You don't have to be crazy to be against Mental Health. In its upper-case incarnations at least -- a National Institute and hundreds of Community Centers -- the Mental Health movement seeks to be a powerful estate in corporate America. The fact that it has largely failed as an agency of social control hardly matters; as a system of mind-bureaucracies it is succeeding nicely. The damage it does is felt not so much in terms of therapeutics as in its social roles. Like its analogous power-estates -- corporate law, corporate industry, corporate media, corporate universities -- corporate Mental Health works to stabilize the values and solidify the ideals of the society it serves. It can be no other way. For despite the best intentions of its practitioners, managerial Mental Health will not destroy the social framework in which it thrives.
     The mind-bureaucrats comprise a commanding class of managers with a vast network of interlocking interests: race relations, the "new consciousness," pharmaceutical sales, health insurance, real estate, building construction, congressional politics, research grants, crime in the streets -- and a lot else. What the managers command are battalions of psychiatrists divisions of non-professional workers and endless armies of the disturbed, depressed and deranged. They control budgets running to hundreds of millions a year; they direct elaborate research projects in the physical and behavioral sciences; they staff commissions, boards and panels that guide national policy about crime, violence, race, delinquency, drugs, pornography and education.
     Mental Health as a social campaign began early in the century in conjunction with the generalized psychiatric movement. Although the two were not identical, these movements represented similar aspects of an historical urge whose time had come: to organize human consciousness for social improvement. For their time, the movements were in many ways revolutionary -- that is, they organized people to deal with themselves, their fellows and their world in radically new ways. We are now, of course, all Freudians, as we are all Marxists.
     As revolutions will, the psychiatric one began to deteriorate as it achieved power in its institutionalized forms, and as its organizers found status in their managerial roles. No need to assign blame; that process of cooptation is as natural and unavoidable as such phenomenon can be. Radical cultural movements can hardly escape the development of the political and economic systems in which they were born. Movements of radical consciousness regularly become expressions of a new status quo, gleaming with glass and steel, brimming with bank accounts, pleased with power.
     The bureaucratization of Mental Health -- and its transition from small letters to grand capitals -- began in earnest after the Second World War, when it was clear that New Deal politics would no longer remake American society into a perfect democracy. Politics died in the Fifties -- that is, politics as once practiced -- and a kind of estate-management began to take its place. The new "politicians" were no longer elected officials and their brain-trusters, but the college presidents, the industrial captains, the media baronets, the legal legionnaires -- and the social science bureaucrats -- who offered some promise of making the super-complex society run smoothly. New Dealers flocked into the new liberal managerial slots, where they quickly found contentment, high salaries and well-appointed suburban comforts. The high-water mark of their establishment was the early Kennedy Administration which founded, supported and operated on a base of the new corporatism. And despite the analysis of Kennedyites themselves, the end of it all did not begin in Dallas, but in Vietnam, Watts and Berkeley. The system created its own destroyers.

     Mental Health found its institutional base in Washington, within spitting distance of the other bureaucratic centers of the State. Geographically and conceptually, the epicenter became the National Institute of Mental Health -- one of ten National Institutes of Health -- which grew up in suburban Bethesda, Maryland, and now lies upon the city of Washington like adrenal glands on the national kidney. NIMH -- in schematic perspective -- is an agency for the accumulation, assemblage and distribution of power. Under the assumption that Mental Health can solve many (some say all) of America's social problems, the mind-bureaucrats attract the support and participation of the rich, influential and educated. For incentive, the participants get salaries and status -- and, more than that, the illusion that they are helpful and right-thinking leaders of their country. Such feelings are actually reinforced when NIMH and the Mental Health system are attacked by the discredited ogres of society -- traditionally, the reactionary right, the know-nothings and the military; and of late the radical left.
     To assemble their power in usable vehicles, the NIMH managers have built Community Mental Health Centers in 260 locations throughout the country; 420 are projected for some arbitrary first stage, and officials are frank to say that they would like to build upwards of 1000 centers, or one per every 200,000 people in the "catchment areas" into which they have carved up the map of America. The centers are meant to provide both emergency care for citizens in the throes of a freak-out, and "rehabilitation" care for those who act chronically in ways which they or the psychiatrists think are aberrant. In practice, they become immersed in the social politics of the communities they serve -- certainly a promising practice, except that they bring all the values of authoritarian, manipulative, class-biased, white psychiatry to those tasks. At first, the centers were involved in race problems; recently, many have become tired of that social war-horse and are concentrating on "trendier," whiter problems, such as freaky kids and dope.
     The Mental Health bureaucracy's power is distributed in a number of ways: therapy at the centers; jobs for professionals and non-professionals; fellowships for psychiatrists; research grants; propaganda for this or that approach to social problems (drug use and alcoholism, for example); and the placement of NIMH people and their associates on policy-making or planning boards. It was striking to see, for instance, that the social science section of the Kerner Commission was directed and staffed for the most part by NIMH types. The same was true for the Commission on Violence and similar panels.
     In all those ways, the Mental Health management closes its system to itself. NIMH controls most of the money spent in the U.S. for research in psychiatry and related fields. Although a pretense of scientific objectivity and independence is maintained, the reality is quite different: grants are reviewed and approved by a predictable collection of established mental health managers, who award their sizable chunks of bread for projects which meet the bureaucracy's ideological needs.
     The ideology, too, flows predictably from the nature of the bureaucracy and its first consideration of self-preservation, perpetuation and extension. NIMH's treatment of the drug "problem," for one example, shows how it works.

     Drugs are defined as a problem in U.S. society for all the well-chronicled reasons: puritanism, functionalism, bewilderment, etc. Once a drug is categorized as prohibited (for any reason), its use is always considered abuse. It turns out, then, that any use of marijuana is drug abuse. Tremendous research effort is then spent in detailing the nature of that use/abuse: most of it with no discernible (at least no relevant) results. The greatest part of drug research grants, for instance, goes into pharmacological studies, which presume to look for objective tests for the effects of marijuana use. Very little money is spent for clinical studies of human heads; what there is goes for research into behavior, not consciousness. As every pot smoker knows, the most interesting thing marijuana does is to the head, not the body. But at present, "science" has no good ways of dealing with such matters; behavior is easier to study, and chemistry the easiest. And so the problem is defined in the terms that are most convenient to research.
      "NIMH thinks that objective events are more important than subjective events," one doctor who has been part of the Mental Health system said recently. "They set up an objective test in which your score can only go down. All their research on drugs is geared to look for bad effects, and if they want to find bad things they'll find them; they'll find anything they want to."
     The NIMH line on drugs as a social issue follows that ideology closely. Use of drugs is always abuse, but more study is required -- by NIMH-funded scientists. Prison and penalties are discouraged; psychiatrists are, after all, tender-hearted and woolly-minded. Drug users are considered sick, if not criminal: which suggests that Mental Health therapists, and not the police, should take charge.
     There is a similar line on schizophrenia, a mental phenomenon which NIMH finds as intractable as it is fascinating. Millions of dollars are being spent on biopsychiatric research in hopes that some molecule will be found which "causes" schizophrenia, in the way a virus causes the mumps. Each year, NIMH functionaries appear at Congressional Appropriations Committee hearings to report startling advances. But real progress has been near zero in establishing a biochemical basis for mental illness. "They come out with an enormous amount of propaganda," a researcher admitted not long ago, "but it's mostly self-aggrandizing Madison Avenue stuff like: 'Just this year there has been a chemical found in the blood of schizophrenics that smells like garlic! Tests on 3419 cats ....'"
     An alternative approach -- that psychosis is definitional, rather than pathological; that schizophrenia is a variant state of consciousness, not a disease; that paranoia may be the only rational way of making sense of the world -- is dismissed at once as "irrational." And that is the most damaging word a super-uptight scientist can apply. The ideas of Jung are treated with skepticism amounting to contempt, and the concepts of R. D. Laing -- who suggests that schizophrenia can be both valuable and restorative to human consciousness -- are an object of scoffing.
     The basic attitude of the mind-bureaucrats is that all the "problems" they see must be defined in pathological terms. It is only in terms of "health" and "disease" that they can exercise influence. Thus, the NIMH social scientists on the Kerner Commission (see "White on Black," Hard Times, No. 44) had to define the riots as a symptom of the social disease of the ghetto. As liberals always do, the bureaucratic shrinks see everyone they deal with as victims -- whether they are blacks, kids, the poor, drug users or schizophrenics. Liberals always have to have victims; if none exist, they'll invent them.

     All the implications of managerial Mental Health come into focus in the operation of the community mental health center, a civic installation that is fast taking its place alongside the police station and school (and replacing the church) as an authoritative and authoritarian command post for social control.
     The centers have been set up under a congressional act passed in 1963 which was a keystone on managerial liberalism in the Kennedy era. (The act gave equal weight to projects related to mental retardation, a pet problem of the Kennedy family, but Mental Health now wags that dog.) The bureaucratic structure and the administrative elaborations of the community mental health center system could be endlessly explained, but provide little illumination into its functional place. What is important is how the centers as institutions house the Mental Health managerial ideology and promulgate it as a community force.
     The Connecticut Mental Health Center, in New Haven, was conceived before the national legislation was passed, and opened in 1966. It differs from many of the other centers around the country in its heavy dependence on state aid and university (Yale) connections, but in its function and effects it is not atypical. The Center consists of one nouveau-airport-modern building and several outbuildings in ramshackle structures for appeal to the lumpen classes it serves. A major part of the Center's work is treating "drug dependence" cases; the Drug Dependence Unit is supported mainly by NIMH funds. (The Nixon administration's anti-drug bill, in October 1970, gives the NIMH major responsibility for education and "rehabilitation" of drug users.)
     There is a range of attitudes the Connecticut Center's directors bring to their work, and some of them are clearly at odds with one another's. But despite some objections, the senior staff psychiatrist said, somewhat sadly, "On pol-(sic)residents are preoccupied with health delivery systems," the director, Dr. Boris Astrachan, explained. "We're increasingly managers, although, we hope, no less academicians." Books on the principles of management crowd out the standard works on psychiatry on his shelves.
      "How do we spend most of our time?" another senior staff psychiatrist said, somewhat sadly, "On politics and budget, not on patients or even staff problems." In early November, the administrators were preoccupied with the changing political complexion of the state legislature from Democratic to Republican. "You play one off against another," one of the administrators said, cribbing a line from the basic hip managerial theory. "We can use Yale to legitimize our function. Of course it's a house of cards, but..."
     It's hard to see how anything more than social management can flow out of such concerns. The Connecticut Center is as modern and groovy as any such facility in the country, with "rap sessions," long-haired shrinks and grass-blowing aides, but the underlying assumptions have to do with delivering health services to drug users, hyperactive school kids, alienated freaks and blown-away blacks, whose major problem is that they cannot find satisfaction and self-integration in super-managerial society. There seems to be no way for the Center to solve its patients' problems; indeed, with such solutions, who needs a problem?

     The backbone of the Mental Health movement is the drug industry. With Congress withholding funds for health care, and insurance companies still refusing to provide coverage against mental illness, the one alternative way for extending the Mental Health movement is the development and widened use of psychotropic drugs, i.e. tranquilizers and stimulants. They are a major force in the "fight against mental illness," making possible the decline in hospitalized patients, and bringing thousands of people within the reach of the "movement."
     This is an enormous and growing business: In 1967, 1.1 million prescriptions for all drugs were filled at pharmacies at a total retail cost of $3.9 billion. The "mind drugs" accounted for about a quarter of that, or $690 million. The emphasis on prescription drugs is increasing. From 1958 to 1967 the number of new psychotropic prescriptions filled rose from 42.7 million to 70.6 million, an increase of 65 per cent. This is nearly double the rate of growth for all other drugs. One out of every four adults takes a mind drug once a year. Tranquilizers are the second most widely prescribed category of drugs in the nation. Much of the market is accounted for by people from 40 to 59; most of them are women. While psychiatrists are generally believed to over-prescribe drugs, the bulk of mind-drug prescriptions is doled out by general practitioners. Looked at this way, the gut of the Mental Health industry is the relationship between pharmaceutical manufacturer and general practitioner, with the psychiatrist forming a sort of research-propaganda appendage to the business.
     While mind drugs are widely advertised and used, there is a continuing controversy as to their medical effectiveness. Librium, one of the most prescribed drugs in the country, has been on the market since 1961. The most recent studies suggest that the medicine is probably not very useful. According to Dr. Richard Burack's Handbook of Prescription Drugs, past studies indicate that phenobarbital works as well as or better than Librium for relief of anxiety, tension or apprehension. Librium's main advantage over barbiturates is that a Librium patient can't use the drug to commit suicide. The obvious disadvantage is price: A person can maintain himself on phenobarbital for five cents a day, compared to 30 cents for Librium. A recent study by the National Academy of Sciences -- National Research Council says that Librium is effective in only one of 12 categories where its use has been indicated in the past. More surprising, in the nine years it has been on the market, there have been but two controlled studies which would demonstrate the effectiveness of the medicine. Librium is among the 10 most-prescribed drugs in the country. It is the second most-prescribed medicine for old people.
     A major part of the Mental Health Industry is devoted to pushing amphetamines ("speed"). Last year the pharmaceutical manufacturers made eight billion amphetamine tablets; most of them were sold to women desiring to lose weight. Speed doesn't have much medical use. Studies indicate people lose about seven pounds over six weeks on amphetamines, after which they build up a resistance to the medicine and it is useless in reducing. While amphetamines are sometimes prescribed for mild depression, this turns out to be a double screw: one part of the amphetamine mix turns patients on, while another part turns them off, thereby canceling the effect. The military sells large quantities of amphetamines to soldiers whom it is encouraging to lose weight. While amphetamines are generally recognized as next to useless from a medical point of view, they can have serious side effects, causing nausea and bleeding. Since the drug elevates heart pressure, it can have a direct effect on the rest of the system, and may aggravate pre-existing diseases. Some doctors regard amphetamine addiction as a far more serious problem than heroin addiction, and much more widespread: nine million Americans are believed to be addicted to amphetamines. In testimony before the Senate, Dr. John Griffith of the Vanderbilt School of Medicine said, "Amphetamine abuse is not confined to students. Our case files indicate that the most likely occupational group to be represented are medical personnel; housewives are next." Of the eight billion amphetamine tablets produced yearly, there is a legitimate medical market for only a few hundred, according to Dr. Griffith.
     Amphetamines are outlawed in Sweden. In the U.S. the medical profession applies a double standard. The American Psychiatric Association, the shrinks' trade board, nominally disapproves of the use of amphetamines, but its weekly news sheet, Psychiatric News, runs speed ads every week.
     Now, with the fresh emphasis on developing yet a new Mental Health market -- childhood mental illness -- the over-ground business in speed is looking up. There is a widening use for the pills in schools. Speed works in reverse in children -- calming them down, supposedly making them better able to concentrate on their studies. The pills get the kids off the teacher's back and make life in the school prison a little less hazardous for the warders.
     The drug companies are running a low-keyed campaign to help parents and teachers determine whether a child is hyperactive, or hyperkinetic, or suffering minimal brain dysfunction. The advertising program is directed at spotting hyperactive kids in the first and second grades. Smith, Kline & French, which makes amphetamines, distributes a booklet which describes the hyperkinetic child: "He is generally irritable, easily frustrated and quick to anger -- in an explosive and unpredictable way. At home or in school, his attention shifts rapidly and he cannot concentrate on any activity for any reasonable length of time. He fidgets or squirms when he sits. His scholastic performance is poor, especially in arithmetic, reading and writing. He tends to take an independent tack -- in school, for example, by asking totally irrelevant questions, pulling another child's hair, walking around during rest period, etc. At home, he has little patience and may not sit still for meals, TV, or even a bedtime story that spellbinds his brothers and sisters. He runs when he should walk, or perversely, walks when everybody's running. He seems to never sleep and may even get out of bed in the middle of the night and roam around the house." Smith, Kline & French says temper tantrums in infants may be "an early warning" of hyperkinesis in youngsters. The company then goes on to promote the use of amphetamines, which it says are useful in slowing down the child, making him "more manageable," and helping a youngster "control his emotions." The company says amphetamines are not habituating or addicting in children. They say that in a few cases children may develop a pale, anxious expression, but the most common side-effects are insomnia and loss of appetite. "But except for individual sensitivity, which your doctor has probably mentioned, experience has shown that hyperactive children usually tolerate stimulating drugs better than adults."
     Ciba, the manufacturer of the popular stimulant Ritalin, goes after the MBD child, described as follows: "He seems in perpetual motion. In constant purposeless activity. He's aggressive, destructive. Easily frustrated. Can't concentrate. He's bright, yet does poorly in school. He wants friends, yet companions shun him. His behavior makes him nearly unbearable to parents, teachers, playmates." Buried in tiny print in the back of the Ciba brochure are side-effects -- including possible psychosis and dependence.

     According to government figures, some ten per cent of all children -- four million in all -- are seriously maladjusted. The drug companies are aiming their sales campaigns at this market. Drug company representative(sic) help set up meetings with parents and teachers to discuss behavior problems. In Seattle, a drug salesman brought together teachers, parents and doctors. In Omaha, there was a scandal over the use of amphetamines in the schools; teachers had referred parents of hyperactive youngsters to psychiatrists, who -- with the school's cooperation -- put the youngsters on Ritalin.
     While many doctors believe that amphetamines help to steady hyperactive children -- an opinion which is formally shared by the NIMH -- there is no unanimity on the subject. In a letter to Congressman Cornelius Gallagher, who is studying the effects of amphetamines on children, Dr. Rada Dyson-Hudson, a Johns Hopkins anthropologist, pointed out, "Though hyperactivity is described as minimal brain dysfunction, there are strong indications that certain forms of hyperactivity are inherited and occur in at least four per cent of boys. (This hereditary hyperactivity is often associated with reading and spelling problems, sometimes termed dyslexia.) To be present in the population at such a high frequency, a genetic trait cannot be an 'abnormality' -- rather it must now have or have had in the fairly recent past some selective advantage. And the population is said to be polymorphic for that trait.
     "In the case of hyperactivity, the selective advantage must be quite large in order to counterbalance the fact that hyperactive children almost certainly have a higher mortality rate. It is impossible to know, with the limited knowledge we have at present, what this advantage might be; but it makes it entirely wrong to think of hyperactivity as a pathology, as medical doctors seem to do."
     Even doctors who believe stimulants are useful in calming active children are disturbed at the long-term use of the medicine; it might be addictive. And there is no clear, consistent definition of what is meant by hyperactivity.
     Doting middle-class parents, who are brought up not to question teachers or doctors, do what they are told. The mother of a seven-year-old child was beside herself when her son did poorly in the second grade. His attention span had dropped. Testing by the local department of education determined that the child had a "learning disability." The mother writes, "He was recommended to a neurologist, who classified him as hyperactive and put him on Ritalin. Personally I don't use more than aspirin in our home, but I was desperate to help my boy. It does make my son very sedate in school, where he can sit for an hour and a half and take a required test. His performance did improve in school, and the teachers finally paid attention to him because he behaved 'normal.' But when I noticed him getting side-effects -- brief headaches, blurry vision, stomach ache, brief anxiety -- I mentioned to the doctor I read an article of Jack Anderson's Washington column on Ritalin. The doctor likened it to the cyclamate 'scare,' and as to my son's side-effects --'...must be seizures, as not one patient has side-effects.' This I do not believe so I have not given my son any Ritalin since school is out, and I will prove to the doctor he will not have any of these symptoms, which he hasn't!"
     In Lakewood, California, children begin speeding in the first grade at the suggestion of their teachers. In one instance, the school principal called a mother and complained that her seven-year-old second-grader couldn't sit still. The child was referred to a psychiatrist, who examined the youngster and found him in good health. However, the psychiatrist thought the boy acted odd in playing with other children, a trifle infantile. Another doctor's advice was sought. After taking a look, that doctor said the kid had a "slight brain dysfunction" and prescribed Ritalin, telling the mother, "Well, we prescribe Ritalin for him and give his teacher some rest and peace." This worked out well until the parents let the prescription run out and the boy crashed. The parents were too frightened of the school and doctors to tell what had happened. The doctor gave the child some more medicine to use with Ritalin. That turned him into a total zombie.
     This family had a younger boy, aged six, who annoyed the first-grade class one day by yelling loudly while another child cut off his hair. The school called the parents, and they dutifully hauled the six-year-old off to a psychiatrist. The doctor said the youngster was in good physical shape, but that a little dose of Ritalin wouldn't do him any harm. The six-year-old broke out in a rash. Summoning all their courage, the parents disobeyed the doctor and took the child off the drug.

      "It used to be that anyone who attacked mental health was a fascist or a kook," one Community Mental Health Center official said nostalgically a few months ago. There are still attacks from the right, but the range of criticism is qualitatively different, now that Mental Health is institutionally established. More serious than the reactionaries from the outside are insurgents within psychiatry and Mental Health institutions.
     The passing of the New Deal Renaissance at the end of 1968 has brought considerable heartache and some hard times to the mind-bureaucrats. Former NIMH Director Stanley Yolles's imperial designs are threatened. He succeeded, under the Johnson Administration, in achieving a degree of independence for the NIMH from the other health institutes; but the NIMH is increasingly bothered by its inclusion in a bureaucratic grotesquerie called HSMHA (Health Services and Mental Health Administration), a division of HEW. Nixon succeeded in forcing Yolles out of office; clearly, the new administration wanted its own man in the NIMH directorship. Yolles was able to make his departure a liberal issue, and he rolled out of the NIMH office building something of a hero. But the heroics are mostly mock; an exchange of bureaucrats is hardly a shattering political event. Yolles helped make heroin and schizophrenia political; he immodestly complained when those politics took away his job.
     At the same time, Mental Health is losing some of its appeal in Congress, without which NIMH would be hard pressed to make its own politics. The original idea of NIMH theorists was to create a network of centers which would give each congressman an important, federally funded installation in his district. Just as congressmen now have a post office and a poverty agency, so would they have a Mental Health Center for all the benefits it might reap in employment, electoral support, community power and so forth. In a few places that scheme has succeeded. In New Haven, for example, the lower-class "Hill" community, which has a special status in the Mental Health Center service structure, made some heavy hay from the jobs and para-professional training opportunities the Center provides. But in most areas, the congressmen get more pains than pluses for their votes, and the budgets are being squeezed. What's more, Mental Health's favorite friends in Congress -- Senators Lister Hill and Ralph Yarborough, and Representative John Fogarty -- are defeated or dead. Mental Health lobbying -- carried out by NIMH types, by Mike Gorman of the National Committee Against Mental Illness, and by some old New Deal reformers still ambulatory in the Capitol -- is not going well.
     While the government is cutting back on the community mental health program, the insurance industry -- which provides important economic incentives for health care -- is still leery of insuring against mental illness unless it is treated in a hospital. The insurance companies fear heavy use of policies permitting out-patient care, and hence they are unwilling to make available coverage on any sort of broad scale. The interests of the insurance companies are against those of the NIMH bureaucrats; the insurance companies encourage people to go into big hospitals, while Mental Health reformers at NIMH are working to get people out of the hospitals so they can receive treatment in community mental health centers.