The other pupil was a girl about whose age there was some doubt, the school giving her age as thirteen and a half and her mother as fourteen and a half. This girl was recommended to the open air school primarily as a conduct problem, although the grounds for admission were present in the very poor general physical condition. The history as given was that she had been growing more and more troublesome for a year past, and recently had become quite incorrigible in the class room. She would thrust her tongue out at the teacher, make faces at the other pupils, etc. The principal referring the girl thought it a case of beginning psychosis. She was in the fifth grade. An older brother had also been very troublesome during his last year at school, in the fifth grade, and had been transferred to the industrial room.

Psychological examination showed an unmistakably feebleminded girl, mental age by the Binet scale being less than nine years. When first admitted to the open air school she reacted in the class room as in the previous school, and gave considerable trouble even in the recess and rest periods. After two weeks trial, it was decided to take her out of the class room, but to let her remain in the school, taking her rest periods with the other pupils and helping the school matron during her class periods. Her improvement was so marked that the consent of the principal was asked for the continuance of the plan. There was no further conduct disturbance though she continued to be noisy and boisterous in play for the first few months. She remained for that school year, her only school work in that time being selected reading. On leaving school she found work in a factory at $7.50 a week and was at the same work when last heard from eight months later.

The home as a factor in the training of a feeble-minded child is of course even more important than the school. Where the home is not in itself capable of giving adequate oversight, the assent and coöperation of the parents are manifestly necessary for supervision from the outside. Under authorized supervision from a central state agency, this question of coöperation would probably never arise, even though the actual visiting were delegated to local private agencies. It is unlikely, however, to arise in the case of any home that is capable of properly training and protecting a feeble-minded child. With the children themselves there is rarely any difficulty in approach, they do not question motives as the normal child.

The parents should be told very frankly any special points in the diagnosis and recommendation and be given specific instructions from time to time as to methods of handling the child. Especially should they be warned of the necessity for the formation of regular habits and the dangers of overstimulation. Ways of fostering the socially positive qualities of the child and combating the negative qualities should be gone over in "words of one syllable," if need be. All work should be directed to the formation of good habits and the avoidance of bad.

Ways of keeping the child's interest in the home should be devised; a habit of reading should be encouraged and books selected for their possibilities of pointing a simple moral without any special stimulation; simple games that give the child a fair chance to win should be provided from outside if the family cannot provide them. Any musical ability or interest of the child should be fostered.

While the child is still in school the question of the kind of work he is likely to do later should be considered. It is well to plan for this as near the home as possible to avoid the expense of carfares and the many undesirable distractions that car-riding involves. Lack of ability to do certain forms of work does not handicap the feeble-minded so much as lack of ability to attend to the job. For the child who has been deliberately trained to a fair degree of stickto-itiveness, this will be much less of a handicap and he should fit very fairly into many forms of unskilled factory work.

Possible employers should be interviewed and interested in the practicability of employing such children. Their response is often surprising. They take the rather sensible stand that it is as well to employ people about whom the worst is known as to run the chance of getting the same people through the regular employing channels. and know nothing of them. One of the most encouraging and heartening experiences that come to the tired social worker is the encounter with the kindly employer or foreman who says he is willing to give the defective child a chance and who gives much more than a chance; the effect of his friendly supervision is shown later in his confidential opinion that the doctor who said that particular child was feeble-minded doesn't know his business. This kind of an employer and especially this kind of a foreman is really not an isolated instance.

A point to be especially emphasized in work suitable for the

feeble-minded is the possibility for supervision. The best and most complete special training can never make of the defective anything but a helper. There is no exception here even in the case of those defectives who have special abilities along certain lines, for although they may be able to do the actual work done by a carpenter or a plumber, they cannot plan as a carpenter or a plumber, or work independently.

Both social workers who give supervision and even more the - families of the feeble-minded persons are apt to forget that a fair amount of recreation is as necessary for the defective as for the normal, and that it is quite natural that he should desire the particular forms of recreation the rest of the community enjoy. Games in the home, music, reading, fancy work, are not sufficient when all the rest of the world, including other members of his own family, are attending moving pictures or a band concert. Outside recreation should be planned for in a degree which does not cause overstimulation, and under supervision which is not so obvious as to arouse antagonism.

In dealing with the adult feeble-minded individual who has been recognized as such for the first time as an adult, one realizes that the most important part of the program of work for the feeble-minded is the provision for methods of early diagnosis. As found, he presents a problem of mental defect with all that it implies of lack of judgment and control plus well established habits that are difficult or impossible to break. If these habits happen to be actively antisocial we have what is so popularly known as the defective delinquent. Treatment of this type outside an institution is practically never successful and institution directors who have dealt with them will say that treatment within any ordinary institutions is quite as unsuccessful. Mental instability is more prominent than mental defect in practically all of these cases, they are not merely untrained feeble-minded. The mental defect, however, is there, and the community should treat them not as delinquents but as the doubly defective individuals that they are.

Work to make the defective safe for the community should go side by side with effort to make the community safe for the defective. This to be effectual must cover a wide range, from education of the community on the significance of feeble-mindedness and the necessity of special provision, to the enforcement of all laws for the protection of children and the security of public morals.

Just as the methods found specially adapted to the teaching of the feeble-minded have contributed much to the educational methods applied to the normal child, so the social treatment of the defective on the individualistic basis is bound to point the way for better methods of dealing with social problems among the normal. So-called individual work with the normal group is much more frequently personal than individual, and failure in the social handling of the normal individual is undoubtedly often due to this fact. The obvious defects in the feeble-minded make it necessary to search out and determine the value of any positive qualities that he may possess and weigh them against the defects. The psychologist or psychiatrist in interpreting the individual furnishes a basis upon which truly constructive work may be done, when the social worker knows the best and can foster it and knows the worst and can fight it.

CASE WORK IN THE FIELD OF MENTAL HYGIENE

BY ELNORA E. THOMSON,

Executive Secretary, Illinois Society for Mental Hygiene.

The attitude of mind of the social worker-perhaps especially in the field of mental hygiene-cannot be better stated than in the words of Dr. Meyer quoted by Miss Richmond: "A willingness to accept human nature and human doings as they are before rushing in with the superior knowledge of how they ought to be. The first need is to know what they are." The motto of every social worker and investigator should be that of Terence's Heauton Timorumenos: One who investigates must be

".

ready to accept

anything human beings think, feel or do as not altogether strange to human nature: 'I am but human and I do not consider anything foreign to me'; it is at least worthy of human consideration."

This implies forbearance with the patient, the relatives, especially those by marriage, other agencies, already wearied with much effort in the patient's behalf-the courts and the state officials. It implies also an ability to reflect the patient's point of view and not one's own, to report symptoms and to know facts. Above all it implies honesty and straightforwardness in dealing with all concerned.

Patients are referred to the mental hygiene social worker in many different ways: in person, through other agencies, through relatives, physicians, institutions, neighbors, courts, schools, etc. and always because of some form of unusual behavior which may manifest itself in an inability to adjust to surroundings, or to acquire knowledge, deep melancholy, addiction to drugs or to alcohol, unreliable or irrelevant statements, ideas of persecution, unusual demands, threats against individuals or groups, etc. It necessarily follows that any plan for investigation must be elastic to meet the demands of the individual case.

The first contact with the patient is often extremely difficult and the successful worker in this field must be resourceful and a responsive listener. Miss Richmond writes: