The Indian Journal of Social Work, Vol. XXIII, No. 2 (July 1962). ...
The Indian Journal of Social Work, Vol. XXIII, No. 2 (July 1962).
EDUCATION AND REHABILITATION OF THE MENTALLY RETARDED
C. A. AMESUR, M.S. (LONDON)
Since time immemorial man has attached very great importance to the functioning of
the human mind. Both ancient and modern societies assign a privileged position to the
scholar, the poet and the scientist.
A society which attaches so much importance to mental ability naturally looks upon
mental retardation as a disastrous misfortune. It is only in recent times that man has begun
to adopt a rational attitude towards mental retardation. Experience has shown that even
the mentally retarded can in many cases be educated and trained and integrated into the
community as contributing members.
T h e primary object of this paper is to present to the reader the essence of modern
evidence which seems to indicate that there is hope for most of the moderately mentally
retarded provided they have an opportunity for education and training. An attempt will
also be made to enunciate some broad principles which should guide the development of
services for the mentally retarded.
Dr. Amesur has been a member of many committees in drawing up the blue prints
of the E.N.T. and Audiology Departments of various hospitals, both at the National and
local levels. He started social welfare work in 1913 by being Founder Secretary-Treasurer of
the Chhaproo Vidya Mandal for the Needy. He has published several articles, 41 on medical
subjects and 4 on social welfare.
—For an understanding of pronounced, that they are incapable of
the type of services needed for the mentally managing themselves or their affairs or in the
retarded it is necessary to understand what case of children of being taught to do so.
is mental retardation. Unfortunately, it is by
—Persons in whose
no means easy to define mental retardation case there exists mental defectiveness which
or deficiency. A fairly large number of though not amounting to imbecility, is yet so
definitions have been suggested by workers pronounced that they require care, supervision
in the field. We might however quote here and control for their own protection or for
the British definition which is as follows: —
the protection of others or in the case of
"A condition of arrested or incomplete children, involve disability of mind of such a
development of the mind, existing before the nature and extent as to make them for
age of eighteen years arising from inherent purposes of section 57 of the Education Act
causes or induced by disease or injury."
of 1944, incapable of receiving education at
The British Mental Deficiency Act school.
classifies the mentally retarded as follows: —
(4) Moral Defectives.
—Persons in whose
—Persons in whose case there case there exists mental defectiveness coupled
exists mentally defectiveness of a degree, that with strongly vicious or criminal propensities
they are unable to guard themselves against and who require, care, supervision and
common physical dangers.
control for the protection of others.
—Persons in whose case
Since definitions of mental deficiency vary
there exists mental defectiveness, which from country to country, the National
though not amounting to idiocy, is yet so Advisory Council for the Education of the'
C. A. AMESUR
Handicapped has just asked its sub-committee
importance. Intelligence is multifactorial, i.e.
on the education of mentally deficient many genes are involved. While their
children to evolve a definition best suited for importance cannot be minimised, they
this country. This committee is also charged cannot be accepted as a sole cause. There is
with the task of making a survey of the existing always a reaction between inherited and
services and suggesting measures for the environmental factors, which determine when,
improvement of the existing services and for how and the extent of maladjustment, if any.
the development of new ones.
The child's personal relations in the family
group early in infancy or in childhood have
—As in most of the countries no an extraordinary influence on the whole future
dependable estimate of mentally retarded life of the child and contribute materially to
persons is available. This is due largely to the
its breakdown or to the inevitability of its
extreme difficulty in identifying mental breakdown. Poor social conditions, bad
defects. Nevertheless, during the Second Plan nutrition, insanitary surroundings, poor
period the Government of India attempted to parental guidance are usually associated with
carry out random sample surveys in Bombay low economical factors and with sub-normal
and Delhi. According to the Bombay survey intelligence. There is a negative co-relation
about 0.6% of the population is mentally between size of the family and intelligence.
retarded. According to another survey being Children of later pregnancy also show a
undertaken with assistance from the Govern-
higher percentage of mentally defectives.
ment of India by the Indian Council for While it is accepted that quite a number of
Mental Hygiene, it is estimated that about feebleminded are born of parents with
one percent of the population is mentally evidence of mental dullness, insanity, nervous
disease or of those with psychopathic
tendencies, it should be remembered that not
The census figures for 1961 seem to all retarded are children of mentally
indicate that the country's population has defectives.
gone up to 438 millions. This means that
there should be at least 4.38 million mentally
Metabolic factors due to Genes.
retarded persons who will require educational of metabolic disorders are described which
and employment services.
have mental defect among their effects. These
are presumed to be a single rare gene. The
—Very little is known today theory underlying their causation is that the
about the causes of mental defects. Neverthe-
presence of a recessive gene causes absence of
less, various workers have been attempting to deficiency of a particular enzyme; the normal
explore this fascinating field and some enzymatic activity is therefore interfered with.
knowledge has been gathered.
Such interference of activity is exhibited on
the metabolic processes associated with and
Various aetiological factors have been involving all three major dietic factors, e.g.
grouped together in which mental retardation
Proteins, Carbohydrates and Lipids. Some of
plays an important part. For proper under-
the important ones are: —
standing, these are put into three broad
groups. Factors operating in: (a) Pre-natal
(a) Phenyl-Pyruvic disease. Interference
(h) Natal/paranatal (c) Post natal periods.
with the metabolism of phenyl-
(a) Pre-natal: These are hereditary factors
alanine—a break down product of
of which genetic ones are of paramount
EDUCATION AND REHABILITATION OF THE MENTALLY RETARDED IN INDIA
(b) Galactosomia. A defect in carbo-
which a cause and effect relationship has
hydrate metabolism specifically affect-
been established, so far as mental retardation
is concerned, is the hormone of thyroid.
(c) Tay-Sach's group affects lipid Miscellaneous group.
—Epilepsy. A convul-
sive disorder, leads to mental deterioration of
a progressive type. There are also a number
(d) Gargoylism. Of complex nature of disorders which result from degenerative
involving more than one system.
processes in the skull. Other disorders
These metabolic disorders open out a new are caused by some other pathological process,
line of thought in as much as eradication of
malignant infiltration, etc. which lead to
metabolic defects leads to cure of mental manifest changes in the confiugeration of the
defects. A new and hopeful approach is thus skill, by which they are easily identified. These
created for tackling metabolic mental may be associated with cerebral palsy or with
disorders of genetic origin.
some other cerebral disorder. Often no
adequate cause could be found.
Infective in origin.
—Of the prenatal
period we recognise three main ones:
—It has been ascribed to partly
(a) Rubella. Infection of the mother about genetic, partly hormonal and partly
the time of conception, is very likely to cause metabolic factors. It is usually recorded in
foetal damage; (b) Toxoplasmosis; mothers of over 30 years of age. Its incidence
(c) Congenital syphilis. These are accepted has been estimated to be 1 in 600. In mono
ones, Encephalomyelitis of bacterial, viral zygotic twins, both are naturally mongols. In
or of unknown origin, occurring in the dizygotic, it is no more frequent to be
embryo or they can cause mental retardation mongols than could be expected by chance.
of a variable degree after birth. This can be In the post natal period any of the cerebral
temporary or permanent, stationary or infective processes can result in damage. But
progressive. There may be direct action or the most distressing are those that result from
nerve tissue or the effect may be an indirect vaccination, usually after small-pox.
one by interfering with the circulation of
cerebro spinal fluid.
It will thus be seen that the causation in
a large percentage of cases remains unknown.
—Before, during or after birth, Almost 90 percent are pre-natal in origin,
Trauma can be the cause of mental retardation
with varying ;genetic influence singly or in
of a variable degree. In this group are also combination.
included the after effects of administration of
chemicals specially Nitrous oxide during the
—It is generally believed that
process of birth. Radiation to the pregnant an inherent mental defect cannot be remedied.
mother—long since forgotten, was responsible But improvement is often possible not only
for some of these conditions. There is by intensive educational therapy but also by
likelihood of increasing use of atomic energy altering the environment.
in future. Hence this reference.
Since so little is known about" the
—Birth injuries may aetiology of mental defect, it is by no means
arrrest certain endocrine glands in the skull, easy to suggest preventive measures. Some
Apart from this the only known hormone, for measures would however appear to be clearly
C. A, AMESUR
indicated. As a first step it is important to
The establishment of more well-staffed and
avoid infections during pregnancy. Consan-
well-equipped child guidance clinics is a
guineous marriages also would appear to be crying need.
a source of danger. Sterilisation is indicated
where the parents suffer from hereditary
—Education of mentally retar-
ded children has received very little attention
in this country. This is apparent from the
Perhaps the most important preventive fact that there are hardly a dozen schools in
measure particularly in cases where retarda-
the country with a total enrolment of not
tion is not inherent is to provide the child more than about 800.
with a healthy environment in which he can
The first school was started by Smt. Jai H.
grow naturally and with a complete sense of
Vakil in 1944 with only two pupils at
Bombay in her own home. This school which
was later shifted to a special building
Although in many cases constructed for the purpose has 163 pupils on
gross mental defect becomes fairly apparent the roll.
by the time the child is of school going age,
it is not always easy to make an accurate
The School is administered by the Society
diagnosis. Therapy will depend on correct for the Care and Treatment of Children in
Need of Special Care which was formed by
Smt. Vakil in 1949. The School attempts to
Child guidance clinics play a very give simple academic education coupled with
important role in the diagnosis and treatment
training in a few crafts. The object is to help
of mental retardation as well as emotional the pupils towards as much independence as
maladjustment. It is the task of these clinics their limited mental abilities would permit.
to make a thorough psychological examina-
tion of the child and also to study the
This is the only institution which trains
environmental factors which might be teachers of mentally retarded children in the
responsible for his difficulties. It is only after
country. It offers a one-year course and
a complete and all embracing examination awards diplomas on successful candidates.
that a decision can be reached.
The need for more educational facilities
Unfortunately the number of child for mentally retarded children is too obvious
guidance clinics is very small. At present there
to be emphasized. The Sub-Committee of
are only about 31 child guidance clinics in the National Advisory Council for the
the country. 5 of them are located in the city
Education of the Handicapped which is at
of Bombay with a population of nearly present reviewing the situation might be able
to suggest some useful measures. Meanwhile,
it is important to bear in mind the fact that
Many of the clinics in the country are not
India is a land of 550,000 villages. There are
well equipped. It is necessary that these only about 3,500 towns.
clinics should have modern diagnostic tools
and a team of experts like a psychiatrist and
The establishment of special schools in
psychiatric social worker, an educationist and
rural areas might not be immediately
so on so that the child can be studied from feasible. In view of this it will be necessary
to consider alternative measures like the
EDUCATION AND REHABILITATION OF THE MENTALLY RETARDED IN INDIA
establishment or special classes in ordinary be taken as a guide the problem is of
schools and the training of teachers to meet unprecedented magnitude. This can be
the needs of border-line cases by giving more seen from the following statement made by
individual attention in the ordinary class.
President Eisenhower while inaugurating
the National Retarded Children's week in
Some of these measures were recently 1956:—
recommended by the International Con-
ference convened at Geneva last year by
"Three percent of the population of
UNESCO and the International Bureau of
U.S.A. came under the category of
Education. They have made a comprehensive
retarded; this works out 30 in a population
recommendation to the member States on the
of a thousand; of these thirty, twenty five
education and rehabilitation of mentally
are considered educable. Very nearly
retarded persons. It will be well for this
seventy five percent of these educable, with
country to bear this recommendation in mind
necessary training and education can
while framing its educational policy in regard
become self-supporting members of
to mentally deficient children.
society and be able to manage their own
affairs. Four of these thirty are trainable
Some good schemes have already been
and can become self-supporting in a
formulated. Dr. K. R. Masani, Chairman of
the Indian Council for Mental Hygiene has
prepared a comprehensive scheme for the
Training is of little value without employ-
consideration of the various states. This ment. It is necessary that voluntary agencies
would comprise at least one large home for and the National Employment Service
mentally defective children, for their care, for should try to place mentally deficient persons
their protection, for their training in crafts, in simple occupations which they can
for 200 pupils at an approximate cost of practice. Experience in other countries has
Rs. 100 per child per month.
shown that this can be done.
The Chairman, the State Aid Society for
Plans for the future.
—Although for the
Children, (Maharashtra), Shri B. R. Bhatt, first time the Central Government had made
has suggested a colony for (a) 1,500 males some provision in the Second Plan for
and (b) 1,500 females, in cottages of fifty providing services for the mentally deficient,
each at a non-recurring cost of 28.5 lakhs and
no scheme was actually undertaken. During
an annual recurring cost of 3.12 lakhs.
the Third Plan period however a beginning
is proposed to be made with the establishment
Training and Employment.
—At present of a school for mentally deficient children in
there are no training centres for mentally New Delhi.
deficient children in India. The need for
such centres is enhanced by the fact that
The National Council has also suggested
most mentally retarded persons cannot that surveys of mental deficiency should be
receive a great deal of academic education. carried out in the various states.
It is only through practical work that they
can become useful and contributing members.
With these small beginnings it might be
possible to build up more comprehensive
In the absence of information about the services in the Fourth and subsequent plans.
size of the problem it is not easy to indicate
how many training centres will be needed.
—Despite the lack of informa-
But if the experience of other countries is to tion about the size of mentally deficient
C. A. AMESUR
population, the present indications are that
The effective implementation of pro-
the problem is enormous. The primary need
grammes for mentally deficient persons
therefore is the rapid expansion of services. requires an effective executive body. That
Concurrently, an attempt should be made to Government is not always able to implement
assess the size of the problem with a little these programmes is shown by the fact that
no scheme could be undertaken during the
Second Plan. It is desirable therefore that
Education of the public is the comer stone the Central Government should set up an
of any system of services for mentally autonomous body to undertake these
deficient children. Unless the community programmes. A welcome development is that
becomes aware of the potentialities of the the Government of India have just announced
mentally deficient and sheds all prejudice, the that in future they will contribute 75% of the
chances of integrating the mentally handi-
expenditure on the development schemes of
capped person into his community which is voluntary agencies. We hope that eventually
after all the aim of rehabilitation, can hardly the Government may agree to pay 90 percent
of the expenditure as advocated by the author.
1. Amesur, C. A.—(a) National Advisory Council for the Education of the Handicapped
in India, Ind. Jour. Oto (1955) Vol. VII, No. 4, 136-143.
S[b) Resettlement for the Handicapped in India, Social Welfare (1949), Vol VI
No. 6, 21-24.
(c) National Advisory Council for the Education of the Handicapped in India, Second.
The Antiseptic (1959) Vol. 56, No. 9, 713-717.
(d) The Nature and Extent of the Problem of the Handicapped and How it is Tackled
in India. Social Work Review (The M. S. University of Baroda, Vol. VII,
July 1960, 3-13.
(e) Welfare of the Physically Handicapped, Chapter 32, in the History and Philosophy
of Social Work in India edited by Prof. A. R. Wadia (1961), published by Allied
Publishers Pvt. Ltd.
2. Begab, Michael J.—"A Social Work Approach to the Mentally Retarded and their
Families" Journal of Mental Deficiency,
(1958) Vol. 63, No. 3.
3. Boggs, Elizabeth M.—Sheltered Workshop for the Mentally Retarded (1954),
Fifth Annual Convention held at Boston (Mass), U.S.A.
4. Goran Teenager.—Social Security in Sweden (1956) printed by Almquist Wiksell,
Uppsola, Sweden, 54.
5. Indian Conference of Social Work (1958).—Report of its Sub-Committee on Mental
Hygien and Social Welfare, 41-42.
6. Jacobs, Abraham and Weingold.—The Sheltered Workshop for the Mentally
Retarded (1958) published by Teachers College, Columbia University, New York.
7. Marfatia, J. C.—"The Problem of Mental Deficiency", Indian Journal of Child Health,
(1959) Vol. 8, No. 5.
8. Social Welfare in the United Kingdom.—Published by United Nations, Geneva,
April 1956, 135-140.
9. Sweden, School Facilities for Mentally Handicapped.—By Board of Education under the
Ministry of Educational and Ecclesiastical Affairs (1957) 1-3.
10. Wright, Beatrice A.—Psychology and Rehabilitation (1959) published by American
Psychological Association, Washington D.C., U.S.A.