When I was doing my pediatrics research in medical school at Meharry Medical College in 1969, I was struck by the finding that many poor African Americans were being diagnosed with mild mental retardation that was attributable to what some people in Nashville, Tenn., called "sociocultural mental retardation."
This disorder was purported to be caused by the reality that poor African American families did not have books in their homes. It also was of interest to me that the more severe forms of mental retardation such as phenylketonuria, Down syndrome, and so on, cut across all socioeconomic, racial, and cultural lines.
At the time, another commonly used label was "minimal brain dysfunction." This diagnosis captured speech and language disorders, attention-deficit / hyperactivity disorder (ADHD), and specific learning disorders.
I found this curious, but I never bought the theory that the absence of books in the home was the cause.
Ten years later, when I was working for the Chicago Board of Education, where I observed 274 Chicago public school children being referred for complete diagnoses, I again saw this phenomenon of mild mental retardation and minimal brain dysfunction, and wondered what could be the cause. Back then, I figured it was tied to the high rates of premature births in poor black communities, as I understood that premature infants were more likely to have intracranial bleeding--which might have caused mild cognitive impairments.
Fast-forward about 6 years. I was on a Texas Department of Corrections (DOC) accreditation visit for the National Commission on Correctional Health Care, when I learned that about 20% of its inmates have issues with mental retardation and, in fact, Texas's DOC has special prisons just for that type of inmate. A large percentage of those inmates fit the demographic I had treated earlier. So, again, I was confronted with this problem of mental retardation in poor African American populations.
More recently, I did a Continuous Quality Improvement review of several school-based clinics in the Chicago public schools, and learned that children with various levels of mental retardation (mostly mild), speech and language, ADHD, and specific learning disorders are identified in the second grade.
From the time they are identified, these children are given individual therapy for behavioral problems. When the therapy fails, often when they are in sixth through eighth grades, they are unfortunately and frequently relabeled with conduct disorder and then shuttled to the Cook County Juvenile Detention Center. I have learned that two-thirds to three-quarters of the youth incarcerated by the county have these diagnoses.
Lastly, I recently have begun to see adult patients with mental illness in large numbers because the state of Illinois seems to be having difficulty paying its Human Services bills. Recently, I picked up 400 patients. Strikingly, slightly more than 10% of these patients have some form of mental retardation. But they are being folded into the general adult psychiatric population.
So again, this vexing …