DR. DONALD OKEN November 29, 1977 ~~ ~ ·rr" EAR Begin~ like.., l t might be useful because of the_,~ way you came on, Pon, perhaps really to talk about the way ~ou really began at NIMH AND THEN we could start to talk about some of the specific questions r have. DO What I remember most was the initial period , ..tct suppose in some ways ~ Q_Jt~ it has·- in my later experience.!Mtaybe a little later to make some comments to .try to put that into a little broader perspective than just some of the negative personal feelings I have. The first thing that happened were/n rapid succession, one, my finding out ~ t"-,ecrui ted me EAR What year are we talking about now? DO We are talking about, I came on, I guess,. the beginning of 66 technically for a while, you know consultant officially, and Ray came up and talked with me the latter half of 65 and of course, Ray was a very sweet guy and I sort of related to him, plus to my image or fantasy of what NIMH was~ iut what happened in somewhat rapid succession was first, I found that there was a reorganization so that in some sense, although I was not that sophisticated at that point,_ in fact the job that I had was in a sense downgraded. I don't think that disturbed me too much at ther:1time, but that was one thing. Second, Ray and I had negotiated a GS grade and there was then some talk about the fact, "'gee, that might not be possible" and partly because of something else that happened, whiah I will come back to. Apparently when I expressed sort of surprise and 2. DO(continued) and dismay, although with really no attempt to act out, I tend to b~ very straight about such things. Stan had lunch with me - I don't know who told me or where it may have been used, some where along the line, someone said to me -"'look because he is trying, he has heard that you might leave and he is trying~alay your anxiety and keep yo1:,and at that lunch, Stan said, no, no, the grade wouldn't go through and -in fact it did and r· remember distinctly, no it will go through and I said we won't discuss it any further, period, that's it, because that'l; the way I was used to doing thi~gs. But, at any rate, the third thing that happ.ene'd., somewhat in the middle~· was that Bob Weiss who had I guess been recruited to take the job that eventually you took, but took it with the understanding that it was a some­ what higher level, under the old organization found between the time that I guess he accepted the job and the time he came down that had in fact been again downgraded, if that's the right word, and then withdrew and went back to Dartmouth and I think probably that event heightened my consciousness more than what was happening to me. So, then I started with that·sort of funny business and then, although I guess there is another area which I will come back to just to play out that theme, then there is the reorgan-i.:.. zation proceeded to be implemented. A lot of tensions arose, there was a lot of anger, feeling of betrayal, and disaffection along a number of people, of course, there was a lot of feeling around. Phil Sapir's leaving - Inasmuch as I can reconstruct it, when Stan ~sked me to be Acting Director of the Division he had told Phil that that job was not available to him, and Phil said that he said "well, given to what seemed to Stan to be the 3. DO(continued) realities and needs and so forth that I might be the logical person because Phil had come to talk 1 to me and you know Phil is not/ at least me doesn't come across to me as a manipulator so r~~didn t t re~:ct that way either. But there was a lot of negative feeling_\-tha·t he· bad done an excellent job and to this day I don•t know whether in fact he might not have been I a good person for that, mistake or not he did have the mentality and maybe there was a need for a professional, I don't know, but he certainly had in many ways provided kind of a creative leader­ ship, although somewhat surprisingly, I think in terms of his boyishness and if is surprising that so many people felt so l9yal and dedicated to him but they were. There was a lot of disaff~ction at that time among the old timers and that's the thing that struck me and then, of course, Ray left not too long thereafter, although the reasons were given in terms of retirment and personal life, and so forth, it seemed pretty clear that some of this had to do with Ray's not wanting to work with Stan, he had just gotten promoted to be Stan's Deputy and I think I took that less ideo­ logically, al though it probably had some meanings that I don '·t understand in that regard as I did a.personality clash b. that the one person that I really - that was very protege, that would be too strong, that I had as a kind of a senior figure I had related to was gone, so that left me somewhat at odds, I don't know that that is terriby important to the histo~y per se, but it maybe reflects, so that's what was going on there at the time and r thought a fair amount of tension and turmoil, but of course there were all of thes~ at the same time sort of 1 4. DO(continued) fantasy positive feelings about what it would mean that we-',might beoome a Bureau and that we were going to be equallto NIH which, of course, subsequently turned out not to be, but that I think bad some ameliorative effect in allaying some of the anxiety because it was clear that people didn't ,--r.elate to Stan the way they did to Bob Felix. I never knew Bob very wel1, so I can•t say mu~h about it, it is an observation that I think is pretty clear. Now that to me, let me try to gene:raiize something away "from my more personal - there was a broader process go}ng on other than whatever the meaning of organization, reqrganization and intra-governmental maneuvering and restructuring and that· is; I think one had the sense of NIMH · as ··a group of people wll2.:n2.a strong sense of mission - I am sure it was romanticized but somewhat selfless. :and terribly ded_­ icated, with their eye on the goal and 'terr'ibly concerned with what they were doing and·what they were accomplishing and really worrying very little about the techniques about the · way they · were doing it except as ways in which they could accomplish things and so the problem ·was, how did you.deal with the rules in order to get what you really wanted to do, rather .fi-lan what were the rules. I think, now I have to jump to my present per- . b ecause I t h 1.n . k now my perception . 15 -~ an d I spec t 1ve, very clearJ-Y think the·national perception of NIMH is of a very bureaucratized and formalistic and less functionalistic, if not necessarily cold at least uninspired body. How much of this is prophesies or self-fulfilling images or self-fulfilling_how much 1-· is actually 5. DO(continued) a change and how much is created change I don't know but at least and I see in some sense that period, the- only rea$©·n I mention this, r- think that that was the turning point, I mean literally when I came, but that period of time was the turning point. EAR Could you say a little bit more about that because I think it is an ✓ important point. Do you think it was primarily a function of . growing size, do you think it was primarily a function~of the age of the Institute, do you iihi:nk it was a function of the change of leadership - all these or any of these other than that? DO Well, I think it is hard for me to be sure, you know very well that I I had very negative feelings about Stan, although they obviously over. time they have been considerably buted so my murderous impulses - but I think probably in two senses or severa:l sens-es what· I think Stan may have been intere~ted in other kinds of things . - second. of alL, he clearly was a very different kind of personality and in­ spired much less of a sensei he is less charismatic and so stimu-. lated less of-that same feeling among other people. But, also I think by virtue of the reorganization and the turnover in perso1'nel, for example, getting if you will someone like Phil Sapir whether it was intended or not probably had that effect of dampening that kind· of thing. It is interesting, I came very clearly as a transient.J when I came it was with no intention of making a career of it but as you well know I got married and in some ways it was really kind of convenie,,nt for me to stay and I was beginning to be seduced into the notion of staying on at least a few more years when the problems 6. / DO(continued) I had with Stan came to a head, :r don't know whether that's the right way to put it, but at any rate when I had the problems then, but my point really is that except for that temporary situation my_life really in terms of my career concept I was really never totally within NIMH - I was a transient - and so maybe my perspective is quite different from some of the people who were there ten years or 15 years or who intended to be for 20 years and what not. I got off the track that was it. I think the size did have something to do with it in a sense that any time you get,an organization that big it gets less personal and more btireaucratized a_nd then you start drawing boxes, worrying about the boxes and then you do lose the people, sure that must have something to do with it. EAR Let me go back. I think the point is very well taken and I think it is important incident in a sense to mark a kind of turning point that you are talking about, whatever the reasons for it may have been, but now I wonder if you would take a few minutes to think about the substantive things that you got involved in and what your feelings were about that and how that in a sense reflected any attitudes or opinions you may have about the Institute operation. DO Well, I am not sure if this is what you are saying. I was thinking in the midst of some of the other business about the image and feeling about NIMH. I also came with a certain amount of - I don't c know what the right word is - huberous in that area that is, let me put it this way, I thought these were really terribly dedicated people but they didn't really know, they were nevertheless dedicated bureaucrats and I found it somewhat humiliating in a positive 7. DO(continued} sense of that term, a humbling experience to find out that there were some really dedicated and very knowledgeable people and that I wasn't coming to·with my brilliant insights from the outside, so that was a very positive experience and I don't think that had to do, so that I found that there were people who could.be, in other words really if it what in some sense was the image of NIMH I think in fact was correct I found when I got there, even though I perhaps out of my own insecurity and narcissism and what not, I had this fantasy that nobody knew anything at least not.as much as I did and I found out people knew quite a bit and that there was a hell of a lot going on. Now, I am not sure whether that quite gets into EAR You are touching on, what I was really getting at was when you came in I think that just to give you some confirmation what I suspect you already know, that is you were among the relatively rare breed of research psychiatrist, we didn't have very many in the Institute at the extramural level, and I think well, Stan, Ray and others of us wanted more of that kind of·competence within the Institute and inevitabl;j!, even though we all disavow it to some extent, there was a hierarchy among the various professions with nursing and social work being low on the totem pole and a struggle between • • psychology and psychiatry as te who realiy was in ai sense:the superior, .with the psychologis.ts · f ee,liing since they wetee really \ the scientists, there were only a few psychiatrists that came along that could do that kind of job and psychiatrists on the other hand feeling that basically this is a medical specialty and everybody else's partially 8. EAR(continued) ansilary I think that within NIMH to use your term about Stan, that was somewhat muted - I think we worked together very well, but it was very important that some­ one like yourself come in and take on the kinds of responsibili­ ties that you were asked to take on. DO That was another reason for recruiting someone like Bob White ·who represented academic psychiatry also, although it was for training function. EAR Well, let me ask you then, but don't hesitate. DO I think that is muted, I hadn't seen at that point and I want to say something again later, in retrospect with time about that. I didn't get much sense of inter-disciplinary tension within NIMH~~ I think there were somewhat within the constituencies and that.is what I maybe want to come back to and in fact, for example, Phil Sapir wasn't a psychologist or a psychiatrist and was re~lly in a sense not a profes~ionalandct'I think did a much, in a way, mqre l\J u- ,f-\-rt sensitive capacity than Dick J;.avert, who was very clearly iden- tified with professional ~syeh~ai:ry psychology and I am nottrying to knock Dick. EAR Phil made himself, so to speak;, he really grew on the job enormously DO So, I didn't get any great sense of that tension - I will tell you where I did see, and tension might not even be the right word, and this, of course, plays on another major theme related to NIMH that is now on a new phase and that is service versus let's say the NIH like functions. I think it would be fair to say that we really had no relationship to the service di vi:sie,·ns ":except very 9. DO (continued) peripher1flly semi socially and even the Applied Research Branch really never~belonged to the Division and was sort of there and Howie was head of that and wasn't really part of the rest of the group, so what was going on in what then became Allen Levinson's shop was sort of out there and that's where I think - I don't think it would seem so much then as :tens'io-n, simply too excessive acti v,i ties. 1 I think we saw ourselves as much more related to intra-mural and I bet the people in training did, too - I conjecture that. That was my sense of it and I think research had a kind of a friendly competition with training, not in a really negative sense but in a sense of we do a better job at our allied thing than they do kind of thing, which doesn't matter if it is true or hot, that was the EAR That had a very practical overtone because it was a competition for funds with the realization, you know, that there was a limited total amount and whoever did the better job might then get a slightly larger piece of the pie. DO Right, although I don't think-it was ever seen so much in that sense but a little bit. I think we, I say I, it would be more accurate. but.>·maybe it was we, saw ourselves as really related to intramural·and to training and service was somewhere out there-. With the reorganization, not only was service de.vel<:>,ped somewhat more elaborately, I think I would have toga back and relock ------ , but there were a number of these speciql agenci~s Centers and special branches in areas of things like minority mental health violence and so forth~ which cut across into 10. DO(continued) service and also cut across into a broader definition of mental health, sometimes it wasntt just service and the change in NIMH, also I think th~t is another key issue, so the issue was not maybe just the b~oadening of service per se, but a somewhat overlapping and concomitant; if you will move away from a strict constructionist definition of mental heaJJ:h, away from mental illness mental health to social problem mental health kind of thing. Now :r don't have a clear image of where Bob Felix stood on that - r:rknow that he was very interested in service but my impression, maybe absolutely wrong, was that he was wi'ithin a more traditional framework. I don't know exactly where Stan ideologically stood on that but op~rationally in terms of his reorganization, it very clearly moved in that directi0ri;; it is unclear to me whether this was simply a very cold and calculated political decision or series of related political: decd.s.ions on Stan's part having !~:.: absolutely no relation to con~ent or whether it reflected his personal beliefs about NIMH and in some sense, that fact that I could even raise that kind of question reflects both my feelings about Stan, but even mo:te broadly my feelings about the Institute and about that comment that I made about mission and so forth. It wasn't even that people felt that the NIMH staff was dedicated but one always knew where they stood, whereas, and again this is colored very much by my subsequent experience with Bert, who is a sweet guy but I wouldn't buy a used car from him and the notion that you do what you think will sell rather than what you think is right - in fact, you don"t even care what is right and that's the, again, i~age, accurate or inaccurate, that NIMH 11. DO (continued) began rapidly to as,stime and -I think in a funny way much more under Bert thatt.e'.~_Stan, even though )3:ert is a more friendly and less cold person. EAR I think you are absolutely right and I think part of it really is that, whether it was clea1::,on the outside or not; Stan did and does have very strong substantive convictions - he is not above being a pragmatist playing a political line, but I-think he had a very strong conviction. DO I could believe that easier about him than about Bert. EAR That's the point I ·am, ma-king, that is very true, I think Bert 1 is much more expedient and much more willing to be political and prides himself now, which is a lovely personal _rationalization that he makes, prides himself onbeing a politician in a political world and that I think can be very dangerous self-perception to have, when that'·s really not the game you are suppose to be playing. DO Well, at least by my de£inition, it~s not, but I think it is by Bert's and you said it wa·sn '·t by· Stan,_ s. I would say that to some extent that was unciear with Stan, although I think people realized that Stan was committed to ----~and that end of it and much more so than to - in fact I think we in research, and I don't know how it was :run Training when you wer¢ there, it may be hard for you since you stayed on in closer relation to Stan, whether you can remember how things were felt then, but at least my perception was that we felt that Stan was too committed to Service and that he really didn't even understand or have a sense1 of what, I will oversimplify it and say the academic, but I think it was more that than that we were concerned about his 12. DO(continued) politicizing, it was unclear rather th~n being clearly in the other direction. EAR It is an interesting issue because in- fact one of the things that Stan prides himself on, believe it or not, is that a great part of his career has been dedicated to serving the so-called scientist, and by that definition../ the academic community and. there were constantly among the kinds of ________in the system, which your one case is an example,· there were constantl.y concerns on the part of the Intramural people, they weren~'-t getting their fair shake, when in fact, I know from personal knowledge that on many occasions Stan went to bat for the INtra­ mural pr0gram, but he was operating against an insurmountable handicap in terms of the very endearing qualities that Bob Felix had and how Bob Felix related to those people pers-onally. DO That may be it;,_ it also may have -to do with - I dont' know, one of my past medical cen.ter President':s would have a terrible habit, he was a very tough guy and he prided himself on being tough and he might go out and try to fight like hell to get you more money, but if he didn't get it, he would then be just- as - instead of comi·ng and saying ''gee, I really feel terrible that we don't.h-aue -it~ he would say, we will just have to do without it, it had nothing to do with. warmth, it ,had to do with his feeling and boy, you had to tighten your belt, but that was the wrong way to do it because people heard it as he didn't fight right. So it may not just be coldness versus warmth, it may also be, I don '·t know how to - smarts, of course out o:f your personality. 13. EAR This touches on the sorts of things that I really want to try to illuminate in this thing because I am so convinced that above and beyond the most obvious influences, political support and all the rest of it, it is all these little nuances that played an important role in the whole picture. DO Let me tell you something that I think has gone on now.. I don't know if -it's original but it has occurred to me as a kind of original thought, I don't know how it plays back to the past. At the moment there is a terribl~ amount of tension on, partly between the ---constituencies, Bert is playing o~f one against the other, he is partly moving in .certain directions that he wants to for whatever reasons, but it is an interesting thing to me, let me see if I can put it this way_, "tnis couldn't have happened some yeat"s ago because the constituencies, other than psychiatry and psychology, weren't a·s powerful and in fact they we:1:en't as powerful because they weren't created, the constituencies that are now pressuring NIMH are creatures o·f ,NIJ.\fH. EAR Exactly, DO And that is an interesting thing to think ofa The monster that was created in my view was spawned by the policies of the last 10, 15 years anyway. ··T only wish· I had more ·foresight· to realize·,· although· I couldn·•·t have done anything more about it. It·is really a strange thing, for·example, you talk· about the non-professional, paraprofessional, apart from some· of th;e· merits in some of·· the· programs, some of the politicizing that was done really c·reated a constituency that now is acting to move eve.n furtherand--very·ciearly 14. DO{continued) and it is a constituency not without force. And, l fault NIMH for doing that~· Maybe they didn't have any more foresight than I d±d, maybe they did, maybe they had different agenda and had the foresight, I don't know, but I think it its worth trying to think:\l5f those, I don't see that, that didn't happen then, but I think some of what happened since then,.· I don':t know if that is helpful, to highlight that, because I think that is one of the cruc·i'<!t1.!_ circumstance that maybe is worth looking back at things then EAR But, now it is part of a much larger issue because I think that the illustration that you are giving,. I th;i,nk; you could find counterparts in other arenas •. I DO I agree, and I thin~ it also relates to pressures, it just wasn't just as if pea.pl~ were totally independent agents, one of the functions~6f leadership it seems to me some times. EAR I think you will fi·nd. yourself getting an argument from some people about wh~ther this is bad or good DO Oh, I understand that EAR And, I give you ano-ther:illustratiori., we might: want to chat about it a moment or two; beaause I think1"'it's part of the same· sort of thing you are talking about. We, apd this is before I left so I can say we, at NIMH were initially very perturbed about citizen participation in committees•·, about opening the committees'' up to people who might in fact be recipients of some of these services rather than the e·xperts who were giving the services and I remember any number of discussions in small staff and elsewhere among the old timers about the fact that this was going to completely erode the quality of review and other people taking exactly the opposite 15. EAR(continued) ·S:-i:de· of the so-called silent population that· was supposed to be receiving all these benefits had to be a+lowed to make some decision, some input into the decision_~making process, and I don't ~lj.i:nk that is still clear as to whether it is all good or all bad, or something inbetween. DO I understand, I thll}k,, 'it also gets into a couple of other areas q?le of wnich may:>be worth ,underlining along, I am sure it is one mapy people have talked about and you have thought about. That is the health versus mental health. Now, I don't know that there w1rs, change in that because obviously,. Bob Felix was always keenly concerned with service for one thing and very clearly I think, although I only have a dim perception of it because most of it occurred at a time in my career when I was pretty naive or totally ignorant, maneuvered NIMH into as much independence as he could, which then finally resulted in the breakoff at about this junction point that we- talked about.. I can see this c1.nd some value and wisdom in this, although that may be· a temperal. question of when 0 it is good and when it's not good, but I c.an see that i ~ was very clear that the whole reason behind the whole mental health move­ ment was that it wasn't getti·ng a fair shake ,,from· heal-th: ilnd so the only way to do that to break off, as long as Mental Health Department, Dept• s of Health or Dept '·s of Welfare there· was a disaster, by creating a special, on the otb,,er hand there is the problem of fragmentation, expediency ··that get' s dangerous, I think though that then that, and as I say, it is not entirely clear to ,me, my impression is that actually Bob Felix, as much 16 DO(continued) as anyone else, wanted to maneuver it separately, I don't know that that was a change, in other words with Stan and Bert. But, I think that what also happened, here I do£'f~'1:.•.:it was a change, although I may be wrong, I speak with more diffidence than I do about some of the other opinions, that this issue of broadening the definition of mental health into social problems which then, you see, intercepts with this, :i:s reinforced that problem, magnified it many times and I think then the final result was that we, and now I clearly have an opinion and we moved much too far from health. Now, concepts of health changed in terms <Df social forces and so forth. I think some of those who have moved too far to incidentally but I really do, I think, have a much more sensitive appreciatio1J of those than most people,· it I s an area of my own personal concern ancl even with~n that framework, although allowing for tJle bi8:s of the MD~:I'.'..think that NIMH has really moved to an extremet-1-- you could really raise a 1qt of questions as to - is rape mental.illness, is alctoholisrn a mental disease - it has been decided by law it's-a disease, I guess, and there is a kind of simplistic thing, some of which again reflects other things, there was this where people have referred to as the disease of the month psychology and ----- , so there is that kind of thing played with that, but I can see that the tactic:: of having moved for State IDepartment's of Mental Health and for a separate NIMH, but somehow I think 'NIMH got too far away from the health umbrella and into [the social action arena, which of~ course, then also linked into what was happening in social psychiatry and social psychoJ.Ogy,• not social psychology, the dicipline, but the the activist social ps:1chology and some other 17. DO(continued) development that .I don't have names for but you know what I am referring to}'so that it: d·idn •· t just occur, the sixties everyone was going to solve racism and violence and poverty and everything else· just J::>y doing .go6d and raising hell, but I think NIMH got caug:ht up in that naively, that would be the best term I would use, I think it was a serious mistake. Now, that interacts with that constiutency issue, also, in maybe in a more subtle way, interacts with that professionalism issue. EAR There's an interesting problem in what you are talking about and I wonder if you would want to comment on it. It is very much a problem of a function of the times and the way things are and I am reminded for example, that when so-called .Nad~r•s Raiders decided they were to take·a look at the mental health program, they made all kinds of criticisms saying in effect that we hadn"t gone far enougi,_ in :=the "direction that you are now talking about and those of us<Mho were inside at the time and Bert was the one who led this effort to counter the intensity of that thrust by being as coopera­ tive as he possibly could. Stan would have thrown them out on their ear. DO Stan would have been right. EAR The irony of all that was that here we had taken a leadership role in a sense, if you want to use that term in the direction in which you are talking about and these guys come in and say we hadn •·t gone far enough. DO But you see, Nader•s Raiders were right in another sense. They were right in saying that there was absolutely no data on the Community Mental Health Center program and in fact there wasn't and in fact, no one has ever collected any and \\.here ·this god damn thing has gone on mushrooming and every time some one collects 18. I DO(continued) any data it really shows that there·is a lot more vapor than substance. It is really interesting coming to a "-S'tate where where I am a little closer to a more rural population. There are a lot of Community Mental Health Centers around and nobody around wants to send patients to ·them because they are no good, ·at least in their view. There accessible, there there but people dont want to use them. The point is that nobody even really knows some of the things. Now, Nader was right in that sense nhey, we poured a huge amount of money into this Program and where is the evaluation?u­ There should have been an evaluation. Now some of that fault may have been a result of this unfortunate total split between 1to over­ simplify, the scientists and the action oriented service people and maybe by better intregation and I am not sure·;r·would hav~ ,the good sense to do that myself at the time, but in retrospe.ct~ the brilliance of hindsight, that would have been the: way to do it, would be to get more evaluation research going and you know it could have been simple operation r,esearch as much as anything else. And; I think some of, spreading further and further might have been checked by a more careful "well, what are we doing and what good is it doing,. what data do we have~• and it reminds me, one response, of course, defensively always, :r remember when, the guy who is head of the World Bank, now, McNamara was head of OD and then he came out with, what was it? PPB? EAR PPBS, right DO So we had to prepare all kinds of stuff for PPB, ·so what would we present as outcome data, the number of grants we had given, you know, that's bullshit. We all know it and we wouldn't say it, but 19. DO) continued) we were doing what was fashionable and hoped it would//-· blow gver before anyone ever questioned it and in fact, it did because of the change of Administration and what not, but in fact I am not sure that that kind of an evaluation is appropriate for the research program, that kind, but I do think there was no evaluation for the Service Program and that was one of the reasons why it got into the diffuseness, that plus the social, but I think that's 'another area with serious problem. Now, you brought up Nader in another way and I guess I maybe in responding to the thought I had, missed your point. EAR Yes, I was, really the generalization was that there is a point which an organization gets :tof3a:i.si"z:e ( ·•where there is a no situation because you get clobbered from both sides, that i!,,no matter what you are doing both sides feil that you are not doing enough and the most amusing illustration of this~was, we would get letters simulaaneously, the early sixties, which in effect said, we weren't doing enough in the direction of pscyhoanalysis and simultaneously, we would get letters from·,a.not.her part of the total constituency saying "what the hell are you doing, too much in the psychoanalytic approachlt, so that I think is a difficult thing to contend with, if you can contend with it at all. Everything you are saying now, though,.:. is real-ly'related to the whole general problem of what happens as an orga:t?rrh-zation gets larger, whether it gets more impersonal for,one, or that in fact you lose the flexibility to move in directions whether you begin to forget to do eviluations, etc., etc., r·guess your tenure at NIMH was really too short for you to have much of. a feeling about that while you were there 20. DO You look at the buildings it was in, you get a picture, I mean, I remember people talking about when we were NBOC or North Bethesda about having been at the Wedgewood Building EAR Westwood Building DO And then, the Barlow Building and now the Park Lawn Building and all you have to do is look at those four buildings,, I have some sense of that and I am sure that enters in. Let me make a comment, the easy answer to that is Nixon's answer and that is regionalize, man, regionalize, and of eours~, that'·s boloney. And that, of course, was terrible, I mean, danger of p9litization. I have some feelings that one of the recomrnendatio:ns I made, organizational input to the biomedical panel, was that the tenure of the Director of NIH and NIMH should cut across presidential terms and be a period of time in the A:rr·thur Byrnes model. Now, you know I realize Part 2 DO As a very conservative and strictly administrator and actually does have some substance underneath, although you have to get underneath his defensiveness to find that out EAR He is a very very tight sort of individual. He hesitated about allowing me to tape him - well, we interrupted ourselves. DO It's hard to put it; I think NIMH is,ILmay be wrong, is more politicized, than any other part of NIH, etc. Obv±ously, the health care financing thing is, but\9 It is a funny thing, obviously, Bob Felix was a consumat.e politician and_one of the reasons for his success, was his political activity~ Yet, I am not sure it wasn •·t a different kind of political actf:v.i ty 21. DO(continued) I may be wrong and it may -that in drawing that distinction is not appropriate. I am not sure I have thought this through either - I am just sort of talking off the top of my head. That is, I get the sense that he used his personal persuasiveness in non-hierarchical lines as a way of accomplishing things. Rather - accomplishing things that he felt were right and· good and so forth, and undboutedly must have made some deals in the process. I don't think anybody cannot, but yet, I have less of a feeling that program was determined by political conse­ quences or predicted political consequences, right or wrong pre­ dicted, that occurred with either Stan or Bert, and maybe in somewhat different ways with Stan and Bert, so I think that was another change. Now as you say, that may reflect a greater polit­ icization of society or at least maybe concomitant with it but I think it is a bad thing and in terms of that business about talJr .... · ing about :c:.emoving . the ,purpoi_ntm~nt process as clearly from the .. . r'--- political arena',> there was· one attempt. to accomplish that and it may be that there was less need to p~otect the Agency then and with the passing of time there is more need to do so. Now, I am not a - I am much stronger in,for example, the traditional view of the appropriateness of the Hatch Act than many people and I do think that people should not be politicking in the other dirlection either. See, it•s not just that I am saying that NIMH, for example, should be free of political influence-, but then should b~ able to politic for those forces at once - I don't thihk it should be doing that either but I do think clearly that it's been subject to tremendous pressures, the classic example, 22. DO(~ontinued) of course, is the FDA. EAR Ok, let's - let me ask you another kind of open-ended question; is there anything in terms of specific incidents even during the time that you were there or in retrospect now about your reflections -of NIMH that would help you to illuminate some aspect of the decis~on making process above and beyond what we talked about? I think you have touched on a number of important aspects as they relate to individuals and as they relate to differences among the various parts of the program but I am really trying to make sure that I don't miss people's own kinds of perceptions about how they saw those thiS:~r~s happening. DO OK. I will say something terriby naive~ I think, it's not surprising because I don't know of any large organizations that aren't this way, but, nevertheless, which I think is less than desirable. I think policy was very of£en-cd:eetdt!f8c~-teo::mttfJ1t~:~by internal politicking - that•·s my impression and I am not talking about people pleading for more money for their particular­ Branch or section or divJ.sion, I mean that is expectable and so forth, but one had the fe.eling, I think, that there was both a certain amount of cronyism, One of the petty examples I think of is your still current colleague, Miller, who I thought was a guy with very cheap values, very expediency....oriented guy, who managed to get things done I think because he had Stan's personal ear - wasn't he Stan's personal assistant for a while? EAR He had once been Stan's boss in the Study Center at Prince George's. They had a close personal relationship. 23. DO And, I think that things, not because of his making.:•':l:~"f• necessarily, that wasn't really, but I had the feeling there was too much of that. Now, I don't know, I guess I am not enough acquainted with what goes on in IBM and so forth; I suspect a lot of that happens there, too. Somehow, it seems to me that unalike in an orgat,.ization where one is selling that maybe a somewhat different system - it is hard, how do you get input from professionals with:1-n a very broad multi-compartmentalized organ­ ization and make decisions - it is difficult, very difficult but I had a feeling it was too dictated, I don't know how it was under Bob Felix, it may have been no different, I dontt know, my fantasy is that sort of everybody was a cron.y and therefore, in a way that diluted it - that may be absoltitely wrong. EAR Some would have more equal than others. DO So, that would be one comment I would make .. I am trying to think if I have any others. I think what organizational meetings I went to, to some extent, when there were bread and butter day-to-day things ___business was transacted in a very straight forward way, but you know, they were the ongoing things that needed to be done, in that sense they are important, but they are not policy issues, but I never had the feeling that either broad policy or even sort of-medium level policy that anyone really asked very,:,many people where their real} interest - you know, "what do you think about this?'' just "are you going to giue me trouble about this". EA'.R In that context, let me ask you about 24. DO That was just during the period I was there - it will reflect me and my relationship with Stan, I· don '·t know. EAR But, also,- twQ s;o:mewh.at related questions, welL, I , one with two ! parts - that is, you attended a number of Peer Review Committee meetings and I don 1 t recall, did you also attend Council meetings while you were there? DO Yes EAR OK, do. you have any ~ee:lings about the way in which the Council for one functioned in its relationship to staff? . DO Well, I think>in a broad sense, Council had almost no relations, but there were obviously several staff members who began to relate often on a disciplinary basis or least close disciplinary basis to specific people on Council and managed to feed in certain kinds of advance information or etc. , etc .. , so that was one thing.. It was perfectly obvious to me also that Stan was doing this - th~t he was meeting privatelywith. several people, I certainly had a very strong· feeling that he:was meeting with Mary Lasker's errand boy regularly, Mike Gorman. I say that deliberately because I don •·t like him and I also some very funny things, that is, you know, Council would be going through· horrendous amount of pos_sible work, it would be to some extent, trying manfully, personfully, to be fair and so forth and yet, clearly there were certain decisions about certain significant sums of funds and so forth, that would have been privately deci-c;led and somehow, with Staff not being aware that is was going to>happen that way. It wasn't just someone, you know, the way a Council member ~ould say "what's the hell going on with this project, I think it is great'", thatts not what r mean and that disturbed me. Again, it is probably naive. I tend 25. DO(continued) to be a very straight person and probably I am still somewhat naive and I was very naive when I was at NIMH. EAR Were there any particular Council members that you remember in whatever context they played an unusual role or a very visible role. DO Well, I remember Mike Gorman playing a very-visible role, but that's partly because of his bombastic personality - I mean he was very comfortable about aggression - you know that tends to move people if only to shut the guy up •.- EAR _ _ _ _Walter was on Council when you were there? DO No EAR I am trying to remember who was on then DO I was briefly - I was there for a while when Lederberg was on at the end and I think his aura and his - he is also not shy - was influential but I think only in petty ways - I don•t think he -ever thought - he was more project and sort program--orient~d, so although I thought it was sort of strange he was id:i:osycratic at times. I don't think he had a terribly influencing role. EAR How about DO If I remembered who was on Council I might EAR That's fine, that means they didn't make that much of an impression. How about the Study Section meetings that you attended? What were your thoughts about them, etc. DO Well, I - very pleasant. I really think people worked hard - they made mistakes, but they really tried· ·to be fair, that they really tried to do their homework. I think it is naive to talk about them as being quite as self-s~crificing - it is hard work, but they also get a lot of learning out of it and that's afterall what business 26. DO(continued) theytre in, but I think that with rare exceptions, and I can identify the rare exceptions, for ql;Jality operation, and the rare excep-t.ions we:1:;e when I was still Division Director after some of·the reqnganization played outag~ some of the special programs developed, I remember going to.the suicide review thing and I thought that was an atrocity, an absolute atrocity, I thought for one thing that they were accepting crap, for another they were very clearly dictated by EAR Ed Schneiderman? DO Absolutely, because also Faberow was on the Committee and also that they were sort of money in search of projects rather than anything else and the idea was to create a program rather than have any sense of - it wasn~t just wasntt not so good, it was really that there was both crap and stuff that really didn't even belong there - it seemed to me within a support program, not just that it was bad. And, a little bit of feeling about that in the Alcoholism program, but much less - when it became separate, I thought some of the alcohol projects under the old Research Division - I remember we went to Rutgers on the site and so forth and I thought thos~ were, you know., It seems to me there were a couple of other · projects like that, you know, that came out of even some of the Centers that didn't have money would sponsor projects and that •··s where the behind the scenes business came in, that is, it would have been decided whether those were g0ing to be supported. or not before Council, I became aware 0f it Conncil, I mean the nature of the process was such that became apparent to me that that had happened. EAR Well, you attended - I dontt know why I asked whether you attended 27. EAR(continued) Councilta::rteetings because I know you did, I remember seeing you'there, but you attended, try to attend almost all the indi;vidua.l:c~s tudy sections. DO I attended a lot of study sections. Now that~:t:tad to do with me, the kind of person I am and what I am interested in and so forth. I felt two things, one - that· initially study sections were - resentful would be too strong a word - but suspicious or negative about staff interjecting evaluative scientific comments that I think were a little overly paranoid, but probably reflected the notion of independent peer review and the worshipping that got it,. so in that sense it was understandable. I also felt, however, that once they got to know me that abated at least partly - it was more at the beginning and less at the end and I really had some feeling that in a way that was too bad, although I understood the reason for it that the Staff were not after all technicians and did have some sense and might be able to make some comments. ::1~1\iR It is ironic but that was the way we km.nd of grew up - the staff was supposed to be in a real sense subordinate EAR Well, they weren't V:{uite as much, I think, as you are suggesting In training it was even less DO You take a guy like - - -Delmare, Jack Lasky. Jack is very careful to be a clerical person and that somehow seemed to me to be the model that people felt was ideal, even though it wasn't always followed. EAR Now, i:t is very interesting because Jack Lasky grew up in the where model ~ftft~ wi~a the Division of Research grants handled all the study sections and that was clearly there model ..- They were 28. EAR(continued) supposed to be nothing but staff supported. period. not interactual, whereas among the Institute Committees' there was somewhat DO Well, in Service, of course, they even had Staff, didn't they bring Regional Office people into the system on that-Committee so that was another experience and in Training I think you are right it was intermediate, that's my perception, too. It varied as I say, it depended upon who it was and how careful - I think maybe I was a little too brash at the beginning which another reason I got a, it never occurred to me that I didn''t have a say so, but EAR It's very interesting that izour comment, of course, is almost a universal comment albout.:=.. ehe <Pee--r· Reviaw",~;.1t'"f\l;~b_::; system - it really worked remarkably well and people did their homework and everyone I talked to since about that all have very positive feelings about it and I think that in a remarkable way, it-'s one of the most beneficial side .effects, s0 to speak, for the entire operation - no one set up the Peer Review Committee System for any other reason than to have some kind of ·outside opinion, never realizing all of the concomittant benefits that derived from that including the fact that waB this was perhaps the most efficient way of setting up a national netowrk of communication on where the scientific field was in that particular area - all you had to do is sit in on one meeting and you were then immediately educated to a level that you couldn't do any other way. !t"was really, and I guess still remains, a very informative. Well, any other thoughts that come to mind in light of what we have been saying that we have left out. 29. DO I don't think so, I had scrawled a few things down - I think main themes more than anything else and I think I covered those. EAR Well, that's very helpful, Don .. DO If you can think of som,ethipg, I would be glad to try and answer. EAR No, I think we have covered much of them too, and it is very helpful because everyone has slightly different role in the Institute. I spent the morning with Jerry King - I guess you never really interacted with him very much. He was there partly - I guess he left just before you got there. When you were there the Budget Officer was who? It must have been ~illy Sidesky, he must have been there at the time. DO Some how I remember. the name Kingman:;] EAR King had an interesting story to tell DO Well, that I don't know anythi:gg about. Was Kelly at HEW earlier EAR Yes DO Do you know him at all, Jim Kelly EAR Only more by reputation than otherwise. DO. He is smart and knowledgeable, he is a hard nose,.you know, budget type, he is very sympathetic towards program and if you want anything of that kind of perspective, although I don ''t know the guy personally 3:--eettid-wri~e-yett-a-re~~er-~e-ft:i::ffl and couldn't write you a letter to him, I have had dealings with him though through the State of New York officially, I have nothing but respect for his capabilitiy and so if you want that kind of perspective he might be a good guy to see. EAR Well, actually, you are right, that' s~a good point, but htP,a reputation at HEW was that he would c.ome to these various Budget Defends meetings and almost invariably be able to make substantive comment for each one of the people that they some times couldn't 30. EAR (continued)- do themselves. Well, the whole thing is very interesting DR. DONALD OKEN November 29, 1977 EAR Beginner I ke .t might be useful because of the way you came on, Don, perhaps really to talk about the way you really began At NIMH AND THEN we could start to talk about some of the specific questions I'have. DO What I remember most was the initial period,-'!:suppose in some ways it has in my later experience .i aybe a little later to make some comments to try to put that into a little broader perspective than just some of the negative personal feelings I have. The first thing that happened were, in rapid succession, one, my finding out fl recruited me EAR What year are we talking about now? DO We are talking about, I came on, I guess, the beginning of 66 technically for a while, you know consultant officially, and Ray came up and talked with me the latter half of 65 and of course, Ray was a very sweet guy and I sort of related to him, plus to my image or fantasy of what NIMH was ,But what happened in somewhat rapid succession was first, I found that there was a reorganization so that in some sense, although I was not that sophisticated at that point, in fact the job that I had was in a sense downgraded. I don't think that disturbed me too much at the time, but that was one thing. Second, Ray and I had negotiated a GS grade and there was then some talk about the fact, "gee, that might not be possible" and partly because of something else that happened, which I will come back to. Apparently when I expressed sort of surprise and DO(continued) and dismay, although with really no attempt to act out, I tend to be very straight about such things. Stan had lunch with me - I don't know who told me or where it may have been used, some where along the line, someone said to me -'look because he is trying, he has heard that you might leave and he is tryingala your anxiety and keep you and at that lunch, Stan YY Yl said, no, no, the grade wouldn't go through and in fact it did and I remember distinctly, no it will go through and I said we won't discuss it any further, period, that's it, because that's the way I was used to doing things.. But, at any rate, the third thing that happened.-; somewhat in the middle, was that Bob Weiss who had I guess been recruited to take the job that eventually you took, but took it with the understanding that it was a somewhat higher level, under the old organization found between the time that I guess he accepted the job and the time he came down that had in fact been again downgraded, if that's the right word, and then withdrew and went back to Dartmouth and I think probably that event heightened my consciousness more than what was happening to me. So, then I started with that-sort of funny business and then, although I guess there is another area which I will come back to just to play out that theme, then-there is the reorgan-i-zation proceeded to be implemented. A lot of tensions arose, there was a lot of anger, feeling of betrayal, and disaffection along a number of people, of course, there was a lot of feeling around. Phil Sapir''s leaving - Inasmuch as I can reconstruct it, when Stan asked me to be Acting Director of the Division he had told Phil that that job was not available to him, and Phil said that he said "well, given to what seemed to Stan to be the 2. 3. DO(continued) realities and needs and so forth that I might be the logical person because Phil had come to talky to me and you know Phil is not., at least ]he doesn't come across to me as a manipulator so IJ:didn't react that way either. But there was a lot of negative feel ng:.tha;t he. .lead done an excellent job and to this day I don't know whether in fact he might not have been a good person for that, mistake or not he did have the mentality and maybe there was a need for a professional, s don't know, but he certainly had in many ways provided kind of a creative leader- ship, although somewhat surprisingly, I think in terms of his boyishness and if is surprising that so many peo: ple felt so loyal and dedicated to him but they were. There was a lot of disaffection at that time among the old timers and that's the thing that struck me and then, of course, Ray left not too long thereafter, although the reasons were given in terms of retirment and personal life, and so forth, it seemed pretty clear that some of this had to do with Ray's not wanting to work with Stan, he had just gotten promoted to be Stan's Deputy and I think I took that less ideologically, although it probably had some meanings that I don't understand in that regard as I did a.personality clash b. that the one person that I really - that was very protege, that would be too strong, that I had as a kind of a senior figure I had related to was gone, so that left me somewhat at odds, I don't know that that is terr by important to the history per se, but it maybe reflects, so that's what was going on there at the time and T thought a fair amount of tension and turmoil, but of course there were all of these1 at the same time sort of 4. DO(continued) fantasy positive feelings about what it would mean that we might become a Bureau and that we were going to be equallto NIH which, of course, subsequently turned out not to be, but that I think had some ameliorative effect in allaying some of the anxiety because it was clear that people didn't ir:1ate toStan •the way they did to Bob Felix. I never knew Bob very well, so I can't say much about it, it is an observation that I think is pretty clear. Now that to me, let me try to generalize something away from my more personal - there was a broader process going on other than whatever the meaning of organization, reorganization and intra- governmental maneuvering and restructuring and thatis, I think one had the sense of NIMHa . qroup of people wth•a strong sense of mission - I am sure it was romanticized but somewhat selfless arid terribly dedicated, with their eye on the goal and terribly concerned with what they were doing and what they were accomplishing and really worrying very little about the techniques about the way they were doing it except as ways in which they could accomplish things and so the problem was, how did you deal with the rules in order to get what you really wanted to do, rather than what were the rules. I think, now I have to jump to my present perspective, because I think now my perception very clear and I think the national perception of NIMH is of a very bureaucratized and formalistic and less functionalistic, if not necessarily cold at least uninspired body. How much of this is prophesies or self-fulfilling images or self-fulfilling-how much'-,is actually DO(continued) a change and how much is created change I don't know but at least and I see in some sense that period, the only reason I mention this, I think that that was the turning point, I mean literally when I came, but that period of time was the turning point. EAR Could you say a little bit more about that because I think it is an important point. Do you think it was primarily a function of .growing size, do you think it was primarily a function,.-of the age of the Institute, do you think it was a function of the change of leadership - all these or any of these other than that? DO Well, I think it is hard for me to be sure, you know iery well that I had very negative feelings about Stan, although they obously over time they have been considerably buted so my murderous impulses - but I think probably in two senses or several senses what I think Stan may have been intereted in other kinds of things - secrtnd of all., he clearly was a very different kind of personality and inspired much less of a:sense, he is less charismatic and so stimulated less of that same feeling among other people. But, also I think by virtue of the reorganization and the turnover in personnel, for example, getting if you will someone like Phil Sapir whether it was intended or not probably had that effect of dampening that kind of thing. It is interesting, I came very clearly as a transient, when I came it was with no intention of making a career of it but as you well know I got married and in some ways it was really kind of convenient for me to stay and I was beginning to be seduced into the notion of staying on at least a few more years when the problems 5. 6. DO (continued) I had with Stan came to a head, I don't know whether that's the right way to put it, but at any rate when I had the problems then, but my point really is that except for that temporary situation my life really in terms of my career concept I was really never totally within NIMH - I was a transient - and so maybe my perspective is quite different from some of the people who were there ten years or 15 years or who intended to be for 20 years and what not. I got off the track that was it. I think the size did have something to do with it in a sense that any time you get: an organization that- big it gets less personal and more bureaucratized and then you start drawing boxes, worrying about the boxes and then you do lose the people, sure that must have something to do with it.. EAR Let me go back. I think the point is very well taken and I think it is important incident in a sense to mark a kind of turning point that you are talking about, whatever the reasons for it may have been, but now I wonder if you would take a few minutes to think about the substantive things that you got involved in and what your feelings were about that and how that in a sense reflected any attitudes or opinions you may have about the Institute operation. DO Well, I am not sure if this is what you are saying. I was thinking in the midst of some of the other business about the image and feeling about NIMH. I also came with a certain amount of - I don't know what the right word is - huberous in that area that is, let me put it this way., I thought these were really terribly dedicated people but they didn't really know, they were nevertheless dedicated bureaucrats and I found it somewhat humiliating in a positive 7. DO (continued) sense of that term, a humbling experience to find out that there were some really dedicated and very knowledgeable people and that I wasn't coming to-with my brilliant insights from the outside, so that was a very positive experience and I don't think that had to do, so that I found that there were people who could be, in other words really if it what in some sense was the image of NIMH I think in fact was correct I found when I got there, even though I perhaps out of my own insecurity and narcissism and what not, I had this fantasy that nobody knew anything at least not as much as I did and I found out people knew quite a bit and that there was a hell of a lot going on. Now, I am not sure whether that quite gets into EAR You are touching on, what I was really getting at was when you came in I think that just to give you some confirmation what I suspect you already know, that is you were among the relatively rare breed of research psychiatrist, Iwe didn't have very many in the Institute at the extramural level, and I think well, Stan, Ray and others of us wanted more of that kind of competence within the Institute and inevitabl even though we all disavow it to some extent, there was a hiearchy among the various professions with nursing and social work being low on the totem pole and a struggle between psychology and psychiatry as to who really was in a sensethe superior, with the psychologists fee&ing since they were really the scientists, there were only a few psychiatrists that came along that could do that kind of job and psychiatrists on the other hand feeling that basically this is a medical specialty and everybody else's partially 8. EAR (continued) ansilary . I think that within NIMH to use your term about Stan, that was somewhat muted - I think we worked together very well, but it was very important that someone like yourself come in and take on the kinds of responsibilities that you were asked to take on. DO That. was another reason for recruiting someone like Bob White who represented academic psychiatry also, although it was for training function. EAR Well, let me ask you then, but don't hesitate. DO I think that is muted, I hadn't seen at that point and I want to say something again later, in retrospect with time about that. I didn't get much sense of inter-disciplinary tension within NIMH. I think there were somewhat within the constituencies and that is what I maybe want to come back to and in fact, for example, Phil Sapir wasn't a psychologist or a psychiatrist and was really in a sense not a professionalandI think did a much, in a way, mQre sensitive capacity than Dick ert, whO was very clearly iden- tified with professional psychiatry psychology and I am notying to knock Dick. EAR Phil made himself, so to speak he really grew On the job enormously DO So, I didn't get any great sense of that tension - I will tell you where I did see, and tension might not even be the right word, and this, of course, plays on another major theme related to NIMH that is now on a new phase and that is service versus let's say the NIH' like functions. I think it would be fair to say that we really had no relationship to the service diisionsexcept very 9. DO (continued) peripherally semi socially and even the Applied Research Branch really neverbbelonged to the Division and was sort of there and Howie was head of that and wasn't really part of the rest of the group, so what was going on in what then became Allen Levinson's shop was sort of out there and that's where I think - I don't think it would seem so much then ast tension[,simply too excessive activities. I think we saw ourselves as much more related to intra-mural and I bet the people in training did, too - I conjecture that. That was my sense of it and I think research had a kind of a friendly competition with training, not in a really negative sense but in a sense of we do a better job at our allied thing than they do kind of thing, which doesn't matter if it is true or not, that was the EAR That had a very practical overtone because it was a competition for funds with the realization, you know, that there was a limited total amount and whoever did the better job might then get a slightly larger piece of the pie. DO Right, although I don't think it was ever seen so much in that sense but a little bit. I think we, I say I, it would be more accurate but>maybe it was we, saw ourselves as really related to intramural and to training and service was somewhere out there. With the reorganization, not only was service .developed somewhat more elaborately, I think I would have to 'go back and relook but there were a number of these special agenis Centers and special branches in areas of things like minority mental health violence and so forth, which cut across into 10. DO (continued) service and also cut across into a broader definition of mental health, sometimes it wasn't just service and the change in NIMH, also I think that is another key issue, so the issue was not maybe just the broadening of service per se, but a somewhat overlapping and concomitant, if you will move away from a strict constructionist definition of mental helth, away from mental illness mental health to social problem mental health kind of thing. Now I don't have a clear image of where Bob Felix stood A. on that - Iknow tha he was very interestdd in service but my impression, maybe absolutely wrong, was that he was within a more traditional framework. I don't know exactly where Stan ideologically stood on that but operationally in terms of his reorganization, it very clearly moved in that dirdti.on, it is unclear to me whether this was simply a very cold and calculated pdlitical decision or series of related political decisions.on Stan's part having absolutely no relation to content or whether it reflected his personal beliefs about NIMH and in some sense, that fact that I could even raise that kind of quetion reflects both my feelings about Stan, but even mote broadly my feelings about the Institute and about that comment that I made about mission and so forth.. It wasn't even that people felt that the NIMH staff was dedicated but one always knew where they stood., whereas, and again this is colored very much by my subsequent experience with Bert, who is a sweet guy but I wouldn't buy a used car from him and the notion that you do what you think will sell rather than what you think is right - in fact, you don't even care what is right and that's the, again, image, accurate or inaccurate, that NIMH 11. DO (continued) began rapidly to assume and :1 think in a funny way much more under Bert thariStan, even though Bert is a more friendly and less cold person. EAR .1 think you are absolutely right and I think part of it really is that, whether it was clear-on the outside or not,. Stan did and does have very strong substantive convictions - he is not above being a pragmatist playing a political line, but. ithink he had a very strong conviction. DO I could believe that easier about him than about Bert. EAR That's the point \IarnTflakidflg, that is very true, I think Bert is much more expedient and much more willing to be political and prides himself now, which is a lovely personal. rationalization that he makes, prides himself on being a politician in a political world and that I think can be very dangerous self-perception to have, when that!s really not the game you are suppose to be playing. DO Well, at least by my definition,, it's not, but I think it is by Bert's and you said it wasn't.by'Stan!'s. I would say that to some extent that was unclear with Stan, although I think people realized that Stan was committed to and that end of it and much more so than to in fact I think we in research., and I don't know how it wasin Training when you were there, it may be hard for you since you stayed on in closer relation to Stan:, whether you can remember how things were felt then, but at least my perception was that we felt that Stan was too committed to Service and that he really didn't even understand or have a sense of what, I will oversimplify, it and say the academic, but I think it was more that than that we were concerned about his DO(continued) politicizing, it was unclear rather than being clearly in the other direction. EAR It is an interesting issue because in fact one of the things that Stan prides himself on, believe it or not, is that a great part of his career has been dedicated to serving the so-called scientist, and by that definition theacademic community and there were constantly, among the kinds of in the system, which your one case is an example, there were constantly concerns on the part of the Intramural people, they *eren.t getting their fair shake, when in fact,I know from personal knowledge that on many occasions Stan went to bat for the INtramural program, but he was operating against an insurmountable handicap in terms of the very endearing qualities that Bob Felix had and how Bob. Felix related to those people personally.. Do: That may be it it also may have €0 do with -,I dont' know,. one of my past medical center President's would have a terrible habit, he was a very tough guy and he prided himself on being tough and he might go out and try to fight like hell to get you more money, but if he didn't get it, he would then be just as - instead of coming and saying "gee, I really feel terrible that we don't have it' he would say, we will just have to do without it, it had nothing to do with. warmth, it had to do with his feeling and boy, you had to tighten your belt., but that was the wrong way to do it because people heard it as he didn't fight right. So it may not just be coldness versus warmth, it may also be, I don't know how to - smarts, of course out of your personality. 12. 13. EAR This touches on the sorts of things that I really want to try to illuminate in this thing because lam so convinced that above and beyond the most obvious influences, political support and all the rest of it, it is all these little nuances that played an important role in the whole picture. DO Let me tell you something that I think has gone on now. I don't know if it's original but it has occurred to me as a kind of original thought, I don't know how it plays back to the past. At the moment there is a terrible amount of tension on, partly between the constituencies, tert is playing off one against the other, he is partly moving in certain directions that he wants to for whatever reasons, but it is an interesting thing to me, let me see if I can put it this wayfis couldn't have happened some year.s ago because the constituencies, other than psychiatry and psychology, weren't as powerful and in fact they weren't as powerful because they weren't created, the constituencies that are now pressuring NIMH are creatures of NIMH. EAR Exactly, DO And that is an interesting thing to think of. The monster that was created in my view was spawned by the policies of the last: 10, 15 years anyway T only wish I had more foresight torealize, although I couldn't have done anything more about it. It is really a strange thing, for example, you talk about the non-professional, paraprofessional, apart from some-of the--merits in some oftheprograms, some of the politicizing that was done really: created a constituency that now is acting to move even further-and--very-clearly fault N1MH for doing that. Maybe they didn't have any more foresight than I did, maybe they did, maybe they had different agenda and had the foresight, I don't know, but I think it its worth trying to think::ib'f those, I don't see that, that didn't happen then,: but I think some of what happened since then, I don't know if that is helpful,. to highlight that, because I think that is one of the cruc1I. circumstance that maybe is worth looking back at things then EAR But, now it is part of a much larger issue because I think that the illustration that you are givingr I think you could find counterparts 'in other arenas..- DO I agree, and I think it also relates to pressures, it just wasn't just as if people were totally independent agents, one of the functionsOf leadership it seems to me some times. EAR I think you will find, yourself getting an argument from some people about whether this is bad or good DO Oh, I understand that EAR And, I give you another illustration, we might want to chat about it a moment or two, because I think-it's part of the same sort of thing you are talking about. We, àd this is before I left so I can say we, at NIMH were initially very perturbed about citizen participation in committees', about opening the ccmmittees.r up to people who might in fact be recipients of some of these services rather than the experts who were giving the services and I remember any number of discussions in small staff and elsewhere among the old timers about the fact that this was going to completely erode the quality of review and other people taking exactly the opposite 15. EAR (continued) -al-de-of the so-called silent population that' was supposed to be receiving all these benefits had to be allowed to make some decision, some input into the decisionrnaking process, and I don't thirk that is still clear as to whether it is all good or all bad, or something inbetween. DO I understand, I. ink, it also gets into a couple of other areas one of wilich maybe worth underlining along, I am sure it is one many people have talked about and you have thought about. That is the health versus mental health. Now, I don't know that there wS. change in that because obviously,. Bob Felix was always keenly concerned with service for one thing and very clearly I think, although I only have a dim perception of it because most of it occurred at a time in my career when I was pretty naive or totally ignorant, maneuvered NIMH into as much independence as he could, which then finally resulted in the bre 3.koff at about this junction point that we talked about. I can see this and some value and wisdom in this, although that may be a temporal question of when it is good and when it's not good, but I can see that it was very clear that the whole reason behind the whole mental health movement was that it wasn't getting a fair shake from' health 'and so ,:,,the only way to do that to break off, as long as Mental Health Department, Dept's of Health or Dept's of Welfare there was a disaster, by creating a special, on.. the oth,er hand there is the problem of fragmentation,. expediencrthat get's dangerous, I think though that then that, and as I say, it is not entirely clear to. me, my impression is that actually Bob Felix, as much DO(continued) as anyone else, wanted to maneuver it separately, I don't know that that was a change, in other words with Stan and Bert. But, I think that what also happened, here I doff€:i:cit was a change, although I may be wrong, I speak with more diffidence than I do about some of the other opinions, that this issue of broadening the definition of mental health into social problems which then, you see, intercepts with this, 4:9 reinforced that problem, magnified it many times and I think then the final result was that we, and now I clearly have an opinion and we moved much too far from health. Now, concepts of health changed in terms of social forces and so forth. I think some of those who have moved too far to incidentally but I really do, I think, have a much more sensitive appreciation of those than most people, it's an area of my own personal concern and even within that framework, although allowing for the bias of the MDI.think that NIMH has really moved to an extremei.- you could really raise a lot of questions as to - is rape mental. illness, is alèoholisma mental disease - it has been decided by law it's.a disease, I guess, and there is a kind of simplistic thing, some of which again reflects other things, there was this where people have referred to as the disease of the month psychology and •. , so there is that kind of thing played. with that, but I can see that the tactic Of having moved for State Department's of Mental Health and for a separate NIMH, but somehow I th.ink NIMH got too far away from the health umbrella and into the social action arena, which of-course, then also linked into what. was happening in social psychiatry and social psychoiOy, not social psychology, the di.cipline,. but the the activist social psychology and some other 16 17. DO(continued) development that I names for but you know what I am referring toso that it didn't just Occur, the sixties everyone was going to solve racism and violence and poverty and everything else. just by doing good and raising hell, but I think NIMH got cauht up in that naively, that would be the best term I would use, I think it was a serious mistake. Now, that interacts with that constiutency issue, also, in maybe in more subtle way, interacts with that professionalism issue. EAR There's an interesting problem in what you are talking about and I wonder if you would want to comment on it. It is very much a problem of a function of the times and the way things are and I am reminded for example, that when so- caile.d Nadr's. Raiders decided they were to take 'a look at the mental health program, they made all kinds of criticisms saying in effect that we hadnt gone far enough in the direction that you are now talking about and those of us::whO were inside at the time and Bert was the one who led this effort to counter the intensity of that thrust by being as cooperative as he possibly could. Stan would have thrown them out on their ear. DO Stan would have been right. EAR The irony of all that was that here we-had taken a leadership role in a sense, if you want to use that term in the direction in which you are talking about and these guys come in and say we hadn't gone far enough. DO But you see, Nader's Raiders were right in another sense. They were right in saying that there was absolutely no data on the Community Mental Health Center program and in fact there wasn't and in fact, no one has ever collected any and here this god damn thing has gone on mushrooming and every time some one collects DO (continued) any data it really shows that there is a lot more vapor than substance. it is really interesting coming to a tate where where I am a little closer to a more rural population. There are a lot of Community Mental Health Centers around and nobody around wants to send patients to them because they are no good, at least in their view. There accessible, there there but people dont want to use them. The point is that nobody even really knows some of the things. Now, Nader was right in that sense They, we poured huge amount of money into this Program and where is the evaluation"" There should have been an evaluation. Now some of that fault may have been a result of this unfortunate total split between,to oversimplify, the scientists and the action oriented service people and maybe by better intregation and I am not sure-I, would have the good sense to do that myself at the time, but in retrospect, the brilliance of hindsight, that would have been the way to do it, would be to get more evaluation research going and you know it could have been simple operation research as much as anything else And, I think some of, spreading further and further might have been checked by a more careful "well, what are we doing and what good is it doing, what data do we have" and it reminds me, one response, of course, defensively always, I remember when, the guy who is head of the World Bank, now, McNamara was head of OD and then he came out with, what was it? PPB? EAR PPBS, right DO So we had to prepare all kinds of stuff for PPB, so what would we presBnt as outcome data, the number of grants we had given, you know, that's bullshit. We all know it and we wouldn't say it, but 18. 19. DO)continued) we were doing what was fashionable and hoped it wou1d.T blow over before anyone ever questioned it and in fact, it did because of the change of Administration and what not, but in fact I am not sure that that kind of an evaluation is appropriate for the research program, that kind, but I do think there was no evaluation for the Service Program and that was one of the reasons why it got into the diffuseness, that plus the social, but I think that's another area with serious problem. Now, you brought up Nader in another way and I guess I maybe in responding to the thought I had,. missed your point.. EAR Yes, I was, really the generalization was that there is a point which an organization gets toa- size 'where there is a no situation because you get clobbered from both sides, that i,no matter what you are doing both sides feel that you. are not doing enough and the most amusing illustration of this,-,was, we would get letters simultaneously, the early sixties, which in effect said, we weren't doing enough in the direction of pscyhoanalysis and simultaneously, we would get letters from... another part of the total constituency saying "what the hell are you doing, too much in the psychoanalytic approach", so that I think is a difficult thing to contend with, if you can contend with it at all. Everything you are saying now, though, is really related to the whole general problem of what happens as an orgai±zation..gets larger, whether it gets more impersonal for one, or that in fact you lose the flexibility to move in directions whether you begin to forget to do evaluations, etc., etc.., Iguess your tenure at NIMH was really too short for you to have much of a feeling about that while you were there DO You look at the buildings it was in, you get a picture, I mean, I remember people talking about when we were NBOC or North Bethesda about having been at the Wedgewood Building EAR Westwood Building DO And then, the Barlow Building and now the Park Lawn Building and all you have to do is look at those four buildings, I have some sense of that and I am sure that enters in. Let me make a comment, the easy answer to that is Nixon's answer and that is regionalize, man, regionalize and of course, that's boloney. And that, of course,. was terrib'le,.I.meai, danger of politization. I have some feelings that one of the recommendations I made, organizational input to the biomedical panel, was that the tenure of the Director of NIH and NIMH should cut across presidential terms and be a period of time in the Arthur Byrnes r"odel. Now, you know I realize Part 2 DO As a very conservative and strictly administrator and actually does have some substance underneath, although you have to get underneath his defensiveness to find that out EAR He is a very very tight sort of individual. He hesitated about allowing me to tape him - well, we interrupted ourselves. DO It's hard to put it; I think N1NH is,Iimay be wrong, is more politicized, than any other part of NIH, etc. Obviously, the health care financing thing is, but. It is a funny thing, obviously,. Bob Felix was a consuma.te politician and one of the reasons for his success, was his political activity, Yet, I am not sure it wasn't a different kind of political activity 20. 21. DO (continued) I may be wrong and it may that in drawing that distinction is not appropriate. I am not sure I have thought this through either - I am just sort of talking off the top of my head. That is, I get the sense that he used his personal persuasiveness in non-hierarchical lines as a way of accomplishing things. Rather - accomplishing things that he felt were right and good and so forth, and undboutedly must have made some deals in the process. I don't think anybody cannot, but yet, I have less of a feeling that program was determined by political consequences or predicted political consequences, right or wrong predicted, that occurred with either Stan or Bert, and maybe in somewhat different ways with Stan and Bert,; so I think that was Another change. Now as you say, that may reflect a greater politicization of society or at least maybe concomitant with it but I think it is a bad thing and in terms of that business about talk.,- . ing about removing the ppçntmnt process as clearly from the political arena, there was one attempt to accomplish that and it may be that there was less need to protect the Agency then and with the passing of time there is more need to do so. Now, I am not a - I am much stronger in,for example, the traditional view of the appropriateness of the Hatch Act than many people and I do think that people should not be politicking in the other diection either. See, it's not just that I am saying that NIMH, for example, should be free of political influence, but then should be able to politic for those forces at once - I don't thiik it should be doing that either but I do think clearly that it's been subject to tremendous pressures, the classic example,. 22. DO (continued) of course, is the FDA. EAR Ok, let's - let me ask you another kind of open-ended questions is there anything in terms of specific incidents even during the time that you were there or in retrospect now about your reflections of NINH that would help you to ilLninate some aspect of the decision making process above and beyond what we talked about? I think you have touched on a number of important aspects as they relate to individuals and as they relate to differences among the various parts of the program but I am really trying to make sure that I don't miss people's own kinds of perceptions about how they saw those thOs happening. DO OK. I will say something terriby naive.., I think, it's not surprising because I don't know of any large organizations that aren't this way, but, nevertheless, which I think is less than desirable. I think policy was very often-Aedid6d.too me by internal politicking - that's my impression and lam not talking about people pleading for more money for their particulàr Branch or section or division, I mean that is expectable and so forth, but one had the feeling, 1 think, that there was both a certain amount of cronyism, One of the petty examples I think of is your still current colleague, Miller, who I thought was a guy with very cheap values, very expediency-oriented guy, who managed to get things done I think because he had Stan's personal ear - wasn't he Stan's personal assistant for a while? EAR He had once been Stan's boss in the Study. Center at Prince George's. They had a close personal relationship. 23. DO And, I think that things, not because of his making: necessarily,, that wasn't really, but I had the feeling there was too much of that. Now,. I don't know, I guess I am not enough acquainted with what goes on in IBM and so forth; I suspect a lot of that happens there, too. Somehow, it seems to me that unalike in an orgapization where one is selling that maybe a somewhat different system - it is hard, how do you get input from professionals within a very broad multi-compartmentalized organization and make decisions - it is difficult, very difficult but I had a feeling it was too dictated, I don't know how it was under Bob Felix, it may have been no different,. I don't know, my fantasy is that sort of everybody was a crony and therefore, in a way that diluted it - that may be absolUtely wrong. EAR Some would have more equal than others. DO So, that would be cne comment I would make. I am trying to think if I have any others. I think what organizational meetings I went to, to some extent, when there were bread and butter day-to-day things business was transacted in a very straight forward way, but you know, they were the ongoing things that needed to be done, in that sense they are important, but they are not policy issues, but I never had the feeling that either broad policy or even sort of-medium level policy that anyone really asked verymany people where their real interest - you know, "what do you think about this?" just "are you going to give me trouble about this". EAR In that context, let me ask you about DO That was just during the period I was there -. it will reflect me and my relationship with Stan, I don't know. EAR But, also.- twQ somewhat related questions, well, one with two parts - that is, you attended a number of Peer Review Committee meetings and I don't recall, did you also attend Council meetings while you were there? DO Yes EAR OK, do you have any feelings about the, way in which the Council for one functioned in its relationship to staff? DO Wel,I I thinkIin a broad sense, Council had almost no relations, but there were obviously several staff members who began to relate often on a disciplinary basis or least close disciplinary basis to specific people on Council and managed to feed in certain kinds of advance information or etc., etc., so that was one thing... It was perfectly obvious to me also that Stan was doing this - that he was meeting privatelywith. several people, I certainly had a very strong feeling that he:was meeting with Mary Lasker's errand boy regularly, Mike Gorman. 'I say that deliberately because I don't like him and I also some very funny things., that is, you know, Council would be going through horrendous amount of possible work, it would be to some extent, trying manfully, personfully, to be .fair and so forth and yet, clearly there were certain decisions about certain significant sums of funds and so forth, that would have been privately deOi'ded and somehow, with Staff not being aware that is was going to.happen that way. It wasn't just someone, you know, the way a Council member ould say "what's the hell going on with this project, I.. think it is great", that's not what I mean and that disturbed me. Again, it is probably naive. I tend 24. DO (continued) to be a very straight person and probably I am still somewhat naive and I was very naive when I was at NIMH. EAR Were there any particular Council members that you remember in whatever context they played an unusual role or a very visible role. DO Well, I remember Mike Gorman playing a very visible role, but that's partly because of his bombastic personality - I mean he was very comfortable about aggression - you know that tends to move people if only to shut the guy up. EAR Walter was on Council when you were there? DO No EAR I am trying to remember who was on then DO I was briefly - I was there for a while when Lederberg was on at the end and I think his aura and his - he is also not shy - was influential but I think only in petty ways I don't think he ever thought - he was more project and sort programorientd, so although I thought it was sort of strange he was idiosycratic at times. don't think he had a terribly influencing role. EAR How about DO If I remembered who was on Council I might EAR That's fine, that means they didn't make that much of an impression. How about the Study Section meetings that you attended? What were your thoughts about them, etc. DO Well, I - very pleasant I really think people worked hard - they made mistakes, but they really triedto be fair, that they really tried to do their homework I think it is naive to talk about them as being quite as self-sacrificing - it is hard work, but they also get a lot of learning out of it and that's afterall what business 25. 26. DO (continued) they're in, but I think that with rare exceptions, and I can identify the rare exceptions, for quality operation,. and the rare exceptions were when I was still Division Director after some of the reorganization played 0ta some of the special programs developed, I remember going to the suicide review thing and I thought that was an atrocity, an absolute atrocity, I thought for one thing that they were accepting crap, for another they were very clearly dictated by EAR Ed Schneiderman? DO Absolutely, because also Faberow was on the Committee and also that they were sort of money in search of projects rather than anything else and the idea was to create a program rather than have any sense of - it wasn't just wasn't not so good,. it was really that there was both crap and stuff that really didn't even belong there - it seemed to me within a support program, not just that it was bad. And, a little bit of feeling about that in the Alcoholism program, but much less - when it became separate, I. thought some of the alcohol projects under the old :Research Division - I remember we went to Rutgers on the site and so forth and I thought those were, you know. It seems to me there were a couple of other projects like that, you know, that came out of even some of the Centers that didn't have money would sponsor projects and that's where the behind the scenes business came in, that is., it would have been decided whether those were going to be supported, or not before Council, I became aware of it Conncil, I mean the nature of the process was such that became apparent tome that that had happened. EAR Well,, you attended - I don't know why I asked whether you attended EAR(continued) CounciIxneetings because I know you did, I remember seeing you there, but you attended, try to attend almost all the ind±U±dua1itstudy sections. DO I attended a lot of study sections. Now thathad to do with me, the kind of person I am and what I am interested in and so forth. I felt two things, one - that initially study sections were - resentful would be too strong a word - but suspicious or negative about staff interjecting evaluative scientific comments that I think were a little overly paranoid, but probably reflected the notion of independent peer review and the worshipping that got it,. so in that sense it was understandable.. I also felt, however, that once they got to know me that abated at least partly - it was more at the beginning and less at the end and I really had some feeling that in a way that was too bad, although I understood the reason for it that the Staff were not after all technicians and did have some sense and might be able to make some comments. EAR It is ironic but that was the way we kind of grew up - the staff was supposed to be in a real sense subordinate DO Well , ntevn ubd±dintassive EAR Well, they weren't quite as much, I think, as you are suggesting In training it was even less DO You take a guy like Delmare, Jack Lasky. Jack is very careful to be a clerical person and that somehow seemed to me to be the model that people felt was ideal, even though it wasn't always followed. EAR Now, it is very interesting because Jack Lasky grew up in the where model that with the Division of Research grants handled all the study sections and that was clearly there model., were 27. EAR(continued) supposed to be. nothing but staff supported.. period. not interactual, whereas among the Institute Committees' there was somewhat DO Well, in Service, of course, they even had Staff, didn't they bring Regional Office people into the system on that Committee so that was another experience and in Tràmning I think you are right it was intermediate, that's my Derception, too. It varied as I say, it depended upon who it was and how careful -. I think maybe I was a little too brash at the beginning which another reason I got a, it never occurred to me that I didn't have a say so, but EAR It's very interesting that_tour comment, of course, is almost a universal comment ábou.tthePee- system - . it really worked remarkably well and people did their homework and everyone I talked to since about that all have very positive feelings about it and I think that in. a remarkable way, it's one of the most beneficial side effects, so to speak, for the entire operation - no one set up the Peer Review Committee System for any other reason than to have some kind of outside opinion, never realizing all of the concomittant benefits that derived from that including the fact that was this was perhaps the most effiei.nt way of setting up a national netowrk of communication on where the scientific field was in that particular area -. all you had to do is sit in on One meeting and you were then immediately educated to a level that you couldn't do any other way. It was really, and I guess still remains, a very informative. Well, any other thoughts that come to mind in light of what we have been saying that we have left out. 28. 29. DO I don't think so, I had scrawled a few things down - I think main themes more than anything else and I think I covered those. EAR Well, that's very helpful., Don.. DO if you can thin]% of something, I would be glad to try and answer. EAR No, i think we have covered much of them too, and it is very helpful because everyone has slightly different role in the Institute. I spent the morning with Jerry King - I guess you never really interacted with him very much. He was there partly - I guess he left just before you got there. When you *ere there the Budget Officer was who? It must have been Billy Sidesky, he must have been there at the time. DO Some how I remember the name Kingman: EAR King had an interesting story to tell DO Well, that I don't know anything about. Was Kelly at HEW earlier EAR Yes DO Do you know him at all, Jim Kelly EAR Only more by reputation than otherwise. DO. He is smart and knowledgeable, he is a ha± nose, you know, budget type, he is very sympathetic towards program and if you want anything of that kind of perspective, although I don't know the guy personally -ee d-wf and couldn't write you a letter to him, I have had dealings with him though through the State of New York officially, I have nothing but respect for his capabilitiy and so if you want that kind of perspective he might be a good guy to see. EAR Well, actually, you are right, that's :a good point, but hi'Ji~.3 reputation at HEW was that he. would dome to these various Budget Defends meetings and almost invariably be able to make substantive comment for each one of the people that they some times couldn't EAR(continued)- do themselves. Well, the whole thing is very interesting 30.