OVERVIEW

CHAPTER SUMMARY:

This chapter gives the background, definition, and history of treatment of mental
retardation and mental illness. Identification of these disabilities began in the early
middle ages and continue to develop to this day. This section provides a basic
background for understanding how disabilities were viewed and how current systems
developed.

TRAINING LEVEL: Beginner

Notes to Trainer: This section is best presented to staff with little or no clinical
background or experience. A brief presentation to experienced staff might be helpful to
set the stage for subsequent chapters. For less experienced staff this section can be
expanded to include more basic information.
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1. Participants will be able to describe briefly the history of treatment of

individuals with mental retardation.
2. Participants will be able to describe briefly the history of treatment of
individuals with mental illness.
3. Participants will demonstrate a basic knowledge of the function of OMRDD
and OMH as service providers.
4. Demonstrate a basic knowledge of the myths surrounding psychiatric
disorders in individuals with mr/dd.
5. Demonstrate a basic knowledge of the facts of psychiatric disorders in
individuals with mr/dd.
6. Demonstrate a basic knowledge of the barriers to services that individuals
with mr/dd and psychiatric disorders face.

Identification of mental retardation and mental illness goes back at least to the early
middle ages, long before there was any real clinical treatment. People with mental illness
were labeled “lunatiks” and people with mental retardation “idiots”. Beginning in the
mid-1800’s efforts to train “idiotic children” began, at times developing from educational
practices used for children with hearing impairments.

In the United States, institutions became the treatment of choice individuals with either
disability from the mid-18th Century right into the latter part of the 20th Century.
(Although there were a few institutions developed earlier).

Almost all of the advances in treatment of both individuals with mental retardation and
mental illness came in the later part of the 20th Century. The closing of institutions for
the mentally retarded began in the 1970’s. The occurred not only in New York with the
scandal that surrounded the infamous Willowbrook State School on Staten Island, but in
other states as well. In addition, the “Education to All Handicapped Children Act” of
1975 (PL 94-142) heralded great changes in the education of children with disabilities.

In the field of psychiatry the advent of psychotropic medication, beginning with

Thorazine in the 1950’s radically changed the course of treatment. Across the county tens
of thousands of patients were released from institutions into the community.

Although references to mental illness in individuals with mental retardation can be found
in psychiatry textbooks written in the 1950’s, the fact that individuals with intellectual
deficits could experience the full range of mental disorders was not fully recognized until
the 1970’s and is still debated today. F. Melaniscino is credited with coining the term
“Dually Diagnosed” for individuals with both disorders.