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Mr. Fitzpatrick suggested that my role this morning might be one of challenge and inspiration. I think we had yesterday the most inspiring day this Association could ever have hoped for at a convention. Anything further along this line would be an anticlimax and besides somehow inspiration is not exactly my long suit. But when Mr. Fitzpatrick suggests that I might throw out some challenges I am quite ready to do so, even though the challenges I would like to discuss here today may impress some of you as rather dreary and dry. Thus I have selected as my topic "Old Words and New Challenges" because at this time when with the publication of the Report of the President's Panel, all sorts of new vistas, all sorts of new programs are developing, we must be doubly sure that we speak a common clear language.

As I have visited during the past several years the facilities and services for the mentally retarded throughout the country, conferred with hundreds of committees and commissions, and reviewed journals and recent books, I have become increasingly concerned with the problem of semantics, the problem of the use of words and the meaning of these words. I know that in this connection many people very impatiently speak rather glibly of playing with words, of splitting hairs, and particularly in an organization geared so much for action as ours, they often tend to ignore these problems of terminology, of semantics, and urge us "never mind the words -- let's get on with the work". Yet, words have deep meaning and we of all people dealing as we do with individuals whose particular deficiency is so often in the area of language, really ought to know what it means not to be able to speak out clearly.

Yesterday morning, listening to one of the early university sponsored television programs, somebody mentioned Chester Bowles' phrase that we are witnessing now everywhere in the world a Revolution of Rising Expectations, a revolution (in the philosophical sense of the word) of ever-increasing expectations of what the individual may expect for himself and for others. An example was given in terms of semantics which struck me as particularly applicable to our topic today. It was pointed out how the meaning of the word individualism is now being interpreted so very differently. It used to be rugged individualism -- rugged individualism for the few -- an excuse for unilateral action by the strong. But increasingly we are now talking about individualism as the opportunity for the many and it impressed me how this applies very definitely to our large institutions where "individualism" should mean making it possible for each of the residents to be considered individually within the confines of a larger group, to be allowed to be a person. Here you have just one example, this one word "individualism" which may point to almost diametrically opposed program objectives in terms of what you propose to do for people.

Let me give you a few very concrete examples from our field of endeavor so that I can convey to you what I am concerned about and where I see work to be done on the State and local, as well as national level.

One of our most progressive Mid-western States has this very month published a very important report produced by a committee of distinguished experts and community leaders. I was dismayed to see that this report, otherwise most interesting, most challenging, specifically selects as the three general categories of mental retardation applicable to programming for all the mentally retarded regardless of age, the terms "educable retarded", "trainable retarded" and "dependent retarded". This is all the harder to understand as the report makes reference to the new Manual on Classification of the American Association on Mental Deficiency which of course, as I hope you all know, two years ago recommended a four level classification of mildly, moderately, severely and profoundly retarded.

While some of us had certain quarrels to find with this classification, overall we thought this was a mighty step forward and yet here comes a new report by an able group which has worked very hard but which simply falls back not only to what now should be past but to a use of terminology that wasn't sound ever.

Particularly as we deal increasingly with the adult retarded, the use of the words "educable retarded" and "trainable retarded" becomes more and more damaging, if not pernicious, because it simply labels the mentally retarded person for life on the basis of what we earlier judged his adjustment to be to a particular school situation. Surely most of you are aware that these were terms specifically selected to deal with a technical educational situation -- to what kind of school group a particular school child should be assigned. It gives rise to concern if this kind of school classification is now used in a broad general application to retardates of all ages by such a distinguished committee, because if we have learned anything in the field of the rehabilitation of the adult retarded it is that we by no means can take school performance as a sure predictor of later vocational performance.

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It should be obvious that lack of attention to basic terminology makes it very difficult for us to communicate. One of our biggest problems right now is to establish communication between the field in which we first began most of our activities, that of the schooling of the mentally retarded and the newly developing field of programming for the adult retarded. To put roadblocks in our way by using misleading and confused terms at a time when we have a better terminology available is the kind of thing we all must work hard to avoid.

While I have used as an example a report released just two weeks ago, I could of course make reference to many other States where similar confusion exists and exists to the peril of the mentally retarded.

It is bad enough that we have among the leading professional organizations still no common agreement. As you know the American Psychiatric Association still goes its own way with regard to mental retardation terminology and any time you deal with a member of that professional group you have to be very careful to find out what he is talking about because his classification scheme is quite different from that which, for example, psychologists are using. Anyone who is following educational literature knows that the educators have anything but a common terminology in mental retardation but that we ourselves continue to add to this confusion is particularly deplorable and, as I said, is something that occurs to the peril of the mentally retarded.

A situation which is similar in terms of the misapplied use of words, and which I would like to pick up as another example, relates to the term "crib cases" in the field of residential care. We still talk a great deal of crib cases. Now, if institutional reports do this simply because this is the way their statistics were set up in the past, this is one thing. If people in our own organization do it, this is quite a different matter. What are we doing here semantically? What is wrong? A crib case is an individual who on admission was judged to need 24-hour bed care. Many of these individuals not only are young in years and need the protection of a crib, they often are on admission physically in such a condition that they need this special protection. But what we are doing wrong is that we label the person rather than the service or facility he needs as we first see him. Once and for all he is a "crib case". To be sure, in a few of our States new programs have been introduced which for the first time provide a planned aggressive therapeutic approach to these profoundly retarded patients. These States have recognized that though an individual may need a crib type of care at one point, the grave error made in the past was simply to take for granted that this was the care he should receive indefinitely. Thus, our crib wards provided an environment and a type of care that hardly was conducive to improvement.

The same type of problem has been so damaging to many of the children with mongolism (or as we are now supposed to say, "Down's Syndrome"). There was insistence that they could not learn and that for this reason they should not be admitted to classes. Then it was proved with their subsequent inadequate performance as young adults and adults that indeed they were quite incapable of learning! However, just as we now have in our progressive institutions a breakthrough, a turning away from this negative approach to a positive treatment program for the profoundly retarded, so we see an increasing number of school systems ready to take a second look at the child with mongolism and to admit him to school if his individual performance makes his progress there a probability.

In any case, the point I wish to make in this context is that we certainly should not fall any longer into this mistake of thoughtlessly labeling a human being in terms of the kind of care which at any one time was thought to be appropriate for him.

I wish we had the time to go on with this and to give a searching look at our institutions and community services in terms of existing terminology, since we would find over and over again programs which are at a standstill because the kind of words used to describe the program are restrictive in themselves, and therefore do not suggest providing the proper care for these individuals. "Custodial care" is an example.

The question, of course, is can we endow a given term with a new meaning or must we replace it with another term so as not to harm the very program we wish to pursue. There have been those among us who have taken it as a bit of an artificial way of doing things that NARC, for instance, has insisted we no longer have an Institutions Committee but a Residential Care Committee. Yet, if we use promiscuously the term "institution" with its past and present connotation, and at the same time set out, as some States are now doing, to create new types of facilities, (small residential units for temporary care, for example) can we really do a good job of selling to the community what we want to do by using language no longer equal to the new challenge we want to pursue? If you still don't quite see the point, just change this to the verb form and speak of institutionalizing a child, and you immediately will recognize that this just doesn't fit anymore, this is no longer what we wish to imply with the new program of residential care.

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But we should not just worry about old words and new challenges, we should also look at another danger and that is the problem of using new words for old challenges. A new kind of tomfoolery is going on in our institutions, characterized by such terms as remotivation, therapy, group therapy, adjunctive therapy. As a matter of fact, in some institutions you can't turn around without running into somebody who proclaims he is doing therapy for something or other. Yet, take a second look and you will find he is working at the old stand, doing what he has always done, in the same inadequate surroundings with the same inadequate tools.

I read a very interesting editorial the other day which comes from a different field, my former field of endeavor of criminology. Dr. Melitta Schmiedeberg, a very fine psychiatrist, had this to say in a recent editorial in the Journal of Offender Therapy:

"For a generation we have glamorized 'therapy' and 'research'. Today disillusionment in therapy is rampant and there is a danger that research will meet the same fate. Both have been expected to magically solve all of our problems without true thought, effort or sacrifice. To fit our day dreams, the concept of therapy has become increasingly so all-embracing that by now it is impossible to agree on the answers to such basic questions as -- Who is to practice therapy? What are the legitimate methods? What are its professional ethics? What are its desired clinical results?

The semantic value of 'therapy' seems miraculous: by naming a relationship therapy it becomes automatically effective and beneficial; by calling oneself a 'therapist' one's status, salary and self-esteem becomes enhanced; to be in therapy gives comfort and a sense of being progressive. It has been estimated that three million persons are in 'therapy'. We are however slowly beginning to realize the disastrous aspects of this Fata Morgana. The ever-increasing trend to replace love and service to one's neighbors, the only basis of any society, by paid and status-giving therapy is in the long run disintegrating, But though we feel uneasy about our 'achievements' we cannot undo the last 25 years; nor do we understand why, if every aspect seemed so right, the sum total should prove so wrong."

Apply this kind of sober thinking when next you visit your State institution and come face to face with all this adjunctive therapy and remotivation and group therapy. Whenever an attendant has 5 residents throw a ball around in a circle, this is now called "group therapy". That is, of course, a mockery of the concept of therapy and a dangerous mockery, because how will we ever introduce good therapy where it is needed if we now allow our State administrators to fool themselves and us by thinking we can achieve improvement just by giving things new names without changing basic qualifications, basic personnel standards, basic facilities in the institution. In most of our institutions it is utterly impossible to give therapy. How can you give therapy in a dormitory building crowded with 70 to 100 people?

Harold Peterson, the administrator of the Brainerd State School in Minnesota, recently felt impelled to take a second look at something which many superintendents are very proud of, his ever growing volunteer activities. As a result, he wrote an editorial in the Brainerd Newsletter and titled it "The Game of Activity Jackstraws". Listen and maybe you will write him for a copy and show it to your own superintendents or call your residential care committee's attention to it.

"Behind any program in an institution for the mentally retarded there must be, we think, a belief in the limitless value and a certain equality of every human being regardless of his or her degree of intelligence. There must be a belief that every human being has capabilities which may be developed and that every human being has a right to that educational training which is in harmony with his needs, be they however lowly or different.

It may be quite impossible to prove scientifically that the equality of human beings exists. Nevertheless, this is an idea which is deeply inherent in the Christian philosophy and is reflected in the Declaration of Independence which is a most basic document in the development of American democracy. At any rate, it would seem to be very difficult to create a therapeutic community without a deep regard for the innate worth of each human being in such a community.

We are in the business of creating treatment programs for institutionalized mentally retarded patients. On the basis of our fundamental philosophy mentioned above we suggest that our programs must contain the following elements. First, all programs should be based upon a very careful, highly individualized study of the patient by building and by ward. Secondly, all programs should be in harmony with the kind of attitudes which promote the greater self-discipline, freedom of the patient. Third, there should be a part in every broad program for every patient and this goes down to the severely retarded bed-fast patient. Fourth, it is obvious that for the operation of the necessary programs there must be the needed personnel. Fifth, we feel that every program developed here should have progression and promotion built into it. Sixth, there is a great necessity of setting up some system of measurement so that we may really know that the particular patient is being improved or not by any part of our program.

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In conclusion it may be said that a 'program' without capability of measurement of its effect may really be nothing but an 'activity'. Enough of such unmeasureable 'programs' and we have nothing but a pile of 'activity' jackstraws, not really planned to train or help the patient.

Plainly, too much of 'training' effort in our type of institution is hopeful guesswork rather than scientifically determined."

That a superintendent comes out in a newsletter directed at the volunteers working at his institution and instead of just saying "come in, more and more of you", suggests that we must take stock whether we are fooling ourselves, whether we are simply carrying on activities without really knowing what we are doing, is certainly a very reassuring and very hopeful thing.

May I now address myself to an entirely different problem of semantics and one which perhaps is the most important one facing us at present. The NARC Board of Directors has just passed the following Resolution:

Whereas at the 54th Annual Meeting of the Governors' Conference in Hershey, Pennsylvania, on July 2, 1962, a Resolution was adopted, calling for the development in each State of a comprehensive master plan for coping with mental disability and promoting mental health; And whereas this Resolution lists mental retardation merely as a "condition related to mental illness" alongside of alcoholism, drug addiction and delinquency; And whereas such choice of words harks back to the days when in terms of patient care, food, clothing and personnel institutions for the mentally retarded received less attention and lower budgets as compared with institutions for the mentally ill; And whereas the President of the United States has in several statements pointed to mental retardation as a major national problem which far too long has been neglected; Now therefore the Board of the National Association for Retarded Children assembled at Chicago, Illinois, the 17th day of October, 1962, strongly urges the Governors of the several States to give separate, adequate, and appropriate emphasis to the problem of mental retardation alongside of but not subsidiary to the problem of mental illness.

Unfortunately, there is not time to document for you today in detail this very serious problem. I do have before me here document after document from official sources in the Federal Government and from official communiques of the American Psychiatric Association and from the leading handbook of psychiatry indicating that this underplaying or sidestepping of mental retardation is a problem which has slowly been generating. As a matter of fact, in some States, as for example California, we have reached a point of complete confusion because there it is specifically stipulated that mental illness includes mental retardation, yet in daily practice this is quite forgotten, as are so often the mentally retarded themselves.

What I am worried about at the moment, ladies and gentlemen, is not just a little purity of language, a little semantic "jag". What I am worried about is the following: We are going to have as a result of the President's Panel on Mental Retardation undoubtedly a good bit of new Federal activity. Now I know that some of you may say that you have this all taken care of in your State because your institution is under the Board of Education, or your institutions are in the Department of Public Health, or you have some other, separate, different set up. But this is not a sufficient safeguard because Federal monies will be made available from Washington with rules and regulations emanating from Washington. And if you would like to hear a negatively inspirational talk on the effects of ill prepared restrictive instructions, for instance on the program of community mental health services, I would quickly relinquish this rostrum to Jerry Weingold or to an appropriate person from California who could point up by chapter and verse and, more importantly, by dollars and cents, what deplorable discrimination against the mentally retarded has resulted from this confusion.

Now may I clear up one point. We are not on the warpath with the National Association for Mental Health. To the contrary, we never had a better, more active and more constructive relationship with the National Association for Mental Health, never a more clearly formulated liaison. We are partners with them. We are partners with the Council for Exceptional Children. We are partners with the National Rehabilitation Association. We are partners with the American Academy of Pediatrics and to some extent now even with the American Medical Association. In other words, we are partners with any and all national organizations which impinge on our field and wherever we impinge on their field. But we are at odds with federal and state pronouncements and policies, with textbooks and professional associations to the extent that they express terminology and definitions which do not soundly represent present day knowledge of mental retardation.

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What we are concerned about and why this Resolution was passed is the fact that this confusion in terms, this inclusion of mental retardation in mental health at one time, and excluding it the next moment, has lead -sic-, I repeat, demonstrably in dollars and cents to a severe discrimination against the mentally retarded. It is for that reason that we recently sent out several memoranda to our membership about this relationship between the field of mental retardation and the field of mental illness, both of them being part of what you might call mental disorder, both of them related to mental health but each having its own frame of reference.

Lest you feel that I see things under the bed, let me read from a letter that comes from the National Institute of Mental Health and was directed to a State official in one of our Western States who specifically had inquired about the confusion between mental illness and mental retardation in conjunction with the Report of the Joint Commission on Mental Illness and Health. As you may know, this monumental five-year report which now forms the basis for a good bit of governmental activity completely ignores mental retardation, and this NIMH letter explains this omission as follows: "Perhaps the basic reason was that the Joint Commission (on Mental Illness and Health) thought that the core problem of mental health is the public care of persons with major mental illness."

Again we face the meanings of words! The dictionary says that "core" means basic to all, encompassing the essence, thus this letter clearly states that mental retardation is not of the essence in the field of mental health. We naturally disagree. Of course, we are not encouraging you to abolish the term mental health or to abolish mental health programs. All we urge upon you is that you be sure that as your State develops new legislative programs and appropriations such as community mental health services, this one simple thing be observed as our Board so very clearly stated, namely: that separate, adequate and appropriate emphasis be given to the problem of mental retardation alongside of, but not subsidiary to the problem of mental illness.

I apologize to you for presenting such a thoroughly uninspiring message. Yet, I cannot think of one more urgent at this particular time with the Federal Government about ready to implement the so vitally important recommendations of the President's Panel on Mental Retardation.