A Disability History of the United States

“Generally, indigenous peoples understood the relationship between body, spirit, and mind very differently than the Europeans who later made their way through North America, the Africans forced in chains to the continent, the Asians who arrived to work the railroads in the nineteenth century, and contemporary peoples.”

In Chapter 1, Nielsen discusses what is known about how Indigenous peoples of North America viewed disability. She explains that while there was no comparable concept for disability, one was thought to be well if one’s mind, body, and spirit were in harmony. Likewise, their belief was that the spirit chooses the body it will occupy and that what was considered disability only occurred when one failed to participate in community reciprocity.

“The consequences of European colonization and conquest not only altered the ways in which indigenous peoples experienced what is now called disability, but it disproportionately killed people with disabilities and also produced disability.”

In this passage, Nielsen is referring to the fact that European colonization of Indigenous peoples in North America fundamentally altered their way of life. The weapons and conflict brought by the colonizers caused destruction, but the diseases they brought caused widespread epidemics that wiped out generations. All of these factors—weapons, conflict, and disease—not only killed and maimed Indigenous people but were even more devastating to those who were disabled.

“Disability was defined as the inability to ‘maintain’ oneself economically, and those unable to do so were discouraged from ever boarding ship for North America.”

Nielsen describes how the Europeans who invaded North America viewed disability. While physical limitations and variability among physical bodies were given little attention, considerable attention was given to those with what today would be termed cognitive or psychological disabilities. If one were considered disabled and unable to labor, they were excluded from traveling to North America.

“The Revolution and the new nation itself would come to be founded on the radical argument of the Enlightenment that citizens, however limited in breadth the category might be, had rights and were capable of reasoned decision making and could be trusted with the vote.”

Nielsen argues that “the decades surrounding the American Revolution were a period of transition for those with mental and cognitive disabilities” (38). This passage refers to the fact that people sought medical explanations and solutions for mental and cognitive disabilities for the first time, rather than relying on supernatural explanations. With this enlightened perspective came the belief that organized care and institutionalization for individuals with disabilities could lead to cures.

“The racist ideology of slavery held that Africans brought to North America were by definition disabled. Slaveholders and apologists for slavery used Africans’ supposed inherent mental and physical inferiority, their supposed abnormal and abhorrent bodies, to legitimize slavery.”

A point that Nielsen returns to several times in her early chapters is that free African Americans and enslaved people were viewed as disabled because of their supposed mental and physical inferiority. She is making the point here not only that this belief was used as a way to legitimize slavery but also that slavery apologists used this belief to argue that slavery was actually beneficial because it provided needed care for enslaved people.

“In the century prior to the creation of the American nation, the legal and economic condition of one’s family and community shaped the definitions, experiences, and consequences of disability. Conversely, it shaped the standards and consequences of ableism. Given the lack of even a weak nation-state, the well-being of one’s community mattered tremendously.”

Because America was a new and relatively weak nation, the experiences of people with disabilities varied depending on one’s resources and the degree of stability of their family and community. In other words, individuals with disabilities who lacked resources and family stability suffered tremendously. Class, along with race and gender, were significant factors in the experiences of people with disabilities.

“Inherent to the creation of the United States was the legal and ideological delineation of those who embodied ableness and thus full citizenship, as apart from those whose bodies and minds were considered deficient and defective.”

In Chapter 4, Nielsen examines the ways in which disability, along with race, class, and gender, established a line of separation between those who were considered full citizens and those who were not. The ableist thinking behind this belief was that the new experiment of democracy required citizens who were competent, both physically and mentally.

“White slave owners and the intellectuals who supported them used the concept of disability to justify slavery, abolitionists used disability to argue against slavery. White and black abolitionists emphasized the physical and psychological damages wrought by slavery, the abuses experienced by slaves with disabilities, and the debilitating and forced dependency of slavery.”

The way in which both supporters of slavery and abolitionists used disability to argue for their position was a unique dichotomy. Enslavers and those who supported slavery argued that it was actually beneficial to enslaved people because their supposed inferiority meant that they required care. Opponents of slavery, on the other hand, claimed that slavery itself caused their supposed intellectual inferiority.

“Across the new republic, beginning first in New England but spreading south and westward, public and private groups thus nearly fell over one another in efforts to establish insane asylums, schools for deaf and blind people, community hospitals for those in poverty, and schools for the feeble-minded and idiots.”

In Chapter 4, Nielsen also discusses institutions, medicalization, and treatment for those with cognitive and psychological disabilities. She points out that the increasing number of institutions and schools for those with disabilities coincided with an expansion in the professionalization of medicine.

“The war and its consequences generated new adaptive devices and medical advances—from the first wheelchair patent in 1869 to improved prostheses—that improved the lives of many, not just disabled veterans. For some, the period was a reminder that people with all kinds of disabilities, including those with psychological disabilities incurred during the war, had a place in the community. For others, the growing visibility of people with disabilities caused fear and suspicion.”

In the beginning of Chapter 5, Nielsen discusses the ways in which the definitions and perceptions of disability changed due to the American Civil War. Medical advances took place as a direct result of the war, but disability itself became more visible throughout the country. People reacted with not only fear and suspicion but also curiosity to individuals with readily visible disabilities. For psychological disabilities that were not so easily noticed, changes came primarily in the form of institutions.

“Wartime made disability heroic—but only for male veterans, and only for men with physical, and visibly exhibited, disabilities. Even heroic manhood, however, didn’t guarantee social acceptance and financial security for disabled veterans. Despite the expansion of federal pension and support programs, disabled Civil War veterans struggled to find employment and family economic stability; Confederate veterans even more than Union veterans.”

Nielsen makes the point that while veterans with visible injuries and disabilities were seen as heroes, those who had disabling psychological damage and other effects that were not readily visible were not looked upon that way. Likewise, even those veterans with disabilities who were considered heroic struggled to find jobs and social acceptance after the Civil War, showing that the cult of “heroic manhood” did not actually result in material support for people with disabilities.

“The creation of Gallaudet reflected the continued expansion of institutions and residential schools for people with disabilities that had begun decades earlier. By the turn of the century, over 130 residential schools served deaf students, 31 served blind students, and approximately 14 schools had been established for those diagnosed as feeble-minded.”

Originally known as the National Deaf-Mute College, Gallaudet University, which Nielsen describes as “the premier educational institution for deaf Americans” (95), was founded in 1864 as a grammar school but grew into the first school for the advanced education of deaf students. It was one of several residential schools for people with disabilities that opened after the Civil War.

“The period from the Civil War until the 1890s is one in which disability became increasingly institutionalized. The solidification of the federal government that developed in this period, along with emerging technologies and urbanization, aided the creation of institutions and the development of policies pertaining to people considered disabled.”

Nielsen states that after the Civil War, disability became more visible in the United States. Disability, at this time, also became more institutionalized, meaning that it began to be increasingly recognized and addressed not only through the creation of institutions and schools for people with disabilities but also through specific policies. Both of these were brought about largely because of technological advances and urbanization.

“The mass immigration of southern and eastern Europeans who provided the cheap labor that fueled the nation’s industrial and economic expansion now generated fears about a deteriorating national body, as did the mass migration of African Americans out of the rural South and into the urban North. Since the early twentieth century, a growing wave of concern about the changing nature of the nation’s citizens had overwhelmed the United States, its politics, and its culture.”

Nielsen opens Chapter 6 with this passage, describing the anti-immigration and nativist attitudes that were prevalent in the early 20th century as a result of the diversity in culture and languages that is inevitable with immigration. Many who thought that diversity was a fundamental threat to American culture sought ways to slow the changes.

“The legal structures and the physical gates at US border locales became sites where ideals about the bodies of American citizens were enforced and reinforced. US lawmakers, scientists, and policymakers established which bodily, mental, and moral characteristics (perceived or real) were acceptable parts of the body politic.”

Nielsen refers to the policies regarding restrictive immigration. She points out that both the Immigration Act of 1882 and the later Immigration Act of 1924 “restricted potential immigrants deemed defective—morally, physically, or intellectually—or even potentially defective” (103). People from Africa, South America, and Asia were effectively barred from entry into the US, as well as Europeans who were seen as having any sort of physical, cognitive, or psychological disability.

“Proponents of sterilization argued that it was a patriotic cause, and a better solution than long-term institutionalization. For the health of the nation the electoral body had to be protected against degenerative elements. Politicians, those in the judicial system, educators, and medical experts increasingly conflated political and economic strength with bodily and mental health.”

Beginning in 1907, 37 states passed forced sterilization laws. The broad list of reasons why a person may have been sterilized included being “feebleminded,” “insane,” criminalistic, “epileptic,” inebriate, diseased, blind, deaf, “deformed,” and dependent (113-15). The belief that certain types of citizens should not reproduce stemmed from the eugenicist belief “that the way to improve society is through better human breeding practices so that only those with ‘positive’ hereditary traits reproduce” (101). Although correctly discredited by serious scientists and medical experts, eugenics was widely supported in the early 20th century.

“The question of how best to maintain the nation has dominated all eras of US history. In the Progressive Era, perhaps more than in any other, however, that meant surveillance and containment of bodies considered deviant or degenerative. Policies were put in place to carefully monitor the bodies of those entering the United States and sterilize the deviant bodies of those already within the nation’s gates. Sexuality, class, race, gender, and ethnicity forcibly intersected with notions of disability and quality citizenship.”

In closing Chapter 6, Nielsen alludes to one of the major themes of the book: The Intersectionality of Disability With Race, Gender, and Class. During the Progressive Era, all of these qualities intersected as policies were put in place to limit the types of people who were allowed to enter the United States and to prevent “undesirable” types of citizens from reproducing.

“The economic inequalities of race in the United States meant that poor medical care sometimes created disability—and the depression exacerbated those inequalities.”

When Helen Keller testified before Congress in 1944 about expanding the Social Security Act, she emphasized how state funding was rife with discrimination as an example of how ableism and racism intersect to limit opportunities. As another example of how the Depression increased racial discrimination in medical services, Nielsen provides an anecdote detailing how a young African American girl with polio in 1929 in rural Georgia was forced to see an unqualified country doctor rather than a doctor at a hospital, as was standard for white children.

“In the decades immediately following World War II, the ideology and language of rights, discrimination, and citizenship increasingly dominated discussions of disability. In disability organizations, in religious institutions, in labor unions, and with respect to the issues of racial and gender equality, people with disabilities increasingly rejected the idea that they had either to adapt to or withdraw from society.”

As people with disabilities began to organize in the decades after World War II, they increasingly took on the language of rights and discrimination that activists in the civil rights and gender equality movements used. People with disabilities rejected the notion that they should adapt or withdraw and instead began making the argument that it was the ableist attitudes that saw them as deficient and that the barriers they faced needed to change.

“Activists also began to explore the relationship between ableism, sexism, and racism. As the Blind Veterans Association began to learn, rejecting hierarchy based on one form of physical difference (like disability) while embracing hierarchy based on another form of physical difference (such as race) left one ideologically (and perhaps ethically) inconsistent and made organizing less effective.”

Nielsen explains that the Blind Veterans Association (BVA) had to learn this lesson because “racism, sexism, classism, heterosexism, and ableism were hard to unlearn” (156). Not only members of the BVA but also all activists with disabilities had to realize the inconsistency of their position if they themselves discriminated against others based on race, gender, or class.

“The disability rights movement was energized by, overlapping with, and similar to other civil rights movements across the nation, as people with disabilities experienced the 1960s and 1970s as a time of excitement, organizational strength, and identity exploration. Like feminists, African American, and gay and lesbian activists, people with disabilities insisted that their bodies did not render them defective. Indeed, their bodies could even be sources of political, sexual, and artistic strength.”

Nielsen is alluding to the fact that the disability rights movement came on the heels of other socio-political movements and was similar to them in many ways. She also makes the point that the movement itself was about something larger than rights and the fight against discrimination; it was also about personal fulfillment and pride.

“Just as the civil rights movement critiqued hierarchy based on racial differences, and just as the feminist movement critiqued hierarchy based on sex and gender differences, the disability rights movement critiqued hierarchy based on the physical, sensory, and mental differences of disability.”

A vital element of the disability rights movement was that it was eventually able to move on from the notion that disability was a “medical, biologically based condition” (162). Instead, members of the movement argued that disability was more of a social condition that led to harmful discrimination and stigma.

“As more people with disabilities became empowered by the actions of others with disabilities, as more and more began to think in terms of rights and citizenship, many disabled people began to consider seriously their own place in the American story—and who got to define that place.”

As the disability right movement began, it focused on employment and accessibility issues, but it later became much larger. Over time, the participants in the movement began advocating for political changes that were broader and more comprehensive in nature in an effort to better the lives of those who would come after them.