Dr. BLAIN. I think the average age of World War I veterans, as I recall, is around 56 or 58. The average age of World War II veterans is between 30 and 40, I believe. The prognosis for the elderly group who have mental illnesses, as regards their length of life, is better than it used to be 30 years ago; they are staying alive longer, and so on. The promises of their being relieved of their mental illness, I would say, are somewhat better, but the changes in what we can do for elderly people are dependent mostly on the amount of attention we can give them, and there is not a great deal more manpower available for them now than in the past. However, some of the studies that have been conducted of people in the hospitals for a long time have been extremely encouraging where they have been able to bring the total assets of the hospital together to focus on their treatment and improve the conditions in the community and in the family so that there is a place for them to go. In the case of World War I veterans, therefore, much depends not only on technological improvements, but I think the greatest single factor is that when a patient has improved so that he could leave the hospital there is no suitable place for him to go. In regard to the prognosis of veterans entering hospitals at this point, in institutions where they are able to bring together the optimum number of professional people-and some of the Veterans' Administration hospitals have been fortunate, where they are located near medical schools, and can get personnel-the number who are released who can go back to their homes and to work has been satisfactory. We have a great deal of knowledge if it can be used, but it cannot be used because of lack of personnel. Mr. DOLLIVER. Has the peak of admissions of World War I veterans to mental hospitals been passed? Dr. BLAIN. That leads to the question of service connections, but generally speaking the number is decreasing. I did want to say something about the ability to get people out of the hospitals. Some of the best manned institutions, showing what can be done if you have the assets, are able to get out 60 or 70 percent of the patients under 3 months. Another 10 or 15 percent are gotten out in a year, leaving something like 10 percent that do not get out within a year. The great majority, though, of the seriously ill cases still have to fight against the fact that we do not know the cause, and therefore we cannot prevent it, such as in the case of schizophrenics. Probably in that one single area in psychiatric research lies the greatest problem of all, but some progress is being made. Mr. DOLLIVER. I would like to ask if there is a classification of these mental diseases as respects the physical evidence, or the physical symptoms, of the disease. Is there any such classification in mental illness? Dr. WORTIS. There are several classifications of mental illnesses. I can give you one. There was another developed during the war. We have one classification that tends to indicate there is mental illness. One shows a brain disease. One can develop abnormality of behavior if he is under the effect of alcohol or a sedative, or he may develop a thinking disorder if he has severe diabetes or if he has a disease of the kidneys. Abnormal behavior may indicate hardening of the arteries. We see at Bellevue Hospital a large number of people come in because grandpa or grandma gets confused due to hardening of the arteries. Sometimes disease of the brain in early life may produce behavior disorders during a lifetime. If there is not enough oxygen or not enough blood pumped to the brain, we have manifestations of brain disorders. There is another group Mr. DOLLIVER. Before you leave that, is it fair to say that in connection with organic disturbances those are readily ascertainable? Dr. WORTIS. I would say reasonably so. They probably represent 10 percent of admissions to a hospital like Bellevue. Mr. DOLLIVER. And is it proper to say the majority of them can be cured by relieving the situation that brought them about? Dr. WORTIS. That depends on how we can reach the situation. If a child has had encephalitis or sleeping illness in early life, I do not think we can cure that. We can cure a certain number of people. People addicted to alcohol or drugs, and people with tumors, we can do something for them. The diagnosis is not difficult, but the cure is doubtful in many cases. As to psychosomatic disorders, in recent years we have come to realize that stress of a certain type in certain people will express itself in distress in a certain organ or group of organs. Individuals who have much stress and keep the trouble to themselves may get ulcers sometimes. There is what we call repressed aggression. A person gets very angry, and feels it inside; there are stomach changes. Ulcer formation in such instances have been proven. In the psychosomatic group Mr. DOLLIVER. Would you define that term? Dr. WORTIS. It is a group of diseases where psychological causes bring about a number of changes, even organic or structural changes in the organs. Mr. PRIEST. Mr. Chairman. The CHAIRMAN. Mr. Priest. Mr. PRIEST. Before asking 1 or 2 questions, I want to make 1 brief observation. Granted that we still have a long and perhaps torturous road to travel before we reach anything like an ideal government, I feel the last few years have brought out developments that are thrilling in this field. Seeing the presence of Drs. Braceland and Wortis and Felix and Stevenson and others takes me back to the original hearings on the mental-health bill, and I am sure Dr. Felix and Dr. Stevenson will recall the discussion we had as to whether it should be called a neuropsychiatric institute or a mental-health institute, and we decided it should be called the mental-health institute. At that time, looking to the original concept of the legislation, this committee felt, I am sure, that in addition to providing a central national place for research into cause and diagnosis and treatment, that this program would result in a great impetus throughout the country at the State and local level in mental health. That has been one of the thrilling episodes throughout the country. I have noticed a change in the public attitude toward mental illnesses. It is no longer considered a disgrace to have in the family someone who is mentally ill. A few years ago it was something people tried to hide, and talked about in secret. I have seen that change in my own home town. I think we have attained that one goal quicker than I thought we would. As a part of this brief observation, I want to pay a public tribute at this time to a gentleman who was at that time a member of this committee and who is not now a member, the gentleman from Ohio, Mr. Brown. He was the ranking minority member of the subcommittee that handled this original legislation. We realized that in going to Congress with that proposal, except for the members of this committee who knew what we wanted to do, we were facing some Members who held the thought that mental health was something we could do nothing about. I recall the day before it was planned to bring the bill before the House, Mr. Brown called me and said, "Percy, we have the toughest selling job we have ever had. I will stand as firm as possible and be as persuasive as possible." I wanted this record to have that personal tribute to the work Clarence Brown did on that bill, because without it it would have been impossible to get it by. It was difficult at best. At that time I think one of the great pressing needs was a very critical, acute shortage of trained psychiatrists. I should like to know to what extent that situation has improved. Has there been an appreciable increase in the number of trained psychiatrists? Dr. BRACELAND. Mr. Chairman and Mr. Priest, there has been a marked increase. There are over 8,000 members of the American Psychiatric Association now. There are over 4,000 psychiatrists who have been certified by the American Board of Psychiatry and Neurology. At the time of those hearings there were less than 1,000. Mr. PRIEST. That is all at this time. The CHAIRMAN. We are all appreciative, Mr. Priest, of what you have done for the general cause of health, not limited to mental health, but, generally speaking, over a period of years, and we are very happy to have you still on this committee so that you can be of assistance. Mr. SCHLAIFER. May I interrupt? The CHAIRMAN. State your name for the reporter. STATEMENT OF CHARLES SCHLAIFER, COCHAIRMAN, NATIONAL MENTAL HEALTH COMMITTEE, NEW YORK CITY Mr. SCHLAIFER. As I said before, I am a layman. My name is Charles Schlaifer, cochairman of the National Mental Health Committee of New York City. I am concerned with what happens to the patients. The remarks Mr. Priest just made and that the Chairman just made led me to interrupt this hearing. I think one of the most exciting things has just happened. This has crossed party lines. This is an American thing that has happened, and I wish all the people of the country could be here to witness a congressional committee holding hearings out of session, and my sympathies are with you, too, to have to sit here and listen to all of the details of these diseases. I believe if I were you I would go home at night and worry about which disease I might have. I think the fact that such a committee would take the time and effort to go into this entire field is a tribute to the fac that much is happening in this field. It is only with an aroused public, and the public as represented by you gentlemen, that we can accomplish this. If we had Walter Winchell and John Teeter, it would help, too. The progress that has been made has all come about because of research. The committee I represent is made up of men like Sherman Adams, Adlai Stevenson, and 40 governors of States that have interested themselves in this field. It is not a matter of party affiliation, but a great American problem. Surely everyone who comes here says, "Ours is the greatest problem," or "Ours is the oldest problem," because all these people become so concerned and work so hard that they can only see the particular thing with which they work but it is a fact that if I should develop a heart attack today it would not cost you gentlemen a cent unless you wanted to send flowers to me or to my wife afterward; but if I should become a schizophrenic or mentally ill it would cost a great deal because the hospitals are tax-supported. Those in this field realize that, and that is why I, as a businessman and taxpayer, am cognizant of it. Just as Walter Winchell became interested in cancer through Damon Runyon, I discovered this vast expanse of hospitals with beautiful grounds surrounding them so that people could point with pride at the great mental institutions or "crazy houses," but inside the patients lived in terrifying conditions. Think of the figure of $2 and some cents per day for the care of a mentally ill person. Just imagine a man in a community who becomes mentally ill in a city of 100,000 population, and they call the family doctor. He is depressed and he cannot work and there is perhaps 1 psychiatrist in a community of 100,000. The man earns perhaps $5,000 a year. The doctor does him a great favor and instead of charging him $15 an hour, he charges him $7.50 an hour. After 3 or 4 months his savings are long since gone, and the doctor can no longer take the time to treat him free. He is somewhat better, but not enough. He becomes worse and threatens suicide or homicide. His wife goes to the doctor and to the Blue Cross. The Blue Cross cannot take care of him. He is sent to a State hospital where there is 1 doctor for 241 patients. This is bringing it down to the common denominator of what happens to a patient. As a layman, it is my feeling that if a little more is spent, or a little more time is devoted to research, or even to train people to apply the things we know today, we might prevent that from happening. It is very important that this committee has taken it up. (The prepared statement of Mr. Schlaifer follows:) STATEMENT ENTITLED "WITH ALL OUR GAINS-WHY ARE WE STILL LOSING THE BATTLE AGAINST MENTAL ILLNESS?" BY MR. CHARLES SCHLAIFER, NEW YORK, N. Y., COCHAIRMAN, NATIONAL MENTAL HEALTH COMMITTEE; MEMBER, NATIONAL ADVISORY MENTAL HEALTH COUNCIL; FOUNDING MEMBER, NATIONAL ASSOCIATION FOR MENTAL HEALTH; MEMBER, BOARD OF GOVERNORS, MENNINGER FOUNDATION; PRESIDENT, CHARLES SCHLAIFER & CO., INC., ADVERTISING AGENCY Cochairmen : Mrs. Albert D. Lasker Charles Schlaifer Executive secretary: Lynn Adams Honorary chairmen : Hon. Sherman Adams, assistant to the president Hon. Douglas McKay, Secretary of the Interior Hon. Val Peterson, Administrator, Federal Civil Defense Hon. Adlai E. Stevenson Hon. Gordon Persons, Governor of Alabama Hon. J. Caleb Boggs, Governor of Delaware Hon. Luther W. Youngdahl, judge, District of Columbia Hon. Herman E. Talmadge, Governor of Georgia Hon. John S. Fine, Governor of Pennsylvania Hon. Dennis J. Roberts, Governor of Rhode Island Hon. William C. Marland, Governor of West Virginia Mr. Chairman and members, I am Charles Schlaifer, a layman, not a doctor. I am cochairman of the National Mental Health Committee, founding member of the National Association for Mental Health, and a member of the board of governors of the Menninger Foundation. I have just concluded a 3-year term as a member of the National Advisory Mental Health Council, of the United States Public Health Service. I am deeply honored to discuss with you the subject of how to reduce the burden of mental illness on our Nation. I am representing today the National Mental Health Committee, an educational group of private citizens and notable psychiatrists who for a number of years now have been sacrificing time from business and professional duties to further this research, and the training of manpower to apply its results. Most of all we are proud of the many State governors, other high-ranking officials and outstanding leaders who are honorary chairmen of our committee, all working to cut down spending for the care of advanced mental patients, by discovering and applying cures in the early stages. Gentlemen, mental illness is no longer a concern solely of its victims and their relatives. It demands the serious attention of all citizens who pay taxes. Mental illness is a community problem, a State and national problem. It is the gravest menace of all to the health of our people. Most of the other diseases throw the cost burden on the patients and their families. This is often a heavy personal strain. But with serious mental illness the cost soon exhausts all resources of the patient and his relatives, and when he finally breaks down completely and goes to the hospital, the burden becomes so great that it falls on all the other taxpayers as well. Year-in-year-out hospitalization is the most expensive form of medical care known to man. There is hardly anyone who is not indigent when the catastrophe of mental disorder strikes. Ninety-six percent of hospitalized mental patients are in tax-supported hospitals. According to a report just released by the research committee of the New York State Council of City and Village School Superintendents, 1 out of every 16 |