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The Origin And Nature Of Our Institutional Models
When the retardate is viewed as a diseased organism, residential facilities are structured on the (medical) hospital model. This model tends to have the following characteristics;
1. The facility is administered by a medical hierarchy: the chief administrative officer (e.g., the superintendent) is a physician, with a hierarchy of other physicians under him, and a hierarchy of nurses under them. Concern about authority lines tends to result in a tightly controlled perpendicular administrative structure rather than a flexible subunitized one.
2. The residence is identified or even labeled, at least in part, as a hospital (e.g. "state hospital and school").
3. Living units are referred to as nursing units or wards.
4. Residents are referred to as patients, and their retardation is identified as being a "disease" that requires a "diagnosis" and "prognosis."
5. Resident care is referred to as nursing care.
6. Case records are referred to as charts.
7. Hospital routines prevail. For example, admission procedures may require days or weeks of "observation" and residence in an "infirmary" or similar unit prior to "diagnosis" and to assignment to regular living quarters. Daily routines may resemble hospital routines in regard to rising, body inspections, sick call, charting, etc.; indeed, the daily schedule may revolve around the hinge of medication schedules. Dispension of medication, in turn, may become the model for intake of nourishment, and for other "treatments" as well. Such other treatments, even if "administered" in the form of education, may be referred to as "dosages." Usually, there is at least moderate emphasis upon convenience of "nursing care."
8. Concern with professional status symbols and status differentiation often encountered in a hospital atmosphere may be expressed by features such as presence of hierarchical staff lounges, showers, and private toilets. There may be separate vending machines for staff and "patients." Staff and residents rarely eat together. Caretaker personnel may wear uniforms. Even professional and semiprofessional personnel may wear uniforms, coats of different colors, badges, name plates with their degrees listed, and similar insignia of their role and rank.
9. Nonmedical personnel may emulate the medical role, e.g., social workers and psychologists may wear white coats or jackets, and prestigious professionals may be referred to as "doctor" even if they do not possess a doctorate degree.
10. Resident management programs are referred to as "treatments" or "therapy," e.g., recreation and work assignments may become recreational and industrial therapy. Even ordinary schooling may become educational therapy.
11. Physicians, whether qualified or not, make decisions about nonmedical matters, e.g., residents' rights and privileges, visits, work assignments, discipline, inclusion in school, training, and other programs. Even if these decisions are made by nonmedical personnel because of temporary or permanent lack of physician manpower, this may be perceived as delegation of medical authority, and as such is perceived and interpreted as undesirable and transient.
12. Departments with the greatest affinity to medicine are given priority in program development, e.g., dentistry, orthopedics, and physical therapy may receive stronger support than behavior shaping, education, etc.
13. Physical and medical techniques are more likely to be used in managing the behavior of residents than other techniques. Thus, disturbed residents are more likely to be physically restricted or settled with drugs than to be counseled or trained; residents with seizures may be placed on anticonvulsant medication with little thought given to environmental manipulation of seizure-precipitating events or to educating the person to develop preventive behavior habits.
14. There exists an excessive abhorrence of any chance or likelihood of injury to the retardate. On the one hand, this is exemplified by lack of stairs and steps, sharp objects and corners, conventional electrical outlets, and access to conventional hot water faucets; etc. On the other hand, it is exemplified by the presence of special features such as ramps, screening of radiators, and screened stairways (if any).
15. A disease conceptualization of retardation tends to result in a management dilemma. On the one hand, such a conceptualization often results in pursuit of treatment hoped to result in cure; on the other hand, unless a "cure" is seen as likely, the management atmosphere is often permeated with hopelessness and treatment nihilism. In other words, the disease conceptualization tends to be correlated with inappropriate extremes of management attitudes.
The Retardate as a Subhuman Organism. The fact that deviant subgroups within a culture may be perceived as not fully human has long been recognized. To this day, large segments of our population deny full humanity to members of certain minority groups such as Negroes and American Indians. Retardates are particularly apt to be unconsciously perceived or even consciously labeled as subhuman, as animal-like, or even as "vegetables" or "vegetative."