Therapeutic Communities and Community Healthcare in 1960S America

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Therapeutic Communities and Community Healthcare in 1960s America

By Martin Halliwell

The Eccles Centre for American Studies

ISBN 0 7123 4466 7

By Martin Halliwell

The Eccles Centre for American Studies

The Inaugural Eccles Centre for American Studies Plenary Lecture given at the European Association for American Studies Annual Conference, Izmir, Turkey, 2012 www.bl.uk/ecclescentre MARTIN HALLIWELL is the 18th Chair of the British Association for American Studies and is Professor of American Studies at the University of Leicester. He was the Director of the Centre for American Studies at the University of Leicester (2005–09) and is Head of the School of English (2008–13). He has published six monographs, including The Constant Dialogue: Reinhold Niebuhr and American Intellectual Culture (2005) and Therapeutic Revolutions: Medicine, Psychiatry, and American Culture, 1945–1970 (2013), two co-authored books, and two co-edited collections: American Thought and Culture in the 21st Century (with Catherine Morley, 2008) and William James and the Transatlantic Conversation: Pragmatism, Pluralism, and the Philosophy of Religion (with Joel Rasmussen, 2014). He is editor of the Edinburgh University Press series ‘Twentieth-Century American Culture’, and he is an Associate Fellow of the Institute for the Study of the Americas, London and the Rothermere American Institute, Oxford. He is currently working on a follow-up book project to Therapeutic Revolutions, provisionally titled Voices of Health and Illness: Medicine, Psychiatry and American Culture, 1970–2000.

THE ECCLES CENTRE FOR AMERICAN STUDIES was founded by David and Mary Eccles in 1991. The Centre is based at the British Library, which houses the foremost collection of American books, manuscripts, journals, newspapers and sound recording outside of the United States. The Centre promotes the Library’s North American collections through its diverse series of bibliographic guides and online exhibitions. It supports American Studies in schools and universities through its well established programme of academic conferences and seminars. And it promotes knowledge and understanding of the North America to a broader audience through its wide-ranging and highly successful public events programme. Details of all of the Eccles Centre’s activities may be found at www.bl.uk/ecclescentre Therapeutic Communities and Community Healthcare in 1960s America

1. New Designs for Healthcare

In 1966 the American architect and hospital consultant Joseph Blumenkranz wrote: ‘when budgets for health replace budgets for destruction, the inventive genius of man will surely catch up with the needs for health in developing the kind of facilities that will more suitably answer the needs of humanity.’1 As a member of the National Commission on Community Health Services task force, Blumenkranz was keen to leave behind the architectural monumentality and rigid structures of mid-century state hospitals. Many of these large state hospitals – particularly those specialising in mental health – had earned the label ‘snake pits’ in the wake of health crusader Albert Deutsch’s 1948 critique The Shame of the States and a series of exposés into poor treatment and inadequate facilities during the second half of the 1950s. Despite the emphasis on improved hospital care during the Truman and Eisenhower administrations, it was not until the Community Health Centers Act of 1963 that a viable alternative arose to the hospital planning of the previous fifty years. Instead of the imposing, symmetrical architecture of these state hospitals, Blumenkranz envisioned better integrated buildings with improved communication, sanitation and internal transportation that could keep pace with the postwar revolution in medical science. His vision was for ‘the totally coordinated biomedical center’ with versatile spaces that could meet the needs of physicians, administrators and patients alike.2 Blumenkranz acknowledged that tight budgets would always be an obstacle, but the aim of the Community Health Services task force was to look beyond present realities in order to better organise healthcare in the years leading up to the nation’s bicentennial of 1976. Just as visionary architect and designer R. Buckminster Fuller had recommended in 1964 that American citizens must forsake ‘specialization’ in order to become ‘comprehensionalists’, so Blumenkranz wanted to devise facilities that could embrace the open-door policy of the Community Health Centers Act.3 2 Therapeutic Communities and Community Healthcare in 1960s America

In his blueprint for the future, Blumenkranz argued against the decentralisation of healthcare facilities because they take up more land and rarely permit the cross-fertilisation of ideas and techniques that he saw embodied in his vision of integrated centres. Such a vision was similar to what Fuller called ‘energetic-synergetic geometry’, which could provide a more integrated model than ‘scientific instruments and formulas’ ever could.4 This philosophy of integrated pluralism chimed with President Kennedy’s own vision of community healthcare, which set the tone for federal initiatives between his inauguration in January 1961 through to the end of the Johnson administration in January 1969. This essay focuses on that period in particular, but also offers backwards and forwards glances in order to identify the reasons why these eight years are so important for understanding a significant shift in the conception and provision of healthcare in the US.

This historical perspective should be set against the broader horizon of repeated presidential attempts to offer a model of responsible governance for healthcare after World War II. However, the oscillation between idealism and realism and between dreams and pragmatism is woven into the fabric of American life, often creating a ‘boomerang’ effect, as Harvard sociologist Theda Skocpol has called it.5 The fierce debates over the 2010 Affordable Care Act (commonly known as ‘Obamacare’) make clear that this boomerang effect is particularly pertinent for healthcare because medical policy is full of proactive and reactive decisions, plans that work and plans that don’t, debates that are difficult to win, and budgets that can never be balanced. Taking a long view of the 1960s provides some perspective on this boomerang effect, particularly as President Nixon was very eager to scale back Johnson’s healthcare and welfare initiatives when he entered office in January 1969.

There are three broad methodological impulses that inform my reading of the emergence and flourishing of community healthcare in the United States in the 1960s. The first is that we tend to receive polarised accounts of American medicine after World War II that lurch between optimistic and sceptical perspectives. Following John Burnam’s 1982 essay ‘American Medicine’s Golden Age: What Happened to It,’ Bert Hansen has argued that the triumphant seventy-year story of medicine – from ‘Pasteur to Polio’, as Hansen calls it – was followed by ‘cracks of hesitation and skepticism’ in the late 1950s and early 1960s, in the wake of reports on incompetent Therapeutic Communities and Community Healthcare in 1960s America 3

medical practice.6 However seductive the golden age of medicine model might be, though, since 1968 the temptation has been to lean just as far the other way and treat medical authority as an ideological state apparatus that subjugates the patient to powerful scientific technology. Although this anti- authoritarian approach is an important corrective to the confident march of medicine (as celebrated in a January 1950 issue of Life magazine), or the promise that science could be an ‘endless frontier’ (as reflected in the title of Vannevar Bush’s famous 1945 report to President Franklin D. Roosevelt), it has an equally problematic tendency toward oversimplification, simply replacing triumphalism with cynicism.7 This essay avoids these polarising accounts by considering both the social and philosophical implications of community healthcare and the practical and fiscal problems that such federal and grassroots initiatives faced.

The second methodological premise at work here is that, even though mental health was labelled ‘America’s No. 1 health problem’ by journalist John Bartlow Martin (writing for the Saturday Evening Post in 1956), the provision for and treatment of mental health conditions tend to be overshadowed in the postwar years by a focus on physical conditions such as polio, cancer and heart disease. However, the prioritizing of these physical conditions would be to overlook the looming crisis in state hospital provision for mental health patients in the late 1950s (a crisis that Albert Deutsch had detected ten years earlier), which a number of typical postwar experiences – white-collar work, suburban living, teenage anxiety, the backlash to of desegregation – tended to exacerbate. Medical progress in the 1950s was patchy, particularly in relation to mental health, and the historical record does not credit President Eisenhower with forthright medical reform, even though he established the Department of Health, Education, and Welfare (HEW) in his first term and tried to push a health reinsurance bill through Congress in 1954-55 (but without success).8 Presidents Kennedy and Johnson fare better in the history of health reform because important legislation was signed on their watch, but it should be noted that Eisenhower followed through on Truman’s pledge of additional federal funds to conduct more medical research, increase the number of hospital beds, improve rehabilitation facilities (particularly for veterans), and extend training for nurses. In signing the Health Amendments Act in 1956 Eisenhower stressed the ‘critically important’ care of the mentally ill, and on 7 April 1959 he publicly observed World Health Day, with its focus on mental health. 4 Therapeutic Communities and Community Healthcare in 1960s America

The third premise is that Freudian thought is often treated as the privileged discourse for dealing with mental health in the mid-twentieth century. Freud was the obvious intellectual resource for many postwar thinkers and writers, but Freudian ideas were deployed in various and conflicting ways, from the conservative belief that an individual cannot transcend his or her instincts to a radical sexual philosophy tinged with anarchism. While Nathan Hale Jr. has traced what he calls the rise and crisis of Freudian thought in the United States between 1917 and 1985,9 I will sidestep dealing with Freudian ideas explicitly here, primarily because orthodox psychoanalysis places the emphasis firmly on the individual within a family context and tends to overlook the importance of broader groups and communities which helped to redefine the parameters of healthcare during the 1960s. In addition, the Freudian account offers quite a bleak view of an individual’s ability to escape from the grip of neurosis – a view which was diametrically opposed to the optimism of the human potential movement that captured the popular imagination in the mid-1960s, particularly on the Pacific Coast.

2. President Johnson and the Federal Response to Healthcare

I want to start this particular story five days after one of the most dramatic moments in postwar history: the assassination of President Kennedy. When Lyndon Johnson mournfully addressed the nation on 27 November 1963 he struck a reassuring tone. As vice president, Johnson had often been off-kilter with Camelot culture, and the two leaders had not always seen eye to eye. But in his televised speech, the new president claimed that his predecessor had been ‘the greatest leader of our time’ and he sought words ‘to express our sense of loss’.10 As well as promising to ‘continue the forward thrust of America’, Johnson projected himself as a leader who aimed to put ‘ideas and ideals’ into ‘effective’ and ‘decisive’ action, including Kennedy’s ‘dream of care for our elderly – the dream of an all-out attack on mental illness – and, above all, the dream of equal rights for all Americans, whatever their race or color.’ This pledge to continue Kennedy’s work with a ‘new spirit of action’ was tempered by the sombre tone of a man who a week earlier had been very much in the shadows. Emerging from the speech are two attitudes: Kennedy’s determination to act and Johnson’s renewed commitment to ‘negotiate the common interest.’ The Therapeutic Communities and Community Healthcare in 1960s America 5

speech was not heavy with therapeutic language (it devoted more words to civil rights and the next tax bill than to healthcare), but Johnson’s evocation of a spirit of ‘new fellowship’ at a time of national trauma struck just the right balance between reflection and progressive action.11

Johnson continued to emphasise community, perhaps even more so than Kennedy. His ‘War on Poverty’ speech of March 1964 sketched out a Community Action Program which would strike ‘poverty at its source’ in both rural and urban localities; following his vice-presidential work on equal employment opportunities he also announced a Work-Training Program for young adults, and a Work-Study Program to provide more part-time jobs.12 His emphasis was on local plans motivated by grassroots energies, but he also announced a new Office of Economic Opportunity which would provide leadership and direction for these initiatives. The balance between central leadership and local cooperative ventures offered a different model of organisation to that of the Eisenhower administration. On a basic level, this model of reorganisation envisioned a series of interacting layers where federal responsibility did not preclude local grassroots energies, and where governance was not at odds with civil liberty.

Some commentators have argued that Johnson’s program was actually ‘a conservative application of structuralist observations’ in his concerted attempt to get the poor back into the workforce.13 But, despite reports coming out of the South in 1967 that poverty had not really been tackled, those living under the subsistence line decreased from 20 percent to 12 percent during Johnson’s five years in the White House. Whether or not Johnson’s determination to win victory over poverty could ever be realised (Nixon later accused him of using ‘inflated rhetoric that promises more than it can deliver’), it showed the caring face of politics in the years between the Cuban missile crisis and the escalation of the Vietnam War.14 In his speeches of 1964 and 1965, Johnson made use of therapeutic language, mixed with a brand of confident pragmatism, which took his presidential policies beyond mere extensions of those of his predecessor. Addressing a large audience at the University of Michigan in May 1964 (when Johnson was running for president in his own right), he stressed that his vision of a Great Society ‘is a challenge constantly renewed, beckoning us toward a destiny where the meaning of our lives matches the marvelous products of our labor.’15 The phrase ‘Great Society’ might be dismissed as a slogan or a grand gesture (Norman Mailer thought it was imbued with 6 Therapeutic Communities and Community Healthcare in 1960s America

a ‘curious sense of happiness’), but Johnson’s pledge was made equally to urban and rural Americans and was enacted through a rebuilding exercise designed to produce jobs and give communities a sense of purpose.16

The amendment to the Social Security Act in 1965 was as important as the Civil Rights Act had been a year earlier, particularly the decision to add Medicare and Medicaid to the Social Security Act: Medicare focused on acute, non-catastrophic care for the elderly; Medicaid administered means-tested benefits for the poor.17 Johnson thought that Medicare ‘foreshadowed a revolutionary change in our thinking about health care’; controversially at the time, he called healthcare ‘a right, not just a privilege,’ and he pledged to invest $29 billion annually, up from $17.4 billion.18 Federal spending on the poor doubled between 1960 and 1970, but the cost of Medicaid was to be shared between Washington DC and the individual states: Alabama, for example, received 75 percent of its Medicaid costs directly from federal funds, while California got 50 percent, and a later report on New York City estimated that combined federal and state investment was only 75 percent ‘of the costs of treating the newly entitled population.’19

Johnson was proud of his work in combating physical and mental illness and in increasing the numbers of doctors, nurses and hospitals, but the dramatic rise in public expenditure and the escalating costs of healthcare were the major reasons why Nixon wanted to scale back spending at the end of the decade. Writing in 1969, the paediatrician (later the Surgeon General and President Carter’s Assistant Secretary for Health) Julius B. Richmond claimed that both Presidents Kennedy and Johnson offered only a ‘fragmented approach’ to healthcare reform, at least until the mid- 1960s when a ‘broader health program’ was prompted by the need for new legislation.20 Richmond argued that this fragmented approach actually continued into the second half of the 1960s, but he was broadly supportive of the general shift from inpatient hospital care to ‘a community health or outpatient program’ during the Johnson years.21 Set against this horizon, the combination of welfare provision, civil rights, community action and job opportunities were the cornerstones of Johnson’s Great Society and suggested that the nation was more caring than it had been ten years previously.22 Johnson could be gruff, and he was at his best as a negotiator rather than an orator, but even Johnson’s critics, such as Norman Mailer and Hebert Marcuse, credited him for his sincere attempt to alleviate poverty, Therapeutic Communities and Community Healthcare in 1960s America 7

and he was enthusiastically described in the mid-1970s as ‘a very human president.’23

This human face of the presidency is very important for my view of healthcare developments in the 1960s, particularly the ways in which Johnson’s ‘new fellowship’ can be seen to parallel developments in humanistic and existential psychology that became increasingly popular from the late 1950s onwards. Thinkers and practitioners such as Carl Rogers, Abraham Maslow and Harry Stack Sullivan privileged the patient’s unique life-world instead of adhering to rigid scientific and diagnostic frameworks, but they also looked beyond the individual to the ways in which new bonds could be forged within communities – what Philip Rieff called ‘commitment therapies,’ as distinct from the ‘analytic therapies’ that characterised the 1940s and 1950s.24 Rather than seeing tensions between the individual and community as irreconcilable – or reducing the social world to an Oedipal family drama on the Freudian model – this group of thinkers saw the two as mutually informing. These humanistic trends can be traced back to mid-century (particularly the founding text of Gestalt Therapy published in 1951 by Frederick Perls, Ralph Hefferline and Paul Goodman), but with a new awareness that health cannot be tackled on an individualistic level or through a conventional one-to-one therapeutic encounter between analyst and patient. Instead, we should take into account the interconnecting spheres of family, group and community existence.

To this end, in the remainder of this essay I will look at three examples of community health care that came to the fore in the period between 1966 and 1970. That is not to deny that there were not earlier models of therapeutic communities – such as a therapeutic centre for naval and marine corps personnel in Oakland, California in 1955-56 and a comprehensive mental health service established in San Mateo in the early 1960s – but they were implemented on a much wider scale in the second half of the decade. The first model I want to consider is the Neighborhood Health Center program developed with federal backing as an element of Johnson’s Great Society agenda, but with the commitment to mobilise grassroots energies. The second is the free clinic model which arose on the West Coast from the mid-1960s to the early 1970s, which combined idealism with hard-nosed realism, especially in relation to drug abuse and drug-related illnesses. And I want to conclude the essay by looking at a third trend: the fusion of therapy, mysticism and physical 8 Therapeutic Communities and Community Healthcare in 1960s America

renewal that found its most famous expression in the Esalen Institute on the central California coast in the late 1960s, intended as a centre for countercultural ideals and alternative therapies at a remove from what its founders perceived as the oppressive regime of the medical establishment. These three examples have quite different developmental arcs and involve different types of health practitioners, but, taken together, they suggest that there was no single solution to understanding, or practically addressing, the interconnected spheres of healthcare.

3. The Promise of the Neighborhood Health Center Program

The most visible way that Johnson helped to move forward Kennedy’s community healthcare plans (as enshrined in the 1963 Community Health Care Act) was through the development of the Neighborhood Health Center program, which began in 1965 under the guidance of the Office of Economic Opportunity – a project which perhaps best exemplifies the ‘new fellowship’ that Johnson sought. A report on ‘The Bright Promise of Neighborhood Health Centers’ – published in March 1968, the month Johnson announced that he would not run for reelection – suggested that out of all federal initiatives, the healthcare centre scheme would be the most successful in tackling poverty. Thirteen family-focused neighbourhood health centres had been established by the end of 1967, with further centres planned and $60 million of federal funding promised.

The author of the report, Judith Randal, was very positive about the benefits of bridging the divide between ‘medicine’s ability to deliver care to the whole community’ and the ‘high quality service it can provide the relatively few’: she wrote that the centres offered job opportunities for the poor and unemployed, training them to assist doctors and nurses or to become family health workers and laboratory aides.25 Randal stressed the close link between illness and poverty as the central tenet of preventive healthcare, particularly in deprived localities such as Watts in Los Angeles, or the all-black town of Mound Bayou in Bolivar County, Mississippi, near the Arkansas border. With only three doctors for 40,000 African Americans in Bolivar County (there were nineteen doctors for the 19,000 white residents), the only previous healthcare facility for African Americans in Mound Bayou was a fraternally run Taborian Hospital, which had been Therapeutic Communities and Community Healthcare in 1960s America 9

established in 1942, with the proto-civil rights activist T. R. M. Howard as the hospital’s chief surgeon for the first five years. Although the hospital also had directors of medicine and nursing, only a few staff members had formal medical training and there were no ambulances.26 The Taborian Hospital was successful in its own right as a grassroots initiative, but a fully fledged medical centre was not available until 1966, when the Delta Health Care Center was established. This new centre emphasised healthcare as a right rather than a privilege and sought to empower its patient community, using good health in the community as a marker of social change. The Delta Health Care Center offered emergency care in collaboration with local hospitals; it served an outpatient community, providing mental health and substance abuse facilities; and it provided financial assistance to those under the federal poverty line (42,000 people in Bolivar County were from families earning less than $3,000 per year).27

Although these new centres had to deal with regionally specific health problems (in Bolivar County, these included high infant mortality rates and malnutrition), Randal noted that the chosen urban and rural localities (‘areas the doctors in private practice have found unrewarding’) were not so distinct: sanitary problems in homes, overcrowding and the transmission of disease were common to both. She saw that the centres helped to facilitate social change within communities – particularly those areas that had not traditionally had medical support (for example, the community-based Pilot City Health Center in Minneapolis began development in 1967, and Lowndes County, Alabama, received a health centre planning grant in 1968) – and influenced university training. At training institutions like Fisk University and Meharry Medical College, both in Nashville, there was a growing realisation that medical theory and practice in the community should be closely linked. And UCLA faculty helped to establish a centre in Watts in 1967, largely in response to the riots of 1965 in that district.28 Randal cited warnings from the American Medical Association (AMA) and pharmacists that the neighbourhood centres ran the risk of undermining free choice for those living within distinct catchment areas, but she applauded Johnson’s aim of having fifty centres by the end of 1968 and ‘the chain reaction this social experiment will set off’ (there were eighty such health centres by 1973).29

The Neighborhood Health Center program was the most visible face of a caring government, and it was a success on its own terms, despite the 10 Therapeutic Communities and Community Healthcare in 1960s America

cost. It stemmed from the Economic Opportunity Act of 1964 and the Comprehensive Health Planning and Public Health Services amendments of 1966, the latter which, as a HEW report put it, was born out of the realisation that a ‘close cooperative effort would be required on the part of governmental, voluntary, and private organizations and agencies’ to develop ‘statewide and areawide comprehensive’ health facilities.30 It was also part of a concerted attempt to return a caring face to medicine, not only attempting to recast the patient’s experience and the doctor-patient relationship, but also reconsidering conditions such as schizophrenia and depression that increased in diagnostic frequency in the postwar years.

In addition to the realisation that something needed to be done to improve care for patients, there was also a crisis in the image of the doctor in the early to mid-1960s, as ongoing developments in the Cold War threatened to replace the friendly family doctor with the more impersonal specialist. Kennedy’s and Johnson’s emphasis on community care attempted to check this trend, but it did not prevent ‘several dozen specialties’ emerging in the related professions: one 1963 book found ‘each specialty budding with sub-specialties,’ many of which were reliant on ‘machines and techniques of dazzling variety and sophistication.’31 The attempt to revive the art of the caring doctor was well expressed in 1963 by the editor of the Lancet, T. F. Fox:

The teachers and the schools will have to decide whether they are content to produce a poker-faced technical expert who will attend to the faulty body as a garage technician attends to a faulty car, or whether, even in the modern world, they should still be producing doctors who will feel the same kind of personal obligation toward their patients as was felt by the old physicians.32

In May of the same year, a Time cover story celebrated the American surgeon, with the message that ‘surgery now offers the first and the best hope of all.’33 And two years earlier, an article titled ‘The Doctor’s Dilemma’ conveyed the strong message that prescription drugs are subject to various safeguards, but also that physicians should be knowledgeable and careful in their treatments.34 It was no accident, perhaps, that this moment coincided with the revival of the Doctor Kildare character that Lew Ayres and Lionel Barrymore had made famous on movie screens Therapeutic Communities and Community Healthcare in 1960s America 11

in the 1930s and 1940s. Nearly two hundred episodes of the show were broadcast on NBC between 1961 and 1966, with Richard Chamberlain playing the role of the handsome young James Kildare, a medical intern and later resident at a large urban hospital. Guided by the AMA’s advisory committee’s desire to safeguard the reputation of the profession, the television version of Doctor Kildare balanced ‘hospital-based “realism”’ in terms of setting and equipment with melodramatic narratives, while Chamberlain played Kildare as a responsible doctor and public servant who held patient care in high regard.35 The emphasis on Kildare’s committed attitude and the Neighborhood Health Center program’s face-to-face interaction complimented President Johnson’s stress on community and fellowship, facilitating a shift away from a normative account of health and pathology that dominated the 1950s to focus more centrally on the patient’s needs and capabilities.

4. The Ideals and Realities of the Free Clinic Movement

The next model I want to discuss found its most visible expressions in California, around San Francisco and Santa Cruz. The free clinic model was linked in spirit to Johnson’s Community Action Program, but it functioned at a local level rather than as a federal or state initiative. The free clinic movement adopted what Louis West, chair of the psychology department at UCLA, called the ‘green rebellion’ against the ‘sterile family and community lifestyle of the suburbs,’ as epitomised by the urban commune and extending through the neighbourhood free clinic.36 The first free clinic was established in the heart of the Haight-Ashbury neighbourhood in San Francisco in June 1967, but it survived well beyond the Summer of Love as a result of media attention encouraging a ‘wave of homeless and jobless refugees’ to move there only a few months later, some having been prematurely released from state mental hospitals.37 The emergence of the Haight-Ashbury Free Medical Clinic marked a cultural moment when the community-action group the Diggers were distributing free food in the Golden Gate Park area, but it was also an anti-establishment institution that quickly learned the hard realities of what providing free medical services entailed, given that hepatitis, venereal disease and drug-related squalor were common in ‘crashpad communes.’38 12 Therapeutic Communities and Community Healthcare in 1960s America

The number of free clinics quickly rose to 61 by 1969 and 135 by 1972 (11 of the original clinics had closed by 1970), most of them operating with an open-door policy and welcoming clients whatever their condition. The National Free Clinic Council (NFCC) chair David E. Smith described this philosophy as involving ‘no probing questions, no ‘morality trips,’ no red tape, no files, no labeling or judging, no ‘put downs,’’ and having a ‘respect for personhood.’39 Most of these clinics were established on the West Coast, such as the Open Door Clinic in Seattle, the Black Man’s Free Clinic in the Fillmore district of San Francisco, and the Berkeley Free Clinic on Telegraph Avenue in Oakland. However, there were also clinics in Tucson, Arizona; two in Boston; five in Canada; and one in the basement of a church in Austin, Texas, that opened near the University of Texas in April 1970, providing services for one night a week and run by a team of volunteer medical and lay staff members.40 The primary work of the Haight-Ashbury Free Clinic related to drug use, but across the country clinics experienced a range of medical and psychological issues, often linked to feelings of alienation and isolation among their young clients.

The NFCC ran a symposium on neighbourhood medical facilities in early 1970 as a way to chart and champion the flourishing of free clinics, which—in Smith’s words—were ‘the one viable alternative to our moribund, bureaucratised health care and delivery system [providing] badly needed services where there are none.’41 Reacting to the perception that official medicine was fragmenting into subspecialties and losing sight of general healthcare, the NFCC’s mission was to promote a mode of healthcare that ‘transcends clinical medicine,’ based on the:

fulfilment of basic human needs, both physical and mental . . . within a context of total health—individual, community, and social health. Total health care implies adequate personnel and facilities, full access to services, and a major new emphasis on preventive medicine via public education.42

Within this context, the NFCC was eager to improve quality and pursued five objectives: first, to provide a focal point for the ‘sociomedical momentum’ of free clinics; second, to disseminate information on healthcare; third, to distribute national funding between free clinics; fourth, to sponsor a regular symposium; and, fifth, to provide consultation on improving services and establishing new clinics.43 Therapeutic Communities and Community Healthcare in 1960s America 13

The NFCC was idealistic in its goals of treating ‘a variety of ills under one roof,’ its emphasis on ‘free’ treatment (the clinics were funded by modest donations), its use of an open-door policy at the heart of a community, and its philosophy of the whole person. But it was realistic in terms of the medical problems with which the clinics commonly dealt: drug use, sexually transmitted diseases, birth control, malnutrition and dental health, as well as psychological problems linked to the use of LSD or heroin, abortions and diffuse forms of neurosis and psychosis. The Haight- Ashbury Free Clinic illustrates this mixture of idealism and realism, linked to the growth of bohemian culture near Golden Gate Park between 1963 and 1967, but extending its work well beyond Haight-Ashbury’s white, middle-class residents. By 1970 the clinic was seeing 150,000 clients a year and providing a service unavailable elsewhere in the city, although San Francisco was touted as one of the best-equipped cities for hospitals (it had twenty-six hospitals in 1960).44

On a more realistic level, the Haight-Ashbury Free Clinic dealt mostly with health and crime-related problems associated with inner-city ghettos, particularly those of residents in communal housing, draft dodgers, squatters, the homeless, ‘hoodies’ and ‘unwanted people’. The director of psychiatry at the clinic, Ernest Dernberg (a refugee from Nazi Germany), successfully treated some clients, but staff members tended to refer clients with serious and complicated medical problems to institutions such as the Planned Parenthood and Venereal Disease Clinic or for free out-of-hours treatment at San Francisco General Hospital. This contrasts with 90 percent of clients treated at the Austin clinic, whose problems included respiratory infections, hepatitis and skin disorders. And the Black Man’s Free Clinic saw regular cases of chronic and acute psychological disturbances, fewer of which were linked to drug use than was the case at the Haight-Ashbury Free Clinic.46 The San Francisco and Austin clinics were frequented by hippies, leading one commentator to describe the Austin clinic as follows:

The first impression one has on entering the clinic is overwhelming. Young people with long hair are everywhere, sitting on the floor, on chairs and benches, or standing in line to be registered. Frequently a tape deck is playing music is the waiting area. . . . Other than their youth and hair, a striking feature of the clinic patients is their courtesy and patience while waiting to be seen.47 14 Therapeutic Communities and Community Healthcare in 1960s America

At the 1970 symposium, the NFCC tried to counter the ‘square’ view that hippies – many of whom had middle-class backgrounds and had chosen a communal lifestyle – ‘have forfeited whatever right they might have had to conventional medical services.’ The general dislike of hippies (and the bias in their favour of the free clinic movement) was emphasised when the NFCC unsuccessfully applied for a National Institute of Mental Health grant to research a project led by the criminologist Roger Smith called ‘The Hippies – Studies of a Drug Based Culture.’ The project was later funded, but only under a different title: ‘Psycho-Social Factors in Drug Abuse.’49

David Smith specialised in drug use, and he published a number of books on the consequences of using heroin, marijuana, amphetamines and tranquilizers. Anxiety and paranoia were common characteristics of the clients of the Haight-Ashbury Clinic who used drugs, and many of them saw the world as ‘a frightening, empty and hostile place rather than a natural repository which can be reclaimed through a new sense of fraternity.’50 Smith did not promote drug use, even though he smoked marijuana partly as a means to help dissolve the conventional institutional relationship between doctor and patient. In fact, Smith was a demystifier of drugs, attempting to heighten the reader’s awareness of the hidden abuse of stimulants and depressants and to counteract ‘inefficient government programs, and naive statements by public officials concerning drug abuse’.51 In line with this, free clinic workers often openly met clients using LSD and heroin, although Smith noted an increasing trend for multiple drug use in his passionate account of the Haight-Ashbury Clinic, Love Needs Care, published in 1971. This includes a dramatic scene in the Episcopal Peace Center, which, beginning in the autumn of 1968, formed an annexe around the corner from the main clinic. Intended as a ‘tranquil refuge,’ the annexe was full of patients ‘in every imaginable form of dress and undress. Some of the young people were wrapped in blankets, their anguished faces barely visible behind blood-soaked bandages. Others . . . were huddled together, trying to stay warm.’52

Rather than a heroic picture of peace-loving hippies, then, this account reveals ‘hopelessness’ among the clientele and a steep learning curve for the clinic’s interns and volunteers. Some psychiatric and counselling work was possible, but in cases of severe or long-term drug use, physicians were obliged to administer sedatives and tranquilizers to ‘pacify acutely toxic Therapeutic Communities and Community Healthcare in 1960s America 15

people’ and to counter ‘the paranoia and hallucinosis characteristic of chronic toxicity.’53 In the account of the clients housed in the clinic’s annexe in the autumn of 1968, Smith and his coauthor John Luce mention a girl who tried to jump out of the window suffering from paranoid fright, a young man who pulled a gun in pursuit of a pusher whom he claimed had sold him contaminated drugs, and another young man who existed in ‘a chemically induced state of well-being’ that he called ‘Terminal Euphoria’ and who liked to boast about how much heroin he could inject.54 The cases worsened through 1968 and 1969, particularly when the Manson murders of August 1969 caused anxiety among young people in San Francisco and Los Angeles (Manson had lived in Berkeley in 1967, and he had homes in Topanga Canyon and Death Valley in 1968-69).

Not all the anxieties experienced by clients of the free clinics could be linked to elements of the national scene, including the disillusionment with the Vietnam War, dismay at the assassinations of 1968, or the shock of the Manson murders in 1969. The sense that things were changing in 1968- 69 was also linked to the disappearance of the hippie philosophy that had given impetus to the San Francisco Free Health Clinic in 1967. Only a year later, the chair of the NFCC concluded that the bohemians and hippies who once inhabited the Haight neighbourhood had been replaced by speed freaks, drug dealers and ‘rip-off artists’ who had shattered an already fragile bohemian community that lacked the cohesion and flexibility to last in the long run.55 In response to this shift in clientele, the clinic opened a heroin section in November 1969 to deal with the rise of ‘new junkies’ who had ‘entered the heroin scene during the demise of the hippie movement and at a time of general disillusionment in the counterculture.’56 By 1972 this new breed of heroin and multidrug users represented over 57 percent of the addicts seen at the clinic. These issues were exacerbated by a swathe of cutbacks to state psychiatric hospitals when California’s new governor, Ronald Reagan, slashed the budget for the Department of Mental Hygiene in 1967, only to reinstate some funding two years later, when it became clear that a large number of fragile patients had been released prematurely.57 Despite these endemic problems, though, the growth of the Free Clinic Movement into the early 1970s indicated how vital they were for communities, particularly those representing a mixed clientele that would not otherwise have access to healthcare. 16 Therapeutic Communities and Community Healthcare in 1960s America

5. Group Therapy and the Esalen Institute

This ambivalent attitude towards drugs brings me to the last of my examples of new therapeutic communities: the Esalen Institute. The free clinic movement balanced the idealism of free healthcare and the realism of dealing with drug use among fragmenting communities, but the Esalen Institute, located thirty-five miles south of Monterey, offered a very different model of collective therapy. I have already mentioned Frederick Perls, who was involved in Gestalt therapy in the early 1950s and the rise of alternative therapeutic practices in the mid-1960s. Perls was only one charismatic (and not wholly liked) example of the many kinds of therapists who practiced at the Esalen Institute, which also offered meditation, yoga, group encounters, visualisation, psychodramatic practices, spa therapy and other somatic disciplines.

The institute was founded in 1962 by two Stanford University graduates, Michael Murphy and Richard Price. As a student, Murphy had converted to Hinduism (after listening to Frederic Spiegelberg’s lectures on contemporary religion at Stanford), and he saw the institute as a place ‘where Western and Eastern thinkers and practitioners could meet in order to fuse the best of both cultural visions and create a new way of being (or indeed becoming) human.’ In contrast, Price had experienced invasive forms of therapy as treatment for assumed psychosis during military service in the late 1950s, and he saw Esalen as ‘a place of healing, as a refuge from the cruelties of Western culture.’58 This balance between alternate world views, ‘education for transcendence’ (the title of Murphy’s article in the first issue of the Journal of Transpersonal Psychology) and a retreat from medical officialdom, marked the institute as a sacred place for Murphy and Price, and for its broad sweep of practitioners and many clients during the 1960s and beyond.59 Esalen was, and still is, a very private place. Many rumors circulate about famous writers and musicians who went to the institute in the 1960s and 1970s, including Henry Miller, Hunter S. Thompson, George Harrison, Susan Sontag, Joan Baez and John Denver. According to other rumours, Nixon’s administration blamed Esalen for indoctrinating Charles Manson and, therefore, considered the institute partly responsible for the Manson murders.60

Murphy and Price were no strangers to psychedelic drugs. They were friends of Timothy Leary in the mid-1960s; Price used psychedelics ‘in Therapeutic Communities and Community Healthcare in 1960s America 17

his own person voyaging’; and Murphy remembers eight trips on peyote and LSD during the early years of Esalen, although he stopped in 1966 when the trips became more ‘painful.’61 They claimed that the period 1966-70 ‘was the most tumultuous, out-of-control time,’ when drugs were rife throughout that stretch of the California coast (there were three drug-related suicides at Esalen), but they did not plan the institute to be a ‘psychedelic initiation center’, and they banned the sale of drugs at the institute and their use in seminars.62 Just as Murphy and Price steered away from medical drugs in favour of meditation and yoga, so Murphy (more than Price) was a strong advocate of a ‘non-drug route’ to personal enlightenment.63 This is related to the fact that Esalen’s natural hot springs (on land purchased by Murphy’s grandfather) made it perfect for a health spa, and to the statement by Esalen’s vice president and the editor of Look, George Leonard, that the institute was devised to ‘help, not the few, but the many toward a vastly expanded capacity to learn, to love, to feel deeply, to create’ by rejecting ‘the tired dualism’ of body and mind in which ‘the joys of the senses’ are neglected or downgraded.64 Although Esalen’s coastal location and philosophy made the institute very different from the free clinics in West Coast urban locations, both ventures promoted holistic philosophies. Esalen operated as a nonprofit organisation, with a mission to develop therapeutic techniques in other localities – such as a San Francisco centre that was more closely linked to the realities of urban and suburban life. Esalen also acted as a training hub for psychologists, social workers, educators and psychotherapists (an estimated seven hundred had visited the institute by 1967). It was also a health centre for around four thousand clients per year in the mid-1960s, who paid between $60 for weekend seminars to $160 for five-day workshops and $3,000 for a nine-month residential fellow course.65

Public interest in Esalen was not just to be found in the Bay Area, where there was a wave of popular courses on meditation and yoga in the late 1960s.66 A broader interest in the clinic stemmed partly from publicity about Frederick Perls and Alan Watts as gurus of alternative therapy in the mid-1960s, but also from interest in Abraham Maslow, who launched the San Francisco branch of Esalen in January 1966; Joy, the widely read book by the Esalen therapist William Schutz; a December 1967 article in the New York Times by the journalist Leo Litwak about his revelatory visit to Esalen in the summer of that year (the article was reprinted in 1968 in a collection of best magazine articles); Paul Masursky’s box office success, 18 Therapeutic Communities and Community Healthcare in 1960s America

Bob & Carol & Ted & Alice; and Murphy’s visit to London in the summer of 1970 to meet members of the Association for Humanistic Psychology and take the Esalen message to Britain.67

Schutz’s popular Joy is arguably the best expression of the Esalen experience and the human potential movement. The book presents ‘joy methods’ in non-technical language; it encourages the reader to explore his or her ‘unused potential’; it advocates a ‘wide variety of approaches,’ many of which can be practiced outside of an institution; and steers away from drugs.68 Schutz does not offer any panaceas, but a renewed awareness of the body and techniques that combine the verbal and the nonverbal, and balance self-exploration with personal interaction. The book is broadly in line with Maslow’s theory of ‘self-actualization’ and promotes exercise to overcome neurosis and bodily debilitation. Schutz makes forays into addressing social repression, but he concentrates on the benefits of encounter groups, psychodrama, physical release and meditation as techniques that can help to reorient the self in its relation to others. This is to be achieved through a threefold theory of interpersonal behaviour that Schutz had outlined in the late 1950s: inclusion (‘the need to be with people and to be alone’), control (a combination of self-determination and receptivity to others), and affection (steering a course between ‘emotional entanglement’ and a ‘bleak, sterile life without love, warmth, tenderness, and someone to confide in’).69 ‘Openness and honesty’ are the driving forces of Joy, but the book also presents a fear that the moment will soon pass unless human potential is grasped.70 Schutz ends his prologue by reflecting on his son and the future – ‘The future is exciting. The pursuit of joy is exciting. The time is now. We’d better hurry. The culture is already getting to him – Ethan looks as if he is beginning to feel frightened and guilty’ – and he closes the book with the renewal of possibility, as Ethan reaches toward the night sky.71

This engagement with the ‘now’ of the late 1960s as a therapeutic moment had its most popular expression in Paul Mazursky’s 1969 film Bob & Carol & Ted & Alice, with which I will draw this section of the essay to a close. Mazursky had recently become a devotee of Esalen. Visiting the institute for a weekend with his wife had given him the impetus to coauthor the first twenty pages of the Bob & Carol & Ted & Alice screenplay, and he was pleased that the film did not compromise self-expression and the feelings of openness that Esalen had awakened in him.72 This is developed Therapeutic Communities and Community Healthcare in 1960s America 19

through the film’s use of method acting, but only to a degree. The long opening sequence of the film is accompanied by Handel’s ‘Hallelujah Chorus’ and depicts expansive views of the Big Sur coast, intercut with shots of the spa, nude meditation, tai chi and scream therapy at sunrise (a shot that includes Mazursky in silhouette), which all emphasise the special qualities of Esalen. The opening introduces Bob (Robert Culp), a documentary filmmaker, and his wife, Carol (Natalie Wood), as they arrive at ‘the Institute’ for a weekend residency course. We then cut to a twenty- four-hour group therapy session that includes candid introductions from the residents, the therapist’s nondirective encouragement, disconcerting close-ups of the residents as they ‘try to learn something about the other person’ without speaking, and a group session in which Carol’s openness to others is contrasted with Bob’s disengagement and deep-seated anxiety, which surfaces during lengthy group therapy. The opening section teeters between documentary realism, a sensitive representation of the residents learning to be emotionally open with each other (including a tender scene between Bob and Carol), and uncomfortable satire as an indulgent group hug ends the Esalen sequence.

The remainder of the film veers toward a comedy of social manners as Bob and Carol test out their Esalen experience on their friends Ted (Elliott Gould) and Alice (Dyan Cannon), a more conventional couple whose growing interest in new experiences serves to challenge the boundaries between ‘hip’ and ‘square’ (Cannon started going to Esalen after making the film, perhaps as a response to her divorce from Cary Grant in 1968, after he reputedly forced her to take LSD).73 Bob and Carol’s new age pretensions are exposed through group situations and conversations that lead to admissions of affairs, a marijuana session, Alice’s visit to a psychiatrist, and a planned foursome – all of which leaves the Esalen experience behind for a fairly lighthearted poke at late 1960s bourgeois manners, in which the search for authenticity is in danger of collapsing into vacuous narcissism.

If we see the film as an example of the ways in which neurosis had become rooted in everyday life by the end of the 1960s (a 180-degree turn from the pathological focus on the asylum inpatient in the early postwar years), then the engagement with discourses of health and illness is fairly thin. Mazursky’s stated aim was to be both funny and touching, but what begins as the potential for group therapy to break through neurotic barriers 20 Therapeutic Communities and Community Healthcare in 1960s America

dissolves into social comedy akin to Woody Allen’s films of the late 1960s and 1970s. Group therapy was not always portrayed in such a positive light: in the 1967 novel and 1970 film Diary of a Mad Housewife, for example, the group session proves useless for Tina Balser, and her psychiatrist shows himself to be insensitive to her domestic frustrations. On one level, Bob & Carol & Ted & Alice marks an optimistic moment for the human potential movement, as is evident when Bob encourages Ted to grasp the liberating spirit of the Institute. However, given that the film was shot during Nixon’s victorious presidential campaign, perhaps Mazursky recognised that the human potential movement was already passing into history.

6. Putting Health into Action

It is clear from this discussion that there was no single or ideal model of community health care in the 1960s, but instead a widespread commitment to rethink health beyond the horizon of the individual and to put health into action. It is clear, as well, that there were many different ideas circulating at the time, drawn from the natural sciences, social sciences, medicine, religion, mysticism and across the cultural sphere, which meant that it was harder to claim that medicine in the 1960s was a sealed profession. But the harsh realities of community healthcare often grated against its idealistic conception, particularly so by the end of the decade and into the 1970s when, as Gerald Grob has argued, ‘many chronically and severely mentally ill persons … were often cast adrift in communities without access to support services or the basic necessities of life’.74 This, perhaps, was one of the reasons that Julius Richmond argued in 1969 that physicians and health administrators needed to have a more panoramic awareness of the interactions between the institutions and spaces of healthcare, leading him to advocate a model in which medical centres with their focus on disease needed to work alongside community health services and their countervailing ‘focus on prevention and continuing, comprehensive family care.’75

Richmond’s prominent role in the Department of Health during the Carter administration (including his participation in the 1977 President’s Commission on Mental Health) was part of a federal push to move beyond the fragmentary nature of 1960s healthcare: what Carter (during his Therapeutic Communities and Community Healthcare in 1960s America 21

1976 presidential campaign) called a ‘haphazard, unsound, undirected, inefficient nonsystem’ that he argued had been worsened by the partial dismantling of Johnson’s healthcare and welfare reforms during the Nixon and Ford administrations.76 Carter noted in the same speech to the Student National Medical Association in April 1976 that healthcare should not be separated off as a sealed sphere of practice and policy, because in reality it is ‘one strand of a seamless social web’, and he argued for a ‘consolidated’ and ‘cooperative’ approach which would involve ‘specialists, generalists and professionals of all levels’.77 If we take Carter’s insights seriously, then we should look beyond a top-down focus on the federal response to healthcare and examine as well the social interactions and cultural expressions that shape medical perceptions. These insights also return us to the beginning of this essay because Buckminster Fuller and Joseph Blumenkranz were arguing along similar lines just a few years earlier, emphasizing the need to give new shape to ideas of ‘comprehensiveness’ and to bring together different spheres of activity within versatile, interconnecting spaces – just as embodied in the community healthcare initiatives of the 1960s.78 22 Therapeutic Communities and Community Healthcare in 1960s America

Notes

I am grateful for the feedback I received on versions of this essay presented at the University of Manchester (November 2011) and Cambridge University (May 2012), as well as the helpful response to my keynote lecture on this subject at the European Association for American Studies Conference at Ege University, Izmir, Turkey 30 March–2 April 2012. Sections of this essay appear in chapters 8 and 9 of Martin Halliwell, Therapeutic Revolutions: Medicine, Psychiatry, and American Culture (New Brunswick, NJ: Rutgers University Press, 2013).

1. Joseph Blumenkranz, ‘Planning Medical Care Facilities: Present Trends and Future Possibilities’, American Journal of Public Health, 56, no. 10 (October 1966): 1694. 2. Ibid., 1686.

3. R. Buckminster Fuller, ‘The Prospects for Humanity’, Saturday Review, 29 August 1964, 4. 4. Blumenkranz, ‘Planning Medical Care Facilities’, 1688. Buckminster Fuller, ‘Prime Design’ (1960), reprinted in The Buckminster Fuller Reader, ed. James Meller (London: Jonathan Cape, 1970), 327. 5. See Theda Skocpol, Boomerang: Health Care Reform and the Turn against Government (New York: Norton, 1997). 6. Bert Hansen, Picturing Medical Progress from Pasteur to Polio: A History of Mass Media Images and Popular Attitudes in America (New Brunswick, NJ: Rutgers University Press, 2009), 10. See also John C. Burnham, ‘American Medicine’s Golden Age: What Happened to It,’ Science 215 (19 March 1982): 1474–79.

7. ‘American Life and Times 1900–1950,’ Life, 2 January 1950, 34–35; Vannevar Bush, Science –The Endless Frontier (Washington: National Science Foundation, [1945] 1960). 8. For Eisenhower’s healthcare proposals, see Lester A. Sobel, Health Care: An American Crisis (New York: Facts on File, 1976), 21–29. 9. See Nathan Hale, Jr., The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans: 1917-1985 (Oxford: Oxford University Press, 1995). 10. Lyndon B. Johnson, ‘Let Us Continue’, 17 November 1963, in Speeches of the American Presidents, ed. Janet Podell and Steven Anzovin, 2nd ed. (New York: H. W. Wilson, 2001), 723–24. 11. For a discussion of Johnson’s double-edged homage to Kennedy, see Philip Abbott, Accidental Presidents: Death, Assassination, Resignation, and Democratic Succession (London: Palgrave Macmillan, 2008), 131–54. Therapeutic Communities and Community Healthcare in 1960s America 23

12. President Johnson, ‘The War on Poverty’, 16 March 1964, in Speeches of the American Presidents, 726–30. 13. James T. Patterson, America’s Struggle against Poverty 1900–1980 (Cambridge: Harvard University Press, 1981), 136. 14. Richard M. Nixon, ‘First Inaugural Address’, 20 January 1969, in Speeches of the American Presidents, ed. Podell and Anzovin, 769. 15. Lyndon B. Johnson, ‘The Great Society’, 22 May 1964, in Speeches of the American Presidents, 731. 16. Norman Mailer, The Time of Our Time (New York: Little, Brown, 1998), 542.

17. Robert F. Rich and William D. White, ‘Health Care Policy and the United States: Issues of Federalism’, in Health Policy, Federalism, and the American States, ed. Robert F. Rich and William D. White (Washington: Urban Institute Press, 1996), 19. 18. Lyndon Baines Johnson, The Vantage Point: Perspectives of the Presidency 1963–1969 (New York: Holt, Rinehart and Winston, 1971), 220, 343. Johnson’s perspective was at odds with that of the president of the AMA, Milford O. Rouse, who thought in 1967 that medical care was a privilege rather than a right, more in line with Nixon’s opinion. See Max Seham, Blacks and American Medical Care (Minneapolis: University of Minnesota Press, 1973), 2–3. 19. The Alabama Project on Medicaid (Birmingham: Alabama Law Institute, University of Alabama, 1997), 2; Eli Ginzberg, From Health Dollars to Health Services: New York City, 1965–1985 (Totowa, NJ: Rowman and Littlefield, 1986), 8, 20. 20. Julius B. Richmond, Currents in American Medicine: A Developmental View of Medical Care and Education (Cambridge, MA: Harvard University Press, 1969), 70–74. 21. Ibid., 94.

22. For Johnson’s emphasis on community action and race, see Jill Quadagno, The Color of Welfare: How Racism Undermined the War on Poverty (New York: Oxford University Press, 1994). 23. Jack Valenti, A Very Human President (New York: Norton, 1975), 394–95.

24. Philip Rieff, The Triumph of the Therapeutic (Chicago: University of Chicago Press, [1966] 1987), 76. 25. Judith Randal, ‘The Bright Promise of Neighborhood Health Centers’, Reporter, 21 March 1968, 15, 16. 26. Ibid., 17. For Howard’s contribution to the Taborian Hospital and his career as a civil rights activist (including a year as president of the National Medical Association in the mid-1950s) see David T. Beito and Linda Royster, Black Maverick: T. R. M. Howard’s Fight for Civil Rights and Economic Power (Urbana: University of Illinois Press, 2009). 24 Therapeutic Communities and Community Healthcare in 1960s America

27. David T. Beito, ‘Black Fraternal Hospitals on the Mississippi Delta, 1942–1967,’ Journal of Southern History 65, no. 1 (1999): 109–40. 28. See Seham, Blacks and American Medical Care, 90–91.

29. Randal, ‘The Bright Promise of Neighborhood Health Centers’, 18.

30. The Urban Planner in Health Planning: A Report (Washington: Department of Health, Education, and Welfare, 1968), 1. For discussion of community projects from a psychiatric perspective, see Leopold Bellak, ed., Handbook of Community Psychiatry and Community Mental Health (New York: Grune and Stratton, 1964), and from a nursing perspective see Frances Monet Carter Evans, The Role of the Nurse in Community Mental Health (New York: Macmillan, 1968) 31. Karl Evang et al., Medical Care and Family Security (Englewood Cliffs, NJ: Prentice-Hall, 1963), 198–99. 32. T. F. Fox, ‘Personal Medicine,’ in The Health Care Issues of the 1960s (New York: Group Health Insurance, 1963), 68. 33. ‘Surgery: The Best Hope of All,’ Time, 3 May 1963, 44–60.

34. Paul S. Rhoads, ‘The Doctor’s Dilemma – Drug Therapy and the Facts of Life,’ Archives of Internal Medicine 107, no. 6 (1961): 810–12. 35. Joseph Turow and Rachel Gans-Boriskin, ‘From Expert in Action to Existential Angst: A Half Century of Television Doctors,’ in Medicine’s Moving Pictures, ed. Leslie J. Reagan et al. (Rochester, NY: University of Rochester Press, 2008), 267–68. 36. Quoted in Bill Kovach, ‘Communes Spread as the Young Reject Old Values,’ New York Times, 17 December 1970. 37. Timothy Miller, The 60s Communes: Hippies and Beyond (Syracuse, NY: Syracuse University Press, 1999), 68. 38. Ibid., 44, 201.

39. David E. Smith et al., The Free Clinic: A Community Approach to Health Care and Drug Abuse (Beloit, WI: Stash, 1971), xiv. See also Gregory L. Weiss, Grassroots Medicine: The Story of America’s Free Health Clinics (Lanham, MD: Rowman and Littlefield, 2006), 28.

40. Richard J. Alexander, ‘People’s Free Clinic,’ Texas Medicine 68, no. 2 (1972): 94–100.

41. Smith et al., The Free Clinic, vi.

42. Ibid., vii.

43. Ibid., viii.

44. After opening in 1968, the Black Man’s Free Clinic in the Fillmore area of San Francisco had a modest clientele of about 8,500 people a year (70 percent of whom were black), while the People’s Community Clinic in Austin saw over 3,000 clients per Therapeutic Communities and Community Healthcare in 1960s America 25

year (1 percent of Austin’s population) in 5,500 separate visits, mostly from the young, transients and migrants.

45. David E. Smith and John Luce, Love Needs Care (Boston: Little, Brown, 1971), 7, 40.

46. ‘Proceedings of the First National Free Clinic Council Symposium,’ in The Free Clinic, ed. Smith et al., 6. 47. Alexander, ‘People’s Free Clinic’, 95.

48. Smith et al., The Free Clinic, x–xi. See also the special issue of American Journal of Psychiatry, 126, no. 10 (1970), which includes two articles on mental health in urban ghettos. 49. ‘Proceedings of the First National Free Clinic Council Symposium’, in The Free Clinic, ed. Smith et al., 13. 50. Smith and Luce, Love Needs Care, 80.

51. Smith and Wesson, eds, Uppers and Downers, 1

52. Smith and Luce, Love Needs Care, 31.

53. Ibid., 34.

54. Ibid., 40.

55. Timothy Miller, The Hippies and American Values (Knoxville: University of Tennessee Press, 1991), 95. 56. Smith and Luce, Love Needs Care, 39; George R. Gay, ‘The Haight-Ashbury Free Medical Clinic’, in It’s So Good, Don’t Even Try It Once, ed. Smith and Gay, 73. 57. See Eugene C. Lee and Willis D. Hawley, The Challenge of California (Boston: Little, Brown, 1970), 129–40; Lou Cannon, Governor Reagan: His Rise to Power (New York: Public Affairs, 2003), 189–94; and John Patrick Diggins, Ronald Reagan: Fate, Freedom, and the Making of History (New York: Norton, 2007), 135–36.

58. Jeffrey J. Kripal and Glenn W. Shuck, ‘Introducing Esalen,’ in On the Edge of the Future: Esalen and the Evolution of American Culture, ed. Jeffrey J. Kripal and Glenn W. Shuck (Bloomington: Indiana University Press, 2005), 5–6. 59. Michael H. Murphy, ‘Education for Transcendence,’ Journal of Transpersonal Psychology 1, no. 1 (1969): 21–33. 60. Jeffrey J. Kripal, Esalen: America and the Religion of No Religion (Chicago: University of Chicago Press, 2007), 3–4, 144. 61. Robert Forte, ‘The Esalen Institute, Sacred Mushrooms, and the Game of Golf: An Interview with Michael Murphy’, in Timothy Leary: Outside Looking In, ed. Robert Forte (Rochester, VT: Park Street, 1999), 201, 199. 62. Ibid., 200. 26 Therapeutic Communities and Community Healthcare in 1960s America

63. Ibid., 201.

64. Quoted in Leo E. Litwak, ‘A Trip to Esalen’, New York Times, 31 December 1967.

65. Forte, ‘The Esalen Institute, Sacred Mushrooms, and the Game of Golf’, 199. For a candid account of Esalen’s residential program, see Stuart Miller, Hot Springs: The True Adventures of the First New York Jewish Literary Intellectual in the Human- Potential Movement (New York: Viking, 1971). For the spiritual implication of Esalen’s work see Marion Goldman, The American Soul Rush: Esalen and the Rise of Spiritutal Privilege (New York: New York University Press, 2012); for Esalen’s wider circle see Walter Truett Anderson, The Upstart Spring: Esalen and the American Awakening (Reading, MA: Addison-Wesley, 1983); and for broader discussions of the human potential movement, see Eugene Taylor, Shadow Culture: Psychology and Spirituality in America (Washington: Counterpoint, 1999), 235–82.

66. Margaret A. Blair, ‘Meditation in the San Francisco Bay Area: An Introductory Survey,’ Journal of Transpersonal Psychology 2, no. 1 (1970): 61–70. 67. George Leonard was also a major promoter of Esalen, particularly in the June 1966 special issue of Look on California (featuring a photo series about ‘The Turned- On People’ that included images of Murphy and Esalen) and Leonard’s 1968 widely read book Education and Ecstasy, which was serialised in Look. For a discussion of Leonard’s promotion of Esalen, see Kripal, Esalen, 202–21. 68. William C. Shutz, Joy: Expanding Human Awareness (London: Penguin, 1967), 11, 15.

69. Ibid., 18. Schutz discusses this threefold theory in FIRO: A Three-Dimensional Theory of Interpersonal Behaviour (New York: Rinehart, 1958). 70. Schutz, Joy, 16.

71. Ibid., 11, 189.

72. Josh Greenfield, ‘Paul Mazursky in Wonderland’, Life, 4 September 1970, 51–56. See also Mazursky’s interview at the Lee Strasberg Theater and Film Institute, included in the 2004 DVD of Bob & Carol & Ted & Alice. 73. Dyan Cannon, Dear Cary: My Life with Cary Grant (New York: It Books, 2011).

74. Gerald N. Grob, From Asylum to Community: Mental Health Policy in Modern America (Princeton: Princeton University Press, 1991), 364. 75. Richmond, Currents in American Medicine, 99.

76. Jimmy Carter, Speech given before the Student National Medical Association, Washington, DC, 16 April 1976, 4. Records of the First Lady’s Office, Mary Hoyt’s Press Releases and Speeches, Box 1, Jimmy Carter Library, Atlanta, GA. 77. Ibid., 10.

78. Buckminster Fuller, Utopia or Oblivion: The Prospects for Humanity (New York: Overlook Press, 1969), 13. Forthcoming publication

Meldan Tanrısal and Tanfer Emin Tunç, eds. The Health of the American Nation: An Historic, Cultural, and Literary Survey. Heidelberg, Germany: Universitätsverlag Winter:

This edited volume, which simultaneously serves as the proceedings for the 2012 EAAS Conference hosted by the American Studies Association of Turkey and held at Ege University in Izmir, provides an overview of the conference theme through an interdisciplinary lens. Comprised of over twenty essays written by emerging as well as established scholars from across Europe and the United States, the collection dissects ‘the health of the nation’ from numerous historical, cultural, and literary perspectives, and represents an important intervention in American Studies from a transnational angle. The volume, which includes a preface written by EAAS President Philip John Davies, as well as an introduction by the editors, is forthcoming from Universitätsverlag Winter. Eccles Centre for American Studies Plenary Lectures at the British Association for American Studies Annual Conference

2004 ‘Maybe Nothing Ever Happens Once And Is Finished’: Some Notes on Recent Southern Fiction and Social Change, by Richard J Gray

2005 Evaluating the Foreign Policy of President Clinton – Or, Bill Clinton Between the Bushes, by John Dumbrell

2006 At Home at the Wheel? The Woman and her Automobile in the 1950s, by Maggie Walsh

2007 Postmodernism vs. Evangelical Religion in Post-1960s America, by Richard King

2008 John Cage Was All The Rage, by Peter Dickinson

2009 The Special Relationship: What Does America Teach Us About Ourselves?, by Janet Beer and Jon Snow

2010 ‘America, Empire Of Liberty’ And The Challenges Of ‘Popular’ History, by David Reynolds

2011 The First Financial Crisis of the Twenty-First Century: Lessons for America, by Nigel Bowles

THE ECCLES CENTRE was founded by David and Mary Eccles in 1991. Based at the British Library – which houses one of the world’s foremost collections of American books, manuscripts, journals, newspapers and sound recordings – the Centre has two broad aims: to increase awareness and use of the Library’s North American holdings, and to promote and support the study of North America in schools and universities in the United Kingdom.

The Centre’s programme includes lectures, conferences, concerts, seminars, teacher and student events and web based study resources. The Centre works in co-operation with the Library’s American curatorial team, with members of the American Studies community in the UK, and with other partners interested in the advancement of knowledge about America. The focus of the Eccles Centre is on North America, in particular the US and Canada, but can extend to include the hemispheric, comparative and international topics in which the US and Canada play a major part.

Full details of the Eccles Centre’s programme can be found at www.bl.uk/ecclescentre