Dr. E. Fuller Torrey: Washington City Paper Profile - Mental Illness Policy Org
Dr. E. Fuller Torrey: Washington City Paper Profile 2017-02-01T12:03:37+00:00


Brain storm

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 orbeer cans. He used to bring some home once in a while, but eventually his wife got sick ofbrain tissue hogging all the fridge space. Since then, the Frigidaire has been supplantedby 38 commercial-size freezers at the National Institute of Mental Health (NIMH)neuroscience center, where Torrey oversees a privately funded research program onschizophrenia and bipolar disorder.

The neuroscience center is tucked away in Anacostia in a century-old red brick buildingon the campus of St. Elizabeths Hospital. The building is a beauty, a classic edifice thatcould grace the cover of an Ivy League recruiting brochure, and Torrey looks very much thepart 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, looksjaunty and athletic despite a degenerative hip that puts a hitch in his stride. Upstairsfrom his office, he comes to a door marked “biohazard,” which he opens to revealbuckets of brains lining row after row of metal shelves. The brains are Torrey’sobsession; he has collected the noodles of more than 200 unfortunate folks who sufferedfrom bipolar disorder and schizophrenia since 1994.

Torrey gets excited when he talks about his batch of brains. “There has never beenan 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 convincedthat madness was not an organic disease but the outgrowth of bad toilet training oroverbearing mothers—problems Sigmund Freud taught them could be cured with a healthydose of psychotherapy. Logic and medical training, however, told Torrey that schizophreniawas 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 ontheir relationships with their mothers, Torrey began collecting spinal fluid from patientsin the wards of St. Elizabeths, looking for clues to the disease. Brain collection was thelogical next step. But brains were a little harder to come by, because research intodiseases of the human mind has historically been an underfunded backwater. Torrey saysthat as a result, most research on mental illness has been conducted on cheaply acquiredrodent brains rather than human ones. “No one has ever looked at bipolarbrains,” Torrey says with exasperation. “Almost nothing is known about thepathology of the depressed brains.”

Down the hall, Torrey stops to observe as a researcher dips into a bucket full ofurine-colored fluid and retrieves a big blob of gray matter. Preservative has turned thebrain into something that looks more like a very large eraser than the human body’s mostcomplex organ. The anatomist plops it onto a cutting board and deftly identifies thecrucial areas of the limbic system—hippocampus, cerebellum, amygdala—parts ofthe brain responsible for emotions and other crucial functions. She carves the rubberytissue into discrete blocks, which get sent down the hall to several women in hospitalscrubs and shower caps hunched over cryostats.

They look up and smile as Torrey explains that they are working on what are essentiallystate-of-the-art meat slicers that reduce frozen, drab yellow chunks of brain to postagestamp—thin snowflakes. The flakes are slide-mounted and shipped off to researchgroups around the world that are all seeking the answer to one of the most underexploredmysteries 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 theanswer to that question. But Torrey says the progress made by the 19th-century researcherscame to a screeching halt in 1911, when Sigmund Freud published his analysis of paranoidschizophrenic Daniel Schreber. Freud never examined Schreber, and he had admittedly littleprior experience working with schizophrenics, but he deduced from Schreber’s 1903 memoirsthat his disease stemmed from a “conflict over unconscioushomosexuality”—or an unhealthy attachment to his father during childhood.

Freud’s analysis and other kooky ideas so captured the imaginations of Americanpsychiatrists that they totally abandoned biological brain research and took to the couchwith psychotherapy. Now that biology has discredited Freud’s analysis of mental illness,genetics has become the leading suspect in schizophrenia, and most federal mental healthresearch money is focused on finding an “insanity gene.” Torrey hasn’t jumped onthat bandwagon, either. He thinks gene hunting is an expensive fad. His own”delusional system,” as he calls it, leads him to believe that the culpritbehind schizophrenia and bipolar disorder might be a little less esoteric: the commonhouse cat.

Torrey is a leading proponent of the not very widely held view that schizophrenia andbipolar disorder are caused not by a gene but by a virus—one that might be carried byhouse 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’scolleagues in the federal research establishment, which has been listening to him harp onviruses for 25 years. But in 1994, the Theodore and Veda Stanley Foundation bet severalmillion that Torrey might be right. With the foundation money, Torrey has set up theworld’s first and only neurovirology laboratory at Johns Hopkins School of Medicine inBaltimore, which is devoted solely to the study of infectious causes of schizophrenia andbipolar disorder. Torrey believes the lab is only a few years away from finding the causeof schizophrenia; once it’s found, he thinks a vaccine won’t be far behind.

“The disease is in the brain. We need brains!”

—Dr. E. Fuller Torrey

Torrey was a junior studying religion at Princeton when his mother called to tell himhis sister had suffered a nervous breakdown. Rhoda had just graduated from high school inClinton, N.Y., and was bound for Elmira College when she first started showing signs ofconfusion. Then came the delusions and the voices in her head—classic signs ofschizophrenia. Her prognosis was not good. In the late 1950s, schizophrenia was badlymisunderstood, and Thorazine—the first major breakthrough in anti-psychoticmedication—was only just coming onto the market.

Torrey’s elderly father had died long before Rhoda got sick, leaving Torrey with muchof the responsibility for his mother and two siblings. He accompanied his mother as sheshlepped his sister up and down the East Coast through all the best institutions in searchof something, anything, that would help her return to normalcy. Rhoda suffered throughelectroshock therapy and insulin coma therapy, the few treatments that were available atthe time, but nothing worked. Failing to come up with an efficacious approach, the doctorsfell 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 bybeing cold and rejecting. In a personal account Torrey wrote for the California Alliancefor the Mentally Ill newsletter a few years ago, he said, “I developed a sneakingsuspicion that these eminent psychiatrists did not know what they were talkingabout.” Even though Torrey had significant doubts about the thinking surroundingschizophrenia, his mother died believing that she had caused the debilitating disease thathad 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 thefield himself. While he had always wanted to become a doctor, his sister’s illness had hada profound effect on him. “It’s probably the reason I got into schizophrenia to thedegree that I am now,” Torrey explains. He took the psychiatrists’ ignorance as achallenge 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, hesays, brain research wasn’t a very respectable field because…well, it required workingwith crazy people. Most of his med-school classmates were planning psychotherapy practicesthat wouldn’t interfere with their tee times.

But Torrey’s version of psychiatry offered him a perfect venue to exercise hisscientific curiosity, love of doctoring, and growing social conscience. While he was amedical student, he joined the U.S. Public Health Service and did a stint as a Peace Corpsdoctor 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’sdegree in anthropology. His quick mind and demonstrated competence helped him land aprestigious desk job as an administrator with NIMH.

The federal research arm turned out to be a stifling place for someone with Torrey’senergy and drive. When Torrey got to NIMH in 1970, he looked around and saw that in spiteof real problems with the mental health system, the federal government’s foremost mentalhealth research institute was spending most of its multimillion-dollar budget on fluffyprojects like improving marriage counseling. “The government ignored both bipolar andschizophrenia for years,” Torrey explains. “NIMH from the late ’60s decided tobecome a behavioral study institute. They kind of forgot the institute was set up tofoster research into severe mental illness.”

In spite of the fact that he was drawing a check from NIMH, Torrey voiced his opinionsabout the institute’s misplaced priorities in speeches and began writing books highlycritical 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 comparedpsychotherapy to witch doctoring in Third World countries; Torrey considered bothpractices useless in treating diseases of the brain. Then, in 1974, he published a booktitled The Death of Psychiatry, in which he accused his colleagues of abandoning theseriously mentally ill, who desperately needed real medical treatment instead of couchtime at exorbitant hourly rates. His book indicted psychiatrists for confining themselvesto treating bored middle-class housewives in swanky private practices far from publicsector hospitals. Torrey proposed abolishing the psychiatric profession altogether andturning over the care of the mentally ill to neurologists, while leaving the housewives tononmedical counselors.

The books didn’t win him too many friends in the profession. Lawrence Sack, formerpresident of the Washington Psychiatric Society, once told the Washington Post inthe early 1980s that Torrey was “an arrogant maverick who thinks he has all theanswers.” Sack’s group had already tossed Torrey out for failing to pay dues, whichTorrey says he withheld in protest because the group used them to lobby Congress forbetter reimbursement for psychiatrists. (“I thought I had joined a scientificorganization, 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 andtook off for the Pribilof Islands in the Bering Sea, far off the coast of Alaska, where hespent a year working for the Indian Health Service as the island’s only doctor. While hewas there, he rediscovered his passion for treating patients. When he returned toWashington, he went to see Roger Peele, then acting superintendent of St. ElizabethsHospital. He asked Peele for a job working in the patient wards—places that had longbeen abandoned by respectable psychiatrists.

Peele, now the medical director at the Northern Virginia Mental Health Institute inFalls Church, was somewhat surprised by the request. He knew of Torrey’s reputation foridiosyncratic 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’tdoing 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 theER to keep his medical skills up. Then I’d find him in the library at the hospital and I’dask him what he was doing, and he said he was working on a book on [former St. E’s patientand fascist poet] Ezra Pound. Then he started working in the shelters with the homelessmentally ill. And if that weren’t enough, he asked me for more work, so I gave him asecond ward.”

“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.”

—Roger Peele, medical director of the Northern Virginia Mental Health Institute

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 wokeup 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 accuseda previous director at the hospital of perjuring himself by declaring St. E’s most famouspatient (before John Hinckley) incompetent to stand trial. The hospital didn’t take kindlyto the characterization—even though Pound’s trial had taken place more than ahalf-century earlier—and fired him.

Torrey, who needed two more years to reach the magic number 20 in the U.S. PublicHealth Service, was left with relatively few career choices and ended up looking for workin prison psychiatry. He was about to take a job at the Atlanta Penitentiary when aposition opened up in the forensic division at St. E’s, and he managed to stay put. Notlong afterward, he applied for a grant to collaborate with NIMH on a study of the cause ofschizophrenia. Starting in 1987, Torrey and his fellow researchers conducted highlysophisticated brain scans on identical twins, which ultimately showed that the brains ofpeople with schizophrenia have clear, structural abnormalities, the hallmark ofneurological diseases like epilepsy.

The twins study ended the debate over whether schizophrenia was a biological disorderor a byproduct of misplaced Oedipal complexes. The study also forced Torrey’s colleaguesto take him seriously. Dr. Daniel Weinberger, chief of the clinical brain disorders branchat NIMH, didn’t return calls for this story, but in a 1991 profile in American Health, hecredited Torrey with advancing the research into mental illness. He told writer RobertTrotter, “Nobody else has shown as much creativity and ingenuity in accomplishing hisgoals, and his work in this area has been so constructive that concerns about hisiconoclastic methods have diminished remarkably.” The scientific community may beguffawing about his suspicions about a link between cats and schizophrenia, but they can’tget around the fact that it was Torrey’s research that took brain diseases off the couchand into the lab, where they belonged.

Torrey’s cluttered office at St. E’s is of the same configuration and size as thepatient rooms two stories above him, except he has a desk where they have beds. The layoutleads to obvious riffs about the inmates running the asylum—especially in referenceto Torrey—but he likes the location because of its safe distance from the meddlingbureaucracy of NIMH in Bethesda.

The twins study may have gotten Torrey invited back into the American PsychiatricAssociation, but he has still declined to join the establishment. His black-and-white viewof the world of mental health leaves him no patience for the “worried well” whopreoccupy most of the mental health field. As far as he’s concerned, thosepeople—neurotics like Woody Allen, who’s been in therapy for 33 years—are partof 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 peoplewho aren’t getting any treatment at all.”

With his thin face cloaked in large glasses and a graying beard, Torrey bears a slightresemblance to his nemesis, Sigmund Freud, but the more salient visual echo is that of anold-fashioned radical. A master of the sound bite, his politics come packaged in genteelcharm and a sense of humor. In fact, his outspokenness can seem deceptively intimate untilyou realize that he has said the same wildly clever and irreverent things to hundreds ofother people. Torrey has the distracted air of the brilliant scientist—thecombination of fearlessness and intelligence, symptomatic of a loose cannon, that may keephis colleagues from totally buying some of his more peculiar ideas. Like the one about thecats.

As odd as his theory may seem at first glance, Torrey is in good company when heinsists that schizophrenia and other mental illnesses may be catching. As far back as1845, scientists were positing that an infectious agent might be at work in causing someforms of insanity. Yet when Torrey resurrected the idea in a paper in 1972 after more than50 years, it was discounted by all but a handful of researchers—including Nobel Prizewinner Carleton Gajdusek.

“I first had lunch with Carleton in 1972,” says Torrey. “He was the onlyperson who didn’t laugh outright at what was then a preposterous idea: that a virus couldcause schizophrenia.” Torrey says Gajdusek, a pediatrician by training, looked at himand said, “Your profession is hopeless.”

Three years before that, Gajdusek had come to the same conclusion Torrey had after hisyears in Papua New Guinea studying an epidemic of a new infectious brain disease calledkuru. As part of his groundbreaking work on kuru and other spongiform encephalopathydiseases (like mad cow disease), Gajdusek had injected schizophrenic brain tissue into hischimps to see whether he could infect them. Nothing happened to the chimps, but Torreypoints out that Gajdusek had no way of knowing whether the chimps were having delusionalthinking. Torrey still doesn’t rule out the possibility that the virus has another way ofcausing the disease. “He was so ahead of his time,” says Torrey.

Gajdusek served on the Stanley Foundation research committee until 1996, when he wasarrested for molesting boys he had adopted during his travels to Papua New Guinea. Torreystill 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 helphim. His contribution to the neuroscience field has been enormous.”

Gajdusek’s work prompted Torrey to dip into his training as an anthropologist to seewhether schizophrenia behaved like an infectious disease. Doctors had long observed thatviral encephalitis and some other infections present symptoms that look likeschizophrenia. Many people with schizophrenia had also reported that their diseases set inafter signs of a viral infection. Torrey figured it couldn’t be just a coincidence. Thedisease turns up in clusters in many of the same environments that breed influenza. Likethe flu, schizophrenia is most prevalent in poor, urban areas in cold climates, wherecrowded households are hotbeds of infection in wintertime. Ireland, for instance, has oneof the highest rates of schizophrenia in the world, while in the tropics it’s virtuallyunheard-of.

“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.”

—Mary Ann Luby

The problem with some of the epidemiological evidence that Torrey compiled is that someof the patterns of the disease could also be explained by genetics. It could be that theIrish just have bad genes. But not long after his lunch with Gajdusek, Torrey found agroup of studies showing that a disproportionate number of people with schizophrenia areborn in the winter and spring. The finding was cathartic for Torrey, because geneticcauses would express themselves throughout the year in a fairly regular pattern.”Viruses have to be prominent. They have seasonal patterns,” he says, pointingout that people tend to get more colds and viruses in the winter months. But when Torreycasually presented his theory to his colleagues, he says, “I was laughed out of theoffice.”

His colleagues’ ridicule only galvanized Torrey’s resolve to find a viral cause for thedisease. After 20 years, he has assembled an impressive set of facts that make his idea aplausible one. There’s only one thing missing: the virus itself. While he hasn’t been ableto pinpoint the particular virus, Torrey has followed some hunches about possible sourcesof transmission. He did some research on environmental factors that might account for therise in American psychiatric admissions that began around 1880. What he found was evidencethat the country underwent something of a “cat craze,” spawned by the firstEnglish cat show in London in 1871, and the increase in cat ownership followed a patternsimilar to that of psych ward admissions.

Cats are known to carry all sorts of bugs that cause disease in humans, especially inpregnant women. Torrey actually tested his feline hypothesis in a survey of the familiesof the seriously mentally ill. He asked questions about whether the children had beenbreast-fed and whether there was a family history of diseases like multiple sclerosis andrheumatoid arthritis, which are thought to be virally caused as well. Torrey found thatthe only significant differences in the survey between the normal children and thementally ill ones were that the mentally ill children were more likely to have beenbreast-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 pregnantduring the 1944—45 famine in Holland, when Nazi troops had cut off food supplies, hada high number of children with schizophrenia. Researchers have speculated that starvationprobably caused some kind of obstetric problem that later affected the Dutch women’schildren. 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 alot of supporters in the psychiatric community. But psychiatrists, of all people, knowthere’s a fine line between genius and madness, so they haven’t completely ruled out theidea. The broader scientific community just doesn’t think that a virus is responsible formore than a tiny fraction of cases of mental illness.

Dr. Richard Warner, medical director of the Mental Health Center of Boulder County anda faculty member in psychiatry and anthropology at the University of Colorado, says,”I think there are much more important factors—for example, genetics and otherforms of obstetrical complications.” He says there is evidence that a maternalinfection could cause schizophrenia but says that it accounts for maybe 2 percent of casesof schizophrenia, whereas genetics can account for 40 to 50 percent. “Maternal viralinfection probably increases the risk for all kinds of brain illnesses. The brain maysuffer 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 genesplay a role,” Torrey says. “I just don’t believe the genetic aspect is thatstrong.” Genes are involved in all infectious diseases, Torrey explains, which is whyeven though most people of his generation were exposed to the polio virus, not everyonegot sick. The major problem with a purely genetic theory of schizophrenia, he says, isthat viruses are known to attach themselves to genes and to get transmitted that way.”What Ôgenetic’ means is much more confusing. The nice distinction between virus andgenes 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 remarkablefindings coming out of the Stanley Foundation’s neurovirology lab at Johns Hopkins. One ofthe great mysteries of mental illness has been why drugs like Thorazine control symptomslike auditory hallucinations and delusional thinking in schizophrenics. Doctors havespeculated that anti-psychotic drugs work by blocking the transmission of certainchemicals, like dopamine, in the brain. But the neurovirologists in Baltimore had a hunchthat 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 seeif it might be effective against the virus that causes AIDS. It was. Clozapine won’t bethe next big AIDS treatment—there are better AIDS drugs on the market—but thefinding is fairly revolutionary because it suggests that anti-psychotic drugs work becauseof their anti-viral properties. It holds out hope for better treatment for people withschizophrenia. Torrey is hoping that within the next year, the Johns Hopkins group willbegin clinical trials using powerful anti-AIDS drugs on people with schizophrenia. Thegeneticists will have a tough time arguing with him if it works. “It’s veryexciting,” says Torrey. “Things are moving so fast. I honestly think we arewithin a few years or a decade of having a much better understanding of thesediseases.”

A few years ago, Torrey met a 19-year-old woman who had been dashing through NationalAirport on her way back to college when she had encountered a straggly-looking woman. Onsecond glance, she realized the woman was her mother. A schizophrenic woman who haddisappeared 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 aVirginia judge refused to commit her against her will on the grounds that she wasn’tdangerous. Three months later, Torrey went back with the woman’s daughter and lied to thejudge, describing her mother as a dangerous, violent woman who had threatened to hurtpeople. The judge institutionalized her. Torrey says the woman responded to treatment andeventually went back to work. When she was better, she thanked her daughter forintervening, 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 afascist, and most recently I’ve been accused of wanting to hospitalize 800,000 peopleinvoluntarily.”

His views on involuntary treatment horrify some advocates for the mentally ill. RobertBernstein, executive director of the Bazelon Center for Mental Health Law, takes issuewith 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 beendevalued,” says Bernstein. “If you don’t want to take heart medication, yourfamily 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 onthe subject of forcing patients to take their medications. Nancy Lee Head, vice presidentof the D.C. Mental Health Consumers’ League—who herself suffers fromschizophrenia—says that while she has the utmost respect for Torrey and all he hasdone for people like her, “Consumers have a different opinion [from his] about forcedhospitalization. Some of us are probably here today because someone has forced us into ahospital, 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 byimages of Margaret Hoffman, the mentally ill homeless woman who was mauled to death by alion after crawling into its den at the National Zoo two years ago. He keeps a fileseveral inches thick full of stories of untreated mentally ill people who refusedmedication and later hauled off and killed their families in delusional rages. Torrey seesfragile people living on streets and in public shelters without medical treatment becausecivil libertarians have fought for their right to get out of mental hospitals but havenever came up with a workable alternative.

The issue of whether the government should have the right to hospitalize the insaneagainst their will has long been a contentious one. Commitment statutes have been abusedagainst people, particularly women, whose political views were unpopular or whose mannersdidn’t fit cultural norms. And the conditions in the state mental hospitals they werecommitted to have historically been so bad that in the 1960s, Bruce Ennis of the AmericanCivil Liberties Union proposed abolishing involuntary hospitalization altogether on thegrounds 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 thatin fact, a large percentage of mentally ill people were living on the street, inconditions 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 holdsabout 1,100, and the city has about 8,000 homeless people—more than a third of whomare thought to be mentally ill. Tension has grown between civil liberties lawyers andcommunities terrorized by some of those psychotic people, whom it is now impossible to getoff the streets and into real medical treatment.

Most states’ laws now say that in order to have people committed without their consentto a mental hospital, they must be a danger either to themselves or to others. Thisstandard has been applied very strictly, especially as the number of available statehospital beds has diminished. Torrey says he once called the police after getting a reportfrom 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 killedanyone yet. Indulging in a little psychiatrist humor, Torrey says, “A danger to selfmeans threatening to kill yourself in front of the psychiatrist, and danger to othersmeans trying to kill the psychiatrist.”

Torrey is an ideologue, but his time in the trenches has given him a moral authoritythat few people in the mental health field possess. Until just a few months ago, Torreycould be found down at the Zacchaeus Free Clinic in Shaw, cajoling shopping-cart ladiesinto taking medication they didn’t think they needed because they were convinced that thevoices 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 15years of volunteer service with the homeless.

While his detractors raise images of him eagerly trampling people’s civil liberties tothrow them into the booby hatch, Torrey’s patients seem rather fond of him. They stillcall him at home, and he treats them in the manner of an old-fashioned small-town doctorwho sits knee-to-knee with his patients. Sister Mary Ann Luby, an outreach worker at theWashington Legal Clinic for the Homeless, was the executive director of Rachel’s Women’sCenter 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 eveningspopping 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 foryears, and that’s what you need for people with mental illness. I know he’s criticized forpushing the meds, but he was masterful with medication. We couldn’t do anything—nocounseling, nothing—until he got people stabilized on the drugs.”

Even the once hostile psychiatric profession is short on criticism of Torrey’s skillsas a doctor. Al Golub, executive director of the same Washington Psychiatric Society thatkicked Torrey out a decade ago, says, “There is a wonderful maverick quality toFuller Torrey, but I don’t know whether it’s real or imagined. He’s a very orthodoxpsychiatrist 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 amodel of humane treatment. “He was getting good results without using seclusion andrestraint,” says Peele, explaining that Torrey put up a chart plotting the timepatients had to be restrained as an incentive for the staff. “He had good rapportwith the patients. He would throw wine parties on Friday nights for the patients who hadto stay over the weekend. I liked his style,” says Peele.

“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.”

—Torrey

His advocacy of involuntary treatment is Torrey’s version of tough love. He believesthat at least a small group of mentally ill people suffer from impaired insight, meaningthat illness prevents them from realizing that they are sick. This group, he says, notonly can’t ask for treatment but often resists treatment when it’s offered. He likens suchpeople to elderly folks with Alzheimer’s disease who wander away from home. The onlydifference, he says, is that society doesn’t allow its senile grandmothers to live inparks and wander the streets barefoot in wintertime. But Torrey says civil libertieslawyers will defend to the death the right of a paranoid schizophrenic to live in a boxunder the Whitehurst Freeway.

“These people do not realize they are sick,” explains Torrey. “To leavethem living on the mezzanine at National Airport is inhumane, and we need to call itthat.”

Still, Bernstein is unswayed. “The question is, how do you determine whetherthey’re incapable [of making decisions about treatment]? Because they disagree with you orbecause there is no insight?” He says the mentally ill have all sorts of reasons forrefusing treatment, including bad side effects to psychotropic drugs and psychic scarsfrom previous hospitalizations. “To conclude from that that these people need to beincarcerated is ludicrous,” he says.

On a rainy night in early November, 60 or so people assembled by the Virginia Alliancefor the Mentally Ill have gathered at the George Mason University law school to get a peptalk from the famous psychiatrist. It’s a friendly audience, made up mostly of people witha 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. Theytalk about Clozapine, Risperadol, dopamine receptors, PET scans, and commitmentproceedings as if they are reading a grocery list.

For years, these families have been more closeted than gays in the military. Mentalillness has always carried a dark stigma, and with all the recent genetic studies showingthat schizophrenia is hereditary, few people are willing to admit on a first date thatthey’ve got insanity in their genes. So families have suffered in silence as state mentalhospitals have closed and sent their residents back home, where elderly parents have beenill-equipped to care for their psychotic offspring. Parents and siblings have suffered asvictims of violence inflicted by their own kin. They’ve grieved over the ones who havehanged 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 understandsmental illness but knows what it’s like to love someone who’s sick. He is the closestthing schizophrenia has to a celebrity. Even though the disease is 40 times more commonthan muscular dystrophy, it has no real public face, no Christopher Reeves, no pinkribbons, no walkathons, no Jerry Lewis Labor Day Telethons. In 1983, when Torrey donatedthe royalties of the hardcover edition of his best-selling Surviving Schizophrenia to theNational Alliance of the Mentally Ill, a family-based association, he became the group’sbiggest champion.

Tonight in Virginia, Torrey looks a little mad himself. His hair is askew, and when hestarts talking, the facts spill forth rapid-fire. “Deinstitutionalization is thesecond largest social experiment in this century. It has been a failed experiment, and itwas 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 peoplein mental hospitals. Today, we have 70,000.” The implications of those numbers, hesays, are staggering. “We have deinstitutionalized 800,000 people.”

It’s the fate of a small percentage of those 800,000 mentally ill that most concernsTorrey. They’re the ones he finds eating out of garbage cans and getting raped in cityparks, and they’re the ones who are in and out of the revolving door of the mental healthsystem. “None of us are saying we need to put 800,000 back in institutions,” hesays, explaining that newer medications developed over the past few years have allowedmany people to live in their communities. “But you need some beds.”

Over the course of two hours, Torrey rails against federal funding schemes for mentalhealth care and attacks civil liberties lawyers for preventing sick people from gettingwell. He takes some potshots at John Mack, the Harvard psychiatrist who bills insurancecompanies for psychotherapy treatment for people who’ve been abducted by aliens. Heskewers “mangled care” companies for paying CEOs multimillion-dollar salaries atthe same time that they deprive the mentally ill of treatment. After noting that in 1994William McGuire, CEO of United Healthcare, received $6.1 million in compensation, Torreysays, “If any of you think William McGuire is going to give back $1 million to open aclubhouse [a successful day program for the mentally ill], see me afterward and I’ll giveyou a prescription for Haldol.”

It’s a stunning performance, full of righteous indignation. Torrey winds up byimploring the audience to become “obnoxious advocates” and schooling them inold-fashioned hell-raising. The people in the audience eat it up, and when it’s over, theylook ready to storm the Capitol with demands for better mental health services. What’samazing about Torrey’s performance is that his lecture is only slightly different from theone he’s been giving over and over and over for the past 20 years. And even though hemanages to maintain the fervor, very little has changed in mental health care servicesduring that time, and what has changed has gotten worse.

For that reason, his lecture at George Mason is one of Torrey’s increasingly rarepublic 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 hiscampaign against managed care. “I’m not very optimistic about services,” hesays. “Things are worse now than they were 10 years ago. That’s why I’m spending mytime on the research. That’s where the big payoff will be.” By his calculations, ifeven a fourth of all existing cases of mental illness could be cured, the federalgovernment 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 hislecture at George Mason, people flock to him with pleas for help and advice. One youngwoman, Nicole McEwan, tells Torrey that she is the primary caretaker for her mother, whosuffers from schizophrenia. At 29, Nicole has seen the commitment process firsthand, asshe has watched her 56-year-old mother go into and out of various institutions. Sitting ona bench in the Metro, McEwan says she came all the way from Philadelphia just to seeTorrey speak. After her grandmother died, she was left pretty much on her own to care forher sick mother, who is always at risk of slipping through the cracks. Torrey’s speechserved as something of a pep talk to keep going in a solitary job she didn’t ask for butcan’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 probablycome too late to help McEwan’s mother. But McEwan would still like to know what happenedthat made her mother sick. “Is it breech births?” she asks. Or is it the productof 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 hermother’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 askedTorrey to sign for her. She smiles and laughs with resignation. Inside, Torrey hasscribbled, “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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