Investigations compel the conclusion that are numbers of mentally defective persons whose training is neglected, over whom no sufficient control is exercised, and whose wayward and irresponsible lives are productive of crime and misery … and of much continuous expenditure wasteful to the community and to individual families … feeblemindedness is largely inherited … consequently there are strong grounds for placing mental defectives of each sex in institutions where they will be retained and kept under effectual supervision as long as may be necessary … to make procreation impossible. (Quoted by Ryan & Thomas, 1980) Box 2.2 The eugenics movement Francis Galton, a psychologist, suggested in the early 1900s that society would gradually deteriorate because of “dysgenic” procreation among people with learning disabilities. Galton believed that a scheme of “marks” for family merit (taking into account factors such as occupation) should be given and early marriage between families of high rank be encouraged through monetary incentives. This, Galton stated, would encourage “eugenic” marriages and, subsequently, children with more favourable genes. Although the eugenics movement was discredited as scientists rejected and argued against the simplistic theories of inheritance proposed by eugenecists, programmes that included (in some cases) forced sterilisation continued into the 1970s, particularly in Scandinavian countries. Sterilisation was often carried out not for medical reasons or due to risks to the individual, but because of concerns that people with learning disabilities might produce children. Further reading Dikotter, F. (1998). Race culture: recent perspectives on the history of eugenics. The American Historical Review, 103, 467 – 478. Ryan, I. & Thomas, F. (1980). The Politics of Mental Handicap. London: Penguin.
Robert used to go the pub and the betting shop quite a lot until he was barred from the latter. Although he enjoys the pub, it seems he can’t be bothered going any more. He recently split up with the woman he had been going out with. Robert’s dad has started to get very irritated with him because he doesn’t have a shower every day and generally spends his time eating. His mum thinks there might be something wrong with him, but dad says he’s fine – all he needs is a “good kick up the backside!” Dad tells Robert he’s going to start going with him to football on Saturdays and says that Robert is going to have to do more in the house if he’s going to carry on eating as much as he does. Robert goes to football with his dad, but complains about the cold and the seats. He says he doesn’t like football, but dad won’t let him give up until he finds something else to do. Mum gets him to go to the shops to pick up milk and papers in the morning but this is a great effort, with Robert trying to avoid it at every turn. Robert’s mum wonders if he might have something wrong with his thyroid. Her dad had thyroid problems and behaved similarly. She takes Robert to the doctor but his thyroid function is fine. The doctor suggests more exercise and getting out to see people. Robert starts to go out of the house after lunch, saying to his mum he’s going to the pub or the gym or to see friends. However, he is going to library to sit in the comfortable seats. He sometimes watches DVDs there, but mostly falls asleep. He has been asked to leave on a few occasions. Either by yourself, or with your mentor, consider the following. Could anything else be happening to Robert? What issues might make it difficult to identify the underlying reasons for Robert’s presentation?
long periods of time, and is described by her father as ‘very in your face’ and ‘difficult to get away from’. “Patricia loves music. Her favourite singer is Daniel O’Donnell and her favourite band is One Direction. She has been to concerts featuring both, thoroughly enjoying them. She can amuse herself ‘for hours’, according to her mother, with her One Direction and Daniel O’Donnell DVDs and CDs. “Patricia is viewed by family members as ‘manipulative’: they say she only behaves like this to get her own way.” Patricia speaks to the nurse and says she is very unhappy now her brother is back home. She says he gets drunk a lot and that he used to hit her when drunk when she was younger. He doesn’t do this anymore, but she is still a bit scared of him. She nevertheless tells the nurse that she can “give as good as I get now!” Patricia is very angry at her family because she thinks they don’t appreciate the difficulties she experiences; she feels is always treated “like a we’an”. She wants more time away, but describes “a cloud in her head” when she gets angry and she hits out before realising what she’s doing. The family don’t seem to communicate well with each other and the nurse notes that for much of her assessment, she feels like she’s “refereeing”. All family members appear stressed and irritable. Either by yourself, or with your mentor, complete the following. Use the 5 Ps formulation template (Figure 4.1) to identify factors that might explain Patricia’s current presentation. Suggest materials that be used to support the development of a shared formulation with Patricia. What amendments might be made when developing a shared formulation with Patricia’s family?