How a Psychological Clinic can help a Special Class
The Psychological Clinic Copyright, 1913, by Lightner Witmer, Editor. Vol. VII, No. 5 October 15, 1913 :Author: Arthur Holmes, Ph.D.,
Dean of the General Faculty, Pennsylvania State College. A psychologist and a set of Binet-Simon tests do not constitute a psychological clinic; much less a medical inspector and a stethoscope; still less a school principal and a special class teacher. The essentials are rooms, instruments, social workers, clinical assistants, psychologists, plus the immense item of specialized experience, all set down in the midst of and closely connected with a host of other clinics and child-helping agencies. A psychological clinic is an inter-clinic. Socially it acts as a clearing house for special children. The nature of its function and the method of its operations make it a most necessary adjunct to the urban public school. Its business is to sort children and to sort them scientifically; or putting it more technically, to diagnose or to classify children according to their mental and moral capacities; and what is vitally to the point, to do that classifying scientifically, i.e. by accurate measurements and by a consideration of underlying causes.
To illustrate more specifically I present a brief description of a few cases showing how one clinic helped a special class. The clinic was the Psychological Clinic conducted by Dr Lightner Witmer at the University of Pennsylvania. The special class was taught by Miss Bertha F. Thompson under the able supervision of Dr James E. Bryan in Camden, New Jersey.
The report suffers from several disabilities. First, the clinic and class were in two separate organizations. This alone militates against the highest efficiency. Secondly, they were in different localities,?in different states, in fact,?necessitating a ferryboat trip for each child. Thirdly and chiefly, since all the children examined were all placed in a special class prior to their visits to the clinic, the most important function of the clinic, that of making the first classification, was prevented or delayed.
Nevertheless the results are valuable in that they show what was done and suggest what might be done. They come from real children, in a real special class in a city school system. To this extent they represent conditions and not theories. In some cases what was not done is just as illuminating as what was done. Two thoughts the reader is asked to keep constantly in mind during this article. First, no criticism whatever is intended against the Camden schools. Circumstances redounding in every way to their credit decreed that their special class be chosen as the one to illustrate the need of school clinics. The very fact that the pupils were brought to a clinic shows their progressiveness. The superintendent, Dr Bryan, as is well known, is a pioneer student in the field of retardation. Miss Thompson, the special class teacher, was quick to see and ready to take advantage of the University clinic for helping her charges. The school board generously permitted her to take time from her teaching in order to bring the children to the clinic. In every way this school system and its administrators are thoroughly progressive, efficient, and active to their utmost. The second thought springs from the very facts just mentioned,? that there was open-eyed perception of an opportunity, that therewas ready co-operation, that there was trained and specialized knowledge of needs and yet that five out of nine special class pupils in one year were institutional cases, that several others could not receive the full benefit of the advice given at the University clinic, that time and money were thereby wasted and possible good rendered impossible,?all of this, I say, argues profoundly for the establishment of fully equipped school clinics. Therefore I ask the reader not to be misled into thinking he is reading a criticism of any school; nor is he studying an inductive treatise proving abstractly that a school clinic is a good institution. He is being presented with a few facts, thoroughly typical, all true, and each and every one of them so charged with tragic significance that it alone is sufficient for the foundation of a school clinic, for here every fact is a human being. With these preliminary cautions, we will take up the nine cases brought to the clinic in one year, and try to show the essential points in each case that demonstrated the need of a school clinic. The first five children are and were always institutional cases. They present, therefore, uniquely the raison d’etre of a school clinic. They should never have entered a public school, much less should they have consumed the time and attention they did there.
Heston, Case 325, is an example of how a clinic can effect all the items above enumerated. At the same time his case suggests what could have been done had he been taken to a clinic at six years of age instead of eleven. Luckily only one year was wasted with him in the regular classes. He was then transferred to a special class and two months after, because his teacher knew of the Psychological Clinic, he was brought there and his case diagnosed as middle grade imbecility. At the same time she received information as to the proper institution in which to place the child and the best method of placing him. Had there been a social worker in a school clinic this could have been done quickly and efficiently. As it was the teacher and school administrators gave time from their legitimate work to interest influential people in the matter and the boy was listed for a splendid school for the feebleminded in his home state. Jabez, Case 355, is typical of what is being done in many special classes. This boy, eight years old when he entered school, was placed in a special class one month afterward and remained there about a year before he was brought to the clinic. His teacher described him on his entrance to school as a very stout boy with club foot, carious teeth, open mouth, a stolid, dull expression. He was unable to read or write, impudent, sneaky, vile-spoken, swearing, suffering frequent attacks of epileptic fits. Adenoids were diagnosed by the school physician and some improvement followed upon their removal. At the clinic he was pronounced an institutional case, unfit to be in school with normal children, and incapable of ever using for good the little reading or writing he could acquire. He could, however, learn a trade and work under supervision at it. He was recommended to an institution for epileptics. On the strength of such recommendation his mother consented and at last accounts (November 15, 1911) papers were made out for his admission. The clinic thus saved the principal, teachers, parents, other pupils and society unknown trouble by a speedy and authoritative decision regarding the mental, physical, social and pedagogical problem involved. If the clinic had been connected with the school it could have followed up the case through its social worker until the boy was safely deposited with the state asylum officers.
Beza, Case 339, was a girl who began her schooling at seven. She was an epileptic. Her parents knew it, the neighbors knew, teachers knew, her fellow pupils had sad and frequent ocular demonstrations of it. But what could anyone or all of them do? None of them knew anything practically about epilepsy. They couldn’t tell how eating much meat or candy or how school study affected the malady. All they knew was that a child must be “educated”, and so they dropped this forlorn bit of neurotic humanity into the hopper and turned the crank for two years. At the end of that time the fits were very frequent, the muscular control poor, the child could not handle a pencil or do number work, but could manage to read some words in the second reader. She told lies, swore, pilfered and mutilated the work of other children. How much society owed her in damages through neglect and injury is not known. At any rate the school did the best it could.
When Beza grew too troublesome for a regular class she was turned over to the special teacher. There in about two more years she was taught to sew, weave mats, make baskets, to read in the fourth reader and write a little. Her physical condition improved, but her epileptic seizures continued.
Then she was brought to the clinic and her real improvement began. Her teeth were cleaned and filled and the epilepsy given the proper medical attention. Under such care she rapidly improved in general health and changed wonderfully in disposition and character. The teacher was told that the ordinary school was useless for her and the only proper place for the girl was an institution for epileptics. Accordingly she was entered in a state colony where at last report she continued her improvement in general health and appearance, and in weaving, sewing, embroidery, and housework. She is merely another example of years spent in school without adequate return to herself or to society and with the inevitable dependency at the end. One important thing the clinic did. It saved society from the burden of supporting this girl’s epileptic, feebleminded, or insane offspring.
Mathilda, Case 165, a girl of fifteen, had encumbered several public schools from her sixth year. She came to this special class a stout girl with defective speech and eyesight; a very nervous child, with a shuffling gait, dull, stupid, seldom smiling or laughing, unsocial but morally “good” according to school standards. At fourteen she could not read or do number work and was not good at manual exercises.
The clinic diagnosis pronounced her a cretinoid case, rapidly becoming a permanent invalid with a kidney affliction, poor eyesight, carious teeth, in need of orthopedic attention and thyroid treatment and permanent care in an institution.
She was kept on thyroid for five months. Special braces were made for her and glasses were recommended. Her general improvement was pronounced. She became more erect, walked rapidly, learned to run and jump, lost much of her nervousness, learned to read and write rapidly, improved in number work, seldom stuttered and became sociable. Then because there was no means in the school of following up the work and securing cooperation at home, the thyroid was neglected, the improvement came to a standstill, and later ill health supervened.
This case presents a clear example of the necessity for having a completely equipped clinic in the public school system. It will be noticed that this girl had been in public schools from six to fourteen. How many hours, days and months of teachers’ good time she consumed is not recorded; how many others suffered on account of her is unknown. We do know that at fourteen she was unlettered and unlearned, and her schooling practically came to naught. All those years she needed a thorough clinic examination; all those years should have been spent and if a school clinic had existed, would have been spent in health-giving treatment and orthogenic training. At last when her real trouble was discovered by a clinic, she was too old to profit completely by it. There was no school machinery to follow up, nor to place her in a proper institution. Rochelle, Case 356, was a boy twelve years old when he finished his six years’ school career in regular classes and entered the special class able to read dime novels and to write, but wholly deficient in arithmetic. He was pale, thin, choreic, with adenoids and enlarged tonsils, and carious teeth; impudent, sly, violent of temper and poor in memory; poorly born and spoiled in the breeding.
At the clinic, after a year’s special class work, besides his other defects, a weak heart was discovered. The general appearance of the boy was not at all prepossessing. His face wore a dogged, stolid, unintelligent expression; his forehead was plowed with longitudinal furrows; his body was emaciated, with marked scoliosis in the thoracic region and with stooping shoulders. His head was dolichocephalic with a low and rather narrow forehead. His eyes were deep set, but his vision was good; his nose was fairly well developed, thick at the bridge with small nostrils; his upper lip was short. His skin was not smooth and was marred in places with acne, especially on the forehead. His ears were not well developed, especially the lobes and helices. His teeth were in a very bad condition with marked malocclusion of the jaws. The heart beat was accentuated on the second sound and a decided mitral regurgitation could be heard. Nervousness, sullenness and irritability seemed to be his chief temperamental characteristics. He was very annoying in the school room, talked incessantly in a clumsy and poorly articulated manner on account of his teeth, and complained continually that people “picked” at him.
All indications pointed to feeblemindedness and his teacher was informed of this diagnosis. On account of parental objection and other obstacles it was impossible to place him in a proper institution. He was treated for chorea, his teeth were filled and his physical condition improved. In spite of this, he remained unreliable, sly, impudent, and advanced only to third-grade mental work where he ceased to make further progress. His manual work was good and he liked his physical exercises. He is clearly an institutional case, but because of lax laws still remains in his wretched home, whence he will eventually go forth a vagabond or a criminal to increase his kind in the earth and to revenge himself without malice upon the society that is so ignorantly neglecting him.
Four more cases are now presented. They illustrate different ways in which the clinic can aid the special class teacher. It must always be remembered throughout these descriptions that the University clinic was laboring under a handicap. The most effectual act of a school clinic, namely the preliminary classification of a child and the prescription of his pedagogical training, was already attempted in these cases before they reached the University clinic. That is, they had been classified by the usual school methods in vogue for all children and trained by the usual methods first in regular grades and later in the special class. If a clinic classification had been made at the very beginning of these pupils’ careers?say, when they first fell behind?altogether different results would certainly have followed. Some of our illustrative cases suffer therefore by the necessity of substituting “it might have been” for descriptions of positive results. This is especially true where some of the children had grown too old before they came to the clinic. Gowan, Case 168, is not so much an example of what a clinic can do as what a state should do for children isolated from a section of the world by a lack of a special sense. Such children are in a sense institutional cases, but not permanently so. They can be trained to do well in the world, but to do that special institutions are necessary. This boy Gowan was wholly deaf. At nine he entered public school. There he met no one who could tell his parents that a deaf boy could be taught to speak and read lips, and furthermore that unless he received such training he would be wofully handicapped in life, while with it not only a useful but a highly successful career was possible. After four years of class work he was transferred to the special class. His face wore a dull and stupid expression; his teeth were very irregular, and his whole demeanor childish for a boy of thirteen years. He was wholly unable to talk vocally. About a year and a half later he was brought to the clinic and referred to the proper hospital departments, where his ears and eyes were examined and orthodontic work undertaken. This last was completed and the boy learned to talk fairly distinctly and to read the lips of others who spoke to him daily. In other respects his progress was great. He began to play outdoor games, did fine manual work, learned reading, writing, and arithmetic very rapidly and when last heard from was developing into a healthy, happy boy. Still, because no institution for the deaf was found for this boy and largely because people in general and even educators in general are not familiar with the enormous advantages accruing to deaf children through lip reading, this otherwise bright boy must suffer through all his life. There are men carrying on large business affairs in America today who were born deaf, or have become totally deaf, but who learned to talk and to read lips and can therefore communicate directly with anyone without awakening a suspicion of their defect. All this clinic experts know. They know too its importance and how to impress parents with it, and lastly how best to secure such education for any child. In this case of the deaf boy Gowan, there was a peculiar opportunity, one partially taken and nobly carried out by the school administrators as far as circumstances permitted. Failure was due to dearth of school organization, the lack of a clinic fully equipped, and not to absence of earnestness or zeal on the part of school teachers.
Wistar, Case 326, illustrates both what a clinic can do and also what a social worker, tactful and experienced, might do in the home. This boy ten years of age, suffered from physical defects and a weak mother. The school clinic might help both; one directly and the other through a social worker.
Wistar began his quest for education at five years of age. For four years he plodded along in a regular grade without much intellectual improvement. Then he entered the special class, a thin, pale, choreic boy partially deaf, suffering from adenoids and rheumatism, irritable, impudent, rebellious to the point of throwing books at the teacher, with no interest in study, unable to acquire more than the rudiments of the three R’s.
In the special class he improved somewhat. He was circumcised, treated for rheumatism, his adenoids were removed, and his ears treated for deafness. The results were good. He began to learn, especially to write, but retained his violent temper, delighted to injure other people, to tear up pupils’ work and to lie. A year afterward he came to the clinic. He was still thin and badly nourished. His eyes were treated and glasses fitted, and treatment recommended for his general physical improvement. He was considered a borderland case, one wavering between upgrade and downgrade, his future destination depending upon environment, treatment, and training. He had in him the making of a good citizen or a criminal. Unfortunately his home was calculated to turn him toward the latter course, and the school could not care for him more than five hours a day, five days a week. At last accounts he was learning very rapidly to read, write, and do number work, and was visibly endeavoring to control his temper. He was still physically weak; there was not much cooperation at home with the school authorities and his future was not bright. A social worker from a school clinic with its staff of specialists might have impressed the mother and saved the boy.
Cowes, Case 357, is an example of wasted years through nobody’s fault in particular but to society’s blame. He started early to school for a free education. From six years to twelve he labored?or rather was labored with,?according to approved methods. He learned to do simple arithmetic, write a little, but could not read. His physical constitution was weak. He was small, pale, thin, choreic, full of nervous action, but weak in musculature; pampered at home with much candy and petty license. As a result he was impudent, sly, morose, inclined to small brutalities, and easily influenced by other boys. Such was Cowes upon entrance to a special class. After two years training there he was able to do fourth grade arithmetic, to read out of a primer, and to do excellent manual work. Then he came to the clinic. His physical defects were diagnosed and treatment recommended. He had carious teeth, indigestion, a weak heart, and hydrocele. The last his father refused to have treated, averring that he would outgrow it. Still his other treatments had their effect. He grew more cheerful, lost his former brutality, became less sly, more self-reliant and respectful, did excellent work in arithmetic, learned to read fairly well in the second reader, loved manual training and physical exercises.
The sad part is that all these improvements came so late. He was then fourteen and ready to leave school, fourteen years being the legal age for him to begin life as a wage earner. Yet anyone who saw the change wrought in this boy by a clinic examination and two years of special training could not help speculating upon the chance he had lost forever to become a sturdy and intelligent citizen instead of one always bordering on pauperism by reason of unpreparedness for work. Sallie, Case 3Ifi, is another case of long schooling and slow progress, who happily found help in the clinic. She first came at the age of thirteen after nearly two years of experience in a special class preceded by four years in the grades where she learned to read the third grade reader and do first grade number work.
When she came to the clinic first she was very small for her age, a pale anemic child with bad teeth, poor eyesight, enlarged adenoids and tonsils, was dull and sleepy, had spells of stubbornness heartbreaking to a teacher, but possessed an excellent moral character otherwise.
By clinic advice and assistance glasses were fitted to her eyes, her teeth were treated, and the nervous and intestinal troubles received the proper medication. The results were gratifying to all. The girl took an interest in her work especially sewing, physical exercise, singing and games and her disposition was much improved. Her powers of doing mental work had so increased that she was returned to the regular third grade, which of course was very low for one of her age.
What was accomplished in this girl’s case was but a small indication of what might have been done by a school clinic when she was six or seven years old. Her disabilities were chiefly physical and removable. Had the school possessed means of treating them, the waste of time, money, and human life could have been avoided. Because it did not possess this means, Sallie, typical of many more, must be handicapped for life.
Finally to sum up these illustrative cases,?five of them were children who should have been sent early to institutions for lifelong care and training. No attempt should have been made to perform the impossible task of educating them in a public school, or to make them self-supporting, or to put upon them the mental stamp of public approval, or to release them to prey upon society through an inevitable degenerate posterity. The years of trying effort made for them were wasted years and the results were worse than nil.
Another case was temporarily an institutional case. That is, the deaf boy should have been trained in a school for the deaf. Another child, Wistar, was very materially helped by his special class and helped especially in those matters affected by a clinic. He was left wavering in the balance because the school had no machinery to protect him from a weak mother. The last two cases were helped materially both by the special class and by the clinic. These nine children spent an aggregate of forty-seven years in school at a cost of over $1056.00, passed through about a total of thirty-six grades in reading, writing and arithmetic, an average of one and onethird years’ school progress for each pupil, none beyond the fourth grade, and yet not one pupil was really ready for self-support in the world. Compare this with the record of one normal pupil at fourteen years of age, with eight years in school, costing $176.00, with a total of twenty-four grades in the three subjects and many more in other subjects, and ready to enter high school or to begin his work in the world.
Possibly in all this matter, we have overlooked two great classes helped by an authoritative diagnosis. These were the teachers and the school administrators. After the clinic diagnosis they were satisfied about each child. They could proceed with assurance. Henceforth they worked with the authority of specialists behind their efforts. With this they met parents’ objections, influenced public institutions and secured the interest of friends. By means of it they coordinated and focussed their efforts upon essentials and made every iota of their work count for good. If a clinic could be organized within every urban school system already almost supplied with the essential parts of such an organization, it would bring the most profitable administrative and pedagogical results and that with no additional expenditure of energy or money.
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