The Moral Treatment, Hygiene, and Education of Idiots

The Moral Treatment, Hygiene, and Education of Idiots and Other Backward Children is perhaps not the most auspicious book title. Nor is Idiocy: and Its Treatment by the Physiological Method. Recently I’ve had the opportunity to read them, and would like to take this opportunity to praise the author, Edouard Seguin, for his truly impressive insight, dedication, and humanity.

Before my son with A Ridiculously Rare chromosomal disorder was born, I had little particular interest in issues relating to disability. I was vaguely aware that there was some sort of movement in the 19th century toward more humane treatment and education of the disabled – especially those with sensory deficits, such as blindness – and people with mental illness. If pressed, I could probably name Samuel Gridley Howe and Dorothea Dix.

At some point after assimilating the news that our son would likely end up with severe or profound intellectual disabilities (I/DD), I became interested in reading about the history of I/DD. His syndrome, which was first identified in the 1960s, initially had a prognosis of probable early death and pretty much a guarantee of never walking or talking. But these were the data from people who were institutionalized as kids. When people with his syndrome were raised at home, as the succeeding generation of kids often were, outcomes were drastically different. The childhood mortality rate dropped to 10%. The vast majority learned to walk. More than half learned some speech or signing.

So despite the vague awareness of something positive for other kinds of disabilities in the 19th century, I assumed the all the bad old days were really really bad. (Simple Simon. “A tale told by an idiot, full of sound and fury, signifying nothing.” The village idiot.) That people with I/DD, especially severe to profound I/DD, were thrown into institutions and forgotten. Or abused. Or rejected by their families. That no one took the idea of educating people with severe or profound I/DD seriously until maybe the 1970s. And, as I read further, some of the old days were bad days indeed. After the 1870s, institionalization was the norm until very recently, and those institutions were, for the most part, extremely not pretty. But by no means were all of those bad days uniformly terrible. And in the mid-nineteenth century, something really interesting was going on. In general, people with I/DD lived at home. And often were, to greatly varying degrees, assimilated into their communities (I mean, at least the village idiot had a village!).

Edouard Seguin, born in 1812 in France and living out his later years in the U.S., had drank some of the Enlightenment kool-aid about the dignity of all men. He was also strongly influenced by Locke’s ideas that we are born with our minds a blank slate, and learn everything through our senses. (I think Locke is quite wrong about this, by the way. This is an interesting case of how a false belief (i.e., Seguin’s faith in Locke’s empiricism) can yield great benefits.) So he took upon himself to do something systematically which no one had done before except in a scattershot way. He attempted to educate idiots (as he called them). A bit about the nomenclature of the time. Morons referred to people with what we call today mild I/DD – the highest functioning group. Imbeciles correspond to what we today would call moderate I/DD. And idiots were those with severe and profound I/DD. Many didn’t walk, and almost none said more than a few words. An IQ of 20 or lower. So Seguin not only wanted to educate people with developmental disabilities, but he believed he could teach those who were considered absolutely the most ineducable.

Contemporary accounts describe his success as phenomenal. He was able to get many of his students walking and talking, and much improved their social skills. Many were even able to hold down jobs.

First the bad parts of Seguin’s writings (besides the dated nomenclature, which is of course neither here nor there). He, like so many before and after him, blamed the parents for their child’s I/DD. Interestingly, though, he did not believe it was how the child was raised – so, not a refrigerator-mother type of accusation. But still the mother’s fault. He thought whatever caused I/DD happened prenatally, and was possibly due to STDs or alcoholism of the mother. He also suggested nutritional deficiencies or too much stress during the pregnancy. He specifies the eating of too many foods such as pickles and “dainties” as a cause. It’s just another example of all those years of all those parents who were blamed for their kids’ I/DD. It’s absolutely heartbreaking.

Seguin was also rampantly classist, and seemed pretty much to believe that poor people couldn’t raise children at all. He endorsed the idea of residential educational institutions. His thinking was that in impoverished households, children with severe to profound I/DD would basically be left in a corner and ignored. In wealthy households, they would be spoiled and given too many sweets and never be asked to do anything for themselves. It was only in a residential institution that the real education of people with severe to profound I/DD could take place. He did specify that institutions should be temporary residences. He fully intended that students should return to their communities. However, his students did not become totally typical, and still needed extra care. Families and communities were often ill-equipped to handle his graduates. Also, as his success became more widely known, parents wanted to bring their children to him. More institutions were built. Many of them did not have staff with the great skill and devotion required. What was meant to be an education became a lifetime in an asylum.

But here’s the good stuff Seguin did.

He believed full-throatedly that there was not a single person, no matter how aboslutely disabled, no matter how apparently non-responsive to the environment, who could not be made at all happier or higher functioning. He had an absolute faith in the severly and profoundly disabled to learn.

The “moral treatment” sounds absolutely horrible. Did people think those with I/DD were immoral? There actually is a tinge of that in writings of the time, where I/DD is seen to be a character flaw as well as a cognitive disability. But in Seguin’s work, the moral treatment has a much broader meaning. It includes both inculcating morals and social conventions. (Contra Foucault, most of us who are caregivers to people with I/DD want to work hard to improve social skills!) He specifies: absolutely no corporal punishment. At worst a firm stance and a strong tone. Much more can be often be said with a look than with a slap. Moreover, the best way for kids with I/DD to learn social skills is from other kids. They learn far more, he wrote, from imitating each other than from direct instruction from an adult. He advocating mixing children with different abilities to learn from one another and be inspired by one another. He had a firm view that a joyful classroom was a proper learning environment. He believed that rote learning was useless.

His “physiological method” involved his belief that through sensory stimuli, the brains of people with severe to profound I/DD could be improved. His view was, that, at the foundation, I/DD was a problem of will (by the way he uses “will”, the word would seem to correspond to what we would call today “executive function”). Through the introduction of certain stimuli, one could encourage the executive function to exercise itself.

He began by introducing his students to all sorts of different textures. Smooth silk and rough sand paper. Hot and cold water. He massaged them. He played them different sounds and had them guess what it was. He introduced them to music and different tastes and smells and sights. He pushed them in swings.

Whenever possible and wherever possible and however possible, he forced them to make choices and act on their own initiative. This was to exercise the executive function. As soon as they could start to do anything he had them clean up after themselves,however slapdash the job, and take responsibility for the order of the classrooms. They learned speech by beginning to imitate syllables, touching the mouth of their educator and touching their own mouths. Then they progressed to words and sentences. As soon as they could say something, they had to talk to get what they wanted. Wherever possible, his learning materials were everyday objects.

He had them carry dumbbells to improve strength and balance. The students who were non-ambulatory first learned to feel pressure on their feet, then were helped to learn to stand, then to walk with guidance. Fine motor training included practicing the grasp of smaller and smaller objects, doing increasingly more difficult puzzles. Eventually, they learned to write (and in so doing, learned to read).

Other than the fact that this occurred in an institution, and that no one was starting iPad training, all of this differs from the modern day education of people with severe to profound I/DD pretty much not at all. This is almost exactly what my son’s physical therapy, occupational therapy, speech therapy, and special education are like. Maria Montessori made her name by applying Seguin’s methods first to students with mild I/DD, and then typical children (children in a Montessori school still do many of the things that Seguin developed for those with severe and profound I/DD). He was really unbelievably modern.

I can’t find a full length biography of the guy, nor a truly rigorous study of his methods and outcomes. It’s a shame, because he was apparently a very meticulous record-keeper. He was also able to follow his students for a very long time. Study of his work by those qualified to decipher experimental data (i.e., not me) would not only be valuable for historical reasons, but may give us significant insight into how to improve our current education of those with I/DD. I was totally shocked when I asked a prominent developmental psychologist whether increasing the frequency of therapies improves outcomes. She said no one knew. No one knows how often kids need these therapies, nor which kinds of therapies are most effective except in the broadest ways. All we really know is that home-rearing and any therapy at all make a dramatic difference, but beyond that, we’re in the dark.

What a shame that this body of knowledge was developed in the 1840s. Educational methods for I/DD that worked were available  for over a century but ignored as people wasted away in asylums.