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Yet often we judge the rehabilitation potential of such persons without first making a determined effort (through medical intervention) to bring about an alleviation of these associated physical handicaps and thereby a substantial improvement in the person's general level of functioning.

Altogether too frequently a diagnosis is automatically read as a prognosis instead of merely as an assessment at a given time under given circumstances -- subject often to distinct change after a lapse of time or under changed conditions, as a result of greater stimulation and motivation, or as a result of specific therapeutic or educational intervention. The confusion between diagnosis and prognosis leads to a vicious cycle -- because it is felt a mentally retarded person cannot achieve a certain level of performance, cannot learn a certain task, he is excluded from such training and thus deprived of an opportunity to prove himself. Rather he can subsequently be pointed out as an individual whose low performance bears out the initial low estimate of his capacity.

On the other hand, most remarkable progress in general functioning has resulted in cases where, in spite of an initial low test performance, vigorous steps were undertaken to ameliorate the general life situation of a retarded person and to subject him to appropriate schooling or vocational and social training.

While in isolated instances, excellent work has been done also in our country, major credit for recognition and demonstration of the rehabilitative potential of the more seriously retarded goes to our colleagues in England, among whom Alan and Ann Clark, Jack Tizard, Herbert Gunzburg, Beate Hermelin and Neil O'Connor deserve special attention. Beginning in 1955, they have contributed to the professional literature lucid accounts of the results of studies which clearly showed how badly the capacity of those with I.Q.'s under 50 had been underestimated.

Again, recognizing that there have been outstanding exceptions in our country, it is nonetheless a matter of record that we have been very slow to emulate the pattern set by England in developing work training on this level or even to recognize adequately in our professional literature the significance of these research findings.

This brings us to a very important aspect: the frequent clear demonstration of hostility and resentment on the part of professional workers when confronted with information regarding the vocational and social achievements of severely retarded individuals. There is no time to dwell on this in detail but perhaps during the discussion period this might be brought up for another look.

At this point, I would like to introduce into this presentation the case of a young worker in an industrial training unit which is part of the mental retardation facilities in the city of Oxford, England. I had the privilege of visiting this Unit and to observe it work, but I must credit the technical details of this case story to an article by Paul Williams which is published in the June 1967 issue of the Journal of Mental Subnormality -- to my mind, one of the best journals available to rehabilitation workers in our field. I have selected this case purposely so that you can look it up in the literature if you are interested in more specific details.

This young man by the name of John is today eighteen years of age. He is an only child. His mother is a teacher and was forty-four years when John was born and his very early childhood was fairly uneventful.

At age two he started to talk and could say a number of words very distinctly. However, by the time he was five, it had become clear that he was severely subnormal (to use the English terminology) and so he was placed in a local training center which is the equivalent to what we would call a class on the trainable level. At that time, he rated about eighteen months social age on the Vineland scale. In the following year at age six, he failed to score on the revised Stanford Binet and, again, his social age was less than two years. In the next several years he was sick a good bit, was away from school a great deal and during that time of illness he stopped talking altogether and has had no recognizable speech since.

Now during all the ensuing years he remained at the lowest class at the training center, a class which (and this is unfortunately all too frequently the practice, not just in England but in many other countries) catered for the "babies", in other words the pre-school aged children admitted to the training center, as well as to the most severely handicapped, both in terms of physical as well as mental deficiencies.

Parenthetically, let me call your particular attention to this practice because it is a good example of a practice that is purely for the convenience of the staff and administration and does not take into account the major needs of the youngsters involved. Severely physically handicapped retarded individuals are a particular "bother" and therefore all too often they are left with the lowest ability group even though they very definitely need and can profit from stimulation of a group more in keeping with their own intellectual capacity.