“The very term [‘mental disease’] is nonsensical, a semantic mistake. The two words cannot go together except metaphorically; you can no more have a mental ‘disease’ than you can have a purple idea or a wise space. Similarly, there can no more be a “mental illness” than there can be a “moral illness.” The words “mental” and “illness” do not go together logically. Mental “illness” does not exist, and neither does mental “health.” These terms indicate only approval or disapproval of some aspect of a person’s mentality (thinking, emotions, or behavior).” E. Fuller Torrey, “The Death of Psychiatry”, 1974
The year before I was born, E. Fuller Torrey published ‘The Death of Psychiatry.’ Therein, he repeatedly made statements that are disdainful of the psychiatric profession and its core concepts. Other quotes include:
“”Many psychiatrists have had, at least to some degree, the unsettling and bewildering feeling that what they have been doing has been largely worthless and that the premises on which they have based their professional lives were partly fraudulent” (p. 199)
“The death of psychiatry, then, is not a negative event”(p.200)
At that point in his life, he also asserted that known brain diseases were responsible for “no more than 5 percent of the people we refer to as mentally ‘ill’” (p.176) In fact, as recently as 1991, he has been quoted as calling for the end of psychiatry. For example, in October of that year in American Health magazine, he said, “Now, if you give the people with brain diseases to neurology and the rest to education, there’s really no need for psychiatry'” (p. 26).
All This Begs Some Very Important Questions: How did the E. Fuller Torrey who wrote ‘Death of Psychiatry’ come to be the E. Fuller Torrey who founded the Treatment Advocacy Center in 1998? How did the man who called for the elimination of the psychiatric profession and eschewed the very idea of ‘mental illness’ become not only the rabid champion of both, but also of forced ‘treatments’ by way of methods in which he once professed not to believe?
Not long ago, I had a conversation with a local mental health provider regarding a notable figure in my own state. The individual about whom we spoke holds both a directorial role at a state hospital, and a seat on the Treatment Advocacy Center’s Board. I had shared that I was nervous about a recent interaction, given the extraordinary divergence of our views. I was somewhat surprised when that provider – who has been working in the field for many years – said that if we went back a few decades, that same individual might have been my biggest supporter. She said he’d somehow lost his tolerance for risk. Surprised, yes. But I shouldn’t have been. It rang a bell.
I thought of Torrey immediately. In fact, he is not an anomaly, and his early beliefs should come as no real surprise in spite of his current position. Rather, he is part of a sizable group of people – doctors, mental health professionals, parents, and so on – whose conservatism has grown rapidly with age. It left me wondering. Never mind those who espouse pro-force attitudes based on ignorance influenced largely by media. What brings on these changes for those who actually know? How many who are now calling for measures like the Murphy Bill and Outpatient Forced Commitment (so often euphemistically referred to as ‘Assisted Outpatient Treatment’) have undergone this brand of transformation? How do some of the strongest voices for one perspective so completely lose their bearings until they find their way to the opposing view and grab on for dear life?
Little did I know that almost exactly one month later, I’d get a big lesson in the ‘why’ of it all. On Saturday, May 17, a serious assault occurred at Afiya, the peer respite that is a part of the Western Massachusetts Recovery Learning Community where I work. I wasn’t there and I didn’t find out until early the next morning. A team member was hurt. Everyone was scared and upset. Someone who had been staying there was arrested under charges that included attempted murder. I remember exactly how I felt: Sick.
Maybe I remember it so clearly because I’ve woken up feeling sick almost every day after. Since it happened, sometimes I wake up with a jolt in the middle of the night and my brain is racing. I can’t stop visualizing every other awful thing that could ever happen within our community. (No matter that many of those awful things can and do happen with much greater frequency elsewhere.) When small conflicts occur, I feel panic overtaking what used to be even-keeled responsiveness. Several times, I’ve thought seriously about quitting – not because I don’t believe in what we do, but because I’m not sure how to fully move through the feeling that I’m just waiting for the next awful phone call.
This is post traumatic stress. It has the potential to effect not just those who were present, but all those whose world view and sense of ‘safety’ in this life were shaken. Personally, I’ve always lived with an extreme fear that I’ll lose my partner or children. Most days, I have intrusive thoughts about all the ways they could be taken from me and find myself visualizing those awful scenes. If I can’t reach them by phone or they are running late and haven’t called, I can go from 0 to panic in well under 60 seconds and they’re likely to find me a ranting, crying mess when they do finally return.
Right now, I’m there with work, too. Notice I don’t call this ‘post traumatic stress disorder.’ It’s not ‘disordered.’ It makes sense given what’s happened. I’m counting on the work aspect of all this settling down once we’ve found our footing and begun moving forward again. However, what I actually find most unsettling is the philosophical slippage I can feel in my own brain. It’s almost tangible. Ideas – like wearing panic buttons, searching people’s belongings and doing background checks – that used to sound flatly absurd to me now sound . . . well, still absurd, but slightly less so. I feel like I’ve lost just a little bit of touch with my own certainty.
Fortunately, as we’ve gone through an intensive review of what happened, the facts are reassuring me. A popular public response to this incident is to question whether or not it happened because most peer respites — including ours — do not have clinicians on board assessing people for dangerousness prior to entrance As it so happens, in this particular instance (although not the norm), a clinician did send this individual our way and had assessed him right before doing so. We actually think that that was a part of the problem – that perhaps this individual had been encouraged by a clinician to call, rather than truly, voluntarily wanting to be there.
Readers commenting on the related news stories online have also blamed our lack of background checks for what happened, as this individual did indeed have a history of violence in his past. And yet, the reality is that most providers and organizations do not do background checks. Not individual therapists who may see virtual strangers in otherwise empty offices. Not clinical respite programs. And, to the best of my awareness, not any other peer respite. Yet violence remains lowest in environments where force, coercion and power are most minimal. We have some work to do, but most of it is about fine tuning, updating and strengthening our commitment to our values . . . not changing them or our approach.
Nonetheless, knowing this intellectually hasn’t changed the part of me that just wants to react. That wants to lock everyone in and keep everyone ‘safe,’ even though the facts-based part of me knows that risk of violence would actually be higher for doing so. This impulse comes from somewhere deeper than intellect. It comes from a place that needs to feel like I’m ‘doing’ something. Anything. Even if it makes no sense whatsoever from a practical standpoint. It comes from the place inside that needs to deny the fact that violence can happen anywhere, and that can’t stand the idea that not everything is in our control.
And when I say ‘need,’ I don’t mean it in a superficial way; I mean it in the sense of a ‘need’ that must be met in order to quell the fear that otherwise might interrupt one’s ability to move through the day and pay attention to everything else. I’m going to work through this, with the support of my community. Fortunately, everyone who was directly involved is essentially okay. That helps a great deal. And, we’ve worked too hard to give up on what we know to be true based on our own lives and on the stories of so many around us.
However, as I go through this process, I find myself with a little bit more compassion for people like Torrey. They are so clearly operating from that ‘need’ place. Imagine how out of control their worlds must have felt at some point in order to drive them to a place where ‘control’ has become such a hyper-focus. I wonder what they’ve been through that has moved them to this place where they can no longer see that force and coercion so often make things worse. I’m unsure as to the answer, but I no longer want to just tell Torrey (or others like him) what’s wrong with him and his views. Instead of the massive debate I’ve always envisioned having should our paths ever cross, I now just want to ask him what has become the golden question of trauma-informed practice. Instead of ‘what’s wrong with you,’ I want to ask:
“Edwin Fuller Torrey, What Happened to You?”
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.