PSYCHIATRIST DISSOLVES 35 YEAR ASSOCIATION WITH
                 AMERICAN PSYCHIATRIC ASSOCIATION

Loren R. Mosher M.D.
2616 Angell Ave
San Diego, CA 92122
tel: 619 550 0312
fax: 619 558 0854

December 4, 1998

Rodrigo Munoz, M.D., President
American Psychiatric Association
1400 K 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.

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? Unforunately, 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.

Sincerely,
Loren R. Mosher M.D.