Recent Trends in the Control of Mental Deficiency in the United States
By Stanley P. Da vies, Ph.D.
(Executive Secretary, Committee on Mental Hygiene, State Charities Aid Association, New York.)
To the average American citizen, mental deficiency was a problem that seemed remote enough before the war. To the man on the street it had to do with a comparatively small number of persons, considerably less than one per cent, ot the Population, who were safely and comfortably isolated in some more or less distant institution. Small wonder then that this same citizen was startled into an ^pleasant consciousness of the mental deficiency problem when, following the war, the official report of the intelligence tests given the troops recruited into the United States Army during the war revealed that 47.3% or practically half of all the white drafted troops had mental ages of less than thirteen years. The many articles published apropos of these results are an indication of the sober though which the problem of mental deficiency began at once to create m the public ^md- One needs to read only the captions of some of these articles to discove the trend of these thoughts: “American Misgivings ; Is America Feebleminded?”; “University Head Derides Delusion of Democracy.
Although psychologists have since pointed out that many of the alarmin# inferences drawn from these findings were wholly unwarranted and due to misinterpretation, and although to the writer, the tests when carefully analysed merely prove that average people have average intelligence, nevertheless, the very suggestion that half of us might be feebleminded, ridiculous as it is, brought mental deficiency close home to Mr. Average Citizen and made him aware of the fact, as never before, that the problem is all about us and not merely within the four walls of a few public and private institutions. It made him realize that there was not lacking an element of truth in that whimsical remark of the late Joseph H. Choate, former Ambassador of this country to the Court of St. James: “The great difficulty which this problem of mental deficiency presents is that there are so many of us.’’
Along with this recent popular appreciation of the extent of mental deficiency, there has been developing a change in public attitude toward the mentally defective person. He was wont to be regarded not so long ago as belonging to an almost distinct species, something less than human. He now appears as a human being not so very different from the rest of us. This growing sense of a common human bond with the mental defective is making possible a sympathy for him and an understanding of his needs and potentialities that was not possible before. It is a matter of general knowledge now that there are many more mental defectives in our midst than are in our institutions and that not a few are working about us, if not with us, doing much of the steady toil of the world and looked upon as plain, hard-working, decent citizens.
True, this latter type is not the one we ordinarily have in mind when we speak of the problem of the mentally defective. None the less the recognition of this type has led to important changes in the public and official attitude toward those who are ‘ ‘problems.’’ The alarmist period of some ten years ago, when the relationship of mental deficiency to crime, delinquency, vice, pauperism and vagrancy was shown to be so close that the mentally defective appeared at last to stand revealed as the root of all social evil, is recent enough to be well recalled. It only awaited the gathering of more complete information about the mentally defective, particularly those in the community, as distinguished from the selected groups of cases in jails, reformatories, houses of prostitution, institutions for the feeble-minded, etc., from which previous conclusions were drawn, to make it plain that these latter were only a small and by no means representative proportion of all the feebleminded. Whether the picture of the mentally defective is seen only in that small part of which we first had a glimpse, or whether it is seen in the large, makes a decided difference in public policy.
In the United States, as in England, the picture is coming to be seen in the large. For every figure in the picture who appears to be steeped in all the evils of our modern society, there now stand out several others with the sweat of honest toil on their brow. If the picture, as formerly, is viewed in its worst part only and every feeble-minded person is depicted as an actual or probable social offender one finds logically resulting the program which formerly prevailed of the endeavour toward complete segregation with perhaps sterilization as an additional safeguard. If, on the other hand, the picture is seen as a whole, and the industrial and social possibilities of the mentally defective are observed to outweigh their potentialities for evil, then one finds reflected in public programs, as of late, the plan of training the feebleminded, in so far as they are capable of it, for the leading of useful lives in the community.
It is on this constructive aspect of the problem that emphasis is now being placed in this country. This program of socializing the feebleminded, so to speak, is being carried out primarily through the institutions, the public schools, and community clinics and field agents.
Without doubt the work of Dr Walter E. Fernald, Superintendent of the Massachusetts School for the Feebleminded at Waverley, and of Dr Charles Bernstein, Superintendent of the Rome State School for Mental Defectives at Rome, New York, has led the way in America to a new conception of the place of the institution in the treatment of mental deficiency. The conception of the institution which formerly prevailed has been characterized by comparing the institution to a still lake which receives a slow influx of new waters and loses its contents only by gradual evaporation. Thus the institution of the accepted type in the past received patients slowly as its capacity permitted and kept them until death took them away. This was the familiar custodial care which the complete segregation program urged. In its favor, be it said, that it did securely restrain from further social damage those whom it kept within its walls. It overlooked or neglected, however, the much larger proportion of the feebleminded not in institutions who remained without proper care or oversight. It was a case of giving undivided attention to one irresponsible, while nine or more others were left to drift to disaster and to add to a fast accumulating pile of social wreckage.
The newer conception of the function of the institution, which has been developing of late, would compare it, to go back to the figure, to a lake fed and drained by a running stream with ample inflow and outflow. In other words the institution is now coming to be regarded as not for custodial care primarily but rather for training purposes and for the final restoration to society o a t ose capable of social rehabilitation. Under this latter plan, an institution of given capacity can be of helpful service to a far larger number of the mentally deficient than under the old plan.
At Waverley since 1918 there has been under Dr Fernald s direction, an extensive, though careful, development of the parole system. Under this system, institutional cases, who, after a period of training, are deemed suitable for life outside are permitted to return to the community on trial, remaining, however, under the supervision of the institution as exercised by its social worker until such time as they give evidence of having sufficently stabilized themselves in their new life to warrant discharge. The report of the institution at Waverley for 1920 shows how this work had developed up to that time. ie ac a prac tically all of the male morons who have no innate propensities for evil, who have finished our course of training in the schools, the workshops, and on the farm, are returning to their homes at the age of 18 or thereabouts, if they have good homes, and are nearly all doing well in every way, gives the impression that the training at the school is practical and useful. Each year we feel more strongly that with a male moron, the crucial period is from 14 to 17 or 18 years, when he eithei forms 52 STUDIES IN MENTAL INEFFICIENCY. habits of obedience and self-control, or gives himself up to self-indulgence and anti-social conduct. If he can be safely led through this critical period and made to feel that he has a place in the world, he is likely to become a useful and lawabiding citizen.” The boys who go out on parole arc charged for the most part with finding their own jobs. Running down an alphabetical list of former male patients now at work in the community one finds such occupations as errand boy, locomotive fireman, machinist’s helper, helper on express truck, stock boy, farm helper, mill hand, roofer, labourer, teamster, packer, porter, etc. Weekly wages range from $10 to as high as $50. At last report 220 former male patients of the Waverley institution were working steadily for wages and had earned during the year a combined total of $198,800.
The parole work for girls at Waverley has developed more slowly than that for boys for obvious reasons. In the 1920 report of the institution Dr Fcrnald states: “Hitherto we have allowed the female patients to go out only in exceptional cases where home conditions are very favourable. The fact that nearly all of these cases so released have done well has encouraged us to believe that it is only fair that a large number of well-behaved girls who have been here for a long time should be given a trial. If the legislature had enacted the long-asked-for law providing for extra-institutional supervision of the feebleminded … at least 100 female patients now present could be returned to their homes.” In other words the matter of restoring many of the institutionally trained girls to outside life is not so much a question of the ability of these girls to do well under supervision as it is a question of providing adequate supervision.
The ability of many of the boys and girls who have completed a period of institutional training to adjust themselves satisfactorily to life in the community is shown in the fact that at Waverley not more than three or four per cent, of those permitted to go out on trial in any given year have to be returned to the institution or are received in other institutions because of social failure.
At the Rome State School for Mental Defectives in New York State, there has been developed under the leadership of Dr Bernstein an additional method of social rehabilitation which serves as a preliminary to parole. This is the colony system. Colony care has, of course, been employed elsewhere, but nowhere on such an extensive scale as at Rome. The Rome colonies have been particularly noteworthy because of the application here of several new principles: (1) colonizing of women as well as men; (2) establishment of industrial colonies in towns for both men and women, in addition to farm colonies for men and domestic colonies for women; (3) using the colony as a definite training centre for community life and as a midway station between the institution and parole. In other words the Rome colonies have not been merely a modified form of institutional care but they have been made a definite part of the institution’s system of training, looking toward social rehabilitation. The colony is one stage in the moving-up process from the institution to community life.
The first Rome colony, a farm colony for boys, was established in 1900. At last report there were in active operation 18 colonies for boys with a total population of 376. Sixteen of these were of the farm type, that is, located for the most part on rented farms within a few miles of the institution, with the boys, twenty or more to the group, living in the renovated farm-house and working the land.
The other two of the boys’ colonies were of the industrial type. Here the boys lived in rented dwellings in the city ol Rome, two miles from the institution, and worked about town in industrial establishments, stores, and at various odd jobs. In immediate charge of each of the boys’ colonies are a responsible man and wife. All of the colonies are under the frequent observation of the Superintendent of the institution.
The first Rome colony for girls was begun in 1914. At last repoit there were fourteen girls’ colonies. Eleven of these were of the domestic service type, where the girls worked out by the day at house-work. The other three were of the industrial type, the girls being employed in cotton mills which in all three cases are ut a stone’s throw from the colony house. The girls’ colonies are located m di erent cities and towns in central and western New York State, the t iree neares being in the city of Rome, the furthest in East Aurora 150 miles from the institution.?
The economic advantages of the colony plan from the standpom o le a e and the taxpayer are obvious. The earnings of the colony members are in practically all cases more than sufficient to cover the rent of the colony house Housing some 700 inmates in colonies, as the institution now does, releases that many beds in the institution and thus provides the institution with increased facilities for the reception of new cases as truly as if the additional beds ia eeno by means of expensive new construction. And yet by the colony plan these additional accommodations are provided without one cent of cost to t e a e. ore over the colonies represent a further large economy in the fact that the majority of the colony members are contributing in large measure to their own maintenance (food and clothing).? llf
The primary purpose of the colonies is not fmancia economy, ow , the social reconstruction of their members. In the case of the feebleminded bo> whose institutional training has been completed, but who canno e e rus make his way in the outside world, the colony is a real salvation. It gets away from the institution and the institutional atmosphere. It makes-him teel like a new person. He no longer has a sense of being locked up. He takes a proprietary interest in his place of work and a real pride in everything he Pi?d?es. He can at last hold up his head in the knowledge that he is at least he p p^ y way in the world. With all this freedom and sense of freedom, this outlet lor oppressed energies, the boys are still, without being over-conscious; of it, uirider eareful supervision. From the standpoint of segregation they are as safe in t eolony as in the institution. From the disciplinary standpoint they give; les trouble in the colony than in the institution. There are fewer boys who run away from colonies than from the institution proper.
, The colony gives the boy training in those very qualities wMch arc necessary for his success in the community and it affords an excellent opportunity ^ the observation of the boy to determine whether he is yet ready forthenextstepof Parole. The colony assures a greater likelihood of success, on the part ol^ those who are later paroled and discharged, both in the direction of industrial useful ness ai*d social fitness,
The colony has proved to be an equally useful and desirable method in the training of girls for life in the community. The colony girls are under the direct supervision of a competent matron and assistant. The girls are made to realise that they are placed in the colony on probation and know that an error in conduct means being returned to the institution. In observing the colonies at first hand one is strongly impressed by the fact that many of the girls who have formerly been delinquent have become considerably sobered by their past experiences, and are now extremely anxious to go right and prove themselves worthy of a trial in the community. If the higher-grade feebleminded girls who are received in the institution are ever to be given a chance to prove their ability to get along satisfactorily outside, the colony plan, in the writer’s opinion, minimizes the chances of failure. The colony helps to fill the rather large gap between the institution and parole. It is, so to speak, the sheltering arm of the institution extended into the community. It is much easier for a girl to “make good” as a member of a group than to “go it” entirely alone. The girls serve as an incentive one to the other. There is competition among them in the making of the best record. There is a strong motive to do well in one’s job and go right in order to win the admiration and respect of the other girls. Furthermore, supervision in the colony is closer and more effective than it can be when the girl is on parole.
In the industrial colonies, for example, the girls not only live in a group but work in a group. Under supervision they can go to work in a group and return in a group. Their amusements can be planned in the same way. The girls, who need it, can in this way have very strict supervision. ‘ ‘What is the use,’’ it may be asked, “of colonising girls who are bound to fall into difficulties as soon as supervision is relaxed ?’’ To that question the answer lies in the still virgin field ?f personality adjustment. Empirically, however, it has been demonstrated in the colony work, that once a girl successfully falls into the colony regime, she is likely to become stabilized by it. Give a troublesome girl of this type good home training such as the colony offers, kindly oversight, companionship with her peers, wholesome recreation, and a chance to be herself; put her at a job that demands her steady attention seven or eight hours a day; let her begin to feel her productive potentialities by a record of steady weekly earnings; have her open a personal savings account and buy some nice clothes with her own earned money; see that she stays faithfully at it for six months, a year, or two years; and an entirely changed girl is likely to result. From such a regime, self-esteem and the desire for the esteem of others are apt to replace former motives. Such results have not been infrequent occurrences in the colony work.
The records of many individuals who have gone out from the colonies into the community show very plainly the extent to which the colony training has been helpful in the making of occupational and social adjustments.
The parole plan as carried out at Waverley is now being quite generally adopted at all the forward-looking institutions for the feebleminded in this country. The colony plan as developed at Rome has been observed with great interest but has as yet not been widely followed. There are some indications, however, that it will be taken up elsewhere. The State of New York has officially endorsed the colony plan by incorporating in the State Mental Deficiency Act sections outlining procedures to be observed in instituting the colony system. Two of the other State Schools for Mental Defectives in New York have begun or are planning to begin colony operations.
Space will not permit mention in detail of two other extremely important agencies in the extra-institutional program: (1) the public school; (2) community clinics and field agents. The public school is now recognized as the largest single agency capable of coping with the problem of mental deficiency. By reason of the compulsory education laws it should be able to identify all the mentally defective individuals of the coming generation and provide specialized training for the majority of them, so that only the more extreme cases would need to be cared for in institutions. It is far better that the backward child be not separated from the normal life of the home and the community in order to receive the training necessary for self-support and self-guidance. Studies of the after-school careers of backward children who had profited by special class training in the schools, studies such as those made in New York City and more recently in Cincinnati, show how well the public school can meet this problem when properly equipped both from the standpoint of intra-school provision, and extra-school and post-school supervision.
The importance of the community supervision of the large number of mental defectives who do not come under the control of institutions has been recognized in New York State by the organization, under the direction of the State Commission for Mental Defectives, of a corps of field agents and a number of community clinics. The work of the field agents is to keep in touch with all mental defectives in the community who need guidance and assistance in reaching a desirable level of economic efficiency and social behaviour. While the field agents supervise mental defectives of all types and ages, their largest and most important single function has come to be in practice the supervision of defective children during and especially after the school period. For the most part, even the school systems which are progressive enough to have special classes and visiting teachers, do not make provision for following up such cases after they leave school. Othei states, among them Pennsylvania, have organized similar corps of field agents in connection with a series of state-wide clinics for mental defect.
The process of socializing the feebleminded resolves itself, as does any process of assimilation or socialization, into a matter of rappvochement between diverse social elements, in this case the better elements of the citizenship on the one hand and the feebleminded in question on the other. It is a process in which all the approach is not on the side of the feebleminded. It is continually emphasized how the feebleminded must be taught to adapt themselves to the community.
There is the further fact that the community must adapt itself to the feebleminded. The community must adapt itself to the feebleminded to the extent of giving them helpful and practical training and supervision, and by making the community far as possible safe for those who are permitted to remain in its midst. Society owes it to the feebleminded to give them the opportunity to come under good influences. For the more difficult cases it should provide institutional care and training and the means whereby the more favourable institutional cases may be gradually restored to community life after their training is completed. For the remainder it should provide special classes in the public schools where they can receive the kind of instruction which’they can best absorb and which will be useful to them in later life. This social program should also include visiting teachers and social workers who can inquire into the home conditions of subnormal children and make necessary adjustments, and who will also stand ready to lend a helping hand when the sub-normal boy or girl leaves special class or institution to make his way in the world. Finally, society’s duty toward the feebleminded is not complete unless it makes available for such as need it, kindly and understanding guidance throughout life.
Those of an intelligence level which is below the standard that we now regard as normal represent no insignificant proportion of the population. Of these there are many who, by reason of favourable environment or personality or both, will get along satisfactorily without special help. Others, because of unfavorable environmental conditions and lack of adaptive powers, will not be able to make their way independently in the world. The well-organized community as a matter of social expediency will put itself in a position to know about its weaker members at as early a period in their lives as possible. It will determine what measures of social control may be instrumental in enabling these individuals sooner or later to become satisfactorily functioning units in the community life, as a preferable alternative to having them cause a serious amount of social damage or become dependents upon the group for the rest of their lives. In other words the far-seeing community will recognize the vast social and economic advantage of making such expenditures for the special education and supervision of the feebleminded as may be necessary to make social efficients of the largest possible number. It will make every endeavour to reclaim these border-line individuals for social life, and, if we may judge by the indications of the work already done in the United States, it will have a profitable measure of success.
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