STATEMENT OF DR. JACOBUS TENBROEK, PRESIDENT, NATIONAL FEDERATION OF THE BLIND, ACCOMPANIED BY A. L. ARCHIBALD, EXECUTIVE DIRECTOR, NATIONAL FEDERATION OF THE BLIND

Dr. TENBROEK. Thank you, Mr. Chairman.

Mr. Chairman, may I say at the outset you will notice from the statement that I am president of the National Federation of the Blind. The National Federation of the Blind is an organization of blind men and women. It is the only national organization of the blind.

While I speak here as president of the National Federation of the Blind, I am also president of the American Brotherhood for the Blind, Opportunities for the Blind, Inc., member of the President's Committee on the Employment of Physically Handicapped, and a member of the California State Social Welfare Board.

These are sideline activities with me. I earn my living as a professor at the University of California in Berkeley.

On my right is Mr. A. L. Archibald, who is executive director of the National Federation, and he will help us answer any questions that may arise after I get this statement in.

Mr. Chairman, I want to direct your attention to the basic question here, which is this: Are the blind and other physically handicapped persons entitled to a place in the sun or merely to a shelter in the shade?

This is the life and death question which this committee and the Congress of the United States must answer in passing upon Senate bill 2759.

The first alternative implies normal life; the second, abnormal or subnormal.

The first alternative implies self-support; the second, lifelong support by the public.

The first alternative implies hope, personal reconstruction, productive contribution; the second implies defeatism, personality disintegration, and productive automatism.

The first alternative implies dignity, independence, equal opportunity, and participation in the main social and economic activity of the community; the second implies segregation, isolation, custodialism, and the workhouse.

Gentlemen, the President's January 18 message of health and rehabilitation espouses the first of these alternatives. In my opinion, Senate bill 2759 adopts the second.

Let me try to make clear the full extent to which this is so.

The President's January 18 message contains these expressions: "Restoring handicapped persons to full and productive lives"; "selfsufficient and taxpaying members of their communities"; "full depth and meaning in human terms" of rehabilitation; "a program that builds a stronger America."

This is the language, these are the goals of true vocational rehabilitation; the restoration of disabled individuals to full and productive lives in normal competitive employment.

To seek less than this is to deny the disabled the right to free exercise of their talents and a fair opportunity to test them in competition. It is to deny vast numbers of American citizens the American birth

right of equal opportunity and personal independence. It is to deny society the contribution these citizens are capable of making to its work and progress.

The contrast between these principles of vocational rehabilitation and the provisions of Senate bill 2759 is profoundly disheartening to the blind men and women of this Nation.

Senate bill 2759 makes two major changes in the existing program: It promotes and supports rehabilitation facilities; it promotes and supports sheltered workshops. These are the innovations made by this bill. These are the projects for extension and improvement, the initiation of which is declared to be a primary purpose in section 1 of the bill. The first of these alters the direction and shifts the emphasis away from vocational rehabilitation. The second repudiates everything that vocational rehabilitation stands for. Let us examine them in turn:

A rehabilitation facility is defined in section 10 (c). The term says that section—

means a facility operated for the primary purpose of assisting in the rehabilitation of disabled persons-(1) which provides one or more of the following types of services: (a) testing, fitting, or training in the use of prosthetic devices; (b) prevocational or conditioning therapy; (c) physical, corrective, or occupational therapy; (d) adjustment training; or (e) evaluation or control of special disabilities; or (2) through which is provided an integrated program of medical, psychological, social, and vocational evaluation and services under competent professional supervision; provided, that the major portion of such evaluation and services are furnished within the facility and that all medical and related health services are prescribed by, or are under the formal supervision of, persons licensed to practice medicine in the State.

Thus the definition set down in the bill itself conclusively establishes the dominantly medical and therapeutic character of rehabilitation facilities.

This feature of such facilities was further emphasized by Secretary Hobby in her testimony on Senate bill 2758 delivered before this committee on March 17. Secretary Hobby there pointed to the essential linkage of rehabilitation facilities with hospitals.

Under the present law Federal construction aid for rehabilitation facilities may be furnished if they are a part of a hospital. Senate bill 2758 would authorize the extension of this aid when they are separate for hospitals.

The purpose of the proposed change is not to change the function of rehabilitation facilities but to stimulate their development.

The change, the Secretary argued, would relieve "the patient load in nursing homes and hospitals."

The rehabilitation facilities, she said further, would not be limited "to persons coming within the scope of the Federal-State vocational rehabilitation program." They would be available to all disabled persons including the children and the aged who are not being rehabilitated for employment and other persons who are being rehabilitated only for self-care.

A number of charts were introduced in which the inmates of rehabilitation facilities are called patients, one of which, chart L, showed that hospital loads could be materially reduced through the use of rehabilitation facilities; and another of which, chart M, listed the common types of disabilities which would be treated in a re

habilitation facility. The list includes: Severe infirmities-paraplegia, quadriplegia, hemiplegia, amputations, cerebral palsy, multiple sclerosis, heart disease, paralysis, speech impediment, hearing defect, blindness; lesser infirmities-simple amputation, less severe paralysis, minor speech and hearing impediments, fractures.

A distinction is thus sharply drawn by Senate bill 2759 and its sponsors between vocational rehabilitation and the rehabilitation which is possible in rehabilitation facilities.

To understand the significance of this distinction and our basic opposition to the inclusion of rehabilitation facilities in this vocational rehabilitation measure, it is necessary to understand the difference between disability and handicap.

Disability is physical or mental impairment. Handicap is the person's and the community's reaction to that impairment.

Disability is individual and personal; handicap is social and attitudinal.

Dealing with the disability is the function of medicine, therapy, or psychiatry. Dealing with the handicap is the function of vocational rehabilitation.

The common stereotype of blindness-a preconception founded in ignorance and passed on from generation to generation-portrays the blind as physically helpless and psychologically abnormal. This can be seen from Webster's Collegiate Dictionary which gives the following definitions of the word "blind":

2. Lacking discernment; unable or unwilling to understand or judge; as blind to faults. 3. Made without reason or discrimination; as, a blind choice. 4. Apart from intelligent direction or control; as, blind chance. 5. Insensible; as a blind stupor; hence, drunk. 6. * ** made without knowledge or guidance or judgment; as, a blind purchase.

The word "blind," then, has many different implications; but, as this list of Webster's so graphically reveals, they are virtually all implications of inferiority, of incompetence, even of stupidity.

To a greater or lesser degree, the same false image is fastened upon all the disabled. The blind or disabled person moreover soon comes to see himself as others see him and to accept the public assessment of his abilities.

It is this social prejudice which constitutes the principal handicap of disability, far surpassing its physical limitation, for the stereotype erects an unconscious barrier against the possibility of independence and the chance of self-support in the form of polite exclusion by society from the main channels of social and economic activity.

The process is self-reinforcing, for the failure of society's institutions to place the public in normal and positive contact with the disabled helps maintain the stereotype and thus justifies continued exclu

sion.

The problem of gaining equal opportunity for the blind and others is, therefore, first of all, the problem of overcoming the erroneous preconceptions of the public, the myriad discriminations to which they give rise and the defeatism and the lack of confidence which they inspire in the disabled.

Viewed in this light, the function of vocational rehabilitation is quite different from the function of the rehabilitation facilities provided for in Senate bill 2759.

Vocational rehabilitation neither begins nor ends with physical adjustment and restoration, with the provision of medical aids and prosthetic devices. These are vitally important services. They are, however, preconditions to a program of vocational rehabilitation. They are not properly a part of such a program. They are not vocational in their emphasis. They are not rehabilitative in their effort. The rehabilitation facilities focus on the physical or mental disability of the individual, substituting the public-health functions of medical care and physical therapy for the vocational-rehabilitation functions of occupational skills and economic opportunity. The emphasis is not on the handicap of clients understood as a vocational difficulty, but only on their disability, understood as a physical or mental condition.

The primary task of vocational rehabilitation-the overcoming of the social handicap, not the physical condition-consists in the creation of an environment within society, as well as within public programs, which will be in the fullest sense conducive to normal livelihood and normal life. Its time-tested tools are vocational orientation, vocational training, vocational counseling, and guidance which stimulates and opens up horizons and, finally, of course, placement in remunerative employment in the common callings, trades, pursuits, and professions of the community.

Since rehabilitation facilities do not contribute to this objective but are preconditions of it, since they are dominantly medical and therapeutic rather than occupational, and since their presence in a vocational rehabilitation bill is a diversion and distraction to its main purpose, rehabilitation facilities should be lodged in an environment in which they can most effectively perform their valuable functions, namely, under the Public Health Service in Senate bill 2758. The House Committee on Interstate and Foreign Commerce observed in its report accompanying H. R. 8149:

The committee believes that additional rehabilitation facilities are needed and needed and that, for the following reasons, at least part of this need should be provided through the mechanism of title VI of the Public Health Service Act

known as the Hospital Survey and Construction Act.

First, services provided in a rehabilitation facility are in many respects an extension of the treatment and services provided in a hospital. Second, it is both logical and economical to utilize the established administrative machinery and experience of the Public Health Service and of the State agencies now administering the program under title VI. Third, rehabilitation facilities have many construction features, and render some services comparable to those of hospitals and related health facilities. Fourth, the construction of additional rehabilitation facilities is a factor which will tend to reduce the demand for hospital and nursing-home beds.

This is, of course, an equally powerful argument for placing rehabilitation-facility establishments and extensions, as well as construction, under the Public Health Service and State agencies now administering that program.

The second major innovation of Senate bill 2759 is the support given a vastly expanded sheltered workshop system.

In section 10 (d) the sheltered workshop is defined. It is a workshop "where any manufacture of handiwork is carried on and which is operated for the primary purpose of providing remunerative em

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ployment to severely disabled individuals who cannot be readily absorbed in the competitive labor market."

This definition must be read in connection with other provisions of the bill.

Section 1 modifies the purpose clause in the Vocational Rehabilitation Acts of 1920 and 1943. Section 1 declares a purpose to assist the disabled to "prepare for and engage in remunerative employment to the extent of their capabilities."

The last phrase "to the extent of their capabilities"-is the new and significant addition. It graphically conveys the assumption that these capabilities are limited.

Section 7 (a) (1) of the bill speaks of the "utilization" of disabled individuals in a "suitable employment." The idea that people are to be "used" is suggestive enough of the patronizing and custodial spirit of the measure; still more significant, however, is the term "suitable employment." That term is in complete contrast to the concept of active participation in normal competitive work.

Then comes the definition in section 10 (d) of a workshop as a place for the "remunerative employment of severely disabled persons who cannot be readily absorbed in the competitive labor market." As a matter of fact, no severely disabled person can be "readily" absorbed in the competitive labor market. It takes a special, often a long and arduous effort of training and placement to accomplish such absorption; and, indeed, eligibility for vocational-rehabilitation purposes is conditioned on the presence of just such vocational difficulties.

Thus, Senate bill 2759 drastically departs from the established goal of vocational rehabilitation-restoration to full and productive lives in the common callings, pursuits, trades, and professions of the community; instead, the effect of the bill is to make subsidized workshops the central outlet for the placement of the rehabilitated disabled. For the blind and the other severely disabled-for those who are least "readily absorbed in the competitive labor market"-it will become almost the only outlet. They will have to abandon all hope of a normal, let alone a full and productive life in ordinary social and economic activity. They will have to resign themselves, from the very beginning, to a life of unproductive stagnation among the mops, the brooms, the broken furniture, and the discarded bric-a-brac of a subsidized workhouse.

This may seem to some a harsh description of the sheltered workshop. The blind men and women of America have lived with and in this institution for generations. Historically, we have lived with and in it since the seventeenth century made it an auxiliary appendage of the Elizabethan poor law. It possesses the opprobrium of the ages. In Senate bill 2759, section 10 (d), the workshop is described as a place of remunerative employment. It might more properly be described as a place where the public provides relief for the destitute and at the same time gives them something to do.

In the first place, sheltered workshops are not only nonprofit; but they are rarely self-supporting. They are not sufficiently productive to succeed in competitive conditions. They are called sheltered shops. Sometimes their markets are guaranteed by preferential Government purchase. They commonly have large budgetary deficits which are