Psychiatrist E. Fuller Torrey took schizophrenia off the couch and into the lab. Now he spends his days at St. Elizabeths probing a single question: What makes people crazy?
By Stephanie Mencimer
Psychiatrist E. Fuller Torrey collects brains the way other people collect stamps or beer cans. He used to bring some home once in a while, but eventually his wife got sick of brain tissue hogging all the fridge space. Since then, the Frigidaire has been supplanted by 38 commercial-size freezers at the National Institute of Mental Health (NIMH) neuroscience center, where Torrey oversees a privately funded research program on schizophrenia and bipolar disorder.
The neuroscience center is tucked away in Anacostia in a century-old red brick building on the campus of St. Elizabeths Hospital. The building is a beauty, a classic edifice that could grace the cover of an Ivy League recruiting brochure, and Torrey looks very much the part of bearded college professor. Then again, he could also be mistaken for a patient, given his constant presence at the mental hospital for the better part of 20 years.
As he walks the yellowed halls of the William A. White Building, Torrey, 60, looks jaunty and athletic despite a degenerative hip that puts a hitch in his stride. Upstairs from his office, he comes to a door marked "biohazard," which he opens to reveal buckets of brains lining row after row of metal shelves. The brains are Torrey's obsession; he has collected the noodles of more than 200 unfortunate folks who suffered from bipolar disorder and schizophrenia since 1994.
Torrey gets excited when he talks about his batch of brains. "There has never been an attempt like this to do a single collection of brains," he says, almost giddily. "This is revolutionary in that sense. The big question is why no one did this before. The disease is in the brain. We need brains!"
When Torrey first started practicing medicine, psychiatrists were all but convinced that madness was not an organic disease but the outgrowth of bad toilet training or overbearing mothersproblems Sigmund Freud taught them could be cured with a healthy dose of psychotherapy. Logic and medical training, however, told Torrey that schizophrenia was a disease of the central nervous system that couldn't be cured on the analyst's couch.
Twenty-five years ago, when most psychiatrists were quizzing schizophrenic patients on their relationships with their mothers, Torrey began collecting spinal fluid from patients in the wards of St. Elizabeths, looking for clues to the disease. Brain collection was the logical next step. But brains were a little harder to come by, because research into diseases of the human mind has historically been an underfunded backwater. Torrey says that as a result, most research on mental illness has been conducted on cheaply acquired rodent brains rather than human ones. "No one has ever looked at bipolar brains," Torrey says with exasperation. "Almost nothing is known about the pathology of the depressed brains."
Down the hall, Torrey stops to observe as a researcher dips into a bucket full of urine-colored fluid and retrieves a big blob of gray matter. Preservative has turned the brain into something that looks more like a very large eraser than the human body's most complex organ. The anatomist plops it onto a cutting board and deftly identifies the crucial areas of the limbic systemhippocampus, cerebellum, amygdalaparts of the brain responsible for emotions and other crucial functions. She carves the rubbery tissue into discrete blocks, which get sent down the hall to several women in hospital scrubs and shower caps hunched over cryostats.
They look up and smile as Torrey explains that they are working on what are essentially state-of-the-art meat slicers that reduce frozen, drab yellow chunks of brain to postage stampthin snowflakes. The flakes are slide-mounted and shipped off to research groups around the world that are all seeking the answer to one of the most underexplored mysteries in modern medicine: What is it that makes people crazy?
Doctors since as far back as the mid-1800s have split open skulls looking for the answer to that question. But Torrey says the progress made by the 19th-century researchers came to a screeching halt in 1911, when Sigmund Freud published his analysis of paranoid schizophrenic Daniel Schreber. Freud never examined Schreber, and he had admittedly little prior experience working with schizophrenics, but he deduced from Schreber's 1903 memoirs that his disease stemmed from a "conflict over unconscious homosexuality"or an unhealthy attachment to his father during childhood.
Freud's analysis and other kooky ideas so captured the imaginations of American psychiatrists that they totally abandoned biological brain research and took to the couch with psychotherapy. Now that biology has discredited Freud's analysis of mental illness, genetics has become the leading suspect in schizophrenia, and most federal mental health research money is focused on finding an "insanity gene." Torrey hasn't jumped on that bandwagon, either. He thinks gene hunting is an expensive fad. His own "delusional system," as he calls it, leads him to believe that the culprit behind schizophrenia and bipolar disorder might be a little less esoteric: the common house cat.
Torrey is a leading proponent of the not very widely held view that schizophrenia and bipolar disorder are caused not by a gene but by a virusone that might be carried by house pets. "There's an assumption that they are genetic diseases," says Torrey. "I don't believe that."
The Typhoid Tabby theory of schizophrenia hasn't swayed a whole lot of Torrey's colleagues in the federal research establishment, which has been listening to him harp on viruses for 25 years. But in 1994, the Theodore and Veda Stanley Foundation bet several million that Torrey might be right. With the foundation money, Torrey has set up the world's first and only neurovirology laboratory at Johns Hopkins School of Medicine in Baltimore, which is devoted solely to the study of infectious causes of schizophrenia and bipolar disorder. Torrey believes the lab is only a few years away from finding the cause of schizophrenia; once it's found, he thinks a vaccine won't be far behind.
Torrey was a junior studying religion at Princeton when his mother called to tell him his sister had suffered a nervous breakdown. Rhoda had just graduated from high school in Clinton, N.Y., and was bound for Elmira College when she first started showing signs of confusion. Then came the delusions and the voices in her headclassic signs of schizophrenia. Her prognosis was not good. In the late 1950s, schizophrenia was badly misunderstood, and Thorazinethe first major breakthrough in anti-psychotic medicationwas only just coming onto the market.
Torrey's elderly father had died long before Rhoda got sick, leaving Torrey with much of the responsibility for his mother and two siblings. He accompanied his mother as she shlepped his sister up and down the East Coast through all the best institutions in search of something, anything, that would help her return to normalcy. Rhoda suffered through electroshock therapy and insulin coma therapy, the few treatments that were available at the time, but nothing worked. Failing to come up with an efficacious approach, the doctors fell back on what was the common response in those days: blaming the patient's mother.
Well into the 1970s, psychiatric textbooks featured descriptions of "schizophrenigic mothers" who supposedly caused schizophrenia in children by being cold and rejecting. In a personal account Torrey wrote for the California Alliance for the Mentally Ill newsletter a few years ago, he said, "I developed a sneaking suspicion that these eminent psychiatrists did not know what they were talking about." Even though Torrey had significant doubts about the thinking surrounding schizophrenia, his mother died believing that she had caused the debilitating disease that had left her daughter confined to a state mental hospital for 25 years.
Torrey's well-earned contempt for psychiatrists didn't stop him from going into the field himself. While he had always wanted to become a doctor, his sister's illness had had a profound effect on him. "It's probably the reason I got into schizophrenia to the degree that I am now," Torrey explains. He took the psychiatrists' ignorance as a challenge and began to see brain research as the last medical frontier to be conquered. "When I was in medical school, the brain was Alaska," he says. Back then, he says, brain research wasn't a very respectable field because...well, it required working with crazy people. Most of his med-school classmates were planning psychotherapy practices that wouldn't interfere with their tee times.
But Torrey's version of psychiatry offered him a perfect venue to exercise his scientific curiosity, love of doctoring, and growing social conscience. While he was a medical student, he joined the U.S. Public Health Service and did a stint as a Peace Corps doctor in Ethiopia and then a tour setting up community health centers in the South Bronx. Torrey completed a psychiatric residency at Stanford, where he also received a master's degree in anthropology. His quick mind and demonstrated competence helped him land a prestigious desk job as an administrator with NIMH.
The federal research arm turned out to be a stifling place for someone with Torrey's energy and drive. When Torrey got to NIMH in 1970, he looked around and saw that in spite of real problems with the mental health system, the federal government's foremost mental health research institute was spending most of its multimillion-dollar budget on fluffy projects like improving marriage counseling. "The government ignored both bipolar and schizophrenia for years," Torrey explains. "NIMH from the late '60s decided to become a behavioral study institute. They kind of forgot the institute was set up to foster research into severe mental illness."
In spite of the fact that he was drawing a check from NIMH, Torrey voiced his opinions about the institute's misplaced priorities in speeches and began writing books highly critical of the mental health establishment as a whole. A 1972 book, The Mind Game: Witchdoctors and Psychiatrists, drew on his training as an anthropologist and compared psychotherapy to witch doctoring in Third World countries; Torrey considered both practices useless in treating diseases of the brain. Then, in 1974, he published a book titled The Death of Psychiatry, in which he accused his colleagues of abandoning the seriously mentally ill, who desperately needed real medical treatment instead of couch time at exorbitant hourly rates. His book indicted psychiatrists for confining themselves to treating bored middle-class housewives in swanky private practices far from public sector hospitals. Torrey proposed abolishing the psychiatric profession altogether and turning over the care of the mentally ill to neurologists, while leaving the housewives to nonmedical counselors.
The books didn't win him too many friends in the profession. Lawrence Sack, former president of the Washington Psychiatric Society, once told the Washington Post in the early 1980s that Torrey was "an arrogant maverick who thinks he has all the answers." Sack's group had already tossed Torrey out for failing to pay dues, which Torrey says he withheld in protest because the group used them to lobby Congress for better reimbursement for psychiatrists. ("I thought I had joined a scientific organization, not a union," he explains.)
Torrey never wanted to be part of the establishment, anyway. Bored with the "culture of mediocracy" at NIMH, Torrey left his administrator's job in 1976 and took off for the Pribilof Islands in the Bering Sea, far off the coast of Alaska, where he spent a year working for the Indian Health Service as the island's only doctor. While he was there, he rediscovered his passion for treating patients. When he returned to Washington, he went to see Roger Peele, then acting superintendent of St. Elizabeths Hospital. He asked Peele for a job working in the patient wardsplaces that had long been abandoned by respectable psychiatrists.
Peele, now the medical director at the Northern Virginia Mental Health Institute in Falls Church, was somewhat surprised by the request. He knew of Torrey's reputation for idiosyncratic thinking and brought him on expecting him to be something of a prima donna. "I found him an assignment in the bowels of St. E's. I gave him a unit that wasn't doing well, and he plowed in, never asked for special treatment," Peele recalls. "He worked hard. Not long after that, he wanted to go to D.C. General to work in the ER to keep his medical skills up. Then I'd find him in the library at the hospital and I'd ask him what he was doing, and he said he was working on a book on [former St. E's patient and fascist poet] Ezra Pound. Then he started working in the shelters with the homeless mentally ill. And if that weren't enough, he asked me for more work, so I gave him a second ward."
By 1983, Torrey was supervising 12 wards, 250 workers, and 400 patients at St. Elizabeths, when it was still under federal control. But one Monday morning, Torrey woke up and found out that he'd been fired. The Post had just reviewed his latest book, The Roots of Treason: Ezra Pound and the Secret of St. Elizabeths, in which Torrey accused a previous director at the hospital of perjuring himself by declaring St. E's most famous patient (before John Hinckley) incompetent to stand trial. The hospital didn't take kindly to the characterizationeven though Pound's trial had taken place more than a half-century earlierand fired him.
Torrey, who needed two more years to reach the magic number 20 in the U.S. Public Health Service, was left with relatively few career choices and ended up looking for work in prison psychiatry. He was about to take a job at the Atlanta Penitentiary when a position opened up in the forensic division at St. E's, and he managed to stay put. Not long afterward, he applied for a grant to collaborate with NIMH on a study of the cause of schizophrenia. Starting in 1987, Torrey and his fellow researchers conducted highly sophisticated brain scans on identical twins, which ultimately showed that the brains of people with schizophrenia have clear, structural abnormalities, the hallmark of neurological diseases like epilepsy.
The twins study ended the debate over whether schizophrenia was a biological disorder or a byproduct of misplaced Oedipal complexes. The study also forced Torrey's colleagues to take him seriously. Dr. Daniel Weinberger, chief of the clinical brain disorders branch at NIMH, didn't return calls for this story, but in a 1991 profile in American Health, he credited Torrey with advancing the research into mental illness. He told writer Robert Trotter, "Nobody else has shown as much creativity and ingenuity in accomplishing his goals, and his work in this area has been so constructive that concerns about his iconoclastic methods have diminished remarkably." The scientific community may be guffawing about his suspicions about a link between cats and schizophrenia, but they can't get around the fact that it was Torrey's research that took brain diseases off the couch and into the lab, where they belonged.
Torrey's cluttered office at St. E's is of the same configuration and size as the patient rooms two stories above him, except he has a desk where they have beds. The layout leads to obvious riffs about the inmates running the asylumespecially in reference to Torreybut he likes the location because of its safe distance from the meddling bureaucracy of NIMH in Bethesda.
The twins study may have gotten Torrey invited back into the American Psychiatric Association, but he has still declined to join the establishment. His black-and-white view of the world of mental health leaves him no patience for the "worried well" who preoccupy most of the mental health field. As far as he's concerned, those peopleneurotics like Woody Allen, who's been in therapy for 33 yearsare part of the problem because they divert resources away from the seriously mentally ill. "For every one of them," he says, "I can show you 10 seriously ill people who aren't getting any treatment at all."
With his thin face cloaked in large glasses and a graying beard, Torrey bears a slight resemblance to his nemesis, Sigmund Freud, but the more salient visual echo is that of an old-fashioned radical. A master of the sound bite, his politics come packaged in genteel charm and a sense of humor. In fact, his outspokenness can seem deceptively intimate until you realize that he has said the same wildly clever and irreverent things to hundreds of other people. Torrey has the distracted air of the brilliant scientistthe combination of fearlessness and intelligence, symptomatic of a loose cannon, that may keep his colleagues from totally buying some of his more peculiar ideas. Like the one about the cats.
As odd as his theory may seem at first glance, Torrey is in good company when he insists that schizophrenia and other mental illnesses may be catching. As far back as 1845, scientists were positing that an infectious agent might be at work in causing some forms of insanity. Yet when Torrey resurrected the idea in a paper in 1972 after more than 50 years, it was discounted by all but a handful of researchersincluding Nobel Prize winner Carleton Gajdusek.
"I first had lunch with Carleton in 1972," says Torrey. "He was the only person who didn't laugh outright at what was then a preposterous idea: that a virus could cause schizophrenia." Torrey says Gajdusek, a pediatrician by training, looked at him and said, "Your profession is hopeless."
Three years before that, Gajdusek had come to the same conclusion Torrey had after his years in Papua New Guinea studying an epidemic of a new infectious brain disease called kuru. As part of his groundbreaking work on kuru and other spongiform encephalopathy diseases (like mad cow disease), Gajdusek had injected schizophrenic brain tissue into his chimps to see whether he could infect them. Nothing happened to the chimps, but Torrey points out that Gajdusek had no way of knowing whether the chimps were having delusional thinking. Torrey still doesn't rule out the possibility that the virus has another way of causing the disease. "He was so ahead of his time," says Torrey.
Gajdusek served on the Stanley Foundation research committee until 1996, when he was arrested for molesting boys he had adopted during his travels to Papua New Guinea. Torrey still talks to him in jail, though. "Many of us are obliged to Carleton," explains Torrey. "That's why so many of us in the neuroscience field rallied to help him. His contribution to the neuroscience field has been enormous."
Gajdusek's work prompted Torrey to dip into his training as an anthropologist to see whether schizophrenia behaved like an infectious disease. Doctors had long observed that viral encephalitis and some other infections present symptoms that look like schizophrenia. Many people with schizophrenia had also reported that their diseases set in after signs of a viral infection. Torrey figured it couldn't be just a coincidence. The disease turns up in clusters in many of the same environments that breed influenza. Like the flu, schizophrenia is most prevalent in poor, urban areas in cold climates, where crowded households are hotbeds of infection in wintertime. Ireland, for instance, has one of the highest rates of schizophrenia in the world, while in the tropics it's virtually unheard-of.
The problem with some of the epidemiological evidence that Torrey compiled is that some of the patterns of the disease could also be explained by genetics. It could be that the Irish just have bad genes. But not long after his lunch with Gajdusek, Torrey found a group of studies showing that a disproportionate number of people with schizophrenia are born in the winter and spring. The finding was cathartic for Torrey, because genetic causes would express themselves throughout the year in a fairly regular pattern. "Viruses have to be prominent. They have seasonal patterns," he says, pointing out that people tend to get more colds and viruses in the winter months. But when Torrey casually presented his theory to his colleagues, he says, "I was laughed out of the office."
His colleagues' ridicule only galvanized Torrey's resolve to find a viral cause for the disease. After 20 years, he has assembled an impressive set of facts that make his idea a plausible one. There's only one thing missing: the virus itself. While he hasn't been able to pinpoint the particular virus, Torrey has followed some hunches about possible sources of transmission. He did some research on environmental factors that might account for the rise in American psychiatric admissions that began around 1880. What he found was evidence that the country underwent something of a "cat craze," spawned by the first English cat show in London in 1871, and the increase in cat ownership followed a pattern similar to that of psych ward admissions.
Cats are known to carry all sorts of bugs that cause disease in humans, especially in pregnant women. Torrey actually tested his feline hypothesis in a survey of the families of the seriously mentally ill. He asked questions about whether the children had been breast-fed and whether there was a family history of diseases like multiple sclerosis and rheumatoid arthritis, which are thought to be virally caused as well. Torrey found that the only significant differences in the survey between the normal children and the mentally ill ones were that the mentally ill children were more likely to have been breast-fed and to have been exposed to a cat at home.
He also cites the famous Dutch hunger study, which found that women who were pregnant during the 194445 famine in Holland, when Nazi troops had cut off food supplies, had a high number of children with schizophrenia. Researchers have speculated that starvation probably caused some kind of obstetric problem that later affected the Dutch women's children. But Torrey notes that it has been well documented that when the food ran out, the people in Holland ate cats.
When he says stuff like that, it's not hard to see why Torrey's theory doesn't have a lot of supporters in the psychiatric community. But psychiatrists, of all people, know there's a fine line between genius and madness, so they haven't completely ruled out the idea. The broader scientific community just doesn't think that a virus is responsible for more than a tiny fraction of cases of mental illness.
Dr. Richard Warner, medical director of the Mental Health Center of Boulder County and a faculty member in psychiatry and anthropology at the University of Colorado, says, "I think there are much more important factorsfor example, genetics and other forms of obstetrical complications." He says there is evidence that a maternal infection could cause schizophrenia but says that it accounts for maybe 2 percent of cases of schizophrenia, whereas genetics can account for 40 to 50 percent. "Maternal viral infection probably increases the risk for all kinds of brain illnesses. The brain may suffer all sorts of assaults. To argue that they're all due to viruses is, I think, stretching the point."
Torrey hasn't totally ignored genetic research. "There's no question that genes play a role," Torrey says. "I just don't believe the genetic aspect is that strong." Genes are involved in all infectious diseases, Torrey explains, which is why even though most people of his generation were exposed to the polio virus, not everyone got sick. The major problem with a purely genetic theory of schizophrenia, he says, is that viruses are known to attach themselves to genes and to get transmitted that way. "What ‘genetic' means is much more confusing. The nice distinction between virus and genes is not as clear as we'd like it to be," he says.
The genetic theory also doesn't offer much of an explanation for some remarkable findings coming out of the Stanley Foundation's neurovirology lab at Johns Hopkins. One of the great mysteries of mental illness has been why drugs like Thorazine control symptoms like auditory hallucinations and delusional thinking in schizophrenics. Doctors have speculated that anti-psychotic drugs work by blocking the transmission of certain chemicals, like dopamine, in the brain. But the neurovirologists in Baltimore had a hunch that the anti-psychotic drugs might also have hidden effects that kill an unseen virus.
Last year, they tested Clozapine, one of the newest anti-psychotic medications, to see if it might be effective against the virus that causes AIDS. It was. Clozapine won't be the next big AIDS treatmentthere are better AIDS drugs on the marketbut the finding is fairly revolutionary because it suggests that anti-psychotic drugs work because of their anti-viral properties. It holds out hope for better treatment for people with schizophrenia. Torrey is hoping that within the next year, the Johns Hopkins group will begin clinical trials using powerful anti-AIDS drugs on people with schizophrenia. The geneticists will have a tough time arguing with him if it works. "It's very exciting," says Torrey. "Things are moving so fast. I honestly think we are within a few years or a decade of having a much better understanding of these diseases."
A few years ago, Torrey met a 19-year-old woman who had been dashing through National Airport on her way back to college when she had encountered a straggly-looking woman. On second glance, she realized the woman was her mother. A schizophrenic woman who had disappeared two years earlier, she had been living on the mezzanine of National Airport. Her daughter tried to get the woman into a hospital for treatment, but she resisted, and a Virginia judge refused to commit her against her will on the grounds that she wasn't dangerous. Three months later, Torrey went back with the woman's daughter and lied to the judge, describing her mother as a dangerous, violent woman who had threatened to hurt people. The judge institutionalized her. Torrey says the woman responded to treatment and eventually went back to work. When she was better, she thanked her daughter for intervening, saying, "You're the only one who helped me."
Torrey is far more famous for these kinds of stories than he is for his virus hunting. Along with bullshitting judges to get people committed to psychiatric hospitals, he has publicly admitted to having medicated people against their will. He supports laws that would make it easier to get people committed to mental hospitals, and he has advocated forcing the seriously mentally ill to take anti-psychotic medications as a condition of receiving federal disability benefits and other payments. And he has argued that mentally ill people at risk of becoming violent should be forced to take medication as a condition of living outside of a hospital.
As a result, Torrey says with a laugh, "I have been accused of being a Nazi and a fascist, and most recently I've been accused of wanting to hospitalize 800,000 people involuntarily."
His views on involuntary treatment horrify some advocates for the mentally ill. Robert Bernstein, executive director of the Bazelon Center for Mental Health Law, takes issue with Torrey's assertion that some mentally ill people need to be forced into hospitals. "Coercive treatment is often just an easy way to deal with a population that has been devalued," says Bernstein. "If you don't want to take heart medication, your family doesn't go to court and try to make you take it."
Even some of Torrey's most ardent supporters are uncomfortable about his dogmatism on the subject of forcing patients to take their medications. Nancy Lee Head, vice president of the D.C. Mental Health Consumers' Leaguewho herself suffers from schizophreniasays that while she has the utmost respect for Torrey and all he has done for people like her, "Consumers have a different opinion [from his] about forced hospitalization. Some of us are probably here today because someone has forced us into a hospital, but I'm still not sure that's the best way."
Torrey is unapologetic, regardless of who is shaking a finger at him. He is driven by images of Margaret Hoffman, the mentally ill homeless woman who was mauled to death by a lion after crawling into its den at the National Zoo two years ago. He keeps a file several inches thick full of stories of untreated mentally ill people who refused medication and later hauled off and killed their families in delusional rages. Torrey sees fragile people living on streets and in public shelters without medical treatment because civil libertarians have fought for their right to get out of mental hospitals but have never came up with a workable alternative.
The issue of whether the government should have the right to hospitalize the insane against their will has long been a contentious one. Commitment statutes have been abused against people, particularly women, whose political views were unpopular or whose manners didn't fit cultural norms. And the conditions in the state mental hospitals they were committed to have historically been so bad that in the 1960s, Bruce Ennis of the American Civil Liberties Union proposed abolishing involuntary hospitalization altogether on the grounds that mentally ill people would be better off living on the streets.
The idea has lost its luster since the early 1980s, when studies started to show that in fact, a large percentage of mentally ill people were living on the street, in conditions far worse than those inside the hospitals. In the District, for instance, St. Elizabeths housed about 7,000 people at its peak back in the late '50s. Today, it holds about 1,100, and the city has about 8,000 homeless peoplemore than a third of whom are thought to be mentally ill. Tension has grown between civil liberties lawyers and communities terrorized by some of those psychotic people, whom it is now impossible to get off the streets and into real medical treatment.
Most states' laws now say that in order to have people committed without their consent to a mental hospital, they must be a danger either to themselves or to others. This standard has been applied very strictly, especially as the number of available state hospital beds has diminished. Torrey says he once called the police after getting a report from shelter workers that a homeless woman was walking the streets of downtown with an ax. He says the police wouldn't take the woman to the hospital because she hadn't killed anyone yet. Indulging in a little psychiatrist humor, Torrey says, "A danger to self means threatening to kill yourself in front of the psychiatrist, and danger to others means trying to kill the psychiatrist."
Torrey is an ideologue, but his time in the trenches has given him a moral authority that few people in the mental health field possess. Until just a few months ago, Torrey could be found down at the Zacchaeus Free Clinic in Shaw, cajoling shopping-cart ladies into taking medication they didn't think they needed because they were convinced that the voices they were hearing came from electrodes the FBI had implanted in their brains. Before that, he spent several years at Rachel's Women's Center, for a total of almost 15 years of volunteer service with the homeless.
While his detractors raise images of him eagerly trampling people's civil liberties to throw them into the booby hatch, Torrey's patients seem rather fond of him. They still call him at home, and he treats them in the manner of an old-fashioned small-town doctor who sits knee-to-knee with his patients. Sister Mary Ann Luby, an outreach worker at the Washington Legal Clinic for the Homeless, was the executive director of Rachel's Women's Center in 1983, when Torrey set up shop there to treat the mentally ill homeless women. "He came to Rachel's when no one else would," says Luby.
Torrey not only came, he got drug companies to donate medication and spent evenings popping pills out of sample packages so he could distribute them to patients. Luby says, "He was just the best thing that happened at Rachel's. He has worked with people for years, and that's what you need for people with mental illness. I know he's criticized for pushing the meds, but he was masterful with medication. We couldn't do anythingno counseling, nothinguntil he got people stabilized on the drugs."
Even the once hostile psychiatric profession is short on criticism of Torrey's skills as a doctor. Al Golub, executive director of the same Washington Psychiatric Society that kicked Torrey out a decade ago, says, "There is a wonderful maverick quality to Fuller Torrey, but I don't know whether it's real or imagined. He's a very orthodox psychiatrist when it comes to treating people with serious mental illness."
When Torrey was running the wards at St. E's, his old boss Peele says his wards were a model of humane treatment. "He was getting good results without using seclusion and restraint," says Peele, explaining that Torrey put up a chart plotting the time patients had to be restrained as an incentive for the staff. "He had good rapport with the patients. He would throw wine parties on Friday nights for the patients who had to stay over the weekend. I liked his style," says Peele.
His advocacy of involuntary treatment is Torrey's version of tough love. He believes that at least a small group of mentally ill people suffer from impaired insight, meaning that illness prevents them from realizing that they are sick. This group, he says, not only can't ask for treatment but often resists treatment when it's offered. He likens such people to elderly folks with Alzheimer's disease who wander away from home. The only difference, he says, is that society doesn't allow its senile grandmothers to live in parks and wander the streets barefoot in wintertime. But Torrey says civil liberties lawyers will defend to the death the right of a paranoid schizophrenic to live in a box under the Whitehurst Freeway.
"These people do not realize they are sick," explains Torrey. "To leave them living on the mezzanine at National Airport is inhumane, and we need to call it that."
Still, Bernstein is unswayed. "The question is, how do you determine whether they're incapable [of making decisions about treatment]? Because they disagree with you or because there is no insight?" He says the mentally ill have all sorts of reasons for refusing treatment, including bad side effects to psychotropic drugs and psychic scars from previous hospitalizations. "To conclude from that that these people need to be incarcerated is ludicrous," he says.
On a rainy night in early November, 60 or so people assembled by the Virginia Alliance for the Mentally Ill have gathered at the George Mason University law school to get a pep talk from the famous psychiatrist. It's a friendly audience, made up mostly of people with a family member who has a mental illness. They're ordinary people, mostly aging parents, who have a stunning medical vocabulary, in much the same way as people with AIDS. They talk about Clozapine, Risperadol, dopamine receptors, PET scans, and commitment proceedings as if they are reading a grocery list.
For years, these families have been more closeted than gays in the military. Mental illness has always carried a dark stigma, and with all the recent genetic studies showing that schizophrenia is hereditary, few people are willing to admit on a first date that they've got insanity in their genes. So families have suffered in silence as state mental hospitals have closed and sent their residents back home, where elderly parents have been ill-equipped to care for their psychotic offspring. Parents and siblings have suffered as victims of violence inflicted by their own kin. They've grieved over the ones who have hanged themselves in the garage after judges have refused to commit them to a hospital.
For those families, Torrey is a voice of reason, someone who not only understands mental illness but knows what it's like to love someone who's sick. He is the closest thing schizophrenia has to a celebrity. Even though the disease is 40 times more common than muscular dystrophy, it has no real public face, no Christopher Reeves, no pink ribbons, no walkathons, no Jerry Lewis Labor Day Telethons. In 1983, when Torrey donated the royalties of the hardcover edition of his best-selling Surviving Schizophrenia to the National Alliance of the Mentally Ill, a family-based association, he became the group's biggest champion.
Tonight in Virginia, Torrey looks a little mad himself. His hair is askew, and when he starts talking, the facts spill forth rapid-fire. "Deinstitutionalization is the second largest social experiment in this century. It has been a failed experiment, and it was an experiment that was based on no data whatsoever," he says feverishly, referring to the movement in the late '60s and '70s to empty out state mental hospitals. Today, he says, if the hospitals had never been closed, "We would have 900,000 people in mental hospitals. Today, we have 70,000." The implications of those numbers, he says, are staggering. "We have deinstitutionalized 800,000 people."
It's the fate of a small percentage of those 800,000 mentally ill that most concerns Torrey. They're the ones he finds eating out of garbage cans and getting raped in city parks, and they're the ones who are in and out of the revolving door of the mental health system. "None of us are saying we need to put 800,000 back in institutions," he says, explaining that newer medications developed over the past few years have allowed many people to live in their communities. "But you need some beds."
Over the course of two hours, Torrey rails against federal funding schemes for mental health care and attacks civil liberties lawyers for preventing sick people from getting well. He takes some potshots at John Mack, the Harvard psychiatrist who bills insurance companies for psychotherapy treatment for people who've been abducted by aliens. He skewers "mangled care" companies for paying CEOs multimillion-dollar salaries at the same time that they deprive the mentally ill of treatment. After noting that in 1994 William McGuire, CEO of United Healthcare, received $6.1 million in compensation, Torrey says, "If any of you think William McGuire is going to give back $1 million to open a clubhouse [a successful day program for the mentally ill], see me afterward and I'll give you a prescription for Haldol."
It's a stunning performance, full of righteous indignation. Torrey winds up by imploring the audience to become "obnoxious advocates" and schooling them in old-fashioned hell-raising. The people in the audience eat it up, and when it's over, they look ready to storm the Capitol with demands for better mental health services. What's amazing about Torrey's performance is that his lecture is only slightly different from the one he's been giving over and over and over for the past 20 years. And even though he manages to maintain the fervor, very little has changed in mental health care services during that time, and what has changed has gotten worse.
For that reason, his lecture at George Mason is one of Torrey's increasingly rare public appearances. He has scaled back his advocacy work to spend more time on research, which he believes holds more promise of improving the lives of the mentally ill than his campaign against managed care. "I'm not very optimistic about services," he says. "Things are worse now than they were 10 years ago. That's why I'm spending my time on the research. That's where the big payoff will be." By his calculations, if even a fourth of all existing cases of mental illness could be cured, the federal government would save $9.5 billion a year in social service, Medicaid, and other costs, and a lot of the problems he's been trying to solve over the years would be rendered moot.
Yet it's hard to see how Torrey could completely disappear from public view. After his lecture at George Mason, people flock to him with pleas for help and advice. One young woman, Nicole McEwan, tells Torrey that she is the primary caretaker for her mother, who suffers from schizophrenia. At 29, Nicole has seen the commitment process firsthand, as she has watched her 56-year-old mother go into and out of various institutions. Sitting on a bench in the Metro, McEwan says she came all the way from Philadelphia just to see Torrey speak. After her grandmother died, she was left pretty much on her own to care for her sick mother, who is always at risk of slipping through the cracks. Torrey's speech served as something of a pep talk to keep going in a solitary job she didn't ask for but can't just quit. "Most people don't get into this for the fun of it," she says.
Any medical breakthroughs Torrey might discover in the next few years will probably come too late to help McEwan's mother. But McEwan would still like to know what happened that made her mother sick. "Is it breech births?" she asks. Or is it the product of a hard life, she wonders. Her mother had both. She would find some comfort in knowing. Torrey can't do more right now than offer her some advice to help her deal with her mother's doctor, but that's more than she's getting from anyone else.
Thoughtfully, McEwan flips open Torrey's new book, Out of the Shadows, which she asked Torrey to sign for her. She smiles and laughs with resignation. Inside, Torrey has scribbled, "Good luck. Keep up the good work. Your mother needs you."
Washington City Paper
January 16, 1998
Reprinted with permission. Copyright 1998
Washington City Paper. All rights reserved.
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