Library Collections: Document: Full Text

-* Presented at the Summer Institute on Social Work in the Rehabilitation of Mentally Retarded Persons, Teachers College, Columbia University, July 17, 1967.-

-**Professor of Human Development, The Florence Heller Graduate School for Advanced Studies in Social Welfare, Brandeis University.-

Not only in the United States but in countries around the world we find today an unprecedented increase of interest in the welfare of the mentally retarded. Whole new systems of services to aid them and their families are being developed, supported by extensive governmental and private efforts. A vast literature has appeared during the past ten years and is growing at ever increasing rates. Millions are spent on research and demonstration projects. Thus it appears quite paradoxical to start off our Institute today with the question "Who are the mentally retarded?" Yet, this paradox is part of the picture we encounter when we take a broad look at our field.

Indeed, what one encounters with increasing frequency is not just a question as to who exactly are the mentally retarded, where are they to be found, and how many are there. The suggestion is seriously offered in recent professional literature that there is no such thing as mental retardation. Usually those who are inclined to deny altogether the validity of the concept of mental retardation point out that as it is commonly understood it covers such a multitude of so widely divergent conditions, resulting from such separate areas of biological or cultural origins, and manifesting themselves in such different, unrelated forms that there is no logical basis for a collective designation.

It is useful in this connection to relate that for a good many years now similar argumentation has been raised against the term mental illness since here, too, a wide conglomeration of conditions of varying origin are brought together.

I can not subscribe to these views. It seems to me that not just for the purposes of an Institute such as this one, but for the daily practice of the rehabilitation, health and welfare practitioners and administrators present here, both these concepts can offer a sound and effective basis. I am willing to concede that there is some validity for the position of those who would prefer that we speak of the field of mental illnesses rather than the field of mental illness, and similar preferences for the plural form have been stated with regard to epilepsy, cerebral palsy, and could be made with mental retardation. Yet in many other instances, we have traditionally used the singular in a plural sense, without any particular resulting problems in communication.

A different position would have to be taken if one were to deal with an institute attended by physicians, bio-chemists and other biological scientists, and concerned with specific diagnostic and therapeutic considerations. But our focus is obviously on the social manifestations to be observed, and the social measures to be considered, and in that context I think we can find a sufficiently firm point of departure in the concept of mental retardation defined as:

Significant sub-average intellectual functioning, manifesting itself during the development period, and associated with distinct impairment in adaptive behaviors.

You may recall that an Expert Committee of the World Health Organization, convened in 1953, suggested for international usage the term mental subnormality, which was to be subdivided into two categories: mental deficiency for cases of biological origin, and mental retardation for cases of socio-cultural origin. Even though this proposal was a focal point of a widely distributed pamphlet published in 1954 and entitled "The Mentally Subnormal Child" (which, by the way, is a most useful document even for today's practitioner -- available through the Columbia University Press or directly from WHO), this terminology has not been accepted, and the World Health Organization today is using the general term mental retardation in its official documentation.

Those of you acquainted with the definition of mental retardation officially adopted by the American Association on Mental Deficiency will note that I have added in the version I presented here two qualifying adjectives. Instead of sub-average intelligency, I spoke of "significant sub-average intelligence" (a suggestion originally made by John Kidd), and instead of impairment in adaptive behavior, I mentioned "distinct impairment in adaptive behavior." This refers to a major international controversy which time does not permit to pursue here in necessary detail, but which can be briefly described as a disagreement between those who are inclined to extend the concept of mental retardation into the area of relatively minor deviation from the norm, and those who feel that both from the point of view of the individuals so characterized and from the point of view of effective administration and practice, a more narrowly circumscribed conception is preferable.