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of feebleminded persons, the prevention of delinquency, and the most effective utilization of the labor represented by the feebleminded population. Nothing is simpler than to give the logical solution to these problems. The reason such a solution is not simple in practice is that human life is not primarily logical. We are still a long distance from conscious intellectual control of social life, and even so the most rigorous intellectual control would obtain its results only through taking into account the working of human impulse and emotion.

Sterilization of the feebleminded is logically the solution for the pioblem of prevention of propagation of the mentally unfit where feeblemindedness is due to heredity. Practically, despite legislation, it has never worked because it is a purely intellectual remedy. It has never considered the prolonged period of preparation and education necessary to change deep-seated primitive attitudes. There may come a time when sterilization of the unfit will be worked into our program, but it will be only when the general level of enlightenment on social problems is materially raised by slow growth.

Segregation, much more than sterilization, offers a practical solution to part of our problem at least, and it may eventually be the final, most practical solution. At present it fails in two, possibly three, respects. First, on the human side, when by segregation we mean a fairly complete shutting off from society of all the feebleminded, including the higher grade types, we ignore a profound aversion on the part of people in general to confinement for life for any human being, particularly when no offense has been committed commensurate with such punishment and when the individual to be segregated seems to the ordinary observer not to be very different from himself. This, combined with the feeling which relatives, particularly of the high grade feebleminded have against segregation, makes any very complete program of this kind quite impossible for some time to come.

Quite aside from the obstacles presented by popular sentiment, there is one fundamental difficulty in the way of segregation as a complete program on the purely economic side, and another which may or may not be fundamental. If the most conservative estimates regarding the percentage of feebleminded in this country now under suitable institutional care are correct, it still remains to provide institutions for at least fifty percent of the total feebleminded population of the United States. According to Mr. Kuhlman (in the Journal of Psycho-A sthenics for September-December, 1916) estimating that five per cent of the entire population is feebleminded, not five per cent of the total feebleminded population is now segregated in institutions for the feebleminded. Even if one disagreed with this estimate, it could be made far more conservative and still leave us with the task of housing a tremendously larger number of feebleminded than any state has ever contemplated. Any approach toward complete segregation is going to mean a construction of institutions on a scale which will postpone realization of the scheme to an indefinitely distant future. In the meantime, the feebleminded are with us, at large in the community for good or ill, with no conscious control of the situation on our part.

The other point to be considered on the economic side is the utilization of the labor of the feebleminded. We have no conception at present how much of the rough work of the world is being done by morons. We are just beginning to get some return from the labor of the feebleminded in institutions through the rise of the colony plan in a few states. But we have no basis for deciding at present whether segregation can ever be made to utilize the labor of the feebleminded to as great economic advantage as some other plan which would allow of the employment of feebleminded in the industry of the outside world. This is a question for consideration and for further investigation, that we may gain facts on which to make a judgment.

Practically then, sterilization from the point of view of human prejudice and segregation from the standpoint of human rights and economic possibility do not constitute an adequate program for the care of the feebleminded population of the country at least for the next quarter century. Even though we press sterilization into service just as far as popular sentiment can be made to tolerate it, and though regardless of sentiment we construct institutions to the limit of the common purse, making full use of the cheaper plants offered by the colony plan, we shall still have a large problem untouched in the feebleminded at large in the community. Shall we continue for the next twentyfive years to depend entirely on segregation and remain in ignorance of the facts regarding the lives of the feebleminded outside institutions?

Important Factors Undetermined How can we decide whether all the feebleminded need segregation; how can we be sure that every feebleminded person is a potential delinquent until we know how many of the steady though humble and unskilled workers of the world are intellectually superior to the feebleminded delinquent or segregated case in the institution for the feebleminded?

Our knowledge of the feebleminded is based almost entirely on our knowledge of intellectually inferior individuals who make trouble for us in society. Is it impossible that there is a class of individuals who by any intelligence test will measure down to the level of the l'nstitu,tional cases whom we label feebleminded, but who are not social problems? The whole question of feeblemindedness seems to be complicated by the question of how much of the anti-social or inefficient conduct of the higher grade types may be due to the intellectual defect and how much to the emotional makeup. That is, may there not be as much temperamental variation in the feebleminded as in the intellectually normal? And that being the case may not the standard of feeblemindedness indicating segregation be as much a matter of type of emotional and impulsive makeup as a matter of degree of intellectual defect? In other words, we seem never to have made any real attempt to study the problem of the feebleminded in the community, to determine

(1) whether there is any class of people apparently feebleminded by our intelligence standards which actually does get along in the world;

(2) to determine what real supervision, intelligently conceived and applied, can do to make the existence of certain feebleminded individuals outside of institutions safe and economically advantageous to society when it would otherwise not be so; (3) to find in how far the so-called feebleminded delinquent is innately vicious and how far he is the result of prolonged maladjustment due to defective intellect, emotional and impulsive make-up, complicated by bad environment and training; i. e., may it not be possible that even in the field of intellectual defect the insight of modern psychiatry as to the mental mechanisms which produce maladjustment in the intellectually normal may have a bearing?

Plan to Combine Treatment with Prevention

The best plan for supplementing segregation and sterilization for the present, even though they should ultimately prove to be the only solution to our problem, the only way to obtain the kind of information we need and must have about the feebleminded, the best scheme for educating the people to a comprehension of the problem and a willingness to accept segregation and sterilization when necessary is, it seems to me, the plan for careful, scientific supervision of the feebleminded in the community as part of a state or nation wide program for control and prevention of feeblemindedness.

I have no theory that the majority of the feebleminded would become industrially efficient, sexually safe or economically self-supporting, if only they could be supervised. I have no illusions regarding the difficulty of providing anything approaching adequate supervision; but I am convinced that for the present there is no other way of getting at the problem, and, after all, it is not as if we had not already taken upon ourselves responsibility for trying out such a plan when we began the movement for ungraded and special classes for feebleminded children. Is that work all to be wasted? Are we to look after these children until they are fourteen or sixteen and then suddenly throw off all responsibility even to the extent of making no attempt to provide institutional care when it is obviously needed?

The school and the ungraded class give us the nucleus for a system of supervision which could be worked in so simply that it would not only not meet with opposition but would be welcomed by the children and by the parents.

In order to make such a system of after care effective in a school system, three things are essential: (1) an adequate mental clinic under the direction of a psychiatrist with psychological training, or of a psychologist with psychiatric viewpoint and experience. Such a clinic ought to provide a routine method of passing on the mentality of every child who enters school in order that the assignment of the child to a special class should not depend chiefly on chance and should not be delayed for several years while the child is struggling vainly in the regular grade and getting the full effects of his maladjustment. This clinic should be the center for a system of registration for the direction of social service and after care and for the vocational guidance of the feebleminded child both in his industrial training and in his placement after he leaves the school. (2) The second essential of supervision is social service, from the time the feebleminded child enters the special class. If a trained social worker with psychological background could act as visiting teacher for the special or ungraded classes, keeping in touch with both child and home, following the child's development, keeping track of his conduct out of school, educating his home to a right attitude toward him, helping him to use the best recreational conditions the neighborhood affords; when the time came for that child to leave school, the combined knowledge of the teacher, social worker and clinic director ought to give a reliable basis for deciding what should be done with him. They would know what his abilities were, what his chance of industrial success, what his tendencies to anti-social conduct and if he seemed to demand institutional care, the friendly relationship with the parents built up by the social worker would offer the best possibility of inducing the parents to permit segregation.

(3) The third necessary factor in a system of supervision is a vocational and employment bureau which shall be merely another phase of the mental clinic and the social service. This bureau would not only attempt to place the feebleminded child in an occupation for which he was fitted, but it would continue to supervise him carefully through the social service worker. Such supervision would do much to keep the feebleminded child steadily at work—not only because the worker could come in at a crisis to help adjust his difficulties and tide him over a period of discouragement, but because the worker would explain the child to the employer and through her ability to adjust problems as they arose would make the employer willing and able to keep a class of workers who might under ordinary conditions be impossible. Such a bureau would have to work up the whole problem of employment of the feebleminded, finding where the feebleminded child can best be utilized, interesting employers in the possibility of making conscious use of feebleminded labor, inducing them to try various experiments with such labor under supervision.

Objections Met

It may be argued that such a system, to be at all adequate, would be expensive out of all proportion to the results. In answer to that it may be said in the first place that we know nothing about the results, certainly not from any experience in this country. In England and Germany and one or two other countries, a certain amount of after care has been tried, with rather poor returns in case of England, and apparently good ones in case of Germany. I doubt very much whether such after care has been done with any but volunteer workers and under any but fairly haphazard and unscientific direction. It seems to me we shall have no grounds for judging the effectiveness of a careful scientific system of community supervision until we have given at least a five year trial.

As a supplement to supervision through the school system, we have in the institutions for the feebleminded, especially those with the colony system and field agents, machinery all ready to our hand for the supervision of institution cases who have improved with training and proved themselves fit for a greater measure of freedom. The institution for the feebleminded is also the logical laboratory center for the schools in its district, and school and institution might well combine on a thoroughgoing plan of training and community supervision wherever possible.

That supervision will be expensive, there is no doubt—but there seems to be no way to avoid the expense entailed by the production of the unfit. Segregation is expensive, special classes are expensive—although perhaps no more so than institutional care for children who are too young to make any return in productive labor—the feebleminded at large in the community unsupervised are expensive. It is not a question of whether we shall or shall not pay for the care of the feebleminded. It is merely a question of whether we shall pay blindly or consciously, whether we shall pay in crime, in courts, in reformatories, in prisons, in almshouses, or whether we shall pay in directed care calculated to give us the facts which may in time make control and prevention of feeblemindedness possible.

It may be argued that such a scheme is impractical because of the numbers to be surpervised and the necessity for real supervision if the plan is to amount to anything.

From one point of view any complicated, extensive task involving care of many human beings is impractical, it is never done simply or easily. The effective education of children in schools is a gigantic task, seemingly almost impossible of accomplishment. But we never consider abandoning it because results are not always ideal or economically profitable. Successful supervision in the community is coming to be the final aim and ultimate criterion of achievement, for the hospital, the prison, the court, the reformatory, and the hospital for the insane. We call these systems probation, parole and after care and no one questions their value or measures them by their economic advantage. It really is not a question of whether or not a system of community supervision of the feebleminded will be simple or cheap. It is a question of when we are going to begin to do this thing which has to be done before we can

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