I Dr. Alan Miller June 21, 1976 Stony Brook, New York AM Do you wlnt to lead me at all? EAR I don't teally think so, Alan, except to say that what I would suggest is that you try tot ink of incidents or circumstances in your own involvement with NIMH that you are related to important decision.making events and/or that illuminate kind of insights into NI'MH- But I think what would be most interesting Si'ltte:ry,o !re a key person is re.ally to talk about how initially how you first got invo~ved. What was it that lead you initially to think of NIMH and the public health slrvice? AM In termslof key decisions and my observations of them they will be necessarily separate! often for long distances in periods and time •. ObViously, I wasn't a key person to the NIMH in its beginning. Because I was beginning as it was. Infact, ~ joined this endeavor before it became or was known as NIMH. And, I think some of ~he imagination and some of the literally vision that a few people had back d Bob Felix was certainly among them was the most---the one who was singly with the development was actually the person who involved me with his this---just as it was beginning or even just before it was beginning. I was al eady in the public health service, although not exnecting to stay. I in for 2 years after finishing my lflbti'.·et:"nship and I was clearly pre-disposed: er of this sort because I had been interested in public health as well as clinical medicine but actually decided that I did not want to be a psychiatrist. I actua that I was interested in psychiatry but the alternatives at least t I could perceive for psychiatrists did not interest me. And, NIMH third at least a third alternative, which had never occured to me or v ry many other people at that time~ We had a strong department of psychiatry 2. ' AM(cont) rel~tively at the medical school. Prominent people with lots of exposure. Mos~ of us who went into psychiatry from that class decided many years aft rwards ... EAR Men ion the school for the record. AM NYU Sam Wortis was the Chairman. He had some good people there. He had managed to get some time in the curriculum. Most of us .• the one thing we ¥ere very much unanimous about when we finished medical school was that we 1i 1 eren't going to be psychiatrists. The alternatives, of course, were the familiar ones. You could decide to either become a psycho-analyst and dev te onets life to what seemed to be at that time, despite its rationalization, is al very small group of people as patients and if someone was in medicine ' I' ' at ~east in part because of some sense of wanting to make a difference that didh't I - at least didn't satisfy me. The alternatives were public psychiatry I whifh in those days meant large state hospitals and we didn't really know much about large state hospitals but much of what we know about them now I I is ruch truer then. They were not attractive places for most people pro- fessionally, fortunately they were for some but they weren't to me. And I sup se there was another alternative there was the private practioner who saw many patients - true - but saw them in what seemed to oe a grotesque way. This was before the days of the new psycho-active drugs. This was the era of the new technique - the electric shock therapy which was being widely indfscrimately used by some practioners in their offices. Well, in any eve t none of this interested me and I had no intention of staying with the 1 pu'fu ic health service. The chance was that Bob Felix had recently been inted director of what was still called the Division of Mental Hygiene. ink my phenology is right. And I was running a rapid treatment center ichmond, Virginia. A small 100 bed hospital and was having a ball. I never, never had an opportunity or experience like that before or in so e ways since. When I learned that that is what I was going to do I was 3. AM (cont) quit dissapt;inted because somehow didn It want to go to Richmond, Virginia and f didn't want to be a hospital administrator. I didn't want to do any of trose things. I couldn't have been more wrong- in many ways it was a fascinating experience which I won't dwell on now and it became a very ing place. Exciting in terms of the way we were approaching the pati nt care with the way were we~e approaching •.. a lot of interesting an inno ative things were going on. We started a lot of research, a lot of trai[ing programs we were involved in a public program which, incidentally, in r trospect had a great deal of preventive probably a great deal of ntive consequence for mental disorders. At least we.were treating syphilis for the first time. Penecillin was new and we had it and we ere using it to treat early neuro-syphilis _arid'•'so·on" I think it was Bob Felix, who had a new division and very few staff and not money and lots of time and of course, a enormous amount of energy was around for people. And he was a school mate - a medical school mate of man who was in charge of the VD program and that part of the country for the public health service a fellow by the name of Bob Zobel. And Zobel said Bob you ought to come down and see that place and meet that fellow. I was notjdisinterested in psychiatry as a field. Infact, I had decided that I was goi g to take some training in psychiatry it was just a psychiatrist that I 't want to be. And so Bob Felix came down in the spring of '46 early er of 1 46 and in a way which I now was characteristic - took me over. t about 10-12 hours and we talked it was one of the most exciting single our period of conversation that I have ever had about the possibility psychiatry and public health might somehow be-influence on another in which nobody could really very well imagine, even Bob Felix. And at time he was just trying to recruit people to this small band. And he was willing to promise almost anything. And, more in the spirit of being une sy about this than driving a hard bargain I kept saying- telling him 4. AM(cont) some of the things that I wanted to do if I were going to go into this field. Andie kept saying OK you can have it, all right you can have it. He did have as you know, or you probably know, the nik-name already in the public heal h service in those days as "promising Bob". And it is not that he didn't of course, he sometimes didn•t rem.ember his promises. But e end of that day he at least had given me something brand new to think and I have always been a sucker for something that is uterly brand new a dimension that had never occurred to me before. And, we tentatively I would, after I had finished that assignment that I would have a in internal medicine because some how I had the feeling that you a real doctor and that was part of being a real doctor no matter did and that I would also get training in psychiatry and I would get in public health and then I would have a series of experiences in and a variety of new experimental programs and that all and all I count on a seven year - seven fat years in which I would really be giv a chance to develop myself even as the Institute was beginning to develop. And and I stayed behind and my life was literally changed. I mig t add that I spend much of the next several years debating with myself arg forth about what this allmeant. And I say with myself adv sably because there was almost noone elae you could tal:k with about this are • Th.at which has become cliche now was really startling then - comm.unity men al health - what the hell-- that was such an extrodinary position and whe someone - when Ernest Gruenberg somehow had found his own way into some liar areas, editing a book which came out as .I recall in about 1950 not to y years after called the Epidemiology of Mental Disorders. It could hav been a best seller on the title alone. That was racy it had heads spinning. Bee use epidemiology and mental disorders had never really been brought together in he same sentence. But there was a tremendous newness and everyone asked my oncerned colleagues and family and wondered what the hell I was getting 5. AM(cont) int. Well what do you mean public health in psychiatry, how are you going to frevent anything and how are you going to change anything. The trouble the people and I were having in applying the familiar models in terms of what people thought of to a human condition as varied and as broad as that include under the behaviors of the mental disorders just was lit rally a unknown area. Getting back to myself and the state of the Insl itute at that time, I didn't hear anything for several months although I w[ent ahead on that basis and made some decisions. I had gone into the reg lar corp - the public health service which I had not decided to do 'before th And as the time approached when I thought I should be heating something I eard nothing I decided to look into it. Being in Richmonci which wasn't too fa from Washington and going up there periodically as we did for various I hunted down the small offices of the NIMH, I think it was 12 by And found that Bob Felix was away as he usually was in those days or often was traveling the country but the man who was there holding the fort wa Dale Cameron who had never heard of me but was happy to meet me and aware of his bases habit of saying things which he meant but then forgetting some­ ho11 to make a note of it or doing something about it was perfectly willing to believe my story, never doubted it, checked it with Bob and I think he reached I hici as I recall by telephone and told him that I was in his office and then haiing gotten the OK proceeded within the next hour to make all the arrangements wh ch was essentially laid out in detail and in practice what Bob had promised. An that ••• I think they were a good working team at that point. Ironically, as you probably will get much more about the history of that relationship • th n I know. I saw it from a peculiar vantage point latter on. Because Dae Cameron by chance became a class mate of mine at the school of public he 1th and Hopkins. So we saw a good deal of one another and through out that ye r we would commute back to Bethesda where his family still lived and I 6. AM (cont) know personally that as late as a week before: he was to return to duty he expe ted to return to duty and the position that he had left that had been left vacant during his absence and did not really know until he got back tow rk that he had somehow been extruded. And that I suppose is another star and I don't know all the things that lied behind that. i do know one that Pale Cameron in all the years I knew him afterwards never once any public complaint about that. Whatever his feelings and I think he was eeply hurt, he spent about the next 2 years really floundering looking for ome place until he eventually went out to Minnesota where he became a commissioner for about 6 or 7 years before he came back to St. Elizabeths. But e never complained he was and saw himself as a good soldier arid that was the ay it was and he wasn't going to let anyone else know how he felt about I think probably the next point at which my career really intersected wit what you could call the history of the Institute was not unitl 1950 by whi time I had had a residency in medicine for a year in New Orleans. I had had 2 years of residency in Fort Worth and I didn lt think any of this is ter ibly germarl.e-"to the history of the Institute and was at Hopkins getting my sters in public health with Paul Eemkau although as it turned out I get ing my Masters in public health and also spending some time with Paul Lem au because it was the oldest department of mental health and mental hyg ene in the school of public health in the country at that time, I think. But it was still as we saw it really not accepted into the fabric of the sch ol and it was almost a sub-division, quite a separate entity. And, rel tively enough within the school itself probably unimportant at least as ar as we students were concerned. I had met during my fwu years at Fort Wor ha women who ~as at that time highly respected as a clinical psychiatrist­ chi d psychiatrist, close friend of Bob Felix's - Maybel Ross. She had come do and spent several days with us residents telling us abput child psychiatry. 7. .AM(cont) And I' - she must have somehow identified me as someone that she thought ought some - that she wanted to have some further contact with or thought the te ought somehow whould put in a useful place and while I was at Hopkins that year. Again I cannot remember exactly how it came about she contacted me asked me if I was interested in considering going to work with her after­ place that was then called the Prince George's County mental health and then in College Park I noticed th~t you have some reference to that outline., As you know the Prince George's Clinic was to have been i of 4 be established in various places in the country. Two of them were actua ly established. And only 1 survived, the other was at Phoenix. The concept itself was so different in so many ways - in ways that now seem common place to almost anything that was then in existence around the country. That the agination in having thought about what it might mean,' and to get it under way again you have to go back to Bob Felix, it was really quite It - Prince Ge9rgets County Mental Health Clinic first of all what There had been child,guidance clinics I suppose or another $ince the ones started out in Denver by Judge - what's e? in connection with the juvenile court back in ••• EAR .AM The name slips me for the moment. One of the early court related child clinics. And of course, there was the Judge Baker and I don't know when started and the IJR and the Commonwealth Fund Clinics starting in 1 20 1 s and NY State actually had about 30 traveling child guidance - sp called. they - s(I the idea of having clinical services available lived was by no means an original idea, they weren't common e idea,,was not original., The fact that it was called the Prince George's Clinic in the first place with an idea behind it, noone is quite sure what he idea meant was almo~t unpresidented as far as I know. It was identifing itsel with a particular population and in that sense it threw back to the 8. AM(cont) cone pts that had been formed even in their poverish days the state hospitals. It r lated to a particular populatinn. And this clinic somehow was to be the coun y's clinic and be like the other county agencies. No one was quite sure what it was to do but it was to, in a way, it was it catchment area. And it was to h ve citizens advising it, Again, that was not a brand new idea but bringing it t gether and somehow it was to demonstrate·that by paying attention to the huma development issues, working with the schools, working with other services agen ies as well as seeing individual patients all of this was somehow to make a di ference. And it was going to try to do some research about it. I don't __.... ,. thin it would be at all fair to attribute to i t more than that.as far as what subs quently became the ideas of a community mental health center because in fact one of the most ---one of the things that it did not do --- and I remember how hocked it was to people when we considered doing was to establish a real sens of a flow and continuity with the hospital services, with state hospitals and can remember the debates even within the staff there when we thought we make an effort as we did and started to make contact with Spring Grove I think was a state hospital in Maryland that served the same population. the patients to be discharged and seen at the center. The idea that they would be sitting in the same waiting room with ordinary people was so upse ting that finally it wasn't done. It was done much more unobtrusively. Anyh w, that was the place that I found was a very modest small program - Mayb 1 Ross was the director and there were -- the idea which of course was traditional in child guidance cliriics was having the team - there ~as a psychologist, Charlie Alderman and a chief social worker, Herb Rooney and was something new had been added and I think partly because there was a link with public health and that was a nurse - a public health nurse - a mental health nurse. Th.at was a new breed that has just been named and identified. But hen I got there •••• EAR What was her name? AM Adele Henderson then. She was very interesting, bright women. She was the widow of a public health service officer who had died studying a disease actually. She was the one as I went there I think there were 2 pea le on the staff an each one was contributing something - a strand of what ltimately became,:.:almost principle in the evolving institute. Although it is much too much to attribute to see these as t!d:b'utaries. They were - it is possible because I should say parenthetically that when I the study center it wasntt called the study center then, we use to goo r to staff meetings of the NIMH and there were at that time - well the whole Institute could sit around one not very large table. So it is possible that ideas as they were exchanged during that relatively small group may have ins e form influenced what came later. Adele Henderson was the one who was the get involved with groups or with seeing very, very sick patients in a out-patient setting and in their home who was doing a lot of - she was the ne who started a motherts group and a baby clinic. Because she saw that this was a possibility at a time when someone was really paying attention of a tering the way the kind of parents they were. And again, these all sound so v ry trite as ideas now but they were outlandish at the time. Charlie Alde an, his major insistence and it made him very unpopular there was that this place should be really much more rigirous. That there should be possible for esearch carefuly research done in a place like this. Herb Rooney liis p~rs stent theme and again a note which is now actually has become part of the b\ute uctatic 'l:tferirl1y'buieiuc~atict'equiremeJ;ttS these days of conducing business had o fight and he did continually that given the chance citizens know what they need. And worked constantly at the developing of this community advi ory board. And I think that has been his pre-occupation through out his carer - citizenswork, volunteers and so·on. What else? Mean while as far as I wa concerned-there was a matter of trying to step up as fast as I could. 10. EAR I wan to put in you said Maybel was in charge? When did you come and literally take ver the Directorship? .AM OK. I came not expecting to become the Director. And I discovered shortly after I got there that Mayble was going to be leaving. I can't remember now what he left to do. I think••• yes, I think I had been there a year and she left o go to the school of public health at Harvard. And another psychiatrist d been working with her, Bob Faucet became the director and I think the 1 expectation was that the he would continue to be the director for a Anyhow, one of the things that I wanted to mention was that the clinic was rt of the community services branch. The only •• the other activity of the comm ity services branch--and again, r think this showed some real administrative im.ag· ation. 'fhe other major activity of the branch was the operation of the regi nal offices who principle function then was to administer the grants and aid rograms to the states. And, of course, you know about all of that. And, but that these consultants were working with the states and of course, of the states didn't have any community mental,health programs and hat wouldn 1 t have had one in most cases if there hadn't been a grant which real y was again for many as they began a fairly empty phrase. But this-­ ther was some federal money to start something and it all it really meant was hat the stat.e should be involved in something in addition to the state hosp tals. This was the alternative. The way it was set up-· jumping ahead a bi at least in my opinion - and I don't think it was by design that is crea ing some kind of constructive tingent - the fact that the Institue at that time had a very strongly anti-hospital bias or at least an un-hospital bias. It n ver came to mind and that the regional office by and large were working with people who were concerned with community programs which were seen as the eplacement for the answer to alternatively - another pan on the scale whic as they grew would necessarily lead to the otherr one shrinking :and ,,rs,o •.on. 11. AM (cont) And a kirid. of a presumption of ••. when successful they would render obsolete allot the things that are perceivable. To some extent I think that kind of separation was even enhanced by the fact that the principle field laboratory I I that ~he regional offices directly had that they might have some influence ' ' over ko us was a community program which really had very little to do as I ! said with the hospital population- many of the severely disabled mentally ' ill p~ople of that area. Well, Bob Faucet surprised everyone by taking a I I posit~on back at the Mayo Clinic in psychiatry were he had gotten his training I I befor~ that and as you know, by the way, you know subsequently what happened. I i But there they were unexpectedly with a vacancy in the Director's position I I I and there I was. i EAR This k.s early 1 51? I AM '52 I; think. Yeah, 1 52. And I don't know how much choice they had as to who mighti have become director. Obviously, it was earlier than I might have I ! expec~ed to be or thought perhaps ready for earlier than they of me because ! that ~s a position. Remember Jim Loury was head of the branch then and he asked! me to write some of my ideas about what I thought the place could be and should become. And I can't remember exactly what I said. I did spend a I lot of time thinking about it, I had done a lot of thinking about it during I I the time I was there. And I had one .• I had the sense that we had not only I I I staye~ at the same size because that was the appropriate size for us to be i but atlso because there were .• there was something kind of stunting our develop- ment. There did not seem to be a natural course for our growth at that point. And I think that one of the reasons that kept st~nding in the way of some kind ther development there was there was something fundamentally dishonest the way we were presenting ourselves, It wasnit intended to be such. really didn't matter as much back in 1 46~'47-'48 or whenever the actually began that we were called the Prince George's County Mental 12. AM(cont) Health Clinic because there wasn't a chance in the world that Prince George1's County was ever going to have a Prinqe George's County Mental Health Clinic. But it s very presence there, for se:veral' years~ had' iJ).fluenced even Prince Georges county and many other places to begin to think that this was an approp iate area of responsibility for a county itself. This was in the same era wh ch produced such things within 2 years afterwards and perhaps influenced by it s the New York State Community Mental Health Act which was ••• not the first one of the first. Connecticut said it was the first but they were all happening around the same time. A state program for the support of county mental health sand of course, Calffornia which followed very shortly and suddenly: it seemed to me that we had suddenly ••were:~standing in of Price George~s County own development. But that we had a very 1 role that we could play. Having had several years behind us and established what I think is a rare, especially if your going to see your having •• as being to scrutinize to observe and use this site for g and research. The kind of trust that that requires and the kind of presence which makes it possible for people to continue pretty much ing what they+,if~lllii:;ci/.lllg, even though you are there. That kind of a possib.lity seemed to be uniquely present in Prince George's. Plus the fact it really was a identified with the well being of the county could most benignly help that county and itself and the Institute and play a role throughout the country. If it moved just to the side of the Center­ freed the center really of the political action or governmental action to vacate then me if nothing else to work with the county in developing its successor. And ten staying in that location and using that one as a much more rigorous and 1 vely center for training research in the areas of service not the first time ut ••by no means not an unimportant occasion in which the NIMH kept to bring together concerns for service even if it wasnlt dissolved and resea ch and training as having been continuely in interplay. And this was 13 .• AM(cont) one fits first experiences at it. It also freed the now new being mental health studies center to grow in rather different ways. And s you know these for quite a· 1ong period of time genuinely:.- flourished. 't know what its present state is. My own history of it, of course, at point my first contact with Stan began about 6 months or so after­ - a year afterwards. I don't now remember exactly how Stan became of us or how I became aware of Stan. It may have been when I went down to Lexington where he was a resident to give a seminar. I did that once. It may have been something he heard from Mayble or Bob Felix or· ody, I don:t remember. I do know that when I met him n~ seemed to me a ideal person to join the staff and to be one of the key people aro d whi:eh\wahld grow, You know his background so I won't but next, I am not sure how • ~ .what year he arrived. You probably kno better than I ... t53 maybe? EAR Yes, early '53. AM Ear '53 and for the next ••• through June •57 him and I worked very closely tog ther and some others joined the staff quite a few people passed t:hTough think had considerable influence on a number of developments many of whi I am sure I will forget. But Jim Osberg came in and joined the staff. of course, he stayed on at the Institute in a variety of acpacities. there. Others •• Itm trying to think ••• of people passed through on relatively brief bccassions. Perhaps one of significant in terms of what it stood for and how in the number of touched was that we were given an assignment of educating a g statistician by the name of Anita Bond,,about what an out-patient ic was all about. And we spent about ---and she learned basically the kind of rec~~d keeping system that we had evolved there and on it was based a nationwide system for collecting for the first time information ! _J 14. AM about what was going on in this country in other than hospital psychiatry. The f ct that we had worked on such .. at the study center itself reflected our n ed to observe ourselves as carefully and as broadly as possible and we sprnd a lot of time in that kind of development in basic methodology. I canlt say we finished as much basic epidemiology research as we should of or wa ted to. We did start some rather interesting projects, some of which, I thirk, were influential even though inco~lete like the epidemiologic re.adirg disability study and some of the others. There was some other clinic practice changes which seemed so revolutionary then and I really think were shapirg and they had to do with ---I really thing they were expressions of the fact that a center like the Institute and I think this is one of the things that tou mean when you say public health decided that a health oriented groups 1 of pr £essions had to do more than be passively the receivers of the problems. I They ad to take initiative, they had to look at populations and try to make iorities, There was an awareness that there was no such things as a ere was no action without a choice - decision to do -.,..not only to do something but not to do many other things. The basic clinical mode which psyc~iatry and other clinical professions even today, I think, tend to be guidjd is that they will do as well as they can for anyone who finds his ways to them. Without really stopping to think about is there any responsibility them. They recognize it as a ethical dimension and every clinical decision to s e somebody. Because it meant they were not going to see somebody else. And ~ was that kind of a feeling which lead us to challenge -relatively minor and et had been orthodox point in the practices of mental health clinics. Psyc iatry, of course, then far more than now although the problems obviously aren t behind us were so insecure about how it was regarded by the public and this got translated into the notion that --- well, I think many of the techniques 15. AM(cont) that were being used for psychotherapy - the techniques seemed in those days was said to depend on the motivation of the person. Which meant if ne wanted you and wanted to get well and came to you voluntarily it was nly then that you could do anything for them - whatever that meant. ation became a very important thing to measure and to respond to and to hide behind. And in fact, lots of clinics use to measure their success, acceptance by the ft'action of their patients who choose them. So that clinic could say everyone who comes to us comes of his own free will and has hosen us and is beseeching us that means we rare doing an excellent job bee se obviously people know and are not ashamed to come here - they trust us. And there were some positive things about it. But they didn't look beyond that person. And the result was of course, there were several results. One was tha, of course, they were very quickly accepted much more than people thought the would be and the classic problem of the clinics in those days was the wai list. Which in those days use to run two years or more. And everyone tho that was a good thing. In a way it wasn't good that you couldn't see peo le but it was good that there were so many people.,. it was a demonstration of nee ;' and desire. And that was the way it was at Price George ts. Which was Here you are trying to serve a county working •• somehow use your limited res urces so it makes the most sense in whatever •• in terms of what that county nee s as well as to recognize the desires of people who wanted to come. And lik most clinics found that when people did get to them as often as not it was either now too late or unnecessary or never was appropriate in the first pla e and so this outlandish idea came t~ us that we would turn us insmde out and we said we wouldn!'t take anybody who has referred himself. Which was in par a device trying to involve the other agencies in the community. Now thee had to be some ways .of doing this so that people weren•t going to be cau ht in some kind of a game between practioners. So there was an excessability. 16. AM(cont) People,, could call and the center stood by and would help them find someone who cold help them get in. And at! sometimes it probably was busy were it meant that they just went down the street to the doctors and sais yes you go there and I will call. But in any case they had made contact with a physician or th public school teacher or somebody. Now, whether this was a write or a wrong certainly has presented-I'm sure it had its flaws but it was the thinking behin it that I think was characteristic of the sort of thinking that was going on at the Institute, as well. EAR Were here tangible circumstances that occurred which reversed this kind of philo ophy? Was there a point at whcih you recall that you and the people at thes udy center said hey, wait a minute what's going on, lets really take a good ook at the criteria that we used before and see whether it indeed is causi g problems. Was there a specific point at which this switck'ip. thinking occur ed or did it just kind,- of grew? AM I can't remember a specific event. EAR OK. AM grew on me fairly quickly after a got there. It bothered me that there were o many unknown people waiting to be seen. It bothered me that we were real not working with other agencies in a real collaborative way. Even though that is what we wanted to do. The first real process was a matter of convincing the Herb Rooney was the first very much to see it in the same way. Char ie Alman was basically the critic on our hearth and so he was bound to be symp thetic with anything that criticized the present way of doing things. But thers on the staff as Abe found this very much harder because it viol tec;l --it still does. It violates a very deep trained impulse on the part of c inicians that you --when someone asks for help you help. But help means some hing direct and the fact that saying yes I will see you was a~ the same time saying to lots of other no I wontt see you ••• I don't know I really can't 17. Whll-t: AM (cont) tel.l you ~ it was that permitted this sort of thinking and that atmosphere i to Igo on. But I don I t think it was just chance that it happened in that ki~d of place or was it the interactions that were going on with the NIMH stjjff which wasn't physically that far away. I don't know! We did of co}se do this in an experimenta.l way. But soon afterwards became not quite as regidly as we had did originally basically changed the way most clinics tho gh of themselves and the ••. I think it was more than likely that some of the sort of thinking that took place within the mental health field tha in other areas of health partly because something which nearly antedates the Institute and helped to shape the fact that it was the first of its kind and remains in many ways still the first-.,.the only one of its ki That there was a long standing tradition of public responsibility mental disorders in this country which meant a habit of thinking about ho do you deal with limited resources and huge problems. And that it was part of the atmosphere in which we all worked all the time. And that re lly isn 1·t very precise about how this particular decision was made and mayl e I attached more importance to it, I am sure I do in retrospect. But I used it really as an illustration of a kind of thinking that was going on 1 thefe. Well, as you know it did grow and removed into larger quarters and in turh they moved after I left to even larger quarters. And when I left to go to England Stan became the director. And it continued to grow in terms of It grew to perhaps the mid-'60's. I don•t know, finally 9ccupying ilding. of its own and so on and so forth. But •• and I really can't evaluate course and influence afterwards. In terms of numbers of people who came thr ugh and spent some time and were influenced by the kinds of issues, ussions, agrumentations that we would have with each other •••• AM(cont-siqe) was at that time the Institutes only outlet. The Phoenix Center 2 as ou know for reasons I don.•t fully understand never really flourished. It 18. I AM(cont) had a lseries of problems. And finally the last director was Bob Hewett. And I thi1k he was the director when the decision was made to close it. And I know that it that time felt very bitterly about that. It never really followed the same generally pattern that Price George's • I EAR Well fet me go back a moment though. What were the internal mechanisms that provi1ed you with the kind of staff feedback. Outriously, there were interactions I among,/itthe,,various staff persons. Did you have weekly staff meetings? Was it primatily your interaction with the community services branch and the reporting of thf program development in that context that provided the feedback. What .•. AM EAR ::~ :t:d::::b::kt:: :::d:::ter about its operation, What kind of self- refleftive mechanisms in a formal sense did you use1 AM Within the study center? I EAR Withi[ the study center. 1 AM Well, that goes back. It wasn I t very large when I left. So, you didn I t really •. I thi k when I left •.. EAR It wa~ automatic. AM Yes, ruch of it was much easier. EAR Yes. ! I AM I thilhk when I left.,it had grown to a professional staff of maybe 12 or 15. By tat time I think we had brought in a number of different disciplines from soci and so on but it was still small. And so one ran into one another. Ther was thought given at that time. It ranged from the usual forms which were to h ve meetings which were devoted not only to our clinical concerns but also what ver projects were going on. We tried to make it physically possible. This is something, by the way, that I learned from Stan,among others that you need anat my as well as the physiology and he was always very conscious about design. And hen we moved out of our really the really make shift quarters in which the 19. AM(cont) study center has existed for its first 5 years. And had a chance to des.ign some pace of our own. I doubt whether it would have occurred to me that we re lly have it in the beginning wired for sound so that we could record from ny room so we could communicate easily so that we had a good conference room, space with •• so that they could be observed and could be taped and probably the b st at the time the best tape recording equipment anyone in Price George's Count ever saw••• that sort of thing. And I say this kind of frivously there wast ought even in the design of the space that there be .a possible easy flow of pe ple and places people could meet and its few mechanical impediments and so on So it was thought about. I cantt recall anything particularly original about the way we went about it. EAR rentt self-conscious about your being the first and only and therefore- just tell you the direction in which I am going. Bob said to me that very arly on he had thought about the fact that the NIMH needed to ~ook at itse in terms of the dynamic process that it was involved in the whole issue of d amic process and there had been an early but avoided effort to have an in-h use dynamic historian. Th.at wasn•t the phrase he used but infact Johnny Clau suppose to serve to take a look at the· s9ci.ol6gy_of what was goin on at the Institute. Now, Johnny Clausen said he never really did that alto gh Bob related that that was what he had in mind. Did the study center have the same kind of self-consciousness. Did you see yourself in such a way that it seemed worthy while for someone to look at the internal process and serv to prottde a running commentary on it? AM Not eally. EAR No. K AM I th nk we knew we were unusual infact we identified --were identified with a rela ively small group of similiar--centers with some sifuiliar characteristics and e would infact we tried --we took some initiative ourselves actually to try o arrange periodic meetings with other like us. We knew that ,, 20. AM(cont) with kind of special quality for example, we arranged a meeting with the Wells ey Project- Linderman and I think it was quite a good meeting although I don't think we had more than 2 finally. And Linderman himself didn't seem , to be terribly uriterested. Icwent up and I think other of the staff did up to acuse where Ernie Gooinburg at that time was running his research project. A co unity research project. And there were one or two others that we knew were like us. But I can't say we were •••we had the opportunity for a kind of reflection on our work but our work was not seen to be ourselves. At least I didn't think at least my recollection is. If it was so it was only from time to tit•· The Institute itself as I said by that time was till very small. It dirn't really begin to take off geometrically until the clinical center. And tte branch - the community services branch was one of severa.Lbrannhes none of them very large - the training branch and you know - you obviously are tllking with people from each of these and you know what the interactions­ both the cooperations and also the conflicts and competitions and just the fact that the people are pre-occupied each with a different area. Then there e research grants - I'm trying to remember who---it was John Eberhart: EAR John erhart, right. And then Phil. AM right. But there weren't many people and there were more to meet. I think we probably got over, I did at least, to T-6 I think more often to meetings than subsequently people from the center got over to ••• what's the name of the building? EAR AM one where you andr::I were when I cam back in 60 ••when we moved in '62 that temporary ••what was the name of that •• you know,, •• your new office buil EAR Nort Bethesda/office center? .AM No, o, before that, before that right next to the clinical center •• that brand 21. ' AM(cont) new ofifice building. ' I' EAR Oh, bjilding 11. AM No, i~ wasn't 11. Well anyhow .. EAR I kno~I what you mean. I AM The tling that I have to keep saying is that there weren't that many of us but as far as a conscious process of recording ourselves and looking at ourselves I thi~k people were not that self-conscious and they didn 1 t have that kind of l I I time. Maybe .. whatever I don't think it happened to that extent. In Bob's mind tt may have been a very important thing and he may have been watching it and sb one. And again it was again small enough for him to have a personal I fatherly sense of knowing each of the people. And, I think his staff relations were rssentially familial which was both good and bad. And depending upon wheth~r you happened to be •.• how your standing was in the family you were treatrd accordingly. And that is probably, for something that size, was had many [ore advantages than disadvantages. EAR But hie had among his many other characteristics he really did have a sense of I I think that at least in retrospect he described it that way in so .•much hist~(y of w1at he was doing and what he was involved in made him feel that they were really AM I EAR And he was conscious and wanted in a sense to preserve it. I don't think he alwa s did by any means. AM I ha e no doubt of that and I think most of us had the exciting feeling that we w re in the beginnings of something and much of what did happen over the next 10 years were things that we might have dreamed about and there was always the einforcement that there wasn't too long a lag between some of the dreams and <leas of projects - things to be done. And often something happening. Ther was really more reinforcement than one would ordinarily expect, particularily in a government organization. ~c had a lot of those characteristics- young, 22. AM(cont) growi and relatively manageable scale-organization. But again if you ask me how e plicitedly aware were we •• I don't want to minimize I am sure there were enlig in comments about how we should be writing our history as we go. Every group discovers •• says that to itself from time to time. We probably did as we 1 as most or did better than some in reporting on our own activities. But I don't think that we were really able to look at this process in any syste atic way. EAR What recipitated your year in England? AM Oh, s veral things• At that time, of course, there was ... England was the All of the changes in their hospitals and their own inquiries their mental health programs which begun in the laste 40 ''s. And had n the mid so•s or early so•s lead to something of a pilgrimage among The open hospital all of those ideas which now seem ancient history. Many f them had been taking place in England. So I was a pre-disposition who c ose to go to England. I met someon~who had come ober to work with Lemkau samatic and when he came here and discovered that Pasamatic had Hopkins and Lemkau had gone to New York for 2 years and no one had both to tell him and I was running Lemkau•s program for a couple of years he g lped three or four times and decided well here I am 1•11 make the best of This was Michael Sheppard. And we became friends and I think learning some hing more about some real possibilities in England and some of the things gain on at the Mordsl,ey intrigued me. I think personally there was something else which made it especially attractive. And that is that is now talking abou the mid-SO•s. In those day in terms of intellectually within psychiatry I wa in a very small minority. At least I think I was in 2 respects and I'm not aying •• one I think... for one I was among psychiatrists --among a very much smal er group that had been ..--had though of ~selves as a community 23. AM(cont) trist or public health psychiatrist and although I was with a cluster I didn't have that sense of isolation. In other words, there were many ings going on in England. But more to the point was that I really was--­ d u~pursuaded that virtually all my other colleagues had concluded was sary part of their training. I had continued to think --was not only a part of training but was anathetical to training. And that was ps)(~o- Now, that idea is not quite so outlandish now there may be others which have certain amount 6£ respectability now. But in those days I really felt quite ewildered because I knew---If I am right how can I be right when all these people are wrong. But that fact was that this was---I was in that respe Stan was, by the way, in the same general same position. There was acer ain degree of professional isolation. Now why this did not make anyone make s miserable when I discovered that there was a place of some excellence and g erally admired where in fact what I held as relatively minority views were e commonly held ones I thought how interesting it would be and how pleasant to go such a place for a year. Just one year in my life. ! really was interested in se ing if the issues on how you train psychiatrists - I look at the Mordsley­ while it was very very-it understood very clearly that to be a university of psych atry there really had to be the free play.,-.and involvement in .all of the ideas ich informed this profession. That is was as un-doctrinal and unscholastic as an place I knew of. It was also good. There had been other places that were had n character at all they never took a position on anything- they were just lousy and they weren 1 t any good. Now here was a place that acknowledged to be of hi h quality but also in trying to do so and being congenial to all the range the f 11 range of ideas. That also attracted me. And I think there were other s that someone would like to take a sabbatical. It sounded like fun. EAR called a sabbatical for you? AM lly. EAR So yo really were the first practically. AM Yes. And so I very carefully mustered together all my arguments and thought it 24. AM(cont) though so I was able to get this across to Bob Felix this outlandish idea. so I thought I was ready and I called him up and asked him for an ap ointment and went to see him. And I took a breathe and launched into wh t I thought was going to be a hard sell and after 5 minutes he said tis a great idea, a perfect idea. And that was it. It too~'about a to work it out but he really -- he wrote to Augie Lewis and paved the wa and he •• I was the first to do that and I think he pinned a lot of ex ectations on it as I did. But I certainly didn't have to convince And I think really at that time he though of me as being one of his mot promising Lieutenants. As you know, events dut±ng that year altered relationship. And I dontt know how much of that is germane to your I EAR As much as you want to tell. AM It isn't a matter of wanting to tell. I have no secrets from you and I am no sure how accurately r can tell ft. But I don't know how much of it -­ I hink more of it has to do with me than the Institute. It is apparently in other people1s:s-,;Jl\trids I was surprised to discover a very important event in the history of NIMH. Felix -- the relationship between Felix and me that rand the year after. EAR 1 you know why. AM 1 I know some of the reasons why but George Tarjan told me that he thinks t that was one of the - as he put it - I forget what the other one was - 2 greatest mistakes that Felix ever made. I mean something like that and didn't mean it in terms of long range policy but just in terms of a mis­ gment- right or wrong. It was--but it was of interest because it was so racteristic of the way Bob related • .Alld I think he changed somewhat after­ ds- quite a lot I don't mean in just the relationsh with me but to many er people. But there was one - it did also point out one of his major - maybe that is too strong a word. He alway~ had the feeling he knew 25. AM(cont) far better than he did. He had the sense of being intimately aware of them. I mean he had the illusion that he knew me- that is in my ic arrangements as if I had been his son. When in fact, I think I had been ·n his house socially maybe twice and he had been in my house socially once in all the years I ever knew him. He didn't really know now, there real was no reason why he should have but he had the illusion that he knew - that e really knew all of his people inside out. And, of course, so he reacted personal way to situations of this kind. And again, I don't really obviously it influenced my life tremendously and I can!t say for the orse but when I came back because he wasn't at all sure what he was going to It was - I was definitely sent to Denver on probation I mean in so many words. because if I screwed up once who knows when I would screw up again. But don't know really what would have happened - of course, I think the things in Denver, by the way, in my bias way I think we really started a lot of that region - regional office and the scale of things were such that we w re in a much better'"position because of how large we were, how small the stat s were and how. undeveloped, •they were to try out and start a number of things whic would have been much more difficult elsewhere in the whole Fort Logan kind of e eriment and the first mental health centers as such named as such and a numb r of other things were possible to do out there that were more difficult to dot an say in N.Y. or Illinois or even California. But it was, of course, what brou ht me into the center for several years I was functioned as any of the other regi nal offices but it was Stan who brought me back into Washington ••• EAR What was your perception of having been in one sense much closer to the middle of NIMH before you went to England and what was your perception of NIMH the time you in Denver aside from starting a number of new things out there. Did you a different perception- :of the Institute from that distance or did it 0 not atter? AM The tggest sense of differences was -came before I went to Denver and had been 26. AM(cont) away or a year. Now there the differences were real, not only my perceptions becau e in that year the Institute had grown in numbers enormously. That was '57. I went away in June '57. EAR nt in June '57 and not before that? AM EAR And u came back in June of '58 AM Right. And during that 12 months I cam back. I had left a place and in a sese I knew everybody and then came back and had the feeling that I didn't know anyb And part of it was because of the enormous number of new people had into the clinical center and I think it was at that point that I pers nally within a staff there is always a certain amount of discontent- I don't know what is going on that sort of thing. But ertainly the feeling that the early days when people were just bumping into another constantly I discovered I came back and I remember I was aske to come back to give a seminar about my ear in England and I met a number of p ople I hadn't known before. And I found myself introducing to each other peop e who were in the Institute and I would have met one person then I would have met another person and there was at that time--I remember there was a certain iron - it seemed to me that although the Institute and I think for good reasons, cons antly talked aboutthe fact that unlike any other Institute it contained rese rch as well as training and service concerns and that these should never bed vided. Infact, for more and more of the people at the working level it didn t change them at all. It may have changed what the Institute could do as an I stitute and it may have changed the fhini:ing,~of the cadre of people who were at the administrative top levels but as far as the working levels felt it they could have been on different planets. EAR Peop e like Lenny Duhl you had not known before you·~eft. ~ I do 't remember exactly when I met Lenny. 27. EAR You had r latively little contact with Joe Bobbitt. AM Joe I had know. EAR Joe you h d know, of course, but in terms of the working relationship. AM Joe's fir t ••• was he the psychologist in the training branch? EAR No, Joe a tually came with Bob at the very beginning. AM Right, of course, but then in terms of position. EAR He·. was p imarily in Bob's office in charge of some of the special projects - the various j venile deliquency projects and other as they developed. He really was working o t of Bob's office in one sense or another. AM What was he question? Did I have more to do with him or less to do with him? EAR No, I am ust trying --- your saying that the year away when you came back your impressio was that the Institute had grown so significantly during that year you were one and I was just trying to pin down the names of some of the people who befor you left perhaps you had little contact or awareness of and those who were for the period before you went to Denver. How long were you back befo e you went to Denver? AM Oh, just month oi: ~o. EAR th or two. OK so you really didn't have that ~~ch contact with him. J AM Then fro Denver my perceptions of NIMH which I think were shared by Stan in this respect ecam.e as I recall increasingly artificial to us and the regional office. That our ontacts were still so narrow and that they were relating to one branch. a sense of being except as we might know someone individually. Quite out of touch ith what was going on in the other parts of the Institute and in a way having be n in that branch before I left and now being at the regional end of it that part of the Institute which I related to at that time hadn't really changed that much. t had changed is all the other things and there was in a sense in the an insufficient connection between what we were doing and what was happening 28. AM(cont) in this much more rapidly much more then much more exciting areas and developments. : ? PerceBtions ...•. EAR Well ]et me ask you .. did you have as clear a sense of mission when you went out I I to Deriver in terms of the opportunities and responsibilities there as you did when tou went to the Study Center? \ AM Yes, ~ do. I think there was still that kind of a feeling among the regional I officJs. And I think it tended to gather peop;_Le, many of them who require a i sense I of mission. If it isn't there they invent it. And I think the other people I with whom we were working had a feeling of being identified with the NIMH ! ! purpo es often had the feeling we had to be kind of devious in order to get that illy Institute to realize what we were trying to say. But as all those peopl in the field always feel when they look at the Central office. But it wa n't a sense of being alien £rim it and yes, I would say that was a period of high excitement. Again, although there was no formal way whether any of the ! you r~ally couldn 1 t yet see what was going to become much more articulate as the I menta} health centers and mental health planning and all the other programs. The-- a lotiof the ideas which finally shaped those programs were part of our conversation and o*r pre-occupation. And where they came from exactly it would be hard to trace. I But Ijthink the NIMH at that time certainly had the highest concentration of people wotkb1g in one organization who were thinking along those lines. And trying in each regional office somehow to put some of this to work. What are instruments ! were ~orking with by that time had changed. Remember, they had begun with a small grant to the state. Small, they began what the minimum grant was $25,000 a yea. Which today seems almost laughable. I think by the time I got to Denver the m nimum was $40,000 or something. And I th.ink we had a couple of minimum grant states. And this was suppose to set up an office in ea<'l'h state and then you consu ted with them and that was your instrument and from that you became sometimes almos too closely indistinguishable from the states own programs. But in the 29. AM(cont) mid late SO's there were some new grant programs that were obviously designed to sh'ft the field. There was the hospital improvement grant. 'fhat was the first time really in the mid-SO's that there was finally recognition that this whole range of concerns had some how be brought into focus. There was ...we sp~nt an aw ul lot of time on what we called technical assistant projects if you remem er? EAR A ha. AM I don't know who dreamed up the concept, but again it was again how do you take a I relat!i.vely small amount of money strategically and bring the right combinations of peopl~ together. We were great party givers in effect. We would get the right peoplr together under the right mix and hope something would happen. And the more carefully we planned the parties sometimes the more ideas we would get •. that was anothlr one of our major pre-occupations. But those were our instruments, and therelweren't very many others. EAR You w rked officially as well as informally with WICHE. AM Right, right WICHE was just also getting under way. At least its mental health divis'on was so was its first person waiting for Dan Blane to arrive and they were also ... I think there were several times when it could have developed into a foolish competition - it didn't actually. m,iw EAR I had the feeling when I came to visit you to give that talk on m?UJIPower. I quess that I as in late '58 or early '59. AM It wo6ld have to have been '59. EAR Yes, early '59 probably. AM Oh no, it could have been either one. EAR Some ereraarudnd there. It was either fall or the early spring. And I really only the delightful memories about that day and a half that when we met in Aspen for the meeting that there was very much, in a sense a kind of family feelingamong those of you. You clearly had the group of people 30. EAR(cont) w!rking with you there all working together as a kind of family in a sense I ttis was a Denver prototype sort to speak of what was going on at NIMH in tje early days. ~at has some similarity I EAR Yes. II AM Akain, the numbers were relatively small in the states. The people were a about similar stages of development. And we had .•• I had forgotten that .• I had forgotten that occassion- it wasn't Aspen but I remember where,,.1we,,;,were­ i was up towards Este's Park. Right? EAR Yes, Right, right. AM Nlw I remember. Julian Hammond came out the same time, I think. Didn't he? EAR Yts, he was there that night. That's right and made some very funny remarks in the Julian Hammond fashion. Yes, and that is when you wrote me this very flmous note afterwards saying •. a note to Bob thanking him for sending me out I there. That all my comments had been apposite. It was the fire!t: time I saw II that work used. I even had to look it up and I was very pleased at that 1lvely compliment you paid me. It was very nice. OK, I just want to finish tlis side which is about another 10 minutes and then we can break. Stan I a~ked you to come back to Washington? I ! AM Yts, it was a very funny time. Whenever I came to Washington, which was f~irly often in those days for me I would at least I would say more than time it seems to me in retrospect I would stay with Stan. And of time he came out to Denver, I think really just to talk to me. d it was a very close relationship and I think at that time I was one of e people that he trusted especially and his judgment we value and he was ing through some rather hard times. And he would tell me all the things at were going on and the problems that he was having and so on. And I d n't remember the exact sequence but when he found himself in a position 31. AM(cont) of bing special assistant to or something. EAR Yes, when Joe Bobbitt had to go on the 20 school study. AM Righ And I remember we had talked quite a lot about some of the ideas I had i about the regional offices and what I thought might be done and somehow to relate them now more to the Institute as a whole and began to conceptualize I what I thought the regional offices could become. Whatever our ideas must have resinated somehow and so he asked me several times if I would come back and really at that point didn't want to. I gave up San Francisco to go to Wash~ngton. After I had been there about a year and a half in Denver the Instktute wanted to move me to San Francisco. And the •. I had liked to be promlted to the majors as it would seem. That was when 2 big offices ... and ur regional director made the appropriate proto-stations. He didn't want to have his staff taken away so a compromise was arrived at afterwards. They would spend a second year another year at Denver and then I would go to San rancisco So I was suppose to go to San Francisco and it was during that I • year --the later part of that year infact, we were already house hunting and then all this happened. And finally Stan, well I guess I couldn't have been too hard to pursuade. There were lots of things that looked like they might be inte esting to try out. But the thing that really intrigued me most was the idea that we could ... all the complaints that we had had over years about the regi nal offices now was the chance to try to do something about it. So anyhow, that is when I came back and started in July '61. And set up what was called the operations as you recall. And the next 2 years were a fascinating 2 ye rs in all kinds of ways~ I really think we really did reshape the regional offi e in many ways. And I think •• ! don't know what it is like now but for awhi e I think they were much more involved in many more ways than they had been. And f course, being in that particular position I found myself getting involved in a number of other programs very, very early. And we had a fantastic small 32. AM(cont) team 1 , I thought, working together. Each complimented each other very well. Sam ucker who is prodigious and Hi:lllro:thea Dolin who is flamboyant and well Rod erker was our .. kept us in tact. But it was •. we really turned out an ous amount of work during that period of time. EAR Doy u think Stan anticipated the developments that went .. is that what he really had hoped would occur when you came in or did he just have a kid I of large vague idea? I AM I doh't know. I really don't know. I think •. I hate to psychologize and I I th i nk Stan's relationship and mine is so complex and so strange all I can 1 telllyou is that period .. basically that period of '61 to '64 when I finally_ retil ed not only were unlike in terms of our personal relations unlike every­ thinr that preceded it and unlike anything that followed it. Ittwas just compfletely ... once I got there the many ways relationships • . . there didn't see:I to be so much strain they weren't strained as they obviously must have bee to me but there was a certain distance. Now part of it is an inevitable distance of having other preoccupations. I think in part Stan felt badly the way I had been treated and in some ways and at leat in the narrow he might have prospered because of my misfortune;, And that may have bee one of the reasons why he wanted me back. I also think at that time tha I was someone he trusted and who he wanted to have close and available. i In siome ways the very success of that operation was our undoing plus the fac that I just can't overl&ok the fact that because of the timing of what As far as I was concerned absolutely bowled me over was partly a the success of that venture and the fact that Bob Felix forgave me. really has no place in any kind of a history but that event was the most single most stunning •• I was younger and more naive in I didn't realize those things happened. But I don~ t think St anticipated lots of ••• the flourishing of that office. The fact that 33. AM(cont) the role that I obviously was playing among others in the development i of atl.l new legislation and so on. I don't know he •• I don't know how it I appekred to him at the time. i EAR But ~ou were doing what he had hoped in the largest sense and this is to I brin~ the regional offices in in a much more tangible way. I AM Defi ately. 1 And the man I think .. and I really do think that at the time I left they had reached a peak in terms of the confidence and moral that maybe they hadn't had every before but accept in the first 2 or 3 years of their exis ence when they had attracted, just by being there, some of the most imag·native people in the country. Who had said "OH, boy! what a chance to dot is." And, of course, our office was also involved in a number of other s . We developed a whole plan for planning and all the preliminaries and lot of other things. You asked me if I think in the broadest sense Stan had hoped that this would be the sort of thing we could do. Yes, I think so. EAR Righl, but in a large sense he let you develop .it and evolve it on your own without •.. AM That was alright. I think everyone was •. again when you come right down to it npw you can recall yourself there weren't that many of us who were I .1 avai[able. Everyone had our programs to operate and everyone was busy. No, ! I fe~t very much involved in all kinds of things and until what I saw as my bani I hmen t which it was in a very physical sense. Even in that banished year I th"nk I found something to do which was useful. That is when we developed the ospital improvement grant. That's right. It was the mental health EAR t grants. AM se before that all the grants. EAR The IT and In-Service training came afterwards. AM That is right, because I was the first director of it. But the •. anyhow that 34. AM(cont) is side from it. I had the sense when I was asked to go back that it was a g nuine request for what I migg.t, have to bring to there and the hope that som of these things would develop. I don~t think anyone knew how far I could go r how well it would go or how quickly it would go. But it was •• it started out as just me and a secretary and it never got very large in numbers because I d n~ t think it should have but well. EAR Thee is one interesting, I really do want to try without making it too simple to thing but wanted to make some interpretations of the manner in whi h the people like Bob and Stan in some respects perhaps yourself or I think you obvious a different person functioned in positions of top responsibility. I t ink both Bob and Stan and I guess Bert to some extent or those he plays am ch smaller role in what we are trying to do, were able on one hand to exc te and to induce people to get involve,and to communicate the kinds of lar er objectives that they had but really maintained some degress of distance almost everybody. I mean here you were in one sense of being groomed as a p ssible successor and yet you say you were in his house twice and he was in our house once. So that on the professional level relationship was quite clo e and very much interactive and yet there was a clear distance in some oth r personal regards and Stan is in many respects the same kind and I think ably Bert is too, the same kind of individual. Now, I am not saying that in ither a positive or negative sense, obviously. But it is an interesting acteristic that the people who played the central role had these kinds of co on characteristics. And it means that everyone who worked with them just got so far in the relationship and no further. Does that seem correct? AM Let me think about it. EAR OK rewound it---you were starting to say. AM In o many ways they are different. That to find this characteristic they _I 35. AM(cont) in common. It was not easy to know either. one of them. I am not sure it ·s useful without trying to compare the two because they were rather erent even in their style of leadership. It is true that I think Bob x had much more emotionality about it. And, of course, what everyone s about is tremendous energy and infectiousness. EAR And pinching the girls. AM And pinching the girls. But there was an abuliance about him. He it his business. to establish some kind of connection between himself anybody. It was almost a joke that you could put a pin within an in the U.S. and within two connections figure out how he was related to omebody in that town. And so there was something convivial also putting it ositively there was something that he was that and the techniques bf his anal manner to inspire. And, of course, there was a great breathe of on but he tended to elevate by his matter the tone of what was going on nd him even and there was enough solid intellect there so that even tho gh he would embarrJKS us at times by his •• and we were embarassed by him as e would be by our uncle:who was always being gosh in public. I remember first time going back many years after I had decided to go to the Institute. is '46 or '47 and as a new regular corp officer I came up for an orienta­ at Kott Cottage or something. And they brought in the Directors of all the new programs, all the branches of the public health service to meet us and to alk with us and they all came on with the proper professional manner and Id n't mean they were all stiff or formal but they were at the expected form of ehavior and then this nut from the National Institute of Mental Health my uture boss came on and he said, 11 My name is Bob Felix and just call me Bob and I don't care what you call me as long as you smile." And everyone pok done another and giggled and that is what I mean by embarrassing. EAR I t ld him when we had our 2 day session that Bob you are sincerely corny. 36. i I AM That 1 s it. Now, I think in a funny way Bert Brown I can't explain his curious hayse1d dresss but any other way as his attempt to capture some of these qualitlies only it doesn't come across. But Bob, of course, was solid enough I that fiinally the scholars respected him. When it came right down to an argu- 1 \ ment ou knew you were dealing with somebody or something very solid. But the matte1 made it look as if he was very You're right. And I think basically he di,n't not feel as deeply about people as Stan. Stan is of course, a very 1 diffe ent person. I think he is much more shy and I think, I am not sure he was any m] re suspicious than Bob. 1 Probably not. EAR No, I don't think so. AM Both f them really were .. had a feeling of being kind of an elite. And so in oi­ der tj he accepted as a real intimate by either of them there were also a sense of thjm having to have respected you intellectually. Stan once put into words somet~ing that .• it was not one of his most attractive qualities in my jude- ment Jeally and I think to some extent was a limitation of his and Bob had the same due but noone would know it of Bob. Were talking about some ••• I think this as when we were on the trip to the Soviet Union. And, of course, Stan and I roomed together and we had a lot of time to talk and he made some reference to the! Institute - the staff of the Institute and he made a distinction between the pebple - the top people that he was concerned about and that was a very small fraction and ther others who were just the and this is the quote "the worker bees" and as far as he was concerned they ~ere just the worker bees. Now I think in that sense you were clearly expendable. Now, any administrator knows that he will make decisions in which you set different values on different kinds f people. The "worker bee" feeling got is his way ietluiiak because think he saw talent, certain kinds of talent when they were really there. felt the same but you would never know it. The .. I think Stan .• I think snot as good at disguising his ambitions as Bob was. Bob really affected 3 7. AM(cont) a mannlr of great egalitarianism and so on. I think probably both of them had the saying grace and that is that they wanted positions so that they could get I somethf:·ng done rather than because primarily because it would grandize them and no as to whether they had in common more than any other administrator the fact tat you really •.• that there are only so many people that really become intimabe with you anyhow in your life time and when your in that kind of a working relatirnship it does get in the way, A really intimate relationship has to be footing. 1 recipr cal and it has to be one in which both enter into it based on the same When you are at a top administrator position essentially because of that no one is quite on the same footing. There is no relationship that isn't some how toucher for it would be rare for it to be touched by the working relationship as well. lo that .. Stan could be an intimate friend with someone status other wise in life would relatively .• I wouldn't say meanial but someone who not necessarily has ,,rttainments. As long as they didn't have that work relationship, But I reallyl_think there is something in the work relationship. You can simulate a relationship where the needs of both are equally met. But it is very difficult t~ havll 2 completely separate relationships with the same person at the same time. EAR I thin that is true. AM And thl difference was that many people - a slight distance from Bob loved him I I becausf they didn't really know him but his manner was lovehble and people from a slig t distance from Stan didn't like him. I think my guess is that the people workin very closely with each were probably very similar actually, very, very simila. Each one had people who were very devoted to them and very loyal and so one But my judgment which has nothing to do with the paper - if your making a numb r of distinctions between the first 2 directors of the Institute and the presen director is what has driven the first 2 was the desire to do something in thi over simplified distinction and the present director wants to be somebody. 38. AM(cont) ally •. it effectsceverything that they do. All 3 had a kind of vanity but he vam.tty is kind of over-riding with the third and with the first 2 it s really not a very unexpected tune. It mattered more to Bob than to an to feel that he was popular, much more. Stan almost prided himself at t·mes with the matter of aact that he was hard-nosed and therefore bound to be loved. I think sometimes he ever courted a kind of dislike which was not necessary and didn't particularly help. EAR OK. hall we stop AM You now better than I about the stopping part because I I DR. ALAN MILLER November ls,I 1977 I I EAJ Niw,I you,.ft<!serv':?"°;:; t\3/,i footnote. ,/ ',l',..,.,F _,,, i ,,/ ,/ ✓,f"',,,-" AM; Wi )11 de,~;,:r-ve //'' )/'/ ,.:"'"' ;;'' EAR /That's.true, but:"will we get it / I / ' /" I /' ./ AM / T~e answer no. EAR Ii told John Romano yesterday as I had mentioned earlier in Boston to both J~e Spiesma.n, he never really had an interactian with him in training, a.nd ' ' H~rb Kelman, who you may recall is one of the names I gave you when you gave ! i m~ that mysterious telephone call about the then Governor •·s mysteriou.s plan I i which I materialized later· on. Anyway, they were both"" they both played different I rl!les and so I interviewed them and I told them and I told Romano yesterday that I am begi~ning.to feel a little overwhelmed with the material, which is a little 1, tei' which is a little late I should have been overwhelmed before I started b*t I wasn't smart enough to realize it at the time and the feeling of being I oterwhelmed st'1!ms primarily from a lack of clarity as to how to go about putting it together. I know what 1 don't want to do, I don't want to Wite a chronolog~ i{al history with maticulous and copious footnotes all the way through and ! gdarantee accuracy of every statement that I have in there, etc., etc., I am I I ndt a historian and I don't think that is a very useful way of telling this i s~ory. So, that's what I am not going to do. What I had intended to do and ' I wl;ten I wrote up in a prospectus for,myself and I sent out a couple of places for t e possibility of getting a contract for thepubl:i.eation,wh:i,eh,. incidentally, I do not as yet have. What I wrote. up was essentially a kind of approach in ich there would be some thread of continuity in the various parts, but primari- 1 it would attempt to tell the story from the standpoint of some of the major p ogrammatic activities, the Research Grantts Program, the Training B.ranch Program, ..., 2 - EAR(cont nued) the Community Services Branch Program,_ the Intra-Mural Program, Th Regional Office Story, Alcoholism, Juvenile Delinquincies, Special jects, 'beginning with a kind of recap of the 25th Anniversary which I think r lly served as the demarcation of the m:tle'stone of the entire Instttute and th n go_baek from that; using that as an introducto-ry chapter, to show where it was and then in a sense a kind of flash-back to the earliest days - how th Institute got started and Bob Felix and Treadway,. first Larry Cobb and Th mas Haran, all tl,.e· old names and how the thin.g g0t started and then the gr wth of the INstitut_e in those early days a.nd hew Job worked and h.ow sem,e of the other key f :f.gures interp-l:ityed with him and all the rest of it. I think -th t's still a doable approach and I still have that as a possibility. ThCl see it at the moment and I am talking out loud to- y0u, so The problem with it is that my primary purpose in all of th s is to be: able ,to higllight two i.mp<)rtant dim.ensioo.s. One,, the people ·c in: lved. because t really think it is a very unusual group of people, that rybody, the Felix's, the Directors. AM -r sure a.bout that? EAR What are your standards of being unusual? Robert Oppenheimer, no Henry Kissinger, no AM I not talking about stature and I mn not sure hew- you measure stature. AM not, indeed. I simply meant that we have been so ~lesely :involved with tbi.s · ticular part of the 'Universe tha:t sometimes we intrude. EAR that can bean advantage as well as a disadvantage 'because in fact in that ve y proximity, you W<>uld then tend to tell the story in such a way that you can - 3 - EAR(con inued) convey what may seem to you the truth and to some extent even in a larger picture has some truth. AM I is really a work of art. 1 I said to a couple of people now that really as I try to think back w yam I doing this to begin with. You know where ft really all began, it is v,ry funny but r have tried to recollect, Many years ago George Sazlow said to mi when he was on the Training Committee, 1tEli, you have t0 write a novel about ttle Review Committee's because I really think that the Review Committee '·s are oJe of the most important phenomena within the totality of NUm, the way these p+ple interact, the sorts of thi,igs they accoinplfsh, not just in terms of the g~ants they approved and disapproved but how they serve as a network of connnunica­ tJon nationally, how the meetings themselves are almost like small plays that tJe dy~amics of what happens at each one of these meetings. A grant that comes :J,f::a:o:::e::t:::•b=e~::sa::e:1:c~: :::.:i:::s:::::/::: :::~::t::san ilteresting set of dialogue for a novel, I knew what he was saying, and I was v ry intrigued with that comment and I really think in some respect trying to r call back that may have been the germ of the idea, let alone my own literary a pirations to begin with, and my feeling of identification with the Institute. So, it's terribly important the way I see this to be able to illuminate, delineate aid bring to life the people involved in a constructive way, I don't mean to be eking at personalities in any sense, so thatls a major issue and the other jor issue which interacts very intimately with that aspect of it, is to sBmehow b ing alive also the various key decisions that were made, how did the community m ntal health center's legislation really come about, what happened behind the - 4 - EAR(conq.nued) scenes, in front of the scenes, in between the scenes AM Pe ple have written what they alleged to be that story, Musto for example. He hasn't got it exactly right. EAR I on't think so and I think that everyone that I know about that's been written ha been primarily dedicated to, in one sense or another, telling a history, I and not so much from a standpoint of the people involved and the decision"1ll.aking I process When I began I really said to myself, look here is an organization i . which over the 25 years that I want to take a look at has made enough within I which organization a number of key decisions have been made. Now, what was the I interplay of forces, individuals, outside pressures, political circumstances I t h at i site • guise • d everyth.1.ng you can t h":i;nk o f ., m~at were t h· e :i,nterp T'1'1.. . 1ay o f t h ose fokces, which in a sense; helped to structure the di.rection of decision went ani how the decision was arrived at. In some respects I suspect that the com.~ m+ity mental health center's legislation for one b a ~e,,ut;fttl example to select, the interplay of people like Stan and you and Bert and people at the prlgram analysis level, like myself and all the outside political figures, I pe ple I mentioned to John Romano yesterday that one of things I have the most vi id recollection about regarding community mental health ce.nter 1 s legislation is the small role I played in the manpower field. I was asked because I was th_n the Prognam Anaylist in the Training Branch, to defend the manpower projections we were making, and it came to the point, as you well know, where the question at the highest level in the White House itself was, should monies be put :into the •lation of training additional psyehiatr:f;sts at.t,ll:e realtzat:f:on that they may take people away from other medical specialJZies~·and should psychiatry then of priority with the potential loss to obstetrics, gynecology; and the answeY- was yes, that it should be done and along - s- t1 EAR(¢on.tii ued) llhite ll'l"se ~• """ a very high 1"'7el meeting tow,n,ds i J • a g--g• precisely OD. the~ the way prior to the time that that decision was literallymaife at end in which that question and alo,,g the way I was .asked to :oic-:.d::l~:~:=:•.::.:~r::=~: ::g:::k:::..:::::: :: thJs: people really need to be· trained ;f.n ordei, to do the jeb you are talking ab lut and hGW many people are going to be: in everyeomR\Unit,- mental health wh· interestingly· eneugh played a key role, hi.s name was Mild! March, he was a Bu eau of the Budge.t Anaylist, a Sr. Budget Analyst, who had begun his career by nailing, literally,. to th.e wall the first Secretary ef Defense,, namely .f'•es Fo restal, who had presentedh:tsfit"st budget. f~r theDepart:nJent 0f Defens.e·and lt+ March, as the· lntdge'tana;ljst probed sufficiently hard to find some fact in th t first budget in some aspect of it and the Department· of the Defense· backed 4. .· •" Ever since then., Mike March was the Ki\ight with shining armour at the Bu eau o~ the Budg~t. · lle was called in as a side issue ·to make svre that there was no hanky panky in.these figures and I had to literally every other week I iuld have to come up with another set of figures to satisfy, it is a minor lijtle story but it plays a part in the total picture a-nd r think it ''s a kind of incident which if I can accumulate enough of them; will give·l:tfe.to thf.s pait of tru, t~bil otory'. That's what J: w<>utd Uke ~• be able to do, Now, yoj said somethill8 a few moments ago which I think 1s very critical.- We know alj this, we lived all this,, how do you tell this· stocy in such a way that· ot'er people can vicariously live this same experience er would want to, Th➔ t"s the most important issue of all: and I'must confess to yeu that! am at th s moment a little bit d:l.scouraged because I have notbeeu able to sell the th book to a publisher. Now•- the diseouragenent stem.s from the 1:aet that those - 6 - EAR~ont ued} people are trained to be alert -to whether something will sell and th question about whether it .will sell.depends on whether people want to bow th se things. Now, it is also true. AM It probably depends on how well known the _____of the attthor is-. EAR tly. interesti-ngly en~gh th•t is partly so, not-altogether and I can take c fort from the fact that:1'"'flllblishers on not on missions, they have many times tu ned books down, which later got published and turned out to be best sellers.­ So that's not the end all of the criterion f0r this but as? say it :ts a little discouraging; the last place I went to was International Un.iversitiet:e: ss which published my very first book, some 23 yea.rs ago, and which is a li tle house, little h0uses are as proud as large houses, but you wou.ld think if s0U1eone comes who has unique edge on this, I: made :f.t very,clear that no C!!ne el e is doing anything like this, no one else has the :ln!i:s se to speak that~ ha e, no one has 7 hours worth af oral history from Bob Felix and other hours · other key people,, ~ there is information and data available to me that is available to any01:1_e else and she said, even more explicit~·, th~n you--said 7 a om.ent ago, you ~re interested in this and rknow that you feel.stroagly the National Institut·e of Mental Health and r don •t blame you fer that h 1 really don't think there ai:-e enough. people aroun,d to¥ke'. it worthwile us to write'a, eontract on the bosk. That"s as it, now stands. It :t.s r~alo::o i tic to assume that were :r able to do what I' ant -new planning t,o do well en.ough t produce a reasonablemanuscTipt, it might well be a totally different s ory when you present a manuscript £or somebody to look at~ I: think too oftea t·e publishers in the past have bought a pig in the poke and feund themselves ,. d"sappointed afterwards so they may be more chary now then: they ever were before, c rtainly ou something that is not a t&tbook, doesn't have too much sex in it - 7 - EAR(co tinued) isn•t in an area where everyone is buying you know, like self.,. I h alth books or diet and cook books, etc., so it is reasonable. to understand. T at, by way of background, you have been involved in this as ~qually j_f not i some respects more deeply than I have, I mean the NI:MH, and you have more p rspective than I have because I really have in a real sense eonvinced myself t,at this is the importa-nt thing to do and I still very much believe in it and I am still intending to do it, but I am clearer now in my own mind that it is n,t going to roll out of its own accord and that I really have taken on a task with so much material available that I am already overwhelmed and I haven't even· rlally begun to look at all the accumulated material. I mean I have all the Clluncil minutes, which I have looked at from year 1 through 1971, and I have now a few dozen tapes from various people and I have about 100 replies from people t,at I have written to, so I have got a good bit of material but there is still a lot more to do and the step after this one, that is after these six months are o er, the step after this is really intensively to sit down with all this material and really absorb it I I , absorb it in such a way that it begins to develop in a • s nse of structure of its own so that the question I: am asking myself now out 1 ud will perhaps be both a little clearer in terms of a question and hopefully a little clearer in terms of potential answer. Any thoughts. AM Q ite a few. You don't need assurance but I think just the documentations you p:t together in s01te form of, _____is precious and was good to have done it. I can't think of anything that has been done so far is not time worth spending f r many others and as the time, well,. :t won't say comes but as the time c ntinues whether this would be alegitimate area for historic research, not just m ntal health but also what was happening at NIMH as a para~ox to other things tat were happening in federal social legislation and r can see this as be:l;ng v ry valuable. There have been 'Some very. important books that have devoted - 8 - AM(continted) themselves not only fairly to movements that located in a fairly narr,w span of time as history goes, 25 years or whatever, is really not that long a period but a very interesting tme to us, the only time we had in some ways In fact some of the most influential books have been reports of one itldi-&idual and not necessarily an individual who was eminent, a world shaker,. whenlyou think of books like --------,,---.......,... really, thel;'e is a work of art in ·hich she selected four people, all of whom were important h1!1t none of them levll of statesmanship or world shaking scientific concept or anything of that dimlnsd.on and yet not only was it a book which was of enormous interest put havl captured an age in miniature and had some influence. I am reading now a bio raphy for the third time. Each time I have read it, I read it for a different set of reasons, enough interval between the readings that part is recollection and part is revelation each time. It happens to be the bii,n;raphy of someone you may never have heard of. Have you ever heard of William Welch? EAR Bacteriologist AM No. It is an interesting occasion point then. Tt is written by Simon and ·J,es F:I.ec;hsner. I don't think they are related to Abraham who did the famous t· I of medical schools, although they must be related. He doesn "t speak of lthat specifically. William Welch, he opens·the book, which was written in the lat!e 30's or early 40's by recalling an event in 1930 or 32, 30 to celebrate Wi liam Welch's 80th birthday and there were messages from all over the world, abut to celebrate this man's birth because he was- clearly the apetheosis of Am riean medicine in many ways,, world wide~ An\ong S0llle· c;,f the milestones o:f hi.!¥ ca eer, he was one of the four doctors, so cal1edl that sta:t1t.ec;l, the llopk,;i;nsi He had done things lc,ng before that~ The UJ>raryf by the way,~ at the Hopkins Me ical Center is the William Welch Library._ He also in describing, well,_ I · on"t want to prolong it except to say that l: can. just t:ie off the things he, ha done just to illustrate that asperity between pers.->n. who of enomotls ~ta;tture in his,.field. He was really one of the early people who tecognized - 9 - ·ed) the critical impertance.of mental health an.d public healih~ He helped tart the school; of public health, he helped to start the Rockerfeller itute when they were looking for somebody, pathological research, that was Re was one who in d"J:"awing up the iaitial currttulum for ins Medical School, spoke of psychology as one of the basic sciences~··• aordinary man. There are two points,' now fargotten,. but to an :b!lportant ience, first of all, when the book was published, it was published for the e'.t'.al audience and was a best seller.., It was a successful book,.;- I' am re"'!:'read;lng ow because I" am thinking again about some of the issues :tn m;edtcal edueatton, he was one of the people who would shake the current system. The- link between of that and some of this is that I think one of the ways I would canceive of being faithful to what the information and a.way of organizing it and than· general inte~ast , .broader than special interest is if you think of EAR twas my original intention, Alan. AM EAR the problem. The bi~graphy was going to be of the NI:Mll as an organic AM history EAR T right. It falls apart as a biqggraphy because it does.n *t have· the personal start to talk about the people. Once you start to talk about AM S ebody could have written abiography of Rob:ert Felix,· EAR , right. AM I. on"t mean a/piece of PR. One of the troubles about writing about anyone's \ bi graphy is that they had their elements of sadness as well as, for example I an rem.ember, you talk about the mental health centers and the feelings around establishment, was Stan and the group working at one end of that Building 31 - 10 - really doing thewrk and Bob at the other end of that hall with his litt e group of 1,'iHe.minent psychiatrists including Frank Braceland talking to them elves, e ~ eJtchanging ideas nth the Council,. none of it having anythil!lg to d - it couldn.,t have happened at the ether end ef the hall :,tf you hadntt be all of the years before, s0 it was :t.n awa,ya kind ef a l;'i;ae and fall; but I us thts l')nly illustratively that tf" you at'~; wtting sQm~hting other than a ully docUJQ.ented dissertation. if you were writing this as a Doctor•s tation, youwould pmbably require to have a hypothesis,? am not sure. som.et:bnes they do; but i t would important in its 1'W!l. right; you would be the cipal benefid:ary and the scholars of the futul'.'e would have this to call That by the way-is the only way which any of the.·cai&eful history of the Dep rtment of Me1;1tal Hygiene is being written now, there are about four doctor that are being written about som.e :blpertan:t aspect, not mean 't for­ I: doubt that any of them woulc!: have that gene'l;'al :btte:l:'est :tn theJ!I; it is f.mportant that there be such a chronicle,, someone someday writing a er hist<,>ryma~ draw upon. Either as an· importan,::t pieceof histary, I.think of ne of them like Kathleen Jones, who Wllote two books on.the history of mental th legislation in England. ·_tu ....•_cy,._·_ _ _ _ _.,..,was the first and then· thue is ccessor and the first one covered a. period of 1840 to 1890 or 1910, but it was because it was done, because it was a beautifully done piece of history, well :r:'ead much_ ~ore widely than people would really expect to it up almost as a text, so that you can write apiece of history about ;hist one aspect of a much more complex scene, but by so placing it in its context you are really writing something which is again net going to. make the best seller lis but it 1s a sort of thing that gets reviewed by gen,eral Journals and the~~, R.ev ews and some other groups that are look.il!lg for something carefully done and the are rating it by its quality, ai.1 you can write as b.iegraphy and :t wonder ,I lJ - 11 - AM(contin:,ed) whether, how much of what you have could be organized around a biog aphy of Bob Felix•. EAR Pr bably a good ·bit except that what would be very impo:r:tant that- t don't have is more of the personal aspects, I think in order to delineate Bob Felix as well as one should with a biog~aphy~ YQu need to have alot more of his ea ly life, he comes from longly distinguished family,, physiei,a.ns~ politicians AM It a differentboek, isn't it?: EAR Ye , it is a different book. r thinlt it would be a very interesting book~ l' th nk that .to the extent that ycm emphasize Bob you :lnevit:ably lose som,e of. th · totality of NlMR because all for the per~ of F'e.l:f:x, you can.it avo:td th t if it is going to be a biography of B·ob Felix and it is interesting that. I eal.lyd:id, it is so clear in IJD;Y' own mind, that r really did think of the NIMH as a biography of NIMR.. AM Yo are talking then a.bout the s.tory of a f ~ily EAR Ye AM A amity h:l:stQry, only it"s a family that if3- def,;tn.ed by its professional af iliations, EAR Ye , right AM Ma be thatt•s the way it· can be - .EAR Lo k, r have no doubt that' it will merge as I: continue ... Romano-'~J,:wa• very th rapeutic yesterday,. I said towards the very eud because it is now clear th t when I get finished with people, they say to themselves, not out loud, but I an hear it nonetheless ... ''M:y God~ I gave h:tm all of· this stuff of my own bu where does this fit into something that'·s a book, I kept on rambling, in fat, did I really say all bhat, it was so incoherent in sc;>me sense and things I ouldn't remember,"r keep on pushing people on for a cmnment like this, I say to them whatever they are taling about a particular aspect, I said - ..~h, I' ld like to hear 11\0re about it, can you think of a 1:1:ttle a little specific in ident that would illustrate that; you know- it is very difficult to do and - 12 - EAR(continued) very difficult to do and so John Romano yesterday who had an extra­ ordinarily memory at one time and still has a very good memory and would say Eli, I can"t recall anything at the moment and so I said at the very end a variation of what I said to these other people. I said you know I am sure that this feels like just one part of a jig,,,.saw puzzle and you can't see the whole jig-saw puzzle but as I begin to accumulate more and more of this I: am sure it will all fall into place but Imnst confess to you now, I said yesterday I am a little overwhelmed and he said uyou should be overwhelmed now, that is just the right feeling to have at this stage of the game and it will all com.e together. AM This is the point which people need to be urged to press on EAR Yes, exactly AM A-moment of maximum confusion just before clarity EAR I think it is a considerable time before clarity AM That's a good sign, too. EAR AM Sure:, it means I have been collecting -~- ......... It also means that you a:i::-e not so desperately in need of closure that you are going to make it prematurely. EAR No, in fact my feeling is not so much·;a desperate need of closure but that in a sense over the past f.ew years I have been involved in so many other things since I :t:fti:'-!etitteeti interviewed Bob. I have a feeling of uneasiness, which I shouldn't some havelat all that some t:ime before going to bed on hna--y evening when he has, noth.:bag else!to thimk abeut it may flit through :Sob Felix's mind, whatever happened to that stuff that I gave to Eli Rubinstein two years ago and I haven"t seen anything of I it y~t. I am sure it hasn't crossed his mind. 1 AM It certainly has occurred tome from time to time .. I i EAR It h~s, thank you, Dr. Miller I i AM It mtst certainly has. I think a lot of us are involved with this with you - 13 - AM(continµed) because it was an odd act of fate because I have a respect for the that you are able to carry on. EAR , yesterday, no the day before yesterday, coming down from Ottowa to cuse, we spent the evening the night before last in Syracuse~ there was dio show, an interview of a man named Paul Horgan, who you may have read, he wrote a number of books including ''The Fall of Angels, which was a best sel~er novel and he wrote a book about the Rio Grande River, which was also a blest seller. Anyway, the book about the Rio Grande River was apparently part of a series of great rivers, which one publihsing house took on to :itself to ldo and from the moment that he began the story to the time it was published, I twe!lve years lapsed, so he said that there were many occasions in the course of those twelve years when the publisher would say to him, ''where is this book you were suppose to produce'', but he said that it was twelve years well spent. Now I not going to spend twelve years on this, but I don ''t have a feeling of ! urg!ency about finishing it and yet I have a. feeling of importance about the proj~ I ec ti• m=;reet=--mi11e I AM In our mind you see this as having a beginning and end to that as the period yo describing. EAR very much so. Well, it is partly artificial but I think there is drama th idea of 25 years and the 25th Anniversary and there is a literary gimic fn..,.. Truman signed the Act initially and at the 25th Anniversary we ha a telegram from, Truman and so .r was really, gai:ng to use that as a ploy to begin with the25thAm.n:tversary and them: as I say to flashback to the very, be...- gi Well, it: is an artifice but I: thinlt :tt :ts a. perfectly reasenable one. AM Let me ask yau as yon have gotten recollections of any people this great VO e, has there been any kind of principal theme that_youmight think of as lager than mental health or let us say inclusive of what has happened :tn,to. wh t extent could this illustrate for hi.story of a partieular i;d,ea.,, c:n, k.tnd, Q.~ - 14 - AM(cont.iµued) idea o-r movement. EAR No so much in terms of substance, Allan, but in terms of process and that is I think it was a very happy accident that Bob Felix and all the other pe ple that he brought in early on, plus, no one could have foreseen this or guaranteed it, plus the continued political support that allowed for the i st~ady growth of NI'.MH GAVE eveybody, especially in the beginning and even I thfough those first twenty-five years a strong sense of connnitment, a strong I senseI of enthusiasm, a strong sense of personal and professional worth at I be~ng involved in this. I AM Nol question about it EAR Evrryone I talked to. has had very very positive memories. AM Nol regrests, essentially for having done it. EAR No!regrets whatsoever. AM Iti's a blessing, isn.'t it? You might write this as a history of blessed I I pepple, people lucky enough to have been involved no matter how it came out. I EAR Abkolutely, a side issue which is kind of interesting, as we all get older, I I Jo Spiesman, I met with in Boston, is very dedicated, very sincere, a very ent person who came·into the NIMR Training program in Psychology, as the forth person in a series of individuals, beginning with Ken Little and I do 't think you had much interaction with Ken Little, but it was Ken Little, th~n Irv Alexander, then Harold Basowitz, then Joe Spiesman. Now, Ken Little wa congenitally abrasive, Irv Alexander, he took delight in being abrasive, Ha · Basowitz had some personal problems which inevitably made him abrasive and it wasn"t until Joe Spi.esm.an came in thatwe had someone who was will:m.g to 11 ten to people~ the other three disciplines in psychiatry; psychiatric s clilwork and psychiatric nursing with a feeling other than condescension, The other psychologists, frankly, felt that all the people in disciplines did not match up to them;, either in intellectual bility, l!l.astery of their field or col),fidence in.doing the job ow_to give them their due, I think they were in some small measure; correct hey probably the brightest of them all, but by no means the most competent n running the program and so I had·when I became Chief of· the-Branch I had y rather strident interactions with som.eof the psychologists. who saw me s a psychiatrist, who sawme·as having taken. the·,tob over as Chief of the raining Branch, which previously had ~en a psyeh:tatr:tst"'s job, because l ad moved into their camp and therefore that they could not either trust me or permit me to be involved in their program, all of·which I knew quite well better than_they thinlc I knew it, and 'i't wasnit until 3'oe came along that I really had a resonable oppoTtunity for interaction, the other guys ouldn't really tolerate me except as·the necessary admiaistrator that they had to deal with. Well~ in talking with Joe, though the other day. AM Where was John Eberha~d in that series. EAR No, John Eberhard was in a totally different emnp. Re just hated Stan, He was the first guy in charge of the training program and then he moved over into research • .A:M I am thinking about way back EAR Yes,. way back he was the ·first Ml He didnt have the same sort of defensivenes-s that I recall. EAR No, I don•t think so at all,. but these guys came in and :r- tlu:ak they were overally defensive, but we got all finished and I said· te·;Joe,, nyou know I really have the feeling that as you look back ,-GU have the~sense of most EAR(co tinued) pleasant nostalgia. H.e said it was a lovely place to work. specially, I recall I went back over this- TJ;ain::tng CO'mlllittee, he said li, those training eommittee_meetingswere an intellectual pe~san.al J . elight. All of us, all of 1,1s .had· that feeling of sharing thi~ interaction here so many good things were said:, so many bright people with no personal eed to take sem.ething away for .themselves ,but to· give te the totality and . ·1;-_. e said he. was always an absolutely wonderful thing and I said, You 'know, oe, I am pleased to h~r you say this because! am reminded that when!I ef.t Bob. Felix at the end of those two days I said to him, Bob you are just inc~.ely corny, he is just that kind of a guy. So is Pete· ow I -have just be~n talking to you pure mush but that is tae cm.ly way it ------- . ¥-ou 11 come out now and l; think it .was nothing tJ\Gre ·tham. a:· demonstration o.f ow ~al'!ll an;d positive a feeling he had had about those experiences and, ndeed, he didn"t say so. I think in: contrast to some of the experiences ·e had leavin8 NIMH and getting into this other world. Re had an unhappy erience with. a res~rch proj~.ct. that he himself had ftd.tfated. We were eally in many respects very fortunate tc\be there~with.a group of very The' point that Joe made, he said '·'man~tmany tfmes there as teo.sion, but it was construll:tive- tension, there was· always something that those kinds of interactions that were constructive for the total I had that feeling wo-rktng w;tth evefyb.c,,dy :i,n the lh:aneh a.nd even ·, utside, so yes you are absolutely right, 1 think that pervas:t..-ve teeel;f:ng tat comes out with talking. AM B ing inv_olved wiJ:h something t:na.t was :bnpqrtant,. well thet-.a we~e t;t,:D,es- e1; g oss - exp;a.nsii,n evolution process and you could see the process, there .,. 17 - i i AM(contihued) were undue delays or obscure evidences only of what you had done, evtn though you were working in a national organization, there was an inreresting feeling of intimacy. EAR T t!hink there was one other aspect of that which was very important for th seof use who had in~eraccions with the other parts of NIH'AND THAT IS ev n among the preminent reputations of all the National Institutes of Health, I lhink those of us at NIMH had the feeling that we were favorably unqiue i a number of ways which made us the best of all the Institute:'s. That is, no other InMtute had the happy accident of having among its personnel, people w~o totally identified with the total Institute. We were mental health s ecialists, that is what the Institute was about. Now heart, cancer and all t them, they had dual professional identifications, yes they were s~eciali~ts in heart reserach or cancer research but they were also something i 1 e se again, whether its physiologists or whatever the case may be and not so our case and then, of course, the NIMH when it got to the point after the Ccimmunity Mental Health Center's legislation where it was first in size for t~at superficial reason but more substantively important was the fact that no o1her Institute, I think, was as innovative as we,'were and some of our grants ' programs no others to e~~iid the total spectrum of the program for research and t aining and services, the very reason that we almost got thrown out of the N H, as you well know, with the Hundley Report, was an asset, was a unique a tribute of the Institute that added to this feeling of uniqueness this feeU,ng o positive identification with the Institute. S:o that m.essage Con\es out wtth e erybody that I talked to, now, granted that t have ~ighl-y, select gt"oup that I have been interviewing, since these people played an important role'i in the I st itute and therefore, a goodly portion of their profession :l:dentification i related to it,· so when you talk to FrankBraceland, even though he is mildly - 18 - EAR(continued) annoyed that it took so long for him to be tangibly recognized as the eminence that he was, nonetheless because of his personal characteristics and because of his feeling about the Institute., none of this was said with an bitterness whatsoever, it was just as if, well you know isn't it too bad th t something happened between me and Bob initially and ''he got his nose out of and so I waan't put on the Council until the late 1950 1 s but I co to testify before Congress, so I said to him at the end, I really fe t I had to say it, I said "Frank, I need to tell you something which I hope won't embaz:rass you, but I want to say it to you in all sincerity, of all the mjbers of the Council that I was privileged to know, you were far and away th, darling of all the support staff, the secretaries and everybody absolutely loled you an.d so he blushed a little bit, and I said, no it was just your thqughtfulness and the fact that you always had a kind word for everybody and alJo you just have a cherubic face, I mean there, is nothing one can do about I that - he is just a very kindly guy and he said a number of occasions how he pl lyed a conciliatory role among people, things that I didn ''t know about what wet on behind the scenes - Mike Furman and some other people and Frank inter,:, ve ed on various occasions. AM Ap opos by the way as an aside people who not only fel,t neglected but felt t neglect was going to remedy and there are a number of those who were never Council. One of them, of course, is Larry Kolb. Did you talk with La EAR Ve brilefly once, one year ago. AM He never quite recovered from that. EAR He never acknowledge that whatsoever. In fact, l: alluded to this earlier, s e people are able to do this much better than others. I mean it has nothing do with what they accomplished·o:t any other aspect than just., I:donlt krlow t i t is, I think Romano in one seneseyesterday did what too many other ""19 ... EAR(conJnued) people could do, put senses together in a sequence where it comes to being of reasonably ordered paper, most of us talk when you read it ards you wonder, it is close to being gibberish because your thought proc esses going on while you are talking and you don't control sufficiently 1 the sequence of words so that without the intonation, without the waving of the the little laugh in between, when you read the cold print it is t not that clear. Now, I have no difficulty because I heard it the first everything I read is fine but I can still tell the difference between someone who has that kind of di!iicipliried command of things and t of the rest of us. In a sense Bob was very good, both in the ability to ak that way but even more importantly to do so for 7 hours. I spent a full 7 ours with him and I think his hypomanic energy level aside, it was the ucturing of material that was quite good. Joe Spiesman, I hate to mention ds but I may have mentioned names, but Joe Spiesman had some difficulty re ollecting, even recollecting names which I empathize with greatly, since I am having that difficulty myself these days" Herb Kellman who is a remarkable c petent writer, who writes extraordinarily gifted papers, long papers, both erate and substantively colorful papers, he has done some very good theoreti.... ca work, his language was interspersed with you know, I mean, all the sorts of things, there is nothing wrong with it, itis just that is the difference be ween someone who speaks like a Romano • AM . , I think, always in addition to his intellectual command has assumed a st nee n,ot only the stance but I think he genuin!!lY describes his vo·c:~tion as an observer, an important observer, somewhat olympian, it often seemed that way ev n by his intimates in his own department and also somwhat outside the Institute he was a bit but not in it ! .J 20 Part 2 AM l'hey were talking about something much more that they ad libbed and I suptose lQts of continuing editing of remarks having to do with their own rel\tionship sorting them out trying to be objective, trying somehow to express thelselves mindful of the history of the posterity uncomforatble with saying EAR•=t :::n::h:an:o:h:kt:: :::l~::::::da problem, AM I on't mean deception EAR No I don't mean that either, I mean just sensored. Now, again to mention· Hollister doesn't want to talk to me. AM EAR now. I am going down to North Carolina next month and I will try to see again. Don Oken is down there on Sabbatical and I wanted to see Don on way - so Don is going to be down there and a couple of other people, in , I will try to see Irv Alexander, I am not sure that Irv will want to talr because I think he has mixed feelings about the Institute but I think I wilt try again to see Bill Hollister..,. he was very open with me about why he felr uncomfortable and I said look, Bill, I don 1't ev~n have to say it because it s your decision to make, but I do hope that you would be willing in any way that you see fit, what you want to say, say and what you don'·t want to say, don t say. AM Did you talk with Curtis Southerd? letter from Curtis, I need to talk to Curtis because he was very anci I told John I was going back to see hfm.;. Next month, I am going fact combining·a ,cot1:ple of ~hings, which you may or may not know, I am a11 AMA committee concerned with p;roject of TV violence and so I am ..:. 21 - EAR(continued) giving a talk at their Auxiliary Scientific Meeting in the middle of December down in Miami. We want to go down there to see Minni~ss folks, anyway, but on the way down there I am stopping at North Carolina to see a I I fet people and hopefully, again to see Bill Hollister. I am going down there frr there to see Jerry Carter and Van Staden. Do you remember Van Staden? who is now on a kind of retired basis and then a couple of other people down I th~re and then in January I am going West. Now both Jim Lowery al'l.d Dale cJeron are retired as you may know in a retirement community in San Diego, called Rancho Vernardo, and I haven't called them yet, but I want to talk to I bo~h of them. I AM I ~ just trying to decide whether they were level with me, EAR Ei~her or both you mean. I AM J:t lived his life like a poker game and you were never sure of what cards h:lhad in his hands but maybe the game is over, that game is over. Dale is vej y different and very close and private. EAR Wei 1, in q. way whatever I can get is to the good. I have to take what I can , obviously, and if they will, they will, and if they won "t ,they won •·t n there is George Tarjan I AM That 's a must. 1 EAR Absolutely, you see these two people to whom I wrote and who said to me in o e way or another they couldn't answer in paper, come interview, so it is Cameron, Jim Lowery, George Tarjan., Jolly West,. Ed Schneidman; who is there and who I think would serve as a lovely, _I den"twant to say vignette, sounds belittling to his program, but he really did a unique thing tan brought him in and I don't know whether you saw his famous· memorandum, ut Ed wrote a memorandum to Stan and I think it was a 13 page 'lll,etnerandUJI\ ecause he. is a very loquacious man to say the least. My interactions with have been, I wished we had taped some of the things because they would - 22 - ! EAR(co~tinued) have been an absolute delight to me. He counts my verbal I ! ;ability to the point that few other people are able to do and we have i jhad interchanges which I wished we had taped but anyway. He said, Eli, I jcan' t write this stuff down, come interview me, so I saw him in San Francisco lat the last APA and I said, "Ed, I am coming down to interview you and he C id come and interview me. AM lweat is he doing now? EAR ~ is a Professor of Psychology at UCLA and he is still involved in suicide I ! AM iWe talk about this counting verbal abilities and having his own, I will never forget one particular exchange I had with him, ve1;y brief, when he developed ,the metaphor of the psychological autopsy and I rem.ember talking to him once labout ----that technique, that kind of intensive careful multi faceted analysis, this case. not of a suicide, but of an episode of violence, someone lthat had run amuk, he said "Great, great, we will call it a psychological !biopsy" you know it was so quick. I EAR jis verbal fluency is just incredible, but couple that he ts e~traord±narily lbright and verbal, but couple that with an absolutely conscious, let alone lnconscious, need to be remembered for posterity, a psychological autopsy is as mµcp an!!Jchneidmanism" for being remembered as for its own utility, so iis your suiidde allergy is his term, the Journal is everything that Ed I !Schneidman does is to make sure that Ed Schneidman is remembered and he has the wherewith.,_1 to do it, I think he will be, he really is an extra0rdinary n, this memorandum that he wrote and I really do think it was 13 pages, 10 objectives that he was going to achieve in his program, sent it to Stan, and one of •Stan's many gifts is to be able to evaluate the eornpetence­ of someone fairly well, and Stan knew he had somebody. Whatever Schneidman anted, Schneidman: got to·para:phrase the old _ _,.._ _ _.......,_so he came in, cocky as they come and came around and what was the phrase I used, he said to me, "Eli, do you think I belong in this Institute? I said, Ed, I think - 23 - EAR( continq_ic;l--) I think you will be a constructive dissonance in the system. I like that he says, I like tht;l'.t, he is a pistol, he really is, so that is another one and a couple' of other people d~wn there, then up to San Francisco. I was supposed to have seen Esth-er Garrison in A~gust and at the very last minute she got a cold and called me thatimorning and said, ''Eli, I cannot see you today because r·have·a cold and I just will not see anybody today because I am not going, to give you the cold and I am not going to get any worse myself, so we will just have to postpone it.ft I' said,, alright, Esther, I will be back again. John Classon, there are a lot of people: en the west coast, so that is my January trip, .for the moment I am only Feb" , March, & April. AM You know what I am thinking as I hear this. If you could capture the fun that you are having in something written EAR As an aside? AM No, not as an aside, if you would c,apt11~e: that feeling you would havewt'itten a book which would be of enormous pleasure as well as interesting. EAR Oh, I see. AM If you could, it is this infectious feeling that you have about the people and about the events which are going to make this book, a book and not just-·-a chronicle, it then becomes a story of Eli Rubinstein. EAR Oh, don''t say that, that's another book, Ive got an<!>ther book, AM No, it seems to me that'·s what the essence of it·._, 1: am serious, J:'ln- totally serious. EAR Then why are you laughing. AM Because that is one of the funniest contemporary c-atch phrases. Haven ''t you heard that, "I am totally serious" EAR Seriously~- t-hat is another book. AM No it'$ not, there is another book, I am sure, but it is so much fun to talk - 24 -- AM(continlted) about this and to hear you talking ,abeut it, 't~at-•s the .quality as well. It seems to me that yo11 are talking about ah~~PPY book• I don't mean a book without --- but we are talking about a great:-.1c,:.venture in which t:here was a quality of excitement among. its partic-:J,pants which desC!r'Ves to be described because it :tsn' t that commo11. Periedtcally you see them or if you are lucky you are part of it. Maybe if yoa are very lucky •yQU .are par.t of it twice in your .lif~. We all try to gene-ralize from itin:ttially, the.first things you haire to do is get it down and I think there are some key sociologic concepts in the event_s ~£ the mental health movement which have not been put together •. All of us are uaually iii a hurry to sit down alone and have t.o recapture some of this, Well, this is usually the ten major factors which produced what? Shift in patients, location or whatever and they are.all.true but it seems- to me there is some binding generalizations having to do with.the velocity of inclusiveness of the species. There- is.an ant:t...segregat:ionist.feel as an open society quality to this which - very few movements, and it wa.s a movemen-t; - . EAR You see why I don•t want this to be_ is ponder.eus and a number ~f peeple.t~. I will mention. one-in particular, John Classon, when I wrote to him, I said,. yo~ know Bob Felix said to me, I think 1.mentioned this to you last time~ that from the very beginning he had a se.nse-.of history from .the .Nnm and so he says Bob Felix, he decided that. he would hav~ an in...house sociologist who would keep notes of everything that was going c,n;who would write a sociological history of· the,' Institute and the first one selected· ,_ was .Johnny Classon. \,', t AM Dick Williams is the ..only one who ever .tried EAR I have not talked to Dic;,k Williams and r ~~tsawJS:tck at the APA and interestingly enoughtDiek gave me a very erudite. and very competent r&countimg I was very pleased, really, we bobh had a good time, so I wrote to Johnny Classon and I said Bob Felix said this and besides would you pleaae send me - 25 - EAR(continued) the material, he was one of the 150 people I wrote, so as with many other people who acknowledged but didn't say anything, he said I am just terrib;I.y busy right now, I can lt do it and I will get back to :"you some months later, then I wrote a reminder note and he.ssaid, well, I rethought and I really feel that your taking too narrow a viewpoint of this, it seems to me unless you bring in all the other pub.lie health forces that are playing on this and indeed what was happening in England and elswhere that the perspective will be too narrow and he wants a ponderous"book. AM I think the problem, as I see it, the literary problem you have, is that to sustain the flavor the quality that you capture when you.talk to individuals for something as long as a book, you can see this, if this were a series of recollections and was published as such, which by the way is a possible format, in which you would link-together almost as if sometimes it is done on a -------recollections of something, this could be reminiscences of the Institute. EAR Did''you see Milton Send new book about the child mental health .AM No EAR What Milton Send did was in a sense the essence of what you are saying, he has a whole series of anywhere from two paragraphs to four or five pages of interviews with key people in the child health movement, divided into various topical areas and it is a whole book, I forgot the title of it, it just came out last yea.rand so he has got interviews including Orville J. Preen· and anybody who is anybody in the field of child health from the mental heald:I side of it not from the physiological or p,ed:latr:tc side of :tt ai,;d it is an interesting little book~ but it is somewhat disjointed inevitably:, since it is just a series of of people although what he does do, which I think is - 26 - EAR(continued) useful, is to introduce each individual with a paragraph, so .putting that individual in his or her place in this total pattern, but yes, I think what you are suggesting- is a possibility~; that certainly is another possibility. Well, listen, Minnie is out in the car. AM In the car, why is she sitting out in the car. EAR She is reading AM It's dark. EAR I didn't realize it was getting so dark, she may be back out in the hall. Let's leave this as tape, this is very useful to me. AM That I doubt. EAR No, seriously, I am being totally-serious.about this. You really gave me a chance to do something I hadn't done up until now and tha.t is reflect 0n this and also to get your reactions on some of these things so in that-sense it is very helpful and also I have had a.cehan:ce now to get some·feedback, you don't Fealize how much you have just given me, so let's leave that. I really do have enough from you substitutively AM Rambling as it was EAR But, there is alot there AM I was on vacation EAR There is really a lot there, so that would be fine and my suspicion is that it is going to take a good bit of my time. What I have now