R. Mosher, M.D.
Letter of Resignation from the American
to Rodrigo Munoz, M.D., President of the American
Psychiatric Association (APA)
December 4, 1998
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 profitdirectly 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
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 contextsrather
we are there to realign our patients' neurotransmitters. The problem
is that it is very difficult to have a relationship with a neurotransmitterwhatever
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 effectstardive
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 meanat 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, relationshipsso vital to the healing processwith the disturbed and disturbing
persons they treat. Their sole role will be that of prescription
writersciphers 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 soalthough its
brief apologia is rarely noted. DSM IV has become a bible and
a money making best sellerits 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 hoaxas practiced today? Unfortunately,
the answer is mostly yes.
What do I recommend to the organization upon leaving after experiencing
three decades of its history?
We seem to have forgotten a basic principlethe
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