Sonne Psychological Problems in Institutionalising Defectives
- Author:
ISABEL M. LAIRD, M.A., B.Ed.,
Psychologist at the The Royal Scottish National Institution, Larbcrt. The types of psychological problem noted in this article appear to have two common qualities?the likelihood of being ignored, and an urgent need of consideration. Their likelihood of being ignored probably arises from two main causes?long-standing blindness to their very existence, or a hurried and even half-conscious forgetting of them whenever they stir the minds of administrators in, and authorities upon, mental deficiency. The urgent need of consideration is patent to the psychologically trained observer at present, and will be much aggravated by the many imminent expansions in Britain of just those conditions which incubate it.
The present discussion is based upon five years’ observation of institutional life, of widely varying kinds, among mentally defective persons of all ages, of all grades and types, and of all social classes. The points chiefly selected are those liable to receive least notice, and certainly to arouse least attack, by casual visitors to our institutions, be those visitors even medical and educational experts.
For the purposes of the present discussion, it is suggested that common ground be reached first in agreement that mentally defective persons should not only be kept alive and cared for, but that they should live under those conditions best calculated to encourage and maintain all-round development.
It is generally believed that the community life of an institution offers the most satisfactory provision for low and middle-grade defectives?the idiots and imbeciles?whether of school age or older- And high-grade defectives ?the feeble-minded?are apparently being recommended in increasing numbers for institutional residence and treatment. In its widest interpretation, the term ‘ institutional life,’ in discussing defectives, must imply any form of group life, in colony, home-school or even in the very intensive boarding-out of patients say in every house in a village or district. But in Britain the movement is increasingly towards provision of very large homes and training centres, and this form of institution will be foremost in mind for the present.
Now, in surveying these huge concerns, with their thousand or so patients and pupils, their pay-roll of two to three hundred names, their vast expenditure of money and energy in myriad activities, the routine of the individual defective is easily forgotten or even overlooked altogether. And in experience, the valuable opportunities offered, and the wise allowances made in institutional life, are merely being given on the one hand, while everyday essential chances of development and outlets for interest, are being made impossible on the other.
In the first tackling of this problem?the search for answer to some such question as ‘ what are the real psychological difficulties in institutionalising defectives ? ‘?the psychologist in full-time work among defectives is confused.
Perhaps indeed she is not unlike the centipede, who, we are told, ‘… . was happy quite, Until the toad, for fun, Said, ” Pray, which leg comes after which ? ” This worked her mind to such a pitch She lay distracted in a ditcli Considering how to run.’
Only, there, the means of advance suggested for analysis were doubtless adequate in the first place. In modern schemes for the care and training of defectives things are otherwise, and analysis ought to bring in its train more of help than hindrance.
In what follows, some psychological difficulties in institutionalising defectives will be grouped under three headings, according as they centre chiefly round the pupils and patients, or round the members of staff, or round the parents and the public at large. It is clear that those categories must overlap, but at least a semblance of order is made possible by their use. Naturally the first group is most vital, and indeed the others are examined here in their effect upon the defectives themselves.
By ‘ institutionalising’’ is here implied the bringing about in the individual defective, such acceptance of continuous herding or being herded, as shall least hinder his development towards happiness and usefulness. And in this implication it must be recalled that a number of these defectives (generally an unpredictable number, and usually from the middle and high-grade groups only) will at some time return to a place in the everyday social system. It is one contention behind the present arguments that a far greater number can probably be trained, on the one hand for this return, and on the other for a vastly fuller and more normally-planned lifetime within institutional limits. Concerning the Dcfectivcs
It will be allowed that the defective is not only defective in intelligence; that his variation from the normal is far more nearly a personality variation; and that the usual course of emotional or social development rightly to be expected among defectives of the several types is by no means yet established. But the defective has of course a great similitude with normal and bright persons, in the patterns of his impulses and reactions, in the ultimate source of his knowledge through his sensory experiences, in his ways of acquiring skills or learning, in his entrance upon social and emotional relationships with other human beings, and so on. Therefore there is an ever-recurring problem to be faced at every stage, from the question of age or standard at which institutional life should begin, to the question of age or standard at which return to ordinary community life outside should be attempted, if ever.
This problem is of the nature of dilemma?in the uncertainty when to be guided by the more intellectual standard of the patient, as in some combination of the mental age and intelligence quotient, perhaps; and when by the picture of his emotional or social age, which may, of course, be a year or two advanced or retarded in comparison. And this discrepancy is, on observation, a far more enduring discrepancy than might be thought.
It arises right at the start. Let it be decided that a particular boy is to be sent to an institution. At what age is separation from the family to be (for him) recommended. Tt is hard to say; but, apart from economic considerations, and all-important variable factors such as the presence or absence of siblings, and their ages, ought we not to be able to decide when family advantages, and when institutional advantages, shall carry more weight ? On the one hand, an early age is to be preferred, giving the sooner an environment in which the child will find himself an average member; and checking the sooner the likelihood of his unhappiness or unnecessary backwardness through either too little or too great allowance being made for his condition. On the other hand, a later age is wiser, in order that stabler emotional ties may be made with his family; for, under present British institutional schemes, the defective child has little or no hope of forming useful parent-figure relationships, has indeed little hope of a lasting, emotionally satisfying, relationship with any adult. We shall return to this point in a later section of the article.
Then, improvement is urgently called for in the everyday conditions under which the mass of defective children grow and live. (We take for granted, of course, all-round satisfactoriness of actual feeding and sleeping arrangements, of medical and general educational attention, in the narrower sense, and therefore the following remarks refer mainly to middle and high-grade children). In how many large institutions do trainable and educable defectives actually see meals being prepared, laid or cleared away? See laundering done ? Handle money or money-tokens ? Know or see anything of the breaking and cartage of coal or wood, or the carrying of stores or of a message? How many, in short, have chances of making the hundred and one daily observations and movements that would be demanded of them in their own homes of whatever status ?
And lest there be retort that all institutions do allow suitable patients and pupils to share in such workaday activities, it may be said in reply that this is true : but that in effect what happens is far from satisfactory for the patients, however useful, for the running of the institution or estate. Thus, patients may at fourteen or sixteen begin to work in the kitchen, laundry, garden, boiler-house, upholsterer’s shop, etc., but from the age of entrance, which may be even five or seven years, until this chance comes, they may have no experience in even observing such occupations. And as a rule, once started in a trade department, they have chance of acquiring knowledge and practice in one department only, perhaps for many years on end.
And here mention may be made of the largely erroneous idea that a necessary concomitant of mental deficiency is preference for monotony. It is true of many defectives, scattered throughout the grades, that they are content to sit at one job year in, year out; but before a simple generalisation can be made about the reasons annexed to this contentment, at least two possibilities must be dispelled: In what degree is it an apathy induced by narrowly limited environment with sheer lack of alternative activities over a long period? and in what degree is it symptomatic of temperamental or mental disturbance either chronic or temporary ?
But to return. It is not only want of opportunity for observing and sharing the everyday events of the home that is deplored. There is a very serious want of things in institutional environment: things to see and touch, smell and handle, things to name and talk about, things to experiment with, to break and to make. So, actual sensory experience is far more limited than need be, vocabulary far more slowly acquired, little skills and muscular coordinations far more delayed in achievement than need be. Therefore institutional school time becomes pre-occupied and school progress hindered by the added task of carrying individual children through stages of learning and experience properly belonging to the pre-school rooms and the extra-school time-tables.
Other consequences follow upon the general lack of objects in institutional life, coupled with the lack of opportunity for hoarding in safe corners. Much of the petty stealing appears motivated by a shallow over-possessiveness, and is observed to stop temporarily with distribution of new gloves or shoes to a group, or even with the arrival of balls or skipping-ropes or dolls in numbers sufficient for each child in the group to own one item (for however short a period the treasure may last). One is, of course, aware that underlying this object-hunger there may well be groping after more fundamental security than the gift of a toy can appease. The point is that a certain degree of relief can be maintained by the giving out of things to possess, to touch, handle, and so on.
Then there is the question of continual supervision. Can any psychological justification be found for the present position in crowded institutional life, under which it is little short of criminal to allow a child out of sight for more than a minute or so, and then only for a visit to the nearest cloakroom ? Workers among defectives must be conscious that these children need more supervision than normally intelligent children, but why enforce a system of constant watching; of playrooms and playfields with the least possible number of projections and erections? Of circumstances making the endless games of hiding impossible, making the task of playing ‘ corner ‘ games incredibly hard.
Concerning the Staff
Concerning the staff, one merely mentions the ironic position of the highly expert medical superintendent whose years brim over with details of correspondence, estate management and ‘ returns.’ Concern is far more with the unit member, the nurse and attendant who have, in fact, the question of the degree of ‘ success ‘ of the defectives, in their hands. At present it is not only almost impossible to keep a minimum staff in attendance, but also apparently impossible to attract even a minimum supply of half-promising applicants for posts. Frequency of change in the nursing staff is therefore appalling.
Even if the nursing personnel remains stable for one month, the real psychological difficulty is not met, however. Much depends on the system of shifts in operation, but mention may be made of two extremes. In Institution A, let us say, the eight-hour day is tried. Defective John will then be transferred at one jump from the family group, with its intensely real unity and continuity for him, to the big block where all who deal with him change over completely three times in twenty-four hours. In Institution B, there is a five-day week instead, and John finds, say, four nurses in his block on the day he is admitted. Since each nurse has two days off per week, and there must be four nurses always on duty by day, when will John next find his original friends all on duty together again? And if he wakes in the night, some completely other nurse comes to his aid, except on the night a week when she is relieved by yet another nurse. Psychological development cannot happen normally or fully under such systems: there is poor chance of real personal relationships in wholly uncertain settings like these.
A further problem concerning staff may best be introduced by three questions of vital importance in any training centre not entirely set apart for idiots. What proportion of the resident staff (matrons, nurses, attendants) hold a certificate in mental deficiency nursing, in any branch other than Bedside Nursing? What proportion of staff in training is being encouraged to take any training other than Bedside Nursing? Is there anyone on the staff capable of giving any other training? If replies come ‘None, none, no!’ it is difficult to conceive how the adequate care and training can be provided for imbeciles or the feeble-minded during the eight or nine hours a day when they are not in school classes or bed. Again, why should it not be possible for ‘ endorsement’ of a final certificate in any one branch of training, to occur a little later, in some other branch ?
But poverty and sparseness of staff ‘ material’ must, one ventures to assert, affect the ideal running of the institution less where general conditions of equipment, space, freedom and so on are more satisfactory?a further plea that root conditions such as are detailed earlier in the article are primary also in importance.
Concerning Parents and, the Public
Concerning parents and the public, the psychologist notes here only one or two points too readily ignored. The weeks immediately following upon admission to an institution are often highly critical ones for the patient or pupil, especially if still a child. It is not so readily seen that they are also often highly critical weeks for the parents, especially, perhaps, for the mother. The relative finally responsible for ‘ putting away ‘ the child undoubtedly does suffer, in most cases, quite intense relief?in all the ramifications implied by the term ‘ suffering relief.’ Usually, in the best interests of the child, the first visit is delayed for a month at least. Since we are in an age that recognises and respects the value of skilled social work, can it not become a part of the routine of arranging an admission (on the part of the Child Guidance Clinic, Education Committee, etc., urging the removal of the child), to see that at least one visit is paid to the home after the removal of the child? Such is the plea of the resident worker among defectives, because the family reaction, particularly the mother’s, and especially on the first visit, can assist or hinder enormously the whole progress of the child’s enjoyment and training in the new surroundings.
And finally?though the limitation is one of space only!?there is the ever-present and subtle difficulty of public ignorance. How best, and soonest, can we teach our fellows that only falseness and cruelty are spoken when one says to another, of a defective child, ‘ He’ll be all right when he’s older.’ How best, and soonest, can we induce our fellows to see that the ‘ stigma ‘ they so easily read into a state of mental deficiency, is entirely a projection of their own attitude, that it exists not in the defective, nor in mental defect, but only in the mind of a civilised community still half-unwilling to meet fully the problems of mental deficiency in its midst.
The psychological difficulties in institutionalising defectives are found not only in the institution, we see, and therefore the solving of them lies not only with those working in institutions. Solution is to some extent a duty of Everyman.*
It is not suggested that all the problems noted here will be found in any one Institution;
but such a discovery would not surprise the writer. Readers zvith first-hand knowledge of solu’.ions in practice are invited to send some account of these to the Editor.
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