1 Dr. Edwin Shneidman EAR And I think you of course played an important role in one part of that, so, begin where you like and do it any way you like. ES I ' l l begin with some reflections about an organization called the National Institute of Mental Health and say that, unless such an Institute would have impact leverage over the. enormous problems of poverty, bigotry, prejudice, the whole process of education for health, for being a parent and so on, which it obvious did not, and in terms of the government structure, could not, it would also have to be the Department of Education, of Commerce, of Urb~n Affairs, and indeed make a case for itself for taking practically all of the domestic budget. Unless it did that, it could not pre­ tend or hope or really aspire to deal with primary prevention. It had to deal within a context of social forces larger than itself. So it was then, willy-nilly, pushed, the people in Public Health talk about primary, secondary and tertiary prevention, I have different words for that. I call it prevention, intervention and post-vention, so immediately you're pushed to interventive and postventive efforts-.- But then it seems to me that you can make major tactical choices and they needn't be mutually exclusive. You can talk about mental health and morale, or you can take specific identifiable problems. An example would be the problem of suicide and suicide prevention. And there are other problems, there are other issues that came oub especially in that division calle:lthe Division of Mental Health Problems and I needn't rattle them off but I ' l l say some of them: delinquency and alcoholism and drug abuse and so on. Alright, so that in the first place, to go off on this, someone, and I.11.11 say Stan and his advisers, maybe he, himself, but there's a background to that, decided that, I'll say suicide, but when I say suicide I mean always fauE words: suicide and suicide prevention and to explicate that in a footnote, I mean an exploration of the makeup of suicidal phenomena, ideologies, and first of all taxonomies of the event, there isn't just one kind of suicide, and secondly, the practical aspect of that, prevention. There's a study of suicide as Derkind did and Freud, in part. There 1 e another study of suicide prevention. When I coined that term~suicidology, which Stan permitted me, I Want to talk about that, that's an awfully cute anecdote and shows something of the interaction of the two of us. But when I coined 2 ES that 1 meant to include both of those. Now to me, the godfather of this whole thing is a man who had his own personal problems but in my mind was tremendously undervalued at the Institute and maltreated. I have great flows of affection towards the Institute but I have some flows of disaffection. It's much on the credit side, but there are some debits and one of those is the way in which Hal Hildreth was shabbily treated by no less than Stan him­ self and others, and was in my mind played some part in his pre­ mature death and I was terribly provoked with Stan, and never really expressed it till this moment. To give you an example, Hal had just broken his back in attempting to have the Institute have a national program in this area, and I wasn't there, but the day it was announced at the staff meeting, I was told this by Hal, Hal was in the audience, and he was caught totally by surprise, the kind of civility that I would have wanted to see practiced would have dictated that Hal would have been alerted to the fact that such a center was going to be established, even if he couldn't for reasons that everyone understood, have been Chief, which was a kind of tragedy in his life. He, at least, should have been told rather than be surprised by it, and taken aback. It wounded him terribly, and while everyone there dressed elegantly, they didn't always behave elegantly, from the Chie~. down, and that hurt me. And that's part of it. And on the other hand, I had a tremen­ dously good run there and enormously beholden to NIMH. It's inci­ dental, it's almost unimportant that my career, such as it was going, and it was going fairly well, zoomed enormously, and I became a national figure by virtue of having a national platform. So, in today's mail I go from Who's Who in America, where I've been for ·y some time, I'm now Who's Who in the World, b.f.d, and you know what that stands for, it stands for a big fucking deal. And its nothing, these kudos are nothing, but the fact is, that now, ten years lat.er, I I m being asked by the Encycloepaedia Britannica and my eight page paper is in there, and I speak now ex-cathedra to American Psychiatry, through the bextbook of Psychiatry, they asked me to write that chapter, and Everybody's Handbook of American Psychiatry and so on and I'm on both sides of this. I know an enormous amount about this topic and I know nothing about it, I am an expert who has confidence in his ~wn experience and I'm a fraud, because there are some lies I can't say, but what the heck. J ES But that experience was really an enormously important one :for me, but that•s not the important point. There was an important one for the country. The real tragedy was that it was pissed away and that's another story, and we'll come to that. The kudos to NIMH was that they recognized the problem and set up a center. That was the most important thing, vis-a-vis suicide prevention the NIMH did, simply to extablish the center. The other things don't accrue t0 me, maybe they do. When I arrived there in 66, there were three established centers in the country. Three years later there were over 200. Today, :fourteen years later, there are around 200, but not the same 200. The interesting thing to contemplate is that that movement, after :federal :funds were totally withdrawn :from it did not attrite and die. I ' l l take a little credit :for that. While I was there I used my being there, stimulated by my being there, as a platform to start an organization called the American Association o:f Suicidology. I can't say it was ever a thriving organization, but to the extent that it was, it thrives today. Its membership holds up, it's only several hundred people, it's a small group, it publishes a journal, a:fter the Bowdner Suicidology died its own natural death, and its called Suicide and Life Threatening Behavior, and it holds i~s own, I think, with any professional journal in a narrow band substantive field. So I think those three years were enormously impactful for suicide prevention in this country. The people who :fed into this, through Stan, but Stan had to have the wisdom and the moxie and the flexibility and really the understanding to see it was an area were a couple of people. Louis I. Dublin, I don't know his impact, and the :fact that his son was a physician there is almost adventitious. It was Louis I. Dublin's presence and Karl Menninger fed into this indirectly, I don't know how he contacted Stan, i:f at all, and as I said, Hal busted his ass putting this thing together. We had this comprehensive grant, you remember a seven year grant, and so on •• So that I had the happy experience o:f being both a recipient and a participant and so on. I'll speak personally, which may or may not be o:f interest to you. I think I came there with three distinct advantages, which didn't accrue to everyone who was there. They were as :follows: I was substantively expert and unwilling to do anything else. I came suicidal, wasn't delinquent, alcoholic, addictive, etc. I had a high grade, I wouldn't be demoted, I cou:l.l.dn't 4 ES be promoted, and I didn't want to more laterally. I cane announc­ ing I was leaving. I didn't do this in a feisty way, but I sa±d I had an invitation to the ce,nter for the Advanced Study of' the Behavioral Sciences, it was for the next year, Stan got on the squawk phone and talked to the director, who was then Meredith Wilson, and in my presence said, can we postpone his coming there and it was understood that I would stay at NIMH for three years. At least it was understood by me, and I think clearly understood by Stan, so I wasn't a career man, I wasn't bucking to stay, I wasn't holding on. I wanted to do a good job. In fact, I said may I come here for a year only, and he said no, you can't do anything in a year. He was absolutely right. The year went like that. And the third thing which I think resounded to my advantage was that I was a PH.D. I mean by that, there was no way in the world that I could get his job. I might add, I never wanted it, but there were some features of' NIMH which I observed, almost as an outsider, because I wasn't in it, looked like a Renaissance court, namely, there was a lot of' knifing and conniving and jockying for position and power and all of' that, I knew I was out of' that, and I think Stan perceived that I was out of' it, so that I could work my ass off', come early, stay late, because I believed in the program that I was engaged in, and in no way threaten anybody. I~ was under• stood that I knew more about suicide than the other people and that I wasn't on the make, and certainly wasn't trying to get his job or your job or anyone else's. And I think that was an enormous advantage, it left me free to pursue the program. The program had many aspects. I was in some forty states, I think I missed Hawaii and Alaska, and some others but I travelled. I soon learned you couldn't be a bigshot. The money was not in my pocket to give away, that was for sure, but people perceived you as having money and you had to beware that you didn't con them or seduce them into letting them think that you, personally, had the money to give them personally. I remember being called there, and then in a snowy winter, living at Linden Hill, rather a nice spot up on the hill behind that little chateau where Queen Wilhelmina was hidden during World War II, on a little portable typewriter, which I used this morning, I'm writ~ng a book on it, the same typewriter, I outlined a ten point program. This is all a waste of your tape, but I commuted almost every weekend, took United 52 home Friday night 5 ES cont. and came back Sunday night on 55. I took a briefcase f'ull of' stuf'f' and did a lot of' my work on the plane. People would ask me that I did and my favorite line was that I was a shoe salesman, and I would simply turn back to the manuscript and work. And I outlined what I thought was a decent ten point program. I think I subsumed it under prevention, intervention and postvention. I made up the last term, but it's a logical term. It means to do af'ter the dire event, working with survivor victims, af'ter the terrible suicide has already occurred, irretrievable. And unless I've romanticized it and changed it, I'd be interested to know Stan's memory of' this, we had this meeting, I thought it was a kind of' exit interview where he thanked me f'or the document and I would go back to Los Angeles and, in a sense, he said, you have to do it. I knew Bob had been interviewed and talked to, and I had no intention of' leaving Los Angeles and I said as much, and he then said something which changed my lif'e, really. He said I would never again have the opportunity to paint on a national canvas. I think those were his words, and he said it in his rather f'lat, laconic way and I thought about it and realized that he was absolutely right, that if' I believed in the program this was the one opportunity that f'ate- would give me to see if' something could be done nationally and I moved my whole family's lif'e around that. We had no thought of' moving, but I really f'elt it was a chance I couldn't let go by. Bunivelantly, I'm glad I did that. EAR What was your impression of' him as an individual at that time. You've obviously been get,ting some thoughts about him as you inter­ acted with him, but the moment when you responded to this rather dramatic point ••••• ES Well, I met him with a bad press, so that my view of' him was not f'air and I was very alert to what might happen between us. I'm pleased to say that he made a number of' statements to me that were in the nature of' promises and kept every single one of' them. I was treated enormously well at NIMH. I've a way of' identif'ying with people whom I like and love and much of' that was tied to Hal. But I f'elt that I was given just an absolutely decertrun. There were some mistakes at the end and they were disastrous. The two candidates to take the job I was vacating, I don't want to say to succeed me as though there some regalous line of' succession here, 6 ES cont. I mention two people, Jerome Molotow and a person who had been noisy in Florida and edited a book and was eager for the job, Resnick. It was soon apparent to me that I had made a disastrous ;mistake in nominating Resnick, but the totality of his program was to ex­ punge what I had done from the record. And that's hardly a program. And then when I went to Mort Miller and said look, we've made a mis­ take, Mort was tough, inappropriately so, his feet were on the table, he was maybe 29, 31, he was playing big-shot and he was too young to p1ay big-shot. I think I tried to get to Stan and say this rea11y is a bad choice and this person has a character flaw, he wi11 be nothing but trouble. He is really hostile, he is not humorously hostile, he doesn't make jokes, he is for rea1, a bright, but he isn't that God-damn bright, he turned out to be stupid. I don't give a damn what his I.Q.was, he was a quiz kid as a child, but he was stupid. He's a dumb man, but he is an angry man and he Ki11ed everything. One of the heartbreaks of my life is that choice. And While I'd read the nomination, I tried to withdraw it and Mort erred badly. He was both obdurate and wrong and that's a bad com-­ bination. They wanted someone tougher than Jerry Mo1otow. Jerry's strength is his civility and gentlemess and he's a strong man in his own quiet way. He was totally misjudged there. It would have been a different program entirely, aotua11y different program. It was a difference between Caligula and Churchill. And I was angry at both Mort and Stan for then insisting that Harvey come in, when it was apparent to me that he hated me and that wasn't a good enough program, that's simply not a good enough program and his interest in suicide was a monetary, ephemeral opportunistic. I understand he is now doing something in sex therapy and if something else paid more, he'd do that. I have no respect for him. EAR Wel1, 1et 1 s go back because I think what would be very helpful ••• I think that your program and some others had the great benefit, in terms of what I'm trying to do, to have litera11y begun as a national program at a time when its birth and development and growth could be described. You mentioned before narrow band, in fact it's not that narrow •••• ES No, self-destruction and inimical behavior that is life-threatening behavior, you could then Jega.tima:tely encompass much of driving, a great dea1 of drinking, a 1ot of drug taking and just patterns of living in which people depreciate and denigrate and carve~'away at 7 ES cont. themselves, so that my concept o:f sudden tension death and all that, so there was an enormous program. It also happened at the time, it just happened, o:f intellectual permissiveness to do it. There was a democratic administration that looked rather be­ nignly at NIMH, indeed at that time, it seemed to me, you know I have no head :for the budgets and the :figures and so on, that each time NIMH would ask :for money, and I think there was a year, un­ less I'm mistaken, they got more than they asked :for, and it was a real honeymoon and I was part o:f that, I went along on the honey­ moon. There was a place :for me in that building with energy, I'm making myself sound, I come out very good at my own self descrip­ tion, and cathexis. Even an enemy o:f mine would not deny that I was concerned with the topic. I was concerned before I got there :for some ten years and I stayed with it. I now have twelve books on the shelf and I'm writing the thirteenth and I have not jumped :from topic to topic. I've stayed with it. It's my life work. And NIMH was perhaps the biggest single three year episode or my suicidological career, but it was just an episode o:f my career and so on. So I came at a terrific time, it just so happened, it.was serendipitous, the whole damn thing was serendipitous, my being here is the most serendipitous thing in the world. Can you imagine, here I am, I got this today, I'm Professor o:f Thanatology, I think the only in the country, I was Professor o:f Medical Psychology but I wanted to change this to legitimatize the :field, to have the University o:f Cali:f.ornia say, yes, this is a legitimate field and I have a relationship, Joly is very different :from Stan, but I have a relationship that is rather similar in some ways and maybe I do that, I make it that way. I work my ass off, I work in a substantive field, I give popular courses that are oversubscribed and I'm left alone. That I'm productive enough is not the issue. And can you imagine this fellow, whom I've never met, is on the Council and happened to take a shine to me and invited me to lunch and happened to ask if I'd like to join his :faculty and I joked that I simply wasn't the Oklahoma type and then he told me a secret, and I said, in that case, I ' l l pay :for the lunch. And here I am at ihe school from which I graduated. I must tell you, if he weren't the chairman, if he had not been the new chairman, my chances of our sitting here today were nil. I don't have to go into who the previous chairman was, but i:f there were :fifty 8 ES cont. openings and two candidates I wouldn't be here. So that life is chance, but Pasteur said it, its chance and the prepared mind. EAR Of course, I was going to say something like that. Say a little bit more about that initial memorandum from Stan because I think in a curious way, however you intended it to be used it was the precipitating factor in his making the overture that he did to you. At the time that you gave it to him, did you have any thought really that that was what was going to happen? ES No, 1 was prepared to move back to California. Absolutely. It was the strength of the document. Let me tell you. Some people think I'm feisty. I don't think of myself that way. I think of myself as, there's some sham in me but there are things which are gemuine. Where I'm genuine, I'm real. I think of myself as a serious person, although I'm very funny. I was working for the United States Government. I'"m not a super-patriot, I'm a patriot. I was a Captain in the war, fought the Nazis, wanted to see them murdered. I'm a lef~-wing democrat. I've been to some countries, including the Soviet Union, there's no country that compares to this country in terms of civil liberties, and so on, the blacks aside and that's our national_ sin and shame and has to be worked out some way. That's another topic. I was working for the govern­ ment as a consultant. I wanted to write a serious document. I didn't pour my heart out. It's not an impassioned document. I poured my head out. I wanted to write a God-damn intellectual, theoretical, practical blueprint for somebody's action. I wasn't there just trying to collect per diem. I wanted to write something that Stan could take and put into action. I wanted it organized. I had a series of points. I remember sub-items under each one, I've forgotten now, I can look that in the Decade. I gave the background for each item, something of the rationale for it and some ways to implement it. I wanted to leave him something. I wanted to earn my money and more. I didn't want to eary my money. I wanted a program that someone would do and that was it. I took that homework seriously. I'd been writing term papers all my life that's what I do. I'm writing a book now, it's a thousand page term paper and I write term papers, that's what I do. I did that one in college, and mastered that in a sense, and I was called to Bethesda to writea term paper, the topic was clear enough, and I did that in good faith, and that was it. It was partially a dream 9 ES cont. and partially it had items which were fulfillable. I tried not to •~blue sky" and just say things, like you know, we need 5 million dollars to do this and so on, things which obviously could not be implemented. EAR Stan read it, right then and there while you were sitting there? ES Oh, no. He was a man who did his homework. He had read it care­ fully and went over it and knew its contents. I don't think he was briefed on it. I think he read it. It was my impression that he knew it. You know what I mean. I don't think someone read it and gave him an Eisenhower precis. And that was a serious con­ versation. To jump to another, several months later, maybe a year or two later, to show you something of his mind, really I think the high quality of it and the flexibility at moments. I wanted to start a Bulletin of Suicidology. I was told it would take years and that I would have to go through 97 steps and so on, and that wasn't my style. I was surrounded by people. I had employees who were foot draggers. Their job was to tell me how I couldn't do anything and my job was to roll my eyes and say to them, don't tell me I can't do it, find out how I can do it. I view myself as not psychopathic. I dnn't steal, there's nothing in it for me. You know, when I come and work here, what is there in it for me? And so, I'm not trying to get away with anything. But I want to do a job and I don't want to read the regulations. That's for people who make a lifetime of reading regulations. So I had this idea for the bulletin and went to Stan and I remember he had to sign it, and I then carried it to DEW downtown and within a couple of months we had a printed journal. We had the dummy of it and so on. But he said, suicidology, Ed, you're always coming up with these damn neologisms. And I said, Stan, a neologism is a neologism until it's used a second time, then it's a word. And he said, okey, I ' l l buy that, Ill accept that, but he said, yeu know that this is a bastard word, it has a Latin root and a Greek suffix and I said, that's very bright of you, that's terribly bright of you to see, but that's what my friends in sociology tell me, and he said, touchee, and signed it. That's my memory of that. And that I view as a civil, fairly high-level exchange where he understood that I was serious about it, and he was serious about it, and we made some puns in it and in a sense, thete wassome I humor, but it was serious business. That in a sens~ almost 10 ES cont. characterizes my interactions with him. I found Miller con­ stricting. He had to do something, and I guess he did it. I would have worked better left alone, but he was alright. I puzzle, whether there had to be that kind of triumviral structure in a division chief. EAR You really weren't concerned about organizational structure as such, as you always pointed out, so •••• ES I tried not to be. I almost studied not learning about it. There were people in the building like you, and tell me the name of the fellow who was Stan's fiscal right hand person (George Kingman) no, (George Van Staden) no, administrative somebody ( ) somebody else (what did he look like) Well, I never met him. EAR You don't mean Jim Isbister? ES Exactly. I never met him, but I had a sense of him and my sense was that he was terribly bright and new the fiscal details and so on of the operation. To be straightforward about it, there was nothing that he knew that I couldn't have learned, but it comes down to where you want to put your energies, and I wanted to be suicidal. I can't evaluate what the impact of that program was. I think, nationwide, I know it was considerable. I started the American Association there. I started a Journal, which became, another journal catalyzed indirectly in some couple of hundred suicide prevention centers. None of the NIMH monies, as we both well know, went directly to service. There was a prohibition against that. Started an interest in more than that. I didn't do this. I came along at a time there was a legitimatization of that field. You no longer laughed when you said, we're working in suicide pre­ vention. Fo the SPC, the Los Angeles center exists to this day and all through the country there are these centers, and its okey to be in suicide prevention. Now Stan and I both understood that one of the things that would happen would be not a great decrease in the suicide rate of the country. That couldn't be an aspira­ tion. There would be some increase which would accrue to more accurate counting, more accurate certification, the whole concept of the psychological autopsy and so on, and those statistics remain an unresolved problem, the interstate statistics, and even intercity kind of grizzly sibling rivalry between L.A. and San Francisco and everywhere you go you see this kind of thing. So that, if you were a Senator asking me, can I demonstrate that I created a reduction in the suicide rate in this counry I would have to say, No, sir 11 ES cont. I can't. And it has to do with larger social :forces. I know a way in which we can reduce suicide, an almost sure-fire way, and that is, to declare war, a good war in which the nation was_ _ __ not the Viet Nam War or the Korean War, which were poor wars. But I would point out immediately more lives would be lost. My own interests have shifted slightly to what a super a.lternate to suicide, that is, death, so that I'm a thanatologist, which includes suicide. Now, it would be a grizzly non-humorous statement :for someone to ask me, am I decreasing death, but I ' l l tell you what my agenda is as a clinical thanatologist. It ain't much and it goes down the tube very quickly and yet I think it's very important. I try to help people die better so that i:f you have a terminal cancer, which is none o:f my doing or yours, that is your oncologist, hemotologist, radiologist, tell me, and they even give me a death date. They talk about dying projectories and talk in terms o:f weeks or date. I'm convinced, I know that i:f you're a certain kind o:f person and we have a certain kind of relationship beyond rapport, your transference to me and my counter transference to you, I can help you die better, and more than that, and this ought to please you, even more, I can help your wife survive better as a widow. I will see her early on, and I work with people like this. The demonstration o:f the pro.6:f o:f this is difficult to come by and I'm in the position o:f testimonials like;~ I was going to say a Chinese herb doctor, since I've taken your herbs I no longer have dandru:f:f, I'm bald, and I don't have pace planus, and I get letters like this from grateful people, which is not scientific proof at all. But there's no question in my mind that American hospitals manage dying poorly. I could give anecdote a:fter anecdote .of the abrasive­ ness of well-meaning surgeons and so on. It wouid just turn your hair. They say things tough, they do things tough, they go into a room of a student of mine who's had a mastectomy and without saying, good morning, how do you do, kiss my ass, may I, with three residents he takes down the sheet, lifts her gown and points out his scar, and she said, she had rather he'd raped her. And I saw him in the dying room a couple of weeks later and I said I heard this from somebody and it couldn't be true. I don't know what happened. And he said, did I do that? And I said, yeah, you did it. That isn't what you should be teaching your residents. But I digress, as I always do. 12 EAR Well, I think this is all very useful becuase it hits the penumbra of' the whole issue. There's another part of what you did that I think you might want to comment on. You had said you visited 40 states, and obviously , :tu became a national program in terms of the kind of national image that you provided for the whole program and the people who worked with you, but you also had to initiate a series of procedures and activities for the different parts of the total program, one of' which was a review committee and a mechanism for the consideration of the grant applications as they came in. Perhaps you might want to talk a little bi 1t about that. ES Yes. I just had an insight which I never had before.. I' 11 say it quite as history and it doesn't belong in this because it's about me and it's of interest to nobody. Some years before, some twenty years bef'ore, I was a young Captain in what was obviously a Colonel's job. I was classification officer :for an Air Force Command, having to do with the processing of' returneies, pilots, navigators, bombardeers, and after some rest and relaxation, putting them in teaching spots in the U.S. and filling overs eas quotas. 1 It occurs to me that the manuals :for procedure, I was writing manuals :for procedure, which I did in 194 5, 44-4 5, w,ere not dis­ similar in their intent than what I was :faced with at NIMH. So it wasn't a new job :for me. Now, there were two committees as you know, there was a Senior Advisory Committee and that was simply a Who's Who that had Henry Murray, Carl Menninger and Avery Wiseman and I'm sure that list exists and they helped in three ways. They gave me the courage o:f my own confusions, they backed me personally because each was a friend o:f mine, they gave me ideas which were just magnificent and enlarged the scope o:f the program, and they gave to the world, to Stan, and the Administration an imprima­ tur, that is, they gave a stamp o:f approval, they said, he isn't entirely a nut-brain and we've looked this over, and it seems alright. So that Naticzmal Advisory Committee-was enormously important in the operation but it :fell o:ff after it began. It was a thrill for me because I respected and, or loved every person on that Committee. They were important people in my own life and without exaggerating it was a privilege for me to be a part of' that operation. It was a high thrill the day that they met in the Barlow Building and I looked at this group and I said, look here we are convened, this absolutely sweet, brilliant, prestigious 13 JES cont.0 group. The working committee, the review committee, the study committee was, with exceptions I don't remember, a ,joy. And I tried to be a good host. I would pick them up at the airport, pick them up at the motel and take them out to dinner and shag my ass around and they were marvelous people. I don't remember the ex­ ceptions. What I do remember is that it was a time when we were serious, they took their homework seriously. I rsmember one instance where the person hadn't read the grants and was terribly chagrined, but they did their homework, read them, took them seriously, wrote essays about them. I remember people, I can mention Irwin Deutscher as an example. You can mention him by name or take his name out. The committee would argue and every- one would say, this is a terrific grant proposal, let's approve it, and I think we ought to, and so and so, a:rrl Deutscher would say, I'm against it. It's good, it comes from a tnajor university, they're up to their chin in money, it's just another good grant, let's save our money for something else. I vote against it. Or something would come in, and everybody would say no, poorly designed, it comes from a minor university, as a matter of fact, maybe a black university in the south, they're barely able to put their thoughts together, down. Irwin would say, we have to approve this. This is unusual, it's different, it's an opportunity for them, you're not going to get this kind of request with this particular slant and approach sociologically it 1 s important that we do this. I couldn't predict his iconoclastic approach but he was not destructive and he was typical 0£ that group. People like Litman and Neuringer and Nancy Allen and Deutscher, all sorts of people. I picked people. I didn't know them all before I picked them but (Second side) and in a sense, touched with hostility, but that wasn't till the end. Now, what did we do? We had a program that was divided tradit~onally into research efforts, training efforts, and catalyzing and indirectly supporting service indirectly, so that the word- was out, so to speak, that it was possible to do service if it was tied to research and to do training if it was tied to research. Now a couple of things happened during those three years. There was a great shift, again my not being a physi­ cian was not a detail, that is, a psychologist was heading this and it meant it gave a place for sociologists, anthropologists, other people;. even linguists, wha looked at language and so on. 14 ES cont. Louis Dublin's impact was considerable. He thought that the lay volunteer was the greatest invention since the wheel, and there's no question in the seven year grant that Norm Farber and I had, in which I was P.I., I was so bright, I did, a thing~_fSO~-~tupid, it I s mind boggling. I asked for seven years of support of an equal sum, it was rectangular. Now it not only didn't account £or raises and so on, it didn't account for the absolutely, almost spectacular growth of costs. That triangle on top of the base support had to be filled in, could I go back and ask for more. It had to be filled in by volunteers and we were forced willy-nilly to go to volunteers. Iihought it at the beginning, I now think they're indispensable, provided three things occur, rigorous and careful selection, con­ tinuous top-grade training, constant never-ending supervision. Now I ha-v:e a program called patient care specialists here, we meet in this room, we bring in chairs and about fifteen of us meet in this room, ~e•ve been meeting for three, four years, they not only hang on and pay their own parking and don't get paid and see dying people, which is onorous, I don't think I could fire them. And they get training they couldn't buy, you just can't drop in at a psychoana­ lytic institute and say I'd like to lo.C;lk in on the sessions, and I insist, where possible, they tape-record each session. The super­ vision is done from a cassette tape. There are some of them. Ami they they don't say I handled the resistance, or there was a lot of denial or something. I can hear it. I might add, although this is not germaine to our topic, none of us ever introduces the topic of death or dying ever, we don't have to, the patient brings it up, and the difference is that we don't run from it when it comes up. Now, back to themselves. In terms of, indirectly in terms of service, I think NIMH through that center gave its blessing for the use of volunteers. A number of people picked this up, not only in LA, but Dick McGhee in Florida. He's made a career of studying what makes a good volunteer, how volunteers should be picked and all sorts of things and has contributed substantially to the literature on volunteers in this field, and that touches other aspects of mental health. In terms of service, the AAS, especially through Jerome Mo-t"to who published a book, co-authored with Nancy Allen and Charlotte Ross and someone from Sacramento, they publish­ ed a book on standards, and the whole point of it is that, here it is, it's Motto, Richard Brooks, Charlotte Ross, Nancy Allen, Suicide PreKention Crisis Centers, and the whole book is on standards. 15 ES cont. So that the AAS indirectly, as a legacy from NIMH, is concerned that there be some monitoring and some standards of selection and of process and a follow-up, and all these things. It's not done as rigorously as I would like. I learned very eary that I could not be a Fed or play big-shot. I really didn't try, but after I was there a year or so, I let it out informally that I would like to have some tapes of what the centers were doing, would they please send them to me, and I received several dozen. I spent hours, much of my work was done after midnight, I spent hours listening to those at home. I had one reaction to them. I was absolutely dismayed, more than that, I was flabbergasted, I was stunned. I had thought I had implied I wanted examples of their best tapes, what else would they send me, and I guess they did send me their best tapes. I then made a record, which you may know of, called the First Training Record for Suicidology, which has examples of how not to do it and also has a printed brochure, and these are just horrendous examples of what not to do on the telephone. It was apparent to me that if this was their best work that there was a great deal of work to be done and I felt in part impotent, I couldn't go into Alabama or Georgia and tell people what to do, except I could be concerned about it and try to send out materials, some of which we wrote ourselves. I wr0te a pamphlet with a fellow named Philip Mandelkorn, a Public Affairs pamphlet and it went through Public Affairs Publications and so on. That had some impact. Our own books had some impact. While I was at NIMH I did two books, called Psychology of Suicide, with Norm and Bob, on the record, or off the record, actually I did the book, but it was our work and so they were legitimately part of that and I edited a book called, I guess I did three books, 0 on the Nature of Suicide" and '1 Essays in Self-Destruction". I can tell you, without making excuses as to not detract from my work time and the hours I put in, it was part and parcel of what I was doing. EAR Can I ask you a hypothetical question, if it's not going to derail you? Let me put it in larger context, one of the problems you touched on a moment ago, if someone had asked you, had you de­ creased the number of suicides or if someone asked you now, had you decreased the ameunt of dying, obviously that's a very diffi­ cult question to answer, and by the same token, within the NIMH, the one tangible index which you used year after year, but beca~e· 16 EAR cont. absolutely clicheed was that beginning in 1955 and thereafter the number of people in state mental hospitals declined, year after year after year. Well, lovely, you know, you latch onto something like that and you use it to death, but did the total level of anxiety in the United States, did the total feeling of despair, did any of that really decrease, no. Now, I want to ask you the hypothetical question then, in that context, because often, if someone were to ask us, well, there's still umpteen this and umpteen that, and we would say, well, just imagine what there might have been if there had not been this program. Hypothetical question - can you think where suicide prevention and the whole field of suicidology might be now had you not had the opportunity to develop the program at NIMH? ES The null hypothesis would say it would be just where it is, that it didn't make a bit of difference. The difficulty •• if I had been Director of NIMH, I would have to contemplate the thought that I had one of the toughest jobs in,the·w0rld, namely that I was in a soft area. As a matter of fact, the criterion which you mentioned a moment ago doesn't impress me. It's simply a redistribution. You can put as many people in mental hospitals as you wish to, in the same way that the average length of stay in a mental hospi­ tal can be arbibrarily set by the administrators, it's three days at my hospital, three months at yours, three years at yours, thirty years at yours, you can do what you wish. Schizophrenia is not a disease, malaise is a state of man. Now you can: count suicides, sometimes inaccurately, but you can count them. I believe in something called tone, and I think what the Centers for Studies of Sui.cide Prevention did f'or the United States was to elevate the moral tone of the country by permitting a topic to be permissible. And that in my mind was the main function of the NIMH, to deal head on with the topics that otherwise would have been put under the rug. The figures never impressed me, the drugs, you can salt anyone down, you can give reds, you can give phenobarbitol, you know, you just do that, you could take a major sedative and sedate the po~ulation, but what would you prove by that? I've seen the drug of the week come and go, the cure of the week come and go, and that's because schizophrenia has neve been adequately dimen-, • tionalized. We don't have a good conceptualization of it. That's the only way in which Saw is correct, but I said that in print 17 ES cont. before he did, except I did not then go on to become destruct­ ive about it. I see him as a nefarious influence. He and I had a debate in San Francisco, it's on tape, you may want to listen to it, it's an acrimonious exchange. I say some very mean things about him without swearing, but they're rather strong. EAR Could you take it one step further, you said there are now 200 centers, whereas when you first got started, there was just a handful. Is that not a tangible change that wouldn't have occurred without the NIMH program, or do you think it would have anyway? ES No, I don't think it would have. No. That's a true-false question and I 1 11 answer it that way. I won't even say it wouldn't have occurred as quickly. I don't think from Los Angeles we could have exerted that type of leadership. What was tied with that was the mystique of money and prestige. To be identified with NIMH was not exactly to be tarred. It was something to boast of. it had its own prestige. It was a good government agency. I don't know what a bad government agency is, but you didn't have to be ashamed of it, it had nothing of, it wasn't like FBI or CIA and it wasn't considered ever, as far as I knew, as a second-rate agency, it was considered to be a fairly bright agency. In fact, it had its own intramural center, something of the ambiance of a university and as a matter of fact, there were professor types there who had come from universities, who went back to universities, so that it was a good place. It added prestige to any of its efforts. EAR Alright, so you're saying you don't think the 200 centers would have materialized had it not been for that program? ES Yes, but then you have to go further, have they saved any lives? EAR Alright, that's a legitimate question and you can answer that better than I can. ES I answer it in the following equivocating way. When one lifts the phone for a suicide call, No, I ' i l say it another way. My way of responding to a suicidal call, which I had this morning, as recently as this morning, is to evaluate in terms of two continuum, perturbation and letha.li!~--y. How disturbed the person is that cuts through all the psychiatric and psychological nomen­ clature, you can have any classification you wish, the person is either hyper-active and maniacally homicidal, he needs four people to hold him down, or the person is inertpd~~:i:bg,~"tl catatonia, hasn't spoken or eaten for some days. But those are 18 ES cont. highly perturbed. Those rate high. Perturbation is one thing, and lethality, the probability of the person's killing himself or herself, is another. Willy-nilly, there can't be a simon pure suicide prevention center, the moment it opens its doors and lifts its telephones, it is also a mental health center. It gets some calls where there's more perturbation than lethality, I'm not complaining. What the suicide prevention centers do is provide a place, a raison d-etre, an excuse, a permissible place to go, for perturbation as well as lethality. There is no ques­ tion in my mind, don't ask me to prove it, that those centers have served to lower the perturbation index of the community. Is that a worthwhile use of taxpayer's money? You're damn right it is, in my opinion. That's what mental health is about. What is mental health? Well, the opposite of mental health is an ele­ vation in personal perturbation, the person is disturbed. It sometimes has serious interpersonal sequelae, like murder, and all sorts of other things, and it's a drag to live with someone who is disturbed, and society is disturbed and frightened by people who are disturbed. Now, you can read perturbed every time I say disturbed. Now ways of mollifying that perturbation in the commuN_ ity I believe is a legitimate task for benign government. If you want to play hard-assed and pull it back and go back to a frontier philosophy and be a right-wing Republican, I made it, don't taz me, literally and figuratively and if you didn't make it, that's your fault and then there's no place for public hospitaLs and really no concern with mental health. But if we cross that bridge and talk about social security and helping blind and aged, then I think we can legitimately talk about people who are perturbed. I liked that mission, I resonated to it, I had a feeling that Stan, most of the time, had a grasp of that mission. I don't know why he left NIMH, but I•11 tell you what I think I know, that he resigned on principle in relation to drug legislation and I say this, to say that that is something that I honor. He might have been fired, but he quitQ Incidentally, we have to talk, on or off the tape, about our friend Bertram Brown. EAR Okey, I ' l l get to that. Okey, now you're talking yourself then on the record, beyond that initial point that you made about improving the tone, Now you're saying, well, there is some ad­ vantage, but maybe you can't tangibly document it, in having 200 19 EAR cont. centers. that perturbations, in general, have decreased and lives have been saved. ES God-damn it, let's not let anyone take that from us. Lives have been saved. Now, it's a one-tail thing. If you say, I've saved a life, then you can be accused of hubris, chutzpah, oh, come on the person would have lived without you. You say, no, I really saved that persons life. I took time, I went over to that person, I not only saved that per~on physically, and turned off the gas and opened the window, which I've done, but I saved that person psychologically. Now, there are people in this building who are employees, who will say to you under oath that I saved their lives. I won't have that taken from me. What is crystal clear to the whole world is where a life is lost, so that the unequivocal criterion is only on one side. There is no question that any suicidologist who works at all has saved a life. When I talk to the San Francisco bridge people who are obdurate bastards, they won't defend the bridge in the sense that I mean it. They're waiting till one of their own children jumps, then they'll change their tone, or there's a public suit. They could make the struc­ ture lighter, more esthetic and everthing. I think they have a mystique, they have some kind of perverse pride in that, but I digress. ~They say, won't some of the people jump somewhere else? Everything we know says that this is not so, but my point was that if we saved one life a year, then it would be worth it. I never said that we would save •• there are now 600 people who have jumped from that structure. I never said that they would save 40 lives a year, never claimed that, but would you settle for 20? That's a kind of grizzly arithmetic, I mean, it boggles my mind, it makes me want to vomit when people start talking in those terms. There's no question that suicide prevention centers prevent some suicides. If you dichotomi~e and say, oh, then you miss the point, as Sol misses totally, but let's not ••••• it's a continuum of lethality, with combinations of perturbation and most people who call are not at 8 and 9 lethality, I give you that immediately. In fact the minority of the people who call, if you save some of those people, you save some lives. The other people are in middle range lethality. You don't have to work that hard to save lives, they themselves are in th~s ambivalent flux. 20 EAR Okey, now one other aspect 0£ this whole story is, again, you alluded to, you mention it, but I think you might want to expand on it, there are now people in the field professionally who probably would not be in the field, whether you're talking about a Si Perlin,, whoever it may have been, there are people in the field (ES - by the dozensl okey, yes, so that you have changed the program has changed •••• ES Well, smicidology was a joke, that word was a joke £or about one-half hour in 1967. It's no more a joke than proctology, otarlaryngology, oncology. It's a legitimate bona-fide field, there are professors 0£ suicidology, and so on. Yes, as a matter 0£ £act, NIMH created a discipline, that's true. EAR Okey, I wanted you to get that on the record becau;e it's been implicit in everything you said, but I think it's important w say it in so many words. ES Now the question is, is the discipline worthwhile, and the answer is yes. It's a major area in the study of man. The whole concept. I don 1 t believe in the death wish at all, except if it's used in its most metaphoric way. I do believe in inimical behaviror.·.. You have ways in which you're your own worst enemy and I certainly do and I don't know anyone who doesn't. There are instances in which I've done colossally stupid things against my own best inter&sts, and I think that's true 0£ every life, some more than others. The whole field 0£ self-destructive behavior is terribly interesting. And in a sense, all 0£ alcoholism, and much of drug-taking, I don't know whether to say abuse, or whatever, can be subsumed under inimical behavior, self-destructive behavior. You could make a point that very few people live optimal lives as really se1£­ actualized, are self-actualized, and live up to potentiaJs in themselves, even with the constraints given them. So, there's a body 0£ research, you know what would be interesting, take a tour of my office, now well begin here. My mentor, a man I talked to just the other day, and whom I write to and talk to every oppor­ tunity and cross the country to see, is Henry Murray. He is in my opinion America's foremost living psychologist. He's a surgeon psychoanalyst, physician, he coined the term "personology", he is in Vibil@~'s terms nomothetic ideographic, he's an ideographic psychologist. He believes in the intensive study of relatively few cases over a long period 0£ time. It's the most partial method 21 ES cont. I know. Here's something that appears in the "Psych • I obsess about Herman Melville. I'm writing a book, I wrote something, I use Melville in this chapter that I wrote on this morning, as I do in every chapter. He speaks to me, he's just one of those •• he did for Americans for me, what Shakespeare did. This is a bas relief of my grandfather, made by my father. This~ the plastic copy of the original, which is in brass or bronze, which Harry took out of his fireplace and gave to me, it's now in my fireplace, and Harry designed this, and I made a cxpy of it, the original is at home, "Let not him who seeks sees, until he finds and when he finds, he shall be established." L Like that. Here's a picture of my wife, we've been married 33 years, and my four' sons. He's a pathologist, he was chief resident a couple of years ago, he's a u.c.L.A. MD, he was an English major here. My second son is a Captain in the Army, he's a dentist. He stayed in Maryland, graduated from the u. of Md. He's a second year medical student at Einstein and he's now a senior here and applying to medical school. He's on JO schools, waiting to hear from them. I've been president of Division 12, Division 18, I've had distin­ guished awards from the AAS, the Dublin award, I got the one from Division 12 last year arrl so on. Some more plaques, the usual junk, the Harold Hildreth award. I honor his memory. I loved him. I really loved him. Pictures, of Jean, this is 1945, that's where I was • Here are books of I'm writing a book now called "Voices of Death". I did two books last year, now, 1976, Death Current Restrictives, Suicidology-­ Contemporary Development. These are edited. Deaths of Man and is now named for the National Book Award. Lourie had won it that year. I'm big in Japan, my stuff has been translated into Japanese, some into Italian, and so on. I'm very interested in philosophy. I read Perse, I think he's very powerful, there's some vintage Stein there, and so on. Now, I'm no different than I was at NIMH, and I saw the people around me there, I could talk to people. Let's go back, let's see, we talked about catalyzing service. • In terms of training, the program of suiciidology at Hopkins, Si and I worked out, wnat I think a marvelous model, that it was at John Hopkins meant that not only was it near NIMH, no, that wasn't the important thing, it meant that it was at one of the first rate universities of the country and I think there is so much training in just suicide prevention work at centers, 22 ES cont. it's almost taken :f.or granted. There is no definitive book in this. Thus, last year, when I did this thing, what I did was rather than introduce each chapter, I want to show you this, I dedicated it to these three men. He was at NIMH :for a year, you remember him Shark Charel l?) here's Dublin, Here's Irwin Shtengel, who 1 s just an absolutely beautiful man. When the book came out, they were already all dead, so it's a kind of' spooky picture. And I introduced each chapter with an old piece. Here's my piece :from the 73 encycloepaedia, prefaced by the 1911, here this is :from the Bills of' Mortality by Gram, 1662, morcelli, so that every chapter has in small type. Here is Motto writing about validation of' tests and what do I do, I quote the Krumbach report on what validity is and so on. In Suicide No Three Considered I quote a :few pages :from the Terman study, so that even if' you read just the interstitial material you'd have a historic scan of' the whole :field. There's this substantive stuff' in writing. You see, this is not a disease, you never discover a coccus or a virus or a spirochete, it's a malaise, it's part of' state of' man and it raises interesting quest&ons like what's the optimal suicide rate, and just :for shockers, I ' l l say, it's greater than zero, but it should be less than what it is. So it's not a problem which I can solve in my lifetime, I can work on it and contribute to it. It's a marvelous :field, in that sense, and that was the task of' all of NIMH. NIMH could never solve schizophrenia, I don't believe, that is, there would be meshugenehs, mishagass or insanity or high perturbation as long as there were people, especially as we crowded the~, and other things. What it could do is address itself' to that. What concerns me is that it's a kind of losing :fight, and things go on, and I would like to see it obviously expanded, and other things have happened and not put under drugs and alcohol, that's nonsense. EAR Now, you wanted to say something about Bert Brown, and I don't want you to do that until you're ready to. ES No, I wanted to ask you about it. EAR Oh, I'm sorry. We'll do that at the very end ••••••• You had had no real interaction with him. ES Yes, I did. He and I had a kind of private relationship which apparently changed but with no sense of' disloyalty to Stan. I didn't :feel it. I would go and talk to Bert about things that wer~ other than practical, that is to say, I did not go to Bert 23 ES cont. importuning him for some administrative thing, space, money,­ personnel, some judgment. We would meet informally, maybe once a month, once every two months, and we would schmooze, we would talk, maybe, like we're talking now. We would talk about the possi­ bilities of training and of public health education, and all sorts of things. He was then interested in a number of things, in out­ lying communities and so on and he was one of my, I don't think he and I were close, but he was one of my intellectual companions. My feelings have been a tiny bit hurt that since I've left, I've never been called back to NIMH. I put that to the sour tast that Harvey left and so on and I view with some absolutely non-hostile jealousy the beautiful way in which Sid Cohen was able to go there, incidentally he was my idea in nominee, and work there as Chief of the drug center and then continue to go back as a person who was continually respected and whose counsel was sought. I wished that that had happened to me, because I wanted to maintain that relationship, literally for the fun of it, for the intellectual fun of it. It did not happen, and there it is. EAR Ed, have you hade any, obviously no way near as an intense experi­ ence with any other federal agency as you've had with the NIMH, but are therea any other agencies that you feel sufficiently in­ timate with to make some comment about comparisons and contrasts? ES Oh, yes, I have a long-standing, abiding, almost deep relationship with the Veteran's Administration. Well, I was a trainee there, I was employed there, I was co-head of a central research unit for the study of unpredicted deaths and I go there every week, to this day, as a consultant. I take one person with me, a different person each time, I have to say that if you came with me you would absolutely believe that I was a psychiatric consultant. I don't prescribe drugs or talk about shock, lobotomy, a touchy subject in this building, but cases are presented and I talk to the person, I always go out and get the person myself and this is not a euphe­ mism, I don't interview people, that is, I don't interrogate them. I talk to them and elucidate certain dynamic threads. I always have an agenda in my mind before I meet the person, based on the presentation of the case. Now, even if it's wrong, it doesn't matter that much. It 1 s never wrong totally. It may not be the total agenda. It may be a segment of what is going on, but I pursue something with a point toward clarifying something and 24 ES cont. making practical suggestions for benign care. I don't arrive at some damn diagnosis, in fact, I eschew diagnosis. I remember as a youngster, that is, in my twenties, and thirties, sitting through state hospital mornings where the whole point was to come out with schizophrenic reaction, paranoid type, it's time for lunch and they adjourned, and I would say, now, what, but there was no now what, that was the whole point of the morning and I thought that was an exercise in n~nsense. But, to compare. The VA is curious, it's one of the most gyroscopic, starlit organizations ever, except locally. UCLA, Joly has made a rela­ tionship with them, I don't say taken them over, but their top people have been placed there are UCLA professors, they're people like Milt Greenblatt and Phil May and absolutely top notch people who are professors of psychiatry by anyone's standards arrl who are here and they've really revolutionized the place. They have many fewer patients, an emphasis on research and better treatment and an up-grading of the whole thing. When I knew it, it was very sleepy and yet I have a way, almost a talent, of working throqgh organizations. I was in the Army, wore a uniform proudly, buttoned all my buttons, saluted majors and above, but I was never in the Army. It was my war too and to tell an anecdote, which shouldn't be in any book, a master-sergeant once came to me and he said, sir, do you realize you're violating articles of war something or other in the way you're moving personnel and something, and you'd better read them and he handed me this cloth-bound volume, and I handed it back to him, and he said, don't you want to read it, and I said, I want to be on record as never having looked into it, and I said that's why you're a sergeant and I'm a captain. I'm a law-abiding person, but I believe that if you get people of good-will together, at NIMH for example, and the 1 re not psycho­ paths, noone was ripping the government off, everyone can tell this story, whatever my salary was I was spending $5,000-$10,000 out of pocket every year. The traveling was not pleasure, this was not going to the Caribean and sitting. I mean, traveling to North Dakota in the wintertime to give some lectures and talk to some people about grants, it's a pain in the ass, and the per diem never covered it, and I never got taken out to dinner, because it was a matter of principle, and so on. But if you get People of 25 ES cont. goodwill together and they work on something, I think that produced something. The difficulty is to demonstrate to the people who want to audit you in terms of dollars. EAR Why wasn't the VA able to do at least some of the things that NIMH has done? The VA began immediately after World War II with a great deal of potential, money, training programs in psychology, mental hygiene clinics, research activities, the whole panoply of potentiality, in one sense of VA to be more than just a service organization, what happened? ES Oh, it didn't exist. It didn't exist, because for example right after the war there was a training program at the VA Mental Hygiene Clinic, there was then Dr. Eugene Pumphrey Midlin, Gene Midlin, who was here, a beloved and beautiful and brillian man in a very quiet way, a psychoanalytic talmudic type scholar, I loved him, but I had to stand in a long, long line to say that. And Ruth Tolman and Mort Meyer and other people. There were absolutely marvelous, first rate. They didn't have the zest for publishing and then that fell apart, they went their separate ways, and then they just got people who just saw patients. That's not enough. Now, you have to get people with a zest for order, and for putting that order into pub­ lications. Now, I became a professor as a professor, I came in at that place, I didn't go through the ranks. I've never published or perished. I have about 100, 200 publications. I can't believe that I would see a dozen people who have died with cancer, I've seen a hundred, and not have thoughts about them and have tapes to illustrate the varieties of thoughts. So, I have to, how could I not then write pieces like "Aspects of the Dying Process" last year and a paper called "Some Aspects of Psychotherapy with Dying Persons". I mean, if I'm going to do {t, I have to think about it, I say to myself, and if I'm going to think about it how better to codify those thoughts than to put the damn thing down on paper, then I might as well send it off to be published. Now, at this point in my life, and earlier, I never felt I needed to publish. I couldn't stop it. The VA didn't have that kind of person and I tend to be critical of that kind of rerson. I belivve that every ward of the VA has a Nobel Prize on it potentially, that's a living laboratory. Why is this guy hearing these voices, and they're no more Napoleons and you could ask a dozen questions all of them more profound than 26 ES cont. the two I've just mentioned and it's amazing to me, except that I'm not going to paddle in schizophrenia. EAR Okey, so the VA didn't get there? ES They didn't recruit rigorously enough, and they got service doctors and service psychologists and that ain't enough. EAR And yet there were pockets of potentiality, if I may use that phrase, like the L.A. Mental Hygiene Clinic, in some respect the little research program that Maury Lorr and I were involved in in Washington, all over the place there were people ••••• ES Those things are known, •••• but there are not many •••• if you look at names, Milt Greenblatt, and Phil May and the Late Arthur Mersky and all sorts of people, then you have productivity from the VA but in effect you're simply extending the university. The question still remains why couldn't the VA do this on its own? It never saw itself with that image. EAR I don't want to belabor the point but I think it is interesting to recognize that the growth and development of NIMH was just more than the availability of monies, more than a mandate for a National Mental Health Act, more than a whole sequence of people who were in a sense given responsibilities for various program areas. There was (and comment if you will) somehow an integration of talents and a very peculiar similarity to an academic community functioning in that environment which allowed for that kind of productivity. ES I saw this more in; the chiefs than anywhere else. If you look at Sid Cohen and Jack Mendelson and the chiefs, this may appear in print and I would not mind if it did, The people I worked with are the people who worked for me or under me in my center, with whom I was saddled when I got there were more drones than anything. The harshest thing that I could say is there are times that I felt I could have done much more without them than with them. They were not highly creative intellectual being, they had the civil service mentality, they didn't publish and they were doing things, and they worked hard and so on and the most I can say is that sometimes they really didn't bother me too much. Other people, like eal Fredrick, I recruited in the same way that, and I want this off the record, that Joly recruits another part of himself to run the total place. He realizes that he can't do everything and I needed a first rate man, so to speak, an inside man, who would take care of budget, personnel, space, housing, keep store and Cal and I got along very 27 ES cont. well, because we played those roles for each other and I ab­ solutely needed him. But I looked to people like Jack Jerome, whom I invited there for a year to go out and talk theopy about, which sounded terribly impractical, except it got translated, some of it got translated into practical program and gave the program that extra stamp of quality. Now, at the SPC, with NIMH money, without ever checking with NIMH, I never checked with anybody because some­ body was liable to say no, I invited people there as Fellows, so Harry came, and Jack Jerome, and Stephen Pepper, who was Professor of Philosophy and Art at Berkeley, and Calcott Parsons and Garfinkel Warnbree, Harvey Sachs, now deceased, Maury Eagle, Louis Dublin, Avery, Dickery:, Lipman, Leo Kessel, dean of the School of Medicine in England, Norm Tobachnik, Norm Farbro, Paul Friedman, now I have the Zilboorg across the hall, Kubie, Crestenburg from Denmark, I met him at Harvard, Shaefer, and we put together a set of essays that got laudatory reviews as an edited book and it would do justice to any major university. This was at the LASPC. My feeling was that it was a good investment in money, yet without ideas we would simply repeat -ourselves. Now, what about research? Take this book and read it carefully. I don't mean do it. And then read the best book that was available in 1965, that's the year before, and I think you will see that there has been great movement, substantive, demographic and look, I chose to up the price of the book by printing tables so that there just wasn't the text of it, that you could go to the God-damn tables and see the figures, and they were fairly recell,t, obviously they will soon be outdated, but the point is there's a of knowledge now called suicidology. Now I want to steer between Scylla and Charibdis of being over-prideful or over-modest. I think with a combination of opportunity, I have to say that without Stan creating that op­ portunity there would have been nothing printed. I don't know what part Hal played in it, I think his putting together that demonstration of research and training and some service components and the fact that the LASPC had an absolutely first rate staff, I'm the only person in the senior staff to have left it. Do you realize that Norm Farbro, who is still a VA employee, but goes every day to the SPC and is the Director of it, with Bob Lipman, Tobachnik and CaRL Wold and Klugman, Heilig, from the earlt 1960s before the NIMH experience, are still there-;-;and expanding in many ways and 28 ES cont. Norm has been President of the International Association for Suicide Prevention, had tremendous impact. So I think Stan sensed that, and we had credentials, that is to say we had PH.Ds or M.D.s, Bob is one of the brightest young men, he's a pyrotech­ nically bright decent sweet fellow, he's a training analyst, and yet not stuffy, you can talk to him all day and he won't say 11 labidinal convexus 0 and that's a good staff. So that Stan maybe appreciated the fact that if it worked in L.A. something, either similar to it, if you put quality and effort into it, you could do something that would resound to the glory of NIMH, and his job was to look for programs. EAR Someone asked me, I don't know who it is, sometime ago, during the course of these interviews, can you name something that NIMH did that represents a kind of seminal product, and I have to tell you I was floored, because I can name dozens of them, in the sense that I tMnk he was asking me the question and the suicide preven­ tion program and the program of suicidology would fall into that category, would you say, ES I would hope so. Yes, I would say so. Nothing that NIMH did was seminal like semen. There's nothing that you can see. NIMH's program mandated from the government is essentially a dealing with intangibles, mental health. I once suggested to Stan, he may not remember this, that we could have an index of perturbation on mental health for a community, for the whole community, some cities at some timESare upset and in ferment, and so on. Some cities live that way chronically. New York, for example. And then it explodes beyond its chronic level of perturbation, but that's software, the whole damn thing is software, and then you say, well, we have fewer days in mental hospitals. It doesn't say anything, and your part is absolutely right. What about the anxiety and depression and perturbation in the community? Put that together with d1vorce rate and alcoholism and everything else and see if you've done any­ thing. Here in California we had a mini-experiment on_a gigantic scale. We had a tight-assed Governor, one of the greatest disasters since the 1906 earthquake, Ronald Reagan, and he saved a lot of money. That's in quotation marks. He closed the state hospitals and put them back in the communities, saying that the counties would pick them up. They never did, and you simply had this come 29 ES cont. out in crime, perturbation, jail time. I don't know that a dollar was saved. I know that a lot of hearts were broken. Now, when you first called, I jotted down something and let's see what I did. I haven't looked at this since you called. I say here that that was the most important incident in my whole professional life. I've been to more impressive places, I've been to Harvard, the Center, but it competes, intellectually. At Harvard and the Center there isn't as much dead wood, I ' l l say civil servants, as there was there. The whole mix was that. It~was the most impactful platform. It was the federal government, and as chief of a center, it sounded good. The thing was serendipitous and I mentioned the reason why I think I had a good run there. I think I was misperceived as being more cute than serious. My clever remarks was not what I was doing. I thought I was being deadly serious (no pun) I took things very seriously. The quipping and the humor, that was just a way of interacting, but I think I was seen as ••••• EAR Do you think that that diminished your public image? ES Yes. In your mind for example •••• EAR Oh, no. You've misperceived. That was a terribly important mode of communication and if anything it enhanced,rat;herthan diminished. ES Well, at the LASPC it's been noted many times, by many visitors that there's laughter in the building. Now, I think it's absolutely true that we don't laugh at patients, we've never made a patient a but of our laughter, we sometimes laugh with patients and we laugh at the life that we know. We also know if we don't laugh we are going to be in trouble. Working with dying people, for example, is very abrasive, because the people die, you get attached to them and they die. In the last severall.years I've wept. I give a course called "Death arrl Suicide". It fills a large auditorium. In part it's a funny course, hardly a lecture goes by that there aren't roars of laughter. I never tell a canned joke. Some things will just come out. For example, I ' l l tell you, it's fresh in my mind. There was a young man in the course, he's 20 years old he had a cancer in the bones of his wrist. He and his father went to the Mayo Clinic and they examined him and they went to the Silirgeon 1 s rd-Om and the Surgeon said, the first thing we have to do is take his arm off, and the father put his arm around the son's shoulder and he said, come on, son, let's go. They came to JO ES cont. an oncologist here, I•11 digress to tell you something; that oncologist heard me talk at a meeting and I had been meeting with him once every two weeks, I ' l l add with no exchange of monies, as a kind of consultant to him and his colleagues, not to tell him about cancer, oncology, about which I know nothing, but more to life their spirits, to give them psychological consultation. They have an onorous practice. This young man was in my class, and I asked him one day as we were walking in, would you talk to the class. and he said, sure I ' l l talk to them. So I said to the c~ass, we have someone in the class who has had cancer five years ago and he's now here, he 1 s 20 years old (actually a beautiful young man) and he came down and he spoke and he broke their hearts. We were~sitting in chairs, side by side, in front of the whole auditorium, he had his microphone, and T said to him, what do you think you'll be doing five years from now? It's a very interesting diagnostic question. I ' l l be dead, would be one answer. And he said, well, I hope to finish college and be launched in my career. I said, will you be married? And he put his hand upon my knee and said, is this a proposition? And I said no, it's a query. And the group just exploded. Now, I remember that because that can't be anticipated. It's a pun on queer or homosexual relationahip am I propositioning him homosexually, on marriage on everything,it touches many taboo and deep things. It relaased the tension of his 20 minute presentation. The young people, the girls in the whole class, they were literally unable to breathe·. He has his arms and he's had chemotherapy and he's been now some years without a metasthesis and so on. It was a moving.session, humor is appro­ priate in that. EAR Let me set the record straight. You ~isperceived me. There are two people in my life whom I have found to have a sense o:f humor so extraordinary that it's always been a joy being with them. You're one o:f them and the other is Pete Rossi. Now, I ' t l tell you a story about Pete Rossi, very very parallel to the one that you just told me. At a manpower meeting some years ago, and it was way before the space program got to the point where it literally went to the moon and Art Brae:field said in the course of this dis­ cussion, Well, you know, what i:f they really do go to the moon and they want to take a psychologist there, what would you think o:f that. And Pete Rossi said, I would say that's lunatic. 31 ES You listen very carefully. I think that's the mark of a good therapist. If you listen especially to people who are psychoti­ cally disturbed, there's an enormous amount of double entendre. It's not funny, it's not humorous double entendre, there's a double meaning of words all the time, one has to, I think, know the lang­ uage well enough to understand at least.the double meanings, the concrete meanings, the metaphoric meanings and so on, and that's very close to punning. EAR And I want to get back to NIMH because this is not off center. Punning, humor, quick intellectual interchange was a very common mode of communication at NIMH, you were one of the better ones at that, but everyone did it so some extent. We had internal memor­ anda which were tongue in cheek from time to time. It was not unusual and I think it was a terribly important •••• ES It 1 S·' the mark of a great university. I •ve not been there except as a visitor, but I've read enough of the kind of talk that takes place, for example, at Oxford and Cambridge and I know Harvard well enough, I have some in depth experience there that some of the conversations of, get this, I.A.Richards,Eric Ericson, Alport, Robert White, Jerry Bruner at Harry's table, the long table he had at 7 Divinity and I was there like this and I never heard such pyrotechnical ideas in language, and this was not a stand or sit down comic show with no substance, just to make fun, just to use the language, this was really the real thing, with such humor you couldn't laugh at it and it was continuous, so that I prize that, was used to it, didn't want to be seen just as being funny. I thought it was funny, but my mission was not funny. Doing something with the topic of suicide is serious business 1 and the interchange with this young man, who at Mayo, the first thing they wanted to do is chop his arm and who could have been dead and whose metasthesms have been spotted and arrested, brush fires all the time. That was overwhelming, it was emotionally overwhelming for the group and the explosiveness of the humor was the release of the tension. Okey, now what else? What we've left out are the hundreds of hours of work, and where does that go? Well, also, what we have to do is give credit to the hundreds of published, and include unpublished intellectual pursuits called research articles all around the country. This was really a national program. I had made a count by states, I think every state is represented and if you just riffle 32 ES cont. through what is the successor of the book on Suicidology, if you look at life threatening behavior, it's all over the country. I think that's part of the legacy of the NIMH center. Just as people have lives (this is benal ?)and they have apogees and they then get older and they die, organizations do this, even long time organizations. Take the Department of Philosophy at Harvard. It's three hundred and forty some years old, 1636 is the founding date, now obviously that department has had ••• it's like a silly simplisbic curve of a manic-depressive psychosis which~ don't think I've ever seen in my life, but the textbook shows, there are times when the department's been great and there are times when it's been in a kind of doldrums almost for a generation's time and so on. Now I think I was lucky, I came to NIMH at an apogee and left during that same period. I never intended to stay, that isn't a deprecia­ tion of the institute, but I'm glad it wasn't my intent to try to hold on and live through the Nixon years and try to make my main art an art of survival. It's marvelous' to be tenured. I don't think about it. I would have to be a homosexual communist at the same time to be fired here. It doesn't enter my mind and noone is about to, and it leaves me free to do the work. I had that feeling at NIMH. The negative side of it are my tears for Hal. Do you want to talk about him? Is there anything that's off the record? EAR Unless you say so, I'd rather not. ES How was Hal perceived there (Eli-should I turn it off?) No. EAR I think mixed, depending on who you talk to. You know, Hal, I think, suffered from the problem of having left the Va under cir­ cumstances that some people probably didn't u:rderstand. I think he came to the NIMH perhaps expecting more than was possible because of his previous position of high visibility at the VA. I think Joe Bobbitt tried very hard to find a place for him in which he could continue to be creative, but he never really had a role which ex­ tended into the kind of administrative responsibilities that he had been involved in •••• ES He was never accepted into the inner circle. Why was that? Was it because of his personality, was it because of his alcoholism? What was it? EAR I don't think there was any one issue and I don't want this to sound harsh, but I don't think there was a place for him at that 33 EAR cont. level at that time, ••• ES Was he considered not bright enough? EAR I don't think so. I, of course, knew him at the VA. We worked together, we edited a book together, so I knew him •• "Clinical Practices in Psychology", he had a chapter in that. ES Was he perceived as having a problem with alcohol? EAR Oh, sure. ES Everybody knew that? EAR Well, people knew it. ES Stan and you knew that? EAR Sure, sure, but I think that the sorts of things that he did were recognized and he may have expected more than was really possible and that's the tragedy of the irlrlividual. ES Why wouldn't Stan have told him that he was going to announce a Center? Did it slip his mind? EAR I don't know the story of that but I think, knowing Stan as well as I do, I don't think it skipped his mind, very few things do. He may just have felt that it wasn't necessary to do that kind of very gentle interpersonal relationship, Stan doesn't have. ES He doesn't have. You are able to say that, you know that. You count it as a defect in him? EAR Well, I have to qualify what I've just said by pointing out that he's basically a very shy person. That interchange between you and him about suicidology and sociology, I don't know if you know him well enough, he is an extraordinarily verbal person in a non­ verbal way. His command of language is, he does the N.Y.Times Sunday Crossword puzzle with a pen, and there aren't many people who can do that. He's an extraordinarily bright man, and not many people know how intelligent he is. He is incredibly gifted, but he does not have the gift of gab, like you do, and to some extent, that I do. ES But he also, he may hear of this, he doesn't have the gift of man­ ners. He's elegantly dressed, but he doesn't behave in an elegant way. EAR Well, I think that you have to look at that on two levels, that sometimes may be very superficial, but by the same token, I don't want to defend him too much. There are times when he has promised people things in ways he didn't realize they heard differently than he did •••• 34 ES No, I can give you examples. I know of two wives whose feelings he hurt irreparably. It didn't have to do with promises or any­ thing. He was just socially tactless where ordinary common sense and civility would lead one to do otherwise. I ' l l give you a somewhat disguised example. I'm trying very much to recruit you for an important position. You are both in my office, I mean, you and your wife, I don't say a word to her, not a word, I don't even aciknowledge her presence, I don't say hello, are you enjoying Southern California, we're having a lot of rain, aren't we, are your quarters alright,~~t's been a pleasure to have met you, she was boggled, more than that, she was incensed. What she said to her husband was, I don't want you working for that man. Now how can he do that? EA....~ He doesn't do that very often? ES How can he be so bright and so dumb? That was an evil thing. EAR Well I think that's an unusual circumstance. ES;' Jimmy Carter woulcln 1 t do that. EAR Right. One of the things that Stan and Bob Felix had in common, even though they were terribly different poeple, remarkably different people in many ways, one of the things that they had in common, very curiously, very ·few people came out of their respective offices having been invited to join the NIMH without a tremendous sense of enthusiasm and the potential of working out. Bob had an added ingredient. When Bob Felix talked to you, you not only wanted to work for NIMH, you wanted him to be your other father. He had this incredibly warm ability to be immediately close to and very comfor­ table with everybody. ES I know what I missed at Nitfil, a father, there was none and that was an indictment of everybody, there simply was none for me. EAR He had left in 1964. Your father left in 1964 before you got there. ES No, there was none for me, which is to say Stan didn't play that role. Harry continued to play that role for me and does to this day, and did before. But I looked for someone, the charisma wasn't from Stan, it was from the mission itself, but I go back to what I said at the beginning, he treated me with infinite politeness, he kept every promise he ever made to me, there was no traduction or no nonsense, and I felt at ease with him, but I know many other people who are absolutely suffering with him. I remember there was some fellow whose name I don't even know, who was a Division 35 ES cont. Chief and he went to Europe, and I heard that he was demoted, his job was taken from him while he was in Europe and his secre­ tary knew this and someone knew it, and even I knew it, and I've forgotten his name now, and I said, why that's absolutely Machia­ velian, how could they do that? I mean, they can demote him, they can fire him, they can say, we don't want you, please leave, but to do this while he's away, that's dirty. EAR Stan can do that. ES and I realized that Stan can do this and there was a kind of heart­ lessness and then I said, Gee, Ed, do you have to be on your mettle? and I said to myself, well, to hell with it, I'm leaving in three years, I'm doing my job, if it happens, it happens, and I'm not going to worry about it, but then I had to fear him a little bit. EAR Well, he's basically a very gentle person, it's a curious thing to say ••• ES With a streak of ruthlessness. EAR with a streak of stubborness, which borders on being ruthlessness, when he's got a aecision to make. ES Why couldn't he wait for this guy to re~urn from Europe? EAR I don't know••••••••••••••••••Is there anything else you want to say? ES Here are the notes I took after you talked, Yl)U phoned me •••• EAR You've gone over some of that I think. ES Well, I repeat myself, it was a time when I could really jell ideas, the whole concept of sudden tension, the whole concept of lethality and perturbation, post-vention, all these things, I was having a great time in my own head.