Lietuviškų intelekto sutrikimą ir jo lygius įvardijančių terminų kaita ir ją lemiantys veiksniai

114 Dalia Gedzevičienė Lithuanian terms for intelligence disorder and its levels terminų kaita ir ją lemiantys veiksniai doi.org/10.35321/term28-06 Lietuviškų intelekto sutrikimą ir jo lygius įvardijančių terminų kaita and its determinants DALIA GEDZEVIČIENĖ Institute of Law, Lithuanian Centre for Social Sciences ORCID id: https://orcid.org/0000-0001-8285-9692 ANNOTATION The article presents Lithuanian terms used in the first two decades of the 20th and 21st centuries to designate intellectual disability and its levels, and in parallel reviews the terms used in the International Classification of Diseases (ICD) to designate the same disorder and its levels. The thesis examines the factors that led to the change of terminology in this field, as well as the reasons why at least four terms (intellectual disability, intellectual disability, mental retardation, dementia) are currently used synonymously in Lithuanian official documents, public discourse, scientific discourse and practice to name intellectual disability and the possible influence of each of these terms on the attitudes of society and attitudes to the group of persons with this disorder. KEY WORDS: intellectual disorder, intellectual disability, 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). Moreattitudes toward the group of individuals with this disorder. KEYWORDS: disorder of over, the article examines the possible impact of each of these terms on societal intellect, intellectual disability, mental retardation, feeble-mindedness, synonym, connotation, International Classification of Diseases. 115Terminology | 2021 | 28 INTRODUCTION The more consistent use of international terms denoting intellectual disorders, which were mainly formed on the basis of Greek and Latin ir įsitvirtinimo medicinos ir kitų sričių kalboje pradžia galima laikyti languages, occurred in the middle of the 19th century, while the corresponding Lithuanian terminology has its origins in interwar intelekto sutrikimo kaip ligos ir smegenų defekto sampratos, susiformavus požiūriui į šį kognityvinį ypatumą kaip į socialinį fenomeną, kurį iš Lithuania. In the second half of the 20th century, in addition to the traditional biomedical essence and the perception of the norm and non-norm of the society of a certain period, attention was drawn to the gogų, socialinių darbuotojų, nevyriausybinių organizacijų atstovų, inteethical aspects of the intellectual disorder and its equals. The efforts šios srities terminija keitėsi, buvo ir tebėra ieškoma neutralaus, tikslaus, of physicians, caregivers and relatives of persons with a pedallect disability have led to a respectful naming of this condition and the persons who are affected by it. In Lithuania, the social harm of outdated, offensive, compromised terms with additional connotations, their connection with stigma and exclusion are emphasized by lawyers (Benkunskas 2012), doctors psychiatrists (Pūras 2015: 69), communication specialists (Jurčiukonytė 2007: 11–14), disability researchers (Ruškus 2019) and employees of European Union institutions (Įtraukioji komunikacija 2018). In many cases, these insights were prompted by the results of research conducted by foreign scientists. In the second half of the 20th century, especially since the 1970s, physicians, theorists of disability studies and other social scientists began to investigate the use of unethical, inaccurate terms that do not correspond to the modern concept of intellectual disability and emphasized the need to change them (Mercer 1973: 27–28; Taylor 1996: 4–13; Shalock, Luckasson, Shogren et al. 2007: 116–124; Taylor 2008: XV; SalvadorCarulla, 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. ). And although the terminology of both Lithuanian and other languages in the field under discussion, usually prompted by the development trends of society, changed, varied, it was (and is) characterized by synonymy, it has not yet received closer attention. 116 Dalia Gedzevičienė The aim of this thesis is to look at the Lithuanian terms terminų kaita ir ją lemiantys veiksniai minologų lingvistų žvilgsnio. Šiame straipsnyje siekiama į intelekto sutriused to name intellectual disorder and its levels, their origin, construction, change, synonymy from the perspective of a linguist, while not leaving aside the social aspects – the possible influence of these terms on social relations nuostatoms ir, atvirkščiai, visuomenės etinių nuostatų įtakos aptariamų terminų kaitai. The article focuses mainly on the terms used in the present time, i.e. in the last two decades of this century, to name intelligence disorders and their levels in Lithuania. At the same time, in order to understand the assumptions of the current situation, the terms used in Lithuania in the 20th century and in the International Classification of Diseases to mark intelligence disorders are also discussed. Thus, the aim of this study is to present the change of Lithuanian terminology designating intelligence disorder and its levels in the first decades of the 20th and 21st centuries and to identify the factors that stimulated this change. 1) to review the terms used in Lithuania in the early 20th and early 21st centuries in the scientific literature of three fields (medicine, education and law), in legislation, court rulings and official certificates to name intellectual disability and its levels; 2) to indicate which terms were used in the English version of the International Classification of Diseases to describe the disorder and its levels during the investigated period, and to investigate the effect of these terms by selecting Lithuanian equivalents; 3) to identify the areas of use of Lithuanian synonyms used in the last two decades for terms denoting intellectual disorder and its equivalents and the reasons for the synonymy; 4) to perform semantic analysis of terms and based on it to decide about the possible influence of individual terms on social attitudes. The thesis applies descriptive, semantic analysis and survey methods. The sources of the research mainly consisted of Lithuanian psychiatry, forensic psychiatric expertise and special pedagogy textbooks, monographs, dictionaries and encyclopedias, as well as decisions adopted by Lithuanian courts in 2005–2020, the subject of which is a person with intellectual disability, articles of the Lithuanian Republic Codes regulating the capacity or innocence of persons with intellectual disability, various official certificates issued by medical and educational institutions to children with intellectual disability, eleven English editions of the International Classification of Diseases, the sixth French, tenth Lithuanian and Russian editions of the International Classification of Diseases. 117Terminology | 2021 | 28 1. Synonyms: According to specialists in child development, a large part of the history of the science of mental retardation (intellectual disability – aut. past.) involves the search for the least stigmatizing term to define this condition (Children’s Developmental Disorders 2003: 208). It is precisely this statement that touches on the essential problematic aspects of the subject-matter in question. The term in question is closely related to the term it denotes: when the term changed, ties aspektus, kuriuos bus bandoma atskleisti ir šiame straipsnyje: 1) teranother term was also sought to name it, and vice versa – for certain reasons, the changed term also changed the content it denotes; 2) persons with the condition named by the terms under consideration have constantly experienced exclusion, stigma in society, and one of the factors determining exclusion are the names of these persons and their condition. Starting with a brief historical overview of the Lithuanian terms now used to name intellectual disability and its levels, it is important to emphasize that the change of these terms cannot be explained completely independently from the development of the concept of intellectual disability, the change of attitudes to this condition and the social changes taking place in society in general, so in this case discussing the history of terms will be mentioned and influenced by both linguistic and social factors. Since a detailed diachronic analysis of the terminology of the research field is not the aim of this article, it will be limited only to the origins of the currently used and relevant terms, hoping to establish the assumptions of synonymy of current terms. At this point, it is necessary to briefly introduce what is referred to by the terms investigated in the article, i.e. to describe the concept of intellectual disability. A mental disorder is a condition that occurs in the early childhood or up to three years of age and usually lasts for life. It can be identified as the only major developmental disorder of a person or as a concomitant disorder of various other developmental disorders, diseases, gebėjimai (intelekto koeficientas (toliau – IQ) lygus 70-iai ar mažiau taškų1 syndromes. This condition is characterized by limited intellectual (according to the standardized intelligence test conducted individually) and adaptive activity deficiencies (determined during the social adaptation study), the disorder manifests itself in the cognitive, language, motor and social abilities of the person. The levels of the disorder in question vary from slight to very severe (Giedrienė 2015: 207; Mačiulis, Šurkus, Lapytė 2017: 243). 1 The IQ is not a percentage of intelligence. 118 Dalia Gedzevičienė List of Lithuanian definitions of intelligence disorder and its levels terminų kaita ir ją lemiantys veiksniai In general, the assumptions about what intelligence is, what it should be, as well as the distinction of IQ points between norm and disorder, historically changed2, along with the change of these assumptions affected the terms used to name the disorder. In the Soviet era and in the period 1990–2020, in official Lithuanian documents, various scientific and practical works, textbooks, intellectual disorder was called mental insufficiency, insufficiency of intelligence, mental abnormality, intelligence defect, intelligence defect3, oligophrenia, dementia, congenital dementia, mental retardation, mental infantilism, speech disability, intelekto nepilnavertiškumu, intelekto nevisavertiškumu, proto negalia, intelevels of intellectual disorder – debility, imbecility, idiocy, moron, and persons with intellectual disorder – debils, imbeciles, idiots, mentally retarded, mentally retarded individuals, mentally retarded children, mentally disabled, oligofrenics. Some of these terms – intelligence insufficiency, intelligence defect, mental infantilism, intelligence deficiency, intelligence incompleteness, mentally disabled – were used most recently in works published two decades ago, therefore they are treated as outdated for current use, currently not considered synonyms of the term intelligence disorder and a person with an intellectual disability and are not further discussed in the article. For a long time, intellectual disorder was considered a disease, the subject of research of one of the fields of medicine – psychiatry, so the first authors of the terms of this concept were psychiatrists. In 1809, the French physician Philippe Pinel, in his classification of mental illnesses, identified and described a disorder he called idiotisme. A few years later, Jean-Étienne D. Esquirol, a psychiatrist who was Pinel's pupil, abandoned the term idiotism and distinguished two separate units, idiotie and imbécillité, and divided them into equals according to the degree of severity (two levels of imbecility and three levels of idiocy) (Binet, Simon 1904: 168–172). Another long-standing change in classifications and nomenclatures of mental disorders came into force2. The exact percentage of persons in Lithuania currently characterized by intellectual disability is not known. According to various sources, this amounts to 1–4% of the population. For example, according to the Hygiene Institute, in 2019 4.4 per cent. Intellectual retardation (intelligence disorder – aut. past.) and psychological development disorders have been identified in Lithuanian children (Našlėnė, Petrauskaitė, Želvienė 2020: 66). However, it is not specified how much of this group of disorders comprises intellectual disability and how much psychological developmental disorders (for example, learning disabilities, multi-dimensional developmental disorders, etc.). It is believed that intelligence disorder, i.e. a condition where the IQ is less than 70, is characteristic of just over 2% of the world’s people (Valionienė 2021: 14). 3 It is necessary to clarify that in some works the insufficiency of intelligence, the defect of intelligence, the defect of intelligence is called an intellectual disorder, and in others – a sign, a symptom of this disorder. 119Terminology | 2021 | 28 min. In 1915, the German psychiatric branches jusį oligofrenijos (gr. oligos – negausus, mažas + gr. phrēn – protas) terproposed to establish a uniform classification of diseases and terminology, ras Emilis Kraepelinas (Kriščiūnas 2002: 138). XX a. vienas reikšmingiausių dokumentų, padėjęs daugelyje pasaulio which was about the same as the International Classification of Diseases dešimtmetį atnaujinama tarptautinė statistinė ligų klasifikacija International (hereinafter – ICD). In the first five editions of the ICD, or revisions, from 1900 to 1947, only diseases that could cause death were listed. The International Classification of Diseases (ICD) is a system of classification of diseases and their associated symptoms, which was first published in 1948 by the World Health Organization (WHO) as part of the sixth edition of the International Classification of Diseases (ICD). ICD-6 became the first classification to include a separate section for mental disorders (Bunevičius 1997: 882). Although one of the goals of the ICD was to create a way to compare health information from different countries around the world and to share it using the same terminology, the ICD did not have much influence on national classifications of diseases and the terms used in them until the 1970s and 1980s. Since the WHO ICD was not a binding document but a recommendation, not all member countries 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 needs. Other countries have applied it only in part (some annexes) or only for statistical purposes (Stengel 1959: 604). In practice, doctors in many countries used the classifications approved in their country, the authors of which were usually authorities in the relevant field – doctors who prepared and published textbooks, monographs, etc. In the last decades of the 20th century – in the era of information technology, digitization and the establishment of international registries – more and more countries began to use the ICD – translating it into national languages, adapting it to the needs of their country, using the coding system provided by it. This has led to an increase in Kadangi nacionalinių klasifikacijų ir pradėtos taikyti ICD terminija neretai the number of synonymous terms in practice – this also applies to the terminology of psychiatry, which for a long time has also studied intellectual disorders. Therefore, in this chapter we will discuss the terms used in Lithuania in the 20th century to describe intelligence disorder and its levels, comparing them with the terms recommended by the International Classification of Diseases (English version, and later – Lithuanian version) for the corresponding period. 120 Dalia Gedzevičienė 1.2.Usage of terms in the International Classification of terminų kaita ir ją lemiantys veiksniai Diseases and Related Health Problems (ICD-10) and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in Kalbant apie intelekto sutrikimo ir jo lygių klasifikaciją ir terminiją Lietuvoje, matyti, kad iki XX a. pabaigos šalies gydytojai tiek praktikoje, the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases tuota lietuviška ICD versija – Tarptautine ligų klasifikacija (toliau – TLK) and Related Health Problems (ICD-11) in Lithuania and in the International srityse išaugo tiek joje teikiamos ligų ir sutrikimų klasifikacijos, tiek ten Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania and in the International Classification of Diseases and Related Health Problems (ICD-11) in Lithuania At the end of the 20th century, with the introduction of adaand its coding system, the significance of terminology used not only in health care, but also in other areas of life. It is necessary to emphasize that at that time the main cause of confusion in the terminology of intellectual disability and its equivalents was not the fact that different sources used different terms for the same disorder, but the fact that both the ICD and the national system applied different classification bases for mental and behavioural disorders, i.e. not only the terms used for intellectual disability and its equivalents differed, but also the concept itself – the disorder was assigned to different categories. For example, for a long time, from 1938 to 1965, the ICD intelligence disorder was named mental deficiency, while in many countries the already mentioned term arba iki trejų metų įgyto intelekto sutrikimo, traktuojamo kaip raidos sutrikimas, – reikšme, lietuviška silpnaprotystė vartota mažiausiai trimis reikšoligofrenia, proposed by E. Kraepelin, was used as a diagnostic term for this disorder. Moreover, in many countries, oligophrenia is used alongside its national equivalents, which have functioned as synonyms of oligophrenia, for example: 121Terminologija | 2021 | 28 demenciją, arba įgytą silpnaprotystę. Pastaroji klasifikacija iš esmės skyrėsi Russian слабоумие, German Schwachsinn, Lithuanian (congenital) silpų natūrystė, English feebleamindedness, etc. These national equivalents could not be treated as the values of oligophrenia, because the aforementioned terms were already used to name the intellectual disorder until 1915 (in this year, as mentioned, E. Kraepelin introduced the term oligophrenia). And although in many scientific works both oligophrenia and its national equivalent were presented as synonyms, over time the uneven semantic scope of such synonymous terms became apparent. Thus, unlike the international term oligophrenia, which was used alone – in this article it is discussed as a congenital disorder: 1) as a synonym of intellectual disorder; 2) as a synonym for dementia; 3) or most often – as a hyperonym, or a broader category, covering two different disorders – intellectual disorder or congenital dementia, and from the classification provided by the ICD: both in the ICD and in its Lithuanian version, the ICD intellectual disorder (so far called mental retardation) and dementia are separate independent nosological units, and in the national Lithuanian literature both these disorders belong to the same general category and are treated as dementia syndromes4. Thus, in short, both the ICD terms (mental deficiency, mental retardation) and oligophrenia were referred to as the same concept, yet the national synonyms of oligophrenia, including dementia, referred to as concepts belonged to a different sub-level of the system and a different classification of concepts. In the following, we will briefly review the terminology used for intelligence disorders in the ICD, later in the ICD-10, and in the Lithuanian national system. 1.2.1. Years 1900-1940 The first edition of the ICD-15 was published in 1900 and listed only 191 possible causes of death. In this version, intellectual disability has not yet been mentioned. In the second edition of the classification, approved in 1909, the following intellectual disorders are already listed: 74A Idiocy, Imbecility; 74B Cretinism (senile dementia is mentioned separately at the end of the list of diseases and disorders: 154A Senile dementia) (ILCD-2). This highlights the direction of classification that has been maintained in all subsequent ICD revisions to this day: intellectual disability and dementia are not branches of one disorder, they are categorized as separate units without a common classification basis. In 1920, the third edition of the International Classification of Diseases and Related Health Conditions (ILCD-3) was published, which no longer included cretinism as an intelligence disorder, but only idiocy and imbecility: 84(1) Idiocy, Imbecility (ILCD-3). For unknown reasons, the fourth edition of the classification, which came into force in 1929, does not mention any disorder that could be treated as an intellectual disorder (ILCD-4). The fifth edition of the classification, which was valid from 1938 to 1948, was valid for about three decades (until 1965, when it expired).4 This classification can also be seen in one of the modern Lithuanian psychiatric textbooks for higher schools (see Dembinskas 2003: 223–231). 5 Since 1900, the International Classification of Diseases is collectively referred to in this article as the International Classification of Diseases and abbreviated as ICD, although the titles of its individual editions vary: the first to fifth editions are referred to as the International List of Causes of Death, in this publication as ILCD and with the edition number, and since the sixth edition (1948, when not only the diseases causing death were included but all diseases known at the time) as the International Classification of Diseases and abbreviated as ICD. The ICD and the revision number shall be indicated. 122 Dalia Gedzevičienė The International Classification of Diseases and Related Health Problems (ICD-7) terminų kaita ir ją lemiantys veiksniai established the already mentioned term mental deficiency (ILCD-5) for the general category of intellectual disability in this document. Thus, in the first five decades of the 20th century, the International Classification of Diseases and Related Health Problems (ICD) used three terms for intellectual disability and its levels: mental deficiency, idiocy, and imbecility. The terminology used in Lithuania in this period to name the respective disorder is best reflected in the first psychiatric textbook published in Lithuanian language, Introduction to Psychiatry (1935), the author of which is the famous interwar Lithuanian doctor psychiatrist, professor of Vytautas the Great University Juozas Blažys. In this textbook, the author uses two synonymous terms for intellectual disorder and its equivalents – the international term oligophrenia and its Lithuanian equivalent silpų natūrybė, and the person who is characterized by this disorder – dementia. From the definition of oligophrenia, or dementia, it is clear that this category denotes precisely the intellectual disorder as a developmental disorder together with its levels (forms): “Oligophrenia is a general name for forms of dementia. Oligophrenia is an inadequate, very different from the norm, development of the psyche, especially the mind, from nature or from early infancy. A demented person is a person whose mental education is significantly behind his age” (Blažys 1935: 4–5). Dementia is described in a separate section, "Skinness": "Acquired mental weakness as a result of gum damage and mental illness is called dementia (dementia)" (Blažys 1935: 167). Thus, in this textbook both the terms oligophrenia and dementia are used synonymously and denote the same concept – intellectual disorder. In addition, in this textbook J. Blažys named the levels of intellectual disorder in terms that had been used by world psychiatrists for several decades: “The most severe degree of dementia is idiocy, <...> the somewhat lighter degrees – imbecility and dementia are described in separate chapters, nevertheless, a common sign, a symptom connecting these disorders is distinguished here as well – ‘mind weakness’, which riuje, tačiau ir jai, kaip oligofrenijai, anot autoriaus, būdingas „proto silpprobably later became the basis for uniting these two different categories, allowing the two separate disorders to be treated as varieties of dementia6. 6 It should be noted that this article was prepared during the COVID-19 pandemic. Due to the strict quarantine requirements in Lithuanian libraries and archives, access to interwar and earlier Lithuanian terminology resources was extremely limited, so the sources for this period consist essentially of the only psychiatry textbook published at the time. In the future, after the quarantine requirements are lifted, the author of the article hopes to tas <...> ir lengviausio – debilitas“ (Blažys 1935: 160). Ir nors oligofrenija išsamią šiuo laikotarpiu intelekto sutrikimui ir jo lygiams įvardyti vartotų terminų apžvalgą. 129Terminology | 2021 | 28 The third version of the Diagnostic and Statistical Manual of the American Psychiatric Association, usually referred to as DSM, was published in 2009. In this version, the terminology of mental retardation and its equivalents – mild, moderate, severe, etc. – was also used to name the intellectual disorder (DSM-III-R: 6), but in practice changes were avoided for some time. This situation is perfectly illustrated by the terms used in Algirdas Mikalkevičius’ book Mental Illness and the author’s position in relation to them. Initially, the author presents the definition of mental retardation based on the old concepts of oligophrenia and dementia, and the levels of this disorder are named as indicated in ICD-10: mild mental retardation (hereinafter – PA), moderate PA, severe PA, deep PA (Mikalkevičius 1999: 47–48), however, later states that “from a clinical point of view it is more convenient to follow the usual old terminology and divide oligophrenia into: 1) idiocy; 2) imbecilitis; 3) debilit”, and the persons with a certain degree of disorder themselves are called idiots, debils and imbeciles (Mikalkevičius 1999: 50–55). However, it is significant in this period that in cooperation with psychiatrists, psychologists and educators, a new classification of disorders was developed and presented for discussion, where one of the ten groups of disorders is identified as intellectual disorders (its subgroups – mental retardation, intellectual regression, other intellectual disorders) (Bagdonas 1995: 6). This proposed classification and the terms used in it became the starting point of the new modern classification and terminology of intellectual disorders. Thus, by summarizing the terms used in the Soviet era and in the first decade of independence to name intellectual disorder and its levels, it can be stated that (1) in the field of health protection the old classification of disorders was followed (intellectual disorder was treated as a variant of dementia), and as diagnostic terms were still used the names of oligophrenia, or congenital dementia, and its equivalents – idiocy, imbecility and debility; (2) at the same time in pedagogy, education and much less often in psychiatry, in addition to oligophrenia, the term mental retardation is used, a new classification of ICD teikiamas jau nuo 1965 m.; (3) XX a. paskutiniu dešimtmečiu padisorders is proposed, one of the supporting classification terms of which becomes intellectual disorder. Summarizing the overview in this chapter, Table 1 presents chronologically parallel terms used in the 20th century and still used at present (in the first two decades of the 21st century) to identify intelligence disorder and its levels in the ICD and in Lithuania. The latter are discussed in more detail in the next section of the article. 130 Dalia Gedzevičienė Lithuanian definitions of intelligence disorder and its levels terminų kaita ir ją lemiantys veiksniai Table 1. The International Classification of Diseases and Related Health Problems (ICD-10) and the International INTELEKTO SUTRIKIMą IR JO LyGIUS ĮVARDIJANTyS TERMINAI* Tarptautinėje ligų klasifikacijoje anglų kalba Lietuvoje Classification of Diseases and Related Health Problems (ICD-11) identify the following types of mental ILCD-3 (1920) Idiocy, Imbecility 1935 m. – oligofrenija, disorders: imbecility; debilitas ILCD-5 (1938) Mental deficiency ICD-6 (1948) Mental deficiency: congenital dementia (rarely – mental moron, in the French development debilite; intelligence; idiocy; other and imbeciliškumas; dementia 1940–1970 – oligophrenia, idiocy; imbecility; mental retardation, version – retardation, mental retardation): borderline unspecified types ICD-7 (1955) Mental deficiency: idiocy; imbecility; moron, in the French version – debilite; borderline intelligence; Mongolism; other and unspecified types ICD-8 (1965) Mental oligophrenia, borderline m. r. mild m. r.; mental ; idiocy; profound m. r. ; severe m. r.; retardation: 1971–1990 m. – ; congenital dementia (rarely retardation): moderate m. r. weakness unspecified m. r. imbecilumas; ICD-9 (1976) Mental retardation: mild m. r. ; other specified m. r. ; moderate m. r. ; severe m. r. ; unspecified m. r. profound m. r.; 131Terminology | 2021 | 28 INTELEKTO SUTRIKIMą IR JO LyGIUS ĮVARDIJANTyS TERMINAI* Tarptautinėje ligų klasifikacijoje anglų kalba Lietuvoje ICD-10 (1989) Mental oligophrenia, (valid 2022-01-01) retardation: until mild m. r. ; moderate m. severe m. r.; profound m. other m. r.; unspecified m. r. 1991–2022 – Congenital dementia: r. ; idiocy; imbecilumas; r. ; weakness. Protinis atsilikimas: lengvas PA; average PA; severe PA very severe PA other PA; unspecified PA. Intellectual disability, intellectual disability, mental disability * The term for intellectual disability is written in normal font, and the names of its equivalents in italics. ** There is still a lack of data to accurately determine whether the terms idiocy, imbecility and cretinism used in ILCD-2 and ILCD-3 referred to separate disorders or different levels of the same disorder. 2. CORRELATION OF SYNONYMIC TERMS IN CURRENT USE By 1997, the entire ICD-10 was translated and published in Lithuanian. Since then, the terms used in it should have been officially used in medical practice, statistics and scientific work. However, in the last two decades, which are treated in this article as a period reflecting the current situation of terminology denoting intellectual disability and its levels, intellectual disability is referred to both in the obsolete (congenital) dementia and in the ICD-10 terms of mental retardation and intellectual disability. In the case of the disorder in question, the diagnostic terms used by doctors are not limited to the medical field, they travel with the person to all areas of social life – law, direction. The following will discuss the use švietimą, socialinę globą ir rūpybą bei kitur, tad atitinkamas diagnozės įvardijimas iš esmės nulemia žmogaus gyvenimo dabartiniame sociume of the current terms and their correlation in various official documents, scientific works and medical practice. 132 Dalia Gedzevičienė Lietuviškų intelekto sutrikimą ir jo lygius įvardijančių terminų kaita ir ją lemiantys veiksniai 2.1. Dementia As already mentioned, in the works of Lithuanian psychiatrists, speech therapists, special educators, the intellectual disorder has long been called oligophrenia, or congenital dementia, and three levels of it have been distinguished – debility, idiocy, imbecility. In the second half of the 20th century, many countries gradually abandoned the national equivalents of oligophrenia (English: feebleamindedness, German: Schwachsinn, Russian: слабоумие, малоумие, etc.) as negatively connoted terms, yet the Lithuanian synonym of oligophrenia (congenital dementia) is still used in the works of specialists in the 21st century. At the beginning of the 21st century, there have been a number of significant works on psychiatric terminology. In 2002, A. Kriščiūnas’s monograph Psychiatry, published in 1997 and presented in discussion of the last decade of the 20th century, was republished. In the monograph published five years later, the chapter “Oligophrenia” remained unchanged – the term oligophrenia is used as a supporting term for the entire chapter to describe the intellectual disorder, and in the text itself the terms oligophrenia, congenital dementia and mental retardation are used alternately as synonyms (Kriščiūnas 2002: 138–143). In 2003, the authors published the original Lithuanian textbook of psychiatry Psychiatry (Dembinskas et al. 2003). In this textbook, the main classification term used is dementia syndromes, which are further divided into congenital dementia, emphasizing that it was previously called oligophrenia, and now – mental retardation, and acquired dementia, or dementia (Dembinskas et al. 2003: 223). And although the term congenital dementia is still used synonymously in several places, the specific disorder is discussed in the subsection “Mental retardation”, its levels are presented as in ICD-10 – light PA, moderate PA, severe and very severe PA, indicating in parentheses that these levels were previously called dementia, imbecility and idiocy (Dembinskas et al. 2003: 223–227). This chapter of the textbook, which partly still relies on the old traditional terms and at the same time is already oriented to the ICD-10 terms, illustrates the situation when not only the name but also the concept itself, the treatment of the disorder, is gradually changing: in the monograph of A. Kriščiūnas, intellectual disorder is defined as a mental illness (2002: 138), in essence it was treated as such in all the previously discussed works of the 20th century, and in this textbook – as a syndrome. And although, as can be seen from the examples, the term dementia is still used in psychiatric scientific works at the beginning of the 21st century, in medical practice it has been definitively replaced by mental retardation. Probably this change was driven by the fact that 133Terminology | 2021 | 28 system, in which the term dementia is not used at all, kad medicinos praktikoje tapo privaloma vadovautis TLK-10 kodavimo and the intellectual impairment is called mental retardation. However, in those fields (such as law) that have not been compulsorily harmonized with the ICD-10 coding and diagnostic terminology system, the use of dementia still occurs. The term dementia was officially used in the Civil Code of the Republic of Lithuania (hereinafter – LRCK) even until 2016. Article 1.84(2) and Article 2.10, paragraph 1, regulating the recognition of a natural person as an incapacitated or limited factor, to identify intellectual disability. Until 1 January 2016, the following word combination was used in these places: “<...> cannot understand <...> because of mental illness or dementia.” The lawyer Valdas Benkunskas, who has studied the use of mental health care terms in Lithuanian legal regulation documents, in 2012, trying to draw the attention of the legislators to the use of the outdated, unethical term dementia in the LRCK, wrote that “often the legislation lags behind in the change of terminology, as a result of which the terms in the legal regulation are used not only inaccurately, but sometimes at the risk of violating ethical requirements” (Benkunskas 2012: 164). Finally, on 3 December 2015, amendments to these articles were adopted (entered into force on 1 January 2016), which completely abandoned the terms dementia and mental illness, naming the aforementioned concepts as mental disorders. This term was most likely taken from Articles 472 and 473 of the Law of the Republic of Lithuania, which define the same civil relations as the LRCK (regulating proceedings for the civilinio proceso kodekso, kur ir buvo iki to laiko vartojamas 465, 466, recognition of a person as incapable or limitedly capable). With another amendment made on 11 January 2019, the wording of the LRCK articles now reads as follows: “<...> due to mental and behavioural disorder cannot understand his actions <...>.” Thus, the terms mental illness and dementia have been replaced by the term mental and behavioural disorder. This is the name of the disorders that may have legal consequencesthe name of the entire fifth chapter of the ICD-10, which includes both mental disorders and intellectual disabilities coded mas jau tiesiogiai perimtas iš TLK-10. Psichikos ir elgesio sutrikimai – tai according to the scale F00-F99. In the Criminal Code of the Republic of Lithuania (hereinafter – LRBK), unlike the LRCK, the term dementia was abandoned much earlier – almost 20 years ago. In Article 17 of the CRPC (adopted on 26 September 2000, entered into force on 1 May 2003), which regulates the immunity of a person, instead of the three terms used in the old version, dementia, 134 Dalia Gedzevičienė The Lithuanian terms ninė psichinė liga, laikinas psichinės veiklos sutrikimas (temporary terminų kaita ir ją lemiantys veiksniai mental disorder, temporary mental activity disorder) referring to intelligence disorder and its levels have been replaced by a broader concept of mental disorder. Despite the fact that the term dementia has not been used in the articles of the codes governing the determination of incapacity and innocence for many years, it is still used in the sense of intellectual disability in decisions of both civil and criminal cases. In the database eteismai.lt, where de-identified judgments and decisions of all Lithuanian courts have been published since 2005, in the period 2005–2020 intellectual disability is referred to as: mental retardation – 2,916 judgments, dementia (this term is sometimes referred to as intellectual disability, sometimes as dementia) – in 825 judgments, intellectual disability – in 64 judgments. And even 153 decisions used the derogatory term intellectual defect, which disappeared from psychiatry and special education textbooks and monographs at the end of the Soviet era. It is true that the use of the term ‘dementia’ in decisions before 1 January 2016 can be justified by the fact that it was used by the LRCK before that date. However, the absence of this term from 1 January 2016 in this legislation did not reduce the number of synonyms of terms referring to intellectual disability in court decisions: from 1 January 2016 to 1 May 2021, mental retardation was used in 1,563 decisions, dementia in 553 decisions and intellectual disability in 16 decisions. Such terms are usually used in court decisions from forensic psychiatric expert reports written by medical psychiatrists, although, as already mentioned, the ICD-10, which is used by medical professionals, does not use the term dementia either in the definitions of the concepts or in their names. However, it is likely that in the future dementia will not remain in the certificates of forensic psychiatrists or in court decisions, especially since in the new manual of forensic psychiatric expertise all mental disorders are named and coded as specified in ICD-10, and thus intellectual disorder is also named as mental retardation (Daškevičius, Daškevičienė, Adomaitienė 2018: 55–57). And when ICD-11 comes into force, mental retardation will also have to be changed to an intellectual development disorder. The term mental retardation was introduced in the International Classification of Diseases and Related Health Problems (ICD-8) in 1965. In countries with a longer tradition of its use, it has been observed that this term has developed into pana11 Why this term only partially corresponds to the concept of mental retardation, see the article below. 2.2.Protinisatsilikimas,intelektosutrikimas,intelektonegalia 135Terminology | 2021 | 28 idiocy, moron, debility, imbecility are used in a figurative ši situacija, kaip ir su jo pirmtakais feeblemindedness (liet. silpnaprotystė), derogatory sense. In the 21st century, therefore, it is necessary to change the cilumas) ir pan., t. y. diagnostikos terminas įgavo neigiamų konotacijų, kai kalboje jis ar jam giminiški žodžiai (pavyzdžiui, angl. retard, liet. atname of the disorder. In the first decade of this century in America, relatives miausia – Amerikoje, o vėliau – ir kitose pasaulio šalyse, dar kartą nuand caregivers of persons with intellectual disabilities, specialists and representatives of public organizations began to emphasize the social damage caused by the term mental retardation. As a consequence of this campaign, not only in public discourse, but also in official documents, the term intellectual disability has been used more frequently instead of mental retardation (Shalock, Luckasson, Shogren et al. 2007: 117). In 2007, the American Association on Mental Retardation was renamed the American Association on Intellectual and Developmental Disabilities, and the name of its journal was changed accordingly (Nash, Hawkins, Kawchuk, Shea 2012: 71). In 2010, U.S. President Barack Obama signed the so-called Rose Act. Rosaʼs 111–256–OCT. 5, 2010), which required all state legislation to change the term mental retardation to intellectual disability, and to designate mentally retarded persons as persons with intellectual disabilities. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013 and replaced mental retardation with intellectual disability. It is important to note that mental retardation is not the exact equivalent of the international term retardation and the terms derived from this word in other languages (French mental retard, English mental retardation). Purchase” (TŽZ 2013: 709), in English retard – “to slow something down” (angl. to make something slower), retardation – “slow development, or development that is slower than it should be” (angl. slow development, or development that is slower than it should be) (CD), so it moji lotyniško žodžio retardatio reikšmė – „sulėtinimas“, antroji – „atsiliis clear that the Latin retardatio first means slowing down, delay, and then lag, and the English retard and retardation – only slowing down, slowing down. Significant in this case 136 Dalia Gedzevičienė The fact that the term mental retardation was used for the terminų kaita ir ją lemiantys veiksniai first time in the English language version of ICD-8 (1965) (one of the official languages of the WHO) brought to the fore the other term mental backwardness, which was antrąją (atsilikimo) reikšmę, o pirmąją – sulėtėjimo, t. y. šiuo terminu buvo kalbama apie protinio vystymosi sulėtėjimą. Tai įrodo ir tuo pat meused in medical practice in English language to name this disorder – the semantics of its backwardness accentuated precisely the second meaning of the Latin retardatio – backwardness, known as a non-useful diagnostic term, while backwardness is a atžangą, likimą visų užnugaryje (CD). Mental backwardness seniai pripareference (CD). However, as already mentioned, the name of the disorder in question žodis backward (liet. atsilikėlis, atsilikęs) nevartotinas jokiomis reikšmėmis mental retardation was translated into Lithuanian language not from the original ICD-8 – English – language and the term used there mental retardation, but from the term known in Russian language умственная отсталость. The latter term is also used in the Russian version of ICD-10, ICD-10. When the entire ICD-10 was translated from English into Lithuanian in 1993–1997, this term was not translated – the Lithuanian equivalent was used. Thus, in the case of the term mental retardation used by the ICD, the emphasis is placed on slowing down, delay, and in the Russian умственная отсталость, Lithuanian protinio atsilikimo and English mental backwardness cases, the emphasis is placed on the “result” of this delay – backwardness, fate behind, this is the same semantic difference as between late and late. It is apparent that the term was not taken from the English or French version of the ICD, but from an existing one, which was probably translated from Russian at the beginning of the Soviet era (probably first used in the 1947 textbook by L. Gutman discussed above), thus obtaining a much more “visual” metaphor that emphasizes not slowdown, but lag. Child development specialists have also drawn attention to the semantica-dictated erroneous approach of another term based on this term, intended to name a person with a disorder – a mentally retarded child: “Today, the statement that mental retardation has no tendency to progress or regress has been rejected. This phenomenon is dynamic and with children in mind it is appropriate to talk not about mentally retarded children, but about mentally retarded children” (highlighted by author of the article D. G.) (Daulenskienė 2003: 4). ICD-11. The WHO ICD Classification of Intellectual Disabilities Group, before proposing a new equivalent for mental retardation, had to decide how to treat intellectual disability – whether Tuo metu, kai Amerikoje buvo aktyviai diskutuojama mental retardation termino (ne)vartojimo klausimu, PSO pradėjo redaguoti ICD-10 ir rengti as a disability or as a health condition. Finally, the nation, to define it as a disability, would have to remove it from the ICD altogether, which would confuse health statistics and policies, limiting the availability of services for this vulnerable group 137Terminologija | 2021 | 28 nutarta šį sutrikimą, kaip ir iki to laiko, laikyti sveikatos būkle, nes nuogąs- (Salvador-Carulla, Reed, Vaez-Azizi et al. 2011). On 18 June 2018, the WHO published the International Classification of Diseases 11th Revision (ICD-11). In the ICD-10, the term "mental retardation" is replaced by "disorder of intellectual development". The most accurate Lithuanian equivalent of this term would be intellectual development disorder. Such a term is already used in the Explanatory Dictionary of Psychological Terms, section “Developmental disorders of the nervous system” (Bagdonas, Blumas 2019: 204). ICD-11 levels of intellectual disability, except for one, are the same as ICD-10 for mental retardation: mild, moderate, severe, profound, provisional (ICD-10 was other), unspecified. ICD-11 officially enters into force on 1 January 2022, but it will take several years from this date until member countries, including Lithuania, translate ICD-11 into national languages and start using it in practice. Thus, in Lithuania, after the entry into force of the new, eleventh, ICD revision, the term mental retardation currently used as a diagnostic term will have to be replaced by the Lithuanian equivalent disorder of intellectual development. Lithuanian law enforcement, education, social welfare and medical institutions are governed by different legislation, which uses different terms for the same disorder. This has led to the fact that in all documents of educational institutions and services subordinate to the Ministry of Education, Science and Sport of the Republic of Lithuania, the aforementioned disorder has been referred to as an intellectual disorder for a decade, and ICD-10 is referred to as mental retardation. The term intellectual disability 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 Protection of the Republic of Lithuania and the Minister of Social Security and Labour of the Republic of Lithuania of 13 July 2011 “On the approval of the description of the procedure for the identification of groups of pupils with special educational needs and the classification of their special educational needs into grades”. In this description and in the decree that confirms it, unlike its predecessor – Decree No. 1329/368/98 of 12 July 2002 “On the procedure for determining the disorders of persons with special needs and their degrees and for assigning persons with special needs to the group of special educational needs”, in which the terms intellectual disability, mental retardation and intellectual regression are still used interchangeably, only one term in this field remains – intellectual disability. Although at first glance 138 Dalia Gedzevičienė It might seem that in Lithuanian terms for intellectual terminų kaita ir ją lemiantys veiksniai disability and its levels, different terms could be used in different fields to name the same disorder, thus emphasizing different aspects of this disorder, but in the life of a specific person (not only for him, but also for educators, caregivers, doctors who work with him and communicate with him) the inconsistency of terms causes a lot of confusion, especially since the intellectual disability of a child can be diagnosed not only by the specialists of treatment, but also by those of educational institutions. At present, in Lithuania, psychologists can diagnose a child with an intelligence disorder after performing an intelligence test and examining adaptation skills. The place where the psychologist works, i.e. treatment or educational institutions, also depends on the name of the diagnosis assigned to the child, because the psychologist working in a treatment institution follows ICD-10, which uses the term mental retardation, and the psychologist working in an educational institution follows the above-mentioned order signed by three ministers in 2011, in which this disorder is called an intellectual disorder. Thus, this situation leads to the fact that some Lithuanian children with the same disorder are diagnosed as mentally retarded, while others are diagnosed as having intellectual disabilities. However, since a person suffering from the disorder in question becomes a subject of health care, education, social security and law, the disorder that characterizes him or her is referred to in the various certificates and documents describing Vienas iš tokios situacijos pavyzdžių: Lietuvoje ikimokyklinė ugdymo įshim or her by, in principle, all the possible synonymous terms discussed in this article. In order to provide the child with additional or specialized educational support, the school refers the child to the Pedagogical Psychological Service (hereinafter referred to as PPS) where the level of his or her special needs is assessed. During the assessment, intelligence tests are performed, adaptation skills are examined and then an intelligence impairment is determined (or not). Then the institution sending the child is issued a Certificate on the Assignment ba mokiniui turėtų būti skiriama ir pan.). Šioje pažymoje PPT specialistai of Special Education and / or Educational Assistance (Annex 8) (the certificate indicates the educational recommendations, according to which it determines (or not) intellectual disability, since the PPT is subordinate to the Ministry of Education, Science and Sport of the Republic of Lithuania and follows the order of 2011. However, before the start of each school year, all Lithuanian children, including pupils with special educational needs, must submit a Child Health Certificate (form No. 027a1/a) to their school, which is issued by the child’s pediatrician or family doctor. In this certificate, the doctor must record the jas šį sutrikimą privalomai pervadina ir savo pažymėjime įrašo protinis at- 145Terminology | 2021 | 28 ti, from their point of view, the most acceptable and appropriate name for the disorder of their child or foster. In addition, it was possible to check two columns – “All terms seem suitable” and “Your suggested option”. Results of the survey: mental retardation as a suitable and acceptable term was chosen by 0 persons; intellectual disability – 78 persons; mental disability – 0 persons; all terms seem to be correct – 1 person; 2 people suggested the term neurodiversity as their proposed option. This survey clearly showed which terms are given priority by the closest, strongest emotional connection with persons with intellectual disabilities and most often voice their opinions and thoughts. In the article, taking into account both the experience of foreign countries and the links of the Lithuanian terms (dementia and mental retardation) discussed in this article with negative connotations that promote stigmatization and exclusion, as well as the opinion of representatives of persons with intellectual disabilities, it is proposed to completely abandon the term dementia and not use it neither in the meaning of intellectual disability nor dementia, and starting to translate ICD-11 into Lithuanian, it is necessary to draw attention to the changed 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, so in the Lithuanian version the term mental retardation will have to be replaced by intellectual development disorder. After the entry into force of the eleventh version of the ICD in Lithuanian, the corresponding term will have to be used in medical practice and in related areas of public life. In informal texts, journalism, colloquial language, the short form of the term intellectual development disorder, currently used in educational documents, may still be used – intellectual disorder. In those works and texts where the emphasis is not on the disorder itself, but on the difficulties faced by people with intellectual disabilities in society, the term intellectual disability should also be used. CONCLUSIONS 1. Tarptautinės ligų klasifikacijos ICD angliškoje versijoje 1901–1964 m. pupil's disorders and diagnoses. Based on the intelligence test performed by the PPT and the certificate stating the intelligence disorder, the intelligence disorder of the treated child was named mental deficiency, and its levels – moron, imbecility and idiocy. In the ICD-10, mental retardation is classified as mild, moderate, severe, profound, other, unspecified, and other, with the exception of mental retardation in the brain. 146 Dalia Gedzevičienė Lithuanian definitions of intelligence disorder and its levels terminų kaita ir ją lemiantys veiksniai 2. In Lithuania, until the Second World War, intellectual disorder was synonymous kai įvardytas dviem terminais – tarptautiniu oligofrenija ir lietuvišku silpnaprotybė – ir išskirti trys jo lygiai: debilitas, imbecilitas, idiotizmas. with3. In Soviet Lithuanian medical works, the intellectual disorder was often niausiai traktuotas kaip viena iš silpnaprotystės atmainų ir įvardytas kaip referred to as congenital dementia or oligophrenia (the second variant of dementia was acquired dementia or dementia). In the context of special education, mental retardation is sometimes referred to as an intelligence disorder. In the period 1940–1999, the semantic scope of three terms used synonymously – weak mental illness, oligophrenia and mental retardation – became uneven. They marked concepts belonging to different classifications: in the International Classification of Diseases mental retardation and dementia are separate independent nosological units, and in the national Lithuanian psychiatric literature both disorders were assigned to one more general category and treated as dementia syndromes. The term dementia was used in the Soviet era in three meanings: 1) as a synonym for intellectual disorder; 2) as a synonym for dementia; 3) usually as a hyperonym, covering both intellectual impairment and dementia. It should be emphasized that until 1965, only the main terms used in the ICD and the Lithuanian national classification system of disorders did not coincide, and the levels of the disorder in both systems were named with the same terms of imbecility, idiocy and debility. They are not taken from the English version of the ICD, but from the French version. 5. In the late 20th century, when ICD-10 was translated into Lithuanian, the term mental retardation became established in medical science and practice. This term was chosen as the equivalent of the English term mental retardation, used in the ICD. However, the semantics of the English word retardation derived from Latin revealed that mental retardation is not the English word mental retardation, but the literal meaning of the Russian term умственная отсталость. The more accurate Lithuanian equivalent of mental retardation, the term retardation, emphasizes not the slowing down, but the possible result of slowing down – galėjęs būti protinio vystymosi sulėtėjimas, o iki šiol vartojamas protinio retardation. In Lithuania, at least four terms are currently used to refer to intellectual disability: in medical research and practice – the term mental retardation; in educational, special pedagogical works and documents of institutions belonging to the educational system – the term of intellectual impairment; in public discourse, social welfare, care documents – terms of intellectual disability or 147Terminologija | 2021 | 28 mental disability; in law, legislation and practice are used both for intellectual impairment, mental retardation, and weakness protystės terminai. Pastaruoju terminu įvardijamas ir intelekto sutrikimas, ir demencija. In the context of changing concepts of intellectual disability and attitudes towards persons with intellectual disabilities in the world, and after the term mental retardation acquired a negative group of persons due to pejorative giamų konotacijų, galinčių nepagrįstai žeminti ir menkinti socialiai pažeiterms (retard and retarded), the search for neutral and ethical terms was once nų. Amerikoje mental retardation antrajame šio amžiaus dešimtmetyje again started, and in the 11th edition of the ICD the term intellectual disability was replaced by disorder of intellectual development. The use of the terms mental retardation and dementia to describe intellectual disorders in Lithuanian language has become problematic, on the one hand, because of the transferent metaphorical meanings chosen to form the terms, which have a negative connotation of meaning (due to the fact that the characteristics or characteristics valued in society are low in quantity or poor in quality, lag behind – the connotation of lag behind from all, delay), and on the other hand, when the terms themselves or related to them lexicons (lag behind, backward, demented) have become pejorative in colloquial language, began to be used in order to humiliate a person. In the article, taking into account both the experience of foreign countries, and the links of the examined Lithuanian terms (dementia and mental retardation) with negative connotations, promoting stigmatization and exclusion, as well as the opinion of representatives of persons with intellectual disabilities, it is proposed to completely abandon the term dementia and not use it neither in the meaning of intellectual disability nor dementia. When translating the eleventh edition of the ICD into Lithuanian, which will enter into force on January 1, 2022, it is necessary to note the changed terminology 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, so in the Lithuanian version, the term mental retardation will have to be replaced by intellect development disorder. Recommended not only in medical practice, but also in related fields – medical theory, legal and educational systems documents, minų painiavos, vartoti terminą intelekto raidos sutrikimas. Šiuo metu švietimo srityje vartojamas terminas intelekto sutrikimas, vertintinas kaip trumcertificates, etc., avoiding the possible intermediate form of the term intellectual development disorder, could be used in informal legal, non-binding documents, 148 Dalia Gedzevičienė In Lithuanian definitions of intellectual disability and its terminų kaita ir ją lemiantys veiksniai publicistikoje, šnekamojoje kalboje. Tuose darbuose ir tekstuose, kur palevels, the focus is not on the disorder itself, but on the difficulties faced by people with the disorder in the social space. ŠALTINIAI Bagdonas Albinas 1995: Sutrikimų klasifikacija, Vilnius: Vilniaus universiteto leidykla. Blažys Juozas 1935: Įvadas į psichiatriją, Kaunas: Vytauto Didžiojo universiteto Medicinos fakultetas. CD – Cambridge dictionary. 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Wehmeyer Michael L., Buntinx Wil, Lachapelle yves, Luckasson Ruth A. 2008: The Intellectual Disability Construct and Its Relation to Human Functioning. – Intellectual and developmental disabilities 46(4), 311–318. Гиляровский Василий А. 1954: Психиатрия: Руководство для врачей и студентов, 4-е изд., испр. и доп., Москва: Медгиз. Кербиков Олег В., Коркина Мария В., Наджаров Рубен А., Снежневский Андрей В. 1968: Психиатрия, Москва: Медицина. 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 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 retardation (1965 to present), while in classification. For example, the ICD listed mental deficiency (until 1965) and mental Lithuania the words such as silpnaprotystė (feeble-mindedness) and oligofrenija (oligophrenia) were and are still used. For a long (idiocy). From the late 20th century until 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 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 152 Dalia Gedzevičienė Lietuviškų intelekto sutrikimą ir jo lygius įvardijančių towards terminų kaita ir ją lemiantys veiksniai 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 protinis atsilikimas (mental retardation) and silpnaprotystė (feeblemindedness) 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 "feeble-mindedness" and "mental retardation" should be abandoned entirely as they are obsolete, offensive and socially harmful. In particular, the term "feeble-mindedness" should not be used in the sense of either intellectual disability or dementia. Gauta 2021-06-23 Dalia Gedzevičienė Lithuanian Centre for Social Sciences Institute of Law Ankštoji g. 1A, LT-01109 Vilnius, Lithuania E. paštas [email protected]