Letter of Resignation from the American Psychiatric
Association
4
December 1998
Loren R. Mosher, M.D.
to Rodrigo Munoz, M.D., President of the
American Psychiatric Association (APA)
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: 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 use
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, 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 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.
Related Story:
Against Biologic
Psychiatry
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