Open main menu

Popular Science Monthly/Volume 54/April 1899/Mental Defectives and the Social Welfare

MENTAL DEFECTIVES AND THE SOCIAL WELFARE.
By MARTIN W. BARR, M. D.,

CHIEF PHYSICIAN, PENNSYLVANIA TRAINING SCHOOL FOR FEEBLE-MINDED CHILDREN, ELWYN, PA.

PERIODS of extraordinary efflorescence or fruitage are followed by exhaustion and sterility not infrequently demanding the free use of the pruning knife; and, just as we remark how frequent is idiocy the offspring of genius, so do we find the same seeming paradox, of mental defect in rank and increasing growth the product of this most wonderful nineteenth century.

True, science has contributed to numbers by revealing as mental defectives the many "misunderstood," "the backward," "the feebly gifted," as well as by showing what was once esteemed moral perversion to be moral imbecility; but a truth to which science also attests is, that unstable nerve centers uniting and reacting through successive generations, producing various forms of neuroses, evidenced in insanity, moral and mental imbecility, idiocy and epilepsy, do show the influence of a highly nervous age.

Our last census reports, although necessarily uncertain and unreliable, yet show ninety thousand mental defectives, not including the insane. Unrecognized and unacknowledged cases swell the number easily to one hundred thousand within our present borders—how many we are going to annex remains to be seen; but this is an enemy that attacks not our frontiers but our hearthstones. We have reached that point when we must conquer it, lest it should conquer us, and the means to this end may be summed up in three words—separation, asexualization, and permanent sequestration. "Diseases desperate grown by desperate appliances are relieved, or not at all," and we must recognize that heroic measures now are as essential to the welfare of the unfortunate as to society, which will then naturally adjust itself to new conditions. Viewing the separation and massing of these irresponsibles—innocent victims of ignorance, debauchery, or selfish lust—men will come to realize that a greater crime than taking is the giving of such life; and so a greater reverence for the sacredness of marriage, a deeper sense of the great responsibilities of parenthood, will do more to avert this evil than the most stringent marriage laws. That the present demands some restraint upon the ignorant and the indifferent there can be no doubt, and laws preventing the marriage of defectives and of their immediate descendants would go far to stem the tide of harmful heredity.

But what to do with those now in our midst is the vital question! They must be provided for in a way that shall insure safety to society, economy to the State, and protection and happiness to the individual. The answer found in the experience of half a century is, briefly, asylums for the helpless—training schools and colonies for those capable of becoming helpful. These in very name and nature being widely separate, just as separate as titles and names indicate, should be their working systems. Work among the feeble-minded, a philanthropic movement directed first toward the idiot, soon found a limit in dealing with a subject not trainable and but slightly if at all improvable. Thence, diverging and broadening as idiocy became better understood and imbecility in various phases became recognized, it found its true province in strengthening and encouraging feeble intellects, arousing and stimulating indolent and weak wills, and in training and directing into healthful channels the abnormal energy of those destitute of the moral sense. How wide the divergence can
 
PSM V54 D772 Images of the mentally deficient classified as unteachable.jpg
Excitable Idiot. Practically unimprovable. Apathetic Idiot. Practically unimprovable. Idiot-Imbecile. But slight hope of improvement.
 

readily be seen, as also how entirely incompatible with union must be work further apart in reality than is the training of an imbecile and a normal child.

For the idiot, who not only can not be trained, but who in many cases is unimprovable even in the simplest matters of self-help, nothing is needed but that care and attention found in every well-regulated nursery of delicate children, the sine qua non being regular hours, simple nourishing food, frequent baths, and tender mothering. As many are paralyzed, blind, lame, or epileptic, it is desirable that the dormitories, well ventilated, be on the same floor with the living rooms and of easy access to bathrooms and playgrounds. Covered and carefully guarded porches should afford the much-needed fresh air and outdoor life in all weathers. These, with cheerful, sunny playrooms, provided with simple toys and furnished with bright decorations varying with the season, will contribute the maximum of pleasure for this life of perpetual infancy. Low vitality, general poverty of the whole physical make-up, the prevalence of phthisis and epilepsy and kindred diseases require he daily inspection of a physician, while the comfort and well-being of the whole, both workers and children, are insured by a capable and sympatheic house mother.

The character of attendants is of the first importance, as these are they who live with the children; it should combine that firmness, tenderness, and balance that constitute an even temperament, capable of recognizing and meeting an occasion without loss of self-control. The duties involve not only the care of the idiots, but the training and direction of idio-imbeciles as aids, and this dealing with natures often wholly animal, requires a certain refinement and dignity of character—at least an entire absence of coarseness—while a knowledge of the simpler manual arts, and if possible of drawing and music, will do much to soften and brighten these darkened natures. As these qualities are valuable as well as rare, the remuneration should be in proportion: certainly sufficient to induce permanency and to compensate for such isolation. A life of constant wear and tear demands also regular periods of rest, and the corps therefore should be sufficiently large to give relief hours daily as well as vacations.

The idio-imbecile, but one remove from his weaker brother, to whose wants he may be trained to minister, finds here his fitting place, and the domestic service of these asylums may be largely drawn from this class and also from that of the low-grade imbecile. Working as an aid, never alone, always under direction, he finds in a monotonous round of the simplest daily avocations his life happiness, his only safety from lapsing into idiocy, and therefore his true home.

The relief to the home, the actual benefit to the State in this housing and care of the idiot and idio-imbecile can never be fully estimated. It is reckoned, however, in a general way that for every idiot sequestrated the energies of two if not four normal persons are returned to society.

Imbecility, mental or moral, congenital or accidental, is either an inherent defect or an irrecoverable loss, an incurable disease for which hospitals can do nothing, nor can reformatories form again that which never has been formed. Could language be made clear enough to enable the public mind to grasp this fact, the work of training schools, the only hope of the imbecile, would then be simplified, and people might be willing to accept what they can give, in the only way in which it can be given, to be of any permanent value. As it is, the few charlatans who profess to train and in a few years send out an imbecile ready to take a high-school or college course not only deceive those from whom they may gather a few thousands, but their representations, coupled with that of a sensational press, effectually impede the progress of a work which must eventually find its true place in the system of public education.

Influenced by these misrepresentations, parents come with profound idiots and high hopes of a course of training (here is one of the misfortunes of an idiot asylum within a training school), and simply refuse to accept a negative to their expectations. Again—to waifs and strays, high-grade imbeciles, developing after years of labored training proficiency in music, drawing, or some one of the industrial arts, friends will suddenly crop up and, dazzled by what seems phenomenal genius, seek to withdraw them just as they become useful to the community. Little do they know of the weak will, indolent nature, and utter lack of "go," that forbid competition with normal labor and must forever be subject to the will of another; still less of the weak physical build that is kept intact only by watchful care, and which would succumb to any undue hardship. So much for the difficulties that beset the work. Now as to the work itself.

As this must vary according to the status of the individual, a careful study and a correct diagnosis are of primary importance in order that the work may be fitted to the child, not the child to the work. The plan pursued is as follows: A thorough examination—physical, mental, and moral—is first made by the chief physician in connection with papers properly filled out giving personal and family history. He is then sent to the hospital for a fortnight to insure immunity from disease. There, while perfectly free and unrestrained among his fellows, he is under constant observation of the nurses; these observations, carefully noted, are returned to the chief physician, who turns both over to the principal of schools, designating the grade in which he is to enter for probation. Here under different environment he is again tested for some weeks and finally placed.
 
PSM V54 D775 Images of the mentally deficient classified as teachable.jpg
High-grade Imbecile. High-grade Imbecile.
Very improvable—can read, write, draw, etc.
Low-grade Imbecile Only slightly improvable.
 

It is bard for the uninitiated to understand that the grade, be it high, middle, or low, is not associated with promotion and advancement as in schools for normal children. On the contrary, it signifies the quality and status of the individual, his limitations, bis possibilities, and consequently determines almost unfailingly the training for bis life work; not by any hard-and-fast lines, but by a general mapping out of means which experience has proved will best insure his development, because best suited to his needs. Every latitude is allowed and, as the comfort of both the teacher and the entire class depends upon each going to his own place, there is easy and natural transference according to the necessity indicated by either progress or retrogression; but the varied occupations in each grade give ample scope for indulgence of individual proclivity in the means of development, and it is found that the original diagnosis, based upon experience, rarely errs.

The motto of the schools—"We learn by doing; the working-hand makes strong the working brain"—shows manual training to be the basis of the scheme of development, varied for each grade to suit the intelligence. Thus classified, various occupations are arranged and presented with the double intent of securing all-round development, and of giving at the same time opportunity for choice according to individual bent, the child being gradually permitted to devote himself more exclusively to that in which he shows a tendency to excel, and to gain a certain automatic ease in what shall prove the initial of a life employment. A knowledge of writing and of numbers is acquired incidentally as a necessary part of these occupations in daily practice, and arithmetic, taught with objects, is chiefly counting, separating into fractional parts, and practical measurements. Books are used rather as a convenient means of attracting and holding attention while inducing habits of consecutive thinking than for a knowledge of facts to be memorized. Those who can learn to read gain naturally a means of self-entertainment, of self-instruction, hence a certain amount of culture, so long as protected in an institution from indiscriminate and pernicious literature.

The low-grade imbecile, but a slight degree removed from the idio-imbecile, is, like him, totally incapable of grasping artificial signs or symbols. He can therefore never learn to read or write; figures have no meaning for him, nor numbers, beyond the very simplest counting acquired in the daily repetition of some simple task such as knitting, netting, braiding rope, straw, or knotting twine. The excitation of interest in these, which will also give hand and arm power, the arousing of the sluggish, indolent will, through the stimulus of pleasurable emotions, the physical development by means of the various drills and the moral influence of refined, orderly surroundings—these, together
 
PSM V54 D777 Images of the mentally deficient classified as moral imbeciles.jpg
Moral Imbecile
of High Grade.
Moral Imbecile
of Middle Grade.
Moral Imbecile
of Low Grade.
 

with some practical work of house, garden, or farm, which forms part of the daily routine, are all that school life can do for him.

From this preparation he passes to the industrial department, where he receives training in that occupation which the school has indicated for him, becoming in his limited way a useful and contented member of a community which should be his life home. As both of these types develop either extreme docility or perversity—the one quiet, gentle, obedient, following any suggestion even of a comrade's stronger will; the other obstinate, indolent, often brutal and cruel—the necessity for constant guardianship is therefore self-evident.

When we consider that the training of a high-grade imbecile takes four times the period commonly allotted to a normal child, some idea of the vital energy expended on the training of the lower grades may be found in the following example:

I find in our museum of educational work a little ball which I am inclined to regard the most valuable thing in the whole collection. The boy who made it was a low-grade imbecile. His hand against every man, he fancied every man's against him. Always under strict custodial care, that he might harm neither himself nor others, he would vent his spleen in tearing his clothing. His teacher, a woman of rare patience and devotedness, sat beside him one day, tearing strips of old linen and laying them in order. "See, Willie, let us make some pretty strips and lay them so." His wonder grew apace at seeing her doing what he had been reproved for doing; at once he responded, and a new bond of sympathy was established between them. She was playing his game—the only one, poor little lad, that he was capable of—and he joined in.

"Now, we will draw out the pretty threads and lay them in rows." For weeks the boy found quiet pastime in this occupation, and the violent nature grew quieter in proportion. One day the teacher said, "Let us tie these threads together and make a long string." It took him months and months to learn to tie those knots, but meanwhile his attendants were having breathing space. "Now we will wind this into a pretty ball, and I will cover all you make for the boys to play with"; and a new occupation was added to his meager list.

The next link in this chain of development was a lesson in knitting. Again, through months of patient teaching, it was at last accomplished, and the boy to the day of his death found his life happiness in knitting caps for the children, in place of tearing both them and their clothing. You see the teacher was wise enough to utilize the natural activities of the child and divert evil propensities into healthful channels. Had she brought knitting and bright yarn or anything foreign to him first, it would in truth have been fitting new cloth to old garments and the rent would have been widened: his obstinacy would have been aroused, and he would have continued to tear to the end of the chapter.

The imbecile of middle grade receives that fuller presentation of work suited to fuller capacity. Some time is devoted to the three "Rs," as it is found that attention may be aroused and concentrated in the phonetic drills, more especially if associated with pictures, and the drawing of the objects named free-hand; thus eye, ear, and hand

PSM V54 D779 Images of the mentally deficient classified as feebly gifted.jpg
High-grade Imbeciles (Feebly Gifted) at Sloyd Work.

are encouraged to work simultaneously. Those who accomplish finally the reading of short simple stories not only enjoy evenings in, the library, but may be enabled to glean suggestions for the various handicrafts for which they are being trained. This effort at quick observation and original thinking is further carried forward in the ambidextrous movements of free-hand drawing, designing, and sketching from life—finding ready and practical application in the daily use of tools. The value of the rule and the try-square is tested in the manufacture of the various useful articles in both paper and wood included under the head of sloyd, and "a boy can not learn to take a straight shaving off a plank," says Ruskin, "or to drive a fine curve without faltering, or to lay a brick level in the mortar, without learning a multitude of other matters which life of man could never teach him."

Equally useful to the girl in the workroom as to the boy in the shop is this training of a ready eye, this quick intuition of balance and proportion, this practice of obedience of hand and arm to brain, until it becomes automatic. To both, therefore, the value of such preparation will be incalculable. It is noticeable that boys of this grade turn out as good workers in the ordinary crafts of shoemaking, carpentering, and house painting as those of higher grade who, although capable of grasping more intelligently the details of work, yet do not bring to it that energy and perseverance of one who finds in it "this one thing I do." With the imbecile of high grade, able to accomplish studies equal to about the first intermediate of the public schools, there is a diffusion of interest; the intelligence broadens rather than deepens during the school period in natural response to environment. With greater grasp of numerical values and of letters he attains proficiency impossible to the lower grades in drawing, in music, in printing, and in cabinet work. Other industries will probably be provided for him as the demand increases, for it must be remembered that this is a class whose needs have been the last to be recognized in a work begun, as I have before said, for the idiot. Regarded as queer, unlike other children—unable to keep up—he has, after an unsuccessful trial at school, been kept at home, in some cases an aid, in others a tyrant, to those relatives charged with his care.

Changed conditions of both family and school, fortunately for him, combine to render this no longer possible, as absence of proper training is always certain to result in deterioration. The pressure upon the primary schools in the struggle for higher education leaves no time to contend with dull, backward children. In the family the care-takers grow fewer in proportion as the home-makers become home-winners, and so these feeble ones are a burden instead of an aid in the ordinary household offices.

The next hope is a training school where, with false hopes fostered by ignorance and sensationalism, they are entered, and after a few years, a time all too short for any lasting benefit, a sentimentality equally stupid withdraws them from that guardianship absolutely essential, with just that little knowledge which will render them more dangerous to society, because less recognizable—an evil element perpetuating an evil growth. Under both conditions these unfortunates have suffered from that lack-t>f constant care and supervision which should be theirs from the cradle to the grave.

The separation of backward children in the schools and the placing of them in special classes tor special training is the first step in the right direction. Here, after sufficient time for observation and diagnosing by teacher and physician, the defectives so adjudged will naturally drift to the training schools for the feeble-minded; these, if relieved of the odium as well as the care of their helpless population, will then be encouraged to arrange for this brighter class of defectives industries which will provide not only for development and happiness, but will largely aid in maintenance. The recognition of

PSM V54 D781 Images of the mentally deficient classified as middle grade imbeciles.jpg
Middle-grade Imbeciles.

the necessity for this weeding out of the schools, having place first on the Continent, next in England, and later in our own country, marks an era in the national as well as in the special schools. Both will be benefited largely, and formal expression of this, found in the addition to our National Educational Association of a department representing the training of all classes of defectives, is one of the most encouraging signs of the times.

The same experience which dictates the separation of the idiot from the imbecile, the backward from the normal child, urges also that a permanent sequestration would tend alike to the safety and happiness of the normal and abnormal classes. The experiment made of preparing and sending out into the world these irresponsibles has proved, to say the least, not encouraging, and the advisability of their permanent detention has become self-evident.

The heads of training schools here are a unit in urging that provision be made for those who have reached the limit of school progress. That experience has reached a similar conclusion in England is testified in the munificent gift lately made to the Royal Albert Asylum, and by the opinion of its superintendent, Dr. T. Telford-Smith, thus clearly expressed:

"It is yearly more noticeable that the public mind is coming gradually but surely to recognize the threefold value of the work of such institutions as the Royal Albert Asylum. The educational and the custodial aspects early aroused the sympathies of the PSM V54 D782 Images of the mentally deficient classified as low grade imbeciles.jpgLow-grade Imbeciles. No. 1, obstinate, perverse, indolent; No. 2, gentle and obedient. charitable; but the preventive aspect is another which must force itself upon all who thoughtfully consider the subject. The far-reaching and inexorable law of heredity is written large for those who study the imbecile."

The following paragraph, from a daily paper, shows that, in America at least, public opinion and the acts of the legislature have become ripe for action:

"The State of Connecticut is about to try a curious experiment in social legislation, having passed a law forbidding any man or woman, imbecile or feeble-minded, to marry under forty-five years of age, the penalty being imprisonment for not less than three years; and persons aiding and abetting are also liable. The hope of the legislature is to keep down degenerate families."

That this experiment is wise and justifiable who can doubt?

To glance at another and sadder, but not less real, side of the same question, can any one doubt but that the adolescent and adult female imbecile needs lifelong care and protection? Surely the noble gift to the asylum by Sir Thomas Storey of a home for forty such cases is a wise, far-seeing, and statesmanlike act.

It is greatly to be hoped that this noble example may be speedily emulated on both sides of the sea, and that each State may shortly possess, in addition to its training school, its own colony farm with all the industries of a village, drawing its workers from the well-directed energies of a carefully guarded community. Cottages, each with its house mother, would insure that sense of home, and that affectionate and sympathetic oversight so essential to this society composed of those who are always children, while measures, which science has already pointed out and experience proved as advisable, might, if protected by wise legislation, permit less vigilance on the part of caretakers and consequent happiness because of greater freedom to its members.

It is a happy coincidence that Massachusetts, the pioneer State in the work among the feeble-minded, should in its fifty-first year celebrate the beginning of its second half century by the inauguration of this most eventful step in the onward progress of the work. The training school at Waltham has lately purchased sixteen hundred and sixty acres of land for the establishment of a colony which is to have natural and healthful growth from the fostering care of the parent institution.

As these colonies increase, drawing from society a pernicious element and transforming it under watchful care into healthful growth, may not in time the national Government, finding these homes of prevention a more excellent way than prison houses of cure for ill, be induced to provide a national colony for this race more to be commiserated because of a childhood more hopeless than that of the two others in our midst on whom so much has been expended?