A Disability History of the United States by Kim E. Nielsen (review)

Kim Nielsen's A Disabiity History of the United States is the first comprehensive history of disability in the United States from the precolonial period to the early twenty-first century. Nielsen draws on the rapidly growing body of scholarship on the history and the concept of disability to recount how both the experience of being disabled and disability as concept have changed significantly over this 400-year history. She skillfully mixes broader generalizations about disability in historical periods with powerful examples of how individuals experienced being disabled, or how medical and state authorities tried to shape and control the unruly bodies and minds of the men, women, and children with disabilities. Nielsen is also very sensitive to the ways in which race, class, and sex often interacted with concepts of disability to influence what it meant to be disabled.

Nielsen largely adopts a social model of disability, though she also traces the ways in which medical models have attempted to understand and cure or control those with disabilities. While the medical model of disability emphasizes the disabling impairment and the medical efforts to cure, control, or care for the individual with the disability, the social model sees disability as a "social category shaped by changing social factors" (xv). Nielsen focuses primarily on how disability was understood as a social category in different social and historical contexts and how that understanding changed as those social contexts changed. Nielsen also stresses how disabilities were experienced in different places and times, such as the nineteenth-century shift from sign language to oralism in teaching deaf individuals.

Nielsen's history of disability is told chronologically, beginning with Native Americans before European colonization. Indigenous societies had no concept of disability as we understand it. They certainly recognized physical and mental differences, but as long as individuals with what we call a disability could provide a useful function in these societies, they typically found acceptance. European colonization brought new ideas and attitudes. European settlers generally found physical disability commonplace and seldom commented on it unless the individual could not work in socially appropriate ways. Mental and cognitive disabilities were more likely to draw the attention of others as they were seen to be more disruptive. Families were generally expected to care for members with mental and physical disabilities, and towns and villages focused on limiting the financial burden to the community posed by these individuals.

In the nineteenth century, disability began to be understood in biological and medical terms. It was still most often seen, however, as an inability to work and care for oneself. The antebellum period saw the creation of institutions and asylums to provide care, education, and perhaps a cure for the disabled. This movement also brought the rise of new professions to staff these asylums and to reshape the understanding of disability and its experiences. They emphasized curing the disabled, and controlling them if a cure was not possible. Whatever the good intentions, the reality of these asylums was often quite horrific, and these conditions spurred reform movements.

One of the strengths of the book is Nielsen's emphasis on the ways in which disability intersected with race. She notes that "the racist ideology of slavery held that Africans brought to North America were by definition disabled." The assumed mental and physical inferiority of those of African descent was frequently used as a justification for keeping them in slavery. Slaves who were themselves disabled, often because of the harsh conditions of slavery, were considered "damaged goods" and often referred to as "refuse slaves" (42). Ironically, emancipation was also seen as disabling, as many whites expected that freedom would drive the former slaves insane. Nielsen also notes that in the postwar South, institutions for the care of the disabled were typically segregated and the facilities and care provided African Americans were worse than for whites.

A key part of Nielsen's book is her exploration of the ways in which disability came...