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Educational Handicap, Public Policy, and Social History: A Broadened Perspective on Mental Retardation
Book Reviews Educational Handicap, Public Policy, and Social History: A Broadened Perspective on Mental Retardation. By Seymour B. Sarason and John Doris. New York: Free Press-Macmillan, 1979,460 pp., h C)h $l . .J".J
Reviewed by Ludunk S. Szymanski, M.D. Using a historical perspective, the distinguished rcscarchc rs Sarasori and Davis examine the complex mutual relationship between mentally retarded persons and society. The first seven chapters discuss the definition, diagnosis, and social context of mental retardation and the current philosophy of community-based care for retarded persons. Societal attitudes toward individuals labeled retarded have been a reflection of the culture of a particular period, rather than a reaction based upon objective characteristics of the retarded person. The authors feel that the diagnosis of mental retardation should not be merely a statement of individual tests and scores, but should focus upon the individual in the total social-interpersonal context. They devote a rather uneven and sketchy chapter to review current changes in institutional care of retarded persons. A very valuable section stresses the necessary ingredients of good, community-based programs. The authors emphasize that current medical training does not prepare physicians, including psychiatrists, to understand their patients as persons functioning within a social-interpersonal context. Instead, they view their patients merely as repositories of signs and symptoms of a disease. More than half of the book is devoted to a discussion of the educational system. The authors trace the development of universal compulsory education in this country from the colonial period and relate it to sociocultural changes. They demonstrate that in the past the attitudes toward children of poor immigrants were similar to attitudes toward mildly retarded children. The origins of special education classes and their evolution are discussed in detail. The authors document how special classes have been used as repositories for minority, poor, and other disadvantaged and unwanted children on the basis of misapplication and misinterpretation of psychological tests of intelligence. A separate chapter discusses the current policy of main streaming handicapped children in regular classrooms. One can certainly agree with the authors' emphasis on
Dr. Szymanski is Director of Psychiatry at the Deoelopmenial Eualuatum Clinic of the Children's Hospital Medical Center, Boston, Massachusetts.
658
Book Reviews
659
the need for an individualized approach related to the student's need and to the teacher's capacity. However, there is no adequate review of more recent research on the effects of mainstrcarning. The last chapter of the book summarizes several major themes. The first theme is that no aspect of mental retardation can be understood unless it is seen from a cultural, historical, and "transactional" perspective. The second theme is the evolution of public policy concerning mental retardation, particularly the education of retarded individuals. The authors do well reviewing the historical perspective but the discussion is unbalanced because they do not discuss adequately the knowledge (or lack of it) regarding what retarded individuals and their families want and need for themselves. The third theme discussed by the authors concerns the changing policies and attitudes toward institutions for retarded persons. This theme is treated too briefly, however. The controversial idea that mental retardation is not "a thing" or even a characteristic of an individual "but a social invention" based on society's ideology and values is the last major theme. Noone will argue that att itudcs toward retarded persons are to a large extent based on societal-cultural factors. Still, one cannot deny that these attitudes are triggered as well by individ ual exceptionality, which may be real and not an "invention" (apart from underachievement caused by poverty and understimulation). If this argument is carried to the extreme it could lead to the conclusion that if there is no entity such as mental retardation, no special services should be provided. Attitudinal factors may be responsible for the degree or severity of a disability, but not, in every case, for the basic handicap itself. The content of this book is interesting and worthwhile. The writing, however, is often verbose, repetitious, and tangential. Long quotations from various sources make it appear like an anthology. Nevertheless, it is valuable as a reference book, particularly for its presentation of the history of cd ucation of retarded persons. In a briefer and clearer form it would have been a required reading for professionals entering the field of mental retardation.
Fifteen Thousand Hours: Sccondary Schools and Thcir Effects on Children. By Michael Rutter, Barbara Maughan, Peter Mortimore, and Janct Ouston, with Alan Smith. Cambridge, Mass.: Harvard University Press, 1979, 285 pp., $10.00 Reviewed by Alberto C. Serrano, M.D. Michael Rutter and his associates at t he I nstitutc of Psychiatry, University of London, report on a 3-year study of 12 secondary schools in a large Dr. Serrano is Clinical Projesstn of Psycluatr» and Pediatrics, and Direr/or oj" the Division of Child and Adolescent Psychiatr» Unioersit» of Texas, Health Sciences Center, San Antonio, Texas.
Reviewed by Ludunk S. Szymanski, M.D. Using a historical perspective, the distinguished rcscarchc rs Sarasori and Davis examine the complex mutual relationship between mentally retarded persons and society. The first seven chapters discuss the definition, diagnosis, and social context of mental retardation and the current philosophy of community-based care for retarded persons. Societal attitudes toward individuals labeled retarded have been a reflection of the culture of a particular period, rather than a reaction based upon objective characteristics of the retarded person. The authors feel that the diagnosis of mental retardation should not be merely a statement of individual tests and scores, but should focus upon the individual in the total social-interpersonal context. They devote a rather uneven and sketchy chapter to review current changes in institutional care of retarded persons. A very valuable section stresses the necessary ingredients of good, community-based programs. The authors emphasize that current medical training does not prepare physicians, including psychiatrists, to understand their patients as persons functioning within a social-interpersonal context. Instead, they view their patients merely as repositories of signs and symptoms of a disease. More than half of the book is devoted to a discussion of the educational system. The authors trace the development of universal compulsory education in this country from the colonial period and relate it to sociocultural changes. They demonstrate that in the past the attitudes toward children of poor immigrants were similar to attitudes toward mildly retarded children. The origins of special education classes and their evolution are discussed in detail. The authors document how special classes have been used as repositories for minority, poor, and other disadvantaged and unwanted children on the basis of misapplication and misinterpretation of psychological tests of intelligence. A separate chapter discusses the current policy of main streaming handicapped children in regular classrooms. One can certainly agree with the authors' emphasis on
Dr. Szymanski is Director of Psychiatry at the Deoelopmenial Eualuatum Clinic of the Children's Hospital Medical Center, Boston, Massachusetts.
658
Book Reviews
659
the need for an individualized approach related to the student's need and to the teacher's capacity. However, there is no adequate review of more recent research on the effects of mainstrcarning. The last chapter of the book summarizes several major themes. The first theme is that no aspect of mental retardation can be understood unless it is seen from a cultural, historical, and "transactional" perspective. The second theme is the evolution of public policy concerning mental retardation, particularly the education of retarded individuals. The authors do well reviewing the historical perspective but the discussion is unbalanced because they do not discuss adequately the knowledge (or lack of it) regarding what retarded individuals and their families want and need for themselves. The third theme discussed by the authors concerns the changing policies and attitudes toward institutions for retarded persons. This theme is treated too briefly, however. The controversial idea that mental retardation is not "a thing" or even a characteristic of an individual "but a social invention" based on society's ideology and values is the last major theme. Noone will argue that att itudcs toward retarded persons are to a large extent based on societal-cultural factors. Still, one cannot deny that these attitudes are triggered as well by individ ual exceptionality, which may be real and not an "invention" (apart from underachievement caused by poverty and understimulation). If this argument is carried to the extreme it could lead to the conclusion that if there is no entity such as mental retardation, no special services should be provided. Attitudinal factors may be responsible for the degree or severity of a disability, but not, in every case, for the basic handicap itself. The content of this book is interesting and worthwhile. The writing, however, is often verbose, repetitious, and tangential. Long quotations from various sources make it appear like an anthology. Nevertheless, it is valuable as a reference book, particularly for its presentation of the history of cd ucation of retarded persons. In a briefer and clearer form it would have been a required reading for professionals entering the field of mental retardation.
Fifteen Thousand Hours: Sccondary Schools and Thcir Effects on Children. By Michael Rutter, Barbara Maughan, Peter Mortimore, and Janct Ouston, with Alan Smith. Cambridge, Mass.: Harvard University Press, 1979, 285 pp., $10.00 Reviewed by Alberto C. Serrano, M.D. Michael Rutter and his associates at t he I nstitutc of Psychiatry, University of London, report on a 3-year study of 12 secondary schools in a large Dr. Serrano is Clinical Projesstn of Psycluatr» and Pediatrics, and Direr/or oj" the Division of Child and Adolescent Psychiatr» Unioersit» of Texas, Health Sciences Center, San Antonio, Texas.