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WRITTEN STATEMENT PRESENTED BY C. E. A. Winslow, PROFESSOR EMERITUS

OF PUBLIC HEALTH, YALE UNIVERSITY, MEMBER PUBLIC HEALTA COUNCIL, STATE OF CONNECTICUT

As stated in an editorial in the American Journal of Public Health for June 1945, H. R. 2550 "may prove the most significant piece of health legislation now under active consideration in Washington.

Nearly one-half of all the hospital beds in any community are occupied by patients suffering from mental and nervous diseases, and the minor emotional difficulties which handicap so many of us in the conduct of our daily lives are also about as serious as all the lesser illnesses of other kinds which affect mankind. Mental hygiene is not just a small section of the problem of public health but more nearly half of it.

Yet we are spending millions of dollars on the study of methods for the control of tuberculosis, of infantile paralysis, of cancer, and devoting pitiably small resources to this much greater menace. Not all mental disease can be prevented any more than all cases of tuberculosis or cancer can be prevented. But organized effort can, beyond any question, decrease the burden of institutional care of advanced mental disease and can vastly increase the happiness and the efficiency of the whole people by dealing wisely with the great volume of minor emotional disturbances. The challenge of the war veteran who suffers from such disturbances is only a more dramatic form of a problem which confronts us always in civilian life.

H. R. 2550 represents the first major effort to deal with this problem on a broad scale. The institutional care of advanced mental illness is properly a function of the States; but adequate leadership in the study of underlying causes, in the provision of preventive measures, and in the training of expert personnel can only be supplied by the United States Public Health Service. Such leadership is at last provided in the Priest bill. It will give us a central research and training center at Bethesda and will provide through grants-in-aid for stimulation of research and demonstration and preventive services by State and local official and voluntary agencies. Such a nerve center at Washington will not only bring rich returns for the funds appropriated by Congress but will stimulate the use of even greater resources for the health services and universities and mental hygiene societies of the country.

The passage of this bill will mark one of the most important milestones of public health progress, not merely in the United States, but in the world.

(From American Journal of Public Health, June 1945)

NEW LEADERSHIP IN MENTAL HYGIENE Mental hygiene is a little like the weather. We all talk of it; but, except for a few pioneer State health departments, we don't do anything about it. At last there seems a chance that this important field of public health will be effectively recognized.

H. R. 2550, presented to the Congress by Representative J. Percy Priest, of Tennessee, promises the dawn of a new day. It may prove the most significant piece of health legislation now under active consideration in Washington.

This bill establishes a National Psychiatric Institute in the United States Public Health Service. It provides for a central hospital and research institute at Bethesda where qualified individuals may pursue an approved program of investigation, and where a permanent staff will provide stable guidance and leadership in regard to the many psychological problems confronting our Government in relation to the general welfare.

Second, this bill provides for grants-in-aid for research under other than United States Public Health Service auspices. In many cases, if studies are to be valid, people must be studied where they are and as a part of their social setting. It is important that such research be decentralized and hospitals, universities, clinics, and other facilities helped financially to pursue the leads that their everyday work brings to them.

Third, the bill provides assistance through demonstrations or grants-in-aid to States, counties and other political units, and to nonprofit agencies in the field in establishing and maintaining adequate measures for the prevention, treatment, and control of neuropsychiatric disorders.”

Finally, since clinics and hospitals are no better than their staffs, training for nurses, psychiatric social workers, attendants, psychologists, occupational therapists and psychiatrists can be provided under the act. This end can be attained not only by fellowships and scholarships, but also. by developing new training facilities for the purpose.

The administrative responsibility for this work is vested in the United States Public Health Service, and real authority is given to a special professional Advisory Council which will pass on all projects. The bill provides four and a half millions for the construction of the new Neuropsychiatric Institute and ten millions a year for research, training, and grants-in-aid.

While grants to States are channeled through State health departments in many States the real administrative agency may be a department of welfare or mental hygiene, the health department serving primarily as a Federal-to-State channel.

The Únited States Public Health Service has shown what can be accomplished in the guidance and stimulation of a national health program in such fields as industrial hygiene, venereal disease, cancer, and, recently, tuberculosis. The development of such a program in the area of mental health would be a contribution of epoch-making importance.

H. R. 2550 deserves the hearty support of all members of the public health profession.

THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS,

Richmond, Va., September 24, 1945. Hon. J. PERCY PRIEST, Chairman, Public Health Subcommittee,

House of Representatives, Washington, D. C. DEAR MR. PRIEST: In reply to your telegram of September 20, I wish to submit the following statement as to the views of the Association of State and Territorial Health Officers relative to H. R. 2550, a bill to provide for, foster, and aid in coordinating research relating to neuropsychiatric disorders, to provide for more effective methods of prevention, diagnosis, and treatment of such disorders; to establish the National Neuropsychiatric Institute; and for other purposes.

The health officers of the country have been very much concerned with conditions which exist in relation to neuropsychiatric disorders and they believe that definite steps should be taken towards the advancement and extension of psy: chiatric services, not only in respect to the establishment of additional facilities for the housing of patients but measures should be instituted for study of more effective methods of prevention and diagnosis. It is believed that to coordinate effective programs, the establishment of a National Neuropsychiatric Institute is essential. Since approximately one-half of all avialable hospital beds are occupied by the mentally ill, the epileptics and others with mental disorders, it is apparent that delay in taking steps towards correction of existing conditions will only increase the difficulties of arriving at a solution of the problem.

It is believed by the health authorities that the enactment of H. R. 2550 into legislation will go far towards not only raising the standards of neuropsychiatric treatment and care throughout the country, but will make research in this field possible, which eventually may develop new scientific discoveries, thus establishing methods of cure heretofore unknown.

The Association of State and Territorial Health Officers hopes that favorable consideration will be given to the enactment of H. R. 2550 into law.

I regret that it was not possible for me to appear personally at the hearing to present the views of the association. Sincerely yours,

I. C. RIGGIN, M. D., President, Association of State and Territorial Health Officers.

CITIZENS MEDICAL REFERENCE BUREAU, Inc.,

New York 23, N. Y., September 19, 1945. Re H. R. 2550. PUBLIC HEALTH SUBCOMMITTEE OF THE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

House Office Building, Washington, D. C. GENTLEMEN: We wish to go on record as opposed to the passage of the bill H. R. 2550 to appropriate $14,500,000 to establish a National Neuropsychiatric Institute within the United States Public Health Service for a campaign against mental disease, for the following reasons:

1. It seeks to federalize activities which under our United States Constitution were intended to be reserved to the police power of the respective States.

2. It involves the most dangerous form of regimentation, because it would tend to regiment the individual in matters pertaining to the mind. The Supreme Court has pointed out that there is “a sphere within which the individual may assert the supremacy of his own will and rightfully dispute the authority of any human government, especially of any free government existing under a written constitution to interfere with the exercise of that will.” The preservation of the right of the individual to assert the supremacy of his own will in personal matters is a fundamental and must not be jeopardized by overzealous psychiatrists who become imbued with the Freudian or kindred philosophies about mental diseases, and wish to use governmental agencies to force their views upon the individual.

3. It involves the use of large numbers of persons in public institutions for mental experimentation in the field of behaviorism, and by branding large numbers of persons as psychoneurotic or otherwise classifying them as being inferior there is the possibility of creating more mental disturbances through these campaigns against mental diseases than the campaigns might be able to correct.

It is significant to note now when it is being seriously proposed to educate an army of so-called psychiatrists and then to turn them loose to experiment with the minds of the people that on November 14, 1921, Congress rejected a bill to employ a psychologist to examine persons brought before the juvenile court of the District of Columbia. At that time Congressman Edward J. King of Illinois asked if psychology is the study of the soul, and Congressman Caleb R. Layton of Delaware, a physician, stated that, “In my judgment, and I want the House to see it, this is a bill in character with other bills beginning here in Washington, insidious in its character, that means to confer upon the Public Health Service of the United States ultimately the power of invading the domestic life of our people. Now, I am not in favor of it.” Respectfully yours,

H. B. ANDERSON, Secretary.

BROOKLYN COUNCIL FOR SOCIAL PLANNING,

Brooklyn 2, N. Y., October 4, 1945. INTERSTATE AND FOREIGN COMMERCE COMMITTEE,

House of Representatives, Washington, D. C. GENTLEMEN: At the last meeting of the mental hygiene committee, a standing committee of the health division of the Brooklyn Council for Social Planning, its members went on record as approving the following resolution:

"In view of the great number of veterans, selective-service rejectees, and other people in the community in need of treatment and rehabilitation as a result of neuropsychiatric disorders, the mental hygiene committee, a section of the health division, Brooklyn Council for Social Planning, endorses, in principle, the National Neuropsychiatric Institute Act, known as bills "H. R. 2550 and $. 1160.” May we urge you to give this vital and necessary measure your support. Very truly yours,

JESSIE E. CRAMPTON,
Chairman, Mental Hygiene Committee,

Health Division.

ASSOCIATION FOR THE IMPROVEMENT OF
CONDITIONS IN MENTAL HOSPITALS, INC.,

New York 18, N. Y., September 24, 1945.
Hon. PERCY PRIEST,
Chairman, Subcommittee on H. R. 2550,

House of Representatives, Washington, D. C. DEAR Sir: The Association for the Improvement of Conditions in Mental Hospitals, an association composed of relatives and friends of patients and other public-spirited citizens who are interested in the welfare of patients in mental hospitals, wish to speak in support of H. R. 2550.

While there are many hospitals whose sole function is the care and cure of the mentally ill, it must be obvious from the statistics you have already received from such sources as the Surgeon General, Thomas Parran, of the Public Health Service, and Maj. Gen. Louis B. Hershey, of the Selective Service, that existing facilities and methods are failing to cure the majority of those under their care,

and that very little or nothing is being done to stem the alarming rate of increase of mental illness in the population as a whole. For those of us, who, through necessity, have become acquainted with conditions in the mental hospitals of New York State, either as visitors or patients, these statistics come as no surprise. Indeed, after what we have discovered about the mental hospitals we are amazed that anyone entering them with a real illness can ever improve sufficiently to leave.

In a social scene of stratosphere flying, jet propulsion, and atomic energy, our mental institutions stand as glaring anachronisms of the medieval days from which they had their origin. While the external structure of some may have been modernized, little change has taken place in the treatment and fundamental attitude displayed inside toward the unhappy inmates.

Our association has studied conditions at various hospitals in the New York metropolitan area, directly through committees appointed for that purpose, and through the reports received from friends, relatives, and patients at these hospitals. Correspondence has been had with the Governor, commissioner of mental hygiene, superintendents and senior business officers, and members of the boards of visitors at various hospitals, in an attempt to relieve, at least temporarily, the worst conditions complained of. We have urged upon the Governor and members of the legislature the necessity for adequate appropriations for the improvements we felt could be inaugurated at this time. The results have been negligible. The system is firmly entrenched. Trained personnel in the hospitals is insufficient, research is almost nil, and changes from existing methods are slow to be tried, if at all. For this reason, we are behind a bill which will foster and aid in research relating to neuropsychiatric disorders, will provide for more effective methods of prevention, diagnosis, and treatment of such disorders, and the establishment of the National Neuropsychiatric Institute. We are for the passage of H. R. 2550, or for any bill which will go to the root of the trouble. We are attaching some pertinent documents. Very truly yours,

Donna DIAMOND, President.

MISSOURI VALLEY COLLEGE,

Marshall, Mo., September 27, 1945. Hon. Max SCHWABE,

House of Representatives, Washington, D. C. DEAR SIR: The National Neuropsychiatric Institute Act, H. R. 2550, should be given your support. The act would be improved, I believe, if the wording were to include, specifically, “psychological authorities and facilities in its provisions, instead of merely “medical or seientific.” I hope that you will see fit to suggest or encourage such a change for purposes of clarification, and to support the bill. Very truly yours,

MILDRED W. SAUPE, Professor of Psychology.

(Telegram]

SEATTLE, Wash., October 16, 1945. Representative Hal HOLMES,

House of Representatives, Washington, D. C.: Heartily endorse H. R. 2550. Getting it out of committee and on floor of House for passage essential for future emotional health of Nation.

ARTHUR L. RINGLE, M. D.,

State Director of Health. Mr. PRIEST. Without objection, the committee stands adjourned. (Whereupon, a$ 12:05 p. m., the committee adjourned.)

APPENDIX

1

MENTAL DISEASE IN SELECTIVE SERVICE REGISTRANTS Mental disease has been the cause for rejection of more selective-service registrants than any other defeet. Among white registrants no other defect approaches it in importance, while for Negroes it is exceeded only by mental deficieney and syphilis. In addition, mental disease has accounted for more disability discharges from the armed forces than any other defect.

Although standards for acceptance of registrants with mental disease have not changed since the beginning of selective-service operations, it has nevertheless been responsible for an increasing number of rejections. This rise is intimately tied up with lowering of physical standards in other defect categories. For instance, many registrants rejected for teeth defects in 1940 and 1941, also had mental disease of a disqualifying nature. When dental standards were lowered in February 1942 such registrants were rejected for mental disease instead of the teeth defects. Similarly, in 1943, the decision to accept for service registrants with uncomplicated syphilis increased the number of registrants who could be rejected for mental disease. The lowering of dental standards particularly affected white registrants while the decision to accept syphilitics mainly affected Negroes.

NUMBER CURRENTLY REJECTED

On December 1, 1944, an estimated 789,600, or 17.7 percent of the 4,458,000 registrants, ages 18-37, in the rejected classes, were so classified because of mental disease (table 1). This figure does not include the thousands of registrants rejected for mental disease at one time or another but who were later reexamined and either inducted into the armed forces or rejected for some reason other than mental disease. This defect accounted for a greater proportion of whites rejected than of Negroes for whom mental deficiency and syphilis occur more frequently than mental disease as causes for rejection.

An important factor in the diagnosis of mental disease was the type of examination given. In 1940 and 1941, when the dual system of examination was in effect, most of the rejections were based on local-board examinations by general practitioners. Only a small proportion of these registrants were examined by medical advisory board psychiatrists. However, all of those forwarded to induction stations had psychiatric examinations, but they constituted little more than half of those examined at local boards. From 1942 on, local-board physicians gave only a screening examination to detect the obviously unfit and consequently the majority of registrants considered for induction were forwarded to induction stations where they were interviewed by psychiatrists. The result was that the psychiatrists diagnosed many cases of mental disease which probably would have been missed by the general practitioner. Thus, the changes in physical standards and the examining procedure may account largely for the increased rejections and incidence of mental disease from peacetime to wartime. Another factor to be taken into consideration is that the various manifestations of mental disease may have become more prevalent as a result of the entry of the United States into the war.

I This report is based on sample studies of the results of examination recorded on DSS Forms 200, Reports of Physical Examination, for selective-service registrants physically examined at local boards in peacetime, and DSS Forms 221, Report of Physical Examination and Induction, for registrants examined at local boards and induction stations during wartime. Data obtained from these studies were published in Med. ical Statistics Bulletins Nos. 1, 2, and 3, but this report discusses mental disease in greater detail. Mental and educational deficiency, which are not included in the discussion on mental disease, will be covered in a subsequent report.

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