Victoria Freeman was only four when her parents followed the standard medical advice of the day and sent her sister away to a distant, overcrowded institution. Martha was not yet two, but in 1960s Ontario there was little community acceptance or support for raising children with Down Syndrome at home. Except for occasional, painful visits, Victoria and Martha grew up in separate worlds, yet Martha's absence marked every aspect of Victoria's life. In this frank and moving memoir, Victoria describes growing up in a world that excluded and dehumanized her sister. She writes too of her own lifelong journey to understand the policies and assumptions about disability that profoundly harmed Martha, her family, and herself. Despite society's long insistence that that only a "normal" life was worth living, changing attitudes to both disability and difference would eventually offer both sisters new possibilities for healing and self-discovery. A World Without Martha is a searing account of the collateral damage of institutionalization on families, and especially siblings. It is also a story of love and loyalty - of the family ties, both traumatic and loving, conscious and unconscious - that bind us to one another over the course of a lifetime.