A conscience for rehabilitation.
The Prophetic Tradition
He was not a believer in any organized religion or creed, yet ironically the writings of Simon Olshansky were reminiscent of the prophetic tradition of the Bible. His jeremiad addressed to the government bureaucracy, his criticism of the public and private agencies which provide services to clients with disabilities, his scathing denouncement of societal neglect of persons with mental illness or mental retardation, all can be likened to the Old Testament prophets who penetrated the social hypocrisies of their time, and recommended reforms and envisioned a better future.
In reevaluating his writings from 1952-1980, the one thread that continues throughout his work is a vision of a more just, humane society for people with disability. In a 1952 paper titled, Needed: a Sense of Humor (Olshansky, 1952), he quotes a New Yorker cartoon, which portrays an employer interviewing a prospective worker, who looks exactly like the employer, with the caption stating, "Bud, I like your looks. I think I'll hire you." His exposure of the hypocrisy of the labor market which is supposed to be free of discrimination, and his ridicule of the universities which teach "absolute rationality" in matching workers to jobs, is illustrated by this one cartoon.
Long before it became a watchword for rehabilitation of the person with mental illness, he discussed the phenomenon of passing and the need for normalization of ex-mental patients. In a famous study of the employment experiences of patients discharged from three state mental hospitals, he observed, in 1960, that approximately one third of them passed into the community without further difficulty and resumed their former lives (Olshansky, Grob, and Ekdahl, 1960). He concluded from this study that about one third of ex-patients do not need the services of rehabilitation. Passing may make some patients anxious, as they camouflage their former hospitalization, but it permits the patients to resume former life functions without the embarrassment and stigma of being identified as a mental patient (Olshansky, 1966).
His criticism did not spare the professional rehabilitation counselor. If normalization is something to be encouraged, then is the counselor more of a hindrance than a help in achieving society's acceptance? He saw the need for a client's ability to master the client's own destiny. If trained professional counselors were always needed to place clients on the job, then clients would always needed to place clients on the job, then clients would always be identified as patients. He suggested that "passing should be encouraged whenever possible. The opportunity to pass should not be blocked unless the costs are likely to be greater than the gains". (Olshansky, 1966, p. 87)
At times his vision ran counter to the prevailing wisdom. When state rehabilitation agencies were beginning to employ counselors trained in physical rehabilitation to counsel with persons with mental illness, he challenged their policies. He felt that the prevailing bias toward serving persons with physical disability and the lack of professional training to serve the person with mental illness would be damaging, if not fatal, to success. After his article titled, "Vocational Rehabilitation and the Ex-Mental Patient," was published in the Journal of Rehabilitation, he was scorned and isolated for many years by the rehabilitation establishment (Olshansky, 1960). How dare he challenge the assumption that every client, no matter what his disability, is a potential candidate for the state-federal rehabilitation program. I remember state NRA meetings when the Commissioner of Rehabilitation in Massachusetts would avert his gaze from Olshansky as he strode into the room. He spent several years in the wilderness after this article was published, only to emerge in the late 1960s as a leader in rehabilitation of the mentally ill and mentally retarded. He paid a price for his honesty.
Olshansky's criticism of the rehabilitation field took place on many levels. He criticized some of the deepest assumptions on which the field was based. In perhaps his most widely influential paper, "Rehabilitation as a Dynamic Interaction of Systems," he criticized "the current and traditional view of rehabilitation as a simple transaction between a single counselor and a single client" (Olshansky, 1963, p. 18). The traditional view held that one counselor, in a trusting, supportive relationship with a single client, could assist that client in making wise choices, obtain necessary training and medical treatment, and obtain work. In his paper, co-authored with Reuben Margolin, he showed that the vocational rehabilitation system was part of many interacting social systems that impinge on the client. These include the social welfare system, the workmen's compensation system, the placement system, the medical system, and the labor market itself. Not only is the client part of a system, but also the counselor functions within the federal-state system of rehabilitation. A competent counselor cannot function within an incompetent agency. An ethical counselor cannot function within an agency that is beholden to political sponsors. Finally, both the counselor and the client function within a dynamic interaction of social systems, and sub-systems, that are constantly in flux and responsive to social, legislative, and economic needs. As an example, the workmen's compensation system often may be detrimental to a client's rehabilitation. "The crucial system at this time is the workmen's compensation system which converts the client into a litigant and produces ambivalences among the employer, counselor, family, and client" (Olshansky, p. 38). The recognition of rehabilitation as a dynamic interaction among systems removes some of the burden upon the counselor, who cannot be expected to cope with the client without external supports.
He used words as a weapon to attack the prevalent attitudes of vocational rehabilitation leaders. In his "Six Scandals of Vocational Rehabilitation," he criticized poor supervision and the exclusion of counselors from policy making decisions (Olshansky, 1973). Based upon his personal experience as a state counselor, and based upon a study of state vocational rehabilitation agencies, he had concluded that the chief administrator of the agency was often an accountant or a person trained in business administration. In his own words, "Too many feel as workers on a bureaucratic beltline turning out 'rehabs' for their remote leaders" (Olshansky, P. 23). He would often recall his experience as a counselor, when he had to persuade the state DVR Director to authorize a maintenance check to a client on welfare. On the other hand, he saw the need for adequate supervision by persons trained in counseling, as a counterbalance to the power of the counselor. Finally he emphasized the need to include persons with disability in making rehabilitation programs and plans, "since each day they live their problem" (Olshansky, p. 23). His "Six Scandals" paper caused Craig Mills, then Director of DVR, Florida, to state: "Without being very specific, or factual, he has slandered the rehabilitation leadership with his broad brush accusations" (Mills, 1973, p. 25). Olshansky's words were used to galvanize change, and when they cut to the heart, they produced an emotional response.
His training in economics and his experience with the Division of Employment Security in Massachusetts led him to place emphasis of the vagaries of the labor market. He constantly discussed the need to persuade employers to hire a person with disability on the ground that the person can do the job. As a sheltered workshop director, he admonished clients (and sometimes professionals) that they were there to learn how to work, and not to obtain therapy. He had a strong belief that vocational counselors should possess a strong background in occupational information and labor market trends, and that knowledge of these areas was as important as knowledge of personality assessment (Olshansky and Hart, 1967).
His philosophy of normalization led him to restrict the number of follow up visits after job placement. He felt that a client's dependency needs would be reinforced by too frequency follow up. As Director of Community Workshops in Boston, he employed psychiatrists, psychologists, social workers, even social scientists, to understand the client better, but in the final analysis he viewed the shop less as a clinic than as a place of work (Olshansky, 1966). A client was prepared to meet the challenges of the business world, where sentimentality was no substitute for work capacity and training for a job (Olshansky, 1980).
At the same time, he did not see work as a panacea for all clients. Some clients would decompensate if they were placed under too much stress at work. Older workers would find work below their earlier occupational level to be degrading. Unlike the professional convinced of absolute certainty about how to rehabilitate clients, he did not believe all clients could be or should be rehabilitated to the competitive labor market.
Of all the disability groups that called for his attention, the plight of the seriously mentally ill population enlisted his continuing effort. In 1956-1958 he completed two studies of employer attitudes and practices in hiring patients who had been discharged from three state mental hospitals (Olshansky, et al., 1960). The data and conclusions drawn from these studies laid the foundation for his seminal thinking about this population. He found that one third of former patients could easily pass into the community, and required no further services. Another third were too impaired to benefit from rehabilitation services. Only one third were suitable candidates for state vocational rehabilitation. Drawing upon a sample of 370 patients taken from a population of 3,000 discharged patients, he found that all patients who were able and motivated to work were employed. The reemployed after hospitalization had spent less time in the hospital, were diagnosed more often with manic depressive disease than with schizophrenia, almost half were married, and had worked for at least three continuous years prior to hospitalization. The marginally employed had fragmentary, unstable work histories prior to hospitalization. The unemployed had distinctly poorer work histories, as evidenced by frequent job changes. He concluded that former mental hospital patients had better work capacity than expected. Previous work history was a better prognostic factor than their illness for employment success.
Based on the findings of these two studies, he concluded that former patients as a group did not seek or need active professional intervention in getting a job. This conclusion led to his thought about passing. If former patients with mental hospitalization can get their own jobs, then why can they not pass into the normal social and vocational life of the community? Always wary of the absolute self-righteousness of the professional specialist, he proposed that the anxiety associated with passing is less than the anxiety of being exposed as an ex-mental patient. He was skeptical of the value of ex-patient social clubs, because they identified people as being mentally ill, although he admitted to me that he thought a small percentage of patients would benefit from them. He realistically acknowledged the stigma of mental illness and realistically encouraged the patient to find his own job whenever possible (Olshansky, 1965).
When the movement toward deinstitutionalization developed momentum in the early 1970s, he remarked to me at a meeting of the state mental health department that "this will never work." He was too much of a realist and pragmatist to believe that the community would welcome ex-mental patients with open arms. His prediction unfortunately came true. In many states, such as Massachusetts, the former patient was released on the street, with no shelter, no job, no income. The state hospitals were denuded of staff and money, yet there was no substantial addition to community resources.
In 1980 he challenged the assumption that deinstitutionalization failed because of lack of funds. He described two factors associated with failure: (a) the general society has a negative attitude toward persons with schizophrenia, because they remind us of our own vulnerability; and (b) there is limited treatment for this disorder, except drugs and behavioral management. He felt that the treatment had to shift from psychiatry to rehabilitation, from seeking a cure for the disorder to assisting individuals to fulfill their potential productivity, within the limitations of their mental disorder. "For the discharged patient, the hospital nightmare is moved to the community" (Olshansky, 1980). One wonders how he would react to the present movement toward rehospitalization.
The Mental Retardation Specialist
Nothing is more illustrative of his compassion for the families of children with disability than his landmark article titled, "Chronic Sorrow." In this widely quoted paper, Olshansky observed that parents of children with mental retardation have a perpetual reaction of chronic sorrow to the "tragic fate" of their child, a reaction that ends only with their deaths or the child's death. Despite joy in their child's small achievements, despite their attempt to conceal their sorrow, despite cultural and religious variation, they inevitably compare their child with their expectations of normality. Whereas professional specialists admonish them to "accept" their child, not to deny their child's disability, to go on with their lives, the parents either acknowledge or attempt to deny their sorrow.
Whereas professional specialist advise them to continue with their previous family plans, parents need time to grieve over the limitations of their child's handicaps. Parents will require a lifetime to adjust their feelings and to organize their personal resources to meet their child's special needs. Chronic sorrow is a natural parental reaction to a child with permanent developmental disability. The counseling process with the parent cannot be compressed into one or two sessions. Counseling will need to be extended over many sessions in which parents can learn to provide for their child without feeling guilty over their own grief.
What Olshansky said about mental retardation can be equally applied to children with other handicaps. How often mental health professionals criticize parents of mentally ill adult children, finding fault with their inability to accept their child's handicaps. I was trained in the era when professionals discussed the "schizophrenogenic mother" who was blamed for the illness of her child. Although we look back on this era with shame, we still refuse "to accept chronic sorrow as a normal psychological reaction" (p. 193) and we still hold parents of children with mental retardation to an impossibly high standard. Some parents take years before they can acknowledge their child's disability.
His optimism about the vocational rehabilitation of people with mental retardation stemmed from his experiences as study director of the Children's Developmental Clinic in Cambridge, Massachusetts. He found that personality was more important than intelligence in evaluating work performance, and that people with mental retardation, contrary to the myth of stereotypical benign, docile personality, had significant variations in personality that affected their rehabilitation (Olshansky, 1969). Moreover, he found that children who were "school retarded" were not "work retarded," indicative of the point that retardation is often situationally determined. Finally, he criticized the tendency to classify and label persons with retardation, encouraging them to pass into the community whenever possible.
The Rehabilitation Counselor
His attitude toward the counselor was ambivalent. He assiduously defended the counselor against the encroachment of the bureaucrat, and he felt that the counselor deserved to be given an important voice in policy making. On the other hand, he railed against the omnipotence of the counselor in relation to the client. He warned against the Albert Schweitzer Syndrome, "the feeling of self-righteousness, the assumed omniscience, the self-appointed mission to correct the client's mistakes and to solve all of the client's problems" (Olshansky, 1978). He told me that the myth of rehabilitating "the whole person" was one of the largest myths in rehabilitation. Clients apply for assistance in solving one or a few problems, and counselors want to reconstruct their entire lives. He genuinely respected the client's choice to place the boundaries around the areas of their lives that they wanted to be fixed.
His critique of the myth, "that the individual counselor, professionally trained, sophisticated, and sharp, can singly grapple with and master all the problems the client presents," (Olshansky, 1972) emerged from his understanding of the interactions of systems and subsystems that impinge on the client-counselor relationship. He recognized that no counselor and no single professional person could solve a client's problem in isolation from the social and economic network. Furthermore, no counselor had the right to decide for the client what is best for the client's rehabilitation.
The Human Being (the Mensch)
There is a word in Yiddish language which best described the human qualities of Simon Olshansky; that is the word, mensch. Although not fully translatable, the most approximate English word is humane. Sy's compassion for people with disability was based on a respect for their individual humanity, their ability to make their own decisions, and their right to work, play, and live without intrusive professional scrutiny.
He constantly emphasized the need for "good feelings" toward people with disability, and he felt that no amount of professional training could make up for a lack of empathy with people with disability. When hiring professional people, he wanted "someone who is warm, with little or no hostility, open or concealed. I want someone who essentially has good feelings for disadvantaged persons and respects them and their capacity for decision making" (Olshansky, 1966).
His Vision of the Future
Concealed behind the curmudgeon side of his personality, there lay a witty, gentle man whose vision of the future encompassed many of the current trends of rehabilitation.
He saw the need to support people with disability in their own living environment without the constant encroachment of professional staff. He saw the need to provide realistic work training centers where preparation for work, not psychotherapy, was the primary activity. He saw the need to provide specialist counselors for people with mental illness and mental retardation. He saw the need to empower the person with disability to provide the person with skills and money in order that he/she might purchase services directly from rehabilitation facilities.
He saw the need to reduce the powers of the bureaucracy which he saw as a cumbersome impediment to services.
He saw the need to change the curricula of rehabilitation training programs, away from clinical assessment and pathology and towards an emphasis on positive assets, skills training, occupational information, and job placement. He saw the need for supported employment services for people with mental illness and mental retardation in order that they could be maintained in the community at a competitive wage.
He had the vision of a humane society where every person with disability could obtain appropriate services commensurate with his need, but not excessive or unwanted services.
We did not always agree. He was a religious skeptic; I was more conformist. He placed no trust in government or in political leaders; I believed in the necessity of big government as a counterbalancing force against big business and big labor. He worked outside the federal-state rehabilitation system, feeling that public services would always be inferior to private services. I worked inside the system, attempting to improve the system by research.
In his final years he was reading Voltaire, whose wit, skepticism, and powerful pen was consonant with his own thought. He walked every day from his home to two community libraries, and he voraciously read four new books each week.
He was the greatest critic and the greatest friend of rehabilitation I have ever known.
Mills, C. (1973). Response: An administrator's view. Rehabilitation Record, Jan.-Feb., 25.
Olshansky, S. (1952). Needed: A sense of humor. Personnel and Guidance Journal, 30, 358-359.
Olshansky, S. (1960). Vocational rehabilitation and the ex-mental patient. Journal of Rehabilitation, 26, 17-19, 40-45.
Olshansky, S. (1962). Chronic sorrow: A response to having a mentally defective child. Social Casework, 43, 4, 190-193.
Olshansky, S. (1965). Stigma: Its meaning and some of its problems for vocational rehabilitation agencies. Rehabilitation Literature, 26, 71-74.
Olshansky, S. (1966). Passing: Road to normalization for ex-mental patients. Mental Hygiene, 50, 86-88.
Olshansky, S. (1966). A look at professionals in workshops. Rehabilitation Record, 27-31.
Olshansky, S. (1969). An examination of some assumptions in the vocational rehabilitation of the mentally retarded. Mental Retardation, 7, 51-53.
Olshansky, S. (1972-1973). Eleven myths in vocational rehabilitation. Journal of Applied Rehabilitation Counseling, 3, 229-236.
Olshansky, S. (1973). Six scandals in vocational rehabilitation. Rehabilitation Record, Jan.-Feb., 23-35.
Olshansky, S. (1978). The Albert Schweitzer syndrome: An excess of virtuousness. Disabled U.S.A., 2, 3.
Olshansky, S. (1980). There is always at least one! Rehabilitation Literature, 41, 22-23.
Olshansky, S. (1980). The deinstitutionalization of schizophrenics: A challenge to rehabilitation. Rehabilitation Literature, 41, 127-129.
Olshansky, S., Grob, S., & Ekdahl, M. (1960). Survey of employment experiences of patients discharged from three state mental hospitals during period 1951-1953. Mental Hygiene, 44,510-521.
Olshansky, S., & Hart, W. (1967). Psychologists in vocational rehabilitation or vocational rehabilitation counselors? Journal of Rehabilitation, 33, 28-29.
Olshansky, S., & Margolin, R. (1963). Rehabilitation as a dynamic interaction of systems. Journal of Rehabilitation, 29, 17-18, 38-39.
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|Title Annotation:||Special Feature: Simon Olshansky, 1913-1991; includes bibliography and related article; tribute to rehabilitation counseling pioneer Simon Olshansky|
|Author:||Goldberg, Richard Thayer|
|Publication:||The Journal of Rehabilitation|
|Date:||Apr 1, 1992|
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