The Eclipse of Community Mental Health and Erich Lindemann

Community Mental Health, Erich Lindemann, and Social Conscience in American Psychiatry, Volume 3

David G. Satin

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000171297
• Edition: 1
• Topic: Education
• Subtopic: Teaching Arts & Humanities

These volumes make new contributions to the history of psychiatry and society in three ways: First, they propose a theory of values and ideology influencing the evolution of psychiatry and society in recurring cycles, and survey the history of psychiatry in recent centuries in light of this theory. Second, they review the waxing, prominence, and waning of Community Mental Health as an example of a segment of this cyclical history of psychiatry. Third, they provide the first biography of Erich Lindemann, one of the founders of social and community psychiatry, and explore the interaction of the prominent contributor with the historical environment and the influence this has on both. We return to the issue of values and ideologies as influences on psychiatry, whether or not it is accepted as professionally proper. This is intended to stimulate self-reflection and the acceptance of the values sources of ideology, their effect on professional practice, and the effect of values-based ideology on the community in which psychiatry practices. The books will be of interest to psychiatric teachers and practitioners, health planners, and socially responsible citizens.

1 A Sampling of Community Mental Health Programs

Introduction

It will be remembered that social and professional change, in addition to the social and moral content, was an important factor in the history of community mental health. Aldous Huxley noted the resistance to change as a human characteristic:

The vast majority of human beings dislike and even dread all notions with which they are not familiar. Hence it comes about that at their first appearance innovators have always been derided as fools and madmen.

Derek Bok, former president of Harvard University, particularized this observation to academia:

many of the most important changes that have taken place in the University have been pushed through in the face of indifference or even opposition on the part of the faculty … A president who always defers to the Faculty will just as surely condemn the University to sluggish conservatism.

During various phases of the era of community mental health [CMH] there were many experiments with community mental health programs. While we do not present a comprehensive inventory of them all or a complete history of each one, we offer descriptions or vignettes of several to give the flavor of the variety of CMH concepts, practices, relationships with their environments (community, academic, governmental, etc.), and the personalities involved. The commonalities and variations are instructive.

Leonard Duhl, who championed CMH in government and academia, thought that most community mental health centers (CMHCs) repeated the old model of clinical treatment of mental illness.¹ Among the few exceptions he counted Robert Leopold’s work with the West Philadelphia program, Sheppard G. Kellam’s work with Woodlawn in Chicago, the Mount Zion program in San Francisco, and the West Side program—the last two which he thought had deteriorated from a CMH ideal. In contrast, Jack Ewalt judged that the CMH programs that succeeded concentrated in caring for casualties, while those that failed tried to address broad social issues such as racism, poverty, and education.² He thought it takes a long time for community boards to learn to be effective in meeting their goals, and that to make massive progress mental health needed to be integrated into federal comprehensive health planning rather than standing alone.

The Group for Discussion of Problems in Community Mental Health Research met several times to monitor and compare several major CMH research projects in various parts of the country.³ They met in 1950, February 1951 in Syracuse, NY, and November 11–December 2, 1951, in Wellesley, MA. Topics discussed were:

The Epidemiological Approach to Mental Health Problems”: introduction—Dr. John Gordon; discussion initiated by—Dr. Edward J. O’Rourke (Department of Epidemiology, Harvard School of Public Health [HSPH]), Dr. F. L. W. Richardson, Jr., Dr. Johannes Ipsen

(Associate Professor of Epidemiology, HSPH)

Reports on Progress by Members:

• “The Wellesley Project for the Study of Certain Problems in Community Mental Health”—Erich Lindemann, M.D.
• “Sterling County Project”—Alexander Leighton (Professor of Sociology, Cornell University)
• “The New Haven Project”—August Hollingshead (Professor of Sociology, Yale University), Fritz Redlich (Director, Department of Psychiatry, Yale University)
• “The Phoenix, Arizona Mental Health Center”—Dr. Robert Hewitt (Psychiatrist, Phoenix, AZ), Dr. John Clausen (Head, Social Science Division, National Institute of Mental Health [NIMH])
• “The Breakstone Village Project (University of Toronto)”—John R. Seeley (Professor of Sociology, Toronto, Canada)
• “The Yorkville Project”—Dr. Thomas Rennie (Associate Professor of Psychiatry, Cornell University)
• “The New York State Mental Health Commission Research Program”—Dr. Ernest Gruenberg (Executive Director, New York State Commission of Mental Hygiene)
• “The Social Science Approach to Community Mental Health Problems”: opening—Prof. Talcott Parsons (Chairman, Department of Social Relations, Harvard University [HDSR]), discussion—Dr. Alfred Stanton (Psychiatrist, Cushing Veterans Hospital, Framingham, MA)
• “Personality Development and Community Mental Health”: opening—Dr. Hubert Coffey, discussion—Dr. Benjamin Spock (Director, Children’s Medical Center, University of Pittsburgh)
• “The Problems of Training Mental Health Personnel in Connection with Research Projects”: Dr. Erich Lindemann

Albany Medical Center Community Psychiatry Project⁴

A biologically oriented member of the psychiatry department faculty was interested in developing a day hospital to maintain patients in the community. A psychiatry resident disciple worked on the project. He recognized the need for public funds and became interested in the emotional problems of the underserved poor, and developed working relationships with community groups and institutions. Opposition to the resident and his work developed among the senior psychiatry staff motivated by seeing a threat to private psychiatric practice and fearing the development of a new facility and staff that would constitute a power base for the resident that would eclipse the medical center’s psychiatric outpatient department. Despite the psychiatry department members’ derision of “grandiosity”, the resident and a collaborating anthropologist won a state-managed Office of Economic Opportunity (OEO) support grant of $300,000. Plans grew into a community mental health (CMH) program, which incorporated private agencies and indigenous workers, with the collaboration of the medical center, the resident and anthropologist, and collaborating psychiatrists, and with the support of the resident’s biologically oriented psychiatrist mentor. The project was delayed by county and city political agencies by setting up various committees and boards without representation of the community poor, and the OEO funds were held up.

The Medical Center Community Psychiatry Project was directed by the Medical College dean and the psychiatrist mentor. With the support of OEO administration, the project submitted a proposal to OEO for $400,000 in support for comprehensive coordination, staffing, and community support. The county psychiatrists wanted county and city involvement. The Council of Churches and local newspapers applauded this approach in contrast to past city and county mental health services that provided unsatisfactory service to the poor. The anthropologist was recommended for academic promotion. The federal government recommended an NIMH grant for a day hospital. The state department of mental health (DMH) supported both the antipoverty (community psychiatry) and day hospital programs, as did the county and medical college, the director of outpatient group psychotherapy, the director of the child guidance clinic. An English department faculty member helped edit newspaper reports.

Subsequently, the county psychiatrists, mayor, and city and county officials withdrew their support. The Medical College criticized in the newspapers the anthropologist for leftist and journalistic characteristics. The chairman of the department of psychiatry encouraged the resident to drop his relationship with the anthropologist as a bad influence and to support M.D.s over Ph.D.s. The medical college, local OEO office, and Community Chest agencies took the anthropologist to task for manipulating the resident. And pressure on the newspaper led to resignations in the program and loss of support from the Catholic community. The Protestant community and the African-American newspaper maintained support, which increased among the intelligentsia and academics. The resident and his mentor forced reluctant senior and county psychiatrists to bring the project before relevant county bodies. The Department of Psychiatry was surprised at the actions. It criticized the resident as unready to direct the day hospital and for emphasizing community psychiatry over individual psychotherapy. The mentor was angered when the resident wrote an informational letter to local authorities. The Catholic hierarchy advised no support of the project though it favored service to the poor. County psychiatrists advised cooperating with the local political machine. The state health department withdrew its support, and the county health department denied that there were mental health problems.

The university’s Department of Psychiatry was divided between those who criticized the resident and anthropologist’s work and sentiments and blamed them for negative newspaper reports and those who offered moral support. While the dean of the Medical College supported the project as contributing to the university’s finances and demonstrating good medical practice, the Department of Psychiatry rumored that the resident and anthropologist were building their own empire and were sociopathic and pressured the dean against the project because the resident and anthropologist were unacceptable to the local political establishment. The dean conceded and did not sign off on the project, though he needed the funding.

In the end, the resident and anthropologist were terminated from the Medical College and university.

Bangor, Maine, Community Mental Health Program

Viola Bernard viewed this program as having many problems of personality clash with the director as well as political difficulties.⁵ In the 1960s, there were convergences of interests, jealousies, rivalries, greediness for money, and problems around control. She thought that those who assumed control knew nothing about mental health and professional staff were not caring or understanding about community process. While many good things came out of the program, it was complex psychodynamically and sociodynamically.

Boston College Department of Psychology

The life of this program serves as a case study of the complications of academic–community relations in CMH.

Boston College adopted the CMH focus partly due to its heritage of service adapted to academic recognition.⁶ Its president wanted to build a small, mediocre school into an urban university in competition with its neighbor, Boston University.⁷ In its struggle to qualify as a fundable scientific institution—secular but not just “do gooders”—it needed to integrate the academic and service aspects.⁸ Since it has no medical school, the Department of Psychology was the vehicle. Community psychology gave psychologists prestige that clinical psychology did not offer, with service as an outlet and psychiatrists not inevitably in control. An influx of psychologists from Erich Lindemann’s projects at MGH and Wellesley Human Relations Service (HRS)—John von Felsinger, Marc Fried, Donald Klein, and William Ryan—brought CMH and social psychiatry perspectives with them and led this restructuring.

Thus was founded the Institute of Social Relations—later renamed the Institute of Human Sciences:⁹

THE GRADUATE SCHOOL OF BOSTON COLLEGE A New Program For Research and Practice in COMMUNITY PSYCHOLOGY and PROFESSIONAL SOCIAL PSYCHOLOGY leading to the Ph.D. IN SOCIAL PSYCHOLOGY With Special Emphasis on: Research on Processes of Social Change and Social Planning; Observation and Intervention in the Natural Human Settings of Work, Education and Health; Ecological Studies of Social Conflict and Organizational Behavior Using University-Affiliated Urban Field Stations as Social Laboratories; THIS PROGRAM IS OFFERED WITH THE COOPERATION OF THE INSTITUTE OF HUMAN SCIENCES; For Further Information … Dr. John M. von Felsinger, Chairman, Department of Psychology, Boston College

John [“Mike”] von Felsinger, Chairman of the Psychology Department, wrote:¹⁰ “Our new Community-University Center for [Inner ci...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• List of Figures
• Preface for All Three Volumes
• Acknowledgments for All Three Volumes
• 1 A Sampling of Community Mental Health Programs
• 2 The Counterrevolution of Biology and Business and the Suppression of Community Mental Health: 1966–1974
• 3 Continuity and Replacement: After 1974—Legacy and Successors of Community Mental Health
• 4 Lindemann, Social Ideology, and Social Conscience in Psychiatry and Society: Expectations and Experience
• Appendix: Informants Interviewed
• Index