BACK TO
FRONT PAGE
For
a printer-friendly version (pdf) of this document,
CLICK
HERE!
You will need Adobe Acrobat Reader.
Click here to get it.
Letter
of Resignation from the American Psychiatric Association
4 December 2021
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.
BACK TO
FRONT PAGE