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Action Implications, U.S.A. Today

From: Changing Patterns in Residential Services for the Mentally Retarded
Creator: Gunnar Dybwad (author)
Date: January 10, 1969
Publisher: President's Committee on Mental Retardation, Washington, D.C.
Source: Available at selected libraries

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Administering a "little institution" housing 100, 150, or more individuals is a major responsibility which invariably brings with it tasks of an urgency which must take precedence over tasks related to situations where the responsibility for 24-hour care rests elsewhere, e.g., with the family. Once the regional system is thus tied to centers where administrators, planners, and staff are confronted with constant and immediate responsibility for a sizable group of handicapped residents, its potential to change and to develop other service alternatives is gravely jeopardized.

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Looking at the problem of change from a broader nationwide perspective, it seems that one can characterize the present development of mental retardation services in the United States somewhat as follows: although there has been widespread advocacy for increased emphasis on nonresidential services, the need for residential services is perpetuated and reinforced by the placing of a low fiscal priority on nonresidential services and a high fiscal priority on maintenance and construction of residential facilities. This results in a shortage of nonresidential services, which, in turn, leads to an accentuation of the urgency for the creation of additional residential services which are storing up an ever larger number, of individuals, since those ready to return to the community cannot be released because of the inadequacy of the supportive nonresidential services. A vicious circle, indeed.

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Legalism as Change Inhibitor. A number of well-intended but rigid legalisms have interfered with change and progress. Originally designed as protective measures, they now produce an overprotection that is in striking contrast with rehabilitative needs. Typical of this are cumbersome procedures for commitment, admission, and various forms of release, and building codes such as those which make it virtually impossible to construct group homes which do not contain dehumanizing features.

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Staff Concern With Job Status, Job Security, and Job Opportunities. In the past, institution attendants were generally among the lowest paid state employees, frequently had to work long hours, were excluded from civil service benefits, and lacked union organization. While pay, and in some jurisdictions hours, may still leave much to be desired, attendants are now more frequently protected by either union organization or civil service or by both. However, civil service regulations and union agreements have a tendency to become rigid and thus interfere with innovative and flexible programming.

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On the professional side, a similar phenomenon can be observed. Certain medical and nursing groups have staked out jobs as their preserve and vigorously resist changes in programming that could lead to more dynamic and diversified services, since their group might then lose jobs, roles, and status of which they may now be the only holders.

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Denial of Reality. The need for change can be effectively repressed by denying unpleasant realities which would underline the urgency for change. For instance, it is considered bad form for workers in the field to publicly label the gross inhumanities which are being committed upon residents of institutions. Those who expose the atrocities will find themselves much more sharply attached than those who commit them. Blatt and Kaplan's (1967) Christmas in Purgatory is one example, and another from a related field is the excellent documentary film Titticut Follies, which depicts the process of dehumanization in an institution for deviant offenders. Even Senator Robert Kennedy had to experience that the people of the State of New York had very little interest in listening to an account of the horrible conditions existing at a large state institution located within the boundaries of New York City, and they were even less inclined to do something about them. The reference in Sarason's chapter to "eyes that do not see, ears that do not hear, minds that deny the evidence before them" is very much in place here.

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One paradoxical but successful maneuver has been administrative protests against invasion of the privacy of institution residents, hereby blocking exposure of institutional practices which result in routine denial of privacy, rights, and dignity of residents.

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A kind of patriotism, state chauvinism, or even parochialism also plays a definitie -sic- role: the great state of . . ., proudly proclaiming its preeminence in industry, finance, culture, and education, cannot afford to let it be known that with all its riches, its glittering state office buildings, its highways and freeways, it treats in its institutions human beings, children among them, day by day in inhuman ways.

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Chauvinism was even apparent in reactions to early drafts of this volume, because it has drawn heavily on contributions of foreign thinkers in the field. This offended the sensibilities of a number of people. One objection raised was that cultural differences are such that experiences and practices in foreign countries have little or no relevance to us. Such reasoning can be seen only as defensiveness.

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