This is a copy of a letter by Dr. Mosher resigning from the American
Psychiatric Association. Note that Dr. Mosher was a pioneer in
establishing programs of psychosocial community care in the field of
psychiatry (e.g., Sartoria); his publications in that regard have been
very
influential (e.g.: Mosher, L., & Burti, L. (1989). _Community mental
health: Principles and practice_. New York: Norton.).
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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.
--
James C. Mancuso Dept. of Psychology
15 Oakwood Place University at Albany
Delmar, NY 12054 1400 Washington Ave.
Tel: (518)439-4416 Albany, NY 12222
Mailto:mancusoj@capital.net
http://www.crisny.org/not-for-profit/soi
A website dedicated to information on Italian-
American history and heritage.
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