An Investigation of the Adjustment of the Feebleminded in the Community
- Author:
Clara Harrison Town, Ph.D.
Director, Dept. of Psychology, Children’s Aid Society, Buffalo, N. Y.
The problems of “what it is best to do for the feebleminded’’ and “how best to do it” have been commanding public attention since, in the early years of the nineteenth century, a difference of opinion between two eminent physicians brought them into prominence. The difference of opinion concerned the diagnosis of a wild boy found roaming in a forest in France. One physician, Pinel, diagnosed the boy as feebleminded; another, Itard, diagnosed him as normally endowed mentally, but wild as the result of deprivation of human contacts. On the ground of this belief Itard attempted to educate the boy. He succeeded in teaching him much, and in the process he discovered two facts: first, that the boy was really an idiot, and second (and this fact amazed all concerned), that even though an idiot, he could, to a certain degree, be educated. The training which was successful up to a certain point met a barrier?the barrier of idiocy?and Itard found it impossible to push mental development further. The boy was never trained to a level which made life with people outside an institution possible. Itard’s pedagogical success led to a more and more extensive effort to educate the feebleminded. The movement gradually spread throughout Europe and the United States, and by the time one hundred years had passed, at the dawn of the twentieth century, the accumulated knowledge concerning the feebleminded began to formulate itself into analytic definitions of feeblemindedness. These definitions, with which we are all familiar, agree in recognizing in feeblemindedness of all degrees a social inefficiency resulting from a mental insufficiency, and they all stress the permanency of the condition. The experience of a century of work led to the clearly formulated conclusion that the feebleminded are incapable of self-directed lives.
At this time began the attempt to ascertain the incidence of feebleminded persons in the population. This attempt is still in process. The first authentic facts were published by a British
Royal Commission in 1908, which placed the proportion of feebleminded in Great Britain at 3.28 to each one thousand of the population, or a little more than three-tenths of one per cent. The latest authentic figures also come from Great Britain in a study published in 1929, entitled, “Investigation to Ascertain the Number of Feebleminded. Report of Mental Deficiency Committee, Being a Joint Committee of the Board of Education and the Board of Control.” This is a thoroughly standardized study, including both adults and children, of six typical areas, each containing approximately one hundred thousand persons. The study was conducted with the utmost care, and has been very fully and clearly reported. It finds that the incidence of feeblemindedness for the areas studied is 8.56 for one thousand of the population, or between eight-tenths and nine-tenths of one per cent. In the United States estimates based on the examination of the enlisted men during the war placed the incidence of feeblemindedness at ten per cent or more. The much smaller proportion found in Great Britain confirms our former impression that the conditions under which the mental testing in the Army was necessarily made resulted in the failure to do justice to the illiterate and the non-English-speaking men, and thus tended to exaggerate the proportion of feebleminded individuals in this country. It is recognized that the advance in diagnostic methods has resulted in the detection of higher and higher types of feeblemindedness, and the hope has grown that perhaps the accepted definitions are faulty, and that the high grades of feeblemindedness may be not as incapable of being trained to social adequacy as the definitions imply.
The Replacement of Feebleminded into the Community As a result, schools in all parts of the country are segregating their feebleminded children in small groups and by individual methods striving to develop them to the limit of their capacity. Also, many institutions for the feebleminded are replacing their charges in the community after longer and shorter periods of institutional training. Dr Fernald was one of the first sponsors of this replacing plan, but his favorable opinion of community replacements was always formulated subject to two provisos?previous long and adequate training and subsequent continual supervision. In 1924 he stated that he “believed it had been demonstrated that many defectives who had no innately vicious character defects and had been given habits of obedience, protected from evil companions, and taught to Avork during the formative periods of their lives, usually behave well if they are given continuous, friendly supervision.” Dr Bernstein, of Rome, favors a more liberal policy of replacement, advocating a much more rapid stabilization process and much less close supervision. His parole system is virtually a system of trial replacement made after shorter or longer periods of residence. Dr Bernstein is of the opinion that this method has resulted in a fair amount of success.
As replacement in the community without close supervision after long or short stabilization periods in institutions is now the New York State policy, since it is a radical departure from all former policies, and as it deeply affects the lives and happiness of a most unfortunate class, and through them the lives and happiness of many others, it seems clear that positive knowledge of the results of its application should be available. Such knowledge should include the actual details of the lives after discharge of an unselected group of consecutive discharges. In order to secure such information to use as a guide in our work with the feebleminded, the study described in this article was undertaken.
Do the Feebleminded Succeed in the Community?
The study was made possible through the cooperation of Dr. Bernstein, the Superintendent of the Rome State School, and Mr. Pollock, the Commissioner of the Department of Public Welfare of Erie County. Through the latter we secured the names of all the commitments to the Rome State School, and through the former we secured data concerning reasons and dates of admissions and discharges, early history, etc. We endeavored from the collated results to discover the proportion of the total group of feebleminded replaced into the community which proved capable either wholly or in part of adaptation to community life. To judge the degree of adaptation we used three criteria:
Ability to support self.
2. Ability to regulate life without assistance either financial or supervisory from family or from agency. 3. Ability to live without infringing upon the law to the extent of arrest or commitment to some type of correctional institution. We avoided too high or too low standards of adaptability by recognizing grades within the criteria chosen. For example, under ability to support self, we differentiated self-support during a six months period and during the total time of discharge, self-support with supervision by family or by agency, self-support without supervision and partial self-support. Under ability to live without arrest or commitment we differentiated between commitment and arrest without commitment and between types of institutions to which committed. We were thus able to substitute for a rigid division into successful and unsuccessful various degrees of adaptation to community conditions. The group is made up largely of American born individuals. Of the total group, including 136 males and females, 120 were born in the United States. The parentage, however, is not so largely American; 49 of the American born are of foreign parentage, and 23 are of mixed American and foreign parentage. Only 47 of the American born are of American born parents.
The Influence of Sex and Marital Status upon Adjustment The first grouping of our individuals shows that the men far outnumber the women (88 to 48). This is interesting as it may indicate a greater tendency to replace feebleminded men in the community than to replace women. Dr Fernald was of the opinion that the replacement of men was more successful.
The sub-grouping of the men and women into unmarried and married also brings out an interesting fact. Of the 88 men only 9, or 10.02 per cent, married. Of the 48 women, 28, or 58.03 per cent, married. The nine married men earned from $16 to $24 per week. None of the 28 married women were self-supporting before marriage. It would seem that inability to support self leads towards marriage in the case of feebleminded women and away from it in the case of feebleminded men.
It, is also of interest to note that the sex life of the women who married is much more irregular than the sex life of the women who did not marry. In the group of 20 unmarried women, we find venereal disease noted in 4, sex offenses in 7 and 1 illegitimate child. In the group of 28 married women we find venereal disease noted in 16, sex offenses in 18, prostitution in 4, 8 illegitimate children and 7 separations. Furthermore, in the unmarried women group we find but 2 court records and one term in a correctional institution ; while among the married group we have 8 court records and 6 prison records.
It seems clear from our records that the women who married are of a more unstable type than the women who did not marry. Twelve of our unstable women were apparently stabilized by marriage, though not in every case by a first marriage. Thirteen of the unstable women remained unstable in spite of marriage. All of the married men were of unstable type and only one was stabilized by marriage.
Incidence of Complete Self-Support and Self-Supervision Considering the group as a whole, men, women?married and unmarried?we find that at the time of the investigation only 22 individuals (16.17 per cent of the total group) were succeeding in maintaining themselves financially without supervision and without material aid, and had done so during periods varying from 6 months to 15 years. The group includes 13 unmarried men, 5 married men and 4 unmarried women. Seven of these 22 individuals who met our economic standards did not meet our ethical standards; 5 had criminal records, one had served a prison term, and one had borne an illegitimate child. Ten of the 22 in the successful group had been economically successful during the whole period since discharge. Two of the 10 had not been ethically successful, one had a prison record, and one is a sex pervert. Thus there remain 8 individuals (or 5.88 per cent of the entire group) who, during the whole period of discharge, met our three highest criteria of adaptation. These are all men and only one is married. This finding is startling and makes us wonder at the easy credulity of those who believe that because such hosts of feebleminded are returned to the community it is the part of wisdom that they should be.
We have closely studied the data concerning these 8 men, hoping to discover some common reason for their successful adaptation, which is so conspicuous in contrast to the partial or non-adaptation of the other 128 feebleminded returned to the community. “We thought there might be a correlation between the time spent in Home and success, but one of the 8 had spent but 2 months there, another but 7 months.
We thought that they might have been especially selected by the superintendent as being potentially able to make good in the community, but we found that 3 ran away, 3 were placed on parole and only 2 discharged at the time of leaving Rome.
There was a possibility that they were emotionally stable inADJUSTMENT OF FEEBLEMINDED 47 dividuals who had never given trouble by behavior, but we found that 6 had been serious behavior problems before their commitment to Rome.
It seemed possible that the environmental conditions to which they Avere returned might have been particularly favorable, but only one man returned to a really stabilizing environment (he entered the United States Army, and has served almost continuously ever since; he has had three honorable discharges and is now a first class private), 4 lived with parents or relatives under very poor conditions, the others lived in rooms or on farms. Type of employment is varied and only 4 of the 8 are steady workers. Three work just enough to supply themselves with necessary money, and change their jobs at frequent intervals. We cannot explain the success by the level of mental development. We have mental ages for only 5 of the 8 men, and all 5 are morons, grading mentally from eight to eleven years. This cannot be interpreted to mean more than that those with a mentality below eight were not successful, as the same mental ages occur in the partially successful and non-successful groups. The amount of schooling gives no common factor, as third, fourth, fifth and seventh grades are all represented. In fact, from a survey of the experiences of these 8 men we find no common element which explains their success, and we are inclined to think the successful adaptation is due to a combination of fortuitous circumstances.
Partial Self-Support and Self-Supervision Nine persons, all single men, and all but one living with their families, were found to be self-supporting under supervision. Their earnings vary from $6 to $26 per week, and they are all steady workers under constant spurring and supervision.
Three of these men have criminal records (disorderly conduct, stealing and assault) and 4 more have given offense by sexual practices. Only 2 of this group have fully met the ethical standards set by our study.
Eighteen persons, 10 single men and 8 married women, were found to be partly self-supporting. Not one of the 10 men has been a constant or steady worker. “When working their wages ranged from $6 to $22 per week. Six were in prison at the time of the investigation. The 8 married women, at some time since their discharge, have contributed from $3 to $13 per week towards the family income. Three are now separated from their husbands. One is in prison, not for the first or second time. Her offenses were stealing and sexual immorality. Only one of the 8 women meets our behavior requirements.
To sum up, the independently self-supporting, the self-supporting under supervision and the partly self-supporting number in all 49, or 36.06 per cent of the total group. Deducting from the 49 the flagrant behavior problems, we have 19 individuals or 14 per cent of the entire group ivho have been wholly or partially selfsupporting and who have met our ethical standards.
The Totally Unsuccessful Group Eighty-seven individuals, or 63.04 per cent of the entire group, have been absolute failures from an economic point of vieiv. Twenty-three failed so entirely of readjustment that they have been recommitted to institutions. Six of these had criminal records. Four had prison records and 3 had served terms in correctional institutions before recommitted (the offenses were disorderly conduct, stealing, assault and sex offenses). Eleven were sent to institutions for the feebleminded, 6 to hospitals for the insane, 4 to institutions for defective delinquents and 2 to sheltering institutions. Thirty-five of the not self-supporting live at home and contribute nothing toward their own support; 26 of these are single men, 8 are single women and one is a married woman. Of the 26 single men, 6 have had temporary institutional care of various sorts, 7 have criminal records (offenses including disorderly conduct, alcoholism, vagrancy and sex offenses). Five men, 2 single and 3 married, live away from home and are totally dependent. Two of these men were in prison at the time of the investigation, 2 others had served terms in the Erie County Penitentiary.
Twelve of the group are married women. Of these, 3 have criminal records, 7 are sexually immoral, 5 have venereal disease, one is divorced, one is married to a criminal and one is married to an alcoholic. Four are prostitutes, all suffering from lues; one has been twice married, one is divorced, 2 have served prison terms, one has several children, legitimate and illegitimate, and one other has one child.
Eight of the group are at present lost to us. Four of the 8 have criminal records (vagrancy, sex offenses, disorderly conduct), one has served a term in prison and 2 have served terms in correctional institutions.
Relation Between Length of Residence in the Institution and Adjustment in the Community
Just as we studied the data concerning the eight successful men, we studied the data concerning the whole group, to ascertain the relation between the degree of economic success: independent selfsupport, self-support with supervision, partial self-support and economic failure, with the length of time spent in Rome. The results show practically no correlation. The percentage of economic failures for the various periods of residence is as follows: 6 months or less 72 per cent of 32 individuals 6 to 12 months 50 per cent of 22 individuals 1 to 2 years 60 per cent of 33 individuals 2 to 3 years 70 per cent of 10 individuals 3 to 4 years 72 per cent of 18 individuals 4 to 5 years 66 per cent of 3 individuals 5 to 6 years 60 per cent of 4 individuals 6 to 7 years. 50 per cent of 4 individuals 7 to 8 years 100 per cent of 4 individuals 8 to 9 years 100 per cent of 1 individual 10 to 13 years 40 per cent of 5 individuals The Influence of Mental Age upon Community Adjustment We also studied mental age in relation to degree of economic adaptation and found the following results: Number of Cases Total Number of Cases Mental Age Recorded Mental Age Extremes Mental Age Median Independently Self-Supporting Self-Supporting with Supervision … Partially Self-Supporting Not Self-Supporting. . Kecommitted to Institutions Whereabouts unknown Prostitutes Housewives, not earning 22 9 18 40 23 8 4 12 16 7 16 23 18 7 4 9 7-10 7-10 7-11 2-10 2-11 9-11 6- 8 7-12
Further Data on Sex and Marital Status We further sub-divided our data into four groups: the mimarried men, the unmarried women, the married men and the married women.
In the group of 79 unmarried men we found that 22 were supporting themselves either with or without supervision, that 10 were partially supporting themselves, and that 48 were economic failures. The ages of these men varied from 11 to 43 years, their mental ages varied from 2 to 13 years. Their wages ranged from $7.50 to $26 per week, with the exception of one man who makes $35 per week as a railroad fireman.
Of the 22 self-supporting men, 6 have criminal records, 6 have given offense by their sexual practices and one lias a prison record. Of the 10 partially self-supporting men, 6 are now in prison and one other has a prison record.
Of the non-self-supporting, 16 have criminal records and 5 have prison records.
Of the 9 married men, 5 were found to be supporting their families and 4 not supporting them. Two have criminal records, one a prison record, one is known to be a sex pervert. The men make from $16 to $24 a week and in the various families there are 10 illegitimate children.
Of the 20 unmarried women, 4 are independently self-supporting, 16 are not self-supporting; 8 of these have been recommitted. The ages of the group vary from 7 to 48. The wages of the four wage earners vary from $10 to $16 per week. Two have criminal records, one is an alcoholic, one has an illegitimate child. Of the group of 28 married women, ranging in age from 21 to 55 years, and in mental age from 6 to 12 years, 8 have been able to contribute more or less toward their own support. None of the 28 has ever been totally self-supporting, either before or after marriage. Eight have criminal records, 6 prison records, 4 are prostitutes, 16 have venereal disease. Three have been married more than once and 7 have been separated.
This group has produced 22 legitimate children and 8 illegitimate chilren. The same group produced, before commitment to Rome, 10 legitimate children and 5 illegitimate children. Eighteen of the group had given trouble by sexual conduct before commitment to Rome, and 18 have given trouble by sexual conduct since discharge from Rome. Five had practised prostitution before commitment to Rome and 4 have practised it since discharge from
Rome.
Why Replacement into the Community Fails The one hundred and thirty-six persons have now told their story and it is not a cheering one. We, the responsible members of the community, accepted the role of protector and guide, and our success seems to be summed up in 8 satisfactory and 11 fairly satisfactory, though partially dependent lives; our failures in 43 lives Marred by criminal records, 20 lives marred by prison terms, many miserable and poverty-stricken lives and 4 lives of prostitution. Could we have done better, or is failure due to the fact that there is for the feebleminded no alternative to miserable living in the community but permanent institutional care?
We think there may be an alternative, but that it lies in a training and supervisory program radically different from any that has as yet been attempted. The training of the feebleminded dates back over a century, and therefore has reached a higher level of efficiency than has the supervision of the feebleminded in the community. At present this supervision differs little in type from the supervision given delinquents or normal individuals needing temporary guidance and care. To be effective, both the training and the supervision of the feebleminded must differ from the training and the supervision of normal persons as fundamentally as the feebleminded and their requirements differ from normal persons and their requirements.
Both training and supervision must be based upon and built up in harmony with certain fundamental limitations and assets which are inseparable from the feebleminded condition. These may be briefly summarized as follows:?every feebleminded person reaches ?t some point in his mental development an. impenetrable barrier which serves the idtimatum, “thus far shalt thou go, and no furtherThis barrier is always reached at some stage before the ability to judge of his actions and to control them by preconceived ideas is attained. The result is an inability to build up forceful motives and guiding ideas. This inability brings with it a compensatory quality, which, under a good educational regime, is a decided asset. Not being governed nor guided by dominating ideas the feebleminded person responds easily to the appeal of the present, and is easily led by any proposal lying within the scope of his comprehension. In other words, he is supremely suggestible. Moreover, not only are the ideas of the feebleminded lacking in controlling force, they are limited in number and vai’iety, and this limitation also has a mental compensation which is a practical asset. The lively play of imagination of a normal person brings before him many possible ways of spending his time, he wishes to try them out, grows tired and restive when held down to a monotonous routine. The feebleminded person, on the contrary, does not rebel against monotony, but against change. He grows restive when expected to make effort to overcome new obstacles which he cannot easily comprehend. He works best and most happily when working automatically, when doing something he has become habituated to doing, when he is conscious of doing well and knows he will be appreciated. Such are the basic mental limitations and the compensatory mental assets which are common to the feebleminded.
An Alternative Program
The realization of these limitations and assets is invaluable in planning and putting into effect both a training and a supervisory program. Such a system recognizes the futility of striving for a development of power of judgment and self-guidance, and substitutes a training through habit forming. There are many things that the feebleminded can be taught to make and to make well?hammocks, lace, knitted and crocheted articles, cake, bread, muffins, pies, candy, and much they enjoy the praise success brings to them.
It is possible by a slow and patient method consisting of much repetition, producing greater and greater accuracy, to train a feebleminded child to do some one of these things supremely well, to produce a really well-made, saleable article. Such success builds up in the child a belief in self and a joy, which can be attained in no other way. The habits of regular and careful work developed in the process of reaching the final skill remain permanent possessions. Such a program differs entirely from one which allows the child to diversify in many kinds of handwork. Its virtue lies in specialization and supremely good work through repetition of process. Such a training program is the foundation from which a new supervisory program could be built. At the present time there is an approach to such a training program in the special classes of the public schools, not usually so specialized a training, but at least a training in making certain things. When the child leaves the public school, however, there is no place for him to put into practice what he has learned at school, he is much in the position that a trained typist would be in a city without typewriters. He perhaps knows how to make reed baskets, brooms or brushes, but 110 one will employ him to make them. The Poor child, deprived of the school regime, and with nothing else to turn to, and lacking the initiative to make new adaptations, idles away his time and gets into difficulties.
What is needed seems to be an Industrial Plant into which those trained in the special classes could be graduated, where those who had learned to make good rugs, baskets, toys, cake, candies or what not, could continue to make them, only now on a paid basis. Such a plant might be an integral part of the public school system or it might be under separate jurisdiction. In either case its industries would have to match or grow out of those taught in the schools. Fortunately for such a plan, the industries taught in the schools (all those above mentioned and more are at present taught in one or another special school) are vocational in character. The plant, of course, would have to be directed by persons experienced in dealing with the feebleminded.
Many of the more capable feebleminded would by such a plan be kept usefully and gainfully employed, and be made happy by the fact that they were self-supporting. Moreover, they would be kept out of harm’s way during the major part of every day. Those who had good homes could return to them at night and those who had not could live in a colony home in which their earnings would probably pay their way.
Such a plant and colony is a suggestion of a type of supervision which might well prove successful with many of the school-trained, high-grade feebleminded of our cities. Such a supervision would not be a supervision imposed over and above the routine events of the individual life, but a supervision integral in school and vocational training, and later in industrial work. It would grow out of the day’s events, the day’s business and behavior, and would therefore be more intimately and immediately related to it than the closest supervision by a visitor.
Such a plant and colony would be in reality the creation of a community for feebleminded within the community rather than an adaptation of the feebleminded to life under existent conditions. However, it would be far from institutional segregation and would result in changing many of the high-grade feebleminded who now lead altogether miserable, wholly or partially dependent lives into useful, self-supporting, self-respecting individuals.
The idea of an industrial plant for the feebleminded is not en54 THE PSYCHOLOGICAL CLINIC tirely new. For some years London has successfully conducted an industrial institution. The London institutions for the feebleminded are distinctly differentiated in regard to intake and function; there is a receiving institution for the younger children, a custodial institution for the lower grade of feebleminded and an industrial institution for those capable of productive work. The London industrial institution differs from the plant which we propose in being residential and in being entirely dissociated from the work of the London day schools for mental defectives.
Our idea is to make the industrial plant the crown of the public school work for mental defectives, the place to which the special schools would graduate their capable workers. It would make necessary in the special schools intensive work along one line of industry with each child. Each child would be trained to make one article supremely well. Among industries now successfully taught in special schools are weaving of many sorts, hammock and net making, chair caning and repairing, basketry, brush making, toy making, sewing, embroidery, lace making, knitting and crocheting, bread and cake baking, preserving, candy making and fine laundering. All of these and more might find place in the industrial plant. Industrial shops for blind workers have long been in existence. Industrial shops for cripples have also proved most successful. We are inclined to predict that a trial would prove such a plant for the feebleminded a practical, humane, economical alternate to either institutionalization or to replacement into the general community of the higher grade feebleminded.
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