190 Social Casework

them to conside r the possibility of a recon- fare of the commu nity's childre n. Its re-
ciliatio n in the future. concili ation service has proved that a di-
In some instances reconci liations are vorce court can make the legal aspects of
brough t about merely throug h the act of divorce secondary to the sociopsychological
filing the petitio n and of sendin g letters aspects that are causative factors in "family
confirm ing the conference that is to take fall-ou t."
place. The letters act as a catalyt ic agent The Concil iation Court has transla ted
that enables the couple to sit down togethe r the age-old princip le of the state's inter-
to discuss their problems. The appoin t- est in family life into a dynam ic progra m
ment letter may have particu lar impact of provid ing counse ling help in a setting
on the respon dent, since he begins to real- where such help usually is not availa ble-
ize that the partner would not be going the court itself. It has demon strated that
to a court to get help if the marita l prob- legal and marital counse ling services can
lems were not serious. be combin ed into a unified force for help-
ing trouble d marita l partner s rebuild their
Conclusion marriag e. In its progra m of help it uses
short-c ontact counse ling at a point of crisis,
The Concil iation Court of Los Angeles a formalized reconc iliation agreem ent, and
County has been a pionee r in the develop- the author ity vested in the Court. The
ment of a short-c ontact marita l counse ling remark able results achieved over a period
service for couples on the verge of separat ion of years leave no doubt that a valuab le
or divorce. The Court is a testam ent to the service to families in conflict can result
capacity of the law to offer an enablin g from co-operation betwee n lawyers, the
service to families that contrib utes to the court, and the various social and psycho-
strengt hening of family life and to the weI- logical counse ling professions.

Chronic Sorrow: A Response to Having

a Mentally Defective Child
Simon Olshansky
The author is Study Director, Children's Developmental Clinic, Cambrid
ge, Massachusetts»

THE PURPOSE of this article is twofold: tempt to help them; and (2) to suggest
(1) to propos e that most parents who have some of the implica tions of the phenom -
a mental ly retarde d child suffer from a per- enon of chronic sorrow for the parent coun-
vasive psychological reactio n, chronic sor- seling process. This discussion is based
row, that has not always been recognized on the author 's person al and professional
by the profess ional person nel-ph ysician s, experiences and on the experie nce of the
psychologists, and social worke rs-who at- Childre n's Develo pmenta l Clinic staff in
counse ling parents of severely retarde d
1 The Children 's Develop mental Clinic childre n.
is sup-
ported by the U.S. Children 's Bureau, the Massa-
chusetts Departm ent of Public Health, and the City
of Cambrid ge. The Phenomenon of Chronic Sorrow
The author is grateful to the followin g persons Most parents who have a mental ly de-
for their consider able help: Dr. Charles Hersch and
Lillian Saltman , Cambrid ge Guidanc e Center; Dr. fective child suffer chronic sorrow through -
Samuel Grob, Massachusetts Association for Mental out their lives regardless of whethe r the
Health; Dr. Robert Flynn, Thelma Bloom, Gertrud e
Johnson , and Marjorie Kettell, Children 's Develop- child is kept at home or is "put away." The
mental Clinic; Catherin e Casey and Hilma Unter- intensi ty of this sorrow varies from time to
berger, Massach usetts Departm ent of Public Health. time for the same person , from situatio n
 Chronic Sorrow: Response to a Mentally Defective Child 191

to situation, and from one family to an- professional helper. This expectation may
other. The sorrow may be more intense make him both resentful and resistant.
for one parent than for the other in the In our clinical experience, we have seen
same family. Many factors, such as a par- relatively few parents so neurotic that they
ent's personality, ethnic group, religion, denied the fact that the child was men-
and social class, influence the intensity of tally defective. We have seen relatively
this sorrow. Some parents show their sor- few parents who did not recover enough,
row clearly; others attempt to conceal it, after the initial shock of discovery, to
and sometimes they succeed. The need mobilize their efforts in behalf of the child.
to keep a "stiff upper lip," especially out- It is understandable that some parents
side the privacy of the home, is a common move slowly and erratically toward recog-
defense of parents. Anglo-Saxon parents in nition of the mental defect and toward
particular usually feel this need. Although meeting the child's special needs. Some of
chronic sorrow may be experienced by them even "regress" to the point of deny-
some parents of minimally retarded chil- ing, at certain times, the reality of the
dren, this reaction is probably more nearly child's defectiveness. On other occasions
universal among parents whose children they become unduly optimistic about the
are severely or moderately retarded- child's potentialities. In our view, such
whose children would be considered re- regression may help the parent to tolerate
tarded in any society and in any cultural better the terrible reality that confronts him
group. each day.
The helping professions have somewhat Why does the professional worker be-
belabored the tendency of the parent to come so impatient with the parent's slow-
deny the reality of his child's mental de- ness or occasional regression and why does
ficiency. Few workers have reported what he feel such a great sense of urgency to
is probably a more frequent occurrence, do something about it? After all, the par-
the parent's tendency to deny his chronic ent has a lifetime in which to learn to
sorrow. This tendency is often reinforced deal with the needs and problems of a
by the professional helper's habit of view- mentally defective child. In most cases
ing chronic sorrow as a neurotic manifes- one can ask what will be lost if the parent
tation rather than as a natural and under- is unable for several years to view his child
standable response to a tragic fact. All the as mentally defective. The parents of one
parental reactions reported in the litera- of our clinic patients have told us that
ture, such as guilt, shame, and anger, may their child was six or seven years old before
well be intertwined with chronic sorrow. they knew definitely that she was mentally
Moreover, a parent's experiencing chronic defective. Although they had sensed that
sorrow does not preclude his deriving satis- her development was slow, they had failed
faction and joy from his child's modest to act on their suspicions until her sub-
achievements in growth and development. normality became self-evident. In what
It can also be assumed that the child's way had the parents been worse off in their
mental defectiveness has symbolic mean- "blissful ignorance"? In what way had the
ing, on an unconscious level, to some par- child been worse off, since she had had the
ents. The data that support this assump- capacity to meet the parents' expectations?
tion, however, are rarely communicated by The parents of a normal child have to
the parent except in deep psychotherapy. endure many woes, many trials, and many
The reality faced by the parent of a moments of despair. Almost all these par-
severely retarded child is such as to justify ents know, however, that ultimately the
his chronic sorrow. When the parent is child will become a self-sufficient adult.
asked to "accept" mental deficiency, it is By contrast, the parents of a mentally de-
not clear just what he is being asked to do. fective child have little to look forward
The great stress professional workers tend to; they will always be burdened by the
to place on "acceptance" may suggest to child's unrelenting demands and unabated
the parent that he is expected to perceive dependency. The woes, the trials, the
his child from the point of view of the moments of despair will continue until
192 Social Casework

either their own deaths or the child's parent and his feelings may encourage the
death. Concern about what will hap- parent to discuss his chronic sorrow more
pen to his child after he is dead may be a openly and freely. There is a danger that
realistic concern for a parent, or it may be some workers will become overinvolved
associated with death wishes, either for him- and sentimental, so that they will serve as
self or for his child. Release from his "wailing walls" rather than as helpers. This
chronic sorrow may be obtainable only danger, however, is always present in any
through death. helping situation if a worker surrenders
the discipline, restraint, and understand-
The Counseling Process ing he must have to fulfill his helping role.
Although chronic sorrow is a natural,
What are some of the implications of the rather than a neurotic, response to a tragic
parent's chronic sorrow for the professional fact, some parents do respond neurotically
person who attempts to help him? First, to their child's handicap and may require
the professional worker should abandon treatment for their neurosis. Judging from
the simplistic and static concept of parental our experience, however, the number of
acceptance. Every parent-whether he has neurotic parents is small. It is regrettable
a normal or a mentally defective child- that this small number of people has re-
accepts his child and rejects his child at ceived so much professional attention that
various times and in various situations. If the tragedy of having a mentally defective
both acceptance and rejection are universal child has been viewed less as a tragedy
parental responses, it is not clear just what than as a psychiatric problem.
the professional person is asking the par- The professional worker who learns to
ent of a mentally defective child to accept. accept chronic sorrow as a normal psycho-
Is the parent being asked to accept the fact logical reaction will grant the parent a
that the child is defective? This the par- longer period of time than otherwise in
ent does, in general. Is he being asked to which to adjust his feelings and organize
meet the child's needs realistically? This his resources, both internal and external,
the parent tries to do, by and large. Is to meet the child's needs. The worker
he being asked to abandon his chronic will also plan to extend the length of the
sorrow? This the parent wishes he could counseling process. He will alter the usual
do but cannot. The permanent, day-by-day practice of telling the parent the facts
dependence of the child, the interminable about the child's mental defectiveness in
frustrations resulting from the child's rela- as few as one to four interviews, since
tive changelessness, the unaesthetic quality the worker will realize that the communi-
of mental defectiveness, the deep symbolism cation of facts is only one part of the coun-
buried in the process of giving birth to seling process and is not necessarily the
a defective child, all these join together most important part. Some parents may
to produce the parent's chronic sorrow.
require months, or even years, of coun-
That so many parents bear this sorrow
seling before they can muster and main-
stoically is rich testimony to parental cour-
age and endurance. (One might ask, for tain the strength and stamina needed to
example, how much progress would have live with the tragedy of having a mentally
been achieved in the field of rehabilita- defective child. What the parent requires,
tion if the issue of "acceptance" had been beyond a knowledge of the facts, is an op-
made the primary focus of professional portunity to ventilate and clarify his feel-
concern rather than the issue of managing ings and to receive support for the legit-
the disability most efficiently through the imacy of the feelings he is expressing. In
use of prosthetic devices.) some instances the parent will need to be
Second, the professional person's percep- given this opportunity at various times
tions of the parent will be different if he throughout his life.
accepts the idea that chronic sorrow is a In addition to providing more time dur-
natural, rather than a neurotic, reaction. ing which the parent can learn to face his
The worker's changed perceptions of the problem, and to offering counseling at a
 Music Therapy and the Mentally 11/ 193

slower pace, the worker should also make cial education classes, day care centers, and
himself accessible to the parent over a long sheltered workshops should be made avail-
period of time. No matter how effective able when they can be used appropriately.
the counseling is, many parents need to dis- Moreover, the mother should be given an
cuss their feelings and the problems as- opportunity to be away from the child at
sociated with a defective child on many recurring intervals. Although some workers
occasions. This need for repeated counsel- tend to discount the value of "baby sitting"
ing is natural and should not be con- services, these services can make it pos-
sidered a sign of either regression or neu- sible for the mother to get much-needed
rosis. The experience of our clinic has relief and can enhance her sense of per-
demonstrated the importance of accessi- sonal comfort. Greater comfortableness
bility-an "open door" policy-for the may help make her chronic sorrow more
parents of mentally defective children. A tolerable and may increase her effective-
parent may telephone a staff member again ness in meeting the child's continuing
and again about a recurring problem, a needs. Also, through increased comfort-
new problem, an emerging crisis, or his able ness the parents may become more
own distress. accessible to psychological help for them-
Finally, if the worker accepts the validity selves.
of the concept of chronic sorrow, his goal In summary, it has been suggested that
in counseling the parent will be to increase the parent of a mentally defective child
the parent's comfortableness in living with suffers from chronic sorrow. This sorrow
and managing his defective child. In addi- is a natural response to a tragic fact. If
tion to providing psychological help, the the professional worker accepts chronic
worker will emphasize, more than formerly, sorrow as a natural, rather than a neurotic,
the help the mother needs in order to learn response, he can be more effective in help-
to manage such problems as how to feed, ing the parent achieve the goal of increased
discipline, and toilet-train the child. Use comfort in living with and managing a
of such facilities as preschool nurseries, spe- mentally defective child.

The Effect of Music Therapy on Mentally III Patients

Janet H. Kirsch
Mrs. Kirsch is Assistant Supervisor, Division of Foster Care, Bureau of Child Welfare, Department
of Welfare, New York, N.Y. She is also a member of the faculty of the New York College
of Music in New York City.

THE EFFECT of music therapy on men- The Meaning of Music

tally ill patients was the subject of my
Master's degree project." My interest in For thousands of years man has known
studying this form of treatment stemmed about the use of music to excite passions
from my experiences as a musician, which or to soothe them. In the literature of the
developed in me a conviction that music social sciences one finds numerous refer-
is a potent healing agent. Music is a uni- ences to the many different societies where
versal language: When words fail, music music was prescribed as a healing agent
can speak; when the expression of emotion for various ailments. Confucius ascribed a
is blocked, music can break down the bar- social value to music.s In ancient Greece
riers to communication. various philosophers mentioned the power
of music upon the mind and body. Among
1 Janet H. Kirsch, "Does Music Therapy Have a
Positive Effect on Mentally III Patients?" submitted
the ancients Pythagoras was the most articu-
in partial fulfillment of the requirements for the
degree of Master of Social Work, Graduate School 2 Arthur Waley, Analects of Confucius (privately
of Social Work, New York University, May, 1961. printed).