Dr. Loren Mosher: A Letter Of Resignation To The American Psychiatric Association

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http://www.redflagsweekly.com/mosher.html

 

A LETTER OF RESIGNATION

 

Dr. Loren Mosher is a board-certified psychiatrist who

received his BA from Stanford University and M.D. from

Harvard Medical School in 1961, where he also

subsequently took his psychiatric training.

 

Among his many projects and wide interests, from 1970

to 1992, he was an investigator and then Research of the Soteria Project - " Community

Alternatives for the Treatment of Schizophrenia. " He

was instrumental in developing and researching an

innovative and controversial non-drug, non-hospital,

home-like, residential treatment facility for newly

identified acutely psychotic persons.

 

Mosher, who has written numerous articles and reviews

and has edited and written books, has his own

consulting company, Soteria Associates, and is

currently a clinical professor of psychiatry at the

School of Medicine, University of California at San

Diego.

 

What follows is a letter Mosher wrote on December 4,

1998 to Dr. Rodrigo Munoz, then President of the

American Psychiatric Association

 

 

 

 

Rodrigo Munoz, M.D., President

American Psychiatric Association

1400 " K " Street N.W.

Washington, D.C. 20005

 

Dear Rod:

 

After nearly three decades as a member it is with a

mixture of pleasure and disappointment that I submit

this letter of resignation from the American

Psychiatric Association. The major reason for this

action is my belief that I am actually resigning from

the American Psychopharmacological Association.

Luckily, the organization's true identity requires no

change in the acronym.

 

Unfortunately, APA reflects, and reinforces, in word

and deed, our drug dependent society. Yet it helps

wage war on " drugs " . " Dual diagnosis " clients are a

major problem for the field but not because of the

" good " drugs we prescribe. " Bad " ones are those that

are obtained mostly without a prescription.. A Marxist

would observe that being a good capitalist

organization, APA likes only those drugs from which it

can derive a profit–directly or indirectly. This is

not a group for me. At this point in history, in my

view, psychiatry has been almost completely bought out

by the drug companies. The APA could not continue

without the pharmaceutical company support of

meetings, symposia, workshops, journal advertising,

grand rounds luncheons, unrestricted educational

grants etc. etc. Psychiatrists have become the minions

of drug company promotions. APA, of course, maintains

that its independence and autonomy are not compromised

in this enmeshed situation. Anyone with the least bit

of common sense attending the annual meeting would

observe how the drug company exhibits and " industry

sponsored symposia " draw crowds with their various

enticements while the serious scientific sessions are

barely attended. Psychiatric training reflects their

influence as well; i.e., the most important part of a

resident's curriculum is the art and quasi-science of

dealing drugs, i.e., prescription writing.

 

These psychopharmacological limitations on our

abilities to be complete physicians also limit our

intellectual horizons. No longer do we seek to

understand whole persons in their social

contexts–rather we are there to realign our patients'

neurotransmitters. The problem is that it is very

difficult to have a relationship with a

neurotransmitter–whatever its configuration. So, our

guild organization provides a rationale, by its

neurobiological tunnel vision, for keeping our

distance from the molecule conglomerates we have come

to define as patients. We condone and promote the

widespread overuse and misuse of toxic chemicals that

we know have serious long term effects--tardive

dyskinesia, tardive dementia and serious withdrawal

syndromes. So, do I want to be a drug company patsy

who treats molecules with their formulary? No, thank

you very much. It saddens me that after 35 years as a

psychiatrist I look forward to being dissociated from

such an organization. In no way does it represent my

interests. It is not within my capacities to buy into

the current biomedical-reductionistic model heralded

by the psychiatric leadership as once again marrying

us to somatic medicine. This is a matter of fashion,

politics and, like the pharmaceutical house

connection, money.

 

In addition, APA has entered into an unholy alliance

with NAMI (I don't remember the members being asked if

they supported such an association) such that the two

organizations have adopted similar public belief

systems about the nature of madness. While professing

itself the " champion of their clients " the APA is

supporting non-clients, the parents, in their wishes

to be in control, via legally enforced dependency, of

their mad/bad offspring: NAMI, with tacit APA

approval, has set out a pro-neuroleptic drug and easy

commitment-institutionalization agenda that violates

the civil rights of their offspring. For the most part

we stand by and allow this fascistic agenda to move

forward. Their psychiatric god, Dr. E. Fuller Torrey,

is allowed to diagnose and recommend treatment to

those in the NAMI organization with whom he disagrees.

Clearly, a violation of medical ethics. Does APA

protest? Of course not, because he is speaking what

APA agrees with but can't explicitly espouse. He is

allowed to be a foil; after all - he is no longer a

member of APA. (Slick work APA!) The shortsightedness

of this marriage of convenience between APA, NAMI, and

the drug companies (who gleefully support both groups

because of their shared pro-drug stance) is an

abomination. I want no part of a psychiatry of

oppression and social control.

 

" Biologically based brain diseases " are certainly

convenient for families and practitioners alike. It is

no fault insurance against personal responsibility. We

are all just helplessly caught up in a swirl of brain

pathology for which no one, except DNA, is

responsible. Now, to begin with, anything that has an

anatomically defined specific brain pathology becomes

the province of neurology (syphilis is an excellent

example). So, to be consistent with this " brain

disease " view all the major psychiatric disorders

would become the territory of our neurologic

colleagues. Without having surveyed them I believe

they would eschew responsibility for these problematic

individuals. However, consistency would demand our

giving over " biologic brain diseases " to them. The

fact that there is no evidence confirming the brain

disease attribution is, at this point, totally

disregarded. What we are dealing with here is fashion,

politics and money. This level of intellectual

/scientific dishonesty is just too egregious for me to

continue to support by my membership.

 

I view with no surprise that psychiatric training is

being systematically disavowed by American medical

school graduates. This must give us cause for concern

about the state of today's psychiatry. It must mean -

at least in part - that they view psychiatry as being

very limited and unchallenging. To me it seems clear

that we are headed toward a situation in which, except

for academics, most psychiatric practitioners will

have no real relationships--so vital to the healing

process--with the disturbed and disturbing persons

they treat. Their sole role will be that of

prescription writers– ciphers in the guise of being

" helpers " .

 

Finally, why must the APA pretend to know more than it

does? DSM IV is the fabrication upon which psychiatry

seeks acceptance by medicine in general. Insiders know

it is more a political than scientific document. To

its credit it says so–although its brief apologia is

rarely noted. DSM IV has become a bible and a money

making best seller-its major failings notwithstanding.

It confines and defines practice, some take it

seriously, others more realistically. It is the way to

get paid. Diagnostic reliability is easy to attain for

research projects. The issue is what do the categories

tell us? Do they in fact accurately represent the

person with a problem? They don't, and can't, because

there are no external validating criteria for

psychiatric diagnoses. There is neither a blood test

nor specific anatomic lesions for any major

psychiatric disorder. So, where are we? APA as an

organization has implicitly (sometimes explicitly as

well) bought into a theoretical hoax. Is psychiatry a

hoax–as practiced today? Unfortunately, the answer is

mostly yes.

 

What do I recommend to the organization upon leaving

after experiencing three decades of its history?

 

1.To begin with, let us be ourselves. Stop taking on

unholy alliances without the members' permission.

 

2.Get real about science, politics and money. Label

each for what it is- that is, be honest.

 

3.Get out of bed with NAMI and the drug companies. APA

should align itself, if one believes its rhetoric,

with the true consumer groups, i.e., the ex-patients,

psychiatric survivors etc.

 

4.Talk to the membership– I can't be alone in my

views.

 

We seem to have forgotten a basic principle - the need

to be patient/client/consumer satisfaction oriented. I

always remember Manfred Bleuler's wisdom: " Loren, you

must never forget that you are your patient's

employee. " In the end they will determine whether or

not psychiatry survives in the service marketplace.

 

 

Sincerely,

Loren R. Mosher M.D.