Aspects of mental health; Community and mental health
The following program is produced by the University of Michigan broadcasting service under a grant of aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. The community and mental health program from the series human behavior social and medical research produced by the University of Michigan broadcasting service with special assistance from the Mental Health Research Institute of the University of Michigan. These programs have been developed from interviews with men and women who have the too often unglamorous job a basic research. Research in medicine the physical sciences the social sciences and the behavioral sciences locational you will hear what may seem like strange or unfamiliar sound. These are the sounds of the participants office his laboratory or his clinic where the interviews were recorded. The people you will hear today are Dr. Lawrence Cobb of Columbia University and Dr. Leonard J duel of the National Institute of Mental Health in
Bethesda Maryland. And my name is Glenn Phillips. Do we as members of a community have responsibilities obligations and challenges when we are confronted with problems of mental or emotional health. The answer most certainly is yes but the magnitude of the problem is recognized by particularly this problem one my ass. Let us once again review some of the reasons why. Mental or emotional ill health are the chief causes of disability in the United States. There are 16 million Americans who feel over half the hospital beds in the United States. Sixteen million directly suffering from mental illness. This figure does not even take into consideration the other millions of family members or friends who are affected through their immediate association with the problem. Yes we do indeed have a responsibility and obligation and a challenge. What of an entire community.
Can they have a common mental illness. Dr. Leonard DOOL said. I didn't say that but I am saying that there is no such thing as an individual. Problem in an individual patient. Any problems exist with patients exist within this family exists within the group that he works with in his religious. Community is a part of the community of the United States. What I'm saying is that an individual patient reflects not only on the inside of the self as an individual but affects his relationships with others that he's learned by rolling up in the particular group that he's grown up in and also
reflects the value system of our total answer your question. I think any mental health problem. Problem is really tied up with the problem. Of. Our. Communities. I asked Doc to explain what he meant by the problem of a community. The best way to describe it is to describe the work of the community organizer in southern Illinois money and has been interested in community development. This man is a person who is not interested basically in mental health but rather in. What he calls community development. He may be called into a community for him to help the community bring new recreation center and to me he goes in with the understanding that he would not just deal with the problem of the recreation
center alone but the broader issues that face this particular community. This means that he starts to ask questions. The community can ask questions of why they need the recreation center the reply maybe delinquency. You may want to find out more about delinquency in this particular community. You may find the area that he's working in. Young people have nothing to do they leave the economic base of the communities. This may be business practices this may be the local business practices may reflect the geography of the neighbors like the fact that prepare for people to really stay and participate but really just educate them. Get them ready to go elsewhere in the United States. So by the time he's done he's taken a good look at the education the recreation the public health the business
practices as well as the needs for recreation efforts in the community. In watching post work it's always struck me as the sun. As the importance side effect of his community development program has been the fact that the mental health community has improved more people participate in community life than before. Resources that people are not in the community before become available as the community gets to know itself better. The community begins to a tremendously broad front and gradually they answer to the presenting problem in a very general plain and I guess pressure has been that this has much lasting effect than if
one went in just to deal with the specific issue. Or the specific issue of just a recreation center. My next question to Dr. rather a two pronged. First how might the reorganization of the community be beneficial and also how my organization brought about Doctor said up to now. We've planned school keeping in mind the prime concern of educating our kids. The school people are experts at this. However some of us who've been working in the mental health fields are what I would call broadly the mental health disciplines you might accuse me of saying a total behavioral sciences are beginning to become more and more aware that a school has much greater effect on kids than just specific education on specific topics.
If I were to be involved in the planning of the school system I would say school teachers in the school people continue to do the planning but let's take into account some variables and then they take into account heretofore to take in account of the impact. The size of classes on the ability to teach teachers to deal with groups of kids and allow them to develop what's the impact of certain kinds of administrative structures in the school system. What's the impact of the school system which has a value that says education for let's level out our education system to mediocrity. What's the impact of a school system which hand pick special kids and give them special kinds of education and maybe separates them out from the mainstream of the school. These are questions we can't. We don't have complete answers for right now we have some answers. But I think what I'm asking for
or I'm. Saying is that I'd like very much for people to consider these variables in the planning operations of a school. Moving to another gentleman Dr. Lawrence Cobb at the Columbia Medical Center in New York City. I asked him what his feelings were on the community aspects of mental health. He commented Well we're engaged in a number of studies in this institution here where I think the institute is the oldest. Research Establishment. And I might say the first multidisciplinary research establishment in this country directed towards discovering the causes of mental illness and infected methods the treatment. We have a new effort occurring in the institute and in the department of psychiatry here Columbia. A. Study on the community agencies and the function of the community agencies as they relate to mental health.
We're attempting to set up a division in this department and we have established a division to bring about an effective organization of the community agencies and to study the extent of the mental disturbances in this community. We're particularly struck by the fact. That the present organization facilities for the care of the mentally ill and emotionally disturbed those with psychosis in the Rosies and. The deficiencies of mental defects and others are quite inadequate because of the historical fact that the responsibility for this care has come under many institutions. The state is required to take care of certain individuals. The city is required to take care of other individuals. There are a number of voluntary agencies who have given themselves to this problem. But the truth of the matter is that the patient frequently falls between. The functions of
many of these agencies and he therefore does not receive the continuous and comprehensive Kerry needs but rather a discontinuous fractionated. And sometimes overlapping and confusing care. For instance in the area immediately surrounding is the institution of the approximately 100000. We know that those individuals who become psychotic are sent to no less. In the last few years nine different mental hospitals some of which are within. Seven or eight miles of us and others of which are up to 60 or 70 miles distance. But these people are returned to the community and they are aided in some instances by attending the after care clinics of the state. Even these clinics are. Distant from the local community. It is impossible under such circumstances. For the state agencies to
effectively. Make a relationship with those persons and those agencies within the local community and bring about the rehabilitation of the individual as well as to advise his family and friends in his future care. We could give many other examples of such problems even the large general hospitals are unable to properly. Manage the diagnostic work and the treatment of the patients. And I say this in the face of the fact that many general hospitals have. General Hospital units and also outpatient department set aside specifically for the care of the mentally ill. For instance one of the problems of the General Hospital existed directly in the admitting office. The admitting is usually. Done by a physician who has had relatively little experience in the. Recognition or care of the person with an emotional illness.
In many instances we have found that the recommendations made at the admitting dest would have been much better done. By a person considerably more experienced than the type of individual who through tradition sits in the position of making the initial dispositions. We find in this city that many of the acute and serious disturbances that occur are in the course of alcoholism or even other illnesses are sent directly to the central unit to the Bellevue Hospital. The physicians working here the psychiatrist working here are tremendously overburdened. In our own community approximately 50 percent of the persons who go to Bellevue and I suspect this same process occurs in other large cities where a central receiving unit exists approximately 50 percent are returned to the community. The central unit
may not. And is not in a position to arrange for the proper after care of those persons who are showing evidence of an emotional disturbance through an acute upset of the nature that takes him to the institution in the first place. We need therefore in my opinion the establishment of community based organizations. Which have as their primary responsibility their provision of the continuous care of patients. Who are recognised as ill in that area. It has been hinted that a mentally ill person will go a distance from his home for that care rather than going to a hospital which may be nearer to his home base. I asked Dr Cobb what caused this person to go to some other unit at a distant point. He said well the establishment of the care of the patients in a city such as New York determines the lines of care that the individual receives. And this occurs in many other states and counties and cities.
There are certain hospitals designated in certain clinics known to take care of. Mental health problems and usually they have such hospitals are designated to care for particular types of problems. What we need is the establishment in each of the local communities of facilities which can care for a multitude of problems that are now. The responsibility of the major institutions such as the state or the city. It shouldn't be necessary that a person who has a. Disturbance coped under the guise of alcoholism is sent to a single institution or a few institutions within the community each community should have available facilities for the care and. Proper diagnostic measures and eventual advice to the individual.
With this type of illness I asked Dr Cobb if this might also be that is the person going from his home base to a distant point for treatment might have something to do with the shame attached to his mental illness. There is no question that this occurs at the moment of people coming to this community in order to avoid the feelings of shame that they would have of exposing such an illness in their own community. Of course this brings up the very important point of the attitude of the community towards a person who has an illness of this type. At that point. Where. All of us are able to accept the psychiatric disease disability the mental illness is. In the same way that we accept such a fit. Frankly physical illness as pneumonia. At this point it will be possible for. A person who becomes upset or becomes aware of his.
Emotional Disturbance to consult with those in his own community. Who can and most properly give him the care he needs. Obviously this. Is preferable to. The effort many people may to attain health away from their own. Home Community. It is economically perfect for preferable that's preferable in terms of their own families and in the long run is preferable as far as retaining them as active persons in their own home community. There is unfortunately a dire lack of persons in the mental health professions to deal adequately with the mentally ill. To offset this lack it has been suggested that a caretaker type organization be established that is someone that the ordinary individual can go to when he is suffering from an emotional disturbance such as the clergy or perhaps even a grocer or a friend. I asked Dr Cobb
what he felt of this particular approach. Well first of all it's clear that. Many people who are mentally ill do talk to many other persons and psychiatrists and these other persons are the roads through wish. It should be possible for the hill. To obtain the proper professional advice regarding their future health. Let's go back for a moment to the attitude of community now that communities are made up of people. If people in the communities if all of us in our communities. Have a capacity for recognizing the existence of a type of illness that we're discussing. Then we should at the same time. See in the illness. A problem for which there is some type of treatment and we should be able to adopt towards an individual tolerant attitude. And I would say that if it is clearly
apparent that our member of our family or our friend or the carryall of Queens even is ill we should. Find it possible and we should suggest that they seek some advice from the proper sources. Now you mentioned that it's impossible for everyone in this country to obtain private care this is true. The real issue however is not the matter of care the first issue is the establishment of what the problem might be. That is what the doctors call the diagnosis. And I would say that a diagnosis should be established through some medical agency as it has in our previous discussion we've defined the fact that. Such illnesses may come from many sources. They may be physiologically determined they may be chemically determined or they may be determined because of the unfortunate consequences of life leading to either improper experiences in the past or the privations of experience. The type of treatment a person
gets. He's determined on the basis of the predominant factors in his illness. And the physician who has some understanding of both the biological and the. Developmental processes is the one that can. Probably make the best determination of the. Treatment required. At this point the person may be referred in many many ways. He may have a problem with the physician can handle then and there. We can through some medical measures or pharmacological measure measures. He may have a problem which will indicate that he should be. Sent to. A psychoanalyst. He may have a problem that would require the aid of counseling that could be provided through some psychological process as he may have a problem with a relatively simple. That is best handled by some of the neighborhood by others in his own community. So I would say the first
issue in the recognition of any illness. One of the first issues for the person who is ill is the decision about from what he is suffering and the advice as to where he should seek the proper aid. There are many many community agencies that provide aid of one sort or another. The question the real issue is to be referred to the proper. Place in the first contact. A recognition of the illness. Dr Cobb has brought us back to the anatomy of the community so to speak. And the question what are the results of overcrowding of the various physical environments of the community on the individual prompted this answer from Dr. Drew. People used to say that overcrowding persay leads to difficulties. In overcrowded areas you have more often delinquency or you have more often tuberculosis or you are in mental illness.
But I think that the whole problem is much more complex than just overcrowding itself because with overcrowding comes other things it becomes lower socioeconomic status it brings certain kinds of people with certain social striving it brings nutritional deficits in populations and brings a different value system. To bear on the individual. So the solution really is not to do something just about the overcrowding I think we found this in in our cities where they've said OK clean the slums and put them in good houses. What happens well they become delinquents in the good houses. And the houses themselves don't do anything for them. But when you take houses plus working with the people and giving them some opportunity to participate for
example in the areas of New York where they have. Workers working with the gangs in Washington here today there when they move people out of the slums in urban redevelopment they have they have a team of. People working with the people who are being relocated sort of taking advantage of the stressful situation that people are facing. And getting ready to move into new houses. But also using this stressful situation with this crisis to help them learn and make better use of their future then then maybe some results will take less then you'll have something. But just to just clean overcrowding and put them in new houses without doing all these things I think is personally useless. Inevitably when talking about overcrowding of a community the question of birth control generally comes up. I asked Dr. Drew if this would be in any way a solution to the problem.
I would answer the question of birth control the way I would answer the question. Just overcrowding. Just do something about birth control itself is not going to do a thing. Birth control is one thing that one might do in a community or with with families. Given the certain set of circumstances I don't see it as a panacea for all the ills. But I see you think it is something that we should definitely consider as our populations begin to burgeon not only in this country but elsewhere. When you start looking at the problem. Somebody will have the problem of mental health in India for example all through Asia. And somebody says well what do you do about mental retardation or about mental illness. That year you find yourself completely and totally frustrated because the individual really isn't that important in the individual lives are cheap.
When you've got almost literally billions of people. And the basic problem there is food and shelter. Some basic necessities of life. It's pretty hard to ask anybody to consider mental health problems. I was asked to deal with mental health problems with a burgeoning community I'd say there are some things that come way before dealing with anything psychiatric. Maybe some of the basic things might be to deal with population. Food supply. Food distribution. To conclude this program about the community and mental health. I ask Dr. Drew if mental health problems were as great in the rural community as they were in urban communities. He commented today. I don't think any really sound studies that have. Reported the actual incidence of mental illness in comparable populations and I. The urban community. However I think we
can say the closer one gets to. The centers of urban density is the closer one gets to the 600. The more chance you have that the community is concerned with its mental health problems. Then if you find yourself in the area in the western part of the United States. And Wyoming is very different from an urban area five thousand right next to New York City. And the one next to New York City may very well be much more concerned about mental illness. You may have many more reported cases of delinquency reported cases of schizophrenia reported cases of mental retardation. This doesn't mean. That there really is actually any more. We don't know the actual measurements of these conditions in these two different communities. We do know. That. There are more reported cases. As you get into urbanized areas of high population density.
And this is what gets me back to a point that I. Think I made to you before. So often some of the problems of mental illness are really problems that. Are socially defined. That a child is not mentally retarded until somebody calls him turd. He may never be considered mentally retarded by his family but when he gets into a school and the school has to evaluate him then he becomes mentally retarded. A kid going to a school and in an Arkansas a small town. Will be evaluated differently than a kid going to school in an upper middle class section of New York City. And. They will be much more concerned in New York City about his abstract intellectual ability than they would in this Arkansas town. Our thanks to Dr. Lawrence Cobb of the medical center of Columbia University and to Dr. Leonard J DOOL of the National Institute of Mental Health in Bethesda Maryland for their participation on this program dealing with the community
and mental health. Next week you will hear Dr. Drew empty Silverton of the University of Minnesota. Dr. John F. Ender's of Harvard University Dr. Joseph Hill of the Wadley Research Institute in Dallas Texas. Dr. John Kinross Wright of the Baylor Medical Center in Houston Texas. Dr. Roger Mitchell of the University of Colorado. Dr. Harry Calvin Jr. of the University of Chicago. Once again you will hear Dr. Leonard J Dilla will also Dr. Don Jackson of the Palo Alto medical clinic in Palo Alto California. Dr. Harry Levinson of the Menninger foundation in Topeka Kansas and Dr. Lawrence Cobb and Dr. Saul Roy Rosenthal of the University of Illinois as they discuss biochemistry and mental health. On the next program from the series human behavior social and medical research we extend our special thanks to the Mental Health Research Institute of the University of Michigan for their assistance.
And this is Glenn Phillips speaking asking that you join us next week and thanking you for being with us at this time. This program has been produced by the University of Michigan broadcasting service under a grant in aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. This is the N.A. E.B. Radio Network.
- Aspects of mental health
- Community and mental health
- Producing Organization
- University of Michigan
- Contributing Organization
- University of Maryland (College Park, Maryland)
- AAPB ID
- Episode Description
- This program focuses on the community and mental health. Guests are Lawrence Kolb, M.D.; and Leonard J. Duhl, M.D.
- Series Description
- A documentary series on the role of behavioral sciences and medical research.
- Broadcast Date
- Media type
Host: Canham, Erwin D. (Erwin Dain), 1904-1982
Interviewee: Duhl, Leonard J.
Interviewee: Kolb, Lawrence, 1881-1972
Producing Organization: University of Michigan
- AAPB Contributor Holdings
University of Maryland
Identifier: 62-18-5 (National Association of Educational Broadcasters)
Format: 1/4 inch audio tape
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- Chicago: “Aspects of mental health; Community and mental health,” 1962-05-01, University of Maryland, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC, accessed November 28, 2023, http://americanarchive.org/catalog/cpb-aacip-500-610vv22x.
- MLA: “Aspects of mental health; Community and mental health.” 1962-05-01. University of Maryland, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC. Web. November 28, 2023. <http://americanarchive.org/catalog/cpb-aacip-500-610vv22x>.
- APA: Aspects of mental health; Community and mental health. Boston, MA: University of Maryland, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC. Retrieved from http://americanarchive.org/catalog/cpb-aacip-500-610vv22x