Mentally retarded persons as parents: Prevalence and the situation of their children

This paper describes a research program on mentally retarded parents and their children. For this nation-wide study, two structured questionnaires were sent to all municipalities in Norway. Both questionnaires were sent to public health nurses and were followed-up by a structured telephone interview based on the questionnaires. The primary aim of the study was to survey the number of children born to mentally retarded parents. In addition, the children's needs and functional abilities were to be assessed. Twenty-three mentally retarded persons had given birth in the course of the past twelve months. A total of 126 children with mentally retarded parents were identified, with an incidence of 27 children per year, and a prevalence of approximately 430 children under 16 years of age in a population of 4 mill. People with a mean of 1.05 child per family. About 43% of the children of mentally retarded parents appeared to have learning difficulties. Forty percent of the children suffered from failures of care. Between 25% and 68% of the children with learning problems had poorly developed motor or language abilities, sense modalities or psycho-social status.     

THE SURVIVING SIBLING: THE EFFECTS OF SIBLING DEATH IN CHILDHOOD

This paper considers the case of childhood mourning in which there is an increased possibility of a pathological grief reaction, due to an incapacity to sustain mourning and an inability to comprehend death. The death of a sibling in childhood is a complex loss to manage, the outcome of which is inextricably linked with parental grief. Maladaptive parental mourning processes, including the phenomenon of the ‘replacement child’, are explored. The effects of this loss on the surviving sibling can give rise to a variety of symptoms that may impair emotional development. Amongst the main responses experienced by the surviving sibling is that of a guilt reaction, not only for having survived when the sibling did not, but also a fear that harboured death wishes may have caused the tragedy. Premature death anxiety and distorted concepts of illness are further possible outcomes of this event. It is suggested that the primary deprivation a child may experience when their sibling dies is the emotional absence of their parents who are preoccupied with their own grief.     

Youth Mental Illness and the Family: Parents’ Loss and Grief

Parents and family members whose adult child or relative has a mental illness endure significant losses, to which they respond with grief. Such grief may negatively affect family members’ physical and psychological health and also the relationship with their relative. Yet, research in this field is sparse. Very few studies have examined parents’ loss and grief in the context of the patient being a child or teen. It is not clear the extent to which parents’ loss and grief in response to their child or adolescent’s mental illness is similar or different to the accounts of older parents and family members caring for an adult relative with major psychopathology (e.g., Schizophrenia, Bipolar disorder). Parental loss and grief is not often addressed in child and adolescent mental health services’ provision of care; alarmingly, little is known about how best to support parents who access these services. The present study aimed to bridge this knowledge gap and identify the therapeutic needs of this younger parent population. Comprehensive interviews were conducted with 14 parents and one custodial grandparent of a youth aged 18 years or younger who was currently attending a child and adolescent mental health service. An inductive thematic analysis identified six themes; parents’ narrative of finding out, profound and pervasive loss, complex grief, waning support, the challenges of caregiving and a call for assistance. It can be inferred from these results that youth mental illness can constitute a source of loss and grief for parents. Participants’ loss and grief was largely consistent with the experience of families caring for an adult relative with major psychopathology. Opportunities for mental health practitioners to support families’ loss and grief were identified. Further studies are needed to enhance understanding of this complex and, to a large extent, ignored familial experience. Results do underscore the importance of clinicians acknowledging parents’ loss and grief and working directly with this experience over the course of youths’ treatment, perhaps in conjunction with family psychoeducation approaches.     

Involuntary sterilization of persons with mental retardation: an ethical analysis

Legitimate concerns on the part of parents and guardians may lead to requests for sterilization of a mentally retarded person in their care. At the same time, mentally retarded persons must be protected from actions that do not serve their best interests. This paper will review the history of involuntary sterilization in the United States and evaluate the ethical arguments that are relevant to decisions about involuntary sterilization. While other, less permanent forms of contraception might be acceptable, involuntary sterilization ought not be performed on mentally retarded persons who retain the capacity for reproductive decision-making, the ability to raise a child, or the capacity to provide valid consent to marriage. Mentally retarded persons who lack capacity in those three areas should be considered for involuntary sterilization only when the procedure is necessary, sterilization would serve the best interests of the mentally retarded person, less intrusive and temporary methods of contraception or control of menstruation are not acceptable alternatives, and procedural safeguards have been implemented to assure a fair decision-making process.     

Measurement of range of motion in individuals with mental retardation and with or without Down syndrome

The purpose of this study was to assess differences in variability of three joints' range of motion in the lower extremity among individuals with Down syndrome, mentally retarded individuals without Down syndrome, and sedentary subjects without mental retardation (ns = 13, 25, and 30, respectively). Range of motion for hip and knee flexion was obtained using a Myrin goniometer. For hip abduction the range of motion was obtained using a double protractor goniometer (Brodin type). Three test repetitions were carried out, and the greatest value was recorded. As no significant differences were found between left and right sides for each motion, the average was used to represent the range of motion. The Down syndrome group had significantly higher mean range of motion in hip flexion than the mentally retarded group. No significant differences in mean range of motion were found between Down syndrome and sedentary groups, but a significant difference was observed between the control and mentally retarded groups. In hip abduction, the Down syndrome group showed significantly higher mean range of motion than the control and mentally retarded groups. The control group had significantly a higher mean range of motion than the mentally retarded group. No significant differences were found in knee flexion between the two mentally disabled groups, but significant differences in mean range of motion were found between each of the two groups of mentally retarded individuals and the control group. Because differences exist in mean range of motion between the two mentally disabled groups, individualized and differentiated training programs to improve flexibility must be designed based on the type of handicap.     

Intentionality Analysis and the Problem of Self and Other

Dennett recounts an alarm clock dream which he experienced as taking a long time even though the alarm presumably sounded for only a short time. His explanation of this paradoxical behavior of time in dreams is that there actually is no dream experience but that unexperienced dreams are composed directly into memory banks and are subsequently played back on awakening. I critique Dennett's theory of dreams in Heideggerian terms on the grounds that he takes temporality in a common-sense superficial way. I review Heidegger's theory of time and using Dennett's own dream show that “temporality temporalizes itself' in dreams too as a free production of dreaming Dasein. Dream time is what dreaming temporality produces whatever the clocks of waking show, and is entirely consistent with authentic dream experience. An appreciation of the process of dreaming temporality temporalizing itself supports Heidegger's concept of temporality as an a priori of Dasein's Being.     

Stillbirth, neonatal death and Sudden Infant Death (SIDS): parental reactions

The differences between parental grief reactions following different types of infant losses were investigated. A total of 117 parents (55 couples) from three groups of parents (stillbirth, neonatal death and Sudden Infant Death), 53% women and 47% men, answered a survey on different grief reactions one to four years following the death. Included in the survey were psychometric measures relating to anxiety, depression, impact of event, bodily discomfort, and general wellbeing. The results demonstrated that the three groups differed in their experience of various grief reactions. Sudden Infant Death Syndrome (SIDS) parents reported significantly more anxiety and intrusive thoughts than the other two groups in the early post-loss period, as well as significantly more anger, restlessness, and sleep disturbances than the neonatal group. The SIDS parents also scored significantly higher on some of the measures (experience of recovery, IES intrusion) relating to how they felt at the time of study. While the death being sudden did not show any correlation with the parents experience of recovery or the psychometric measures, the length of time the child had lived showed a strong relationship to these measures. It is emphasized that counselling to parents must be based on increased knowledge about parental reactions, tailored to the individual family's needs.     

An Activities Approach to the Treatment of Mentally Retarded Clients in an Acute Care Psychiatric Hospital

This article describes therapeutic activities offered in an occupational therapy treatment program for mentally retarded patients in an acute-care hospital facility. Implications of therapeutic activities for the building of ego strengths are discussed.     

Does medics' social identification increase handicap for mentally retarded patients?

Briefs about mentally retarded people are more negative than briefs about other social categories; professionals, such as medical doctors evaluate them most negatively of all. It was hypothesized (a) that medics' beliefs about mentally retarded people are mediated by psychological salience of their clinical social identification, rather than by personal characteristics that medics happen to share and (b) that such beliefs will bias decisions, rather than enhance accuracy. Forty-five doctors and medical students were randomly assigned to conditions designed to enhance salience of their shared clinical social identification or individual self-perceptions. Subjects completed semantic differentials about mentally retarded people and distinguished between slides of ‘mentally retarded’ and ‘normal’ children. Beliefs of subjects in the medical condition were significantly more negative than those in the personal condition. A signal detection analysis revealed no difference between conditions in subjects' ability to distinguish between children but showed that subjects in the medical condition were significantly more likely to judge a child ‘mentally retarded’ when in doubt. Results were discussed within an information processing framework and supported the idea that a salient clinical social identity can mediate beliefs that are likely to handicap patients.     

Dreaming for the World: A Jungian Study of Dreams During the COVID-19 Pandemic1

This project explores what dreams might reveal about the collective psyche’s response to the COVID-19 pandemic in its first year, before the development of vaccines. A brief survey, distributed to Jungian colleagues and organizations, and to various social media sites, invited people to submit online a dream related to the COVID-19 pandemic. Four hundred and thirty-six dreams were submitted. Forty additional Russian dreams were collected and submitted by Russian colleagues. Using qualitative research methods based on phenomenological hermeneutics, the researchers categorized and counted the range of COVID imagery. In addition, the researchers describe a range of psychic responses to the pandemic, including horror, grief, sickness, social discord, and violence, but also images of healing and transformation, increased sense of community, and spiritual renewal. Several healing nightmares are presented. Healing alchemical and anima/animus imagery is described. Twelve dreams are introduced and presented. It is concluded that the collective psyche, rooted in the Self, is a healing resource for social and cultural trauma. This project supports Beradt’s (1968) inspirational study of dreaming in Nazi Germany, as well as recent studies of COVID-related dreams and recent publications on the social nature of dreaming.     

Memory in dreams1

In this paper the author discusses a specific type of dreams encountered in her clinical experience, which in her view provide an opportunity of reconstructing the traumatic emotional events of the patient’s past. In 1900, Freud described a category of dreams – which he called ‘biographical dreams’– that reflect historical infantile experience without the typical defensive function. Many authors agree that some traumatic dreams perform a function of recovery and working through. Bion contributed to the amplification of dream theory by linking it to the theory of thought and emphasizing the element of communication in dreams as well as their defensive aspect. The central hypothesis of this paper is that the predominant aspect of such dreams is the communication of an experience which the dreamer has in the dream but does not understand. It is often possible to reconstruct, and to help the patient to comprehend and make sense of, the emotional truth of the patient’s internal world, which stems from past emotional experience with primary objects. The author includes some clinical examples and references to various psychoanalytic and neuroscientific conceptions of trauma and memory. She discusses a particular clinical approach to such dreams and how the analyst should listen to them.     

Caregiver interactions with autistic children

Caregiver interactions with young autistic children were contrasted with those involving caregivers and developmentally matched mentally retarded and normal infants. Caregivers of autistic children were similar to other caregivers in their responsiveness to child nonverbal communication bids and in their engagement in mutually sustained play. Caregivers of autistic children were similar to caregivers of mentally retarded children in their greater use of control strategies. However, these two groups of caregivers differed in the particular strategies they used to shape their children's behavior. Caregivers of mentally retarded children pointed to objects while caregivers of autistic children spent more time physically holding their children on task. Individual differences within the autistic sample indicated that caregivers regulated their children's behavior less and showed more mutual play and positive feedback to more communicatively able autistic children. These findings suggest that caregivers respond differentially to the specific deficiencies shown by their children.     

Clinical Implications of Unconscious Communication in the Analytic Dyad; Towards a Deeper Therapeutic Engagement

ABSTRACT

In this article, clinical examples focus on unconscious communication between patient and analyst which take the form of physical sensations, dreams, temporarily debilitating shared grief, deep immersion in dissociated affect and shared trauma.     

Evaluation of project reentry

This report describes a project designed to return to regular classrooms a group of rural poor elementary schoolchildren who were suspected of having been misplaced in special classes for the educable mentally retarded. At the end of the 3-year project, more than half the children were returned to regular classrooms, with proportionately more boys than girls being returned. The total sample of Project students gained significantly in verbal IQ over the course of the project, compared with a sample of students who remained in special education classes. The implications of the project for research, intervention programs, and educational practices are discussed.This study was supported by a grant from the Hogg Foundation for Mental Health.     

Social problem solving and mother-child interactions of educable mentally retarded children

Mothers of retarded children and nonretarded children were observed and videotaped as they interacted with their own child in a seminaturalistic situation, requiring teaching, cooperation, and free play. The child's social problem-solving abilities were assessed independently. The Vineland scale was employed to provide some convergent evidence of social problem-solving as a component of social competence. Twelve educable mentally retarded and 19 nonretarded 10-year-old children and their mothers comprised the sample. For the mentally retarded group, it was found that the higher maternal directiveness, the lower the child's social problem-solving skills. Mothers who often gave the child opportunity for decision-making and social influence had children with higher problem-solving skills. The retarded children produced significantly fewer different strategies for solving social problems, but gave a wider range of strategies than has been found in previous research. There was some support that social problem-solving skills are related to social maturity.     

A COMPARISON OF PEER-DIRECTED AND TEACHER-DIRECTED EMPLOYMENT INTERVIEW TRAINING FOR MENTALLY RETARDED ADULTS

Interview skills deficits may limit employment prospects of mentally retarded adults. Although numerous papers highlight the importance of interview skills, few have validated effective strategies for use with mentally retarded persons. Further, there has been a lack of research contrasting rival interview skills training strategies. The present study was conducted with two mentally retarded young adults. It contrasted peer-directed instruction, in which both participants were equally deficient in the target skills, with teacher-directed instruction. Results of the investigation indicated that instruction, rehearsal, and feedback may be effective strategies regardless of who provides instruction. Comparisons of teacher-directed and peer-directed instruction indicated little or no difference in the effectiveness of the two procedures. However, the peer-directed procedure involved considerably less staff time than did the teacher-directed procedure.     

‘Who am I?’

The dreams and existential questions of those, who came into being in order to replace a dead person, pivot around a central cry: ‘Who am I?’ If conceived, born or designated as a replacement child, such an individual may suffer—even as an adult—from a rarely recognized unconscious confusion of identity, compounded by grief and survivors’ guilt. From before the child is born, the archetypal forces of death and life are joined in a fateful constellation; the soul of the replacement child bears the shadow of death from the very beginning of life. Hope for the replacement child lies in an emergence of true self as soul recreates original life. Analysis can help the replacement child experience a ‘rebirth into true life’, not as ‘the one who returned’, but as a psychologically newborn individual; the path of individuation countering the replacement child‘s identification with the dead. Jungian analysis offers unique concepts for understanding and healing the replacement child; C.G. Jung himself was born after two stillborn babies and an infant that lived only five days.     

Understanding the family in multiple cultural contexts: Avoiding therapeutic traps

Developing a balanced picture of a family's functioning is difficult when the family is culturally different from the therapist. Open-minded family therapists often translate culturally different traits and behaviors as culturally appropriate and exclude them from clinical judgment, which can limit therapeutic range and effectiveness. The following case study about an Indian family with a mentally retarded child is especially illustrative of the dilemmas facing the therapist working with families of different backgrounds. Therapeutic traps were avoided by having the family assess its own differences, while the therapist held steadfast to social interconnectedness as essential to healthy family functioning.An earlier and somewhat different version of this material appeared under a different title in Families, published by the Family Institute of Philadelphia.     

Parents of the Handicapped Child: Facilitating Acceptance Through Group Counseling

All parents have an image of the way they would like their children to be. Often this expectation is contradicted by reality for the parents of a handicapped child. Whether at the time of birth when obvious differences are apparent or later when performance differences are recognized, the discrepancy between expectation and reality causes parents to experience a loss and accompanying feelings of grief. This article suggests that the method of group counseling using a relevant framework on which to base discussion is without equal as a means of assisting parents to deal with their situations. Presented to those who lead parent groups for these persons is an applicable model and guidelines for its implementation.     

Constructions of Mexican American family grief after the death of a child: an exploratory study

Using a collective case study ethnographic approach, nine individuals comprising three Mexican American families were interviewed about their family bereavement experiences after the death of a child. All families were Catholic, had surviving siblings, and had had three or more years to grieve their loss when interviewed. The deceased children ranged in age from 3 to 14, and all experienced sudden, traumatic, nonsuicide deaths. To provide a broader, contextual picture of their grief experiences, four individuals who supported these family members after the loss were also interviewed. Unique grief experiences were identified, and eight common themes emerged, reflecting the ways in which family members maintained their bond to the deceased: dreams, storytelling, keepsakes, sense of presence, faith-based connections, proximity connections, ongoing rituals, and pictorial remembrances. The cultural implications of family bereavement are highlighted.