2

The Mind Freedom Hunger Strike

In July of 2003 David Oaks and seven other psychiatric survivors (former mental patients) went on a hunger strike for “an indefinite period of time” to protest the abuses of the psychiatric profession and to hopefully attract public attention to their claim that the psychiatric profession has been deceiving and poisoning (with psychiatric drugs) the American public. According to Oaks, the psychiatric profession has no proof that emotional distress or mental illnesses are caused by brain disorders or biochemical imbalances. In order to demonstrate this, Oaks and the hunger-strikers posed a series of questions to the American Psychiatric Association. Oaks also recruited a team of the leading critics of psychiatry to back up the strikers. The result was one of the most interesting public exchanges in the history of modern psychiatry. One might call this intellectual battle “Mental Patients Liberation versus the Psychiatric Establishment.”

To understand the significance of the hunger strike, it is helpful to place it in historical context. By the late 1980s the biopsychiatric model had eclipsed psychoanalysis as the dominant model in the mental health field.*16An editorial in the Archives for Psychiatry and Nervous Diseases opined, “Psychiatry has undergone a transformation in relation to the rest of medicine. This transformation rests principally on the realization that patients with so-called mental illnesses are really individuals with illnesses of the nerves and the brain.”1

This editorial aptly describes the change that psychiatry has undergone in the last few decades—but it was not written, as readers might imagine, in 1997, but in 1867! My point is that this is not the first time that psychiatry has “realized” that what it has called mental illnesses are really brain disorders. (In modern terms it has realized that mental illnesses are caused by biological disorders of the brain.) The public does not know that dominant models of madness fall in and out of favor and that biopsychiatry had once before been dominant—in the nineteenth century until Freud’s appearance in the early twentieth century led to the captivation of the popular imagination by psychoanalysis.

The modern Freudian or psychoanalytic effort that spanned most of the twentieth century and attempted to prove that mental illnesses were caused by childhood traumas has now been deemed a failure by most psychiatrists and many, if not most, psychologists. Freudianism was finally undermined by numerous factors: the failure to provide more than anecdotal evidence for its theories; the increasing evidence that people, even children, were more resilient than psychoanalysis allowed; and the exposures of Freud’s own personal and theoretical failings (particularly Freud’s effort to cover up sexual abuse of children by adults). All of these factors left psychoanalysis vulnerable when biopsychiatry became (once more) the rising star by the 1990s—and one that offered psychiatry considerably greater economic advantages. Thus mental health professionals, particularly psychiatrists, routinely tell their patients that their mental illnesses are caused by genuine biological brain disorders or biochemical imbalances of the brain. However, the fact is that psychiatry does not have the evidence to back up its claim. The 1867 editorial represents a hope on the part of psychiatry or, as a review article by Guy Boysen in The Journal of Mind and Behavior terms it, “an empty biological promise . . . that has never been fulfilled.”2

The American public has been convinced by a massive advertising effort undertaken by the psychiatric-pharmaceutical complex in the 1990s “proving” that mental illnesses are caused by biological abnormalities. However, as Boysen aptly puts it “[t]he plain, cold, hard fact is that there are almost no mental disorders for which a specific biological cause can be pinpointed.”3 (The exceptions that Boysen mentions, e.g., Alzheimer’s, are not generally considered mental disorders.) Privately, as we will see, the American Psychiatric Association (APA) acknowledges this cold hard fact.

The biopsychiatric model is appealing to psychiatrists for a number of reasons—not least of which are its obvious financial advantages. It is the biopsychiatric model that provides the foundation for the symbiotic relationship between Psychiatry and the pharmaceutical companies that developed in the last few decades. Psychiatrist Peter Breggin has chronicled the formative phase of this relationship in the late 1970s and 1980s, which led to the creation of the psychiatric-pharmaceutical complex. As Dr. Breggin puts it, “In the early 1970s [the] American Psychiatric Association was in financial trouble. It was losing members and its total income was $2 to $4 million per year”—as compared to its 2003 income of over $38 million dollars.4

Why was Psychiatry in such hot water in the 1970s? Primarily because the idea of solving problems with psychotherapy—trumpeted by Freud and his followers—had become rooted in the imagination of the American public. In the countercultural 1960s all kinds of new schools of psychotherapy had sprouted and bloomed. Thus it is not surprising that by the mid-1970s “psychiatry was losing badly in the competition with psychologists, social workers, counselors, family therapists and other nonmedical professionals who charged lower fees than psychiatrists for psychotherapy patients. Psychiatric journals and newspapers were filled with gloom, lamenting that psychiatrists could no longer easily fill their work weeks.”5 At the same time, the image of psychiatry had been tarnished by a wave of criticisms from within and without that reached a peak in the early 1970s—as exemplified most powerfully by the movie One Flew Over the Cuckoo’s Nest (based on Ken Kesey’s classic book of the same title).

A small group within the psychiatric profession throughout the 1970s believed that psychiatry needed to raise its own ethical standards. Some members of the APA’s board of trustees felt—according to the American Journal of Psychiatry in 1974—that the APA’s relationship with the pharmaceutical companies was going “beyond the bounds of professionalism” and compromising the APA’s ethical principles.6 The APA appointed a “Task Force to Study the Impact of the Potential Loss of Pharmaceutical Support.” The task force concluded that the loss of support of the drug companies would be catastrophic. Thus the decision was made to continue to collaborate with the multibillion-dollar drug companies.

Dr. Breggin wrote, “The floodgates of drug company influence were open and would grow wider each year.” This was only the beginning: in 1980 the APA board of directors decided to “throw ethical caution to the winds”7 and solicit drug company support for major professional and cultural activities. Psychiatrists who criticized these new developments were ignored by the leadership of the APA, and the collaboration between psychiatry and the drug companies was extended to the political sphere—to influencing congressional legislation. Dr. Breggin wrote, “Whatever function APA had ever fulfilled as a professional organization was now superseded by its function as a political advocate for the advancement of psychiatric and pharmaceutical interests.”8

What is most important to understand is that in order to protect and advance these interests, Psychiatry must promote the biopsychiatric model; it must assert that mental illnesses are caused by biological dysfunctions—and that these dysfunctions can only be corrected by psychiatric drugs. Psychiatry realized that it needed to embrace the biopsychiatric model to survive and prosper in the marketplace. The APA continually reiterated in its in-house publications that “only a medical or biological image can enable the APA to compete economically.”9 A major effort was undertaken throughout the 1990s to prove that mental illnesses (the problems of living) are caused by biological disorders; the public has been deceived into believing that this effort has succeeded. The research that psychiatrists undertake today is not disinterested scientific inquiry. It is mostly financed by the pharmaceutical companies, and it is designed to promote the joint interests of psychiatrists and the drug companies: selling the biopsychiatric model, selling drugs, and buttressing the image of the psychiatrist as the medical specialist most qualified to treat people’s emotional problems—by prescribing the correct medications.

While the majority of psychiatrists accept the biopsychiatric model and proclaim that there has been remarkable scientific progress within the last two decades, there are still heretics. Thomas Szasz, now in his nineties, continues to denounce the myth of mental illness. In Szasz’s view, as Roy Porter wrote, “The entire history of psychiatry is an obdurate and pitiless defense of a fantasy.”10 Szasz denies that there has been any psychiatric progress at all. He writes, “When I was a young psychiatrist, there were but a handful of psychiatric diagnoses/diseases. Now there are more than three hundred. Not one was discovered. All were invented. In the absence of empirically verifiable discoveries, they had to be.”11

Szasz and the various other critics of biopsychiatry agree on this one point: there have been no empirically verifiable discoveries of biological (brain) disorders. If there had been such discoveries, diagnoses today would be confirmed by laboratory tests, just as they are for physical diseases. Psychiatric drugs were not designed to treat diseases that had been discovered. Szasz cogently argues that the diseases were invented to justify the “treatments” (the medications). He notes that the textbook most widely used in medical school lists approximately three hundred “psychotherapeutic drugs” considered appropriate for the treatment of these disorders. Szasz pithily comments, “This plethora of drugs reflects the psychiatric view . . . that the vexations of life are due to mental diseases caused by chemical imbalances in the brain, and that these can be effectively treated by a balancing of the chemicals.”12 But, Szasz argues, no one has demonstrated the existence of diseases of the “mind” much less of the “chemical imbalances” that were allegedly causing them.13

While the propaganda machine continues to proclaim that mental illness is a product of a brain disorder, privately the search for the physical defect of the brain continues quietly, with Psychiatry assuring its in-house critics that it is only a matter of time before the defect is identified. I agree with most of the critics of biopsychiatry that the very idea of a disorder of the mind or of the brain persists partially because of the propaganda of the psychiatric-pharmaceutical complex. In addition, I would argue that the public was susceptible to this theory from the start, despite the lack of real evidence, because it is rooted in the collective imagination: the idea that there is something wrong with the mind has been the abiding obsession of Western culture for centuries.

In the age of religion, Western civilization was convinced that our souls were diseased, flawed, and damaged because of original sin. In the age of science—when few people believe we have souls—it was first the mind and now the brain that is ostensibly diseased (and not just in a few people but in a rapidly growing proportion of the population). In both cases we are possessed by the idea that the core of our being is flawed or tainted. This idea originally was presented in Christian terms; it derives from Augustine and from the Protestant Reformation (Luther had been an Augustinian monk)—but not from Jesus, and not from the gospels. It was Augustine who first claimed that our souls were all irreparably damaged, “totally depraved” (in Calvin’s words) as a result of original sin.14

Jesus was a radical in the tradition of the great Jewish prophets: he believed that the human soul was whole, holy, and that despite the ubiquity of human sinfulness, the soul retained it likeness to God—in whose image it was created. It was the idea of the sacred worth of every human soul that provided the philosophical basis for a democratic society; thus the early church was an egalitarian organization.15 However, Jesus’s democratic ideas were inconvenient for the fledgling Christian church in the fourth century when it decided to become allies with the Roman Empire, and thus the idea that the human soul has no worth took hold of Western Christianity, and thus of Western civilization.16

For most of the twentieth century we believed we were flawed as a result of the Oedipal complex or maternal deprivation—the “original sins” of the parents according to Freud. Now we are convinced that the problem is defects in the brain. The embarrassment for Psychiatry today—now that it has asserted that it is this physical (brain) defect that is at the root of mental illness—is that it has been unable to find hard evidence. Despite years of searching and numerous “scientific” studies published, Psychiatry cannot demonstrate the existence of a brain defect or chemical imbalance. Nevertheless, Psychiatry continues to reassure the public that mental suffering is due to biochemical imbalances and gets irritated when its critics point to the failures of this assertion.

None of the critics of the medical model argue that human unhappiness does not exist, but most of them are convinced that “problems of living,” as Szasz termed them, must be faced by human beings—not avoided by attributing them fatalistically to biological defects. By the end of the 1990s as is evidenced here, resistance was mounting against the massive drugging of America. Psychologist John Breeding and neurologist Fred Baughman teamed up to protest the psychiatric drugging of children. They both asserted that “attention deficit disorder” was a bogus disease used to rationalize the massive drugging of children.17

In 1998 Dr. Loren Mosher wrote a long letter (that was later published in Psychology Today) resigning from the APA after thirty-five years. Mosher, who had been a founder of the Soteria Project and director of the studies of schizophrenia at the National Institute of Mental Health from 1969 to 1980, wrote that the reason for his resignation was that the American Psychiatric Association had actually become “the American Psychopharmacological Association.” Mosher went on to say prophetically, “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. . . . 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.”18

The adversaries of the psychiatric-industrial complex include dissident psychiatrists and other mental health professionals, as well as those who are active in the psychiatric survivors’ or the Mad Pride movements. The largest organization of psychiatric survivors today (see chapter 3) is Mind Freedom International (formerly Support Coalition International), both of which were founded by David Oaks.

Oaks has spent most of his adult life attempting to demonstrate to the public that the biopsychiatric model is a fraud; psychiatry has not proven that the “mentally ill” have brain defects or diseases. Mind Freedom International is both an activists’ organization that sponsors protests and lobbying efforts as well as a self-help forum (see chapter 1) in which those who have been assigned to the role of chronic mental patients are provided the opportunity to make a transition from that social identity to another: activists working collectively for the liberation of other psychiatric survivors. This transition from patient to activist is a radical psychological transformation—a fact that is unacknowledged by the psychiatrists and their supporters, who have both vilified ex-patient activists as enemies of science (as discussed later in this chapter) and ignored the fact that their self-transformation proves that biopsychiatry’s position on madness is wrong. If the dominant position were correct, these activists would be chronically disabled and dependent on psychiatric drugs instead of high-functioning activists who have found they can handle life’s challenges and their own moods without resorting to the routine use of psychiatric drugs. (I say “routine” because it is possible that they take a sleeping pill every now and then.)

The basic intellectual framework of Mind Freedom International’s leading activists is a rejection of biological Psychiatry—a conviction that psychiatric drugs are harmful—and above all, a commitment to oppose all involuntary psychiatric treatments. Since the organization is pro-choice it is of course open to all persons who oppose involuntary treatment, even those who take psychiatric drugs.

As we will see in chapter 3 the mental health system attempted to induct Oaks into the role of a chronic mental patient, but instead of being incorporated into the psychiatric metanarrative, Oaks—like the other psychiatric survivors in the movement against psychiatric coercion and misinformation—developed a “resistant identity.”19 What made Oaks and the other subjects in this book become resistant, how and why they differed from those who accepted the role of chronic patients and its discrediting consequences, is a matter that cannot be adequately discussed here. I think long-time activist and former mental patient George Ebert aptly described his decision to resist when he said to me, “If I had accepted that I was so-called mentally ill, I would not have been able to accept myself.”

From the psychiatric perspective Oaks met all the criteria for the diagnosis of “mentally ill.” He did not become a chronic patient because the diagnosis is a self-fulfilling prophecy—and David rejected the diagnoisis. The important fact is that the more patients become aware of stories like Oaks’s, the more they tend to resist being inducted into the role of chronic patient and the more attracted they become to the idea of assuming the identity of a creatively maladjusted activist like Oaks. Once Oaks became an activist, he set out to debunk the very idea that he and other former patients had brain defects—the current psychiatric dogma. It is my contention that psychiatry has not been able to find brain defects in the so called “mentally ill” because they are not defective—not because psychiatry has not invented yet the right instruments.

Oaks and his comrades in his organization Mind Freedom also knew that psychiatrists had no real evidence of brain defects; this is why they came up with the idea of the hunger strike, which they initiated in July 2003. The strike received media attention and captured the interest and ire of the APA. The rest of this chapter will present several documents, which include those from mainstream media sources as well as excerpts from the original statement by the strikers and the responses from the APA.

The following Washington Post article by Kimberly Edds, dated August 29, 2003, reports on the hunger strike, which was already under way.

California Hunger Strike Challenges Use of Antidepressants

After two weeks, four mental health advocates are still on a hunger strike, protesting the widespread use of prescription drugs to treat mental illnesses and challenging psychiatrists to document their rationale for prescribing them. Over the last few decades, doctors have embraced the view that depression, schizophrenia and other mental illnesses result from imbalances in brain chemistry, and they have treated such illnesses with drugs intended to rebalance that chemistry. In recent years, the use of antidepressant drugs has grown dramatically in the United States, with the number of prescriptions nearly doubling since 1998, according to the pharmaceutical consulting company IMS Health.

As more people turn to antidepressants, mental health experts and patient advocates are beginning to raise questions about side effects and the potential for addiction.

The strikers are calling on some of the strongest voices in the psychiatric profession, including the American Psychiatric Association and the National Alliance for the Mentally Ill, to provide concrete evidence that mental illnesses are the result of brain chemistry imbalances. They also want to call attention to alternative treatments.

“Millions of people are signing up for these prescriptions because they are convinced they have a chemical imbalance. But there is not one piece of evidence that can back that up,” said David Oaks, executive director of Mind Freedom Support Coalition International, or SCI, an organization of current and former psychiatric patients that organized the strike.

A spokesman for the American Psychiatric Association referred a reporter to a letter the association’s medical director, James H. Scully, wrote to Oaks on Aug. 12. “In recent years, there has been substantial progress in understanding the neuroscientific basis of many mental illnesses,” it said. “Research offers hope and must continue.”

The National Alliance for the Mentally Ill (NAMI) did not respond to several requests to comment, but Oaks made available an e-mail he received today from Rick Birkel, NAMI’s national executive director.

“NAMI has never stated to my knowledge that ‘mental disorders are caused exclusively by biological factors,’” it said. “Instead, we are saying that biological or genetic vulnerability appears to be pre-requisite to serious mental disorder.” Birkel added that mental disorders result from complex interactions of many factors, including environmental forces, stress, personality, social support, illness and injury.

Birkel’s e-mail reflects a growing consensus in the psychiatric establishment. Most psychiatrists say that complex mental disorders are like arthritis and other chronic physical ailments—no less real because they cannot be spotted with laboratory tests.

The hunger strikers, who include three former mental patients, said that the responses were not satisfactory and that they wanted a study and a diagnostic lab test that proves the connection. Until then, they plan to continue their protest.

They began with six hunger strikers, but two, including Oaks, left because of health difficulties. The remaining four have been downing daily a dark red brew of juices from garlic, beets, kale and carrots, and spending their time answering supporters’ e-mails and making phone calls to media outlets.

Hunger striker David Gonzalez said he spent two years confined in an inpatient facility after being diagnosed with major depression and, later, manic depression, and that he was forcibly drugged during that time. He said the drugs impaired his eyesight and memory.

“When someone has cancer, they don’t lock the door behind them, and they show them the tests,” Gonzalez said. “But when someone has a mental illness, they lock the door behind them and show them no tests. When they lock that door behind me, I want to know why.”

Oaks said he, too, had been confined in institutions and forcibly drugged for what was diagnosed as schizophrenia. He recovered, he said, through the love and support of his family, rather than drugs.

“People do not know what it’s like to be on these drugs,” Oaks said. “If you want to take it and it obliterates your pain, that’s one thing, but when you are pushed to be on it, it’s like a wrecking ball to your thoughts and feelings.”

Studies have shown that daily exercise, psychotherapy and even changes in diet and nutrition are as effective as, if not more effective than, prescription drugs, said Stuart Shipko, a Pasadena psychiatrist and panic disorder specialist who serves on an SCI scientific panel. But there is not widespread support for such treatments.

“We’re overdiagnosing. How many of these supposed mental illnesses are really just problems in your family life? They’re anxious, and they’re being put in a chemical straitjacket,” Shipko said.20

Before beginning to fast, the hunger strikers released this July 28, 2003, statement outlining their grievances with the psychiatric-pharmaceutical complex and requesting clear information regarding the use of psychiatric drugs.

Original Statement by Hunger Strikers to Psychiatric Association, National Alliance for the Mentally Ill and the U.S. Office of the Surgeon General

1. A Hunger Strike to Challenge International Domination by Biopsychiatry. This fast is about human rights in mental health. The psychiatric pharmaceutical complex is heedless of its oath to “first do no harm.”

Psychiatrists are able with impunity to:

Incarcerate citizens who have committed crimes against neither persons nor property.

Impose diagnostic labels on people that stigmatize and defame them.

Induce proven neurological damage by force and coercion with powerful psychotropic drugs.

Stimulate violence and suicide with drugs promoted as able to control these activities.

Destroy brain cells and memories with an increasing use of electroshock (also known as electro-convulsive therapy).

Employ restraint and solitary confinement—which frequently cause severe emotional trauma, humiliation, physical harm, and even death—in preference to patience and understanding.

Humiliate individuals already damaged by traumatizing assaults to their self-esteem.

These human rights violations and crimes against human decency must end. While the history of psychiatry offers little hope that change will arrive quickly, initial steps can and must be taken.

At the very least, the public has the right to know IMMEDIATELY the evidence upon which psychiatry bases its spurious claims and treatments, and upon which it has gained and betrayed the trust and confidence of the courts, the media, and the public.21

I have excerpted additional relevant passages from the statement below.

Why We Fast

There are many different ways to help people experiencing severe mental and emotional crises. People labeled with a psychiatric disability deserve to be able to choose from a wide variety of these empowering alternatives. However, choice in the mental health field is severely limited. One approach dominates, and that is a belief in chemical imbalances, genetic determinism and psychiatric drugs as the treatment of choice. This medical model is sometimes termed “biopsychiatry.” Far too often, this limited choice has been exceedingly harmful to both the body and the spirit.

Governments and the mental health industry use extensive taxpayer funding, judicial edicts, and repressive laws to enforce a biopsychiatric approach. The mental health system rarely offers options other than psychiatric drugs, and still more rarely offers people full, accurate information about the hazards of psychiatric drugs. The mental health system is coercing increasing numbers of people to take psychiatric drugs against their will, even on an outpatient basis in their own homes. Electroshock, even forced electroshock, is quietly making a comeback.

Biopsychiatry is now one of the most profitable of all industries and its power is globalizing rapidly. The World Health Organization and the World Bank have multibillion dollar plans to spread biopsychiatry to developing nations.

Given all these facts, citizens have a right to ask:

“Has science established, beyond a reasonable doubt, that so-called ‘major mental illnesses’ are biological diseases of the brain?”

“Does the government have compelling evidence to justify the way it singles out for its primary support this one theory of the origin of emotional distress and of pharmaceutical remedies for its relief?”

Both public and personal health and safety are dependent on the answers to these questions.

This fast is not about judging individuals who choose to employ biopsychiatric approaches in an effort to seek relief. We respect the right of people to choose the option of prescribed psychiatric drugs. Some of us have made this personal choice.

We must act in the nonviolent tradition of Cesar Chavez and Mahatma Gandhi by saying “No!” to oppression with our bodies and spirits through fasting, while affirming the humanity of those people to whom we make our demands.

“If you see injustice and say nothing, you have taken the side of the oppressor.” —DESMOND TUTU

WE THE UNDERSIGNED WILL REFUSE ALL SOLID FOOD for an indefinite period of time as we await our challenge to be met by the following:

1. American Psychiatric Association (APA)

2. National Alliance for the Mentally Ill (NAMI)

3. Office of the Surgeon General of the United States

WE ASK THAT YOU PRODUCE scientifically-valid evidence for the following, or you publicly admit to media, government officials and the general public that you are unable to do so:

1. EVIDENCE THAT CLEARLY ESTABLISHES the validity of “schizophrenia,” “depression” or other “major mental illnesses” as biologically-based brain diseases.

2. EVIDENCE FOR A PHYSICAL DIAGNOSTIC EXAM—such as a scan or test of the brain, blood, urine, genes, etc.—that can reliably distinguish individuals with these diagnoses (prior to treatment with psychiatric drugs), from individuals without these diagnoses.

3. EVIDENCE FOR A BASE-LINE STANDARD of a neurochemically-balanced “normal” personality, against which a neurochemical “imbalance” can be measured and corrected by pharmaceutical means.

4. EVIDENCE THAT ANY PSYCHOTROPIC DRUG can correct a “chemical imbalance” attributed to a psychiatric diagnosis, and is anything more than a non-specific alterer of brain physiology.

5. EVIDENCE THAT ANY PSYCHOTROPIC DRUG can reliably decrease the likelihood of violence or suicide.

6. EVIDENCE THAT PSYCHOTROPIC DRUGS do not in fact increase the overall likelihood of violence and suicide.

7. FINALLY, that you reveal publicly evidence published in mainstream medical journals, but unreported in mainstream media, that links use of some psychiatric drugs to structural brain changes.

Until the above demands are met to the satisfaction of an internationally respected panel of scientists and mental health professionals, we plan to drink only liquids and to refuse solid food for an indefinite period of time.

Signed by Fast for Freedom Participants:

Initial core group committed to fasting:

Vince Boehm, Krista Erickson, David Gonzalez, David Oaks, Dawn Rider, Hiromi Sayama, Mickey Weinberg, LCSW

Initial scientific panel to review evidence:

Fred Baughman, M.D.; Peter Breggin, M.D.; Mary Boyle, Ph.D.; David Cohen, Ph.D.; Ty Colbert, Ph.D.; Pat Deegan, Ph.D.; Al Galves, Ph.D.; Thomas Greening, Ph.D.; David Jacobs, Ph.D.; Jay Joseph, Psy.D.; Jonathan Leo, Ph.D.; Bruce Levine, Ph.D.; Loren Mosher, M.D.; Stuart Shipko, M.D.22

The APA responded to the hunger strikers: the following letter was sent to Oaks, through Dr. Shipko, on August 12, 2003.

Response from APA

Dear Mr. Oaks:

I am acceding to your request that I send my response to your letter of July 28, 2003 to Dr. Stuart Shipko.

The mission of the American Psychiatric Association is to promote the highest quality care for individuals with mental illness and substance abuse disorders and their families. In recent years, there has been substantial progress in understanding the neuroscientific basis of many mental illnesses. Research offers hope and must continue.

The answers to your questions are widely available in the scientific literature, and have been for years. I suggest you begin your review with Surgeon General David Satcher’s report, “Mental Health: A Report of the Surgeon General.” In addition, I recommend the Introductory Textbook of Psychiatry (3rd edition), edited by Andreasen and Black. This is a “user-friendly” textbook for persons just being introduced to the field of psychiatry.

A more substantial and advanced series would include The American Psychiatric Publishing, Inc.’s “Textbook of Clinical Psychiatry (4th edition),” edited by Hales and Yodofsky. For the latest science, of course, there are the American Journal of Psychiatry and Archives of General Psychiatry, among many other journals which are available in both printed and on-line versions.

These are but a few of the extensive number of scientific publications that answer your questions.

I share the concern of Rick Berkel [sic] of NAMI that your proposed activities are ill-considered and invite you to join NAMI to help improve the care of our fellow citizens who suffer from serious mental illnesses.

Sincerely,

James H. Scully, Jr., M. D., Sc.D. Medical Director23

The panel of dissident mental health professionals responded to the APA with a letter of their own, which follows below. In brief they noted that, “In the judgment of the panel members, your reply fails to produce or cite any specific evidence of any specific pathophysiology underlying any “mental disorder.” The reason the APA failed to do so is because there is no evidence that there are brain disorders underlying “mental illness”: there is not a single study that provides valid and reliable evidence for the “biological basis of mental illness.”

I would add that in the absence of discernible brain pathology, there is no basis for any kind of claim of “mental illness”—or mental disorders. Yet the APA diagnostic manual used in every mental health clinic claims to be a manual of mental disorders, and the term the mentally ill is routinely used by mental health professionals and journalists. The term mental illness is a misleading metaphor: in the 1990s the psychiatric establishment had decided that those previously labeled mentally ill were not merely ill in a nonphysical sense (whatever that means), but they had brain disorders. As we see from the following letter, dated August 22, 2003, there is no evidence for that claim. The diagnosis of mental illness is based exclusively on deviant behavior: the mentally ill person acts strange—her behavior is disturbed or disturbing to other persons. This is a value judgment. But there is no objective basis, no biological evidence, that the behavior troubling to the psychiatrist is caused by a defect in the brain.

Scientific Panel Addresses APA Claims

Dear Dr. Scully:

David Oaks, Executive Director of Mind Freedom, has forwarded to us your reply dated 12 August 2003 to the hunger strikers involved in a “Fast for Freedom in Mental Health.” We are a panel of 14 academics and clinicians who have agreed to review any such reply for scientific validity.

The hunger strikers asked your organization, as well as the Surgeon General of the United States, and the National Alliance for the Mentally Ill, to provide:

1. evidence that establishes the validity of “schizophrenia,” “depression” or other “major mental illnesses” as “biologically-based brain diseases”;

2. evidence for a physical diagnostic exam that can reliably distinguish individuals with these diagnoses (prior to treatment with psychiatric drugs) from individuals without these diagnoses;

3. evidence for a baseline standard of a neurochemically-balanced “normal” individual, against which a neurochemical “imbalance” can be measured;

4. evidence that any psychotropic drug can correct any “chemical imbalance” attributed to a psychiatric diagnosis;

5. evidence that any psychotropic drug can reliably decrease the likelihood of violence or suicide.

In your reply, no specific studies of any kind were cited with reference to any of the questions above. You cited three general sources, including the recent Surgeon General’s report on mental health and two textbooks of psychiatry.

In examining each of these sources, we found numerous statements that invalidate suggestions that behaviors referred to as “mental illnesses” have specific biological bases.

Mental Health: A Report of the Surgeon General (1999) is explicit about the absence of any findings of specific pathophysiology:

p. 44: “The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic, or general medical, disorders, since there is no definitive lesion, laboratory test, or abnormality in brain tissue that can identify the illness.”

p. 48: “It is not always easy to establish a threshold for a mental disorder, particularly in light of how common symptoms of mental distress are and the lack of objective, physical symptoms.”

p. 49: “The precise causes (etiology) of mental disorders are not known.”

p. 51: “All too frequently a biological change in the brain (a lesion) is purported to be the ‘cause’ of a mental disorder . . . [but] the fact is that any simple association—or correlation—cannot and does not, by itself, mean causation.”

p. 102: “Few lesions or physiologic abnormalities define the mental disorders, and for the most part their causes remain unknown.”

In the third edition of Textbook of Clinical Psychiatry (1999), we find similar statements:

p. 43: “Although reliable criteria have been constructed for many psychiatric disorders, validation of the diagnostic categories as specific entities has not been established.”

p. 51: “Most of these [genetic studies] examine candidate genes in the serotonergic pathways, and have not found convincing evidence of an association.”

In Andreasen and Black’s (2001) Introductory Textbook of Psychiatry, we find, in the chapter on schizophrenia:

p. 23. “In the areas of pathophysiology and etiology, psychiatry has more uncharted territory than the rest of medicine. . . . Much of the current investigative research in psychiatry is directed toward the goal of identifying the pathophysiology and etiology of major mental illnesses, but this goal has been achieved for only a few disorders (Alzheimer’s disease, multi-infarct dementia, Huntington’s disease, and substance-induced syndromes such as amphetamine-related psychosis or Wernicke-Korsakoff syndrome).”

p. 231: “In the absence of visible lesions and known pathogens, investigators have turned to the exploration of models that could explain the diversity of symptoms through a single cognitive mechanism.”

p. 450: “Many candidate regions [of the brain] have been explored [for schizophrenia] but none have been confirmed.”

As you are no doubt familiar with these textbooks you cited, you will agree that such statements invalidate claims for specific, reliable biological causes or signs of “mental illnesses.” In the judgment of the panel members, your reply fails to produce or cite any specific evidence of any specific pathophysiology underlying any “mental disorder.”

You have also referred us to 60 volumes of Archives of General Psychiatry and 160 volumes of The American Journal of Psychiatry. The 28 July 2003 cover letter from the hunger strikers and panelists that they sent to you by certified mail stated:

“We are aware that research studies can run to thousands of pages. Therefore, please respond only with those studies that you consider the best available in support of your claims and theories in a timely way. When responding with evidence, please send citations for the original publications or copies of the publications you are citing.”

Like you, we are familiar with the material found in these journals. It is understandable why you did not provide any citations. There is not a single study that provides valid and reliable evidence for the “biological basis of mental illness.”

The members of the panel wish to make some further observations which we hope will assist the American Psychiatric Association to present an honest scientific stance with respect to the hunger strikers’ questions. In the panel’s view, the questions posed by the hunger strikers are serious and fair. These questions are legitimate questions that any patient or family member or interested person might ask of any psychiatrist, or a student might ask of a professor. The panel was therefore quite dismayed that you, as Medical Director of the world’s largest, wealthiest, and most resourceful psychiatric association, could not provide a more specific or substantial response than the equivalent of, “See our textbook.”

If, as you state in your letter, “the answers to [the above] questions are widely available in the scientific literature, and have been for years,” then it behooves your organization to make these answers and their specific sources—if they differ from the quotes we present in this letter—available promptly.

The panel members could not help but notice the contrast between the hunger strikers, who ask clear questions about the science of psychiatry and consciously take risks in the name of protecting the well-being of users of psychiatry, and the American Psychiatric Association, which evades revealing what actual scientific evidence justifies its authority. By not giving specific answers to the questions posed by the hunger strikers, you appear to be affirming the very reason for the hunger strike.

Sincerely,

Fred Baughman, M.D.; Mary Boyle, Ph.D.; Peter Breggin, M.D.; David Cohen, Ph.D.; Ty Colbert, Ph.D.; Pat Deegan, Ph.D.; Al Galves, Ph.D.; Thomas Greening, Ph.D.; David Jacobs, Ph.D.; Jay Joseph, Psy.D.; Jonathan Leo, Ph.D.; Bruce Levine, Ph.D.; Loren Mosher, M.D.; Stuart Shipko, M.D.

At the end of the letter it stated, “The hunger strikers endorse the scientific panel’s statement.”24

A month passed. There was no answer to the dissidents’ letter. The hunger strike ended.

Then on September 26, 2003, the APA put out a press release—clearly an attempt to counter any negative publicity provoked by the former “mental patients’ hunger strike.” In the press release, which follows, it is revealing that the APA is obviously extremely annoyed by its critics. One would expect that legitimate scientists would welcome critics; this after all is how scientific progress is made. One would expect that they would be curious about how former mental patients with severe mental illnesses were able to recover from their illnesses and function effectively without taking psychiatric drugs. Genuine scientists would be interested in investigating these unusual people and trying to determine how they were able to recover.

Instead, the APA—acting like the medieval church denouncing heretics—asserted that the hunger strikers were enemies of science itself! The APA states, “It is unfortunate that in the face of this remarkable scientific and clinical progress [in successfully treating “severe” mental disorders], a small number of individuals and groups [who were themselves diagnosed as severely mentally ill—the APA neglects to mention] persist in questioning the reality and clinical legitimacy of disorders that affect the mind, brain, and behavior” (my emphasis).

The APA felt threatened. Here were the pesky ex-mental patients who were exposing to the public that the emperor had no clothes. Their franchise was being attacked, their facade was being torn off, and like any imperialists the APA lashed out against the enemies of the empire.

The term clinical legitimacy is revealing. It is a term that is intimidating but means nothing—or to be more precise it means that the problems of living that sometimes overwhelm people can only be treated by “clinicians”; “clinical” disorders by definition “belong” to psychiatrists. It is reflective of the debasement of the public discourse that the term clinical depression is often used as if it were a term with a referent different from those denoted by despondent, sad, anguished, and the like. But as Boysen notes, “The plain, cold, hard fact is that there are almost no mental disorders for which a specific biological cause can be pinpointed.”25

Therefore instead of “clinical disorders,” I contend there are only problems of living—problems that cause unhappiness and fear or despair. However, as becomes evident in the following letter, the APA does not agree. (If readers find the technical language in the document confusing, I suggest they skip forward and read first the more lucid response to this letter by the dissident professionals.)*17

American Psychiatric Association Statement on “Diagnosis and Treatment of Mental Disorders”

Over the past five years, the Nation has more than doubled its investment in the study of the human brain and behavior, leading to a vastly expanded understanding of disorders that afflict and are mediated by the brain. This effort, undertaken by both the public and private research sectors, as well as by diverse professional organizations that are dedicated to moving new information about mental disorders into clinical applications, has greatly improved our ability to treat severe, frequently disabling mental and behavioral disorders effectively. Improved treatments dramatically improve the quality of health care and, in turn, the quality of life for millions of Americans who themselves have a mental disorder as well as for countless families in which a family member has a severe mental or behavioral disorder.

It is unfortunate that in the face of this remarkable scientific and clinical progress, a small number of individuals and groups persist in questioning the reality and clinical legitimacy of disorders that affect the mind, brain, and behavior. One recent challenge contended that the lack of a diagnostic laboratory test capable of confirming the presence of a mental disorder constituted evidence that these disorders are not medically valid conditions.

While the membership of the American Psychiatric Association (APA) respects the right of individuals to express their impatience with the pace of science, we note that the human brain is the most complex and challenging object of study in the history of human science. Conditions termed “mental disorders” that affect or are mediated by the brain represent dysfunctions of the highest integrative functions of the human brain including cognition, or thought; emotional regulation; and executive function, or the ability of the brain to plan and organize behavior.

Research has shown that serious neurobiological disorders such as schizophrenia reveal reproducible abnormalities of brain structure (such as ventricular enlargement) and function. Compelling evidence exists that disorders including schizophrenia, bipolar disorder, and autism to name a few have a strong genetic component. Still, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical lesion such as a tumor may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry. Research already has elucidated some of the mechanisms of action of medications that are effective for depression, schizophrenia, anxiety, attention deficit, and cognitive disorders such as Alzheimer’s disease. These medications clearly exert influence on specific neurotransmitters, naturally occurring brain chemicals that effect, or regulate, communication between neurons in regions of the brain that control mood, complex reasoning, anxiety, and cognition. In 1970, The Nobel Prize was awarded to Julius Axelrod, Ph.D., of the National Institute of Mental Health, for his discovery of how antidepressant medications regulate the availability of neurotransmitters such as norepinephrine in the synapses, or gaps, between nerve cells.

In the absence of one or more biological markers for mental disorders, these conditions are defined by a variety of concepts. These include the distress experienced and reported by a person who has a mental disorder; the level of disability associated with a particular condition; patterns of behavior; and statistical deviation from population-based norms for cognitive processes, mood regulation, or other indices of thought, emotion, and behavior.

As noted in the Diagnostic and Statistical Manual of Mental Disorders, which is published by the APA, the lack of a laboratory-based diagnostic test is not unique to mental and behavioral disorders. The identification of migraine headache is based on symptom presentation, and the presence of hypertension is detected through a measure of deviance from a physiological norm, or standard. The definition of “high” cholesterol has moved downward in recent years as more has been learned about the role of low-density lipoprotein (LDL) cholesterol as a risk factor for cardiovascular disease and as medications highly effective in reducing LDL cholesterol have been refined and increasingly available.

The mapping of the human genome already is spurring the search for genes and gene variants that singly or in combination may confer risk for the onset of a mental disorder. It is highly likely that the maladaptive expression of a risk gene will be shown to require “triggering” by certain adverse environmental influences. Here, “environment” may refer to traumatic events, prenatal/obstetric complications, or other phenomena that act on and interact with the brain. Thus, mental disorders may well be shown to be emergent properties of multiple systems that have gone subtly awry.

The lack of a laboratory-based diagnostic test for mental disorders does not diminish the irrefutable evidence that mental and behavioral disorders exact devastating emotional and financial tolls on individuals, families, communities, and our Nation. The National Institute of Mental Health estimates the direct (clinical treatment and services) and indirect (lost/diminished productivity and premature mortality) cost of mental disorders to be some $160 billion annually in the United States. And the landmark Global Burden of Disease study, conducted by Harvard University scientists under the sponsorship of the World Health Organization and the World Bank, found mental disorders, including suicide, to rank second in societal burden, behind only cardiovascular conditions, in established market economies such as the U.S.

Growing public awareness of the burden and costs of mental illness and of the gains being made through research are contributing to increasingly enlightened policies for the organization and financing of mental health care. Last year, President Bush identified three obstacles that prevent Americans from getting the mental health care that they need—stigma, unfair treatment limitations and financial requirements under health insurance plans, and a fragmented mental health service delivery program. In April, the President’s New Freedom Commission on Mental Health recommended strategies for redressing these and other barriers to high quality, appropriate mental health care for all Americans who need it. The APA was privileged to participate in the development of the report and strongly endorses the call of the President’s New Freedom Commission “. . . to protect and enhance the rights of people with mental illness.”

In the months and years ahead, the APA, along with the National Alliance for the Mentally Ill, the Nation’s mental health research and clinical communities, and the public at large will strive to achieve the President’s New Freedom Mental Health vision, and will not be distracted by those who would deny that serious mental disorders are real medical conditions that can be diagnosed accurately and treated effectively.

The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 35,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use disorders. For more information, visit the APA Web site at www.psych.org.26

The response of the panel (below) of dissident professionals to the APA statement speaks for itself: it is a scathing critique of biological psychiatry and of the medical model of human psychology. The medical model obscures the roots of human suffering. The emphases in italics are my own, intended to call readers’ attention to the most significant points.

Scientific Panel Replies to APA statement

Dear Dr. Scully:

We believe that the above-mentioned APA Statement was released in response to the questions posed last summer to the American Psychiatric Association, the National Alliance for the Mentally Ill, and the Surgeon General of the United States by the Fast for Freedom in Mental Health based in Pasadena, California.

The scientific panel convened by the hunger strikers has written the present letter to respond to this APA Statement. We have paired the contents of the 11-paragraph APA Statement to the strikers’ original questions and also added our own comments about some issues the APA Statement raises.

The Fast for Freedom in Mental Health wrote on 28 July 2003:

“WE ASK THAT YOU PRODUCE scientifically-valid evidence for the following, or that you publicly admit to media, government officials and the general public that you are unable to do so:

1. EVIDENCE THAT CLEARLY ESTABLISHES the validity of ‘schizophrenia,’ ‘depression’ or other ‘major mental illnesses’ as biologically-based brain diseases.

2. EVIDENCE FOR A PHYSICAL DIAGNOSTIC EXAM—such as a scan or test of the brain, blood, urine, genes, etc.—that can reliably distinguish individuals with these diagnoses (prior to treatment with psychiatric drugs), from individuals without these diagnoses.”

The APA Statement’s fourth paragraph states:

“Research has shown that neurobiological disorders like schizophrenia reveal reproducible abnormalities of brain structure. . . .” Without any citations, these statements cannot be supported, qualified, or rejected.

However, in the fifth, sixth, and eighth paragraphs, the APA Statement admits to the absence of “discernible pathological lesions or genetic abnormalities” in mental disorders. This admission contradicts the previous assertion of “reproducible abnormalities.”

Without evidence of brain pathology no basis exists to call emotional distress, disturbing behavior, or unusual thoughts or perceptions “neurobiological disorders.” This and similar terms negate the sufferer’s distress as reaction, protest, or adaptation to his/her position in the personally relevant social context. A person is understood in terms of personal history and social circumstances. A neurobiological disorder is understood differently. The choice of labels is of great consequence.

Moreover, finding reliable biological markers would be only a first step toward concluding that mental disorders are essentially neurobiological. For example, blushing, an obviously physical reaction, is not biologically caused. Its effective cause is acute embarrassment. Biological processes make blushing possible but they do not cause blushing.

Even total congruence between biological processes and psychological events does not show that the former cause the latter. In other words, just because the is a correlation does not mean there is causation. Psychiatric research is far from showing any reliable connections between mental disorders and biological measurements, much less revealing anything definitive about the nature of mental disorders.

Aware of this shortcoming, the APA cites migraine headache and hypertension to illustrate that the lack of biological markers (and thus of physical diagnostic tests) is not unique to mental and behavioral disorders. It is true that medicine has yet to find the biological cause for these two disorders, though it has developed a very reliable physical measurement for blood pressure.

However, in other branches of medicine such disorders are exceptions. In psychiatry they are the norm. Psychiatry is the sole medical specialty that treats only disorders with no biological markers.

Moreover, hypertension is regarded as a symptom of physical disease because hypertension can degenerate into frank physical disease, even death. No such parallel exists in psychiatry. For example, people diagnosed with schizophrenia or major depressive disorder often are physically healthy: unless their social circumstances and neglect interfere negatively, they may live long lives and die of the same physical causes as other people.

The APA confirms in paragraph six that, in the absence of biological markers, mental disorders are defined by “a variety of concepts”: “distress experienced and reported,” “level of disability,” “patterns of behavior,” and “statistical deviation from population-based norms.” Precisely. The APA should therefore explain how such sociological concepts—which easily define conditions such as poverty, discrimination, or war—substantiate the existence of “neurobiological disorders.”

The Fast for Freedom in Mental Health also requested:

“3. EVIDENCE FOR A BASELINE STANDARD of a neurochemically-balanced ‘normal’ personality, against which a neurochemical ‘imbalance’ can be measured and corrected by pharmaceutical means.”

These issues were not addressed in the APA Statement.

The APA Statement could have replied accurately that neuroscientists have not established any normal baseline quantity for any known neurotransmitter (no measurements even remotely parallel to blood pressure to diagnose hypertension exist), nor have they shown any chemical imbalance to correlate with mental disorders diagnosed in un-medicated individuals (Breggin, 1991; Healy, 1997; Valenstein, 1998).

The Fast for Freedom in Mental Health also requested:

“4. EVIDENCE THAT ANY PSYCHOTROPIC DRUG can correct a ‘chemical imbalance’ attributed to a psychiatric diagnosis, and is anything more than a non-specific alterer of brain physiology.”

The APA Statement merely states what has been known for at least 50 years, that “medications clearly exert influence on specific neurotransmitters. . . .” This response states the obvious: all mind and mood altering drugs have effects on the brain. This includes illegal mind and mood altering drugs, though no one has suggested that they correct chemical imbalances in the brain.

Given the Food and Drug Administration’s impotent exercise of its mandate to protect consumers from false advertising, pharmaceutical companies recklessly advertise cartoons showing neurotransmitter “imbalances” corrected by drugs. However, in the absence of scientific proof to substantiate such claims, it is ethically and medically reprehensible for doctors to convey such messages to justify prescribing drugs, and for the APA’s own journals to publish such advertisements.

And finally, the Fast for Freedom in Mental Health also requested:

“5. EVIDENCE THAT ANY PSYCHOTROPIC DRUG can reliably decrease the likelihood of violence or suicide.”

Not addressed in the APA statement.

“6. EVIDENCE THAT PSYCHOTROPIC DRUGS do not in fact increase the overall likelihood of violence or suicide.”

Not addressed in the APA statement.

“7. FINALLY, that you reveal publicly evidence published in mainstream medical journals, but unreported in mainstream media, that links use of some psychiatric drugs to structural brain changes.”

Not addressed in the APA statement.

Despite its use of terms such as “compelling evidence” and “research shows,” the APA Statement provides no citations to any scientific literature. This was also the case in the first letter that Dr. Scully addressed to the scientific panel on 12 August 2003.

Associations devoted to research and treatment of genuine diseases readily provide consumers with scientific references on the pathological basis of these diseases. The APA is a 35,000-member organization, with an annual budget exceeding $38 million. With a handful of allies, it shapes mental health practice and policy in this country and has convinced taxpayers to spend billions to support its claim that psychiatrists treat “neurobiological disorders.”

The APA should be able to provide a one-page list of published scientific studies to support this claim. Yet, the APA only speculates on future findings: “Mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry.” (This sentence is yet another de facto acknowledgement that neuropathology cannot be shown in mental disorders.)

The APA uses terms like “complex,” “emergent properties,” and “subtle” when describing people’s overwhelming mental and emotional crises. It states: “the human brain is the most complex . . . object of study in the history of human science.” Yet this language about complexity is completely at odds with the biological model that reduces the human mind to a machine. Since the discovery of the infectious cause of neurosyphilis nearly a century ago, this model has failed to explain the cause of a single mental disorder. Yet this model dominates the mental health system.

Aware of this utter failure to find causes, the APA claims that money spent by the public and private sector “has greatly improved our ability to treat severe, frequently disabling mental and behavioral disorders effectively.” However, relevant indicators show the exact opposite.

For schizophrenia, worsened relapse rates and increased numbers of people on disability status characterize outcomes over the last 50 years (Hegarty, Baldessarini, Tohen, Waternaux, and Oepen, 1994; Whitaker, 2002). For depression, increased incidence and prevalence are reported. Indeed, the APA Statement cites that mental disorders “rank second in societal burden, behind only cardiovascular conditions” in modern societies.

Perhaps the treatment is worsening the disorder. At best, the treatment is not helping: researchers now recognize that the most popular psychiatric drugs, the SSRI antidepressants, rate only slightly better than inert placebos (Kirsch, Scoboria, and Moore, 2002; Kirsch, Moore, Scoboria, and Nicholls, 2002). In addition, negative research findings (sponsored by industry) are commonly suppressed, and adverse drug effects are massively under-reported in psychiatric journals and to the Food and Drug Administration. These dubious but tolerated practices create an enormously misleading view of the actual impact of drug treatments.

Rather than acknowledge the lack of progress despite the huge expenditure of public and private funds, the APA dismisses its critics as denying the reality of suffering and impatient with the “pace of science.” A genuine science states hypotheses in ways that allow them to be proven true or false. For a century now psychiatry has put forth hypothesis after hypothesis that is not falsifiable.

Today, despite no biological causes, no discernible biological markers or abnormalities, no diagnostic tests, no accurate predictions of treatment response and outcome, the APA still continues to claim that emotional disorders are genuine neurobiological disorders . . . with causes too subtle to detect at present! This is hardly an advance over earlier unfalsifiable ideas such as the Oedipal complex.

In sum, the APA’s statements reflect less the “pace of science” than the pace of commerce: they blur with the pharmaceutical advertising themes saturating our media. This is because the APA is not an independent organization. One third of its operating budget comes from the drug industry. Drug companies dominate its professional meetings to advertise drugs. In addition, the drug industry funds, directs, and analyzes many drug studies (Healy, 2003), and psychiatric journals publish so-called scientific reports of these drug studies that are ghost-written by industry employees or marketing firms. Psychiatric drug experts with no significant ties to industry can hardly be found. Industry largesse binds many psychiatric practitioners to the industry (Editorial, 2002).

The hunger strikers asked the APA for the “evidence base” that justifies the biomedical model’s stranglehold on the mental health system. The APA has not supplied any such evidence, which compels the scientific panel to ask one final question: on what basis does society justify the authority granted psychiatrists, as medical doctors, to force psychoactive drugs or electroconvulsive treatment upon unwilling individuals, or to incarcerate persons who may or may not have committed criminal acts? For, clearly, it is solely on the basis of trust in the claim that their professional acts and advice are founded on medical science that society grants psychiatrists such extraordinary authority.

We urge members of the public, journalists, advocates, and officials reading this exchange to ask for straightforward answers to our questions from the APA. We also ask Congress to investigate the mass deception that the “diagnosis and treatment of mental disorders,” as promoted by bodies such as the APA and its powerful allies, represents in America today.

Signed:

Scientific Panel for the Fast for Freedom in Mental Health: Fred Baughman, M.D.; Mary Boyle, Ph.D.; Peter Breggin, M.D.; David Cohen, Ph.D.; Ty Colbert, Ph.D.; Pat Deegan, Ph.D.; Al Galves, Ph.D.; Thomas Greening, Ph.D.; David Jacobs, Ph.D.; Jay Joseph, Psy.D.; Jonathan Leo, Ph.D.; Bruce Levine, Ph.D.; Loren Mosher, M.D.; Stuart Shipko, M.D.27

One of the psychiatrists on the hunger strikers’ team of experts was Dr. Loren Mosher, whose career in psychiatry exemplifies the sad story of the forces of change in the mental health system. As a young psychiatrist in the early 1970s, Mosher was a supporter of the mental patients’ liberation movement and a student and friend of R. D. Laing. By the end of the 1970s Mosher was appointed head of the National Institute of Mental Health. In this role he procured funding for and did the pioneering research for the Soteria Project, a very successful model of a largely drug-free alternative treatment for “psychotics.” Soteria’s funding was cut in the mid-1980s, and Mosher was removed from NIMH. In spite of assiduous efforts, he was never again able to get funding for a drug-free alternative to standard treatment. He died one year after the hunger strike at the age of seventy-one.

Today in 2012, the words of Mosher’s resignation letter to the APA ring truer than ever: “The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. At this point in history, in my view, psychiatry has been almost completely bought out by the drug companies. . . . Psychiatrists have become the minions of drug company promotions.”