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On the other side of the coin, the belief of some primitive people that the severely retarded were divine creatures also finds its parallels in modern life in the U.S.A. Within the Roman Catholic church there is a strong movement referring to the mentally retarded as "Holy Innocents", and contemporary literature in this country, both Catholic and Protestant, includes many autobiographical accounts or parent guidance materials describing the mentally retarded child as "a special gift of God" -- a privilege bestowed on the faithful.

However, again in keeping with Edgerton's observation that among primitive men reaction to the mentally retarded is usually on a continuum from favorable to unfavorable, so also in developed countries such as the U.S.A. can be found a viewpoint opposite to that of the "Holy Innocents", namely the retarded child being ascribed to the parents as punishment visited upon them for their sins. (12)

Interesting from a religious point of view is also the work of the anthroposophical movement in the field of mental retardation. Their very positive attitude toward the retarded person and their insistence on his dignity and his right to an ethical approach and an aesthetic environment (which has led to some outstanding care programs under anthroposophical direction in several countries) undoubtedly can be related to their belief in reincarnation.

There is a definite connection between the religious and the health aspects of mental retardation. Edgerton refers to examples where the mentally retarded person is considered to have healing powers but conversely retardation is also seen as the object of the witch doctor or magic healer even after medical treatment of illness has been successfully introduced. In Nigeria this is so deeply rooted that the Department of Psychiatry, of the University of Ibadan, in the development of out-patient clinics in certain villages has utilized the services of the traditional healer or witch doctor in epidemiological studies, community attitude surveys and social and group approaches. The Nigerian psychiatrist. Dr. T. A. Lambo (13) comments "without their help we would not have known how and where to look".

Meisgeier (14) provides us in this context with interesting material from the Mexican-American groups in Texas, based on an earlier study by Fantini. (15) Mental illness and mental retardation are considered a "mal puesto", an unnatural disease, and it is the "curandero", the folk-healer, to whom they turn first for help. Combined with the fatalism which pervades the life of this population group, this has resulted in failure of efforts to introduce programs of rehabilitation as well as prevention. One wonders whether Texan physicians would ever consider the approach utilized by their Nigerian colleagues, namely to accept as a reality the population's faith in the healer and to try to win him over and work through him.

(15) Fantini, A. E., Illness and Curing Among the Mexican-Americans of Mission, Texas, unpublished master's thesis. University of Texas, 1962.

Two additional comments suggest themselves in a discussion of this aspect of Edgerton's paper -- the first is the increasing recognition of the role malnutrition plays in the etiology of mental retardation. Recent communications from Nigeria (16) and from Kenya (17) refer to protein-caloric malnutrition of varying severity up to the fully blown Kwashiorkor which in its early stages can be reversed through a high protein diet resulting in physically and mentally fit children, but which after prolonged exposure eventually brings permanent damage. With regard to the Mexican-American group, Benjamin Pasamanik (18) called attention to this problem already seventeen years ago and the point was recently reiterated by Meisgeier, while Cravioto (19) has demonstrated the connecting link between inadequate diet and inadequate intellectual performance through studies in Mexico and other Latin American countries. The most recent reports on the unexpectedly large degree of malnutrition and actual starvation in the United States suggest that this factor should receive far more careful consideration in assessing the results of socio-economic and cultural deprivation in the U.S.A.

(17) supra 5

(18) Pasamanik, Benjamin, The Intelligence of American Children of Mexican Parentage -- A Discussion of Uncontrolled Variables. Journal of Abnormal Psychology. 46., 1951.

(19) Cravioto, J. and Robles, B., Evolution of Adaptive and Motor Behavior During Rehabilitation from Kwashiorkor. American Journal of Orthopsychiatry, 35, 3, April 1965.

The second point refers to confusion between mental retardation and mental illness. In some of the examples given by Edgerton one wonders whether in the minds of the observers there was a sufficient differentiation between the "idiot" and the "maniac". Maisgeier points out that among the Mexican-Americans the more severely retarded are often mistakenly categorized as "loco" (crazy) and a similar report has come from India. Even many relatively intelligent people in the U.S.A. are confused about the difference between mental retardation and mental illness.