MENTAL RETARDATION

The number of mentally retarded patients who are getting care in residential institu­tions is minimal about 200,000 or roughly 4% of the total. It has been estimated that it would cost $1 billion a year to construct ade­quate facilities and institutions, and provide special care in the family home for mentally retarded patients. Other services required by the mentally retarded and their families in­clude: (1) diagnostic and clinical services, half of which were established in the last decade; (2) special education for the mentally retarded, a task for which 75.000 specialized teachers are reckoned to be needed: 13> preparation of professional personnel in many areas: i4) vo­cational rehabilitation (though 25% of those coming out of special classes cannot be placed): (5) parent counseling; (6) social services and (7) research.

It would be wonderful to put a finger on the chief causes of mental retardation and thus to get some promise of stopping the condition. Unfortunately this is not the case: 75 to 85% of the retarded show no demonstrable gross abnormality of the brain, and their condition must be regarded as caused by incompletely understood psychological, environmental, or genetic factors. Only m 15 to 259' of the diag­nosed cases of mental, retardation can a specific disease entity be held responsible (e.g. infections of the mother, brain injury during delivery particularly in premature infants  abnormal grouping of chromosomes) Be­cause of increased survival rates of retarded infants, it is now held that 75% of the re­tarded under 6 years of age have some asso­ciated physical disability.

It must also be conceded that the improved and more extensive prenatal, obstetrical, and pediatric care m the United States in the last 20 years has brought about the survival of a great many infants who were premature, had congenital handicaps or malformations, and suffered from mental retardation  a frequent concomitant of such handicaps. This fact op­erates to increase the number of retarded at all age levels. According to one government estimate, unless there are major advances in methods of prevention, there will be as many as one million more mentally retarded per­sons in the United States by 1970. Other problems for the mentally retarded are also foreseen: for example, as machines replace unskilled labor, which is what educable re­tarded children could be trained to do, oppor­tunities for employment will diminish.

The complex problem of America's mentally retarded cannot be dropped down the drain, and it will not go away. More concern must be taken with it and for it at all levels: federal, state, and local community. Many of the 90 recommendations of John F. Kennedy's panel will have to be carried into operation. One of these, that might spearhead the rest, reads as follows: "A formal planning and coordinating body made up of all appropriate segments of the community [should be] established with the mandate to develop and coordinate pro­grams for the retarded."*

In summary: This chapter has been devoted to two major subjects, mental illness and mental   retardation, which  are related but essentially different and separate problems. We have described mental illness as the ab­normal exaggeration of personal feelings, and we have discussed the types, causes, extent, and improved treatment of mental illness. With psychotherapy, new drug therapy, hos­pitalization, and other treatments, the out­look for the cure of those mentally ill patients who can obtain adequate treatment is indeed good. The outlook for the "cure" of mental retardation (once called feeblemindedness) is at present less favorable, primarily because much less is known about the causes of men­tal retardation. Nevertheless the problem is now being attacked with vigor in the United States. It is partially obstetric. In the next chapter we shall consider two serious social problems which are essentially psychiatric in their origins and management: alcoholism and drug addiction, both of which can be con­sidered as particular kinds of mental illness.