DR. NI:CHOLAS HQBBS April 23, 1978 EAR You do it any way you like, but you have had at least three or four different involvements with NIMH,as a grantee, as a member of the Study Sections and Review Committees, on the Council and as a kind of senior advisor in a variety of ways, so start wherever you like and go ahead. NH Well, when you wrote that letter some time ago, I just had great difficulty in generalizing it all and I still do, so that I haven't had occasion to try to think about issues and generalizations and then everything I would have would be highly particular, so I am going to need some guidance from you.I was thinking about today I was hardpressed to know how I could use your time well. EAR Well, perhaps the thing to do would be to start with Project RE ED, how that developed and its relationship with NIMH and I think it is a very important story and I think that the role that NIMH played in that and of course, you went beyond NIMH in terms of the the other kind of support that you got. But early on, NH That's all together remarkable that a Government could be that responsive and would be stand in sharp contrast to what is possible today. The way that came about was intricately involved with NIMH. Actually has its clear origins in a study that was supported by NIMH, done by the Southern Regional Education Board, do you remember that? Assessing:,! the mental health training and research resources in the South and I was the Director of that project and that was a great experience because I had been going down the line of traditional blinical psychology, psychodiagnosis, individual psyc~therapy,with 2. NH(continued)_ children, mothers, and that experience. made it very clear that that's a dead end, so early on I felt we had to really change. I guess it was because I had served on that Commission and had become known to leaders in psychiatry that I was invited to be on the Joint Commission, the only way I could figure it out. As a part of that, there had been some effort to get information about mental health programs in Europe and there was a fair amount known about working in England, and Scandanavia, the -----countries where people publish in English; but almost nothing known about programs in Italy and France and about children especially, this is zero big void so talking with Jack Ewald about it, I had a sabbatical coming up, Jack said."we will pay your way to go look and see what's going on, which, you know, was amazing that they would do that and so I spent about four months, Mary and I and our son in Europe looking at programs for children - found almost nothing in Italy, but was quite amazed with the program development in France, where out of sheer necessity after the war with probably several hundred thousand homeless children handicanped t h ere,~~ney nau to or ta kotherwise e care or t h em an d t h ey. b. ui•lt institutions · · · around using available buildings, chateau. Of course, there were no people, no psychiatrist~ or psychologists, so they just carefully selected young people and gave them quick training, put them in charge of children and it is working well, very impressive, it is to this day, so that was a very new idea at a time when the only approved pattern for care 3. NH(CONTINUED) of disturbed children was the psychiatric team in a hospital only legitimate way to treat children, so it was interesting, I don't know if you know this story, but I am almost amazed that it happened so well. I came back and talking with my colleagues and other people about the French pattern and also the pattern in Scotland that was almost .a direct repetition of it. Children who had been moved to the country during the blitz, Those who could not adjust which meant the severely disturbed ones were then sent to another center in Scotland, there was a residential treatment center, staffed entirely by people they called educational psychologists, but had one or two years of graduate training. EAR This was 1956? NH Yes, 1956, so here it was re.pea.ted in Scotland, essentially the same pattern, maybe 12 or 15 fine young people, ]I!e.n and women, responsible for 40 or 50 very disturbed children with psychiatric consultant about 1 psychiatrist in Glasgow and he was helping them. So I began talking about this,so Rupert Peabody thought we really ought to try something, so it was as casual as this as I recon- struct it, Eli, you know history is memories of and what really happened I guess I don't know. I remember going to a meeting, probably it was a meeting of the Training Committee, Psychology Training Committee and going to see Joe Bobbitt at the end of the first day, Joe and I were old friends and told him about this idea, and he said we really ought to try that, it's just right and we would like to have a chance to do it and the next morning, I remember it so well, I was over at the Stone House, I am not sure whether you were present at that time, EAR No, I wasn't 4. NH(continued) The pattern was to assemble the Training Committees for four, maybe five and Bob Felix would always give a kind of I state/of the Institute presentation and fairly along in the midst of that I suddenly heard him say, "that last night I heard one of the most exciting ideas I've heard since I have been at NIMH, Nick Hobbs said to Joe Bobbitt and Joe Bobbitt told me" and Bob in those heady times said its got to be tried" and it was really fantastic, so we got a group of people together under SREB to carry the thing out, first it was to have four states, we wanted to avoid any group of people work hard enough can do something and wanted to show that it could be replicated at a distance and it didn't take special group of people. Len Duhl was extraordinarily important in this, he should get a great deal of credilt and I have always tried to give it to him, simply because he insisted that it be done. I know many people who tried_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _not the right way to go about it, John the man established ways of doing things and the staff was taking too much initiative, there were all kinds of objections to doing it that way, but it came through. We had a very thorough site visit. EAR T~is was out of special funds? NH I think it was the first power project. I may be wrong, but I think it was number 1, it opened up power projects about that time, it was certainly among the first ten and I guess among the ' largest. EAR Let me take you back to two things at the same time, if I may, you mentioned this to me a couple of times, and as you know in undoubtedly, the NIMH has some involvement evenAdevelopment s. EAR (continued) of SREB. Jerry Carter was involved ea.r ly on._ Were you involved in those early days with SREB? NH Yes, EAR I thought you were NH A good bit before that incident. EAR Are there any aspects of the NIMH involvement in SREB that come to mind, if you would want to mention, and then come back to this other thing. NH Just the encouragement that the SREB gave to the recommendation of that report, which recommended continuing council, which they have had until this day with NIMH support. EAR It has been off and on. I remember Paul Penningroff and of course, SREB in a sense-was the model, although which he wont.t accept it, but I think SREB was in a sense the model, Those regional activities also have some very important inter­ relationship with the NIMH program and what do you say about Bob that next day, is really a beautiful confirmation of the way the senior staff worked, they weren't afraid to take on something which you point out, and I have talked to Lennie Duhl, not about this one project, but other things.· NH That's an interesting contrast, people have asked us many times why didn't you take it to education, it's an educational model, up and down, left and right, but education then was just in rigor mortis practically, a state of tetemus with the integration thing, it had no money, so just barren ground, Eli. EAR Well, now you are touch~ng on a point that really I hope I can make some comment about without meaning to cast aspersions on other federal agencies, I think there was something unusual about NIMH .a.b0ut the. combination of people,. 9-,bout the way it saw .tts, mission. Every time a new challenge came along, NIMH seem to feel 6. EAR(continued) that it ought to undertake that challenge and despite potential hurdles that you point out that Lenny Duhl was so insistent that this not be undermined by some seeming difficulties that might arise whereas the Office of Education in those days and I suspect even later on, was never able to do that sort of thing. Even NIE, which has developed an effort trying to move in that direction,~ don't think has been able to accomplish Nery much. NH It seems to me terribly important to make it possible for good people to work and that was running strong at that time a great interest in mental health almost a new discovery, parallel I say played a wrong would be the Bureau of Education of the Handicapped has done equally imaginative effective things it seems to me because the handicapped began to be emphasized a little bit later. EAR Had you, I am sorry not to have made a thorough examination of all your accomplishments but had you had much involy~ment with the Veterans Administration in those days? NH A fair amount EAR Perhaps you want to take a moment or two to comment on the comparisons and differences between the VA and the NIMH because early on, if one were to say in the late 1940's and very early 1950's, I think one could almost say, the input of funds and the opportunities with a slightly different population were probably as great in the beginning as they were in the NIMH, as you well know, up until the early 1950's, there were literally more VA psychology trainees than there were in NIMH and yet here we are, and the VA, as much as it has done, I think that's terribly important, didn't take advantage, perhaps that's too 7. EAR(continued) strong a statement, didn't take advantage of some of the opportunities it might have had in naw directions. NH I was really not close enough with policy, most of my stuff was local, that is an interesting point EAR And, the other thing that happened which, and please contradict or add or modify what I am saying, the other interesting thing is that I think early on, NIMH took on a kind of special aura cache in the minds of people in the field, which was very, very positive, which was a kind of a reinforcing influence, people wanted to be involved, good people wanted to be involved with NIMH, and the more good people that wanted to be involved with NIMH, the more good NIMH was able to do. Do you have that feeling? NH Oh, yes. One of the things that was a cause of its great s,uccess, and may paradoxically be a cause of its greatest failure, 1I have been thinking of that recently as a member of one of the panels on the President's Commission, often a movement has, it seems to me, at its outset the seeds of its own ondoing, anyway its set up, and one of the things that fascinates me how that is, what we did all of us contributed to it was to define mental health almost in the terms of the quality of American life and that was great and it allowed a lot of people to do a lot of important things, but it seems to me, the result today is a disappointment and a great neglect of mentally ill people. Just think of where we have come to, we have almost passed them by and we have most State hospitals run by, heavily by, 8. NH(continued) the least competent of people, foreign doctors, relatively little research on hard-core problems of ~chizophrenic and manic depressive, proportionate . to the enormous investment in other things and then a lot of people sort of lost in the community. Psychiatry at least used to be accountable when they were in hospitals,.you can see them and now no one can quite be responsible. so· much of the effort now, it seems to me, goes into helping middle class people, I exaggerate a little bit, not too much, deal with problems that probably one could argue whether the State has any great role in helping people with problems of marital adjustment and so on. EAR That's a~.very important point and I think it has to be said in terms of what in effect might be the alternative, because you were making comments about this when you were on Council and you were very much in the minority as you know, on occasion, trying in a sense point out to the other people on the Council that there was a need to clearly define the boundaries within which the N,IMH. NH I remember that EAR Yes, I remember it on a number of occasions and the dilemma it seems to me, that this raises is, and it is a policy and political dilemma in a sense. Is there the right time or is there never the right time to say this in such a way that you accomplish ultimately the purpose that you are pointing out, namely,don't lose sight of an important population that really serves as the core definition of your operation and yet simultaneously not lose in the political and.pragmatic sense the opportunity for additional funding, extension of program, taking advantage of new opportunities and all the other things that,NIMH was famous for in a sense early on. NH Especially when you were getting political validation all the time. EAR Absolutely NH I remember Bob over and over again, Bob Felix coming to u~ and saying 9. NH(continued) the test have had all Congress last week and they said"now Dr. Felix, what budget do you support" and he said I support the administration proposal and then they would say "well now, we understand that, but suppose you· now had an opportunity to make recommendations to the administration, what would be some sort of things you would recommend. EAR Your professional judgement NH Your professional judgement, exactly, and he would say those and then they would. vote the money for it, that's validation was off the top. EAR We will be jumping around a little bit, I hope you bear with me, but I think that brings a very important point and I would like to get your comment on it. YOu have known in one way or another, certainly a11 three Directors of ltIMH, Bob in the early days, and through the time that he left, and then Stan, you came on literally at the time that Stan was really coming really to the fore and you were there when Stan resigned, so to speak, that was your last year, how did you see, let's not talk about Bert for the moment, but how did you see Bob's Directorship and leadership in those early years and how would you compare or contrast it with Stan's? Have you ever given that much thought one way or the other?, NH I really haven't, that's an interesting question and I don't have any content EAR Let me make a comment and then you can react one way or the other, my feeling is that, a pre:patory comment, I am really in an unusual way, one of the people who has worked very closely and very positively with all three of the Directors and I feel very close to all three of them, but I really have a feeling that Stan could never have done the job that Bob did, and frankly, vice versa, that Bob's corny, absolutely magnificent inter­ action with people and his ability to be enthusiastic and to make people 10. EAR(.continued) enthusiastic, his willingness to jump in, his master­ ful relationship with the political strength on the hill and the, everyone has told me that I have spoken to, way he allowed staff really to use their own initiative and then support them very strongly for whatever directions they wanted to go. People like Joe Bobbitt and Lenny Duhl are unique individuals and each in their respective ways played a tremendously important role in the growth and develop ent of NIMH. Now, Stan is a totally different individual, he doe n't have that kind of outgoing, warm relation- is ship with people, lthough in some respects he~brighter than Bob was, if that's aningful dimension to discuss and organization- ally, was much mor willing and able to handle a complex, growing organization-in a ormal sense, than Bob was, so that in a peculiar way, they were both exactly right for the times that they were involved. No, behind those very superficial comments, there's ' a tremendous amoun of other issues which developed including some difficulties withi the NIMH that Stan, in a sense, inherited, because he wasn't ob Felix. Those .things never came into your thoughts. NH Well, yes, but I r ally never thought about it much. I don't think I have anything to offer there but it sort of rings true. EAR How about Joe Bobbitt. I should tell you that one of the serious disappointments of trying to do this book is that I didn't get to Joe in time. In fact, to kind of comment about Joe Bobbitt and perhaps since you had known him early on and the sorts of things, are there any incidents that come to mind that you think would be helpful in putting him in the right perspective? NH Well, I think the one I gave about RIAD is so terrible that it could rest on that, that's quite remarkable, that he picked this up and 11. NH(continued) and saw Bob Felix within a twelve hour period and some­ how got Bob's officially engaged that he was convinced that it should be done. That's a very good example, and I have intimations of a number of others, I don't recall any others specifically, It started in mental retardation, it didn't originate with him, but he was very encouraging ----Peabody. I could be wrong about this, I would love to know what the facts are, but my impression is that the Mental Retardation Training Program at Peabody was the first, or one of the first beyond the four disciplines. EAR I will pursue that NH And that the RIAD Program was the first demonstration, it certainly was among the very first and Joe was very encouraging in all those. He was a kind of steady, affirmative presence. EAR Let me go back to the Joint Commission because I think that in many ways, there are aspects of the Joint Commission, and I haven't had a chance yet to talk with Jack Ewald but I will, and it seems to me that the Joint Commission both in being the first major government funding of any consequence, about$4,000,000? NH It seems right to me. EAR And a five-year study for the government to sponsor a five-year study with that kind of funding and all the complicated aspects of it. What comes to mind in terms of the Joint Commission that you think is useful in pursuing, both its relationship to NIMH and its very important involvement in the further growth and development of the whole mental health field? NH Well, I am not sure this is a kind of response you would want, but let me make it because it is something I have given thought to in the last couple of years a good bit. You see I served on the Joint Commission on mental illness and health, the Joint Commission on . The PresJdent ts; - menta1 health of children, ..... /\ . panel on mental retardation, actually 12. NH(continued) the Academy of Science Advisory Committee on Children Presidents and second echelon position in thel\Commission on Mental Health and all these experiences led me to believe that you shouldn't do it that way. You are exactly right about the influence of the $4,000,000 in five years of study. My perception of that is that you can't find a recommendation for the comprehensive community health center in the book and that afterwards, a relatively small group of people got together and said what are we going to do, and came up with that idea, a very good idea. The Joint Commission on Mental Health of Children was even more impotent, it seems to me. The President's Panel was the only one of those that was successful and I think that, that was largely due to the involvement of Mrs. Schriver and Mr. Schriver and the direct access to Mr. Kennedy and the effectiveness of George Tarjan and the Director of it and two or three other Tab McGoon and maybe a dozen members of that Commission privately and it resulted in the establishment of the National Inst.iuute of Child Health and - - - - - -The President's Panel has continued to this day, stepped up training programs, the beginning recommendations for the National Institute of Education, I am leaving out a few things, but it was really very powerful, but actually the Academy thing was a complete bust and the current President's Commission, I don't know how that is going to turn out, but it was done in such a hurry that I have just grave reservations about the contribution that my group and I made to it, there was none of which I am proud, there is no way it could be, helter skelter, haram, scaram, it is just incredible an area really that we have in the human services broadly define no sustained way of addressing policy issues and that's why we are trying to start our - - - - - -study of famishing children public policy. In 13. NH(continued) no way you can build up the wisdom requiring to address policy concerns. EAR This is a~ area that I am very interested in, too, Nick, the whole business of how one effectively develops public policy and I think, and I want you i: please, to comment on this. I think one of the problems is that these efforts begin with a very serious fundamental error, and that is that somewhere there is a basic truth and/or direction that can be described, which will set things in motion really by having come to that kind of understanding. When, in fact, what is necessary, is some kind of continuing effort in which you grow on past experience, not on what you say someone develops as a blueprint for all times there is no such thing. NH Constant adjustment, _ _ _ _ _kind of feedback, I agree with you. EAR Absolutely· and I think that what you need is what I have been calling in the area that I am now involved in, some kind of continuing instrumentality, so that by the sequence of its own series of experiences, one approximates directions and you can't predict beforehand, nor can you lay out the complete direction, which is what each one of these efforts have tried to do, there very simplistic, often much too short a period of time and under other kinds of serious constraints, the sheer visibility and the involvement are highly visible people who do it on a part time basis, almost dooms it to defeat from the very beginning on that basis alone. NH If you make it up with representations of organizations, you really have an enormous political conflict, leads to least common denominator conclusions. EAR Right, and yet, the political realities are. such that everytime a new group comes in, they almost find themselves doing this because the visibility, the presumption that this is really going to accomplish something, and even if it doesn't they can always say, well, we tried, we tried as hard as we could, we brought in the best people we could find, we gave it a very high priority. Now, on the President's Commission, I understood they would do the report 14. EAR(continued) out on the 20th of A~ril, I thought that Mrs •. Carter was going to make a formal presentation on· the 20th of ApriL, Was· that your under..-. standing., NH. We have an invi.tation that came yesterday, I think it is the 28th of'. April EAR I am sure there wa.s; great fan f:are that the whole report wi:11 be accepted, and then the question becoming, where doeg one go from there., and to be fair, ::it may accomplish s-omething, you· know, if there are additional funds for research, that •:s fine.•, I:£' it gives a new priority in terms of the 0MB, etc., but in terms: o:f substantive is-sues, inferms of really s·etting a course and/ or a direction, I thinR I agree with you, that '~s not the way to do it. And, yet to go ha.ck to the J'oint Commissin, the firs.t Joint Commission, it is a. par·adox because it is literally true that while no one of those recom- mendations· fOr mental health can now be viewed as having been --- implemented, it did, it certainly did, serye as a precm;sor to the Community Mental Health legislation,so it is a funny kind of·business and a number of people think this is inconsequential, a number of people were involved in that in a real s·ense became increas-ingly visible, perhaps not because of having been inv·olved in that, partly so •. NH If you can use those things. for consciousness raising, for getting people to talk with each other; it costs less money, you can _.just say we don't do that, we could probab.ly do it in different ways., EAR Well, you see, you are talking from the wisdom of an elder statesman, and people coming along now· dont:t feel that way, they just won't buy it. NH. The Commission has some political capability that Study Centers don't, it would seem to me very important to have available for Commissions solid back­ grounds ·of policy work at the time they come together, so you·.. have in the President'- s Commission a group of people meet there on a weekend and coming up with th.e paperH, it is ridiculous, they should have the important issues they need the information, that information should have been worked upon by a group of competent people for two or three years, ·we can afford that, much less costly. EAR And, of course, the other ser.i.ous error i.s not only in bringing to~ether all these highly v;i.sible and highly competent consultants and members of these various panels, which I think·is good, there •is a body of wisdom in this group that is terribly important but working this way is very difficult and then I thirik compounding the error bringing together an ad hoc group of people working in the program on a Staff basis and you know, Betty Hamburgh is a remarkably_ competent person and I know there are a number of other people and I know there are a number of other people there too, but it is an ad hoc operation from start to finish, it is extraordinary. NH It is impossible to get together a highly competent ·smoothly working staff I have not seen one yet that have that. They dissipate all that-effort wisdom, you dissipate it at the end of the project, so it is not the way to do it, I .think, Eli. EAR I agree with yotJ, but I think in your. operation here now and other efforts concerned with this is belaboring the obvious, it is not enough to S?Y this isn't the way to do it, you have to start to provide in the cli.ch.e of the day, viable alternatives to demonstrate how· it really snould be done and I think that is the way to do it, which is the way to do it, which will take time. Let me go back to your participation on the various committees, you were on the Psychology Training Committee at a time when, as you described it, all the Training Committees got together as a group at Stone House, subsequent to that time, as you undoubtedly know, the Committees functioned somewhat more independently, they didn't have joint meetings in the beginning. Well, when I came in in 1958, it was about the last year there were really "joint meetings and from then on they all functioned somewhat independently so that when you were on Council, for example, 67-71, the various committees did not meet in any group sessions whatsoever, they all functioned independently. So, I want to go back, in your recollection of your participation on that Committee, were therg: any things that come to mind that you feel are important examples of the strengths and/or weaknesses 16. EAR(continued)_ of tha.t Committe operati.on1 NH I don't recall anything especially, I just remember it as a very high level group with a remarkably competent staff, this was always a pleasure to work with EAR And Norm Gommers NH Well, now who before him EAR Max Levin NH He was very good, very thoughtful about the future of psychology, quite imaginative. I wish I could think of something, it was just a good, I have always felt, like solid wood and I don't think of any dramatic examples or difficulty. EAR Any thoughts about those joint meetings other than the lovely incident such as the one you just described. NH WELL, one of the kinds of things that was very evident during this long period was the dominance of psychiatry at the outset and the gradual re--alignment over the years it seems to me, so that some of the early days were incidents involving the unquestioned assumption of psychiatric leader­ ship and priority, to me that existed, to this day, pervasive at that time. EAR Yes, it was and I don '.t know whether this ever came up in the discussions in your meetings but early on I really have to pin this down, I haven't found anyone who knows exactly how it began, but I will find it. There was a so-called 40-20-20-20 distribution of moneys in the Training Program NH I remember that. EAR With 40% going to psychiatry and 20% to each of the other three of the so-called four mental health disciplines. Now by the time I came in 58, that had been somewhat modified for a variety of reasons, so that in fact, psychiatry all told was getting.more than 40% and psychology was coming close to the 20% but not quite and nursing and social work were even further behind because of things like the General Practioner Program and psychiatry and some other programs in psychiatry but early on when the NIMH was first beginning to 17. EAR(continued) function in 47-48, there was laid down this informal pol~cy in the Training Program, that 40% would go to psychiatry and the other 60% divided equally·among the other three disciplines, which, of course, since psychology especially wastvery serious bone of contention as an inappropriate reflection of the respective importance of the various disciplines. But, despite that I think what is important to the Training Program and I wonder if this will prompt any other thoughts in your mind, is that the monies that did become available permitted all of the disciplines to enlarge their involvement in aspects of professional activity beyond the narrow confines of the traditional mental health approach, and as you know, Vestermark in 1957 made this talk at.the APA which he said that program support was going to go significantly beyond the area of clinical psychology and indeed, it :did. There is one other part of this though which I think is very important and you have been ·involved in this, too, and perhaps it might spark some thoughts in your mind. One of the things that NIMH did with all four disciplines in the field of training especially was to sponsor periddically these various conferences and psychology, from the Boulder Conference on, the Miami Conference every major conference in.psychology has had signficant input of funding from NIMH and that I think, and we can talk about psychology, since we both know that best, but I think that sequence of conferences, National Training Conferences, was very important. You were at the Boulder Conference and the Miami Conference and those were the first two major ones and both of those were sponsored by NIMH and to some extent NIMH involvement, although the major input of ideas and work was on the part of the academic people. What are your thoughts about the Boulder Conference and the Miami Conference? NH Let me make a parenthetical thought about your earlier. comment. I rememberr: one particular meeting of the Training Committee with a decision that was made by the NIMH administration to take somebody off the top, remember that? And Vestermark was identified with, Lwas always very fond of him, and I think it had to do.with General Practionerer Program, I am not sure, but anyway 18. NH(continued) in 40-20-20-20 now the decision was made to give s.ome programs priority over those and they were almost entirely pscychiatric programs at the outset, that is the way that we perceived it, that seemed kind of doubly unfair, it is sharper because of the exchange that occurred around that incident. The Boulder Conference was just extraordinarily interesting, important and it would seemed to be the first time that clinical psychology ever thought of itself as a science and profession ________of psychologists, there were psychologists and other people there, you really couldn't anticipate it. I think influencing a great deal but they were not able to do it. It was a good experience. The reason that I, the specific thing I recall about that was that we had already started the work of the Committee that developed the state of ethical standards of psychologists, that would have been on the way for twb years, I am not sure of the time, but anyway pretty far down the road, and at this Conference there was a proposal that a Code of Ethics be developed and naturally I was quite involved and the leader of that I would have to go back a look through the roster to remember who it was, but he was one of the psychiatrists and he felt that_____always respected a great deal, we ought to have a Code of Ethics and ought to write it that weekend and that really upset me. I remember impassioned arguments about that and they persisted, I should have been wise enough to know that they wouldn't succeed and go ahead and hang themselves EAR Well, you remained in that area for quite some time, well beyond the Boulder Conference NH Right EAR Was the NIMH involved at all in that, I didn't think so. NH No, that was money from, I would say it was from Carnegie, we got it from a Foundation, ----Wolfley and I called on one of the New York Foundations. I would say Carnegie. 19. EAR And the Miami Conference, which was really an effort to review again and where things were, although by that time in 1958 the concern for less than doctoral training was very much involved and I remember people getting up, that was the first meeting that I ever attended, people getting up in the middle of the various discussions to make important and somewhat emotional statements about less than doctoral training one way or the other. Norm _ _ _ _ I remember getting up and a variety of people getting up and by that time, interesting enough, some people had become visible to bring in the other area that we were talking about. George Alby was then visible because by that time his whole work in the field of mental health manpower had become visible, so there was an inter-relationship of other aspects of the NIMH operation and the Joint Commission operation with this particular area. What other activities come to mind over and above the formal kinds of grant activities other than the ones we were talking about, conferences of one kind, special projects such as your project, anything else come to mind NH The start of the Mental Retardation Program was extremely important, that was way ahead of its time. That came about, I think, that I had a long talk with Harry Levin in some City in the west, maybe Denver, it was an APA convention I am almost sure, I remember talking about future psychology with him and it was a good discussion, wide ranging and we talked about mental retardation among a number of things that we discussed. Harry felt that it was an area of great neglect and I began to speculate about it and I remember that as a stimulus .that led me to talk with my colleagues here. By that time, it was not an unprepared soil here, because we had already brought in Lloyd Dunne, you know Lloyd? EAR Yes, I know Lloyd. NH Well, there weren't very many people in Special Education then, especially Ph.D. levels before that strong psychological training. of S_am Kirk, two or three others, but that was it and Lloyd Dunne was one of Sam Kirk's students, 20. NH{continued) young,b:r,ight, hard driving, so he was the onlr .,,....,.....,,..,,-,,_,,_that then had the beginnings of interest in the problem and so we applied for a Training grant to train.research people for the field of mental retardation of psychologists That came.through, it was a very modest grant at the outset, I would say $150,000 or $160,000 for several years, but it was then followed up, so that that program continues. It may be going to this day, I don't know, it went at least for 25 years, something like that, 21 years and that was done with real help from the Staff at NIMH. EAR Again, Lenny Duhl was involved NH Lenny's involved was very important, the mentally retarded had just been completely neglected, no one was paying any attention to them, so this was a real departure and it certainly was among the first, if not the first,breakaway from the four disciplines, brought on the concept of a training mission EAR Right, let me go back now, If I may, to the Council because you spent four years on the Council at a time when a lot of things were happening, the growth of NIMH into the whole community mental health field was developing at that time. Stan was really very much taking hold of the larger growth of NIMH, including for a short period of time, its identification as a totally separate bureau_ _ _ _operation. NH I remember now EAR Which was something we have been working towards for a long time. I think you may know but it wouldn't have been terribly important, I think in your own involvement, that there had been a very serious effort around 1959 to dismember NIMH, and to separate out the service component, the research component, and the service component was going to go downtown and the research component was .going to stay up at NIH, so that NIMH in that new guise would be more like the other NI's of H than it was and as you well know, NIMH found its inception was kind of a mutant among the other Institutes' and Jim Shannon and Bob Felix had many fights, friendly but often strong differences of opinion about NIMH as related to the other Institutes' and by the time Stan 21. EAR(continued) came in all of these efforts were really moving.in the direction of a higher visibility of NIMH and concurrently, of course, much larger budget went over the half billion, about $500 billion dollars,·I guess about the time that you were there. Do any thoughts come to mind about the Council, and the functioning of the Council and the sorts of responsibilities that you had while you were on Council? NH Well, I always felt that the Council had a hard time defining its role and I think that I feel that it never got the help from the Administration that it might have had. It is terribly hard for a group of people to come together intimately to be effective, a lot of built-in headways against them, operating efficiently. It seemed to me that the Council should have given its maximum attention to policy issues for debate, disclosure and sharp recemmendations to the Administration at NIMH about policy directions and I don't think that was ever, while I was on it, done well. I remember pressing _______ for more attention to children and.we never got engaged with that and sometimes I felt that Administration really had just as soon keep the Council busy, that's a paranoid look, not intentially, but the agenda got filled up with stuff and if the leadership of NIMH had wanted the Council to lean heavily in the direction of policy, an examination of the internal operations and the direction it was going, it could have achieved that. Yes, I don't believe that it deliberately didn't do that, a conspiratorial moment of history, you know their impressive to me. The contrast in rather sharply with the first days of the Council of the National Institute of Child Health and Human Development, I was a member of that Council in the beginning, I think, I may have come on a year.. late, but I believe I was a member of the first Council. Bob Aldrich was the Director and for, at least the first year, there was a genuine engagement of the Council with respect to th.e fundamental structure admission of this new organization. We would all debate _____, it was obviously wanted advice and wanted counsel, got that communicated and got a good response. Bob left and it changed, and it became a kind of formal. It shifted away from policy issues to all 22. NH(continued} great approval.-:_...: of. grants, it kept us busy and we never got around to the policy discussion. EAR Do you think,-Nick, that partly derived from the fact that.indeed you were on the first Council, the whole development of the Institute was- very much up for consideration in that time, whereas by the time you came on to the NIMH Council, those issues had been decided really, in a sens·e, although I don't mean to diminish the importance of the criticism that you are ID.Rking I think it is a valid one, and I think that the staff had this conflict, internal and external, -about the best ways to use the Council and as you know, while you were there, we established the first Council Secretary, Bob Stubblefield served as. a Council Secretary and·· I was the Staff Liaison to that and there was a genuine effort to involve Council, but there is another attribute that comes up that's important to discuss your comment on this from your varied experiences on both sides of this issue. I think at times those of us who were privy to, among senior staff, who were privy to what was going on within the Institute, had a feeling that as we attempted to describe to Council some of those things we were involved in, whether it was budget or policy, or what, that it was almost impossible to describe adequately all of the complicated play of horses that we were tending with, and so that the Council's comment inevitably was less well informed than the Staff comments. I think that by the same token we cared in not realizing that the Council members brought to play other outside experiences which perhaps compensated partly for our knowledge, and that even if it didn't, that these opinions, less than fully informed notwithstanding, were terribly important to put into the picture and I talked to Jolly West, who, in a delightful but thoroughly plaintive way, said to me that in the four years that he was on Council, he thinks he batted about zero, trying to get some of the recommendations, that he wanted to put forth really implemented by Staff, and that he·didn't quit trying but in retrospect he doesn't feel that he, accomplished a great deal. Now, I think he is not being fair to himself, 23. EAR(continued) I think he did accomplish_ a great deal, but not all that he had hoped to. Are there any particular aspects, you said that you came in with this clear emphasis on making more visible and more important to all children, are there any particular incidents or any particular aspects of this that would help to describe the sorts of frustrations that you dealt with? NH It is really hard to make a judgement about that,·becausemaybe my position is extreme that one should, I would redistrubute the resources so radically that it probably wouldn't be wise but my impression is that children have never had the priority in NIMH that it deserved, and there has lots been done,you have to say it right aways the big investment in children, but not proportionately and not to a measure of that theory which suggest or equity. Someone said that recently, justas a quip, that one of the meetings of the President, the current President, or the Committee associated with the President's Connnission, said that children had been the number one priority of NIMH for a number of years and we wish they were not, if it were not they might get some money, all the things that have low priority, get the money, while children remain the highest priority. It is not NIMH, it is the pattern of the nation as a whole ___________ connnitment to them as a corporate community public responsibility not high, so EAR Well, let me ask you an unfair question, what would you have done differently in any specific fashion, obvious-ly a different distribu­ tion of funding, but in terms of operation, is there something tha.t you felt fairly clearly should have been done that wasn '· t done in terms of either organization and/or policy? NH I can't remember any sharp issue that would.,, I remember that there were several people interested in children and my impress-ion was that that number diminished, but I: could· check on that. I had the same feeling about that may have reflected Jolly West, it didn '· t do what I wanted to do, so it is no damn good. 24. EAR You know, some input became subtly influential so that you didn't see it in a direct fashion, but I think it was there and perhaps to some extent, NICHD, itself, NH flubbed it EAR Well, flubbed it to some extent, but I was going to give them credit from the beginning that NICHD was a partial response to the need for more visibility and program operation. NH I must say it, if I construe what happened properly NICHD grew out of perceived failure of NIMH to address problems of children, I think I remember that issue being addressed directly by Bob Cook, they were just not interested_.· You see NIMH interest in mental retardation at that time was pretty close to zero EAR This isn't the time or place to recount the whole struggle at the time the Joint Commission about mental health and mental retardation which I think people take very strong,,have very strong opinions about in both directions hhat mental retardation should not have been separated out, that it certainly should have been separated out and all the attended arguments that goes with those two positions NH It is interesting that the first Joint Commission didn't address issues of children, didn't amount to anything. I was the only one who did the RIED stuff. Well, the NIMH on the ohher hand my fear about that was that it started off I think exactly in the right direction and the _ _ _ _ _ _ _of CHD is on target but it got captured by the cellular biologists. My position there was to invest more of the many of whole organisms, it didn't matter what they were but treat whole organisms whd get 25. NH(.continued} the balance of the budget, at one time I think there was something like 80% _ _ _ _on biology and 20% on other things and it ought to be at least 50/50, cellular and ------ biology EAR What is your thoµg.ht about that development as a reflection of adequate or inadequate of the early policy discussions about NICHD when you helped formulate the Institute, was that appropriately they way the policy discussion went NH Just the opposite, it's a kind of phenomena in human whereas the people do what they can do, if you got incompetence people exercise it and people know how to do that stuff in laboratories and I think that was the problem that if it had stacked the staff from White H·ouse, wherever, in the direction of people who had whole organism developmental interest they might have had a different history. EAR I wonder if you would comment, you just remind of something I didn't ask you, from your own perspective, to what extent do you think that whatever strengths NIMH had derive from the identity that Staff and people on the outside had with the field of mental health as opposed to for example, NICHD, where people from various disciplines had an interest in children and human development but did not see themselves as falling fully within that particular framework whereas a clinical psychologist, I think of myself as a ,mental health or psychiatric social worker thinks of himself or herself as a mental healther and do you think that was tangibly one of the strengths of NIMH and conversely, one of weaknesses of NICHD and the other Institutes for that matter 26. NH I never thought of that, Eli, it sounds it rings true EAR Let me just tell you that f·or example., one of the arguments that you mentioned a few moments ago of the whole individual one. of the. 9-Fguments that we made. a.t the. time that the NIMH was in danger of being split between Servi.ce and Resea.rch. components and Thad the dubious privilege of writing some of the memoranda for the Training Program arguing against this split and saying- in effect that the NIMH was the only Institute in which the laboratory that we dealt with. was: the whole individual that in the Cancer Institute and the Heart Institute, the other Institutes, they didn't deal with the whole individual, they dealt with parts of the body and while they may have done so dyna.mi:.cally enough it was all research and it was easily all research., but in our case, dealing with the whole individual the reseach in the Service components were inextricably inter­ woven and you could not separate out Service components from ·'- ! Research. components and still have an effective total mental health program, I don't know whether that was bought, I think the politics involved working behind the scenes was what really did the job, but in a real sense that's a unique strength that the people in the mental health field have. Now, NICHD should have been able to borrow from, lean on, derive some of its strength from the same kind of perspective and I take it from what you are saying, that they didn't because if they ~ent cellular biological they immediately lost that strength. NH I believe that so strongly from the very earliest University experience of believing that programs that combine very fundamental research with applied research and put it to practice so it would likely be much stronger than those that 27. NH(continued) mutuality. EAR And, as you know, applied research programs at NIMH were among the earliest. NH That's right. EAR Anywhere in the NI's of H, research and the desire for evaluation and all the things that became so much more visible in the late 1960's and early 1970's. We had an Applied Research Program before anybody else did, the whole Applied Research and I think that's another one of Stan's strengths that people don't give him enough credit for. I think that he had the vision, administratively, he was sitting in his office many days putting boxes together, Administrative boxes, he would play with these things and the sorts of activities that Bob Felix just didn't have the character, I mean character in terms of psy9h019gical makeup to do because he was doing so much better a job at stimulating people to work as they saw fit and Stan took, paranoid is the wrong word, but a much more suspicious approach to people you had to keep on pushing them to make sure that they got the job done, whereas Bob would stroke people and they would just blossom out. No one that I have spoken to has failed to point out what a totally stimulating guy Bob Felix was, always bubbly, NH He had the capacity to make you feel as though you were the most important person in the whole mental health field and that what you did next was going to make ---------seemed quite genuine and it was always filled with details, he was not a fluffy substantive, really quite remarkable. EAR A very remarkable guy. Let's spend a few more minutes and then perhaps I will ask you fill in some other things that come to mind in the course of the discussion. Is there anything else 28. EAR(continued) about the Council, about, for example,one thing that you may recall is that Stan brought in these so-called liaison members to the Council which was something totally new in 1968, anything else about the Council operation that comes to mind? You did not attend that meeting with Fred Mallock, do you recall that? NH He was the efficiency expert EAR From the DHEW, downtown department, who had come to talk with us once, I guess you were at that meeting NH ± don't remember that, I was involved in something else at that time, I remember meeting with him but it was downtown EAR Yes, it was downtown, he also came out after that meeting to talk to the Council. Anything else in terms of Council meetings that stick in your mind? Any memebers of the Council, Mike·Gorman was on, Jolly West was on, Josh Wetherberg was on, John Conger was on, Quigg Newton was on, Reg Lurie, Senator Earl Morris, you may recall NH That's my home state, they were all great people EAR Paul Lemkow was on and of course, Dave Baslon was on NH There was a Mrs. Mahoney? EAR The lady that was on at the time that you were on was NH Skelly Wright was on EAR Skelly Wright was on and I guess Jerry Josephs, Mary Ann Javits was on but for just a couple of sessions. In fact, one time you were absent, she was on, you may even have missed Mary Ann Javits NH I think I did. I don't think, it was a good experience, I was real positive and I have great affection for a lot of those I do remember and maybe this is more of an - - - - -kind of thing, there were two groups that I enjoyed working with most and it so obviously subjective and subject 29. NH(continued) to distortion, but I remember the Psychology Training Committee as very effective, problem oriented, articulate and not sub-serving in any way. I also felt that way about the Board of Directors of APA, quite remarkable group, that was a really good experience and I always felt less so about NIMH Council, though I would say that compared to other groups with which I have worked over the years, it certainly was one of the better ones. EAR You mention APA and perhaps you should spend a moment or two on that because as you do know, the U and T Board was supported f©r many years by NIMH NH Isn't that fantastic .EAR So that the APA and the NIMH relationship is another interesting thing kind of NH Very important EAR Very important and I think another interesting confirmation of the point that I made about NIMH having a professional identification with a meaningful body of professionals, I mean the American Psychiatric, the American Psychological, the National Association of Social Workers and the American Nurses Association, all ·see the NIMH in a sense as their organization, so to speak. NH I never thought about it before, but you look back at the kinds of things that NIMH supported, that APA was involved in, there were things that have a generative power, they weren't just a one shot, the Boulder Conference, the Miami Conference and I think they were involved in a School Psychology., Couns:eli.!)-g Psychology Conference in Ch£cago EAR Oh., yes Nff And, th.en, Pscyh. .Abs.tracts and the Traini!)-g Committee, .those a.r·e 30. NH(.continued) all generative productive, forth.coming kinds, it is not just a contract that you might have EAR And, one other thing that I guess people might come into in todays time, partly negatively because it sounds like the old boys syndrome, there were people that went back and forth from NIMH to responsibilities. Sherm Ross, for example, who was very much involved in NIMH at one time and at the APA and there are a number of people who did that same sort of thing and within NIMH, people left NIMH took on important responsibilities at APA, one of the Executive Directors of APA had formerly been at NIMH as you well know and people from NIMH, and I am strictly talking about psychology now, went on to become Departmental Chairmen at various places, in fact, the Training Specialist at NIMH NH Well, I would comment on the quality of pscyhology staff, it was unusual, very unusual over the years sustained high quality, I can't think of a single dead public works, remarkably competent technically professionally and also, generally rise and care for people EAR Well, psychology among the four disciplines, I guess, had the clearest arrangement, arrangement is the wrong word, but what actually came to pass was that people would be Training Specialists in Psychology for a few years, having come from an academic position and/or returning to an important academic position, so that the continuity between academia and the NIMH was maintained and so you took advantage of being in the best of both possible kinds of circumstances, each borrowing, in a sense, from the experiences of the previous, and I think that was a tremendous. We talked at one time, you may not recall, but when I went to the Center, 67-68, it was the year after you were there, we talked 30. EAR(continued) about the need to stimulate good people from academia to take a position in the government, you went to the Peace Corp, for example, not as a permanent effort but certainly in the course of your professional career and that until and unless you could get really good people to take a stint in positions of responsibility in federal government, then there ought two constraints on you simultaneously, one don't criticize because you haven't done your bit and secondly, don't carry back in a sense a discussion about the limitations if you haven't done something yourself to get rid of those limitations and I remember then you were supportive of my writing a piece, so I ultimately wrote a paper which wasn't anything like what I wanted to do on the Federal Health Scientist Administrator, which was published in the American Psychologist. NH The federal relationship was just right EAR Nick, have I left anything out, I have a feeling that perhaps I've tried to touch on most of the important things and I did want to get your perspective on these, is there anything else that comes to mind NH Let me just say I have always been puzzled that the lack of section, interest in all the way up, Project RIAD on the part of the Institute, another way of saying it, why didn't I press it harder and I am willing to say that may have been, but here was a very successful experiment, one of the few major projects that continued after federal support stopped, good research results, a result of NIMH investment of $2,000,000 and it always people speak favorably of it, but never any initiative of anybody since in that contrast with the initiatives taken by Len Duhl and Joe Bobbitt and in the phases of that, I have never understood 31. NH(continued) that, but I never fretted about it too much~ EAR I don-•t know that I can explain it to you, although I think that as you said early on, that the seeds of an organization ':s distruction are often sewn in the ve¥y circumstances that helped to build it up initially. I think maybe part of the problem at NIMH was that all of us were so enamored of new things that once something was no longer new, it's as if, well, we did that one. And, I think incidentally, on that very point, the basic fallacy the in terms of this kind of issue,Abasic fallacy with the first Joint Commission was that it didn't offer something new, to do more of this, more of that, more money in the State hospitals, reduce the size of the State hospitals, do all the things that are now being done but do them bigger and better with slightly different priorities. There was nothing that captured the imagination as the Community Mental Health Center approach and its in a sense an artificial and an unfortunate attribute of a highly visible body coming out with a set of recommendations. I think it is almost a given in our society, if you are going to spend a lot of money and a lot of time and get good people, they should come out with something that nobody thought of before. NH That's a good point, a very good point. EAR Unless you have anything else, I know that you have an awfully busy morning. NH Well as usual, Eli, this is fun to do, it was a great pleasure to work with you. EAR I appreciate your taking time, especially a morning like this when you are so anxious to get off. 32. NH(continued) I think I am in a pretty good shape, I am sure by tomorrow I will find something that I failed to do, but that's life.