November 5, 2003: Features

Dr.Brain
As he has done for decades, E. Fuller Torrey ’59 is battling the psychiatric establishment — this time, in his effort to cure schizophrenia

By Richard Just ’01

Psychiatrist E. Fuller Torrey ’59 is preparing to leave his office at the Stanley Medical Research Institute, located on a secluded plot of land just outside the Washington beltway, when he goes to his shelf and removes a book. Torrey’s most famous book, Surviving Schizophrenia (1983), is considered by many to be the indispensable manual for families of those suffering from the disease; another, The Roots of Treason (1983), was nominated for a National Book Critics Circle award. Yet the book he pulls from his office shelf is neither of these. Instead, it is a paperback copy of Freudian Fraud: The Malignant Effect of Freud’s Theory on American Thought and Culture. With evident pride, Torrey says it was “scathingly attacked – not once, but twice! – by the New York Times.”

And so it was. The Times called the 1992 book “shrill,” “flip,” “cursory,” “superficial,” “nasty,” and “voyeuristic,” cramming all those adjectives into just one of its two reviews. Freudian Fraud was calculated to provoke. The book’s thesis is that Sigmund Freud was a quack who dreamed up his theories while in a cocaine-induced haze; decades later, Torrey argues, those theories found a natural home among American intellectuals and gradually became part of the U.S. political and social landscape. The book goes on to trace a significant number of contemporary problems in American life to alleged lies that Freud and his disciples perpetrated on the world.

Torrey’s attack on Freud wasn’t the most famous battle he has picked in his long career as a researcher, doctor, historian, activist, and public intellectual, but it was typical of his style. The man the Washington Post in 2001 called “perhaps the most famous psychiatrist in America” seems to have spent much of his adult life fighting one battle or another. He repeatedly has fought the National Institute of Mental Health, publicly accusing the organization of squandering its resources on frivolous studies. He has fought groups that advocate for the legal rights of mental patients, arguing that they prevent the mentally ill from receiving needed treatments. He has fought drug companies for trying to buy the loyalty of doctors. He has fought the ghosts of Margaret Mead, Karl Menninger, Benjamin Spock, and other luminaries of the social sciences, who, he says, placed too much stock in environmental influences on intelligence and behavior. He has fought liberals for caring too much about the legal rights of the mentally ill, and conservatives for caring too little about their welfare. And he has frequently fought his own profession, saying psychiatrists focus too much on the “worried well” at the expense of those with mental diseases.

He is a prolific author. His most recent book, The Invisible Plague, which traces the rise of mental illness over the course of 250 years, was published last year; he is working on his 19th, tentatively titled Beasts of the Earth: Animals, Humans, and Disease, which will focus on how humans catch diseases from animals. Torrey, who has a knack for remaining in the public eye, notes that he and his coauthor, Robert Yolken of Johns Hopkins Medical School, started working on the book before the outbreak of SARS and monkeypox – but that those diseases will no doubt increase his subject’s relevance.

Torrey, who played hockey at Princeton and was known for his aggressiveness on the ice, seems to relish the role of outsider, and to welcome a good fight. More than three decades ago, when Torrey first began studying schizophrenia, his ideas were considered outlandish. As a resident at Valley Medical Center in Santa Clara County in California from 1967 to 1970, Torrey observed patients with profound mental illness, mostly schizophrenia or bipolar disorder. At the time, California was emptying its mental hospitals, and many of the newly deinstitutionalized patients were showing up at Valley Medical Center. The dominant thinking among psychiatrists at the time, Torrey recalls, was that “all mental disorders were caused by your mother looking at you cross-eyed.” His patients at Valley – along with his sister’s schizophrenia, which was diagnosed while Torrey was a sophomore at Princeton – led him to suspect that the conventional wisdom about severe mental illness could not possibly be correct. “These people had something very wrong with their brains,” he says. “There was nothing wrong with their mothers.”

In the intervening three decades, Torrey has become a well-known advocate of the idea that severe mental illness is triggered by biological factors, not social ones. As the pendulum in the broader nature-nurture debate has swung toward nature, his ideas – once summarily dismissed – have gained increased currency. Torrey believes that schizophrenia is caused largely by one or more infectious agents that get into the brain either before birth or during the first eight to 10 years of life. According to his theory, the agent lies dormant until early adulthood, at which point symptoms of schizophrenia begin to appear. Torrey doesn’t completely discount genetic factors; he believes some individuals may be more susceptible to the effects of the infectious agents because of a genetic predisposition.

Though the days when psychiatrists believed schizophrenia was entirely caused by environmental factors are long gone, Torrey’s ideas about infectious agents remain controversial. One Torrey idea that has raised eyebrows over the years is the notion that cats may carry infectious agents that cause schizophrenia. David Garver, a professor at the University of Louisville’s School of Medicine, says that while there are many questions yet to be answered about the involvement of viruses in schizophrenia, “there is fragmentary evidence that there is something going on with viruses. . . . It seems like there is a glimmer there that wasn’t demonstrated before.” But asked what most psychiatrists think of Torrey’s efforts to cure schizophrenia, Dave Davis, medical director of the Piedmont Psychiatric Clinic in Atlanta, says simply, “Bizarre.”

To investigate his ideas, Torrey has assembled a collection of 575 human brains that he stores in massive freezers. He and his staff, including 14 researchers, work with the brains and also ship them to other scientists. Torrey cannot use about 150 of the brains because the subject suffered trauma or other conditions, or because he was unable to obtain complete medical records for them. The remaining brains are divided into four categories: those from sufferers from schizophrenia, bipolar disorder, and severe depression, and what he calls “unaffected” controls – that is, brains of people who never suffered from mental illness.

Torrey’s brain bank is in a rented laboratory that is part of the Uniformed Services University of the Health Sciences behind the Naval Hospital in Bethesda, Maryland. It consists of 56 freezers, hooked up to a central computer. If the air conditioners fail, the computer automatically starts calling the home numbers of brain-bank employees, who come to turn them back on. Two $30,000 machines cut brains in slices thinner than postage stamps. The enterprise is funded by Theodore and Vada Stanley, who, since 1989, have donated more than $170 million to pay for Torrey’s work. The Stanleys’ son Jonathan, now a lawyer for Torrey’s Treatment Advocacy Center, was diagnosed with schizophrenia as a student at Williams College.

The two philanthropists have given Torrey the ammunition he needs to wage what will probably be his toughest and most important battle yet: the fight to cure schizophrenia. If Torrey is correct that the disease is caused largely by an infectious agent that gets into the brain, he believes he might be able to develop a vaccine that could be given to pregnant mothers or young children. In 1998, speaking about his search for a schizo-phrenia cure to a writer for the New York Times Magazine, Torrey said, “I think we can do it in the next five to 10 years.” Today, he says he is five years away from being reasonably certain of which infectious agents cause large numbers – or perhaps the majority – of schizophrenia cases, as well as cases of bipolar disorder.

If Torrey had confined himself to researching schizophrenia, he still would have earned some degree of notoriety. But he has devoted himself to activism as well. “Nothing gets accomplished unless you enter into the political arena,” he says. “You have to get involved in the politics of the situation to make things happen.” No issue has earned him more attention, or enmity, than his support of forced treatment. Torrey founded the Treatment Advocacy Center, a group of three lawyers that fights for states to enact and enforce laws allowing for forced treatment of the mentally ill. Most notably, the organization worked closely with New York State attorney general Eliot Spitzer ’81 to pass Kendra’s Law, named after Kendra Webdale, who died in 1999 after being pushed in front of a subway train by a mentally ill man who was not taking medication. The new law created a procedure for obtaining court orders to compel people with mental illness to accept outpatient treatment. Torrey, and many other psychiatrists, believe such laws make perfect sense, because a severely mentally ill person is in no position to weigh his or her own best interests. “I think forced treatment is really necessary,” says Garver. “It saves a lot of suffering for patients who are not competent to choose for themselves.”

But libertarians and advocates for the rights of the mentally ill don’t see things that way. These activists, many of whom are themselves former psychiatric patients, accuse Torrey of hyping the threat of violence posed by the mentally ill to convince the public to accept forced treatment laws. Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitative Services, says Torrey “spends a lot of time establishing himself as a national expert on why mentally ill people are dangerous” and that Torrey “really set us back” in efforts to destigmatize mental illness. Others contend that forced medication doesn’t work because it creates resentment on the part of the patient. “When you force things on anybody, the result is going to be a poor one,” argues Emily Hoffman, who says she almost died as a result of forced medication; she is now the state network coordinator for On Our Own of Maryland, a mental illness advocacy group.

Even Torrey’s opponents allow that he is a determined advocate for his views. “There’s that intensity,” says Joseph Rogers, head of the Mental Health Association of Southeastern Pennsylvania, before clarifying that his compliment is a backhanded one: “The same intensity that probably gets results – you go too far sometimes.” Torrey’s disposition is familiar to Michael Viola ’59, a friend from Princeton who went with Torrey to McGill University for medical school. “Fuller was different – let me put it that way,” he says. “He was far more focused and serious and goal-oriented than most.” Viola adds: “Fuller likes to cause a commotion, and he likes to be the stimulus for causing people to think about things in a different way.”

As a young doctor, Torrey spent two years practicing medicine in Ethiopia as a Peace Corps volunteer, from 1964 to 1966. He later spent 1975 as a doctor on the remote Pribilof Islands of Alaska, serving a population of 700 Aleuts, who were living on two islands where they had been forcibly resettled by the Russians a century earlier.

Torrey recalls how he acquired “early notoriety as causing trouble” in the early 1970s, when he chided his employers at the National Institute of Mental Health for not requiring psychiatrists to perform public service. At the time, Torrey recalls, N.I.M.H. was putting $100 million of government money into training psychiatrists, so he argued that psychiatrists should pay back this investment by working with at-risk patients. He also criticized N.I.M.H. for not requiring community mental health centers to provide services for patients who emerged from mental hospitals during deinstitutionalization.

Torrey’s reputation for being outspoken only grew with time. A religion major at Princeton, he had written his thesis on T. S. Eliot’s use of religion in his drama, and read work by Ezra Pound in the process. More than two decades later, while working at St. Elizabeth’s Hospital in Washington, D.C., Torrey took an interest in the psychiatric records of Pound, who had stayed in the institution after World War II. Pound, who was notoriously anti-Semitic and had engaged in pro-fascist activities during the war, used a diagnosis of mental illness to avoid facing justice on charges of treason, and was able to live at St. Elizabeth’s as a patient for 12 years. Torrey argued that the hospital’s superintendent protected Pound despite the fact that the poet was not clinically insane. The result was Torrey’s widely acclaimed book on Pound, The Roots of Treason. But the revelations created anger among his superiors, and Torrey says he was demoted during a reorganization in 1981. He left the hospital four years later.

Over the years, Torrey also learned the tools of public persuasion. In 1983 he appeared on a Donahue episode that he says was the first national television show to discuss schizophrenia. Torrey’s public discussion of schizophrenia research, particularly his criticism of now-discredited theories that the disease resulted from bad parenting, has won him the affection of families of those who are afflicted. (Asked whether he thought that the movie A Beautiful Mind provided a portrait of schizophrenia that helped advance an accurate view of mental illness, Torrey’s answer was an emphatic yes. Though he thought the movie, about John F. Nash Jr. *50, had “romanticized the disease,” he lauded it for driving home how impossible it is for schizophrenics to separate reality from hallucination, and how unable they are sometimes to make decisions in their own self-interest.)

To hear others talk about Torrey, and to learn about his legendary battles with so many different adversaries, one might expect him to be combative in person. In fact, he is soft-spoken and warm. He has a sense of humor about his theories – for instance, his office is decorated with Freud paraphernalia, in particular a picture of a cat labeled “Sigmund Fureud.” His office has a lot of cat jokes, he says, for obvious reasons.

Torrey’s efforts to cure schizophrenia, however, are nothing if not serious, and he is unswayed by the existence of disapproval among his peers. He is used to that. Torrey has spent the better part of a lifetime arguing for his ideas in the worlds of science, politics, and history, and he has seen many of them gain medical and popular acceptance. Now he has a self-imposed target of five years, an office filled with 575 brains, and one more battle left to fight.

Richard Just ’01 is the editor of the American Prospect Online.