The Problem of Mental Deficiency: Eugenics, Democracy, and Social Policy in Britain c.1870-1959 (review)

Mathew Thomson has given us a well-researched and cogently argued administrative history of British policy concerning the mentally disabled. This remains an understudied yet significant topic, for as Thomson points out, by the 1930s almost 100,000 persons labeled as “mentally deficient” were under some form of state supervised care, making it one of the main areas of social welfare provision. Thomson situates his study within the late-Victorian and Edwardian movements for the professionalization of health care and social work as well as the changes wrought by new education policy.

The introduction of universal elementary education in 1870 triggered the idea that “mental deficiency” (the condition of permanent mental damage or incapacity from birth as compared to mental illness or insanity) was a serious social problem. The new schools and standardized tests drew attention to children who needed special training if they were to be educated. At the same time, changes in the labor market made it difficult for the mentally retarded to contribute to their own support, and families found it increasingly difficult to provide care at home for disabled children. During the 1880s, special schools rather than residential institutions became the favored solution to the “slow child.” Voluntary and charitable organizations had done most of the work with the mentally retarded during the nineteenth century, but by the early-twentieth century the private sector felt overwhelmed and lobbied the state to provide permanent care for the mentally disabled.

Heightened awareness of the extent of mental deficiency coincided with growing fears of national degeneration, and as such provided more grist for the eugenics mills. A 1908 Royal Commission Report on the “Care and Control of the Feeble-Minded” eventually resulted in the 1913 Mental Deficiency Act, which is the real starting point of Thomson’s history. The 1913 Act reformulated mental deficiency as a national problem which demanded a national policy. The provision of institutional and community care services was made an obligation of every county and borough authority in England and Wales. The Act provided for the compulsory supervision of mentally disabled persons and in some cases their permanent segregation from the community in institutions.

In discussing the creation of yet more state institutions, Thomson resists a strictly Foucauldian approach. For, as he points out, the 1913 Act and its supporters hoped to care for the disabled more humanely by removing them from the prisons and workhouses where they had often been kept in miserable conditions. And yet a constant shortage of funds in the postwar world meant that austerity and neglect remained the order of the day. Attempts to create therapeutic communities where patients learned trades, lived in model cottages, and gardened ultimately gave way to considerations of management and economy.

The main alternative to the institution was “supervised care” in the community, whereby a social worker would periodically visit the person and his or her family. The very term “supervision” reflected an emphasis on policing and reforming behavior, rather than providing aid, and the main hesitation to transferring more people from institutional to community care was fear about the sexual behavior of released patients. Such concerns were highly gendered. Women were the primary target of this sort of regulation because controlling their sexuality was seen as the most effective way to prevent the breeding of future generations of the mentally retarded. In fact, concern over the sexuality of the mentally disabled within the community was a main impetus for sterilization during the interwar years.

Thomson’s chapters on the sterilization debate are among the strongest in the book. He brings a fresh approach and new insights to this issue, especially in his insistence that support for or opposition to sterilization should not be viewed simply as a gauge of the popularity of eugenics. The 1931 Bill proposing the voluntary sterilization of the mentally disabled was defeated by a wide margin, but...