The Barden-La Follette Act sought to prime the civilian rehabilitation program to contribute to the pressing needs of the wartime economy. In so doing, however, policymakers put in motion a longer-term transformation of the program that would contribute to the growth of the disability rights movement. The expanded civilian rehabilitation program aimed to provide “all services necessary to render disabled persons capable of engaging in remunerative employment, or of becoming more advantageously employed, on a normal competitive basis.” The pressing needs of the wartime economy led lawmakers to liberalize services available to disabled citizens, allowing federal funds to be used for “the physical reconstruction of the handicapped so that they can as nearly as possible approximate normal work capacity.” It also extended rehabilitation to people with mental illness and intellectual disabilities and made psychiatric care available both to people with mental disabilities and those “with physical disabilities complicated by the presence of psychiatric difficulties.”100
War needs also encouraged policymakers to shift more of the financial burden for the program to the federal government. They removed the fixed ceiling on federal appropriations, and the federal government covered all state administrative costs, which essentially meant that the federal government paid the full cost of providing vocational guidance and counseling. Medical and training costs were shared on a matching basis—one federal dollar for every state dollar, except in specific cases where the federal government committed to covering the full cost: civilians disabled in the conflict, including merchant seamen, and federal employees injured on the job. The day-to-day business of rehabilitation remained with the states, and states continued to place individuals accepted for rehabilitation into existing training programs through public and private schools and in on-the-job training programs with established companies. Medical services were to be obtained through local physicians.101
The civilian program worked closely with the Employment Service; state education, welfare, agriculture, and workers’ compensation agencies; “Crippled Children’s Societies”; the American Red Cross; and a range of community members and service organizations, from doctors to churches, to identify potential clients. An applicant would receive medical examinations “to determine eligibility and to link his capacities with the physical demands of jobs” and “a vocational diagnosis” after completing various aptitude tests and interviews to determine past education, work experiences, and interests. Throughout the process, rehabilitation workers sought to help the client “understand his assets and liabilities, the causes of his present problems, and the steps necessary to correct these difficulties.” “Physical reconstruction,” if it would significantly reduce the individuals “employment handicap,” followed for individuals deemed eligible and feasible for rehabilitation. Medical rehabilitation services could include a wide range of medical, psychiatric, surgical, convalescent, hospital, and dental care; therapy; and prosthetics, drugs, and other medical supplies. Once “physical reconstruction” was complete, clients pursued training, and rehabilitation counselors assisted them with job placement.102
Rehabilitation represented a medical- and means-tested form of aid. Applicants had to be disabled enough that rehabilitation would “reduce substantially or eliminate the employment handicaps” and yet able-bodied enough that physicians viewed their physical and mental condition as “relatively stable and remediable.” Essentially, rehabilitation was not meant to provide “long-term care for chronic illness,” and indeed, hospital care was limited to ninety days. Disabled people’s attitudes also figured into the determination of eligibility and feasibility. As Michael J. Shortley, director of the new U.S. Office of Vocational Rehabilitation (OVR), put it, “there must be a sense of directed objective, which is ‘hope’ expressed in another way.” All those determined to be eligible received counseling, training, and placement at no cost. Financial need opened the door to medical services, financial support during rehabilitation, and assistance with supplies and other training materials.103
While disability activists demanded the right to shape federal services, the OVR instead turned to a range of professionals for advice in developing the expanded program. The office established two new advisory committees. The first, the National Rehabilitation Advisory Council, was “composed of outstanding representatives of business and industry, labor, education, medicine, services to the blind, social welfare, and other interests closely allied to the problems of rehabilitation.” The second, the National Professional Advisory Committee, brought physicians more directly into the program. This committee advised “on matters of professional policy in the general operation of the program” and provided “technical recommendations for physical restoration services.”104 Though this expanded program offered disabled citizens greater services and opportunities, the fact that it reified the power of medical professionals and ignored disabled citizens’ calls for the right to shape its administration would contribute to the growing wave of disability rights activism.
World War II was a moment of promise and consequence for people with disabilities. The booming war economy breathed life into the New Deal promises of opportunity, security, and work for people with disabilities. Indeed, people with disabilities clamored to work, serve the nation on the home front, and contribute to victory, and policymakers worked to secure them space in the wartime economy. Rehabilitation and a host of federal efforts to bring disabled people into the workforce represented a federal promise of inclusion—the promise of salvaging people.
In seeking to shore up the gaps in the no-man’s land of state and federal aid policy that made it difficult for people with disabilities to contribute to the war effort, however, policymakers set in motion a medicalization of disability policy. More than additional funding, World War II rehabilitation policy redefined the program, opening the door to a range of medical services to support the transformation of dependents to workers.
In the short term, the rehabilitation bureaucracy would focus on immediate results, growing the wartime workforce. In the long term, the growth of the rehabilitation bureaucracy would further mark people with disabilities as others. Individuals who sought rehabilitation would encounter a growing body of experts who would dictate the terms of their inclusion into the workforce and the broader boundaries of citizenship. Physicians and a range of rehabilitation experts would increasingly claim expertise over people with disabilities, arguing that disabled people needed their specialized knowledge, and presumably their supervision, to be prepared for and placed in jobs. Moreover, much as Strachan had predicted, the Barden-La Follette Act never came close to covering the gap.
Both the promise and consequence of the war would explode into the disability rights movement. In the years to come, AFPH members and leaders along with other disability activists would fight to shine a light on that no-man’s land of public aid that had shaped “New York’s 100 Neediest Cases” and colored the realities of everyday life for Americans with disabilities. They would demand that the state make full citizenship accessible to people with physical disabilities through a range of policies that would support disabled people’s access to the workplace, better educational opportunities, health care, and improved medical treatments as well as their physical access to public spaces. Further, disability activists would demand that people with disabilities define and shape these policies, challenging the growing authority of a range of experts in the rehabilitation bureaucracy.