Every Fourth of July, we retell the same story: fifty-six men, a hot room in Philadelphia, a document that reimagined what a government owed its people. It's worth noting that one of those signers, Benjamin Rush, believed the Declaration's promise of dignity should have extended further than it did — to the enslaved people it deliberately excluded, and to a group it never even considered: people with mental illness.
Rush wasn't just sympathetic to the first cause. He was a founding member of the Pennsylvania Society for the Abolition of Slavery, and later served as its president. He was on Jefferson's side of that fight — the side that lost when delegates from South Carolina and Georgia forced the removal of Jefferson's anti-slavery language from the Declaration's final draft.
I recently interviewed Dr. Josh Feder, a board-certified child and adolescent psychiatrist and Executive Medical Director at Positive Development, which provides relationship-based support for autistic children and their families nationwide. I asked him about the moral obligations we have to those with disabilities, physical or intellectual, and to whom we could look to as an early reformer.
"I'd look at someone like Benjamin Rush," he said. "He's often called the father of American psychiatry. He took people out of dungeons and into living spaces. He was very much a humanist."
Rush's biographer, Carl Binger, believed Rush's contribution to what would later be called psychiatry must be understood in the spirit of the Declaration of Independence: "This attitude was all of a piece with his passionate dedication to democracy, and with his hatred of brutality and tyranny."
That conviction followed him into the wards of Pennsylvania Hospital, where mentally ill patients were confined in basement cells — and where he spent thirty years treating patients everyone else had given up on.
What he was up against
Patients at Pennsylvania Hospital were shaved and blistered, bled "almost to the point of insensibility," purged until there was nothing left in them, and chained by the waist or ankle to iron rings set in the floor. Some were dressed in a "madd-shirt" — a sleeveless canvas restraint, an early straitjacket — and put on public display for a fee, like an exhibit.
Even the law treated madness as a species of crime. A 1727 Connecticut statute establishing the colony's first house of correction lumped "persons under distraction" — the mentally ill — in with vagrants, "common railers," and fortune-tellers. Everyone admitted was automatically whipped ten times, no exceptions noted.
This was the baseline. This was normal.
A founder before Rush was old enough to vote
Rush wasn't the first Philadelphian to push back against this. In 1751, while Rush was still a child, Benjamin Franklin petitioned the Pennsylvania Provincial Assembly to found a hospital, writing that "the Numbers of People, the number of Persons distempered in Mind and deprived of their rational Faculties, hath greatly increased in this Province." Franklin argued these were people who deserved treatment, not people the colony should simply lock away and forget. The Assembly funded it. That hospital — the one Rush would later join, and later transform — became the first in the American colonies to accept both the physically and the mentally ill under one roof.
An overlooked first
Rush's specific reforms at Pennsylvania Hospital included warm and cold bathing rooms and running water for patients confined in the asylum wing — basic dignities that hadn't existed before. But he went further. For patients well enough to work, he proposed spinning, sewing, and churning for the women; grinding corn, cutting straw, weaving, gardening, and carpentry for the men.
Binger calls these measures "among the first provisions for what would later be called occupational therapy."
What the day is actually about
It's not a clean line from dungeon to dignity. Rush's medical theories were often wrong — he believed nearly all disease, mental and physical alike, came down to one cause, treatable by bleeding and purging, the same methods he used against yellow fever.
What Rush got right was a premise the Declaration itself failed to live up to. That people who had been treated as less than fully human were not, in fact, less than fully human. That the response to suffering was not exhibition, chains, and the whip, but water, warmth, useful work, and the recognition of a person still inside.
"How we treat people with disabilities reflects who we are as a society," said Dr. Feder. "Are we going to move in the direction of the Third Reich, where if you were different, you might be exterminated? Once you start drawing lines around whose life is worth supporting and whose isn't, it doesn't really stop. The circle of exclusion can always get tighter. More and more kinds of differences can get added to the list of those who 'don't matter.'"
Rush didn't get everything right. But on a day built around the idea that a document could change how a country understood dignity, it's worth remembering he spent thirty years trying to extend that same idea to people with disabilities — a group the Declaration never considered at all.
Sources: Carl Binger, Revolutionary Doctor: Benjamin Rush, 1746–1813 (New York: W. W. Norton, 1966), pp. 250–262.
Interview with Dr. Josh Feder