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Yet for those involved with the problem, such as for instance parents of afflicted children, there is a very definite qualitative differentiation between mental illness and mental retardation. Furthermore, there is distinct difference of opinion as to whether the one or the other is socially more "acceptable". A more detailed cross-cultural study on this qualitative differentiation should produce interesting results.

Indeed, beyond the specific differentiation between mental retardation and mental illness there lies the intriguing question regarding the existence of a hierarchy or handicaps in general, on the one hand in the eyes of the general public, on the other in the minds of the handicapped persons themselves.

Edgerton's story of the retarded boy leading about the blind man actually hits very close to a much debated question that has wide practical significance in vocational rehabilitation: Is it possible to "mix" people with different handicaps, including the mentally retarded, in a sheltered workshop? I was told the story of a man of normal intelligence who had had an arm amputated and who had been trained by the rehabilitation agency as a spot-welder. In the sheltered workshop the only job requiring spot-welding involved metal chairs and a mentally retarded young man with mongolism was assigned the task of lifting the chairs on to a work table so the welder could perform his task. At first both men objected strenuously to this arrangement -- the welder because he felt he was being demeaned by having to work with such a misfit and the young man because he was terrified of the welder's torch. However, with the encouragement of the staff, the two became reconciled to the situation, the welder because of the steady work performance by his partner, while the latter was pleased with the social recognition this assignment gave him. When the amputee eventually left the workshop, the young man with mongolism asked for and was given the welding assignment at which he became proficient.

The problem of providing employment opportunities for the handicapped, including the mentally retarded, has led to an interesting development in Poland: Invalids' Cooperatives run their own factories and have become a recognized part of the nation's productive capacity. While at first limited to the physically handicapped, the Cooperatives recently have begun to include the mentally retarded though at first in segregated units or in one or two cases, in special units together with the mentally ill.

Discrimination among those discriminated against by the general public as "deviants" deserves further analytic study not only with regard to acceptance of the mentally retarded by persons with other mental or physically handicaps but, indeed, also with regard to acceptance of the severely retarded by those with lesser degrees of intellectual handicaps. Edgerton's significant study on stigma in the lives of the mentally retarded (20) and, indeed, the whole area of the self concept of the mentally retarded (21) have obviously great significance for strategies in rehabilitative efforts, particularly the selection criteria to programs of care and training.

(21) Cobb, Henry V., The Self Concept of the Mentally Retarded. Rehabilitation Record, 2,3, May-June 1961.

Edgerton arrives at the conclusion that something more than a simplistic environmental deterministic formula must be invoked to account for the differential treatment accorded the mentally retarded in the world's non-Western societies and that the answer must lie somewhere in the complex web that unites culture and social organization. A recent Expert Committee of the World Health Organization (22) parallels this thought by the statement that "Criteria of mental retardation do not relate only to the individual and his handicap but may also reflect the complexity of the demands that society makes upon the individual as well as the threshold of its tolerance for deviation." But what causes this threshold of tolerance? Why has Spain, with a considerable (though now rapidly diminishing) rate of illiteracy, a low tolerance of intellectual deficit, designating as retarded (subnormal) even those with relatively minor intellectual deficiency, when Denmark and Sweden, with a high level of literacy, are far more tolerant of variation in intellectual performance and as a result arrive at their much discussed low rate of incidence and prevalence? The need for further study in this direction is obvious.

With regard to the fourth assumption put forth by Dr. Edgerton, namely that the mildly retarded do not constitute a social problem, I would like to address myself in particular to the problem of productivity -- one of the salient factors leading to social acceptability. In a paper on the problems in special education of children in the multi-cultural society of Israel, Emmanuel Chigier (23) describes Israel's problem in trying to integrate the children of immigrants coming from countries with low levels of cultural expectations and adds that these problems are likely to increase as the country progresses technologically toward automation. In other words, here again is the thought referred to repeatedly by Edgerton, that as society gets more advanced in technology, the intellectually limited population will increasingly become misfits. Yet, it can hardly be disputed that hunting game or locating water or (as was pointed out) steering a canoe over long distances without a compass requires a great deal more intelligence than wiping oil from a big drill press or riding every day 20 blocks on a bus.