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New hope and inspiration pervade the psychiatric atmosphere. There is a feeling everywhere that the time is ripe for the knockout punch. With the creation of a national foundation such as RISE to augment our research program, there is every reason to believe that schizophrenia, the No. 1 health menace of our time, may one day be brought under control. Mr. Fog ARTY. Doctor, I think this is a splendid attempt on your part to do something for these people. I think you should be congratulated on making this move because in my experience during the 12 years I have been on this particular committee, I know it is only because of men and women like you who have taken the bull by the horns, if that is a good expression, that anything has really gotten started in this field. I remember when the American Cancer Society was reorganized. They reorganized the American Cancer Society in 1946 and it was then that Congress started to increase these appropriations for research in cancer. That is the reason we are spending more Federal funds in research in cancer today than any other disease. I am for it. I think we ought to be spending more than we are spending. I think there is an area we can expand, too. It was not until the American Cancer Society was reorganized and really started working, that we were able to get the interest of people. They in turn contacted Members of Congress and that is the reason these appropriations have kept going up. Then followed the National Heart Institute and the enactment into law of the National Mental Health Act. Then in 1948 we began appropriating funds. It was not until 1948 in mental health that we appropriated 10 cents of Federal funds to NIH for research in mental health and in 1948 the first appropriation was $4,250,000 and now it is up to $39 million. They are asking a little less this year which I think is a mistake. I remember when the first request was made for Federal funds for research into mental illness, that over half the people who were sick with mental illness were people with schizophrenia or dementia praecox. Is that the same thing? Dr. DEAN. The same thing. Mr. FogARTY. The committee was impressed at that time. I am surprised to find out as you say in your statement that with the Federal funds and with the National Association for Mental Health there is only about $1 million being spent on research in schizophrenia. That seems like a low figure to me. I understood that the Institute of Mental Health was allocating much more funds than that in research in schizophrenia. I thought Dr. Felix said this year we were spending 7 or 8 or 9 million dollars in this area of schizophrenia. I am not sure about that. I am surprised we are not spending more money in this area because of the prevalence of schizophrenia as a real problem in mental health. I think you should be congratualted and Mrs. Rockefeller and Congressman Morano for forming this organization. Knowing you were coming here, I did ask some questions about you and I understand you have been a very successful man in medicine over the years and you have a real sincere interest in this particular field. I heard was good from doctors I talked to and asked about you.

The clerk just brought to my attention the transcript of Dr. Felix's testimony: Mr. DENTON. How much is being spent on schizophrenia? Dr. FELIX. The National Institute of Mental Health this year is spending a total of $8.6 million on schizophrenia, in the field of research alone. I do not have a break out as to how much of our consultation to States, et cetera, goes into this area, but I would think, considering what we do in that field, that we could certainly add another $100,000 to this. Dr. DEAN. I have been in very close and continuous contact with the National Institute for Mental Health and National Association for Mental Health and various other mental health agencies and I have a letter from Mr. Halper of the United States Public Health Service saying that no figures, this was as of about 2 months ago, no figures were available for the amount of research specifically allotted for schizophrenia and it was impossible to give me a breakdown at that time. I will be happy to submit a copy of that. Mr. Fog ARTY. When you contact somebody like that in the Public Health Service maybe he should know but unless he is directly connected with the institute with the responsibility for allocating these funds he probably would not be in close contact with how much was being expended. That is beside the point anyway as far as getting something accomplished in this area is concerned. Dr. DEAN. The $8 million, sir, we have over $30 million heart fund, $50 million polio fund, about $45 million cancer fund. Schizophrenia certainly ranks up with them. Mr. FogARTY. I agree it does rank No. there. But for some reason or other the National Association of Mental Health has never been very successful in raising funds privately. Dr. DEAN. Outside of the Scottish Rite. Mr. Fog ARTY. Compared to heart and cancer and even muscular distrophy and cerebral palsy, the mental health group seems to have a more difficult time. We are having a drive now, they are having a hard time getting people to contribute to this. I know they have on a nationwide basis. The experience of this committee has been over the years since we started increasing appropriations for cancer research the private contributions to the American cancer drive every year have gone up, too. Heart is the same. Dr. DEAN. A person can identify himself with heart or cancer or polio because it means something. Mental health is a generalized, ambiguous term. Mr. Fog ARTY. That may be the answer to this thing. We raised the question 2 or 3 years ago about this problem of mental retardation in children. I did not know much about this problem until I was asked to address a group of parents of mentally retarded children in my State. We began to ask questions about what the Federal Government is doing in the field of mental retardation. We found we were doing nothing. As a result of the parents of those children organizing into a group, a national association, where we were not spending anything in this field 3 years ago we are going to spend four or five million dollars this year just in research. But it was not until the parents of these children got together and expressed an interest and that was relayed to Congress that we were able to get Congress interested specifically in that field of research in mental retardation.

.-y \\\opace devoted to schizophrenia. ow *.sity. It has been because of the lack of interest of the woc in this particular area, . This is the first time to my ohat anyone has appeared before us to talk to just the blem of schizophrenia. We talk in terms of mental health one in Congress agrees we should do something in the field health. But as you say it is pretty ambiguous wording pretty generalized term. Congress has responded rather well , mental health is concerned, but not specifically in this area. . .ake myself plain? What I am trying to say is I think you are arheading a real good movement and I think it is necessary and 1 think it might be the answer to getting more interest in this field as far as the public is concerned. It is the way of pinpointing the tremendous problem that exists in this particular area. Mr. MoRANo. Mr. Chairman, I am sure we do not wish to detain you unduly. Mr. FogARTY. You stay as long as you like. Mr. Denton has an interest in this also. I am sure he has some questions to ask. Mr. MoRANo. I want to compliment Mr. Denton for his alertness in raising the specific question of schizophrenia. I would like to make some suggestions as a Member of Congress. It is my hope that perhaps the committee can earmark some money for schizophrenia out of this mental health appropriation, No. 1. No. 2, it is my hope that your report will contain some of these facts that are presented here after you have established that they are sound facts in your report, to point up specifically the urgent need for more attention to schizophrenia as a major mental health problem. Mr. Fog ARTY. The report will contain something about this problem. I think I can say that as long as I have the responsibility for the report. I think this committee would like to raise the administration's figures on mental health as a whole and I do not know if we could earmark it or not. This is only one area. We have other areas we would also like to raise. But we need help when we get on the floor of Congress because we still have many Members of Congress who do not believe in spending funds for research. Mr. MoRANo. I do not believe you can include me in those Members. I am a Member of Congress who has tried assiduously and vigorously to support this. r. Fog ARTY. You know the fights we have had on the floor in trying to get these appropriations. Mr. MoRANO. I realize the problems you have and I can say to the chairman and the other members of the committee that I for one will continue my support of this committee's program. Mr. Fog ARTY. We need it and a lot more. You are talking to a very sympathetic committee as far as spending Federal funds for medical research is concerned. Mr. MoRANo. I hope you can earmark funds for research in schizophrenia. Mr. FogARTY. Did you understand my position, Doctor? di Dr. DEAN. We believe schizophrenia holds the key to all mental 1Sea.Se.

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Mr. DENTON. As Chairman Fogarty said, I am inte, question. I am very glad you made this presentation, am very much interested in the same thing. o, Let me ask you this. How much do you think we ought to the appropriation for schizophrenia? * Dr. DEAN. I can only quote comparative figures. There many schizophrenics in hospitals today as heart cases, almost as I, \-2 Mr. DENToN. We have had difficulty to get doctors in this partic field. We set up a program to train more psychiatrists. The Men Health Society was in here yesterday t g about trying to tra psychiatrists from the medical profession and have them go into tha #. The Veterans' Administration has had quite a campaign in this way to get doctors. They put some figures in the record on how much the Government would save in care in Government hospitals and on a number of other matters the Government has. If there was a cure for this it would be astounding how much the Government would save. TREATMENT

About treating schizophrenia now, what do you think is the approved practice? Is it psychotherapy, is it shock, or drugs? Dr. DEAN. A combination of each. I could not as a busy, active, private physician—I am only a country doctor and a private physician—I could not practice without shock treatment. I could not practice without the tranquilizing drugs nor without psychotherapy. So presently we are using all three of them in treating schizophrenia. We feel that our treatment is still inadequate. We do not know the cause. We do not know what we are treating. We are working in the dark. Mr. DENToN. We had the mental health group here yesterday. They felt that they had made great progress with tranquilizing drugs. Dr. DEAN. There has been great progress. Mr. DENToN. But there is a need for more psychiatrists. Dr. Overholser has charge of this Scottish Rite fund. He appeared before the committee in another connection and testified to that. We are building a facility at St. Elizabeths Hospital where the Mental Health Institute and St. Elizabeths Hospital work together on this subject with drugs. There are facilities out there for it now where they are working on it at the present time. They said they did not have the subjects classified at the present time. Some drugs helped some and some another. I am one member of this committee who is very sympathetic with what you are presenting and I am delighted you have set up this organization. I think it is a very worthy cause.

TERMINOLOGY

Dr. DEAN. Schizophrenia is a stepchild of psychiatry. Let us call it by its name.

Mr. DENTON. What do you mean by that?

Dr. DEAN. We do not know very much about it, not 1 in 50 people would recognize the name if they heard it. It is pretty much of a mystery. I think we ought to call schizophrenia schizophrenia and not mental illness.

Mr. DENToN. They all know dementia praecox.

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Dr. DEAN. Not many. We all do here. This is an enlightened group. The public at large is pretty vague about dementia praecox or schizophrenia simply because their attention has been focused on mental illness. We should call this by name, establish foundations in its name and we can accomplish more than by keeping it hidden behind the skirts of mental illness.

Mr. MARSHALL. I would like to commend Mr. Morano for bringing Mrs. Rockefeller and Dr. Dean before us this morning to talk about this important subject. The committee has spent considerable time going over the justifications and I am sure the testimony you have given will be given great weight before this committee.

Mr. MoRANo. Thank you very much, Mr. Marshall. I want to say that we are grateful to you, Congressman Marshall, Congressman Denton, and Congressman Fogarty, for the sympathetic way you have received us here this morning and we apologize for imposing unduly on your limited time. You have been very kind and have given us a lot of time. We need say no more. Thank you very much.

TUBERCULos Is CoNTROL AND MEDICAL RESEARCH PROGRAMs

WITNESSES

DR. JosłPH. B. STOCKLEN, TUBERCULOSIS CONTROL OFFICER OF CLEVELAND AND CU YAHO GA COUNTY

DR. WALSH McDERMOTT, LIVINGSTON FARRAND PROFESSOR AND CHAIRMAN, DEPARTMENT OF PUBLIC HEALTH AND PREVENTIVE MEDICINE, THE NEW YORK HOSPITAL-CORNELL UNIVERSITY IMEDICAL CENTER,

Mr. Fog ARTY. Dr. Stocklen, we will be glad to hear from you.

STATEMENT OF DR. JOSEPH. B. STOCKLEN

Dr. STOCKLEN. I am Dr. Joseph B. Stocklen. I am a physician. My official position is the tuberculosis control officer of Cleveland and Cuyahoga County. I am here as a member of the board of directors and have been directed by them to present their views on several problems relating to tuberculosis. I have a statement I would like to file, if I may.

Mr. Fog ARTY. Very well.

(The statement referred to follows:)

Our Nation’s efforts to control and eventually eradicate tuberculosis have in the past decade shown gratifying results. This success and the degree of attainment thereof, must be measured in light of the very serious problem which still remains. It would be an unforgivable action for those who have the responsibility of determining the course of our Nation's fight against this dread disease to underestimate the very real danger in view of the fact that some 14,000 Americans died from tuberculosis last year and that some 70,000 Americans were known to have contracted tuberculosis, and that there are some 2 million Americans who have or have had tuberculosis living in this country today. Programs waged against TB are becoming increasingly expensive. Last year the American É. spent some $752 million as a result of their efforts to battle this disease. owever, cost alone cannot be our only consideration. We cannot diminish our efforts at this time for the existence of one case in a community is a very real threat to the health of the entire community. uberculosis today is being attacked on a wide front. All aspects of the patient’s life are affected. There exists not only the problem of rebuilding the person physically, but emotionally. The patient has the need for care and guidance of trained specialists. The Fedo §ot through the Public Health

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