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Book Reviews   |    
Disability at the Dawn of the 21st Century and the State of the States
Reviewed by Neal Adams, M.D., M.P.H.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.9.1295
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edited by David Braddock, Ph.D.; Washington, D.C., American Association on Mental Retardation, 2002, 510 pages, $99.95

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This book, published by the American Association on Mental Retardation, is in its fifth edition; the original volume was completed 20 years ago. Disability at the Dawn of the 21st Century and the State of the States is a treasure trove of information, statistics, and data analysis, organized by state, chiefly about programs and services for persons with developmental disabilities.

For the most part the book is a reference and resource for those involved in such areas as services research and policy analysis relating to disability services and systems. However, the first chapter of the book is likely to appeal to a much larger audience. Titled "An Institutional History of Disability," this extremely well-researched and well-documented chapter describes the history of disability in Western society from prehistoric Neanderthal man to the present day. The authors' explain how discrimination against persons with disabilities has its roots in 19th- and 20th-century social and political perspectives on poverty. They posit that the congregation of persons with similar disabilities helped forge group identities and facilitated some of the disability rights activism that we see today.

Part of what is fascinating about this historical account is how the roots of 20th-century institutions go back as far as the fourth century, where we see evidence of hospice care and shelter being provided to disabled persons. People with intellectual disabilities and mental disorders were considered and treated as one category until some time between the 17th and 19th centuries, when there was increasing recognition of the difference between "idiots and madmen." The book also covers the treatment of the deaf, blind, and physically disabled. For the reader who is seeking a concise but detailed and comprehensive history of attitudes and practices in the treatment and care of the disabled, Disability at the Dawn of the 21st Century is an excellent source.

About 200 of the book's 500 pages are dedicated to graphs, tables, and charts documenting trends in such areas as spending, residential care, and supported employment for each U.S. state's developmental disabilities system. Another major portion of the book covers a highly detailed comparison of the developmental disabilities systems in Michigan and Illinois, two states selected "to illustrate the complex interplay of forces at work in shaping how long-term care service system priorities are formulated and implemented."

This highly specialized book will no doubt be relevant and useful to only a small and select group of readers. I would encourage the authors to consider expanding the first chapter into a stand-alone volume, as it is an insightful analysis of history and trends that should have wider exposure.

Dr. Adams is medical director of adult services in the California Department of Mental Health in Sacramento.

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