MR. ROBERT ATWELL January 19, 1978 EAR I would really like for you to begin with your first involvement as Budget Officer, even say some of the things you did at NIH generally, but most importantly how you got involved in the whole legislative package and then how you made the transition from there to NIMH, so go ahead, at your own pace. RA About January of 1961, the time the Kennedy Administration was coming in. I went back to the Budget Bureau after, about a year in a foreign aid program, and was assigned to work on NIH, and I was in effect, the Bureau's Examiner for NIH, and there were then nine of the NI's. In the latter days of the Fogarty/Hill domination of NIH legislative matters and the Budget Bureau had a hard time being effective in the Public Health Service generally ~ in at NIH because of Fogarty, in effect it was dominated by the Congress and Fogarty and Hill went traditionally in giving the Agency more money than any President had recommended and the President's hadn't figured out how to beat that system and those were the real salad days of NIH. I think I was probably the first person assigned to kind of work full time on NIH. By then, as I remember, in the billion dollar a year range. I went around and tried to familiarize myself with each of the Institute's and with Jim Shannon's people, Chuck Kidd and that operation. It became clear to me that in all of this that the one NIH I found the most interesting, probably because I could understand it a little bit easierr NIMH. NIMH seemed to be different, the people seemed friendlier, but mainly it was sort of more understandable, comprehensible to a layman, such as myself. I 2. RA(continued) became kind of sold on the notion of mental illness as a tremendous problem of the population in contrast to, but not in contrast, but incidents and prevalence were greater than even the aancer and heart, and so forth. It didn't seem like you could do a hell of a lot for cancer and heart, anyway, because they were kind of the fair-haired ones and gather still are. _ So, I began to spend a little more time on that one than any other and then I don't remember dates at all, but it wasn't very long into that process that I was sitting one day reading the Sunday New York Times and came across this reference to the Joint Commission and I remember I read that, ripped it out and got a hold of the Joint Commission and had some kind of conver­ sation or other exchange with Bob Felix or Stan Yolles and that group about -my question was, what are you guys doing about this? I think Stan at that point was more my contact than Bob Felix. My memory of contacts with Bob Felix when I was Examiner were pretty much sort of informal, ten minutes around his table or something, but nothing very substantive ever took place with Bob. That happene_d with Stan, so there then were series of meetings with involving you and Bert and Stan, people whose names I am sure I wouldn't remember anymore. Ray Feldman somehow· figures in there, of course. EAR Phil Sapir? RA Well, not so much Phil EAR Lou Winkowsky? RA No, not Lou Winkowsky, I know those people and so on but EAR You were talking about having seen Stan after you had a look at the Joint Commission report asking about what they could do about it. 3. RA At that point by that time you guys had your game, or your act was beginning to come together and all that stuff that led to the famous green book, as I remember it, was the color of the darn thing and my role was to, I was at least smart enoug.h to realize the Kennedy's family interest in MR and my aim in that and Bert Brown, it's about at that point that Bert and I became friends. Mine and Bert's interest was to keep the two married and not let the Kennedy's put too much emphasis on M.R. and that meant that the M.H. stuff and the Community's Mental Health concept had to be brought along rather rapidly because it became clear that we were beginning to work toward a Presidential Message. When was the Message? EAR 1963 RA Okay, well we were really a couple of years away from that Message, but the whole effort was to kind of let Mental Health ride in on the Mental Retardation coatails. My colleagues_ in the Bureau, I was in sort of an odd role at that point, not totally unprecedented by any means, but sort of strange, of being an Advocate and it's hard in the Bureau, was hard in the Bureau to be an Advocate ----------------your a cutter and all that. I became a kind of advocate, so I was on the one hand trying to sell my superiors back in BOB on the important of a kind of new concept of delivery _________mental health problem and trying to get the NIMH addressing the questions that I knew that my superiors would be interested in at the Bureau trying to kind of to be sure that the quality of staff 1 were produced by NIMH would pass muster, so that's the sort of thing that I was doing. The time trains here just completely 4. RA(continued) escape me. I suppose that during that period from sort of say late - halfway through 1961, or late 61 until the middle - stretch of ft year and a half. Probably, 25 to 30 to 35% of my time was·going into NIMH, to some extent at the expense of other things and I began to encounter within the Bureau, the Mike March pr9blem and this guy had been there a lot longer and had a lot of more influence than I did. I was sort of junior in the place or midway between junior and senior, anyway at the most, and Mike never was much of a believer and he was a pretty effective guy and we had many arguments. When did Bert leave NIH to go? EAR To the White House? 190-1961. I think mid 61. You mean for the / ( mental retardation thing? RA Yes. EAR It was from mid 60's. He left very shortly thereafter and then came back again. There was a problem in the White House, which T still haven't been able to fathom yet, but he got into some difficulty with the people at the White House, came back to NIMH and then went back again to the mental retardation program for so many months thereafter. RA I think it was at about the point he went back when this guy from use, the medical guy. EAR Phil Lee? RA No, EAR Oh, yes, Warren, Ive forgotten his name. RA The older man EAR That's when Bert returned RA Bert went back and sort of a staff guy to him and then Bert and I were able together to fight a lot of battles within the Budget Bureau. Bert became very involved with me, with Mike March, and 5. RA(continued} Bert had more influence and a little more effective at the sort of political level of things in the Bureau and certainly at the White House than I was. When we got down to sort of a nut cutting time early drafts of presidential messages time and so forth, we were both very involved and both of us could point to particular words of ours, sentences of ours in the message and forever enshrined in presidential prose kind of thing, but Bert more than I and Ted Sorenson more than either of us. EAR Go back a moment though to how the special Ba.rthley-Jones Committee got set up with all the representatives from the - you remember that and I think you were involved really in helping to get that get set up, if I have my facts straight., RA One of the objections, I think, to the way we were proceeding with NIMH doing most of the staff work and my trying to sell it and so forth. Mike March would keep saying and others would keep saying, but there are other people involved in this, this is such a big thing it goes well beyond the NIMH, it includes the VA and the Labor Department, and so forth .. Let's us have an inner agency committee that really does this and so I guess I tried to influence the creation of an inner agency committee that wouldn't - Mike March, I think wanted one that would zap the whole thing and I wanted one that would bust the whole thing and somehow out of that, the famous Barfley-Jones Committee emerged. I ran into Pat Moynihan on an airplane recently and he's become famous and I walked up to him and introduced myself to him and said "do you remember me, we sat around the same table", but I don't think he really did but when I mentioned the BeattJones Committee his eyes.lit up and said "good old Beau Jones, how the hell is he and so forth" and Beau was a nice guy. I never felt he cared enough about the topic and I don't think Moynihan cared about it at 6. RA(continued) all. 'My impression was there was a guy who staffed in for Beau Jones. Who was that? EAR I don't remember his name, there was a guy who staffed it for Pat Moynihan, too, from the Dept. of Labor. I don't have all the names down yet, but Beau Jones is one the people I want to see. He is down at Atlanta, Ga. now. RA I've ,lost touch with those names, too. EAR Rashy Fein was there RA Rashy Fein from CEA, sure enough. a very bright guy. Anyway, my recollection of it is that the NIMH people were able somehow to control the outcome of that so that it was certainly benign and helpful, am I correct about that? EAR Yes. RA I don't even remember, was there a final report of the Beau ·Jones Committee? EAR Yes, there was. Actually there was a letter to the President which Moynihan had large responsibility for drafting, which pre­ sented all the material from the Beau Jones Committee, but as you know the NIMH staff was turning out staff pppers, almost daily. There was RA There was power projections EAR Everything. That was one, certainly, and I had to keep on going back, the one that is most vivid in my memory and I am telling you this to refresh your own memory, there was a call from downtown for a review of the relationship between law and psychiatry and Stan who was sponsoring this whole thing asked Bert and me to put something together. We got the request on a Monday and we had to have something downtown by Thursday, which was about par for the course, we were given like three or four days lead time on these 7. EAR(continued) Well as luck would have it, there was a book that had recently been written on law and psychiatry and so we literally I xeroxed the whole damn thing, I literally took paragraphs out of that, cut and paste the thing, put transition sentences in and by Thursday we sent down a 65 page mon9graph on law and psychiatry with. recommendations, principles, the whole works, and the word we got back from Beau Jones office was,"how do these guys do this, you know everytime we ask them for something which seems impossible, we get actually what we are looking for" We lucked into a number of times, but as you well know there is a tremendous amount of work behind the scenes and Joe Douglas, and Bert and myself and Stan, of course, honchoing people like Julie Siegel doing some work. We were really spending a tremendous amount of time on that. RA There was always a kind of gap between that work, my role was sort of mediating between that work and the way the Bureaus' hierarchy looked at life which tended to be different and a different set of questions were coming out of the Bureau at that point. I suspect that the bureau could have really sabotaged or have stopped the whole thing had it wished to do so, so my role was kind to insure that they didn't, once I became kind of committed to the basic concept. I think that the thing that finally sold it within the Bureau, the Bureau always likes new ways of doing things, hates old ways of doing things, this was a~ew delivery concept, that's really what did it and of course, all through that period, you would remember all this better than I, we were being attacked from the right wing of the Public Health Service, from those who felt that the delivery of health care was their responsibility. EAR It is very interesting because I think one of the important parts of this whole thing and you mentioned it yourself in commenting 8. EAR(continued) on the Joint Commission. The Joint Commission Report if you well remember, was really more of the same, a lot more money to put into hospitals, etc. RA It was NIMH that came up with a EAR That's right and so that when I taught courses on Social Poli,cy and Social Change, I point out very often the intricate sequence of events that often take place. The Joint Commission Report began with the Joint Commission, 1955 - it took five years to produce that thing, they ended up with more of the same kind of concept, but it nonetheless was the stimulus for the Community Health Centers legislation which took place literally 8 years ,1 after the Joint Commission began in 1955, so you have to put oall of these things in perspective and you just now added a very important additional attribute to this, that is the Bureau of the Budget was intrigued because it was something new rather than a continuation of the old. RA That was always the most saleable thing about i t and all along the job was to keep MR from off on its own. EAR What was your recollection and what was your involvement if any with the things that were happening at the White House at that time. Let me just remind you of one thing that I heard about second hand although I am assuming it is correct and that is, there was indeed, a point at the time that the legislation was being considered for implementation where the concern was raised at the White House level that if this program was funded it would inevitably mean the diversion of the pool of physicians in training from other specialties into psychiatry with this additional funding and Meyer 9. EAR(continued) Feldman and a few other people at the White House would literally, I think Bert and/or Stan were there, I didnlt ask this question, maybe you were there too, there literally was a question raised about whether the White House wanted to put money into psychiatry for this new program at the expense of the production of other specialists because the Medical School output obviously was fairly static at that time and if you fund this you are going to have more psychiatrists, and less surgeons, or less pediatricians or what. They finally decided obviously they were going to go with this. Does that ring a bell with you? RA Yes. I was only at one Mike Feldman meeting over in the West Wing, but I think that it dealt with that subject and I think Bert was there, Stan may have been there, I am not sure, Beau Jones was there. I have to say that throughout this whole period I had very little direct access to the White House. Bert had quite a bit, I had virtually none, that isn't the way the Bureau worked. I remember becoming kind of bureaucratically outraged, how come that Mike March can go to some of those meetings and I can'· t sort of thing, did the people representing me, like P. Sutton and so forth, were they really, but I was junior and that's the way it was. But I went to one of those meetings and I think it dealt with that subject, and I think the answer kind of comes down to "well, sure what you are clearly going to have to do is have more Doc's and this is a huge part of the total medical problem and that's kind of the way they answer to that. EAR Well, so then the legislation of course, was eventually passed and by that time you had gotten sufficiently enamored of the total 10. EAR(continued) NIMH program, why don't you tell us that part of the story. RA I had - there is a plus and a minus, the minus part of it is that I had really spent my chips on the struggles within the Bureau, I had not only antagonized Mike March, but I had really stretched my luck with all the people I worked for - all of that was sort of it gave me a feeling that "gee, I really kind of had it here and I really might need to get out and somehow or other I think Stan put the bug in my ear or Bob Felix's ear something about coming out to help the thing get set up and it really appealed to me very very much. At about that time we had bought a house out in the Rockville area, so the notion that one should commute after seven years was a pain in the ass. So I began to think that maybe that wouldn't be such a bad idea afterall to go down there to Building 31 and I really did like that program and wanted to continue my interest in it and that's how that kind of naturally evolved. I think there were some things that were in people's minds that were never fully expressed at that point, namely, the whole idea that Bert Brown will come back and take the thing over, that worked out fine but I think they kind of had that in mind and didn't tell me. There were always kind of hidden agendas around NIMH and one of the things that I have to say about NIMH, my memory of the NIMH, is that as a bur~auacracy, it is sort of quintessential to me, I suppose the greatest bureaucracy that I ever worked for was the BOB, the quality, the leaness, the analysis, the mere sheer confidence of people that worked there was very high and I have sort of always proud to have been a graduate of the place. First class organiza­ tion. I did not on the whole quite find the NIMH that good, the quinessential part of that as sort of a bureacracy to me is that 11. RA(continued) is my memory of the constant reshuffleings, continual reorganization, terrible back-biting and bureaucratic struggles which went on and I never fully understood why that was, but it always bothered me and the NIMH acted all the time as though it were fighting for its existence, when in fact, it was a reasbnably secure bureaucracy and kind of territoriality, and all of those things were incredibly important and I just remember my memory of those couple of years was full of all that kind of stuff that had never been part of my experience in BOB. EAR Could you relate that to individuals, do you think that just what you described is part of the role that Stan was beginning to assume more and more as Deputy Director. RA Yes, there was - I think Stan became Director in - when did he become Director. EAR In 1964 RA He became Director when I was there and I think Bob was about to leave at the time, I don't know. I certainly was never close to Bob. I didn't know the man, really very well, I found him sort of amusing but I didn't really know the man. I was closer to Stan, but Stan was a fairly secretive guy, he had his hidden agendas and you weren't quite sure and people were afraid of Stan, too. He was never the slightest bit mean to me, and I knew he was very bright and very analytical, well organized, and all those kinds of things, but I think people perceived him as devious 12. RA(continued) and I think maybe he did contribute to that sort of atmosphere, there was a sort of sense that Stan had his favorites and if you were one of them and Bert was for a while, boy you were just in and if you weren't, forget it. He could· be terribly sarcastic about people he didn't happen to like and tended to really make good or bad kinds, there weren't very many shades of grey in his judgment of people, not the most charitable individual that I've met. I think Stan kind of contributed to that, Stan had a kind of fortress like mentality toward the world and on the other hand he was certainly extremenly competent~ I don't mean to unduly knock the man. EAR Well, it's an irony, of course, I have now worked with him for 18 years, so I guess I know him as well as anybody does. It's an irony that so many, in a sense, conflicting points of view about him, depending upon the role that you played with him for one and also depending upon whether he is interacting with you individually or in a group. Individually, he is really very kind and a very considerate guy, in groups he has great difficulty relating to groups and relating to individuals in groups, that's not his style. Of course, that was Bob Felix' great strength working in groups. RA Just the reverse, wasn't it? EAR Exactly the reverse and so I think you saw one part of Stan's operation, but I think if you really look at the phenomena that you describe, namely, the shuffling and the reorganization and the kind of territorial approach to things, I think that there is no question that Stan contributed very signifcantly to that atmosphere. RA I remember how one guy, Joe Douglas, I watched Joe fall from grace, it happened before my very eyes, it happened on that trip 13. RA:(continued) to Europe and I don't fully understand it but Joe's place in the picking order wasn't good enough for Joe and Joe is a guy who is very concerned about place in the picking order. Do you know what ever happened to Joe by the way. EAR He died. RA Did he? Of what? EAR A heart attack about 3 or 4 years ago. RA Was he at NIMH at the.time? EAR No, he had long since left, he had gone down to help set up the 1970 White House Conference on Southern Youth and then he really got lost in the shuffle, it is a very sad story, but what happened in that trip to Europe. Let me give you some inferences Stan has, as many bright people do, a very high regard for intelligence and I think initially he thought, not that Joe was really scintillating intellect, but that he was a fairly hard working guy and fairly well organized, therev,1was no question that Joe was a very hard working guy, but I think something must have happened on that European trip, either that Joe revealed himself as being less bright than Stan originally thought he might be, or another very incidental and yet for Stan a very important attribute, that he had no interest in culture. Stan is inordinately interested in all kinds of cultural things, from Egyptology on, he is a very highly cultured guy and I suspect that he went to a a lot of museums while you were on the trip to Europe and a lot of things on his own, which Joe may not have participated in. RA No, I think you had come close to it by a comment there. I think that he concluded, and I believe he was right, that Joe wasn't very smart. I certainly came to that conclusion about Joe. Joe was a nice guy, Joe was incredibly hung up about the race question. Joe spent that whole trip wanting to be slighted, 14. RA(continued) wanting to be slighted by his colleagues and wanting to be slighted by Europeans. Europeans never slighted him, they never obliged him. Stan did on many occasions. Joe wanted to be Stan's roomate and Joe was assigned to me it' became kind of Van• and Stan and Joe and me, that didn't bother me at all. I figured I was number 4 in the picking order all along so, but Joe thought he was going to be and all of that kind of got to Stan. Part of whats happened there - 4 .guys were together too damn long. I was once married to a woman who said that "guests stink like fish after three days: We were together too much and we just got sick of each other and that was particularly what happened between Joe and Stan. I don't think anything between Van and Stan. EAR No, I don't think so either. I think that they were compatible in a number of ways. Incidentally, I saw Van last month. He is down in Florida and is really enjoying himself. Yes, they thought alike in many regards and another thing that they had in common, which is kind of curious, they both had the same opinions about a number of other people that they knew in common and that in a curious way RA They really reinforced each other in a lot of different ways, they were both fairly secretive guys and all that. I don't recall particulary having any fallings out on that trip except a couple with Joe maybe, but that wasn't serious~ I always remember Joe getting up in the morning, Joe with his bag of hair-strightening stuff, and skim stuff and· I told him he was trying to scrub off the black. I swear he was, and he got mad at me one time when I tried to deal with that question with him and Joe was a guy who would check out of a hotel and hand the porter a tiny little briefcase to carry out to a cab and he would give him a couple of dollars tip. I used to kid him about that endlessly. He didn't have much of a sense of humor about things like that. 15. EAR No, he didn't have much of a sense of humor about things like that and that's another thing that bothered Stan because Stan does have a sense of humor and he sees that as a mark of intellect and if you don't have a sense of humor then you lose a couple of points autimatically. EAR What were some of the things that - I am not going to put any of the things we just talked about into the book, obviously, but what's important about it is that it kind of sets a tone for the way decisions were made because I think Stan, and he knows this as well as I do, I think ineviteably·is the captive of his own feelings about people and in some instances I think he may not have gotten the most out of individuals because of certain hang­ ups he had himself about that, was his problem with Bert for example that Bert was not given an opportunity to use his potential as best he might. RA Stan was a much more analytical guy and when I worked for Brown for Bert when he was Branch Chief and I was #2, it was one of those situations where I did what I called the work and Bert did his thing, which is sort of the outside politicking thing and I was kindly mildly resentful of that at times. Fundamentally, Bert and I were such good friends we could kind.of laugh together and so forth that all of that was manageable, but I begin to understand that there were some hollow qualities in Bert, in terms of kind of the background that I had had, at least, Bert's - I guess it was okay because Bert let me run the show defined as getting out the regulations for Community Mental Health Centers and getting the regions organized and keeping the staff in tow, and all those crazy people that we had, Harry Kane and all that, that was really my thing and Bert was running off making speeches 16. RA(continued) and spending his life on airplanes and so forth, and doing some things, I guess, were not even related to NIMH for that matter. Bert was so much better with that kind of thing than Stan. Stan was really terrible, as I remember it, at the PR stuff, I suspect he had pretty good testimony in terms of stuff on the hill. EAR Extraordinarily good testimony. RA Not in terms of the work at the bars and back lobbies and the men's rooms and all that kind of stuff, that wasn't his thing, that was Bert's thing and I think that Stan on one hand resented the fact that Bert was more gregarious indidividual, a more suffcessful politician and at the same time realized that he wasn't a good manager. One of my hangups all the time, of course one of my great deficiencies in that place is the psychiatric domination of it and you just, which I am sure you felt all the time you were there, you had to be a shrink or you were nothing around that place and that always bothered me and if you weren't a shrink you had to be a Ph.D., if-you were neither of them,it seemed to me kind of dumb, I can't understand it. EAR Well, it is an interesting phenomena RA They even signed the mail, I always tell people, they even signed the mail down there Ph.D. EAR Let me comment on that, maybe that will refresh your memory for some other comments on your part. There is an interesting, almost paradox about NIMH, that you are absol~tely right, ther~ was medical primacy from the word go and I have now documented that in ways that I knew from the beginning anyway, but there 17 EAR(continued) are some interesting RA I always felt Stan was a believer in that, too. EAR Everyone was a believer in that, but at the same time to be fair to everyone, beginning with Bob Felix, they were extra­ ordinarily liberal by comparison with most of their colleagues RA I agree. EAR in brin~ing~in non-M.D.'s into responsible positions, so there you were, you see and me, in a senior position, so it is a paradox in a sense, they never let that thing go and yet they had the flexibility to bring good people in, even though they weren't M.D.'s and in a way, in a real world so to speak where you talk about the NIH is a medical community, and I think that none of the other Institutes' had that degree of flexibility, so there we are. RA As I look back, the person I really became the closest to at NIMH was Phil Serodkin EAR Of course, Phil has a Ph.D. RA Phil and I identified very easily very early, I.came there before he did, but he had been known by all of you for years, and had been in the business for a long time and so on, but he and I still are much closer - I talked to him yesterday - than'I am now with Bert, Bert and I will see each other but rarely, he is always too damn busy and so on, but Phil and I have been close, Phil and I thought alike and Phil became my kind of entre to Stan. Stan isolated himself, that was my memory, he was a hard guy for me to get to see ultimately, but I could do that through Phil. Phil, for a while, had a pretty good relationship with Stan, I suppose maybe he always did EAR He did, actually Phil began working for Ray Feldman, and then 18. EAR(continued) shortyl thereafter he moved up to work for Stan, and remained with Stan, and Stan has a very high respect for Phil, understandably so, because Phil is an extraordinarily hard worker, a very astute guy, and a very solid citizen. I haven't had chance to talk to him, I've got to go out and go to ColoFado there are so many people to see, this thing has gotten so mushroomed, there are so many people that played an important role. You were starting to say, to get back to the issue, that your involvement in the Branch really was as Deputy to Bert, because of Bert's own style, really to do most of the work at home while Bert went on the aeroplane. What were some of the things that you can recall that came up early on that perhaps had a critical impact on the way things went, the five essential services, well you go ahead. RA The five essential services thing was a struggle within ourselves for a while, what they were and whether we were going to require all of them and so forth and I don't remember what side of those arguments I was on, it doesn't really matter but I suspect Bert and Stan were pretty tough about the minimum five and I assume I was, too, the memory of the greatest single issues had to do with ourselves versus the Hill-Burton people, to what extent this was a facilities construction program, it was going to be run like one and to what extent it was going to be something different and I remember just a kind of series of lost battles in there with them, I don't remember the names of some of those characters, but I remember the hours, hours we spent EAR Harold Granning RA Granning, yes, but there were staff guys, Bill Burley, a whole bunch of guys that I did battle with, I was in one of those 19. RA(continued) offices at the time that Kennedy was assassinated I remember that quite vividly, we were trying to retain as good bureaucrats the program for ourselves rather than give it to them, substantively to keep it as a program EAR Also, to keep centralized control rather than than out at the regions. RA There was the centralization question, there was the State's rights question EAR And the size of the catchmederius RA Yes, size of catchmederia was one of my favorite struggles, I wanted small catchmederia and I think the 100 thousand thing was something that I was battling for and Bert did not feel: nearly as strongly about, but that was one of my things because I imagined new mini-state hospitals of the catchmederia was too large, transportation problems and so forth and I remember argu­ ments with Bert, I think about the 100 thousand catchemderia thing. EAR What or how strongly do you think the problem of centralized control versus localized control really played a poor kind of influence, that is, I am pretty sure even though I haven't asked this question directly of Stan, but I am pretty sure that part of Stan's almost implacable approach to this was there had to be standards, there had to be national standards, they had to be held very tightly, if you let go for flexible things at the regional level, the whole thing would fall apart, quality wise. RA You could give it away to the States and we were pretty contemptuous of State Mental Health authorities being hospital dominated and all that kind of stuff and we were afraid of the Public Health Service, so we were kind of on the one hand, we·'.were bureaucrats 20. RA(continued) fighting for our turf, on the other hand, we were visionaries fighting for something we believed was the way to go, we were certainly federalists, we did believe that, if there weren't all those standards, that you would never never achieve, it would somehow get pissed away into the great mauve of huge States' systems. EAR Can you recall any particular incidents, there was a big fight as you know in Los Angeles about the whole catchment area, were you involved in that one? RA Harry Brinkman, I don't remember the issues again. EAR The problem in Los Angeles was that if they weren't permitted to violate, so to speak, this catchment business, they really couldn't set up an effective system. RA That must have been after my time. I remember Harry Brinkman, I remember talking to him, but I believe that question got settled after my time, in-fact, no money had gotten disbursed by the time I left, which was in February of 65. EAR A couple. 6f other points. RA We were fighting for the principle of staffing grants and Phil always felt that I had a lot to do with staffing grants, and of course, I was much more interested in staffing grants than I was construction grants. I think he tended to overestimate of how important I was in that, but he always frequently mentions that. EAR The idea that there were going to be 2000 community mental health centers, which was a very neat way -- 2000 x 100,000 is two hundred million, we got the whole population covered and that was going to have, clearly have, have the population state mental hopsitals. Now, George Tarjan the other day said, that's an almost ridiculous 21. EAR(continued) piece of arithmetic because all you had to do is have 100 beds in each one of these places, so there is two million people in all the community mental health centers you then have the four million population of the S - no four hundred thousand population of the State Mental Hospitals. RA We didn't think of it in those terms. EAR No, I know we didn't, but it is interesting that that I believe is illustrative that comment by Tarjan is illustrative of some of the suspicion, perhaps even some resistance, that existed out in the field. Can you recall any other incidents in which' that happened.? RA Everybody, including the regional people, and the State Mental Health Authority types, well state mental health hospital types, all those people felt that we were supremely arrogant about that one hundred thousand catchmeria and five central services thing, ,I and they tried to weasel that thing and chip away at it at every opportunity, and I suppose in many respects, they were righti those were the lines, and we had them all the way through, it was an endless struggle to keep what we felt was the conceptual integrity of the thing. I think this is one of Stan's great strenghts, he held on to that against everything, and you couldn't do that now in this era of States' rights, but who is to say what's right. EAR You raised an important point, I think that one of the themes that comes out of this whole examination of the NIMH is that in many respects we caught things, we caught the development of movements at a crest in the tide, where we could take advantage of things, and had we been a little bit earlier, you wouldn't have the clout to be able to do some things, had it been a little later in the times, it would have been such you couldn't have pushed some of 22. EAR(continued) those things through and at each pha.se of the growth and development of NIMH, I think, there is a great deal, of pener serendipity, almost luck involved, in being there at the right time with the right kind of development. Now, obviously, luck doesn't play the whole story by a long shot, but it is part of the picture. From your perspective in terms of the Community Mental Health Centers legislation, the Kennedy's were there, and you knew what was happening in the BOB, that this was a time to take advantage of that sort of thing. RA There was an atmosphere which we supposed to be taking a look at the country's problems and what we can do about it. An exciting time. EAR Anything else in terms of your involvement, Bob, that you want to put in the picture, I know that your responsibilities were on the one hand, very broad, and yet, very much focussed on the Community Mental Health Centers legislation once you got to NIMH. To the best of my recollection you never attended small staff meetings, did you? You~ay have gone there once or twice with Bert. RA I don't remember to tell you the truth. Being now that I am married to a physiological psychologist, one of my kind of regrets in a way is that when I was at BOB, I didn't pay more attention to research. I guess I felt pretty hampered about that, but I didn't know that Kety was famous and John Eberhard's whole operation, which I really never paid much attention to. You know, I suppose in the long term, that kind of stuff, as well, of course, the thing you were involved in, is kind, maybe that's what really lasts SIDE 2 23. RA tremendously high quality, not only the granting ones, but the Intermu:tal stuff and that probably could have been stressed a bit more attention given to what the major thrusts ought to be and so forth and the emphasis now on the biological basis of.mental illness, which was defintely not in at the point that I was there. That's pretty exciting stuff and it really needs to be pushed. EAR I guess one of the things you didn't have a chance really to see in total perspective because of your concentration on this issue. RA At BOB I could, not when I came over. EAR Even at BOB you latched on to this thing early on, but I think one of the great strengths of NIMH is precisely that we had, as distinct from the other Institutes, research and training, which the other Institutes had, and also a Services Program and so that -- tripod which remains, even today, although NIMH has gone through all kinds of transformations, that tripod has· really been the strength of NIMH. Now, the Intramural Program very important but not distinct from the other Institutes', they all had Intra­ mural programs. RA NIMH had a Service Orientation and all the rest did not. EAR Yes, a Service Orientation, not at the expense of research and training, but in addition to and that's something that a lot of people, both in the research area, John Eberhard's for example, have never been able to fully to accept the fact that the Ser~±ce Program, not only has not hampered the" Research Program, either 0 Extramural or Intramural, but in fact, has augmented it, that is that no money, you can play games with figures, of course, but that no money,to the best of my understanding, has ever been taken away from research and/or training to put into the Services Program, we got more money for the Community Mental Health Services it wasn't taken away. Any other points that you want to make 24- EAR(continued) in terms of your involvement that perhaps we ought to put on the record. RA I had real questions all the way along about the quality of staff, particularly at the Regional level. I had questions about the quality of our own branch. I don't think we were the greatest, we had some real weaknesses there and I think that the quality of staff in the Regional Office was very mixed. I never was terribly impressed and I really always wondered whether those people really had the religion, whether they had been converted to this thing that I thought I was pushing and that's that kind of fru~tration about bureaucracy. EAR Are there any people at the Regional Office that you recall in any particular light, John Bell, for example, did you have much interaction with John Bell. RA Yes, you mean did I think well of EAR Whether you though well or not so well of them, any sorts of interactions that document the issue that you just described RA I guess I am just too far away from it, I guess. EAR John Bell, though, I suspect, probably is reasonably high in your recollection of confidence among Regional Office people. He really was one of the stronger people at the Region. RA Could be. EAR What about Phil Sorotkin's involvement in all this. Anything that you can call specifically. RA He was a strong, strong, Federalist all the way through and at the same time having been in a State Mental Health Authority he really knew that world, the political world, I just felt that he had done it all and he was sort of a complete individual because of his background experience, as well as his skills, and 25. RA(continued) he was, of the people, close to Stan, the most kind of committed to the program and I think from his own ambitions. Phil was always ambitious, but not in the way that Bert was, but I just felt that he was the most influential guy in the office. EAR One last question, perhaps, very difficult, if not impossible to answer. In retrospect, are there anythings in idle thoughts you \ may have had about this whole program, anything that you think we took a very bad wrong turn or contrary wise anything we really stuck to our guns appropriately for? RA We stuck to our guns appropriately for the five essentail services for the catchmedieria. I felt at times that we let ourselves slide iii.to a Hill-Burton construction model without, with what we thought, but could have somehow fought that battle a.little more effectively, a little better, because the people we were up against weren't very smart, I felt and they had a lot of political clout, but I felt we could have really won that. I didn't like the way this thing was kind, I felt uncomfortable with these bricks and mortar characters in the early days. I didn't feel that was where it was at, it kind of slid into that. EAR Let me ask you a personal question, Bob. You came to the Institute having been attracted by, as you described earlier, in one sense the quality of NIMH, it was a comer by contrasts to the other Institutes' and there seemed to be more competent people there, it was an area that you understood better, all of these things got you attracted and then, of course, the circumstances of being involved in Legislation, so that you came there with a very positive feeling, and it certainly worked that way, what was that prompted it you to leave, wasAthe attraction of the outside more than anything within? 26. RA I was sick and tired of Washington, D.C. and I wanted to move to a certain part of the midwest, the Wisconsin, Minnesota area, and when Bob Aldrich, who was kind of constantly a friend, while I was around there, turned up of something of interest to me and I sort of snapped at it, it was a tremendous opportunity, so on the positive side, an opportunity to go to the part of the country that I wanted go to, into education, which I wanted to go into, all that, and 90% was all that, the other 10% was my frustration over this ponderous bureauacracy, and some of the comments T just made and feeling there wasn't any future for a non-Doc like me and this crazy zoo of shrinks, and I think that was right and I had given quite a few years at that point with the BOB time, nothing really terrible. EAR Anything else you want to comment on, anything we left out, we covered a lot of territory but maybe we left something out that you wanted to comment on. RA Well, just a person in all this, Harry Kane, I always think of Harry as my protege EAR He has gone quite far RA He has done magnificently, but he is the guy I sort of hired. I thought he was one of the really bright ones around the place. I think you look about how you feel about these things and some­ how when you look back on a career and what you were able to do, part of the joys had to do with the people that you have helped to bring along and the good guesses, and God knows, in my own case I have made enough bad guesses on people, but those good guesses make you feel really good. RA Have you been in touch with Harry recently? What's he doing? 27. EAR He is high up in HEW, in some office of planning and control. I've forgotten the title, but he has gone quite far. RA Do you spppose he's the guy whose getting my.name on the social security EAR Oh, yes, it could easily be. RA I haven't had any contact with Harry in years - six years ) EAR He is at that level, very easily. Well, I thank you for taking time out of your busy schedule, getting nostalgic about things. RA Sorry you are not staying around longer, where are you going from here? EAR We are going to L.A. RA I would have liked to shown you around and go out for a drink or something, I have·a Faculty meeting right now EAR I have a wife waiting for me over in the Library. I appreciate that, I really feel that if I am going to get this done, I had better spend all my time on the business end. RA Is this a sabbatical for you? EAR Yes, I am on six months sabbatical now