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The Rationale of the Book

The President's Committee on Mental Retardation has been deeply concerned about the issues sketched above. The Subcommittee on the State of the Nation was instructed to give serious study to this problem in 1967/68. As chairman of the Subcommittee, I have invited several American and European leaders known for imaginative conceptualization, planning, construction, or administration of residential and other services to take a thoughtful look at the plight of our nation's residential programs and facilities for the retarded, and to put their thoughts on paper. No attempt was made to develop an exhaustive handbook on residential care, but to examine the present system and to delineate some alternatives and courses for action. While the focus of this effort was to be on residential services in the United States, it became obvious that one cannot look at the residential problem without addressing oneself broadly to all aspects of services to the retarded, and even to human services more generally; and that in examining our problems, we can both learn from and perhaps contribute to the experiences of our colleagues in other countries.

The compendium of papers was intended to serve as a resource to the Subcommittee, and ultimately the total Committee, in formulating recommendations to the President and the nation. However, it was felt that the thinking of the authors should also be brought before a wider audience, and that this compendium that has contributed so much to the deliberations of the President's Committee should be published. Specifically, an attempt was made to structure the contributions to this volume in such a way as to make them useful not only to specialists in the field but also to nonspecialists who can or must make decisions relevant to the future of the field. Among such individuals might be legislators, officials at various levels of local, state, and federal government, and parent leaders. Last but not least, it was hoped that part or all of the book could be useful to students of mental retardation.

The rationale for the composition of the book deserves some discussion. The concept of "models" underlies the entire book and ties its various elements together. First, we attempted to provide an understanding of the current situation, i.e., the current models, and the first four parts (five chapters) of the book are devoted to this. The next three parts (eleven chapters) introduce suggestions and examples for constructive change (new models). The last part attempts to digest and integrate all of the earlier chapters and to translate them into specific recommendations for action. Appendices were added to a number of chapters. These appendices contain material that would disrupt the continuity and balance of a chapter, but which provide documentation or elaboration that might be of high interest to some users of the book. A more detailed discussion of this progression of the book follows below.

In Part 2, immediately following this chapter, Butterfield presents an array of basic facts about public institutions for the retarded in the United States. The intent of this chapter is to inform the nonspecialist and foreign reader of some quantitative aspects of the problem and to serve as a reference source to others. It should be noted that other chapters frequently make reference to the type of data presented by Butterfield.

Part 3 contains accounts of personal reactions to visits of rather typical state institutions for the retarded. Blatt's chapter is related to a book (Blatt and Kaplan, 1967), repeatedly referred to by other authors in the volume, and to an article based on this book and published in Look. Blatt depicts realities which many of us would prefer to deny, but which can only be called inexcusable for a wealthy nation such as ours. Indeed, such conditions are a disgrace to the nation, as should be clear from the next chapter by Nirje.

Nirje brings a perspective to bear which can be very valuable to us. Highly knowledgeable of mental retardation services across the world, he visited the United States with few preconceived ideas of what he might see, and -- what is particularly painful to us -- he had no axe to grind or vested interests to represent; thus, only someone with a strong vested interest himself could dismiss his judgment of our institutions lightly.

To understand the present and minimize errors in the future, one must know and understand the past. In Part 4, Wolfensberger attempts to interpret the history of United States institutions for the retarded in the light of certain theoretical constructs that have gained prominence in recent sociological thinking. A construct of particular strength in Wolfensberger's analysis is role and role perception. According to this analysis, our institutions generally function as if their retarded residents were perceived either as a social menace or as subhuman organisms, and institutional reform will depend more on changes in ideology than on vast monetary expenditures.