Horowitz (2002), states that the ways in which disabilities are categorised are controlled by the ‘dominant mode of thinking’ at a specific period of time. It is precisely this ‘mode’ of thought that affects the way in which a society responds to certain positions, such as disability and poverty. Sixteenth century England proved to be an excellent example of this. By marking a momentous turning point in religious history, it offered new ‘modes’ of thought in regards to disability, as well as creating a shift in the way that people with disabilities, illness’ and impairments were cared for, and perceived.
Whilst the teachings of Martin Luther were gaining momentum, and support for his attack on Papal control was rising throughout Europe, in England it provided a perfect opportunity to be exploited for monarchical gain by Henry VIII. With the implementation of the protestant reformation, England saw rapid and significant change of perceptions towards the disabled and infirm. This change in attitude appears to be catalysed by closures of monasteries and abbeys, which previously served to provide aid to such individuals.
Prior to the reformation, England had seen a support system for individuals with impairments and disabilities akin to that outlined by the social model of disability, with focus on integration and support (Stone, 1984 as cited in Sheer and Groce 1988). Stainton (2002), states that there was, in fact, no medical remit for institutions assisting those with intellectual disabilities prior to the reformation, and suggests that the fact that ‘inmates’ had intellectual disabilities was merely incidental. This illustrates that although individuals with disabilities may have still faced socially constructed barriers, emphasis was still placed on the care of individuals within communities; with disability often a secondary complaint next to poverty. Likewise, with Horowitz’ statement in mind, the ‘mode’ of disability at the time appears to be considered spiritually-derived and socially addressed, rather than medically labelled and treated.
Along with the reformation, other factors contributed to this shift in treatment of disabled individuals; a rising population, advancements in communication and a move towards an interest in science and medicine, meant that Europe was undergoing social and cultural change at an exponential rate. The political and economic issues of the mid-16th century had serious consequences for the most vulnerable within society. Within England the closure of religious caring institutions, such as monasteries, led to an increase in vagrancy and poverty. Poor laws were thus adapted in response to these changing times.
The ever evolving laws, ironically only served to heighten the social disparity for those with disabilities and eventually the economic crisis resulted in greater upheavals, such as increased vagrancy and disease spread. It became a cyclic, and destructive series of amendments that responded to immediate pressures placed on the state, rather than seeking out long term solutions. Religious and communal support systems were rapidly replaced by public hospitals and medicalisation, and those most in need, (categorised by Sheer and Groce (1988), as ‘unmarried mothers, orphans, mentally and physically disabled, and sick person’s’) faced new forms of discrimination and stigmatism.
Stone (1984, as cited by Sheer and Groce, 1988), suggests that disabled people did not become detached from traditional methods of support until industrialisation in the 19th and 20th centuries, and that institutionalisation did not begin until this time also. However, I would dispute that claim and argue that the initial movement away from traditional care systems occurred as a consequence of the reformation, with the foundations for institutionalisation and social control being laid during this time period.
Here I will set out an argument that outlines the mechanisms behind the changing of attitudes towards disabled individuals during the period of 1485 to 1700. I will evidence how the aftermath of the Protestant reformation in England brought about social change for people with disabilities; shifting from a structure of religiously led support systems, and social integration and care, to an economic crisis resulting in vagrancy, exclusion and discrimination. I will compare attitudes towards disability, both pre and post reformation; discussing how the closure of religious caring establishments moved care of the disabled and sick from a family and communal based system of care, to one of duty-bound state institutions.
Additionally, I will go on to argue that the consequence of this cultural shift further reinforced a negative view of disability within society, changing people’s perceptions of disability from one of an ingrained sense of care, to a perception of burden. Where disability was seen as a holy and spiritual act prior to the reformation, it was soon deemed disdainful, and draining to state finances post reformation.
Pre reformation attitudes towards Disability within Europe; 1485 – 1532.
The concept of ‘disability’ is a modern idea; The World Health Organisation describes to the term as the restrictions observed by an individual as a consequence of their impairments. The term ‘disability’ was not recorded in English history until the late 16th century, during which time it was used to refer to a ‘want of power, strength or ability’(Wasserman et al, 2016), as opposed to a social disadvantage brought about through impairment. It is clear that disability was not viewed then as it is now, within its modern day meaning. Indeed, prior to and during the 16th century, individuals were not considered ‘disabled’ within the modern meaning at all, as social integration was viewed as a normality, and persons with impairments did not face the same social construct of disability that people do in society today. However, for clarity and the avoidance of repetition, I shall use the term ‘disability’ to refer to individuals with impairments or illness that may have potentially caused disability, as we would understand it within the modern meaning.
During the middle ages, (5th-15th century), impairments and illness were commonplace, regardless of age, wealth or social status. It was prevalent amongst both peasants and nobility, and accepted equally by both. Although disability was viewed differently between different societies within Christendom, it was not usually seen as a cause for complete segregation or isolation from normal society. In the middle ages, ‘non-normative’ bodies were seen to be a canal for God, with the rich donating alms in exchange for spiritual encounters (Row-Heyveld, 2009; Jarrett, 2012; Metzler, 2006). Others, such as those with physical impairments, were believed to be suffering punishment for their past sins, or those of their parents (Covey, 2005). Whilst those suffering from mental illness could be viewed as undergoing demonic possession.
There were various examples of the consequences of sin, and teaching of how such actions would lead to imperfections n the human form, outlined in biblical passages as a warning to those who may succumb to temptations (Metzler, 2006). The impact of these cautionary teachings for most, would have resultantly relied on the clerical interpretation from Latin, therefore widely inaccessible for the poor pre-reformation.
Attitudes towards disability had seemingly changed very little by the turn of the 16th century, and although the social structures of European countries remained complex, they remained under the governance of the Catholic Church, and led by ancient doctrines. The monarchs of Christendom still took dictation from the Pope and papal representatives, and so a certain degree of uniformity was maintained throughout the Holy Roman Empire.
Society during the period is best described by Miles (2001), who, when discussing the Germanic region of the early sixteenth century, suggested that it was:
‘pre-scientific, pre-printing, narrow, inflexible, dominated by hierarchical religion and supposedly all-embracing doctrine, characterised by superstition, credulity and dependant on translated and packaged knowledge from ancient authorities’.
Due to the nature of the environment, accidents and illnesses were common place, and frequently left individuals with permanent disabilities and impairments, which were often regarded as ‘divine interventions’, (Loimer et al, 1996). Some individuals would face life changing disabilities brought about by common practices, for example swaddling, which prevented vitamin D uptake and ultimately caused Rickets (Penny-Mason & Gowland, 2014). Disability also came in the form of congenital defects, learning disabilities and ‘mental illness’. Regardless of the mode, attitudes towards disabilities were mixed during these times, as I shall go on to discuss. Despite this, the upkeep of such individuals was viewed as a civic duty of care, rather than a need to treat or cure. This is not to say however that all individuals were cared for, some were abandoned by society, and forced to turn to begging in order to survive (Erskine & McIntosh, 1999).
Prior to the reformation, vagrants with disabilities had been viewed as the responsibility of religious institutions, such as monasteries, and were able to seek refuge and shelter throughout the land. As such, they were deemed by the state as the ‘deserving poor’ or ‘worthy poor’ (Sheer & Groce, 1988), and likely to receive donations and religious help, (Row-Heyveld, 2009). However, as the population increased towards the early 1500’s, more disabled beggars were seen on the streets, putting an increased demand on religious institutions and local parish’s, and for those who were not in a position to be assisted by communities, they were forced to either find work or move on. It is important to note here, that for the ‘worthy poor’, those with disabilities or impairments restricting them from work, begging was legally allowed by means of survival.
For the majority of those with disabilities and impairments who were able to work, and not forced into vagrancy, there is abundant evidence to suggest that they were well integrated into society, often maintaining employment and engaging in community life (Metzler, 2006; Row-Heyveld, 2009; Jarrett, 2012). Those that were able to participate in such activities were cared for by relatives or the parish, and often in receipt of alms from rich sponsors, usually in the form of housing or monetary donations. This was usually a non-altruistic exchange, as it enabled the sponsor to encounter divine presence by assisting the ‘blessed’, (Row-Heyveld, 2009).
Prior to the reformation in England, Religious institutions played a pivotal role in the care of the disabled. Whilst basic hospitals catered for the poor and infirm, the expectation was that the sick, customarily pilgrims, would reside there short term, ordinarily one night, in order to receive rest and a hot meal (Mahood, 2015). These ‘spytalls’ did not offer diagnosis or medicalisation in the sense that we would observe today, although more long-term establishments did ensure quarantine against infectious diseases such as leprosy, which was prevalent in England during the Middle Ages. Leprosy was regarded as an act of divine penance for sexual sins (Augente & Gilchrist, 2011), with those in care receiving religious prayers and interventions, rather than long term, medical assistance.
The spytalls were still closely overseen by religious authorities (Augenti and Gilchrist, 2011), sparse in their locations, and in short supply (Mahood, 2015). Those with disabilities who were unable to seek long term care from their families, often had very few options but to travel to spytalls away from their home towns, thus travelling vagabonds became common. Spytalls which offered long term provision were in short demand, and thus overcrowded and underfunded.
One such notable establishment was the priory of Bethlam, (or ‘Bedlam’ as it became later known). Although predominantly caring for the sick poor, Bethlam started to gain a reputation for its attentive care towards those with mental illness, and by 1403 cared for an inordinate amount of such individuals (Andrews, 1991). At this time, Bethlam, like the other spytalls and priories, was known as a place of respite, and did not become known as an ‘asylum’ or medical institution until 1634, (Andrews, 1991).
As a disability was seen to be an act of God in one capacity or another, the monasteries, priories and abbeys served to help those who may be afflicted to understand their circumstances; seeking atonement for past sins, whilst simultaneously acquiring refuge and understanding from the community within the monastery walls, which acted as a ‘surrogate family’ for those who society had rejected (Crislip, 2005).
Medical care in the late 15th to early 16th century was limited to those who could afford it, with practitioners being of wealthy and educated backgrounds (Augenti & Gilchrist, 2011). Royal physicians were seen in courts across Europe, however there role was little more than the preservation of the monarchs health, and advising in the acquisition of male heirs (Nutton, 2018). The physicians seemed to have little responsibility regarding permanent disability. Since court life was centred on politics and status, physicians often played additional advisory roles within the court. This remained common practice prior to the reformation through to the 19th century, (Nutton 2018).
Medical intervention at court was little more than management of pain caused by illness. Long term and life changing disabilities were still perceived to be a consequence of divine providence, and those with certain ‘intellectual impairments’, were thought to have been derived as a direct result from holy blessings and spiritual connections (Lipscomb, 2012, as cited in Jarrett, 2012; Levitas & Reis, 2003). This belief led to the employment of ‘fooles’, (or ‘naturals’ and ‘innocents’ as they were otherwise named), by monarchs, whose purpose was to entertain wealthy courtiers. This practice was common with monarchs throughout the sixteenth century, and across Europe, and changed little post reformation. Although this remained relatively unchanged, I feel it important to include it here as I believe the contradictory discourse concerning the employment of fools provides much evidence of the treatment of those with learning disabilities, and mental illness during the late antiquity, through the 16th century.
Some academics state that the presence of ‘fools’ at court highlighted the close proximity of the monarch with sentient beings, and those who were blessed (Lipscomb, 2012, as cited in Jarrett, 2012). Evidence to support this is found in artwork such as the painting ‘The Adoration of the Christ Child’, circa 1515, which is believed to depict an image of an angel with Downs Syndrome (Levitas and Reid, 2003). This suggests a link between the perceptions of such conditions with divinity. However, others argue that the ‘abnormality’ observed in fools was a ‘sentence passed by God’ for previous sins, and they were therefore placed with in society to be ridiculed as penance for this (LeGoff, 1988, as cited in Metzler, 2006).
I would argue that the latter suggestion is somewhat misleading, as there is a large body of evidence to suggest the ‘fools’ were valued members of court, and admired for their honesty and innocence, hence considered spiritual. For example, the famous fool of Henry VIII, Will Sommers, received the highest forms of gratitude and privilege from the King; in the form of monetary rewards, and heightened social status. This was not an isolated case, as fools across Europe were granted similar privileges. Conversely, the language used when discussing fools in literature would suggest that all too often, especially in older citations, academics confuse the treatment of those with mental illness during the period, with that of those who we may identify in present day as having learning difficulties.
The reformation, vagrancy and a change in perception.
The trigger of the reformation in England, between 1532 and 1534, generated a rapid political, economic and cultural reconstruction. As Henry VIII broke from the Holy Roman Empire, he turned to other reformist countries to take their lead, which inadvertently lead to a change in the way society treated people with disabilities, impairments and illness. This change was in part the responsibility of practical factors such as the dissolution of the monasteries, but also due to a social need to seek out new religious influences and biblical interpretations; mainly those of the Germanic reformer, Martin Luther.
There has been much discourse concerning Luther’s opinions towards disability; some academics perceive Luther to hold great prejudices towards disabilities, focusing on his warnings of ‘changelings’ and ‘witchcraft’ (Miles, 2001), and his attitudes towards ‘mentally retarded children’ (Colón, 1989, as cited in Miles, 2001). However others, such as Miles (2001), take a more subjective approach when evaluating Luther’s teachings. It is impossible to correctly infer Luther’s thoughts on disability as we do not have his opinions concisely recorded. Nevertheless, it should be accepted that Luther’s attitude towards vagrancy had a direct impact on the disabled poor of England.
Luther’s preface in the book Liber Vagatorium (Anon, 1528), states clearly Luther’s attitudes towards vagabonds and beggars. It proposes that the public should be ‘prudent and cautious in dealing with beggars’, and that parish councils should know and register their poor, so as to eliminate vagrancy and ‘knaveries’. By these means, Luther suggests that councils can ensure monitory donations are only given to ‘honest paupers and needy neighbours’. This publication, along with many other of Luther’ works, had a substantial impact on the reformation movement, as it coincided with recent advancements of the printing press, enabling propaganda material to be easily published and distributed. Indeed, the Protestant reformation was first major campaign to utilise the printing press in order to expand communications across Europe, (Edwards, 2005), and literature regarding Luther’s interpretations of biblical texts, and his thoughts regarding vagrancy, were now readily available to the English reformers; possibly indirectly contributing to the stigmatisation of the disabled that followed.
Between 1532 and 1534, the reformation gained ground in England. The country witnessed a devastating effect on the disabled, brought about by the dissolution of the monasteries, and closure of over 260 religious ‘spytalls’ and almshouses: more than half that were present in England at the time (McIntosh, 1988). The closures forced the poor and disabled onto the streets, increasing levels of vagrancy. This happened with almost immediate effect after the reformation, as outlined in a petition to Henry VIII, in 1536, which called for:
‘an immediate reopening of the hospitals as ‘the miserable people lyeing in the streete, offending every clene person passing by the way’, (Strype, 1820).
In response to the emergency, Henry VIII legislated the ‘Act for Punishment of Sturdy Vagabonds and Beggars’ as part of the English poor laws. This act served to ensure that parish councils were held accountable for their poor and disabled parishioners (Slack, 1995). However, the new amendment to the law proved to yield little by the way of outcomes for several decades and England saw a period of sixty years where religious sanctuaries had been eradicated, and the new hospitals and alms-houses that would replace them, not yet built (Penny-Mason & Gowland, 2014). Those with disabilities who could not be supported by their family or community members, now had very little choice but to turn to vagrancy.
In 1547, Edward VI gave permission for parish’s to increase taxes in order to fund the new building of hospitals. For example, In London, taxes were raised to fund the erection of St. Bartholomew’s hospital (McIntosh, 1988), which arguably led to a replacement of the religious caring establishments, with medicalised institutions. Other cities soon followed suit, and the heavy burden of tax inflations further took its toll on the poor. The hospitals, though being constructed, were still not built, and the state placed increasing responsibility on local parish’s to care for their infirm. Rich investors were now invited to sponsor the erection of new almshouses, though this provided to be little more than an opportunity to increase personal popularity, than to assist those in need (Jarrett, 2012). I would suggest that this was the turning point from the caring nature of the church, to a civic duty of the councils.
The responsibility of religious institutions as care providers was removed officially in 1572, by Elizabeth I, with the introduction of the Vagabonds Act. This legislation set out the new obligations to parish councils with respect to their poor and infirm, and ordered the Justice of the peace for each ward to distribute donations to those unable to work. The act set out governance stating that any ‘able bodied poor’ should be put to work to reduce the vagrancy population, these individuals faced heavy penalties if they failed to comply, such as whipping, branding and ‘ear boring’ (McIntosh, 1988). The ‘impotent poor’, those individuals known to parishes as too infirm or disabled to work (Sheer and Groce, 1988), were to be supported by the state, suggesting this was the initial precursor to the welfare system in England.
Although designed to protect the ‘impotent poor’ – that is, those with genuine conditions preventing them from work – it could be argued that the act served to further persecute them. With local parish’s now being responsible for their budgets, and the religious caring institutions gone, the disabled were beginning to be viewed as a burden on local societies and communities. As poor laws were refined to punish those who were seen to be undeserving, more individuals turned to feigning impairments to exploit the alms given to the ‘worthy poor’. One account suggests that some beggars would consume soap to induce convulsions similar to epilepsy, (Erskine & McIntosh, 1999), others were known to feign blindness, (Row-Heyveld, 2009). This generated stigmatism and provoked a negative backlash for the ‘worthy poor’, and those with genuine disabilities and impairments, who were now more commonly viewed as fraudsters.
Between 1563 and 1598, the poor population had increased so significantly that now over half of the population were unable to work through issues such as disability (McIntosh, 1988). MacFarlane (1990, as cited in McIntosh, 1988), suggests that the lack of assistance offered by wealthy families to their poor neighbours led to a rise in witchcraft charges around this time. I would go further and argue that that the collapse of social care from monastic provisions, coupled with the increase in poverty, not only promoted witchcraft charges, but also led to a direct persecution of those with disabilities by means of early eugenics; that is the deliberate eradication of those with disabilities and impairments to relive their ‘burden’ on the state.
By the late 16th and early 17th century, attitudes towards the disabled had changed significantly from the pre-reformation days of social and religious care. The late 16th century saw an upsurge in interest in scientific and medical interventions, and institutions such as Bethlam had begun to specialise care, placing focus on medical interventions rather than traditional methods (Jarrett, 2012). Although thorough the 16th and 17th century the care of those with mental illness was still mainly allocated to families (Covey, 2005), a large proportion of individuals remained on the streets (Jarrett, 2012), with no care or social support akin to that they would have received prior to the reformation. I would also suggest that it is apparent through the change in langue found in records such as parish census’ and hospital registers, that stigmatism and labels for those with such conditions, were now being formed; with a shift of language from terms such as ‘natural foole’ and ‘impotent poor’, to ‘idiots’ and ‘lunatics’.
The late 16th and 17th century also saw a rise in ‘witch hunts’ which saw direct discrimination of those with physical and mental disabilities. Though many disabilities were still perceived to be a consequence of sin, the treatment towards disabled individuals had now shifted from one of a duty of care, to a right to persecute, ridicule and stigmatise.
Conclusion and Discussion.
Horowitz (2002), stated that society will always label and stigmatise. Whilst evidence would suggest this statement to be partly correct, in that people with disabilities have always faced prejudiced attitudes and persecution throughout history, it is also clear that the treatment of such individuals is influenced by the social and political pressures of the time period.
It can be said with a high level of certainty that disabled people were confronted with a rapid shift in legislation, as well as a change in the level and method of delivery of care, as a consequence of the economic aftermath of the reformation. Where there had previously been an inclusive and social support system, focused on spiritual healing, refuge and acceptance, the disabled citizens of post- reformation England faced vagrancy, institutionalisation and discrimination as consequence of the political upheaval. I believe this marked the initial shift from an early version of the social model of disability, toward a society beginning its journey down a path towards a medical based model of disability.
Not dissimilar to modern day, the economic position of the country throughout history has dictated the support received by disabled individual. However, unlike modern day, I would argue that prior to the reformation, there resided an ingrained system of social care, with families and religious institutions being the keys to inclusive provision. Stainton (2002) proposes that that it was poverty as opposed to impairment that drove the change in support during the sixteenth century. Whilst I agree with this statement, I would also add that it was also this poverty that lay the foundations for medicalisation of disabled individuals at this time.
The impact of the reformation on disabled members of society runs far wider than the issues addressed here. Further reading will undoubtedly highlight how the evolution of language, led to the formation of certain labels becoming common parlance, thus reinforcing stigmatism and discrimination at this time. Evidence may also be uncovered when further evaluating the impact on Luther’s teachings on disability, or how the English poor laws affected the early American settlers, and their views of disability in the sixteenth century. The reformation clearly proved to be an important, and pivotal turning point in the history of disability, having consequences not only for our disabled ancestors, but also shaping the future of disability and social care.
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