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COST OF MENTAL PATIENT CARE
AND RESEARCH FOR NEW CURES-1950

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Dr. WORTIS. Mr. Chairman, I would like very much to have Dr. Kety address the committee. STATEMENT OF DR. SEYMOUR S. KETY, ASSOCIATE DIRECTOR IN

CHARGE OF RESEARCH, NATIONAL INSTITUTE OF MENTAL HEALTH Dr. KETY. Mr. Chairman, these eminent psychiatrists have spoken of the good results that can be achieved in the field of the mentally ill. Those of us in the field of research are concerned with those problems remaining in the large areas where the results are not promising, where the psychiatrist does not have the tools or information to cope with the problem. We are working in an area which is largely unknown. We are working in a field where we do not know the fundamental causes. And in the field of mental illness the causes may arise in a very broad spectrum, from the anatomy of the brain to the psychological experiences of the child and throughout his life. Therefore, research in mental illness has to cover this wide spectrum. Although my primary interests are in basic research, I think we should make the point that basic research in medicine flourishes in an atmosphere of clinical medicine. The basic scientist, by constant experience and constant contact with mentally ill patients and with people treating the mentally ill, is constantly stimulated to devote his research energies to these important problems.

I might mention one or two interesting research developments over the past decade or so, to give you the feeling that this is not an entirely hopeless field, and although the path may reach for many years toward ultimate solution, we are achieving results along the way.

Recently there have been 1 or 2 drugs developed. One, lysergic acid, if administered in infinitesimal doses that could hardly be produces a condition similar to schizophrenia. That does not mean that schizophrenia results from something you eat in your food, but the important lead is that here is a chemical substance producing something like schizophrenia. If we could find out where it works in the brain, we might have some important clues as to the nature of schizophrenia.

Another drug is sodium pentothal, which will bring a schizophrenic into an area where he can be spoken to intelligently. Unfortunately, this persists for only a short time, but it has altered the schizophrenic for that period of time.

Jy group has been doing work on circulation in the human brain, measuring the amount of blood that flows to the living, thinking brain, and the amount of oxygen and glucose which it utilizes.

Schizophrenia is a mysterious disease. For many years it was believed that the schizophrenic became so because his brain did not receive a sufficient amount of blood. Studies have shown that the schizophrenics have a normal blood supply and a normal oxygen supply in the brain, and have suggested that perhaps schizophrenia is not so simple a disease of the brain; it may be related to the past experience of the individual and his impact with society.

The same technique has been used to study people with senile psychosis. In people with senile psychosis there is a marked diminution in blood that flows to the brain and a marked diminution in oxygen to the brain. This is also characteristic of increasing age. All of us, as we grow older, suffer a decrease in the blood flow to the brain. In some the diminution is greater than in others.

These are simply examples of the kind of research that is being done. This, of course, is just one iota in a vast field. Research is being conducted in the National Institutes of Health, and some research is being supported by private institutions, on the anatomy of the brain, on the chemistry of the brain, and on the interrelation of one part of the brain with another. A young man at our institute has been working on spatial patterns in the cortex of a monkey, and one can see the action on a screen. It is possible to put fine electrodes in single nerves in the cells and record the action.

There are other important areas of research: The factors that influence behavior; the factors that guide the behavior of animals and convert them from normal to abnormal.

There are important developments in the sociological field and work in clinical psychiatry to better study those conditions. I have tried to touch only on some of the biological aspects. I am sure others here are better qualified to touch on the psychological aspects.

The CHAIRMAN. Any questions?

Dr. WORTIS. I would like to call on Dr. Sanford, who is a psychologist and can discuss clinical psychology.

STATEMENT OF DR. FILLMORE H. SANFORD, AMERICAN PSYCHO

LOGICAL ASSOCIATION, WASHINGTON, D. C.

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Dr. SANFORD. I would like to reiterate the point that has been made several times that more money put into research is likely to be a very sound investment. It is simple arithmetic that if you double the national expenditure for mental illness you would increase the budget by $1 billion. If you doubled the amount for research you would add $5 million or $6 million, or less than one-half of 1 percent, to the total expenditures. I think it can be argued that increasing the amount for research by $5 million or $10 million is likely to be a very good long-term investment, and while we know comparatively more, our ignorance is still vast. There are many cases we cannot do anything about. There are cases where a given treatment is a lit-or-miss matter. As a matter of economics it is a good thing to invest increased amounts of money if the money can be spent wisely in research. You cannot do research without trained people, and if you do not have the trained people the increased money cannot be spent wisely.

I cannot talk about the content of research in this particular area. I can talk about research strategy. I think in the strategy of dealing with the problems in the area of mental illness, or in the larger areas of mental health, we need to put due emphasis on research. I am sure you have heard this all the week. But while research on the Rorschach technique is helpful, I do not think it will give us a cure. If we are going to decrease the number of people in mental hospitals, we have to know more about the causes and we have to go way back asking questions that have no immediate relation. It might be well to point out that atomic fission was not brought about by experts in explosion. We will be struggling with mental illness for a long time.

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