We show our concern and our sympathy when fellow church members suffer, at least, we should. The whole church, and espe­cially through the office of deacons, has a duty to care for the needy and the helpless. Perhaps there is one category of such people who are often overlooked, not so much because we do not sympathize with them, because we do not know how to.

Until fairly recently the term "retarded" 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.

1.  History⤒🔗

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 "holy innocents," or were kept as "king's fools." 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 "simple Simons," 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 1800's when some progress was made in training them, but a regression took place in the early 1900's. The handicapped were regarded as "a menace to society" 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. "Out of sight" 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 "final solution" 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 in the needs of the handicapped was the establishment of the Committee on Mental Retardation by President John F. Kennedy in 1961. It directed the nations' (US) professional and financial resources to improve the care, education and protection of its handicapped citizens. (Gerald Oosterveen, Coping With Retardation, pp15-18).

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 "idiocy" and "insanity" were made until the 1860's. 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 no 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 nation's (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 among us have something to do with there not being some denominational effort for caring for the handicapped? Factors which determine the kind of care 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 "normal" 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 from 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 "incurable" condition and is irreversible. It affects the person's intellect and usually their social functioning. Although intellectual impairment is permanent, it can be compensated by development of the individual's 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 "normal" 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.

1. Shock and denial at first, which softens the initial impact.
2. Grieving comes when the terrible impact is realized. This grieving never stops and can return in intensity during high points in the life of the impaired, but especially when these are seen in the life of normal children, such as at baptism, birthdays graduations, etc.
3. Depression occurs because of the inability to cope, and re-occurs as time goes on.
4. Guilt is experienced for various rea­sons. There is a feeling of having done something wrong to cause the child's handicap. Guilt is also experienced as a result or anger and resentment against God for allowing this to happen and it is necessary that those involved with spiritual care differentiate between these kinds of guilt.
5. Sometimes there are rebellious thoughts against God for giving this child. Death wishes for the child are not uncommon and can re-occur in varying intensities.
6. Helplessness may be felt at first impact, but may re-occur repeatedly.
7. Shame may be experienced because often it is felt that society has a stigma against mentally impaired persons. Looks and attention received in public reinforce this feeling.
8. Frustration is experienced again and again in coping with the child's limited abilities.
9. Fear of the future is often great. This may be experienced in regard to the long-range needs of the child in connection with sexual development, financial burdens, living arrangements, etc. Failure is a feeling often experienced and can lead to a lowered self-image and withdrawal from church, friends and society.
10. Alienation may result from a reluctance to face family, friends, the public, because of the fear of curiosity, disapproval, pity, feelings of inferiority.
11. Repulsion and rejection of the child may be felt initially and may re-occur.

The shock of accepting a mentally impaired child is often compounded by professional ineptitude. Professionals sometimes inform the parents in a harsh manner, using terms such as "vegetable." 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 about the potential of a particular type of impairment can give hope in the face of tragedy.

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 "outsiders" and sad to say, often it is those who should be the most supportive, who make the parents feel guilty. "Outsiders" 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 "baby" 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 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 "angels unawares," "holy innocents," and "special children," 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 God's image in man with man's rational powers. This leads to the conclusion that the mentally impaired are subhuman 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, "an individual created in God's image, yet temporarily limited in abilities." (Oosterveen, p.12). 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 God's eyes and therefore deserve our ministry and care, like every other individual. This has tremendous implications for the church's 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 mother's womb is not normal as 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 church's task "to speak justly" of "God amid the awesome fact of suffering." The church must seek to "vindicate 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 points which the divine purpose seems most implausible and questionable, namely, amid suffering." (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. 5:12-21). 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 world's 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 God's 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 church's 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 God's 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←⤒🔗

"Why me?" and "What's the purpose?" 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 God's 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. "My grace is sufficient for thee" (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 "communion of the saints."

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 one's 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. "Friendship Series" of the Christian Reformed Church).

The mentally impaired are members of God's 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 an interest in the things of God their simple faith is often very trusting and touching. The classical, touching story of a Scottish boy, Yeddie's 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: "This is all part of God's wonderful plan for your life," or "God singled you out for His special attention," or "this is God's will for you." (pp. 24, 25). Parents of the handicapped are often torn by guilt feelings because they have trouble accepting God's 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. Clichés don't work and using them can turn suffering parents against the church and hinder them from receiving the support they so desperately need.

The officers 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, support (possibly financial help) and advice from the deacons should be a normal part of the church's 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 don't 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. "Mainstreaming" 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 "normal" as possible within the community. A choice of foster homes, day care, group homes, "respite" 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 God's 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 "bear one another's burdens" (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.