« PreviousContinue »
War College. I asked him how he was getting on, and he said, "I am not getting on at all.” I said, “What's the matter?” He said, “The old men, they have the power, they do not understand. The young men, they understand, they do not have the power.
Now, psychiatry is something new in a scientific way. I know when I was at college there was a thing called psychology, but I never heard of psychiatry. I never heard of it. It is a matter of two generations, and the old generation of medical men don't know about it, and it is a lot of work to have to learn a new branch of medicine after they have graduated from college without any training in medical school on the subject. Therefore, the resistance is tremendous. Some of them deny it; they throw it out the window, and others yield half-hearted support by way of acceptance of psychiatry as a science. So I think this is an exceptional field in which, regardless of a proper general aversion to getting the Government in too deeply-I believe this is an emergency which in the national interest requires unusual action, even admitting your general principle that you do not want to have everything regulated and inspired from Washington.
Mr. Brown. I thank you, and I very readily agree the Federal Government belongs in research, and should have research institutions and so on.
The main question I am raising on this bill, and the reason I ask your advice, is as to how far we should go in giving aid to State and local institutions, and how much control should the Federal Government exercise in health and medical matters. In other words, do we want to adopt a policy of Federal aid for this particular training out in the States. If so, will the next step be Federal aid for some other type of educational training, which may not be quite as important, as this, but still very important to our general welfare, and, if so, how much responsibility shall we leave to the States. There is no question we do need mental research, something on the basis of the National Cancer Institute, which I think has done remarkable work.
Mr. MEYER. You mention cancer, Mr. Brown. I am sympathetic with the cancer research and everything that is done for it. Cancer is something we know about and can see. It is tangible. The results are material. The only reason you don't think this is as important as cancer--and I think it is more important
Mr. Brown. I didn't say that. I think this is an equally important matter.
Mr. MEYER. Is because it is more intangible. But it is more important; it affects more people than cancer does. Here is a provision in this last paragraph:
Such research projects as are recommended by the National Advisory Mental Health Council.
That is not an invitation for everybody to come in and feed at the trough. I think the bill is pretty well drawn. I have avoided going into the details of the legislative draftsmanship, for I assume you are better at that than I am, and technical witnesses who have made a study of this have testified or will testify on that subject. I think, as to the drafting in a general way, it seems to protect the Government interest adequately. I do think it is an exceptional case of great urgency in time, and I hope it will be acted on favorably.
You know, I think institutions have to have a certain amount of elasticity and Government has to have some. When there is an
lémergency you can properly do some things with great speed, whereas when you have to make a goneral policy in meeting problems which bare not immediately critical a different approach may berjustified.
Mr. PRIEST:Are there any other questions? If not, we thank you, Mry Meveri
[X B ili 14.11.14 tsit?!,!17! biliMr: MEYER. Thank you, gentlemen, for the opportunity to appear.
I appreciate it. 10 ??! Pa jihu d'hi "1995-911 I muodov 17 SPOJITET Sviss viel Bir 119411 11)
"It toite:1999 Ilo o be STATEMENT OF COLI JOHN H. BAIRD, CHIEF, NEUROPSYCHIATRY, ON to login pit, VETERANS' ADMINISTRATION);"!!!
". 1,- Mr. PRIEST. Will you give the reporter your full name and vyour title? 12
Ti00; }* mos O TIVI ni 1209903 Colonel BAIRD. John H. Baird, Assistant Medical Directori in charge of the Bureau's Psychiatric Division, Veterans Division Mr. PRIEST.' All right, Colonel; you may proceed
!! YO3715.9 9V Colonel Bairb. Mr. Chairman and gentlemen, I hardly think I vän speak for the Veterans' Administration officially, but those of us in the Neuropsychiatric Division have for some time been very much interested in this proposed bill, perhaps somewhat selfishly, because, pershaps, the Veterans' Administration might profit from some of the provisions of the bill, and, of course, which is more important; the psychoneurotic veterans of the Nation, we think, might be given more comprehensive care and treatment in this 2 Obviously, for years to come, the veterans, not only suffering from very severe psychoneurotic handicaps will require psychiatric treatment; but thousands of their milder i ones, I should say, will require mental hygiene guidance and also therapy.!iia til -Bigling i I think we are all deeply concerned with any plan at all that looks toward the establishment of some program that will make for a sounder recovery of these ment and some women and to make for better adjustment of this group in their various communities! 47316 17 To The Veterans Administration is planning as you may have read in the papers, to establish a number of mental hygiene clinics. As a matter of fact, some of them are being established now in the regional offices located in some of the larger teities of the country. It is also establishing some in-patient units for the treatment of the more severe psychoneurotics, but we feel that all this, even when it gets going, will only be a drop in the bucket, so to speak, insofar as reaching any appreciable numbers of disabled ex-servicemen, so that unless something is done to assist the local mental-hygiene clinics that are now operating, and perhaps doing something toward assisting others to perform, I am just wondering how the hosts of psychoneurotics are going to receive the treatment to which they are entitled and which they ought to have, which they need. Therefore, to me it seems rather feasible and certainly wise, if the Government could distribute funds to the various public-health departments, State public health departments, and to the local clinics to help them operate. ;
Mr. BULWINKLE. How many mental cases have you under the Veterans' Administration from World War I?
Colonel BAIRD. Well, let us see: I think at the present moment in the neuropsychiatric hospitals there are approximately 51,000 under hospitalization. About one-quarter of those are World War II, so what is left are World War I, still remaining. The vast majority of these are being treated for psychosis, not psychoneurosis.
kes use of
MI BULWINKLE. What do you estimate they will Vå lur apporld 220 Colonel BAIRP? Well, Tdon't khów what the neuropsychiatrie load Will be, but I think it has been estimated that there will be need for some 300,000 beds if the program goes on as it is now, for all types
of Veterans in
in 1975. We are Building nowi additions and new institutions that will provide 9,000 additional beds, as it is spoken' of, within
eve the President has approved an addi? tional 9,000. That will make 18,000 beds for neuropsychiatric pas
tients that will be available within the near future, within the next 2 years or 2 years and a half, and that is in addition to whatever Army hospitals are turned over to the Veterans Administration for such use.
Mr. PRIEST. Just one more question on the same subject. You will have within a year or two, or as soon as construetion is finished, 18,000 additional beds for neuropsychiatrie patients. I wonder how many qualified psychiatrists the Veterans Administration makes today to handle the load you now have, and the load that will develops. Ar Colonel BAIRD. Well, we have at the neuropsychiatric hospitals around. 400 physicians. I would say that perhaps not more than 30
bit more, 35 percent have had Many training of any extent in neuropsychiatry i The other men' have been in our hospitals, and have been exposed, you may say, to the beuropsychiatric atmosphere, have attended staff, have examined patients, and have strugględ'along, but I am afraid, in a rather floundfering manner. They need more formal training, which we have attempted to give at some of the institutions where we have, perhaps, more personnel.'We have sent one group to the Mason General Hospital on Long Island for a course in-nieuropsychiatry, and we hope to send some more there later, and then as we receive more medical officers, perhaps send them also to private clinics and universities for training, but just now our stáff is so depleted we just can't spare anybody. 1915 31011 pod $1191119,3?"I! 90. mitmeibo o 012209 ore PRIESTI
" lop anybody in the Veterans Administration, but imáde a Visit last fall to a neuropsychiatric hospital of the Veterans Administration, where I realized the acute shortage of men qualified to do this work. This Visit first aroused my intense interest in this whole field of (neuropsychiatric training. You have 30 percent now of 400?cht tot Solo Colonel BAIRD. Yes, sir.
Du ei si 9 10 11 90 TOU LIBIL 6 oudy Mr.' PRIÉST. That is around 120. whom you consider are well qualified to do this job. Is that the situationOf MTOOST CF 1. Oolonel BAIRD!' I should say perhaps 35 percent. That is only a guess. It is hard to say when is a psychiatrist a. psychjatrist. 5. Mr. PRIEST. I realize that. But even if the 400 were experts, in my opinion, there is still an acute shortage of 787396) DE SET Colonel BAIRD. There is an acute shortage. In all of the hospitals ( how . Admissions are so rapid, the turn-overs are so rapid, the duties are so many that it is very difficult for a doctor to give very much time to the individual patient, which is the secret of the whole thing. on on
Mr. CHAPMAN. Colonel Baird, would you care to estimate about what'proportion of the patients in veterans” hospitals really ought to have the attention of trained psychiatrist?!?!
Colonel BAIRD. What percentage of the total hospital population? Mr. CHAPMAN. Yes.
Colonel BAIRD. Well, of course, practically all of the physicians in the neuropsychiatric hospitals should have psychiatric training: As the hospitals grow, and as the whole program expands, doubtless there will be other physicians on duty, like pathologists, eye, ear, nose, and throat men, and cardiologists, and what not, who will probably have little or no interest in psychiatry itself. The majority should be changed, and even in the general hospitals they should also have several trained psychiatrists. We have 50 general hospitals now, so if you put two in each one, that would be 100 right there, and then some 15 tuberculosis hospitals, there should be at least one resident psychiatrist in each one of those. We need several hundred immediately, and they are just not obtainable unless we get them from the armed forces when they are discharged.
Mr. PRIEST. Colonel, may I ask you a question there? Of the number that might be expected to be made available from the armed service any time within the next year and a half, how many would you be likely to get?
Colonel BAIRD. I don't know. All I know about it is this. I think a questionnaire was sent out some months ago by the Army. The Army itself can answer that better than I. The medical officers, I believe, were asked what they wanted to do after the war, and I think the vast majority of them want to go into private practice, and those that want to go into the specialties, I think general medicine and surgery headed the list. I am not sure whether I am correct on that or not, but that is the impression I had. Psychiatry was away down at the bottom of the list as being a specialty in which these men were interested; tuberculosis was also away down on the list.
Mr. PRIEST. You may proceed with your statement.
Colonel BAIRD. I should say that the advantages of such a scheme as proposed, having the veterans with psychoneurosis treated in home communities, in clinics, would be several. First of all, I can think of the possible advantage in the treatment being more effective if it is administered by physicians trained in psychiatric treatment who are also familiar with the psychology of the local community, the local groups, familiar also with the industrial situation, the social contact situation.
Secondly, I should think that treatment might be more effective for those psychoneurotics if it could be given in the local community where a man may be at work while he is being treated, where he could get off an afternoon or an evening a week, or a couple of times a week, to report to the clinic. We all know that work is about the best treatment, after all. At least, that is the object of the whole thing, to get these men adjusted.
Then, third, I think there is merit in the suggestion that if these men are treated away from the atmosphere of compensation, pension, it is not a bad idea. Certainly those elements tend to interfere with therapy on the part of some of them, so that if the therapy is given them in installations that do not have any connection with the granting of such monetary benefits, I should think that it might be helpful.
The most important thing, perhaps, is this, that the Veterans Administration program of handling the psychoneurotics so far I fear is only going to scratch the surface, because under the present scheme of things we cannot have medical set-ups in all the local communities,
only in the cities where the regional offices are and the branch offices and the hospitals.
Mr. Priest. There will have to be some community responsibility in the smaller communities.
Colonel BAIRD. I should think so, sir. So the whole thing seems to me to be very, very feasible.
Mr. Priest. We certainly thank you, Colonel, for your interest and for your statement.
Colonel BAIRD. Not at all.
STATEMENT OF MAJ. D. D. BOND, CHIEF, PSYCHIATRIC BRANCH,
OFFICE OF THE AIR SURGEON, WAR DEPARTMENT Major Bond. I would like to say that I speak as an individual, and not with full official backing. I have very little to add to what has been said by the other services. I would just like to join with them in saying that the Air Corps, too, has had very severe problems with emotional disorders. The emotional disorders of the flyers have been the most difficult and the most frequent problem that the medical department has had to face. They have bulked very large in the removing of people from flying-and most of these men are officers, or at least, the large proportion of them are officers. They have accounted for 50 percent, or slightly under, of all separations from the service for medical reasons.
Mr. PRIEST. You mean that psychoneurotic disturbances have accounted for 50 percent?
Major Bond. Slightly under 50 percent, sir, of all people separated from the service for medical reasons.
Mr. Priest. That would be higher, I suppose, in the air force than in any other branch of the service.
Major Bond. It might well be. I think that the experience of the air force has been such that it points up very clearly the lack of understanding of emotional disorders in people of all sorts, that the boundary lines of medicine and the law, and where psychiatry hinges upon administration are most confused, and in general there is a great misunderstanding among medical men, administrators and lawyers alike, on just what psychiatry is trying to do.
We have been fairly successful in training general medical officers in psychiatric thought at several centers, but the time is too late. That should have been done a long time ago. The air force had about 200 psychiatrists that were qualified. That has not been anywhere near enough. Many of those men have not been qualified in modern psychiatry and that makes a great deal of difference. I know that I feel very strongly that further education, both of the public and of medical men, is imperative at this time. Certainly many problems have arisen, particularly recently, on compensation and how psychiatric disorders should be handled upon discharge from the services. There has been much confusion, and important confusion, in regard to what is best for the patient who has a neurosis, how he can best be handled. That has never been clearly defined.
The research in psychiatry that must be done must be both the socialogical kind of research, I think, and then the straight physicalmedicine research, in which more modern methods of physics and