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The Economics of Mental Retardation
Book Reviews
197
infinite universe. T h e white mind seems to serve similar emotional needs for many nonblacks in modern America. In fact, dehumanizing people, standardizing them, and dividing them into easily identifiable blacks and whites is frighteningly similar to industrial packaging. I had hoped that Beyond Black and White would discuss American cultural diversity as a possible source of moral strength for nonblacks to draw upon to expand the limits of “whiteness” in their minds. Beyond Black and White left me equally concerned with how to define “black.” A nonblack hesitates to enter into a discussion of this topic, not having shared that group’s particular experience of historical and personal oppression. And yet, it seems even more important here to go clearly beyond definitions constricted by slave laws, social oppression, and uniform notions of culture. Comer’s book would have proved more useful had it more deeply explored some of the insights of blacks as a diverse group with shared cultural expressions. Black resilience, after all, must amount to more than merely a dialectic of oppression. The human race probably originated in Africa and spread around the world 40,000 years ago. Serial culture, biological inbreeding, and crossfertilization have been the rule of human history since then, not the exception. North America was populated by outside peoples only in recent times. In a real sense, most of the hard-won cultures of mankind mingle in our barely formed new world. Each culture limits the world view of its members, yet can contribute to that of others. Community, expressiveness, and artistic insights have been highly developed among American blacks, equally with survival skills. The modern world, deeply steeped in European ideologies and insecurities, sorely needs Afro-American traits. As a question of emphasis, this reader looks toward black writers to swing the balance from standardization toward beauty, variety, and contrast, personally and in culture. These perspectives could help us all go beyond a world reducible to black and white.
The Economics of Mental Retardation. Bv Ronald W. Conlev. Baltimore, Md.: Johns Hopkins Univers(ty Press, 1973, 377 pp., $15.00. Reviewed by Elizabeth M . Boggs, Ph.D. This book will be of little interest to clinicians but of considerable interest and utility to program managers, strategists, and public advocates for the mentally retarded. It will also be of interest to anyone concerned with the interface between our systems of money values and human values, and to those involved in the impact of managerial concepts on the changing shape of human service delivery systems generally. Dr. Boggs zsfonner Presadent of the Nutzonal Councal of Developmental Dasabalztzes, and actaue an the Nutzonal Assocaataon for Retarded Catzzens.
Book Reviews
198
Conley has a professional background in economics, as well as professional experience in the Rehabilitation Services Administration, Department of Health, Education, and Welfare. The book was initiated while he was on the staff of the President’s Committee on Mental Retardation. Being familiar with mental retardation in a member of his family, Conley came to his task with an affirmative motivation and understanding, which grew as he worked. “Despite my early involvement in this field, I was astonished to find how incredibly complex and many-faceted is the problem we so simply sweep under the term ‘mental retardation.’ The result is a felicitous combination, a wide-ranging review and precis of data and findings from a variety of fields not generally juxtaposed, a scientific synthesis tempered by caveats based on human value judgments. Conley’s stance, with one foot planted in each of t w o camps that often are hostile to one another, is epitomized in his remarks on Program Planning Budgeting System (PPBS): “The PPBS approach was imposed upon many government agencies before being itself properly PPBS’ed. Persons familiar with PPBS lacked sufficient understanding of the programs they were called upon to evaluate. Professional staff of most agencies, although familiar with the programs, lacked sufficient familiarity with PPBS to properly utilize the technique. . . . A PPBS system suitable for evaluating social programs is still not adequately developed. However, if properly developed, and if used with a full appreciation of its limitations, PPBS is an enormous aid” (p. 327f.). Cost-benefit criteria are explored in an intelligible way. A prodigious amount of epidemiological and program data from diverse sources has been condensed into the book’s 377 pages and 63 tables. For many students and writers in the field it is likely to become a dogeared reference, not least because it reaches back into significant studies done 40 and 50 years ago and seldom cited today. A remarkably useful job has been done of splicing data together “from unlikely sources and in unlikely ways, justified only by the sobering fact that no other data were available” (p. xii). In addition to direct service costs, estimates of lost earnings are developed. The author is careful to distinguish among the labels attached to services, facilities, and people, noting that many of the retarded persons are found in facilities designated for the deaf, the mentally ill, in prisons, and the like. He educes information on the retarded clients in many of these settings. The converse may not be quite as scrupulously investigated. For example, in Table 19 it is assumed that 100 percent of those accepted for service in “mental retardation clinics” are in fact mentally retarded, whereas available analyses indicate that almost half are found not to be so. Conley admits to having had problems of coming to closure on his study. Readers reap a serendipitous benefit. Just prior to press time, the author was able to insert a considerable amount of 1970 data alongside his original 1968 data, thus giving us glimpses of the rates and directions of change. Overall expenditures on services increased about 30 percent in two years, partly as a result of increased per capita costs and partly as a ”
Book Reviews
199
result of increased enrollment. An analysis of the breakdown is worthwhile; for example, enrollment in sheltered employment rose nearly 50 percent in the two-year period. There are omissions, inevitably. Closure came before the publication of HEW’SMental Retardation Source Book in September 1972, and no intimations are given of the impact of “social services” funding under Titles IVA and XVI (now Title VI) of the Social Security Act. It would have been helpful if the main sources of primary data could have been listed at the end of each chapter, along with the useful chapter summaries. These summaries compensate to a considerable extent for the fact that the index, although extensive, does not quite d o justice to the book. The very compactness of the contents leaves opportunity for uninformed interpretation. In the hands of the naive person or the zealot who wants to base his facts on his conclusions, the findings summarized in this book can be misused and misinterpreted. In the hands of responsible and conscientious professionals, the book can be an important tool in policy development and decision-making.
197
infinite universe. T h e white mind seems to serve similar emotional needs for many nonblacks in modern America. In fact, dehumanizing people, standardizing them, and dividing them into easily identifiable blacks and whites is frighteningly similar to industrial packaging. I had hoped that Beyond Black and White would discuss American cultural diversity as a possible source of moral strength for nonblacks to draw upon to expand the limits of “whiteness” in their minds. Beyond Black and White left me equally concerned with how to define “black.” A nonblack hesitates to enter into a discussion of this topic, not having shared that group’s particular experience of historical and personal oppression. And yet, it seems even more important here to go clearly beyond definitions constricted by slave laws, social oppression, and uniform notions of culture. Comer’s book would have proved more useful had it more deeply explored some of the insights of blacks as a diverse group with shared cultural expressions. Black resilience, after all, must amount to more than merely a dialectic of oppression. The human race probably originated in Africa and spread around the world 40,000 years ago. Serial culture, biological inbreeding, and crossfertilization have been the rule of human history since then, not the exception. North America was populated by outside peoples only in recent times. In a real sense, most of the hard-won cultures of mankind mingle in our barely formed new world. Each culture limits the world view of its members, yet can contribute to that of others. Community, expressiveness, and artistic insights have been highly developed among American blacks, equally with survival skills. The modern world, deeply steeped in European ideologies and insecurities, sorely needs Afro-American traits. As a question of emphasis, this reader looks toward black writers to swing the balance from standardization toward beauty, variety, and contrast, personally and in culture. These perspectives could help us all go beyond a world reducible to black and white.
The Economics of Mental Retardation. Bv Ronald W. Conlev. Baltimore, Md.: Johns Hopkins Univers(ty Press, 1973, 377 pp., $15.00. Reviewed by Elizabeth M . Boggs, Ph.D. This book will be of little interest to clinicians but of considerable interest and utility to program managers, strategists, and public advocates for the mentally retarded. It will also be of interest to anyone concerned with the interface between our systems of money values and human values, and to those involved in the impact of managerial concepts on the changing shape of human service delivery systems generally. Dr. Boggs zsfonner Presadent of the Nutzonal Councal of Developmental Dasabalztzes, and actaue an the Nutzonal Assocaataon for Retarded Catzzens.
Book Reviews
198
Conley has a professional background in economics, as well as professional experience in the Rehabilitation Services Administration, Department of Health, Education, and Welfare. The book was initiated while he was on the staff of the President’s Committee on Mental Retardation. Being familiar with mental retardation in a member of his family, Conley came to his task with an affirmative motivation and understanding, which grew as he worked. “Despite my early involvement in this field, I was astonished to find how incredibly complex and many-faceted is the problem we so simply sweep under the term ‘mental retardation.’ The result is a felicitous combination, a wide-ranging review and precis of data and findings from a variety of fields not generally juxtaposed, a scientific synthesis tempered by caveats based on human value judgments. Conley’s stance, with one foot planted in each of t w o camps that often are hostile to one another, is epitomized in his remarks on Program Planning Budgeting System (PPBS): “The PPBS approach was imposed upon many government agencies before being itself properly PPBS’ed. Persons familiar with PPBS lacked sufficient understanding of the programs they were called upon to evaluate. Professional staff of most agencies, although familiar with the programs, lacked sufficient familiarity with PPBS to properly utilize the technique. . . . A PPBS system suitable for evaluating social programs is still not adequately developed. However, if properly developed, and if used with a full appreciation of its limitations, PPBS is an enormous aid” (p. 327f.). Cost-benefit criteria are explored in an intelligible way. A prodigious amount of epidemiological and program data from diverse sources has been condensed into the book’s 377 pages and 63 tables. For many students and writers in the field it is likely to become a dogeared reference, not least because it reaches back into significant studies done 40 and 50 years ago and seldom cited today. A remarkably useful job has been done of splicing data together “from unlikely sources and in unlikely ways, justified only by the sobering fact that no other data were available” (p. xii). In addition to direct service costs, estimates of lost earnings are developed. The author is careful to distinguish among the labels attached to services, facilities, and people, noting that many of the retarded persons are found in facilities designated for the deaf, the mentally ill, in prisons, and the like. He educes information on the retarded clients in many of these settings. The converse may not be quite as scrupulously investigated. For example, in Table 19 it is assumed that 100 percent of those accepted for service in “mental retardation clinics” are in fact mentally retarded, whereas available analyses indicate that almost half are found not to be so. Conley admits to having had problems of coming to closure on his study. Readers reap a serendipitous benefit. Just prior to press time, the author was able to insert a considerable amount of 1970 data alongside his original 1968 data, thus giving us glimpses of the rates and directions of change. Overall expenditures on services increased about 30 percent in two years, partly as a result of increased per capita costs and partly as a ”
Book Reviews
199
result of increased enrollment. An analysis of the breakdown is worthwhile; for example, enrollment in sheltered employment rose nearly 50 percent in the two-year period. There are omissions, inevitably. Closure came before the publication of HEW’SMental Retardation Source Book in September 1972, and no intimations are given of the impact of “social services” funding under Titles IVA and XVI (now Title VI) of the Social Security Act. It would have been helpful if the main sources of primary data could have been listed at the end of each chapter, along with the useful chapter summaries. These summaries compensate to a considerable extent for the fact that the index, although extensive, does not quite d o justice to the book. The very compactness of the contents leaves opportunity for uninformed interpretation. In the hands of the naive person or the zealot who wants to base his facts on his conclusions, the findings summarized in this book can be misused and misinterpreted. In the hands of responsible and conscientious professionals, the book can be an important tool in policy development and decision-making.