t \ Stanley F. Yolles St'ony Brook AJ/ril 21, 19 7 5 I • EAR As~ I told you, I have already interviewed Phil and still haven't ~ heard from Phil Hallen. And I hope to soon. I told Phil I would come back and see him again, because of the fact that in an hour and a half we really just touched on some of the highlights, and what I want to do with you is to have in this initial session really a kind of beginning interview. If you have no objection, it would probably be best to start at the point where you first came to the Institute--the things you mentioned ~ybriefly when we talked a couple of weeks ago. SFY You mean the Mental Health Study Center? EAR What I want to do with each of the three of you, especially with you and Bob is to set up kind of a personal involvement by virtue of what the beginning interaction was, and I think it would be useful for a variety of reasons to know how you first became affiliated with the Institute. Even that odd episode that you mentioned about the problem of getting the thing off the ground. And then, obviously, we will have to have a number of additional sessions. We can move on from there, but I think just to set the stage initially • • • SFY We've got to go back to 1951. When I got out of internship at the Public Health Service Hospital in Staten Island, I knew I wanted to go into psychiatry at that point, and after having come out of a background in public health, I wasn't sure in my own mind whether I should have an MPH first or do psychiatry residency and then go for training in public health, and .frankly, 2. SFY(cont) asking people around was no help whatsoever. Nobody could give me any advice at that point. So I went to Lexington to do my residency, • • • EAR How did you hear about Lexington in the first place? SFY Well, at the Public Health Service Hospital at Staten Island, we were aware of public health service residencies, plus I had more than the usual association with the public health service since in my senior year in medical school I had done a two-months rotation with the public health service at my own arrangement. I did two months with the New York City Department of Health, and then two months with the U.S. Public Health Service, rotating through all of their services in the Begional Office, which also included working with the quarantine people on Staten Island, and boarding ships for examination of the ship itself (you know, looking for rats and all the rest of it, the usual business} as well as the examination of aliens. That was just about the time that all the shiploads of displaced persons from Europe were coming in, so I knew the setup in the Public Health Service. As a matter of fact, when I was rotating through Psychiatry in the Regional Office, (what's his name, a young fellow who became psychotic later, the psychiatris~ he was in the interviewer program later on--the classic one. His father was a psychologist and his brother is a psychologist. A psychiatrist who went bats, and John Eberhardt had to go get the police.} He was in the Regional Office at the time. He was the regional psychiatric consultant, and he suggested to me that I go into psychiatry training, at which time I told him • • • 3. EAR You mean Ray Gould? SFY No. I mean floridly psychotic, not a manic depressive. He was a paranoid schizophrenic. Which came up later, as a matter of fact, because he was on my interview panel for the regular core examinations of the public health service which I took at the end of my internship here, and by that time I had been accepted in psychiatry. He said to me, "How did you become interested in psychiatry2° He was a member of a board of three people. He obviously didn't remember me at all. rr:m in a rotation. I said, "Because you suggested it.n When I got to Lexington, nobody was of any help there. They were all interested in clinical operations. They were interested in drug abuse, and it was a very busy time for the first two years, and the third year I had more time to reflect on what I wanted to do, and I still had the same unanswered questions. Should I go to school of public health, or should I at this time get some experience in psychiatry before going to school of public health. And I talked to Murray Diamond, and Murray said,nWhy don't you talk to NIMH." Now remember that Lexington was part of the Division of Hospitals, a different Bureau. Violently antagonisti6 t6 NIH. Of course, they were supposed to be the cream ofihe crop, and getting all the best money, and all the rest of it; so, they had all of the training programs that fed into the NIH and other Bureaus, the Bureau of State Services at that time. And they had a tendency to hold on to their people for their own clinical programs in the Division of Hospitals. But, in spite of that, 4. SFY(cont) they sug-gested that I contact NIMH and apply there since NIMH was interested in a type of public h~alth psychiatry. That would steer me from there on in. And as I told you, I applied for assignment to NIMH, and I got a very cold letter back saying they didn't have any openings, and besides, all psychiatrists assigned to NIMH would have to be analyzed beforehand, etc. It was obvious I didn't have an analysis. That ended the first chapter. And so a few months passed and I talked with Murray again, and he said, "What have you got to lose? Write to them again." This time I got a reply, "Yes, come down." It was close to the end of my residency and here was somebody applying for the first time, asking to transfer to NIMH out of the Division of Hospitals, and there were so few. Maybe it was a poor year. Anyway, I got a request to come down, which I did, and I was seen by Joe Bohbifat. .. EAR At that time Murray was in personnel? SFY No, Murray was the Clinical Director at Lexington. I was seen by Joe Bobbitt because Vesty was busy. We talked at long length about plans, but he really didn't have any suggestions to make one way or the other. And finally he knocked at Vesty's door and Vesty stuck his head out and he introduced me to Vesty. And Vesty looks at me and says, "Young man, if you're interested in an analysis, you'll have to get it on your own." That was the end of the interview with Vesty. Whether Murray wrote to anybody else up there at NIMH, whether he wrote to Lowery or not, I don't know. Murray had been in the Regional Office at New York and so 5 .. ...,,,, SFY(cont) he knew Jim Lowefry, -....:,, who was Chief of the Community Services Branch. But at any rat~, I got a call one day from Jim Loqry asking if I was still interested in being assigned to NIMH, and that there were positions in the Community Services Branch. I said, "Yes." And he said, "Well, it might be a good idea if you came down and sat in on the National Advisory Mental Health Council just to get some idea of the way we operate." And the Community Services Program was coming up on the day that he arranged. rrAnd then you can talk with some of the people up here.n Which Tam and I did as~a matter of fact. It was just at the time that she was pregnant with Melanie, and we flew down. We were wondering about that afterwards, if we should have flown. It was very pleasant-- a very pleasant session, and Loffj:y said of course he couldn't say anything definite. I had put in a request for training outside of the Service at that point. And Low'?'ry said the v Committee had reviewed it. They got in touch with me saying that the request for training outside the Service had been turned down, but that they did have positions in the Community in that Services Branch, and was I interested/in lieu of training outside the Service for an MPH. I remember I had a discussion with Lot!,"1:-y about it. He said, "Well, the Committee decided, and you know, we don't know if this is final." No, no, this conversation steered me in a different direction. It is interesting. Apparently he had called to say that he wanted to interview me in relationship to this training outside the 6 .. SFY {cont) Service, and because it was in Public Health, he was interested for the Community Services Branch, which was doing consultation, etc. Because I asked him how about my application for training outside the Service, and he said he didn't know. It was in the hands of the Committee, and I remember at that point being a little annoyed at that sort of bureaucratic brush-off, and I said, "Well, it's only a matter of you~~e getting up and_ going across the hall ~nd asking them." And he said, "Well, it's not that simple. I don't know. I can try to find .out for you." But nothing came of it, anyway. And that's when he invited me to come back and sit in on the Council, which we did. It was then decided that I was to go to Chicago; the Regional Office was in Chicago. And Lo~ty said that since Harold ',Eranning was the Regional Director in Chicago, I should talk with Harold since he had to approve any transfers since ·!he :was Regional Health Director, and the Mental Health came under his purview. He was going to the Dedication of the Environmental Diseases {?) Research Institute which he had established in Cincinnatti. It was just opening, and that he would stop at Lexington, and would I talk with him. So, it was all set up several months in advance (maybe a month), and then about a week prior to tranning's coming down I get this call from Lawry's office, and Lowry gets on the line and says, "There's been a change of plans entirely. We don't think you ought to go to Chicago. You don't have enough experience to be there as a Psychiatric Consultant on your own, but there is an opening 7. SFY(cont) in the Mental Health Studies Center in Prince George's County, and would you be interested in that?" I said, "Yes." He said, "Obviously there you're going to do public health psychiatry and there's research going on, etc.n So I said, "What about Dr. 1ranning?" He said, "Well, that's the problem. You're going to have to get him to say 'no' to your coming to Chicago, because we at this point have made a commitment to him, and we can't withdraw it." They're turning this over to a fledgling, supposedly. So we had quite a session there. I took him around the hospital, and he was, I remember, very, very perturbed be­ cause walking down one of the staircases we proceeded by a florid transvestite. He was a black fellow with orange hair and wearing half female clothes, and he was flaunting his rear end and swaggering down the stairs. 'iranning 1 s eyes were practically out on stalks. We got to the downstairs, I remember, in the main lobby, and he said, "What do you do about such things?" "We don't do anything.u He said, "But it's a problem.u Having been programmed to turn him off as much as I possibly could, I said, "Well, the problem is only in the eye of the beholder." You know, if you don't see it as a problem, it isn't a problem, which was one black mark. But you have to realize that Branning was desperate and he wanted a psychiatrist, so he was going to take anything that came along that was warm with and had two legs. And, then we met/a number of people, and %"ranning was Chairing this, and they were asking me all sorts of questions. I was putting up all sorts of road blocks, and 8. SFY(cont) all sorts of demands--that Tam would have to have a job in the Regional Office, and this and that and the other, and (h finally, ~ranning threw up his hands in despair and said, -'I just can't see that this would work out. I cantt make such commitments and guarantee all these things. Why don•t you consider, and I'll reconsider also." And we left it at that, which was a very happy arrangement. When it came July 1, I went off to Prince G~orge's County. Alan Miller was the Director. EAR You didn't do anything about the Prince George's Study Center before that? SFY No, I knew it was a Mental Health Clinic that was being operated by the NIMH, but nothing more than that. We were located in the Richie Coliseum at that time--College Park. In order to get tb the toilet, unless you wanted to go away downstairs, and around to the back of the Coliseum, you had to go through Alan Miller's office to get to the toilet which was at the other end of his office. It was a • • • he and I at that stage of the game were the only two psychiatrists, of course, in the place. Adele Diefenbach, then Adele Henderson, was the mental health nurse. There was a social worker, (I forget that name by now) who left after I was there a year, and her place was lee , taken by Grace Littlejohn. Our psychologist was -Gi-i Margoltn. EAR That name will crop up again. Go ahead. SFY I was smiling, because I was blocking it out as you remember. There were two secretaries. That was it. Total staff. 9"' EAR It had been in eJistence I how long when you arrived? . I SFY Prine~ George Me~tal Health ~linic was opened in 1948 with . I the opening of t~e Institute. Th~ first Director was Mabel I Ross, who had bee n hired to take the job. 1 She came on early i before the place ipened. It was in the Community Services Branch. The Ment~l Health Study Center was part of the Community Services Branch. It was in operation through Surge Unit One of the six that was supposed to have been established under the National Mental Health Act. Actually, it was the first that was established. The second was in Phoenix. The Phoenix one was dedicated much more to research. Bob Hewitt was there as the Director. And it folded after about a year and a half. They had problems with the community, because they offered no service base at all. Prince George's operated under a different philosophy that Mabel Ross brought with her--that you offer service first, and that way you can then look at some of the things in the community. Under Mabel there was very little active research. There was some. And then, she was followed a few years later by Bob Fawcett, who was Director, I think, for a year, and then left, and sub­ sequently died. He was electrocuted by an electric power mower. And then Alan became the Director. It was a very fascinating program. Mabel Ross went from there to the Regional Office. She became the Regional Psychiatric Consultant in New York City. Alan Miller had come into Public Health Service from Fort Worth, or rather into the NIMH from the Division of Hospitals, Fort 10. SFY (cont} Worth, the :Fort Worth Hospital, and he had previously had two or three years in the rapid treatment center, the VD Treatment Center in the South. He had been at Hopkins for part of his residency training, and I think he ended up at Forth Worth, or it might have been vice versa. But the program at Prince George's County Mental Health Center was a very interesting one, and we were involved rather heavily in a epidemiologic study at that time. The epidemiology reading disabilities, not from the point of view of being particularly interested in reading disabilities per se, but for convoluted type of thinking if you will. In looking for indicators of community disfunction in terms of mental health or mental illness, we noted that there was a very high correlation between juvenile delinquency as an index of dysfunction in the community, and the high rate of occurrence of reading disabilities. A very strong positive correlation. So we decided that since the light was so to speak over here, we'd look for the watch that we'd left over there, over here, and that we'd look at the epidemiology reading disabilities as an indicator of other pathology in the same sense that one in a laboratory looks for ecoli as an indicator of contamination other by typhoid or/pathogenic organisms. You don't look for the pathogenic organisms. And so we had a very extensive data collection system that we worked out, working with all of the schools in Prince George's County. And, in that respect, they stored all of their records of all of the achievement tests 11. SFY and all of the intelligence tests that they did in every other grade throughout the county with us, since we had more daily use of them than they did. We had it all worked out by school districts, and we,filing them over a period of years. We published one introductory article on the subject, a number of us together. Then we had also done studies on intake policy, taking all the intakes from gatekeepers in the community vs. self-referrals, and what happened to them when we did a follow-up of the patients who were referred to other places and to other service facilities. We did a study on record-keeping. I became involved in setting up a classification system for reprints for community facilities, and that was what worked out to be this filing system here. So that a number of applied types of research were going on. And we saw a regular case load of people. So, it was a very fascinating place to be. Then • • • EAR Were there any initial difficulties with the community, and how did you resolve them? SFY A fascinating business, that partly due to, I think, (maybe this is wishful thinking on my part), the fact that Mabel Ross (1) was a public health person with an MPH, Alan Miller was an MPH, and I have an MPH, we were very much aware of the fact that this was a federal facility, sort of superimposed upon the county. (1) We knew that if we wanted to do any research, that it had to be a quid pro quo, that we had to give the community something in order to get the response of the 12. SFY(cont) community. And that we couldn't be too nosy and too proud. So in turn to the school system: we_ gave them just carte blanche consultation with their counseling personnel, their attendance people. They would come in, we would go out, we would hold case conferences in the schools with the guidance person. We would have the guidance persons in to the Mental Health Study Center, and we had seminars for them. We also had one to one supervision for them. So, there was a lot of service that we gave to the school system. We worked very closely with the welfare people. We brought them in from time to time. So we worked with all of the community agencies, plus we had a very active Community Board, an Advisory Board that we appointed of leaders from the community ranging from the Superintendent of Schools through all of the key people in the Mental Health Association, etc. I think Alan verbalized the status of the Mental Health Study Center at that time in the community py saying that it was a foreign body which had become encapsulated and causing no further irritation in the community, and there was a sort of symbiosis going on. We were always very much attuned to the fact that we were to do (and again, this is a sort of translation of principles from one field into another which is sadly lacking sometimes today in terms of co1lllllunity mental health). But I remember Alan telling me when I first got there, uAs far as our concern and our relationship to this community (Prince Georgers County), we hold the same principle that you hold in medicine--"primum non nocher". Above all, do no harm to the community .. "' SFY (cont} so we were very much aware of any inroads in the community •. We had to look at it from th.at point of view. But, beyond that there was a positive contribution, because I remember in my second year there we started to work with the State and the County to develop their own Mental Health Program, and it was through us for the first time that the Department of Community Services, if you will, of the State Community Mental Health Services got together with the hospital people for the first time in the history of the State and were talking together, and it was through our good offices that they got their first one-day-a-week clinic in Prince George's County (mental health clinic), which has now grown to three clinics, I believe, five-day-a-week clinics. We didn 1 t consider that as a threat to us, but this is our contribution to building up the community. It was a very comfortable relationship. We also had another function, being part of NIMH and the Community Services Branch. We were a demonstra­ tion clinic, to demonstrate many different things. And as such in the first few years, we were goldfish in a goldfish bowl. We were on view for everybody. Remember the show-and­ tell officer in Title V? That's where the notion came from, because we originally derived the idea at that point, that we needed somebody fulltime to demonstrate, so that you don't take the research and clinical personnel away fulltime from their duties--or one of those people. But that there needed to be someone designated (the show-and-tell officer, if you will}, 14. SFY(cont) who knew eno~gh about the operations to take visitors around, etc. Then, in addition to that, we went out all over the Country talking, consulting. The various Regional Offices would call us in if they had a problem in some spedific area which was related to the activities of the Study Center. So, for example, I remember the first talk I. gave as a member of NIMH was in Oklahoma (late 1954, early 1955, maybe), on the operations functionsorganization of the Community Advisory Board Clinics. We were talking to Advisory Board members and to Clinics staffs, etc. (I was). I remember this was part of the Health Department. I had met with the State Health Officer, (or was it the City Health Officer) in Oklahoma City; but, at any rate, he was expecting typical psychiatrist. We were having dinner in the evening, and he asked me what I thought of the City, how I liked the accommodations at the hotel, and I said, "You know, I find the hotel very nice, except you have a very severe problem in terms of that hotel with back siphonage of water from the bathtub. He looked at me. He didn't say it, but you could see it in his eyes. "How did you know about back siphonage." It was a very interesting time. There were problems in terms of some of the staff not feeling they should be as intimately involved in seeing patients as doing research, etc. That•s not unusual in an organization. At the same time, as part of the Community Services Branch, we were invited to all of their major functions. EAR Who was in the Branch at that time? Joe was the head of the Branch? 15. SFY No, Curtis Southard was the head of the Branch. And Warren Lanson was the Chief social Worker there. Pearl Shallott was the Chief Nurse. Later on they got to the Anthropologist. EAR You mean the one who had been to studies in the Pacific? SFY Yes. Tom • • • he drove a Porsche. He was so proud of that. Tom Gladwin. We were in part step-children in that Branch, in that we had our own organization. It was a fascinating business in terms of administration. When Alan left to go to England, {I had been to School of Public Health by that time). I had come back; then Alan left to go to England, and I took over as Director. The question of administration came up, and one of the things that stuck in my craw was that we did not have a budget of our own. Here was a major unit that had grown and had a number of people in it,--Denny Flint was in it; and I think Osberg had come by that time. There were a number of other people up and down the hall. We had moved to new quarters, which, incidentally, I designed in the basement of an apartment house in Adelphi. And so, we fought a battle with Community Services Branch. The standard reply (it is always the reply) is, "Don't we give you everything that you ask for, so what do you need a budget for?" But, we finally got a budget. But, the interesting times--fascinating to all of the top staff members of the Mental Health Study Center--was to go to the yearly (one time it was semi-annualt but later yearly) staff meeting of the Branch when all the Regional Offices people came in. And then, the politics that went on. Henry Shumacher SFY(cont) was the regional psychiatric consultant to San Francisco-- an old-timer, well versed in everything--politician A...;l; he knew his way around. Very capable. And he and Mabel Ross used to clash immediately at every one of these meetings. She would sit at one end of the table. He would sit at the other end of the table. I remember it so vividly as a youngster. They would clash in a friendly way. They were never enemies, but philosophical viewpoints were 180 degrees apart, and there would be reports. It was more of a coffee klatch than a regular staff meeting in that sense. It was usually around a day before or a day after the Advisory Council meeting. We would have the annual picture taken out on the lawn. EAR Did Bob attend any of these meetings? SFY Yes, he always came and always talked about his great friends in the Regional Offices, and he used to kiss all the girls. His heart was out in the Regional Offices, and if he could only be separated from the office, that he would live in the Regional Offices all the time. If he was talking to San Francisco, it would be San Francisco. In New York, it was New York. But, I think he established a very good feeling of pas de familias coming in, being very pleasant. The Regional Offices in that time ran almost autonomously. There was absolutely no direction out of Washington. At least NIMH had their own Regional Offices. And ostensibly they were under the Regional Health Director, but the Regional Health Director in very few cases could tell the mental health people what to do because, in the first place, 17. SFY(cont} the mental health people were from NIMH and all the rest of them were Bureau of State Services. Besides, just on pro­ fessional content, they usually didn 1 t know enough to • • • so what you had, in essence, was a group of very dedicated Regional Office people--far too few for the jobs that they assumed, even in those days--but very, very much aligned and identified with the State that they were in. There was never a question, but if the State said this is the way it is sup­ posed to be, that was the way it had to be. Not that they didn't realize how bad the States were in some of the things. For example, the State of Oklahoma didntt have a single solitary mental health clinic of its own that wasn't run on money given by NIMH out of that pitiful small amount that was allocated in those days for community mental health. It was realized, and they were willing to operate on the basis of, "You take the States where they are." They never dealt with the City directly. If you went to see a City, you went with a State representative. You take them where they are and help them to develop what they want. You may urge them. You may point out directions, but it was basically where they wanted to go, and how they saw it. And while, the basic State plan was submitted to the Public Health Service for approval so that they could get formula grant funds. No one ever dreamed of turning down a State plan. That was almost heresy to talk in such terms. This was the milieu in which I grew up in NIMH. 18. SFY (cont) We would have a science, semi-scientific, .scientifi.c session of the Regional Consultants,• etc., of the whole Branch in which Bob would sit in. I remember once presenting the program of the Study Center. For the remainder of the contacts of the people in the Branch and in the Study Center with Bob Felix, for example, were only at National Advisory Mental Health Council Meetings. Bob, before the meeting, would start to go around. We's sit outside the rim, you know, in the stone house, and he'd go around and say a few words to each person in the room. And, of course, in that time when Bob still had the procedure in effect which later ceased, of having every new per­ son who joined NIMH come to his office, and he would say a few words to them. Bob Dafsinger. And then, one day in '59, I guess, I got a call from Bob Felix. He asked me to come down to go over to Bethesda. They were still in T-6. EAR So you had been at the Study Center by then only? SFY From '54. Almost five years. One year away at school. And he said that they were going to do this 20-school study and that Joe Bobbitt had been detailed to full-time on the study for a period of three months (whatever it was}, and he wanted to know whether I would fill in for Joe as Acting Assistant Director of the Institute. It hit me like a bolt out of the blue. My contacts with Bob Felix had been about three or four in all the years--maybe five altogether. EAR Why do you think he did it? SFY I asked him. We were driving from an appropriations hearing one 19. SFY (cont} day and I. said, ~•sob, whatever ind,uced you to a.sk me ·to come up to headquarters? Y~u know, I'veheeri curious about it, because you didn't know me that well. I certainly didn't know you that well. What happened? Why?" You couldn't anything out of him. Never. I couldn't make one intelligible word of what he said in answer. EAR I'll try again. SFY You try. I'd be curious to know if you'll ever get an answer from him on it. EAR It may not be the right one, but I 1· 11 try. SFY I was curious over the years, because someone had . . . . I'm getting ahead of myself .. EAR Well, who else could it have been? There obviously had to be a psychiatrist. SFY Well, it didn't obviously have to be a psychiatrist. He could have taken someone from the Intramural Program. He could have called in one of the Regional psychiatrists. So, I came up there; I guess I made Osb~rf Acting Director passing over Denny. It's easy to check out. It was a fascinating setup. I almost said it was a medieval setup. I came into that office--an office with the secretaries like so. You entered here. Mary Lou sat here, and later on the other side was Doris • • • Dotty (it will come back to me). That was later. I remember it had a dim quality to it. EAR Dottie Wren. SFY Dottie Wren, thank you. Mary Louts office was here. Felix's 20. Q~ SFY(cont} office was off to the r~ght, and J~ Bobbitt's. office was off to the left. Mary Lou was most helpful. I don't think there was a selfish bone ·in th~t girl~ body, bedause she was just absolutely a slave of Bob Felix.. She· just worshipped him and did everything for him. We often used to joke about it. I once asked Bob. At that time in his office, he had a big long office. It must have been about 40 feet long. And he had two glass-top (or rather glass-covered wooden tables) tables. The big old-fashioned kind in the center of the room. And if anyone spilled any water on the glass, the door would open automatically from the other end of the room and Mary Lou would come running in and wipe it up. I accused Bob of having a hidden bell. He would come in in the morning and say, "Good morning, Mary Lou." And she would pop up from her desk. You could hardly see her behind it, because she was very short. She would pop up from her desk and curtsy. "Good morning, Dr." And sit down again. It was a little ritual. A superbly handled office, superbly handled. The girls were just the best secretaries I've ever come across in my life. Smooth .. Everything was smoothly handled. No one was ever turned away angry. The time went fast enough. I remember my first boo-boo as Acting Assistant Director. Bob was away and some grant awards came in. She just brought all the mail in to me because Bob wasn't there. And I signed them. I found out quick enough. Nobody, but nobody if Dr. Felix wasn't there. It had to be signed by Dr. Shannon. I learned that lesson. I'm not sure 21. SFY(cont) if it was my first time around, _or if it was the second time· around, but Bob asked me to (I think it was the first time) look at the question of in-ser~ice training for psychiatrists, and asked me what I thought of the idea of having a program such as that~ since the only real training ground at that time was the Mental Health Study Center; we had a number of young people (psychiatrists) in there. And so, he suggested that I appoint a Committee of people from the Institute (senior people from the Institute). Which I did. I may be confused on the time. It may have been when I came back the second time, a few months later. But, Bob Cohen, Joe Bobbitt (it may have been the second time, because I think Joe Bobbitt was in that group~ but then it may have been continued and with Joe Bobbitt continuing in it), but some of the key people in the Institute--the Branch Chiefs, etc. 41\M.QV' EAR Was Ray Fel:.e:eR there then? SFY Well, it must have been Vesty at that time. And we hammered out some of the first general principles of the MHCV Program. I fiddled a little with it, made a few changes in it. I came back to Bob and said, "We have a possibility of something here which is somewhat different than the other services have, but basically it is pretty much the same sort of thing with out­ of-service training, return for pay back years, except in this case there is moral pay back rather than "you sign on the dotted line"; there seemed to be no point to sign on the dotted line since the courts never upheld those commitments anyway. 22. SJ?Y (cont) So Bob said, -'O.K., if youtre ready to_ go wet 11 do ~mmething about it." And r remember, he called Fogarty. Told him he had this plan, and would Fogarty mind if he moved $100,000 out of the appropriation for the Training Branch (or something) for in-service training? And Fogarty said, "No, it sounds like a good idea to train your own people." He checked it out with Hill, and that's the way the MHCV Program started. EAR That must have been 1960 by then. SFY Yes. The whole thing was strung out over a period of time. I don't remember too much of that first two or three months that I was in the office there. EAR You physically occupied Joe's office, and Joe was in Building #1 at the time? SFY Right. Something happened, because publicly Bob made a statement about how well I handled something or other--tactfully, with insight about the personalities of the people involved in the political feelings. It totally escapes me what it was. It never impressed me at the time that I handled it as being that big a deal. It was just handled like you would handle anything, but apparently, at least according to his public statement, it impressed him. I must admit that to this very day that I never felt comfortable with people who came into the office. Whether it was my own projection or whether there was a quality of cold­ ness with which they approached talking with me--whether they resented that I had been brought in, or what--nothing as overt 23. SFY as what happened later, but it was more than just reserve. I wasntt one of the •·tin group"i, you see.. And I was dealing only with nin groupn characte~s. EAR Did you have a feeling at that time that it had anything to do with the difference in style between you and Joe Bobbitt? SFY Maybe. But I only knew Bobbitt peripherally. I hadntt even talked to him, and I had no idea of • • • It might have been more of the "young whippersnapper coming in"', or something of that sort (the "ninety-day wonder" coming in). I don't know. And when Joe came back from Building #1, I remember Bob wrote a very nice note which he put in my file. He mentioned that same episode again. When it comes to the end of it, I went back to the Study Center and we continued doing some of the same things we were doing before. At that time I interviewed Bert Brown, who had been referred to me by somebody that was up in Boston. At any ,rate, Bert was with Gerald Kaplan. He was due to go to the field artillery, because he was one of those deferred plans, and he was looking for a position in the Public Health Service. He came down to be interviewed for a position at the Study Center, (and that's where I told you-­ Joy sat through the whole interview). I made it clear to Bert at that time that if he did come he would have to come as a member of the regular Corps. If he was a member of the Reserve Corps that would not get him out of his obligation to the Army, but he had to join the regular Corps of the Public Health Service, in which case he was in one of the uniformed 24. SFY(cont) Services as a regular member. He had no objection to it. I don•t really think he understood what I was sayi!).g to him at the time. So, on the stre!1gth of my administrative expertise and knowing how things like that were handled sometimes, in spite of the fact that he had taken no examina­ tion for the Regular Corps, and all the rest of it, he sent me his filled-out application. I remember the two little boxes up in the top corner. You would check one for Reserve Corps and one for Regular Corps, which was for office use only. I checked Regular Corps. That•s how Bert got in the Regular Corps. He came on duty after I had gone up to NIMH to Head­ quarters the second time. EAR Now, how did the second time come about? SFY Out of the blue again. I had almost no contact with Headquarters after I came back. Then one day Bob called again and said could I come up to the office. He wanted to talk to me. That time he said he was reorganizing. They had had Committee talking about reorganization of the Institute (before Hundley). This -Intra was an inter/ Institute Committee that had given its report about a year and a half before. Bob sat on it. EAR Whose Committee was that? Do you recall? SFY I'll have to think about it a little bit. I might be able to fish out the Report, where they had urged him to set up an Associate, or something or other. So he decided he was going to set up an Associate Director for Extramural Programs. An Associate Director for Intramural Programs, and an Assistant 25 .. SFY(cont} Director for Program Development. Why he did that .. . .. never in my association wi.th Bob did I ever hear him say a real derogatory word about Joe Bobbitt. He made comments about his talkativeness. We all kidded about that, but apparently something went on there. He wanted to know if I would take the • • • he told me I was going to take. That was the way Bob operated. He asked you, but you knew full well that you had better. It was the job of Associate for Extramural Programs. Yes, I did have contact with Bob in­ directly during that time. When I got back, I had heard that Bob had moved from T-6 to the Doghouse, so I remember very clearly that I went out and I got one of these red hydrants that kids play with and I sprayed it with gild paint, and I wrote a little verse and sent it to Bob to celebrate his being in the Doghouse. And he had the artist at NIMH or whoever it was (somebody at NIMH} draw a cartoon with Felix and the plug, and he sent it back to me. That was the contact. I just recalled the plug. My reception at NIMH was somewhat less than auspicious. I arrived and asked Bob where I was going to sit. He said, "Ask Joe," who was then across the hall. He said';e~AskeJoe .. I understand Hector's made all sorts of arrangements that Joe knows about. So I went in to see Joe. That's where the classic remark was made, "As long as you have to be here, I might as well tell you what is going on." So I went next door where Hector had a suite. Hector was a one~room with sedretarial space ~ut front. 26. SFY(cont) And there was another room. Helen May was sitti~g at one end outside ~f Hector's office and there was a vacant desk out here, and in the office I was supposed to share, there was a desk. That's it. No chair. Nothing. There was just a desk. And that's the way we started. I remember in terms of Hector, who really ran things around the Institute, that as usual, he was going to find out who was running the show, and either put me in the category he had most of these other people in, or whether it was not going to be that easy. After the first one or two little episodes with his denying a requisition--refusing to process a requisition for something that I had put through, I called him into the office and I told him I was sending these requisitions to him because that was the proper channel through which they went. I was not asking for his approval. I was sending it to him to expedite it, that he was working for me. There was a little fussing back and forth about the matter, and expostulating. He then went in to see Chuck Mills and put it in very politic fashion, "Did he have the-right (Chuck told me afterwards) to turn down and deny the requisitions?" Chuck said, "Let me put it this way, Hector. You work for me. I'm not sure that I have the authority to turn down a requisition. I certainly can't refuse if Dr. Felix does it. I'm not quite sure about it if one of the Associate Directors asks for it. Wouldn't it be wiser just to agree.u So that sort of straightened that part out. I remember we went for quite ·a number of weeks recruiting a secretary,_ getting a secretary all on my own, you know. 27. SFY(cont) I had to arra~ge the whole thi~g. Thr.o~gh the_ good offices of Helen May--not through her boss, frankly--because Hector if anything was more closely allied with Bobbitt and that group, while Chuck was clearly allied with me. Because he also was looked on as an outsider in the Institute. I remember one of the first activities that I took on was to bring the three Branch Chiefs together to have regular meetings. And that was \ with mixed feelings on the part of the Branch Chiefs. And by this time Vesty had died. Ray never voiced any objections. was I don't think he really had any .. Curtis, of course,/on the horns of a dilemma in terms of that he was looked down upon by the training people and the research people, and certainly by the intramural people. They wouldn't have anything to do with him. You know, that was the low status branch. So that he had no allies on that side. He found it very difficult to bring him­ self to deal with me who after all was formerly one of his junior people and now was his boss. So, he was very ambivalent in his reactions to proposals, because he would swing one way, and he would swing another way, and it was understandable, the way he was reacting. Phil Sapir is typically Phil Sapir in this, and it was epitomized by his response on two occasions to letters that he had written that had to go through my office for approval before they went out, if they were policy responsive. In one he angrily threw back the redraft that I had done saying, "If you want to send it out, serid it out over your S:L-gnature. You politicians mangled the whble letter." There was such a violent 28. SFY(cont) diatribe in the or~ginal letter tha,t nobody would have.sent it out the first time. The other was in response to some scientific inquiry by somebody, and Phil had written something that was rather superficial, and I felt that it was someone (a Congressman or something, I don't know) who deserved a little bit more detailed answer. And I asked Phil to amplify it--you know, either you write it or I'll write it, but let me know. He said, "I don't think you would be able to understand." I think that between the two of those· things, you could understand the /4ay he viewed my position. So, they were the three Branch Chiefs, and the reason for the meetings was to try to get a common Extramural policy, because on the one hand the Training Branch was supporting the Western Branch of the APA Program. The same program had been applied for under slightly different terms to the Research Division that was being sup­ ported, and I pointed out, "You know, this is not a situation that we can really tolerate--to have one part of NIMH say 'yes, it was well done' and to have another part say 'no, it wasn't well done, it couldn't be supported'." Well, you know how that was, in terms of each branch feeling it was autonomous, and having its own power base on the outside, and its Committees, etc. Early on, there were a number of things that we tried to do. One was to try to separate the Regional Offices from the Community Services Branch. Then that I proceeded to do with Bob's blessing by making the Regional Offices at the Institute rather than the Community Services Branch. Not that it_ got 29 .. SFY (cont} anythi~g to say about research or trai.ni~g, but at least it became the Regional Offices of the Institute .. The second was to set up a clearing house of information. There was another plan also to set up some surveillance units around the Country to know the level of mental health planning, but that never came to fruition, because we couldn't agree on the name. The surveillance had dire connotations and all the rest of it, you know. There was one other~ There were three basic things. The Clearinghouse, the Regional Office separation, and one other thing I can't seem to think of what it was. EAR You don't want to mention the Branch books. SFY No, that was later. It was at that point, at that time, that we started appointing the Special Assistants--Joe DouglasS(that's an interesting story in itself). Joe DouglasShad applied to the Institute for a job. Joe DouglasShad been carrying on communication and activity with the Professional Services Branch through Lenny Duhl and others, in all sorts of outside activities. When he applied to that Branch for a job, he was turned down because he wasn't qualified enough. EAR Was it after he had worked in the Secretary's office? SFY No. It was long before. Lenny comes in to me one day and says, "You're going to need personnel in here. You know this guy, Joe Douglas, this bright sociologist, etc., etc. Why don't you talk with him." Well, I. got some of the background, and we put him on as a Special Assistant in my office. He had worked in (\v..._ the Secretary's office before under Fleming, and then he had 30. SFY(cont} been out. (VII,.. EAR Right. Then he had been in Flemi~g"s office. SFY Yes. Then Alan came back from England and he became a Special Assistant. And then ~~~ we put on as a Special Assistant when we had to pull him out of the· White House. rescue him from the White House. He had beeri assigned to the White House to work with the Committee on Mental Retardation,. the Planning Committee. EAR Wait. Go back to Allen. I think you have Allen"s sequence wrong. Allen had come back from England quite some time before. SFY Sorry. He had been in Denver. We brought him in from Denver. That's right. Thank you for reminding me. We can back up there a few facts on that, too. That takes us back to the whole Allen story. EAR So you had two Special Assistants. SFY Three. Bert. EAR Bert and Joe and Alan. Alan was listed as a Special Assistant at that time? SFY Sure. EAR I thought he had a special title at the Regional Offices. SFY That was later. That's when we got to Building #31, but when we were still in Building #20 or wherever it was, he was Special Assistant for something or other, I forget what it was. It had to do with the Regional Offices,. but. no, he remained a Special Assistant later on. But at any rate • to l:ack up-- 31. SFY (cont} I came there ·csecond time around} in July of 1960. July 1. Yes, I think that's right. This· was just the time of the Hundley Report. rt was at this point that they were going to take the Community Services Branch and move it downtown. Some of our dearly beloved people from NIMH had testified that that might be appropriate. Mabel Ross was one that said, "Well, you know it could go either way.n In return for which she was appointed as Special Consultant in the Bureau of State Services, as liaison to NIMH. They wanted to take off Biometrics. Those were the two major ones. Part of Training was to go downtown. EAR Service Training? SFY Service Training was to go downtown. All of this was cooking, and Bob had gone to hear the preview session of the Hundley Report in Building #1, and they were told when they opened up that they were there to hear the results and there would be no discussion allowed, etc., and he came back ripsnorting mad, etc.; and we talked about all sorts of possibilities of how it was to be handled, what sort of counter-proposals to make. This was during July, I guess. Then one day Bob walks in and says, "Stan, you know, every year in August I take off for vacation. I'll be leaving on such and such a date in August. Why don't you carry on." And he walked out leaving me with the whole Hundley problem&® At that point I h~d to contact the State and Territorial people, and governors. I still have some of the documentation about it. We were writing some of the statements 32. SFY(cont} for some of these people to send in to the Su:t"geon General and all sorts of thi~gs. That was before I had the Special Assistants. We were still in Building #20 over there. It was still in th~ very early days. It was an interesting way to jump into the soup. I don •·t know whe.ther Bob felt comfortable with it, knowing that he was going to go, or had gone already to Fogarty and Halan was going to have it blocked, but or whether he had, and it was very early on, so he had just found out the results of it. He may not have made that deci- sion as yet. A short while after that came Bob Atwell, with his, "Well, what have you done about the Joint Commission Report, and we had Bob He,;fitt, who was our representative • ....:_.I First, it had been Bobbitt for a long time. Bobbitt was a . good note taker, and he had made certain suggestions of a real scientific report each time. But as far as any politic­ ing or any tacti6al suggestions as to how to do anything about the report. Nyef. And the same thing with Hewlitt. The point of view of the Institute at that point in time was a holding action. They didn't know what was going to come of it, and they weren't going to commit themselves, and that whole sort of bit. And then, of course, the fat was in the fire be+ we.\\ with Bob Atfalt coming in. My feeling at that point was-- I said, "Sure Bob Hewlitt is our liaisoo~towards this. Better do something." And I felt the fat was in the fire as far as I was concerned, and besides, we should be doing something about it. I started some talk with Bob and Bobbitt was in on 33. SFY(cont) it .. How we should approach thi,s. And one of the S~9"gestions among others was to talk with Atwell ~gain and see what they thing would.do-~which ·we did, and he didn"t have any/specific, but the next thing we knew we. got word from the White House back, 0 What sort of implementation was going to go on and if the President was appointing a committee to set up. Before that, there was a meeting out at the motel EAR Before that, there was a meeting out at the motel to discuss the Joint Commission Report. Do you remember that meeting? SFY I think that came about • • • I'm not sure any more ..... I think that came about as a result of Atwell's stimulation. I don't think it came before Atwell's stimulation. EAR I think it did, because I think it came at the time that the Joint Commission Report had been out very shortly, and you know that the official Report was a second draft of something that Williams did, and the first draft had been unacceptable to Hewlitt and some other people, so it was redone. That second draft which then resulted in action for mental health was discussed at this famous meeting out at the SFY May be so. Was that one where Mort reached in and said, •~r have two papers here that talk about this and that and the other.u Remember that one.? EAR I think so. I think there were about a dozen sitting around the room (more than a dozen). Well, go ahead. I don't want to interrupt you, but I think Atwell came after that, and I want to find out what happened at the White House. 34. SFY(cont) But what did we decide in that meeti!).g? I don~t remember any more. EAR I have a document. SFY Good. EAR There were a whole series of acceptances and qualified rejections of the Joint Commission Recommendations. A very specific analysis of the whole Joint Commission Report. I"ll have to double check whether your meeting with Atwell and the initiation at the White House preceded this or followed it.. That would be interesting to find out. SFY I'll have to fish out the early documents. EAR One other thing. This might be a good place to stop anyhow. Do you have a copy of the Case History that was done on the Hundley Report and the NIMH response to it? It was one of these Case History things. In an informal comment after this interview, Dr. Yolles remembered that the third category of program development was the initiation of a Program Analysis Activities for all three Branches, and a formal effort to develop a comprehensive Program Analysis Activity for all the Branches. Stanley F. Yolles, M..D. M~y 1, 1975 . SFY • an implement i.n the Joint Cominis-s:ion Repo;r;-t? EAR Right. SFY The report itself? Until we were aske·d to come up with some legislative proposals, and we wrote to Bo Jones about it, that's what started off that whole committee. EAR Yes, thatts what I showed you. SFY Almost a year later. EAR Yes. This is what I showed you, is this the one you have, too? SFY No, I have all the previous ones as well, you know. Everything leading up to this. EAR Everything leading up to this? Terrific. SFY Now, which is this? This is November, 1961. There's a later one. There's a final position paper as modified by the recommendations of the National Advisory of Mental Health. I have every one. One right after another. EAR Right. SFY And that's not a complete file. They gave it to Esther and Doris to do. EAR And they :tore _it__ up? __ SFY No. It's not complete. Because we never had a complete file in Central FileS anyway, you know, as a matter of fact. Every­ body kept their own pieces of paper. Steve Goldstein_ got all this t~gether out of Central Files the first time around. EAR Yeah. Incidentally, did I tell you, J called Carolyn Evans and the·re are no transcripts· left. SFY They deStroyed the·rri all? EAR Now, .whether someone has one squirreled f;J.Way somewhere, I don t t know., SFY I think the<y"re still squirreled away. EAR But I think when I_ go see Bert T''ll talk to him .. SFY Bert wouldn"t know. EAR He wouldnrt know? SFY No. EAR And Lou • • • SFY If Lou knew, he· wouldn't tell you. Lou .is going off to the WHO for a year. EAR Yes, I knew that. Who told tne? SFY Felix. I talked to Felix when r was out in St. Louis. I talked to him on the telephone for about an hour. EAR Really? This is the letter that Moynahan wrote. That was the first draft. And I'm pretty sure that's the one he says he wrote. And there is attached to it SFY The . do you remember? I have a vague recollection that we were unhappy with the first letter he wrote. I made some comments about it, and either we sent him some proposed draft for inclusion, and then he rewrote the whole thing himself. Because I vaguely remember that we weren't happy with his first draft because it was totally_ glack-en de-velken and it had nothi~g to do with. EAR I don't think that's this one. ·Ith.ink this is the second one because ·this one is not bad at ·all. ·The wordi~g of this is fairly_ good. Well, what I want to. do tho~gh and you started 3 .. EAR(cont) it off very nicely with what you said a few moments ~go--we stopped, _and I don't think we: :need to be too concerned about having this strictly chronological, but we stopped at the _point where you were talking about the Joint Commission and I mentioned the fact that we had that meeting at the Motel in which we had discussed SFY This was from your files. EAR Yes. That's from my files. We ·had discussed the Joint Commission Report, but I think what might be useful to concentrate on tonight is your recollection and your comments specifically about what you said a moment ago; that is, the Joint Commission Report came out. Obviously with everythi~g they tried to do about im­ plementing it, it still had a number of problems attached to it programmatically, and yet it served with equal obviousness as the stimulus for the next step. Now, would you like to comment about your recollection there? Or wherever you want to begin. SFY Yeah, well, I'm trying to think about it~ There was an inordinate amount of activity starting in late 1 60 and through at least the first half of 1 61 on developing a position on the Joint Commission Report. And from what I can tell about the whole thing and remember in part i.s that we were responding directly to each one of the recommended points in the volume, because the reports show there is a recommendation and there is a comme.nt. · And then there •·s that business of doubli~g and trip­ li~g, you know, the business. And i:e you look at it, :it bears ver"y little ·relationship to the :Gr:ee:ri Book which came out later 4. SFY(cont) which was really the more innovative thing that was done by NIMH and not in response to the Joint Com.mission Report, the implementation of the Joint Commission Report .. But frankly, I had forgotten about that whO:le flurry of activity in there; sort of blotted out in my mind by everything that we had done as a follow-up on that--you know:, with the group working. EAR Wasn't that earlier phase really partially precipitated because of the role that Bob Hewitt played as the liaison person to the Joint Commission. SFY Yes, but that was so much earlier, Eli. Let's see. Bobbitt was the first, I think, representative that's in the Joint Commission Report. And Bobbitt got disgusted because of all the fiddle-faddling around, and he wasn't happy with the way the report was being written. And then they put Bob Hewitt in, if I recall correctly. And Bob Hewitt, in typical Bob Hewitt fashion was put in so. off the record, so to speak, because he wasn't going to accomplish much and they didn't want anything ·accomplished. That's why they put him in there. And he didn't have any very high position in the Institute and Bobbitt was the Assistant Director of the Institute, and so that sort of removed us from the implementation. And then, when finally Greer Garson rewrote the thing. EAR Greer Williams. SFY I know. (la~gh) EAR I want to make· sure it's r:i-ght on here. (la~gh) SFY And it was more ·acceptable. 5. SFY (cont} rt.ts funny,--you knowf with ·all the in.put that NIMH had in stimulati'.!,'lg that Joint Cornmiss'ion Report and_ getti~g the funding out, and all the rest of it, tn.e:re was really a si'.!,'lgular lack of involvement of the Institute in the ·thing. Whether it was because Felix in '61 was President o:f the APA, and the year before he was the President-Elect, and his thoughts were else­ where • • • EAR Didn't that distance begin long before that? SFY Yeah, I have that feeling. That there was a singular lack of interest in it, and it wasn 1·t followed-up, and there was a growing divorcement from it. And then that intensive flurry, and all I can attribute that to--that whole flurry there--was Bob Atwell's intervention. Because it was still • • • well, Felix in '61 still was President and we were still in the dog­ house, because I almost have a visual image of talking with Bob Atwell in my office. EAR This is sometime after Action for Mental Health was published, obviously. SFY Wait a sec. There's something very funny. What are they doing sitting on that side of the room? You see, rtm a visual person. You don't remember that office. EAR Your office in Building 20? SFY Yeah. EAR No. SFY Did I move? I must have moved,. _because Joe Do~glas • office was off to one ·si:de as a SpecTal Ass·istant out ·of the Suite. And I 6 .. SFY(cont) know, when I first came in, _I :just had that little room there .. And it was shari~g that Suite· with _· • .. • yes, you know,. Hector was on one ·side, and I was on :the· :othe.r· side, and Helen May was outside his office, and Rosanne was outside .. It's started to come back. I think I booted Hector out of his office, and took over that whole unit in there ..· That's how I_ got to be sitting on the other side. I just couldn't visualize, because I have a visual image of where my deSk was in that little room, and I know I wasn't facing that way, and I place things in time, you know, depending I can visualize myself in certain situations, so O.K., all right. That's better .. Now I feel more comfortable. But I remember very clearly talking with Bob Atwell in that office. The second office. EAR At his instigation? SFY He came in without any prior notification in the sense that he was going to talk about the Joint Commission Report. He was the Budget Examiner. He came up to talk. He was new, really. EAR So this must have been late '61, or early '61. SFY I wish I could remember when I got that, to tell you the truth. EAR Well, we can check back on that. SFY Because, it wasn•t . . . . it must have been '61, because I got there in '60, and that August when we were having . . . . we were still respondi~g to the Hundley Report, and I was looki!l,g through the . . . . EAR See that's dated November '61 and that's not the last one. SFY No, and I was looking thro~gh ·that ·case Study, and I was' looking at the letter from Dan Blaine,· :and from Paul Hoke. Those T wrote 7. SFY (cont) to J?aul Hoke and .to Dan Blaine, and asked trrem to wr.ite letters to the Su~geon· General opposl~g the: Hundley Committee ·Report, and I remember, I had to send .both ·of· the·m back.. I called Dan, and Dan, of course, was always, /'Oh sure .. '' Because he had written something in typical fashion which was not to the point, to say the least. So I had to quote over the telephone and tell him what to write. We sent it back to Paul Hoke and asked him to strengthen certain pieces of it and make it more pointed. But, it was one of the things· when we were drumming up support for it. Where was I? I got off this whole business. EAR Atwell came into your office. SFY Yes, I think this was his response to Atwellts stimulation, and I think that's what stimulated that whole flurry of activity, and we had to respond in some way, and so we started to respond to the actual report of the Joint Commission. EAR Right. O.K. SFY And it went along, and I guess we had that Retreat to look at a draft of it. Joe Douglass was the one who was drafted to write the report. But I remember being very unhappy with his first draft. E·AR Very tu~gid la~gu~ge. SFY Tu~gid. It was that stilted prose which was just a bit out of context with reality the way it was phrased. And it was re­ written. I think you will recall those first sessions .. That whole work-up took an awful lot :of work, becaus·e thexe must have been at :least five re-drafts of· that document. Then the Retreat. SFY (cont} Then it was p.;r.-esented to the Council ( _and the. Council made certain points :about it. And· then we redrafted it in the light of the Council's recommendations( and sent that to NIH, and to Hundley, and Brinkley. Mertol·was in the ·act there for Shannonts office, and then the Surgeon Gerieral"s office asked for what our legislative proposals would be for t72,. EAR For '72? SFY For '62. I'm sorry. And we started to draft some, and the first versions were a recap of what we had in this thing. Then we sent them downtown. We sent copies to Bo Jones, and at that point, whether it was due to Bo Jones, or whether it was due to Bob Atwell's maneuverings through the BOB around the back way, when the Presidential Task Force was set up which put a stop to everything we had done on the implementation of the Joint Commission, we used it as a springboard to start it off, but it is very clear from the very beginning that we would have to develop something new. And, I guess, the first two sessions or so Felix went to. But I know that he had gone to the first two, maybe three. I don't remember how many there were. Then he sort of lost interest in it, and then I started to_ go down.. Did Van_ go along? I. don't remember, because I know you were there X number of times, when we were talking. You had that manpower issue, _which was the bi9"gest issue of the whole implementation. Van must have_gone along( because if you look at all of the official papers that are in Central Files, Van has more in there than anybody :else·.· SFY(cont)Did I_ go over the business of how we worked on the implementation? EAR No. SFY The original implementation, :this document " .. • This imple­ mentation involved almost all of· the top staff of the Institute .. Bobbitt and Kremer and the Branch ·chiefs and all the Special Assistants. I had three special assistants then--Bert, Alan Miller, and Joe Douglass. In other words, it was the top group" and the Branch Chiefs. EAR Is it your recollection that Bob officially turned this over to you, or is it • • • SFY Not at that stage. As I recall, he was Chairing those meetings at that point in time. It really wasn't (it's amazing how much you can forget} • • • because Joe Bobbitt was playing a very important role in it at that time, and it wasn't until we started going downtown with the Bo Jones thing that Bobbitt dropped out of the whole picture. Talking about it made me recall something else, because I remember Bobbitt got very annoyed, and he went into Felix one day and said the whole thing was being dug down 0 the hall, and Bob's reply was, So?" And Bob would never have another thing to do with it thereafter. But it snowballed from the fact that Joe Douglass was the amanuensis for this document and so we had a constant input to it and we started to go over his drafts. Certainly Bobbitt was never involved as far as I know with .that downtown Task Force. EAR Not that .I recall. SFY Maybe he· ·wa·s. If you ever talk :to him, find out. · But I don't 10 .. SFY (cont) re.call his. beip,g involved with it .. EAR I dontt think so, either.. But., :what rtm interested in explori~g is, and you' re beginning to talk about it---how in ef:feet this snowballed so that--are you at the ·point now in your recollec­ tion where you see you and other·s goi~g downtown to meet with Bo and the res·t of the Committee? SFY Yeah, you have to think back to that whole ·scene. Again, I have to visualize the whole scene,... As soon as I visualize that I can see people in the scene. I can remember them that way. George Keenan played a very important part. EAR Yes, of course. Absolutely. SFY And he was involved with correcting some rif Joe Douglass' manuscripts. And he was eager to do something about it. And he had ideas. And I guess Van was • • • I wonder when Van came on board? And when did Chuck Mills die? EAR Chuck died, I think, in 1960, no later than 1961, and I think it was early 1960. Chuck died shortly after Vesty did, and Vesty died in February of 1960. SFY We were still in T-6 when Vesty died. EAR Yeah, it was February of 1960. SFY Because. I can see Felix in hi.s uniform, and I was in uniform, and Frank Braceland came in in his Admiral's uniform. And Felix was bei~g very coy. we were in T-6 at the time.. Felix was being very coy about wearing his uniform. So, Chuck. died about then, yeah ·• EAR It was ·late that same year .. SFY Well, Chuck Was in the d9ghouse·,: :to.o. EAR I think ·he moved that summer. · I think :it was in the summer of l 6Q • SFY He may have. Yeah.· And, well the.re's a whole story about how Van got on board, too. I just saw that piece of paper, too, the other day. I have it someplace either in the office or at home here. Felix is • .. • wha·t a convoluted character he is. This document on how to select an exec'utive officer of the Institute. Did you ever see that? EAR No. SFY In order to_ get the· ·person that he wanted, he made so many categories of necessaries for someone to work in a Behavioral Science Institute, that there was no way that anybody could maneuver, and he would fill in the categories and check all the boxes for any one of the candidates, and he was the only one who could select one. No, I'll fish it out and show it to you. It's quite a document. He gave it to me and said you may use it in future years, you know, if you want to select a person that you want. Use it on them. So, George was an influence in that, simply because of his interest. There was a_ good deal of ant~gonism between Bobbitt's part of the Institute and Extramural l?r9gr,ams. I don't know whether it was later or then. I still have a piece of paper that Felix sent me. A very, very a~gry note. He never: expressed himself in such language in writi~g. And it was a result :of l3obbitt havi~g gone in to him and complained very viole.n'.tly- that we were 'doi~g something to him. r still have :that piec·e of paper, because it engendered 12. SFY (cont) one of my violent scenes. One of the·: ·few violent ·scenes l ever had with Felix. EAR And the letter was addressed to you? SFY It was a handwritten note saying he· does·n I t want anything like this to happen ?lgain. That we were being something . . . . it ·brings it back, because 'I was talking about the antagonism. And Felix backed off totally, because I went in there and I was red hot. And I think that was one of the things that really separated our two parts of the Institute. Since he wasn't supported, he was through. We spinned through most of the implementation, if it wasn 1 t already there. Besides that, you recall, Joe had the Professional Services Branch, which at that time didn't have very many people left in it. He was going through a series of Cook and all that causerie there, you know, with the psychotic ones. You remember, you saw Cook. So Joe Bobbitt had to rely on Joe Bobbitt, which was pretty good material, because he could produce, but he only had himself. And here was this whole panoply of Special Assistants and all the rest of the thing that we had started over. And, obviously we could turn out a lot more, which we did. I wish I could remember when Felix sort of turned the whole thing over to us. EAR It must have been early in the_ :game. SFY It was, .because there was one me·eti~g I remember very clearly. At that time we -were meeting as ·a result of the· ·Bo Jones businesses,· and we were coming in.. We ·came ·in on Saturday 13. SFY (cont} mo:r;-ni!l,g and one of the few times :that :Felix showed up on Saturday--I mean, he came in without a tie, and I wa:s horrified, you know. You know·, _he was still in that .stage that he never wore any sport clothes: -or anything. He didn't even wear a stripe in his. ~ • :r remember heckling him the first time he ever wore a suit with a stripe in it. He looked embarrassed. But, he was in, and sort of presiding in hiS usual fashion. And we were going through some discussion about some phase of Community Mental Health Centers, and it was at one of those times that • • • let me jump around. The Community Mental Health Center concept, I think, was a development-of Felix's reflected back from Bo Jones, and the Mental Health Clinics, which had been recommended, etc.; and the idea came out as a Mental Health Center, and there was a lot of inputs from a lot of people. EAR Do you recall when theterm, "Community Mental Health Center", started? SFY Started? Because it had always been Clinics. Felix used the term. I'm pretty certain that Felix was the one to use the term first. EAR I really think we have to nail that down, because that's a great historical • • • SFY Don't ask him, because he"ll tell you tha·t he used it .. EAR Of course, of courseo SFY No, I am pretty certain that he wa:s the one that spra!l,g the term, ucommunity Mental Health Center"·. EAR The ter·m ncomprehensive"· came in later .. 14. SFY(cont} No, that .caine .in away later, .away later. Community :Mental Health ce~te:r. · I"d have to .look in those documents out. there to see ·the first time it is mentioned. ·But it's • • • because we were talking about Community Mental Health Centers to Bo Jones while we were Still writing about some ·of this. And, well, we" 11 get back to this.. His Des:ocializing Mental Health-­ that whole concept, which ·r always found very interesting. We had beeri talking at long length, and you know, Felix and I had a special session. We went up to Canada. I guess, it was the 2nd World Congress--the 3rd World Congress, or whatever it was. Which one was in Madrid? It was the 3rd? The 2nd was up in Montreal, I guess. Yes, Montreal. And we got together-­ oh, it must have been about 15 of the leading people in the field of Psychiatry in the United States and Canada. We got them all in the same room, because I remember, I had suggested to Felix that we ask, because we couldn't arrive at what an adequate number of beds would be for a catchment area, you know. We haggled over that for a long, long time, and we decided we would ask other people. Get their opinions. We got no answers. No answers at the session. But at one of those meetings on a Saturday in my office down at the other end, I remember we were talking about Community Mental Health Centers, and we were talking about various and sundry parts of it, you know, and what to do. And we had ~greed at that point that we would_ go for this as· a major factor. And I r·elt\ember sayi~g (because we had had all of this Gree·n Book prep:aration· on the hospitals and all the rest of it}, "What do we do in the interim with ·the patients 15. SFY (cont} in hospitals?" And I said, ,°We have :to do ·so;me.thi~g foi;-. th.em .. We"ve fo~gotten all about tha;.t. we·"·re_ :goi~g to do away with the hospital .. What happens with ·the patients until the Centers take over?" That was· conundr·um.. And at that point we said, "Well, we want to have demonstrations or Somethi~g." And we filled in the blank with ·that, and we added the IFT at the same time. I remember (check this out with other people, and see what their recollection of it is--mine may be a screen memory)--but, I have a recollection of • • • fairly strong of having this sort of suddenly hit me, that here we have been proposing this major thing, and then that we would have 2,000 or whatever it was, by such and such a date, and then it dawned on me, "What do we do until they take over?n Because we were talking in very bold terms in the very beginning there, that we would do away with all the mental hospitals. You know, Felix was off on this kick about that we're going to turn them into Junior Colleges, do you remember? EAR Right. I remember very vividly. SFY But that's when we added the ISZ's andthe HIP. If you recall, in the early implementation, we decided to get some money for the Clearing House out of that, so we threw that in as a National Center for Cleari~g House, altho~gh we had the Clearing House antedated by a long shot in the implementation of the Joint Commission Report as such, but we put it in there to. get some mile~ge out of it11 The first few sessions, we were pre­ paring_ general bac~ground material on the status of mental health, in effect, in the United States. And thatts when Joe ·and Ruth 16 .. SFY(cont} Nee produced the Hospital documents--you know, _with all those f~gures·. That sure was a tour de: :force ..· · The"y turned out 20 .... 30 p~ge papers overn~ght, you· know. EAR Who initiated it? Was that Bo. Jones initiative primarily asking for documentation? SFY I think the Committee peo·ple ·ask for what is the current background on which to do some planning. EAR Every time a new topic came up, they wanted a background paper. And my most vivid recollection, Just to stimulate yours (not because T want to intrude}, is the time that Bert and I produced this paper on law and mental health .. literally overnight. Fortunately there was a document available which we cribbed from extensively. But that was just one of many that were produced that way. SFY Yeah, but remember all the work that you did with the people downtown on manpower projections? That you remember very clearly. EAR Yes, that I remember very clearly. (laughs) SFY Ah, back and forth with that Mike March. Every time he would counter an argument, you would have to come_ up with more data. And those projections which we used for years--you know, those _graphs • • . EAR Well, I'm not_ goi~g to detract from what you're sayi~g, but that's a whole othe:r story to which ·r could put much comment. (laughs)· SFY Someday we :o~ght to comment on .the·. validity of certain data. 17. EAR. I want to te:11 you that I made a projection· on psychologists ten years later, and do you· know tha;t I was only off by five. It was an incredible projection. · r"ll never do it ~gain in my whole life. Never ~gain. ·Go ahead, you were saying about producing all the~e staff papers .. SFY One of the key things that r remember very vividly is that Rashy Fine and Bob Atwell es·poused the idea that the Federal Government should be ·a permanent contributor to the partner­ ship on a continuing basis, whatever the percentage was. I was a little astounded;· r know the Institute was a little taken aback at that, because it hasntt been our pattern at all over the years. We were in Public Health Service and not had that pattern of continuing support that it would be in the form of grants or what have you, but not as a continuing support or subsidy. Because I remember • • • what was it that I proposed should be supported at 20:1 the same way that roads were supported. And all the people laughed at me suggesting it. I remember very clearly, I had suggested that this be. EAR I remember that, too. It wasn't staffing. It wasn't a. general concept. SFY No, it was something specific. It wasn1:t staffing. What was it? EAR I remember, too. I even remember the analogy to roads .. SFY I'll have.to see if I can find it in some of those papers .. When th~ - - ~ I'm just Jumpi~g· around • • • V.A .. people pro­ duced nothi~g for it,_ Pat Moynahan reacted very interestingly 18. SFY to a lot of -S~9gestions, a.nd was very supportive., _I. suspect. I don't susp:edt; I remember. Didn't he· send one of his people down? He had someo"ne from the Manpow·er. He ·sat on that side of the room. We sat he·re. EAR I think the man's name was Goldberg or something like that. He was there almost all the· time, and he· carried his little black books for him. SFY We sat over here. Rashy Fein and Atwell sat over there. The V. A. II gook sat over here, and Pat sat over there, but further back. I don't know how that room was arranged, but I know their relative positions. EAR It was one of the Board Rooms downtown, wasn't it? Because my recollection was of Boisfeuillet Jones sitting at the front end. SFY When he was there. EAR Right. When he was there. SFY Pat sat over there, and the V.A. people were sitting in the middle. I don't know what kind of seats they were sitting on. Was it a sofa? And it fell into the background, you know, literally and as well as the fact that they produced very little. The other side of the table ·er know there was a table)--on the other side of the table was Bob Atwell and Rashy Fein and oc­ casionally Mike March when he was there. EAR Now, Fein was representi!}-g the: council of economic advisers .. SFY Right. And Bob was BOBr and March ·was BOB when he· wa·s there. 19. SFY (cont) And Moynihan, the secretary of Labo"r(. .the .V •. A., nicksr and HEW was Bo Jones; and we were staff .. EAR And there was a Department of· Defense ·rep:reseritative •· r don tt know if he came ·all the time,: _but the.re was one. SFY If he did, he never said anything. I don"t reCall him at all. EAR I thought there was, but rtll have to double check. SFY I remember very clearly the two V.A. nicks. They always held each other's hands, to support each other. EAR You're probably right, because it's not in here. SFY I remember a number of times we went to talk to Bo in his office about business. I remember a number of times Bo mentioning this business of, nwe've got to do something to desocialize mental health." And he considered State Hospitals to be socialized--the one form of medicine that had been socialized for a long time. And he wanted to desocialize by bringing in the private sector. That's what triggered when we wrote it later for the Community Mental Health Centers, involving the private sector. Because the private sector had never been involved as far as the Public Health Service was concerned. At least, explicitly building it into the thing. Then there's a whole complicated business about the l~gislation itself that we finally wrote. There was absolutely 0-.n spite of what our friend, _Mike Gorman, says) no input from Gorman on the l~gislation unti:l after we sent it down. EAR So, youre ·really sayi~g he didn't have any part of writing it whatsoever, until after that mes·s~ge ·was written. SFY Well, Bert was in on that. You remember the telephone 20. SFY. communications--the u:rgent :com.inunication·s--STOP, PRESS, NEWS-­ every five. minutes.. We have a sentence in there. (la~ghJ And then, only part of the sentence_ :got in of what we had written. Remember that? EAR And, much later on we•·11 have ·to talk about mental health and mental retardation. SFY Well, we can talk at long length about that. EAR I know. SFY Not this one. The thing was in the State of the Union Message. EAR Right. That was the short piece. SFY That was the one we were talking about. This had a lot of stuff that we had prepared. Bo was pushing • • • Bo likerl the idea from the very beginning of having a community program. Whether they were called Centers in the beginning or not, he liked that idea, and he pushed for us to develop that as the major part of the program .. We worked for quite a while on the idea of a Community Mental Health Center, what it was supposed to be, and what it was supposed to have in it, and we finally got to some . • • Alan Miller was in it. I remember that famous time when Alan • • • I asked for his comments, and he blew his cork, and he said he wasn't going to prostitute himself and prostitute his ideas to other people. And he_ got up in a huff and left the room, EAR You asked him to develop the· staffing pattern? SFY No, No. We asked him for his. opinion about somethi~g .. Would he s~ggest somethi~g as. to how· we were to move in the: next piec'e of this. And what he said in effec·t was, he ·wa·sn't. going 21 .. SFY (cont} to give. us hls :ideas. He was goi~g .to: ... , ., if he had any ideas, he· would have theiri for· hims'el·f. · And he walked off in a huff- EAR Really? SFY Yeah. And he didn •·t come back into the thing for quite a while. I dontt kriow what tr~ggered it at that point, but he was very angry--very annoyed. I wish I could remember how we got to the point of construction, but we had talked about Community Mental Health Centers and establishing them. And I know that I had for a long time been thinking in terms of a building program. Where that started, I dontt know. But, you know, r remember very clearly following a Saturday session when we had sort of put things together as to what we wanted, I went home, and on Sunday r took the Public Health Service Manual on laws and regulations home with me, and took Title VI, the Hill-Burton Act, and wrote the Community Mental Health Centers Act (What did we call it the first time? It was written on yellow paper. I remember that very clearly, because I don't write on a yellow pad. I hate yellow paper.), dropping out those pieces I didn't think were important enough, and building in the construction. EAR I think that's where the 20:1 ratio comes in. SFY Was it? EAR I think so, in terms of the construction. SFY Well, we'll have to look and s.e:e, but we bro~ght it back and I remember Bert. Came up from the :White Jtouse, _or maybe· ·Bert was back by that time--I don't kriow. · But I remember Bert 22 .. SFY (cont). was insisti!lg that we .put .in maintenance o~ effort of .some. sort into it'.""'-that :there wo.uld be ·some_ ~guarantee that the :States were goip.g to continue to put as much ·into the area of mental health as they had previously.· . And Bert--who worked with him on that? EAR Was Steve Goldsten involved at ·that time? SFY I dontt think Steve was involved as yet. I think Steve. wait, when Steve came on, we were ·still building Twenty. EAR Oh yes, Steve worked on it. SFY Thatts right. He was there during that, of course. Because he came over when we were in the doghouse, when we moved to Building 31. Yes, I'm sure he was there. EAR Well. We were talking about·the maintenance of effort. SFY Yeah. Bert (maybe it was Steve, I dontt know), but I don't think Bert ever worked for Steve. It would have had to have been some­ one more senior for Bert to have worked underr even at that time. But he worked for somebody. Because, I r.emember clearly, Bert had come up with a number of different things that should be built into the thing in terms of program. Because, we had talked about what we needed--you know, what a Community Mental Health Center should be, and in writi~g the Act, I used the framework of the Hill-Burton construction and built in the program into it. And r: remember Bert, when we :were_ goi!).g over the framework . . .. wellf let me come back to Bert in a second., We had a lo~g drawn out discussion--Van and a whole bunch of us--as to whe.the·r we· :should put .it in as :an Amen'd,merit .to the Hill~Burton 23. SFY(cont} Act. And Felix ·said yes·, that was the. way i t should go, be­ cause it would be easier to get it in as an Amendment. And I said, _nNo, lt should be a separate Act in its own r:Lght.u Do you remember that a~gumerit?: EAR Yes, I do remember that. SFY And we all took sides on it, and we ended up with the separate Act. And then we had a fight with ·the Hill-Burton people, and with the drafters. But we had come in with an already drafted Bill, and· that"s what P.O."d them, because they were prepared to go along with us, but they would write the bill, and here we had the whole thing already drafted, do you see? EAR Harold was involved? SFY Harold and I forget the name of the guy who was the drafter-­ legislative-drafter. It wasntt Sid Sapperstein at that time. Maybe it was Sid. I don't remember. But they proceeded in spite of us to try to write another draft and we fought them down and wouldn 1 t accept it. And we got a separate Bill, a separate Act. That's what went down. But Bert and somebody had been working on a lot of the finer details of what should be included, what were the necessaries. What we would build into the total pr~gram. Not the key thi.~gs--you know, the five essential elements. But then the famous business. we proposed the Bill, and we had a meeti~g with the PHS people an,d finally ended up with the Bu~get. We :had a meeting with the Bureau of the_Bu~get. I' went down and: Van. Pid you_ go down? EAR I dontt think so •. 24. SFY (cont} And Bill Stewart by. then was the Spec.ial Assistant in the Secretary's Off ice, or was he ·• ~. ~.· no •.· •.. • I don "t r·eme.mber to tell you· the truth whether he was :still in the· Bureau of Public Health M.ethods ....-you know, .which was in the office of the Surgeon General, or whe:ther he was ·• • • EAR I think he ·was in the Bureau when the Hundley Report was being argued back and forth.· I think after the Hundley Report he moved on. SFY And where did Bo_ go? EAR Bo left shortly thereafter, altogether. SFY Well, maybe, and then he followed Bo. He took Bo's place. EAR Oh, that I didn't know. SFY In the Secretary's Office. Yeah. He became the Special Assistant to Health and Medical. EAR Was that Bo's title? SFY That was Bo's title. Yeah. And he was there, and he was sitting on our side of the table .. And Herb Sutton, and Mike March. I think Atwell was there. EAR Yes, I think Bob was. By that time Bob had taken this well on as a personal chore. SFY And, Sorotkin was with me. Sorotkin had come on by that time .. Yes sir, because • • • that starts another train of thought. Because I had the :feud with Bert. Bert wanted the catchment area size at .250,000, and I said no. I wanted to limit to 20O,000,: because T did not want to include the :R~gional l?r~gram in Illinois which ·was set to 2,5.o:,:o_.o:o.. Which I felt was entirely 25. SFY (cont) too b;i_,g. The)::;e we;re five r~gions ·in .all of Illinois.· We could have five Community Mental He:alth Centers in Illinois. It just didn 1 t make sense from ou·r point of view. And r remember Bert was pushing for it. But .apparently Bert had talked to Wysotski or whoever it was at that time, and was_ going to_ get it through. But some interes·ting things--you know, we had built in the business of the non-residency requirement, and all of those things. And when Felix saw it, he Said, uoh, well, you'll have to take that out, you know. You'll never get the residency thing through.n What else did he object to? He objected to the si'Ze of the catchment area--the catchment area sizes. EAR How about the continuum of care? SFY I don't remember what his reaction was to the continuum of care. He was enough of a clinician to not have objected to that, but, I remember he objected to some of the liberal inclusions in the Bill. And he argued that • • • by that time we had all with­ closed ranks as far as the people who were drafted. Van was in favor of it. Everybody was in favor of it. Because, I remember Sorotkin was in there at that time. He had just come on board. We had just_ got him. Alan had recommended him. He had been fireo., you know, out of California. And he had an interim job. We brought him in. EAR But, I tho·~ght he had worked .for· Ray initially. SFY Maybe he· did. EAR He was Ray's. ·Special Assistant .. · SFY But, how did he_ .get .in the,r·e? How did he_ :get .out there? EAR aecause Ray was not really very heavily involved in all of this. SFY But, I remember havi1:1g him sit in Felix'·s office ·when we were talking about it. EAR It could well be.· SFY Yeah.· Because,· for another thing, which follows---and this was in late '62 by this time,·---when we were down the·re in this meeting in the Bureau of the Budget, Bill Stewart started arguing that we should not have a requirement for all five elements. He said (and he was talking from the traditional approach point of view of the Public Health Service) that the State should be allowed to put on any one of these and be supported and work toward adding the others. Take them where they are and help them along, etc., etc. And it developed into an open argument right there. And I said no, that we had enough evidence in the field of mental health where we had been sup­ porting places like the State of Oklahoma for 15 years or whatever it was. It started in '48 and we were now in '62 .. Twelve years, whatever it was. Where they still had just the same amount of service in terms of Mental Health Clinics, and it was all what the Public Health Service was putting in and nothi1:1g in the State of Oklahoma. That's because we took them where they were and we were supporting them. And, it_ got to be fairly heated, and Bill Stewart was_ goi1:1g to be sort of standi1:1g on his d~gnity.. Y~u .kn·ow t _he was. goi1:1g to call the shots, _and I wasn't havi1:1g it. ·And Herb Sutton was :enjoyi1:1g all of this and he said, finally, _'lWell,. geritle:rrieri, _I su9.gest 27. SFY (cont) that we adjourn and let you people: f.rom NIMH-..-.frqm Public Health ·service caucus as to what your position is. And I know • •• I_ guess it was Van. I said to Van, "We better . get to Felix quick, because Stewart is goi~g to call Felix." And whe·n I_ got to the· telephone, it was busy, and sure enough, that was the famous time when· he cut off the· limb. He told Stewart, nsure, we '11 take the·m where they are, and give them, you know, a start, and all the rest of it." And we never had another meeting in the Bureau of Budget, because I never went, and so they never had another meeting down there. So that the issue was never resolved at that le~el. In spite of the fact that Stewart called Felix, and Felix said o.k., when. from the theoretic point of view as far as Herb Sutton was concerned in the Bureau of the Budget, it made better sense to them if somebody wanted Federal money, to start a new Program such as this, that they should conform to all the requirements of the Federal Program, so that you had a whole thing going, rather than this old business of dribs and drabs and you never were certain that you were going to ever get continuity of care, or, you know, the whole business. And so, from their point of view, when the l~gislation was submitted requiring all five elements, they never objected to that. But it was this Public Health Service that was objected to in a typical BSS letter. Business. But, .. r remember very clearly when Sorotkin found out about it, he turned white. You· know· :the· way Phil, _when: he'._ '.got a~gry 28 .. SFY (cont) used to turn white? He turned .white :at the fact tha.t Felix had cut us off at the pass that way. It's an interesting thi~g, you know, if you stop to think back, Felix was dis­ affected, really, with the Joint Commission implementation away back. He ·sort of got s·ome ·enthusiasm_ generated when we generated enthus-iasm with that whole ·team op thing_ going there, and he sort of felt the· group--you know, the boys were working for him, and he could. . . but, I dontt think he ever had any really basic interest. When the • • • what was it, when the staffing went through • • • I guess in '65, I saw him at the APA meeting, and I said, nBob, you know, we have this big success,n and all the rest of it. And he sort of sneered, and he said, uwell, you only got 65, with whatever millions it costs us; that's a new sort of program.u And I was so startled, you know, because he had been in on the original thing in terms of construction and staffing which went in, and we were defeated on the staffing business. He never was very heavily invested in the whole business, which ties in again with that business at the counsel that I told you about. A very interesting sort of thing, though. I don't know what it had to do with. I think it was distractions of lots of things; the fact that he became the President cf the APA, and he· was comi~g close to pushing 60, and 30 .years in the Public Hea·l:th Service, and a lot of other things we.re occupyi~g his mind .at that point. EAR And wasn•t he becomi~g philosophical, rather than pr~·grammatic in orientation·? 29. SFY R~ght. Yeah. And it was interesti~g ,.: ;tho~gh. The :1~gisla­ tion was :subndtted--you know,: _was wr:itteri up.. We 'had • • • it was :funny. We ·had written into it :a special priority for General Hospitals that·a Mental Health 'Center that was af­ filiated with a General Hospital would have ·a higher priority. Whe·n we met with ·the Hill Burton people with the legislative draft of Sid Sapperstein, the'y said, ~'What are you_ going to do about the mental hospitals?'" And that" s when we made that quick change in the thing by saying, "'Well, they could be a Community Mental Health ·center for surrounding their own area,"and built them in, but it was funny because you would have expected just the reverse. You would have expected them to stand up for the General Hospitals, and here they were the ones who raised the story about the. They were a very interesting business, because they laid claim to the Program because it was a construction program. And that's when the famous compromise was made, that in approving such a thing, it would have to_ go through the • • • that the regulations would have to be approved by the Federal Hospital Council as well as the National Advisory Mental Health Council, and that was a sort of compromise arrangement. We fo~ght bitterly, but we compromised on that, and it turned out that there really needn't have been any point to f~ghti~g because the Hospital Council never even said boo about the r~gulations when they went thro~gh. But we. did have a f~ght---an o~going fight with :the Hill Burton people. They took it upon themselves: to write l~gislation 1 to draft regula­ tions, and they sent therri to the :Su~geon General's office. And 30. SFY(cont} they notified NIH so late, that by the: time Mertel.got to us to Say tha.t we had to respond 'by 'such :and such ·a date, it was already po.st-dated. Then, .I .r·e:m:embe.r havi~g a real set....to with Marold Granning about the: pr<:>gr·am. He was sayi~g, lfYou can't tell anybody who_ gets a. grant what sort of program he has to have ·in his hospital. •r I ·said, nwell, that 1 s exactly what we I re doing. 0 Well, the· Hill Burton Program • • • I said, nLook, as far as I ani concerned, that's a major flaw in the Hill-Burton Program, because what you're saying is that if somebody came in to you and said, 'I am_ going to build a hospital without any provision for surgery,' you would have to s.ay, O.K. that's the way it 1·s going to be.'r I said, nI'm not about to." We got our way on that one, obviously, and later he became an ally of ours on that, and if you recall later on the Regional Offices got into the act, and the Regional Directors got into the act, and the General Council's Office got in the act. Remember, the law stated that you had to set up an agency to administer the Program, and the Secretary's Office and HEW General Council wanted it to be Governor's choice (I forget what that part was, the argument was). And we had another point of view, and they sort of in very lordly manners said, '•This is the way it's_ goi~g to be. You know, after all, we are the General Council's Office .. u I remember Harold and I drafted a memo which ·went to the General Council-­ the Department and said, "Thank: >you for your opinion. ·when you have the responsibility in la.w, :the·n you can make ·the decision. But as such,: the law states. very clearly that Dr. Granni~g and 31. SFY (contl, . NIM:R have the res.pons.ibility, :and we •··.re doing it this: way, and this is what t•s. goi~g out to the· :B,~gion·s,. They were so' mad. I remember that very clearly. Haro.Id -and I were allies by that time.· EAR Now, all of this is prior to the ·time ·that the White HouS·e. got involved? SFY In terms of? EAR Well, this mes:sage, which ·was February of '63 • • • SFY Well, this had been cooking for a long time, because • • • I wish somebody could pin it down, whether it was Bob--you'll have to talk to Bob. EAR I certainly will. SFY Ask him whether he was the one that told us about Kennedy having made the remark in the White House (some of hiS advisors were around}, uWhat•s happening with the implementation of the Joint Commission Report?" And whether that stimulated Bob Atwell originally, or • • • I don 1 t know. But, at any rate, that re­ mark was made. EAR Yes, but that's long prior to all of this work, and long prior to all the work we did. SFY Yes, exactly. EAR But, what I'm leadi:~1g up to and the question I want • • • SFY Is, how did this come about? EAR Well, partly how did this come ·.about, and also what were the final obstacles over and above the·. ·great concern r~ght :in the White House ·about the production of psychiatrists at :the· expense of all the :other spec'ialists, .so that I: know that 1 s • • • 32 Ill SFY rt was the, :reverse f Eli"' The :.c.once.rn was in the Bureau of the Bu~get with Mike March,' .and it was. ·take:n to the· White House for· decision. EAR r'm sorry, you're right., Y~u,re abs 0:lutely r~ght. 1 But, the decision, as r recall havip.g heard · (I was- not the.re}; that in fact the deCision was made in the White House. That it was presented to them in just this way, and that they literally made a conscience decision. Someone up there, including (Who was the Jewish lawyer there?} . . . . SFY Oh, the mental retard~tion one? EAR Well, whoever it was. But they apparently consciously decided that they would support this legislation with the realization that they might be depriving some of the· other medical specialties in order to produce the additional psychiatrists. SFY Yes. Right. But, the trigger for this was the fact that a. twin bill was being prepared. You you have to remember in 1962 • • • '61. Sixty-one, I guess, it was. Because if the Joint Commission Report came out in '61"":'-early in '61--the mental retardation people immediately wanted a similar sort of thing and they set up that Commission. What was his name who was heading it up? EAR This is the one that Bert went to work for? SFY Yes. Re came in from Wisconsin or someplace like that. EAR I thought he was from California. SFY I don't know. Wolford? No. And that's when that whole document was written, you know, and Cook was in it. They had this whole 'big .te·am, and Queen Elizabeth.,..;-:-Elizabeth :from New 33 .. SFY (cont} Jer.s.ey, Elizabeth B9ggs, and then .B·ert- was: sort of bei~g the Executive_ Sec·retary in addition· to the: :formal people :the:re, and when we started drafting the :1~gisl:ation for the Community Mental Health ·centers, Bert started drafti~g the same thing for the Community Mental Retardation Centers. And their Committee ·sort of took the ·same ·pattern, and then when the legislation was submitted, the ·two were ·put togethe·r into one Bill, 88164. No, it went in as separate Bills. They were written as separate Bills. EAR Yes, they were, because he says it here. These twin problems are mental illness and mental retardation. SFY I have the bills here someplace.- They were written as separate bills and introduced by Senator Hill as separate bills. EAR Well, you're absolutely right. SFY Then they were combined into 88164 .. I have the briefing book, incidentally--the first briefing book. But. EAR See, this message says, on mental illness and. SFY Mental retardation. That's what stimulated this. The inclusion of the MR. There may not have ever been a message like this if MR hadn't_ gone, and there been a provision which intrigued the Kennedy people, and that's what res·ulted in this. EAR And, you know, as obvious as it :is to us, I think it has to be said ~gain that so much of this important . . . . so many of these important events turn on minor personal circumstances. Namely, that the:re was a mentally retarded child in the- :Kennedy family. 34. SFY Of course •..Of course~ Mike, :that la\\7.yei in the White House. .. • • his name was Mike .. EAR It was a Jewish name • • • Feldman? SFY Feldman. Mike ·Feldman. Meier Feldman .. And he was Sorrenson's Assistant. A whole piece is miss·i~g in this. I'm trying to recapture some of it. You see, the· staffing is or~ginally written • • • I don't rec'all whe·n we_ got involved in all of those different support patterns. Mann must have worked up about 150 different patterns. EAR Of staffing patterns? SFY Yeah. Support. Percentage~ of support, and th~n the length of time. I suppose they would have had to have been worked out when the Bills were originally submitted. EAR Well, there was a great deal of staff work trying to develop a model staffing pattern with the numbers of peoples in the various. SFY But, that wasn't what I was referring to. No, that was when he came up with the 108. But, I wasn't talking about that. I was talking about the support patterns for staffing. In other words, you know, we started off with 75% Federal and 25% Local, and then, 60 and then 45, and then 30 • • • and over 15 months .. But, that was compromis·e. number 925, because I remember there were a whole series of those .. Different patterns. EAR Well, .wasn't that partly related too, to an earlier document, when the whole private sector business came up where we developed f~gures indicating what :the States: had been providing all alo!,tg, what the private ·sector· had been providing all along EAR (cont} to the support of Mental Health l?rpgrams:--the implicit a~gument bei~g that with ·the· increase ·:of· fede.ral monie.s:, State monies did not decreas·e;' in fact,: :the·y increased, and so you could us,e the argument tha.t Feder:a1 monies stimulated State monies rather than substituted for them, and so I think all of that was in the bac~ground when you worked up these variations on the· ·staffing support patterns. SFY It's interesting that when the legislation was submitted, we didn't have much to do with its introduction in working with the Cammittee·s at that time, but it wasn "t like later, you know, where we had a very definite place in operating. When the staffing went through,· we met with the Committee in Executive Sessions, as a matter of fact with Hill's Committee in the Executive Sessions. EAR And the Chairman in the House, what was his name again? SFY Harris, Oren Harris. EAR Yes, who did a lot of very positive work. SFY It was a lot of very interesting political shenanigans. The AMA came out against the staffing. It was socialized medicine. EAR Was this before or after the meeting we had that Wilbur Cohen had talked to this group? SFY That was when we did that to_ get 89105 thro~gh, the Staffi~g Bill. EAR That's what I mean. SFY I'm talki~g about the or:3--ginal Act. The or~ginal Act had staffi~g in it, and the AMA came ·out stro~gly ~gainst it, .and the,re was a Campa~gn Dinner .. And at th.e 1ast minute the White :House told Oren Harris-:-it had already be:e:n pas'.sed by the Committe·e,· approved -36. SFY (cont) by the Coltlmittee. The White. House·. ~g.o.t .in the act. They we:re afraid .for the· mental retardation· st;a:ff.,. and thei .told Oren Harris to withdraw it. So Oren Harris.called another· meeti~g of the Committee for· some trumped-up ~reason .. He said there wasn't a quorum the first time ·or· somethi!lg or other, and the second time around, the"y defeated it in the Committee. So he withdrew· the staffing provision • EAR • • • with ·the political_ gimmick that if construction was successful, there would be time enough to reinstitute it. SFY Well, whatever it was. But T rember--was it Shoyer from Pennsylvania--somebody raised trouble on the floor about it, and there was a last-minute ·flurry of telegrams that we stimu­ lated, and all the rest of it. And Oren Harris finally got up and said, "Disregard this manufactured flurry of telegrams," and all the rest of it. But, that was at the White House-­ the request that they withdrew the staffing the first time. EAR And the reason was because of the AMA? SFY Yes, and they were afraid that the whole Bill would fail, if we included the staffing, so Oren Harris took it out. He had no objection to it. And I remember, in one of those sessions, the President of the • • • the President-Elect ..... or the President of tlte AMA, was on the l'anel. lie had been invited to speak, and he. gave the AMA position, and when he got finished he came down and he turned back ·to those ·who had come with him and he ·said, ••why are we opposi!).g staffi!).g? '' We were :all sitting there,· you know. EAR Was there ·any ke·y villain in this one? 37. SFY Somebody in :the Rouse was an M.D. f.ron,· Kansas( _I thtnk, who had tr~9gered all of this nonsense .. EAR He was ·from· Kansas, not South :Carolina? SFY No. But, that whole flurry of· • ·• • we worked our fi~gers to the bone sending out letters: to everybody and calli~g people and telling them to write and to call. And it didn "t do any _good. It was defeated. It was passed in the Senate, of course, but defeated in the House.· EAR And, I think I do recall that the· argument was that there would be time enough 'if the construction proved itself successful. SFY Well, we have the transcript from the floor. EAR Yes, I'll get that. SFY There was a whole interesting series of things there. EAR On the legislative sequence? SFY Famous testimony. The Honorable Anthony Calabrese. EAR Do you have the original on that? SFY Yes. I have to fish that out. What a horrible thing that was. Will Piccone and I had to go back in the afternoon. EAR To rewrite it? SFY No, to retestify. To get the facts stra~ght .. EAR He couldn't tell the difference between the NIMH out in Bethesda, and the l?rogram out in the Country. SFY He kept_ getti~g mixed up between the· numbers of Centers and the number of millions. That's whe·n: one of the_ guys was_ goi~g to heckle him, and he said somethi~g about mental he.alth,· _and he was sayi~g, "'Mr •. .Secretary, _wha.t's your opinion about :.steriliza­ tion of mentally unfit peo"ple?·" Oren Harris, who" was chairing 38. SFY(contl the thing, said, •1 M:r:-. Secretary, L· .g:ue-s'tian the advisability o;. your answeri~g that :questi:on:." I never fo~got: tha.t one. There ·was another famous bon mot, if you will, of that kind that Oren Harris pulled. It was in the· Hearings on Staffing, and Jake Pickle from Texas said that he didn 1 t have any particular interest in this Bill .. He said he didn't know anybody who did have any interest in this Bill; he said that none of his con­ stituents were interested in this Bill. And Oren Harris said, "Mr. Pickle, I can cure an error. I know of one constituent of yours who is mightily in favor of that. In fact, he submitted this Bill. The President." EAR Oren Harris was sharp. SFY He ran his Committee. He was absolute dictator of that Com­ mittee .. EAR But, I think it's a whole other story, really, to try to dis­ cuss in depth, not just the contributions of the key people, the Hills, the Fogartys, the Floods, the Harris 1 s and the rest, but the manner in which their personalities were in­ volved in all of this, because obviously while Hill and Fogarty are talked about as a pair, they were so totally different individuals, and r think this is a fascinati~g story in and of itself. SFY When 89105 was up for consideration---·the Staffi~g Bill, in '65-­ of course, the Senate had passed it, you know, originally, and Senator· Hill didn't hold any he:ari~gs on it. we got a call one day to come ·aown, so Phil and· I weht down. 39 .. SFY (cont} down( as s·oon as his Legislative Assistant., Bob Barclay,· ._comes in, he ·says, ncome on inside .·n · I r·em:err.iber looki~g ,·· :and I said, ~'The'ytre in Executive Sess'ions?·'t: He :said, n'S'o what, come in .. u· We went in there. The whole Se'riate :Committee was meeting in Executive Session( and the Senator said, "'Sit down, Doctor. Sit down, Doctor." ''We may have some ques:tions to ask you, Doctor, about this Bill, although it's a pretty good Bill, and we are all in favor of it, aren't we, gentlemen?n EAR He must have been quite a guy in his day. SFY And, they talked for a few minutes, and then he Said, "T take it there's a.unanimous consent?" IIAye. 11 "Aye.n uAye." "Thank you, gentlemen." "Thank you, Doctors, we thank you so much for coming down all this way. 11 That was typical. He went on at long lengths about what a favor we did for them to come down there. So, that's how staffing got passed in the Senate. Now, Oren Harris. Joe artd I sat outside there, and we were having conniption fits. They passed the wrong thing. They got all mixed up. They got it passed backwards. Oren Harris came out onceo Jim Nenger came out. Everybody came out. We were sitting out there rewriting pieces of it, and sending pieces in by message. It was all about in staffing, whether they should . go--whether there had to be a State plan, or whether they should . go thro~ghthe State, or whether it should be done separately, and all that. They_ got it all mixed up. EAR Well, it :seems to me you':t:'e touchi~g on somethi~g now· that 1 s a terribly impo:t:"tant continuing thread in this whole history, 40 .. EAR(cont) and that is,: the manner in which you, ;when you had .the res-; ponSibility;: :a.ob, be;(ore ·and :to ~fome ·extent les·s no·w:; Bert. But, in each ·instance the: d~gree· ·to which. ·there was a really important effective close ·1ink~ge ·with the key Congressional people. SFY Yeah. Of course, Bob was very close· ·with Senator Hill, and you know the famous story about how he·_ got Mike Gorman and Bob reconciled. EAR No. SFY Nate Klein and Mik.e ·Gorman in ''54, t55, "56 maybe (I'm not sure of the exact year, but just about then), took off violently and publicly against the NIMH for opposing and not supporting, joyously and effectively with ·exuberant enthusiasm, psychopharmacology. The Institute's reply to Felix--I remember the article in• Time· Ma<Ja·z·i·ne. It was a typical bureaucratic reply, "Of course we're supporting it. We're investigating the aspects of it." And etc., etc., etc. There's a difference between having two or three projects that you're supporting, than to having a Program. And Nate Klein and Mike testified very vigorously in the Senate and the House about how lax the Institute was, etc. They were at d~gger points with Felix, part of it due to the role that Mary Lasker played in this. And that started early on and away back when her husband, Albert Lasker, who was interested in mental health~-when they approached the Institute to offer support and advice, the:Y were turned off cold. The· Institute: did not want anybody muscli~g in telli~g them what to do and how to do it. In fact it was. done quite :crassly, because 41 .. SFY (cont) it abso·lutely ·ant~gonized Mary Las.ker .and Albert Lct;ske·r ... He never came back ~gain to ever ask .. Felix never would have anything to do with Mary Lasker·. Shannon didn t t like her any too much,· but the'y tolerated he·r in the :Committees. Felix wouldntt have anythi~g to do with her, even though ·occasionally he was forced into it. Mary Mahoney, on the Council one time. EAR Florence Mahoney. SFY Florence Mahoney. Mike, working for Mary Lasker, of course, was not persona grata with the Institute, and the'ri with this last attack. And finally Hill called Felix, and he called Mike .. He got them in his office, and he said, ,rNow, I'm strongly in favor of mental health. You know, Bob, I love you like a son. I'm equally fond of Mike here. And if I have to knock heads together, I'm going to knock heads together. But both of you had better get along." And that was that. Felix told me that story. EAR Well, those are turning points, terribly important turning points. SFY I was saying that he was close to Hill, and he always had been very close to Hill. He had originally worked closely with Percy Priest in the House .. And then, with F~garty, he was on close terms, but not quite as close terms as with Rill. He also worked very well with Mel Laird. I told you that story about the: hearts and flowers .. EAR Yes.· SFY So that he wo'uld always_ go up to F~garty beforehand, _and talk 42. SFY (cont) about what we· needed.. It was ·a routine ·fo;r us to write· ·for us to write- fo;r the Committee·. · I"m. tryi~g to think of· the :F~garty Administrative Assistant that we; knew .·s:o well .. 8/23/75 i EAR You s.~Y they were discussing a -grant application· ;from M;as,ters-. -'· f . .. 'Was that? .·:When it SFY It was ver'y early in the time ·that l was there. I can"t place whether it was when I first: c·ame· up and took Joe ·Bobbitt's place temporarily. But I have a visual rec·ollec·tion that it was in T-6. I know Sapir was in the ·room· because Sapir apparently had presented the fact that they were ·applying and there ·wer·e all sorts of comments being about, about the micro'!"'-cameras which were ••• are on the instruments and all sorts of things. Plus a good deal of laughter and not the slighest bit of consideration to deal with this appointmeni, not the slightest, it was all a big joke you know. EAR Her.was::~there by himself? SFY Master's wasn't there. EAR Masters was not there. I thought you ment Masters was there. SFY NO, It was Sapir, Felix and Bobbitt. EAR A formal application had come in? SFY I can't swear to that. But I know we were talking about support for Masters. EAR But it must have been '59 or '60 early. SFY Yes, but it is interesting. I know it was one of the things that I raised my eyebrows at that time. You know. EaR Kind,kind of a behind the scene double-dealing sort of thing. SF.Y Well it was a little callus sort of disr~gard for ••. simply because it was sex. And it was the s.ame Sort ·of· anxious laughter and joking that you usually_ get. And not being one :of the in-gro-up rea'.lly as yet, I was more sensitive ·to what was hap.perii~g then· they were. 2 EAR Aftet awhile you..9et inur.ed to. -it.._. Well, you rai~e -an important point though ·be·c:ause ·x think the:re are a number of incidents of which ·that is just one which ·r think can illuminate for us" I don't want to put it in any derogatory way .. " SFY No, it doesn't gain yoti anything.._ EAR But I mean just a straightforward statenien·t of what some of the problems were in some of thes·e difficult areas and try to play it straight. Well, I want to turn it off in a minute because""""_" __ SFY Well, I know it is important. Given a group such ·as that with you know maybe 30 study sections is one thing to talk about cross fertilization. I wonder how much, I don't know what you would want to call it, whether you call it sub-livital or even pre-conscious stimulation of people ·on the study sections came from their review of other people's work. EAR Absolutely. SFY And you know this is something that is never mentioned publically .. EAR I know. a SFY And because it is\very ticklish area to talk about .. EAR But it is a reality .. SFY Well it is, of course, it is a reality. But and it had a positive effect, in terms of science as a whole. Because of the cross reference section .. not EAR Well, you should read,if you have~1'yet seen it,this weeks· S'ci•en·ce Ma:g·a·ztne ..· There is an editorial by Arthur Cornberg which is adapted from some remarks he made :at the NIH reunion, which we did not attend .. And he compliments the NIH highly as being the university par excellence for the ·whole ·field,.. bio-medical scie·nces·. It is 3 EJ\Rlcont} very nicely. done. But he ;m,ent;i,.ons, ;Ln tti;ere al~o what a incredible succes:s the :p.e·e:r .review system was-.· · Tha:t :cill the.se years billions and billions -of dO'llars were ·awa:rded with not one hint of chicanery, that is the exact phrase. That is a slight exaggeration. But when you think of it in terms of how much money was really given out, how much outright deception how much outright, I am thinking of it in terms of business practices. I don't think they are ·anywhere near the ·same. Sure there is the old boy system, sure "there was an incredible amount to knowing what was going on and the point that you make that they inevidably benefited just by being emersed in it. SFY That is right. Any guy sitting there ·on a specific study section rbecause that was his area of principal expertise or interests. Reading 100 different applications which bear on his subject even if he didn't pick up any specific from anybody elses work it is just the concatenation of all those things may have treated lots of new things in his mind giving him an advantage that nobody else had, who was not on a study section. EAR OK, now but I think that whole thing could be discussed trying to look at it from a point of view above any one individual. Granted that someone like Dave Hamburg, I don't want to mention names, or John Lacey or a dozen other people that we know that were on study sections for years on end benefited on all of this. But if you think of each one of those individuals as themselves being a contributor however they obtained this information being a contributor to a total accumulation of knowledge then it was a symbiotic kind of advantage. They gained something but the field gained something by their gaining something. SFY No doubt, that is what I mean by the positive of the field. It 4 SFY Ccontl would be i,nteresti!lg i:e there were sorne way of ~tudyi~~ J?~o~ ductivity before, _during the :study section and. after. ¥:9u know, during and after·. The·r·efs no way of doing that. EAR No, of course ·not· bec·ause 'it ·is -s:uch ·an inter-:active effect, that you can"t possibly sep·arate ·them. But I think, to repeat the point, that here is a phenomenon· that was part and parcel, not just of NIMH but the whole NIH but part and parcel of the whole program which if appropriately discussed, and I would like to do. I remember so vividly having an everiing discussion with George Saslo way early in the game before he had come as rambunctious as he finally did with that trip to Hawaii and everything else that he did. But I remember his saying, it was after a study section meeting, he had been chair­ men., He had been chairmen of a number of study sections but he had been chairman of the ·psychiatry training committee at one time after he had already served on a number of study sections and we were talking about the whole ·study section phenomenon and he said you know, someone really has to write this up because it is a unique contribution not just to the field of mental health but to the whole field of science. And it was fortuitous noone decided inititally, wow, this is really going to be a way for improving science. It was peer review, period. SFY The improvement to science, a direct improvement to science was a spin off to use the lab terminology, of the system. EAR And I think to use that as one example of what the total program meant. Xou know I even thought through you start with some incredible ·statistics about .the number of people that served the numbe·r of hours they se·rved the. n·umber of applications they read the numbers of dollars that we·re· :i.nvolved in the approved and 5 EAR (cont) unapproved_ grants~ To start with ·.s:ometh;i.ng like· :that and then and I wish :here ·r· had and maybe someone has their. own files some illustrative 'incidents· from· var.iou·s study section· meeting themselves. You know, how a study sedtion·· mee·ting actually went. The psychology and dynamics of a study section· meeting which you could do, infact one of the things I had bee·n toying with ·and I ''m still keeping it in the back of my mind is that in effect there would be descriptions in the book which ·you would have to say are not absolutely verbatum but they are illustrative ·they are not poetic license"=but literary license to describe what a typical study section is like and I think I could do that having statl~::with enough of those and I want to be able to communicate to the people reading the thing who either those who sat through it who of course would be able to immediately empathize with it but those who had not to be able to get them to understand what this was really all about. Just to say a peer review or what the congressmen •• it doesn't say anything, it doesn't mena anything. SFY It is too bad we couldn't have had cable T.V. cameras to report these sessions. EAR It would have been fantastic. Because some of them were really incredible, really incredible sessions. And I remember so well especially the years that I sat in on the study training committee meetings when I was so totally emersed having read the application so carefully bef.dre hand and you would sit there as a member of the staff i,n the old days when the staff didn't say very much and I would be· ·on occasion sitting on the·..e~ge ·of my chair because they were making mistakes·, your wro~g that is not the way that_ grant should be 6 EAR.tcontl reviewed.· l-\nd the.:h fina,lly .someone :would just be~ore it £.el)., o;l;f the ed.ge of the pressafi.ce :s·omeone would say .something and b:t:'ing it back ·you know, now· you got it and all this was going on in my mind,. good, good, that is. :good, yes keep-: it up your doing fine. Ah,· you finally c·ame to the right decision and it is exactly what the dynamics were ·1ike. That is exactly the way it worked. It was really funny. SFY The group was always fascinating. EAR And to some extent, of course, at another level we had the same k.ind of dynamics in counsel. I don't think it always went as well. SFY Was counsel was a little different. EAR A little more complicated, and because of the politics and every­ think else. SFY And because coming in there they were expected to be philosophers. You know, to voice their opinions and to air their additions. The study sections as a rule ran different, even in terms of the way they would sit down at a table. They would come into a study section sit down and everybody would unload his briefcase and spread out his papers and add notes on this and put them all. together before the meeting would start. Counsel would come in it was bland, bland handling. EAR Yes, that is right, the role model was purier in< the study section._ than in the counsel •. SFY Much more professional in the· sense of doing their job which had to be done .. · EAR Exactly. You knew what your re'.s·ponsibilities were much more 7 EA.R(contl p;r;-ecisely and the lnteraction· there~Ore was much :c.leaner and the ·chairmen I think in the :study section in some ):espects being in the member of the_ ·group rather than at counsel where it was either you or Bob.had a also a clearer role as part of the operation whe·re ·as in counsel in some subtle'.;:,Ws\Y it was the chairmen as the director against everybody else sort of speak. It might not always come out that way but whether it was a Quig Newton telling you to have a 4 year budget plan for the next 4 years or whether it was Mike asking you whatever happened to that grant becuase he had just gotten a call the night before from the guy who wanted to know whether he was going to get his money or whether it was jolly Wess with one of his pontifical statements about what ought to be done to save psychiatry from itself. All these things, it was you against them or them against Bob. Or the philosophers you say, we had enough of those too. But not in the study section. SFY You know, in a sense the study sections felt themselves more of the institute as really quasi staff doing the job that the institute had to have done. Then the counsel that was coming in that felt that in some way it had to tell the institute what to do. EAR Absolutely. SFY Which was the role that they had. EAR But it was a differnt dynamic. OK, so there is one case in which it seems to me --that what needs to be done is pretty clear and you then have carved out one important cUlnien~,i-~:to_f_the total panorama of activities that the Nn/4H rep·.resen:ted and the study section is one. And I don"t know whether I c.ould do it whether it would really add that much ·but also at the ·appropriate time want to talk to some 8 EAR Ccontl extent about on the· one h~nd; f:i:;-om .Bob~ s point of view because he described it in an inte.r·esti!).g way his brown b~g luncheon sessions either around his ·tab.le or around Veste ''s table and after the fact, I don't know whether he did this consciously, but after the fact he verbalized that he felt that it was a way for him to allow the family -to_ get together under informal circumstances and to talk about anything that in a real sense it was his way of getting everybody interactive with everybody else and leep the lines of communication clear to make him that much closer to everybody else. I think he made some of that up after the fact, obviously. But he did have a style that way. SFY There is not doubt abbut that that was his style of operation. But it didn't always work that way and anything that didn't work according to his plan was not recognized as existing, you see. So that the other luncheon group which went on concurrently he never recognized as really as existing. EAR Well, you have all of these counter plays going on all the time. And then I think the way you ran a small staff was another very important dynamic. I think all of the interaction took place at various levels not just the obviously one of John Eberhardt coming in always to defend the intermural against the extramural and not understanding what you were doing behind the scenes to help him. That plus the kind of competition among the various directors from the various parts of the program. And what you _got out of it which :r think you would like to talk about it some­ time, So those are other aspects of illustrative phenomenon about how the whole ·program wo:rked. Then that is one leveil of presentation, the other way of being illustrative is what we 9 .EAR Ccont) allready have talked abo:ub havi~g,_ gone too far in doir,g it and that is to p,ick 'the highl~ghts. of' some of the ·important events whether it is the community of,' mental health center ts program whether •• what happened to staffi~g, the joint commission would talk about briefly. What I' want to do, taking a little bit away from us for a moment, I' have ·a list of about 200 names, roughly 200 names of people to whom I' am_ going to write a letter. I was not intending to do it over' the' summer because so many people would be away and I' haven't completely finished the letter but in effect it would be an invitation to the·se ·people who have in one way or another played an important role in some aspect of the NIMH program to share with me incidents or events in which they have been involved and if any of them have and want to share some material that they may have elected-that also provides additional insights that would be very useful. Dave for example, Dave Shakow has a whole series of files of personal files especially in the early days when he was on the first psychology study section which he said he would be very happy to let me have .. So when I come back early in the fall to talk to both Eberhardt and Bob Cohen I'll pick that suff up. Incidentially, I want to let you do some talking but did you know that both Dave Shakow and John Eberhardt have been trying to get Bob Cohen to write a history of the intermural program? And Dave said to me it use to be a year or so ago and he would talk to Bob like at least once a month. He ~aid now, he only talks to him about once every three m.onths' about it and I said well- I heard that f:rom John and I certainly dontt want to interfere with what Bob does, no Dave 'said you_go ahead Eli, you go ahead because 10 EA.RCcont) my_ guess is th.at it will be· 4060 .at best that Bob will w;rite that.. And he:ar is this man in his ,early 70 • s sitti~g there every morning·from 7:30 to 11:30 '.writi~g this stuff out. He is really such a delightful person, he has turned into a complete scholar, there is no other way to des'.cribe him. SFY He always was. I mea:nt to ask you when you were in Washington I wish you could okk for there wer·e 2 boxes of files that I saved specially when everything else was thrown out which were the meetings of the fist study sedtions and the first counsel meetings in 1948, they were in my closet. EAR I have the official minutes of the first counsel meeting. SFY There was a whole box of stuff. EAR Bert seems to think that you have taken everything that you want. Because he said on 2 separate occassions Stan has all that stuff. SFY No, that was the community of mental health center's stuff. They •• both those boxes were sitting in that closet where I had that locked safe. You know? EAR I remember SFY They were sitting on the floor then. I really should have taken those with me. EAR we➔l=l, next time I go in l will talk to him about it.._ Incidentially, did you know that Bert has 30, he said, 30 hours of oral history on the Kennedy Administrationfrom the time he was in office and to be his usual dramatic self when he 'told me that. I said well, if there is anythi~g there that you think would be useful for me to have and if you want to share :it. No, he ·said I can"t do that because ••• 11 ~n I can" t releas.e:. !.t until 20·. ye~a atte:rf the._. president ts, .dead"' ~ rn a, sense he said with evecythmg that· is: going on now with .Tedcy Kennedy I can '·t do it. SFY He has 30 hours of ....... that he· recbrded., EAR 30 hours that he dictateclback after.the· first Kennedy assassination. It is in the Kennedy libra:ry under· sane kin.d·of control. SFY I don't doubt that he.has recorded. some. EAR I am not arguing. SFY 30 hours, maybe EAR It is possible SFY It is possible. You've got to take everything he· says with a grain of salt. Two grain to. EAR I know but an~y that is one example and r·am sure I have already told you that Bob Felix told me that he had askedJohnClausson early on to kind of se:r:ve as the scribe and observer of what was going on in the early days. So Hohn was suppose to do that. I spent a few minutes John didnot do •• Probably not, I haven't called him.. But I did talk to Mel Cohen for a bit and told him what I was doing. He was ver:y intrigued. He said look anytime you want to cane back and interview me I would be happy. He said you know I am probably well he said I am the first person flt'an within wh0--:ecame in as a fairly junior person initially who ended up being a laboratory chief. So he said I really have ...... SFY You really ought to talk to ruin about theHaggers-Towns .. EAR Yes he knows about that, right. SFY Because that was the early stu!t when: we·.were working at the.public health se:rvice den:onstration. 12 Well there. ~e ~ lot ·of .people· the;r;e, . ~ ·wMtea,· to. ta,lk .to. :M;L.lt ~tm,ap, but as· usual.he·came up to· say.hello.and J:·saidMi.lt do.you·have a coupl~ · of minutes? Because I was suppose to.see Bert but he won i t be able to spend as much time with ine as he· originally intended. r didn •t tell him what it was for. Milt said r am on my way to catch a plane right now. So he was gone. SFY If you can get hold of some of the· files of the camnunity seJ:Vicesb~dt. You know·r can kick myself now because a year and a half ago or a year ago I was cleaning out some stuff in the· attic and I threw out all the ccmnunity seJ:Vice•s camrl.ttee meetings book that I had. I had a lot of them way way back but there was an awful lot of stuff. You know why we were talking you reminded me •• way back in 1956, 57 the cammunity seJ:Vices branch was talking about the importance of camnunity nental health boards. And it was a big deal and they were really pushing it and I think of how far in advance of today's consumerism •• EAR Well, that is terribly important. r really think :that those kinds of historical touches are so terribly important then••• SFY That was my first major speech that I. made. EAR Really? SFY It was at Oklahoma on the importance of community health boards. I was talking to the boards members of the associated boards in Oklahoma. '!hat reminds me I have to •• I have a gocxlly number of your speeches and Bob's speeches to. But that gets me back to the other thing. '!here is so much material it scares me when I stop to think of how much there is. '!hat is why I have been carefully in my mind, but not carefully enough in writing it dCMn. working through,· what I have to avoid dof:Ilg as much as I have to do ••• SFY You know you canoe· in~iguedby'.certain.points and then.go down the.garden path with it you know•••••• .13 FAR io~ can spend an inCJ:"edible anpunto~ time.. · S?Y Because it is intete~ti~g. EA.R Well, on the othet hand I don·l·t want to worry ab:out not having covered everything because "l ·am not·. going to be able to do it anyway. And it maybe more important or useful to find a few really . good illuminating incidents around a particular area then to try to do a carefully delineated total •••• SFY Well it occurs to me too that it is to bad that we didn't keep some careful minutes of some of the retreats that we had. You know, especially ~t the beginning when we really decided to do the whole institute. Because then we ·started to come up with everybodies ideas on what needed to be done in the 'field. You know ••• EAR Yes. Well I have some of those early books, some of the organization books and I think when we got to •••• that is a very good point because I think what we might do is ••••• What I think we might do when we get to that is really pull out one or another of the documents that still remain and H:r~ntry to talk ••• your memory is good and mine is reasonably good. Talk to some of those things. I remember some of those early meetings to •. At the moment for example the thing that sticks out in my memory about one of the meetings is every time something came up about finding someone in the institute who would do a good job in this particular spot, Howie Davis' name came up and at one point someone said whether it was Jim or Bert said why don't we see id5, Howie can write up a statement on this. We were at Ailie House. Jim called Howie about 4 o'clock in the afternoon, 6 o'clock that night Howie was at A.ilie House,· Jim told him what it was that had to be done, 9 o "clock the. ·next morning Howie :came back with a statement. He had worked all n~ght on it and c·ame in.. He was such 14 EAR (cont). an eager bea;ver you couldn't be.:L!:eve. iou couldn ~•t. believe and he was so, so personally involved with Sim that it was· really some­ thing. And that man had the most incredible motlvation to be of service of anybody I have ·ever seen·. He could not say no, could not say no. And it turned out that was partly his downfall .. Because no matter who asked him to do something, off he went running. Anyway that was one minor inciderit of one ~f the Ailie House meetings that I remember, and I kriow the·re were a number of others.. There is a beautiful illustration, some of the retreats. I think that there were a lot of things that we did that few other organizations did in the way that we did .. Including the 25th. anniversary. Now everybody is copying and having 25th. anniversaries all over the I place. Incidentially, Bert said, and it was very funny; I said Bert what is your recollection about who really had the idea for the 25th. anniversary? And he said I don't remember who had the idea first but what I do remember is that faithful week when I took over the thought crossed my mind then or shortly thereafter that one way of keeping the institute thinking towards the future and drawing on the past would be to have a big 25th. anniversary celebration. But he said I would not take credit for the idea initially and I am not sure that it was mine all I can tell you is that once I was on board I thought this was a very good idea. SFY Now, that you are talking about it didn't we discuss that with a small staff a number of times· and we were kidding about whether it was the 24th, year or the 26th.· year depending on how you wanted to look at it in 1948 or '46? EAR I don"t remember. 15 SFY You don't. remembe:r? Now ,tna;t y:ou, ment;Loned it, i .o,on it ;r;emember whether it wa;~t my idea O;t; not·., EAR I think it wa.s, initially. SFY But we talked. I won't swe'ar to it but I have such a strong feeling that we were laughing about it. How you said it and when do you set the time for it. EAR Well, my recollection is and maybe ·ram making it up now. But my recollection is that you came up with it some time early that year. Now, maybe it was January, maybe it was February you left in June but I think early that spring ~e' · started to talk about it. Then of course when you left in June but I think the reason Bert reniem]jers;~=-i,,~"the~·way he does is that it was already, it was already in everyone consciousness. SFY That it interesting. When you mentioned it, it suddently brought back the amusement that I had about the whole idea. EAR It could well be. It could well be that we had to do that. Incidentially, you know this 100th. council meeting that you are attending SFY They all made up the 100th. council meeting. EAR Exactly. SFY I know that. EAR I said to Carolyn Evans, I went into her office and said gee, it can't be the 100th. already? Because I am up to 84 the last one I got is the meeting of the 84th. council in November of '71. And this is only '75. She said •••• SFY The 100th. member. EAR No, no, it is not. I don"t :thlnk so. 16 SFY Bert sa:Ld something. EA,R REally? .It must be :more than that.,· Eu.t a.nyway, _she said remember that for the past few years we. have had 4 a yea·r. Oh,· yes I said I remember. I said, but, nonetheles·s, r can tell you since I · now have all the council minutes· ·from· day One. That I had to number the first because they weren/t officially numbered until number 17. And I had to number the first and I can tell you that in 1948 and 1949 there were a couple of times· when there was a meeting on May 7th a and 8th. and then pres·umably another mee·ting on May 9th. So if that meeting one and two rather than all meeting one. She said please Eli don't say that now, it is all set the lOOth.· meeting is coming up. It is officially the 100th. meeting, don't mix anything up now. I said OK t'm just talking to you. She really took me seriously. But I told you tiatI asked Bert if he was_ going to invite me. I said I shared some of those meetings on some parts of the day. SFY And what did he say? EAR He said yeah. I said you are not going to invite me. He said no. SFY He is getting more straightforward .. EAR That is right. He knows how to say no sometimes., It is going to be a big shindig. Everyone who was., .. SFY He is tieing it in with the corporation. EAR Well,ithat will be interesting~ Xou haven't heard anything further about the corpo1;ation? SFY No, I was suppose to have_ gone ·to a. meeting of the corporation in Anaheim , what's his name ·from· the Faulk :Founda.tion?. EAR Allen. SFY Phil stopped' me ·in the hall and insisted that l c·ome ·and I didn •t_ go 17 SFY lcontl and then :c couldn't go to that big. think they had -:Ln Washington,· _which was a fias.co t understand .. EAR You know that there was a· meeting. Bert_ got invited by Phil Sapir. SFY You told me. EAR I told you that about ••• SFY About that in-group mee·ti~g EAR And that Eberhardt was blushing wheri he found out that Bert was but if was after that that did! tell you also tli~t:he was that Bob said watching Joe Bobbitt leaving the ·car clinically depressed. Apparently the two of them did no talking whatsoever. So Bert was in the car ••• SFY That was interesting. EAR Bert was in the car with ..·•• SFY When did Bob see Joe Bobbitt last? EAR At that meeting. SFY At that meeting .. EAR And it was a week later that he had his heart attack, about a week or ten days later. And I told Bert that I had asked Joe Bobbitt if he would be willing to have me come and interview him that he originally said yes and then he said no. And r said had he ..... SFY He never gave up that fight you know. EAR I also think it was his dep.:res·sion. SFY But you know his attitude ... You wete extramural. In that sense he was very petty. EAR He was. Oh,· we ·can go thelie ~- · we·: :c.ari cut it ·off.,