The Colony and the Young High-Grade Mental Defective
- Author:
GUNZBURG, B.A., D.Phil.
Education and Training Officer, Monyhull Hall, Birmingham. The population of a colony for mental defectives harbours such a variety of different types that an ordinary observer begins to Wonder how it is possible to classify them all under the same heading. At one extreme we find the helpless, speechless and thoughtless idiot, who is evidently in need of constant Assistance and at the other extreme a wellniannered and normal looking individual who expresses himself with ease and skill and who aPpears to score highly above many uncouth labourers outside the colony. His behaviour and appearance are, however, deceiving and he very likely turns out to be an illiterate and to have in the vast majority of cases subnormal niental capacity. However, neither his illiteracy nor his low mental efficiency would justify his detention in an institution were it not for his apparent inability to look after himself and to keep out of trouble. Thus, not intellectual lnferiority by itself but only its combination with social inefficiency, lead to the internment of high&rade mental defectives, who might, but for their Cental instability, be useful members of society. It is still not quite clear why one feebleminded Person should succeed in society and be no trouble to social agencies, whilst the other has to be kept constantly behind institution walls. However, it has increasingly been recognized ln recent years that emotional maladjustment Plays a great, if not decisive part in the feebleminded person’s failure in society and that intellectual inferiority should be considered only ?n aggravating factor in many cases. Whilst 1ntellectual inferiority is held to be irremediable, Maladjustment is definitely often accessible to treatment, though success or failure may largely depend on the intellectual factor.
Considering, therefore, the problem of the young high-grade defective as one of treatment ?f maladjustment rather than one of custodial care, new avenues of research and therapy open UP- If we are able to treat that maladjustment successfully, the ” turnover ” of patients in a colony may be considerably increased above the Present level, because we shall then achieve earlier and more lasting successes, and the colony will then approximate more nearly to the function of a ” mental hospital ” aiming at rehabilitation of the patient than is the case at present.
The question arises how far the average presentday colony can assist in the first exploratory steps and whether the ” colony idea” is capable of such organizational alterations as may prove necessary for a specially designed therapeutic programme for only a limited proportion of the institution population. There is little doubt that a colony which has originally been conceived as an autonomous and fundamentally stable community for patients whose mental condition is unalterable, is not able to assist actively in the treatment of problems presented by a potentially fluid population, unless some drastic changes in attitude and practical issues take place. Some points relating to this problem complex are indicated in the following, but it is obvious that the approach is incomplete and largely determined by the present writer’s particular sphere of work. The practical execution of a broad therapeutic programme will necessitate the close collaboration of all workers in this field, particularly of psychiatrist, clinical psychologist and psychiatric social worker.
The Adolescent and the Colony
The colony for mental defectives is, besides serving as a shelter for the low-grade permanent population, also a place of detention where troublesome high-grade feebleminded persons are segregated from the community in the hope that they will learn there the lesson which will permit their return to society. The ” rehabilitation policy ” pursued in the colony is essentially neutral because the colony provides only the framework of a regulated organization in which the prospective licensee may hibernate and “cool off”, passing the troubled years of adolescence until he has gained a more mature and settled attitude to life. Whether and to what degree institutionalization is instrumental in bringing about final success is difficult to determine at present, nor do we know the particular set of circumstances which could be made responsible for failure. It is, however, obvious that the needs of emotional maladjustment have not been recognized by the organization of the colony nor in training of institution staff, and life in the institution is, therefore, adjusted to the requirements of intellectual subnormality only. It is difficult to imagine the present type of institution life contributing substantially to a lasting emotional stabilization of a high-grade defective.
Many of the high-grade defectives had worked and enjoyed themselves with and like the rest of the adolescent normal population, until the ” crucial event ” happened which made their institutionalization necessary. For these youngsters the enforced stay in the colony means serving a sentence in a special type of prison. An ordinary prison sentence has, however, a time limit and the prisoner knows exactly when he will be free again. The defective does not know how long his “sentence” will last and he realizes too that good behaviour alone does not necessarily secure release since he sees old and well-behaved patients spending their lives in institutions. The long drawn-out and therefore not justifiable punishment seems to him to be out of proportion to the incidents which caused his internment, and leads of necessity to resentment, hostility and opposition. A youngster, who has previously spent his life with normal and congenial friends and contemporaries is now suddenly thrown into the society of low-grade morons, imbeciles and idiots with whom he has nothing in common, who are ” silly ” and repulsive in his eyes. The young high-grade defective has now to live in a world determined by the needs of the low-grade patient. Demands and work, institution routine and rules are designed to assist this majority. The power and right of decision is taken away from him, he shoulders no responsibility and the continuous supervision by trained and uniformed nurses makes it quite clear that no initiative is expected from him. Very quickly he conforms to this situation which asks for less energy, less foresight, less initiative, and offers a very comfortable existence. It need not be pointed out particularly that this kind of ” training ” near the ” cabbage-stage ” does not represent a desirable preparation for subsequent success in life.
Of course, attempts are continually made to give selected patients extra responsibility and special work, but the frequent failures seem to justify the pessimism and reluctance of those in charge. It is then scarcely considered how the discouraging, stale atmosphere of the colony must affect and nullify these attempts which may : not only fail to contribute towards the final aim, but may even reinforce the discouraged and insecure attitude of many patients.
Though the colony provides work for the patients, partly of a maintenance character and partly of an arts and crafts type, it offers little opportunity for interesting and absorbing work, which the adolescent defective can appreciate. Much of the work is of a very simple character or far removed from the reality of practical life as it is known to the high-grade. Rewards or “wages ” are ridiculously small in comparison to what the defective is probably used to obtaining ” outside ” and other incentives may appear very childish. But for sudden dashes for freedom as shown by absconding, the defective displays, usually, little ” drive ” and he sees little need to function efficiently and to the full extent of his capabilities in such an ” easy ” environment. Whilst he may to all outward appearance become stabilized or rather ” institutionalized ” he really becomes more and more estranged from the life to which we wish to return him one day.
Already this short description of the position of the young high-grade defective in a colony designed for low-grade defectives, should make it clear that this climate of resentment and apathy cannot be overcome merely by providing more and better workshops, better staffing, more testing and ” psychological ” treatment. As long as the colony is unable to treat the emotional maladjustment, as long as the colony is only considered a better kind of prison with an indeterminate sentence, and as long as the colony is an organism detached from reality, there is little hope to achieve more than a mere chance ” cure
The following outline of a three point programme, as seen from the educational and vocational angle in its widest meaning, indicates a possible development of colony organization for the benefit of that group of patients who may thereby be rehabilitated with better chances for success than the present system offers.
Satisfaction of Emotional Needs Maladjustment is most frequently the outcome of the extremely unhappy family upbringing which forms almost invariably the background story of most cases. The limited mental resources of the subnormal are not capable of dealing with the resulting problem situations, and their thwarted desires and urges attempt to find substitute satisfactions in other directions. Their immediate environment offers often easy opportunity for gratification and smce the family has been unable to implant in the children a framework of socially acceptable responses, a career of delinquency or other Maladjustment frequently follows. Though institutionalization interrupts further a social deterioration by simply withdrawing opportunities to fail in society, this in itself does not necessarily initiate a change for the better. The youngster submits only too often to the influence of his former surroundings and drifts back into the old grooves, when later on he is given a chance to prove himself outside the colony. The impersonal handling of these adolescents ?y an all male or all female nursing staff, does n?t create that atmosphere where rules and a code of behaviour are felt and absorbed and not merely learnt and known. Though it is nowadays attempted to bring up children who have to be separated from their own families, in families ” with substitute parents in lieu of the real ones, this has not been found necessary tor the adolescents. With this an opportunity uas been missed to let grow within a ” family circle” that pattern of socially acceptable responses which will facilitate adjustment to society. It is necessary to do away with the board and lodging ” aspect of the institution y the provision of a decent home-like background of a small group with emotional ties to those in charge. Despite their age these adolescents need their ” mother ” and ” father ” and domestic warmth, as much as the younger a?e groups.
A ” family a unit by affective ties as well as by working relations, is far better suited to e*ercise a forming influence by social approval fnd disapproval, by the liking taken to mother ” and to the fairness of ” father tnan the present conglomeration in an overcrowded institution home run by overworked officers and nurses whose foremost task it is to insist on the observance of institution rules, “sychological treatment has a better chance to be Accepted and to become effective in the family climate ” where the individual handling of a case is neither interfered by nor itself interferes ^th institution administration and where the family ” is an adjustable and easily regulated setting for therapeutic work. If there is any nope to counteract the effects of early maladjustment by individual treatment, then it is certain that a ” home ” background and a small group are unavoidable preliminaries. . *
Neither the ” home “?nor the small group atmosphere will, however, have any effect unless ” parents ” are able to give the youngsters that feeling of security and trust which will make attachment to their new ” home ” possible. And here we seem to arrive again at the old conclusion which ascribes all success to the personality of individual trainers irrespective of the material conditions ; nevertheless there is little doubt that many potentially successful personalities have not the slightest chance to make themselves felt at present in a large institution organization which makes them? ?in the eyes of the adolescents?mere representatives of restraining authority and where the ” institution-pattern ” prohibits and discourages unavoidably unorthodox handling of an individual situation.
” Detention ” or ” Training ” The adolescent high-grade defective recognizes very grudgingly the need for detention in the institution. He resists his unlimited sentence which deprives him of the possibility to earn wages, to help his people and to lead an independent life. It needs practical explanations to make him see that his detention in the colony is not only justified, but for his own benefit. Such a practical explanation is for instance a real training in trades, which he could receive in the colony and which may assist him later on outside the colony. Many youngsters come to the colony quite willingly under the impression that they had been sent there to ” learn a trade “. The necessity to learn ” something” before one can expect to earn reasonable wages is a fact easily understood by the feebleminded youth, and the attendance at a ” Training School ” is, if suitably explained, certainly a more acceptable necessity than the detention in a colony for mental defectives.
Such manual training must, however, not be mere camouflage but must become real preparation for the work which the feebleminded youth can be expected to do outside. His training has to be specially planned since he has limited powers of adaptation, sometimes poor manual control, very often little foresight, little perseverance and a small capacity of learning. Nonrecognition of this poor personality endowment in his colony-training will make adjustment to the fast moving life outside, very often extremely difficult and will lead frequently to friction and subsequent breakdowns. An unsympathetic employer, a teasing workmate, an uncongenial job may spoil the subnormal’s chances for good. Unfortunately less consideration is usually shown to a subnormal than to a ” normal ” youth.
Thus it is a necessary precaution to make the mentally defective youth already in the preemployment stage, acquainted with his future work, with the tools, their usage and care, with factory ways and the prevention of accidents. During his training he must learn how to maintain steady output and accurate workmanship. He must be employed on and taught a fullsize job and should be engaged on the production of useful and saleable goods. Arts and crafts should be included in the syllabus only in so far as these skills contribute directly to the learning of a trade. Some of the crafts, like embroidery and jewellery-making, for prospective discharges of the male sex, should be discontinued, and the ” institutionalized trades ” of rug, basket and brush-making should be limited to the permanent institution population. Tradesmen with a gift for teaching ought to be fully employed in teaching, and not primarily as maintenance staff of the colony. Machinery should be used, suitably guarded according to modern factory regulations, and not be kept away from the youngsters, who are otherwise faced with an unfamiliar situation when sent out on licence. The girls should receive domestic science training according to modern principles which will make them familiar with the small household where they may obtain their first situations. The practical work should be augmented by relevant talks and demonstrations. In short, the principles of modern practical training of apprentices of either sex should be applicable to the feebleminded adolescent’s training as well. The usual type of ” occupational training ” or ” occupational therapy ” concentrating on arts and crafts and achieving little more than skill in making nice looking odds and ends, is completely inadequate for our purposes. The training must be reality centred, directed towards agricultural skills if subsequent employment is likeliest in farming, towards factory skills if employment will be found in industry, towards ” service ” skills for the girls who will take domestic positions. It is a real waste of valuable training time if promising high-grades are merely occupied with producing articles of perspex, embroidery, jewellery, etc., or are engaged in assisting maintenance workers by passing the tools and fetching tea. All ” training ” which they receive thereby is merely incidental and often not relevant to their future career and is in no proportion to the time taken.
Ignorance of reading, writing and arithmetic represents for many high-grades a constant source of irritation and inferiority feelings, besides being a handicap in the working life outside the colony. They will seize eagerly the opportunity to improve, to maintain or to acquire knowledge if special tuition is provided. New methods for teaching these high-grade adolescents have to be developed since many of them lack confidence and are easily disappointed. Academic work given as part of the trade training appears now in a new light and of new importance.
Working on this basis, a new sense of purposefulness and reality will enter the atmosphere around the subnormal youth. He may now recognize the value of the training, and its interesting and direct relationship to real life, and may become more reconciled with his fate and more open to the character-forming influences of the ” home”. Training on ” real ” machinery, producing ” real ” things, doing a ” man’s ” job, is certainly more likely to produce efficiency in conformity with the youngster’s capacity than working at monotonous and unreal jobs like rug or mat-making. ” The Training School” offers also the opportunity to do the vocational guidance work for feebleminded adolescents which has been neglected in the past. Many semi and fullyskilled jobs can be executed successfully by the feebleminded whilst certain other unskilled jobs may be unsuitable for them. We know at present next to nothing about the factors affecting their work output, their efficiency, their fatiguability, their persistency, their proneness to accidents, etc. Vocational guidance for the feebleminded will also have to estimate the capacity of the labour market in the vicinity of the colony and will have to advise as to the particular lines of training. In due course it should contribute considerably to the shortening of training and to increasing success by eliminating the initially unavoidable trial and error system.
Integration with Life
There is, however, more to the task of rehabilitation of the defective than the mere provision of modern workshop equipment and practice. Neither manual nor mental training even in conjunction with the “home life” described in the first section, is of course able to give that atmosphere of necessity, of direction and of reality, which pervades the open community. Since demands in the colony are lowered to be within reach of most of the patients and since for the same reason, life and expression ls regulated from above, it is inevitable, as has been pointed out before, that the level of the high-grade defective is gradually adjusted to that of the low-grade. With the lack of stimulation and incentives, all need and all desire for developing efficiency disappears or is canalized lr*to the asocial patterns of how to get round regulations and how to cheat the staff. The Unnatural but nevertheless very real climate of the institution cut off from reality, creates a new Pattern of institution responses and a mistaken conception of life arises.
To overcome this major difficulty within the framework of the present colony is an impossibility, because it would mean the creation of an autonomous organization within the boundaries of an old-fashioned institution organization, ^he obvious solution of the problem is the creation of a unit geographically removed from the colony, where special regulations and conditions can be applied without danger of their interfering with the regulated framework found necessary for the custodial care of the Majority of patients. There conditions can be created, which are similar and nearly identical y^th real life situations. Incentives consisting ln wages according to ability, steadiness and Perseverance in work, can be introduced, and F’ore freedom and responsibility can be given lri. order to make the potential leaver familiar ^ith his future life and to bring out the best of ^hich he is capable.
The present trend to create bigger colonies exceeding 1,000 beds, defensible as it is from the administrative point of view and securing thereby Material advantages for health and entertainment of the patients is, it must be realized, at the same time jeopardizing our hopes to solve at least Partly the social problem of feeblemindedness Though it is true that smaller places are generally rUn less efficiently and provide less material c?mfort for their patients, it is nevertheless the small place which offers far more opportunity the individual treatment within a group than the large place with so many uncontrollable and unaccountable factors interfering. Even 11 a new administrative regulation were to ^gregate hundreds of promising adolescent ^gh-grade from low-grade defectives into a sPecial large colony, it would be an entirely artificial organism unable to induce the growth that attitude which contributes towards socialization. If part of the trouble is to be ?und in the defective’s lacking ” super-ego ” development which had no chance to mature in the appalling conditions of his childhood, then only the small place with individual attention by selected staff is able to remedy the maladjustment. If, on the other hand, inability to adjust to the requirements of society has other roots, we can be sure that the small place will give us a better opportunity to study causes and effects and that it will enable us to modify our therapeutic approaches as necessary.
There is, of course, the danger, that such a place will deteriorate into a small self-contained community where a little band of devoted people fight an unceasing and unrewarded battle for the patients against the consequences of inconspicuous isolation. It is therefore of extreme importance that the staff as well as the patients know what they are doing, what they have achieved and by what means.
Modern psychometric and projective testing has given us the means for a better understanding of the make-up and the capabilities of our individual trainees and this knowledge must be integrated into the training programme. Finally we must know how prognosis, theory and practical method stand up to the test of life. We must know how actual working conditions affect the defective and must attempt to remedy on the basis of this knowledge the faults in our training techniques. This obvious procedure utilized by every car manufacturer, engineer, builder, etc., has been very much neglected, making it impossible to say where exactly our treatment of the high-grade defective ceases in fact to be ” treatment “.
There are obviously many ways to investigate our problem in its emotional and social aspects and it would need at least another article to outline other possibilities. One way of creating the necessary framework for exploration would for example consist in enlarging the ” Training School ” by combining it with a hostel for those adolescents who have been considered fit for work under ordinary conditions. Whilst giving thereby the more reliable elements better opportunity to show their metal, this ” TrainingSchool Hostel ” offers also a chance to study closely the effects of the impact of reality and to give ” first aid” when the youngster finds adjustment difficult. The instructors and staff who have in the preceding years established close contact with the adolescent should now at this crucial point be able to assist in the problem of adjustment. At the same time, the presence of youngsters who actually go out to work and are in their last stage of institution confinement, should act as a continuous incentive to others still in training. The experiences of their workmates are fed back into the ” Training School ” and, if properly supervised and integrated into the practical teaching of the school, should assist considerably in forming a new conception of life.
There exists probably in every colony for defectives only a fairly small proportion of high-grade adolescents of either sex who would benefit by a training programme like the one outlined above. To make special provision for them in the colony is very often impracticable, uneconomical and in the long run unsatisfactory. Nevertheless it would be unjustified to sacrifice the needs of a group of potential licensees to the requirements of the permanent institution population. Hence, a small and specialized institution, a ” Training School” for the rehabilitation of the adolescent high-grade defective seems to be the most satisfactory solution.
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