For most of recorded history, people with disabilities were viewed through a lens of moral judgment, economic usefulness, or medical deficiency. How a society treated its disabled members depended heavily on the era’s dominant beliefs, economic structures, and the power of religious or state institutions. The story is not a simple arc from cruelty to compassion. It includes periods of surprising care alongside organized violence, and many of the assumptions that shaped past attitudes lingered well into the modern era.
Ancient Greece and Rome: More Complex Than the Myths
The most widely repeated story about disability in the ancient world involves Sparta. The first-century philosopher Plutarch wrote that Spartans brought their newborns before a council of elders, and babies deemed “lowborn or deformed” were left outside to die. This account became so embedded in Western culture that Hitler cited Spartan eugenics in a 1929 speech, calling Sparta “the purest racial State in history.”
But the archaeological record tells a different story for much of ancient Greece. A 2021 study published in the journal Hesperia argued that Greek parents, midwives, and physicians “often took active and extraordinary measures to assist and accommodate infants born with a variety of congenital and physical impairments.” Excavations of infant remains showed that disabled babies were cared for until they died of natural causes rather than being abandoned. In one burial from the Athenian Agora dating to the second century BCE, an infant with upper limb differences was treated no differently than the other infants buried at the same site. At least one ancient Greek physician dedicated professional thought and practice specifically to treating children with conditions like clubfoot and limb differences.
The reality was likely uneven. Individual families made their own choices, some communities were harsher than others, and social status played a role in who received care. But the idea that the ancient world uniformly discarded disabled people is an oversimplification, often used by later movements to justify their own agendas.
Medieval Europe: Sin, Saints, and Charity
In medieval Europe, disability was understood primarily through religion. People believed it could be a punishment for sin, the result of being born under the hostile influence of the planet Saturn, or, paradoxically, a sign that someone was closer to God. The reasoning behind that last belief was striking: disabled people were thought to be suffering their purgatory on earth rather than after death, meaning they would reach heaven sooner.
In practical terms, care for sick and disabled people fell to the Church. Monks and nuns followed what were called the seven “comfortable works,” which included feeding, clothing, and housing the poor, visiting them when sick or imprisoned, and providing burial. The seven “spiritual works” added counsel and comfort. Monasteries and religious houses sheltered pilgrims and strangers as a Christian duty, and disabled people were among those taken in. This system was charitable in intent but also kept disabled people dependent on institutional goodwill, with little autonomy or social standing of their own.
How the Industrial Revolution Created “Disability”
Before industrialization, the structure of daily life was more flexible for people with physical impairments. The economy was largely agrarian, production centered on the home, and workers set their own pace. An injured or chronically ill person could still take up productive or socially valued roles because work routines and expectations adapted to individual capacity.
The factory system changed this fundamentally. Disability scholar Vic Finkelstein argued that “disability” as a social category is essentially a creation of industrial capitalism. Mechanized factory work introduced four elements that pushed impaired people to the margins: faster production speeds, stricter workforce discipline, rigid timekeeping, and standardized production norms. Together, these made workplaces hostile to anyone whose body didn’t conform to the new requirements. People who couldn’t keep pace were excluded from work entirely or relegated to low-status, poorly paid roles. Increasingly seen as unproductive, they were subjected to institutional “solutions,” placed in specially created facilities and segregated from the wider community. The pattern of warehousing disabled people in large institutions, a defining feature of the next two centuries, grew directly from this economic shift.
Asylums and Public Spectacle
Perhaps no institution better captures the dehumanization of this era than Bethlehem Royal Hospital in London, known as “Bedlam.” Until 1770, the hospital was open to any member of the public who wished to come and watch the patients, with donation boxes placed near the entrance. The display of human suffering for entertainment and profit became such a powerful symbol of cruelty that “Bedlam” entered the English language as a word for chaos and disorder.
Bethlehem was not unique. Across Europe and North America, large institutions became the default response to disability, mental illness, and poverty alike. Conditions inside ranged from neglectful to deliberately abusive, and residents had few if any legal protections.
Eugenics and Forced Sterilization
The late 19th and early 20th centuries brought a new justification for the mistreatment of disabled people: the pseudoscience of eugenics. Proponents argued that disability was genetic and that allowing disabled people to reproduce would weaken the broader population. Indiana enacted the first eugenic sterilization law in 1907, and the U.S. Supreme Court upheld such laws in 1927. By the time World War II began, sterilization programs in the United States had forcibly sterilized approximately 60,000 people.
These American programs directly influenced Nazi Germany. Beginning in 1939, the Nazi regime launched what it called the “Euthanasia Program,” a systematic campaign to kill institutionalized people with physical and mental disabilities. The regime considered them both a genetic threat to the “Aryan” race and a financial burden on the state. In August 1939, the Reich Ministry of the Interior required all physicians, nurses, and midwives to report newborns and children under three who showed signs of severe disability. Parents were encouraged to admit their children to specially designated clinics. As the program expanded, it included young people up to age 17. At least 10,000 disabled children were killed through this child-focused operation alone.
For adults, the regime established gas chambers at six facilities across Germany and Austria. Between January 1940 and August 1941, these sites killed 70,273 people, according to the program’s own internal records. Public awareness and protests, including from some clergy, led Hitler to formally halt the adult program in August 1941, but the killing of children continued. In August 1942, medical professionals resumed killing adults as well, this time in a more concealed manner. The Euthanasia Program predated the systematic murder of European Jews by roughly two years and served as an operational blueprint for the Holocaust.
Postwar Institutions and the Push for Change
The end of World War II did not end institutional abuse. In early 1972, investigative reporter Geraldo Rivera was contacted by an activist physician who had been fired for speaking out about conditions at Willowbrook State School, a facility for people with developmental disabilities on Staten Island in New York. Rivera’s resulting exposé, “Willowbrook: The Last Great Disgrace,” showed the American public what life inside these institutions actually looked like. The broadcast triggered a class-action lawsuit filed against the State of New York in March 1972, which resulted in a 1975 settlement to dismantle Willowbrook entirely.
The Willowbrook case catalyzed a wave of similar lawsuits across the country, each arguing that people with disabilities had the same constitutional rights as other citizens, including freedom from cruel and unusual punishment, due process, and access to developmental services. These legal battles fueled the broader movement toward deinstitutionalization, shifting the goal from containing disabled people in facilities to supporting them in communities.
From Medical Problem to Social Barrier
Throughout most of this history, disability was understood through what scholars now call the “medical model,” which treated a person’s impairment as the core problem and the individual’s body as the target for intervention. The oldest version of this framework, the “moral model,” went even further by associating disability with sin or moral failing. Terms like “cripple,” “imbecile,” and “lame,” some traceable to the 9th century, reflected these assumptions.
In the late 20th century, disability scholars and self-advocates proposed a fundamentally different framework: the social model. British scholar Mike Oliver argued that disability was distinct from impairment. Impairment is the physical or mental condition itself. Disability, in this view, is what happens when society fails to accommodate that condition. A wheelchair user isn’t disabled by their legs; they’re disabled by stairs, narrow doorways, and a lack of ramps. From this perspective, medicine’s focus on “fixing” impairment reinforced the idea that disability was an individual tragedy rather than the result of choices society made about how to build its spaces, write its laws, and organize its workplaces.
The social model became the intellectual foundation for disability rights legislation and shifted the conversation from what was “wrong” with disabled individuals to what was wrong with the systems around them. That shift, still incomplete and still contested, represents the most significant change in how disability has been understood in at least a thousand years.