Mental Retardation

   (See also Autism.)

   Mental retardation (MR) was once in the province of psychiatry, but even though the diagnosis continues to be included in DSM, the condition has now largely passed into the hands of pediatrics. MR is defined by three criteria: (1) an intelligence quotient (IQ) of less than 70–75; (2) a significant limitation in meeting the challenges of life ("two or more adaptive skill areas," according to the American Association on Mental Retardation); (3) the condition having been present from childhood. There follow some landmarks in the understanding of MR, which is considered to be a developmental disability rather than a medical disease. Before the nineteenth century, children with MR were seen as objects of demonic possession. The modern history of encouraging their development begins with the work of Onésime-Édouard Séguin (1812–1880), a Parisian educator who in 1839 founded a school for the training of "idiot children." Séguin had highly prescient ideas about their education: in his 1846 book, Psychological Therapy, Hygiene and Training of Idiot Children (Traitement moral, hygiène et éducation des idiots), he believed that with training, MR could partially be overcome, and advocated a system of drills and physical exercises. In 1850, Séguin emigrated to the United States, where in 1852 he established in South Boston a special school, then another in Syracuse, New York, in 1854, collaborating in founding a number of such schools in the 1850s in other states. Finally, after gaining an American medical degree in 1861, he settled in New York, and in Orange, New Jersey, opened the doors of the Séguin Physiological School for Feeble-Minded Children. In 1866, he wrote Idiocy and Its Treatment by the Physiological Method, becoming in 1876 the founding president of the Association of Medical Offi-cers of American Institutions for Idiotic and Feeble-Minded Persons. The "degeneration" period in the history of MR sounded notes quite different from Séguin’s: viewing retarded children as objects of poisoned heredity and as potential threats to society. In 1871, the Elwyn Training School in Pennsylvania added a custodial department for mentally retarded people of all ages. Psychologist Henry Goddard (1866–1957), director of the psychological laboratory of the Vineland Training School in New Jersey (who in 1909 introduced Alfred Binet’s [1857–1911] and Théodore Simon’s [1873–1961] IQ test to the United States), described in his 1911 book on The Kallikak Family: A Study in the Heredity of Feeble-Mindedness, a stream of "degeneracy" flowing from the Piney Woods. In 1927, Justice Oliver Wendell Holmes of the U.S. Supreme Court, upholding a sterilization law for the mentally retarded, declared, "Three generations of idiots are enough."

   In terms of the diagnosis and treatment of MR, there has been some progress.

   (See Phenylketonuria (PKU)

   A major step forward has entailed rescuing people with MR from the often horrifying institutions to which they had been consigned and giving them the opportunity to develop in the community to their maximum ability. The seminal figure in the United States is Wolf Wolfensberger (1934–), professor in the school of education at Syracuse University, who as early as 1969 in a volume of essays edited by Robert Kugel, later in a book on the Principle of Normalization (1972), advocated the "normalization" of MR, which previously had been considered deviant behavior. Inspired by what he had seen in an earlier trip to Scandinavia, Wolfensberger campaigned for conditions in which people with MR could lead "culturally valued lives."

   Beginning in 1968 at the Special Olympics in Chicago, Eunice Shriver (1921–), her husband Sargent Shriver (1915–), and the Joseph P. Kennedy, Jr. Foundation, led efforts to reactivate children with MR by getting them involved in competitive athletics. Special Olympics turned into a worldwide program that has realized many of the principles of Séguin.