America's Crises; 12; The Emotional Dilemma

H3A NET The following program is from NET — the National Educational Television Network. Well, I cry a lot, I cry... it seems to me that I cry most all day long, and I can't get in the housework done, I just... I just don't have any energy. ...and I lost a lot of my patience with my little girl. I'm trying to be very nice to her. You know, I'm trying to understand her, because I realize she's a complete opposite to the NIME. She's very tomboy, she's very outgoing, she's very boisterous, and I hate girls like that. Someone who is really depressed as suicide is very often appears to be a welcome outlet, anything to escape from the anguish. You have many types of emotional problems. You see children that cry quite easily. You see children that they refuse to attend school.

And the parents, in many cases, can't seem to make them attend school. Do we have to go off the deep end to get help? And why is it when they go to the deep end? All of a sudden there's all kinds of help available. What can we do for you, all of a sudden? Happy? Who's happy? What happens if you believe that there ain't no such thing as happiness in this world? And that you're as happy as somehow you have a right to be, or the norm of happiness is what you are. And what are we? Side by side we march each in his own private world, where in this vast arena of friends and neighbors, seemingly successful with families and careers, who do we truly know? And who knows us? Of a side is our public face. However many people you may think are living in deep emotional distress, there are more.

People with a potential for happiness that may never be realized. Any one of us may be one of them, for there are 20 million Americans in deep emotional trouble, and they have become the nation's number one health problem. Some do not know that they can be helped, that there are many new and remarkable developments, but the real tragedy is that in the face of these encouraging advances, a vast number of Americans who want help cannot get it. The National Educational Television Network presents in its America's Crisis Series, the second of two programs on mental health, the emotional dilemma. One out of five adults have said that at one time or another, they have felt themselves to be on the verge of a nervous breakdown. One out of seven have at one point in their lives sought help for their overwhelming emotional problems. The people you will see in this program know that they are not alone, that their problems are not unique.

They have allowed our cameras to follow them in their search for help, so that others may also know that they are not alone, and they can be helped. What is it like when you need such help? Is Vivian Vance? Because at one time in my life I had a crack up, a nervous breakdown, no matter what you want to call it, but at one time in my life I did crack up, and I was unable to face reality. If you break a bone, people see a broken bone. If you bleed, people see the color and know that there's something wrong. But when you try to explain to somebody that you're desperately afraid, and you don't know what you're afraid of, you'd like to run out into the night, you'd like to run from this unknown fear, and nobody understands it. If somebody said there's nothing there, you could get over that if you wanted to. I can't say strongly enough. What a terrible thing that is to say to anybody who has this problem, because that person wants so desperately to get over it and is not able. He or she is not able.

This I know from experience. What is there about life that can cause people such great pain? Many of us assume that our emotional problems are aggravated by the stress and strain of city life. If only we could escape from the Russian pressure, from a world of too many strangers and too few friends. If only we could turn away from the blank stairs of the glass-eyed buildings and the beehives that are called home. Oh, to find ourselves in the peace and serenity of the country, close to nature, and the real things in life, then everything would be fine. In the Upper Winnouski Valley in Vermont, the people don't go in for a lot of talk about emotional problems. They live close to the earth away from the stress and strain, and they have one of the highest suicide rates in the nation. This community has never had any contact with mental health services. Would they make use of such help if it were offered to them?

To find out, psychologist Harold Boris came here on a government NIMH grant. Now, the theory behind this was that psychological consultation could be useful. The problem behind it was, yeah, that's what we say. But how do we bring it within a tasting distance? This New England area has, at least by reputation, always been a kind of self-sufficient, independent, self-reliant, non-asking for health, non-self-indulgent group. It was their strength. It was a thing that people have admired about them. It's the thing that they admire in themselves. It's almost hard to imagine the countryside in relation to the mood of the people. For me, it's a beautiful country. But in a way, I suppose, for those who are brought up here and experienced it, it has the same kind of difficulties that the city has for those who have gone there.

And the city almost have the feeling that there's a frustration because there's so much opportunity in the country with all its beauty and magnificence. The frustration is almost the same except it's put in different turns, with all this around me how come I'm not happier. It's an area of people who have a tradition. It's an area which has a problem because the tradition no longer works the way it used to. And people feel betrayed. They can't live the life that is demanded now by the increasingly industrialized society, which is more and more like every section of the American society. And still hold on to their self-reliant things. You don't ask. You don't ask for help. You don't say that you're needy. You do it yourself. Things which we would consider from another context in suburban Winetka or Rai New York as all reason enough to have consulted somebody 20 years ago.

Here it's just beginning to be reason enough to take serious. So that when my associate goes door to door and she does, that's exactly what she does. She goes from any house to the next house and she starts anywhere and she goes around. And she says, look. I'm Barbara Davis from Cabot and I'm the girl that's been working on this mental health project with Harold Barris. And next fall, we were thinking perhaps if there was interest in this area we might come over into Calis and Woodbury and talk with some of the people over here. Have you heard anything about this mental health project? No, I don't know. What we're doing is getting groups of people together who feel that it would be useful for them to sit down with others and talk about anything that concerns them that a psychologist might be useful with. And do you think this is anything that might interest you and your wife?

Yeah, I don't really know. They usually run the meetings for eight weeks and it's one night a week and it's time well spent if you've got the time. Not now, not in the spring, but you know in the fall when things sort of ease off on the farm. Yeah, I wouldn't say I'd go. You don't presume a virtue, we don't think that those who work with us are any better psychologically or in any value way than those who refuse. And I feel this very deeply. It seemed to them that probably we were going to change them. We were about to get them out of their old from our traditions and we were about to make them progressive and liberal and democratic and federal and all kinds of things. So that we received, I think, with a good deal of antagonism. But when it becomes evident that the offer to be of use is couched

as if to say, look, this is just a moderator or a referee. This is just somebody who is a catalyst who helps out. And the essential process comes back to you and I'm not stealing away your independence or your values or your convictions or your preferred ways of behavior or in the deepest sense of all your hopes. Then people will make use of you. How did the people react? Mrs. Sandra K. Smith, Housewife. Well, when I first heard about it, I just, well, I didn't know what to, I really didn't know what to think or what to feel because I didn't know anything about it. It's the first I heard about it. And then Barbara kept coming back to us and I got to thinking about it and it sounded very interesting to me because I thought it would help.

We like to think in terms of a family, we always work together, we play together and I thought, you know, this would help us with some difficulties that we had that this would help us. So I said that I would do it. But then there was another side of the story that I worried about and that was the townspeople. Now, why we worry about the townspeople, I don't know, but it's something that everyone always does. And in this area, people right away didn't, they just didn't look on this as anything they wanted. So I kept to think worrying about, well, what will the people think? Well, they think that we are, you know, what will they think of us because we join the group? And then finally, I said to myself, really, what do I care about the other people? I'm more concerned with our family than I am the other people.

So we went ahead and started attending the sessions and enjoyed it very much. Mr. and Mrs. Glendony Randall Sr., dairy farmers. Well, I heard about it, oh, let's say a year before we participated in it. Frank, I didn't think much of it. Why not? I don't know, I just didn't, I didn't take the time to try to understand what it was. I just wasn't interested in it. Well, I think I wanted to go sooner than he did, actually. Yeah, I think she changed my mind for once. Actually, I went looking for a fight. I liked, I liked, I got to know where that's a trait of. Canadians are monitors, but I like to argue. And actually, I thought it might be quite interesting to argue with the psychiatrists. I found out that they don't argue.

What do they do? Well, they make you think. And something that we haven't done too much of, I don't believe. It's to try to work out our problems in a common sense way and try to reason them out. Well, I think it's worked out real good. I feel that I've got a lot from the meetings. And I think that my husband and I both have a better understanding of one another's needs and problems. What do your neighbors say? They're very careful not to mention it to me. And when I say, well, gee, I'm sorry, I can't work on the supper tonight because I have to, you know, I'm going to one of my meetings with Mr. Boris. And they just kind of, they look, they don't say anything. It's the look.

Oh, yes, one of those meetings. And I don't bother to say, well, what do you mean by those meetings? Because they've had their minds made up that they, you know, I just aren't going to listen about it anyway. It's something that Shirley and I both felt at first. You're afraid of. Don't ask me why you're afraid. I guess just human nature. I guess you're afraid of everything or anything that we don't really understand. I think you're afraid of being changed. Quite possibly, but I guess we could all stand change more or less. Well, I think some of them are afraid to let people know that they've got any problems. I've heard several people say that to be in a group, they didn't want other people to know their problems. Yes, some were interested in this way. We don't wish to attend your meetings. We don't wish to go to them. We don't need them, but I wouldn't any more get in from the barn.

And I'd have a telephone call at 8 o'clock and say, Sandy, how was the meeting? Who was there? What did they talk about? What is it like? What do you talk about? You know, just how personal do you get to, you know, do they throw questions at you? And I say to them, well, you know, it really sounds to me like you're interested. Why don't you, you know, come and join our group. And they have come in remarkable numbers. Only families with children under the age of 18 living at home were invited. And in the first year alone, one out of three came to take part in meetings such as this one. Six young mothers in their early 20s all starting out, meeting in one of their homes and talking of seemingly minor problems. They come not to examine any illness, but to examine their lives. Cautiously, they begin to lift the lid of some of their bottled up feelings, particularly anger. Well, something, do I do all the time?

Please have a beer to pick me up. What, why is it not fun to argue? Well, he never did it as many. You end up hurting each other's feelings. And that same thing, do you wish to have him that much? What, what, how could it be that you say something you wish to have him? Well, I like water, for example. Probably things have been bothering you for months. You shouldn't say before. What do you mean you said that you wish to have him? Well, you say something like telling us so much they get mad and they storm out the door or something? Yeah. So they take off the day, whatever you prove. I mean, haven't proved your point. You lost your hope before they go off. You're stuck home. So, in other words, you feel that you're playing from a kind of feeling of weakness that you don't dare. That's right. That's right. And yet they can dare. They do though. They'll do dare. They'll be right off and go. Yes. So, how come you can do that? How come you're so weak? They don't wish time doesn't mean that. You see, this surprise me that it seems to me that many people have a feeling of being angry with their husbands and nothing has come up.

You see, nothing that they can point to and blame them for and start to fight that. You're just annoyed by a whole lot of little things that they could never really put into words. Hey, what do you do then? What do you call it? Do you? Yes. What's so down and talking over? What do you do with the anger? Stand in front of the mall and have a change in the baby or something? Over glass of water, is that important? Is it that important? That's a question only you can answer. I know I have the feeling, it's just a guess, that you would answer yes. I'm wondering, you see, when you teach something that you have this kind of grown-upness, where you have to protect the marriage from organs and protect things from coming to a knock-down drag-out

and protect the electric life bill and do all the rest of it, that that makes them feel like junior members of the firm. Come on, they shouldn't act like it then. Do they act like it first or second? This is going around a vicious cycle. That's right. So you think that if you made them, if you just refused to do these things, that they would accept the responsibility of doing them? I don't know. It may be that as much as they resent it, they want you to be the mother, type person. But that does not sound a question that bothers me. The question that bothers me is, do you want to be that sort of person? No. So what happens in these groups is that people begin to entertain the fact that conceivably they can be angry at their husbands or their children or their mother and also their fathers for debts that have been stored up over the years.

And they can try it out and they can say, by God, I was furious. It doesn't destroy the world. Now when this happens in a group, it's not because I'm there. It's because everyone else is there. So bad that everyone else is there. That is sometimes the key. And not only in Vermont, this group of parents live in a suburb of Boston. Each has a child who goes for therapy to the South Shore Community Mental Health Center in Quincy. Whenever the center treats a child, they require that his parents also receive therapy. Here, working together in a group, these parents hope to learn more about themselves and the ways in which their problems may be affecting their children. Well, last time, folks, we all got involved in a pretty frantic discussion about why it is that we can have four or five children in a family. And each one of them seems to turn out differently, have different effects upon us, even though we like to think we're treating them all equally.

I think sometimes a child would remind you of some member of the family, an uncle, or an aunt, the preps. You don't care too much for. You know sometimes you can see a trait in a child. And sometimes I think that can kind of aggravate you some of the things that they do. I think sometimes the sex of the child has something to do with it. That you may feel differently about a boy or a girl. A mother might feel differently towards a boy and a father would feel differently towards a girl than he would towards his son. I know. He just had too much responsibility at two young and age. And I think then when the next one came along, she got so much attention and also was a favorite. And her father's. And I think the father's just weighing up to the fact that he unconsciously did spoil it. I'm trying to be very nice to her.

You know, I'm trying to understand her because I realize she's a complete opposite than I am. She's very tomboy. She's very outgoing. She's very boisterous. And I hate girls like that. Oh, now she's in love, you know, and I mean she doesn't even know what a boy looks like, actually. And her brother's friends come and they tease, you know, tease her. And she'll come in the house crying when actually you know she loves it, you know. And she's so tomboy. You know, I mean she's very athletic. I hate athletic girls. I can't stand them. She keeps telling me she wants a softball glove and I keep telling her no. But she's still very young. And then she... Well, she probably will be very feminine. She gets older though. But I see I never did those things. We always played in a large crowd. And I always was the one that never climbed a tree. Why do you like that so much tomboy? I can't. Well, it's just not feminine. I mean, it must be something. Because probably because I wasn't like that. Well, he's just like that when he opens his mouth.

His sister's all out of home. That's what it must be. That's the reason, yeah. I see his sisters in here continually and I don't want her to grow up like them. I wonder if what surprises folks is really the fact that one of my members has been rather frank in stating a negative feeling about one of her children. I wonder if she's really if she's so unique in that. Whether maybe at times we all have pretty strong feelings about our kids that aren't so pretty, you know. I think at different times I've had negative feelings about each one of my children. The South Shore Center is in walking distance or an easy drive for over a quarter of a million residents in nine suburbs of Boston. It has a variety of services, an excellent professional staff of 65 and a long waiting list. The usual wait here, as in most places, is one to two years, unless you're lucky. This mother of seven got action.

A true and son was taken off the waiting list and accepted for immediate treatment as an emergency. When we asked him why he didn't want to go to school. He couldn't give us an answer and he wouldn't talk to us and he said that he couldn't possibly discuss it with us. I think now that he probably didn't really know himself what his problems were, but at that time he wouldn't talk to us at all. It bothered us when he said he couldn't go to school. He made a difference to himself, the difference between he wouldn't go and he couldn't go. And that really stumped me. I couldn't understand it. But one day we had a real knock down drug, a battle over the whole thing. And I realized that this was something high-profit that we couldn't handle. So I called the people at the clinic again and they arranged them to come right in as an emergency. But for most mothers, the waiting list is reality. And while they wait, their children suffer. I started five years ago when he was five. He is now ten. I went to some clinic in Boston.

And I started because in school. And I talked to his teachers and I went to a clinic. And the agreement was the sensation I got was that I was being a nervous mother, exaggerating a problem. I kept going from one to another and this was the sensation. In fact, one doctor called me. I was a great child and I knew what to do. I wouldn't be here. But there was nothing. And then when we moved to the channel right now, I just told that if it was not a medical problem, I could get help through the school, through the clinic, from the school. So I went and I had the physical medical test done on him. And they agreed he needed help. The records were available and I'm still waiting. That was two years ago. He is ever so much better. He wouldn't know he was the same boy. He's not at all depressed. And he's a happy kid. He's contented when we recommend him.

It isn't a big crisis and it isn't something that makes him sulk for two or three days. And he takes his criticism along with everybody else. He accepts it and he's almost a wise guy, really. And that's very refreshing to us. So we have to go off the deep end to get help. And why is it when they go the deep end? All of a sudden there's all kinds of help available. What can we do for you, all of a sudden, when it reaches an extreme point? And I'm practised that it might reach an extreme point. Why must we go to extremes? They want early symptoms. Yet they're not right. He's nice. I really believe if he had started five years ago, this would be over and done with. Now I know it's a long-term treatment. Saul Cooper, assistant director of South Shore, is painfully aware of this critical situation. And he, along with the entire profession, is trying to find a solution. The expansion of staff is a kind of a fantasy that every center has. We can go back here, for example, 12 years to a point in time when we had three people on the staff. And we had the fantasy that if you had 12 people on the waiting list and you added one professional, that took care of it.

But what seems to happen is that as you add staff, the community seems to add cases. It's almost as if there's a kind of a spigot out in the community that people can sense when you're able to give service. And they add those number of cases necessary to pick up your staff so that in growing from the three to, well, all of these names represent staff people at the moment where we were planning next year's schedule here, we still face the same problems of waiting list. You don't seem to be able to solve it by adding personnel. I suspect this is the single major challenge that community mental health centers to be effective are going to have to tune into the needs of the community and then begin to change their skills, their techniques, their procedures to meet these needs. We're now moving toward 24-hour services, daycare, nightcare, but for the most part, professionals work nine to five. Now, this is fascinating because it has certain built-in assumptions that are rather idiotic. It assumes that people who need help are only going to need it between nine and five. All the evidence we have would go in the opposite direction, that people who need help, need help with two in the morning or eight at night, different times.

At different times and in different places, the South Shore staff is moving out from behind their desks and going into the community to help fight the waiting list, putting into action the new concept of preventive care. They're going into the schools to help children understand more about human behavior and their own emotions. They're going into the police precincts to help develop new understanding that might be used to prevent a crisis. Well, we went to Boston to pick up a 15-year-old runaway girl, asked her why she ran away. She said she ran away because she felt her parents didn't trust her. We brought her back to Quincy and her mother and father was waiting for us when we got here. And we explained, try to explain to the mother and father, which should be done, but the mother continued to say, how can you do this to me? I finally asked the father to step from the road and I talked to him outside and I said, unless you do something right now, I said, but I feel you're about to find a suicide on your hand by morning.

I said, instead of you standing there staring at it, I'm not talking to it. I think you should go on and put your hands around it. I think you should take a home. I think you should get a good feed. A troubled person often turns first to his minister for help, Saul Cooper and a group of clergymen discuss such a case. She approached me the first time after a Sunday morning worship service and indicated that she wanted to talk with me privately, wanted an appointment in the church office. Within moments of this first meeting, she bled it out that her husband wanted to leave her, that her child Paul was a common thief. She recognizes that her problem is a marital one. Several sessions with the family, I felt that the problems were just too deep for me to handle. When I discovered there was an extremely heavy case load, both at the family service agency and both at the mental health company, and at the family would have to wait several months.

Now, my problem very simply then is this, what can I do to help hold this family together during these two months or several months that will expire before they're able to get the kind of help they need? Where do I go from here? One useful device here is to bring both parents in and focus not on who's right or wrong, which will get you very quickly into the role of an umpire, but rather on where does the communication break down in this marriage? Where are the distortions? See, if you can help them to see where they're not communicating, where they don't see eye to eye, and then offer possible ways of looking at the situation that would help. Could it be suggested to them that the boy be allowed to work in the store by time be paid for this? That was a very good idea. Very, very good suggestion. This is the kind of a suggestion or advice giving, I think is legitimate. You've got to watch out for, as you said before, this is very important not becoming an umpire, not giving advice a quick solution perhaps in the situation because then you become the one that they can focus upon if it fails.

And God too, you say, you can all of this. That's a very good suggestion because it helps to link an identity between father and son that we'd like to see strengthen. I think we're saying that the agency will eventually have to deal with the underlying problems that affect the marriage, that we're trying to arrive at a solution that will allow the case to be maintained by the minister. And at the same time maybe make some progress, it's rather surprising sometimes how you can accomplish a tremendous amount with what starts out as a holding operation. Even with this valuable community help and with plans for expansion, South Shore, like most such facilities across the nation, is inundated. And while people wait for help, most of them remain in emotional pain or get worse. In most American communities there are no waiting lists because there's nothing to wait for.

Two-thirds of all counties in the United States have no psychiatrist at all. More than half of all counties not only have no psychiatrist, they have no psychologist, no psychiatric social worker, no treatment resource of any kind for those who are emotionally troubled. Suppose you live in a typical community in the heart of America. Suppose for example you live in Great Bend, Kansas. I'm a general practitioner in a town of about 18,000 major portion of my patients have a variety of illness and naturally some of them are suffering from mental illness. We have tried to recruit psychiatric help, we have no full-time psychiatrist and naturally when a person gets a psychiatric problem, why it's difficult to know what to do for the patient. We quite often under treat them and which is not good for the patient. And then we quite often have to neglect other patients in order to help these people who are definitely in the psychological help. From director of the elementary schools, so I deal mainly with elementary children but we, you have many types of emotional problems.

You see children that cry quite easily. You see children that they refuse to attend school and the parents in many cases can't seem to make them attend school. In some instances you will find children that refuse to stay with their parents. You see children on the playground that will not participate with other children in games. They stay off with themselves all the time. But many times that child is one that a teacher should be more concerned with. This child that creates no disturbance says nothing, never gets out of line. The family doesn't know what to do. The schools can't help them along this line without a school psychologist which we don't have in which I certainly hope that we will have in the near future young children. They need help to adjust.

It's right now we ready for the most part to have no place to go. What if they could go to the big cities in New York, California, Pennsylvania or Massachusetts? In those four states alone, a half of the nation's practicing psychiatrists. Or they could come to this building at Fifth Avenue in 96th Street in New York City. Theoretically they could choose from among the 45 psychiatrists who have their offices here. In this one building alone, a more psychiatrist than you'll find in 12 different states. But if the people of Great Bend really did come here for help, most likely they would only find a place on a waiting list with the rest of the New Yorkers. While it is true that there are great many more professionals in the big cities, it is also true that there are great many more people waiting to see them. The difference is that in these great centers, some of the most important research is going on. Searching minds are trying to evaluate the effectiveness of present methods and answer basic questions about who we are and what may help us.

New methods and new approaches are being developed, some of which may well change the whole concept of mental health treatment. Dr. Nathan S. Klein has been honored for his work in the development of tranquilizers, and more recently the remarkable anti-depressant drugs. The kind of depression he deals with is no ordinary Monday morning blues. It's hard to describe to someone who's never really suffered from it, and some people have the idea that it's no worse than the mild sort of thing they may have felt. I don't mean this sort of thing. Now, there are times when depression becomes extremely prolonged, that is, it's longer than the occasion calls for, particularly if it occurs without any apparent cause. And secondly, the depression can be so intense that it literally makes the person not only unable to function, but makes them desperately unhappy. And I've had patients who, one woman who compared it with a concentration camp said that she'd go back any day rather than have to suffer from the anguish of depression.

This woman was started on anti-depressant drugs one week ago. She's with her husband. Okay, well, tell me what you can't do. I've got everything that I used to do, I can't do it, and to love to cook, and I used to love to shop, and love to clean, and do everything. And let all time tell me I can. Can't do it. Because you were in bed for about two weeks. Open up, and I'd get up, and I'd go to bed, and I couldn't, I couldn't get enough into anything. I only wanted to lay. All right. Those lonely days I can't stay in, I want to run out of the house. Right. And I tell better when I'm around people, you know, when I'm alone, I'm alone. Oh, when she's alone, I got my hands.

Yeah. But I'm fighting now. Four weeks later. I think you certainly look wonderful. Yes, I feel good. I'm back to my same routine. Really? Yeah. Yes. I feel just like myself. I go shopping. I go to open a restaurant. And I started cooking. With my cooking again, my children. Some of the results seem spectacular, but are there side effects? The medication that's potent enough to do you any good is almost invariably going to have some side effects. Unfortunately, no one can tailor drugs to do just one thing, so that there are almost always some side effects to medication. Usually, these are relatively mild. These almost always disappear when the drug is withdrawn. Occasionally, there are more severe side effects. Certainly, one doesn't take medication lightly.

One has to weigh the advantages against the possibility of side effects or danger involved in a drug. I might point out that probably somewhere between 15 and 20 percent of the patients, whom I currently see are referred by psychotherapists who, for one or another reason, are unable to successfully conduct or complete drug. Sometimes, these patients are treated purely pharmaceutical. In other cases, the psychotherapy is continued. And the combination of the two sometimes works out better than other treatment alone. This woman, however, is going to be treated by drugs alone. This is her first visit. Insomnia, depression, don't want anything. I don't care for anything. I haven't been in a movie for about a year. I don't want to go into one. I fear people. I fear that I have them four weeks later.

And in three or four days, my depression lifted. I accepted already a little girl with my daughter. I accepted to be out early 11 at night. And my hand stopped hurting. Now what else do you want to know? No, obviously you're getting along. You're enjoying the shore? Very much. Good. Very much. I enjoy being alone, seeing people, which I didn't want before. Yeah, but the depression, as you pointed out earlier, the week has lifted. Oh, entirely. But I can't take it. But I still think you have a way to go. I think when you're really feeling well, you're going to be able to get it. I cannot take small talk of the women. Right. I can't. I run away. If I go visiting and I hear the cooking process and I don't hear anything sensible, I run. Right. And I condemn myself for going. And that's still a depression. That is. You're correct.

I should be able to take the patients. I should have the patients to take the average small talk of women. You've shown such remarkable involvement. I've shown very good improvement, considering how terrible sick I was. I'm not well yet. And we can't make it perfect. It wants to be perfect already. I just want to get out of that depression, and I'll go along with my ears and their own aches. Do you have to increase the dose for the drugs to be effective? There is no development of tolerance. In other words, one can take them indefinitely without any lessening of effect. There are other medications, the stimulants and the sleeping medications and so on, for which patients usually do develop some tolerance. This is one of the problems that then one has to increase the dose. But with the major groups of drugs, fortunately, the tolerance does not develop. Now, the drugs are not the sort of thing that give one wild and delirious feelings of joy and happiness. And they don't provide a treat instead of a treatment.

But what they do is to make up or compensate for some aberration, something unusual, something wrong in terms of the total individual. And in that sense, they probably are a crutch, but there's nothing wrong per se with a crutch. I use a crutch every day of my life. I couldn't get along without it. And anyone who would tell me that I ought to throw my glasses away because they're a crutch, I would laugh at. How do the drugs work? If I knew the answer to that, I would write a paper and probably win a Nobel Prize. The use of drugs has proven to be a major contribution in the treatment of deep and profound depression. But there are many different kinds of emotional disturbances, and the treatment for each must be individually determined. I've been feeling very, I guess, very depressed. I cry a lot.

I cry. It seems to me that I cry most all day long. And I can't get in the housework done. I just don't have any energy. And I lost a lot of my patience with my little girl. Often of prime importance is the availability of immediate emergency treatment at any hour of the night or day. A young woman like this can simply walk in off the street at the Massachusetts Mental Health Center in Boston, no telephone calls, no appointments, and receive immediate treatment. This is a rare service. My husband's more like my mother. He's colder. He's just interested in what he's doing. He doesn't think about what. Later she can come by appointment, but this immediate therapy may have averted a severe crisis. Dr. Jack R. E. Wall, director of the Massachusetts Mental Health Center and director of the Joint Commission on Mental Illness and Health, whose report formed the basis for new federal legislation. The principal thing that is essential to a service of this sort is that you make the services available to anybody that walks in and when they walk in.

Irrespective of the seriousness of their illness, so that a person who's just upset about some misadventure in their life, we will see. I think anybody that feels he needs to see a psychiatrist ought to be able to see one, when he wants to see it. I don't think you can schedule these things from eight to five on working days and close them down at night or on holidays and whatnot. The treatment must not only be available, it must be appropriate to the problem, and new methods are being developed and used for the crucial responsibility of diagnosis. This family has come to see Dr. Nathan W. Ackerman for guidance in determining the proper method of treatment for their son. Bobby is in constant trouble. He's threatened to run away even to kill himself. The recommendation of two other agencies is that he could best be helped away from his family in a residential treatment center.

To evaluate this opinion, Dr. Ackerman is using the new technique of family interviews, which he helped pioneer. Often, the so-called patient may be only the symptom of a disturbance within the entire family, a disturbance that can sometimes better be worked out together rather than through separation. To find out whether this is true in Bobby's case, the doctor sees the whole family together. Observing behind one-way glass are psychiatrists, psychologists, and social workers. Some are here to learn this new technique. Others are staff members who will help decide whether Bobby really needs to leave his family in order to be helped. As you say, you don't want to place Robert in a special school. He's your son. You love him. You want him where he belongs, where he was at home. You say you love him, and he says he ain't you.

Hmm? We know him. And he wants to leave you, drop you when the ash can, just two parents, and adopt forms of another set of parents. His teacher, Bobby, he also said to come with me into my family, didn't he? Bobby, I like you, come sit over here next to me, would you? Can I sit with mom? Dr. Ackerman is trying to stir emotional reactions in order to observe family patterns and get a true picture of the strengths as well as the strains. This is their third diagnostic session. You still feel that way. You'd like to live with a teacher and her family or me and my family. Would you be happier then? But you know, Bobby, I don't understand really what made you so miserable in this family.

I got your parents' idea, but their ideas and the whole story, I know this. Is it true you've only been miserable for a year or something? Were you happy kid before then? Do you remember? You said the whole trouble started when your mother and dad gave in to the strict principal. You got so out of them for that. Well, that was part. You knew I didn't get what I wanted for my birthday? Oh, I see. Well, let's talk about your disappointment. But when was your birthday? I'm 22. I see. And was it the electrified guitar you want for your birthday? And it's been a very unhappy since then.

Well, come on in. Let's argue that out about the guitar then. Bob? Come on in. Bobby, please. Robert, you're the one who has wasted your time. That's right. He's holding up the works here. He wants his guitar. What do you want, Andy? She has it. I know. First, it was all $500, piano. What the piano cost? $500. And the first, you cost $500? Yep. Nice piano. When I was his age, I had the same kind of... Oh, shy, grandpa. Well, there we come back to the same old thing. You feel she's getting the raw end of the situation? Yeah, what you do? No matter what you do. How old are you?

Yeah, then you can have all the clothes he wants and all the pants and shoes. And you? No, go out. Please. What is wrong? Tell me where you going. I'm going out. I'm not still. Maybe I'll come back. Son there was still the lawn. The boys were playing ball in the backyard. They were all in something. Then he had a favorite one. A younger boy threw a ball at one of the younger boys. I tried to tell him why. Yeah, were you just gusted in front of all of his friends? You could have called to me and said it. But in right in front of all of his friends, you started there. Yeah, you are. Sister Andrea. It's going to bump you side in this argument. No, I mean, you shouldn't have threw the ball at the kid, but there was no reason for my father to discuss it right in front of all of his friends. You sure I'm up in front of the friend? Do you think maybe Andrea has a point there?

Andrea, would you perhaps like to go out and talk to a puppy and maybe the two of you come back together like you did last time? Do you want to do that? You're missing me. You want your brother here. So you were out gambling. Bowling. Gambling. Well, I think about 9 o'clock in the evening, and I think by then everything is over with. So why? That's when they begin at 9 o'clock in the evening, right? Totally. That's when the fun starts. When the excitement starts, you go bowling with the boys. But I just wonder whether you, when the old man's out to 5 o'clock in the morning, does he get next to Bobby? They say love him very much. Thank you. To just snuggle up to him. If I could, I'd be glad.

Did he come back to you? Yeah. We could be sitting on the couch watching television. Snuggle up to him. You don't know what you're missing. Do you know what you're missing? Yes, though. What are you missing? Companion ship at night. Share with me. Share with me that feed. I have to sit and watch television by myself, or I sit and do something else by myself, or have a row with him, water. There. Did you hear that, Papa? No one else. Take it out on except Bobby. He's just a pretty guy, you know. He comes home 4 or 5 o'clock in the morning. You can't feed him up to any fast asleep. No, I'm not safe in the sleep. You wake up when he comes home?

I do every time he comes home. You take the strap to him when he comes home? No. I take it out another way. But you see, Bobby listens to you, Andrea. Right now, he listens to you. He didn't want to listen to his mother and dad. He listens to you, and sometimes listens to me. I think we can start a whole new program to sail. Like, um... But on a Sunday afternoon, we went somewhere where all the family wants to go. We had more family than we ever did together. Where we always wanted to go. Just a moment. He was spoiling it, mama. You cut in on your daughter. She's a testing program. Maybe it wouldn't work. But you didn't listen. And I said to you before, Bobby doesn't listen to you. You must also... You was too much tonsil on him. Give me an idea. Where would you go on a Sunday? My father liked him also.

Let's say once we went bowling for the afternoon... Before we began. And, um... Or we can go to the movies and eat. We do this sometimes. But I think we made it a weekly project. It doesn't have to be anything expensive. Just coming out, you know, anyway. We went just riding around. The parents got here precisely because in their hearts they could not make peace with this recommendation. But they said they loved the boy and they won him home. The staff found that the violence of Bobby's protest was a clue to the unsolved disturbance between his parents. Despite the intensity of his defiance, he and his parents very much want and need each other. I gather you're all agreed. Yes. Pretty much all agreed. It would be incorrect and dangerous to place this boy in like breakfast school. Except that the boy must do practice.

The individual therapy of this child would be, uh, to say the least, unprofitable. All right. We agreed on that. We wanted to keep family together now. What do we do for now now? What they decided to do was to start family therapy treatment immediately. Bobby can either get well nor stay well unless his family is made well too. They must learn to hear what he is truly demanding of them with his emotional outbursts. And then they must learn to answer. As a result of treatment together, the family has shown striking improvement. One family is being helped, but 20 million Americans also need help and not enough of them are getting it. Produce a Harold Mayer is interviewing Dr. Stanley F. Jolus, director of the National Institute of Mental Health, the government agency, which is directing and coordinating the massive mental health program recently enacted by Congress. The nationwide needs for treatment services

keeps growing faster than we were able to provide it. Recently, the Congress passed laws which will help to provide the needed services for all those who are in need of such services. The laws provide assistance to communities to help construct mental health centers and also provide assistance to help in staffing such centers with the best qualified people. We hope to have 500 such centers in operation by 1970 and in the remaining 10 years to provide an additional 1800 such centers. What kind of services will these centers provide? At these centers, anyone in the community will be able to get the kind of treatment he needs when he needs it. Emergency services will be available at any time of the day or night for those patients who need it. For those persons who have less serious problems, how patient services will be provided so that the patient need not disrupt his home life or his job situation.

For those persons needing hospitalizations such services and facilities will be provided in his home community so that he need not be sent far from home to large impersonal and often frightening institutions. What about people who can't afford to pay? All these services will be available to everybody regardless of his ability to pay and without restriction. This means that treatment will be available to those people who need it who have been deprived of it in the past largely for reasons beyond their control. All this sounds very promising but realistically speaking, when will it actually be put into practice? Well, I've outlined the plan. It's a long-range plan and it will take a tremendous amount of effort. We know it's going to take a long time and doubtless there's going to be many discussions, many disagreements, many plans, many votes before the plan will come to fruition. It will happen only over a long period of time but at least and at long last,

we're on our way. But how long will it take us to get there? With each day, the waiting list grows and the nation's number one health problem remains unsolved. When America decides to tackle a problem, it usually solves it. Must we really wait until 1970 to get 500 mental health centers? A mere drop in the bucket compared to the need? By that same year, for example, we plan to spend some 30 billion dollars to get us to the moon, fast. Some of this money might be more profitably spent to get us to a good mental health center faster. Is it possible in the future to survive all control?"

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