The Burden of Defect
WITH the publication of the Annual Report of the Board of Control* we are reminded again of one of the growing problems of our time—the burden on our finances and energy of mental disease and deficiency. The weight is growing well-nigh intolerable. The magni- tude and gravity of the issues involved can scarcely be exaggerated : a consideration of even a few of the cases cited in the Report will furnish abundant proof of this : Case No. 1. Father : Welsh collier. Mother : Feeble-minded.—
(1) Daughter, born 1895, feeble-minded. In institution for three and a quarter years. Died therein of influenza and pneumonia. (2) Son, born 1899, feeble-minded, in certified institution for four years. Died therein of bronchial pneumonia. (3) Son, born 1897, imbecile. Under care in institution for mental defectives since August, 1915. (4) Son, born December, 1900, imbecile. Under care in institution for mental defectives since March, 1918. (5) Son, born August, 1904, imbecile. Under care in institution for mental defectives since September, 1920. (6) Daughter, born October, 1908, feeble-minded. Under care in institution for mental defectives since March, 1928.
These are the six mentally defective children of one family ; there were no other offspring.
Case No. 2. Father " in and out " of Mental Hospital. Mother, feeble-minded.—(1) Daughter, aged twenty-nine, feeble-minded. Under care in Mental Deficiency Institution since August, 1921. Two illegitimate children. (2) Daughter, aged twenty-four, feeble- minded. Under care in Mental Deficiency Institution since March, 1921. Previously sent to Industrial School for consorting with prostitutes. (3) Daughter, aged seventeen, imbecile. Under care in Mental Deficiency Institution since January, 1928. Found wandering round army camps. (4) and (5) Two sons, " unemployable."
Case No. 3. Father described as being fairly normal. Mother mentally defective.—(1) Son, aged fourteen, an imbecile. Under care in Mental Deficiency Institution since April, 1927. (2) Daughter, aged eleven, feeble-minded, under care in Mental Deficiency Institution since April, 1927. (3) Son, aged fourteen, feeble-minded. In Poor Law Institution awaiting removal to Institution for mental defectives. (4) Son, aged seven, feeble- minded. Under care in Mental Deficiency Institution since July, 1927. The parents of these four mentally defective children have themselves received indoor relief for a number of years.
After giving three more similar cases, the Report continues : " Had the six mentally defective parents been dealt with under the Mental Deficiency Act early in life and segregated, the community would not have had to support twenty-nine other mentally defective persons." We might add that there would have been twenty-nine fewer unhappy beings in the world ; for what fate could be more miserable than that of a sub-human in a world of struggling men and women !
In the face of such family histories (as the Report observes), " no one can dispute that mental deficiency is the fundamental cause of much pauperism, and of a great deal of petty and serious crime. It is also the fundamental cause of much inebriety. Mental deficiency is intimately allied with insanity." The biological link between the two forms of mental disorder is manifest in the larger number of mentally pathological pedigrees : where one member of the family is insane, another is feeble-minded. Clinkally, of course, they are very different. A lunatic has been aptly likened to a house with the roof blown off or collapsed, while an " ament " (to use the term which covers all grades of mental deficiency) is a house which has never had a roof at all. - We may well ask ourselves why the Mental Deficiency Act is not rigorously enforced ? There are two main answers. First; Local Authorities seldom trouble to certify, with the consequence that most people believe the total number of aments " to be, as here reported, 61,522—a comparatively trifling number. The real number, according to reliable and conservative estimates, is between 200,000 and 400,000, to which should be added, respectively, 400,000 or 800,000 of unemployable " carriers " of the disease. The second reason is the probable cost of enforcement of the Act : £100;000,000 a year, on a cautious estimate, would have to be spent * H. M.'s Stationery Offiee (Is. 6(1.)- on the proper care and Segregation of all mental defectives. It is true that uncontrolled " aments " are already costing the country more than this—in crime, venereal disease, illegitimacy, pauperism, and all the varieties of social failure. But still, we have not the money for their proper upkeep, still less for the capital expendi- ture ; and a nation, like an individual, must cut its coat according to its cloth. Besides, even if the money could be found, would it not be better spent on housing and educating the normal healthy child than on trying to teach mental failures ? As it is, in the L.C.C. special schools over £90 is spent on each defective child and £12 on each normal child in the elementary schools— so that we are denying much to the healthy child in order to enable his defective brother to have a little learning at great cost.
Wholesale segregation must therefore for long remain an impossible ideal, a measure to be reserved only for those lunatics or " aments " who are actively anti-social. Meanwhile there is serious danger of the huge remainder outbreeding the normal population that keeps them alive ; for their numbers and proportions have grown considerably during the last two decades. Sterilization —though the word frightens those who do not under- stand it—is the only practical remedy that has yet been proposed. The Board, of necessity, maintains a non-committal attitude, though a bias in its favour, in some cases at least, is perhaps discernible between the official lines. The corresponding body in New Zealand has for long vigorously advocated sterilization, while in Alberta a Bill has actually become law. Several of the American States have been sterilizing defectives for many years past, and in California, where the policy has been most thoroughly pursued, it has been followed by a series of scientific investigations. Briefly, no ill results have yet been recorded ; while it seems clear from family histories that in sterilizing a defective there is little fear of cutting short a strain of genius, or even of talent. Indeed, contrary to popular belief, great wits are not allied to madness, much less to mental defect.
With this evidence and these authorities in its favour, there seems a case for the adoption of sterilization in certain cases. The problem must in any case be tackled promptly and effectively, not only for the sake of the unhappy beings who ought never to be born, nor only on account of their cost to us. Man has attained his place in nature by his mind, and by mental evolution he has created civilization. The existence of the sub-human and mentally defective is a peril and an affront to the dignity of Man.
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