The History of Disability Treatment in the United States: From Exclusion in Inclusion

By Julia Baldowski

The treatment and perception of individuals with disabilities in the United States have  undergone profound changes from the colonial period to the present day. These transformations  reflect broader social, political, and economic developments, as well as shifting notions of  citizenship, productivity, and human rights. Tracing the major phases in the history of disability  treatment in the U.S. will serve to explore the movement from institutionalism to community based care and the ongoing struggle for equality and inclusion.  

Early American Approaches to Disability 

In the colonial and early national periods, disability was largely viewed through religious  and moral lenses. Many disabilities, particularly intellectual and mental disabilities, were  interpreted as divine punishment or moral failing [1]. Families typically bore the responsibility  for caring for disabled relatives, and there were few formal supports. Those who could not be  cared for privately might be relegated to almshouses or local poorhouses, institutions designed  for the indigent rather than specialized care for disabled individuals [7].  

Institutionalization and the Rise of Asylums 

The 19^th century saw the rise of more formalized approaches, influenced by  Enlightenment ideals and the belief in the perfectibility of humankind. Reformers like Dorothea  Dix advocated for the creation of specialized asylums for people with mental illness, arguing that  humane care and moral treatment may lead to cure [2]. This era also saw the founding of  institutions such as the American School for the Deaf in 1817 and the Perkins School for the  Blind in 1829, reflecting the belief that education could elevate disabled people into productive  citizens [5].  

Yet, the promise of education and rehabilitation often gave way to regimens of discipline  and normalization. Many schools and asylums operated less as places of learning or healing, and  more as sites of segregation. As the century progressed, the ethos of care increasingly merged  with anxieties about social control. By the late 19^th and early 20^th centuries, the institutional  model expanded dramatically. State schools for those labeled “feebleminded,” asylums for  people with mental illnesses, and residential hospitals for the physically disabled became central  to public policy. Institutions like the Fernald School in Massachusetts and the Willowbrook State  School in New York grew overcrowded and underfunded, notorious for poor conditions and  abuse [3].  

Eugenics and the Policing of Disability 

Perhaps no force shaped early 20^th-century disability treatment more profoundly than  eugenics. Influential scientists, policymakers, and social reformers argued that disability,  especially intellectual and mental disability, was hereditary and posed a threat to the nation’s 

biological fitness. Eugenic policies aimed to reduce or eliminate these perceived threats through  segregation and sterilization. The infamous 1927 Supreme Court decision Buck v. Bell upheld the  constitutionality of forced sterilization laws, enabling states to sterilize individuals deemed “unfit  to reproduce.” As Justice Oliver Wendell Holmes wrote in his opinion, “Three generations of  imbeciles are enough” [4]. Between 1907 and the 1970s, more than 60,000 Americans were  forcibly sterilized under these laws [1]. Eugenic ideology reinforced institutionalization as the  preferred policy response. Disabled people were not only to be removed from public view but also  prevented from reproducing, erasing disability from the future body politic.  

The Seeds of Change: Deinstitutionalization and Civil Rights 

By the mid-20^th century, cracks began to appear in the institutional model. Exposés  revealed the horrific conditions in many state facilities. Geraldo Rivera’s 1972 report on  Willowbrook shocked the nation, exposing severe neglect, abuse, and overcrowding [3]. At the  same time, parents, advocates, and disabled people themselves increasingly demanded  alternatives.  

The deinstitutionalization movement gained momentum through legislation such as the  Community Mental Health Act of 1963, which aimed to replace institutions with community based services [7]. Although implementation was uneven, the principle of integrating disabled  people into the least restrictive environment took hold. Education reform followed suit. For  example, the Education for All Handicapped Children Act of 1975, later renamed the Individuals  with Disabilities Education Act, guaranteed access to public education and special services for  disabled students [5] Importantly, these reforms were not simply top-down initiatives. Disabled  activists organized sit-ins, protests, and legal challenges. They reframed disability as a civil  rights issue, drawing on the strategies of the broader civil rights, feminist, and LGBTQ+  movements.  

The Americans with Disabilities Act: A Landmark Victory 

The culmination of decades of advocacy came with the passage of the Americans with  Disabilities Act (ADA) in 1990. The ADA prohibited discrimination against disabled individuals  in employment, public accommodations, transportation, and other areas of public life [6]. It  reflected a powerful shift in thinking, that disability was no longer viewed primarily as a medical  problem to be treated or hidden, but as a matter of civil rights and social justice. The ADA also  codified the idea that barriers to full participation, whether physical, technological, or attitudinal,  were the real disabling factors. As historian Douglas Baynton has argued, the disability rights  movement forced a reconsideration of long-standing assumptions about normalcy and citizenship [1].  

Continuing Struggles and the Work Ahead 

Despite these advances, the promise of equality remains incomplete. Disabled Americans  continue to face disparities in employment, education, housing, and health care. People of color with disabilities often experience compounded discrimination [5]. Debates over institutional care  versus community living persist, particularly as aging and economic pressures strain public  services. At the same time, the disability rights movement continues to evolve, pushing for  accessibility in digital spaces, greater representation in media and politics, and deeper  recognition of intersectionality. The history of disability treatment in the United States reminds  us that inclusion is not a static achievement but an ongoing project, one that demands vigilance,  advocacy, and imagination.  

Sources

1. Baynton, Douglas C. Disability and the Justification of Inequality in American History.  In Paul K. Longmore and Lauri Umansky, eds., The New Disability History: American  Perspectives, 33–57. New York: New York University Press, 2001. 

2. D’Antonio, Patricia. American Nursing: A History of Knowledge, Authority, and the  Meaning of Work. Baltimore: Johns Hopkins University Press, 2006. 

3. Kluth, Paula. You’re Going to Love This Kid! Baltimore: Paul H. Brookes Publishing,  2003. 

4. Lombardo, Paul A. Three Generations, No Imbeciles: Eugenics, the Supreme Court, and  Buck v. Bell. Baltimore: Johns Hopkins University Press, 2008. 

5. Longmore, Paul K., and Lauri Umansky, eds. The New Disability History: American  Perspectives. New York: New York University Press, 2001. 

6. Scotch, Richard K. From Good Will to Civil Rights: Transforming Federal Disability  Policy. 2nd ed. Philadelphia: Temple University Press, 2001. 

7. Trent, James W. Inventing the Feeble Mind: A History of Mental R********** in the  United States. Berkeley: University of California Press, 1994.