Thoughts on the Treatment of Individuals with Disabilities in the United States.

Today's tea is served black... No cream... No sugar. 

The United States has a dark and complex history involving people different from the average, white, typical American. This history is repeated as new groups of people emerge. Whether it is the use and sale of enslaved people, segregation of black Americans, placing Asian Americans in internment camps, or extreme sentencing and imprisonment of Hispanic and black Americans, history remains the same. We have a pattern of prioritizing separation over inclusion. This pattern continues as you explore the historical treatment of individuals with disabilities in this country. 

Recently, Dr. Bruce L. Keisling came to speak to our class about this sobering history as we explored the importance of understanding our future patients' cultural and historical experiences.

In the 20th century, people with disabilities were deemed feeble-minded. With rhetoric mirroring that of Hitler during WWII, the government attributed people with disabilities to increased crime rates and poverty and viewed them as a general burden to society. In the eugenics movement from 1920 to 1965, it was acceptable to sterilize patients without consent in the hopes of genetically breeding out these "unfit" characteristics. Asylums began popping up in the 1930s and became the prominent means of separating people with disabilities from the general public until the 1970s and 1980s. Families and loved ones were encouraged to sign over care and responsibility of their loved ones to the states and these asylums. 

The systematic encouragement to view those with disabilities as less than, coupled with vauge descriptions of disabilities, caused an increase in individuals encouraged or forced to live in asylums, including individuals with mild disabilities, some with none at all. Overcrowding became common in these institutionalizations. The overcrowding created impossible work environments for the staff and unsanitary and inhumane living conditions for their patients. Due to this, rehabilitation and reintegration were not a priority. Many patients remained there for the majority of the time they were open. Abuse and mistreatment of patients were uncommon in these institutionalizations, and this treatment continued until a majority of them closed in the 1980s.  

I am sickened by the pattern of mistreatment of diverse individuals in this country. While I recognize that we have made drastic improvements in treating people with disabilities, I do not think we are close to being done. For example, legislation is still detrimental to the growth and inclusion of individuals with disabilities in the workplace. The Fair Labor Standards Act of 1938, section 14 (c), allows for individuals with disabilities to be paid below minimum wage from certain types of employers with the hope of being trained in skills to transition to other higher compensation employment options. While this legislation might have been necessary while society was working on inclusion and the destigmatization of individuals with disabilities, it has become detrimental to these goals in today's society. 

"Only 5% of individuals who go into sheltered employment obtain competitive, integrated employment (GAO Report). Additionally, more than 50% of individuals working under a 14(c) certificate earn less than $2.50/ per hour (GAO Report). This practice reinforces the stigmatic misconception that people with disabilities are less productive and creates an artificial competitive barrier to future employment opportunities." 

While some states are working towards repealing this Act, others are not. Tennessee is one of the states who has voted to keep this bill as of April of last year. I admit that I do not know the complexities of why people would vote to not repeal this Act, and I am looking for ways to understand this perspective. As of right now, I believe that this Act shows that we are still on the journey to true exclusivity.

Following this lecture, I plan to prioritize learning more about the experiences of people with disabilities, especially in health care. I hope exposing myself to more stories and experiences will help me to be a more mindful and culturally humble OT practitioner in the future. I am excited and encouraged that if we continue to prioritize inclusivity for all, we can break the United States' past patterns. Learning about our failures is necessary when looking for ways to avoid their repetition. I am grateful that our class has had the opportunity to do our part in breaking this pattern.

References:

Subminimum wage. NDSS. (2021, December 22). Retrieved February 16, 2022, from https://www.ndss.org/subminimum-wage/