Until fairly recently the term ÒretardedÓ was used. This has now become a pejorative word and the terms developmentally impaired, delayed or challenged are used by professionals. For the sake of simplicity we use the term mentally impaired or handicapped.
In pagan societies the mentally impaired were sometimes tolerated but rarely treated with kindness. Usually the deformed and handicapped were killed at birth or whenever their disabilities became evident. Greek philosophy held that the laws of nature dictated that only the fittest survive. Although Christianity with its doctrine of compassion for the suffering improved the lot of the impaired considerably, it must also be recognized that Christian attitudes have been subject to social influences.
Early Christians often rescued exposed handicapped infants. During the Middle Ages asylums were built by the church to house them. Some were allowed to roam freely and were regarded as Òholy innocents,Ó or were kept as ÒkingÕs fools.Ó Others regarded them as demons. Even Luther did so! (See his Table Talks) During the Renaissance, when the intellect was highly prized, harsh and cruel treatment of the handicapped prevailed. Called Òsimple Simons,Ó they were often imprisoned under the most wretched conditions and hunted as witches and demon-possessed beings. Until the seventeenth century not even the church helped the handicapped!
In spite of some instances where shelter and care was given to the mentally impaired and other unfortunates, no efforts were made to educate them until the early 1800Õs when some progress was made in training them, but a regression took place in the early 1900Õs. The handicapped were regarded as Òa menace to societyÓ and they were often feared. No training or education was provided, little love was given them, and those who were able worked long and hard. ÒOut of sightÓ was the policy, so that parents hid handicapped children in back rooms and attics. Isolation and sterilization were recommended to protect the general population. Nazi Germany applied the Òfinal solutionÓ to all inferior stock, including the handicapped.
With an increase in knowledge of genetics, the use of IQ tests and the gathering of statistical data, improvements in attitudes towards the handicapped increased dramatically. Particularly helpful in stimulating an interest for the needs of the handicapped was the establishment of the Committee on Mental Retardation by President John F. Kennedy in 1961. It directed the nationsÕ (US) professional and financial resources to improve the care, education and protection of its handicapped citizens. (Gerald Oosterveen, Coping With Retardation, ppl5-18).
2. Defining Mental Impairment
Early literature shows that little distinction was made between mental illness and mental impairment. Some attempts were made by men such as John Locke (1690), but no real distinction between ÒidiocyÓ and ÒinsanityÓ were made until the 1860Õs. The real breakthrough came in 1934 when a condition known as Phenylketonurio (PKV) was discovered. This attracted researchers into the field of mental impairment so that now we know that various factors are involved in its cause. Impairment may be genetically caused, but also physical and social-psychological environment are contributing factors. The difference between mental impairment and mental illness is that the latter is an ostensibly curable and temporary condition, while mental impairment is not. Mental impairment is a permanent, irreversible condition for which there is not hope of cure (Full Participation, Handbook for Congregations, p.9).
3. Causes of Mental Impairment
Mental impairment can be caused by any conditions that hinder or interfere with development before or during birth, or in childhood years. Only about one-quarter of all causes are identified, however. Some causes are genetic irregularities. These may be inherited or caused by disorders of the genes occurring during pregnancy or by over-exposure to x-rays, the abuse of alcohol, drugs, or by infections. Malnutrition, diseases and other disorders of the genes may also result in impairment of the brain.
Brain damage may occur during birth due to complications such as severe stress or injury. After birth, childhood diseases such as measles and meningitis may cause brain damage. Malnutrition, injury, toxins, etc., may retard or damage the brain and nervous system of the young child. Usually impairment occurs during the earliest development periods of life, but a brain injury or toxemia may cause impairment at any age.
Mental impairment may also be caused by environmental factors. Statistics indicate that 75% of the nationÕs (US) mentally impaired citizens come from poverty areas, suggesting that social-psychological environmental influences cause impairment. Malnutrition, lead poisoning, disease producing conditions and other health hazards are more prevalent in low social/income families. It is also known that under-stimulation and lack of bonding during infancy and early childhood can result in irreparable damage. (Full Participation, A Handbook for Congregations, p.9).
4. Levels of Mental Impairment
About 3% of the total population is mentally impaired. One out of every 10 families is affected by it. It would be interesting to find out how these statistics compare with our church membership statistics. Could a lower than average percentage have something to do with there not being some denominational effort for caring for the handicapped among us?
Factors which determine the kind of care which the mentally handicapped need is that almost 90% of the mentally impaired population is only mildly impaired and such individuals can be trained, educated and work somewhat competitively, living ÒnormalÓ independent lives. About 6% of the mentally impaired population is moderately impaired and these persons usually need to live and work in a more supportive environment. About 4% of the mentally impaired population is severely or profoundly impaired. These people have motor, speech or language problems which range form moderately dependent to completely dependent (Full Participation, p.9).
This means every family and every mentally impaired person has different problems and they need to be dealt with and counselled according their needs.
5. Some Characteristics of Mentally Impaired Persons
Mental impairment is an ÒincurableÓ condition and is irreversible. It affects the personÕs intellect and usually their social functioning. Although intellectual impairment is permanent, it can be compensated with development of the individualÕs full potential. These people have the ability to learn, and do have certain work capabilities and skills. Their abilities may be limited and patient and thorough training may be required. Like all of us, they have some special gifts and talents and they need to be developed.
There are still some myths to be dispelled about the mentally handicapped. Usually, they are no more violent than ÒnormalÓ people. Usually they can be expected to behave rationally according to their developmental age. They will not be violent except under conditions that may cause violence in non-mentally impaired persons as well.
The mentally impaired enjoy the normal activities of daily life as much as anyone else. Often, they do not look very different than most people. They are individuals with unique traits and stereotyping them is wrong. They experience joy, grief, anger and depression. They have the same need for affection, love and respect as all of us. They also have a lot of love to offer in return.
6. Problems Encountered by Parents and Family Members
When parents are confronted with the impairment of a child, a process similar to that of death occurs. The difference is that these feelings never go away. Death is a once-for-all tragedy, and can even be welcomed in the case of the aged or pain-ravaged person, but the tragedy of a mentally impaired child remains as long as the child and the parents live. Their initial feelings may re-occur and resurface again and again.
Some of these feelings include:
Feelings of grief, shame, guilt, alienation, repulsion and death wishes are not uncommon. The shock of accepting a mentally impaired child is often compounded by professional ineptitude. Professionals sometimes inform the parents in a harsh manner, such as the term Òvegetable.Ó Others withhold the truth. When no information is given the parents go through a time of suspense and fear. More often parents suffer from incomplete information. Providing information abut the potential of a particular type of impairment can give hope in the face of tragedy.
Sometimes the parents develop defense mechanisms as emotional tensions occur throughout the lifetime of the parent and child. Defense mechanisms such as denial, rationalization, rejection and over-protection are a normal part of coping. It is therefore important that those who are involved with the pastoral care of the parents have some general knowledge of appropriate feelings and defense mechanisms.
Decisions, such as how long and whether to provide home care, foster-care, choice of training and schools need to be made. Thankfully, a lot of help is available from secular sources, but not always from the Christian community. Some of the decisions parents have to make can be very traumatic, especially when the child is severely impaired and the parents have other stresses and responsibilities. This can cause misunderstanding on the part of ÒoutsidersÓ and sad to say, often it is those who should be the most supportive, who make the parents feel guilty. ÒOutsidersÓ may be sure that parents of mentally impaired children do not make their choices lightly.
A mentally impaired child can also put a severe strain on a marriage, especially if it is shaky already. There usually is a severe impact on the family as well. The sibling order often becomes reversed due to the presence of a mentally impaired child. In a normal family, sibling order is fixed. If the first-born is mentally impaired, it will eventually assume ÒbabyÓ status. Stress will become especially evident when the second-born overtakes the first-born. Siblings, especially when they reach their teens, may become ashamed and shun their impaired family member and the handicapped child may become the scapegoat of tensions in the home.
As the handicapped child grows, there arises a dissonance between the below age-level mind and the adult body. This causes problems for the parents and child in regard to spiritual nurture, education and training, vocation, activities, living arrangements, marriage and sexuality.
7. The Biblical Perspective
The most important role the church can fill is to provide a Biblical and spiritual perspective for the problems of mental impairment. It is in this area where parents and family members experience the greatest and deepest problems. Confrontation with mental impairment shakes the deepest meaning and purpose of life. Mental impairment confronts us all with the eternal questions of the nature of (impaired) persons, the origin of (this) evil, the basis of (their) salvation, the need for knowledge and the nature of sin (Oosterveen, p.62).
However comforting it may be to view mentally impaired persons as Òangels unawares,Ó Òholy innocents,Ó and Òspecial children,Ó these terms do not adequately answer the question of who they are, nor give a Biblical perspective. Even cruel, is the view of some theologians such as Brunner, Tillich, Niebuhr and others, who equate GodÕs image in man with manÕs rational powers. This leads to the conclusion that the mentally impaired are sub-human and not capable of salvation and restoration. (Oosterveen, pp.14-16).
I believe it is Scriptural to view the mentally impaired, like every other descendant of Adam and Eve, Òan individual created in GodÕs image, yet temporarily limited in abilities.Ó (Oosterveen,p.l2). Scripture is silent in singling out the mentally impaired for special attention. It does stress, very much, compassion for the needy, down-trodden, and handicapped (Lev.19:14). David cared thoughtfully for Mephibosheth (2 Sam.9); Jesus healed an epileptic (Mk.9:19-29); etc. This silence implies that there is no basic difference between mental and physical handicaps. Humans are accountable according to their ability. Within the class of homo-sapiens there is a wide range of different degrees of personality, intelligence, ability and physical characteristics.
The mentally impaired, like every other human being, has worth, eternal worth in GodÕs eyes and therefore deserve our ministry and care, like every other individual. This has tremendous implications for the churchÕs ministry to the mentally impaired, their parents, families and other care-givers. How we care for the handicapped among us tells the world more about our view of euthanasia than what we say privately or publicly. Increasingly the practices of euthanasia and abortion focus on the child born handicapped or whose development in the motherÕs womb is not normal as can be detected by ultra-sound pictures.
Flowing out of the theological view of the value of the personhood of the mentally impaired is the necessity of having and developing a proper view of suffering. Suffering is an inevitable part of living with the mentally impaired. In order to help with the suffering experienced by the family and loved ones of the mentally impaired, it is the churchÕs task Òto speak justlyÓ of ÒGod amid the awesome fact of suffering.Ó The church must seek to Òvindicate the divine attributes, especially justice, mercy, and love, in relation to the continuing existence of evil. It wishes to speak about God with justice precisely at those point which the divine purpose seems most implausible and questionable, namely, amid suffering.Ó (Thomas C. Oden, Pastoral Theology).
8. A Disrupted Creation
All evil can be traced to the fall. Yet, grace was present from the beginning (Gen.3:15). All sickness, including mental handicaps, is evidence of a spoiled creation caused by sin. Handicaps confront us with the disastrous result of the sin in which we all share equally. . There is a relationship between collective suffering because of collective sin (Rom.5:21-21). Collective suffering is the result of collective sin, but not a direct consequence of personal sin. This does not answer the question why one family is chosen to suffer more than another, but it does point to communal responsibility to empathize and relieve suffering.
The devil has part in the disruption of this worldÕs order (Job 1:6,7; Lk.13:6; Matt.4:10; 16;23; 2 Cor.12:7). This does not minimize collective guilt, but there is an adversary at work, disrupting GodÕs good creation (2 Cor.11:14; Eph.6:10-13; 1 Pet.5:8).
Disaster strikes believers and unbelievers alike (Num.21; Mk.9). Sometimes there are causal links, such as alcoholism, drugs, abuse, etc., but in most cases no particular reason can be detected. Yet, also where there are direct causes, spiritual care which involves confession, repentance, forgiveness and acceptance needs to be administered.
Guilt feelings are experienced by the parents of the mentally impaired because people have always attributed calamities to causes (Ex.20:5; Jn.9:2; Ezek.18:2). Jesus proved this wrong (Jn.9:3; Lk.13), and it is the churchÕs task to provide appropriate ministry and educate its members on this point.
There is comfort in realizing that impairment is not an eternal scourge. It is temporary and pertains to this life only. Eventually, in GodÕs time, there will be healing (Isa.35:5,6; Ps.103:3). We all have handicaps and imperfections. The difference is that the impaired are more severely affected.
9. The Providence of God
ÒWhy me?Ó and ÒWhatÕs the purpose?Ó will be questions asked. Faith is brought into the crucible and a theology of the heart is being forged through experiences of pain, grief and suffering. No full answer will ever be given. God never gave an account to Job. Yet, no answer still is an answer. Job was granted a personal encounter with God and gained new insights into GodÕs being and attributes. He discovered that God is redemptively involved in suffering.
10. Growth in Faith
The church needs to be actively involved in supporting and sustaining the faith of the family that receives a handicapped child, especially through the office bearers. ÒMy grace is sufficient for theeÓ (2 Cor.12:9) is what the family of the impaired often may experience. The struggle and suffering of the family living with the mentally impaired can be a blessing for them and a witness for others. The interaction with suffering can draw out resources of faith in the church as well and bring about real Òcommunion of the saints.Ó
The handicapped also have something to offer to the church. Graces, such as the unaffected loving response of the handicapped, a deeper understanding of suffering and preparation for oneÕs own calamities are learned.
11. The Spiritual Nurture of the Mentally Impaired
By virtue of being creatures of God and the special privilege of being born into the church, the mentally impaired are members of the covenant as much as those who are not handicapped. Because of the wide range of impairment, it is not possible to make categorical judgments on the religious education of the mentally impaired. Research shows that mental age is the most significant factor in the level of religious understanding the mentally impaired can attain. Trainable mentally impaired children until their teen years can usually be kept with children similar in mental development in church education. As they get older, separate classes are usually more helpful. Usually teaching has to be one-on one. Church education material, geared to the trainable mentally impaired is available from several sources (E.g. ÒFriendship SeriesÓ of the Christian Reformed Church).
The mentally impaired are members of GodÕs church and part of the covenant community. They are to be baptized, nurtured and led to make profession of faith and partake of the sacraments according to their capabilities. When they have interest in the things of God their simple faith is often is very trusting and touching. The classical, touching story of a Scottish boy, YeddieÕs First Communion, is an example of such simple faith.
12. Church Support for Families of the Mentally Impaired
The families of the mentally impaired have special needs and there are many crosses to bear for the duration of the life of the mentally impaired child. These need to be shared by the church community and its ministry. The first, indispensable requirement is to be understanding and empathize. Do not begin with theologizing. According to Oosterveen, who is the parent of a mentally impaired child, much frustration and added burdens are the lot of such parents, because of the insensitivity and lack of understanding. Never say: ÒThis is all part of GodÕs wonderful plan for you life,Ó or ÒGod singled you out for His special attention,Ó or Òthis is GodÕs will for you.Ó (pp.24,25). Parents of the handicapped are often torn by guilt feelings because they have trouble accepting GodÕs will and they have been taught that God controls all things. There may be times of rebellion towards God and death wishes for the child. ClichŽs donÕt work and using them can turn suffering parents against the church and hinder them from receiving the support they so desperately need.
The office ministry of the church should be involved in the spiritual training and oversight of the mentally impaired and their families. Visitation by the pastor and elders, visitation, support (probably financial help) and advice from the deacons should be a normal part of the churchÕs ministry. Members can help by showing sympathy, understanding, and relieving parents by offering respite care either in the home or away from home. If you donÕt know what to do, just ask or tell the family they are in your prayers. A kind word or gesture can mean so much!
13. Education and Training
Education acts have made it mandatory that public education for all handicapped children be provided. Christian day schools in various communities also try to meet the needs of the handicapped who are educable. ÒMainstreamingÓ which places mentally impaired children into regular class-rooms is very time consuming and an expensive proposition. Christian schools are often financially strapped. Only few Christian communities are able to afford special schools such as the Christian Learning Center in Grand Rapids. Is the church doing all it can?
14. Community Services
Most larger communities have an Information and Referral Service which guides parents of the mentally impaired to programs and services available in the community. Disability benefits are available for the handicapped of ages 18 and over, provided they are unable to engage in substantial gainful employment. Most communities provide services for the handicapped through an Association for Community Living. These services generally include comprehensive evaluation, financial advice, residential arrangements, medical services, counselling, education, training, vocational services, legal aid, and even special recreation.
Developments in recent years have placed many mentally impaired adults in gainful employment, either in regular work places or in sheltered workshops with various degrees of supervision. The trend is to have mentally impaired individuals live as ÒnormalÓ as possible within the community. A choice of foster homes, day care, group homes, ÒrespiteÓ care and independent living arrangements are available for mentally impaired adults in most communities.
Few communities have Christian homes* for long term care, however. Even fewer have respite care (short-term placement for children under eighteen). In Ontario we are aware of several group homes for adults operated by Christian Horizons ministries (head office: Elmira, Ontario, Tel. (519) 669-1571), the Salvation Army, Catholic Social Services, the Canadian Reformed Church and some private Christian homes.
15. Marriage and Sexuality
There is no correlation between intellect and deviant sexual behaviour. The mentally impaired are no more deviant than normal adults. Like normal people, the mentally impaired develop sexually and fall in love. Sometimes this can lead to mutually satisfying marriages. There is a controversy regarding the marriage of the impaired. A negative view usually is concerned with the raising of a family. The Presidential Task Force of Mental Retardation (U.S.) states that marriage must not be denied to the mentally impaired and depends on the degree of impairment (Elia Katz, The Retarded Adult at Home, pp.73-81).
Mental impairment involves sorrow and suffering. With GodÕs help it can be endured and transcended to become a blessing to the family as well as to the church, especially if we practice our Christian duty to Òbear one anotherÕs burdensÓ (Gal.6:2).
*The Canadian Christian Source Book lists Christian references and resources available in Canada. It may be obtained by sending $20.00 to Salem Christian Counselling Services, 1 Young Street, Suite 512, Hamilton, ON., Tel. (905) 528-0353.
*Full Participation. A Handbook for Congregations, 5523 University Ave., Madison, WI 53705.
*The Retarded Adult at Home by Elias Katz, 4535 Union Bay Place NE., Seattle, WA 98105.
*Coping With Retardation. Dissertation for MTh at Calvin Seminary, Grand Rapids, MI., 1977.
*Pastoral Theology, Thomas C. Oden, San Francisco: Harper & Row Publishers, 1983.