Dr C. P. Blacker
Dr C. P. BLACKER, the editor of this volume,* can make at least one claim for it without any reservation, namely its novelty. No one has written a book on this subject previously. Indeed, the conception is so novel that the editor has included the interrogation mark in the title. (We wonder whether this was done before or after receiving the contributions of the various experts). Students of the social sciences, however, will agree that the time had arrived for the presentation of the data that are available for testing the validity of the conception. The publication of this volume shows great ‘nitiative and also much courage; many will feel indebted to Dr Blacker for giving in this compact form the results of recent researches in this field of study.
The investigator for the Wood Committee (Dr E. O. Lewis) records in his section of the report two general impressions he received in the course ?f his investigations. The first was that a large proportion of the mental defectives, and especially the feeble-minded, were discovered in a relatively small section of the community. The other impression was that amongst the relatives of the defectives in this small section there was a high incidence ?f such behaviour abnormalities as insanity, delinquency, epilepsy, alcoholism, Prostitution and of chronic pauperism. Dr Lewis has not formulated his
A Social Problem Group? Edited by C. P. Blacker, M.D., F.R.C.P. Humphrey Milford, Oxford University Press. 15/-.
evidence in support of these impressions except in respect of pauperism. Thus, in classifying the homes of the defectives he finds that approximately 21 per cent, of the feeble-minded persons came from very poor homes. The concept of the Social Problem Group formulated by the Committee can be said to be the embodiment of these two impressions. But on reading the Wood Report it becomes obvious that the Committee regarded the conception as a hypothesis and, indeed, merely a working hypothesis. No claim to proof or finality is made. But the conception has been one of the most discussed features of the Report, and when its implications are fully grasped this is not surprising.
What are its implications? The most obvious is that many chronic social evils of the modern State are closely related?so closely that probably they arise from the same group of conditions. An implication of greater significance is that these evils are to be regarded as the characteristic reactions of a relatively small group of the community.
Up to the present, the tendency has been to regard many social problems, such as mental deficiency, mental disorders, epilepsy, recidivism and chronic pauperism as separate entities. At any rate, they are dealt with administratively by different departments, and from the practical standpoint this may be a sound policy. But if this conception of the Social Problem Group is right there must be some, if not considerable, overlapping of the activities of these departments, with a risk of much waste of public money and of the time and energies of the officers serving central and local authorities. Of more importance, however, will be the inadequacy of measures applied to the solution of the various problems. Each department adopts its special ameliorative or palliative measures but is unable to adopt effective preventive measures. The conception of the Social Problem Group focusses our attention upon the group and not upon its various activities; and really preventive measures are likely to be applicable to the group as a whole.
It is well, however, to emphasise that this conception does not imply that all mental disorder or defect, recidivism, chronic pauperism, etc., arise from this small section of the community. This point can well be elucidated in reference to mental deficiency?the subject of special interest to the readers of this Journal.
The term mental deficiency is merely a generic name for a variety, probably a large variety, of clinical conditions, all of which have in common some impairment of the mental capacity of the individual from birth or an early age. Gradually various clinical entities are being sorted out. Such entities as mongolism, cretinism, mono- and di-plegias, and congenital syphilis have been long recognised. More recently the classification has been extended to such entities as amaurotic family idiocy, epiloia and, latest of all, phenylketonuria. In passing, it is of interest to note that the last group comprises not only clinical but also genetic entities; and it appears that the search for such entities promises to be the most fruitful line of investigation at present. But it is very unlikely that all cases of mental deficiency can be classified into these pathological and genetical groups. Probably a not inconsiderable proportion will be found to belong to what has been designated as the subcultural group.
The chief if not the only feature of cases in this group is a sub-normal endowment of intelligence and the contention is that a large proportion of subcultural deficiency is to be found in the Social Problem Group.
Should this contention be right, a new orientation will be necessary in regard to preventive measures to be applied in this restricted field. The mental inefficiency is only one aspect of a complex group of social abnormalities, and very little will be achieved if we attempt to deal with the mental condition as if it were an isolated problem. We should need first to ask ourselves how the Social Problem Group has come into existence and why the behaviour of so many of its members should be anti-social. Effective preventive measures are likely to be those that can be applied to the group as a whole and not to any one aspect of its activities. It is such considerations as these that make Dr Blacker’s volume of more than theoretical interest to students of mental deficiency.
What evidence have we that the Social Problem Group exists? This is the question Dr Blacker and his collaborators have set themselves. With the exception of Mr. Lidbetter, whose investigations are well-known, none of the contributors to this volume makes any claim to have made ad hoc investigations of the subject. Their observations are based upon data of a general nature which were not specially collected to elucidate the degree of concentration in any one social group of such conditions as chronic pauperism, insanity, mental deficiency, epilepsy, recidivism and prostitution. In the first chapter, which the editor himself has written, this is recognised but it is maintained that it ” is the only method by which an objective view of the subject can be obtained.” The contributors, each of whom is a recognised authority in his or her particular field of study, have examined the data?mostly those of other investigators, but in some cases their own?in order to determine to what extent there is a concentration of the various abnormal conditions said to occur in the Social Problem Group.
There are many difficulties to be surmounted in this method of approach to the problem ; and the various contributors are obviously very conscious of these difficulties. Before it is possible to conclude that there is an unduly large concentration of any of the social evils we have mentioned in a certain section of population it is necessary to have reliable control data of the incidence of these conditions in the general community. Such control data for this country, however, are not available, with the possible exception of mental deficiency. But the results published by the Wood Committee show that the incidence of mental deficiency varies greatly in different communities and it is not justifiable to apply the mean incidence of the whole country to a relatively small proportion of the population. Even if control data were available for each condition there is a further difficulty. How are we to decide what degree of overlapping is required in order to establish the existence of the Social Problem Group? The greatest handicap, however, is to be found in the inadequacy and incompleteness of the family histories hitherto collected by most of the investigators. It is only in recent years that the technique of collecting a family history has received the attention it deserves and this technique is still far from perfection. The accumulation of a large number of incomplete family histories does not lessen their inadequacy and inaccuracy.
This may seem a somewhat trite and obvious remark but on reading many treatises on human genetics which have been published in recent years we feel that this truism has been lost sight of. When these and other difficulties are borne in mind it is not surprising that most of the contributors to this volume admit that they have no conclusive answer to give to the question ” Does the Social Problem Group exist ? ” No attempt will be made here to summarise the conclusions of the various contributors. Dr Blacker had done this clearly, concisely and in a well-balanced manner in the first chapter of the book. The two contributors who appear to get nearest to giving an affirmative answer to the question are Dr Newth and Mr. Lidbetter; and the explanation is fairly obvious. Both these contributors have made intensive investigations of definitely restricted groups of the community, and the restrictions they have imposed upon themselves have enabled them to secure data which are relatively complete. Their contributions in particular, together with the suggestions found in some of the other taining what degree of concentration of the various social evils exists in certain districts of the investigated area.
The conception of the Social Problem Group can be established or refuted only by a series of ad hoc investigations. It should not be difficult to have a number of such investigations carried on at the same time. The ideal areas would be County Boroughs with populations from 100,000 to 150,000 where it should be possible to have a comprehensive view of all the various social services. Also, some rural counties with slightly smaller populations should be investigated. In areas of these dimensions it should be a relatively simple matter to obtain complete, or almost complete, ascertainments of all chronic paupers, mental defectives, insane persons, epileptics, criminals and other persons who manifest the anti-social behaviour or in other ways become an exceptionally heavy charge upon the public purse. Since the family grouping is an essential feature of the Social Problem Group conception, it would be necessary to obtain the services of some well-trained social workers. Two or three vears should be sufficient time (provided all departments of the local authority co-operate well) for a small team of workers to collect the relevant data. The services of a statistician would be required to advise on the collection of the data and to examine and analyse these with a view to ascertaining what degree of concentration of the various social evils exists in certain districts of the investigated area.
These, broadly, are the lines of an ad hoc investigation which is suggested to us by the reading of this volume. If such investigations are undertaken, doubtless it will be found necessary to make certain modifications or adaptations of this general procedure in order to meet local conditions. It is to be hoped that one practical outcome of the publication of this volume will be that some medical officers of health or other officers of local authorities will undertake investigations of this character. The obvious practical value of such researches should commend them readily to local authorities.
The closing contribution to the volume is “A Note on the Definition of a Social Problem Group,” by Mr. Caradog Jones. No one can speak with greater authority upon this subject than Mr. Jones. That great and most illuminating report on the Merseyside Survey for which we are indebted largely to him gives probably what is the most conclusive evidence yet available of a high degree of concentration of abnormal social conditions in relatively small groups of the community?which is the central feature of the Social Problem Group conception. In this note Mr. Jones deals with the basic point?what is the fundamental relationship between the various abnormal mental conditions and behaviour of the Social Problem Group? He contends, and rightly so, that whilst poverty may be the condition which leads to the discovery or ascertainment of members of the group, it cannot be regarded as the fundamental condition. Poverty cannot be said to be the cause of much mental deficiency, insanity, epilepsv, alcoholism or recidivism. Mr. Jones puts forward the view that subnormalitv of intelligence is the basic and determining factor.
Some of our previous observations indicate that we agree there exists a close relationship between subnormal intelligence and the various mental and behaviour abnormalities associated with the Social Problem Group. But why is it that, whilst large numbers in our Mental Deficiency Institutions and Colonies (because they have proved themselves to be socially inefficient) have 65 to 80 per cent, intelligence, there are even larger numbers of persons of these grades of intelligence living in the general community and able to fend for themselves? In Mental Deficiency Institutions there are many men and women whose intellectual endowments are superior to those of a not inconsiderable proportion of persons living in the general community; but it would be unfair both to these defectives themselves (and to the general community) to give them their freedom. Such cases indicate the need for some reservation in accepting the view that subnormalitv of intelligence alone is the determining factor of the social inefficiency of those comprising the Social Problem Group. Temperamental instability obviously is a contributory condition in many instances. Possibly environmental factors, amongst which might be included obsolete conventions of morality and unfairly discriminating industrial and economic conditions, may actually be the factors that precipitate the social inefficiency of many members of this group.
Such speculations are premature. Our first task is either to discard the conception of the Social Problem Group or remove the question mark from the title of this volume. A direct attack by means of such ad hoc investigations as we have outlined should be made upon this subject. If these are undertaken in the near future much of the credit will be due to the editor and contributors of this stimulating volume. ” X “
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