In October 1984, the Institute of Medicine (IOM),1 having critically reviewed the progress and prospects of research in mental and addictive disorders, arrived at a stark and ineluctable fact: there has been perennial underfunding of research support. Further, there have been periods of striking plateaus: in Fiscal Year 1967, the National Institute of Mental Health (NIMH) research budget was $103.8 million, and by FY 1977 it was only $104.1 million. In FY 1980, the budget was $143.5 million and two years later, only $143.8 million.
The authors and the usually staid IOM appear to have been startled when they viewed the unadorned evidence of decline but indisputable scope and costs of mental illnesses—and, in contrast, the richly expanding opportunities for research. Facing this illogical conjunction of disparate facts, they peered at the abyss—the task of making conclusory fiscal recommendations—and then determinedly moved forward to find the firm ground of