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.

MENTAL RETARDATION

Mental retardation, mental deficiency, or (as it was once called) feeblemindedness is a problem quite different from mental illness, to which we have devoted the bulk of this chapter. We cannot run away from the prob­lem of mental retardation because it presents a major challenge to our society to find causes, seek prevention, and provide the best possible assurance for lives of maximum use­fulness The late John F. Kennedy, when he was President of the United States, ap­pointed, in October 1961, a panel of physi­cians, scientists, educators, lawyers, psycholo­gists, social scientists, and others to review programs and needs; to ascertain gaps: and to prescribe a program for action. This panel presented a 200-page report with 90 specific recommendations in October 1962.

The panel's report showed mental retarda­tion to be a major national health, social, and economic problem, affecting some 5.4 million children and adults and involving some 15 to 20 million family members in the United States. The panel estimated that the cost of care for America's mentally retarded was about $550 million a year, not counting a loss of several billion dollars of economic output to the nation annually.

Mental retardation has been denned as a condition, characterized by faulty develop­ment of intelligence, which impairs an indi­vidual's ability to learn and to adapt to the demands of society. The failure of intelligence to develop normally may be owing to diseases or conditions, occurring before or at the time of birth or in infancy and childhood, that dam­age the brain. The retardation may also be owing to factors determined by heredity that affect the development of the brain.

The magnitude of the problem of mental retardation in the United States may be roughly cast up on the basis of standard in­telligence tests. It has been generally noted that anyone with an I. Q. below about 70 has significant difficulties in adapting adequately to his environment. About 39t of the popula­tion score below this level.

Taking this figure of 3% it can be estimated that of 4.2 million children born each year. 126.000 are or will be classed as mentally retarded. Of these it is estimated that 4200 (0.1% of births) will be retarded so profoundly that they will not even be able to take care of their own creature needs. Another 12.600 (0.3% of births), it is calculated, will suffer "moderate" retardation, that is. they will re­main below the 7-year intellectual level. The remaining 110,000 (2.6% of births) are those with mild retardation and represent those who can, with special training and assistance, acquire limited job skills and achieve almost complete independence in community living.

If these percentage figures were applied to the population as a whole, it would indicate that there are 5.4 million mentally retarded people in the United States-60,000 to 90,000 profoundly retarded; 300,000 to 350,000 "moderately'' retarded; and some 5 million mildly   retarded  children,   adolescents,  and

adults who are able to adjust in a limited way to the demands of society, and possibly to play a positive role as workers.