News and Notes
“Mental Deficiency in its Social Aspects.”
The discussion which took place on this subject at the recent meeting of the Section of Medical Sociology of the British Medical Association at Portsmouth was one of great interest, and we have pleasure in giving our readers a short summary of the proceedings taken from the official report which appeared in the British Medical Journal of 11th August, 1923.
The discussion was opened by Dr W. A. Potts whose introductory paper outlined the problem of Mental Deficiency as a whole and touching some of its ramifications?venereal disease, alcoholism, crime, the “unemployable,” the “borderline” and unstable?showed its complexity and pleaded for a “larger vision” in dealing with it.
Mrs. Pinsent (Commissioner, Board of Control) followed with a paper on the Mental Deficiency .3t ? .vhit it hi? accomplished and what it has failed to accomplish. She stressed specially in this latter connection its failure in providing for defectives that continuity of control the need of which the Commissioners in their Report of 1908 emphasised so strongly,* but showed that if such sections of the Act as do attempt to make provision for this were fully carried out, and specially if the Education (Defective and Epileptic) Children Act could be thoroughly and scientifically worked, much might be done to secure it even without an alteration in the law. Dealing with the question of the provision of Institutions Mrs. Pinsent produced figuresf to show how little had yet been accomplished in comparison with what still remained to be done and pointed out, moreover, how inevitably slow further progress in this direction will be. She therefore urged the need for more intensive study and more experimental work into the whole subject. The following questions, in particular, she contended, call vitally for an answer:?
(1) Is there any method of community control outside institutions which would ensure th * safety of the defective and the protection of the interests of the community ?
(2) How far is complete segregation of large numbers and varying types practicable, and if rigorously carried out how far would it cut off the supply ?
(3) If the community decides that the segregation of defectives is essential for its welfare, what steps can be taken to render it less irksome for the individual ?
(4) Is it possible to promote scientific research which may reveal the causes of congenital mental deficiency and suggest its prevention?
In a paper on the Segregation of Mental Defectives, Dr Devine (Medical Superintendent, Corporation Mental Hospital, Portsmouth) discussed from the sociological point of view the limitations and the possibilities of segregation as a method of dealing with the problem of the prevention of Mental Defect. As a eugenic policy he contended that segregation would never have any but limited results and we should always be left with a “large number of mentally unstable and intellectually deficient people who for various reasons cannot be segregated, but who, nevertheless, are a source of anxiety and need help and guidance.” To prevent these Persons from propagating is then our problem and probably it is along the lines of educational method’s which we must look for its solution?a solution which will not in his opinion, present itself in terms of ‘cut and dried methods.’
This view was not shared by Dr Gibbons, (Gynaecologist to Grosvenor Hospital for Women) who read the next paper before the meeting, for he considered that “Sterilisation” was likely to prove the sovereign remedy, or at any rate one which should be specially tried.
Dr Norwood East (Senior Medical Oflicer, H.M. Prison, Brixton) with a paper on “The ncidence of Crime and Mental Deficiency’” % which contained statistics showing the value of the : *eiital Deficiency Act in preventing recidivism, but showing also how fallacious were some ideas prevalent in the past about the relation between crime and mental deficiency.
In a suggestive paper on ‘ ‘Organisation for the Supervisioji of Mental Defectives” Dr Mackfie ^ampbell, Director of the Boston Psychopathic Hospital, Mass., pleaded for what might be termed a ‘ ‘change of heart” towards defectives. People in America (though he concluded this is not so much the case in England) were inclined to be too much obsessed by intelligence quotients , forgetting that what mattered was adjustment to environment, and that many individuals with a low intelligence quotient could be made into useful members of society if care was taken , ^ * For further discussion of this point see Miss Fox’s article and Summary of Report of Board of Control (page 80). t Summarised on page 81. t See * ‘News and Notes,’’ P84.
to provide i’or them an environment suited to their capacity. The psychological motive behind the cry for measures of segregation was too often, he said, the wish to be spared the ‘ ‘bother” of defectives?a reluctance to undertake personal responsibility for them. He suggested that instead of envisaging the problem as consisting of 0.5 defectives per cent. multiplied by the total population and so becoming overwhelmed by its magnitude, we should think of that 0.5. as being assimilated by every 100 normal members of the community?in other words we should emphasise the fact that for each defective in the community there are 200 normal people, and that to expect them to join together to shoulder the burden of him is not making an excessive demand. In conlcusion Dr Campbell stressed the responsibility of the medical profession in this question, and urged the importance of introducing into medical training from the outset that study of the neuroses which has led to the treatment of the patient as a “sick person at grips with destiny” rather than as a ‘ ‘laboratory animal.’’
Sir Frederick Mott in a paper on “Heredity and Social Conditions among the Mentally Defective’’’’ gave an account of the investigation which was carried on in this subject by Miss A. Ivelley in Haggerston in 1915* and expressed the hope that the investigation might be pursued by either the Board of Control or the Eugenics Society, so essential was it that the facts of the problem should be brought to light. He was not disposed to advocate a policy of sterilisation. Ill the discussion which followed these papers both Miss Evelyn Fox and Dr. Prideaux took part, dealing principally with the subject of the education of defectives and the problems involved. Dr Prideaux also drew attention to the need of educating the medical student in psychological medicine.
The proceedings terminated with an address from the President of the Section, Dr H. B. Brackenbury, who gave a most masterly summing up of the whole discussion.
Later on in the same day Miss Evelyn Fox exhibited to the members of the Section the C.A.M. W. Film on the training of mentally defective children which aroused great interest.
Some Recent Statistics on Mental Deficiency and Crime. —————————————————–The following statistics on this important subject are the most recent which have been put forward. They should, we think, be given a wide publicity amongst Mental Welfare Workers in order that they may be in a position to dispute some of the wildly exaggerated statements which are from time to time made in the press and elsewhere, and we therefore lay them before our readers:?
Of 66,715 prisoners received into prison during the year 1921 to 1922, 223 were certified as Mentally Defective. Of some 60,983 prisoners received into prison in 1922?1923, 246 were so certified.
During the two years April 1st 1921 to March 31st 1923, 16,017 prisoners were admitted to Brixton Prison on remand or before trial; of these, 1,517 were remanded for special psychological examination but only 139 were found to be certifiable under the Mental Deficiency Act.
In the opinion of Dr Norwood East, Senior Medical Officer of H.M. Prison, Brixton, who has made public the statistics given above, an accurate estimate of the incidence of mental defect amongst unconvicted prisoners would be 5%. At one of the recent meetings of the British Association there was again emphasised, in a discussion on liThe Delinquent Child” the comparatively small part which mental defect plays in the production of juvenile delinquency.
It is true that Dr Cyril Burt stated that of the children examined by him 40% were ‘ ‘educationally backward’’ but actual mental deficiency he found in only about 8% of the cases. The estimate given at the same discussion by Dr W. A. * See report published as Supplement in Board of Control’s Report for 1915. t Paper read at meeting of Brit. Med. Assoc., Portsmouth, July, 1923. Since published as a pamphlet (see Bibliography).
Potts was lower still; in his experience only from 3 to 5% of the children brought before the Courts in Birmingham could be certified under the Mental Deficiency Act.
In a Report made to the London County Council, * Dr F. C. Shrubsall, Senior Assistant Medical Officer, comments upon “the very small proportion of Special School children who subsequently get into serious conflict with the law.” Some interesting statistics he has lately published on the whole question we hope to record fully in our next issue.
The Record of a Mentally Defective Boy. ————————————-The fact that, as seen from the figures given above, the mentally defective criminal or delinquent is rarer than is commonly supposed does not mean that the problem when it does occur is any less serious or that we need slacken our efforts to reduce it to still smaller proportions. How serious it is, regarded in terms of human suffering and wasted opportunities ma)7, be gathered from the following record which has been brought to light by the Scottish National Council of Juvenile Organisationsf and which is, unfortunately, typical of many others hardly less glaring. The child, at the time of committing his first offence was 10 years old. This is the pitiful tale of his next four years:?
Appearances in Court. Offence. Treatment by Court. ————————————————-3 Nov. 1917 (1st appearance) Theft Admonished. 12 Jan. 1918 Malicious Mischief Adminished 26 Mar. 1918 Attempted House-breaking ,, 24 July 1918 Robbery Birch Rod?8 Strokes. 19 Jan. 1920 Theft Proceedings dropped 8 May, 1920 Theft, House-breaking Admonished 2 Mar., 1921 Theft Proceedings dropped 2 April, 1921 Theft, House-breaking Proceedings dropped on ground of mental defect.
Comment is needless. We need only note that to prevent the continuance of this state of affairs in Scotland the Committee urge the organisation of a scheme whereby special medical examination shall be ensured in all cases of the kind and in towns with a population of, or exceeding, 150,000 the services of a specially qualified medical man shall be procured for the purpose. In the formation of the Scottish Association of Care Committees which, with the appointment of an Organising Secretary is now in full working order, lies also, we feel, the hope of better things.
Mental Tests and the Influence of Education. ——————————————-Mr. Hugh Gordon, one of His Majesty’s Inspectors of Schools, has been conducting an inquiry into the effects of schooling on the response to mental tests, with a veiw to ascertaining whether as is sometimes claimed, such tests are in no way influenced by the subject’s education or lack of education. * Annual Report of the Council, 1922. Vol. III. “Public Health. Page 95. P.S. King & Son. 2s.Cd. t Report of an Enquiry into Juvenile Delinquency. P. 29. K.M. Stationery Office. . net.
The results of the inquiry have been published by the Board of Education* and the Report contains material of great interest which no one concerned with Mental Testing in either its theoretical or practical aspect, can afford to neglect. Mr. Gordon took as his material four groups of children, viz., children attending schools for the physically defective, children attend ng “Backward Classes,” Canal Boat children and gypsy children, and to each group he applied the Terman Revision of the Binet Tests as well as certain scholastic tests standardised by Dr. Ballard and Dr Cyril Burt.
In all these groups (the average physical age of which was between 9 and 10) the average mental ratio was discovered to be very low (P.D. School children, 85.5; Canal Boat Children, 69.6; Gipsy Children, 74.5; children from Backward Classes, 68.6 and 74.9) and it was found that the lower the average school attendance the lower was the ratio, except in the case of those backward children whose retardation was due to natural dullness rather than to lack of opportunity for development.
From this and other data recorded in detail in the report, Mr. Gordon arrived at the conclusion that “it is quite evident that although the mental tests used do undoubtedly test some kind of ability or abilities, such abilities are not developed without schooling or its equivalent, and as a consequence the tests do not evaluate them apart from schooling, except perhaps in the case of children under 6 or 7 years of age.’’
He notes, however, that it does not follow that because the tests used failed to reveal mental development of an intellectual nature the children in question therefore lacked mental development in other directions, and suggests the need of devising and standardising tests suitable for the special kind of environment in which these children live in order that some fairer estimate of their capacities may be reached.
After-Care in Home Office Schools. ——————————–The Home Office has recently issued a Circular on the subject of the provision of After-Care for boys and girls discharged from its Schools urging its necessity and outlining a scheme for its systematic operation.
The primary responsibility for such After-Care is to continue to rest with the Managers of the schools, but it is impossible for them unassisted to ensure that it is provided in every case and it is proposed that a ‘ ‘net-work of helpers’’ willing to act in conjunction with the schools shall be set up.
The Home Secretary has already secured the co-operation of a number of societies and agencies and amongst them is the Central Association for Mental Welfare which has offered its help in making provision for the After-Care of any defective, subnormal or unbalanced children for whom such care is desired. “After-Care.” Some Recent Statistics.
The Report of the Birmingham After-Care Committee recently published contains some interesting statistics concerning the 2933 ex-Special School children of the City of whom records have been kept since the year 1903. The percentage of cases “doing remunerative work” in 1923 was 35, as compared with 32 in the previous year. A comparative table shows that the highest * Mental and Scholastic Tests among Retarded Children. Education Pamphlets, No. 44. H .M. Stationery Office. Price la. 3d. net. $7 number recorded in work was in 1916, when 49% were employed, the lowest in 1906 when it was only 16%.
The number of cases in Institutions has fluctuated between 2% in 1903 (when there was of course no Mental Deficiency Act) and 26% in 1915 and 1916. Since 1919 there has been a drop and in 1920, 1921 and 1922 the percentage in institutions was 16.
The Committee has records of the Marriages of 153 boys and girls of whom 64 have had families varying in size from one to 5 children. These statistics are not of course in any way complete but they serve to indicate what would be the value of extensive and scientific enquiry into the subject, undertaken with a view to formulating a constructive policy.
The Problem of the Dangerous and Violent Defective. ————————————————–In the Board of Control’s Report for 1922, just issued,* there is published as an Append ixf a report of the Medical Superintendent of Ramp ton State Institution on the year’s work which gives a vivid picture of the types of defective for whom the Institution exists and the difficulties which their care Involves. Such statements as the following seem to present the problem for a moment in high relief and merit the attention of those of us who are inclined to criticise too hastily the Rampton regime. Dr Rees Thomas states, speaking of the need for more single rooms:?
4 ‘It is necessary that patients who are subject to fairly frequent outbursts of violence should sleep alone, otherwise, as their conduct invariably acts as incitement to others, our troubles would be materially increased. Again, for reasons such as bad language, smashing propensities, constant talking and quarrelling, moral depravity, intense attachments with subsequent outbreaks of jealousy, suicidal tendencies, extreme irritability, a consider ab e proportion of single rooms become a necessity. Lower grade patients are markedly imitative, and their conduct reflects the vices of others, and is no real index of their turpitude.’’
A continued effort has to be made to prevent too close association and it is found essential that patients should be isolated “as soon as they show any signs of undue excitement or violence.” It is interesting to note that these outbreaks are far more frequent on the female side; for the male patients seclusion is only rarely necessary.
The difficulties experienced in organising occupations are indicated in the following passages:?
“The average daily percentage of patients employed is 94. The greater majority, however, are untrustworthy and quarrelsome, which makes it necessary to employ a very high proportion of attendants to working patients. Great difficulty is experienced in finding suitable occupations lor the female patients. Outdoor occupations available are few, while “indoor industries requiring any marked degree of concentration react adversely on many of those employed in them and workers have to be carefully selected and gradually trained. I may instance in this connection lace-making. A number of our more intelligent patients were at first ?See page?80. tAppendix D. Pp. 102 et seq. employed at this work with the unfortunate result that their instability, loss of control, excitement, and violent outbreaks were exaggerated; some indeed became totally unfit for this special occupation. We new employ only those of lower grade, and although they learn the work more slowly they are less intolerant, and the concentration has a beneficial effect on their mental state and behaviour.”
On the subject of “recreation” we read:?
“As the greater proportion of our patients take any and every opportunity to escape, outdoor exercise and recreation presents many difficulties.” Nevertheless, country walks are persisted in, and outdoor games and physical drill form part of the regular routine. Dancing and concerts are popular as indoor amusements.
Dr Rees Thomas divides his patients into three groups:? (a) simple mental defectives, (Males 20.9%, females 5.1%); (b) mental defectives with instability (Males 26.4%, females 37.2%) and (c) mental defectives with psychosis or neuropsychosis (Males 52.7%, females 57.7%).
He is fully alive to the fact that not only each group but each individual patient needs separate treatment, and that there is scope at Itampton for a “large expert medical staff.” Until these conditions arc provided progress must be slow and it is only possible to make in certain of the most promising cases the detailed study which should be given to each of the 331 who were on the books during the year under review.
A rich field of research is lying untilled in the interests of ‘ ‘economy’’ ; that in a nutshell, is the position at Rampton.
Education (Institution Children) Act, 1923. ——————————————-This Act deals with the education of children who are sent by Boards of Guardians or by a Charitable Institution to a public elementary school or a school certified under Part V of the Education Act 1921,* located in an area other than that to which they belong. It provides that in such cases the Local Education Authority concerned shall be empowered to exact payment from the Local Educat:on Authority from whose area the children come in respect of every child so educated.
In the case of Poor Law Children the ‘ ‘area to which they belong’’ shall be that in which they have a ‘ ‘settlement.’’ In the case of children in a charitable Institution it shall be taken to be:? (i) the area in which they last resided for 6 months (other than the Institution), or (ii) if this cannot be ascertained, the area in which they were born, or (iii) if neither of the above facts can be established such area as the Board of Education may determine.
This Act merits the attention of Secretaries to Voluntary Associations as amongst the children whom it will of course affect are defectives who are boarded out by Boards of Guardians in order that they may attend Day Special Schools. ?This is the Section of the Act dealing with the education of Defective and Epileptic Children.
Special Schools and the Board of Education. —————————————–The official view of the Board of Education with regard to Special Schools is recorded in their Report recentty issued, in the following paragraph:? ‘ ‘The cost of Special Schools is the main obstacle to their provision on a comprehensive scale, and the Board have had under careful consideration ways and means of reducing this cost. With this object in view they have issued a Circular (Circular 1297) in which they have formulated a revised standard of staffing. As explained in this Circular, the Board do not disparage the ideals which have been pursued in the conduct of the best of these schools; but they have been forced to the conclusion that some compromise with these ideals is necessary if, within a reasonable time, adequate provision is to be made for the children who require the special forms oi education offered by Special Schools, and they believe that the balance of advantage lies on the side of making less costly arrangements for greater numbers.
It should be noted in this connection that the Circular referred to above has met with considerable opposition from Special School teachers and soon after its issue the National Special Schools Union sent a deputation to the Board which was received by Mr. Wood, and Dr Eichholz.
The Hon. Secretary of the Union (Mr. J. H. Hudson) opened the case for the teachers based on the contention that the efficiency of the schools was incompatible with “diminished expenditure, larger classes and dilution of the teaching staff.” He further urged that in future the Union should be consulted by the Board before any far-reaching Circulars of this kind were issued.
Mr. Dodds (London), and Miss Collingwood (Birmingham), then spoke from the point of view of teachers in M. D. Schools and Miss Lockwood (London) from that of teachers in P.D. Schools; Miss Jackson (Manchester), Miss Bennett (Birmingham) and Mrs. Swallow (London) took part in the subsequent discussion.
The Deputation received a sympathetic hearing but Mr. Wood was unable to hold out any hope that the Circular would be withdrawn. He offered, however, to consider carefully any cases in which it was felt that hardship would result and suggested that if at the end of six months the Special Schools Union had to report any cause of serious complaint the Deputation should meet him again. He emphasised the fact that any money saved by the economies outlined in the Circular would be devoted to the opening of additional Special Schools and that the Board had no intention of accepting any teachers less competent than those permitted under the existing regulations.
“”Report of the Board of Education, 1921-22. Page 74. H.M. Stationery Office, 2/-.
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