The Royal Medieo-Psyeliologiesil Association
(Contributed)
The Annual meetings of the Association took place on July 5th, 6th and 7th, under the Presidency of Dr F. Douglas Turner, at Colchester and Clacton- on-Sea, namely, at the Albert Hall and the Royal Institution for Mental Defec- tives at Colchester, and the Town Hall, Clacton. In view of the specialisation of the new President in mental deficiency as contrasted with full lunacy, this meeting can be said to have been a Mental Deficiency Study.
THE PRESIDENT’S ADDRESS
Dr Turner said he thought this was the first occasion on which a member had been chosen as President whose life-work had been on mental deficiency, and a fitting sub-title for his address might well be, ” The wheel always comes full cycle.” Over and over again in the case of defectives, during the past hundred years, methods and ideas were used, then discarded, and at a later date were re-introduced and hailed as new. The basic principles of Seguin’s methods were those in occupation centres to-day, i.e., to first awaken the senses, educate the larger muscles of the body, and infuse vitality, passing on then to the finer co-ordinating movements. 28 years ago the aim was first to teach reading and writing, but that idea has now been discarded.
After dealing with the history of the movement, Dr Turner went on to say that in the first instance nearly every great cause had been commenced by the voluntary efforts of people whose sympathies had been stirred by becom- ing aware of some evil, and who did their best to help their fellows. Usually the State had only given help after years of voluntary effort had shown the way. It was not until the passing of the Mental Deficiency Act in 1913 that the Local authorities were empowered to build their own institutions for defectives, and to contract with existing institutions to take their cases on payment. The Royal Institution at Colchester still had a charit- able income of nearly ^10,000 a year, and maintained 200 patients by its charitable funds. Plans were now being made for the accommodation of 444 additional patients. Up to the present time defectives in England had been protected by three separate Acts of Parliament, and the wheel had only to take one more turn to get back to full cycle and come again under the Lunacy Acts, a consummation which he hoped not to see. Both England and America had had alarmist periods, which commenced when it was recognised that many defectives could not be cured, and was added to by the invention of intelligence tests, the latter being the sole arbiters as to feeble-mindedness. Emphasis on eugenics and studies of heredity seemed to teach the same alarmist doctrine, and the compilation of family histories was hopelessly unscientific. Less than ten years ago a well-known society, established to improve the race, said in a pamphlet it published, ” If all mental defectives could be prevented from having child- ren, the number of mental defectives in the country would be halved in about three generations.” Those with every-day experience of mental defectives would agree that such a statement had no basis in any knowledge the profession at present possessed. Defectives in institutions now lived longer than formerly : in the five years preceding his appointment, the death rate averaged 7.5% each year, whereas now it was 1.4%. It was, he thought, wrong to consider mental defect as a separate entity owning one single cause; there were perhaps a dozen or twenty causes; in some cases it followed birth injury, congenital syphilis, or encephalitis, or some alteration in the secretions of some glands. The hopeful types were those in which the cause was known. He did not think it could be said how much mental defect was due to preventible causes, how much was due to heredity acting alone, how much was due to a mixture of both. But he had been much struck by the effect of environment on the production of certified defectives; he believed that had the environment of those cases been better, the person would probably have led a hardworking and blameless life, though in a lowly sphere. The legal definitions of a defective were of social character ; they depended on the social capacity of the subject to live in the world to which he belonged. Civilisation produced defectives by making living con- ditions more difficult, and a person regarded as defective in a city might easily pass muster in a village. When cases due to disease or injury were excluded, there remained a large number who were simply normal people on a low grade.
An intelligence below the average was no more abnormal than a height which was less than the average. Whoever might be sterilised, there would still be a failure to eliminate the normal people below average intelligence who could not react successfully to their environment, and who, therefore, would be labelled ” Defective.” It would never be possible to provide a sufficient num- ber of big training institutions to allow of every mental defective in the country being retained in them permanently; the expense would be prohibitive. The problem was to find the best way in which the central institution could, within the limits of its capacity, give the greatest service. The instrument by which the desired re-socialisation could be attained was an ever increasing and more effective use of one of the most valuable things the Mental Deficiency Act con- tained, i.e., the liberty to grant long leave of absence or license to defectives from an institution for as long as might be deemed necessary. Dr Bernstein not only sent his patients out on license, he also had a valuable half-way house, which he called a colony. These colonies were miles from the institution, they were separate houses or farms, from which the boys and girls went out to dailv work in the neighbourhood. They were really trying-out places for the purpose of determining whether or not the defective could stand the increased responsibility entailed in this added freedom. This had been somewhat copied also in England. Dr Turner did not agree with the sending of defectives direct to foster parents, for if a defective had failed at home, it was not fair either to him or the guardian to send the case to the same sort of environment, especially as he thereby missed the skilled examination, training and treatment at the central institution. The essence of the scheme, and a necessity for its smooth working, was that all defectives who had once been admitted to the institution, whatever their subsequent transfers, such as to colonies, must remain on the books and be considered as on license from the parent institu- tion. Certainly every large institution should be a training school, not only for the teachers and nurses on its staff, but for anyone who wished to take up the work. He did not favour the idea of the medical superintendent acting as adviser to the local authority.
The future policy of these institutions should be a recognition that the defective was, in the majority of cases, a normal person, and a turning away from the alarmist doctrines prevalent in the immediate past. Another paper on the subject was read by Mr. Edgar A. Doll, Ph.D., Director of Research in the Training School at Vineland, New Jersey, on
COMMUNITY CONTROL OF MENTAL DEFICIENCY IN THE U.S.A.
He said that the conclusions reached in England on the subject of mental deficiency had largely influenced the professional points of view held in the States. His own interest in the community control of mental deficiency was directly attributable to an article by Miss Evelyn Fox in ” Mental Welfare ” five years ago. In the States the term ” feeble-minded ” was used in a generic sense and was held to include idiot, imbecile, and moron, the latter term having been coined by Goddard to avoid the confusion then prevailing. In the States it was generally concluded that one per cent, of the total population was men- tally defective; this figure was exceeded in rural areas and districts where in- breeding was prevalent. And at least two per cent, of the school population were mentally deficient. Their principal agencies for dealing with the men- tally deficient were (a) public and private institutions, (b) elementary schools, (c) public welfare organisations. Nearly every State had at least one public institution for the mentally deficient: and many State hospitals for the insane also received mentally deficient patients; almshouses and correctional institu- tions also cared for an uncertain number. In 1928 there were 65,000 patients in institutions for the mentally deficient; the number was now probably about 80,000. Thus only about six per cent, of the total number were cared for in public institutions. It was felt that something like a systematic programme should be provided for the vast majority of mentally deficient persons who at present had no institutional care. The cost worked out at about ^’100 per head per annum. The cost of care in private schools varied greatly, in some being as high as 2,400 dollars per annum each. Institutional segregation was not justified for mental deficiency alone : it was this plus some complicating factor, such as dependency, social mal-adjustment, delinquent behaviour, crippling, misconduct at school, etc. The parole was extended to all kinds of deficients.
There were now 8,000 patients on parole from State institutions in his country.
There were 25 million children of school age in the United States, and it was estimated that 500,000 of them were mentally deficient, and but few of the schools took steps to insure institutional care of those who were of too low a grade to profit from ordinary instruction in school conditions. The special education of mentally deficient children in the rural districts of the States presented a particularly difficult problem, largely because the population was so scattered.
The majority of mentally deficient persons resided in the community, so that this represented the most important aspect of the problem. In the States there were few agencies or programmes comparable with those developed in England for this phase of social control; most of the State agencies were con- cerned with the co-ordination and supervision of State institutions. Mental hygiene clinics had been extensively developed in some urban centres, and travelling clinics were available for some rural districts. In some communities, too, child guidance clinics had been developed, and in some cases they served rural areas near large cities. Vocational and educational guidance clinics, as well as mental clinics, were available in many of the U.S.A. universities. In some municipalities and in a few rural areas the visiting teacher was an im- portant aid in relation to mental deficiency, but it was too expensive to be adopted on a large scale. But there was little provision of occupation centres, boarding homes, residential schools, social and industrial placements, follow-up and supervision.
The White House Conference Sub-Committee on Mental Deficiency advocated a social classification of mental deficiency as follows: ? 1. Low grades, those in this grade being so subnormal that aid had to be given them in feeding, dressing and personal care, as well as protection from ordinary dangers. They could receive such training in personal habits as would make it easier for the family to resume care of them.
2. Adjusted high-grade patients. These included high-grade imbeciles and morons difficult to manage at home and not amenable to class-room disci- pline in the elementary schools. They were properly institutional cases. 3. The physically handicapped, including mentally deficient persons to whose condition were added serious physical handicaps which increased the social liability of low mentality. These defects might be so severe as to need similar care to that given to the low-grade cases.
4. The aged high-grades, including the comparatively senile or in- dustrially incapacitated so that they could not be cared for in their own homes nor be economically adjusted to the community. Such patients could be cared for in almshouses, where the facilities were less expensive than in a training institution, and where only personal care of the aged was required.
5. Clinical types, including the clinical varieties of mental deficiency, for whom mental treatment could not be provided satisfactorily, either at home or in the community. These patients had serious physical stigmata and ortho- paedic and other complications. Presumably some of these could be returned to the community after an extended period of institutional treatment or care. 6. Neuropsychiatry types, including mental deficiency, with such mental disorders as epilepsy, psychopathy, psychosis, or neuropathology with deteriora- tion. These, also, were properly institutional, and could be suitably provided for in hospitals for the insane.
7. Well-adjusted young high-grades, a group well adapted for special education in the elementary schools. If the home was economically and socially capable of caring for such children institutional care was not imperative, and they benefited from continuing to live in the community, for this enabled them, under supervision, to adjust socially and economically.
8. Well-adjusted high-grades, including those for whom community supervision under well-considered programmes of occupational placement and home care were adequate.
Large numbers of mentally deficient persons were now being cared for in good homes where the family was able and willing to provide the necessary care and supervision.
With regard to sterilisation, authorities in the States seemed to be much more optimistic as to the possibilities in this direction than those in England. The experiment in California had demonstrated that sterilisaton of mental defectives was not followed by sexual promiscuity, but it did make possible the restoration to family or community of people in whom the sex factor had been of prime importance. The trend of authoritative opinion in the States favoured selective sterilisation. In that country, too, the outstanding development in this matter was in research.
A remarkable and memorable feature of this Annual series of meetings was the demonstration of what is being done for defectives in the Royal Institu- tion at Colchester which the President controls. The workshops were seen to be hives of industry, and included shops for shoemakers, tailors, mat making, basket making, ordinary sewing and embroidery, weaving, knitting, brush making; while the musical and recreational aspect was even more admirable.
The girls of fitting grade gave a delightful entertainment in the theatre, ruled by the orthodox fairy queen, with her electrically lighted diadem and wand, and it passed off without a hitch. In the grounds, on a fine piece of grass sward, and favoured by perfect weather, an exhaustive series of exercises and games were given by both sexes, to the accompaniment of the institution-trained band, and their efforts were loudly applauded by a large company of visitors. It was evident to all that a happiness and contentment pervaded the whole exhibition which speaks volumes for the skill and care bestowed.
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