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The transplant debate

FINALLY -- major news outlets have written about whether a New Jersey child who has a genetic condition and intellectual disability should be denied a kidney transplant. The blogosphere has been abuzz with opinions by parents of children with special needs over the last couple of days and over 38,000 people have signed a petition asking the Children's Hospital of Philadelphia (CHOP) to reverse its decision.

Today in the Huffington Post, Parentlode blogger Lisa Belkin argues that Amelia Rivera (left) should not be eligible for a transplant. And in a companion piece, Susan Senator, author of Making Peace with Autism, argues that she should.

Check out this interview with the family on NBC.

You can read Amelia's mother's account of a conversation she had with a transplant doctor at CHOP about Amelia's eligibility. And you can read a number of responses CHOP has posted about its transplant criteria on its Facebook page.

You may also be interested to read these recent BLOOM posts about an ethics conference at the Montreal Children's Hospital which looked at how cultural devaluing of children with disabilities plays out in their care:  The disability paradox; Costs, quality-of-life ratings puts complex kids' care at risk; Burden of kids not whole picture, ethicist says; and A fate worse than death.


The tyranny of two words


Mental retardation was coined as a medical term over 50 years ago—a then neutral term to replace idiot, imbecile and moron. But a quick trip to the thesaurus reveals that the words today mark a person as “abnormal, subnormal and deficient.” And any kid can tell you that the shortform “retard” connotes someone who’s useless.

Special Olympics is holding an awareness day today to encourage people to give up use of the R-word in casual, everyday language. I wrote about my support last Friday. But ever since then I’ve found myself fretting about the two words the R-word originates from: mental retardation.

Divorced from our culture, the words are relatively benign, indicating mental slowness. My angst stems from the realization that there is no way of separating out the stigma our culture attaches to these words.

My post may have implied that I’m totally cool with the clinical use of the words, when really, I’m not. They felt like an assault the day I first saw them attributed to my son, and they still do.

More importantly, I never, ever think of him in that context. What I mean by this is that I do not see my son—in any way—as “abnormal, subnormal and deficient” or as somehow of less value than someone with average or Einstein-like intelligence. He is a child who struggles to learn, but I do not see him as “slow.”

Mental retardation is not a topic of discussion in our house and we never told Ben about the diagnosis. We may talk about why things are harder for Ben to do, but we don’t label that under the catch-all of mental retardation. This is similar to our approach to our adopted daughter who has issues related to trauma and attachment. We might talk about why kids whose biological families are disrupted early have problems trusting others, but we would never tell our daughter: “You have attachment-disorder. You are attachment-disordered.”

On an everyday basis, these clinical terms that seek to categorize and delimit have no relevance to our life.

I remember a family whose healthy son had a massive, unexpected bleed in his brain. After months of gruelling rehab he regained his speech and some mobility. When his mom spoke to him about the fact that he’d lost his vision, his response was: “Mom! I may not be able to see. But I'm not BLIND!”

No one wants to be defined by a label that puts them in a box!

Perhaps some of you have the same feeling about the word disability. Because I've worked in a pediatric rehab hospital for so long, I've become desensitized to the word. But I remember when Ben was young I didn’t in any way identify him with having a disability, or being the opposite of “able.” I still don't think of him as “disabled” even though he has multiple disabilities.

People with disabilities have taken ownership of a word that was once used to stigmatize them, but the word itself—taken at face value as a negation of ability—hardly seems a starting point for describing the complexity of a human being. It doesn't in any way describe the flesh-and-blood people who adapt to all kinds of differences.

When I look at my son, the defining characteristic that rises to the surface is not disability. It's a mix of honesty, capacity for great joy and connection, and enthusiasm for life.

I see a kid who loves scrolling through photos of his classmates and family on his iPod. A kid who loves to dance to Pixar theme songs like “You've got a friend in me.”

I see a young man who stops on a busy sidewalk to wave his hello to the homeless man sitting on the concrete. One time he approached a man using a walker in a park and spontaneously gave him a hug. Another time he saw a man with dwarfism in a store and gave him an enthusiastic pat on the back (Ben too has a form of dwarfism).

I see a kid who humors his mother by calling her “cool.” And a kid who knowingly signs “sad” when his mom talks about missing Grandpa.

I see a teen who’s never been able to speak and struggles to hear, but surprises his parents and researchers by scrolling through an iPod he’s been given to communicate and finding folders we didn't think he could read: one for “manners,” one called “categories.”

My son experiences life fully. He’s already looking forward to his birthday at the end of the month. So last night when a package arrived that he figured held Star Wars characters he’s been asking for, he couldn’t contain his excitement. “When are you wrapping them?” he signed repeatedly. “When will I open them?” Then he went downstairs to look for the big container we keep the wrapping paper in. “Can I help?” he asked.

He’s a boy who adores tradition – he still likes pin the tail on the donkey and piñatas.

He’s someone who can lose himself in the silliness of a funny book or movie—giggling with abandon—even though he’s experienced more physical pain than I can imagine.

A couple of weeks ago I rubbed his back when a doctor held a mask to his face and he breathed in the stinky propofol that would knock him out for a cat scan. He's got more guts than I'll ever have.

My son is my hero. He's taught me more about life, about love, about courage and about what matters, than anyone.

Is it any wonder that parents like me want to throw off words that don’t in any way do justice to the essence of our children, and which have been twisted into epithets of cruel abuse?

The R-word: It's a hateful slur that's got to go


Use of the word “retard” is so pervasive it's said in the White House and even in our house. I remember when I first heard my pre-pubescent daughters and their friends—good, caring kids all—peppering their sentences with reference to how “retarded” certain people or things were. “Don't be a ‘tard,” rolled off one of their tongues and I felt like I'd been sucker-punched. “In the olden days, that's a word that was used to describe people like your brother Ben,” I said, eyes wide and wild. “It's demeaning and we don't use it.”

“I don't mean it that way,” my daughter said. “Stop freaking out, Mom!”

I'm sure White House Chief of Staff Rahm Emanuel had a similar reaction when he got in hot water in January for calling liberal activists “f**cking retards.”

“I don't care if you don't mean it,” I’d tell him, as I told my daughter. “You know the origins of the word and how it's been used to discriminate against people like my 15-year-old son (above).”

Of all disabilities, mental retardation is most loaded with stigma—a badge that singles one out as subhuman, worthless, and elicits a shocking degree of hate and fear, even within the disability community.

As a parent of a child with mental retardation, I don’t mind the clinical use of the term. In fact, I bristle at the thought that my son’s medical condition is so shameful it can’t be named.

The colloquial use of the word “retard,” however, has got to go; it’s evolved, since the inception of the clinical term 50 years ago, into a hateful taunt against one of the most marginalized groups in society.

Why is the stigma so entrenched? Prejudice against people with low intelligence has a long, little-known history that gained momentum in the first half of the 20th century and included a state-sanctioned killing program in Nazi Germany. Social Darwinism and eugenics played into a ranking of human worth—based on intelligence, economic contribution and behaviour—in which people with intellectual disabilities were deemed genetically inferior and thus less human.

The result? Between 1939 and 1943, 6,000 German children with physical and intellectual disabilities were killed through starvation, exposure to cold, poisoning and lethal injection. Over 70,000 adults with disabilities—including mental retardation—were gassed to death during early WWII in six killing centres set up for the purpose.

To those who say that’s ancient history, let’s look at some of the more recent hate violence against people with intellectual disabilities. Last week, an Italian Facebook group with 1,700 followers proposed that children with Down syndrome be used for shooting-target practice.

U.S. officials are investigating whether the horrific torture and death last week of Pennsylvania-resident Jennifer Daugherty—a 30-year-old with a mental capacity of 12 years—qualifies as a hate crime.

And a New York Times Motherlode blog in January titled “Should Down Syndrome be cured?” produced a slew of reader comments that implied life with intellectual disability is less than human.

“The reason it is called a disability is because it is a lack of something that makes a complete human being,” one reader noted. “That is a tragedy; it is not another equally good form of personhood.” Said another: You’ll never meet a doctor or a lawyer with Down syndrome.”

Doesn’t that sound like a ranking of human worth based on IQ? Are people with high intelligence genetically superior, inherently “better” people than others? Are we less human when our academic intelligence is limited?

Eugenics-like thinking spills over into the field of prenatal genetic testing.

Sixteen years ago, when I balked at having an amniocentesis after finding out I had an increased risk of having a child with Down syndrome, the grey-haired obstetrician sent in to “counsel” me flipped: “If you have a Down syndrome baby, that’s a burden you’ll live with for the rest of your life,” he squawked, eyes popping and mouth twisting. “If you have (an amnio-induced) miscarriage, you’ll be depressed, but then you’ll get pregnant again and have a ‘normal’ baby.”

When I later gave birth to a child with a rare genetic condition, a genetic counsellor explained it was a random, not inherited, occurrence then enthused: “You have every chance of having a perfect baby—next time!”

Doesn’t talk of perfect and imperfect babies, of normal and abnormal babies—in the profession of prenatal testing—make you shudder? Isn’t it just a little simplistic? Is even the healthiest baby in any way destined to be perfect? I thought to be human was to be imperfect.

My son Ben managed to elude a diagnosis of mental retardation until he turned 11. He was challenging to test because he didn’t speak. I remember the day I opened a psychological report and for the first time saw those two words—mental retardation—staring back at me. “It doesn’t change anything,” I told myself, but as the night wore on I railed against it, unable to sleep, and wept in my boss's office the next morning.

But when I looked more closely, I saw that my sorrow wasn't for my son—who had not changed one iota since the night before and was no less whole in my eyes—but for the terrible stigma that had befallen our family.

And I couldn't help thinking, like so many other things I’d learned in life: “It’s not what I thought it was.” My conception of mental retardation prior to having Ben in no way matches the reality of his life—or of my ability to love him. My son is bright and clever and curious and a million other good things that are visible to people who take the time to get to know him. And he has a rare gift: he has no pretence. He accepts himself and others as they are. In that way, he is more able, more evolved, than I am.

My first instinct as a mom was to hide his diagnosis. But how will we ever change perceptions if we’re too afraid to talk about taboos? So I wrote about it in the hope that it would convey that my kid has this thing—and he’s awesome. Yes, my kid is mentally retarded and I love him. No, I would not change him. No, I do not feel his worth as a human being would increase if his intelligence shot up.

We also need to talk about the violence and discrimination associated with the common, crass use of the word “retard.” And in the same way we’ve outcast the N-word from the popular lexicon, we need to give the colloquial use of the R-word the heave-ho.

“You can’t ban use of a word!” some will say.

No, you can’t. But you can make it socially unacceptable to use it. Case in point:

My 10-year-old Haitian son Kenold came home from school one day and surprised me by saying: “Someone called me nicked.”

“Nicked?” I said. “Do you mean ‘naked’”?

Of course it didn’t take long to realize the kid had called him a “n**ger.” After discussing what the word meant and why decent people didn’t use it anymore, I called the principal. Her response was swift.

The next day, she called Kenold into her office and had him look through photos of the entire student body (Kenold hadn’t known the child who taunted him). As soon as he was identified, he was hauled into the office, educated about the word, and his parents were called. They were told if it happened again the kid would be suspended.

End of story. End of problem (though I know racism is something he’ll be up against all his life).

Things aren’t always that simple. But why couldn’t similar social limits be placed on kids’ use of the word “retard?”

The social justice curriculum that has helped rid schoolyards of racial epithets needs to be broadened to include the history of discrimination against people with intellectual disabilities and education about why the R-word is a hateful slur.

Then we need to hope that role models—from movie stars to Emanuel—get with the program to make demeaning people with mental retardation “uncool.”

I support Special Olympics in its awareness day March 3 to Spread the Word to End the Word.

The child who never grew


When my son was just a baby and I was madly surfing the net for anything about child development, I came across this book title: The Child Who Never Grew.

I didn’t know it then, but it was a seminal book about raising a child with mental retardation, published in 1950 by Nobel- and Pulitzer-prize winning author Pearl Buck at a time when intellectual disabilities were hidden. Buck writes about her daughter who never developed past the mental age of four.

Early on, the book title terrified me. I wasn’t sure if it referred to children who didn’t grow physically or developmentally. Growth is highly valued in our culture – whether in height or intellect – and I questioned whether happiness could coexist without it.

“Couldn’t we still be a happy family?” I asked my husband when Ben was three days old, and we were waiting to learn what syndrome he had.

Fifteen years later, I’d say “yes,” but I believe my understanding of happiness has changed, as well. I used to think happiness was the absence of pain; that you could somehow manoeuvre around pain, outsmart it, so that it never touched you.

Now I think of life as being like cookie dough with equal parts joy and sorrow, and the two inextricably linked. I’m not afraid of sadness the way I used to be, because I take it as an essential part of life. And I know that the ability to feel and appreciate goodness is heightened when we’ve experienced pain.

Buck, in The Child Who Never Grew, talks about “the inescapable sorrow” that attends parents of children with intellectual disabilities. When I saw the words “mental retardation” ascribed to my son in an evaluation at age 11, I railed all night, unable to sleep, and wept in my boss’s office the next morning.

But was it sorrow for my son – who had not changed one iota since the night before – or sorrow for the stigma of mental retardation that had befallen our family? Of all disabilities, intellectual disability is viewed as the most tragic and despised – even within the disability community.

“It was getting harder all the time for another reason,” Buck writes of her daughter. “The child was older and bigger and her broken speech and babyish ways were conspicuous.” While saying she herself felt no shame regarding her daughter’s lagging development, she soon observes two American women (she lived in China) who stare and refer to her daughter as “nuts.”

Dealing with people’s reactions to our children – and the inevitable comparisons that show up their differences – is wrenching.

At a Christmas get-together, I couldn’t help comparing my 15-year-old son, who doesn’t cope well in group situations because of his hearing loss and anxiety, with his four-year-old cousin. His cousin could play a card game that Ben couldn’t follow. My brother-in-law noted that it was time to teach his son how to tell time, and I couldn’t help thinking, will Ben ever learn? Then at one point Ben got anxious and began picking his nose. Those moments are always awkward. There’s a part of me that fears others are judging Ben, and a part of me thinking: “Obviously my parenting skills have been less than stellar!” Because I was brought up in a family that valued manners, I feel an extra twinge when my son can’t follow social mores.

Reminders that Ben won’t be doing what his peers do sting. Like when one of my daughters asks: “Will Ben learn how to drive next year?” In a way, I don’t want him to turn 16 because the older he gets, the more behind he appears. When I filled out his camp application, I didn’t want to write “16” where it said “age of camper next June.” I fear the time when he starts “aging-out” of programs.

But it is only in academic and social comparisons that my son comes up short. He amazes me, on a daily basis, with his spirit, his sense of humour, his sensitivity, his capacity for joy and his curiosity.

And he has a rare gift: he accepts himself and others exactly as they are.

“He can’t try to act like someone he isn’t,” says my husband D’Arcy. “When you meet Ben, there’s no guile, no disguise. He is as he is. That means I don’t have to put on a disguise either. I can be me."

There are no pretences with my son. In that way, he is more able, more evolved, than I am. How many of us can say we've walked through life without pretending to be someone we're not?

I don’t take anything about Ben for granted. When he signs “What do you want for Christmas?” my heart bursts – because I know how hard it is for him to communicate and to initiate a question like that. I've seen how effortless language is for my typical children. As Ian Brown says in his memoir The Boy in the Moon when describing his son's smile or their shared language of tongue clicks: “Everyday occurrences for a normal child. But I know their true value.”

While Buck says “Had I been given the choice, I would a thousand times over have chosen to have my child sound and whole,” I can not say that I feel the same way about my son. Ben wouldn’t be the person he is – with his own mix of strengths and vulnerabilities – without his intellectual disability. Part of his essence, his way of interacting in the world, would be altered. Something genuine and irreplaceable would be lost.

'The Throwaway Child'

I'm reading a book called Matthew – about a boy who was born the same year I was, in 1964. When we were both 3, I was thriving at home in Toronto with my brothers, dad and full-time mom. Matthew, who lived in England, was also thriving. But because he had Down syndrome – his mother was driving him to an institution.

A string of doctors – some famous, his own father and family friends were convinced Matthew’s presence would destroy the family and, in particular, damage his older sister.

Writes Anne Crosby: I...put in the motorcar...(Matthew's) blue pedal-car. He sat his constant companion, a velvet lady pig, behind the steering wheel. It was almost unbearable to sit beside him, witnessing the pleasure he was feeling as we drove toward the hospital. He liked being driven through the park and he was delighted that we had his car inside my car. "Two drivers, Mum."

That charming reflection of Matthew’s – on his way to what his mother later refers to as incarceration – makes me weep.

I have a child who has mental retardation, and, despite his challenges with academic learning, it’s the beauty of his personality, his spirit, his intelligence, his humour and his unique take on life that most defines him. He’s the kind of kid who could have triumphantly signed – because he doesn’t speak – “two drivers, Mum.”

I can't imagine living in a time when raising my son at home would cost me my marriage, family and friends, and pit me against doctors who said my child needed to be with his “own kind."

So I was taken aback when I read results from two new studies about public attitudes to people with mental retardation.

In Israel, more than 50 per cent of 750 adults said they would not allow people with mental retardation to live in their immediate vicinity, according to a survey published Friday by the Welfare and Social Services Ministry's Department of Care for the Mentally Retarded. The study also found that more than 50 per cent do not want their children to have contact with children with intellectual disabilities in school. Forty per cent believe children with intellectual disabilities should live outside the family home.

In Brazil, a new study of over 18,500 students, parents, principals, teachers and school staff in 500 public schools revealed that 98.9 per cent want to keep a social distance from people with intellectual disabilities.

In 2007, a national survey of almost 6,000 American middle school students published in Exceptional Children found that almost 50 per cent wouldn’t sit next to a child like mine on a school bus and 73 per cent wouldn’t talk to him about personal things.

When I was growing up, children with intellectual disabilities didn’t go to my elementary or high school. The Exceptional Children study indicates that students today also have surprisingly little contact with peers with intellectual disabilities. Less than 40 per cent had had a student with an intellectual disability in their elementary or middle school.

The researchers note that exposure is not enough to lead to positive attitudes. “Contact and exposure that provide youth with the opportunity to witness the competence of individuals with intellectual disabilities” is the pivotal factor, the study authors say.

Isn’t that another way of saying if only kids with intellectual disabilities could be more normal in their achievements, attitudes would improve?

Measuring a person’s value against a dictionary definition of competence seems to feed into the counsel that a famous child psychologist gave Anne Crosby, mother to Matthew, the boy with Down syndrome who was sent to an institution: “Here is the important child, the bright and whole one,” he said, nudging her typical daughter. “We can safely say the other is The Throwaway Child.”

It seems to me that we need to develop a new scale for measuring personal qualities that make us worthy human beings.