The Feebleminded in the State Of Missouri
- Author:
Wallace Wallin, Ph.D.,
Psycho-educational Clinic, St. Louis, Mo.
We shall first consider the present situation in the state with respect to the state care, control, education and identification of the feebleminded; and secondly, some of the needed remedial measures which we have recommended in connection with our work on the Children’s Code Commission.
In 1911 it was estimated that there were 11,427 feebleminded persons in the state of Missouri. The basis for this estimate was not revealed. On the basis of figures published in connection with a small Psychological research in 1914 the number of feebleminded children between the ages of 6 and 21 was estimated to be 38,260. This estimate exceeds by 2598 the estimate made by the British Royal Commission on the Feebleminded of the number of feebleminded children in all of England and Wales. After having spent about seven years in the almost daily clinical examination of mentally deviating children, we are of the opinion that the larger estimate of the number of feebleminded in Missouri is very considerably exaggerated while the smaller estimate is also probably too large. In the interval between September, 1914, and November 24,1916, we examined 1181 children from the St. Louis public schools (exclusive of 31 re-examined cases, and 45 other cases which do not properly belong to the series), the majority of whom were sent to the clinic as candidates for special schools for the feebleminded. Of these children, however, only 28.1 Per cent could be definitely classified as feebleminded, while 46 per cent were classified as feebleminded, potentially feebleminded and borderline. Some of the later will eventually prove to be feebleminded but the larger number will probably prove to be merely backward. In order to determine whether the children who were most seriously retarded were being sent to the clinic and in older to get at the children from the schools which had not referred any cases, we made a census of pedagogically retarded children last February and March. This census included all children of 9 years age or less who were pedagogically retarded two years or over, and all children over 9 years of age who were pedagogically retarded three years or over. From the reports sent to the clinic by the principals we examined 67 pupils who had the most serious record of pedagogical retardation. The percentage of feeblemindedness found 1 Delivered before the Missouri Conference for Social Welfare, Columbia, November, 1916. among these children was 31.3, which is only 3.2 per cent higher than the percentage found for the entire group. The percentage diagnosed as feebleminded and borderline was 56, which is 10 per cent higher than the corresponding figure for the entire group. In the belief that a large number of feebleminded children still remained in the schools, the principals of the schools were definitely and emphatically instructed in September, 1916, to submit the names of all the pupils in their schools whom they considered to be feebleminded. Under this strong-arm method of rounding up the feebleminded, we have thus far this fall examined 318 new cases. Owing to the hurried and hampered conditions under which these examinations have been made our data on these cases are not so satisfactory as those for the two preceding school years. However, we have been able to classify only 22.6 per cent of these children as definitely feebleminded, while 33.3 per cent were diagnosed as potentially feebleminded and borderline, giving a total of 55.9 per cent of feebleminded and borderline cases. In other words, the percentage of feebleminded found by the strong-arm method of routing them out was 5.5 per cent less than the per cent found in the entire group of 1181, while it was 6.9 per cent smaller than the number found in the school year 1914-1915, 8.2 per cent smaller than the number found in 1915-1916, and 8.7 per cent smaller than the per cent found among the cases examined from the census of retardates. On the other hand the percentage of feebleminded and borderline cases was 9.9 per cent larger than the per cent so classified among all the cases, 15 per cent and 12.2 per cent larger, respectively, than the per cent so classified among the 1914-1915 and 1915-1916 cases, and .1 per cent less than the per cent so classified among the cases examined from the census of retardates. During a period of two years and three months in which we have been mentally examining children in the St. Louis public schools, we have identified 333 as feebleminded and 544 as feebleminded, potentially feebleminded and borderline in an elementary school population of over 80,000. This is exactly 333 too many feebleminded?so much human excess baggage?while there is plenty of humble and crude work in the world for the borderline to do. The point is, however, that on the basis of our studies in the St. Louis schools1 we feel warranted in saying that we do not believe that the percentage of feeblemindedness will exceed one-half of one per cent of the public elementary school population. This estimate is very much more moderate than the claim that from 2 per cent to 3 per cent of school children are feebleminded.
1 The details of these studies may be found in the Reports of the Board of Education of the city of St. Louis or 1914-1915, pp. 129-160 and 1915-1916, pp. 142-211; and in the Problems of Subnormality.
This huge difference in estimates is undoubtedly largely due to a difference in standards of judgment. The liberal estimates made during the last six years have almost invariably been based on certain arbitrarily assumed standards of mental retardation. But the ultimate test of all these standards is socio-industrial competency. We do not think that the concept of feeblemindedness should be applied to anyone unless he is so deficient mentally from birth or from early life that he is unable to make a living or to get along without external support. This concept is in harmony with the definition of Tredgold, the most eminent authority on feeblemindedness, and with the definition of the English Mental Deficiency Act adopted by Parliament in 1913, according to which the highest grades of the feebleminded, often called morons in America, are ‘persons in whose case there exists from birth or from an early age mental defectiveness not amounting to imbecility, yet so pronounced that they require care, supervision, and control for their own protection or for the protection of others.” In other words, only when the social or industrial incapacity is due to mental deficiency dating from birth or from early life and when it is so extreme that the person cannot get along without external support, should the person be classified as feebleminded. We must remember that there are other causes of social inefficiency besides feeblemindedness.
How many feebleminded, then, are there in the state? Nobody knows. Personally we are not prepared to say that the number exceeds 6000. This is based upon an old estimate of one feebleminded person to every 600 in the general population which we believe is more in harmony with the facts than some of the recent estimates. But this figure is almost staggering in view of the deplorably inadequate facilities afforded for the care and control of the feebleminded in the state. The number of inmates in the institution for the feebleminded at Marshall last September was only 588, and of these 162 were epileptics, most of the latter probably being mentally deficient. No more can be admitted because of lack of accommodations, although there are 800 names on the waiting list. The number of feebleminded now confined permanently or temporarily in improper kinds of institutions, such as private or public hospitals for the insane, workhouses, industrial schools, reformatories, prisons, jails, and infirmaries, is probably very much larger, say 1500. This would leave 4000 feebleminded at large in society. It is probable that not much over one-half of these are properly supported, safeguarded or controlled at home, leaving at large possibly 2000 dependent, or neglected, or unprotected, or delinquent feebleminded persons who, for their own good and for the protection of the state, should be permanently confined in institutions and colonies specifically organized for their proper training, care and control, and for the utilization of their labor possibilities.
There is no state in the Union of the same population and wealth as Missouri, with possibly one exception, which has provided such meagre institutional facilities for the care of the feebleminded. This is shown by the following data which were secured through correspondence during the month of October this year.1 Massachusetts housed at that time 2900 feebleminded and epileptics in two institutions for the feebleminded, one colony annex, and one epileptic colony. If Missouri provided the same accommodations as Massachusetts in proportion to population she would care for almost the same number. Massachusetts is doing almost 500 per cent better than this state. Iowa provided accommodations in one institution for 1185 feebleminded and 299 mentally deficient epileptics, or a total of 1484, and has under construction a separate colony for epileptics which will be ready next summer. If Missouri did as well as Iowa in proportion to population she would now provide institutions for over 2200 feebleminded and epileptic inmates. Iowa now does almost 400 per cent better than Missouri. Pennsylvania provided beds for 3984 inmates, of whom 3384 were feebleminded and 600 epileptics, in three institutions for the feebleminded, including one semi-public institution, and in one colony for the epileptic, while a separate village for feebleminded women is now being constructed. If Missouri did as well as Pennsylvania in proportion to population she would care for about 1700 feebleminded and epileptic. Pennsylvania does almost 300 per cent better than Missouri. The true figure, however, is somewhat less than this, as the semi-private institution contains inmates from outside of the state. New York had accommodations for 6000 feebleminded and epileptic in five institutions for the feebleminded and one institution for the epileptic. If Missouri did as well as New York in proportion to population she would now care for about 2100 feebleminded and epileptic instead of less than 600. New York does 350 per cent better than Missouri. We do not wish to be understood as implying that we have the same ratio of feebleminded and epileptics as the three eastern states mentioned above, but there can be no doubt that our institutional facilities are utterly inadequate.
The state of Missouri has likewise been equally remiss in establishing special classes in the public schools for the proper training of feebleminded children. In this state, it is entirely optional with the local boards of education to open special classes for the feebleminded. In New Jersey school districts are required by law to open such classes when there are ten or more mental defectives in a given school district (but they would not all be feebleminded, according to the standards which have been laid down). In Minnesota the establishment of special classes has been assured by the granting to local school districts of a state subvention, authorized in 1915, of $100 for every child in attendance throughout the year in a special class. Under this regulation many cities of this state have already opened special classes. Only two cities in our entire state have established special classes for the feebleminded, namely, St. Louis, where special classes were organized in 1908 and where the number of classes is ample, and Kansas City, where two classes were opened in the fall of 1915. In all the other public school systems of the state, if our information is correct, the feebleminded children are trained in the regular classes for the normal children, where they impede the progress of the normal pupils and rob them of the time and attention which by right are theirs?unless indeed the teachers, driven to despair, neglect the feebleminded, as is not infrequently the case?where they sometimes exercise a pernicious influence upon the morals of the normal pupils, and where they fail to obtain the type of training which fits their peculiar needs. In fact, most of the feebleminded merely vegetate in the regular grades year after year. The economic waste suffered by the taxpayers of the state due to the education of feebleminded and normal children in the same classes, amounts to many thousands of dollars every year. Moreover, there is a large number of children?far more numerous than the feebleminded,?who are so pedagogically or mentally backwaid, although not feebleminded, that they cannot keep up with the pace of the normal pupils. These pupils are a heavy drag on the regular classes where they rob the normal pupils of their birthright and where they vainly try to do work for which they are not adequately prepared or for which they have no aptitude. The work m the grammar grades, because of its abstract nature, is largely incomprehensible to these slow minds which function only in concrete terms. Many of these children, because they were denied appropriate training in school, later in life become an economic burden to the state and a moral menace to society. Children of this type of mind should be trained in ungraded classes (which should be distinct from the feebleminded classes.) Borderline cases will necessarily gravitate to the ungraded classes and indeed should be tried out in these classes before being considered for the special schools for the feebleminded.
In the ungraded classes abundant opportunities should be afforded for individual help and the instruction should be predominantly concrete, and, for the more backward types, industrial and motor. A beginning has been made to organize classes of this kind in the St. Louis schools, but merely a beginning. It is safe to say that where there is now one ungraded class in the public schools of the state there should be a hundred such classes, together with supplementary elementary industrial schools for vocational or prevocational training.
The third defect is the woefully inadequate provision afforded by the state for the proper educational and psychological examination and classification of feebleminded, backward and other types of mentally variant children. There is not a single college, university, institution, or police board or criminal court in the state which supports a properly manned psychological or educational clinic. The St. Louis schools support a clinic, but the staff is not large enough to make it possible to examine all the children who should be examined or to do the work with the requisite thoroughness. Mental tests, largely the Binet tests, are being given in the Kansas City schools, in the Juvenile Courts of St. Louis and Kansas City, in one of the dispensaries connected with Barnes Hospital, and probably in other places. But none of these agencies supports a psychological or educational clinic, technically so-called, with a specialist on feebleminded and backward children. The inadequate provision in the state for accurate psychological and educational diagnosis is a very serious handicap, because the differential diagnosis between feeblemindedness and backwardness is by no means always easy, and the consequences of a blundering diagnosis may be very grave to the individual or to society. On the one hand, backward children may be mistakenly diagnosed as feebleminded and then assigned to special classes for the feebleminded or committed to institutions for the feebleminded. We could give numerous instances where both of these things have happened. We need not dwell upon the manifest injustice of treating backward children as though they were feebleminded. On the other hand, feebleminded children are often diagnosed as backward, and thereupon given the educational and social treatment befitting backward or normal children, and the parents are assured that there is no cause for worry as the children will eventually “outgrow the trouble” when, as a matter of fact, there is no method known to modern science by which the defective can be brought to even approximate normality. It is well to emphasize that the diagnosis of mental defect and deficiency is often difficult and that a correct diagnosis is of vital practical consequence to the individual concerned.
FEEBLEMINDED IN MISSOURI. 61
The fourth defect is the inadequacy of the state statutes for the legal commitment and permanent detention of the unsupported, uncontrolled and delinquent feebleminded in the state. There is no law by which an improperly supervised or restrained feebleminded person can be committed for permanent detention to the state institution for the feebleminded against the wishes of parents or guardians. The consequence is that the commitments are usually of persons whom the parents or guardians wish to have committed although these persons may be less in need of commitment, so far as the state’s interests are concerned, than other feebleminded persons who are not under adequate restraint. Furthermore, there is now nothing to prevent parents or guardians from removing a committed person when the fancy strikes them. When persons are returned to homes in which they are not properly protected or restrained they are liable to become a serious menace to the community, either because of their industrial incompetency or because they become willing cat’s-paws or unsuspecting dupes of evil designers, or because they become aggressive offenders.
The defects pointed out above reflect accurately, we believe, the lack of popular interest in the state in the problems affecting our feebleminded dependents. In order to remedy these defects in some measure we have recommended, through the Children’s Code Commission,1 among others, the following measures: 1. The enactment of a law providing for the mandatory commitment and permanent detention in institutions of all dependent, unsupported, or unprotected feebleminded persons in the state. 2. The enactment of a law forbidding the commitment of any but feebleminded persons to a feebleminded institution and providing for the release of persons committed as feebleminded who later prove on careful study not to be feebleminded.
3. The enactment of a law providing that certification of feeblemindedness shall be made only by psychologists or by physicians who are specialists on feebleminded and backward children. 4. The establishment of a state bureau for mental defectives, to aid in the examination and classification of feebleminded and backward children. The most modest proposal is to organize a small bureau in the extension division of the state university. 5. The enlargement of the state’s institutional facilities so as to provide shelter and protection for 1500 or 1600 feebleminded persons, in a central colony at Marshall, combining the features of an asylum, school, farm colony and workshop, in an auxiliary institution near St. Louis, designed especially as a school for educable feebleminded
1 The complete report is available in the published report of the Code Commission.
children, and in small permanent or temporary camps. It is further recommended that the epileptics be colonized in a separate institution.
6. The abolition of the present political method in favor of a merit or efficiency method of appointing the superintendent of the institution or institutions for the feebleminded.
7. The permanent detention of feebleminded prostitutes in detached cottages, either in the Industrial Home for Girls or in the central colony for the feebleminded as well as the permanent detention of feebleminded delinquents and criminals of any age and of either sex in detached cottages.
8. The enactment of a law providing for the mandatory establishment of special classes for the feebleminded whenever ten feebleminded children are found in any given public school district. Ungraded classes should also be established for slow and backward children. Eventually the establishment of these classes should also be made compulsory by law.
9. The appropriation of $5000 by the state for the conduct of a census by qualified investigators, of the number of the feebleminded at large in the state, and in the elementary schools, penal and eleemosynary institutions and county infirmaries, and the making of further recommendations with respect to the care and control of the feebleminded in the state.
Let us say, in conclusion, that the question of the elimination or reduction of the feebleminded by sterilization, or birth control, or regulation of marriage is worthy of consideration, but it is not believed that effective legislation could be secured at this time, or if secured that it would be enforced.
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