Current care for the disabled and activity guidance have undergone significant development throughout history. In the past, people with an intellectual disability were considered ‘insane’. These people were hidden away in shelters, as far away from the outside world as possible. Fortunately, nowadays people know better and these people are at the center of society just like everyone else. What happened before that? It’s quite a story…
In the old days
In the past, people had a very different view of people with an intellectual disability than they do today. In Roman times it was not uncommon for a child with a disability to be killed. Some faiths, for example the Jewish one, saw having a child with a disability as a punishment from God. The parents would have been sinful and therefore had such a child.
Consequence of a sin
In the Middle Ages it was also said in the church that a handicapped child was the result of sin. Making love on Sundays during Lent or during menstruation would be harmful and would conceive children with disabilities. Sometimes parents of children with disabilities were so ashamed that they simply left the child somewhere out of fright. Since the fourth century, monasteries have sheltered children who were exposed for this reason. Children who were considered capable of working could go to farms. Children who were less fortunate had to fend for themselves by begging, for example.
Dolhuizen
Around the twelfth century, disabled people were seen as dangerous, just like the poor, unemployed and homeless. Initially, these could only go to monasteries for shelter. In addition, the first shelters were founded in the larger cities. These were the guesthouses, foundling homes and ‘madhouses’. These originated in the twelfth to fourteenth centuries. In addition to ‘insane’, as they were called at the time, ‘fools, heretics and whoremongers’ also resided here. It was more about the person’s behavior not fitting in with society and less about the disease or condition itself. From the sixteenth century there were also reformatory houses, asylums for beggars, and reform schools around the nineteenth century. In smaller towns, disabled people were housed with private families, who usually received compensation for this. Admission to asylums was still quite expensive and only those who absolutely needed to be nursed were admitted. In the seventeenth century, internment houses were founded in western Europe. Here beggars, the unemployed, whores, alcoholics and criminals were imprisoned, who were forced to work (weaving, spinning, sawing wood) to keep them busy.
Specialized institutions
In the eighteenth century, more and more specialized institutions were established for different types of abnormalities. Medicine also became more concerned with the insane and slowly the term mental illness emerged. In 1884, the Insane Act was introduced and there was state supervision of insane care. As a result, the asylums were improved; There used to be iron handcuffs and footcuffs, but during this period restraints made of linen were introduced. Inspectors of the asylums encouraged patients to be busy by distributing lists of activities (so-called ‘crazy work’).
Occupational therapy
One of the founders of occupational therapy in psychiatry was doctor Everts. He was medical director of Meerenberg (now the Provincial Hospital of Santpoort). He was in favor of occupational therapy in his institution. The work took place in workshops and vegetable gardens. In the mid to late nineteenth century, there were more and more psychiatric patients and more institutions had to be built, preferably outside asylums such as agricultural colonies. The Dutch Psychiatry Association was founded in 1871.
Other groups
Increasing attention was also paid to disabled people such as the blind, deaf and deaf-mutes. Previously they were left to their own devices, but around 1790 the first deaf and mute institute was founded in Groningen. An educational institute for the blind was also established in Amsterdam in 1808.
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Not much was known about mental retardation. This group was seen as idiotic and it was felt that nothing could be done with it. This changed around 1840, when a number of doctors started educating the mentally retarded. First as an experiment, later institutes were founded for this target group. The purpose of these institutions was initially to cure mentally retarded children.
‘More active therapy’
In 1924, a certain doctor Hermann Simon introduced ‘more active therapy’ in Gütersloh, Germany. This therapy appealed to the healthy side of the sick person by allowing him to actively participate in all kinds of activities.
These were Doctor Simon’s principles:
- a healthy part of the personality can be discovered in every mentally ill person.
- most of the features of mental illness for which the patient was not thought to be responsible were a result of bad habits and maladaptive behavior.
- These characteristics can be unlearned by making the patient responsible for them.
Important points in his therapy were work, re-education and a healthy and dignified environment. The work had to be meaningful and match the patient’s capabilities, so that the patient could learn to adapt. Furthermore, order, regularity and discipline were very important in re-education. Patients were rewarded if they adapted and punished if they showed undesirable behavior. Good housing and good hygiene contributed to a dignified existence. Doctor Simon’s ideas were widely followed. In the Netherlands, it was Van der Scheer, medical director of the provincial hospital in Santpoort, who advocated the introduction of Doctor Simon’s more active therapy.
The first steps towards adapted education
Under his influence, occupational therapy in institutions became increasingly popular. In the beginning, mainly from a practical point of view, because during the crisis years (between 1920 and 1930) it was necessary to involve patients in the work to stay afloat. There was a lot of work in the laundries, kitchens, tailors’ shops, shoemakers’ shops, forges and linen rooms of the institutions. Despite this, there were also many patients who did pointless work such as sorting peas and beans. They often had to select the same bags for days to keep busy.
Because hope for a cure had disappeared, many institutions increasingly became homes instead of institutions where people were treated. Ultimately, an intelligence test developed by Doctor Simon and Doctor Binet discovered that there are varying degrees of intellectual disability. As a result, teaching methods adapted to the intellectual abilities of the students were developed. Schools for special primary education were established, mainly focused on practical learning.
HIGH
In 1927, the Dutch Association for the Promotion of Labor for the Disabled (AVO) was founded. This association wanted jobs for the disabled. However, the crisis left many people unemployed, meaning there were no employment opportunities for disabled people. It was difficult for many people to find work. As many felt inadequate due to unemployment, experienced loss of status and received a lower income, understanding grew for how disabled people might feel. After the Second World War there was a general feeling of connection with the fate of everyone and there was innovation in the institutions. Around 1950, there was increasing interest from science for the disabled child. It was discovered that behavioral disorders could be changed pedagogically and there was more interest in the individual patient. Instead of very large groups, patients were accommodated in smaller groups. And there was more respect for the patient’s own input.
Other activities
In many institutes other activities were also applied than just the (necessary) labor ones. People increasingly saw the importance of self-development and expression. Sports and games were also seen in a different light; sport leads to relaxation and shows people as they are, it is a way of ‘being in the world’. Movement therapy was born from this idea.
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Expression
Dance, theater and music also offer opportunities for expression and this gave rise to cultural therapy. Creative skills such as working with paper, paint, clay, wood, metal and leather were seen as forms of free expression. This required specific knowledge and skills. This knowledge gave rise to creative therapy, a form of therapy in which one gets to know the patient in the way he uses the tools and the workpieces he produces.
Occupational therapy
Occupational therapy was also on the rise. Simple work such as making clothespins and assembling bicycle wheels was done in sheltered workshops. There was also seasonal work on farms and in agriculture and horticulture. Later, jobs were also created at factories. Employers paid these employees little and did not consider them as full employees. The employee’s pace and performance was much lower than that of the other employees.
In the 1970s it was felt that occupational therapy was still part of traditional institutional psychiatry. Many former patients complained about the drudgery of work they had to do in the institutions and it was felt that little had improved since then. Nowadays there is more and more money for psychologists, social workers, creative therapists and movement therapists. This created more variety in the range of therapies available.
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Welfare
There were changes in occupational therapy, there was more attention to observation, group occupational therapy emerged and much changed in the working methods of occupational therapists due to training and status. This gave them more in common with creative therapists and movement therapists. The current activity guidance originated from welfare. When the Netherlands was liberated by the Allies in 1944, people came into contact with ‘welfare officers’, these were officers who were trained to help injured soldiers to develop and relax. It had been discovered that keeping the wounded busy would promote healing. The Red Cross took over keeping the wounded busy as a distraction and this then became one of their peacekeeping tasks.
educations
From 1951 onwards, the Red Cross and Zonnebloem started training people for welfare work. Volunteers received ten-evening courses for this purpose and received instructions for manual labor, pathology, lessons on syndromes and psychology.
This way, volunteers could provide patients with distraction in the form of manual labor in a responsible manner. In addition, people also saw the importance of professionals who could guide volunteers and who worked more professionally. These became the occupational therapists, who started working in hospitals.
In 1963, the welfare worker training course was recognized by the Ministry of Education and in 1967 a subsidy was given for this and it became a secondary vocational training course. The name of welfare worker was changed to the name of occupational therapist. As more and more nursing homes opened, there was more work for graduated occupational therapists. In addition, the number of hospital beds also increased and more money was made available for meaningful use of time for patients. An educational goal was increasingly linked to it, because the aim was ‘to help people discover what their possibilities are, in order to live their lives optimally and to fill them in as meaningfully as possible’. It was no longer about distracting from the problems, but about guiding the problems through busyness. The training also placed more emphasis on the development of creativity and dealing with yourself and others.
Therapy?
The word ‘therapy’ was examined more closely in the 1970s. People started to wonder what therapy was and at what level a therapist should be. It was felt that therapy, guidance and care were ultimately three different concepts within care. That is why it was decided in 1979 to replace the occupational therapy training with activity guidance. The purpose of this training was to guide people who were necessarily admitted to an institution due to special circumstances, with the help of activities. An important goal became to help promote the well-being of people and to ensure that the person seeking help feels valuable while maintaining their own norms and values. It was not only about offering creative activities, but also productive, recreational and educational activities.
Activity guidance nowadays
Nowadays there are many options within activity guidance, for example day centers, where a combination of activities and relaxation is offered. What is emphasized (for example creative activities or care and relaxation) depends on the group and the degree of the disability. A care farm is also an option within activity guidance. This is a farm where people who need care can live and/or work. For example, they can care for animals there or work in the garden.
There are also options for activity guidance in work centers, where people with intellectual disabilities are offered a workplace that is as normal as possible. For example, assembly work can be carried out and products can be packaged. Sometimes clients can work in regular jobs (paid or unpaid). A suitable workplace is then searched for with the help of work integration and the client is also guided in this.
People can also find daytime activities in the form of work projects, for example candle and soap makers, potteries, painting studios or the catering industry. Even though working in a regular company is not for everyone, everyone is still offered the opportunity to perform work.