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The first point I would like to make is that research must be oriented toward the basic. I would like to point out also that research that has relevance to mental health must be multidisciplined research. That point has been made previously.
There are many scientists who can and will make advances having effect on people in mental hospitals, and all of these scientists must have encouragement to make their contribution to these problems. I would like to emphasize that we have much to learn in the very strategy of getting research done, about the administration of research programs.
In this area I think it would be interesting to think a moment about how Government relates itself with scientific research. I think it is a fact that the governmental concern and involvement with scientific research has doubled or trebled in the last 10 years, but I think both the Government and science have a lot to learn about this partnership.
In the behavioral sciences, it is true that the United States, both governmentally and nongovernmentally, supports behavioral science more than any other culture in the world. This, incidentally, is the basis of some patriotism on my part. The concern with mental health and the concern with the behavior of human beings is very recent in the history of science, and there is a real concern for it, and a willingness to support it, which is a very fine thing and a natural democratic thing to do. It is a question that makes my hair stand up when you consider the severity of the problem.
It is gratifying that the citizens of the Government of the United States can concern themselves and itself intelligently with this sort of business.
There are a few things about which I would like to talk, which might be considered piddling things, perhaps, but I think the Government needs to learn a great deal about the administration of research contracts which it fosters and pays for.
It seems to me to be true that the Government still tries to buy research like it tries to buy tanks or paper clips. The form of the contract somehow does not fit its proper function. I will leave that and go along.
Another aspect with which both the Government and scientists need to concern themselves is that of scientific publications. In a particular field there are a number of problems arising because the Government itself will not finance scientific publications. The Government will pay for the services of scientists; it will pay all expenses in getting research done, but it will not pay for the dissemination in most instances of scientific information.
The expense of publishing scientific knowledge is very high. The scientist cannot work in social isolation. The expense of publishing scientific articles is borne mainly by the readers of those articles mostly people in research institutions and universities or by libraries who subscribe to scientific journals.
I make those points and stop there.
(The prepared statement of Dr. Sanford follows:)
STATEMENT OF THE EXECUTIVE SECRETARY OF THE AMERICAN PSYCHOLOGICAL
I. THE SIGNIFICANCE OF MENTAL HEALTH
The present statement need not add to the evidence, presented in other statements now before the committee, on the frequency of mental illness, on its cost to the Nation—in both misery and dollars-on the need for facilities to care for mental patients, and on the relatively small part of total medical-research expenditures that are directed toward the solution of mental-health problems.
It may be well to point out here, however, that the magnitude of the mentalhealth problem is not to be measured by counting the number of people now in mental hospitals. In addition to those who are institutionalized, there are many others, considered relatively normal, who, nonetheless, have severe and crippling emotional problems. There are delinquents, alcoholics, and those who are accident-prone. There are people whose failure to adjust swells our divorce rate. There are people who do live normally and work regularly but whose happiness and effectiveness are hobbled by curable psychological difficulties. For each of the half million Americans now in a mental hospital, there are perhaps 10 or 20 or 50 whose lives are crippled by some form of personality disturbance.
The problem of mental health is vastly greater than the problem of mental illness. The two problems can be separated only if we draw an arbitrary line between health and illness. In thinking about social or governmental responsibility for mental health, the line should probably not be drawn; nor should it be drawn in considering research; mental disorders are human disorders and there is good reason to believe that we will understand the more dramatic forms of disorder when-and only when we understand the natural laws of human behavior. Research that helps us understand the human being will benefit not only the mentally ill but also the potentially ill and the millions of people who now live, because of emotional problems, far below their best level of effectiveness.
II. RESEARCH ON MENTAL HEALTH
It is obvious that solutions to our mental-health problems are to be found only through research. As our population increases, increasing millions of people will suffer from mental troubles and the burden on the taxpayer will grow unless we find new ways of preventing and treating mental illness. We can find these new ways only through scientitic research. We will not find them for a very long time if we continue to put piddling amounts of money in mental hospitals and research centers, if we continue our failure to attract into the behavioral sciences a sufficient pumber of gifted young people, if we continue to make research work less remunerative-psychologically and financially—than service activities, and if we continue to build new wards and add beds while the labora. tory is still housed in some cramped and ill-equipped attic.
The science of human behavior is a very young science. For centuries man has directed his scientific curiosity almost exclusively to the world about him. Only recently has he asked meaningful questions about events occurring within his own skin, and only recently and reluctantly has he given up his ideas about witches and devils as the causes of behavior disorders. Scientific psychology began less than a hundred years ago in a laboratory in Leipzig. The first American laboratory of psychology was founded by William James at Harvard University in 1874.
There is no reason in the nature of things why we cannot have a sound and systematic science of human behavior. We are making genuine progress in all scientific fields concerned with the behavior and well-being of the human being.
In the field of mental illness we are now able, for example, to prevent disorders due to dietary causes. We have learned through research what causes a few of the forms of mental deficiency and we know how brain injury can produce permanent mental impairment. We know how to treat successfully a great majority of the cases of involutional melancholia. And over four-fifths of the epileptics can now be restored to a socially normal life (though we still do not know how to prevent epilepsy). We know ways to help those with "normal" personality disturbances, and we have found out a good deal about factors producing delin. quency, alcoholism, divorce, and other behavior problems.
There has been progress. But our knowledge of human behavior is still fragmentary and our understanding of mental illness is very incomplete. There are still many thousands of patients whose mental illnesses we simply do not know how to treat or how to prevent. For example, present-day treatment of schizophrenia, the most prevalent and most chronic of the severe mental illnesses, is still very much a hit-or-miss procedure.
Within the existing limits imposed by shortages of money and of trained people, present knowledge is being applied with intelligence and effectiveness. But present knowledge, if applied by twice the present number of psychiatrists, clinical psychologists, social workers, hydrotherapists, occupational therapists, and others, and applied in twice the number of institutions, could not possibly do more than halve the number of people in mental hospitals. A single research discovery tomorrow or next month or next year might achieve the same result. In the light of the slow pace with which science seems to develop, it would be very optimistic to bet all of our money that such a discovery will come even during our lifetime. But it would be foolhardy, on the other hand, to spend all our money applying treatment methods known to be only partially effective. We need to know more. A. Research costs money
Knowledge gives man power. But power from knowledge is proportional to the resources spent in gaining it.
Each year the various States spend an estimated $560 million, in capital and operating costs, on mental hospitals and related services. The Federal Government spends an equivalent amount for the psychiatric care of veterans, and in the payment of pensions resulting from psychiatric disabilities. The total annual amount, from all sources, spent for research on mental illness is about $6 million or about one-half of 1 percent of the total expenditure. To most informed observers, this division of expenditure is grievously unsound. It is as full of folly as a military decision to freeze weapons development, putting all resources in the manufacture and use of existing weapons while little or no attention is paid to the future to the improvement of weapons or to the increased study of better ways of using them. Research must be basic
It would be a mistake to assume that bigger and better hospitals and greater numbers of people engaged in treating mental illness will automatically result in new knowledge of human behavior. Research involves something else than the clinical concern for patients. While it is very important that we learn more about existing diagnostic tests and about the most effective use of known methods of treatment, we will probably make more real progress if we invest heavily in the man who seeks to understand the basic laws of human behavior. The discoreries made by the basic scientists do not often have the appearance of immediare utility. But over a period of time it is the theoretician and the basic experimentalist rather than the engineer who does the inventing. (Atomic fission was Dot brought to pass by experts in explosives. The theoretical physicists did it.) C. Research must involve a number of sciences
Research in mental illness must involve many disciplines. We know there are biological, psychological, and social factors in mental illness. We should know that an understanding of mental illness will not be created by those who apply any single scientific discipline. Research on mental illness not only must emphasize basic science, but must emphasize basic sciences. The neurologist, the physiologist, the physiological psychologist, the sociologist, and the anthropologist have significant roles to play in supplementing the research of the psychiatrist and the clinical psychologist. D. Research requires trained men
Scientific research is a very demanding activity carried on by gifted and highly trained people. Research gets done only if there are people both able and available to do it. There are not enough people now available for needed research in the behavioral sciences. There seem to be several reasons for the shortage.
1. American waste of the talented.-Manpower experts, believing our very survival to be dependent on our creative use of our scientific and technical resources, are seriously alarmed over our failure as a Nation to use our intellectual talent. We have hundreds of thousands of potential scientists and engineers who, for one reason or another, do not continue beyond a high-school education. And even those who do receive college degrees and who do have the talent for science, turn to business or to the professions when they find that research positions are not very secure nor very remunerative.
2. The competition for researoh skills.—The behavioral sciences must draw their gifted young people from a limited supply pool. At the present time the behavioral sciences-physiology, psychology, sociology, and anthropology-cannot compete too successfully with the older, more established, and more pres. tigeful natural sciences. A man with a Ph. D. in chemistry earns from $1,000 to $1,500 more per year than a man with a Ph. D. in psychology . (And while both the chemist and the psychologist drive Fords, the chemical engineer drives a Cadillac, or maybe a Chrysler.)
3. Seleotive Service policy.-Ourrent Selective Service policy cuts very seriously into the supply of those who might become creative scientific specialists. In the past, Selective Service has postponed the drafting of graduate students until they had completed their specialized training. But no more. The country spends large amounts of money on the nurturing of special talent. The Govern. ment itself, through scholarship and fellowship programs, invests in the training of scientists. The Government needs scientists. The military needs scientists. But Selective Service steps in to stop the training of scientists, often just as the period of usefulness is about to begin. In at least two known instances, graduate students on Government fellowships were taken out of graduate training and drafted into the military, where their limited scientific training may or may not be used. Such procedures do not seem to make sense. The Government needs to get together with itself on manpower policy. No one can object to a policy that demands of each citizen that he directly serve his country for an equitable period. But there can be grave doubt about the wisdom of saying “You serve now” when in 2 more years the service can be very much more valuable to the country.
4. Patient load.-When a hospital is understaffed, a psychologist or a psychiatrist has more work than he can handle in giving whatever help he can to people who are desperately ill, whose suffering makes an appeal to every ounce of humanity he has in him. It would be a rather strange psychiatrist or psychologist who could deliberately turn his back on human beings to whom he might be a help and retreat to a laboratory where he could test an hypothesis on white rats. Intellectually be knows it would be very worthwhile to humanity to get some new ideas into the mental health business, but humanly he could not turn his back on people who need his help at that moment
The only way to meet this problem is to make decent allowance for the care of patients, to seek out those talented people who can do research and to give them a clear assignment, a clear understanding that they are encouraged to do research work in an atmosphere in which they have time to do it.
It is fairly clear that in none of the specialized fields concerned with mental health is the supply of personnel up to the need. In many cases the supply is not even adequate to the existing demand. In 1953, there are approximately 500 clinical psychologists, or 1 psychologist per 1,000 patients, employed in State mental hospitals. The minimal standard for psychiatric hospitals and clinics, recommended by the American Psychiatric Association, calls for 1 clinical psychologist for every 100 patients for admission and intensive treatment service and 1 clinical psychologist for every 500 patients for continual treatment service. E. Rescarch requires facilities
Modern research demands equipment and modern scientific equipment is getting more and more expensive. Of course, you can run an entire psychological laboratory for years on the money it takes to build 1 cyclotron, 1 or 2 million dollars, But it's still true that the cost of laboratories and of scientific equipment is considerable. It is often thought by the public that the scientist is a queer duck who only needs a garret in which he can assemble a few old square boxes and some copper wire and some motors he has taken out of electric fans; but we cannot get new advances in modern science by continuing to treat scientists as poor relations. Mme. Curie and her husband worked in a freezing cold laboratory and in an unheated shed for years, but there is no reason to believe that their blowing on their fingers to get them warm enough to do their work actually helped their brains operate better.
The mental health expenditures for research operations are very small, as we have seen, but the capital expenditures for laboratory space and equipment represents an equally discouraging picture. Research scientists must have more tools and more space in which to use them.
F. Research requires organization and facilitation
Modern research tends more and more to be a team operation. Congress itself gets its information through teams of research staffs and through teams that are called committees. Thus it gets from exchange of facts and ideas a better result than any individual member could hope to get on his own. So modern science is no longer an aggregation of soloists, of virtuosos. It is like a symphony in which each player contributes a small part to the whole.
Research must be organized. But we must be careful that it not become so highly organized that the scientist is more of a hired hand than a creative individual. The most important factor in scientific research is thinking. And though thinking can be programed, it is sometimes programed into stultification. In many cases the best way to get the best thinking accomplished is to bring talented and trained people into contact with problems—and then leave them alone. If there needs to be research planning or supervision of research, it is cardinally important, both for the morale of the scientist and the productivity of the project, that planning be as intelligent and as flexible as humanly possible. And supervision of research must be in the hands of those technically and intellectually competent to judge the quality of research efforts. Many scientific and professional projects, both governmentally and privately sponsored, have suffered grievously because nonscientists and nonprofessionals have been given direct supervisory control over activities they do not fully understand. Those who do administer research must be responsible, ultimately, to nonscientists. But direct supervision of research personnel needs to be handled by those who know good research when they see it.
There is currently much dissatisfaction among scientists, both in the Government and in the universities, with the governmental handling of the administrative side of research. For example, take the case of one university scientist engaged in research on a problem of obvious and direct interest to the military. He refused several other opportunities for employment in order to accept a promised contract for research from a Federal agency. For 6 months the contract was under negotiation, while the scientist waited for his salary and his detailed assignment. After 6 months, the contract negotiations were dropped completely because of a legal technicality involving a copyright and having no relation to the content of the research, but which no university would have found acceptable. Needless to say, this research worker will be somewhat hesitant to offer his research efforts to the Government again.
In general the Government attempts to buy research in the same way it attempts to buy paper clips or rifles. Somebody needs to do careful thinking about the form, content and supervision of research contracts if our scientists are to do their best work and if the country is to derive the greatest benefit. G. Research must be communicated
Research depends on communication. Science is a social phenomenon. Scientists need to interchange ideas if knowledge is to be, as it must be, cumulative. Those who sponsor research need to remember that scientists need to attend meetings, publish and read papers. Many scientists will agree that federally sponsored research programs-in the behavioral sciences and in all sciencessuffer because the Government does not recognize the importance of scientific communication. The Government will hire excellent scientific personnel and will pay all expenses of getting research done. But there the Government stops. It will accept little responsibility for the publication of the knowledge its scientists discover. The expenses of scientific publication are borne by libraries or individuals, who through subscription to journals, pay the costs of publication of governmentally sponsored projects.
From the standpoint of simple economy, the failure to publish in established journals the results of research is a serious waste. It leads to unnecessary and unproductive duplication of research.
In connection with the problem of publication, a resolution recently passed by the American Psychological Association is relevant :
“A research program is not complete without the dissemination of findings having general scientific significance. Publishing is an integral part of the research progress, and should be supported on the same basis as any other part. Agencies sponsoring research, including universities, should make adequate provision for publication of results in any appropriation for a research program. It is particularly undesirable to leave the burden of paying for publication as a personal charge upon the scientist himself."