« PreviousContinue »
Many scientists, both within and without the Federal Government, will also agree that the recent drastic cut in travel funds, cuts making it impossible for Government scientists to attend scientific and technical meetings, falls into the category of very dubious long-term economy. The scientists cannot work with effectiveness in social isolation. If the Government takes steps to keep its scientists' noses to their isolated grindstones-through prohibiting travel and through refusal to sponsor publication—the Government is taking steps to emasculate science.
III. Information about the organizational activities of the American
Psychological Associution in the field of mental health The American Psychological Association is a scientific and professional organization whose chartered purpose is “to advance psychology as a science, as a profession, and as a means of promoting human welfare." Besides its organizational function, the association publishes 10 scientific journals. The nonpublication activities of the association are financed through member dues. Its publications are financed through subscriptions. The organization at the moment has 11,000 members and will take in more than a thousand new members on January 1, 1954. Approximately 60 percent of its members possess the Ph. D. degree in psychology. The remaining 40 percent have the M. A. degree or its equivalent.
There are many kinds of psychologists who work in a variety of settings. There are experimental psychologists, physiological psychologists, educational, child, social, statistical, counseling, school, industrial and clinical psychologists. About half of all these psychologists are engaged in research and teaching in college or university settings. Others work in industry, in schools, in State and local hospitals and mental health clinics, in governmental (both military and nonmilitary) programs of research, and in connection with governmental (military and nonmilitary) hospitals and clinics.
The psychologists most directly concerned with mental illness are the clinical psychologists. Of the 11,000 members of the American Psychological Association, about 4,200 specialize at various levels of training in the clinical area. About half of these are connected with colleges and universities. The other half are engaged in research or service in nonacademic settings.
Graduate training in psychology is designed to prepare students primarily for research. There are many psychologists, as indicated above, who become involved with the treatment of mentally ill persons. They are obviously making an important contribution. But psychologists probably will make their greatest contribution through research.
Approximately 55 percent of these 4,000 clinical psychologists hold the Ph. D. degree. Another 20 percent are still in training. Another 25 percent hold the M. A. degree and are employed, under professional supervision, in research or service operations. Seven hundred and seven clinical psychologists hold the diploma of the American Board of Examiners in Professional Psychology.
The American Psychological Association, through its 17 divisions, its 40 boards and committees and its 10 publications, works in a variety of ways to help these and all other psychologists make their best contribution to the human enterprise.
The CHAIRMAN. Are there any questions, gentlemen ?
I was greatly interested in a remark which you have just made with respect to the lack of publications. What reason would you assign for that? It would seem to me that it could be termed as neglect.
Dr. SANFORD. I think, generally speaking, scientific publication in the area of behavioral sciences is pretty good. It would be, it seems to me, a good deal better if it were possible for the Government to put some of the resources-some of the research budget-into publications.
I think the reason for this failure on the part of the Government to support publications has come about because people do not know the difference between printing and scientific publications. It is understandable that people working for the Government cannot go outside to buy printing, except in exceptional circumstances. The Government can do its own printing very well, but the Government cannot do scientific publications. Only existing journals can make an article ready for publication through abstracting the material and disseminate it into the libraries. Only existing established scientific journals can perform scientific publication. The Government cannot collect the facts in the way of operating in the scientific field.
The CHAIRMAN. That surprises me in view of the fact that frequently there comes to our attention publications by the Government on certain subjects and you wonder who is responsible. I have in mind one of these Government publications having to do with the lives of bumble bees, or something to that effect, and I am wondering about that sort of publication, together with publications on recipes of good cooking and all those sorts of things, when there is such a hesitancy in this particular line which you have directed our attention to.
Dr. SANFORD. Well, the Government does do a good deal of publishing in the field in which we here are interested, but the point I would
like to make is that governmental publication is not as adequate in the field of science as publication through existing scientific journals, which the Government, because of some interpretative handling somewhere—I do not understand it—the Government cannot purchase printing in a scentific journal and it cannot substitute effectively for printing in a scientific journal.
The CHAIRMAN. We appreciate your having emphasized this thought that you have just expressed, and it is a matter to which the committee could probably give some serious consideration to its solution.
Mr. PRIEST. Mr. Chairman, would you yield for one question?
Mr. Priest. I gathered from what you said that you believe that the successful publication of scientific information was a job for the scientific journals in any particular field. Then, you suggested also that the Government—the position of the Government might be to give some additional attention to the dissemination of scientific information in its budgetary program. I wondered if you had in mind, for example, let us say, the publication at Government expense in the American Psychiatric Journal of a special study or of information that might be considered of great value to the profession and to the public at large. Is that what you had in mind, Doctor?
Dr. SANFORD. Yes, sir.
Dr. SANFORD. I do not know about the finances of the American Journal of Psychiatry.
Mr. PRIEST. I used that merely as an example. Dr. SANFORD. We publish 10 journals and we get them out somehow. They are much smaller than they need to be, and the research that is coming out of governmental programs in psychology is not competitive with research that is coming out of the universities and there is no way that the Government can make more publication space available under present regulations.
Mr. PRIEST. Thank you, Mr. Chairman. That is all.
Mr. DOLLIVER. I am interested in the various names of these associations here, and I direct this question to anyone whom the moderator will wish to reply to it. We have the National Association for Mental
Health, the American Psychiatric Association, the American Psychology Association, the National Mental Health Committee, the Association for Research in Nervous and Mental Disorders, and the one which is entitled the "Institute for Living." Those are the ones listed here. Now, I do not take it, then, that the sole interest of all of these various organizations represented here is mental disorders. These sciences have some aspects aside from mental disorders; do they not?
Dr. WORTIS. Mr. Chairman, I believe Dr. Braceland could answer that.
Dr. BRACELAND. Mr. Chairman and Mr. Dolliver, these association names came out in various guises as we proceeded, and I would like to eliminate one immediately, and that is the one which was used simply to identify one of the speakers. That is the Institute of Living which happens to employ me at the moment, and I in identifying myself brought that name in as a way of saying where I came from in this work. It is a private mental hospital-nonprofit—and is 130 years old.
The American Psychiatric Association is an association of American psychiatrists, as the term implies. It is the result of the work orig. inally of mental hospital superintendents, and it used to be the association which concerned itself primarily with the insane in mental hospitals, and then it was elaborated upon.
The American Psychological Association in turn is a group of clinical psychologists and research psychologists and educational psychologists banded together on a national scale.
The National Association for Mental Health is a combination of several societies which Dr. Stevenson represents and is the medical director of and could speak much better about it than I. It is a group of laymen and professional people who are interested in the welfare of the mentally ill.
Then we have the Association for Research in Nervous and Mental Diseases, a group which crosses all party lines, as it were, and takes in neurologists, psychiatrists, basic research men, and they are particularly interested in research material and are represented here today by our moderator, Dr. Wortis.
Mr. DOLLIVER. But the fact is that all the interest of these associations and, indeed, the individual psychologists is not directed to mental disorders, but they have some research in the ordinary mental processes as distinguished from mental illness; do they not?
Dr. WORTIS. Mental health and mental illness.
Dr. BRACELAND. The line is thinly drawn between the two in some instances.
Mr. DOLLIVER. It must be rather difficult sometimes to distinguish between those who are mentally well and those who are mentally ill. Have there been any acceptable standards drawn up to determine that?
Dr. BRACELAND. Not exactly, Mr. Dolliver. There is a general feeling, however, and the psychologists would like to go on record as saying that they do not consider it their task to push people through a little door marked "Mental illness," but rather to make the road of normality so wide that we can get most everyone on it.
Mr. DOLLIVER. Just from a layman's standpoint, I would assume that the thing we are talking about today are those who are very clearly over into the area of those who are mentally ill.
Dr. WORTIS. No, sir. We are talking about a group which covers the entire spectrum from maladjustment to the area of mental illness, and I hope some of the other speakers this morning will elaborate on that.
Mr. DOLLIVER. I will defer any further questions I have on the subject until that time.
Dr. WORTIS. I would like to call on Dr. Stevenson, who has had an enormous experience in this field and who, I hope, will clarify some of these points, Mr. Dolliver.
The CHAIRMAN. Before we proceed with Dr. Stevenson's presentation, I believe Mr. Heselton has a question.
Mr. HESELTON. Pursuing somewhat further the line in which Mr. Priest was interested with regard to the enactment of the national law and what followed, I understand the State governments conducted quite an extensive survey of institutions in the entire field so far as they were concerned as well as from the county standpoint. I also understand there has been tremendous progress in the grant-in-aid program in establishing clinical facilites and things like that. I assume there is something on the bright side of this picture in terms of what the State governments and the counties have been able to do in cooperation with the Federal Government. I hope someone will cover that now and show what progress has been made.
Dr. Wortis. I was going to ask Dr. Felix to cover that situation, since he is close to it. I thought perhaps, with your indulgence and the chairman's indulgence, we would have Dr. Stevenson first and then ask Dr. Felix to explain that situation.
STATEMENT OF DR. GEORGE S. STEVENSON, NATIONAL
ASSOCIATION FOR MENTAL HEALTH
Dr. STEVENSON. I assume that the question has to do with the full range of mental deviation. I think that can be clarified best by saying that there is a dividing line, which we call "commitment” which in general segregates a certain group who are ill, and hospitalizes them against their will. There are in hospitals, in addition, à considerable number who go there of their own volition. They agree to give notice of 3 days or 10 days or whatever it may be, and you might say they come in a little bit below that very severe group. But, in the aggregate, these probably run around 900,000 to 950,000 cases, of which all but perhaps 300,000 are in mental hospitals.
Studies, Mr. Chairman, that have been made indicate that there should be around 900,000 or 950,000 of that sort, and if one extended the figures—the statistics from New York—to the whole of the country, he would find about that many missing. If one used the statistics found in epidemiology studies in Baltimore and in Tennessee, the same approximate result would come.
Now, that accounts for approximately 1 million. There are in addition, representing another line—the mentally deficient group whose characteristics are not strange behavior but, rather, simple behavior, and they are the ones that you recognized when you were in school.
They failed year after year, and they just could not keep up with the great majority, and in adult life they were able to do only simple jobs. That also includes a severe group which amounts to about 150,000 who are in institutions at any one time.
Now, below that, you have a considerable group of more or less incapacitated individuals who are living in their communities. Some of them are very severe cases of psychoneurosis, and that severity might run down into cases who are able to carry on their regular work, and maybe their chief handicap is social or domestic, but they have still a serious handicap although not serious enough to incapacitate them. There are others whose difficulties are more along the lines of inability to follow the usual lines and dictates of society. They represent a distinct—not too distinct-I should say, clinical grouping, but we find them more frequently as violators of the law and we find many of them in our penal institutions. We find quite a number of them in our institutions for alcoholics or for drug addiction.
Then, there is that strata—and that is a very sizable group-and we cannot count them because the borderlines are always too uncertain and numbers tend to accumulate-I mean the size of the numbers accumulates at the borderline. Then we have below that in severity what we might call primarily behavioral disorders. We would not say that they are essentially neurotic, although some of them are not differentiated from neurotic patients, but they are people who get into difficulty. Perhaps the best way by which we could identify them would be to say the "unapt group" that we found in the armed services.
Below that and still in this same general group of people we have a large number—an uncounted number—who come to the attention not of physicians—some of them may be referred to a psychologist or other physician-but they come to the attention of other functionaries in the community. Some are very disturbed over philosophical matters or are in a religious quandary, and naturally they go to their clergymen. Some of them have problems entirely within the area and functions of the clergy. If the clergyman is well informed, he recognizes problems which he would want to handle only in cooperation with one experienced in the area of mental illness. Some of these people, as I indicated before, the teacher finds in school. There are those who fail year after year.
Then there are those who are chronically economically incapable of handling their own lives, and there are agencies which run into a large number of those.
There are those who come into the courts, and I have referred to them already.
There are other functionaries in the community that run into this large borderline group, and they can sort out some of them for psychiatric study, but the majority of them they have to handle in the course of their own techniques and their own daily activities.
That constitutes the full range and it is a rather immense range. You have then the alcoholic, the delinquent, the addict, and the extension of delinquency into the criminal problems. Then we come to that large group that is found in our general hospitals. About 40 percent of the patients in our general hospitals have a sizable element in their disabilities and health that is dependent primarily on the same sorts of life experience that handicapped the mentally ill, and the handling of their problems is inadequate. Many of the hospitals