Gorman was not the only writer to draw attention to the plight of the mentally ill during the 1940s. Newspaper journalists in Ohio, Illinois, California, and other states publicized the poor conditions in state hospitals. Veteran journalist Albert Deutsch, who had published a history of mental illness treatment in 1937, investigated psychiatric hospitals in a dozen states and published his findings in the New York Star during 1946-47. Deutsch's articles were published as a book, Shame of the States, in 1948, and he received a Lasker Award in 1949; novelist Mary Jane Ward published The Snake Pit in 1946; the book was made into a movie in 1948; Life magazine ran a pictorial about mental hospitals titled "Bedlam 1946" that year. Unlike most of his fellow journalists, however, Gorman went on to organize lobbying campaigns to remedy the situation. He would later note that, early on in his Oklahoma experience, he assumed that exposing the problems in psychiatric hospitals and getting readers up in arms would lead naturally to demands for substantive changes. He learned, however, that public attention faded quickly and that entrenched political and social institutions and practices did not change without constant agitating from outside.
When Gorman finished his work with the President's Commission on Health Needs, Mary Lasker asked him to stay in Washington and run the National Committee Against Mental Illness (NCAMI). Lasker and Florence Mahoney had established this advocacy and lobbying organization toward the end of World War II (as the National Committee for Mental Health) as an alternative to the National Mental Health Association. Lasker had earlier joined that group but was disappointed to find that though its members wanted to raise public awareness of mental illness, they were resistant to getting politically involved and agitating for changes. Gorman seemed the ideal person to direct the small NCAMI staff in coordinating lobbying activities and following various mental health bills. In this post, Gorman would become perhaps America's best-known crusader and publicist in the cause of psychiatric hospital reform and the community mental health center movement.
As Gorman had learned during his initial foray into the world of psychiatric hospitals, patients, and treatment, the theory and practice of mental illness and health had been in flux for several decades by the late 1940s. Late nineteenth-century psychiatry had been based largely in insane asylums and focused mainly on the custodial care of those with severe chronic mental illnesses. Care in those institutions might also include vocational therapy and, less commonly, psychoanalysis. By 1900, a new generation of psychiatrists, seeking scientific legitimacy, was increasingly emphasizing physiology, pathology, and pharmacology as keys to understanding and treating mental illness. This trend was spurred partly by the development of neurology as a specialty, and partly by physicians' increasing recognition that abnormal behavior in some cases was directly related to underlying physiological causes. These included tertiary syphilis, brain tumors, Huntington's disease, atherosclerosis, and nutritional deficiencies such as pellagra. Between 1920 and 1940, new somatic treatments were developed to control psychotic symptoms with malaria-induced fever, insulin-induced coma, seizures (induced with the drug Metrazol, or electric shock), and lobotomy (surgery to sever the nerve fibers between the two lobes of the brain.)
At the same time, the very definition of mental illness shifted and expanded to include not just organic psychosis (e.g. schizophrenia), but conduct disorders and social deviance resulting from abnormal personality structure (which in turn could result from any number of environmental stresses.) The scope of psychiatry, in turn, expanded beyond the mental institution to schools, workplaces, and social service agencies. Concurrently, an early mental hygiene movement took shape. Clifford Beers, a former mental patient, founded the National Committee for Mental Hygiene (now the National Mental Health Association) in 1909. This organization's mission was to help prevent severe mental illness through scientific knowledge and organizational action. To this end, it carried out several surveys of mental institutions and social problems such as alcoholism and juvenile delinquency during the 1920s and 1930s. It also commissioned a history of mental illness and treatment from journalist Albert Deutsch. Deutsch later investigated state psychiatric hospitals, starting in 1944, and published a series of newspaper articles about them. Gorman apparently did not see this work until after his own first investigation in 1946.
The experiences of World War II military psychiatrists also produced a shift in psychiatric thinking. They found that mental disorders were far more prevalent than previously supposed, and that the stress of combat was often the primary cause. Field experiences with "combat exhaustion" (called "shell shock" in World War I) demonstrated that when early symptoms (nightmares, anxiety states, small behavioral changes, etc.) were noticed and promptly treated by physicians at battalion aid stations, most soldiers recovered quickly and could return to duty. This generated much enthusiasm for early diagnosis and outpatient treatment as a way to prevent more serious psychiatric disorders and the subsequent need for institutional care. By the end of the war, legislation was introduced to enable the federal government to fund research into the causes and treatment of mental illness, to fund training of mental health personnel, and to establish the National Institute of Mental Health. The National Mental Health Act was passed in 1946, sponsored by Senator Claude Pepper and Congressman J. Percy Priest.
By the time Gorman became director of the National Committee Against Mental Illness in 1953, another major therapeutic change was underway: development of the first antipsychotic tranquilizers, reserpine and chlorpromazine. These drugs, by calming manic or violent patients and muting their hallucinations, promised to transform psychiatric hospitals, and perhaps render institutional care unnecessary for many patients. Gorman was an early advocate of the new drug therapy and of large-scale research on the use of such drugs.
Despite the efforts of Gorman and others, reform of the mental health system progressed quite slowly, one state at a time. There was no general plan for the nation because psychiatric hospitals, like many other public institutions, had always been the responsibility of state and local governments, not the federal government. (Services for military veterans, Native Americans, and residents of the District of Columbia were exceptions to this rule.) Reform on a larger scale would require first, a national study to obtain accurate information about all the state and local facilities and establish some basic standards for care, and second, a long-term, nationwide planning strategy. The Mental Health Study Act of 1955 provided partial funding for a Joint Commission on Mental Illness and Health (JCMIH), with members from thirty-six organizations, to carry out the study and formulate the strategy. For the next five years the JCMIH, which included Mike Gorman, did formal studies on mental illness and health and contributing factors, methods for diagnosis, treatment, care, and rehabilitation, recruitment and training of mental health personnel, and psychiatric hospital conditions. The final report, Action for Mental Health, was released in early 1961. It recommended increased funding for basic research, especially at the federal level; "expanding treatment of the acutely ill mental patient in all directions, via community mental health clinics, general hospitals, and mental hospitals" as rapidly as personnel became available; and increasing public information about mental illness to reduce the stigma attached to it. The report also gave an estimate of what these measures would cost, and how to fund them. The main challenge, as Gorman often noted, was not economic, but moral: the U.S. could well afford to improve its mental health system, but Americans had to be persuaded that this was just as important for the country as other expenditures such as highway systems.
The JCMIH's recommendations were developed further by the Presidential Task Force on Mental Health and two NIMH policy groups set up in 1962. Their final recommendations, crafted in large part by NIMH director Robert Felix and assistant director Stanley Yolles, focused much more heavily on community mental health services than on facilities for acute, chronic mental illnesses. The emphasis on community mental health centers embodied two beliefs: first, that early intervention could keep problems like depression from becoming disabling, and second, that many institutionalized mental patients could, with proper support and medication, be cared for within the community, mainly as outpatients, with only brief hospital stays. The NIMH group even predicted that such programs could eliminate the need for psychiatric hospitals within the next twenty-five years.
Mike Gorman helped enlist President John F. Kennedy's help in this cause. Kennedy was sympathetic to such appeals; his sister Rosemary suffered from mild mental retardation and had spent many years in institutions. The president included some of the Joint Commission's recommendations in his message to Congress in February 1963, and declared mental illness and mental retardation to be among the country's major public health problems. He asked Congress to authorize grants to states for expanding mental health and mental retardation services. That fall the Mental Retardation Facilities and Community Mental Health Centers Construction Act, sponsored by Senator Lister Hill and Rep. Oren Harris, was passed. It was hailed by supporters as the start of a new era in mental health care.