Exactly fifty years ago John F. Kennedy was inaugurated President of the United States, and during the past week we have been reminded both of his inaugural address and also of the death of one of his last living close associates, Sargent Shriver. Let us also look back on Kennedy's commitment with persons who display mental illness and mental retardation. His message "To The Congress of the United States" (from "Message from The President of the United States relative to Mental Illness and Mental Retardation; February 5, 1963; reprinted in American Journal of Psychiatry, Feb. 1964) was the impetus for many of his fellow citizens to know more about, conduct research on, and treat these two conditions--fulfilling, at least from my view, mandates included in the Sermon of the Mount:
It is my intention to send shortly to the Congress a message pertaining to this Nation's most urgent needs in the area of health improvement. But two health problems--because they are of such critical size and tragic impact, and because of their susceptibility to public action is so much greater than the attention they have received--are deserving of a wholly new national approach and a separate message to the Congress. The twin problems are mental illness and mental retardation.
Mental illness and mental retardation are among our most critical health problems. They occur more frequently, affect more people, require more prolonged treatment, cause more suffering by the families of the afflicted, waste more of our human resources, and constitute more financial drain both upon the public treasury and the personal finances of the individual families than any other single condition.
This situation has been tolerated far too long. It has troubled our national conscience--but only as a problem unpleasant to mention, easy to postpone, and despairing of solution. The Federal government, despite the nationwide impact of the problem, has largely left the solutions up to the States. The States have depended on custodial hospitals and homes. Many such hospitals and homes have been shamefully understaffed, overcrowded institutions from which death too often provided the only firm hope of release...
There are very significant variations in the impact of the incidence of mental retardation. Draft rejections for mental deficiency were 14 times as heavy in states with low incomes as in others. In some slum areas 10 to 30 percent of the school-age children are mentally retarded, while in the very same cities more prosperous neighborhoods have only 1 or 2 percent retarded...
We must act--to bestow the full benefits of our society on those who suffer from mental disabilities; to prevent the occurrence of mental illness and mental illness whenever and wherever possible; to provide for early diagnosis and continuos and comprehensive care, in the community, of those suffering from these disorders; to stimulate improvements in the level of care given the mentally disabled in our State and private institutions, and to re-orient those programs to a community-centered approach...to reinforce the will and capacity of our communities to meet these problems, in order that the communities, in turn, can reinforce the will and capacity of individuals and individual families...
These words have had a massive effect, from creating an awareness and charitable response among citizens in the entire nation, saving many lives that would have been lost, to building many effective programs while introducing the opportunity for waste and even fraud in others. From my view Head Start is one of the valuable and functioning legacies--the greatest cause of mental retardation is now not the slum areas Kennedy noted, but rather genetic causes, many identifiable in the womb. Early intervention programs for children have brought a normal or near-normal life and subsequent economic productivity to many who would have been a burden on society or their families. Research studies funded through the National Institute of Mental Health and Veteran's Administration have brought greater effectiveness in treatments for schizophrenia, depression, post-traumatic stress disorder, and other conditions. There are community mental health centers, funded by Medicaid, where quality psychological help is available for poor people. Perhaps one of the greatest positive effects has been in brightening the lives of the mentally retarded, many who have been allowed the opportunity to be proud citizens of their communities.
Despite all of these wonderful things occurring, Kennedy's words have not been a panancea, and as Christ would note, the poor in Spirit--those with mental retardation and mental illness--still reside with us. When the large psychiatric institutions were closed--some of these had over 5,000 residents--too large a number of patients were unable to adapt, and now we deal with the problem of too many homeless people on our streets. They are there, not by their own free will, but because of insurmountable emotional and psychiatric problems. I surmise--lacking research findings or statistics--even that some of the unstable and dangerous persons who live among us have slipped through the cracks, and may have found, in a system with larger institutions, places of care and asylum. And still another problem we deal with in the gigantic bureaucracy is Medicaid Fraud--a two edged sword which can allow public monies to be stolen while at the same time keep eligible persons away from the help they deserve.
Can we learn from Kennedy's "national mental health program and the national program to combat mental retardation" which he proposed and which found great support after he was assassinated? Kennedy's words have gone beyond being fond memories or inspiration--they are now part of history, and with this perspective perhaps their real consequences can be separated from their ideal hopes, and we can apply this knowledge and discussion to similar national issues which face us today.
William Van Ornum
Thanks to Tim Reidy for his research in finding the great photo. You can see the people identified in the photo at:
http://www.arcmass.org/jfk/tabid/635/Default.aspx
Jesuit Father Robert Drinan, SJ was instrumental in helping to put Kennedy's ideas into action. bill
Head Start and Early Intervention programs-no chemistry involved! Teaching, singing, interacting, tutoring.....great programs. bill
I don't think anyone is suggesting that anyone be forced to receive services.
Janice, good thoughts. bill
It seems reasonable to conclude that JFK's concern came from the experience of his sister Rosemary's struggle with mental retardation. Eunice Kennedy Shriver's exemplary work in support of the mentally retarded can certainly be traced to this.
One of my brothers was diagnosed as mentally retarded in the mid 1950's. In retrospect it seems clear that he had serious learning disabilities. We have long since learned to identify such disabilities and provide effective treatment for them.
More distressing is the anxiety that can be fueled by the experience of being different. Children can be very cruel unless they are raised and educated otherwise. It may be this anxiety and the isolation attending it that David Smith is referring to.
Not sure if that was meant to be snark or not. But this notion of "who we are," always troubles me, as if we are all born with an immutable self that we should never attempt to modify, mentally impaired or otherwise. I hate getting up in the morning and going to work everyday; it's definitely not "who I am," but as a member of society we all have an obligation to not become burdens on others if we have the ability to do so, happiness be darned. Surely (with exceptions for associated risks to causing danger to others) it's always better to make those who could be productive, become productive and hope that they find happiness in it.
Going back to Bill's reference to the beatitude, the poor in spirit, which our children and many, many more mentally ill persons exemplify, I have to ask why our church is not responding to their and their framilies needs. In our diocese we seem to have a ministry for just about every need,,but none for the mentally ill. Because our diocese was hit with an almost 100 million dollar sexual abuse settlement, all ministries and education have suffered cuts. The director of the social ministry told me that he thinks the church is in the middle ages regarding mental illness. So,I've come to the conclusion that help must come from other sources and it seems to me the issue is both one of social justice and of pro-llife. How does one get the Catholics in these movements to get together and instead of continual arguing do something for "the poor in spirit"?
With deep cuts in Medicaid and SSI, we can't rely on the government for future needs. The greatest fear for families of mentally ill and/or developmentally disabled children is what will happen when I can no longer care and provide for them? My hope is with the young people, like those who commented on this blog and who have commitments to living out the Gospel in service to others. I also hope that people in the pro-life movement step up to the plate and follow the pro-life philosophy to its logical conclusion,helping all mothers who give birth regardless of the condition of the child.........and throughout the life span of those children who are mentally disabled.
Regarding medication (chemicals). They can be a gift from God when prescribed and managed by a competent psychiatrist. My son was free from psychosis for 16 yrs on one medication. He is now on another one as the first one stopped being effective.
It is one thing to philosophize about autonomy, choice, options,etc. It is another to witness a person in the throes of a psychotic episode, hallucinating, delusional, unable to care for their basic needs. I do favor laws that mandate out-patient treatment and am wondering about mandated in-hospitalization. What are "civil rights" good for if you are living in filth, cold and danger on the streets and your loved ones are helpless to do anything about it?
As a young, idealistic social worker at Catholic Charities, I was inspired by the words of JFK, never dreaming that the subjects he spoke about, mental disabilities, would become the dominant realities of my life.