doi.org/10.35321/term28-06

The changing terminology for intellectual disability and its levels in Lithuanian, and the factors driving that change

DALIA GEDZEVIČIENĖ

Institute of Law, Lithuanian Centre for Social Sciences

ORCID id: https://orcid.org/0000-0001-8285-9692

ANNOTATION

The article presents the Lithuanian terms used in the 20th century and the first two decades of the 21st century to denote intellectual disability and its levels, and reviews in parallel the terms used to designate the same disability and its levels in the International Classification of Diseases (ICD). The study examines the factors that prompted changes in the terminology in this field, as well as the reasons why at least four terms are currently used synonymously to denote intellectual disability in official Lithuanian documents, public and academic discourse, and practice (intellectual disability, intellectual impairment, mental retardation, dementia), and the possible influence of each of these terms on public attitudes and perceptions of the group of people with this disability.

KEYWORDS: intellectual disability, intellectual impairment, mental retardation, dementia, synonym, connotation, International Classification of Diseases.

ABSTRACT

This article presents the Lithuanian terminology used to name intellectual disability and its levels in the 20th century and early 21st century, and reviews the terms denoting the same disorder and its levels in the International Classification of Diseases (ICD). It explains what factors led to the change of the terminology in this field and what causes determined the emergence of at least four terms, which are currently synonymously used in official Lithuanian documents, public and scientific discourses and in practice to name intellectual disability: intelekto sutrikimas (disorder of intellect), intelekto negalia (intellectual disability), protinis atsilikimas (mental retardation), and silpnaprotystė (feeble-mindedness). Moreover, the article examines the possible impact of each of these terms on societal attitudes toward the group of individuals with this disorder.

KEYWORDS: disorder of intellect, intellectual disability, mental retardation, feeble-mindedness, synonym, connotation, International Classification of Diseases.

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INTRODUCTORY REMARKS

The mid-nineteenth century may be regarded as the beginning of the more consistent use and establishment in the language of medicine and other fields of international terms denoting intellectual disability, which were formed mainly on the basis of Greek and Latin; the origins of the corresponding Lithuanian terminology date back to interwar Lithuania. In the second half of the twentieth century, alongside the traditional biomedical conception of intellectual disability as an illness and a defect of the brain, a view emerged of this cognitive characteristic as a social phenomenon, essentially created by the way societies of particular periods perceive the boundaries separating norms from non-norms. Attention was consequently drawn to the ethical aspects of terms denoting intellectual disability and its levels. The efforts of doctors, educators, social workers, representatives of non-governmental organizations, and the guardians and relatives of people with intellectual disabilities led to changes in the terminology of this field; a neutral, precise and, above all, respectful way of referring to this condition and the people who have it has been, and continues to be, sought.

In Lithuania, lawyers (Benkunskas 2012), psychiatrists (Pūras 2015: 69), communication specialists (Jurčiukonytė 2007: 11–14), disability researchers (Ruškus 2019), and staff of European Union institutions (Inclusive Communication 2018) have emphasized the social harm caused by outdated terms discredited by offensive and other connotations, as well as their connection with stigma and exclusion; the need to refer respectfully to people with disabilities and other vulnerable groups is also discussed more broadly. In many cases, these insights were prompted by the findings of studies conducted by foreign scholars. In the second half of the twentieth century, especially from the 1970s onward, doctors, disability studies theorists and other social scientists began examining the use of unethical and imprecise terms that did not reflect contemporary conceptions of intellectual disability, and emphasized the need to replace them (Mercer 1973: 27–28; Taylor 1996: 4–13; Shalock, Luckasson, Shogren et al. 2007: 116–124; Taylor 2008: XV; Salvador-Carulla, Bertelli 2008: 10–16; Wehmeyer, Buntinx, Lachapelle, Luckasson 2008: 311–318; Salvador-Carulla, Reed, Vaez-Azizi et al. 2011: 175–180; Nash, Hawkins, Kawchuk, Shea 2012: 71; Harris 2013: 260–262; Tassé, Mehling 2015: 2–12 et al.).

Although terminology in this field in Lithuanian and other languages has changed and varied, most often in response to trends in social development, and has been (and remains) characterized by synonymy, it has not yet received closer attention from terminologists and linguists.

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This article aims to examine, from a linguist’s perspective, the terms used to name intellectual disability and its levels, their origins, formation, changes and synonymy, while also taking social aspects into account—namely, the possible influence of these terms on social attitudes and, conversely, the influence of society’s ethical attitudes on changes in the terms under discussion.

The article focuses primarily on the terms currently used in Lithuania—that is, during the last two decades—to name intellectual disability and its levels. At the same time, in order to understand the premises of the current situation, it also discusses terms used in Lithuania in the twentieth century and in the International Classification of Diseases to denote intellectual disability. Thus, the aim of this study is to present the development of Lithuanian terminology for intellectual disability and its levels during the first decades of the twentieth and twenty-first centuries, and to identify the factors that prompted this development. To achieve this aim, the following objectives were set: 1) to review the terms used in Lithuania in the early twentieth and twenty-first centuries to name intellectual disability and its levels in scholarly literature in three fields (medicine, education and law), legal acts, court rulings and official certificates; 2) to indicate which terms were used to denote the disorder under discussion and its levels during the period studied in the English-language version of the International Classification of Diseases, and to investigate the influence of these terms on the choice of Lithuanian equivalents; 3) to identify the domains of use of the Lithuanian synonymous terms for intellectual disability and its levels used over the last two decades, and the reasons underlying their synonymy; 4) to conduct a semantic analysis of the terms and, on that basis, consider the possible influence of individual terms on social attitudes. The study employs descriptive, semantic-analysis and survey methods. The research sources consisted mainly of Lithuanian psychiatry and forensic psychiatric assessment textbooks, special-education textbooks, monographs, dictionaries and encyclopedias, as well as rulings issued by Lithuanian courts between 2005 and 2020 in cases involving a person with intellectual disability; articles of the Codes of the Republic of Lithuania regulating the legal capacity or criminal responsibility of people with intellectual disabilities; various official certificates issued by medical and educational institutions for children with intellectual disabilities; eleven English-language editions of the International Classification of Diseases; and the sixth French, tenth Lithuanian and Russian editions of the International Classification of Diseases.

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1. SYNONYMOUS TERMS: ORIGINS OF THE CURRENT SITUATION

1.1. The relationship between the concept of intellectual disability and the term

According to child-development specialists, a substantial part of the history of scholarship on mental retardation (intellectual disability—author’s note) has involved the search for the least stigmatizing term to define this condition (Child Developmental Disorders 2003: 208). This statement touches on the fundamental issues in the field under discussion that this article will also seek to elucidate: 1) a term is closely connected to the concept it denotes: as the concept changed, another term was sought to name it, and conversely, a term changed for certain reasons also altered the content it denoted; 2) people with the condition named by the terms under examination have continually experienced exclusion and stigma in society, and one of the factors contributing to their exclusion is the names used for these people and their condition.

In beginning this brief historical overview of the Lithuanian terms currently used to name intellectual disability and its levels, it is important to emphasize that changes in these terms cannot be explained without reference to the development of the concept of intellectual disability, changing attitudes toward this condition, and social changes in society more broadly. Therefore, in discussing the history of the terms, both linguistic and social factors that influenced it will be mentioned. Since a comprehensive diachronic analysis of the terminology in this field is not the aim of this article, the discussion will be limited to the origins of terms that are currently used and relevant, in the hope of identifying the premises of the synonymy among current terms.

At this point, it is necessary briefly to explain what the terms examined in the article denote, that is, to describe the concept of intellectual disability. Intellectual disability is considered a condition that is congenital or manifests before the age of three and usually lasts throughout a person’s life. It may be diagnosed as the person’s sole primary developmental disorder or as a comorbid disorder accompanying various other developmental disorders, diseases or syndromes. The condition is characterized by limited intellectual abilities (an intelligence quotient (hereafter IQ) of 70 points or lower¹ on an individually administered standardized intelligence test) and deficits in adaptive functioning (identified during an assessment of social adaptation); the disorder manifests in impairments of the person’s cognitive, language, motor and social abilities. The levels of the disorder range from mild to profound (Giedrienė 2015: 207; Mačiulis, Šurkus, Lapytė 2017: 243).

¹ An intelligence quotient is not a percentage measure of intelligence.

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In general, views on what intelligence is and what it should be, as well as the IQ cut-off point between normality and disorder, have changed historically²; alongside this, changes in these views also affected the terms used to name the disorder.

During the Soviet era and the period from 1990 to 2020, in official Lithuanian documents, various scholarly and practical works, and textbooks, intellectual disability was referred to as mental deficiency, intellectual deficiency, mental abnormality, intellectual impairment, intellectual defect³, oligophrenia, feeble-mindedness, congenital feeble-mindedness, mental retardation, mental infantilism, intellectual inferiority, intellectual inadequacy, mental disability, intellectual disability; the levels of intellectual disability were termed debilism, imbecility, idiocy, moronity; and people characterized by intellectual disability were referred to as debilists, imbeciles, idiots, feeble-minded people, mentally retarded people, mentally retarded individuals, mentally retarded children, mental invalids, oligophrenics. Some of these terms—intellectual deficiency, intellectual impairment, mental infantilism, intellectual inferiority, intellectual inadequacy, mental invalid—were last used in works published at least two decades ago and are therefore considered obsolete in current usage; they are no longer regarded as synonyms of the terms intellectual disability and person with an intellectual disability, and are not discussed further in this article.

For a long time, intellectual disability was considered a disease and an object of study in one of the medical fields—psychiatry—and therefore the authors of the first terms for this concept were psychiatrists. In 1809, the French physician Philippe Pinel listed and described in his classification of mental illnesses a disorder he called idiotism (French idiotisme). A few years later, P. Pinel’s student, the psychiatrist Jean Etienne D. Esquirol, abandoned the term idiotism and distinguished two separate entities—idiocy (French idiotie) and imbecility (French imbécillité)—and further divided them into levels according to severity (two levels of imbecility and three of idiocy) (Binet, Simon 1904: 168–172). Another term that became established in classifications and nomenclatures of mental disorders for a long time…

² It is not known exactly what percentage of people in Lithuania currently have an intellectual disability. According to various sources, it accounts for 1–4 per cent of the population. For example, according to data from the Institute of Hygiene, in 2019 mental retardation (intellectual disability—author’s note) and disorders of psychological development were diagnosed in 4.4 per cent of Lithuanian children (Našlėnė, Petrauskaitė, Želvienė 2020: 66). However, the proportion of this group of disorders accounted for by intellectual disability, as opposed to disorders of psychological development (for example, developmental disorders of learning abilities, pervasive developmental disorders, etc.), has not been specified. It is thought that intellectual disability, that is, a condition in which the intelligence quotient is below 70, is present in slightly more than 2 per cent of the world’s population (Valionienė 2021: 14).

³ It should be clarified that in some works, intellectual deficiency, intellectual impairment, and intellectual defect are used to refer to intellectual disability, while in others they refer to a feature or symptom of this disorder.

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the term oligophrenia (Greek oligos – few, small + Greek phrēn – mind), used to designate intellectual disorder, was proposed in 1915 by the German psychiatrist Emil Kraepelin (Kriščiūnas 2002: 138).

In the twentieth century, one of the most significant documents that helped establish a uniform disease classification and terminology in many countries around the world was the international statistical classification of diseases, International Classification of Diseases (hereinafter ICD), which was updated approximately every decade. The first five editions, or revisions, of the ICD, in force from 1900 to 1947, listed only diseases that could be causes of death. In preparing the sixth edition of the ICD (1948), the World Health Organization (hereinafter WHO), established at that time, took over the International Classification of Diseases and its revision; from then on, the international disease manual also included diseases that were not fatal. ICD-6 was the first classification to include a separate chapter on mental disorders (Bunevičius 1997: 882).

Although one of the aims of the ICD was to make it possible to compare and share health information from different countries around the world using uniform terminology, the ICD’s influence on both national disease classifications and the terms used in them remained limited until the 1970s and 1980s. Since the ICD prepared by the WHO was a recommendatory rather than a mandatory document, not all member states used it. For example, in 1959, almost six decades after the first ICD appeared, only Finland, New Zealand, Peru, Thailand, and Great Britain had adapted this classification for their own use. Other countries applied it only in part (using some appendices) or solely for statistical purposes (Stengel 1959: 604). In practice, medical professionals in many countries used classifications approved in their own country, whose authors were usually authorities in the relevant field—physicians who had prepared and published textbooks, monographs, and so on. In the final decades of the twentieth century, during the era of information technology, digitization, and the creation of international registers, an increasing number of states began to use the ICD—to translate it into their national languages, adapt it to their own needs, and also use its coding system. Since the terminology of national classifications and that of the ICD, once adopted, often differed, this led in practice to an increase in synonymous terms; this also applies to psychiatric terminology, as intellectual disability was for a long time an object of psychiatric study. Accordingly, this section will go on to discuss the terms used in Lithuania in the twentieth century for intellectual disability and its levels, comparing them with the terms recommended for the corresponding period by the International Classification of Diseases (in its English version and, later, its Lithuanian version).

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1.2. Overview of the use in Lithuania and the International Classification of Diseases of terms denoting intellectual disability and its levels

When considering the classification and terminology of intellectual disability and its levels in Lithuania, it is apparent that until the end of the twentieth century, the country's physicians tended to rely in both practice and scholarly work not on the classification and terminology of mental and behavioural disorders, including intellectual disability, recommended by the ICD, but on the national system. At the end of the twentieth century, when an adapted Lithuanian version of the ICD—the International Classification of Diseases (hereafter, ICD) and its coding system—came into use, the significance of both the classification of diseases and disorders it provided and the terminology used in it increased not only in healthcare but also in other areas of life. It should be emphasized that at the time, the greatest confusion in the terminology of intellectual disability and its levels did not arise because different terms were used in different sources to denote the same disorder, but because both the ICD and the national system applied different foundations for classifying mental and behavioural disorders; that is, not only did the terms used to denote intellectual disability and its levels differ, but so did the very concept denoted by them—the disorder was assigned to different categories. For example, for a long time, from 1938 to 1965, the ICD used the term mental deficiency to denote intellectual disability (Lithuanian texts occasionally used the equivalents intelekto nepakankamumas, intelekto deficitas), while in many countries the previously mentioned term proposed by E. Kraepelin, oligofrenijos, was already being used as a diagnostic term for this disorder. Moreover, in several countries, alongside oligofrenijos, national equivalents were also used, functioning as synonyms for oligofrenijos, for example: Russian слабоумие, German Schwachsinn, Lithuanian (įgimta silpnaprotystė), English feeble-mindedness, and so on. These national equivalents cannot be treated as calques of oligofrenijos, since the aforementioned terms for intellectual disability were already in use before 1915 (in that year, as noted, E. Kraepelin introduced the term oligofrenijos). Although many scholarly works presented both oligofrenija and its national equivalent as synonyms, over time the unequal semantic scope of such synonymous terms became apparent. Thus, unlike the international term oligofrenija, which was used in one sense—namely, to mean congenital intellectual disability or intellectual disability acquired before the age of three, treated as a developmental disorder and discussed in this article—the Lithuanian term silpnaprotystė was used in at least three senses: 1) as a synonym for intelekto sutrikimo; 2) as a synonym for demencijos; and 3) most often, as a hypernym, or broader category, encompassing two distinct disorders—intelekto sutrikimą, or įgimtą silpnaprotystę, and

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demenciją, or acquired intellectual disability. The latter classification differed substantially from the classification provided by the ICD: in both the ICD and its Lithuanian version, the ICD, intellectual disability (still called protiniu atsilikimu there) and dementia are separate, independent nosological entities, whereas in national Lithuanian literature both disorders belong to the same, more general category and are treated as silpnaprotystės syndromes⁴. Thus, in brief, the terms used by the ICD (English: mental deficiency, mental retardation) and oligofrenija denoted the same concept; however, the concepts denoted by national synonyms of oligofrenija, including silpnaprotystė, belonged to a different level of the system and a different classification of concepts.

Next, we will briefly review chronologically the terminology used to denote intellectual disability in the ICD, later also in the Lithuanian ICD, and in the Lithuanian national system.

1.2.1. 1900–1940

The first edition of the ICD, ILCD–1⁵, appeared in 1900; it listed only 191 diseases, disorders, and injuries that could be causes of death. Intellectual disability was not yet mentioned in this edition. The second edition of the classification, approved in 1909, already identified the following intellectual disabilities: 74A Idiocy, Imbecility; 74B Cretinism (senile dementia was also mentioned separately at the end of the list of diseases and disorders: 154A Senile dementia) (ILCD–2). This reveals a classificatory approach that was maintained in all subsequent ICD editions to the present day: intellectual disability and dementia are not branches of a single disorder; they are categorized as separate entities with no common classificatory basis. In the third edition of the classification, published in 1920, cretinism is no longer mentioned as an intellectual disability or one of its levels; only idiocy and imbecility: 84(1) Idiocy, Imbecility remain (ILCD–3). For unknown reasons, the fourth edition of the classification, which came into effect in 1929, mentions no disorder that could be regarded as intellectual disability (ILCD–4). The fifth edition of the classification, in force from 1938 to 1948, for nearly three decades (until 1965, when it ceased to be in force—

⁴ This classification can also be found in one of the contemporary Lithuanian psychiatry textbooks for higher education institutions (see Dembinskas 2003: 223–231).

⁵ The International Classification of Diseases, compiled since 1900, is referred to collectively in this article as the International Classification of Diseases and abbreviated ICD, although the titles of its individual editions vary: the first through fifth editions are titled International List of Causes of Death; in this publication they are abbreviated ILCD and identified by edition number, whereas from the sixth edition onward (1948, when all diseases known at the time, not only those causing death, were included), the title is International Classification of Diseases, abbreviated ICD and identified by edition number.

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ICD-7) established in this document the above-mentioned term mental deficiency for the general category of intellectual disorder (ILCD-5). Thus, during the first five decades of the twentieth century, three terms were most commonly used in the International Classification of Diseases (ICD) to designate intellectual disorder and its levels: mental deficiency (Lith. intellectual insufficiency), idiocy (Lith. idiocy), and imbecility (Lith. imbecility). During this period, the terminology used in Lithuania for the corresponding disorder is best reflected in the first psychiatry textbook published in Lithuanian, Introduction to Psychiatry (1935), authored by Juozas Blažys, a renowned interwar Lithuanian psychiatrist and professor at Vytautas Magnus University. In this textbook, the author designates intellectual disorder and its levels with two synonymous terms: the international term oligophrenia and its Lithuanian equivalent mental deficiency, and refers to a person with this disorder as a person with mental deficiency. The definition of oligophrenia, or mental deficiency, shows that this category denotes specifically intellectual disorder as a developmental disorder, together with its levels (forms): “Oligophrenia is the general name for forms of mental deficiency. Oligophrenia is an insufficient development of the psyche, especially the mind, markedly different from the norm, present from birth or early infancy. A person with mental deficiency is someone whose intellectual development is significantly behind that of their age” (Blažys 1935: 4–5). Dementia is described in a separate chapter, but, according to the author, it too, like oligophrenia, is characterized by “weakness of the mind”: “Acquired weakness of the mind, as a consequence of brain damage and mental illness, is called dementia (dementia)” (Blažys 1935: 167). Thus, in this textbook, the terms oligophrenia and mental deficiency are used synonymously and denote the same concept—intellectual disorder. Moreover, in this textbook J. Blažys designated the levels of intellectual disorder using terms that psychiatrists around the world had already been using for decades: “The most severe degree of mental deficiency is idiotism, <...> the somewhat milder degree is imbecillitas <...> and the mildest is debilitas” (Blažys 1935: 160). Although oligophrenia and dementia are described in separate chapters, a common feature, a symptom linking these disorders, is nevertheless identified here as well—“weakness of the mind”—which was probably later adopted as the basis for uniting these two distinct categories, allowing the separate disorders to be treated as forms of mental deficiency⁶.

⁶ It should be noted that this article was prepared during the COVID-19 pandemic. Strict quarantine requirements in force in Lithuanian libraries and archives severely restricted access to resources from the interwar period and earlier in the territory of Lithuania; consequently, the sources for this period consist essentially of the only psychiatry textbook published at that time. Once the quarantine restrictions are lifted, the author hopes to conduct a comprehensive review of the terms used during this period to refer to intellectual disorder and its levels.

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1.2.2. 1940–1999

In both the sixth (1948) and seventh (1955) editions of the ICD, the term mental deficiency (Lith. intelekto nepakankamumas), which had appeared in the fifth edition of the classification, is used for the category of intellectual disorder, while the terms idiocy, imbecility, moron, mongolism are used to name the levels of this disorder, determined on the basis of IQ and other data. The synonymous term feeble-mindedness is used as an explanatory term for the mildest level of intellectual disorder, designated by the term moron. The term oligophrenia, meanwhile, is used in this classification to name just one atypical branch of the intellectual disorder category, phenylpyruvic oligophrenia (intellectual disorder resulting from the hereditary metabolic disease phenylketonuria) (ICD-6; ICD-7; for further discussion, see MIS 1957: 123–124). The terminology used in these two editions of the international classification particularly highlighted the inconsistencies between the conceptual classifications used in international and national systems. For example, in many national systems, including Lithuania’s, terms such as oligofrenija ir silpnaprotystė (English equivalent feeble-mindedness) denoted the entire category of intellectual disorder, whereas in the international classification these terms named individual, specific subcategories of intellectual disorder (e.g., oligofrenija), or were used in definitions of the levels of intellectual disorder as explanatory words denoting a symptom characteristic of a particular level (e.g., English feeble-mindedness, Lith. silpnaprotystė).

Over time, from the mid-20th century onward, international medical terms used to designate levels of intellectual disorder and the people with those levels began to be used with different meanings in the public discourse and everyday speech of many languages. Debility, idiocy, idiotism, imbecility became metaphors for stupidity, while morons, idiots, and imbeciles became metaphors for people who think and behave foolishly, inappropriately, or illogically, used exclusively in a negative context to demean the person so designated⁷. Thus, terms used in a fairly narrow professional field were essentially subject to semantic determinization: they began to be used with an additional lexical meaning carrying an extremely negative connotation. Before long, the insulting, derogatory, disrespectful connotation of the secondary meaning

⁷ According to Leo Kanner, it is difficult to determine exactly when the Greek-origin word idiotas (Gr. idiōtēs) began to be used with the meanings familiar today. Ancient Greek written sources record the following semantic shift in idiotas: “private individual” → “ordinary person” → “layperson without professional knowledge” → “ignorant, poorly informed person.” Eventually—and this is not attested in ancient Greek literature—idiotas acquired specific connotations of mental defect (Kanner 1967: 4–5).

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tation began to be associated with the first—the terminological—meaning as well, and with the denotatum of the signifier: a group of people characterized by certain intellectual features. This additional nuance of meaning in terms describing a group that, historically, had always been socially vulnerable became an obstacle to the development of a different approach taking shape since the middle of the last century—humanistic, directed toward living together for all members of society, not one that sorts and groups society but one that integrates. Consequently, conscious efforts arose to abandon offensive names for this disorder and the person who has it, and to find the least stigmatizing term. In 1961, the American Association on Mental Retardation (English American Association on Mental Retardation) introduced a new term for intellectual disorder—mental retardation. The American Psychiatric Association (English American Psychiatric Association) adopted this term very soon thereafter. Mental retardation (Lith. protinis atsilikimas) then replaced such outdated terms as feeble-mindedness (Lith. silpnaprotystė), idiocy (Lith. idiotija), and mental subnormality (Lith. protinis nenormalumas), which had already become pejorative (Harris 2013: 260).

This was one of the most significant changes in the history of terminology for intellectual disorder, and it was reflected in the ICD-8 edition published in 1965. The terminology introduced there was carried over both into the ICD-9 edition (which came into effect in 1976) and into the ICD-10 edition (which came into effect in 1989), which is still used today. Thus, more than half a century ago, through WHO efforts, outdated terms were removed from the International Classification of Diseases and Health Problems and replaced with others: mental deficiency (Lith. intelekto nepakankamumas), used to denote the entire category of intellectual disorder, was replaced with mental retardation (Lith. protinis atsilikimas); the terms for different levels of intellectual disorder—idiocy, imbecility, moron, borderline intelligence, mongolism, other and unspecified types—were replaced with borderline (Lith. ribinis), mild (Lith. lengvas), moderate (Lith. vidutinis), severe (Lith. sunkus), profound (Lith. labai sunkus), and unspecified (Lith. nepatikslintas) mental retardation (Lith. protinis atsilikimas). Since ICD was little used in the practice of various countries for a long time, the appearance of an updated classification alone did not accelerate the changes its authors sought in the fairly inert domains of public attitudes, language use, and healthcare. National systems continued for a long time to follow their own classifications of disorders and terminology for naming them; as a result, terms such as idiotija, imbecilumas, debilumas, idiotas, imbecilas, debilas continued to be used for levels of intellectual disorder and the people who have them

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and were used in the language of medicine, special education, and related fields to refer to people with these conditions until the very end of the twentieth century. Here, it is worth taking a closer look at the terms used in the second half of the twentieth century in the work of Lithuanian physicians, educators, and other specialists to name intellectual disorder and its levels.

In discussing the use in Lithuania of terms denoting intellectual disorder and its levels from the 1940s to the end of the 1990s (1940–1999), it is most useful to subdivide this period into three stages: 1940–1970; 1971–1990; 1991–2000.

Kalbant apie pirmąjį etapą (1940–1970) pabrėžtina, kad Lietuva didžiąją šio laikotarpio dalį priklausė Sovietų Sąjungai, tad čia vadovautasi ta terminija, kuri oficialiai buvo vartojama Sovietų Sąjungos psichiatrijos autoritetų. Aptariamuoju laikotarpiu pasaulyje galiojo ICD šeštoji ir septintoji redakcijos, kuriose visa intelekto sutrikimo kategorija vadinta mental deficiency (liet. intelekto nepakankamumas) terminu, tačiau, kaip jau minėta, praktikoje ICD šiuo periodu naudojosi itin mažai šalių, tad ir šis terminas tiek Lietuvoje, tiek apskritai Sovietų Sąjungoje vartotas gana retai. Sovietų Sąjungoje tuo metu buvo įsitvirtinusios dvi psichikos ligų ir sutrikimų klasifikacijos: (1) Kerbikovo, Ozeretskio, Popovo bei Snežnievskio ir (2) Giljarovskio (Stengel 1959: 606). Pernelyg nesigilinant į šių klasifikacijų skirtumus, pažymėtina tik tiek, kad intelekto sutrikimas abiejų klasifikacijų autorių buvo įvardijamas tuo pačiu oligofrenijos terminu, be to, oligofrenija, remiantis vienu bendru simptomu (proto silpnumu) su demencija, sinonimiškai dar įvardyta kaip įgimta silnaprotystė (rus. врожденное слабоумие), o demencija – kaip įgyta silnaprotystė (rus. приобретённое слабоумие) (Гиляровский 1954: 500; Кербиков ir kt. 1968: 394–395).

Although during this period the overarching category of intellectual disorder was called by different terms—intelekto nepakankamumu in ICD, and oligofrenija in the national systems of various countries; in addition to oligofrenijos, other synonymous terms were also used (e.g., in Lithuania, silnaprotystė)—the levels of intellectual disorder were named both in ICD and in various countries using the same three main terms: idiotijos, imbecilumo, and debilumo. It is important to note that the English-language ICD version used the term moron for the mild level of intellectual disorder, whereas the version published in French, another official WHO language, referred to this level as debilite mentale (MCS 1950: 114). Thus, it is evident that the terminology for the levels of intellectual disorder in the French version of ICD became established in the national Lithuanian classification.

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In Lithuania, shortly after the Second World War, in a textbook Nervų ligos published for medical students in 1947, Professor Lazaris Gutmanas briefly described oligophrenia, distinguishing three degrees—debilitas, imbecilitas, idiotia. From a terminological perspective, this work is significant because the term protinis atsilikimas was used several times here as a synonym for oligofrenijos (Gutmanas 1947: 345); later, until the 1980s, it was very rarely used in Lithuanian works. In the textbook Nervų ir psichinės ligos, translated from Russian for medical schools in 1959, just as in the earlier work, oligofrenijos was used as the principal, headword term for intellectual disorder, while the synonyms given were psichinis atsilikimas, protinio vystymosi atsilikimas and įgimta silpnaprotystė (Michejevas, Nevzorova 1959: 216–218).

In a lecture compendium published in 1966, Lithuanian psychiatrist Aldona Lapytė provided a concise definition of intellectual disorder and established a classification and terminology that remained little changed over the next two periods discussed below, up to 2000: “Dementia is an intellectual disorder manifested by its insufficiency. Dementia may be congenital or acquired. Congenital dementia is oligophrenia. <...> Its most severe form is idiotija. <...> Imbeciliškumas is a milder degree of dementia. <...> The mildest degree of dementia is debiliškumas. <...> Acquired dementia is dementia” (emphasis in the article by the author, D. G.) (Grigas, Jocevičienė, Lapytė, Ostrauskas 1966: 112–113).

Vėlyvojo sovietmečio laikotarpiu (1971–1990), lyginant su anksčiau pristatytuoju, pasirodė kur kas daugiau leidinių, kuriuose iš dalies aptariama ir intelekto sutrikimo tema, taigi šiuo metu išryškėjo būtent lietuviškos psichiatrijos mokyklos požiūris į intelekto sutrikimą, taip pat ir vartojamos terminijos tendencijos. Šiuo etapu jau buvo galutinai įsitvirtinusi klasifikacijos kryptis intelekto sutrikimą traktuoti kaip vieną iš silpnaprotystės atmainų, taigi silpnaprotystė buvo skirstoma į įgimtą silpnaprotystę, kuri sinonimiškai dar vadinta oligofrenija, ir įgytą silpnaprotystę, arba demencija. Įgytosios silpnaprotystės, arba oligofrenijos, lygiai vadinti idiotija, imbecilumu ir debilumu (Grigas, Jocevičienė, Lapytė, Ostrauskas 1972: 128, 172–174; Medicinos terminų žodynas 1980: 135, 139, 265, 266, 389; Dembinskas, Eglytė 1985: 133–137). Asmenys, kuriems būdingas intelekto sutrikimas, vadinami oligofrenais (Goštautas, Dembinskas, Pilkauskienė 1979: 6), idiotais, debilais, imbecilais (Dembinskas, Eglytė 1985: 134–135 ir kitur).

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It should be recalled here that, during the period under discussion (from 1965 to the present), the term used in the ICD to denote the category of intellectual disorders (i.e., intellectual disorder with all its levels) has as its main component retardation (English mental retardation, French retard mental). In 1975, Chapter V (psychiatry) of ICD-9 was translated into Russian and adapted for use in the Soviet Union (Bunevičius 1997: 883). The ICD term mental retardation was not translated into Russian; instead, the existing Russian term умственная отсталость was adopted to name the concept. Moreover, the existing Lithuanian calque of this latter Russian term, protinis atsilikimas, also began to be used increasingly in Lithuania. Thus, here too, the term was not translated from English or French; rather, the Russian version of the ICD was followed, probably because the original English- or French-language versions of the ICD were generally inaccessible to Lithuanian specialists at the time⁸. Protinis atsilikimas was used as a synonym for oligophrenia in the aforementioned 1947 work by L. Gutman; during the period under discussion (1971–1990), however, this term appeared more often in publications for special education teachers and speech therapists than in medical works. In some publications, for example Jūratė Daulenskienė’s Oligofrenijos klinikoje (1981), intellectual disorder is referred to interchangeably as silpnaprotyste, oligofrenija, and protiniu atsilikimu (Daulenskienė 1981: 3–23), while other works use only protinis atsilikimas for this condition (Danilavičius 1973: 22). An interesting fact about this period is that one publication for special education teachers and defectologists attempted to distinguish the concepts of oligophrenia and mental retardation (oligophrenia was defined as a disorder arising before a child begins to speak, whereas mental retardation encompassed both oligophrenia and other pathological conditions of the nervous system) (Vaikų vystymosi sutrikimai 1978: 48). Thus, the terms oligofrenija and protinis atsilikimas are treated here not as synonyms, but as a hypernym (protinis atsilikimas) and one of its hyponyms (oligofrenija). No later works have been found that record either such definitions of these concepts or this relationship between the terms.

Paskutiniu XX a. ir kartu pirmuoju Nepriklausomos Lietuvos dešimtmečiu (1991–2000) iš esmės tęsėsi jau prieš tai aptariamuoju laikotarpiu fiksuotos intelekto sutrikimui ir jo lygiams skirtų terminų sinonimijos situacija. 1991–1993 m. išleistoje Medicinos enciklopedijoje intelekto sutrikimas nuosekliai vadinamas oligofrenija ir traktuojamas kaip silpnapro-

⁸ At the time, the ICD-9 chapter on mental disorders had not been translated into Lithuanian, and Lithuanian physicians coded mental disorders on the basis of the Russian adaptation of the classification.

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a form of dementia—įgimta silpnaprotystė (ME 2 1993: 101)—and is further divided into three degrees: debilumas, imbecilumas, and idiotija (ME 1 1991: 166, 339–340, 343). Algirdas Kriščiūnas’s monograph Psichiatrija (1993) uses terms analogous to those in the Medicinos enciklopedija, but also uses the term protinio atsilikimo synonymously on several occasions (Kriščiūnas 1993: 166–169). During this period, a work of particular significance for Lithuanian psychiatric terminology appeared: Trumpas psichiatrijos terminų žodynas. However, with regard specifically to the terminology for intellectual disorders, the editors chose traditional terms and the older classification of the disorder—oligofrenija, įgimta silpnaprotystė, debilumas, imbecilumas, idiotija (Lapytė, Šurkus 1996: 19, 38–39, 60). Thus, the editorial guidelines set out in the dictionary’s preface, such as “we endeavored to follow the World Health Organization’s recommendations, <...> we abandoned outdated and highly specialized terms,” were not applied uniformly across all fields. In providing terms for intellectual disorder and its levels, the editors probably followed a different criterion—“we took into account the traditions of psychiatric terminology in Lithuania” (1996: 2)—since, as noted, the WHO had already abandoned in its ICD manuals, from 1965 onward, such names for levels of intellectual disorder as idiotija, imbecilumas, and debilumas⁹. By the first decade of independent Lithuania, Lithuanian psychiatrists were already familiar with the Lithuanian-language terminology used by the WHO, which expressed a much more respectful attitude toward patients¹⁰. From 1993 to 1997, the entire ICD-10—the tenth revision of the International Statistical Classification of Diseases and Related Health Problems—was translated into Lithuanian and published for the first time (it comprises several publications; the following are most relevant to the subject under consideration: Tarptautinė ligų klasifikacija TLK(ICD)-10. V skyrius: Psichikos ir elgesio sutrikimai (F00–F99), 1995; TLK-10: Tarptautinė statistinė ligų ir sveikatos problemų klasifikacija: 10-oji red. 1996; TLK-10 Psichikos ir elgesio sutrikimai: klinika ir diagnostika, 1997). In addition, in 1993, the following was translated into Lithuanian:

⁹ The precursor to this dictionary was Trumpas psichiatrijos terminų žodynėlis (Lapytė, Šurkus 1978), which appeared as part of a teaching resource prepared by the same authors in 1978. Both the first version (1978) and the dictionary discussed above, published 18 years later (1996), use the same terms for intellectual disorder.

¹⁰ For example, in 1993 A. Kriščiūnas already referred in his work to the levels of intellectual disorder specified in the ICD-10 classification. Clearly, he was not relying on the Lithuanian translation (since it had not yet been published and, moreover, uses different terms), but most likely on the English version, as he uses names for the levels of intellectual disorder that are not mentioned elsewhere in later sources (lengvas sumažėjimas (level of intelligence—author’s note), vidutinis sumažėjimas, etc.); these were presumably translated by the author himself (Kriščiūnas 1993: 168).

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the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, usually referred to simply as the DSM, was published; it also used the terminology protinio atsilikimo and its levels—lengvo, vidutinio, sunkaus, and so on (DSM-III-R: 6)—to designate intellectual disorder, yet changes were avoided in practice for some time. The terms used and the author’s position toward them in Algirdas Mikalkevičius’s book Psichikos ligos illustrate this situation well. The author first defines protinio atsilikimo on the basis of the older concepts of oligofrenijos and silpnaprotystės, while naming the levels of the disorder as specified in the ICD-10: lengvas protinis atsilikimas (hereafter PA), vidutinis PA, sunkus PA, gilus PA (Mikalkevičius 1999: 47–48). Later, however, he states that “from a clinical point of view it is more convenient to adhere to the customary old terminology and divide oligophrenia into: 1) idiocy; 2) imbecility; 3) debility,” and people with a disorder of a given degree are themselves called idiotais, debilais ir imbecilais (Mikalkevičius 1999: 50–55). What is significant about this period, however, is that psychiatrists, psychologists, and educators collaborated to develop a new classification of disorders and submit it for discussion. One of its ten disorder groups was designated intelekto sutrikimai (its subgroups were protinis atsilikimas, intelekto regresija, kiti intelekto sutrikimai) (Bagdonas 1995: 6). This proposed classification and the terms used in it became the starting point for a new, modern classification and terminology of intellectual disorders.

Thus, in summarizing the terms used to designate intellectual disorder and its levels during the Soviet period and the first decade of independence, it can be stated that (1) in healthcare, the old classification of the disorder was retained (intellectual disorder was treated as a form of dementia), and the diagnostic terms oligofrenijos, or įgimtos silpnaprotystės, and the names for its levels—idiotijos, imbecilumo ir debilumo—continued to be used; (2) at the same time, in pedagogy and education, and much less frequently in psychiatry, the term protinio atsilikimo began to be used alongside oligofrenijos; the ICD had included this term since 1965; (3) in the final decade of the 20th century, a new classification of disorders was proposed, with intelekto sutrikimas becoming one of its key classification terms.

To summarize the review presented in this section, Table 1 gives a chronological, side-by-side account of the most common terms used in the ICD and in Lithuania during the 20th century, and still used today (in the first two decades of the 21st century), to designate intellectual disorder and its levels. These terms are discussed in greater detail in the next section of the article.

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Table 1. Names for intellectual disorder and its levels in the International Classification of Diseases (ILCD, ICD) and in Lithuania

TERMS DENOTING INTELLECTUAL DISORDER AND ITS LEVELS*

In the International Classification of Diseases in English

In Lithuania

ILCD-2 (1909)

Idiocy, Imbecility, Cretinism**

ILCD-3 (1920)

Idiocy, Imbecility

1935 – oligophrenia, feeble-mindedness: idiotism; imbecilitas; debilitas

ILCD-5 (1938)

Mental deficiency

ICD-6 (1948)

Mental deficiency: idiocy; imbecility; moron, in the French-language version – debilite; borderline intelligence; other and unspecified types

1940–1970 – oligophrenia, congenital feeble-mindedness (rarely – mental retardation, psychic retardation, retardation of mental development): idiocy; imbecility; debility

ICD-7 (1955)

Mental deficiency: idiocy; imbecility; moron, in the French-language version – debilite; borderline intelligence; mongolism; other and unspecified types

ICD-8 (1965)

Intellectual disability: borderline m. r.; mild m. r.; moderate m. r.; severe m. r.; profound m. r.; unspecified m. r.

1971–1990 – oligophrenia, congenital mental deficiency (less frequently, mental retardation): idiocy; imbecility; debility

ICD-9 (1976)

Intellectual disability: mild m. r.; other specified m. r.; moderate m. r.; severe m. r.; profound m. r.; unspecified m. r.

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TERMS DESIGNATING INTELLECTUAL DISABILITY AND ITS LEVELS^*

In the International Classification of Diseases in English

In Lithuania

ICD-10 (1989) (in force until 2022-01-01)

Intellectual disability: mild intellectual disability; moderate intellectual disability; severe intellectual disability; profound intellectual disability; other intellectual disability; unspecified intellectual disability

1991–2022 – oligophrenia, congenital mental deficiency: idiocy; imbecility; debility. Mental retardation: mild mental retardation; moderate mental retardation; severe mental retardation; profound mental retardation; other mental retardation; unspecified mental retardation. Intellectual disorder, intellectual disability, mental disability

^* The term designating intellectual disability is set in regular type, while the names of its levels are set in italics.

^** At present, there is insufficient data to determine precisely whether terms such as idiocy, imbecility, and cretinism used in ILCD-2 and ILCD-3 denoted separate disorders or different levels of the same disorder.

2. CORRELATION OF SYNONYMOUS TERMS IN CURRENT USAGE

By 1997, the entire ICD-10 had been translated into Lithuanian and published. From then on, the terms used in it were officially supposed to be adopted in medical practice, statistics, and scholarly work. Nevertheless, over the past two decades—which this article treats as the period reflecting the current state of terminology denoting intellectual disability and its levels—the condition has been referred to both by the outdated term (congenital) feeble-mindedness and by the terms mental retardation, intellectual disability, used in ICD-10. In the case of this condition, the diagnostic terms used by medical professionals are not confined to medicine: they accompany the person into every sphere of social life—law, education, social care and welfare, and elsewhere—so the way a diagnosis is designated essentially determines the course of a person's life in contemporary society. The following discussion examines the use of these current terms and their correlation in various official documents, scholarly works, and medical practice.

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2.1. Feeble-mindedness

As already mentioned, for a long time Lithuanian psychiatrists, speech therapists, and special education teachers referred to intellectual disability as oligophrenia, or congenital mental retardation, and distinguished three levels: mild intellectual disability, idiocy, imbecility. XX In the second half of the twentieth century, many countries gradually abandoned national equivalents of oligophrenia (English feeble-mindedness, German Schwachsinn, Russian слабоумие, малоумие, etc.) as terms with negative connotations; nevertheless, the Lithuanian synonym for oligophrenia, congenital mental retardation, continues to be used in specialists' work in the twenty-first century.

At the beginning of the 21st century, several works of great significance to research on psychiatric terminology appeared. In 2002, A. Kriščiūnas’s monograph Psi-chiatrija, published in 1997 and discussed earlier in connection with the final decade of the 20th century, was reissued. Five years later, the “Oligophrenia” chapter in the reissued monograph remained unchanged: oligophrenia serves as the chapter’s central term for intellectual disability, while the text itself uses the terms oligophrenia, congenital feeble-mindedness, and mental retardation interchangeably (Kriščiūnas 2002: 138–143). In 2003, an original Lithuanian psychiatry textbook written by a team of authors, Psichiatrija, was published (Dembinskas et al. 2003). The textbook uses feeble-mindedness syndromes as the main classificatory term, then dividing them into congenital feeble-mindedness—noting that it was formerly called oligophrenia and is now called mental retardation—and acquired feeble-mindedness, or dementia (Dembinskas et al. 2003: 223). Although the term congenital feeble-mindedness is also used synonymously in several other places, the specific condition is discussed in the subsection “Mental Retardation”; its levels are listed as in ICD-10—mild MR, moderate MR, severe and profound MR—with a note in parentheses that these levels were formerly called debilitas, imbecility, and idiocy (Dembinskas et al. 2003: 223–227). This textbook chapter, which partly still draws on older traditional terminology while also adopting ICD-10 terms, illustrates a situation in which not only the name but also the concept itself and the understanding of the condition are gradually changing: in A. Kriščiūnas’s monograph, intellectual disability is defined as a mental illness (2002: 138), as it was essentially treated in all the 20th-century works discussed above, whereas in this textbook it is treated as a syndrome.

Although, as the examples show, the term feeble-mindedness was still used in psychiatric scholarly works at the beginning of the 21st century, it was ultimately replaced in medical practice by mental retardation. This change was probably prompted by the fact that

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medical practice came to require the use of the ICD-10 coding system, in which the term feeble-mindedness is not used at all, and intellectual disability is called mental retardation. Nevertheless, instances of feeble-mindedness still occur in fields (for example, law) that were not required to align with the ICD-10 coding and diagnostic terminology system. The term feeble-mindedness was officially used to denote intellectual disability in Article 1.84(2) and Article 2.10(1) of the Civil Code of the Republic of Lithuania (hereinafter, the LRCivC), which regulate the declaration of a natural person as legally incapable or partially capable, until 2016. Until 1 January 2016, the following wording was used in those provisions: “<...> due to mental illness or feeble-mindedness is unable to understand <...>.” In 2012, lawyer Valdas Benkunskas, who studied the use of mental health care terminology in Lithuanian legal and regulatory documents, sought to draw legislators’ attention to the use in the LRCivC of the outdated, unethical term feeble-mindedness. He wrote that “legislation often lags behind changes in terminology, as a result of which terms in legal regulation are used not only inaccurately but sometimes also at the risk of violating ethical requirements” (Benkunskas 2012: 164). Finally, amendments to these articles were adopted on 3 December 2015 (and entered into force on 1 January 2016), entirely abandoning the terms feeble-mindedness and mental illness and replacing the concepts concerned with the single term mental disorders. This term was probably adopted from the Code of Civil Procedure of the Republic of Lithuania, where it had already been used in Articles 465, 466, 472, and 473 of provisions defining the same civil-law relations as the LRCivC (provisions governing cases concerning a person’s declaration as legally incapable or partially capable). Following a further amendment on 11 January 2019, the wording of the aforementioned LRCivC articles now reads: “<...> due to a mental and behavioural disorder is unable to understand their actions <...>.” Thus, the terms mental illness and feeble-mindedness were replaced by the term mental and behavioural disorder. The designation for disorders that may have legal consequences was now taken directly from ICD-10. Mental and behavioural disorders is the title of the entire fifth chapter of ICD-10, which covers both mental disorders and intellectual disabilities, coded on the F00–F99 scale.

In the Criminal Code of the Republic of Lithuania (hereinafter, the LRCC), unlike in the LRCivC, the term feeble-mindedness was abandoned much earlier—almost 20 years ago. Article 17 of the LRCC (adopted on 26 September 2000 and entering into force on 1 May 2003), which governs a person’s criminal non-responsibility, replaced three terms used in the former version: feeble-mindedness, chro-

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mental illness, temporary disorder of mental activity began to be replaced by, and has continued to be replaced by, one broader concept of mental disorder.

Although the articles of the codes governing the determination of legal incapacity and criminal irresponsibility have not used the term silpnaprotystė for many years, it is still used to mean intellectual disability in rulings in both civil and criminal cases. In the eteismai.lt database, where anonymized rulings and decisions of all Lithuanian courts have been published since 2005, intellectual disability was referred to by the following terms in the period 2005–2020: protinis atsilikimas—in 2,916 rulings; silpnaprotystė (sometimes used for intellectual disability, sometimes for dementia)—in 825 rulings; and intelekto sutrikimas—in 64 rulings. A derogatory term that had disappeared from psychiatry and special education textbooks and monographs by the end of the Soviet era, intelekto defektas, was used in as many as 153 rulings. It is true that the use of the term silpnaprotystės in rulings up to 1 January 2016 can be explained by the fact that it was used in the LRCK until that date. However, although the term was removed from this legal act as of 1 January 2016, the number of synonymous terms used to refer to intellectual disability in court rulings did not decrease: from 1 January 2016 to 1 May 2021, protinis atsilikimas appeared in 1,563 rulings, silpnaprotystė in 553, and intelekto sutrikimas in 16. Such terms usually enter court rulings through forensic psychiatric examination reports written by psychiatrists, even though, as already noted, the TLK-10 followed by medical practitioners does not use the term silpnaprotystės either in definitions of concepts or in their names. Nevertheless, it is likely that in the future silpnaprotystės will disappear both from forensic psychiatrists’ reports and from court rulings, especially since the new forensic psychiatry textbook names and codes all the indicated mental disorders as specified in the TLK-10; accordingly, intellectual disability is also designated as protinis atsilikimas (Daškevičius, Daškevičienė, Adomaitienė 2018: 55–57). And when the TLK-11 comes into force, protinis atsilikimas will also have to be changed to intellectual developmental disorder.

2.2. Mental retardation, intellectual disorder, intellectual disability

Mental retardation, a term for which protinis atsilikimas may be regarded as a partial Lithuanian equivalent¹¹, began to be used in the International Classification of Diseases (ICD) in the 1965 edition of ICD-8. In countries with a longer tradition of using it, it was eventually observed that this term had acquired nega-

¹¹ For an explanation of why this term only partially corresponds to the concept denoted by the terms mental retardation, see below in the article.

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This situation, as with its predecessors feeble-mindedness (Lith. silpnaprotystė), idiocy (Lith. idiotija), moron, debility (Lith. debilumas), imbecility (Lith. imbecilumas), and so on, that is, the diagnostic term acquired negative connotations when it or related words (for example, English retard, Lithuanian atsilikėlis) began to be used figuratively in a derogatory sense. Thus, in the 21st century—first in America and later in other countries around the world—it was once again decided to rename the disorder in question.

In the first decade of this century, in America, relatives and guardians of people with intellectual disabilities, specialists, and representatives of civic organizations began to emphasize the social harm caused by the term mental retardation (Lith. protinis atsilikimas). This campaign led to the term intellectual disability (Lith. intelekto negalia) increasingly being used instead of mental retardation, not only in public discourse but also in official documents (Shalock, Luckasson, Shogren et al. 2007: 117). In 2007, the American Association on Mental Retardation (English the American Association on Mental Retardation) was renamed the American Association on Intellectual and Developmental Disabilities (English the American Association on Intellectual and Developmental Disabilities), and the title of its journal was changed accordingly (Nash, Hawkins, Kawchuk, Shea 2012: 71). In 2010, U.S. President Barack Obama signed the so-called Rosa’s Law (English Rosa’s Law, named after one girl with an intellectual disability whose relatives contributed greatly to the campaign for changing the term) (PUBLIC LAW, 111–256–OCT. 5, 2010), requiring all states to replace the term mental retardation with intellectual disability in their legislation, and to refer to protiškai atsilikusius asmenis as asmenis su intelekto negalia. In 2013, the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM–5) was published, likewise establishing the term intellectual disability in place of the former mental retardation.

At this point it is necessary to note that protinis atsilikimas is not an exact equivalent of the international term retardacija or of terms in other languages formed on its basis (French mental retard, English mental retardation). The first meaning of the Latin word retardatio is “slowing down,” and the second is “falling behind” (TŽŽ 2013: 709); in English, retard means “to make something slower” (English to make something slower), while retardation means “slow development, or development that is slower than it should be” (English slow development, or development that is slower than it should be) (CD). Thus, it is clear that the Latin retardatio primarily means slowing or delay, and only then falling behind, whereas the English retard and retardation mean only slowing down, deceleration. Significant in this case is

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The fact that the term mental retardation was first used in the English-language version of ICD-8 (1965)—English being one of the WHO’s official languages—made salient not the second meaning (backwardness), but the first: slowing down; that is, the term referred to slowed intellectual development. This is also evidenced by another term used in English in medical practice at the same time to name this disorder, mental backwardness: the semantics of its component backwardness emphasized precisely the second meaning of the Latin retardatio—lagging behind, falling back, being left behind everyone else (CD). Mental backwardness has long been recognized as an unacceptable diagnostic term, while the root word of backwardness, backward (Lith. atsilikėlis, atsilikęs), is unacceptable in any sense (CD). Nevertheless, as already noted, the name of the disorder under discussion, protinis atsilikimas, was translated into Lithuanian not from the original English-language version of ICD-8 and its term mental retardation, but from the Russian term умственная отсталость. The latter term is also used in the Russian version of ICD-10, МКБ-10. When the entire ICD-10 was translated from English into Lithuanian in 1993–1997, this term was not translated; instead, its existing Lithuanian equivalent, already in use, was adopted. Thus, in the case of the term mental retardation used in ICD, the emphasis is on slowing or delay, whereas the Russian умственная отсталость, Lithuanian protinio atsilikimo, and English mental backwardness emphasize the “result” of that delay—falling behind, being left at the rear. This is the same semantic distinction as that between to be late and to arrive late. It can be seen that the term was not taken from the English or French version of ICD, but that an existing term was adopted, one that was probably translated from Russian at the beginning of the Soviet period (most likely first used in L. Gutman’s textbook discussed above, published in 1947). This yielded a much more “vivid” metaphor, emphasizing not slowing down but falling behind. Child-development specialists have also drawn attention to the flawed attitude dictated by the semantics of another term formed on this basis to name a person with the disorder—protiškai atsilikęs vaikas: “Today, the claim that mental retardation has no tendency either to progress or to regress has been rejected. This phenomenon is dynamic, and when speaking about children it is appropriate to refer not to mentally backward children, but to mentally delayed children” (emphasis by the article’s author, D. G.) (Daulenskienė 2003: 4).

At a time when the use (or non-use) of the term mental retardation was being actively debated in America, the WHO began revising ICD-10 and preparing ICD-11. Before proposing a new equivalent for mental retardation, the WHO ICD Classification of Intellectual Disabilities Group had to decide how intellectual disorder should be treated—as a disability or as a health condition. Finally

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it was decided to continue treating this disorder as a health condition, as before, because of concerns that defining it as a disability would require removing it from the ICD altogether, disrupting health statistics and policy and limiting access to services for this vulnerable group (Salvador-Carulla, Reed, Vaez-Azizi et al. 2011). On June 18, 2018, the WHO published International Classification of Diseases 11th Revision (ICD-11). Unlike ICD-10, it uses the term disorder of intellectual development, rather than mental retardation, to name intellectual disorder. The most accurate Lithuanian equivalent of this term would be intelekto raidos sutrikimas. This term is already used in the Aiškinamajame psichologijos terminų žodyne, in the section “Neurodevelopmental Disorders” (Bagdonas, Bliumas 2019: 204). The levels of intellectual developmental disorder in ICD-11 are the same as those for mental retardation in ICD-10, with one exception: mild (Lith. lengvas), moderate (Lith. vidutinis), severe (Lith. sunkus), profound (Lith. labai sunkus), provisional (Lith. įtariamas) (ICD-10 used other (Lith. kitas)), unspecified (Lith. nepatikslintas). ICD-11 officially comes into force on January 1, 2022, but it will take several years from that date for member states, including Lithuania, to translate ICD-11 into their national languages and begin using it in practice. Thus, in Lithuania too, once the new, eleventh edition of the ICD takes effect, the diagnostic term currently used, protinis atsilikimas, will have to be replaced by the Lithuanian equivalent of disorder of intellectual development.

Different legal acts govern law enforcement, education, social welfare, and healthcare institutions in Lithuania, and different terms are still used in them to refer to the same disorder. This is why, in the documents of all educational institutions and services subordinate to the Ministry of Education, Science and Sport of the Republic of Lithuania, the disorder in question has been called intelekto sutrikimu for a decade, whereas the ICD-10 names it protinis atsilikimas. The term intelekto sutrikimas was established by Order No. V-1265/V-685/A1-317 of the Minister of Education and Science of the Republic of Lithuania, the Minister of Health of the Republic of Lithuania, and the Minister of Social Security and Labour of the Republic of Lithuania, dated July 13, 2011, “On Approval of the Procedure for Identifying Groups of Pupils with Special Educational Needs and Classifying Their Special Educational Needs into Levels.” This description and the order establishing it, unlike its predecessor—Order No. 1329/368/98 of July 12, 2002, “On the Procedure for Identifying Disorders and Their Degrees in Persons with Special Needs and Assigning Persons with Special Needs to the Group of Special Educational Needs,” in which the terms intelekto sutrikimas, protinis atsilikimas ir intelekto regresija were still used interchangeably—uses only one term from this field: intelekto sutrikimas. Although at first glance

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it might seem that different terms could be used in different fields to name the same disorder, thereby emphasizing different aspects of it; nevertheless, in a person’s life (not only for the person themselves, but also for the educators, caregivers, and doctors who work with and interact with them), inconsistency in terminology causes considerable confusion, especially since a child’s intellectual disorder may be identified by specialists not only in healthcare institutions but also in educational institutions. At present in Lithuania, psychologists can diagnose a child with an intellectual disorder after administering an intelligence test and assessing adaptive skills. The name of the diagnosis given to the child depends on where the psychologist works, that is, in a healthcare or educational institution, because a psychologist working in a healthcare institution follows ICD-10, which uses the term protinio atsilikimo, whereas a psychologist working in an institution belonging to the education system follows the aforementioned 2011 order signed by three ministers, in which this disorder is called intelekto sutrikimu. Thus, this situation means that some Lithuanian children with the same disorder are diagnosed with protinis atsilikimas, while others are diagnosed with intelekto sutrikimas. But because a person with this disorder eventually becomes a subject of healthcare, education, social security, and the law, the disorder attributed to them is referred to in the various certificates and documents describing them by virtually all the synonymous terms discussed in this article. One example of this situation is as follows: in Lithuania, a preschool or school, seeking to arrange additional or specialized educational support for a child, refers the child to a Pedagogical Psychological Service (hereinafter, PPT) department, where the level of the child’s special educational needs is assessed. Intelligence tests are administered and adaptive skills assessed during the evaluation, after which an intellectual disorder is identified (or not). The institution that referred the child is then issued a Pažyma dėl specialiojo ugdymosi ir (ar) švietimo pagalbos skyrimo (8 priedas) (the certificate sets out educational recommendations, including what support the pupil should receive, and so on). In this certificate, PPT specialists confirm (or do not confirm) an intelekto sutrikimą, since the PPT is subordinate to the Ministry of Education, Science and Sport of the Republic of Lithuania and follows the 2011 order. However, before the start of each school year, all children in Lithuania, including pupils with special educational needs, must present their school with a Vaiko sveikatos pažymėjimą (forma Nr. 027-1/a), issued by the child’s pediatrician or family doctor. In this certificate, the doctor must record the pupil’s disorders and diagnoses. On the basis of the intelligence test administered by the PPT and the certificate confirming an intelekto sutrikimas, the child’s doctor is required to rename the disorder and enter protinis at- in their own certificate.

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silikimas – this is mandatory because the doctor is not an education specialist and must therefore follow ICD-10 and the disease and disorder names and coding system it provides. Thus, every year on September 1, such a pupil arrives at school with two documents about them issued by different institutions—the PPT certificate and the certificate issued by their pediatrician—intended for teachers, the school administration, and other specialists who will work with them. Yet these official documents use two different terms to name the same disorder in the same child, terms that essentially denote two different concepts and shape different attitudes toward the pupil, as well as different relationships and approaches to working with them.

It is likely that this ambiguous situation, recurring every year for numerous Lithuanian children for a decade and caught in a labyrinth of several terms and concepts, will soon come to an end because, as noted, ICD-11 will enter into force on January 1, 2022, and will use the term disorder of intellectual development instead of mental retardation (Lith. protinis atsilikimas). Translators and specialists in this field, when translating ICD-11 into Lithuanian and adapting it to their country’s needs, should note the substantial changes in the English terminology in this field and select a suitable and precise Lithuanian equivalent for disorder of intellectual development, such as intelekto raidos sutrikimas. Once ICD-11 has been translated and TLK-11 put into use, the terms it uses for the disorder and its levels should be consistently aligned with the names used for the same disorder in other official documents and legal acts. It is recommended that the term intelekto raidos sutrikimas be used not only in medical practice, but also in medical theory and in documents and certificates issued by the legal and education systems. The term currently used in education, intelekto sutrikimas, should be regarded as a shortened form of intelekto raidos sutrikimas and could therefore be used in informal documents without legal or binding force, in journalism, and in spoken language.

In lower-level documents regulating social care and the rehabilitation of people with disabilities, in works of popular science, as well as in the media and public discourse generally, the term intelekto negalia is currently used quite frequently (for example, phrases such as asmuo su intelekto negalia, intelekto negalią turintis asmuo¹², “a person with an intellectual disability,” are particularly common, and so on). This ter-

¹² Previously, people with intellectual disabilities and people with psychosocial disabilities were officially referred to by a single term, psichikos invalidas—that is, “a person recognized as disabled in accordance with the procedure established by regulatory acts on account of mental illness or dementia” (Socialinės apsaugos terminų žodynas 1999: 69).

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This term is a literal translation of the American term intellectual disability, which replaced mental retardation in DSM-5. However, as already noted, when preparing the new (eleventh) edition of ICD, the WHO, wishing to emphasize the disorder rather than disability as a health condition, chose for the new classification not the term used by Americans but disorder of intellectual development. It may be assumed that, once ICD-11 enters into force and is translated into Lithuanian, and the term protinis atsilikimas finally disappears from official use, the term intelekto raidos sutrikimas or its shortened form intelekto sutrikimas comes into general use, the term intelekto negalios could continue to be used alongside it, since the different second elements of these compound terms (sutrikimas ir negalia) imply different meanings for the concepts they denote. A disorder should be understood as a dysfunction of a person’s function or organ (for numerous reasons—illness, injury, genetic factors, or the like, which may also be unknown), while disability is understood as difficulties arising in the areas of a person’s basic abilities and social functioning. From a medical perspective, these difficulties, that is, disability, are caused by the person’s disorders and illnesses; according to the contemporary social model of disability, however, a person is made disabled by an inaccessible environment, limited availability of alternative means of information and communication, a lack of pedagogical methods for teaching diverse children together, and so on (Ruškus 2019). Thus, sutrikimas is not equivalent to negalia, nor are these concepts strictly determinative of one another: not all disorders necessarily result in disability (because the disorder may be mild, or because of the efforts of an empowering society surrounding the person, and so on). In various documents, the term proto negalios is also used as a synonym for intelekto negalios; the correlation between these two terms requires a separate discussion and scholarly study.

2.3. Connections between metaphorical terms and social attitudes

According to the findings of contemporary research, the causes of the problematic integration of people with disabilities and the obstacles to their adaptation are primarily not the people with disabilities themselves and their particular disorders or disabilities, but rather the attitudes of all the “able-bodied” people around them and the actions these attitudes determine toward people with disabilities. Therefore, in order for people with disabilities to become an integral, full-fledged part of our society, the established attitude toward people with disabilities, especially those with intellectual or psychosocial disabilities, should first be changed. Social attitudes can be regarded as a structural component of the attitude entrenched in society. A social attitude is a state of consciousness, a person’s position toward an object (a person, group, situation, value). It is expressed in various

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symptoms or indicators—words, tones, gestures, or their absence. An attitude models future behavior in advance (Ruškus 2001: 20). This article hypothesizes that one of the many factors shaping a social attitude toward a particular object or subject is the prevailing way of naming that subject or object in the relevant linguistic community, first and foremost in its official and public discourses; therefore, changing the lexicon and terminology can also influence attitudes, since a new term is not merely an empty verbal shell—it denotes a new concept and different content. Drawing on the results of psycholinguistic experiments conducted abroad, the article assumes that a change in a name or term can bring about or accelerate a change in social attitudes, society’s position, and even patterns of behavior toward the subject being named.

Historically, many terms denoting intellectual disability in various languages around the world have had to be changed repeatedly for several interrelated reasons. First, such terms have been or are being abandoned because they denote concepts that have been scientifically refuted and are socially harmful, in which disability is understood solely as a deficiency inherent in the person (e.g., when the name comprises words such as defect, abnormality, and the like), eliminating the role of the social environment and social attitudes in the formation of disability. Second, most terms in this field, like many names for socially vulnerable groups in general, have over time begun to be used figuratively and pejoratively in colloquial speech and have become pejoratives; consequently, the continued use of such words as diagnostic terms has become unethical and further encourages discrimination against this vulnerable group of people. In this subsection, we will examine more closely the extent to which this particular lexical expression of a term—where words with figurative meanings and negative connotations were selected to form it—contributed to the formation of a mistaken concept and the transformation of terms into pejoratives. What is significant in the cases examined is that the still relevant and currently used terms silpnaprotystės and protinio atsilikimo were formed using a figurative, metaphorical meaning.

Metaphor is not an uncommon phenomenon in the terminology of Lithuanian or other languages of the world; for example, metaphorical terms make up about 8.8 percent of all Lithuanian legal terms (Gedzevičienė 2018). Nevertheless, Lithuanian terminology studies display an ambivalent and fairly cautious attitude toward metaphorical terms. On the one hand, it is acknowledged that metaphorical transfer of meaning is one way of creating terms (Gaivenis 2002: 45–52; Jakaitienė 2009: 192); on the other hand, for two reasons—1) that metafo-

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raphor gives a term emotional-expressive connotation and thereby causes it to lose stylistic neutrality; 2) that when metaphorical terms are translated metaphorically from other languages into Lithuanian, the influence of the semantic field of the corresponding word in the source language is strongly felt—there is still a tendency to avoid metaphorical terms. Although Lithuanian linguistics has no separate theoretical scholarly works examining the relationship between terminology and ethics, practicing terminologists have nevertheless continually emphasized that stylistic neutrality should be one of the requirements for terms. Terminologist Kazimieras Gaivenis even identified certain areas of social life and activity in which emotional-expressive connotation and vividness in terminology would be particularly undesirable. Among the areas he mentioned is the one examined in this article: “Names of professions, diseases, patients, and the like must be emotionally neutral. <...> [Inappropriate] terms could offend patients. Emotionally neutral terminology is also needed in pedagogy, politics, and law” (Gaivenis 2002: 47).

The mechanism by which metaphor gives a term emotional-expressive connotation is best explained through conceptual metaphor theory developed in cognitive linguistics. According to this theory, metaphor is understood as the transfer of a source domain to a target domain (Lakoff 1993: 245); thus, metaphor allows us to understand one phenomenon by drawing on the lexicon of another. The source domain is most often associated with relatively concrete phenomena from our experience and environment, while the target domain is associated with more abstract ones (Lee 2015: 6). In the terms examined in this article, the target domain is the abstract concept of a particular disorder, while the source domain consists of actions characteristic of a person’s everyday physical activity, for example, atsilikimas, and physical characteristics, for example, silpnas.

The metaphorical process foregrounds meanings associated with source-domain phenomena, so it is difficult to avoid a certain connotation entirely when choosing metaphor as a way of creating terms. Atsilikimas, silpnas—lexemes more often associated with negative than with positive connotations. The first literal meaning of the verb atsilikti given in Dabartinės lietuvių kalbos žodyne (hereafter DLKŽ) (the noun atsilikimas is derived from this verb) is “to fail to keep up with others, to remain behind”: He falls far behind his friends. Behind the train. The second, figurative meaning, which developed from the first, is “to fail to reach a certain level,” for example, To fall behind in one’s studies. Backward technology (DLKŽ). The examples given for both meanings imply a visual association with the separation of two groups of people—one leading group at the front and another that has fallen behind the “leaders,” remaining “at the back.” DLKŽ lists six meanings of the word silpnas. From the first to the sixth meaning, the discussion concerns an insufficient amount of some quality valued in society—

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the amount of a characteristic or the poor quality of that characteristic: the first meaning defines weak physical strength, the second poor health, and the third a weak character. The fourth meaning is figurative and closest to that chosen for the term silpnaprotystė; it describes a poor, inadequate, nonphysical-sensory but more abstract—character-related—quality or trait, for example: a weak student, a weak mind, weak supervision, weak discipline, weak leadership. The fifth and sixth meanings are likewise associated with a small amount or concentration of a desired characteristic (DLKŽ)¹³.

Metaphor in general is one of the most influential and effective means of creating imagery, so it may be hypothesized that this image of separating two groups, with one lagging a certain distance behind the other, can be projected from linguistic and conceptual space into social space—that of behavior, actions, and relationships with the group of people so designated. Metaphors used in language influence and shape the thinking of those who use them, their attitudes toward the phenomenon designated metaphorically, and, at the same time, even set the direction of their behavior and actions toward it. That this thesis is not merely a theoretical assumption is confirmed by psycholinguistic experiments conducted by foreign researchers using metaphorical discourse about another socially excluded group—people who have committed crimes¹⁴. Based on the experimental results, it may be hypothesized that designating people with intellectual disabilities as mentally atsilikusių or as having diagnoses of protinio atsilikimo, silpnaprotystės may also dictate corresponding perceptions, social representations, and certain behaviors. The article’s author poses rhetorical questions: what kind of educational or therapeutic approach—and ultimately what sense of their work—do educators see when they receive a report about a student with

¹³ It should be noted that DLKŽ includes no lexicographic labels indicating figurative meaning either for the second meaning of atsilikti or for the fourth meaning of silpnas. In treating the meaning under discussion as figurative, the author draws on conceptual metaphor theory, one of whose fundamental tenets is the transfer of a concept from the physical, tangible, visible, or otherwise perceptible domain (the source domain) into a more abstract space (the target domain). In the case of the terms under discussion, the target domain is the nonphysical, often not even visible at first glance, domain of intellectual disability; the lexemes used to designate it name characteristics, actions, and so on of a physical, tangible, perceptible, and visible reality. According to conceptual metaphor theory, the aforementioned word meanings can be called dead, fossilized, worn-out, or lexicalized metaphors.

¹⁴ Cognitive psychology and linguistics researchers Lera Boroditsky, Paul Thibodeau, and James L. McClelland studied the impact of two metaphorical models established in American public discourse—the criminal is a predatory beast and crime is a virus—on people’s attitudes and possible behavior. For some participants, the description of rising crime in a city was structured according to the first model, and for others according to the second. It was subsequently found that the first group of subjects proposed tightening laws and punishments, building more prisons, and hiring more police officers as ways to solve the problem, while the second group proposed social reforms, urged attention to prevention, and emphasized community social work. The experiment’s results showed that the metaphors we use to designate problems steer our thinking about them in a particular direction and even suggest ways to solve them (Thibodeau, McClelland, Boroditsky 2009; Thibodeau, Boroditsky 2011).

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and finally, what sense of their work do educators see when they receive a report about a student with protinį atsilikimą, and a report about a student with intelekto sutrikimą; or what influence does a forensic psychiatric expert’s conclusion about a person’s silpnaprotystę, compared with a conclusion about a person’s intelekto sutrikimą, have on a judge’s decision to declare that person legally incapacitated or capable?

On the other hand, the use of both the terms protinio atsilikimo and silpnaprotystės to designate intellectual disability became problematic not only because of the figurative meanings chosen to form the terms, which carry negative connotations (the lexeme silpnas conveys the quality of being too small in quantity or poor in quality, while atsilikimas connotes lagging behind everyone else or being late), but also because pejoratives formed on the basis of these terms (atsilikėlis, atsilikęs, silpnaprotis) are used in everyday speech not with their terminological meanings but to demean, belittle, and insult the person so designated. According to Marco Tassé and Margaret Mehling, “when we use such words in everyday speech, they further reinforce the connotation that people with lower intelligence and poorer adaptive skills are useless, incapable of doing anything, stupid...” (2015: 4–5). At the beginning of the 21st century, a social movement emerged in America urging people to stop using the words retard (Lith. atsilikėlis), retarded (Lith. atsilikęs) as pejoratives, in the hope of severing the term mental retardation from its stigmatizing connotations. However, when the desired result did not come quickly, it was decided to replace the term mental retardation (Lith. protinis atsilikimas) with intellectual disability (Lith. intelekto negalia), a term that was neutral in the linguistic community and did not yet carry the burden of negative connotations (Tassé, Mehling 2015: 4–9).

The creation of terms for socially vulnerable groups should be guided by a sensitive approach; therefore, when seeking an appropriate, ethical way to designate a person and their condition, one should also take into account the views of the relevant group of people and the emotions people experience when they are called by one term or another. In Lithuania, people with intellectual disabilities are, for now, seen as a silent—or simply unheard and unasked—group, which, because of frequent difficulties with language comprehension and expression, cannot express its views on the most appropriate way to designate its condition on an equal footing with others without the mediation of family members or members of the public. For this reason, on January 4, 2020, the article’s author conducted a survey in a private Facebook group bringing together parents and guardians of children with various developmental disorders (including intellectual disability) who live or have lived in Lithuania. The survey included 79 participants. They were asked to choose from among three proposed terms—protinis atsilikimas, intelekto sutrikimas ir proto negalia

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to choose, in their view, the most acceptable and appropriate name for their child’s or ward’s disorder. In addition, respondents could also mark two columns: “All terms seem suitable” and “Your suggested option.” The survey results: mental retardation was selected as a suitable and acceptable term by 0 people; intellectual disorder by 78 people; intellectual disability by 0 people; all terms seem suitable by 1 person; and 2 people suggested the term neurodiversity as their own alternative. This survey clearly showed which terms are preferred by those closest to people with intellectual disorders, who maintain the strongest emotional bond with them and most often give voice to their opinions and thoughts.

Taking into account the experience of other countries, the associations of the Lithuanian terms examined in this article (silnaprotystė and protinis atsilikimas) with negative connotations that promote stigmatization and exclusion, and the views of representatives of people with intellectual disorders, the article recommends completely abandoning the term silnaprotystė and not using it to mean either intellectual disorder or dementia. When translating ICD-11 into Lithuanian, it is also essential to note the change in the designation of the disorder discussed in this article: in the English version of the classification, the term mental retardation has been replaced by disorder of intellectual development; accordingly, in the Lithuanian version, the term protinis atsilikimas will have to be replaced by intelekto raidos sutrikimas. Once the Lithuanian eleventh edition of the ICD comes into force, the corresponding term will also have to be used in medical practice and in related areas of public life. In informal texts, journalism, and spoken language, the short form of the term intelekto raidos sutrikimas—currently used in education-sector documents—may continue to be used: intelekto sutrikimas. In works and texts that emphasize not the disorder itself but the difficulties faced in society by people with intellectual disorders, the term intelekto negalios (intellectual disability) may also be used.

CONCLUSIONS

1. In the English version of the International Classification of Diseases (ICD), from 1901 to 1964 intellectual disorder was designated by the term mental deficiency (Lith. intelekto nepakankamumas), while its levels were designated by the terms moron (French debilite, Lith. debilumas), imbecility (Lith. imbecilumas), and idiocy (Lith. idiotija). From 1965 to the present, the ICD has used the terms mental retardation (Lith. protinis atsilikimas) and, for its levels, mild (Lith. lengvas), moderate (Lith. vidutinis), severe (Lith. sunkus), profound (Lith. labai sunkus), other (Lith. kitas), and unspecified (Lith. nepatikslintas).

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2. In Lithuania before the Second World War, intellectual disorder was designated synonymously by two terms—the international term oligofrenija and the Lithuanian term silpnaprot ybė—and three levels were distinguished: debilitas, imbecilitas, idiotizmas.

3. In Soviet-era Lithuania, medical works most often treated intellectual disorder as one of the forms of silpnaprotystė (feeblemindedness) and designated it as congenital feeblemindedness, or oligofrenija (the other form of feeblemindedness was įgyta silpnaprotystė, or demencija [dementia]). In special education works, intellectual disorder was occasionally also referred to by the term protinio atsilikimo (mental retardation). Over time, differences became apparent in the semantic scope of the three terms used synonymously during 1940–1999: silpnaprotystė, oligofrenija and protinis atsilikimas. They denoted concepts belonging to different classification systems: in the International Classification of Diseases, protinis atsilikimas (mental retardation) and demencija (dementia) are distinct, independent nosological entities, whereas in Lithuanian national psychiatric literature both disorders mentioned were assigned to a single, broader category and treated as syndromes of silpnaprotystės (feeblemindedness). In general, during the Soviet period the term silpnaprotystė (feeblemindedness) was used in as many as three senses: 1) as a synonym for intellectual disorder; 2) as a synonym for dementia; and 3) most often as a hypernym encompassing both intellectual disorder and dementia.

4. It should be emphasized that until 1965, only the principal terms for this disorder used in the ICD and in the Lithuanian national classification system for disorders differed, whereas the levels of the disorder were designated in both systems by the same terms: imbecilumo, idiotijos and debilumo. These terms were adopted into Lithuanian not from the English, but from the French version of the ICD.

5. After ICD-10 was translated into Lithuanian at the end of the twentieth century, the term protinio atsilikimo (mental retardation) became established in medical research and practice. This term was specifically chosen as the equivalent of the English term mental retardation used in the ICD. However, an examination of the semantics of the English word retardation, which derives from Latin, showed that protinis atsilikimas (mental retardation) is not a translation of the English mental retardation, but a literal translation of the Russian term умственная отсталость. A more accurate Lithuanian equivalent of mental retardation could have been protinio vystymosi sulėtėjimas (slowing of mental development), whereas the term protinio atsilikimo still in use emphasizes not slowing but its possible outcome—being behind.

6. At present, at least four terms are used in Lithuania to designate intellectual disorder: in medical research and practice, the term protinio atsilikimo (mental retardation); in education and special education research, and in documents of institutions belonging to the education system, the term intelekto sutrikimo (intellectual disorder); in public discourse and social care and support documents, the term intelekto

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disability or intellectual disability terms; in legal scholarship, legislation, and practice, the terms intellectual disorder, mental retardation, and dementia are all used. The latter term denotes both intellectual disorder and dementia.

7. As the concept of intellectual disorder and attitudes toward people with intellectual disorder change around the world, and as the term mental retardation has acquired negative connotations because of pejoratives common in language (retard “a retarded person” and retarded “retarded”), which can unjustifiably demean and belittle a socially vulnerable group of people, the search for neutral and ethical terms began once again. In America, mental retardation was replaced in the second decade of this century by intellectual disability, and in the eleventh edition of the ICD by disorder of intellectual development.

8. The use of both the mental retardation and dementia terms to denote intellectual disorder became problematic in Lithuanian, first, because of the figurative, metaphorical meanings chosen to form the terms, which carry negative connotations (the lexemes weak evoke qualities or traits regarded negatively in society, or a small quantity or poor quality of something; backwardness connotes falling behind everyone else or being late), and, second, because the terms themselves or related lexemes (retard, retarded, mentally deficient) became pejoratives in colloquial speech and began to be used to demean people.

9. In view of both the experience of other countries and the associations of the Lithuanian terms examined (dementia and mental retardation) with negative connotations that promote stigmatization and exclusion, as well as the views of representatives of people with intellectual disorders, the article recommends completely abandoning the term dementia and not using it to mean either intellectual disorder or dementia. When translating into Lithuanian the eleventh edition of the ICD, which will enter into force on January 1, 2022, attention must be paid to the change in terminology for the disorder discussed in this article: in the English version of the classification, the term mental retardation has been replaced by disorder of intellectual development, and thus in the Lithuanian version the term mental retardation will have to be replaced by disorder of intellectual development. It is recommended that the term disorder of intellectual development be used not only in medical practice, but also in related fields—in medical theory and in legal and education-system documents, certificates, and so forth—in order to avoid possible terminological confusion. The term currently used in the field of education, intellectual disorder, which may be regarded as a shortened form of disorder of intellectual development, could be used in informal documents that are not legally binding,

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in journalistic writing and colloquial speech. In works and texts that emphasize not the disorder itself but the difficulties people with the disorder encounter in social settings, the term intellectual disability may also be used.

ŠALTINIAI

Bagdonas Albinas 1995: Sutrikimų klasifikacija, Vilnius: Vilniaus universiteto leidykla.

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Daulenskienė Jūratė 1981: Oligofrenijos klinika, Vilnius: Lietuvos TSR aukštojo ir specialiojo vidurinio mokslo ministerijos Leidbyinė redakcinė taryba.

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DSM-5 – Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edition, Washington, DC: American Psychiatric Association, 2013.

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CHANGE OF TERMS DEFINING INTELLECTUAL DISABILITY AND ITS LEVELS IN LITHUANIA AND CHANGE-DETERMINING FACTORS

Summary

An assessment of the terms used to describe intellectual disability in the International Classification of Diseases (ICD) and the terms used in Lithuania during the 20th century and the early 21st century shows that by the end of the 20th century, the main terminology in use greatly differed between the ICD and the Lithuanian classification. For example, the ICD listed mental deficiency (until 1965) and mental retardation (1965 to present), while in Lithuania the words such as silpnaprotystė (feeble-mindedness) and oligofrenija (oligophrenia) were and are still used. For a long time, only the terms used to name the different levels of intellectual disability were the same in both systems: debilumas (debility), imbecilumas (imbecility), and idiotija (idiocy). From the late 20th century until now, intellectual disability has been defined by at least four terms in Lithuania: protinis atsilikimas (mental retardation), silpnaprotystė (feeble-mindedness), intelekto sutrikimas (disorder of intellect), and intelekto negalia (intellectual disability). In the 21st century, with a fundamental change in attitudes

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towards people with intellectual disabilities and the resulting effort to reduce the exclusion of this social group, more attention was paid to the negative stigmatizing connotations of the term ‘mental retardation’, and the search for a more neutral, ethical term for this disorder began. In America, the term ‘mental retardation’ was replaced by ‘intellectual disability’ from 2007 to 2010 and, in ICD-11, which will be officially adopted on 1 January 2022, it has been supplanted by ‘disorder of intellectual development’. The use of protin is atsilikimas (mental retardation) and silpnaprotystė (feeble-mindedness) in Lithuanian has become problematic, partly due to the negative connotations of the words, which have metaphorical meanings [the lexical item silpnas (feeble, weak) has the connotations of a very small quantity or a poor quality of any attribute valued in society, and the lexical item atsilikimas (backwardness, lag) has the connotation of lagging behind all, delayed], and partly because the terms and related words [atsilikėlis (retard), atsilikęs (retarded), silpnaprotis (feeble-minded)] have become pejorative in colloquial speech, used to humiliate the person called in such a way. Thus, this paper proposes the term intelekto raidos sutrikimas (disorder of intellectual development) or its short form intelekto sutrikimas (disorder of intellect) when referring to intellectual disability in Lithuanian official documents. In the contexts where the disability or the dysfunction caused by the disorder are emphasised, the term intelekto negalia (intellectual disability) may be used. Meanwhile, metaphorical terms such as silpnaprotystė (feeble-mindedness) and protin is atsilikimas (mental retardation) should be abandoned entirely as they are obsolete, offensive and socially harmful. Silpnaprotystė (feeble-mindedness), in particular, should not be used in the sense of either intellectual disability or dementia.

Gauta 2021-06-23

Dalia Gedzevičienė Lietuvos socialinių mokslų centro Teisės institutas Ankštoji g. 1A, LT-01109 Vilnius E. paštas [email protected]

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