated from society, and prevented from reproducing.

Increasing concern regarding provision for the feeble-minded had led in 1895 to the creation of the National Association for Promoting the Welfare of the Feeble-Minded, through the efforts of three women. Two of these women, Ellen Pinsent and Mary Dendy, became the most significant lobbyists for government action for the feeble-minded. Along with the awareness of the costs of special educational provision, this led first to the establishment of a Parliamentary Committee on Defective and Epileptic Children in 1898, and then in 1904 to a Royal Commission on the Care and Control of the Feeble-Minded.

The report of the Royal Commission, published in 1908 as the Radnor Report, was in turn the main influence on the 1913 Mental Deficiency Act, which was the first legislation by the British government specifically related to services for people with learning disabilities. Up to that point the same institutions provided care both for those who were feeble-minded and those who were insane.

The Act embodied two key principles: separation from the community (hence the new 'colonies' established for their care, rather than asylums); and control (most clearly indicated by the name of the new regulatory body set up under the Act, the Board of Control).

A second important event one hundred years ago was the publication of what came to be the most authoritative medical text in the field. This was the 1908 first edition of Alfred Tredgold's Mental Deficiency, which reached an eighth edition by 1952, with subsequent editions by Tredgold's son. This book was the basic text for the training of both doctors and nurses, and it promulgated both the view that further propagation by people with learning disabilities should be prevented and that society needed to be protected from their lack of usefulness.

The beginning of the 20th century also saw the Frenchman Alfred Binet, together with Théodore Simon, develop the first edition of their test for identifying students in schools who needed help in coping with the curriculum. The American Henry Goddard, already Director of Research at the Vineland School for Feeble-Minded Boys and Girls at Vineland, New Jersey – the first 'laboratory' to study mental retardation – visited Europe, including London, and translated Binet's tests into English in 1908. Four years later Goddard published his notorious and later discredited study of the Kallikak family, purporting to show the large numbers of 'defective degenerates' that were the descendants of one couple.

The first psychologist in Britain to be appointed to work in schools, Cyril Burt, was appointed by London County Council in 1913 with responsibilities, among others, to examine children for admission to schools for the mentally defective. This task of ascertainment of the suitability of an individual child for normal education, and assessment of their degree of mental defect, then became a central task of the emerging profession of educational psychology from the 1920s. There were several factors leading to this new speciality: the influence of the American mental hygiene movement of Clifford Beers; the influence of the child study movement in Britain, led by James Sully (who was the initiator of the first meeting of what was to become the British Psychological Society in 1901); and the creation of the child guidance movement (Keir, 1952).

Alongside the concern for the assessment of children, hospitals and colonies for adult 'defectives' also saw psychological assessment of residents as essential. A 1934 article by Dr Thomas Lindsay, Medical Superintendent at Caterham Mental Hospital, saw mental testing as a 'sine qua non in all well-administered institutions', evidently without assuming the involvement of any psychologist! Although John Raven the elder, later to move to the Crichton Royal Hospital at Dumfries, had worked with Lionel Penrose in a major research project on defectives at the Royal Eastern Counties institution at Colchester in the 1930s, there was little other published research in the field of mental handicap before the Second World War.  

In the 1940s and 1950s the stat of services for people with learning disabilities, and the level of understanding of their needs and capabilities, were both extremely limited. The legal framework for services was still as set out in the 1913 and the later 1927 Mental Deficiency Acts. Hospitals were overcrowded and were administratively separate from the rest of the hospital network. Educational psychologists were few in number and were not attached to the adult mental handicap institutions. While the introduction of the NHS in 1948 brought these hospitals within the new service, there was only limited public and political awareness of the parlous state of these hospitals, which were massively underfunded and with overwhelming staffing problems.

Against this background, from the early 1950s three groups of psychologists in Britain carried out groundbreaking research into the extent to which people with learning disabilities could learn. Forthcoming issues of The Psychologist will feature some of these figures in more detail: here I give just a brief introduction to the impact of their work.

The first group was based in the Medical Research Unit at the Institute of Psychiatry, that became best known as the Social Psychiatry Unit. From the beginning a number of psychologists were employed in this unit, including the New Zealander Jack Tizard and the Australian Neil O'Connor, working on the employment of mentally handicapped people. They went on to conduct a series of research and service development studies into child development, learning disability and autism, which had collectively an enormous impact on practice not only in those fields, but also in institutional care generally. They were both influenced by Russian theoretical work, particularly the work of Pavlov, Smolensky and Vigotsky, and together they published The Social Problem of Mental Deficiency in 1956. Both Tizard and O'Connor continued their research interests after they left the Social Psychiatry Research Unit, Tizard and his wife Barbara moving to the London University Institute of Education, and O'Connor moving to a specially created Medical Research Council Developmental Psychology Unit.  

Alan and Ann Clarke, after both completing doctorates at the Institute of Psychiatry in London, started their pioneering work at the Manor Hospital at Epsom from 1950. They showed that defectives were capable of learning new skills exceeding expectations based on their intelligence level, and that this improved performance endured. Their joint research led to major insights into the capacity of those with a mental handicap to learn. In 1962 they moved to Hull University, where Alan became Professor of Psychology, and where they both continued research in this field. Alan was a member of the British Psychological Society's working party that presented evidence to the 1957 Royal Commission on Mental Illness and Deficiency, just 50 years after the Royal Commission already mentioned.

The third base for work with people with learning disabilities was Monyhull Hospital in Birmingham, where from the 1940s Herbert Günzburg, an Austrian émigré, had been working as a training officer, as he could not at first be recognised as a psychologist. His initial interests were in vocational and social rehabilitation. His work in these areas encouraged the use of peer influence, and used an incentive scheme that employed progress charts, later embodied into his Progress Assessment Charts. He built up a psychological service for people with learning disabilities covering the whole of the West Midlands, and continued at Monyhull until his retirement. He was centrally involved in setting up the Midland Mental Deficiency Society in 1952, the first multidisciplinary professional body dealing with mental handicap in England, and for many years he was the editor of the British Journal of Subnormality, which became the British Journal of Developmental Disabilities.

These developments in research and clinical practice led to a conference in 1956, and this work was brought together in 1958's Mental Deficiency: The Changing Outlook. Edited by Alan and Ann Clarke, 16 of the 18 chapters were written by members of the above three groups. This pioneering volume was the first British book offering a psychological analysis of the nature of mental deficiency. It summarised the existing research and practice literature on psychological and social aspects of mental deficiency, and was informed by formal psychological learning theory, illustrating the 'intimate, reciprocal and enriching relationship between theory and practice'. It also demonstrated in a practical manner how both the learning difficulties and social problems of people with a learning disability could be ameliorated, with an awareness of the value of remedial education and industrial training. As a book focusing on clinical problems it was in advance of the then current American research, and stands as possibly the most significant British book written on clinically related topics in that decade. The book went on into three more editions, the last in 1985. It can justifiably be seen as contributing to the practice ethos among clinical psychologists of that period that facilitated the early spread of behaviour therapy, and thus the major shift in psychological practice towards a therapeutic role.

The work of these three very different groups and individuals remains as an inspiration. Unusually they included three couples who worked together – Jack and Barbara Tizard, Alan and Ann Clarke, and also Herbert and Anna Günzburg, Anna being an architect who both published with her husband and succeeded him as editor of the British Journal of Developmental Disabilities.

Together they challenged then accepted assumptions about the limited capacity of people with intellectual disabilities to learn new skills, and were committed throughout their careers to improving services to those people on the basis of the research they had initiated. Both they and psychologists who immediately succeeded them, such as Peter Mittler who worked at the Hester Adrian Centre at Manchester and headed the National Development Group for Mental Handicap, were not just academics or practitioners. Their work influenced the 1971 White Paper Better Services for the Mentally Handicapped, and the initiatives that followed, including the Jay Committee on residential care for people with mental handicap. Several of them were publicly honoured: Jack Tizard and Neil O'Connor were jointly awarded the American Kennedy International Scientific Award in 1968, and both Jack Tizard and Alan Clarke were Presidents of the BPS and both were appointed CBE.

Those now researching and practising in the field, not least those working at the Tizard Centre at the University of Kent, can see the work of 50 years ago as overturning the conceptual and practice shackles set up 100 years ago, and laying a foundation for the psychological work done since then. 

John Hall is Professor of Mental Health at Oxford Brookes University [email protected]

References 

Clarke, A.M. & Clarke, A.D.B. (1958). Mental deficiency: The changing outlook. London: Methuen.

Keir, G. (1952). A history of child guidance. British Journal of Educational Psychology, XXII, 5­–29.

O'Connor, N. & Tizard, J. (1956). The social problem of mental deficiency. London: Pergamon.
Royal Commission on the Care and Control of the

Feeble- Minded (1904–1908). The Radnor Report. Cd 4202. London: HMSO.

Thomson, M. (1998). The problem of mental deficiency: Eugenics, democracy and social policy in Britain, c.1870–1959. Oxford: Clarendon Press.

Tredgold, A.F. (1908). Mental deficiency. London: Ballière, Tindall & Cox.

Wright, D. & Digby, A. (1996). From idiocy to mental deficiency. London: