Community Schemes for the Social Control Mental Defectives
EVELYN FOX (Paper read at the First International Congress on Mental Hygiene, Washington, May 1930.)
” The only satisfactory criterion of mental deficiency is the social one, and if a person is suffering from a degree of incomplete mental development which renders him incapable of independent social adaptation and which necessitates external care, supervision and control, then such person is a mental defective.”
The above quotation from the recent report on the Mental Deficiency Committee of the Board of Education and Board of Control (Part I page 13) gives us the keynote to the modern method of approach to the problem of mental deficiency. Can we, by spending time, money, thought and energy, provide for the mental defective that external care, supervision and control which he requires for his social adaptation, and shall we by these means find a solution to one of the most serious racial problems of the modern state? The competitive conditions between modern states make the fitness of their citizens a matter of supreme importance and at the same time these very conditions render the socialization of the unfit peculiarly difficult. The modern state demands from its citizens a high degree of social adaptation; it enforces these demands through a complex system of laws and regulations. Even within the home and family, the individual’s social relations are subject, not only to the traditions and conventions of his class and country but to the requirements of the county or the city in which he dwells. The state of cleanliness of his home and person, and the infectious illnesses that he may contract, may at any moment call for outside intervention. His methods of work, his rate of remuneration, and his relations with fellow workmen, are regulated by organizations whose aims may appear inimical to his well-being.
Should he, owing to untoward circumstances or the peculiarities and idiosyncrasies of his temperament or character, come into conflict with this weight of written and unwritten laws, all his powers of social adaptation, with all their implications of intelligence and self-control, will be needed to bring his life into harmonious working relations with his fellows. Co-operation, coordination, collaboration, teamwork, all express one of the most widespread tendencies of the day. In this complex system of social relations, what place can be found for the subnormal individual, who starts life, not only with a poor mental endowment but with temperamental difficulties he can neither understand nor control? Will external help give him a place, however humble, in the community? Can he be protected from dangers, and can others be safe-guarded from the results of his asocial conduct?
The answers to these questions will be found only in the establishment of a comprehensive system of social control over the individual defective. Whilst every civilized country has made and is making efforts to provide schools and institutions for some at least of its defectives, little has been done toward the creation of a system of social service that shall be available for all defectives living in the community.
On what should such a service be based, and of what should it consist? First, the ascertainment of all defectives in the community at as early an age as possible.
Second, the provision of every possible variety of methods of training in day schools and centres, as well as in residential schools and institutions for all defectives.
Third, the provision of continuous home supervision and control for all defectives throughout their lives, if possible by one authority or organization with a body of specially trained social workers keeping continuous records of all such cases.
Fourth, the provision of varied and well-graded institutions for all defectives who cannot be adapted to social life in the community, and who is a danger to themselves and others.
Fifth, the provision of adequate facilities for the training of the whole personnel required for this work?psychiatrists, psychologists, social workers, teachers, and administrators.
Sixth, education of public opinion to a recognition of the racial dangers underlying the unchecked increase of mental deficiency.
The limits of this paper oblige me to confine myself strictly to the discussion of a constructive policy of social control and to pass over accepted methods of dealing with defectives which need only expansion and development. The establishment of day schools and classes for defective children of the feebleminded grade is accepted as part of the modern educational system.
The necessity for an adequate provision of institutions is acknowledged by all, the cost of such provision being the main factor that delays its adequate development. Some forms of community control for selected groups?
notably, children leaving special schools, and defectives leaving institutions? are to be found in certain countries? Germany, Switzerland, Belgium, Denmark, England, and a few of the States? but even for these limited groups, the ground is inadequately covered.
Boarding out, family care, foster parents, guardianship? all these methods are employed, generally rather loosely by most countries (except in Belgium), but are not closely correlated with other forms of work.
Ascertainment.?The systematic ascertainment of defective children in the population is the first essential. The haphazard picking up of adult defectives after they have proved themselves social failures is incompatible with any scheme of social control that will have the slightest chance of success. Compulsory school attendance; the training of the preschool child in creches and day nurseries, and so forth; the extension of education to embrace the whole of the child’s life, his health, his recreation; the effort to give him, within the limits of the school and class, on the one hand, possibilities of individual growth and development, and the other social training through ordered relations with other children in work and play, and finally the development of standardized tests? all these measures contribute to early recognition ?f the differences in individual children, and the possibility of a fairly complete ascertainment of defectives and temperamentally handicapped children of school age.
For the adult defective, ascertainment cannot be so complete, and figures are unreliable. As a rule, the adult defectives who are discovered are those whose moral and economic failure has been of so marked a degree as to bring them into contact with the law, with relief organizations, and so forth, or has made their families realize the need for their further protection. But one interesting fact has emerged as a result of the establishment of training and occupation centres in England to which older defectives are admitted, and that is the large number of individuals of stable temperament who have led decent but useless lives in good homes, untrained and unoccupied, without interests and pleasure, but free from social dangers. These cases were unknown to all authorities, and have shown us the supreme importance of getting to know our young defectives.
Efficient social service for the future must, therefore, concentrate its efforts on the young defectives now in schools, and the adult of the present day must be fitted as best he can into a graduated scheme for dealing, first with the school child, then with the trained adolescent, and then with the adult.
In all European countries, as well as the United States, we find the same situation: an effort to discover the number of defectives; in some favoured areas the establishment of a few day schools or classes for feebleminded children of the higher grades; and almost complete neglect of (a) the lower grade children (I.Q. below 55) excluded from school, (b) the defective children who remain to mark time in the ordinary schools. It would be interesting to discover what percentage of ascertained mentally deficient children are receiving special training.1 If we take the figures from the Report of the Mental Deficiency Committee on the incidence of mental deficiency amongst children, and compare them with reports from any of the American States,2 we find that the number of children receiving any form of special training or education is far below any reliable statistics on the estimated number of defective children in the population. It may be of interest here to quote Dr Lewis’ estimated number of defectives based on the detailed investigations in six typical areas, with a total the population of over 600,000.
Rates per 1,000 of the total population. In urban areas : Children 3.14 Adults 3.34 Children and Adults 6.49 In rural areas : Children 5.16 Adults 5.01 Children and Adults 10.66 Figures for all areas combined, 7.34 per 1,000 of the total population.3 The ascertainment of the defective child includes (or should include) the fullest possible medical, psychological, and educational records, on which the In England, only some 16,000 feebleminded and educationally defective children out of an an estimated total of some 105,000 is actually in special schools.
2See A Brief Survey of Special Education in the Public Schools of Baltimore, by J. E. W. Wallin. Baltimore: Department of Education, 1929. 3See Dr Lewis’ report on his investigation in the Report of the Mental Deficiency Committee. Part II pages 182-3. provision of training and the type of social supervision, as well as the advice and help to be given to the parents, should be based. Training.?The provision of training should follow automatically the diagnosis of the defect.
The adaptation of the defective to life in the community is possible only if he has received the specialized training he requires. Such training should give him the greatest measure of self-control of which he is capable, and provide him with some means of work or occupation. Untrained, uncontrolled defectives have no place in the community; their only safety lies in the life of an institution.
It has been estimated by Dr Tredgold1 that out of 100 aments, there are 6 idiots, 19 imbeciles, and 75 feebleminded; 94 per cent, of defectives, therefore, require special training, and even some of the idiots and cot cases can be taught cleanliness and control. The type of training to be given must depend on the mental and temperamental needs of the individual and the facilities the district affords.
To draw up a community scheme for the training of defectives, I suggest that they be divided roughly into two groups; those who must be sent to institutions and those who can be trained outside institutions whilst living in their own homes or boarded with foster parents. The chief reasons for placing defectives in the first group are unsuitable home circumstances, lack of local provision for their training, their own physical and mental characteristics, and their difficult and unstable temperaments, which unfit them for life in a family. Unfortunately?as we realize, perhaps, more acutely m the field of mental hygiene than in any other?no grouping will avoid borderlands,” and any such divisions as the above will always leave us with some cases in which no reliable prognosis can be made. In such cases institutional training should generally be selected. In the second group, the determining factor in considering whether the training of the defective shall be carried out by day or residential methods is the likelihood of their future successful social adaptation. For those of a stable temperament, both imbeciles and feebleminded, who appear capable of being controlled and occupied, training outside an institution is, I personally think, preferable. The home must be good of its type, even if poor and humble, the parents and relations able to appreciate the methods of training and control required and to co-operate with the school and centre. Given these conditions, the defective in the home has opportunities of meeting and surmounting everyday difficulties and problems, of adapting himself to varied surroundings, of being thrown with the same people he will meet in later life at play or at work, ?f growing up in the same world to which he must fit himself in adult life. This principle is acknowledged in the provision of day schools for the feebleminded, but it has not been accepted to the same extent for the imbecile. It xSee Mental Deficiency, by A. F. Tredgold, M.D. 4th Edition. Pages 12 and 13. is true that the wonderful system of boarding out imbecile children in Belgium, which has been so successful at Gheel, has initiated and developed this idea, but in spite of this pioneer work, over and over again in all countries the statement is made that imbeciles should be trained in institutions. Our experience in England, however, short as it is, has shown us that imbeciles and low-grade feebleminded children (i.e., with I.Q.’s below 50 for children up to eleven years, and below 55 for children up to the age of fifteen or sixteen) with decent homes and in attendance at occupation centres can be successfully trained, and that the possibilities of their social adaptation, as a result of the combination of home life and training, are as great as?I venture to think greater than? for those trained in an institution. It is impossible to collect and bring to one centre a large number of imbeciles even with a great range of chronological age. Fifty is probably as large a number as can be brought together in any area. Centres are necessarily small, very simple, and run on practical, homely lines, with meals to be laid and eaten and washed up, and homely tasks to be performed, all on the small scale of a private home. Visitors drift in and out, bringing valuable outside contacts; children of all ages (and in certain cases older defectives as well) all work closely together; and conditions much more like family life are thus secured.
Another important factor in favour of the day centres is that parents who live near them are encouraged to come as often as possible, to see what their child is being taught, to help in the work, and thus to learn in the easiest way the methods employed at the centre, and to be shown how to carry them on at home. This close relation of the parent to the centre is of inestimable value when the child is transferred to a centre for older children or finds an occupation in his home or outside. The social worker visits the homes of the children and thus early friendly relations with the family are established.
Another strong argument in favour of establishing occupation centres is that they provide the defectives with their only opportunity for social intercourse. If their adult life is to be passed at home, they must early be taught to have controlled and orderly relations with their fellows. In spite of many, many years spent in visiting defectives, it was not until we had occupation centres that I realised how isolated is the life of the defective. They are debarred from most social intercourse; when taken to parties and outings they are generally lookers-on; and a very large number, more especially amongst the children of the respectable, ” superior ” classes, have no opportunities of mixing with others. The development of k< social sense ” in defectives after even a short time at a centre has been a revelation to me of the traric isolation of their lives.
I advocate, therefore, that whenever possible, the imbecile who has a good home and cannot go to a special school should be left at home and trained in a centre, just as the feebleminded or moron is trained and educated in a special day school. This is the first step towards the social control of lowergrade defectives. Occupation centres, if the figures of Dr Lewis are generally accepted, can be established in almost any town of a population of 27,00c1. The numbers in attendance can be few, as the cost is low, and a great deal can be done even if the centre is open only five half-days a week. Every effort, however, should be made to open the centres for children for five whole days.
The necessity of special education for the higher grades of defectives in special schools or classes, or in groups within the school system, is so universally established as to need no particular mention, but for those who cannot attend day schools or classes or centres, much remains to be done. In the case of feebleminded children in rural areas, the smallness of their numbers does not permit of the formation of a special class; they must remain in the elementary schools. An experiment is being tried in England of sending a specially trained teacher round to the various rural schools with defective children in attendance. In co-operation with the class teacher, she studies the needs of the individual child and makes out for him a plan of work that will fit in with the work of his class and that will be sufficiently progressive to give him suitable occupation until her next visit. In diis way quite a marked improvement can be made in the development of individual work for the subnormal child in the rural school at a negligible cost. In view of the fact that the incidence of feeblemindedness is so much higher in rural than in urban areas (see Dr Lewis’ table, on page 172) anything that can be done to give these children training should be tried. Moreover, the records of the child’s work are an invaluable guide to the social worker for his future supervision and control.
For low-grade imbecile children (I.Q. below 50) and for adults who are incapable of work under industrial conditions and who cannot attend centres, a home teacher is perhaps the only method of training, and even with few visits much may be accomplished, especially in showing the parents how to train the child in good habits. Exercises for acquiring muscular control, easy handwork, preparatory steps for carrying out simple household tasks, recreational occupations, develop the defectives and sometimes, we have found, completely revolutionize the parents’ treatment of their child. It is desirable that the home teacher’s time should be concentrated on younger defectives, but the teaching of simple recreational handwork to the adolescent and even to the elderly defective has been known to make all the difference in the happiness of their lives. Finally, centres for older defectives, either of the imbecile grade or of the class of feebleminded who can secure only intermittent remunerative work, should be an integral part of community control.
Such centres may be mainly for occupation, but I have classified them here under training, as they are attended by defectives learning a craft as well as by those actually following an occupation. They have been developed in JSee Report of the Mental Deficiency Committee, Part I, page 167.
Switzerland, in Basle (weaving shops) and Zurich,1 have been started in Berlin and other German towns, and are steadily growing in England, where they are financed by the Authority for the Care of Defectives. There is no doubt that these centres have in all urban areas a great future before them, as they can be established on such varying lines. Some are workshops for skilled workers; others are only for the occupation of low grades in the simplest tasks. That such workshops can, as a rule, pay a living wage is extremely doubtful. Defectives capable of earning a living wage in a centre can do so outside, and the work of the lower grades and of the unstable requires so much supervision that a considerable part of what they earn is consumed by staffing expenses. But they are usefully and happily employed and are given self-respect and a feeling of independence, as well as being kept out of mischief. Many can after a time get work outside; somfr?but very few, according to the results of experiments tried in Switzer-la^ro?progress sufficiently to do lucrative home work.
The cost of their maintenance to the community is less than in an institution, and far, far less than the indirect cost of an idle, unoccupied defective drifting aimlessly about all day long at the whim of the moment, a menace to himself and to others.
I have not referred to the training in the institutions or in the hostels for working patients, whether run by or in connection with institutions. Their utility has been clearly established. They are in use in the United States (where, indeed, the Rome hostels are universally recognised for their pioneer work) in Germany, Switzerland, England, and so forth. They are an integral part of community control, one amongst the many means for securing our desired ends. y
To sum up, the training of ascertained defectives is essential for any scheme of community control, and to secure such training every method must be used. Defectives who appear likely to remain in the community should, so far as possible, be given training whilst at home or boarded out in families. The lower grades who cannot go to schools or classes should attend centres or receive the visits of home teachers. If no training on these lines is possible, or if the homes are bad, the parents unco-operative, then the case should be sent to an institution.
Social Services for the Control and Supervision of the Defective in the Community.?The inquiries made by Dr Lewis gave us a useful guide to the numbers of defectives who require control and supervision in varying degrees. He gives the numbers who could remain in the community as no less than 72 per cent, of the mentally defective children and 45 per cent, of the mentally JSee 25 Jahre Hilfsschulfilrsorge 1903-8. Erziehungs- und Fiirsorge-Verein filr geistig Zuriickgebliebene (Schzvachsinnige) Kinder in Berlin. Festbericht Erstattet von dem I Schriftfiihrer Rekton G. Guerlich, 1928, pages 39 et seq. See also, ” Work Among the Menally Defective in Switzerland,” by Gertrud Lortscher. Mental Welfare Magazine, Vol. 6, No. 3, 1925.
defective adults.1 His conclusions are borne out by the practical experience of our Mental Welfare Associations, which, in areas embracing two-thirds of the population of the country, visit defectives who require friendly assistance and advice, as well as those who are under definite statutory supervision under the Mental Deficiency Acts. But although many defectives may in themselves be suited for community control, such control cannot always be exercised in the defective’s own home.
To quote from the Report of the Mental Deficiency Committee2 “… our findings … [seem] to establish the fact that feeblemindedness is more likely to occur among populations of a generally low mental and physical level than elsewhere?that is to say, in slum districts and in rural areas with a poor type of inhabitant, and that, broadly speaking, it is likely to be most prevalent in a certain limited group, which may be termed the subnormal group, of the general population.”
The many special investigations in the United States of America have also brought out this ” family ” distribution of feeblemindedness. As a result of this distribution of feeblemindedness, every form of boarding out, foster parents, guardianship must be developed. Belgium, the pioneer in this work, Germany, Switzerland, and so forth, all emphasize the need for this type of care.
In view of the close connection between feeblemindedness, pauperism, recidivism, slumdom, the danger to the community of the defective procreating his kind must be ever before our minds in any attempt at social control. The argument that practically all defectives should be sent to institutions and only a few discharged under the strictest supervision has, therefore, considerable force. The task of safeguarding defectives would be infinitely easier if limited to this small group, but it is surely no understatement to say that no country has so far faced the burden of providing institutions for the majority of its defectives and, further, that no country is at present in a financial position to meet the cost of building and equipping sufficient institutions without penalizing the claims of the ordinary citizen to many essential public services of health and education. I am also convinced that the understanding of the problem of the mentally defective is not so widespread amongst the general population (which includes the families of the defective) as to secure the admission into institutions, if places were available, of any large proportion of the defectives in any country. The natural hesitation of parents and relations to recognize the seriousness of the defective’s mental condition, and even if recognizing it, to part Wlth the defective; their ignorance both of the possibilities of training in the Modern institution and of the fact that even a minor degree of mental retardation is one of the most hopeless handicaps to success in life; the inherited and JSee Report of the Mental Deficiency Committee, Part II, pages 154-5, 164. See Part III, page 38.
deeply rooted dislike to anything that savours of detention?all tend to make the removal of a defective who is at the moment neither a social menace nor an economic burden a matter of the greatest possible difficulty. The only preventive work we can do .is through friendly supervision over those who are not yet in danger and through the influence the social worker can thus bring to bear on the family.
In the provision of social service for the control of defectives, each country will select its own methods. The many types of local government systems, the widely different relations of central and local authorities, the varied roles played by social organizations and their relations to official departments, that are to be found in the various countries, and even within each country, make it useless to suggest any one method. But our experience in England seems to indicate that the adoption of certain principles will secure the best results. The first essential, as we have seen, is the ascertainment of all defectives, if possible, but in any case of all defectives of school age, and the second is that some authority should have, not only a power, but a duty to exercise control and supervision over defectives in their own homes, and, if such supervision ” affords insufficient protection,”1 to remove them from their homes either by boarding them out or by sending them to an institution. Such a power does exist in many countries, but in no case has it been exercised to its fullest extent. In England, the county councils and city councils have definitely laid on them the duty of supervising the majority of defectives in their homes, and of providing them with training and occupation, and a real effort is now being made by many authorities to administer this law.
Thirdly, every child ascertained to be a defective of whatever grade, in attendance at whatever school or excluded from school, must be under the supervision of an authority or social organization so constituted that the child can be visited by the same group of workers, not only during childhood, but throughout its life.
Can anything be more useless than to have an elaborate psychiatric, physical and psychological examination of a defective, to tell the parents ” your child is defective,” and to offer them no further assistance? From the moment the diagnosis of defect is established, the family should be visited and advised, and friendly relations with the responsible social worker established. When adolescence and the crucial moment of leaving school come, the parent and visitor who have known each other often for years can co-operate harmoniously together for the good of the child, in a way no newly appointed after-care visitor can. The excluded unbalanced child, the feebleminded child in the elementary school, as well as in the special school, all need supervision, and the success of their future care may often depend on the protection afforded in the first few years.
In England the most successful method has been for the school medical England, Mental Deficiency Acts, 1913-1927. Section 30 (b). officer to refer every defective child, irrespective of the school he attends, to the Mental Welfare Association for his area. The association visits continually, advises the parents, reports to the appropriate authorities the home circumstances, relation of the defective to his family, difficulties of temperament and character, and the possibility that supervision will afford sufficient protection. This social service can be established in any area as soon as trained personnel is available for it; if an adequate number of workers are employed, an efficient method of social control will have been initiated.
As has already been pointed out, in most countries?the United States, Germany and Switzerland?the defectives in the community who are visited are those who have been to special schools (after-care) or to institutions (parole). There is little evidence that defectives who have not passed through one or the other of these institutions are kept (either by the state or by voluntary organizations) under any supervision.
The defective in the elementary school who is not in immediate danger nor too serious a burden on his family?whether through his incapacity to support himself in industry, or through physical or serious mental handicaps -?is for the most part unknown to any authority and stops at home, often till it is too late to do anything really constructive for his training and protection. He is picked up in the courts, in prisons, in institutions, in homes for rescue cases for the poor, for tramps, and so forth, and by that time he may have so deteriorated as to be incapable of social adaptation.
Those who are actually either in institutions for defectives or in mental hospitals form but a small proportion of the total number, and in too many instances have found their way there because no assistance was forthcoming to help them before they had drifted into bad ways.
Community care should vary from the giving of purely friendly advice and help to the various forms of state guardianship with compulsory powers tned in America, in Belgium, in England. It should include the power of affording every kind of assistance to the defective?boarding out, maintenance grants, the provision of tools, of travelling expenses to and from work, of temporary care, of change of air?in a word, all those things that will enable a defective to remain safely in his family. It may be argued that thousands ?f workers can never make such provision for themselves or their families, but the positions are not analogous. If the state has undertaken the duty and responsibility of active interference in the life of the individual, by supervision, c?mpulsory detention, and so forth, it must undertake the corresponding duty ?f making his life as happy as possible.
The effective control of a defective at home does inevitably mean a restriction in his complete freedom to go in and out as he pleases, to make ^hat friends he chooses, to select whatever type of employment he likes out of those that are open to him. To impose these limitations without at the same time giving compensating interests and amusements is to court disaster. A high-grade defective, living under these conditions, will be dissatisfied and miserable, and will either sink into apathy and cease to make an effort or take the law into his own hands and lead a life of license, become a danger to the community, and be obliged to be removed (too often via the prison with all its disastrous knowledge and environment) to an institution. A defective boy or girl with these experiences is, even after the best training of the institution, very difficult to adjust to life in the world. Many defective girls who can be useful at home deteriorate rapidly after leaving school, become listless and supine, with no initiative and energy, because their lives are so monotonous and restricted. The better cared for they are, the duller their existence. For such girls part-time attendance at a centre, where, besides singing and dancing games, they are taught various forms of recreational handwork which they can do at home, has been found to make the whole difference in keeping them contented and happy and easily capable of control. The social worker must arrange for this.
Employment.?Finding employment for the adult defective is one of the most important, and one of the most difficult, functions of the social worker.
In spite of the organization of industry which I alluded to at the beginning of my paper, there do remain a considerable number of occupations that the workman of normal intelligence, when he has a choice, finds too simple, too mechanical, but that the defective can satisfactorily carry out. There is a niche for him if it can be found. But the finding of the niche can be satisfactorily undertaken only by those who know the defective’s potentialities and limitations.
The careers of children who have left special schools (Berlin, Birmingham, London, Zurich) are a testimony to the good results of special training and to the trouble taken by social workers in finding suitable employment.1 xThe returns of the London Association for Mental Welfare (Report for 1928) on a total of 1,277 cases between sixteen and eighteen, gives us the following results : ? In industrial or manual work, trades, etc … 786 In agricultural work, commercial, army and navy 17 In blind-alley occupations 113 In domestic occupations 164 Out of work, but employable 113 Unemployable 61 No information 23 1,277 The placings by the social workers employed as work-seekers was 802?156 in skilled, 287 in semi-skilled, and 359 in unskilled processes of different industries. Footnote continued on next page.
The suitability of the employment is of paramount importance, for the defective cannot cope with difficult industrial conditions. The returns of employment for defectives leaving special schools vary to an almost incredible extent according to the types of employment available in their neighbourhood. Where there are factories and simple mechanical jobs to be carried out, defectives can comparatively easily find and keep employment. A certain number find employment in some of the routine rural occupations, but modern agri- cultural methods are diminishing the number of occupations suitable for defectives, as in many areas these mechanical processes are only seasonal. These variations all point to the necessity for a wide-spread organization for the employment of defectives. By an extension of boarding out, cases could be transferred to areas where employment could be found and where the local social worker would supervise them. Where the occupations are seasonal only, they could, when out of work, attend a workshop for defectives. The job, or jobs, found?for, alas, with some cases constant change is needed?the supervisor must still keep an anxious and careful eye on the conditions of the defective’s life and arrange his recreation?see that a club and classes are available for him and that he has safe and pleasant social intercourse.1 The possibility of economic independence amongst defectives varies, not only with the degree of mental retardation, but with the temperament and character of the defective, and to one defective able to support himself altogether, there will be a large number only partially self-supporting, either because of the small wages they can earn or the intermittent nature of their employment. Some will hardly earn their keep, whilst others again will merely be occupied, without any question of remuneration.
But the experience gained is a sufficient indication that the possibilities of adapting the trained defective to community life are infinitely greater and Footnote continued from previous page.
The report of the Birmingham Education Committee (Special Schools After-Care Committee), 27th July, 1928, shows that of 4,301 cases that had left the special schools 1,695 were doing remunerative work, 667 were living at home doing no paid work, 280 were excluded from school as incapable through mental or physical disability, 213 had been transferred to other schools, 437 were in institutions for defectives, 16 had joined the army, 160 were in other institutions, 580 had been lost sight of, 253 were dead.
One of the striking features of this report was the high wages some of the defectives were earning and the length of time they had kept their employment. In Dr Lewis’ report he makes an estimate of the employability of defectives which cannot be given here in detail, but to which reference must be made. See pages 124-127, 201, of Dr Lewis’ investigation.
JClubs have been organized in most areas where there are special schools, London, Zurich, Berlin, and so forth.
more varied than the uses that have been made of them. We in England are only just realizing that workshops for defectives, handicraft centres, domestic training centres, as well as occupation centres where low grades can be occupied, combined with the constant supervision of the social worker, will make the possibilities of social adaptation of the defective who is not antisocial more promising than anything we had dared to hope for in the past.
I cannot leave the subject without a reference to the problem present in many people’s minds. Would sterilization enable us to adapt a far larger number of defectives to community life? Undoubtedly there are a number of cases who for the sake of the community must now be sent to institutions, but who could live safely in good homes with suitable employment if there were no danger of sexual intercourse. But such cases, taking the total number of defectives and not merely those in institutions, are probably very few. Other disabilities almost always exist; in particular, their lack of emotional control would lead to the spread of venereal disease. As a matter of practical politics, the controversies that rage round proposals for sterilization in most European countries (and possibly in some of the States) will probably delay rather than facilitate the provision by authorities of social supervision for defectives. Bitter resentment will be aroused, and there are indications that the certification of high-grade defectives by doctors and magistrates will be hampered, and that the co-operation of parents will be harder to secure if sterilization is connected in their mind with the policy and function of the authority for the care of defectives.
Up to the present we have insufficient data to make a definite pronouncement on the question. The first step?and one that can be taken with little controversial legislation and with the minimum of expense?is to gain a thorough knowledge of defectives and of the conditions under which they are living. When we know this, when we have definite data on the lives of the majority of defectives, we can then base our policy regard to sterilization on facts and not on speculations.
The length of this paper forbids me from giving details of the various methods of training courses, and so forth, for psychiatrists, teachers and social workers that have been established in various countries, but it will be found essential to the success of a scheme for social control to provide all workers with train- ing in their special branch of work.
In conclusion, I would draw attention to the wider implications of the problem we have been considering. The mentally defective form only one section (the lowest) of the whole group of mentally subnormal persons, estimated at 10 per cent, of the total population. All evidence points to the fact that from this subnormal group are recruited most of the social failures of the modern state. Is it too much to hope that intensive social work, such as has been described here, will guide us to practical methods for the social adaptation of the rest of the subnormal group ? If so, no more important contribution could be made to the state by any form of social service.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.