Basingstoke, Palgrave, 2004, ISBN: 333912551X; 301pp.; Price: £16.99
University of Leeds
Date accessed: 31 January, 2015
Disability Studies is a growing multi-disciplinary field. Although it is a relative newcomer to the academic arena, it has firmly established itself as a serious area of scholarly interest. However, while scholars in the fields of social policy, sociology, law, literature and the medical humanities have all embraced the relevance of disability studies within their chosen fields, historians have remained largely in the background.
At the moment, disability exists on the periphery of mainstream, canonical history. Most investigations with an historical perspective have been written by sociologists and disability activists.(1) Historians themselves have given the subject little attention. True, institutional history, the development of psychology, and the history of medicine have garnered the interests of the historical profession. Yet what of disabled people themselves? How did people with disabilities in past societies cope with their impairments and societal attitudes towards their bodies? How did different societies view and treat the disabled? How did societal attitudes shape social policy, medical treatment and acceptance of disabled people? With historical interests in welfare, poor law policy, poverty, labour, class, social medicine, social Darwinism and bodily difference it is puzzling as to why disability has been neglected. If one considers the matter further, one can find a place for disability in nearly all avenues of historical inquiry.
A few scattered studies have appeared over recent years. Most comprehensive of these is Henri Stiker’s A History of Disability, published in 1999, which gives an overview of attitudes towards disability from antiquity to present. Steve Humphries and Pamela Gordon also compiled an evocative account of childhood disability using oral testimony in Out of Sight: the Experience of Disability from 1900–1950.(2) More recently, American studies have emerged which combine history, social policy and disability activism. They contribute to both disability studies in the academic arena and to the disability rights movement. Amongst these works are P. K. Longmore’s and L. Umansky’s The New Disability History: American Perspectives, and Simi Linton’s Claiming Disability: Knowledge and Identity.(3)
Yet academic interest in Britain has been slow to emerge. With such a dearth of available literature, Professor Borsay’s Disability and Social Policy in Britain since 1750 is a welcome text which provides an accessible and cogent overview of the treatment of disabled people since the Industrial Revolution. It is an important study both for those interested in disability history and for those wishing to broaden their understanding of the history of welfare and social rights in this country.
Disability and Social Policy is divided into two main sections. The first looks at institutional living. Here Borsay examines workhouses, hospitals, asylums and special schools. The second discusses community living. Borsay concentrates upon employment, financial relief, community care, and community medical support. This second section of the book focuses predominately on the later half of the twentieth century, specifically on programmes put in place since the Chronically Sick and Disabled Persons Act of 1970.
The book ‘offers a historical interpretation of how since the Industrial Revolution, social policies have created and sustained the discrimination that continues to make disabled people excluded citizens’ (p. 1). Borsay argues that since 1750 disabled people have been excluded from the full rights of citizenship because they were marginal to the labour market. She examines the predominance of economic rationality and medical power. The predominance of ‘economic rationality’, she maintains, has excluded the disabled from citizenship and social rights. She further argues that ‘divisive practices’ such as segregated schooling, institutionalisation and separate training workshops have exacerbated this exclusion. In order to pursue her examination of social policies over the past two hundred and fifty years, Borsay analyses the ‘mixed economy of welfare’. She looks at how the disabled were cared for by the state, philanthropy, public assistance and familial networks. While charitable support was strong, she continues, it further promoted ‘divisive practices’ which denied the disabled the full rights of social citizenship.
According to Borsay there are currently three main approaches to studying the history of disability. First is the biographical approach, which looks at great reformers and their institutions. Second is the empirical approach, which evaluates different care strategies and the development of rehabilitation and orthopaedics. Third is the approach which Borsay herself takes, the materialist. The materialist view ‘locates past experiences of disability within the political, social and cultural organization of society’ (p. 12). It examines how society, not the actual impairment itself, creates disability. Prominent academics in disability studies have long held this view. Colin Barnes, Vic Finkelstein, Simi Linton and Brendon Gleeson are among the scholars who posit that the transfer from feudalism to capitalism further excluded and disenfranchised disabled people from society. Much like class historians who also take this approach, they place perhaps too much emphasis, as Borsay herself argues, on the Industrial Revolution.
Borsay examines past policies towards the disabled using the ‘social model.’ The social model focuses on the various environmental barriers that the disabled encountered, and continue to encounter, in society. It argues that economic, political and cultural barriers were (and still are) the major cause of disabled people’s individual and collective disadvantage. It is a tool which explains society’s response to impairment. It suggests that society creates disability through various environmental barriers. These barriers include discrimination, segregated schooling and lack of accessible transport.
One may not need to tell historians that disability is a social construct, that how far one’s impairment hampers one’s ability in society is largely determined by the culture in which the disabled person lives. However, up until now disability in history has not been viewed in this light. Traditionally, disability was viewed as a personal trouble and a medical condition. This ‘medical model’ is how doctors in the past have perceived disability. With the growth of orthopaedics in the late nineteenth century and the increased intervention of the state and public medicine, ‘defective’ people were ‘cured’ and returned to ‘normal’, or at least as normal as was deemed possible. It was assumed that any ‘deviation’ from the norm was necessarily a tragic loss or misfortune (p. 9). In disability studies, the social model is a new way of exploring the experience of disability.
As disability history is scattered and scarce, Borsay helpfully compiles and assesses the existing historiography for the reader. She cogently brings together existing studies from the fields of history, sociology and social policy and refers to them critically and fairly throughout the text. Another merit of the text is the way it handles its material. Borsay is obviously passionate about disability rights and has sympathy for her historical subjects. Nevertheless, she is able to maintain an objective distance. Although she hopes the book will raise both the ‘personal and political consciousness’ (p. 207) of the disabled community in Britain today, she does not condemn the past, but assesses it in a balanced and analytical manner.
In her survey of social policy Borsay also briefly looks at major cultural ideas and issues, such as the enlightenment epistemology, Darwinism, eugenics and phrenology. While space does not permit a detailed investigation of each of these movements, the author deftly incorporates a number of ideas with reference to disability. She examines how the various ideas and ideals affected treatment of the disabled. Most prominent in her study is economic rationality and its role in the mixed economy of welfare. The argument is complemented by literary and visual sources as well as documentary texts and oral testimony.
Disability and Social Policy is an ambitious and comprehensive text. It provides an excellent overview of policies and programmes for the disabled and places them within the context of general welfare. As there has been no previous general text about disability published in Britain, this book provides a much needed foundation for the history of disability. It is useful for the student, as it provides a clear and cogent elucidation of social polices without assuming too much prior knowledge. Academics too will find it engaging. The old and new poor laws, charities, voluntary hospitals and other institutions are all re-examined with new emphasis on the disabled. Making disability the focal point of such policies and institutions will hopefully raise some new questions and inspire further research into the history of disability and disabled people.
One of the shortcomings of this book however, is the need for more evidence. Coming from a background in medical humanities, Borsay’s research methods may differ from those of historians. Most striking is the shortage of primary sources. The text does boast a great deal of testimony from disabled people themselves, yet this evidence is largely taken from previously published secondary sources. This may especially be seen in her use of the research from Humphries and Gordon. Their study Out of Sight is relied upon extensively in the sections on children and schooling. Primary sources within other texts are selected for a specific reason: to prove the author’s argument. One has to wonder if, by examining this text and not primary evidence directly, Borsay may have been influenced by the arguments put forth by Humphries and Gordon.
Very little primary research was undertaken by the author herself, and only a handful of primary sources are evident in the extensive bibliography. That being said, primary sources concerning disabled people in history are difficult to find; very few disabled people in the past have left accounts or recollections of their experiences, and neither have those who cared for the disabled in both the state and voluntary sectors. For this reason, the study of disability history is notoriously tricky. It could also be a major factor in the dearth of historiography surrounding the subject. One does, to a certain extent, have to rely on previous research. This is especially true of oral testimony.
Yet sources exist. Parliamentary documents and debates are conspicuously absent from this book which examines state policy. Hansard was only footnoted once, yet an examination of parliamentary debates in the past two hundred years will reveal the extent to which disability and welfare were issues within parliament. Moreover, the papers of chief medical officers, which, in the early twentieth century, reported extensively on ‘cripple schools’ and ‘defective’ children, are not mentioned. These reports offer valuable insights into how doctors and the state treated the disabled both medically and socially. Reports of the Local Government Board (another important source for teasing out policies and attitudes towards the disabled) are occasionally referred to but not rigorously examined.
Another concern is the range of evidence given within the text itself. Swansea is represented quite heavily, with detailed statistics and examples given throughout. Other geographical regions, however, are neglected. Some claims are left unsubstantiated. For example, on page ninety-four, Borsay states that patients within asylums often colluded with one another; while this is footnoted, no specific examples are given. Borsay states that disabled people in institutions often resisted and rose up against their oppressors; again, there is very little evidence given to this fact. Each chapter has a section reserved for perspectives from the disabled people themselves. However, these sections are rather thin, and there is often little anecdotal evidence to back up the arguments she makes. As mentioned before, testimony from disabled people is quite difficult to find, so one often has to make do and extrapolate from the meagre sources which are available. Yet surely in more recent history examples could be found. The final chapters would have benefited from more evidence from disabled citizens post 1970. Some explanation of methodology at the beginning of the book would have gone a long way to assist the reader as to why she chose the sources that she did.
Borsay covers both mental and physical disabilities and, while acknowledging the different barriers and situations faced by people with varying types and degrees of disability, discusses their ‘common experience of exclusion’. Whereas previous studies have focused on specific groups such as children, women or veterans, Borsay examines the experience of disability of a broad range of groups. This is to her credit, and proves the comprehensive scope of her study. However, her treatment of the elderly is vague. The reader is left questioning the purpose of including this social group in this study. Yes, there were (and are) elderly people among the disabled population. And yes, this becomes more relevant as the population ages and there is an increasing likelihood of more of us surviving ‘disabling’ illnesses long into old age. However, if this was Borsay’s intention, it remained unclear. Oftentimes, the elderly are discussed as a separate group. Old age pensions are examined, not with reference to disability but as a welfare issue in their own right. Primary evidence on workhouse admissions and poor law policies are also used to describe the condition of the elderly, but not the disabled elderly. Workhouses under both the new and old poor laws grouped the ‘aged and infirm’ together, yet surely historiography should not do the same? While reasons for including the elderly can be seen, the purpose or intention was inexact.
The text covers a lot of ground, and it is not easy to be specific and expansive at the same time. Since existing disability history is sparse, what is needed is a general, overarching text to provide a solid foundation, and the author provides this. Borsay’s book is an important contribution to disability studies and to disability history. It is the first text to place disability policies in Britain within an historical framework. The writing is fluent, the format engaging and accessible. While it stands strong on its own, Disability and Social Policy in Britain is sure to provoke further interest and act as a springboard for additional studies in the history of disability.
- See, for example, C. Barnes, ‘A legacy of oppression: a history of disability in Western culture’, in Disability Studies: Past, Present and Future, ed. L. Barton and M. Oliver (Leeds, 1997), pp. 4–24; L. J. Davis, Enforcing Normalcy: Disability, Deafness and the Body (1995); and B. J. Gleeson, Geographies of Disability (1999).Back to (1)
- S. Humphries and P. Gordon, Out of Sight: the Experience of Disability 1900–1950 (Plymouth, 1992); and H. J. Stiker, A History of Disability, (trans. William Sayers Michigan, 1999).Back to (2)
- S. Linton, Claiming Disability: Knowledge and Identity (New York, 1998) and P. K. Longmore and L. Umansky, The New Disability History: American Perspectives (New York, 2001). See also R. Garland Thomson, Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature (New York, 1997).Back to (3)
I welcome this opportunity to respond to Meaghan Kowalsky’s balanced and thoughtful review of my book. Although my present post is in medical humanities, I am a historian whose research has focused on the social history of medicine. Therefore, I am acutely aware of the plethora of primary sources that are available for a monographic study of a particular aspect of disability. But that was not my purpose. Rather I set out to produce a broad-ranging analysis of physical and mental disability across 250 years that integrated perspectives from history and the social sciences. I am pleased that this has been achieved in a successful ‘overview of policies and programmes’ for disabled people, which locates them ‘within the context of general welfare’, ‘cogently brings together … studies from the fields of history, sociology and social policy’, and ‘provides a much needed foundation for the history of disability’.
Given this agenda, my strategy was to conduct a comprehensive review of the existing literature and turn to primary materials to fill the more glaring gaps. Mental illness and learning difficulty are comparatively well researched, and old age is better served than physical impairment. Consequently, I concentrated my archival work in this area. Of course, Hansard, the papers of chief medical officers, and reports of the Local Government Board are rich sources for the history of disability, but it was impossible for me to look at them for the host of policies relating to physical and mental impairments since 1750.
Geographical coverage is likewise an issue in a book that purports to deal with Britain as a whole. I attempted to flag up any variations in policy between England, Scotland, and Wales, and to pick examples from different areas of the country. Of necessity, my archival research was more selective. However, as well as using the British Library and the Wellcome Library for the History and Understanding of Medicine, I did examine the holdings of record offices and/or libraries in Derby, Nottingham, Exeter, Shrewsbury, Cardiff, Birmingham and Swansea. If the references to Swansea are excessive, perhaps they can be regarded as compensation for the neglect of Wales in general discussions of policy history.
Disability studies have tended to exclude elderly people and my effort to include them is not without problems. When, as Kowalsky herself concedes, workhouse records conflate the ‘aged and infirm’, it is difficult to see how historiography can entirely escape this categorisation and disaggregate the ‘disabled elderly’. Similarly, old age pensions are, by definition, confined to elderly claimants. By the late 1960s, however, approximately two-thirds of the impaired population was over the age of 65, making retirement pensions the principal means of financial support for a majority of disabled people. It was for this reason that I considered old age pensions worthy of discussion ‘as a welfare issue in their own right’.
I was surprised to be accused of leaving claims unsubstantiated but, for reasons of length, it was not always possible to include specific examples in the text. My bibliography, described as ‘extensive’, is titled a Select Bibliography and lists the secondary sources most directly relevant to disability. However, full details of all the sources – primary and secondary – are given in the notes to each chapter. It is true that although the book ‘boast[s] a great deal of oral testimony from disabled people themselves’, I did not undertake any new research in this field. With a project of this kind, it was not practicable to do so. Nonetheless, to represent the voices of disabled people, I did draw on a number of published oral testimonies, including Out of Sight: The Experience of Disability, 1900–1950 by Steve Humphries and Pamela Gordon – a splendid collection of oral histories that offers many insights into different aspects of disabled people’s lives. I hope that my book will ‘act as a springboard’ for other such studies in the history of disability.