Agents Of Change


In October 1963 Congress implemented the plan, in the Community Mental Health Centers Act of 1963. It was the last law signed by President Kennedy, and it began the reversal of national health policy—from “stockpiling” patients to what would be known as dumping.

It can be argued that the plan was never given a chance. The report called for some two thousand community mental-health centers, but fewer than seven hundred were ever built. Smaller intensive-care hospitals were not built at all. And though the report recommended tripling spending on the mentally ill, Congress and the states used it to justify cutting spending.

Legislators and mental-health ad-ministrators were hoping to reduce, not to increase, their budgets. They could use one new treatment the commission advocated as a means to that end. In 1954 the drug chlorpromazine, with the trade name Thorazine, was introduced. Pushed heavily by its maker, Smith Kline & French, whose salesmen argued that its use would more than pay for itself in reduced staff injuries, damage to furniture, and broken glass from violent patients, it was called by some doctors a “medicinal lobotomy.” But Ewalt supported its use, saying, “Unquestionably, the drugs [in its class] have delivered the greatest blow for patient freedom, in terms of nonrestraint, since Pinel struck off the chains of the lunatics in the Paris asylum 168 years ago.”

To administrators, Thorazine and its ilk offered another sort of hope. Drugs might pacify patients outside the institution while contact with family and community helped heal them, all while money was saved.

The results took time to become evident. The discharges began in such Northern states as Massachusetts and New York and progressed to less prosperous and less urbanized ones. A whole generation of highly motivated professionals worked to establish successful community health centers, but few of them were created, and there was almost no coordination with existing mental-health hospitals, which nonetheless began discharging patients and cutting their admissions.

At first most of the discharged patients, roughly two-thirds of them, went back to their families. But by 1975 the figure had dropped. By then some 28 percent of discharged patients in New York were headed for destinations listed as “places unknown.” Gradually, the anecdotal evidence suggests, families became unable to deal with patients. Many stopped taking their drugs, which tended to have debilitating side effects, and many who did take them wandered city streets in a zombielike gait that became known as the Thorazine shuffle.

THE DEVELOPMENT of Hoff‘s microprocessor has taken on a sense of inevitability unknown since the nineteenth century.

The process was abetted by the 1972 broadening of Social Security benefits called Supplemental Security Income; it provided checks to the mentally disabled. This gave deinstitutionalization added momentum. In 1955 an estimated 0.47 percent of the population was sleeping in a mental hospital on an average night; by 1990 the figure had fallen to just 0.05 percent.

The larger public policy consequence, as Sen. Daniel Patrick Moynihan has argued, was a miscasting of a problem: What appeared to be a shortage of housing was in large part a lack of mentalhealth care. The nation wrestled with its conscience, but with little awareness of the events that had brought on the crisis. And the crisis continues.


“The engines of personal computers” they are often called, but micro-processors now also run our toasters, preventing golden brown from becoming char black. They control the mixture of gasoline and air in automobile engines. (Souping up a hot rod is no longer a matter of greasy muscle work with wrench and drill but one of finding a nerdish specialist in aftermarket controller chips.) Like the insects their packages resemble, microprocessors have spread around the world on gossamer wings of marketing and innovation.

The man behind these tiny bits of reason etched in sand was Ted Hoff. Hoff worked for Intel, which had led the way from integrated circuits made of separate transistors wired together to printed circuits on single chips of silicon. Hoff and Intel’s client was a Japanese calculator maker, ETI, whose product had the awful name Busicom. Asked to design a dozen chips to fit inside a hand-held calculator in 1970, Hoff and his colleagues instead managed to combine onto one fingernailsize chip not only all the functions of a pocket calculator but the logic unit of a mainframe computer—the equivalent of a three-hundred-thousand-dollar room-size IBM machine of only a decade earlier.

Ironically, the executives of Busicom at first resisted his idea; later they went bankrupt. No laurels descended on Hoff’s head then or later. He continued to labor valiantly for Intel, then went on to work for Atari, one of the first personal-computer companies, before he retired to tinker in his garage, that proverbial gestator of Silicon Valley entrepreneurialism.