Clinical Problems in the Vocational Guidance of the Mentally Deficient 1
The Psychological Clinic Copyright, 1931, by Lightner Witmer, Editor Vol. XX, No. 2 April, 1931 :Author: Morris S. Viteles, Ph.D. University of Pennsylvania It is to a playwright and a poet, the inimitable W. S. Gilbert, to whom we must go for the simplest resolution of the clinical problems involved in the vocational guidance of the mentally deficient. “I often think it comical,” he says, “That every boy and every gal, That’s born into the world alive, Is either a little liberal Or else a little conservative.”
?”Iolanthe,” W. S. Gilbert. In these few lines, Gilbert has pithily expressed a prevalent attitude not only toward liberalism and conservatism but toward normality and mental deficiency. Not only the layman, but many among those technically trained in psychology and in the allied sciences seem still to be obsessed with a belief in the specific unit character of mental deficiency. There is still more than a marked tendency to look upon the mentally deficient as a group set apart by birth from the normal and differing from them in every essential mental characteristic. The acceptance of this point of view carries “with it, in the vocational guidance of the mentally deficient, the assumptions that this group can be treated as a whole, that there is little need for making within this group the fine differentiations, the clear cut discriminations of mental make-up which are required m the vocational guidance of the normal.
1 Read at the annual meeting of the National Vocational Guidance Association?joint meeting with the staff of the Vineland Training School, “V inoland, New Jersey, February 22, 1930. Individual Differences Among the Mentally Deficient As a matter of fact, the outstanding clinical problem in the vocational guidance of the mentally deficient, as in the vocational guidance of the normal, is that of determining the respects in which each mentally deficient differs from others and to make these differences, as in the case of the normal, the basic factors in giving aid in selecting, preparing for, entering upon, and progressing in a career.
The situation with respect to individual differences within the mentally deficient group has been well stated by Wallin.2 “From these and other considerations we reach the conclusion that feeblemindedness, instead of being a simple classificatory (nosological) entity due to a constant specific cause with definitely restricted and invariable symptoms (such as is diphtheria or typhoid fever), is a highly complex condition, complex in respect to the fact that it may affect in unequal degree various functions, physical, intellectual, instinctive, volitional, emotional, social, and moral; in that it may cover a wide range of defect from profound idiocy to high-grade feeblemindedness; in that it may be caused by a great variety of etiological factors, hereditary and acquired, and in that the underlying brain defect (pathology) may differ greatly.
“Let us remember that there are pronounced differences in physique, disposition, attitude, emotivity, energy, application, and in social and moral traits between feebleminded children even of the same grade of intelligence or degree of impairment, just as there are similarly pronounced differences between normal children of the same age, maturity, or intelligence level. No two idiots are exactly alike: some are apathetic, others excitable; some have more of one trait, others more of another. The ‘typical imbecile face’ of established tradition is largely mythical. Some imbecile faces are pleasant, others repulsive; some are beautiful, others ugly; some look intelligent, others vacuous; some are mobile, others immobile. Few characterizations apply to the whole class of the feebleminded, and fewer still to every feebleminded individual. Between feebleminded, as between normal individuals, diversity, unevenness, and variation are the rule and not uniformity, symmetry, and sameness. Hence descriptions of the feebleminded must be largely restricted to generalizations respecting the average 2 J. E. Wallace “Wallin, The Education of Handicapped Children, Iloughton Mifflin Co., 1924, 58-59. or most frequent representatives of the different grades or physical types. Owing to the demonstrated existence of ‘individual differences,’ in the mode of origin (pathogenesis), in the underlying brain defect (pathology), and in the manifestations (symptomatology), there is no simple, single, or infallible test of feeblemindedness such as demanded by the assumption that it is due to the absence of a unit trait.”
Case Studies from the Psychological Clinic op the University of Pennsylvania
The significance of these differences among the mentally deficient, particularly as they affect vocational guidance, may be illustrated by a brief reference to two or three cases examined in the Psychological Clinic within the course of a single month. The first is a girl (Rose), fourteen years of age, brought to the Clinic for educational and vocational guidance. In appearance she exemplifies the danger of a pre-analytic diagnosis on the basis of general appearance. She has a pretty face which lights up expressively as she speaks. She responds very acceptably to the demands of an everyday, casual conversation. Socially she has proven acceptable to girls of her age. She has a cheerful, helpful disposition,?evidenced in her readiness to do any of the tasks assigned to her in the household and in the school.
From her appearance and from a casual conversation with her, not even a practiced clinician would surmise that after more than six years of school training she has not achieved first grade proficiency in school subjects. As a matter of fact, an examination of school proficiency showed that she had exactly 1A proficiency in reading, writing and arithmetic. Approximately twenty hours of individual instruction, extended over a period of weeks, under the guidance of a trained teacher in the Psychological Clinic resulted in no noticeable improvement in her ability to read, although it did lead to the conclusion that she could probably advance to a greater Proficiency in the field of arithmetic.
A review of the data obtained in the course of the psychological examination reveals an Intelligence Quotient of 58. The forward niemory span is four. In the course of the first examination, it was impossible to obtain a reverse span, partly because of the difficulty in interesting her in attempting this task, partly because of the difficulty she apparently experienced in comprehending the direc36 THE PSYCHOLOGICAL CLINIC tions. After some instruction at a later date she managed to give a reverse span of two digits.
An analytic study over a period of weeks brought into focus the high degree of distractibility,?distractibility which, however, seemed to be associated with an unwillingness to concentrate attention upon a task in which the girl expects failure. In tasks of a non-intellectual nature which she deemed herself capable of doing Rose showed none of the symptoms of distractibility observed in connection with the intellectual task. The analytic study of imagery also led to the conclusion that the girl’s chief difficulty lay in an inability to recall visual images of the abstract type. As a matter of fact, this defect was so marked, so characteristic of lier performances, that it led to a suspicion, at least, of true word blindness. The defect in imagery does not, however, extend to concrete material. The girl seems entirely capable of formulating clear images of this type and of recording them. In addition, in so far as motor traits are concerned, as measured by a series of performance tests, the girl exhibited a degree of ability that would seem remarkable to one who is willing to accept an Intelligence Quotient of 58 as indicative of feeblemindedness, but which has been found to be not at all uncommon among those who are intellectually deficient. The presence of these “practical” abilities was evidenced not only in the Clinic, but in the samples of sewing and embroidery brought by the mother and in the account of the household duties which she has proved capable of doing.
The clinical picture in this case is definitely one of mental deficiency on the intellectual scale, that is, with respect to the ability to profit from instruction on the three R’s. On the scale of socioeconomic competency, this girl cannot be described as being mentally deficient, or even as being markedly handicapped by mental deficiency. One needs to think only of the service occupations such as manicuring, waiting on table, etc., to find one in which she will be perfectly capable of self-support with a minimum of outside supervision. In contrast with Rose is another girl (Miriam) sixteen years of age. In this case the dwarfed stature, the small head, the unhealthy hue of the skin combined to give an impression of mental deficiency which was readily confirmed in the Psychological Clinic. Not only is Miriam’s appearance in distinct contrast with that of the girl described above, but her facial expression extends as far in the direction of dullness as that of Rose extends in the direction ?f liveliness. The same differences are present with respect to Personality. It is difficult to engage her in conversation. She is not disagreeable in a positive sense, but there is a total absence of the attempt to be agreeable. Her reactions in the Clinic, and the school and family history show an absence of initiative. The general picture of personality is one of infantilism. The school history of this girl is more favorable than that of Rose. She entered school at the age of six, but was forced to leave on account of illness which lasted over two years. Returning to school at eight years of age, she failed to make normal progress, repeating the second, fourth, fifth and sixth grades. Had she returned to school in June 1929 it would have been necessary for her to repeat the sixth grade a third time. Her school work was always poor, her conduct good. Her present proficiency in reading, writing and arithmetic is at about the fourth grade level.
On the Stanford Revision of the Binet-Simon test, Miriam obtains an Intelligence Quotient of 64.5, somewhat above that of Rose. The forward memory span is seven, and the reverse span is four. On the performance tests used in the course of the examination the results are consistently well below the average of children of her age. Neither on the performance tests nor in her responses at home and in school does she reveal any of the specialized abilities which have been shown to exist in the case of the other girl. From the point of view of intellectual status the two girls resemble each ?ther, but in the case of the latter girl there is no compensation in tlip way of specialized abilities of the sort which will make it Possible for the first girl to adjust herself at a self-sustaining level, with a minimum of supervision, outside of an institution. Moreover, she has not. the advantages of good health, of vitality, which, in addition to the specialized abilities and the favorable qualities of Personality will favor social adjustment in the case of Rose. Both are intellectually deficient, but with a socio-economic criterion of feeblemindedness, a criterion of social competency, the first cannot he described as feebleminded, the second must be so designated. From the viewpoint of individual differences the variation between these two is in no sense different in character and in extent from that found in samples of so-called normal human beings.
Factors to be Considered in Guidance The purpose in presenting these cases is not only to illustrate the significance of individual differences among the mentally deficient, but also to lead on to the discussion of the second clinical problem in the vocational guidance of the mentally deficient to be discussed in this paper. This problem is that of weighting with the data on the individual mental make-up of the mentally deficient the other factors which are of importance in determining vocational success and failure. As in the case of the normal, the problem of vocational guidance for the mentally deficient is that of determining not only the nature and extent of mental difference, but of building up a complete picture of the total situation in which the individual finds himself, a picture which constitutes the sole sound basis of adequate guidance.
It is impossible to undertake a lengthy discussion of this particular problem. What has been said elsewhere, by the author,3 concerning the importance of health, social and economic circumstances, appearance of individual, etc., in the guidance of the normal is applicable in the discussion of the guidance of the mentally deficient. Another case from the records of the Psychological Clinic of the University of Pennsylvania may serve to bring into relief this particular problem.
The subject, in this case, is a boy thirteen years of age at the time of the original examination, fifteen years of age at the time of the second examination. A detailed statement of school history, social history, etc., will be omitted. It is sufficient to state that at the time of the last examination his school proficiency was at the fifth grade level.
At the time of the original examination his Intelligence Quotient was 71, at the time of the re-examination 72.6. A strict adherence to the Terman classification favors, of course, a diagnosis of feeblemindedness. The boy’s auditory forward memory span was five and the reverse span three, confirming the picture of intellectual deficiency shown in the Intelligence Quotient. In contrast to this the results on the performance tests were uniformly good,?sufficiently good, as a matter of fact, to suggest that the boy is sufficiently endowed with the elements of motor ability to be able to earn his living at one of a number of semiskilled trades, in spite of his low intellectual level. In addition 3 Viteles, Morris S., The Clinical Approach in Vocational Guidance, Voc. Guid. Mag., Vol. VII, No. 1, October, 1928, pp. 1-8.
lie has been uniformly conformed in his behavior. These qualities, combined with the judgment he has exhibited in his daily life in school and in the home, suggest that he will also be capable of supervising his own conduct. However, in spite of these advantages, it is extremely unlikely that this boy will ever be able to maintain himself as a self-supporting member of the community, not by virtue of the intellectual status itself, but because a damaged heart makes it impossible for him to develop the energy necessary for Maintaining production standards on the type of semi-skilled job on which he will have to be employed. In other words, in this case, the competency which he possesses to maintain himself in a semiskilled occupation cannot be put to use because of the health condition. If he could earn his living through the exercise of intellectual competency the health condition would be a minor consideration, but under the circumstances which do exist, it becomes a major item in the situation and will make self-support practically impossible.
The Limitations of Mental Age
There is just one more phase of the problem to which a brief reference must be made before bringing this paper to a close. It is an aspect of the problem which is touched upon, by implication, in the discussion of individual differences among the mentally deficient in an early section of this paper, but which, perhaps, deserves special mention outside of this setting. This is the much discussed question of the significance of mental age per se in vocational guidance in the case of the mentally deficient. There is a marked tendency to assume that mental age is the predominant factor, insofar as mental ability itself is concerned, in determining vocational success and failure. This belief has led, in a number of cases, to a formulation, ofttimes on merely a priori grounds, of levels of mtelligence necessa^ for certain occupations. It has been assumed that general intelligence level constitutes a final criterion in Predicting vocational competency. So, for example, Laird has submitted an outline of what he describes as “mental qualifications for many common tasks” in terms of mental ages ranging from those of editors, lawyers, business executives, etc., at the 18 year level to factory laborer and domestic servant at the 11 to 12.9 year level and unskilled laborers at the 8 year level. According to this author, in respect to vocational labor at least “with a mental age rating obtained” it is safe to advise the use of the table as a guide for employees selection.
The fallacy of such conclusions concerning mental age has been demonstrated in a number of experimental investigations. Even a limited experience in the application of clinical methods in vocational guidance will reveal the impracticability and invalidity of such a criterion of vocational success in the guidance of even a mentally deficient.
There are other numerous problems which deserve discussion in this connection. Much can be said about the importance of job analysis as a preliminary in the guidance of the mentally defective. The ears of school administrators could be made to burn with a recital of the school’s failures in providing suitable training for borderline deficients, for the mentally deficients with specialized skills so necessary in supplementing the guidance process. However, the limitation of space permits only a few more words in the nature of a summary of what is perhaps the essential problem raised in this discussion.
The Psychologist as “Prophet”
In their final analysis, the clinical problems in the vocational guidance of the mentally deficient, as in the guidance of the normal, resolve themselves into a single problem, that of making an analytic diagnosis and a prediction of future success or failure in a single case. Statistical studies of group data furnish general principles with which a clinician can work. The problem of clinical psychology is essentially that of balancing these principles, of determining how far they apply in a particular instance, and whether they do apply. His point of orientation must always be the individual and his future, an individual who is completely lost whenever massed data are the subject of treatment. In the case of this individual, he must exercise all the judgment he possesses to balance the facts and to arrive at what is not only a statement of present status, but of a prophecy of future status in this complex world of ours. It is not strange if, as a prophet, he falls into error and actually is forced to be as pessimistic about his accomplishments as Job himself.
During such pessimistic moments the clinical examiner may raise many questions concerning his own competency as a prophet, not only facing, but, perhaps, magnifying the difficulties involved. At other times, perhaps, he is too prone to fall back on the note with which Mr. Underbill of the United States House of Representatives ended a debate on a Bill providing for the psychologist in the Juvenile Court in the District of Columbia.
The author quotes from the Congressional Record 1921, Vol. 61, Part 8, Pages 7670-7687.
“Mr. King. I see that this bill provides for the appointment of a psychologist at a salary of $2,000 per annum. Would the gentleman, as a matter of information, answer one oi two questions in reference to that ? Who determines who the psychologist shall be, and what training does the psychologist have to have? “Mr. King. A psychologist is, in other words, a social worker. Such a worker can go into the home; will advise in any case, whether be that of disease or mental trouble or even financial trouble. ‘Mr. King. Psychology is the study of the soul, is it not? ‘Mr. Underbill. Let us not get into these technicalities.”
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