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Mr. Priest. Has your association approved in substance the principles of this legislation.

Dr. MARQUIS. We did not feel competent to judge its legal language. We approve its objectives and general provisions.

Mr. PRIEST. You make no suggestions for its amendment?

Dr. MARQUIS. No; it was carefully studied. Two or three suggestions for amendment were brought up for discussion, and it was decided they were not necessary or desirable.

Mr. PRIEST. I appreciate that very much. We are glad to have you here. We have had a number of letters from various members of your association endorsing the bill individually, expressing in sub-, stance the same interest you have expressed here, and particularly in clinical psychology. We certainly thank you, Doctor.

STATEMENT OF MISS FRANCES HARTSHORNE, EXECUTIVE SEC

RETARY, CONNECTICUT SOCIETY FOR MENTAL HYGIENE

Miss HARTSHORNE. Mr. Chairman, I have no written statement and I am not competent to talk about the technical provisions of this bill. I would like to speak briefly about it from our experience, from a little group of people in Connecticut who feel the need for the things that will be provided for in this bill.

Connecticut, as you may know, was the place where the first Society for Mental Hygiene was started, and perhaps for that reason we are a little further along in our care of the mentally ill and in our interest in meotal health. We find ourselves in rather a dilemma just because of that, because we are constantly in a position of creating a market for goods which we simply cannot deliver.

While there is still a great deal to be done in the way of education and an understanding of the things that make for mental health, there is a tremendous interest in the subject and we are constantly impeded by a lack of personnel, by the fact that the general medical practitioner has not received training along psychiatric lines, by the lack of literature, and films and movies-all the things that go to the education of the public along these lines.

During the war we have had three different communities who were very aware of the need of psychiatric services for the families of the servicemen, and, of course, now for the returning servicemen, and the community was ready for it. The general hospitals would have welcomed a clinic, but we did not have the personnel. We were not able to go ahead with that.

Mr. PRIEST. Is this Society for Mental Hygiene in your State financed by appropriations from the State?

Miss HARTSHORNE. No; it is an organization which is financed by private contributions, just as the National Committee for Mental Hygiene is.

We have in the State a bureau of mental hygiene under the department of health, and we are more fortunate, perhaps, than some States in that we have a certain number of clinics, but those clinics are still not adequate, although we perhaps have more than almost any other State, for the size of the State.

Just because we have them, and the public is educated, they want more, and I think that even in Connecticut, which I understand is traditionally a State that likes to solve its own problems and not look

to Federal Government for help, I think in this case that they do look to the Federal Government for help, because our State now has gone ahead with the provision passed by the last legislature providing funds for the establishment of psychiatric service in the local general hospitals, but the thing that is going to slow up that program is the need for personnel.

Because we have opportunities, we are perhaps in a position where we can go out and rob other States, but we see what that is going to do, and we are interested in the national problem, because we had distributed some literature and because Mr. Clifford Beer's book, The Mind That Found Itself, is still in circulation, we are aware of the need throughout the country, because of the constant letters coming in to us asking for help, asking for literature, and I have run across the feeling among the people that the Federal Government could provide help in certain fields. The Children's Bureau has done a great deal of work. They have literature to distribute. The Public Health Division has done excellent work. We see their pamphlets on industrial medicine, and in other fields of that kind. People are always writing to the Department of Agriculture for literature and for information and advice, and we think there is a very definite feeling that in this tremendously important field of mental health we cannot look to the Federal Government for the help that we would like to have.

We feel that the United States Public Health Service which has had a Division of Mental Hygiene for some 20 years could be of great assistance to us if its capacity to act were enlarged through the provisions of this bill. The Connecticut Society for Mental Hygiene at its annual meeting in May 1945 voted its approval of H. R. 2550 and urged its passage.

We are also aware of the tremendous increase in the interest and awareness of mental illness and mental health problems. We feel that because of all that has been written and said about the psychoneurotic soldier in the Army that people are worried-they are interested. The men are coming back from the services where they have been fortunate in having good psychiatric care, and they are asking for it in their own communities, and are constantly coming to us asking, “Where can we get it, where can we find it?”

I think it is not only in our own State, because we are in a somewhat better position, but we have people who come into our office from the Southern States, from Virginia, and from others, saying, "Can you tell us where we can go in our own State to get this help?”

Mr. PRIEST. Miss Hartshorne, we certainly appreciate your appearance. I know from correspondence that your society has been very active and very interested in this program. We appreciate your being here today, and your very fine statement supporting this legislation Miss HARTSHORNE. Thank you. Mr. PRIEST. Is Admiral McIntyre of the Navy here? Captain BRACELAND. A representative, sir.

Mr. PRIEST. Very good, Captain, will you give the reporter your full name?

STATEMENT OF CAPT. FRANCIS BRACELAND, CHIEF, NEURO

PSYCHIATRIC BRANCH, BUREAU OF MEDICINE AND SURGERY, UNITED STATES NAVY

Captain BRACELAND. My name is Francis J. Braceland, Chief of the Neuropsychiatric Branch, Bureau of Medicine and Surgery, together with my colleague, Dr. Rome, appearing as individuals with the full approval of Admiral McIntyre, and representing him, sir.

Mr. Priest. You may proceed.

Captain BRACELAND. The Navy Department has not been advised by the Bureau of the Budget of the relation of this report to the program of the President, so we represent the Bureau of Medicine and Surgery instead of the whole Navy.

With the chairman's permission, I have a prepared statement and enough copies, if I may distribute them.

Mr. PRIEST. Very well.

Captain BRACELAND. There is little question of the merit of a program which promises an all-out attack on the problem of mental illness and human behavior. These, as well as others of our postwar problems, have a common denominator-the human factor which requires much study and constructive effort. Accelerated research and the rapid advances which have come about in the fields of physics, commerce, and chemistry will be of little good if unpredictable human behavior is allowed repeatedly to lay waste our civilization.

Up to now the job of psychiatry has been to apply scientific techniques and methods to the problems of mental illness and human behavior. Its task has been not only the recognition and treatment of the mentally sick but also the discovery of better ways and means to prevent these illnesses. Again and again the war has demonstrated that in order to understand mental illness, what is first required is an understanding of men; how they live, what they want from life, where they have come from, and what their backgrounds have been. Men do not get mentally sick “out of the blue," so to speak; in a large measure, their illness or well-being depends upon their relations with other men.

The war's smashing climax at Hiroshima and Nagasaki hammered into the consciousness of all men one irrefutable fact: More than ever before, man's very existence is dependent upon his fellowmen. This realization, great though it is, is not enough. Ways and means have to be created for better understanding human behavior and doing something about its training. It is tragically significant that our civilization found it easier to split an atom than it has to join man with man.

The ultimate benefits of an increased understanding are implicit in a program as comprehensive as this. It is imperative that a central foundation be established upon which each additional block of know). edge can be laid. Admittedly the final goal is a long way off, but it is well to remember that there is no end without a beginning.

There are some immediate and tangible rewards to be gained. But before we can hope to accomplish a full and complete understanding of the larger issues at stake, we have to appraise our present status.

There is a considerable block of our population which does not enjoy mental health. This committee, in these sessions, will have been given data which will amply testify to this indisputable fact.

reserves.

Each analysis which has been made clearly indicates that mental disease is not restricted to any one group or any particular level in the Nation. Still further, it is apparent that mental disease itself is only part of the mental health problem. The experience of the armed forces—I speak particularly for the Navy-shows that 90 percent of psychiatric problem is concerned with mental disorders other than insanity. Despite the fact that as a group the armed forces are the most fit of the young adults of the Nation, every branch of the services has had its quota of the unstable, the emotionally disordered and the mentally ill. The psychiatric problem pervades every aspect of our national life, and collectively these disorders constitute the largest single medical problem which confronts the Nation.

The inventory of the health of the Nation's manpower, which has been made by the Selective Service System and the medical departments of the armed forces, leaves no doubt that, health is a national resource more vital to our economy than coal or oil or chemical

And yet it must also be recognized that we have done little to conserve it. We have spent far less on mental health research than we have in the research which led to the development of highoctane gasoline, for instance. We have done less on a national scale for the prevention of mental illness than we have to prevent soil erosion and the wastage of our lumber reserves. We have less coordination on a national scale as concerns mental health than we have in the mining and distribution of coal.

I understand that the amount of money spent in research of mental disease is far less than 1 percent of all of the funds that are expended to take care of these people throughout the Nation—just a fraction of 1 percent.

It adds up to this: Despite the excellent beginnings made by isolated private groups and agencies and even in some instances, committees, real progress toward the goal of mental health has not been accomplished because of the limited scale and the lack of coordination of their endeavors.

We have seen in the development of the atomic bomb the enormous profit in pooled production and research. Fundamental research on this scale requires the cooperative enterprise of many groups. Particularly in matters as complex and as far-reaching as mental health is it desirable to have the advantages of a collective approach by many persons and groups. The scale on which this has been possible heretofore has been limited. Few if any teaching institutions or communities or philanthropic foundations have been in a position to either afford or command the personnel and facility resources necessary for such an undertaking.

Pilot studies have given leads which indicate the value of the more extensive roles which psychiatry has to be concerned with both inside and outside of the mental hospitals. The advancing progress of scientific medicine has made us a nation of older people—subject to the diseases and disabilities of older life. This change in events has had a marked effect upon the population of the mental hospitals. Twenty or twenty-five years ago by and large mental disease was regarded as a problem of adolescence. At the present time, because of the marked shift in the age characteristics of the general population, the mental disorders of old age predominate in the mental institutions. Relatively little research has been done on this aspect which

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promises to be a most important problem 10 or 15 years hence. The adequacy of mental institutionalization for all mentally diseased patients has to be investigated. The development of foster home care and the possibility of extra institutional colonization have to be considered by an agency which can study the issue in its broadest aspects.

The placing of these people in large hospitals is something we are not even sure is the final answer. In Gayle, in Belgium, the entire community of this little town is rather consecrated to taking care of the people who are mentally ill. They live out in the community and they work, certain classes of them, and they are much better off for the fact that their lives are more normal than that of a person on the back ward of a State hospital.

The entire matter of the prophylactic measures which can be used to prevent mental illness brings to the fore a most important phase. Psychiatry in the future will not content itself with the belief that it is doing a full job when it merely provides care for disease. The job of tomorrow's psychiatry is, as Dr. Parran said, large-scale prevention. The conquest of the infectious diseases and certainly our war statistics testify to this—did not come about until there were such measures as vaccination and immunization. In the same manner in which medicine has overcome such diseases as lockjaw and smallpox by prophylaxis, psychiatry can do likewise by providing information and a public understanding which will prevent much unnecessary unhappiness. We believe that the technique of more successful living can be taught.

Such a community educational program, to be wholly successful, would necessarily have to be comprehensive. Adult- and child-guidance clinics, counseling and professional assistance to the courts, and consultation clinics for the public schools are some of the subsidiary projects which come to mind. The training program for this role of psychiatry will require coordination and pooled resources.

Perhaps the greatest hiatus in the over-all psychiatric program appears when the facilities and opportunities for education are stacked against the needs. Without trained people to do the job, these plans are merely academic speculations. There are not enough psychiatrists, psychiatric training opportunities or qualified psychiatric teachers at the present time to meet the demands of the expanding Veterans' Administration, the postwar Army, Navy, and the Air Force, the Public Health Service, and the civilian institutions and schools. Without materially augmented support, such as this bill will provide, it is not likely that this deficit will be overcome.

There is a need for a radical revision of the entire structure of psychiatric education. It is not necessary that every person with an emotional disorder be seen by a psychiatrist. The first line of psychiatric defense is the general medical practitioner. He, if properly trained for his task, can handle competently the majority of his patients' psychiatric complaints. However, not a little of the bottlenecking in psychiatry is attributable to a failure of this first-line defense. There is need for considerable research in teaching techniques which will overcome this deficiency which is generally recognized. The use of training motion pictures is an example of one improved method which deserves exploitation.

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