they can be drafted off into state institutions for the feebleminded. In the light of these views it is not surprising that many school officials hesitate to make adequate provision for the education of the mentally retarded. But let us consider these objections more carefully, to see to what extent they are well founded. In the first place, is it true that most of the mentally retarded are delinquent or in imminent danger of becoming so? While it seems to be true that most of the delinquent children in the public schools are mentally retarded, it does not necessarily follow that most of the mentally retarded are delinquent. In the large cities that have separate special classes for the delinquent and the mentally retarded the enrolment in the latter is almost invariably several times greater than in the former, although in the classes for the delinquent are found pupils of normal intelligence as well. This is all the more surprising when it is borne in mind that delinquency frequently originates in the discouragement and humiliation that comes from repeated failure, and usually the mentally retarded child has had abundant experience with failure before he is put into the special class. In the public schools of Detroit in June, 1924, the enrolment in special classes for the delinquent was less than 400, and in special classes for the mentally retarded, more than 2,600. However, among the 2,600 there were 6 per cent who had been behavior problems during the school year. Counting in this 6 per cent with the pupils found in special classes for the delinquent, the total is less than 20 per cent of all the mentally retarded. In other words, more than 80 per cent of the mentally retarded are not behavior problems. Not only are most of the mentally retarded not delinquent, but the largest percentage of delinquency is found, not among those most seriously retarded mentally, but among those of less mental retardation. However, it may be said that many of the lower grade feebleminded delinquents are sent to institutions for the feebleminded instead of being committed to reform schools or penal institutions. If this were true to any great extent, we should expect to find in these institutions a much larger percentage of males than females, for it is a well-known fact that male delinquents greatly outnumber female delinquents, yet the statistics for the country as a whole show that in institutions for the feebleminded the sexes are almost numerically equal, 51 per cent being males and 49 per cent females. In special classes for delinquents in the public schools the percentage of the mentally retarded who have an intelligence quotient under 50 is less than it is in the special classes for the mentally retarded. Furthermore, in the latter it is usually the pupils with intengence quotients above 50 who are the troublemakers. Looked at from almost any angle, it is evident that the most seriously retarded mentally do not furnish as large a percentage of delinquents as those of less mental retardation. Let us now consider the second objection to the adequate education of the mentally retarded, namely, that it is a waste of money because they can never be made self-supporting members of society. To what extent is this true? The followup work that has been done in Detroit and in other cities with the boys and girls who have been in special classes brings to light the fact that some of them with a mental age of eight, and a few of even a lower level of intelligence are law-abiding, self-supporting members of society. But what shall be said of the 15 to 20 per cent who have an intelligence level, at the time of leaving the special classes, of less than eight? For with the best of training in special classes few of them will ever become self-supporting. Many feel that this group has no place whatsoever in the public schools, and should be excluded as institutional cases. In fact, many school systems refuse to take into special classes pupils with an intelligence quotient below 50 who have a mental age of less than five. This means that these children cannot even enter the public schools until they are ten or eleven years of age. During this period the child remains at home, a burden to parents often hard-pressed to provide the necessities of life. Yet even under such conditions most parents are unwilling to send a young child away to a state institution. Would it not be a wiser policy to provide a class in the public schools for such children and put in charge of this class, not a high-priced teacher, but a matron who would look after their physical needs and teach them the simple practical things children of their level of intelligence are capable of learning? If, under right conditions of training and instruction, 80 per cent of the special-class children possess the possibilities of developing into self-supporting, law-abiding citizens, the problem of special training has the greatest significance, especially when the other alternative is considered, viz., support in a state institution either for the feebleminded or for the delinquent. But it is evident to most of us who are engaged in the work of educating handicapped children that we have a long distance to travel before we shall be able to develop into law-abiding, self-supporting citizens 80 per cent of the mentally retarded who come under our direction. It is not enough that we provide proper physical training and health instruction, that we insist on the formation of desirable habits, and give them that knowledge which will be of most worth to them in those simple occupations that they are destined to enter. To be successful we must get them early. It is too much to expect us to take them, after they have become discouraged and delinquent through repeated failure, and convert them into useful members of society, when we have them under our control only five or six hours per day, five days in the week, nine or ten months in the year. Even those schools and institutions which have them under control twenty-four hours per day find it difficult to break up bad habits of long standing and form new ones that will stand the test of experience in our complex social and industrial life. It is the same old story: an ounce of prevention is worth a pound of cure. It is even not enough if we get these children into the special classes during the first year of their school life, before they have become discouraged through failure in school. We must reach them during the preschool period, for there is such a thing as disheartening failure long before the child enters school. We dare not forget that most of them come from the homes of the poor, the ignorant, the unintelligent. They come from homes where children are neglected through ignorance, or through poverty, or indifference. If those in charge of special education regard their domain as not extending beyond the school, the work is doomed to failure. The department of special education is the trouble department of a school system. We must go to the seat of the trouble, which in such a large percentage of cases is the home. Habits which may determine the entire future of the child's life are formed during the preschool period. We must not forget that one-third of the feeblemindedness is due to nonhereditary causes. But this knowledge will be of little value to us if we close our eyes to the fact that many of these children suffer from wrong feeding, insufficient clothing, preventable disease, and improper training during the years before they are of school age. But how are these children of preschool age who stand in need of help to be found? One way is through the organized charities, for where a family is so poor that financial assistance is needed, ignorance and incapacity are also apt to be found. A second channel of approach is through the children in the special classes for the mentally retarded. One mentally retarded child is all too often a precursor of another in the same family. In some special classes there are at one time two or three children from the same family, The third objection to special education is that it simply increases the number of mentally retarded boys and girls who will probably marry and propagate their kind. For we make the girls more attractive as wives by the practical training we give them in sewing, cooking, and laundering, and we make the boys self-supporting through the varied training we are offering them along manual lines. In other words, the more successful special education is, the more children we shall have who need special education. It must be confessed that there is something incongruous in the more intelligent members of society spending their lives in educating the least intelligent without seriously attempting to remove the causes of mental retardation. We have already suggested that much can be done through preschool training, especially for that large group of children whose mental retardation is due to environmental causes. But what shall be said of the larger group, constituting not less than two-thirds of the mentally handicapped, whose condition is due to hereditary causes? It is true that the special class affords an excellent opportunity for the discovery of the more serious of these cases with antisocial tendencies before they have committed crimes or reached the age of adolescence. These could well be confined in our state institutions for the feebleminded. But even if those with antisocial tendencies were confined in institutions, there remains the problem of the much larger group of the mentally retarded who are reproducing their kind in large numbers. We deprecate the increase in the birth-rate among the inferior classes and the decrease in birth-rate among the upper classes, and raise our hands in despair in regard to what should be done. The fact is, as everyone knows who has given any thought to the matter, that birth control is practiced by the middle and upper classes, but that this knowledge, which is current among the more intelligent, is not the common possession of those most inferior in intelligence. Then why not give the mentally retarded instruction in birth control? Why not recognize the fact that the sex instinct and the parental instinct are not the same? The sex instinct may be very strong with little or no desire for children. If free clinics were established where knowledge in regard to birth control might legally be obtained from physicians, the problem of the excessive increase in the number of defective children would in large measure be solved. For then nurses and social service workers could direct to these clinics those standing most in need of this information. Can anything be more unintelligent than for the intelligent to go on caring for and educating the handicapped without attempting to reduce their number? INDIVIDUALISM AND THE ORGANIZATION IN A COMMUNITY Adolf Meyer, M.D., Director, Henry Phipps Psychiatric Clinic, It is just ten years since I discussed before the Conference on Social Work the organization of a community into districts with a constructive community program and a review of the available helps for mental health problems obtainable through district and community organization. When I undertook to review the problem again for this occasion I became very conscious of a profound change that has taken place we might almost say a temporary revolt against organization of the type I looked forward to and an emphatic assertion of individualism. I feel today the urge to deal with the new problems which have come to the front through the trend of the times in the direction of individualism and certain counter movements. How can we learn to organize our work and forces in keeping with the ever more largely individualistic mood of the times? I hope to show that mental hygiene has, from the start, been headed in a promising direction by turning more and more to a dynamic conception of man instead of fixed traditional notions, and to a broad interest in the beginnings of difficulties in addition to its concern for the mending of full-fledged trouble. Nearly twenty years ago Clifford Beers came to me, recommended by Dr. Stewart Paton and William James, with the page-proof of his personal experi E ence in the land of mental disease. He was full of a zeal for reform, anxious to have the legislators of every state stirred to investigate the asylums. Fortunately, his fundamentally broad bringing up allowed him to rise enthusiastically to the suggestion of turning his whole energy toward the constructive task of what we then decided to call mental hygiene. Not that we turned our interest away from the so-called asylums and the full-fledged patients inside and outside of the institutions, but we thought more of each patient as an individual and of the conditions under which we might get at the root rather than at the consequences of troubles. One of the first preparatory steps in practical spheres probably had been the introduction of the indeterminate sentence and the parole system in our prison reform. That which the older Christian teaching alone does not seem to have been able to bring about, i.e., a fundamental obligatory desire for understanding and forgiveness and a melioristic and helpful interest instead of punishment, was to take root in the reformatories on ground of common sense. There evidently were cases and spheres in which the doctrine of retaliation had to yield to the recognition that those who are caught are not necessarily worse then those who are not caught. The decline of faith in purely verbal goodness makes many of us realize more of our own undesirable tendencies and actions as well, and inclines us to be more patient with our less successful fellow-beings. A most practical influence in the right direction came from such places as the juvenile court of our Judge Lindsey, with its introduction of equity principles and a spirit of helpfulness instead of prosecution. Then came the work of Dr. Healy and others, which pointed to the extension of the study of the behavior problems to schools and even to the preschool period. Our 1914 survey of a school district of Baltimore was followed by surveys of the school populations in numerous states, all of which have given us a demonstration of the need of attention to mental difficulties in their beginnings. It is not only the feebleminded that constitute the 10 per cent of all children that ought to be studied before they are ruled or allowed to rule themselves. There is today a general awakening to all kinds of behavior problems, demanding a working together of school and parent. The habit clinics were developed, and since then the National Committee for Mental Hygiene has been enabled to establish its child guidance clinics, nominally for the prevention of delinquency, but really a step toward reaching the broader needs of health, happiness, efficiency and social adaptation. We are at times made to believe that all our mental hygiene work and effort aims largely at the prevention of "insanity and crime," just as the early advocates of psychopathic hospitals made it look as if, through the creation of a psychopathic hospital in each state, the existing state hospital care would then be made less expensive and perhaps in part unnecessary. To be sure, early work means a heading off of some of the disastrous depth of aberration and deviation, and much unnecessary blundering. But the chief goal is much more direct: it offers prompter and more and more enlightened help to both |