Brain Storm
Renegade psychiatrist Fuller Torrey has taken on fiery critics, federal researchers and Freud in a decades-long search for the causes of schizophrenia.
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| BRAIN TRUST: Torrey's Maryland lab supplies tissue specimens to researchers around the world. |
WHEN E. FULLER TORREY ARRIVES FOR WORK at 7 a.m., the first thing he does is check on his brains.
At Torrey’s Maryland research laboratory, some 490 human brains have been bisected, cataloged and stored in freezers and formalin-filled plastic buckets for use as tissue specimens. Harvested within 48 hours of the donors’ deaths, the brains come from victims of car crashes, heart attacks and suicides, most of whom had one thing in common: they suffered from mental illness.
The brain bank is an important part of one of the most controversial investigations in modern psychiatric research, and a pet project of a man described by the Washington Post in 2001 as “perhaps the most famous psychiatrist in America.” Torrey, MA ’69, has spent two decades and tens of millions of dollars trying to prove that viruses cause schizophrenia.
If a living psychiatrist can truly be called famous, Torrey probably qualifies. Many people in and out of medicine—hundreds of thousands have bought his book Surviving Schizophrenia—credit him for changing the establishment’s view of mental illness, advancing treatment and saving patients’ lives. He has also made a career of putting noses in the psychiatric community decidedly out of joint. For every scientist who lauds him as a courageous visionary, you may find one who thinks his ideas are, as one researcher put it, “bullshit.”
Torrey’s contention that the delusions, hallucinations and scattered thinking symptomatic of schizophrenia are at least partially caused by “infectious agents attacking the brain” was once almost universally dismissed as unlikely, if not ridiculous. However, his research and advocacy have finally won considerable mainstream acceptance. Even the National Institute for Mental Health (NIMH), a favorite target of Torrey’s over the years, now allows that viral infections “may play a role” in schizophrenia.
At the Stanley Medical Research Institute (SMRI), founded by Torrey in 1989, 25 medical researchers have spent thousands of hours scrutinizing brain tissue from deceased mental patients. Torrey says the team is getting closer to identifying the viral culprits that could lead to effective new drugs and perhaps even a vaccine for schizophrenia.
SCHIZOPHRENIA AFFLICTS MORE THAN 2 MILLION AMERICANS and costs an estimated $40 billion in health care and lost productivity every year. Its victims often hear voices and see visions that are difficult to differentiate from reality; it is not, as commonly believed, a Jekyll-and-Hyde disorder involving multiple personalities. Persons diagnosed with schizophrenia—onset usually occurs between the late teens and early 30s—have difficulty getting or holding jobs, suffer severe anxiety and bear the stigma of an illness that is often misunderstood. Torrey estimates that 40 percent of them are not being treated and at least 200,000 are homeless on any given day. One out of 10 commit suicide.
For many years, schizophrenia was deemed a behavioral problem, a psychological response to childhood trauma or parental abuse. Torrey has helped to debunk that view. Most researchers now agree that schizophrenia is a brain disease with a physiological origin. Most also agree that genetics plays a role, but nobody has identified precisely how the illness occurs or what triggers it.
Working out of the SMRI labs at Johns Hopkins University in Baltimore and at the Uniformed Services University of the Health Sciences in Bethesda, Md., Torrey and his investigators are looking for evidence that viruses somehow serve as a wake-up call for schizophrenia, either by setting off violent immune responses in the brain or by releasing toxins that disrupt the central nervous system.
SMRI is funded by Ted and Vada Stanley, whose college-age son was diagnosed with bipolar disorder, an ailment that produces violent mood swings from mania to depression. The institute has a $33 million annual budget and distributes more than $20 million in research grants each year—funding one-fourth of the schizophrenia research and half the bipolar research in the United States.
Torrey and his team are currently scrutinizing cell damage in neurons and glia (neuron-support cells) that may point to viral infection. They are also searching for infection-fighting antibodies in brain cells and for the cytokines (chemical substances released when the body fights infections) that would demonstrate the presence of infectious agents.
According to Torrey, his lab results strongly suggest a viral presence in the brains of many mental patients. “We haven’t found the smoking gun yet,” he says, but he predicts a breakthrough within the next few years.
Some prominent mental health researchers are beginning to express cautious support for Torrey’s theory. “There’s no doubt that germs play a much larger role than we previously thought in diseases such as cancer and heart disease, and Fuller Torrey makes good sense with his theories about how infectious agents can trigger some forms of mental illness,” says Paul Ewald, author of Plague Time: The New Germ Theory of Disease (Anchor Books, 2002). “People scoffed at him for a while, but his ideas are becoming more accepted every day.”
Not everybody buys it, though. “There’s no data out there at all to back up Torrey’s theory of viral involvement,” says Loren Mosher, a Stanford- and Harvard-trained psychiatrist. “As long as I’ve known him, Torrey has been making spurious associations between viruses and mental disorders such as schizophrenia.”
Mosher, ’56, the first-ever chief of the Center for Studies of Schizophrenia at NIMH (1969-80), explains: “If viruses were the cause of mental illness, they would surely leave characteristic patterns of injury in the brain, such as lesions. But there’s been no evidence of such lesions in the brains of people with schizophrenia. . . . I’m tired of spending my time answering the same old bullshit from Fuller—he’s way-out wrong!”
A FORMER ICE HOCKEY DEFENSEMAN who helped establish Stanford’s club hockey team in the late 1960s, Torrey’s idea of fun these days is piloting a one-man sea kayak in Chesapeake Bay. Professionally, he has been making waves for more than 30 years.
Torrey earned his medical degree in 1963 at McGill University, served two years in the Peace Corps and followed that with a year in a South Bronx clinic. In 1967, he came to Stanford for a psychiatry residency and simultaneously worked toward a degree in anthropology. His first book, The Mind Game: Witchdoctors and Psychiatrists (Emerson Hall Publishers, 1972), was an overview of the psychiatry profession based in part on research he’d done at Stanford. The Mind Game compared the methods of Zar priests of Ethiopia and Menang healers of Sarawak, Malaysia, with those of a group of Stanford-area psychiatrists, psychologists and counselors and concluded that “they got about the same results.”
Not surprisingly, The Mind Game ticked off psychiatrists. But that flap seemed minor compared with the hurricane of criticism that blew up around Torrey’s 1992 exposé, Freudian Fraud (HarperCollins), which attempted to demolish the already shaky scientific legacy of Sigmund Freud. After describing the father of psychoanalysis as a chronic cocaine abuser, Torrey argued that Freud’s “daffy” ideas about the importance of sexual experiences in childhood development had produced a “malignant effect” on both American psychiatry and American culture.
The author of 16 books on psychiatric topics, Torrey became a relentless foe of Freud-based psychoanalysis while watching his sister Rhoda struggle with schizophrenia starting back in the 1950s. In fact, he traces his interest in psychiatry to a call he received from his mother when he was a sophomore at Princeton. Rhoda, a happy and popular teenager at the time, had been acting strangely, Torrey’s mother said, and Torrey rushed home to find his sister lying on the family’s front lawn yelling, “The British are coming!”
In the early years of Rhoda’s illness, says Torrey, a series of psychotherapists suggested that Rhoda’s mother had caused the ailment through either neglect or psychological abuse.
“I developed a sneaking suspicion that these eminent psychiatrists did not know what they were talking about,” Torrey wrote in the Journal of the California Alliance for the Mentally Ill in 1992. “My mother was told in so many different ways (mostly implicitly) that she had caused Rhoda’s illness that she came to believe it. And in later years, no matter how much data I showed her proving that schizophrenia is a brain disease, she never quite believed me.”
In 1970, Torrey joined NIMH as an administrator. He stayed five years, becoming increasingly disgruntled. According to Torrey, the federal research agency was and still is pouring millions of tax dollars into what he considered marginal activities—such as studying the behavior of pigeons—while “failing dismally” to fund research on both schizophrenia and manic-depressive illness. “Instead of focusing on research into severe mental illness, they became a behavioral study institute,” he complains. Torrey became a notorious gadfly who insisted that the kind of “grandiose thinking” inspired by Freud had led many psychiatrists to regard themselves as “all-wise and all-knowing social engineers.”
Torrey left NIMH and spent a year caring for Native American patients in Alaska before signing on as a ward physician at St. Elizabeth’s Hospital for the mentally ill in Washington, D.C. St. Elizabeth’s was often criticized as a “snake pit” where some staffers treated patients with indifference and even outright contempt. Torrey built a reputation as a determined and energetic advocate for the mostly indigent mental patients. And he spent nearly a decade studying schizophrenia up close.
“Fuller Torrey was known at St. Elizabeth’s as an innovator . . . whose ideas were sometimes in conflict with the establishment,” says Donald R. Soeken, a clinical case manager at the hospital during Torrey’s years there. “Everyone knew he was a renegade, a staunch critic of the NIMH who wasn’t afraid to speak out. But there’s also no doubt that he cared deeply about his patients.”
Rose Mary Phibbs, now 71, is a schizophrenic who was living in a homeless shelter in Washington, D.C., in 1985, when Torrey, then working as a volunteer on the city streets, intervened. “He rescued her,” says Phibbs’s daughter, Pat. Torrey prescribed medication to stabilize Rose Mary’s condition and helped her get a job as a church secretary and an apartment of her own. She says she has lived a satisfying life ever since, in spite of her illness.
“He was very kind and very thoughtful,” says Phibbs.
WHAT TORREY SAW AT ST. ELIZABETH’S and in his volunteer work with homeless psychotics further convinced him that the devastating symptoms of schizophrenia could not result from “your mother looking cross-eyed at you during your childhood.” Those experiences also convinced him that victims of mental illness are often incapable of helping themselves. Through the nonprofit Treatment Advocacy Center, which he founded in 1997, Torrey is trying to reform laws and clinical policies that prevent ongoing treatment of adults with brain disorders unless the patients request it. “Schizophrenia and manic-depressive illness can severely impair an individual’s self-awareness, causing many to believe they are healthy and not in need of medical care,” says the center’s website. “Their brain disease has impaired their brain function, and since they don’t think they’re sick, many of them do not actively seek treatment and often refuse it.” The results, according to TAC, are hundreds of “preventable tragedies” involving mental patients, including suicides, homelessness and violence against others.
The issue has thrust Torrey into the spotlight again, and, as usual, he is cast as both hero and villain. The TAC won a victory this fall when California enacted “Laura’s Law,” which provides for court-ordered outpatient treatment of unwilling mental patients in cases deemed appropriate because of danger to the patient or others. The law is named after 19-year-old Laura Wilcox, who was killed in January 2001 by an untreated man suffering from delusional paranoia.
Civil libertarians and some patient advocates strongly oppose Torrey’s initiative. Last May, a group spearheaded by the Montgomery County (Md.) Coalition for Human Rights in Mental Health protested an appearance by Torrey. In its call to action, the group urged supporters to speak out against “Torrey’s agenda of force and coercion.”
Laurie Ahern, co-director of the National Empowerment Center —an advocacy group organized by former mental patients that vigorously opposes forced medication of schizophrenics—describes Torrey’s approach as “misguided and sometimes destructive.”
“The problem with relying on drugs for treatment is that drugs can never address the whole person—the person who dreams and fears and has memories and hopes,” says Ahern, who is herself a former mental patient. “We need to treat the entire human being, not just his or her brain chemistry.”
Torrey isn’t deterred. At 65, an age when most professionals are winding down, he’s working harder than ever to identify the causes of schizophrenia and to find new treatments for its victims, he says. Torrey, who raised two children with his wife, retired economist Barbara (Boyle), ’63, MA ’70, maintains a 12-hour-a-day, six-day-a-week work regimen. Friends and colleagues speculate that he is motivated by a deep-seated need to solve the mysteries of mental illness, partially as a result of the suffering he witnessed in his sister’s lengthy bout with schizophrenia.
“Fuller is a brilliant person, that’s for sure. I think he could have done anything he wanted with his life,” says Robert H. Yolken, a longtime Torrey associate who directs the SMRI facility at Johns Hopkins. “But I also think his sister’s illness had a powerful impact on him. I’m sure she’s part of the reason why he’s so driven to understand the causes of schizophrenia.”
Yet Torrey refuses to ascribe his dedication solely to Rhoda’s 40-year struggle with mental illness. “I don’t personalize what happened to her,” he says. “After all, I’ve cared for thousands of other patients over the years, and I was just as determined to help them.”
Does he fret that so many psychiatrists and mental health researchers dispute his theories and criticize his polemical style? Not really. “I know a lot of researchers in my field disagree with me about these issues, and that’s fine. When they call me a maverick or a renegade, I just tell myself: ‘Hey, I’ve been called worse.’
“I haven’t become respectable yet, but I’m getting closer every year.”
Tom Nugent is a freelance writer in Hastings, Mich.