Styopa Streltsov is determined to stand up. The little boy steadies himself, clasping a visitor's hands, and straightens his legs until he is teetering on his feet. He pulls himself up a dozen times more, cackling with delight. Only when a nurse gently disengages his hands does he stop.
Styopa should be able to stand and walk on his own. But officials at this state orphanage, a rambling white structure in an isolated farming village a night's train ride south of Moscow, say no one has time to teach him. There are 309 mentally disabled children here, 52 of them bedridden, and it's all the orderlies can do just to feed and wash them.
Nor does the state expect much else. In Russia's terminology, Styopa is officially labeled an "imbecile." Given up by his parents after he was born with Down syndrome, he has spent most of his life in tattered diapers in an iron bed, in a room full of diapered children in iron beds. Now three months shy of his eighth birthday, he weighs less than 19 pounds and is only 31 inches tall -- the size of a normal 15-month-old.
Asked to describe Styopa's future, Nadezhda Malikova, the orphanage's blue-eyed head nurse, stood still, startled. "No future," she said.
Much the same can be said for the 29,000 other children in Russia's 148 institutions for the severely mentally retarded. In a society that heavily stigmatizes the disabled, these children are viewed as dead weight. Government officials openly say their families should not be burdened with them, and don't bother to include them on the list of children eligible for adoption.
It is not uncommon to see these children straitjacketed, lying naked on linoleum floors, cowering miserably in corners or penned up in outdoor wooden shelters at orphanages that hold up to 600 children. Almost a fifth of the children, gaunt and severely stunted, never get out of bed, state statistics show.
The most severely retarded are classified as "idiots," helpless and unable to speak or learn. The others are diagnosed as imbeciles who are unfit for a classroom and capable of only primitive feelings. Yet some appear to outsiders to be of average intelligence. Three organizations -- the World Bank, Mental Disability Rights International and Human Rights Watch -- concluded in studies over the past year that a significant number are misdiagnosed.
Three decades ago, Western countries began to shut down such institutions in favor of foster care, group homes and services to keep children in their own families. Not so here: Russia maintains 2,000 orphanages but has only 239 foster families, most of them in one region, a 1998 state report shows.
The number of orphans is mounting with Russia's social problems: There are now 160,000, a third more than in 1994, most of whom have at least one living parent. The U.S. Agency for International Development hopes a $6 million grant for family and community services will help reduce the flow of children into institutions, but its three-year program has just begun.
A true picture of the homes for the severely retarded is difficult to obtain. Journalists are expected to request permission from regional authorities before any visit, and officials restrict which institutions can be toured.
Nonetheless, visitors can sometimes slip in unnoticed on weekends. The Washington Post recently visited five institutions, sometimes in announced visits, and sometimes by simply walking in and asking to see a particular child. All persons interviewed for this article knew they were speaking to a reporter.
The government body responsible for these children is telling in itself. Some orphans are assigned to the Ministry of Education and given schooling, but the severely mentally disabled are placed under the department for veterans and the elderly in the Ministry of Labor and Social Development.
"These children are ascribed to the same department as old people because there is no question of development for them," said Roman Dimenshtein, a critic of the system who works with families of disabled children in Moscow. "It's just a question of finishing their lives and passing on to another world."
How many of the orphans die prematurely is not a question that government officials will answer. In a 90-minute interview, Raisa Kuznetsova, a labor ministry official who helps oversee the orphanages, known as internats, insisted that she did not know the number and could not find out. Asked in writing, the ministry replied: "Regrettably, the ministry has no data."
"It is worse than a state secret," said Dimenshtein. "No one counts."
At Internat No. 8 in northern Moscow, staff psychiatrist Larisa Bogaeva compiled a list. In an institution that held at most 100 children, 16 orphans ages 4 to 15 died from January to September 1998, three child advocates familiar with the situation said.
Half of the deaths occurred when the orphanage lacked even a competent nurse, and half after an inexperienced pediatrician joined the staff, the child advocates said. No autopsies were performed. No one even recorded the children's weights. The cause of death was listed simply as "deficiencies incompatible with life."
Bogaeva was so horrified that she took her list of dead children to local officials. But Anatoly Severny, president of the Independent Association of Children's Psychologists and Psychiatrists, said no investigation was conducted.
Strangely enough, Russia is a society that dotes on children. Each state-subsidized preschool has its own doctor, and advising parents on how to properly feed and dress their children is a national hobby.
But the country also has a long tradition of hiding the disabled. After World War II, for instance, soldiers with amputated limbs were exiled to Valaam Island, north of the city then known as Leningrad.
Even now, Russian officials question a concept accepted in the West: that the state should support families with disabled children instead of putting the youths in institutions.
"Even if such a child is in a family that loves and takes care of him, nonetheless this family has grief on its soul," said Kuznetsova, the labor ministry official. "Even if it's a well-intentioned family, they can't give the specialized education and care that this child might need.
"At home, this child wouldn't have any friends because the parents would be embarrassed to show them around. We think the system justifies itself. There may be insufficiencies . . . but we don't have unfed, neglected children in our institutions."
Child advocates say the pressure on parents to give up disabled children begins in the maternity ward. Parents who keep their children find themselves essentially on their own, without services or access to schools. The state gives about $13 a month to provincial families with disabled children, and $21 a month to Moscow families. It pays institutions eight times as much.
Many children whose parents surrender them go first to "baby houses." A morning visit to one in Moscow was telling. In the dayroom, one little boy eagerly tossed an old plastic bottle across the floor to a glum-looking orderly seated on a couch. She wordlessly kicked it back three times, then declared the game over. That was the only interaction between the staff and a dozen children under the age of 5 in nearly an hour.
By the age of 4, more than four-fifths of the children in the baby houses are diagnosed as retarded. Those considered only slightly disabled are sent to Ministry of Education orphanages and given schooling. Severny, of the association of psychologists, has begun a study of those homes. Of a group of 15 teenagers, he found 12 were misdiagnosed as retarded.
Those classified as more severely mentally disabled end up at institutions like No. 15 off a busy Moscow highway. Behind its blue iron gates and concrete walls, a four-story building houses 400 children.
One floor is for the lezhaschiy -- literally, those who are lying down. One recent Saturday, five of 11 children in one room were straitjacketed so tightly they could barely roll over. Those who could sit up rocked rhythmically in their beds -- a motion that child development experts say is typical of children without any stimulation.
Racing down the overgrown paths was Natasha, an athletic, sociable 17-year-old. Natasha learned to read and write at Ministry of Education orphanage No. 67.
Had she remained there, she would now be entitled to a one-room apartment from the state. But two years ago, her diagnosis was changed from slightly retarded to imbecilic, and she was sent to No. 15. When she turns 18, she said, she will be transferred to an adult institution "for life."
Natasha's 14-year-old friend, Katya, ran back to their old orphanage two months ago. Privately, out of sight of the orderlies, she and Natasha explained the consequences. After Katya was found and returned, they said, she was punished with repeated injections of aminazine, a tranquilizer that put her to sleep for days at a time and caused painful cramps.
Ivan Zhigalov, the director of No. 15, declined to be interviewed. After six months as director, he said, he is ready to leave. "Have had about enough," he said.
Buturlinovka is set amid southeastern Russia's potato fields, instead of apartment buildings. But like No. 15 in Moscow, it is home to children whose diagnoses seem inexplicable.
One June afternoon, a 13-year-old named Yaroslav peppered a reporter with questions about America and sang a popular love song while the orphanage's silver-haired director, Sergei Terichenko, watched with a smile. "Some of these children, if they were brought up in a normal family, you wouldn't even know the difference between them and a normal child," he said.
Several children call Terichenko "Papa," and he knows many by name. He refuses to send even some as old as 34 on to adult institutions. "They perish there," insisted Nina Shteltser, his deputy.
But even Buturlinovka, with its well-intentioned staff, presented arresting scenes. The 58 children classified as idiots were confined in outdoor pens -- tall wooden, roofed structures enclosed on one side by a narrow slatted fence. Rusted iron pails in the corners served as toilets.
Girls and boys looked alike: All had shaved heads. One boy, lying on a blanket, slapped himself over and over with a neighboring boy's hand. Another boy howled miserably, his pants bunched below his hips. Except when the director was there, the gates were tied shut, and the children peered out from the dim interior through three wide openings in the slats.
In one of two "lying-down" rooms inside the orphanage, a little girl named Marina clambered into a visitor's arms, swimming in her hospital-style gown. Ten years old, she is no bigger than an average 18-month-old.
Sergei Koloskov, who heads the internationally funded Down Syndrome Association, is on a lonely crusade to help children like Marina. He showed the staff at Buturlinovka an album of before-and-after photos of children now at orphanage No. 8. Koloskov's team, working along with government staff there, has managed to double the weight of formerly emaciated, bedridden children and taught many to walk and talk.
"Compare this skeleton to this plump kid," he said, pointing to a photo of one 9-year-old girl. "These are not unique kids. No miracle. . . . You just have to know how."
But Koloskov is one reformer faced with thousands of orphans whose fates are sealed. At the age of about 18, children in institutions like Buturlinovka move on to institutions like Kandaurovsky, outside the city of Tambov in southern Russia.
There, 310 residents, many of them aged and with obvious psychiatric problems, aimlessly mill about a two-story building, dressed in ragged housecoats and slippers.
Director Nikolai Gorbachev, giving an impromptu tour one afternoon, flipped on the light in a dark hallway. There stood 20-year-old Sveta Matsneva, a new arrival. "She is our local beauty," the director proclaimed.
Sveta, a pink scarf around her neck, trailed a few steps behind the visitors for the next half hour. She kept her distance from the woman mumbling to herself and turning in circles, and from the woman who sat in the dirt yard and glared at her.
Then, as the visitors unlocked the car door to leave, she seized the moment.
"Please," she said, her voice low and urgent. "I want to be free. Here, you only walk to the fence. That's all.
"Can you help me pull myself out of here?"