The Retrospectoscope Revisits Old Eli

A number of posts to this blog have dealt with  issues involving Yale University.The issues have included visits by supreme court justice alumni,renaming of Calhoun College,new campuses, (domestic and international) and 1960’s era recommendations of A.K.Rice re:Yale Medical School.The latter recommendations which I had considered “missing” were generously made available by President Salovey’s chief of staff (J.McGrath) allowing me to confirm a judgement made on this blog that Yale by now,had probably gone beyond those recommendations.(which were not accepted at the time) Nevertheless a review of that document was highly instructive both as to the brilliance of A.K.Rice and, that notwithstanding, the correctness of the decision.

Ken Rice used concepts of boundaries,inputs,throughputs and outputs quite masterfully in support of the major premise that the Medical School ,Nursing School,Mental Health Center,and School of Public Health had a responsibility to the surrounding community,the state and the nation that required the positioning of the patient and services as the focal point  of activities.It was on this basis that then Dean Redlich ( former chair of Psychiatry) requested the consultation and recommendation to then President Brewster.The result of the complexity that Ken Rice encountered and acknowledged was a recommendation for the creation of a University of Health Sciences integrating the Medical School, the School of Nursing and the School of Public Health at a minimum.It is reasonably clear that this was to acknowledge that other parts of the university could not follow the same mandate. Even with the patient as the acknowledged center of the health universe,the inputs and outputs of this model are incredibly complicated(individuals,individuals and families,community supports etc.) with the throughput process .becoming correspondingly complex.Put into the university structure the result was a a recommendation for two to four provosts,four deans and necessary alteration of the activities of chairs and tenured faculty as well as a redefining of standards for and meaning(less) of tenure.

A half century later it is apparent that all parts of a structure in what Rice would call an open system need not be equally responsive to change. (historical or technological)The relationship between academic psychiatric services in the traditional structures of that day and the Yale New Haven Hospital were significantly altered in the 60s by the creation of the original Emergency Treatment Unit.(supplying brief treatment with heavy use of medication ,family involvement and trained non psychiatrist paraprofessionals) Psychiatrists in the community,families  and individuals in distress responded positively to this availability and the unit became the intake focus of the YNHH despite its non-analytic focus and its non participation in resident training activity.This phenomenon was repeated with the original community area service which became the only fully federally funded community mental health center but was part of the larger Connecticut Mental Health Center. The latter is still a vital part of the Psychiatry Department while the former has disappeared with federal defunding.Of course clinical psychiatry in that era lacked its own science save for a theoretical,unproveable basis in analytic theory and an evolving identity in community notion equally unproveable. Academic Psychiatry,some might argue, was therefore more amenable to change .I believe,however, that the same process was occurring throughout the medical system.. The other issue involved is the time rate of change(largely unknowable in advance) and the number of lives and careers ground up for those caught on the cutting edge of change.(In terms of availability of care as well as availability of career)The argument might be made that the large unwieldy evolved structure might minimize this but the argument that the conflicts involved might wreak even worse havoc  seems equally cogent.The involvement of university and medical school with industry is another huge issue and whether or not the proposed megastructure would have facilitated, clarified or made impossible evolving linkages is also unknowable but it is probable that the survival of the traditional university structure that bends but does not break in the face of change is a positive.

Ken Rice identified sentient groups as a natural consequence of our humanness but warned that they are not work groups and could not be counted upon to accomplish the primary task of an institution indeed often interfering with it.It would follow that they not be interdicted but be be allowed to exist provided that their efforts not interfere with that(clearly articulated) primary task.(The responsibility of higher administration)So using “follow the money” as the dictum in a input -output- throughput model, the monitored use of resources seems more important than a name change.(Again the responsibility of higher administration). As far as Calhoun College,new residential colleges and new campuses are concerned. the point of it all seems to be to allow the future to unfold and not to be bound ceaselessly to the wheel of likes, dislikes and preferences of a bygone era or a privileged few.
There are still important things to be learned from looking at the era of the 60s,perhaps somewhere in the vastness of Yale’s intellectual pursuit someone is working on or has already answered another of our questions i.e. Why has New Haven disavowed its position as the probable prototypic “Model City”?In the meantime this octogenarian finds the previously stated “Well done Old Eli” still appropriate.


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