In the Topeka, Kans. home of psychiatrist Roy Menninger, there is a needlepoint pillow made by the doctor's wife, Beverly. On the pillow is the inscription: "INSANITY IS HEREDITARY. YOU GET IT FROM YOUR CHILDREN."

The Menningers are joking, of course. But they do know about children. He is the father of four from a first marriage, she a mother of three, also from a previous marriage. All these young people are between the ages of 16 and 23, prompting Dr. Menninger to confess, "I no longer lecture on teenagers. All it does is make them mad—the arrogance, the hubris of someone not a teenager thinking he can understand them. I decided it would be best if I talk about myself and the midlife crisis."

The 50-year-old "Dr. Roy," as everyone calls him, is the fourth president of the world-renowned psychiatric institute that bears the family name. The dynasty began with Dr. Roy's grandfather, Charles Frederick Menninger. A small-town general practitioner, Dr. C.F. paid a visit to the Mayo Clinic in Minnesota in 1908 and was inspired to set up a similar group practice back home in Topeka. He hoped his three boys would join him, but middle son Edwin had his own ideas—he became a distinguished horticulturist and writer.

Son Karl graduated from Harvard in 1919 and considered staying in the East to enter the emerging field of psychiatry. Dr. C.F. persuaded him to come home to Kansas "while we pioneer this specialty." Dr. Will joined them in 1925. The Menninger Clinic was established the same year, and over the next four decades Drs. Karl and Will made a formidable impact on American psychiatry with their research and writing.

Roy, who was one of Will's three sons, knew he was going to study medicine by age 10, after he had abandoned the notion of becoming a locomotive engineer. (He remains a model train enthusiast. "There is a certain fantasy about control, and you have these things running at your beck and call.") An independent lad, he went off to Washburn, Swarthmore and Cornell University Medical College and began a private psychiatric practice in Boston. But in 1961, after nearly 20 years away, Roy felt "it was my destiny" to return to the Menninger Clinic. In 1967, shortly after the death of Dr. Will, Roy was elected the foundation's president (Dr. C.F. died in 1953, but Dr. Karl, at 83, is still an imposing presence at the clinic in spite of an operation last year for a brain tumor).

Dr. Roy presides over a campuslike complex on some 431 acres. In a half century the institution has treated some 75,000 patients from all over the world. "They come here expecting magic. We haven't got much of that to give," says Dr. Roy. "But we do have the kind of intensive, total treatment that will make a difference to people with long-term disturbances. This is very much a place of last resort."

With patient costs spiraling ($138 a day), Dr. Roy devotes much of his time to fund raising. Though he is very much in command now, his early years as president were difficult. "Initially, like a psychiatrist," he recalls, "I was sympathetic and supportive when somebody screwed up. I spent the first five or six years trying to unlearn some things."

Ultimately, says Dr. Roy, "I think it quite possible for someone without the Menninger name to run the foundation." Yet, he notes, "it is somehow symbolically important that we are a family organization. The sense of continuity is important." With seven Menningers involved in one way or another now—and younger ones coming along—the odds are that it will stay that way.