In dominant definitions of mental retardation, researchers have insisted on the diagnosis being restricted to conditions manifested during the developmental period. However, even in the 19th century, this was only one of several conceptual options, some of which did not exclude adult brain injury or dementia. Events in the 19th and early 20th centuries, particularly with the growth of institutions, scientific study, and, later, intelligence testing led to these other options being excluded. Here, I discuss the proposal that current definitions are highly contingent on factors that are neither essential nor necessary. Although not arguing for any specific changes to current definitions, I do argue that theoretical options should be kept open and that dominant ones should be questioned.
The position of mental retardation within psychiatry has long been characterized by ambivalence and ambiguity. The conceptual distinction between mental retardation and mental illness continues to be blurred to some degree in contemporary psychiatric nosography, with the two still commonly falling under the same conceptual rubric (see, e.g., American Psychiatric Association, 1995; Greenspan, 1979). Commentators on mental retardation have, perhaps, been most disparaging of this “unhelpful” (Scheerenberger, 1983) “confusion” (Race, 2002). Indeed, the essential difference between the two fields is a basic tenet for modern definitions of mental retardation (Benton, 1964; Kanner, 1964; Race, 1995; Tredgold, 1920), with some commentators even seeing signs of the self-evident distinction going back to the middle ages (Braddock & Parish, 2001; Rushton, 1988). Here, I explore the way in which understanding of mental retardation as a specifically developmental condition contributed to this distinction.
Developmental, in the sense employed in this paper, refers to any definition or conceptual model of mental retardation restricted solely to instances of cognitive deficit arising during the period of mental and physical development (i.e., up to around age 18). The term is, thus, used to make two key distinctions: (a) from strictly congenital models, which do not depend on any concept of child or human development, and (b) from models, all but vanished, that did not draw binary divisions between “idiocy” and brain injury acquired in adulthood or dementia. Even behavioral and functional models, emphasizing mutability and the importance of environmental factors in shaping social competence, still make this fundamental separation and are, therefore, included under the broad heading of developmentalist. Whatever other elements are present and however the relative emphasis on them is placed, current definitions of mental retardation invariably relate in some way to “a condition of arrested or incomplete development of the mind … manifested during the developmental period.”
Some of the highly contingent historical threads that contributed to the conceptual closure of developmental models are traced in this paper, which is by no means an exhaustive account of the multifarious factors that resulted in this closure nor even the full circumstances of those that are considered. Neither of these is a requirement for my principal aim in this paper, namely, to demonstrate that it is neither obvious nor necessary that mental retardation should be regarded as a developmental condition. In this paper I seek to pose questions about the construction of the field, not argue against developmental approaches.
The Inconsistent Legacy of Psychiatry
At first consideration, it may seem quite reasonable to dismiss historical instances of idiocy and insanity being conceptually linked. Andrews (1996), for instance, noted the tendency of parish authorities in early modern England to use terms such as idiot, mad, or distracted almost interchangeably. However, there is another body of work that quite intentionally brought idiocy under the same broad heading as other forms of insanity, namely, psychiatry.
Prior to the 19th century, the very presence of idiocy within classificatory systems of insanity was inconsistent. In some, it did not appear at all (e.g., Arnold, 1963, from the late 18th century), although in others it did appear (e.g., Cosin, 1963, passim; Crichton, 1798). Even where this term was present, however, its position was often limited or bore little conceptual association to the present day. Idiocy appears in the case files of Perfect (1987) as a sequela of insanity and never as a species in itself, whereas in Crichton's (1798) influential treatise on insanity, fatuitas figures as one of the six categories of amentia, itself one of three subcategories of derangement. However, it occupies almost none of the rest of the book. Cullen, in his even more significant taxonomy of disease, expressed his inability “to throw much light upon it [either amentia or oneirodynia], and as they are seldom the objects of practice, I think it allowable for me to pass them over at present” (Cullen, 1829, p. 195). In treatment, the marginalization of idiocy was also common, generally on the grounds of therapeutic pessimism (see, e.g., Pinel, 1962); the Retreat, the pioneering British lunatic asylum in York, specifically excluded idiots from admission for precisely this reason (Tuke, 1996).
Then, in 1806, Pinel, a French physician and the man widely regarded as the founder of modern psychiatry (Shorter, 1997), published his seminal Treatise on Insanity (Pinel, 1806/1962). In addition to being perhaps the outstanding physician of his generation, Pinel is best known for his, largely symbolic, act of removing the chains from the “lunatics” of the two Paris asylums of which he was superintendent (Bicêtre and Salpêtriére) and for developing the system of moral treatment (Porter, 1997; Weiner, 1993), which was to have such a strong influence on Seguin (Kraft, 1961; Seguin, 1866; Simpson, 1999). The very wide-ranging definition that Pinel (1806/1962) adopted excluded dementia but did include numerous conditions that would certainly not be recognized as mental retardation today:
Ideotism, which by the author of the Synonymes Francois is defined to be a defective perception and recognizance of objects, is a partial or total abolition of the intellectual and active faculties. This disorder may originate in a variety of causes: such as excessive and enervating pleasures; the abuse of spiritous liquors; violent blows on the head; deeply impressed terror; profound sorrow; intense study; tumors within the cavity of the cranium; apoplexy; excessive use of the lancet in the treatment of active mania. (p. 165)
For Pinel (1806/1962), not only does accidental ideotism (i.e., that acquired later in life) fall within the general scope of the definition, it occupies the greater part of his chapter on ideotism in his treatise. Such causes even went beyond physical trauma to include emotional shock. One unfortunate engineer, Pinel noted, was projected into such a complete state of immobility, through the shock of being praised in a personal letter from Robespierre for his plans for a new type of cannon, that he had to be transported to Bicêtre, as a hopeless ‘idiot.’
In Revolutionary France, incarceration of the mad by royal decree through lettres de cachet was symbolic of despotic power, while the moral method, by contrast, aimed at the restoration or conversion of lunatics into liberal citizens, persons fitted for a democratic polity (Castel, 1988; Foucault, 1967). In their understanding of insanity, Pinel and the “alienists” who followed placed emphasis on the centrality of the powers of reason as definitive of what it was to be human and on returning lunatics to standards of social propriety. Although clearly by no means insensitive to organic impairment and etiology, these matters were simply not of central importance within the scheme.
By the end of the century, however, the grouping of idiocy with mental illness or dementia was being regarded increasingly as a blatant category error and no longer as a defensible perspective (e.g., Fish, 2004): “One is defect, the other disease” (Arnold, 1904, pp. 18–19). Binet and Simon castigated Pinel for grouping developmental retardation and acquired intellectual impairments, confusing the states of stupor and dementia with actual idiocy, “that which is so from the beginning” (Binet & Simon, 1976, p. 335). From their perspective as pioneers of intelligence testing, Pinel's model could be none other than confusion and absurdity. However, even before the advent of intelligence testing, the nascent medical specialty of idiocy restricted its own direction to the developmentalist view. This leaves us with the question, How did it happen that it became no longer possible to include postdevelopmental cognitive impairment within the discourse and rubric of idiocy?
Developmentalism and the Institution
One of the most significant factors leading to the exclusivity of developmentalism was the role of the institution. It was only after the establishment of an autonomous institutional structure that idiocy was decisively split from the rest of medical psychology at a conceptual level.
In one of the earliest typologies of idiocy and imbecility, William Ireland, Superintendent of the Scottish National Institute for Imbecile Children, produced an etiologically based taxonomy. His system was influential in the United States as well as the United Kingdom (Kanner, 1964) in addition to having similarities with other nosographies that emerged at around that time, particularly in the emphasis on the somatic aspects and etiology of idiocy (e.g., Bourneville cited in Scheerenberger, 1983; Shuttleworth, 1895). In Ireland's system, a number of types are identified that relate to impairment arising after birth (i.e., epileptic, paralytic, traumatic, inflammatory, and idiocy by deprivation). There is no obvious medical reason why these forms of cognitive injury when sustained in childhood should be regarded as different in kind to those in adulthood, at least none that is provided. If the basis of idiocy, as a developmental impairment, lay in the malnourishment of the brain, as Ireland elsewhere suggested, then there is no conspicuous reason to include traumatic impairments at all. In spite of this, physical trauma after birth is included in Ireland's typology, though all of the illustrative case material relates to individuals rendered idiotic in childhood.
In an earlier legally oriented context, congenital impairment was important insofar as it gave a strong indication of likelihood of cure, which had major implications for the disposal and management of the individual's estate in the United Kingdom (Achenbach, 1967). These are not issues that would obviously affect the development of medical psychology. Perhaps there is a far more mundane reason why Ireland's cases should be focused on idiotic children; quite simply, it reflected the experimental population on which knowledge of idiocy was founded. The institutions that sprang up across the eastern seaboard of the United States and in Europe had begun to perform their scientific role of data-gathering very effectively. The literature on idiocy burgeoned, particularly in relation to clinical case material. The institutions and the bulk of the literature up to the late 19th century was produced primarily in pedagogical institutions for the educational treatment of idiotic children (Brodie, 1856; RT, 1976). It is, therefore, not surprising to find that all of the cases of idiocy being considered were of individuals identified as idiotic at a young age. Repeating a widely held opinion, the superintendent of the Western Counties Asylum in England in 1877 commented: “One great benefit attaches to an increase of numbers … viz. that a better classification of the pupils' training and teaching can be made” (quoted in Gladstone, 1996, p. 148).
The aim of improving scientific knowledge had always been a central objective for most of the new institutions for idiots as well as a feature of the demand for more rigorous differentiation and institutional separation of various problematic groups (Ferguson, 2004; Gollaher, 1995; Rothman, 1971; Scull, 1989). It was only when idiots were gathered together in sufficient numbers that they could be studied and grouped into now visible types—a point made quite explicitly by Down (1866). There is no nosological differentiation of idiot types to speak of in Seguin's work and little possibility of constructing one; the data did not yet exist. The very limited number of clinical case studies available prior to the establishment of the institutions was certainly not sufficient for a nosography such as those provided by Down and Ireland. It was scarcely to be wondered at, then, that the differentiation of types and systems for their classification formed around the children being treated and educated in the institutions. By the turn of the 20th century, when an adult population would have begun to be established, their target had been firmly defined.
The complementary side of this factor was the importance of pedagogical interventions as virtually the only weapon in physicians' arsenal of treatments. Little purpose would be served by extending a definition that included those for whom no therapeutic optimism was held. For Pinel, the issue was much simpler because there was no therapeutic optimism for natural idiots either, in fact there was less (Itard, 1972). Marking idiocy off in relation to the developmental years, therefore, also had an important practical function in targeting those who could benefit from such a regime of treatment: “It will not be found convenient to classify together those who have been born defective (congenital cases), and those whose mental decadence has been produced by disease acting on a perfectly formed and gifted body” (Duncan & Millard, 1866, p. 2, emphasis added). In relation to epilepsy, Ireland (1877) suggested:
Epilepsy, as is well known, is one of the commonest causes of insanity as well as of idiocy, and in making our definition of classes it is difficult to know where to draw the line between epileptic idiocy and epileptic dementia. It is inconvenient to draw the line so as to include children under the heading of lunatics, in case they should be sent to asylums for the insane, where there is no proper provision for their training and treatment, and where, owing to their proneness to imitate bad examples, they rapidly deteriorate. If the epilepsy has caused the faculties to become impaired before the age of seven, it appears to me that the patients ought to be treated as epileptic idiots, and I see no practical difficulties to their being admitted to training schools if they be at all educable. (p. 126, emphasis added)
The development of classification schemes based on pathology constituted a further factor tending towards a developmental, as opposed to strictly congenital, model. Only two of Ireland's types were firmly identifiable as being of congenital origin: microcephalic and Mongolian; it is not surprising that these disorders had the clearest pathological symptoms. In addition, infantile and childhood diseases (e.g., nervous diseases, seizures, and hydrocephalus) were known to be common causes of much of the idiocy exhibited among the institutional populations. Significantly, the revised version of Ireland's book was entitled The Mental Affections of Children, Idiocy, Imbecility and Insanity (1898).
Ultimately, however, differentiating types of idiocy is a pointless exercise unless it has implications for treatment or prophylaxis; this was the main issue for classification. The hope was that, in time, the treatment of idiocy would not be delivered on a uniform basis regardless of etiology or type. Instead, treatment would be based on individualized assessment and classification and on the development of truly medical therapies. Of course, for the most part, treatment in institutions did remain fairly uniform (whether pedagogical or custodial, as was increasingly the case). The shift was essentially a theoretical one, allowing medicine to open up new directions of investigation and intervention. Initially, etiology connected with treatment only in a vague way (except for complicating conditions, such as epilepsy), but it did, nonetheless, preclude consideration of the adult brain-injured and, further, did not significantly differentiate treatments according to causation.
Even for Ireland and others, however, etiology still did not yet connect clearly to either nosology or treatment. By beginning with detailed case descriptions, particularly from pathological anatomy (e.g., Ireland, 1873), the investigators who studied idiocy tried to push both backwards into the unique causes of the different types and forwards into specific treatment strategies. Without making any significant progress himself in such developments, Ireland's classification was more explicitly medical because it made links between pathogenesis and cure (and, insofar as it does this, it is of more lasting significance than the physiognomically based racial typology of Down, 1866).
Idiocy, Eugenics and the “Normal” Child
Another factor bringing about the closure of developmentalism was the consequence of considering idiocy, particularly diagnostically, in relation to other children and to infants. Ireland (1877) made precisely this comparison when arguing that “Idiocy bears much resemblance to the ordinary condition of infancy. … [Idiots] very slowly … move towards the efficiency and maturity of the motor and reasoning powers which characterize the normal adult” (p. 2). In a rough way comparison with normal children had always been important for clinical diagnosis. The reliance on such peer comparisons also meant that parents of idiots were more likely to identify the postcongenital period of development as the point of origin of their child's condition (Wright, 1996). However, the development of much more rigorous concepts of intelligence at the beginning of the next century (Binet, 1905; Spearman, 1904) and the subsequent creation of practical methods for testing (e.g., Binet & Simon, 1914; Terman, 1919) would subsequently make this connection to child development even stronger.
In addition to the impact of medico–pedagogical methods and institutions mentioned above, education also impacted on the development of theories of feeblemindedness from the outside via universal compulsory education. Binet and Simon developed their intelligence tests to meet the demand of the French schooling system to identify (for removal) children deemed unable to benefit from mainstream classroom schooling (Binet & Simon, 1914; Wolf, 1973). Feeblemindedness, therefore, came to crystallize heavily around a problem of the schooling system (Trent, 1994), that is, a problem relating to children. As Sutherland (1981) noted, mass schooling was a necessary prerequisite for modern conceptions of special education because it was only in this context that the full variety of children emerged.
Just as systems of medical classification were contingent on the creation of institutions and the large group observations they made possible, the classroom allowed for the development of the concept of mental age (MA). Intelligence-testing implied a concept of feeblemindedness that defined the “abnormal” child in relation to the “normal” child precisely in terms of respective rates and levels of development: “The normal child is always there to refer to and consult” (Kuhlmann, 1976, p. 380). Even though they did not employ a concept of MA per se, Binet and Simon (1914) did define defect in direct relation to typical development:
[a] child of nine, who has learned nothing, has a retardation of three years in three years at school—that is to say, a percentage of 0; our child of twelve, who is in the “intermediate course, first year,” has made in six years half the normal progress; he has therefore a “knowledge percentage” of 50. (p. 65)
Comparison with normal children was not, however, entirely unproblematic, threatening, as it did, to undo any conceptual distinction between the feebleminded and the typical child. For Penrose (1934) this “overlapping” of the typical and defective classes was due to (a) the imprecision in the testing apparatus and (b) antisocial behavior being part of the definition of feeblemindedness, though not exclusive to it. Similarly, even though parents were viewed as principal aides for the monitoring and treatment of the idiot child (Seguin, 1866), they were also viewed with suspicion for their deceptions and inability to recognize and accept their child's abnormality (Ireland, 1976), thus requiring careful management (e.g., Brockley, 2004; Davenport, Laughlin, Weeks, Johnstone, & Goddard, 1911).
The contingency of the genealogy of developmentalism is also very dramatically illustrated in the way in which the threshold of abnormality that arose from the schooling problem was raised enormously, to the extent that the newly created category of “moron” exceeded the idiot and imbecile in a ratio of 1:3:12, according to Kuhlmann (cited in Scheerenberger, 1983) while in the United Kingdom it was estimated that for every 5 idiots there were 25 to 45 imbeciles and 50 to 75 feebleminded persons—in the British sense of that term (Herd, 1930). The potency of the linkage between intelligence testing and eugenics transformed the field in the United States (Carey, 2003; Trent, 1994) and, to a lesser extent, the United Kingdom (Rose, 1985; Thomson, 1998). The “discovery of the moron” (Gelb, 1987) had not only massively increased the numbers of those regarded as pathological, by transforming a formerly subpathological category, indeed a noncategory, into a fully fledged condition, it constructed the most pressing condition of all (Arnold, 1976).
With the construction of links between intelligence testing and theories of genetic decline (Ryan, 1997; Trent, 1994), it should not be surprising to find that a program whose very essence was the control and elimination of hereditary weakness would have little concern with feeblemindedness resulting from traumatic brain injury, even in childhood let alone in adulthood. Goddard (1912) estimated heredity as being the primary etiological factor in 65% to 80% of cases of feeblemindedness, though this was certainly not a balance reflected in his own or the work of other eugenicists (e.g., Newman, 1921; Rubin, 1938). His statement that “Feeble-mindedness is hereditary and transmitted as surely as any other character” (p. 117) is unambiguous in its marginalization of nonhereditary defect. Indeed, so far as feeblemindedness was concerned, the proponents of eugenics were more concerned with its hereditary linkage to other genetic “defects,” as varied as propensity towards sexual promiscuity, crime and alcoholism, epilepsy, insanity, and physical deformity (see, e.g., Davenport et al., 1911; Newman, 1921) as they were to its connection to exogenous causes of feeblemindedness.
The Role of Development in the Mental Retardation Complex
The strengthening of the developmentalist position at the turn of the century can also be illustrated by looking at the first formal definition of idiocy and feeblemindedness to be adopted by the American Association on Mental Retardation (AAMR), then called the American Association for the Study of the Feeble-Minded. This was proposed by A. W. Wilmarth and adopted by the association in 1877.
Idiocy and imbecility are conditions in which there is a want of natural or harmonious development of mental, active, and moral powers of the individual affected, usually associated with some visible defect or infirmity of the physical organization and functional anomalies, expressed in various forms and degrees of disordered vital action, in defect or absence of one or more of the special senses in irregular or uncertain volition, in dullness, or absence of sensibility and perception. (quoted in Scheerenberger, 1983, p. 110)
This definition shows clear signs of the influence of the experimental populations and the exclusively institutional base that the Association had at that time with its emphasis on clinical observations and differentiation and lack of express reference to social incompetence. By 1910, the Association was explicitly using MA as the basis of differentiation for idiots, imbeciles, and morons, and the concern about social competence of the feebleminded at large was evident:
The term feeble-minded is used generically to include all degrees of mental defect due to arrested or imperfect development as a result of which the person so affected is incapable of competing on equal terms with his normal fellows or managing himself or his affairs with ordinary prudence. (p. 61)
This definition then settled into the now very familiar three part concept of “(1) social inadequacy, (2) due to low intelligence, (3) which has been developmentally arrested” (Doll, 1936; quoted in Scheerenberger, 1983, p. 179). The social competence component was to undergo some further conceptual mutation in 1959 to “impairment in adaptive behavior” (Heber, 1959), but the developmental closure was already well-established.
At first consideration, the significance of restricting the field of mental deficiency to conditions arresting, retarding, or simply occurring during the period of mental development may appear slight. Does it not, perhaps, merely have importance for professional and organizational arrangement: the division and allocation of medical specialties, for example, or for the purposes of diagnosis and prognosis? On closer view, however, it is possible to see that, in fact, a number of consequences have followed directly from the exclusivity of this theoretical option.
As I have shown, the ascendancy of the developmental concept was deeply enmeshed with the emergence of the medico–pedagogy of Seguin and his contemporaries. It was in the pedagogical institutions that a new rationale was established focusing the theory and practice of idiocy on children and childhood. The rash of institutions that fanned across Europe and America for the education (medical or otherwise) of idiots established the foundation for subsequent developments in the field. Developmentalism was, therefore, not a logical inevitability; it was a historical event arising out of these various practices and circumstances that both shaped the developmental approach as well as foreclosing on others.
Whether by affirmation or negation, public provision for idiots has centered heavily on their putative capacity to improve. As a direct result of this, the fortunes of those enmeshed in the mental retardation “complex” of knowledge and systematized practices have waxed and waned in almost direct proportion to the optimism of professionals, policymakers, and the public regarding educability. In this way, Seguin's asylum stamped itself and its rationality on the whole nexus of mental retardation right up to the present in a quite unforeseen and unintended way.
In different ways, both the medico–pedagogues, like Seguin or Samuel Howe, or the later nosologists, such as Ireland and Down, marked key points for the developmental tradition by focusing their studies and methods on the learning, development, and treatment of idiot children. Neither takes a congenital approach and both implicitly rejected certain earlier approaches and theories. Ultimately, however, it was the fabrication of a new apparatus of assessment, rather than intervention, that was to prove decisive. Once again, it was a child-focused practice, this time in mainstream classrooms, that produced the conditions in which one of the most pervasive and most controversial psychological technologies was able to develop, namely, intelligence testing.
In this respect, the ultimate success of the developmental strategy also highlighted the vulnerability of medicine. In spite of Ireland's own inclinations towards a developmental view and the decisive advance marked by the pathological classification in terms of the advancement of medicine, the fact remained that it was still the “psychic” dimension of intellectual deficiency that provided the only common link between the pathological types and was ultimately the primary factor in constituting the field. This was to become more significant with the establishment of psychology as an increasingly independent discipline and profession and the fact that intelligence testing was essentially nonmedical (Binet & Simon, 1914; Grob, 1994; Simpson, 2001). Although a number of theoretical options remained open within medicine, the success of intelligence testing was to close all but one, namely, the developmental.
That said, despite the ubiquity of development as one of the definitive elements of mental deficiency from this point onwards, closure was never so complete that alternative statements never appeared. The boundaries between mental defect and mental illness, or between developmental abnormalities and adult brain trauma, continued to remain contestable and ambiguous, albeit only at the margins. For example, in 1962, Carter stated: “Mental defect is usually present from birth and the more severe forms can be recognized as early as six months of age. There are, however, forms which develop later in childhood and some which develop in adult life” (p. 221).
Psychiatry, as well as government policy and legislation in many countries, continued to conflate the categories of mental retardation and mental illness under a broader heading of mental disorder. Clearly, neither medical nor nonmedical psychology approaches entirely eliminated or come to totally dominate the field, which continues, for instance, to leave the judiciary as final arbiters of professional power (Castel, 1988). Closure, therefore, is still largely limited to the mainstream of medicine and psychology and to associated groupings and practices, such as special education and social work. However, given that between them they provide the conceptual foundations for almost all assessment, diagnosis, and intervention, particularly for children, such closure is not inconsiderable.
In conclusion, it is worthwhile pausing to consider the current definition of mental retardation of the AAMR (Luckasson et al., 2002) and the continued legacy of developmentalism. This definition reflects an even stronger functional orientation that that in 1959. The current AAMR position explicitly rejects any suggestion that retardation is either a medical or mental disorder: “Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18” (AAMR, 2005, p. 1).
This definition marks the most complete shift away from organic models, emphasizing mutability and environmental interaction in the production of social competence and incompetence. However, the accompanying guidance avers that the “complete and accurate understanding of mental retardation involves realizing that mental retardation refers to a particular state of functioning that begins in childhood” (American Association on Mental Retardation, 2005, emphasis added). Two questions remain unanswered. First, why is “childhood” relevant or necessary at all in this definition? Why, for instance, could the first part of the definition not stand and the second be struck out? Second, on what basis can the persistence of the developmental period in the definition be justified in terms of completeness or accuracy? At most, it could only be justified in terms of utility, in which case the putative advantages of its inclusion must be demonstrated and not merely assumed. Such an approach may be defended if it could be demonstrated both that people exhibiting the characteristics in the first part of the definition during childhood differ in kind from those for whom they arise only after physical and mental development and that all those differences are not apparent among children identified with mental retardation. However, this seems to cut across the functionalist approach and, at present, these assumptions have not been verified. More significantly, they suggest the unexamined persistence of historical contingency.
Even though I have restricted myself to a few dimensions, I have shown that dominant accounts of the lineage of today's concepts seriously underestimate the extent of the conceptual rupture that developmentalism implied and the conceptual diversity of the field before the mid-19th century. Furthermore, this change cannot be easily explained through recourse to any simple notion of the progress of knowledge or scientific discovery as some have suggested (e.g., Beier, 1964). The basis of the essential distinctions that were drawn between idiocy and adult brain injury were as manifest to Pinel as to Binet and Simon; they were merely unimportant within the framework of classification and treatment. However, in addition to the contingencies that surround considerations of utility, there are also those that arise from unplanned, often external, events and circumstances. The eventual restriction of mental retardation to the developmental period was the unforeseen product of the development of medico–pedagogical practices aimed at children and an institutional population of children around which a discourse was built, subsequently reinforced by intelligence testing. It was, therefore, not only highly contingent, but far from inevitable. For the moment, the circumstances and purposes of reopening alternative theoretical options or generating new ones remain stifled questions.
Murray K. Simpson, PhD, Senior Lecturer, School of Education, Social Work and Community Education, Gardyne Rd. Campus, The University of Dundee, Dundee DD5 1NY, Scotland, UK. email@example.com