Loren R. Mosher M. D.
2616 Angell Ave
San Diego, CA 92122
December 4 1998
Rodrigo Munoz, M.D., President
American Psychiatric Association
1400
94 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 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 organization) 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 convenient for families and practitioners
alike. It is no fault insurance against personal responsibility. We are 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, irrelevant. 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 systemically
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?
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.
