He's an aide in the Carter White House and the program he's supposed to shepherd through Congress has bogged down. Every time he goes up to hustle support he has the feeling that they're laughing at him. This last week he's found it hard to look people in the eye. Maybe he's as worthless as they think he is. Who can he talk to about it?
She's an assistant secretary of a cabinet department, and she's sure that the way she handles male subordinates has badly affected her own "staff evaluation." The fact that she hasn't actually been fired yet just makes it worse. Her husband says she's paranoid, but he's been jealous ever since she got the job. Who can she see for advice?
Sen. and Mrs. Blank are a respected unit on the Hill-- until Mrs. B. tells him she's signed a book contract with a $100,000 advance to write an "honest, straightforward" account of their life together. Ms. magazine announces it will be excerpting a chapter. The senator develops a dependence on Valium. Who can help him?
These days it doesn't take a genius to understand why Washington has the highest concentration of psychiatrists in the world. There's always been a fine mother lode of paranoia available. Things like cabinet shakeups and staff evaluations make it that much easier to tap. The Washington Psychiatric Society reports psychiatrists are in such demand now that an appointment can take up to six months to arrange. It's only natural for a person to want to get his or her head straight before it rolls.
The examples above indicate the kind of people who might end up consulting Dr. Bertram S. Brown, who, until last year, was head of the National Insitute of Mental Health. Quietly and confidentially, in addition to his regular duties as the country's top shrink, he counseled and treated at no charge more than 100 depressed and anxious governmental VIPs: cabinet members and their top assistants, presidenial advisers, members of Congress and their important aides, generals and high level bureaucrats. His two predecessors did the same thing (not as readily), even though the practice would appear to be in violation of departmental glidelines. He argues that it is important for an administrator to keep up his clinical skills.
Brown was fired himself last year by former HEW secretary Joseph A. Califano Jr. (along with the heads of several other medical institutes) as part of a drive for "new blood" at the top. Brown now is working on projects for the Woodrow Wilson International Center for Scholars, but he says his VIP clientele, if anything, has grown since his ouster from NIMH. He calls his practice "curbstone," to indicate it's done free, on the run, but it can extend to 15 or more sessions before, after or during regular working hours.
For such an ardent scholar of power as Brown, it is a wonderful change to see exactly how the game affects the most important players. And, when he was head of NIMH, to put those same players in his debt. We could call Brown's particular commodity "mental health units," and he claims these debts can be just as valuable as more common ones like votes, money or information.
"It's clear to me," he explains, "that intense personal interest in an area (by a VIP), based on a personal problem, is something that can be translated into a program."
Until he ran afoul of Califano, Brown had been involved in high-level mental health administration in Washington for close to 20 years, starting in 1961 as special assistant to President Kennedy in the field of mental retardation, moving to chief of NIMH's Community Mental Health program in 1963, becoming deputy director of NIMH in 1966 and director in 1970.
"Early on I began to study my counterparts in other countries to see how they survived," he says, marshaling his thoughts. "There were four commonalities. First: in addition to administration, they all had clinical contact with the whole range of people and had built up in these people a sense of trust. Second: all were keenly interested and attuned to the political process.THIRD: they were all leaders in their own profession. Fourth: all of them had at least the possibility, the allegation, or the attribution of having inside information because they had treated VIPs. I studied these lessons very carefully."
Of course, there are plenty of shrinks to pick from here. However, Brown has noticed there is a definite VIP sociology at work: the more famous the person, the more famous the shrink. It's really not so far from the Soviet Union, he points out, where VIP's have their own separate health-care system.
"If you have spent time in public life, mornings and afternoons on the Hill dealing with congressmen and staffs, and they size you up as friendly, warm, available, not kooky, then they feel freer to give you a call the next day or to come and see you on a personal problem," he explains.
Brown is talking now from a small office in the Woodrow Wilson International Center for Scholars on the fourth floor of the Smithsonian Institution's castle building. He was a fellow last year, working on a study of health and science exchanges between the United States and the Soviet Union. This year he is coordinating seminars and symposiums between "power figures and scholars," and waiting for his 20-year pension from the U.S. Public Health Service. He does not know what he'll be doing next year , but you get the distinct feeling he'll be doing his best to stay in Washington.
"You can be a member of the intellectual elite," he says to an old friend on the telephone. "I'll just stick with the power elite."
He won't write the book on what he's learned, though, in spite of a $50,000 offer from a publishing company that was made after the depth and range of his clientele was explored in the Wall Street Journal a few months ago. Because Brown, scholar and psychoanalyst of power, user of power and recently a victim of power, knows that it is neither exercised nor studied in the open. It's a close-to-the-vest game where secrets and confidences are betrayed only as a last resort. However, he did agree to sit for a five hour interview.
Brown, at 49, still retains the ingenuous arrogance of the precocious kid he once was: top of his class at Brooklyn Technical High School, Brooklyn College, and Cornell Medical School; a one year internship in pediatrics at Yale, three years in psychiatry at Harvard plus an M.A. in public administration. He also looks like the precocious kid, with those big ground gripper shoes, high waisted baggy pants and slightly hunched shoulders. His manner is clinical: lots of eye contact, lots of informal laughing. The interview switches roles on him a little, though, and he'll suddenly change from genial father figure to brilliant student answering professor.
Q: As a psychiatrist, how do you think the Carter administration shakeup affected the people involved?
A: Enormously. Thousands of lives are affected, and the impact goes on down through the ranks. The changes will override many people's ability to cope with situations around them. You can predict that about 5 percent of those affected could become clinical casualities . . . that is, unable to function effectively for weeks, months or, in some cases, years.
Q: Have you noticed any change in the symptoms of people you treat?
A: No, the symptoms of stress are always anxiety and depression. But they have increased as the vulnerability of the high level executive has increased. For example, with the reform of the bureaucracy, an assistant secretary now has only a year and a half to burn out his people to make his name. A career bureau chief is now only apt to be there two or three years. A lot of the people who have come to me for help over the last few years are being forced out of their jobs or overworked by this phenomenon.
Q: What about paranoia?
A: Clinically, "paranoia" refers to psychotic breaks with reality, and I haven't seen any of this.
Q: But what about paranoia in the general sense of vague fears and worries that somewhere behind the scenes an ax is being sharpened. Maybe a bit of paranoia is actually necessary to survive here in Washington?
A: One of the things I teach as an administrator is the need for what I call "trained paranoia." People who move into a complex in Washington bureaucracy from a field like surgery, where clearly professional or intellectual merit is the dominant mode, have to be given lessons in "trained paranoia." In order to operate in this complex system they have to be taught that not everybody is warm, trusting and decent; in fact, many people are going to be just the opposite. The problem is, when you successfully develop "trained paranoia," it might easily spill over into your personal life.
Q: For example:
A: I remember a very interesting situation involving a person from a university environment who was handling a very complex bureaucratic enterprise. He was doing quite well at it and was becoming appropriately cautious, suspicious, aware of ambiguity, and generally getting trained in useful paranoia. Then one of his parents died. He began to handle the disposition of the will as if it were just another bureaucratic problem. That created all sorts of contentiousness in the family, enough so that the family were the ones who came to see me, not the person. At which point it took only one session to clarify for this person that it was not a piece of legislation to get passed. It was the death of a parent and an ordinary will to be administered. However, this person did not take my advice to spend three to five weeks doing what we call "an adequate mourning job." In my professional opinion, he will be paying the piper for this later.
Q: Has the self-indulgence of the "Me Decade" had any effect on Washington workaholism?
A: There's been an interesting change. When I first started in the early 60's, the great bulk of high level government employees were careerists. Now, 30 or 40 percent are much more concerned with what they should do to meet their own interests. The issue is that they are still up against the demanding boss who still expects them to be in the old mold. I see a lot of people who want to say no but haven't figured out how.
Q: What about Watergate?
A: The people I see have internalized the general lack of esteem for the government, the hostility that began during Watergate, so it becomes a personal lack of self-esteem. Treatment or counseling in this area seems relatively successful. You point that the same things have happened to their university colleagues or their corporation colleagues and that this is a phenomenon of breakdown in esteem for authority structures in general. The evidence is so clear that this is a general phenomenon you can take it quickly by treatment from an internalized loss of self-esteem to a generalized appreciation of the social reality that now exists. So they end up as knowledgeably unhappy rather than clinically unhappy.
Q: Can we go one step further, where you have people working for the Carter administration, which is perceived by many as ineffective. Have you had any contact with people for whom this is a clinical problem?
A: Generally, of course it would have an effect on some people. I've heard that morale in the Energy Department is, predictably, extraordinarily low. But I do not want to talk about it in terms of the people I've had contact with. The game is still being played.
Q: You said earlier that you had counseled people from the Nixon White House about confusing the authority of their with their own personal authority, and that they did not seem interested in listening to you. What about the Carter White House people?
A: They seemed appropriately interested. About six weeks ago I was invited to talk to the White House Fellows about these problems.
Q: How has the sexual revolution affected your curbstone contacts?
A" Increased them about five times. There are a whole new set of situations, in particular stemming from the women's movement, such as the two career family, which creates enormous stresses and strains about when to have children, how to share out the child care and home care, what happens if it becomes clear that the woman is smarter and going to be more successful than the man, etc.
Q: An example?
A: A young mid level government guy once asked to see me because of the following problem: His wife was a lawyer, doing very well and was very busy, and he started to find himself carrying out what is called a house-husband role. The reason he saw me was because he liked it so much. And he was anxious about whether this meant that at heart he was feminine. Rather than recommend in-depth psychoanalytic treatment, I dealt with it in terms of current life issues that a lot of people are facing. He relaxed after a while.
Q: Any other examples?
A: There has been a dramatic shift in the situation of the internationally mobile high-level executive, such as career State Department or military people.Wives now want to be meaningfully occupied in their new posts, and many are refusing to go along at all. It's getting to the point where the preferred executive is recently divorced, rather than a stable family man. I assisted in the development of an orientation session around these problems for the State Department.
Q: Overall, what is your prescription for mental health?
A: A mentally healthy person is one who has achieved a balance between love and work. If you have one without the other, you're going to end up with clinical problems.