1 ~rtram S. Brown Rockville,. Maryland fulY 30, 1975 EAR What I'd like to do since we have •• I think we are about ready now. And incidentially, as you well know, all you have to do is just talk nonnally. I'd like you to begin really from your earliest experiences at NIMH, this ~es you out of the present moment and you may not be able to do that. But primarily fran the standpoint of hav you got in::and then very quickly fran there really your first major activity was in terms of working very closely with Stan on a conmittee of health centers operations. So from your perspective whatever cares to mind, unless you want to start somewhe:re else. I don't want to stop you, did you want to do sonething else? BSB My mercories run sanething like this. During residency at the Mass. Mental Health Center I was somehow spotted by Ienn.y Dule and Stan Yolles. I have to take a one step back because I don't think the sto:ry makes any sense about how NIMH and I got together, without going back just very briefly to medical school. Where in medical school since~ only image was a general practitioner image, Brooklyn background, and all that the solution to the fact that I was •• did well and enjoyed the full range of things - pediatrics, intemal medicine, surgery, etc. was a good fortune of having an outstanding Professor of Public Health, Wilson Smily who authored a text book and he became~ major identification figure. And I·chose as an organized,.conceptualized.career, a career in public health. 'Ihen thought through during rredical school what a career would be in public health. You have heard this beofre, Eli. I decided that the two key things to take training in were pediatrics and psychiatry, which is why I went for a year -to Yale in pediatrics and Milton Send he was~ consultant about what to do next. And then to the Mass. Mental Health Center. During the course of the pediatric year and the first year of residency I had~ first experience which applied to the Conm:onwealth Fund laying out clearly what I thought was necessary for a 2. BSB(cont) career in rrental health, public health or public health, mental health whatever the name was which docments I still have in my personal files basically said that one ought to be trained in the following tlrings: psychiatry, pediatrics, internal medicine and public administration. I laid out a beautiful 5 year program which was tum.ed down by the Ccmronwealth Fund as being unusual and over-ambitious. EAR What year was this Bert? BSB 1957, '58. And as has characterized my career•• this sort of thing only was a spur to go on. I felt that the·establishrnent didn't have the imagination they should. But during the course of this I then applied to Gerald Kaplan to take their corrmunity mental health, as it was called in that day, and the second major episode was being rejected by Gerald Kaplan. Gerald Kaplan's sto:cy is a ve:cy ~rtant part of NIMH because when I went into see Gerald.~ Kaplan in my ·second year of residency telling him I wanted to combine my MPH and my third year residency he in essence said "Go away", I want real psychiatrists, I want you to finish your residency first. I argued that that was ridiculous that people did laborato:cy work and all sorts of work why couldn't I do my MPH and do my third year work. He would turn me dCMn so I applied to the Public Health Service and received a title one fellowship independent of Gerald Kaplan and did not get a Masters in Hygiene but got a MPH and it wasn't until I went to the White House that I was dubbed a protege of Gerald Kajµlan with whom I had the most tenuous and tense relationships during my MPH career in the School of Public Health. So there was alot of expost facto dubbing of proteging. During this second and particularly third years I went into the School of Public Health, I don't know how. Ienny Du.le and/or Stan Yolles heard about me because I was in the Ber:cy Plant Air Force Reserve I just don't have the m.emo:cy at the nome:n.t. I would not want to down play the 3. BSB(cont) significance of Ienny Du.le, I think he is a critical one for you to interview at length. But I do remerriber caning dCMn here, meeting these two young cats and Stan Yolles playing a leading role and at that tirre he was at the study center but on leave for six months with Felix or sanething like that. EAR Right, exactly right. BSB Exactly right. EAR He was substituting for Joe Bobbitt who was doing a 20 school study. BSB Very interesting and Stan was his •• .irmediately positive chemistry between the two of us we didn't have to waste any tune. We both knew we were smart and so the elitist kind of bond formed within that one minute- saved a lot of trouble testing each other. He then offered me nore than he cou-id deliver which is that I could stay on and get my doctorate in public health for an extra year so that I could arrive at NIMH with a doctorate in public health as well as a full residency training and that my only job was to get out of my Air Force Ccmnission and to get into the regular court of the public health service. 'Ihe next episode is kind of complex, I don't remember, I think Stan was helpful, I think Ien was helpful, I am not sure. But I remember that I was quite active in writing letters and playing the bureaucratic game. But I did go for this marvelous three day test to get into the regular corp of the public health service including being asked about the cranben:y crisis, snoking, and a whole host of things at the Boston Public Health Hospital. And did succeed in getting a canrnission in the regular oorp £ran Bay I of the Public Health Service and getting out of the Air Force Ber.ry Plant and getting my MPH and my third year residency and working at the ccmnunity extension service on a NIMH title 5 grant. So it was kind of a busy third year. During this third year I remember receiving a phone call £ran Stan and he said "Sor.ry fellow you have to cane down, you can't stay on for the extra year" it has to do with canmission. I 4. BSB(cont) did not find out until 6 nonths·or a year later that Stan had made me the number one on his mental health career development notion. He didn't share it with me but it was sane genius plan he was cooking up and he fit me into it, one of his manipulations. But the chemistI:y between Yolles and I was that I did not mind being manipulated like that. I didn't• have~,:the usual angry outburst that people have when they are being manipulated. I trusted his purposes which has been one of his problans. I came down and was assigned for the mental health study center and at this point rather dramatic a set of ships took place because it was exactly the point that Osburg was called back fran the Atlanta: Regional Office and Stan came in as Associate Director, I think, and left the study center and I started as a typical staff person at the mental health study center. Now, I spent almost a full year until the famous evening of June 10th. of 1961 when I received a call fran the White House at Kennedy at the Mental Health Study Center and that year could take an hour of talking about. So let me stop there and ask you how much do you need about that year. It is a colorful year because so many people and things went on. EAR Just give me a few little highlights because I want to get to the next phase. BSB Yes, you thought we would came back. EAR Yes, I know what you are saying BSB Now, that year was marked by an extrodina.ry,: situation. I arrived at the Mental Health Study Center which was one of the prime heartfelt pilot research station with Felix, Mabel Ross and Allan Miller, and Stan Yolles and its productivity in numbers of research papers and output was miniscule, there was a Miller-Rooney paper of '55, there were the Yolles dreams about epidemiology of the school system and I decided to use what has became xey hallmark. I marched in and announced after getting the ambiance of the situation that I 5. BSB(cont) would be the.nuber·two or number three· authors on.every body elses constipated works. And the year there was nw nost productive year in thenns of research papers. Eight Research papers for which I was the number two and number three authors. Each of one of which has seriously becane a classic for example there was the Osburg-Shellow Brown paper on Family Group, one of the earliest papers. So each one of the papers has a story because after finally getting it out of these crazy cats they ended up fighting who would be one and who would be two. I was happy to be three. 'Ihe Boone-Brown Mental Health-?ublic Health Nursing Paper, and on and on, I don't remember all the papers. I also did sanething unusual and this is i.rrq;x)rtant for later events. During this year at the Mental Health Study Center beside having gotten a MPH it was critical that I actually study at the Health Department. So I spent half nw time at the Prinee,,:~;ge's County Health Department where Yolles and other had initiated an alcoholism program, working with the general hospital and it was a real life setting where Murray Grant was the Health Officer and Gusto Eskebel was the Psychiatrist intthe Bureau of Mental Health. So that this half time connection at one, thetilml.eaiate place that Yolles had left and two, an inlrrroi.ate place that Yolles had interest in/ the alcohol thing, kept rce closely •in contact in a very graceful way with what ordinarily a first year corp or a first year post resident officer would not have. I don't remember any strain at the contacts with Yolles, Du.le or the other but alm::>st, in a sense almost proving nw rcedal, fran.Jihe first day. A lot nore about that year because each of the figures became i.rrq;x)rtant. Grant and Yolles became i.rrq;x)rtant in St. Elizabeth and I could go on and on and on. And Osburg became i.rrq;x)rtant in later events but I won't belabor it. Till the fanous night, Sunday night, June 10, 1961, now the background of that is I had done a paper on Hane Visiting by Psychiatrists. It was part of nw third year of 6. BSB(cont) residency under a NIMH grant, the carmunityextension service that came out in the Prevention of Hospitalization Book by Green Blant. I had had this experience which I often talk about about being rejected by the American Joumal of Psychiatry, I was accepted at the Third World Congress of Psychiatry in I'vbntreal to give this paper. Felix was at that World Congress and I remember neeting all the figures with whom I am now colleagues. Tom Lambo and his Nigerian robes, Felix and all the world leaders, kind of a big event for ne and I flew back with Felix in the plane discussing with Felix,,:r_:~'~Wh.y was my paper rejected?" and"What did it nean that it was given at the World Congress?" And was given a fatherly lecture about how the establishment always rejects its revolutionaries and how he was rejected. He didn't tell me anything that I knew but it was only three days later that I was back in his office as his tentative boss. This was on June 8th. or 9th. What happened was, Sunday night, there was a call, and my wife said it was one of my jokester friends, it was the White House and the President would like to speak to me, indeed it was the President and asked if I would help to get a mental retardation panel put together. I remember calling Yolles and Duhl that night and I remember showing up in T-6 on I'vbnday morning at which point I had gone,th:ro~ghtthe silliness of wondering whether I should do it or not and Bob Felix started with a twinkle of humor and got up and saluted me and then told ne I was a silly fool of course, he was the Camma.nder of Chief, I had forgotten that I was in the regular corp, camnission corp. I then spent essentially the next from that June '61 until three weeks before the assasination on October '63 assigned to be in the White House. Let me stop there and ask, that was the transition point. Yes, but say sonething about those years because I think that is important. It was during that time. 7. BSB June '61 to October '63 · EAR Yeah, you were also involvecr during that time Ccrrmunity Office Central Iegistation Activity. BSB It is a very canplex two years because I was Kennedy's special assistant for mental retardation. For the first three or four months before the panel was fanned I worked with Maslind, who was the Head of the Neurology Institute there has been many papers written which I have about how the two things went on simultaneously, the updating of the joint camnission on mental health and illness and the MR panel. I becane F:elix and Yolles man in the White House. I was the key person who was able to link together the whole President's message. I was doing the staff director's job for the panel on mental retardation I was also as the chief shrink around the White House, the key person that Yolles, Joe Douglas, and Felix and ~ y were counting on to kep them abreast of what was going on at the White House. '!here was a period where I was booted out and had to cane back for four to five months before Myer Feldman called me back to rescue the retardation camnittee. It is a very complex two years. It isn't easy to smrmarize. I might say that those two years, I quess it is a little more than two years, were the subject of thirty hours or oral history by the Kennedy Library. Which I was the only person to refuse in any way, to give them rights to use the material because of the infonnation that I learned during that period. 'lllis was five or six years ago when the Kennedy oral history was hot. 'llle rationale-I have the only copies of those documents they have sane for the archives, its because the issues that were picked up and as I said five or six years ago it seared to be clear that Teddy Kennedy would sane day be a possible candidate for the Presidency and the issues that I was aware of around the Kennedy family and stuff were to current politically hot to have those released. But the two years covered at least three or four different levels, one level was the final outcane of the 8. BSB(cont) President's pan.el on mental retardation. The second level was the analysis of the joint ccmnission on mental illness and health and the third level was the integration said in the February 5th. message, the fourth level was all that went on with Felix as an attenpt to have a Bureau of Mental Health and Retardation and the fights that went on, and lastly the learning I did which was the i.rrprinting period for really understand pc:Mer and politics and others which •• I'll give you one colorful anecdote of this sort of thing that pappened since I was the Chief Psychiatrist around and did curbstone consultation in sort:.:.of a genial way I becarre Ve-J;Y friendly with the Secret Service, I became very friendly with how White House cases were handled at the Northwest gate. I was able to make several major i.rrproverrents in the management of psychiatric cases with the Secret Service something I never publicized very much. It also lead to iey special study::.in ~69 - '67-'68 about whether there would be a change In White House cases when it went through Johnson to Nixon, a very interesting study, unpublished. EAR Really! BSB There is an outcare of the Warren camnission has not finished that particular assigrnnent on Presidential assasinati0ns and sane of those issues which is now becoming hotter. I give you that as an example of the almost unspeakable set of issues with which I was involved. EAR Well let me ask you, because you have touched on sanething that I am concerned about in a general way and specifically in the case you just described. It would obviously be very easy for me in trying to do this job to get carpletely and undated list data. BSB Yes. EAR Obviously. BSB Right 9. EAR But, 9n the other hand it is equally true that there are same people that have in their own personal archives material which can be very, very illuminating in temts of the focus on what I am trying to do. Now, I am not sure one with a •• your willing to share. BSB I am not willing to share the stuff that I did for the Kennedy oral history. It is full of very, even as it ripens it becanes more explosive, Eli. EAR Ok, alright, OK. So then we have to ignore that but there are some of the published papers-the stuff that you just talked about in temts of this little White House consultation. Because I think it is important, it may very well have a bearing in a suttle kind of way on sanething Itwant you to talk about namely, I was not there but I think I'm correct in assmning that there was a rrornen.t when the manpower decision had to be made conmtmity of mental health center's legislation in which literally Feldman and same other people in the White House were keenly aware that the legislation might take manpower away it from other medical specialities. and ·J?Uh1iinto psychiatry and they had to make .that decision. Now I would quess from what you've said and what I know that youn.involvernent at the White House prior to that may have had sane role in that decision making process. .Am I right? BSB Yes, well we have to•• this is why it is hard to tease out .with0ut careful preparation of many hours. There is two file cabinets there to which you are welcomed. Stan.took a caaplete set on the 'White House analysis and the budget things are what Mike March and I did because in addition to re-writing the President's power report and making alnost mortal enemies of Mayo who was the Chairman. I was also the Chief Assistant to Mike March and Bob Atwell, who remember became my Deputy in doing the analysis of what the .nnpletation of the mental health center thing would do. And it was quite clear in these various decision making documents that the manpower issue had a canmand 10. BSB decision kind of quality.was one willing to expand the total pool to deflect a certain higher.proportion into·mental health and yes I think in a supportive and quiet way I assisted that process though I was skillful and deferential enough to really let Yolles and Felix you know be the major decision makers. But I was the or··~- catalyst. Ok. Well here is a beautiful example of what I am talking about. I think that the subtleties of the decision making process are••• and sane of the vagaries of the decision making process are almost as important, if not in sane instances nore important, than taking a look at the step by step seemingly logical way that sanething took place. There are·alwayP intemediate variables. BSB But isn't this what Musto has done. I though Musto was a historian•• has point out that the Harrison Act and the others have just as much to do with group dynamics and other adventitious advantages. You seem to be following that historic track - decision making as having chance elements, vagary elements, group dynamic elements, personal elements. And I am intrigued with hc:M the other facet of looking at this in sane complex cohesive way is really to think of NIMH almost as an entity. I mean a real entity in which each of us played a particular role so that we are all in one sense individuals and yet canponents of a larger social bcx1y. And this is an effort to do a biography of NIMH as that kind of entity. What was it that happened in the first 25 years of evolution of NIMH that are really the important critical variables and there very corrplicated and they inevitably involve these kinds of things. The point that you made a moment ago about you and Stan mmediately having this kind of relationship. You both knew you were bright and you didn't have to go through all this business when you first met. Well, that is very important I think in many respects with many of us 11 EAR (cont) there were many of these kinds of camaraderie aspects of working together· with ·intellec'tual and professional peers which I suppose, I'm sured occured in other agencies to but I think it was especially a hallmark with NIMH. And one more thing than I'll shut up because you are suppose to be doing all the talking­ I am very intrigued, and I hope I donl,t make you self-conscious by this comment but I am very intrigued by the fact that in certian respects the tree of you were right for the times you came in. Stan could have not done the job that Bob did, it is just perfectly clear to me that Stan could not have taken that organization in its initial phase and done what Bob Felix did. And conversely I think that Bob left •• he was absolutely right •• whatever it was he could not have taken it the next step. He didn't have Stan's organizational skills, he didn't have Stan's strength of purpose to do it come hell or high water whatever the personal sacrifices may have been on the part. BSB Shut the machine off for a second. Your last point was that I was right for the times. EAR Ok let go on. BSB Lets go, what else do you want to cover now for this first that would be most helpful to you and the other things you had •• EAR Alright, go on beyond the community mental health centers. When you really ••• BSB I came back just about 3 or 4 weeks before the assas.sination. To Be head of head of something called the community mental health center staff group. It was kind of vague and eventually it became 12 BSB (cont) a branch and there wer·e :all sorts of dynamics and I was the first Chief of the ·community of mental health ·center branch and there was all sorts of tensions about what the community services branch would be verses the centers beanch. And then a lot of tension around the research branch, I remember. And I did that for a year and a half or two. Now, I remember, quite clearly that I had a small bear boned staff of 5 or 6 people and had both the conceptual and salesmenship job to do and it was just a great joy to do it. Very hard work but I didn't mind the work. I remember the people quite clearly, Marie Macabol, Jerry Osterwyle, Lucy Oserin, Bob Atlow was my Deputy and he was positively brilliant. Clyde Dorset was an arc:fuitect was the first one I hired. I may be leaving out but it was·a very small corp group that had this first implementation of the construction thing.:.:that had passed. Then somehow after that was under way and the planning for planning and the construction plan and a whole host of things got going I became the Associate Director for services, it must have been one of the period of restructuring that Stan thought through in '65, long meetings you know how you go through that. I think it was a tremendously important set of decisions that were made and still are in place 10 years later. So that parti­ cular episode on, for your purposes, on how decisions are made are very important along with Stan and his trains as we like to call the "in group". But is really •• purposes of how not to get dismembered how to keep :tes:earch and training together and all sorts of stuff that went on in the decision making process, attempted participation by others about where they want to be and I 13 BSB(cont) occassionally look through those books to see what people said about themselves·. And then just to briefly_ go to the <episode of hbw I became Deputy Direc"tor. Which is an absolutely dramatic moment of truth, it was quite clear, as far as I was concerned, that having gotten the centus program underway in rather well respected, I thought by my peers, not always liked bµt respected by you,Greg Feldman and others. Really respecting and admiring Stan a great deal because he was terribly helpful to me personally. The episode that I tell all the younger people I know think is when he sat me down and said if I ever hear you say the wora "I" once again I'll cut your throat. The most helpful thing he ever said to me because you have to work in terms of the purposes you have not in terms of the narcissistic center. But nevertheless, I became friendly with Elliott Richardson and Volpe and was asked to be the Commissioner. I was not satisfied since I already was an Associate Director. I don't know what the episodes were but I remember Stan calling me in and saying that he had made a mistake that he had under=judged that he was offering me the Deputy Directorship and order me not ' to go to become the Commissioner. I was really offered the Commissionership and a Professorship at Harvard. · ~.rt·tiw:onLctli>e<d;:f,a.scinating to know what went through Stan's head but again the rapport between he and I had always been good even through the rawest periods and he could say something to me, I misjudged I should have offered it to you 4 months ago. I remember I had the kind of feelings that many others hacfthat anybody who could be cruel enough not to talk to you for 4 months about your future is a pretty tough son-of-a-bitch or pretty 14 BSB(cont) insensitive or what have you. I was one of the few who was able to take it and then to chose the Deputy Directorship over the Commissionership. So that is another fascinating ••• Again, I'd be very interested, if you shut the machine off, and tell me what you remember about that episode. EAR Absolutely, it is another critical point at which the history could have gone one way and it went anothe~ way. BSB I'd be curious to know who the alternatives were, who else he was considering as Deputy. I mean only from the historical perspective. EAR I understand. BSB What the eecision was. EAR My hunch is that he wasn't considering anybody else. Maybe this came you know as a kind of circumstance that maybe he didn't completely predict. He has a habbit, again, I am not telling you anything you don't know, of sometimes under-estimating what another person will do as an alternative. That is why he is so willing to push to the limit on the presumption the other person won't take the untimate recourse. And in this case, of course.:: he had to back down ••• BSB The second •• the next major set of episodes I just want to give you once over lightly because we have to end. The one that I won't ~eally feel to free to talk to you about because it is the one, unspoken, painful, heritage witht,which I am left and that has to do with the St. Elizabeth thing. Because I am still handling it and I am practically the Acting Superintend~nt now and that essentially led to a year of exile and almost a split between Stan 15 BSB(cont) and I. EAR I understand. BSB He gave me the assignment and I offered to be the Superintendent and I don't know it was just so complex, all I know is that the St. Elizabeth set of decisions was a heavy tail to have added on and it use to be 3/5 of the old NIMH and it is now 7/8 of the new NIMH, it is kind of incredible. I have 4,000 staff and I have 490 staff communities, isn't that interesting. EAR One of the things tha-rt iCa.In\;going to have to do this ••• incidentially, I want to include appropriately, you know photographs just to make it somewhat even more vivid, but I am also trying to figure out how best to have a whole series of organizational charts that don't become so complex and boring that people won't even look at them. But that is another important and intriguing aspect of the attributes ot NIMH and most important, because there is some tremendously important episodes like the Hundly report for one and Stan pro­ clivity to put things in boxes I think has to be in some way made visual by seeing the NIMH development and fortunately I don't have to deal with the complexities after 1971. I think at that stage it would become impossible. Well listen, I know that you are busy and that you have so many other things to do. I do want to try to come back sometime in the not to distant future and I will come back next time perhaps with some more pointed kinds of questions by which time I will have had the chance to go through some stuff with Stan again. I want to go over just one more point. It will take 2 minutes. Tell me: now from your perspective and this is because I literary am_ going to begin the book with the 25th. anniv. 16 EAR(cont) It was originally Stan's idea, he was never able to carry it out before he left that there would be a 25th. anniversary. Did you discuss it with him. Who is. going to take authorship for the 25th. anniversary idea. I didn't ask him so ••• BSB As I remember in the very critical 48 hours in which Stan was fired or resigned or whatever it was and I took o:f,f.ice and all the rest of it I decided that there would be a birthday party at the end of the year. I don't even claim to be a prime author. There must have been in the air about the 25th. anniver­ sary. But I do remember just grabbing it as a major initiative that would give shape to the year. EAR Right. BSB But I don't have any particular claims, that !t just came out of the blue. It must have been in the air, we must have been thinking about it, we must have been talking about it. As an actual administrative initiative I would trust your memory more than I would trust anybody elses. It seemed like a sharp thing to grab hold of that first year. EAR OK, as I said I am going to begin with that because it is a very nice way ••••• BSB But it was a way of •• you know if you want a little color around it, which is what I think you need if your going to start the book that way. In the heat of real trauma the first set of nicks and firings, Commissioner Allan and Joe English and Yolles all in the same week. That very same week I took office, Finch leaving, and Richardson coming in. I mean there wasn't any more dramatic week. The idea of looking at the continuity and 17 BSB(cont) institutional history of a quarter century seemed both phil­ osophical, historical, and also tiseful survival technique. What other organizationcould look upon its celebration of its 25th. anniversary as a survival technique. EAR Very good point. Very good point. Absolutely. BSB Enough depth to the history to be useful in the heat of the politics of that day. I mean I am just spilling out words but that is exactly how it went through the line. And it worked. EAR Absolutely. And I think there have been in the past probably less dramatic events that fall into the same category. Well, this is very useful and I am sorry that you are so darn busy that we can't spend more time. BSB Yes, as I said we can ••••