Looking back and forward: a personal view on public care
Shrewsbury, Massachusetts, United States
September 10, 1927
Mrs. Mary Reidy
99 Downing Street, Worcester, Mass.
Dear Mrs. Reidy:
Your little girl Katherine was examined in our out-patient clinic on Thursday, and she presents a complicated problem. She is nearly 12 years of age and psychological tests show that she has a mental age of less than 3 years. She seems brighter than this in some ways, however, and her language is remarkable for one with her great retardation. The convulsions which she has several years ago were apparently epileptic in type and will probably recur.
She certainly needs very close supervision and until she can be admitted to some institution she will have to be closely watched at home. We would advise you to get in touch with Dr. Morgan B. Hodskins, Superintendent of the Monson State Hospital at Palmer, to see if she could be admitted there. Our house for little girls of her age and type is very much overcrowded, and if she came here and later developed any convulsions we would have to arrange for her transfer to the Monson State Hospital. She is, of course, not ready for any school work, and even if she went to an institution the possibilities for development are very meagre.
Very truly yours,
Ransom A. Greene, MD, Superintendent
Walter E. Fernald State School
The letter is on the stationary of the Massachusetts Department of Mental Diseases, carefully folded three times into a rectangle, with a hole punched in the top so that it could be safely kept in a binder. It was preserved and saved by the mother. Her son, born in the year it was written, kept it in his papers. His son, in turn, found it almost ninety years later, in a box among faded photos and other mementoes. Everyone involved has long since passed away. The Fernald School, once the largest institution in Massachusetts for people with developmental disabilities, is now completely emptied, its days of overcrowding long gone.
What can we make of this old piece of correspondence from a doctor to a patient’s mother? It is a fragment of history, but it might help us see the past more fully and, in doing so, give us a better sense of our own time and our place relative to an unknowable future.
Almost ninety years after this letter was written, a newspaper wrote a disapproving piece about the Fernald School, the doctors who ran it, and their advocacy for eugenics. Dr. Greene is mentioned in passing. His historical legacy is small. Articles about Fernald refer to him as one in a series of superintendents who was responsible for the administrative and clinical aspects of the facility and active in the eugenics movement. He is perhaps most remembered in contemporary histories of Fernald for his observation that, in light of limited state appropriation and rising costs, he needed thirty percent of Fernald’s residents to be non-disabled ‘morons’ to provide unskilled and unpaid labor for the financial sustainability of the facility. A building on the grounds was named after him. He lacks that mark of modern recognition, a citation in Wikipedia. He is all but forgotten.
We can surmise that Dr. Greene was “a man of his time” which is a useful phrase to describe one in the past whose actions would be frowned upon now. He was one of many physicians and public officials advocating for eugenics in the early twentieth century. The same year of this correspondence, Justice Oliver Wendell Holmes wrote the majority decision in Buck v. Bell on the topic of forced sterilization with his infamous statement that “three generations of imbeciles are enough.”
Looking back, it is easy to judge and difficult to be sympathetic. Dr. Greene had a challenging job, one that few people then or now would volunteer to take. Managing the clinical and logistical aspects of an overcrowded institution must have been a continuous struggle. We could surmise that he was a well-intentioned man who was at a busy intersection of new ideas: how to care for people with disabilities and the role of the state. He must have felt that he was at the forefront of a great movement. But the great advances in care and public policy were beyond his horizon.
And what of the mother and daughter, the subjects of Dr. Greene’s letter? What marks did they leave in history? Institutions such as Fernald were created in part for them. The institutional mission was to care for people like the daughter who were disabled and could not be cared for at home, but the names engraved on the institutional buildings are those of the staff not the patients. Historical traces of the patients, if they exist, are on bits of paper in cardboard boxes or simply in memory—ephemera that make it difficult to form clear images. Dr. Greene’s clinical summary may be read as the concise, if curt, clinical assessment by one of the leading experts of the day. It may also be read as paternalistic dismissiveness. But there is that one curious reference to the girl’s verbal abilities, a spark that Dr. Greene also found interesting though he did not expand on it. We surmise that the girl and her mother spent most of their waking hours together, probably talking quite a bit to each other and to people that they interacted with as they went through their daily activities together. Their world was rather active. They lived on the first floor of a three family apartment building, one of hundreds in a large city. The father worked at a large loom factory one mile away. The family frequently attended a large church located between their home and factory. Their neighbors attended the same church, worked in the same local factories, and mostly immigrated from the same country. It is likely the girl’s remarkable verbal skills were the product of a rich home life.
The girl’s parents immigrated to America as teenagers. They left behind home and family—forever—for a hope of better. Their journeys were not recorded, but imaginable, at least to many of today’s immigrants. We do know that each originally was from a family of ten siblings living in very rural areas. They, too, were at a busy intersection of new things in their new country. Urban America in 1927 was quite different from the world in which they had grown up. They could not know that in ten years there would be a massive economic depression resulting in the closing of the loom factory and their eviction from their Downing Street home. And in five years more the girl’s two brothers would join the military in a global war that was, in part, about fighting dictators whose ideas on race and eugenics were taken to grotesque extremes. In terms of Dr. Ransom’s letter, there is no other correspondence that exists on this matter; we only know that Catherine’s parents decided to keep her at home.
At the beginning of the 1960s, public policy started to evolve with respect to care for the disabled and the role of the state. Catherine, now a woman of forty-five years, still lived with her parents by the time Kennedy was president, though the parents had become frail through stroke and dementia. The parents did not live to see the advances in clinical care nor the creation of government funding through Medicaid. But after her parents’ deaths she lived out her life in a nursing home that was adequately financed through Medicaid, periodically inspected by state health officials, and a five minute drive from her brothers who visited her regularly. She died in 1982. In 1985, the Supreme Court decided, in a series of cases supporting the rights of the disabled, that if a disabled child requires special education, the school must pay the additional expense.
Nearly a decade later, her nephew walked the grounds of Fernald unaware of his aunt’s brief connection with the place. He walked through the institution’s old library building, a grand old edifice with elaborate woodwork and air of an auspicious past. But by the 1990s it was largely abandoned, although there were still many cabinets with drawers filled with heaps of old laboratory slides: cell samples of brains and other organs whose labels and purpose had long since disintegrated.
We have the luxury to look back on Dr. Greene and the world as he knew it. The world of late twentieth century was unimaginable to him and his peers. Our view of that time and its people is colored by the events of the past ninety years. Did they ever think of how the world would be in 1960? 1980? 2020?
Now at the early part of the twenty-first century, we are people of our time. We may feel that we are at the forefront of great changes in care or policy. A girl who is 12-years-old today may live to see the year 2100, and she will live a life that we simply cannot imagine. What might she—and her children—think of us, if they happen to find some fragment of our lives? By then, our current institutions may be emptied or even dismantled. Our current practices may seem alien. They might even have a sense of relief that they are not part of our time. History is challenging. Pivoting from looking to the alien past to the unknowable future, we might develop a sense of dizziness, if not uncertainty. We are confident that we are well intentioned. Are we right in what we do? Time will tell.
Matthew Reidy works in an administrative position at the University of Massachusetts Medical School. This article is based on correspondence that Mr. Reidy found among some old family papers. The subject is his aunt Catherine who died in 1982. In 1927 when Catherine was 11, her mother had her assessed by a clinician at the largest facility in Massachusetts for people with developmental disabilities, the Fernald School. Mr. Reidy had done some work in the past related to the Fernald School but had been unaware of his familial connection until quite recently.
Spring 2016 | Sections | Psychiatry & Psychology