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Can we diagnose feeble-mindedness in childrenP.M. Bachelard Ph.D. aa Teachers' College , MelbournePublished online: 17 Jan 2008.

To cite this article: P.M. Bachelard Ph.D. (1931) Can we diagnose feeble-mindedness in children, Australasian Journal of Psychology and Philosophy,9:2, 120-130, DOI: 10.1080/00048403108540929

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CAN W E DIAGNOSE FEEBLE-MINDEDNESS IN CHILDREN ?

By P. M. BACHELARD, Ph.D., Teachers" College, Melbourne.

T~E question of determining who are feeble-minded has become of grea t importance. In all civilized countries people have realized the necessity of giving these unfor tuna te children an educational t r e a t m e n t which will render them capable, as fa r as possible, of becoming self-supporting, h a p p y and useful members of society. The grea t num ber of feeble-minded adul ts is such a burden upon the finances and well-being of the communi ty , t h a t a t last i t has been b rough t home to us t ha t i t would be a great economy in expense, crime and unhappiness to reduce this large a r m y of incompetents , instead of vot ing year ly supplies for the damage it does and for its upkeep in inst i tut ions or gaols. In this endeavour to untwis t the Olivers r a the r than to p a y for the incarcerat ion of the Bill Sykeses, we t ry to take in hand the feeble-minded f rom early childhood, before menta l arres t sets in, and give them an educat ion which will, if no t r emedy their men ta l defect, a t least so develop their hidden capacities, t h a t they will be self-supporting to a cer tain ex ten t and will no t remain a p e r m a n e n t danger to themselves and to society. The first question therefore is to determine which children are feeble-minded; in other words~ we mus t determine wha t kind of menta l defect detectable in childhood will cause t hem to join the disorderly and expensive a r m y of adul t feeble-minded.

WHAT DEFINITION MUST WE GIVE OF FEEBLE-MINDEDNESS ~.

Words have an inexorable logic of their own t h a t often leads us to the mos t illogical situations. Ye t we cannot do otherwise t han use them in their accepted meaning. The word " feeb le -mindedness" , considered in itself, migh t be t aken to mean any weakness in men ta l s t ruc tu re ; a cognitive, emot ional or conat ive weakness. I t is a well-established fact t h a t m a n y adults are misfits no t because of some intellectual weakness bu t because of a pe rmanen t dis turbance in their emotions or because of a distort ion of their instinctive drives. Ye t nobody would call t hem feeble-minded, for their intelligence seems unimpaired. The accepted meaning of feeble-mindedness has the essential m a r k of cognitive or intellectual weakness. This class of misfits we have, then~ especially to consider, leaving aside misfits abnormal in emotions and urges.

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FEEBLE-MINDEDNESS IN CHILDREN. 121

In passing, we m a y notice t ha t psychology as ye t has devised no reliable means of determining which defect in emotions and urges, measurable in childhood, will be responsible for children becoming malad jus ted in adul t life. The a t t emp t s of Downey, Fernald, Pressey~ the psycho-analys ts and others are mere gropings in the dark for perchance hi t t ing upon some measure of the set emotions and drives of adults. I n determining the intellectual weakness of children our knowledge is more advanced, owing especially to the excellent work done b y Binet and Simon in connection with the school children of Paris . Their intelligence tests, a f te r having encountered much opposition, have proved of immense benefit to educators. Their ac tual usefulness in educational pract ice is their justification. We should remember , however, t ha t the original purpose of these tests was purely pedagogical and not diagnostic. Here we shall a s k : " D o these tests also supply us with a basis of cer ta in ty for diagnosing feeble-mindedness in chi ldren?" To a t t e m p t an answer to this question we mus t first be clear as to wha t we intend to diagnose, viz., the precise nature of feeble-mindedness. I t is impera t ive t h a t we shmild obtain an answer to this impor t an t question. For there exists the tendency, on the basis of these tests, to cert ify certain children as feeble-minded and to segregate t hem and subject t hem to supervision. Any cur ta i lment of the l iberty of the subject , even or ra ther especially in the case of helpless children, demands t h a t our diagnosis in every individual case should be based on a finding t h a t leaves no room for doubt . I f our diagnosis is founded on false assumptions or mere probabilities, dull or backward children will be in danger of being forced into inst i tut ions for the feeble-minded; in actual pract ice this has happened to perfect ly normal children. The injustice and insult of being pu t under res t ra int and labelled a fool for life is too glaring to need any emphasis.

W h a t then mus t we unders tand b y feeble-mindedness ?

To obtain a reliable definition we cannot do be t te r t han tu rn to the English Mental Deficiency Act. Mental defectives or aments are divided into three classes: idiots, imbeciles, and feeble-minded.

Idiots are " persons so deeply defective in mind f rom bir th or f rom an early age as to be unable to guard themselves against common physical dange r s "

Imbeciles are " persons in whose case there exists f rom bi r th or an early age men ta l defectiveness not amount ing to idiocy~ ye t so pronounced t h a t they are incapable of managing themselves or their affairs, or in the case of children, of being t augh t to do s o "

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122 FEEBLE-MINDEDNESS IN CHILDREN.

Feeble-minded are " persons in whose case there exists f rom bi r th or f rom an early age menta l defectiveness not amount ing to imbecili ty, ye t so pronounced tha t they require care, supervision and control for their own protect ion or the protect ion of others, or in the case of children, t ha t by reason of such defectiveness appear to be pe rmanen t ly incapable of receiving proper benefit f rom the instruct ion in ordinary schools ".

The American terminology differs slightly f rom th i s : in America the t e rm " moron " is used as equivalent to the English t e rm " feeble-minded " ; the American t e rm " f e e b l e - m i n d e d " has the same meaning as our te rms " a m e n t " and " men ta l defective ". " H i g h - g r a d e feeble- m i n d e d " is ano ther t e rm for " m o r o n " . I n these three classes of defectives the essential condition is a psychological one, more exactly, a defect of intelligence, not of emotions or d r ives ; the u l t imate criterion is a social one, the abil i ty of t~.king care of oneself and one's affairs.

Do THESE DEFINITIONS ]=[ELP PRACTICAL CLASSIFICATION?

This division of men ta l defectives into three classes is a convenient one in theory, bu t in fac t the three classes are not sharply divided one f rom the other. The lowest class b y impercept ib le gradat ions passes into the middle class, and similarly this one into the highest class. This gradual t rans i t ion occurs also between the feeble-minded and the merely dull, and be tween the dullards and the normal . I n real i ty there is only one class of h u m a n beings with infinitesimal var ia t ions f rom the lowest to the highest intelligence. I f the division of mank ind into normals , dullards, feeble-minded, imbeciles and idiots was such t h a t each class had well-defined and invar iable intellectual characterist ics specific to each class, the assigning of an individual to his own class would be a re la t ively easy mat te r . B u t men ta l defectiveness is not a simple condition due to one specific cause wi th definite and invar iable symp toms ; i t is a complex condition with va ry ing causes and symptoms .

I t is not so difficult to determine which adults are idiots, imbeciles or feeble-minded. The his tory of their case will show t h a t in spite of opportuni t ies they have never guarded themselves aga ins t common physical dangers, or have never been able to manage themselves or their affairs, or have a lways required care, supervision and control for their own protect ion and the protect ion of others. F rom their p roved inabil i ty to care for themselves we are justified in inferring their incapac i ty for learning to do so, a t least b y our actual methods of healing and teaching. A mistake, if made, is of less consequence;

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FEEBLE=MINDEDNESS IN CHILDREN. 123

in the case of these mental dwarfs the mistake concerns only what might-have-been~ if in their childhood proper mental nourishment had been supplied.

In the case of children the difficulty is immeasurably g rea te r : the criterion of actually not having adapted them- selves socially and economically cannot be appl ied; t h e y never ye t have had an oppor tuni ty of testing their ability. Perhaps proper training, before mental crystallization sets in~ may develop the minds of handicapped children sufficiently to enable them to take care of themselves. In the case of children with the possibility of training still before them we must find a practical criterion other than the social one. In their case there is required a diagnosis and a prognosis. We must determine the intellectual factor or factors whose absence cannot be remedied or supplied by training and invariably entails non-adaptabi l i ty to a given social environment in adult l i fe ; and then we must devise tests t ha t will accurately probe this factor or factors in the individual child. Before examining the possibility of doing this by means of known mental tests, we m ay first ask:

CAN NEUROLOGY FROM WELL-DEFINED AND INVARIABLE SIGNS PROGNOSTICATE FEEBLE=MINDEDNESS IN CHILDREN ~.

I t is indeed most reasonable to assume tha t a t least every congenital mental defect is due to some weakness in the s tructure or the functioning of the brain. Bu t i t is admit ted tha t m a n y brain defects in the living person will elude the most modern means of observation. A post mortem m a y or ma y not reveal i t ; bu t a post mortem diagnosis, so valuable for science, is of no avail to the individual diagnosed. Fur ther , we are told tha t sometimes gross nerve lesions are not accompanied b y considerable mental deterioration, and t ha t brilliant minds may inhabit nervous systems tha t would not pass the neurological tests.

If, again, we inquire whether there are no external defective features which ~ l l with cer ta in ty characterize the individual as feeble-minded, we are told tha t about 90 ~o of the feeble-minded have no visible s t igmata to distinguish them from the normal population. The remaining 10% have such characteristic clinical features, bu t then an individual m a y have these defective features and not be a mental defective.

Medical science is able to diagnose cretins, mongols, microcephalics, hydrocephalics, active syphilitics, etc. But., again, many of these physically defective patients are b y no means mental ly defective.

In the last resort, then, every exper t t rying to diagnose feeble-mindedness is forced back to the use of psychological

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124 17EEBLK-MINDEDNESS IN CHILDREN.

tests, and indeed to psychological tests of intelligence, since b y definition feeble-mindedness is characterized by a defect in intelligence.

ARE THE INTELLIGENCE TESTS NOW IN USE OF SUCH A NATLVRE THAT FROM THEIR RESULTS WE CAN PROGSI0STICATE WITH CERTAINTY FEEBLE-MINDEDNESS IN THE INDIVIDUAL CHILD

TESTED .~

TO unders tand why our answer to this question mus t be negat ive, let us first review the various s tandards of diagnosis t h a t have been proposed and the absurd consequences to which their use has led.

1. Standard in Terms of Mental Retardation.

I n the giorious t imes of implicit fa i th in menta l testing, when the Vineland revision had been " m a t h e m a t i c a l l y demons t ra ted " as " a marve l of accuracy " in enabling us to s ta te " to a nicety jus t where a child stands in his menta l capaci ty " , large numbers of social and psychological workers were appoin ted as " experts " of feeble-mindedness in the schools, courts and clinics th roughout America. These " so-cMled psychologists " (J. E. W. Wallin, " P r o b l e m s of S u b n o r m M i t y " , pp. 113 ft.) adopted, on the recommenda t ion of Goddard in 1910, the Binet age of twelve as the upper l imit of feeble-mindedness in the case of adults. I n the case of children the accepted s tandard was a Bluet-age re ta rda t ion of more t han two years when under nine years of age, and of more t h a n three years when above nine.

Then the Binet testers, neglecting the warning of Bluet and Simon tha t their intelligence scale was not " a n au toma t i c weighing machine like those in rai lway stations, which au tomat ica l ly register the weight of a person wi thout in te rvent ion or assistance ", went tes t ing through the schools and inst i tut ions of the States. I f we were to believe their statist ics based on these s tandards, several millions of Americans would be feeble-minded. To evidence the absurdi ty to which such ru le-of- thumb procedure leads, i t is sufficient to give one i l lustration f rom Wall in 's book (p. 173). Two Binet testers (teachers t ra ined a t Vineland), " ex t remely careful and c o n s e r v a t i v e " , working under the Children's Commission, were appoin ted to tes t the school children of a quiet residential city. Their pub~shed repor t s tates t h a t there were 11% feeble-minded in only the mos t favourab ly located schools ". As WaUin remarks , this would work out a t abou t 2,000,000 feeble-minded children in the e lementary public schools of hmeme_~.

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Thorndike has shown tha t Goddard was not justified in his assert ion t h a t " the Binet scale (Vineland revision) was wonderfully accurate ". The same m a y be said of any existing revision and scale of menta l measurement . I t is evident , too, t ha t the upper l imit of twelve is too high. Although the two French psychologists were claimed for the twelve-year s tandard, their views were less ex t reme and much less dogmatic . Simon wr i tes : " Provisional ly i t might be proposed to fix a t nine the upper l imit of feeble-mindedness." Fo r Binet " a re ta rda t ion of three years indicates a child who should be regarded as a suspect ", bu t only f rom the pedagogical point of view for recommending him for a special course of instruction, not f rom the legal point of view of cert ifying him feeble-minded.

We m a y agree with Wallin in accepting a negat ive threshold, viz., the possession of a t en-year men ta l i ty m a y be considered proof posit ive t h a t the individual is not feeble- minded, however abnormal and anomalous he m a y be in other respects. The same au thor i ty is undoubted ly r ight in refusing to admi t t h a t an inflexible line can be drawn a t any fixed age, as the upper limit of feeble-mindedness (p. 215).

H. H. Goddard, in " Feeble-mindedness, A Question of Definition ", published in 1928~ suggests seven as the upper l imit of menta l defectiveness. He re-defines " morons " as " t h a t large group of people whom we recognize as of dull intel l igence". Wi th such a definition the " morons " should not be considered as menta l defectives, since with special t ra ining they can become to a certain ex ten t competen t members of society. This low limit minimizes the dunge r of unjus t ly st igmatizing any one with men ta l defectiveness ; bu t pract ical ly it has no value for helping us to solve our main problem, the diagnosing of " high-grade feeble-mindedness ", a defectiveness t h a t apparen t ly does exist wha tever our terminology. Also theoret ical ly we m a y object to any inflexible line of demarcat ion, based merely on the largely unknown factor measured by menta l tests which, when present only to a fixed degree, would b y itself alone~ and invariably, entail incapaci ty for social adapta t ion . The mos t we can a t present say with cer ta in ty of the intelligence tes ted b y the Binet tests is t h a t i t is a k ind of intelligence necessary for success a t scholastic work ; bu t it is far f rom certain t h a t this " school intelligence " is exact ly t h a t intellectual factor which is the sine qua non of social and industrial success.

2. S tandard in Terms of Intelligence Quotient.

In 1910 Stern suggested the intelligence quot ient instead of menta l re ta rda t ion as a rough scale for diagnosis. La te r

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126 FEEBLE~MINDEDNESS IN CHILDREN.

Terman proposed the following s tandards of diagnosis : 90-110, n o r m a l ; 80-90, dull or backward, rare ly feeble- minded; 70-80, border-line deficiency, sometimes dullness, often feeble-mindedness ; below 70, definite feeble-mindedness; 50-70, " moron " ; 20-50, imbecile ; below 20, idiot.

This rigid classification has given rise to the dogmat ic tendency to t ake it for granted t ha t all children who tes t below 70 are menta l defectives, and t h a t with the approach of adolescence, a t the latest, the S ta te should take them all into custodial care for its own protect ion.

To check this tendency tha t has been harmful in practice, we should bear in mind tha t mathemat ica l accuracy cannot be predicated of any existing measurement of intelligence. 1~o elaborate statist ical show accompanying such measurements should make us oblivious of the fact tha t wha tever diagnosis or prognosis can with cer ta in ty be based on these statistics, concerns only the group as a whole and not each individual singly ; in individual cases only a probable diagnosis is justified.

The Stanford revision is certainly not so perfect as to jus t i fy the belief t h a t by apply ing the tests, even with the greates t care, we can measure the intellectual level of every person to a nicety. The mos t we can main ta in is t h a t the scale has been carefully constructed and, in general, enables us to measure with a very fair approx imat ion the level the person tes ted reaches in t h a t something which we are very p robab ly justified in calling intelligence.

Fur ther , Te rman ' s classification is based on his normal curve of intelligence distribution. I t should not be forgotten, however, t h a t the scores plot ted are not ma themat ica l ly exact and t h a t the curve is to a certain ex ten t artificial. To ment ion only one f a c t : the scoring of the answers is somewhat arb i t rary , for i t has been s tandardized jus t with a view of obtaining this required bell-shaped curve. Again, the division of the intelligence quotients on the abscissa by mult iples of ten is a rb i t r a ry and not based on actual diagnoses. We m a y go one step fur ther and main ta in tha t , even if all scores were ma themat ica l ly exact and their plot t ing na tura l ly resulted in a perfect distribution, i t would be p rema tu re to fix any ma thema t i ca l point wi thout b read th along the base of intelligence quotients as the inflexible l imit of menta l defective- ness. This becomes manifes t when we reflect t h a t the nature of the factor or factors measured b y these tests is not sufficiently known (it has been described as " school intelligence "), and t h a t i t is not proved t h a t a determinable deficiency of this " school intelligence " is a necessary factor in the causation of wha t is technically known as menta l defectiveness.

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To establish an inflexible limit it should be experimentally proved tha t any child with an intelligence quotient X turns out an adult mental defective, and tha t no competent adult ever scores as low an intelligence quotient as Y. This has not been done and our experimental data seem to show tha t i t cannot be done. We can only hope for an average with its s tandard devia t ion; but such a limit by its very nature is flexible and can supply a foundation for only probable diagnosis in individual cases.

In justification of 70 as the limit, understood as a flexible line, it may be urged tha t roughly 1 °/o of mankind is mentally defective and tha t Terman's curve shows tha t only about 1% score an intelligence quotient 70 and below. Bu t the sample tested included only school children and was therefore not representative of the total population~ and among these children the major i ty of mental defectives must have been of the feeble- minded or " moron " type with very few imbeciles or idiots. The Repor t of the Mental Deficiency Committee for England and Wales, in its calculation of the incidence of mental defective- ness including the three classes~ gives the following numbers (IV, p. 82) : Adults and children, 8.41 per thousand ; children alone 4.62 per thousand. Therefor% this theoretical limit of 70 seems too high from theoretical considerations alone. This limit of 70, taken as an infle~cible line, cannot be upheld in the case of adults. For it is a fact tha t there are adults who are socially and economically very competent and yet their intelligence quotient is not above 70. Striking examples are given by J. E. W. Wallin~ " Problems of Subnormali ty "~ pp. 222 ft. I t is generally accepted tha t a mental age of ten is proof positive tha t the individual is not feeble-minded. There may be a good m a n y illiterate but successful workers who do not reach ~ mental age higher than ten, and no one would think of them as mental defectives. Yet their intelligence quotient would work out at 64. Referring to Goddard's new standard of seven, we may admit the poss ibf i ty tha t a man with a steady character may succeed in making an independent living at some unskilled work in a simple social milieu, although his " school intelligence "~ us measured by the Binet tests~ does not rise above the level reached by the average child at the age of seven. Such a man would not be feeble-minded, al though his intelligence quotient works out at 44.

I n the ease of children we may feel more inclined to agree tha t an intelligence quotient below 70 is a suspicious symptom : a score of 70 in early childhood generally diminishes as the child grows older. We may accept the rule tha t a young child whose intelligence quotient does not rise above 70 is a suspect. ]~ut then we must always keep in mind the importunt practical

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128 FEEBLE-MINDEDNESS IN CHILDREN.

principle, t ha t in establishing general rules we may rest satisfied with probabilities, bu t in diagnosing feeble-mindedness in every individual case we must rest satisfied with nothing less than certainty. The word "feeble-mindedness " has a well- defined legal meaning implying permanent incapacity for ever leading an independent existence without some control or supervision. Before irremediably relegating to this class of " na tura l fools " a child whose potentialit ies are still, to a large extent , a closed book to the most clear-sighted neurologist or psychologist, the conscientious exper t will pause and consider whether his diagnosis is based perhaps only on unproved assumptions and probabilities. Common sense and natura l humani ty tell us that , before curtailing the l iberty of and stigmatising an individual for life, we must have for our judgment a foundat ion of certainty.

Such cases of wrong diagnosis have happened in every country , where legislation has made it easy to segregate the feeble-minded in order to supply them with adaptable t r ea tment in schools and institutions. The Repor t of the Mental Deficiency Committee for England and Wales (IV, p. 51) mentions tha t one-third of the children who are certified as mental ly defective at special schools cease to be regarded as mental ly defective af ter the age of sixteen. In such cases the certificate has to be destroyed.

In most countries it is now recognized t h a t the diagnosis of feeble-mindedness (excluding imbecility and idiocy) has often been made according to a too rough and ready method. I t has aroused opposition in psychological circles, bu t in the general public the method has fostered a spirit of callousness to the sting in the meaning of the te rm " feeble-mindedness ". To give only one personal experience. A head mistress, unable to manage a troublesome child, excla imed: " I f only I could get t ha t child certified, I could get rid of her, bu t the mother will not hear of i t ." The head mistress ma y not have been wrong ; but the child may have been lucky in having a mother not favouring off-hand certification. W h a t about children tha t have no mothe r !

Concluding, we stress the undeni~bJe fact, t ha t no single criterion, psychological or otherwise, can form the sole and adequate basis for diagnosing feeble-mindedness. A correct diagnosis must be founded on the to ta l i ty of facts obtained by the several criteria, medical, educational, psychological and socio-industrial. For adults, the socio-industrial criterion is the ul t imate and practical one, though the psychological criterion is essential. In the case of children the socio-industrial criterion cannot be applied. We are forced to prognosticate their future social and economic incompetence from the findings of the other criteria. This is an exceedingly difficult p rob lem: in some cases it can be solved by experts, and in others t ime

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alone will solve it. Here we use the t e rm "feeble-minded " in its English meaning, as excluding imbeciles and idiots. A wrong diagnosis may have dire consequences for the individual. Had Helen Keller been sent to an insti tution as a mental ly defective child of any of the three types, she would probably have grown up mental ly deficient and economically incompetent , and as an adult now she could r ight ly be certified as a menta l defective.

This criticism seems mainly destructive. Bu t destruction of faul ty work is necessary tha t i t may give place to a be t t e r construction.

Considering all the mistakes made and the little good certification has done, we are justified in asking the quest ion: Is there any necessity for certifying children as feeble-minded ? Of late suggestions have been made tha t we should delete the word " f e e b l e - m i n d e d " from our dictionary. So the Repor t of the Mental Deficiency Committee for England and Wales. Goddard 's re-definition of " m o r o n " is to the same purpose. Whatever we m a y th ink of this proposal in regard to adults, i t is undoubtedly very a t t ract ive in regard to children, consider- ing the great difficulty of giving a certain prognosis in their case. I t is here maintained tha t it is not the business of the school to label any child as feeble-minded, before i t has been given an oppor tuni ty of proving itself in the social and economic world. On this principle we are ready to accept the suggestion of the Repor t of the Mental Deficiency Committee, tha t children should be divided into three classes: normal, intelligence quotient above 80 ; retarded, intelligence quotient between 50 and 80 ; defective, intelligence quot ient below 50. Under this scheme the defectives include only imbeciles and idiots who are identified with comparat ive ease; they are entrusted to the mental deficiency au thor i ty and are taken care of in occupation centres and colonies. All the others come under the educational au thor i ty and join the regular school, where, with the minimum of stigmatization, special courses of instruction are provided for the normal children and the various grades of the re tarded according to the amount of re tardat ion of these grades. Only when a child has proved, af ter a fair trial, its inability to follow any of the provided courses, will it be deemed wor thy of inst i tut ional care under the menta l deficiency authori ty.

I n Victoria a very good beginning has been made in supplying the less gifted children with appropriate t raining in oppor tuni ty grades. Upon its credit side must be entered the fact tha t a t least one source of great injustice has been avoided, a readiness officially to brand children as feeble-minded.

Fa r more impor tan t than classifying children, on b u t probable psychological grounds and a hypothet ical want of

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fu ture social adaptat ion, into official divisions whose label will stigmatize and handicap them for life, is the constructive endeavour to explore the hidden potentialit ies of handicapped children and by adapted courses of instruction t ransform them into actualities ; this t r ea tmen t will offer to as many children as have it in them the chance to keep their good name and take an honourablc place, however humble, in a society in which they will be allowed to move with freedom and self-respect.

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201

4