Health care for aging people with mental retardation.

The health practices and needs of two samples of older individuals with mental retardation were examined and contrasted over a period of 5 years. Their health status varied markedly, but most had poor health maintenance practices, and almost all had difficulty communicating with health care providers. Those who lived in community residential facilities or relatives' homes usually had adequate health care provided for them, whereas individuals who lived more independently had difficulty accessing health care. There is a pressing need for health care advocacy programs to help prevent chronic disability.

Culture and schizophrenia: the DOSMD challenge.

The World Health Organization's International Pilot Study on Schizophrenia (IPSS) and subsequent Determinants of Outcomes of Severe Mental Disorder (DOSMD) studies have reported that the course of schizophrenia is more favourable in 'developing' than 'developed' societies. The 1992 DOSMD study attributes this difference to culture. We review studies concerning the course of schizophrenia and conclude that the evidence for a more favourable course in developing societies is not conclusive. Indeed, a favourable course has also been reported in various industrialised societies. We also raise questions about the findings reported in the recent DOSMD study, including the conclusion that the putatively more favourable course is a product of culture. Finally, we argue that longitudinal, direct observation of patients in their natural environments must be carried out before variations in the course of schizophrenia can be adequately understood.

Aging in the community--a matter of choice.

A sample of 16 older persons with mental retardation (mean age, 61 years; mean IQ, 62) who were originally studied in 1960-1961 and subsequently followed up in 1972-1973 and 1982 were reexamined. Despite advancing years, their independence, social competence, and zest for life had increased. The patterns of their lives were discussed in comparison with their counterparts who had spent their lives in more restricted residential settings.

Alcohol and drug use by mentally retarded adults.

Alcohol and drug use have been reported to affect adversely the community adaptation of deinstitutionalized mentally ill persons. Data from ethnographic studies of four samples of community-living mentally retarded persons were presented showing that the majority of these persons used drugs and alcohol rarely or not at all; indeed, they used these substances less often than did their nonretarded parents, siblings, spouses, and friends. Those who did use alcohol or drugs typically did so in socially acceptable ways. Reasons for these patterns of low alcohol and drug use were discussed.

The participant-observer approach to research in mental retardation.

Participant-observation, which calls for long-term immersion in the world of the persons being studied yet disciplined detachment from that world, has long been utilized in various social sciences. This method of data collection was seldom used in the study of mentally retarded people until recent years; however, it has now been employed in the study of many aspects of the lives of these people and their families. Although this method of research is expensive and time consuming, it has the advantage of allowing investigators to learn how people actually behave in a variety of contexts and to grasp the meaning these activities have for them.

Anthropology and mental retardation: research approaches and opportunities.

Although mental retardation is largely a sociocultural phenomenon, anthropological interest in this field has been slow to develop. In recent years, anthropological concepts and methods have been used in study of the community adaptation of mentally retarded persons and societal reactions to them. As an illustration, research developments at the Mental Retardation Research Center, UCLA, are discussed. The need for expanded, collaborative research by social and biomedical scientists is examined. The research puzzles include the links between poverty, ethnicity, schools, families and mental retardation, as well as the nature of intelligence and adaptation.

The cloak of competence: after two decades.

Fifteen mildly retarded persons originally studied in 1960-1961, and restudied in 1972-1973, were studied again in 1982. The quality of their lives over the past decade was reexamined with an emphasis on personal and social resources for coping with chronic or acute stress. We found that these persons were less dependent on others than they had been previously. Moreover, compared to other aging mentally retarded persons described in the literature, these persons were more hopeful, confident, and independent, despite ill health, stressful life events, and the lack of assistance from mental retardation service agencies.

Labeling and the perception of handicap among black mildly mentally retarded adults.

Participant-observational research and interviewing with 45 black young adults who were labeled mildly mentally retarded during their school years indicated that the majority of these persons continued to label themselves in various ways and to perceive themselves as adaptively limited. Moreover, all of their parents labeled their adult children and recognized limitations in their adaptive behavior; observations confirmed the presence of various adaptive limitations. We concluded that these black mildly retarded adults did not "disappear" into their communities but continued to see themselves and be seen by others as limited in adaptive skills, particularly "academic" skills such as reading and writing.

Traditional treatment for mental illness in Africa: a review.

The publication of The Quest for Therapy in Lower Zaire (University of California Press) by John M. Janzen (with the collaboration of William Arkinstall), and African Therapeutic Systems (Crossroads Press), edited by Z. A. Ademuwagun, John A. A. Ayoade, Ira E. Harrison and Dennis M. Warren, calls attention to recent research findings which indicate that mentally ill persons, particularly schizophrenics, may recover more rapidly and fully in non-industrialized societies than they do in industrialized ones. The books by Janzen and Ademuwagen et al. will be examined as contributions to a growing body of information on native African therapeutic practices. Evidence relating to the apparently benign course of psychosis in Africa will be examined, and various explanations for this pattern will be evaluated. Finally, some guidelines for future research will be suggested.

The cloak of competence: years later.

A sample of the persons in Edgerton's 1960-1961 study, The Cloak of Competence, was revisited in 1972-1973. The life circumstances of many of these persons had improved, but predictions of the direction and nature of community adjustment in a number of cases proved to be inaccurate. We discussed the issue of diversity in these cases and factors which make prediction problematic, such as environmental variables (as opposed to personal ones) and the effects of time on individual adaptation. Caution was suggested in looking at short-term adaptation without considering these factors. The importance of recognizing the individual's own definition of success was also stressed.