PSYCHICALLY IMPAIRED. – The term m. p. (or psychically abnormal) has a medical-pedagogical value and is used in school medicine and corrective pedagogy. Some authors prefer the terms “disharmonic,” “unfit,” or “irregular.” In any case, these designations refer to individuals (especially children and adolescents) who show deficiencies in learning because they have not attained the mental capacity typical of their age, or who cannot adapt their moral behavior to the demands of economic life. They are therefore distinguished into intellectually impaired or weak or mildly feebleminded (v. FRENASTHENIA) and characterologically impaired or unstable or affectively abnormal, which correspond to the milder forms of childhood neurosis and psychosis. Mixed impairments, the most frequent, are those in which weakness and instability coexist.
The causative factors may be biopathic, cerebropathic, or mixed (true psychically abnormal); or extrinsic to the nervous system, linked to physical frailty, exhausting diseases, adenoidism, intoxications, moral abandonment, family conflicts, erroneous educational methods, etc. These are the false psychically abnormal or defectively normal, who appear temporarily below the average level but can be normalized through appropriate medical-pedagogical treatment.
Such a distinction between “true” and “false” impairments is largely based on practical outcomes; however, it often presents considerable difficulties in advance. Moreover, such classification and the presumption of the subject’s adaptability are essential so that the m. p. can be directed to the most suitable institution. This task falls to “medical-pedagogical centers,” where psychiatrists, psychologists, educators, and social workers collaborate. These centers, which are essentially the Italian interpretation of the American and English “Child guidance clinics,” also engage in prevention and treatment.
The problem of social placement and rehabilitation of the m. p. has undergone successive phases of evolution and refinement: from indifference to institutionalization, from segregation to prevention. The first attempts were made about a century and a half ago in France and Germany; in Italy, the first institute for cretins was opened in Aosta in 1848. Initially, the problem concerned only a few volunteers driven by charity, philanthropy, or science; later, state intervention was added, though legislative provisions supporting and regulating private institutions remain scarce (cf., e.g., Royal Decree no. 577 of February 5, 1928). Among the most active figures in this field were Tommasini, Gonnelli-Gioni, Bonfigli, and especially S. De Sanctis and Montesano.
In Italy, the institutions that provide instruction and education for m. p. deemed socially adaptable are: 1) “differential classes,” which operate within elementary schools and serve for false psychically abnormal children who are not severely delayed or nervous (Momestano), for whom scholastic leveling and eventual return to mainstream schools are foreseeable after some time. Other characteristics of differential classes include a limited number of pupils, specialized staff, differentiated instruction, medical and psychological consultation, and social-moral assistance. 2) “Special schools” or “autonomous schools” or “school-asylums” for true m. p., autonomous in location, management, and disciplinary, didactic, and educational organization. These are parascholastic institutions aimed at the social adaptation of m. p. primarily through work, organized as day or boarding schools with special schedules and calendars to ensure continuous care. Even in these autonomous schools, there is ongoing medical-psycho-pedagogical collaboration, differentiated instruction, correction of speech defects, corrective physical education, moral and social assistance; particular importance is given to work, educational work, and vocational guidance. The “autonomous school” thus represents a type of open assistance. 3) “Residential medical-pedagogical institutes” provide boarding accommodation for m. p. without family support or those who must be removed from their families because the environment is unsuitable for their development or moral correction, or who reside in remote areas. These institutes have the same organization as autonomous schools, but affective education is more developed.
Residential institutes, often run by religious organizations, or the sections for juvenile feebleminded in psychiatric hospitals, serve instead for severe cases deemed socially non-adaptable (or non-recoverable), called major feebleminded, which include those affected by glandular dystrophies and severe psychopathies; individuals who often require only basic physical care.