44 Mental Retardation
Name: Carla Tate
Source: The Other Sister (movie, 1999)
Background Information
Carla Tate is a Caucasian female around the age of 18-20 (her age was not specified.) She currently has no job, but is attending a vocational school called Bay Area Poly Technical school, and only took one class, Computer 101, which she passed. A lowered intellectual quotient (IQ) and slower processing overall characterize her mental health. No drug or alcohol usage has been reported or detected. Tate recently moved out of her parent’s house and into her own apartment, although her parents pay for it. She seems to have a very healthy family structure overall. She comes from an upper socioeconomic status. She has two sisters, whom she frequently talks to, and a mother and father that are still married. Her father seems passive and very supportive to Tate. In contrast, Tate reports and it has been witnessed that Tate’s mother is very controlling and overly protective. Tate complains that her mother inhibits her freedom and does not allow her to try new activities. Although this causes self-reported strain in their relationship, Tate still says she is close to her mother. Tate is very social and seems to have a positive base line of friends. Her goal is to become a veterinary assistant in the future and continue to gain freedom from her controlling mother. Her daily activities include going to her classes and spending time with her significant other and family.
Description of the Problem
Tate currently has a lowered IQ (probably around 70, although further testing would be necessary) and impaired cognitive processes. Her mother and father report that these symptoms were also present in early childhood. She also displays impaired social behaviors by violating social norms and over sharing. Tate’s physical condition is very healthy. She is in her weight class for her height. She has not reported physical problems and none have been observed. Her mood is very positive and open. However, she sometimes displays rapid mood swings and quickly gets upset at what most view trivial things.
Diagnosis
Carla Tate appears to meet the criteria for mild mental retardation (317.0).
A. Significantly sub-average intellectual functioning: An IQ of approximately 70 or below on an individually administered IQ test. For infants, a clinical judgment for significantly sub-average intellectual functioning.
Although not specifically told, Tate has been diagnosed with a lowered IQ because she went to a certified school for individuals with lowered IQ.
2. Concurrent deficits or impairments in present adaptive functioning (i.e., the person’s effectiveness in meeting the standards expected for his or her age by his or her cultural group) in at least two of the following areas:
1. Communication
2. Self-care
3. Home living
4. Social/interpersonal skills
5. Use of community resources
6. Self-discretion
7. Functional academic skills
8. Work
9. Leisure
10. Health
11. Safety
Tate displays a deficiency in communication when she is upset especially. Her words become slurred and rapid. She also qualifies for social and interpersonal skills impairment. Although she is an outgoing individual, she sometimes misinterprets situations. She also acts out and causes scenes in socially inappropriate places. Overall, she takes direction well, but she often misunderstands what the instructions are if they are not given to her very simplistically. Her functional academic skills are also impaired. Although Tate does attend Bay Area Poly Technical School, she struggles to keep up with the other students, and can only master basic concepts. Although no tests have been conducted, her IQ is estimated to be around 70. Tate also currently does not maintain employment at any job. Although Tate is relatively safe, there have been past reported incidences by her mother and Tate herself, of inflicting harm on other children by accident and setting accidental fires, which falls under safety. Tate does meet the criteria for mild retardation, which she has been diagnosed with and treated for in a special school, but she is relatively normally functioning in day-to-day life.
B. Onset before the age of 18
Tate’s parents were alerted of her learning difficulties and social impairments around the age of 8 or 9 (no specific age was given.) She was sent to a special school soon after
because her parents felt they could not help her adequately.
C. Stable IQs from early in life to adulthood
As reported by her mother, Tate has maintained a longitudinal average of a lowered IQ from her early childhood to present.
Accuracy of Portrayal
The average person watching this movie would automatically be able to diagnose Tate as someone who is mentally retarded. However, many individuals do not understand that different levels of mental retardation exist based on IQ scores. Although mild retardation is the most common level of retardation, accounting for 65-75% of all diagnoses of mental retardation, most of the population lump all forms of mental retardation together. Another fallacy which might be correct with an everyday person watching this movie is understanding that although mentally retarded individuals are limited in some of their functions, they can become with supportive help, a very productive member of society. One possible misconception the movie might give viewers is the idea that mentally retarded individuals normally come from a higher SES and often have people to take care of their needs. However, statistically most people with a mental handicap, especially people with mild retardation, come from a low SES neighborhood. They often become homeless or wards of the state because of lack of specialized training and education.
Treatment
There is no cure for mental retardation. The goal of treatment is to maximize her potential in every area of life despite her mental condition. Special teachers and programs intervention at the youngest age possible is recommended, which she received. Tate should be trained not only in life skills and academic areas at her level, but also in social skills and self-control. Family therapy should also be conducted to help the family better understand her condition and to help her family better know what are the most effective ways of dealing with her. They should also be informed of her abilities and limitations. Tate is a highly functioning female with mental retardation, and therefore, needs less care from her family. However, because her mother is slightly controlling, it limits Tate’s autonomy, which is very essential for all humans, especially for someone with mental retardation. This situation should be addressed and healthy boundaries should be agreed upon among Tate, her mother and the therapist. Autonomy will allow Tate to develop to her full potential and has shown great success in the past with other similar patients.
Name: Charles Gordon
Source: Flowers for Algernon (movie, 2000)
Background Information
The main character of this movie is Charlie Gordon, a mentally challenged 32-year-old man, with an IQ of 68, who works at a bakery as a delivery boy and moonlights as a janitor. He also attends the adult school for the mentally retarded at night after work. Charlie is a simple man with simple goals. One of his goals in life is for people to like him. When Charlie was little, his mother and father abandoned him shortly after they discovered that he is mentally challenged. Charlie was put in a foster home when he was merely a child. When he is old enough to make a living, he moves out and lives by himself in a deteriorated apartment in the middle of a suburban area, a place that he could afford. Isolated and alone since childhood, Charlie yearns for close relationships; as a result, it is no surprise that he wants to be liked and wanted. For example, occasionally at the work place, he would act like a clown (e.g., pretend to slip and fall, put flour on his nose, make funny faces, etc.) in hope to make his coworkers laugh because he thinks that they like him and are his “friends” but, alas, little does he knows that they are not laughing with him but at him.
One day at the adult school, his special education teacher, Ms. Kinnian –who is very impressed with his free-spirit, friendliness, and curiosity to learn –tells him about the brain-operation experiment, an experiment that promises to make people like him smart. Charlie immediately signs up for the experiment because he feels that if he is smart then maybe people would like him more. After the controversial experimental brain surgery, Charlie’s IQ increases at an exponential rate, tripling his original IQ at 185. With Ms. Kinnian’s guidance, Charlie also learned to read advanced level books, such as Robinson Crusoe, mathematical quadrants, etc., and write in comprehensive sentences, as demonstrated in his “progris riports.”
Shortly after the brain-operation, Charlie explores his inner feelings and emotions, such as betrayal, jealousy, love, and pain that he never thought he had. He begins to understand the world around him. For example, after the brain surgery, he begins to understand that his coworkers aren’t really his real friends after all because real “friends” would not invite you to bars and poke fun at you in front of everyone for good laughs. In addition, before the brain-surgery, he never knew he could fall in love and reciprocate his feelings. But as time goes by, his feelings for Ms. Kinnian develop. Alas, the ephemeral love between Ms. Kinnian and Charlie does not last. The movie ends with Charlie telling Ms. Kinnian goodbye the day he learns that the experiment would not work and that he would have to go back to being the mentally challenged man that he once was. Before the reversal of his intelligence, while he is still able to think and make decision, Charlie moves far away to another place to live, a place where Ms. Kinnian cannot find him.
As a man who is mentally challenged, Charlie has many difficulties and challenges in life. As you can see, his life difficulties involve deficits in intellectual abilities and functioning, such as the ability to read, write, and speak in coherence sentences. He may have learning disabilities, such as Written Expression (as demonstrated in his “progris riports”), Reading Disorder, and more. He also has difficulties in establishing interpersonal and social relationships because he does not have the ability to read facial cues and expressions. Little is known about his family mental health history. Charlie does not seem to have drug or alcohol problems. He also does not seem to have physical impairments, but mostly psychological and cognitive impairments.
Description of the Problem
Life is already hard, and life is even harder if you have Mental Retardation. As demonstrated in the movie Flowers for Algernon, Charlie shows significant limitations in intellectual functioning, such as not being able to read, write, and communicate coherently. He demonstrates maladaptive symptoms, such as emotional deficits and interpersonal problems. He does not seem to have sensory symptoms. His sensory modalities work fine. He can work and make a low profile and honest living as a delivery person and janitor at the bakery. He is not physically handicapped or in any way.
From the movie, Charlie is a mentally challenged man with an IQ of 68 and the symptoms that he shows qualify him for Mild Mental Retardation (MMR), which will be discussed in the diagnosis section. He is portrayed as a care-free and happy person, whose personality is almost childlike. He is not passive, placid, dependent, nor aggressive. He does not have severe nor profound mental retardation and he does not depend on anyone to dress for him or take care of him. But he does show signs of lack of communication skills, developmental delays, social and emotional deficits, impaired ability to solve or understand social problems and issues, and impaired ability in recognizing emotion in others. His academic performance is also affected by his mental delays; as a result, he goes to the adult school for the mental retarded instead of going to college. He can adapt easily at his working place, such as working as a delivery boy, janitor, and running errands, except that he does not have the capability to use a dough mixing machine, which requires the ability to follow instructions. The symptoms that Charlie has qualify him for MMR. He does not have self-injurious behaviors or stereotypical movements.
Overall, Charlie can function adequately at a slow pace environment, an environment that does not require higher order thinking and decision making abilities.
Diagnosis
Charlie Gordon meets the criteria for mild mental retardation (317.0) using the criteria from the DSM-IV-TR:
A) Significantly sub-average intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test.
Gordon has an IQ level of 68 since childhood. This qualifies him as having significantly sub-average intellectual ability.
B) Concurrent deficits or impairments in present adaptive functioning (i.e., the person’s effectiveness in meeting the standards expected for his or her age by his or her culture group) in at least two of the following areas: (1) communication, (2) self-care, (3) home living, (4) social/interpersonal skills, (5) use of community resources, (6) self-direction, (7) functional academic skills, (8) work, (9) leisure, (10) health, and (11) safety.
Gordon meets more than two symptoms of the above areas. He has problems in (1) communication, (4) social/interpersonal skills, (6) self-direction, (7) functional academic skills, and (9) leisure. He does not have deficits in (3) home living, (5) use of community resources, (8) work, (10) health, and (11) safety.
C) The onset is prior to 18 years of age.
Gordon has shown signs of mental retardation since childhood. The onset must be before the age of 18; hence, he also meets this criterion.
Accuracy of Portrayal
The movie does a good job in describing someone with mental retardation, especially a man with mild mental retardation. This movie was adapted from the original novel, Flowers for Algernon, written by Daniel Keyes. Keyes knew what he was doing when he was writing this novel. He had worked at many mental retardation facilities and had worked as a special education teacher before he wrote this novel. With the skills and trainings that he developed, he was able to describe in details the behaviors that he had observed from his students with mental disabilities, such as how they talk, write, associate with others, and so on. A person watching this movie would not be misled but be persuaded by the information that this movie provides and how it accurately portrays someone with this mental disorder. A person watching this movie would also get to learn more about MMR and the symptoms that a person with this disorder has.
Treatment
Currently, there is no cure for mental retardation. Mental disorder are an enduring and pervasive disease (which is why it is listed on Axis II), but several empirical supported studies show that therapy, special education and training, and social skill training can help ease the symptoms of mental retardation. Mental Retardation is not an easy disorder to treat since it is related to genetic factors, such as irregular genes or genes that did not fuse together properly (i.e., Down syndrome), and environment factors (e.g., infections, chromosomal abnormalities, metabolic, and nutritional, especially for persons with low socioeconomic status [SES]). It is also important for a trained specialist to evaluate the person for co-morbidity with other disorders, such as Attention-Deficit/Hyperactivity Disorder, Mood Disorders, Pervasive Developmental Disorders, Stereotypical Movement Disorder, Down syndrome, Fragile X, and more since these disorders may also affect the diagnosis and outcomes. The prognosis depends on the severity of the disorder, such as mild, moderate, severe, and profound. The less severe the levels and the early the treatment, the better the outcomes. Many people may lead productive lives and function on their own; whereas, others need a structured environment to be most successful.
