American Psychosis (7 page)

. . . assume citizenship responsibilities for policy forming at whatever level we can—in the Board of Education, City Council, civic clubs, welfare groups, legislative committees, Congressional hearings. . . . As psychiatrists, we are expected to provide leadership and counsel to the family, the community, the state, welfare workers, educators, industrialists, religious leaders, and others.
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The third psychiatrist who was part of Felix’s inner circle was Francis Braceland, who had come from Philadelphia and studied psychoanalysis with Carl Jung in Switzerland. Braceland believed that the causes of mental illness lay in interpersonal relations: “Men do not get mentally sick ‘out of the blue,’ so to speak . . . their illness or well-being depends upon their relations with other men.” The role of the psychiatrist was therefore to teach people how to live together, in the broadest sense. “Modern psychiatry,” he said, “no longer focuses entirely upon mental disease, nor the individual as ‘mental patient,’ but rather it envisages man in the totality of his being and in the totality of his relationships.” “Psychiatry,” he added, was “an essential part of the overall science of man. . . . One might even say the ideal goal of the psychiatrist is to achieve wisdom.”
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Felix, Ewalt, Menninger, and Braceland had lofty visions of using the federal government to create a brave new world, a mentally healthy America. Without Mike Gorman, the fifth member of their group, however, their lobbying would probably have been in vain. The son of Irish immigrant parents, Gorman graduated cum laude from New York University in 1934, then undertook 2 years of graduate work in history but did not receive a degree. Following work with the
New York Post
, he joined the Air Force in 1942 and was assigned as a public relations specialist to Tinker Air Force Base in Oklahoma. After being discharged in 1945, Gorman went to work as a reporter for the
Daily Oklahoman
. Following the publication of
Life
magazine’s 1946 exposé of conditions in state mental hospitals, Gorman’s editor assigned him to investigate Oklahoma’s state hospitals. The result was a sensational newspaper series that, 2 years later, was published as a book:
Oklahoma Attacks Its Snake Pits
. Gorman compared the hospitals to “a witch’s brew of jangled minds rattling about in cobwebbed filth and misery.” The dining room of one hospital, wrote Gorman, “made Dante’s
Inferno
seem like a country club,” and the kitchen “was more gruesome than the Black Hole of Calcutta.” The patients were described as “groveling about the floors and wards sans the slightest stitch of clothing,” and the hospital superintendents as being “more concerned with the animals on the institution farm than with the patients on the crowded wards.” Gorman’s book was condensed by the
Reader’s Digest
in 1948, thus providing him with a national forum. Mary Lasker, a wealthy New York philanthropist who was an advocate for increased research spending on various diseases, subsequently hired him to go to Washington to lobby for increased research spending on mental illnesses (
Figure 2.2
).
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FIG
2.2 Mike Gorman, a mental health lobbyist who worked for Mary Lasker. He played a major role in getting the community mental health centers program implemented and in shutting down the state psychiatric hospitals. Photo courtesy of Michael Gorman Jr.

Mike Gorman had two experiences that dominated his thinking on mental illness and ultimately shaped the federal mental health program. First, like many radical students in New York in the 1930s, he was a member of the Communist Party. According to an FBI investigation carried out in 1952, “Gorman was a member and reputed leader of the National Student League,” identified as “a front organization of the Communist Party” at New York University. He was said to have been “thoroughly imbued with radical political philosophy, . . . espoused Communist ideas, . . . [and] approved a centralized form of government.” According to these records, Gorman’s mother said that he and his brother both “talked like regular Communists.” As late as 1943, while in the Air Force, Gorman was accused of being a Communist and did not deny it.
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Second, Gorman had had personal experience with the mental illness treatment system. In 1945 he had been discharged from the Air Force because of psychiatric symptoms, specifically “anxiety . . . insomnia, emotional outbursts, anorexia and vomiting.” The FBI files mention rumors that Gorman had been hospitalized, but this was not verified. Following his discharge, Gorman drank excessively and at some point underwent psychoanalysis, although he later derided psychoanalysts as “the High Priests of the Oedipus Complex and the rampant Id.”
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Armed with his public relations background, writing skills, and considerable personal charm, Gorman became a consummate Washington insider, one of the most
effective lobbyists the nation’s capital had ever seen. He claimed to be “on a first-name basis with one hundred fifty, one hundred seventy-five members of the House,” including “all the members of the Appropriations committees.” On the Senate side, Gorman was on a first-name basis with Senator Lister Hill, chairman of the Committee on Labor and Public Welfare and one of the most powerful men in the Senate. As early as 1955 Gorman was ghostwriting speeches for Hill, and in 1956 Gorman dedicated his book
Every Other Bed
to “Senator Lister Hill, valiant legislator for, and compassionate friend of, the mentally ill of this nation.” Gorman’s considerable lobbying skills were assisted by Mary Lasker’s considerable money; she was known as “one of the nation’s more generous campaign contributors.” Most of the contributions were publicly targeted to members of the key committees; Bertram S. Brown, former director of NIMH, recalled Gorman showing him $1,200 in hundred-dollar bills to be given to a chairman of a key House subcommittee. Gorman himself described his lobbying activities as a “high class kind of subversion. Very high class. We’re not second story burglars. We go right in the front door.”
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Gorman’s mental health agenda coincided perfectly with the agenda of Felix, although the two men did not like each other. No room was large enough for both egos, and on one occasion a friend had to sit them down together to mediate their dispute. Gorman despised state hospitals, referring to them as “secular cloisters of the mad,” and he later acknowledged that “my hidden agenda was to break the back of the state mental hospital.” The plans of Felix and his psychiatric colleagues to involve psychiatrists in social problems to promote a “mentally healthy” environment would have also resonated with Gorman’s socialist beliefs. Gorman wrote: “Mental illness is really a social problem. It is not exclusively a psychological or biological one. We frankly have to help people change their communities if necessary . . . until the noxious milieu in which the illness festers is tackled.” He praised the work of mental health centers that were “involved in housing committees and tenant councils, which force slumlords to improve living conditions.” Finally, Gorman strongly agreed with Felix that the federal government should be intimately involved in the care of mentally ill individuals. He wrote: “It was a historic mistake to make the State alone responsible for public care of its mentally ill residents . . . sparing the Federal Government anything but peripheral involvement in the problem.”
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ACTION FOR MENTAL HEALTH

By the mid-1950s, the mental health lobby was fully operational. Felix’s psychiatric favors, combined with Lasker’s fiscal favors, had persuaded many key members of Congress that supporting mental health was a good thing. The hot war in Korea had given way in 1953 to a more amorphous cold war with Communism, and economic
prosperity reigned. Belief in the ability of the federal government to solve all national problems was at an historic high, illustrated by such things as President Harry Truman’s Fair Deal and President Dwight Eisenhower’s interstate highway system.

To the mental health lobby, it seemed like a propitious time to implement the next phase of the federalization of American mental health. Accordingly, in 1954 the American Psychiatric Association issued a call for a national commission to “study current conditions and develop a national mental health program.” This was followed by legislation to create such a commission, introduced in the Senate by Gorman’s friend, Senator Hill. First-term Senator John F. Kennedy was a cosponsor; both Felix and Gorman were aware that Kennedy’s sister had been mentally ill as well as mentally retarded, and they targeted the new senator to join their cause.
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Hearings on the proposed commission were held in the House and Senate during the spring of 1955. Felix described state mental hospitals as warehouses where almost nobody got well or was discharged:

By the time the patient has been in the hospital for 2 years, his chances of getting out alive. . . . I should say, are about 16 to 1. By the time the patient has been in the hospital for 8 years, his chances against getting out alive are poorer than 99 to 1.

Braceland testified that if such statistics were “for any other condition, it would be regarded as a national emergency immediately, but with mental disease peculiarly in many cases we meet with only a sympathetic and respectful apathy.” Gorman emphasized the tremendous cost to the states of caring for mentally ill persons. In New York, he claimed, “the mental health budget for the current year is up to $158 million a year, 35 percent of their operating budget.” Nationally, the “annual cost increase” to the states was “exceeding $100 million.”
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Voting to support a national commission is usually a safe vote for members of Congress, and the bill to establish a Joint Commission on Mental Illness and Health passed both houses without a single dissenting vote. Predictably, Congress then appointed Felix to set up the commission, and Felix promptly appointed Ewalt to be the director and Braceland and Gorman to be commission members.

In setting up the commission, Felix and Ewalt demonstrated their astute understanding of how Washington works. The intended purpose of the commission was to prepare the ground for a far-reaching national mental health program. To garner public support, a wide range of professional organizations were invited to appoint a member to the commission. By the time Felix and Ewalt finished, they had 45 individual members representing various organizations and 36 “participating agencies,” including the American Academy of Neurology, American Academy of Pediatrics, American College
of Chest Physicians, American Medical Association, Catholic Hospital Association, National Education Association, U. S. Department of Defense, and U. S. Department of Justice. Almost everyone, it appeared, was against mental illness and for mental health. But the most inspired move of the organizers was to persuade the politically conservative American Legion to also sign on. As will be described in
Chapter 5
, many Americans in the 1950s suspected that the mental health movement was a left wing, even Communist, plot. Having the American Legion’s imprimatur for the commission blunted such criticism.
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The Joint Commission on Mental Illness and Health held a series of public hearings between 1955 and 1960. The purpose of the hearings was to build a consensus and persuade the public, and members of Congress, of the need for a national mental health program. Much of the public education was accomplished, according to historians of the movement, by attracting “broad media coverage over a sustained period of time; from academic journals to Sunday supplements, the whole society had been exposed to an education in mental health.” The success of the campaign can be measured by the increases it produced in NIMH’s budget. Between 1950 and 1955, the NIMH budget had increased modestly, from $9.2 to $14.0 million ($83.5 to $114.3 million in 2010 dollars). However, between 1955 and 1960, while the Joint Commission was proselytizing the principles of community mental health across the nation, the NIMH budget increased almost fivefold, from $14.0 to $67.5 million ($114.3 to $499.0 million in 2010 dollars). In a 1972 interview, Felix expressed great pride in his success in having increased NIMH’s budget, placing the institute in the “top three” institutes at NIH, “along with cancer and heart.”
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The final report of the commission contained something for everyone. As David Mechanic described in his book
Mental Health and Social Policy
, “the report of the Joint Commission . . . was largely an ideological document, and, like poetry, it was sufficiently ambiguous to allow various interest groups to read what they wished into it.” It included predictable calls for more federal funds for research and mental health manpower training as well as three key recommendations.
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