"They cover a dung hill with a piece of tapestry when a procession goes by,"
MIGUEL DE CERVANTES
There is a hell on earth, and in America there is a special inferno. We were visitors there during Christmas, 1965. During the early fall of that year, United States Senator Robert Kennedy visited several of his state's institutions for the mentally retarded. His reactions to these visits were widely published in our news media. These disclosures shocked millions of Americans and infuriated scores of public office holders and professional persons responsible for the care and treatment of the mentally retarded.
A segment of the general public was numbed because it is difficult for "uninvolved" people to believe that in our country, today, human beings are being treated less humanely, with less care, and under more deplorable conditions than animals. A number of the "involved" citizenry, i.e. those who legislate and budget for institutions for the mentally retarded and those who administer them - were infuriated because the Senator reacted to only the worst of what he had seen, not to the worthwhile programs that he might have. Further, this latter group was severely critical of the Senator for taking "whirlwind" tours and, in the light of just a few hours of observation, damning entire institutions and philosophies.
During the time of these visits I was a participant in a research project at The Seaside, a State of Connecticut Regional Center for the mentally retarded. The superintendent of The Seaside, Fred Finn, and I spent a considerable amount of time discussing the debate between Senator Kennedy and his Governor, Nelson Rockefeller. We concluded the following. It does not require a scientific background or a great deal of observation to determine that one has entered the "land of the living dead." It does not require too imaginative a mind or too sensitive a proboscis to realize that one has stumbled into a dung hill, regardless of how it is camouflaged.
It is quite irrelevant how well the rest of an institution's program is being fulfilled if one is concerned about that part of it which is terrifying. No amount of rationalization can mitigate that which, to many of us, is cruel and inhuman treatment. It is true that a short visit to the back wards of an institution for the mentally retarded will not provide, even for the most astute observer, any clear notion of the antecedents of the problems observed, the complexities of dealing with them, or ways to correct them. We can believe that the Senator did not fully comprehend the subtleties, the tenuous relationships, the grossness of budgetary inequities, the long history of political machinations, the extraordinary difficulty in providing care for severely mentally retarded patients, the unavailability of highly trained professional leaders, and the near-impossibility in recruiting dedicated attendants and ward personnel. But, we know, as well as do thousands of others who have been associated with institutions for the mentally retarded, that what Senator Kennedy claimed to have seen he did see.
In fact, we know personally of few institutions for the mentally retarded in the United States completely free of dirt and filth, odors, naked patients groveling in their own feces, children in locked cells, horribly crowded dormitories, and understaffed and wrongly staffed facilities. After a good deal of thought, I decided to follow through on a seemingly bizarre venture. One of my close friends, Fred Kaplan, is a freelance photographer who has worked for many national publications. The following plan was presented to him.
We were to arrange to meet with each of several key administrative persons in a variety of public institutions for the mentally retarded. If we gained an individual's cooperation, in spite of the obvious great risk he would be assuming with respect to his institutional status and possible job security, we would be taken on a "tour" of the back wards and those parts of the institution that he was most ashamed of. On the "tour" Fred Kaplan would take pictures of what we observed, utilizing a hidden camera attached to his belt.
During the month of December, 1965, we visited - at our own expense - five state institutions for the mentally retarded in four eastern states. Through the efforts of courageous and humanitarian colleagues, including two superintendents who put their reputations and professional positions in jeopardy, we were able to visit the darkest corridors and vestibules that humanity provides for its journey to purgatory and, without being detected by ward personnel and professional staff, Fred Kaplan was able to take hundreds of photographs. The latter point deserves some comment.
Our photographs are not always the clearest and, probably, Fred Kaplan is not proud of the technical qualities of every one published in this book. On the other hand, it required a truly creative and skilled photographer to take these pictures, "from the hip" so to speak, unable to use special lighting, not permitted to focus or set shutter speeds, with a small camera concealed in multitudes of clothing and surrounded by innumerable "eyes" of patients as well as of staff. Although our pictures could not even begin to capture the total and overwhelming horror we saw, smelled, and felt, they represent a side of America that has rarely been shown to the general public and is little understood by most of us.
We do not believe it is necessary to disclose the names of the institutions we visited. First, we have a deep debt of gratitude to those who permitted us to photograph that which they are most ashamed of. To reveal the names of the places we visited is, assuredly, an invitation to invite their instant dismissal. However, we have a much more forceful reason for not admitting to where we have been. These pictures are a challenge to all institutions for the mentally retarded in the United States. We are firmly convinced that in many other institutions in America we could have taken the same pictures - some, we are sure, even more frightening.
Our "Christmas in Purgatory" brought us to the depths of despair. We now have a deep sorrow, one that will not abate until the American people are aware of - and do something about - the treatment of the severely mentally retarded in our state institutions. We have again been caused to realize that "Man's inhumanity to man makes countless thousands mourn," It is fitting that this book - our purgatory in black and white - was written on the 700th anniversary of the birth of Dante.
Description of Children's Ward
"Suffer the little children..." "Suffer the little children..."
The infant dormitories depressed us the most. Here, cribs were placed-as in the other dormitories-side by side and head to head. Very young children, one and two years of age, were lying in cribs, without interaction with any adult, without playthings, without any apparent stimulation. In one dormitory, that had over 100 infants and was connected to 9 other dormitories that totaled 1,000 infants, we experienced a heartbreaking encounter. As we entered, we heard a muffled sound emanating from the "blind'' side of a doorway. A young child seemed to be calling, "Come. Come play with me. Touch me."
We walked to the door. On the other side were forty or more unkempt infants crawling around a bare floor in a bare room. One of the children had managed to squeeze his hand under the doorway and push his face through the side of the latched door. His moan was the clearest representation we have ever heard of the lonely, hopeless man. In other day rooms, we saw groups of 20 and 30 very young children lying, rocking, sleeping, sitting- alone. Each of these rooms were without toys or adult human contact, although each had desperate looking adult attendants "standing by."
In another dormitory, we were taken on a tour by the chief physician who was anxious to show us a child who had a very rare medical condition. The doctor explained to us that, aside from the child's dwarfism and misshapen body, one of the primary methods for diagnosing this condition is the deep guttural voice. In order to demonstrate this, he pinched the child. The child did not make any sound. He pinched her again, and again-harder, and still harder. Finally, as if in desperation, he insured her response with a pinch that turned into a gouge and caused the child to scream in obvious pain.
In some of the children's dormitories we observed "nursery programs." What surprised us most was their scarcity and the primitiveness of those in operation. Therefore, we were not unprepared to see several children with severe head lacerations. We were told these were "head bangers." Head banging is another condition that some people think is inevitable when confronted with young severely mentally retarded children. We challenge this. We have reason to believe that head banging can be drastically reduced in an environment where children have other things to do. The "Special Education" we observed in the dormitories for young children was certainly not education. But, it was special. It was among the most especially frightening and depressing encounters with human beings we have ever experienced.
Description of Day Rooms
"I sometimes wish that God were back..." "I sometimes wish that God were back in this dark world and wide; For though some virtues he might lack, He had his pleasant side."
In each of the dormitories for severely retarded residents, there is what is euphemistically called a day room or recreation room. The odor in each of these rooms is overpowering. After a visit to a day room we had to send our clothes to the dry cleaners to have the stench removed. The facilities often contribute to the horror. Floors are sometimes wooden and excretions are rubbed into the cracks, leaving permanent stench. Most day rooms have a series of bleacher benches, on which sit unclad residents, jammed together, without purposeful activity, communication, or any interaction. In each day room is an attendant or two, whose main function seems to be to "stand around" and, on occasion, hose down the floor "driving" excretions into a sewer conveniently located in the center of the room.
We were invited into female as well as male day rooms, in spite of the supervisor's knowledge that we, male visitors, would be observing naked females. In one such dormitory, with an overwhelming odor, we noticed feces on the wooden ceilings, and on the patients as well as the floors. The question one might ask is, Is it possible to prevent these conditions?
Although we are convinced that to teach severely retarded adults to wear clothes one must invest time and patience, we believe it possible to do so-given adequate staff. There is one more requirement. The staff has to be convinced that residents can be taught to wear clothes, that they can be engaged in purposeful activities, that they can learn to control their bladders. The staff has to believe that their "boys" and "girls" are human beings who can learn. Obviously, the money and the additional staff are vitally important. However, even more important, is the fundamental belief that each of these residents is a human being.
Christmas in Purgatory, Blatt and Kaplan, (Previously published by Allyn and Bacon, Inc., 1966) current copyright, Human Policy Press, Center on Human Policy Syracuse University P.O. Box 35127 Syracuse, NY, 1974.