E. Fuller Torrey recently posted a response to my blog, “Anosognosia: How conjecture becomes medical ‘fact’”. Bob Whitaker has responded with a forceful post that exposes the gross distortions in Dr. Torrey’s argument.
Dr. Torrey did not address the substance of my argument. He re-stated what was posted in the original TAC post, namely that studies have found group differences between those who were identified as having anosognosia and normal control subjects. The studies found a variety of differences and it therefore seemed, at the very least, premature to make the conclusion that, “Anosognosia, or lack of awareness of illness, thus has an anatomical basis and is caused by damage to the brain by the disease process.”
Dr. Torrey goes on to make the following comments about me:
“In short, any mental health professional who doubts schizophrenia is a brain disease is probably restricting their scientific reading to the National Geographic.”
“Another woman, trained as a mental health professional, briefly examines some scientific data and concludes it is wrong because it conflicts with her deeply held social belief system. This is denial.”
“Mental health professionals who deny that schizophrenia is a brain disease have no such excuse, however, and are simply demonstrating their ignorance.”
He refers to Mad in America and those who write here as “the new anti-biological antipsychiatry”.
He also gives his example of a person who has anosognosia:
“A woman with schizophrenia sits daily in Lafayette Park, across from the White House, believing she is married to the President and waiting for him to call her to come over. She believes he has to wait to acknowledge her because of the interference of Israeli secret agents. She is very patient and, at night, sleeps on the streets, where she is regularly abused. When offered medication, she adamantly refuses it, saying there is nothing wrong with her.”
As readers of Torrey’s website know, Dr. Torrey’s approach to this woman would be to commit her to a hospital and force her to take medication.
I will not bother to address Dr. Torrey’s attacks on my training or attitude about the biological nature of psychosis. What I will address is how I would approach the woman in Lafayette Park.
I would ask her what she needed. I would try to make a connection with her based on a shared view of her needs. I would hope that our first shared goal would be to get her fed and our next goal would be to get her into a safe place at night.
I would know that if my first approach was to point out the folly of her most deeply held beliefs, that I would not be likely to be of any help to her at all.
I would understand that although I might at some point feel compelled to force her into a safe place, I would also know that on some level this decision would mean that I had failed in my effort to help her. I would know that forcing her into treatment in the short term would not necessarily lead to long term changes in her life. She might be less delusional after taking medication but then she might not continue with a drug that was forced on her and she would be very likely to end up back where she was now feeling alienated from those who wanted to help her.
I would understand that this work is hard and that there are often no easy answers.
This understanding does not come from “a deeply held social belief system” because quite frankly I do not have one. It also does not come from my rejecting the role of the brain in understanding the most complex of our cognitions and experiences. My training is not dissimilar from Dr. Torrey’s and at an earlier point in my career he was a psychiatrist I admired and respected.
This understanding comes from my direct experience. I do – as I have written about openly on this site – force people into treatment. But it so rarely helps. For every individual I have known who has been grateful after the fact that he was forced into treatment, there are so many others who are angry, resentful, and alienated from the very people and institutions who are supposed to be helpful.
Dr. Torrey accuses me of being ignorant and perhaps in this regard he is correct. Where he sees such clarity, I see profoundly difficult questions.