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Dr. Rosenzweig quite correctly called attention to the fact that a real hazard for the retardate in the community is social isolation. For the retardate in the institution the exact opposite would seem to be the case, at least as far as the more severely retarded in U.S.A. institutions are concerned. Theirs is an unmitigated herd existence, with no escape from the large group to which they are assigned during waking and during sleeping hours. Therefore let us insist on small buildings with perhaps two dormitories of 14 to 16 each. As an absolute minimum we should insist on dormitories that provide, through partitions and bedside tables, a minimum amount of privacy, a sense of individuality. However, there is no reason why we cannot refine our clinical evaluation to make possible appropriate assignments to smaller groups of residents. This in turn would enable us to develop some buildings with bedrooms for smaller groups rather than the usual dormitories, a problem that should challenge the imagination of our architects.

From time to time the point has been made by educators that certain of our retarded individuals must be protected from over-stimulation and that therefore schoolrooms for these individuals should be furnished and organized accordingly. I do not wish to espouse here the theories of Dr. Alfred Strauss and his associates but it is astonishing that so little attention has been paid to the damaging psychological effects we must be inflicting on some of our residents with the strains of congregate living in our large housing units. As I travel year after year from institution to institution the standard fare is the big day room with benches (and in the luxury institutions, tables and chairs) and a TV set loudly blaring away. For the sensitive youngster, for the child who is upset, there is, in the words of the spiritual "no hiding place down there". I am particularly chagrined in such situations when I see that in another corner of the building there is the dining room locked up after meal hours and not available as extra living space.

Our juvenile detention homes have long ago demonstrated how by intelligent use of safety glass partitions one employee can supervise different groups in a "noisy" and a "quiet" dayroom. Should the dining room have a serving steam table it would not be difficult to have a folding partition which shuts off the serving area and frees the dining room as extra living space. Perhaps I should call attention to the fact that I have not spoken of "home-like atmosphere". This to me seems to be an unreasonable demand for most institutional situations, but certainly the plea for privacy and a degree of individuality should not be judged as unreasonable.

In this connection let me make a comment on food service. I have seen some institutions where food was served in the cottage in an attractive way. Still, with 25 to 35 youngsters in the dining room this is hardly "home style". Recently I had occasion to see some new central dining rooms to which the different housing units came for their meals and where service was provided cafeteria style in attractive surroundings, on small tables seating four with freedom to choose a table regardless of one's group and with boys and girls, men and women, thus sitting together. Nobody made any pretense about it being homelike but it was totally different from the old regimental institution mass feeding and similar to the situation one would meet in any cafeteria "at home". I am not saying that the one method is superior to the other: there are advantages in both, underlining that there is always room for quite different solutions of a given institutional problem. Indeed, there are institutions which use both methods -- centralized dining rooms and individual cottage feeding, as seems best suited for the type of patient.

I regret that there is no time here to-day for me to relate what I have learned in my travels in Europe and the U.S.A. regarding substituting wasteful costly state hospital architecture with imaginative building methods adapted to the needs of the more severely retarded about whom we are talking here.

Just a word about size of institutions. The State of Connecticut has just declared two large institutions are enough, from now on they will build smaller regional facilities, immediately adjacent to or right in a city. Other administrators feel that a large institution of 1,000 to 1,500 beds is needed to develop within the institution the full complement of professional help from all the medical specialties, psychology, education, rehabilitation, needed for a comprehensive treatment program. I personally consider 1,000 residents the absolute upper limit for anything I would wish to plan but would agree that much depends on the institutional plan of organization. What sort of an institution do we want and who should run it?

At C.A.R.C.'s last convention Dr. Jack Griffin, Division General of the Canadian Mental Health Association, raised in his excellent dinner speech the question "Is Mental Retardation a Mental Health Problem?" His discussion brought out that it was certainly that, but it was also an educational problem, a problem of vocational training and rehabilitation, a neurological problem and definitely a social problem. In a similar vein let me ask here today: "What is the Mental Retardation institution? A school? A hospital? A nursing home?" The Group for Advancement of Psychiatry last year released a report insisting that what we need in the field of Mental Retardation are Psychiatric Centers for Children. This is true if one clearly understands that is but one of many types of residential care we need for the Retarded. Yet for the Group for the Advancement of Psychiatry the answer is clear and unilateral: -- the Psychiatrist is the key expert in Mental Retardation.