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The Origin And Nature Of Our Institutional Models
"In mountain heights, past stream and plain,
Could anyone believe that this hallowed Garden of Eden became the institution for 3,400 and one in which, according, to a recent prominent visitor from abroad, residents are treated worse than in any institution he had seen in a dozen countries and, indeed, worse than cattle are permitted to be treated in Denmark (Children Limited, Dec. 1967, p. 2). Or that a mother recently preferred that her child die than live at Sonoma? (Anonymous, 1968).
In 1901, an observer remarked that retardates in a certain Midwestern institution were being herded like so many cattle (Clark, 1901). Today, 68 years later, the residents are still being herded like cattle in the same institution in that cattle-oriented state. How many more years?
A 1787 visitor to Pennsylvania Hospital, the first U.S. public institution to receive the mentally afflicted for treatment, saw naked residents bedded on straw, in locked, underground, dungeonlike cells that had small windows for passing food, and he exclaimed in seeming self-satisfaction that "...every possible relief is afforded them in the power of man, " rejoicing in "...the pleasing evidence of what humanity and benevolence can do...." (Deutsch, 1949, p. 62). Deutsch also described a case cited by Dorothea Dix in 1847, in which a harmless deranged person was kept summer and winter in a open pen. He was fed hog slop and kept on straw which was changed every two weeks in summer, less often in winter. He was exposed to rain, heat, cold, and snow, and his feet had frozen off into shapeless stumps. The keepers of this wretch, however, saw themselves as offering kind treatment.
Today, all of us see the inhumanity of such treatments, because our values have grown. But some of us do not see the 1968 equivalents of the 1787 and 1847 treatments, or of the keepers' responses. Are not, in 1968, denial of property rights, of human contacts and perceptual stimulation; restriction of movement and communication; denial of wages for work; compulsion to use nonprivate toilets; denial of the privilege to wear clothes; behavior control by means of medication rather than education or guidance; enforced idleness; and innumberable other practices common in our institutions the equivalents of the inhumane practices of 1787 and 1847? Are not the rationalizations of these 1968 practices equivalent to the protestations advanced by the keepers of 1787 and 1847? How will the professionals and public of 2068 judge them?
3. Institutional segregation did not contribute much to prevention of retardation, and the deviant retardate is still with us. Indeed, there is reason to believe that with the increasing complexity of life, the number of persons who will fail to meet societal demands will increase.
4. Institutionalization was not accomplished inexpensively, as had been claimed. The concentration of retardates in large institutions has, in most cases, been more costly than provision of community services would have been. Work, first rationalized as constructive occupation, became exploitation as cost cutting became important and, again contrary to claim, only a modest number of retardates became self-sufficient in the institution. Those retardates who did become good workers began to replace institution employees and thus became too valuable to be released; the institution could not have functioned without unpaid captive labor. To save money, the large solid multi-purpose (usually original) building of the institution was permitted to become an overcrowded dungeon; cottages conceived to replace them became large overcrowded buildings, sometimes housing 200 residents and their attendants (Bliss, 1913); the "plain, substantial buildings" designed to reduce expenses became bare, vast mausoleums; and the colonies which were to relieve institutions of their crowdedness, bring about more humane living conditions, and reduce costs became large institutions in their own right.
5. The concentration of skilled expert staff never materialized, one of the main reasons being the partially self-elected isolation of institutions remote from centers of learning and population. To the contrary, institutions have tended to act as sieves, retaining professionals who are deviant themselves, and passing on the others to universities and community programs. The unlicensed physician, often unable to communicate in English, is notorious, as are professionals who are alcoholics, drug addicts, unstable, or health-handicapped. While it may be desirable to find niches for such individuals, it is significant that such persons should have become concentrated in our institutions. Professionals not good enough to work on us or our normal children were, it seems, good enough to work on our retarded children. Employees, as much as residents, become "institutionalized" (Gleland & Peck, 1967).