Part of this culture is deeply embedded in language in everyday use. I remember the particular thrill of learning a new pejorative as a child - how from a sophisticated Mancunian friend I learned to replace 'wally' with 'spaz' or 'mong' and used it at every available opportunity, which is to say probably every other sentence. It wasn't too long before I was caught using the word by a parent or teacher and lectured on its meaning and the smallness of speaking and thinking in that way, but it certainly wasn't a habit entirely lost after leaving my teenage years.
Working in liberal Massachusetts in the beginning of the 21st century I learned about the American fondness for 'retard', examples of which are only too easily found out and about in Interwebshire. My job was supporting people with learning disabilities who lived and worked independently in their communities. The majority had been residents of Fernald, a notorious institution of which the stories and indeed very well-documented practices over the course of the 20th century make the pop-culture stereotype of the treatment of mental health familiar from "One Flew Over the Cuckoo's Nest" seem like the epitome of enlightened care. Many of these practices carried on well into the 1980s and 90s, until residents, families and other concerned people sued the state to provide the assistance needed to fulfill their right to normal lives in the community.
A clue to the nature of the place comes from the name it carried until 1925: Fernald was known as the Massachusetts School for Idiotic Children. Although such a term was by 1925 was considered inappropriate, it is interesting to note that the state body which provides liberal Massachusetts with treatment, care and support for people with developmental disabilities is to this day the DMR - the Department of Mental Retardation.
I remember being inducted into my work in a leafy satellite town outside Boston, and being somberly instructed that the labels 'client' or 'service-user' were deemed unacceptable for use describing the people who we provided support for, the preferred term being 'individual'. This led to the use of such natural-sounding and empowering sentences as "We held a dance at the centre last week, which all the individuals really enjoyed." I later asked why the DMR hadn't changed it's name to something a little more modern and less negative-sounding - I was told that such a proposal had long since been sadly rejected on grounds of the undue expense that a change of name would entail - such as printing up new stationery, erecting new signage, etc.
The unnecessary expense argument was doubtless a thoroughly realistic one for what I learned of the mechanics of state expenditure in one of the richest and most progressive places on the planet. Every year, for example, the state would vote in a $1 an hour increase for the lowest paid workers in the care sector - and every year, after the Commonwealth's budget had been overspent or vanished into the Big Dig, the voted-for increase would, with great regret, be cut.
The School for Idiocy is also a reminder that although terms like spaz and retard might chafe as particularly obnoxious, 'idiot', 'moron', 'imbecile' and 'cretin' are all words which don't seem to require comment or apology when used in polite society or the Houses of Parliament either. They originate as specific terms for forms of developmental disability. The Ninth edition of the Encyclopaedia Britannica catalogues the terms carefully in Vol. 13's essay INSANITY (by J. Batty Tuke M.D., F.R.C.P.E), and Vol. 6's CRETINISM (by William Charles Smith LL.B, Advocate). The 11th Edition versions of these essays can be found at the Love To Know 1911 website here and here.
Where we pussyfoot about today with terms like developmental disability and mental illness, Dr Tuke can fairly confidently cover a great range of conditions with the term 'Insanity', consisting of "two great classes" : Congenital Insanity and Acquired Insanity. Those afflicted by the first class are idiots and cretins, the second are lunatics. Dr Tuke's consideration of the subject is rational and conscientiously avoids bias :
"In most treatises on the subject will be found discussed the bearing which civilization, nationality, occupation, education, &c., have, or are supposed to have, on the production of insanity. Such discussions are generally eminently unsatisfactory, founded as they are on common observation, broad generalization, and very imperfect statistics... Of much greater importance is the question of hereditary predisposition to nervous disease"
In both Batty Tuke's and Charles Smith's essays the employment of the terms idiot and cretin can hardly be expected to fail to raise either a smirk from the schoolboy or a tut from the enlightened humanist in me, such as when reading that Dr Ireland (esteemed author of On Idiocy and Imbecility) "subdivides idiots, for the purposes of education, into five grades" or learning that "There are cretins at Chiselborough in Somerset." The fact is, the authors make a clear and admirable effort to educate by describing a wide range of impairments as accurately as possible, speculating on their causes with a clear hope of medical practice being able to provide a remedy for or future avoidance of the conditions. In general the language used does, however, appear to be somewhat lacking in compassion, even where exhibiting broad-mindedness.
"Comparatively speaking, there are few idiots or imbeciles who are uniformly deprived of mental power ; some may be utterly sottish, living a mere vegetable existence, but everyone must at least have heard of the quaint and crafty sayings of manifest idiots indicating the presence of no mean power of applied observation. In institutions for the treatment of idiots and imbeciles, children are found not only able to read and write, but even capable of applying the simpler rules of arithmetic."
The same can even be claimed for many schools, universities and workplaces in Britain today.
As for the treatment of both idiocy and lunacy, Dr Tuke is pleased to report that the barbaric practices including cupping and leeching (see The Madness of King George) had towards the end of the 19th Century been almost entirely abandoned. "In asylums of the present day a shaved head is never seen. It was likewise the custom to administer large doses of sedatives. The system of treatment which now generally obtains is almost purely hygienic." Rest and nursing is what the finest minds of the 1880s believed held good, in an age that hadn't yet learnt to appreciate electro-shock therapy, benzodiazepines and Prozac.
"[T]he main question concerning treatment is, Where [is it] best to be obtained ? In the case of the poor there is no alternative, even in comparatively mild cases, but to send the patient to an asylum. In the case of the rich it resolves itself very much into a question of convenience, for, with plenty of money at command, the physician can convert any house into an asylum. But under ordinary circumstances, when the patient is violent, noisy, suicidal, homicidal, or offensive to society, it becomes necessary to seclude him, both for the purposes of cure and for the safety and comfort of the family. Except among the very affluent, treatment at home is for the most part unsatisfactory ; it is very generally tried, but breaks down under the constant strain to which the friends are subjected. In a well-ordered hospital for the insane there is every possible appliance for treatment, with trained nurses who are under constant supervision ; and it therefore affords the best chance for recovery."