>> WELCOME. I'M JEFF RES INITIATION CK SENIOR HISTORIAN HERE FOR AND THANK YOU FOR -- JOINING US. WE HAVE HISTORY FOR BIOMEDICINE, SOCIAL SCIEN SCIENCES AND HUMAN. WE SUPPORT THE COMMITMENT OF THE NLM FOR THE DIVERSITY OF DLEKSES WHICH HAVE A RANGE OF DIJ CAL FORMAT AND RANGE OVER THE WORLD. WE HAVE VOICES OF PEOPLE OF COLOR, WOMEN AND INDIVIDUALS OF A VARIETY OF BACKGROUNDS WHO VALUE THESE COLLECTIONS AND USE THEM AT THE ADVANCE THEIR RESEARCH, TEACHING AND LEARNING. WELCOME EVERYONE. FOR THOSE OF YOU WHO WISH TO SHARE THEIR QUESTIONS WITH SPEAKER, USE THE LIVE FEEDBACK BUTTON ON THE VideoCast. TODAY I HAVE THE GREAT PLEASURE AND PRIVILEGE TO INTRODUCE NAMHEE LEE WHO IS WITH EWHA UNIVERSITIES IN SOUTH KOREA AND TEACHES HISTORY THEORY TO GRADUATE STUDENTS. HE WAS A POSTDOCTORAL FELLOW AND TEACHES IN SOUTH KOREA. SHE COMPLETED HER PhD. IN HISTORY AT SYRACUSE EEFORT WITH THE DIRS TAITION ENTITLED SPOCK PARADOX,IVENESS AND CONTROL AND NEW ADVICE FOR PARENTING IN DEMOCRACY. DR. LEE IS AUTHOR OF ANY TIME RUSS SCHORLY AVRILS TWO IN JOURNAL OF MELON TALL HEALTH INCLUDING THE DREAM OF THE NEW DESCRIBE TRI WILLIAM C. MANAGENNER AND PSYCHE ANALYSIS. SHE'S PUBLISHED IN THE KOREAN JOURNAL IN HISTORY AND WESTERN REVIEW. SHE SHARES ASPECTS OF RESEARCH IN MENTAL WE WELL-BEING IN WESTN AMERICA FOCUSING ON ROBERT H. FELIX. IF IN HER RESEARCH SHE IS HE BEEN DRAWING ON THE NLM'S COLLECTION OF DR. FELIX'S PAPERS. DR. LEE, THANK YOU SO MUCH FOR JOINING US FROM SOUTH KOREA. >> THANK YOU, JEFF. THANK YOU FOR LETTING ME HAVE THIS OPPORTUNITY TO PRESENT MY CITY. IT'S THE PRIVILEGE AND HONOR FOR ME TO DO SO. I WOULD LIKE TO AND BEGIN -- THERE WE GO. I WOULD LIKE TO BEGIN BY REFLECTING ON THE REMARK WHICH [INDISCERNIBLE] WROAPT IN THE AMERICAN JOURNAL OF PSYCHIATRIC RI IN JULY 1961. IN HIS INTRODUCTION, ROBERT FELIX, THE NLM PRESIDENT FROM 1960 TO 1961 HE WAS DESCRIBE DR. FELIX AS SUMP. AS WE SURVEY THIS WONDERFULLY PRODUCTIVE CAREER IN WHICH A DEDICATE MAN CARRIED BENEVOLENCE, WE CAN I SAY TO HIM AND OF HIM. THIS REMARK ALLOWS US TO ASSUME THAT THE PATH DR. FELIX WENT THROUGH MIGHT BE DIFFERENT THAN OTHER PSYCHIATRISTS SINCE PROMINENT FIGURES IN PSYCHIATRY AND THE DISCIPLINE BEGAN TO ACQUIRE FAME AT THE TIME. DURING -- TODAY I WOULD LIKE TO DRAW ATTENTION TO DR. FELIX'S EFFORT IN ESTABLISHING THE POST WAR DIRECTION IN PUBLIC MENTAL HEALTH. BEFORE MOVING ON TO HOW DR. FELIX CONTRIBUTED TO THE NATIONAL HEALTH SECTOR, I WANT TO INTRODUCE OVERALL INFORMATION ABOUT DR. FELIX WHO HAD A LONG CAREER IN THE PUBLIC SERVICE, PHS, ALL THEAUX THERE IS NO PUBLISHED NOTTOGRAPH OR PUBLISHING ON DR. FELIX, HE'S PROMINENT IN THE MENTAL HEALTH RELATED TOPICS AFTER WORLD WAR R II, IT FELIX APPEARS WITHOUT FAIL IN DEALING WITH NATIONAL MENTAL HEALTH FUNDING FROM RESEARCH INSTITUTES AND DRUG-RELATED EMENTS. LMENTS. DR. FELIX WAS EYE PSYCHIATRIST, MEDICAL DR DOCTOR AND ADMINISTRATOR. WIDELY KNOWN AS THE FIRST DIRECTOR OF THE NATIONAL INSTITUTE OF MENTAL HEALTH, FRM 12959 TO 1964. HE WAS THE PRESIDENT OF THE AMERICAN SCR PSYCHIATRIC ASSOCIN FROM 1960 TO 1961 AND ONE OF THE KEY PLAYERS TO DEVELOP A OVERALL PICTURE OF MENTAL HEALTH POLICY WHO MADE A MENTAL HEALTH ACT IN 1946 POSSIBLE. BORN IN 1904, DOWNS KANSAS TO [INDISCERNIBLE], HE FER SUED A CAREER IN PEN TALL HEALTH RATHER THAN PSYCHIATRY. AFTER GRADUATING FROM -- HE WORKED AS A RESIDENT AT COLORADO PSYCHOPATHIC HOSPITAL. HE BEGAN HIS CAREER IN 1933 AND MAINTAINED VARIOUS POSITIONS AT THE PHS DURING THE SECOND WORLD WAR. AS ON OFFICER OF THE PHS FROM 1936, HE WAS ASSIGNED TO THE FEDERAL NARCOTIC TREATMENT CENTER IN LEXINGTON, KENTUCKY. AFTER SERVING FOR THREE YEARS AT THE PHS CENTER IN SPRINGFIELD MISSOURI UNDER THE DEPARTMENT OF JUSTICE. HE RECEIVED HIS MASTERS DEGREE FROM JOHNS HOPKINS UNIVERSITY SCHOOL OF PUBLIC HEALTH IN 1942 AND WAS DEPLOYED TO THE COAST GUARD ACADEMY AS A PSYCHIATRIST AND SENIOR MEDICAL OFFICER. HE RETURNED TO THE PHS IN 1944 AND WORKED AS AN ASSISTANT CHIEF IN THE BUREAU OF MEDICAL SERVICE. IN THE SAME YEAR, DR. FELIX BECAME THE CHIEF OF THE MENTAL HYGIENE DIVISION. HIS CAREER DEVELOPMENT ALLOWED HIM TO BE THE MOST EXPERIENCED OFFICER WHO UNDERSTOOD PUBLIC MENTAL HEALTH POLICY DURING THE TIME. AROUND 1940s, MOST PSYCHIATRIC SPECIALISTS HAD EXPERIENCED -- HAD EXPERIENCE WITH STATE HOSPITALS OR RUNNING PRIVATE CLINICS. IN CONTRAST, FELIX, BECAUSE OF HIS CAREER AND EXPERIENCES AT A COUPLE OF AGENCIES UNDER THE PHS WAS ONE OF THOSE WHO KNEW BETTER THAN ANYONE WHAT WAS NEEDED TO IMPROVE THE MENTAL HEALTH CARE SYSTEM WHICH WOULD DETERMINE THE GREAT FRAMEWORK FOR POLICY DIRECTION AFTER WORLD WA WORLD . ALSO THE FACT THAT HE WAS OUT OF THE POST WAR DEBATE ON PSYCHE O ANALYTIC APPROACH PLAYED A ROLE IN HIS UNRIVALED POSITION. KNOWN AS THE FIRST PRESIDENT OF THE NATIONAL INSTITUTE OF MENTAL HEALTH AND A CENTRAL FIGURE IN PASSING THE NATIONAL MENTAL HEALTH ACT OF 1946, FELIX IS NOT A WIDELY KNOWN FIGURE COMPARED TO THE FAME OF HIS TIME. DESPITE PLAYING AN IMPORTANT ROLE IN DETERMINING AMERICAN MENTAL HEALTH POLICY IN THE MID 20TH CENTURY, INFORMATION ABOUT HIM IS IT LIMIT COMPARED TO OTHER MEDICAL PROFESSIONALS WHO WORKED AROUND THE SAME TIME. FORTUNATELY I WAS ABLE TO HAVE AN OPPORTUNITY TO RESEARCH THE ROBERT H. FELIX PAPERS AT THE NATIONAL LIBRARY OF MEDICINE IN SUMMER 2022. THIS TALK IS PART OF THE THE STUDY BASED ON THE FIELD WORK FOR THE FELIX PAPERS. HE'S KNOWN TO SOME EXTENT SERVING AS AN OPPORTUNITY FOR THE DEVELOPMENT. OF BOTH AMERICAN DESCRSCRIKS AND MENTAL HEALTH. IT WILL WOULD BE GOOD TO TRACE HIS ACCOMPLISHMENTS AND CONTRIBUTIONS AND ALSO THE UNDERSTANDING OF THE DIRECTION AND GOAL OF THE FEDERAL MENTAL HEALTH POLICY WOULD ILLUMINATE THE ORIGIN AND COMPLICATE THE REALITY OF POST WAR NATIONAL MENTAL HEALTH POLICY. SO, WHEN WE DEAL WITH CHANGE OR DEVELOPMENT, OFTENTIMES OVERCOMING VARIOUS CIRCUMSTANCES OF THE PAST AND IMPROVING IN A BETTER WAY IS THE IDEA OF DESCRIPTION. THE PERIOD I COVERED HERE WAS RECOGNIZED AS MODERN DEVELOPMENT OF PSYCHIATRY OR A PERIOD OF CHANGE. WORLD WAR II GAVE UNPRECEDENTED EXPERIENCE BECAUSE OF THE NUMBER OF PATIENT SOLDIER WHOSE SUFFERED FROM NEW NEWERO PSYCHIC SYSTEMS -- NURO PSYCHIATRIC SYSTEMS. THEY REALIZED THE STATEMENT OF THE HOSPITAL SYSTEM WHICH HAD BEEN MAINTAINED UNTIL 40. HOWEVER, THESE DRAMATIC ELEMENTS HAVE THE EFFECT OF MAKING THE PREVIOUS WEAK AND EXPISSING EXIG PRACTICES LOOK LIKE FAIL LTD ATTEMPTS. I WANT TO TALK ABOUT EARLY MENTAL HEALTHCARE IN THE EARLY 20TH CENTURY FIRST. AS PREVIOUSLY KNOWN, THE REALITY OF PSYCHIATRIC INSTITUTIONS AT THE BEGINNING OF THE 20TH CENTURY DID NOT SEEM IDEAL. IN PARTICULAR, MENTAL HEALTH SITUATION JUST BEFORE WORLD WAR II SEEMED TO BE WORSE THAN THAT OF OTHER MEDICAL DEPARTMENTS AT THAT ADVOCATED SCIENTIFIC MEDICINE. AUTOMATIC THOUGH WORLD WAR II AND SCWEPT CHANGES SEEMED TO HAVE A SIGNIFICANT IMPACT ON PSYCHIATRY'S TRANSFORMATION INTO A DISCIPLINE THAT PLAYS A MAJOR ROLE UNTIL POLICY, THE WAR WAS THE MAIN CULPRIT AT THAT MADE THE SITUATION OF WAR-TIME MENTAL HEALTH MUCH WORSE. UNDER THE WARTIME SYSTEM, PSYCHIATRISTS WHO WERE NOT PLENTY HIM TO GO TO THE BATTLEFIELD. THIS WAS NOT LIMITED TO DOCTORS. WILL ALL NURSES AND OTHER STAFF WHO WERE DIRECTLY OR INDIRECTLY ENGAGED IN THE STATE MENTAL HOSPITAL SYSTEM HAD TO MOVE TO WORK FOR THE COUNTRY IN A CRITICAL NATIONAL CRISIS. AS A RESULT, THE NUMBER OF DOCTORS AND MEDICAL WORKERS TO PATIENTS DECREASED EVEN MORE. IT WAS RELATIVELY TO MAINTAIN THE STATUS QUO IN MENTAL HEALTH BECAUSE FUNDS WERE INVESTED IN CONDUCTING WAR IN ALL DIRECTIONS. HOWEVER, THE POOR MENTAL HEALTH SITUATION HAD ALREADY DWUN IN THE EARLY 20TH -- BEGUN IN THE EARLY 20TH CENTURY. THE TURNOVER RATE OF PATIENTED L ADMITTED TO MENTAL HEALTH HOSPITALS DROPPED. THERE WAS THE THOUGHT PSYCHOSIS WAS INKEURL DISEASE. PATIENTS WERE DISCHARGED. THE STICKS WERE NOT AN INDICATOR OF THE EFFECTIVENESS OF THE PRE20TH CENTURY HOSPITAL SYSTEM. PATIENTS SUFFERING FROM CHRONIC DISEASE WHO WERE NOT ABLE TO BE TREATED WERE SENT TO OTHER INSTITUTIONS. SINCE THE 1890s HOSPITALIZATION STEADILY INCREAINCREASED AND LONG TIME HOSPITALIZATIONS WERE MORE THAN FIVE YEARS AND ACCOUNTED FOR MORE THAN 50%. THIS CHANGE WAS ACCOMPANIED BY MEASURES TAKEN BY STATE POLICY. THE CLEAR LINE OF THE COMMUNITY RESPONSIBLE FOR CHRONIC PATIENTS AND THE GOVERNMENT IN CHARGE OF TREATING ACUTE PATIENTS AND STATE INSTITUTIONS HAVE BEEN BLUSHED SINCE THE END OF THE 19 H 19TH CENTURY. TREATMENT APPEARED TO BE EFFECTIVE IN MENTAL ILLNESS BUT FACILITIES UNDER LOCAL COMMUNITY APPEAR TO BE INEFFICIENT AND POOR INSTITUTIONS FILLED WITH COUNTRY ILL PATIENTS. STATE OFFICIALS, THEREFORE, DETERMINED THAT STATE-AFFILIATED HOSPITALS ADMIT PEOPLE WHO COULD BE CLASSIFIED AS MENTALLY ILL. THE THING IS THAT THE CHRONIC CONDITION OF THE PATIENTS WAS NOT THE RESULT OF THEIR CONFINEMENT 23 IN COMMUNITY INSTITUTIONS. MOST OF THEM COULD RECEIVE -- COULD NOT RECEIVE FAMILY HELP IN THE FIRST PLACE. EXPWH LOCAL GOVERNMENTS DID NOT MISS A GOLDEN OPPORTUNITY FOR BUDGET. THEY IDENTIFIED VAIR JUST MENTAL DEFECTS AND DEGRADATION CAUSED BY SENILITY. BY 19150, 40% WERE OVER THE AGE EVER 60. STATE MENTAL HOSPITALS WHICH HAVE MAINLY DEALT WITH SHORT-TERM AND EXTREME SYSTEMS BECAME INSTITUTIONS RESPONSIBLE FOR CHRONIC PATIENTS WITH PHYSICAL ILLNESS ESPECIALLY OLDER PATIENTS SINCE THE 1920s AND THESE INSTITUTIONS OFTEN HAD TO TAKE CARE OF THEM UNTIL DEATH. EFFECTIVE TREATMENT AND SUCKFUL OVERCOMING GRADUALLY DISAPPEARED AND THE STATE HOSPITALS SIMPLY BECAME PLACES WHERE THE PATIENTS STAY UNTIL THEY DIE. 23RD PATIE -- 23 FOR PATIENTS WH PHYSICAL ILLNESS OR AGING, THE PSYCHIATRIST WOULD RELIEVE OR STABILIZE THE SYSTEMS. COST OF CARE WAS THE MAIN TASK. THIS CHANGE WAS NOT JUST A PROBLEM FOR STATE MENTAL HEALTH HOSPITALS. THE EXPERIENCE WAS A FACTOR IN MAINTAINING MEDICAL DISCIPLINE. BUT PRESCRIBING LONG TERM PATIENTS DRUGS AND MONITORING HAD THOUGH CHOICE BUT TO NEGATIVELY EFFECT PSYCHIATRY AS MEDICAL DISCIPLINE ITSELF. IN ADDITION TO THE POOR WORKING CONDITIONS, THE INABILITY TO FEEL REWARDED AS A PROFESSION MAKES PSYCHIATRY EVEN MORE UNATTRACTIVE AND THE CLINICAL EXPERIENCE THAT IS MOST ESSENTIAL FOR THE DEVELOPMENT MEDICINE WAS LIMITED TO EAJ GROUPS AND SPECIFIC DISEASES. THE TREATED PATIENTS WITH NEW SYSTEM, WAS RI RISKY BUT STATE MENTAL HEALTH HOSPITALS WERE NO LONGER ABLE TO PLAY THIS WILL ROLE. HOWEVER, IT IS INTERESTING TO NOTE THAT MENTAL HOSPITALS CONDITIONS WERE RELATIVELY BETTER THAN OTHER STATE DISMERINSTITUTIONS WERE BETTER. HOSPITALIZATION TREATMENT WAS BETTER THAN COMMUNITY AND INDIVIDUAL MANY TREATMENT. THE NUMB NUMBER OF ELDERLY PATS COULD NOT BE CARED FOR AT HOME INCREASED IN THE AFTERMATH OF THE COUNTRY CRISIS. MAINTAINING THE STATUS QUO ALONE MIGHT HAVE SEEN LIKE A BETTER CONDITION AT THE TIME BUT THAT DOES NOT SOLVE THE MENTAL HOSPITAL ITSELF WHICH HAD BEEN REVEALED SINCE THE 1920S. TIME PASSED WITHOUT CHANGING THE REALITY OF INCREASING PATIENT NUMBERS REDUCED FINANCES AND AGING FACILITIES. COMPARED TO THE 1930s, THE 1940s, THE EXISTING PROBLEMS BECAME MORE EVIDENT. THE INCREASING NUMBER OF PATIENTS WITH CHRONIC DISEASES MEANT AN INCREASE IN THE DENSITY OF THE RECEIVING POPULATION. THE 1930s, EVEN INSTITUTIONS THAT RECEIVED STABLE FINANCIAL SUPPLY AND DEMAND WOULD HAVE BEEN ABLE TO MAINTAIN THE STATUS QUO. SO IT WAS DIFFICULT TO EXPECT TO IMPROVE THE ENVIRONMENT OF PATIENTS. THE BIGGEST PROBLEM WAS THAT THE NUMBER EVER MEDICAL PROFESSIONALS WAS DECREASING NATIONWIDE DUE TO WORLD WAR II. THE NUMBER OF PATIENTS PER CAPITA INCREASED, MUCH COURSE OT MADE FOR PRESSURE ON IN-PATIENTS. THE CARE INCREASED AS THE NUMBER OF EMPLOYEES DECREASED. FINANCIAL DIFFICULTIES MADE IT IMPOSSIBLE TO BUILD NEW FACILITIES TO ACCOMMODATE A GROWING NUMB NUMBER OF PATIENT. WORLD WAR II HAD A NEGATIVE EFFECT ON THE EXISTING STATE MENTAL HEALTH HOSPITAL SYSTEM. IT IS WELL-KNOWN THAT WORLD WAR II WAS A SYMBOLIC TURNING POINT, AS I MENTIONED BEFORE, FOR THE DEVELOPMENT OF PSYCHIATRY IN THE UNITED STATES. THE IMAGE OF THE DISEASE PREVIOUSLY DEALT WITH BY PSYCHIATRY WAS TREATED FROM MODERN SCIENCE WHICH ADVOCATED A SCIENTIFIC APPROACH UNTIL THE MOMENT THE UNITED STATES DECIDED TO PARTICIPATE IN THE WAR DUE TO THE ATTACK ON PEARL HARBOR, PSYCHIATRY WAS STILL POOR IN DEALING WITH MENTAL ILLNESS AND MENTAL STATE. SINCE THE END OF THE 1-9DTH CENTURY, MANY THEORIES HAVE EMERGED DUE TO PSYCHE ANALYSIS BUT WERE REJECTED BY THE AMERICAN PSYCHIATRIC COMMUNITY BECAUSE THOSE THEORIES HAD A EUROPEAN TRADITION OR SEEMED UNSCIENTIFIC FOR THEM. FROM THE MID TO LATE 19TH CENTURY, STATE MENTAL HOSPITALS WERE BY NO MEANS AN UNDER-DEVELOP ACCOMMODATION FACILITY. 50% OF PATIENTS WITH ACUTE MENTAL ILLNESS IN THE 19th CENTURYIVE WERE HOSPITALLED FOR LESS THAN A YEAR. UNTIL 1808 THE NUMBER OF PATIENTS WITH CHRONIC DISEASES REMAINED AT 5 TO 10%. THIS DETERMINED THE CAPACITY OF MENTAL HOSPITALS. IT CAN BE SAID THAT PSYCHIATRIC DEPARTMENTS CENTERED ON PSYCHIATRIC HOSPITALS BEFORE THE 20TH SE CENTURY EXPERIENCED RELATIVE SUCCESS BEFORE THE 20TH CENTURY. THE CARE IN THE EXISTING ENVIRONMENT WAS RECOGNIZED AS THE BEST TREATMENT FOR ACUTE DISEASES. HOWEVER, THIS BLEEFL LED TO THE ENVIRONMENTAL DEGRADATION OF STATE MENTAL HEALTH HOSPITALS FROM THE LATE 19TH CENTURY TO THE EARLY TO MID 20TH CENTURY. THIS DETERIORATION LOAD TO EFFORTS TO IMPROVE THE ENVIRONMENT IN MEN HALL HEALTH HOSPITALS. THE BEGINNING OF THE ME MENTAL HEALTH MOVEMENT WAS THE PUBLICATION OF THE BIOGRAPHY IN 1908 WHICH WAS A FAMOUS ONE. THE ESTABLISHMENT FOR THE COMMITTEE FOR MENTAL HYGIENE IN 1909, THE SCOPE OF THE MENTAL HEALTH MOVEMENT GRADUALLY EX-PNDED TO AREAS IT THAT WERE THOUGHT TO BE RELATED TO MENTAL HEALTH AT THE TIME. AS THE IMPORTANCE OF THE ENVIRONMENT, INCLUDING THE RELATIONSHIP WITH CAREGIVERS EXPERIENCING THE PROCESS OF GROWTH WAS HIGHLIGHTED IN THE HUMAN MIND. IT WAS THOUGHT THAT THE ENVIRONMENT SHOULD BE IMPROVED TO PREVENT THE DETERIORATION OF MENTAL ILLNESS IN EVENTS. THEREFORE, TRILLION IN LECTURE DISABILITY SINLS SINCE THE 192N POOR ENVIRONMENT IN THE STATE HOSPITALS WAS MADE. THIS WAS E EMPHASIZED IN A QUARANTINE OF IMMIGRANTS AND FOREIGNERS. SCHOOL AGE OF SCHOOL CHILDREN EXPANDED TO AREAS EVER MENTAL PROBLEMS SUCH AS JEUF NIEF NILE DLIRCHG T DELINQUENCY AND OTHER PROBLEMS. IT WAS RELATED TO DRUG ADDICTION. THE ENACTSMENT OF THE HARRISON NARCOTIC ACT OF 1914 MADE IT POSSIBLE TO PUNISH DOCTORS WHO HAD THE AUTHORITY TO PRESCRIBE DRUGS. HOWEVER, DRUG ADDICTION WAS NOT THE ONLY AREA WHERE THIS WAS CURED, ALTHOUGH IT WAS NOT EASY TO UNDERSTAND THE DIRECTION OF THE MENTAL HYGIENE MOVEMENT AT THE TIME AND THE ADDICTION OR DISPENT AT THE TIME. DPLENSED AT THE. DEPEN DANCE. THIS WAS A PROBLEM TO BE SOLVED NOT JUST BY CRIMINALIZATION. THERE WAS CREATED THE DIVISION OF MENTAL HYGIENE AND EXPANDED THE ROLE OF FEDERAL GOVERNMENT, THE DIVISION OF CANDIDATES LED TO RESEARCH ON NATURE AND TREATMENT METHODS OF DRUG ADDICTION AND REHABILITATION OF ADDICTS SPREAD INFORMATION ABOUT TREATMENT AND RESEARCH. WORK WITH THE STATE AND COMMUNITY IN MAINTAINING FACILITY FOR THE TREATMENT AND CARE OF ADDICTS AND PREPARED MEDICAL AND PSYCHIATRIC TREATMENTS IN FEDERAL PRISONS. IT ALSO PLAYED A ROLE IN INVESTIGATING THE PROCESS OF SPREAD OF NEUROSIS AND PSYCHOSIS AS WELL AS THE METHODS FOR PREVENTION AND TREATMENT. IN 1938, BARNES COLE WHO WAS KNOWN AS THE AUTHORITY ON DRUG RESEARCH AND TREATMENT WAS THE HEAD OF THE DIVISION OF MENTAL HYGIENE CAME TO THE POOR AND SERVED AS THE LEADER AND THEN HAD A SUCCESSOR IN 1944. HOWEVER, FROM 1939 WHEN THE DEVASTATION OF THE WAR HIT EUROPE, THE UNITED STATES HAD TO CONSIDER PARTICIPATING IN THE WAR. IN LINE WITH THE ROOSEVELT GOVERNMENT, THE FUTURE WAR WAS TO SAY GOOD-BYE TO NON-SCIENCE WHICH WAS UNPREDICATED IN THE PREVIOUS WAR. THE ESTABLISHMENT OF THE OFFICE OF SCIENTIFIC RESEARCH AND DEVELOPMENT, OSRD, IN 1941 WAS LIKE SIGNALING THAT THE SITUATION DURING AND AFTER WORLD WAR II WOULD BE COMPLETELY DIFFERENT FROM BEFORE. AS I MENTIONED PREVIOUSLY, FELIX'S HISTORY ALLOWS TO US PRESUME WHY HE WAS THE FIRST DIRECTOR OF THE NATIO NATIONAL INSTITUTE OF MENTAL HEALTH WHICH WOULD HAVE POLICY AFTER WORLD WAR II. MANY PEOPLE IN THE POST CAR PSYCHIATRY THOUGHT THAT THE DISCIPLINE SHOULD PLAY AN STNDED ROLE DIFFERENT FROM BEFORE. BUT THERE WAS DIVISION ON THE APPROACH AND METHODOLOGY STARTING FROM WORLD WA WORLD WA, VOICES CALLING FOR EXPANDING THE ROLE OF PSYCHIATRY WERE -- CENTERED ON THE AMERICAN PSYCHIATRIC ASSOCIATION. THIS DEBATE REPRESENTED A DISAGREEMENT BETWEEN THOSE WHO WERE TRAINED IN THE STATE PSYCHIATRIC HOSPITAL SYSTEM BEFORE THE 1940s AND THOSE WHO WERE NEWLY DEPLOYED DURING WORLD WAR II. HOWEVER, BECAUSE THE NUMBER OF DOCTORS WHO WORKED BEFORE WORLD WAR II WAS ALMOST THE SAME AS THE DOCTORS WHO WERE PUT INTO THE WAR FRONT. THE DIRECTION OF DEVELOPMENT IN PSYCHIATRY AND MENTAL HEALTH DEPEND MORE ON NEWLY -- DEPENDED MORE ON NEWLY-TRAINED DOCTORS. THEY ACTIVELY TRIED TO USE PSYCHO DYNAMIC THEORY TO EXTEND THEIR POWER. AND STAFF WHO WERE FAMILIAR WITH THE HOSPITAL SYSTEM WERE AGAINST THIS TREND. HOWEVER, BY NUMBERS, ABOUT HALF OF THE ASSOCIATION'S APA MEMBERS SEEMED TO HAVE AGREED TO EXTEND THE PSYCHIATRIC DIEMENT AND EXPAND THEIR INFLUENCE AND A WATER EVER THE MEMBERS FIRMLY EXPRESSED ANTIPATHY TO THIS. THE MANAGER WHO ROSE TO THE HIGHEST RANK WHO FOUGHT DURING WORLD WAR II LED THIS CHANGE. HE WAS THE MAIN SUPPORTER OF PSYCHO DYNAMIC THEORY AND WANTED TO MAKE THE MOST OF IT TO EXTEND THE AUTHORITY OF BRANCH OF PSYCHIATRY TRI BY ACHIEVING THIS TOGETHER. FELIX WAS DISTANT FROM THE ASSOCIATION'S DEBATE. WHEN THE APA BEGAN DEBATING WHAT ROLE THEY SHOULD PLAY AFTER THE WAR, FELIX HAD ALREADY PLANNED UNDER THE LEADERSHIP FL LAWRENCE COLE, HIS MACHINER TO, A BLUEPRINT OF REGIMENTAL HEALTH. HE WAS PREPARING FOR A LEGISLATIVE PROCESS FOR THE NATIONAL ACT AT THE FEDERAL LEVEL WHICH FAILED ONCE BEFORE. THE DIVISION OF MENTAL HYGIENE, WHICH WAS CREATED IN 1930 UNDER THE INFLUENCE OF THE MENTAL HIGH JOAN MOVEMENT IN THE EARLY 19 PT CENTURY WAS UNPRECEDENTED IN SCALE AT THE TIME BUT IT WAS PRIMARILY RESPONSIBLE FOR DRUG ADDICTION. THOARP FOCUSED ON -- THEY WERE FOCUSINGED ON THAT. HOWEVER IN 18936 THE NATIONAL SURVEY COMMITTEE WAS LAUNCH ALONG WITH THE APA AND OTHER MAJOR MEDICAL ASSOCIATIONS. THIS WAS BECAUSE THEY WERE AWARE OF THE POOR ENVIRONMENT OF MENTAL HOSPITALS AT THE TIME AND THERE WAS SOME CENSUS THAT THERE SHOULD BE FEDERAL ACTION TO IMPROVE THE SITUATION. II'M ALSO NOW STUDYING HIS PAPES AS WELL, COLE. IT WAS THOUGHT THAT THE INSTITUTIONS FOR BASIC RESEARCH SUCH AS NATIONAL CANCER INSTITUTE IN 1937 WERE NECESSARY TO IMPROVE MACHINE TALL HEALTH. COLE PLANNED TO CONDUCT MORE RESEARCH AND ESTABLISH AN INSTITUTE TO FUND STRATEGIC AREAS BUT IT WAS NOT REALIZED DUE TO THE OUTBREAK OF WORLD WAR II. FELIX'S ROLE IN ENACTING MENTAL HEALTH LAWS SHORTLY AFTER THE WAR CAN BE UNDERSTOOD AS AN EXTENSION OF THE PUBLIC HEALTH DEPARTMENT'S CONSISTENT EFFORTS. IN 1943 STUDY, INTEGRATED MEDICINE COLLEGE PROGRAM AT THE U.S. COAST GUARD ACADEMY WHERE HE WAS SERVING, FOUR AUTHORS INCLUDING FELIX MEASURED WHETHER SUCCESS OR FAILURE IN PERFORMING THEIR DUTIES AS AN OFFICER WAS PREDICTABLE DURING A VARIETY OF METHODS INCLUDING IN-DEPTH TESTS. PERSONAL DATA SURVEYS AND GROUP PSYCHOLOGY TASKS. IT WAS CONCLUDED THAT THIS COMPLEX TESTING METHOD ALLOWED THE POTENTIAL FOR SURVIVOR AND A DAP NATION GROUPS. ADAPTATION IN GROUPS. IIT SHOWS THAT FELIX WAS SOMEWHT DIFFERENT FROM CONVENTIONAL PSYCHIATRISTS. MANY PSYCHIATRISTS WHO SERVED AS MEDICAL OFFICERS DURING WORLD WAR II OFTEN DIRECTLY OBSERVED AND DEL DEALT WITH THE SYSTEMS F WAR LOSSES WHILE FELIX WAS CUTTING RESEARCH TO ESTABLISH NATIONAL MENTAL HEALTH POLL SIGNIFICANCE. FELIX WAS STRUGGLING WITH FEDERAL MENTAL HEALTH POLICIES WHEREAS OTHER MENTAL HEALTH PROFESSIONALS HAD MADE EFFORTS TO IMPROVE THE STATUS OF PSYCHIATRY AS A MORE ACCEPTABLE DISCIPLINE TO MAINSTREAM MEDICINE. AFTER WORLD WAR II, MENTAL HEALTH TOOK ON A COMPLEECTLY DIFFERENT APPEARANCE AND DIRECTION. AS HISTORIAN GERALD ROBB NOTED, THE LONG LASTING PAIR TIME THAT WHOEVER HAD A MENTAL ILLNESS SHOULD GO TO A MENTAL HOSPITAL HAS CHANGED. ALTHOUGH THE ENVIRONMENT UNTIL MENTAL HOSPITALS IN THE 19TH CENTURY IS STILL CONSIDERED POOR. THEY WERE INSTITUTIONS THAT TOOK CARE OF PATIENTS WITH UNCONTROLLABLE SYSTEMS ON BEHALF OF THEIR FAMILIES OR COMMUNITIES. BASED ON THE HOSPITAL'S RECORDS, MOST OF THE PATIENTS WERE SENT BACK TO THEIR FAMILIES AFTER SPENDING SOME TIME IN THE HOSPITALS. THERE WAS NO REASON NOT TO SEND PATIENTS WITH MENTAL ILLNESS TO THESE INSTITUTIONS. EVEN THOUGH SOME INSTITUTIONS SUFFERED FROM FINANCIAL PROBLEMS, THEY SHOWED A SHORTAGE OF MEDICAL PERSONNEL AND DETERIORATION OF THE ENVIRONMENT. THE SUPERINTENDENTS AND STAFF OF THE INSTITUTIONS THOUGHT THAT THOSE PROBLEMS WERE NOT UNSOLVABLE. THEY ORPHAN THOUGHT THAT FINANCIAL AND MANPOWER SHORTAGES COULD BE TEMPORARY SO THAT THE IMPROVEMENT OF THE ENVIRONMENT WAS POSSIBLE ACCORDINGLY. HOWEVER, AS WE'VE SEEN DETERIORATING IN THE PSYCHIATRIC HOSPITALS IN THE EARLY 20TH CENTURY AND NEUROSIS FURTHER MADE THE SYSTEM INOPERABLE. PATIENTS SUFFERING FROM NEWERO PSYCHIATRIC STIM TOMORROWS INCLUDING WAR NEUROSIS WOULD NOT BE ACCOMMODATED IN AN ENVIRONMENT WAR TREATMENT EFFORTS WERE MAINLY FOCUSED ON PSYCHOSIS. FURTHER MORE, THERE WAS NO WAY TO EXPLAIN NEWERO PATHIC SYSTEMS CAUSED BY EXTREME - SITUATIONS. THOUGH NEEDED TO BE TREATMENTED IN PERSON TO CERTAIN WHICH WAS CLAIMED. THE NEW MENTAL HEALTH HAD TO GO IN A COMPLETELY DIFFERENT DIRECTION FROM THE SYSTEM. HOWEVER, IT WAS NOT ENOUGH TO DETERMINE THE NATIONAL MENTAL HEALTH POLICY SIMPLY BY GOING DIFFERENTLY FROM THE EXISTING SYSTEM. SINCE THE MID 20TH CENTURY, MENTAL HEALTH POLICYS HAD AIMED TO CREATE AND IN-DEPTH UNDERSTANDING OF THE DISEASE. , THE NECESSITY FOR THE MEDICAL PERSONNEL AND THE CREATION OF AN ENVIRONMENT COMPLETE BY DIFFERENT FROM THE EXISTING SYSTEM. THEREFORE, THE NATIONAL MENTAL HEALTH ACT IN 1946 PRO INDIVIDUALED RESEARCH SUPPORT -- PROVIDED RESEARCH FOR THE CAUSE, DIAGNOSIS AND TREATMENT OF PSYCHIATRIC BASED ON ESTABLISH THE OF RESEARCH INSTITUTE WITH HOSPITALS AND LABORATORIES CAPABLE OF CLINICAL TESTING, FOSTERING PROFESSIONALS CAPABLE FL SIMULTANEOUS RESEARCHING AND NURTURING PRS PEBLGHTIVE -- PROSPECTIVE STUDENTS FUNDED BY STATE GOVERNMENT TO EXPAND THE NATIONAL HEALTH FOUNDATION OF THE COMMUNITY. IF MENTAL HEALTH PATTERNS DEVELOPED AROUND THE OPERATION AND MAINTD OF STATE HOSPITALS BY 1940, IT BECAME CLEAR THAT THE DIRECTION OF POST WAR MENTAL HEALTH POLICIES WAS SIGNIFICANTLY DIFFERENT. FELIX'S TESTIMONY AT THE THREE-DAY HEARINGS HELD IN SEPTEMBER 1945 AND 1946 REPRESENTS THE VIEWS OF THE PHS, A HOUSE HEARING HELD IMMEDIATELY AFTER THE END OF THE WAR EMPHASIZED THAT THE HEALTH SYSTEM DURING THE WAR WAS TEMPORARY. HE EMPHASIZED A NEED TO REAND REEXAMINE THE MENTAL HEALTH SYSTEM NOTING THAT THE TRANSITION FROM WAR-TIME TO PEACE-TIME WAS NOT LIMITED TO VETERANS. IT WAS AN URGENT TASK TO DETERMINE WHETHER STATE OR COMMUNITY FACILITIES AND PROFESSIONAL TRAINING INSTITUTIONS WERE PREPARED TO ACCEPT NEW CHANGES. AFTER THESE PREPARATIONS WERE COMPLETED, IT WAS PLANNED TO ALLOW MEDICAL STUDENTS TO RECEIVE BASIC PSYCHIATRIC TRAINING. THIS WAS THE FIRST LINE EVER --E OF DEFENSE WHICH MEANT GIVING GENERAL PRACTITIONERS INFORMATION OR TRAINING TO DETECT VARIOUS SYMPTOMS. SO IT WAS MENTIONED THAT HOSPITALS WERE EMPTY SEATS ACCOUNTED FOR TWO-THIRDS. IT WAS ARGUED THAT OTHER INSTITUTIONS THAT CAN BE TRAINED SHOULD BE INCREASED. AND MENTAL HEALTH MEDICAL PERSONNEL SHOULD BE EXPANDED AS SOON AS POSSIBLE. THROUGH SHORT TERM TRAINING OR LOW INTENSITY TRAINING UNDER THE SUPERVISION OF PROFESSIONAL MANPOWER. AFELIX PREPARED A DOCUMENT TO WATCH THE SITUATION ALREADY. VOICES OF GREAT OPPOSITION TO THE URGENCY WERE NOT GAINING STRENGTH, BUT FELIX REMAINED CAUTIOUS UNTIL THE END. THE BLUEPRINTS WERE WELL-CONTAINED AND EMPHASIZED THE NEED FOR MORE MANPOWER. SINCE TRAIN WAS NOT POSSIBLE IN A SHORT SOMETIME, IT HAD TO PROCEED QUICKLY. EXPANDING MANPOWER WAS AN WE VEREQUISITE. HE MENTIONED THAT THE NUMBER OF FACULTY MEMBERS SHOULD BE INCREASED IN MEDICAL SCHOOLS AND ADDITIONAL TRAINING CENTERS INCLUDING HOSPITALS AND MEDICAL SCHOOLS AND OTHER EDUCATIONAL SCHOOLS SHOULD BE INCREASED. HE EMPHASIZED THAT THE STANDARDS FOR ESTABLISHING ELD KEATION AND INSTITUTIONS HAD ALREADY BEEN ESTABLISHED. SO IT CAN BE IMPLEMENTED IMMEDIATELY, HE THOUGHT IT WAS USELESS TO SET UP CLINICS AND INCREASE MENTAL HOSPITALS WITHOUT ADEQUATE MANPOWER FOR EXTENSION. IT WAS A STEP-BY-STEP PROCESS FOR HIM. IT WOULD HAVE BEEN HOSPITAL TO EXTEND THE FIELD EVER RESEARCH IF MORE PSYCHIATRIST'S COULD BE TRAIN. FELIX POINTED OUT THAT THE IDENTIFICATION OF CAUSES OF MENTAL ILLNESS UP TO THAT POINT WAS POOR. HE THOUGHT THAT RESEARCH TO EXAMINE THE INNATE KRIK TRIS PARTICULARS OF MEN TAM ILLNESS SHOULD BE CONDUCTED FIRST. THE STUDY WAS CONDUCTED TO EXPLORE THE FUNCTIONAL TYPES SUCH AS DIET AND NUTRITION. MECHANISMS OF THE AUTONOMY NERVOUS SYSTEM AND CONDITION REFLECTION, FUNCTIONS OF VARIOUS BRAIN REGIONS AND ELECTRIC MOVEMENT IN THE BRAIN. IN ADDITION, THAT WAS THOUGHT THAT THE EFFECTS OF VARIOUS CAUSES MUST BE STOOD FROM THE PERSPECTIVE OF THE DYNAMICS OF MENTAL ILLNESS. THROUGH THIS, HE ARGUED THAT CASE DISCOVERY TECHNIQUES THAT CAN BE APPLIED TO MANY PEOPLE SHOULD BE DEVELOPED. THE DIRECTION OF THIS STUDY WAS ULTIMATELY ONE OF THE BASIC TASKS FOR COMMUNITY HEALTH. IN PARTICULAR, IDENTIFYING HOW THE DISEASE ITS SELF DEVELOPS AND RATHER THAN DEVELOPS IN AN INDIVIDUAL SPECIFIC SITUATION WAS ESSENTIAL TO THE HEALTH PROMOTION PLAN FOR THE GROUP. IN ADDITION, FINDING OUT THE MECHANISM OF THE DISEASE WAS ONLY POSSIBLE WHEN IT WAS POSSIBLE TO SPECIFY THE INITIAL STAGE AND DETERMINE WHAT MEASURES WERE POSSIBLE. THE PLAN TO INTERFERE WITH THE PROGRESSION OF THE DISEASE AS MUCH AS POSSIBLE THROUGH PREVENTION AND INITIAL INTERVENTION WAS AN URGENT REQUISITE FOR THE TRANSITION TOMORROW COMMUNITY HEALTHCARE. IT CAN BE DIFFICULT TO ESTIMATE THAT CLINICS OR HOSPITALS ESTABLISHED IN THE COMMUNITY WILL BE ABLE TO FUNCTION PROPERLY ONLY AFTER THESE THINGS, IT PRESENTED A BLUEPRINT FOR EXPANDING OUTPATIENT CLINICS IIN THE HOSPITALS TO TO -- COMMUNITY CLINICS MUST BE EASILY ACCESSIBLE TO ANYONE AND IN-PATIENTS WERE CONSIDERED TO MANAGE THEM AFTER EARLY DISCHARGE IF FOLLOW-UP TREATMENT SERVICES THROUGH THE CLINIC WERE POSSIBLE. THIS WAS A WAY TO IMPROVE THE EFFICIENCY OF MENTAL HEALTH HOSPITALS THAT HAD CONSIDERABLE FINANCES AT THE TIME. TO CONCLUDE, DR. FELIX'S EFFORT ON NATIONAL MENTAL HEALTH REPRESENTS AN ASPECT OF MOTOR CONTROL IN MOST WAR AMERICA TO ME. LOOKING AT THE ESTABLISHMENT IN OPERATION OF NLM FROM 1949, WE CAN SEE THAT THE GOAL OF THE FEDERAL POLICY WAS TO PENETRATE EVERY DAY LIFE IN ALL DIRECTIONS. THIS IF YOU DIRECTION OF MENTAL HEALTH POLICY AFTER WORLD WAR II SIFTED THE CENTRAL POINT OF CONTROL THAT WAS UBIQUITOUS BY CHOOSING TO INFILTRATE COMMUNITIES. IN OTHER WORDS, UNLIKE THE EXISTING CONTROL METHOD. IT WAS A WAY TO PREVENT THE MENTAL HEALTH OF THE COUNTRY TO DEVELOPING DISEASE AND DEFEND AGAINST MINOR PROBLEMS. MY POINT OF VIEW IS MORE ACCUSTOMED TO THE AUTHORITARIAN SYSTEMS OF THE STATE. I DON'T KNOW. THIS ALL THE FILTRATION INTO THE COMMUNITY MEANT DECENTRALIZE. CONTROL WITH CENTRALIZE FEDERAL FUNDING. THANK YOU VERY MUCH. THIS IS IT. >> DR. LEE, THANK YOU VERY MUCH FOR YOUR TALK. FASCINATING. SEVERAL QUESTIONS WE'VE RECEIVED AND I'D LIKE TO BEGIN WITH A VERY BROAD ONE. MANY HAVE WRITTEN IN THIS THANK YOU FOR YOUR TALK, OF COURSE. THE BROADER QUESTION IS TO WHAT EXTENT IF AT ALL AND THE ASSESSMENT OF ENVIRONMENTAL FACTORS AS YOU DESCRIBE REFLECT THE BEGINNINGS OF WHAT WE CALL TODAY THE "SOCIAL DETERMINANTS OF HEALTH." ANY THOUGHTS ON THAT? >> ENVIRONMENT, I GUESS I'M STRUGGLING WITH THE CONCEPT OF THIS ONE NOW. I THINK I MIGHT JUST GENERATE MY MEMORY. ENVIRONMENTAL. II THINK IT'S EARLY 20TH CENTURY OR A FREUD FREUDIAN ERA. 1920s IN THE U.S. ENVIRONMENT MEANT THAT SOME SORT OF -- LIKE THE CHARACTER -- EGO DEVELOPMENT OR CHARACTER DEVELOPMENT OR DEALING WITH SOME SORT OF SELF-DEVELOPMENT. IT WAS MORE LIKE A FIRST CAREGIVER AND ME. THEY'RE GOING TO -- INTERACTING WITH EACH OTHER THROUGH THAT PROCESS SOMEONE ACTUALLY WAS SHAPED. OR SOMEONE'S CHARACTER WAS SHAPED THROUGH THAT PROCESS. SO I GUESS IN THE INITIAL STAGE OF THE PSYCHE ANALYTIC THOUGHT, THE ENVIRONMENT WAS MORE LIKE AN ABJECT RELATION THEORY WAS SOME PART OF THE FORMATION OF THE CHARACTER THAT WAS THE ENVIRONMENT. LIKE YOU ARE FAMILY AND SOME SORT OF -- THE BOOK THAT YOU READ OR SOMETHING LIKE THAT. BUT THEN, I THINK AFTER WORLD WAR II, THE ENVIRONMENTAL FACTOR WAS MORE LIKE EXPANDED TO AN EXTERNAL STRESS OR EXTREME ANXIETIES. AT THE TIME THEY FELT SOME SORT OF VERY DIFFERENT EXPERIENCE. THEY FELT AND THEY EXPERIENCED THERE SOME SORT OF VERY EXTREME FEELINGS OF SOMETHING. SO I THOUGHT IT WAS IDEAL TO -- I NEED TO HAVE MORE CLEAR CLASSIFICATION OR DEFINITION OF THE ENVIRONMENT, BUT I NOW JUST BRIEFLY, I COULD DRAW THE LINE BETWEEN THOSE ENVIRONMENTAL OR ENVIRONMENT, THE CONCEPT OF THE ENVIRONMENT. >> SURE. AND YOU'VE DN AN EXCELLENT JOB IN THAT REGARD. THE TRAJECTORY FROM THE INTERNAL TO THE EXTERNAL. THANK YOU, THAT'S VERY GOOD. APPRECIATE THE QUESTION. SOMEONE ELSE WRITES IN, THANK YOU FOR YOUR RESEARCH INTO DR. FELIX AND THE AMERICAN MENTAL HEALTH POLICIES. THE QUO IS WAS THERE ANY FORMAL EVALUATION OFFER THE EFFECTIVENESS OF PSYCHIATRIC TRAINING INTO MEDICAL SCHOOL. WHEN DOCTORS THAT WENT INTO PRACTICE INTO MEDICINE, DID IF IMPROVE THEIR ABILITY TO REFER PATIENTS TO MENTAL HEALTH SPECIAL CYSTS? >> IT'S A DIFFICULT QUESTION FOR ME. AS A HISTORIAN, NOT A DOCTOR. SO I'M NOT REALLY SURE ABOUT THAT. REFERRING TO WORLD WAR II AS I KNKNOW, THERE ARE A BUNCH OF PHYSICIANS THAT TRAIN RESIDENTS OR SPECIAL EDUCATION FOR MAYBE TWO TO THREE WEEKS OR A MONTH, THEN THEY JUST GOT INTO THE WAR FRONT OR SOME SORT OF ARMIES AND THINGS LIKE THAT. THEY PROBABLY COULD RECOGNIZE THE SYMPTOMS OR EXTERNAL -- I DON'T KNOW HOW DO YOU SAY, SYMPTOMS AND SIGNALS. THAT'S WHAT THEY DID ACTUALLY DURING THE WORLD WORLD WAR II. DR. FELIX INCLUDING OTHER SCRITSES, PSYCHIATRISTS, THEY FY WERE NOT PREPARED FOR THAT SORT OF SITUATION. LIKE SO MANY PEOPLE SUFFERED FROM LIKE NEUROTIC SYMPTOMS. AT THE TIME NEUROTIC SYMPTOMS WERE VISIBLE. SOME I THOUGHT IT WAS -- THEY WERE PROBABLY COME GUESS AND ALSO WITH THEIR TRAINING, THEY COULD TELL SOMETHING. BUT I DON'T THINK IT'S PROPER TRAINING TO BE REAL PSYCHIATRISTS. I THINK DURING THE TIME, BUT I DON'T KNOW BEING A REAL SPECIALIST OR MEDICAL PROFESSION, OR JUST -- IT WAS MY GUESS. >> SURE. >> TO UNDERSTAND. >> THANK YOU. HOW DID YOU BECOME -- I'M SORRY. >> THAT'S FINE. >> HOW DID YOU BECOME INTERESTED IN FELIX AND THE BROADER SUBJECT OF MENTAL HEALTH IN AMERICA? >> Dr. Lee: ALL RIGHT. AS YOU KNOW, MY DOCTORATE DISSERTATION WAS ABOUT PEDIATRICIANS. THE MOST FAMOUS DR. SPOCK, RIGHTS? -- RIGHT? SO I NATURALLY GOT INTO A DISCIPLINE OF MEDICINE AND I WAS MORE INTERESTED IN THE CONCEPT OF SOMETHING. I WAS PLEASED TO HAVE THAT FIRST QUESTION, THE CONCEPT OF ENVIRONMENT AND THEN THE DEFINITION THAT I AM ALWAYS INTO THAT KIND OF CONCEPT. AND I GOT INTO THE CONCEPT OF ADDICTION FIRST. AND AS I MENTIONED, LAWRENCE COLE, HE WAS A SPECIALIST FOR ADDICTION. AND I WAS ON WONDERING WHY DR. FELIX WAS -- LAWRENCE COLE WALS AWE PREDECESSOR -- LAWRENCE COLE WAS A PREDECESSOR OF DR. FELIX. LAWRENCE COLE WAS A PSYCHIATRIST AS WELL, BUT THEN HE WAS A SPECIALIST ON ADDICTION. AND THEN I WAS JUST PUZZLING AT WHAT IS KIND OF THE CONNECTION BETWEEN THE ADDICTION SPECIALIST AND THE PSYCHIATRIST. PSYCHIATRISTS AT THE STATE HOSPITAL, THEY GOT WITH THE DRUGS. PROBABLY THERE WERE SOME SORT OF CONNECTIONS BETWEEN THEIR PROFESSION OR EVEN THEIR RELATION. BUT THEN I AM DIGGING IN WITH THE CONCEPT EVER A DEKS AND HOW -- CONCEPT OF ADDICTION AND HOW HE PUT ADDICTION IN THE ELEMENT OF PSYCHIATRY AS WELL. HOW I GOT INTO DR. FELIX WAS AT THAT POINT. ACTUALLY THERE WAS A CONNECTION BETWEEN LAWRENCE COLE WAS THE FIRST. AND THEN I FOUND FLEKS' PAPER, OF COURSE COLE'S PAPER IS ACTUALLY ON LINE. I THOUGHT IT WAS INTERESTING TO SEE ACTUALLY BOTH OF THEM. >> RIGHT. >> Dr. Lee: FROM PHS AND I WANTED TO FIGURE OUT HOW THE CONCEPT OF ADDICTION ACTUALLY DEVELOPED INTO THIS PSYCHIATRIST TERMS AND IT WAS UNTIL PART OF THE PSYCHOPATHIC DISORDERS, ACTUALLY, IN THE FIRST EDITION OF THE DSM. I GOT INTO ALL THOSE INTERESTING THINGS. >> VERY GOOD. VERY GOOD. GLAD THE LIBRARY COULD BE A RESOURCE FOR YOU. >> A LOT OF THINGS TO DO FOR ME. >> SO, A COUPLE MORE QUESTIONS. THANK YOU, AGAIN FOR THIS EXCELLENT AND INFORMATIVE TALK. COULD YOU SAY MORE ABOUT THE BUDGET ASPECTS OF MENTAL HEALTH INSTITUTIONS IN THE EARLY 20TH CENTURY. WAS STATE AND FEDERAL FUNDING AVAILABLE FOR INSTITUTIONS AT THE COMMUNITY LEVEL? AND WERE THERE FOR-PROFIT INSTITUTIONS THAT TOOK MONEY FROM FAMILIES TO PAY FOR INSTITUTIONS. HOW DID THE FOR-PROFIT INSTITUTIONS COMPARE WITH THE STATE FUNDED FACILITIES? >> Dr. Lee: I ASSUME THERE SHOULD BE SOME INSTITUTIONS WITH THE -- JUST A PROFIT FROM THE PATIENT'S FAMILY. BUT I HAVEN'T LOOKED AT DEEPLY OR THORL AT THAT. DEEPLY -- OR THORLLY AT THAT. IN THE 1920s, THEY BUILT SOME SORT OF INSTITUTIONS OR ASYLUMS OR -- NOT ASYLUMS BUT A SEGREGATED COLONIES OR FARMS BECAUSE THEY WANTED TO DIVIDE SOME PATIENTS INTO DIFFERENT PARTS OF INSTITUTIONS BECAUSE AS I MENTIONED, UP UNTIL 19 40S, THEY FELT -- 1940s, THEY FELT A HELPLESSNESS, FOR PATIENTS, THEY WERE NOT REALLY CURED. IT WAS MORE LIKE A HELPLESS FEELING IT MAKE A CLASS AT THISCATION OF THEM. AND 1920s AS YOU MIGHT KNOW, IT'S THE ERA OF SC SOME SORT OF- I WOULD SAY THE SEGREGATION OF THE -- HOW DO YOU SAY THAT -- I JUST -- I SLIPPED THAT WORD. INTELLECTUAL FITS, I GUESS I WOULD SAY. AND I GUESS THAT WAS KIND EVER FEEBLE-MINDED PEOPLE. DURING THAT TIME THEY CALL THAT. THEY WERE SEGREGATED AS WELL AND STATE POLIC POLICIES WITH MORE E THEY BUILT SOME SORT OF INSTITUTIONS OR MORE LIKE A WORKING FARM IN ORDERE IN ORDERM TO WORK. THEY WERE NOT REALLY HANDICAPPED. THEY WERE NOT REALLY WITH DISABILITIES. THEY THOUGHT THEY WERE MORE LIKN CALLED FEEBLE-MINDED, THEY WERE MORE LIKE LOW INTELLIGENCE OR SOMETHING LIKE THAT. AND A LOT OF PEOPLE, I GUESS, MAYBE ELITE GROUPS IN THES THOUGHT IT WAS USELESS TO HAVE THEM IN THE HOSPITAL. THEY WANTED TO MAKE THEM WORK SO THEY COULD SEND THEM TO ANOTHER INSTITUTION. SO PROBABLY THE STATE FUNDED A LOT OF MONEY TO BUILD THOSE FACILITIESES FOR. AND THEN THEY WANTED TO DIVIDE IT OR EVEN FOR STATE MENTAL HOSPITAL, THEY WANTED TO HOUSE OR THEY WANTED TO HAVE THOSE LIKE LONG-TERM PATIENTS. BUT THEN IT GOES UP TO -- I MEAN THE BUDGET, THEY'RE MORE LIKE RUNS OUT OF THE BUDGET TO HAVE ALL OF THEM UNTIL THEY TIE. I GUESS IT'S THE REASON WHY THEY WANTED TO DIVIDE A LEVEL OF PATIENTS AND SEND THEM TO UTILIZE THEM AS WORKERS OR LABORERS IN THAT INSTITUTION. I THOUGHT IT WAS -- I DON'T KNOW. ACADEMICALLY INTERESTING TOO TO SEE THAT AS WELL. IT'S ANOTHER ONE THAT I'M DIGGING INTO NOW. >> THANK YOU. SO WE HAVE TIME FOR ONE MORE QUESTION. YOU NOTED THAT OLDER PEOPLE WITH COMMON AGE-RELATED MENTAL DECLINE WERE OFTEN INSTITUTIONALIZED BY THEIR FAMILIES. DID THE MANAGERS AND LEADERS OF THE INSTITUTIONS TRY IT DISCOURAGE THIS BY REJECTING THOSE PATIENTS OR EXPLAINING TO THE FAMILIES THAT THEIR RELATIVES WERE NOT MENTALLY ILL, JUST EXPERIENCING NORMAL AGE-RELATED DECLINE? >> I THINK I JUST MISS THE QUESTION. >> SO -- MISSED THE QUESTION. >> I THINK WHAT IN QUESTION GETTING AT, IS DID THE LEADERS AND MANAGERS OF THE STATE INSTITUTIONS, DID THEY TRY TO DISCOURAGE THE -- >> Dr. Lee: YOU MEAN DECLINE THEM TO BE INSTITUTIONALIZED? >> CORRECT. >> Dr. Lee: WELL, I GUESS MAYBE UNTIL 1940s, THEY COULDN'T REJECT THEM. BECAUSE, I MEAN, WHEN THEY GOT THEIR PATIENTS PROBABLY JUST THEY HOUSED UNTIL THEY DIE. THAT'S KIND OF THE PATTERN BECAUSE OF THAT. COST OF CARE WHICH MEANS -- CUSTODY OF CARE WHICH MEANS THEY DIDN'T HAVE ANYWHERE TO GO. I GUESS THEY PROBABLY -- IN THE BEGINNING OF THEIR INSTITUTIONALIZATION, I GUESS, THERE IS NO PLACE TO GO FOR THEM. SO INEVITABLY, THEY WERE MORE LIKE PERMANENT PATIENTS. SO THAT'S WHY I MENTIONED THE SUPERINTENDENT SERVED THE INSTITUTION, THEY ESTABLISHED ANOTHER ONE TO LIKE INSTITUTIONALIZE SOME SORT OF HYBRID OR IN-PATIENTS WITH SOME SORT OF ABLE-BODIED. I GUESS THAT'S PART OF THE SITUATION THAT THEY KIND OF TRY TO MAKE THE SITUATION BETTER WINDCHILL THAT DENYING PEOPLE OR OLDER PEOPLE WITH ANY POSSIBILITY TO RECOVER. I GUESS THAT'S THE WAY -- THEY DIDN'T REALLY REJECT, BUT THEY DID SOMETHING TO SOLVE THE PROBLEM WITH THE OLDER PEOPLE LIKE JUST -- I MEAN LIKE USING SEDATIVES TO BE CALM. AND I GUESS THAT'S KIND OF THE SITUATION DURING THE 1940s. BUT UNFORTUNATELY AFTER 1940s, THEY MOVED TO THE DREKS DIRECTIN THE 1940s AND 1950s, THIS WERE MOVING TOWARD SOME SORT OF COMMUNITY-BASED NON-INSTITUTIONALIZED PSYCHIATRY. I THOUGHT IT WAS KIND OF THE END OF -- UP UNTIL THEIR LIFE, THEY DIDN'T GET ANOTHER PATIENTS MORE. BUT I GUESS -- UP UNTIL 1940s THEY HADN'T REJECTED -- THEY DIDN'T. BUT THEN, I WOULD SAY THEY USED DIFFERENT WAYS OF CLASSIFYING THOSE PATIENTS. I WOULD SAY THAT. >> OKAY. THANK YOU. >> WE'VE REACHED THE END MUCH OUR TIME TOGETHER. ON BEHALF OF THE NATIONAL LIBRARY OF MEDICINE AND MY COLLEAGUES, I WOULD LIKE TO THANK YOU VERY MUCH, DR. LEE, FOR PREPARING THIS CAU TALK AND COMING TO OUR CENTER FOR RESEARCH. WE'RE HAPPY TO SEE YOU VIRTUALLY AND IN-PERSON AND WE WISH YOU SUCCESS IN YOUR SEARCH AND PUBLISHING YOUR WORK SO WE CAN LEARN MORE ABOUT YOUR WORK ON DR. FELIX AND RELATED SUBJECTS. I WISH YOU WELL YOU AND YOUR FAMILY IN SOUTH KOREA. I KNOW IT'S THE MIDDLE OF THE NIGHT FOR YOU SO WE'RE ESPECIALLY GRATEFUL FOR YOU TO BE WITH US. WE LOOK FORWARD TO KEEPING IN TOUCH WITH YOU. THANK YOU. >> Dr. Lee: THANK YOU. >> BEFORE OUR VIEWERS LEAVE US TODAY, I WOULD LIKE TO RENIEND EVERYBODY THAT WE HAVE -- REMIND EVERYBODY THAT WE HAVE OUR LAST NLM HISTORY TALK COMING UP THURSDAY NOVEMBER 21ST. WE'LL WELCOME DR. WILLIAMS FROM THE UNIVERSITY OF BUFFALO WHO IS AN ASSOCIATE PROFESSOR THE HISTORY THERE. SHE'S A 2022 NLM FELLOW. THE TEATAL OF HER TALK IS "ASSAILED AT HOME THE PUSH FOR MATERNAL CARE ADVANCEMENTS IN NIGERIA." PLEASE JOIN US NOVEMBER 21ST, 2:00 EASTERN TIME. THIS WILL BE VideoCast. IN THAT REGARD, I WOULD LIKE TO THANK OUR COLLEAGUES BEHIND THE SCENES THAT MAKE THE VideoCast AND YouTube STREAMS POSSIBLE AND WE THANK YOU DR. NAMHEE LEE FOR HER RESEARCH TODAY. WINDOW THANK YOU HER AND ALL OF YOU FOR TUNING IN TODAY. WINDOW LOOK FORWARD TO SEEING YOU ON NOVEMBER 21ST FOR DR. WILLIAMS' TALK. THANK YOU, HAVE A GOOD DAY. GOOD-BYE.