American Psychosis by M. D. Torrey Executive Director E Fuller Page A
Tags: General, Medical, History, Psychology, Health & Fitness, Diseases, Nervous System (Incl. Brain), Psychiatry, Public Health, Clinical Psychology
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Education. During the 1962 discussions, he was one of the strongest voices on the task force urging the closing of state hospitals and the federalization of mental health programs. Thinking back on the program during a 2011 interview, Atwell recalled: “I really wanted this thing to work. . . . I was a believer.” When asked why the program failed, he said: “Funding was always going to be a problem and was never forthcoming.” Rashi Fein has had an equally distinguished academic career and in a 2010 interview clearly recalled that members of the task force “were all troubled about the funding.” In retrospect, he added, “we should have more carefully examined and discussed what it would take in dollars and commitment at the local and state levels to make the model work.” 2
The other official member of the task force, Robert Felix, was the director of the National Institute of Mental Health (NIMH) and architect of the proposed plan. Even as he was retiring from NIMH in 1964, however, he expressed some doubts about the plan, calling “essential” the “follow-up and rehabilitative services for persons returned from inpatient psychiatric care, or under foster home or similar care.” Previously he had ignored such services and had not included them in the essential services for mental health centers. In 1984 Felix publicly acknowledged that “many of those patients who left the state hospitals never should have done so. . . . The result is not what we intended, and perhaps we didn’t ask the questions that should have been asked when developing a new concept but . . . we tried our damnedest.” Until his death in 1990, Felix continued to express serious doubts about the value of his legacy. 3
Stanley Yolles and Bertram Brown were the NIMH psychiatrists working closely with Felix at the time of the Interagency Task Force meetings. Yolles, who died in 2001, also expressed doubts about what they had created. He decried “the ‘dumping’ of mental hospital patients in inadequate community settings” and claimed that “the current situation results, in part, from an assumption made in 1963 that has not proved to be correct. At the time, many community psychiatrists believed that almost all mental patients could be treated in the community. This optimism was too euphoric. It now seems probable that there will always be some chronic patients—say, 15% of the total—who will require long-term, residential care.” Yolles added that “it is now obvious that . . . aftercare and rehabilitative services must be available within communities.” 4
Brown, the youngest of the psychiatric triumvirate that led NIMH down the community mental health path, is alive and was willing to recount these events during extensive discussions. He said that he and his colleagues “were carrying out a public mandate to abolish the abominable conditions of insane asylums,” but in doing so “the doctors were overpromising for the politicians. The doctors did not believe that community care would cure schizophrenia, and we did allow ourselves to be somewhat misrepresented.” He acknowledged a “failure of appreciation of the care needed by seriously mentally ill patients.” “For Yolles and me, individuals with serious mental illnesses were not a primary concern. . . . We should have done something to cover them, but it was not a priority. . . . We wanted to do something to help people using public health.” Asked what he should have done differently, Brown said he should have hired “five good mental health superintendents as consultants.” Looking back on it all, Brown characterized it as “a grand experiment” but added: “I just feel saddened by it.” 5
Fifty years after the initiation of this grand experiment, we also look with sadness upon the detritus of mental health dreams and lees of lost lives. As sociologist Andrew Scull observed, too often “the new programs remained castles in the air, figments of their
The other official member of the task force, Robert Felix, was the director of the National Institute of Mental Health (NIMH) and architect of the proposed plan. Even as he was retiring from NIMH in 1964, however, he expressed some doubts about the plan, calling “essential” the “follow-up and rehabilitative services for persons returned from inpatient psychiatric care, or under foster home or similar care.” Previously he had ignored such services and had not included them in the essential services for mental health centers. In 1984 Felix publicly acknowledged that “many of those patients who left the state hospitals never should have done so. . . . The result is not what we intended, and perhaps we didn’t ask the questions that should have been asked when developing a new concept but . . . we tried our damnedest.” Until his death in 1990, Felix continued to express serious doubts about the value of his legacy. 3
Stanley Yolles and Bertram Brown were the NIMH psychiatrists working closely with Felix at the time of the Interagency Task Force meetings. Yolles, who died in 2001, also expressed doubts about what they had created. He decried “the ‘dumping’ of mental hospital patients in inadequate community settings” and claimed that “the current situation results, in part, from an assumption made in 1963 that has not proved to be correct. At the time, many community psychiatrists believed that almost all mental patients could be treated in the community. This optimism was too euphoric. It now seems probable that there will always be some chronic patients—say, 15% of the total—who will require long-term, residential care.” Yolles added that “it is now obvious that . . . aftercare and rehabilitative services must be available within communities.” 4
Brown, the youngest of the psychiatric triumvirate that led NIMH down the community mental health path, is alive and was willing to recount these events during extensive discussions. He said that he and his colleagues “were carrying out a public mandate to abolish the abominable conditions of insane asylums,” but in doing so “the doctors were overpromising for the politicians. The doctors did not believe that community care would cure schizophrenia, and we did allow ourselves to be somewhat misrepresented.” He acknowledged a “failure of appreciation of the care needed by seriously mentally ill patients.” “For Yolles and me, individuals with serious mental illnesses were not a primary concern. . . . We should have done something to cover them, but it was not a priority. . . . We wanted to do something to help people using public health.” Asked what he should have done differently, Brown said he should have hired “five good mental health superintendents as consultants.” Looking back on it all, Brown characterized it as “a grand experiment” but added: “I just feel saddened by it.” 5
Fifty years after the initiation of this grand experiment, we also look with sadness upon the detritus of mental health dreams and lees of lost lives. As sociologist Andrew Scull observed, too often “the new programs remained castles in the air, figments of their
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