Read American Psychosis Online

Authors: M. D. Torrey Executive Director E Fuller

Tags: #Health & Fitness, #Diseases, #Nervous System (Incl. Brain), #Medical, #History, #Public Health, #Psychiatry, #General, #Psychology, #Clinical Psychology

American Psychosis (6 page)

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THE NATIONAL NEUROPSYCHIATRIC INSTITUTE

In ordinary times, Felix’s radical mental health plan would have quietly circulated in Washington among a few interested people, then died a natural death. But the postwar years were not ordinary times. The end of World War II confronted the nation with two disturbing facts: serious mental illnesses were much more prevalent than people had previously believed, and conditions in state mental hospitals were appalling. The first became clear from congressional testimony regarding the military draft. Among all men rejected for induction during the war, 18% had been rejected because of “mental illness,” 14% more because of mental retardation, and 5% because of neurological diseases. Once in uniform, among all men discharged for disability, 38% “were due to mental disease.” General Lewis B. Hershey, director of the Selective Service System, testified that “mental illness was the greatest cause of noneffectiveness or loss of manpower that we met.”
11

Conditions in state mental hospitals became public when more than 3,000 conscientious objectors—mostly Mennonites and Quakers—were assigned to alternative duty during the war in one-third of the nation’s state mental hospitals. These idealistic young men were appalled by what they found and in 1943 began publishing their findings. The reports of the conscientious objectors included scenes such as the following:
He opened the door to another room. I stood frozen at what I saw. Here were two hundred and fifty men—all of them completely naked—standing about the walls of the most dismal room I have ever seen. There was no furniture of any kind. Patients squatted on the damp floor or perched on the window seats. Some of them huddled together in corners like wild animals. Others wandered about the room picking up bits of filth and playing with it.

Such conditions should not have been surprising, as the hospitals were grossly overcrowded and understaffed. The population of state mental hospitals had increased dramatically, from 150,151 in 1903 to 423,445 in 1940. In addition, up to half of the hospitals’ professional staff members had been drafted for the war effort.
12

Investigating commissions followed the published reports, and in 1945 a Grand Jury indicted the State of Ohio for “the uncivilized social system which enabled such an intolerable and barbaric practice to fasten itself upon the people.”
Life
magazine picked up the story, and on May 6, 1946, published a sensational exposé, “Bedlam 1946: Most U.S. Mental Hospitals Are a Shame and a Disgrace.” Included were Bosch-like photographs of naked patients. The story etched the problem of mental illness into the consciousness and conscience of the nation as nothing had previously done.
The prevalence of mental illnesses and conditions in state mental hospitals stirred Congress to action, and on September 18, 1945, just one month after the surrender of the Japanese, congressional hearings opened on the proposed National Neuropsychiatric Institute Act and national mental health plan. Its purpose, as stated in the legislation, was “to provide for, foster, and aid in coordinating research relating to neuropsychiatric disorders; to provide for more effective methods of prevention, diagnosis, and treatment of such disorders; to establish the National Neuropsychiatric Institute; and for other purposes.” A national institute to support research on neuro-psychiatric diseases had originally been proposed in 1939, shortly after the National Cancer Institute had been set up by Congress; its mission was to carry out “laboratory and clinical investigations of mental and nervous diseases.” In congressional hearings on the newly proposed institute in 1945 and 1946, frequent references were made to the Manhattan Project, which had resulted in the making of the atomic bomb. Because research had made the bomb, surely a similar research effort could discover the causes of and treatments for mental illnesses.
13
The proposed National Neuropsychiatric Institute, however, was intended to do much more than just research. That was assured by Felix, who with his colleagues had largely written the bill and then persuaded Representative Percy Priest, chairman of the Labor and Public Welfare Committee, to introduce it. In addition to research on neuropsychiatric disorders, the legislation said that the proposed institute would “provide for more effective methods of prevention, diagnosis, and treatment of such disorders” and be used “for other purposes.” Such vague language was intentional; as Felix later recalled in an interview, “I wanted [the bill] written in broad language . . . and the Act is broad. There is literally nothing I can’t do.” Insofar as it had a non-research as
well as a research mission, the National Neuropsychiatric Institute would be different from the National Cancer Institute and other research institutes to be later created under the National Institute of Health.
14
Felix knew precisely what his non-research agenda was going to be under a National Neuropsychiatric Institute. In congressional testimony, he proposed using “grants-inaid to States . . . for the establishment of psychiatric out-patient clinical facilities, for demonstrations of approved community mental health programs.” Such clinics would be used “to treat individuals before they reach the point where they must avail themselves of such asylum as is provided. If it would assist to stimulate the states to provide these outpatient facilities, I think it is proper for the federal government to contribute a certain amount of money.” Thus, for the first time, the federal government would be taking on a fiscal role in the clinical care of individuals with mental illness, other than the federal narcotics hospitals and St. Elizabeths Hospital. It was a federal foot in the states’ door, and it would never be closed again.
15
Once passage of the National Neuropsychiatric Institute Act was assured, Felix and his psychiatric colleagues suggested changing the name of the new institute to more clearly reflect its intended mission. “Neuropsychiatric,” they concluded, was too medical and too narrow. According to Gerald Grob, “the psychiatric establishment, because of its prevalent psychoanalytic emphasis, leaned toward mental health rather than neurology.” Among alternative names considered were the National Mental Hygiene Institute and the National Institute of Mental Health (NIMH). The latter won out, and within NIMH mental
health
would thereafter take precedence over mental
illness
. This shift in priorities would prove to be crucial. On July 3, 1946, President Harry Truman signed the bill, and the federal government had officially gone into the business of mental health.
16
Given the magnitude of the proposed departure from almost 200 years of the existing federal–state allocation of fiscal responsibilities, it is surprising that more questions were not raised during the 1945–1946 congressional hearings. The main voices of dissent were those of Senator Robert A. Taft and Representative Clarence J. Brown, both Republicans from Ohio. Brown, who had been the Ohio state statistician, secretary of state, and lieutenant governor, strongly agreed with the need for a national research institute but was highly suspicious of federal money being used to support psychiatric services:
I agree with everything that has been said as to the necessity for research and study of this problem, but it seems to me that we must always draw the line somewhere, or build a fence to define the field of activity in which the federal government can participate and the field in which the responsibility rests with the local and state governments and with the individual citizens themselves. I believe the federal government should lead the way in research, in furnishing information and advice to the people of the states and their local subdivisions, but I don’t think the federal government should take the responsibility of administering aid to the individual all the way through.

Representative Brown also observed that local and state governments would be quick to seize upon federal funds as a means of saving their own funds:

That is . . . because a lot of our citizens are very short-sighted and don’t seem to realize that when the federal government spends the money it costs them just as much, if not a little more, as when the local government spends the money, and they have to pay for it in the end anyhow.

Brown appeared to have been the only member of Congress who correctly understood Felix’s true intentions and where his national plan was heading:

Men get strange ideas; they get hobbies and they decide the only way in the world they are going to solve all the problems of mankind is to do a certain thing and that their field is the most important.
17

THE MENTAL HEALTH LOBBY

Robert Felix’s “hobby,” the federalization of mental health services, was underway. By 1948 he was using his broad new authority to award $2.1 million ($19.0 million in 2010 dollars) to 45 states “for assistance in the development or expansion of community mental health services.” The federally funded activities included, according to Felix, “the establishment and maintenance of out-patient community mental health clinics”; paying “mental health personnel who can serve . . . in a consultant, supervisory, or service capacity to State and community health and welfare agencies, as well as to schools, courts, well-baby clinics, prenatal clinics etc.”; setting up “short courses . . . to demonstrate techniques of disseminating the latest psychiatric information to the practicing physician,” especially “the newest accepted concepts of the role the emotions play in illness”; and finally, “education and preventive activity . . . in schools, colleges and community groups such as the P.T.A. . . . [in] cooperation with State and local mental hygiene societies.” Based on Freudian and mental hygiene theories, the federal program was intended to carry the concepts of mental health to every corner of American society; this idea would dominate the psychiatric landscape for the next half-century. As Felix phrased it in 1957: “From the simple gesture of a helping hand we have gone
on to create a network of community mental health services which has been woven into the structure of our society.”
18

It should be noted that the new federal mental health program did nothing to improve state mental hospitals. That was because Congress, fearful that NIMH would try to completely usurp the authority of the states, specifically stated that “federal funds could
not
be used to train personnel or obtain equipment for state hospitals.” This exclusion was agreeable to Felix, and he may have even suggested it. As one historian noted, Felix was “from his early days as a resident . . . committed to abolishing the state mental hospital in favor of some form of community care.” He would later predict that “public mental hospitals as we know them today can disappear in 25 years . . . [because] all the various types of emotionally disturbed patients can be handled in the community.”
19
By the late 1940s, Felix had developed a coterie of like-minded colleagues who shared his vision of a mentally healthy America. This group would become a powerful lobby and would be largely responsible for the unprecedented increase in federal mental health allocations over the next two decades. It consisted of three psychiatrists who had helped Felix write the original plan to create the National Institute of Mental Health—Jack Ewalt, William Menninger, and Francis Braceland—and a crusading journalist, Mike Gorman. They all shared a belief that psychiatric illnesses could be treated in the community and that state mental hospitals were no longer necessary. They also shared a belief that mental illness could be prevented using the principles of mental hygiene. Felix, Ewalt, Menninger, and Braceland had all been, or would be, trained in psychoanalysis, and all would become presidents of the American Psychiatric Association and thus be in a national position to help implement their mental hygiene vision, using federal funds to do so.
20
Ewalt, like Felix, had come from a small town in Kansas and had also attended the University of Colorado and trained in psychiatry with Dr. Franklin Ebaugh at the Colorado Psychopathic Hospital. As Ewalt wrote in 1955: “The goal of community mental health services is to prepare people for living, to promote health. It should aid in the development of resilient character among the population, so that the vicissitudes of life can be handled.” Its activities should include the early detection of cases but also “consultation with school teachers, guidance counselors, school psychologists, physicians, health nurses, judges, the clergy, and other key persons to promote healthy attitudes in the community, and to improve areas in the community that foster discontent and tensions.” Like other members of the mental health lobby, Ewalt believed that the federal government should take financial responsibility for the care of mentally ill persons. In fact, it was said that Ewalt “desired total federal financing for the cost of services for the mentally ill.”
21
Menninger was also from Kansas and had founded, with his father and his older brother, Karl, the Menninger Clinic. As part of the Kansas connection, he was a crucial
Felix ally; their fathers had been friends, and Menninger and Felix had known each other since childhood. Menninger believed that because psychiatrists “have some knowledge of the unconscious dynamics” of human behavior, they are obligated “to participate in community affairs in order to apply our psychiatric knowledge to human problems.” Specifically, he urged his colleagues to:
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