Sometime in the next few months, the Journal of Nervous and Mental Diseases will publish an article that describes an unusual experiment with newly diagnosed schizophrenics. This experiment randomly assigned young people with that diagnosis to one of two different forms of treatment. Some entered a psychiatric hospital where they received drugs to quell their psychotic ravings. The others went to a place known as Soteria House. They lived there for several months with a small group of other schizophrenics and a team of empathetic men and women (not medical doctors) who gave the disturbed individuals round-the-clock emotional support. The study tracked the research subjects for two years. According to the new report, the schizophrenics who lived in the therapeutic home and received no drugs fared better than the ones who received medication in the hospital. Furthermore, “The ones who did the best are those who would have been predicted to have the worst outcomes,” Loren Mosher says.
Mosher, a San Diego psychiatrist, was the principal architect of the Soteria experiment. What unfolded during the years it operated (1971 through 1983) shaped his ideas about schizophrenia, a condition estimated to afflict 1 to 2 out of every 100 Americans. Unlike the majority of his professional colleagues, Mosher was never persuaded that psychotic behavior is caused by brain abnormalities. He moreover came to believe that if schizophrenia is not an organic disease, then it’s wrong to force schizophrenics to take drugs that change their brains. He acknowledges that the powerful antipsychotic medications prescribed for schizophrenia nowadays often do suppress the symptoms of lunacy and make disturbed individuals easier to control. But Mosher argues that there are better ways to help most schizophrenics recover their sanity — cheaper, more humane and libertarian, less devastating to the human body and soul.
Because he holds these beliefs, the 69-year-old doctor claims, “I am completely marginalized in American psychiatry. I am never invited to give grand rounds. I am never invited to give presentations. I am never invited to meetings as a keynote speaker in the United States.” Yet from 1968 to 1980, the period when many of his unorthodox beliefs came into focus, Mosher occupied a prominent position in the American psychiatric research community. He was the first chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health in Washington, D.C. He founded the Schizophrenia Bulletin, and he served as its editor in chief for ten years. The story of how and why he became an outcast in his profession reveals much about the profound ways in which the concept of madness has changed in America over the past 40 years.
In Mosher, maverick tendencies can be traced to his childhood. A sickly boy plagued with allergies and asthma, he lost his mother to breast cancer when he was 9. Shunted between various relatives, he says he more or less raised himself from the ages of 8 to 14. By 1949, he had settled with his father in Marin County, but he continued to enjoy extraordinary freedom as a teenager. He had both a car and a driver’s license when he was 14. Summers he explored the Sierra Nevada wilderness on an old Arabian stallion loaned to him by an uncle. In the two and a half months after his high school graduation, he toiled as a roughneck in the oil fields of Montana and Wyoming, having used a fake ID to prove he was 21. “My story was that I was working after college to get money to go to medical school.” The lie transformed him, he recounts. “Presto chango. I was ‘Doc.’ My practice was luckily limited to simple first aid, common ailments like colds, and sexual complaints like the crabs and gonorrhea.” But Mosher was astonished and delighted by the importance he suddenly gained in the eyes of his fellow roughnecks “because I seemed smart and was ‘going to be a doctor.’ ”
College had to come first. He’d won a scholarship to Stanford, then known as a party school for WASPs. He says he liked the idea of partying but also had to work for all his living expenses. Mosher knew that a medical degree was his ultimate goal. He’d admired the lady physician who had treated his many childhood illnesses and says her competence and empathy made him want to be a doctor too. Turned down by Harvard’s medical school, he attended Stanford’s for two years, then took off a year to work and save money. At that point, Harvard accepted him as a transfer student. “So my degree — with honors — is from Harvard Medical School. Which is important,” he says, looking mischievous. “It explains a lot of things I’ve been able to do that other folks have trouble getting away with.” Mosher likens the Harvard credential to having a “very, very good union card.… Your ability to do things is enhanced.” After graduation, he did an internship at the University of California in San Francisco. “And then I took my psychiatric residency at Harvard again.”
Why psychiatry? Mosher points to several experiences in medical school that piqued his interest in the field. He once came down with “a case of medical student hypochondriasis” severe enough to make him get psychological help. “In psychotherapy for more than a year, I experienced firsthand the healing possibilities of a caring, human relationship.” A summer psychiatric fellowship introduced him to visionary Bay Area psychiatrists such as Gregory Bateson and provided a glimpse into “humanistic possibilities” in psychiatry that to Mosher contrasted with the technological, mechanized aspects of many other medical specialties. All his friends seemed to be going into psychiatry; he followed suit.
He says the year he spent as a medical intern helped form some of his key attitudes. Confronted daily with “sickness, unkindness, and death, situations over which I had little influence or control,” Mosher felt determined not to think of his patients as objects, as so many of his fellow physicians seemed to do. He found inspiration in the writings of existential and phenomenological thinkers of the day, such as Rollo May, Søren Kierkegaard, Jean-Paul Sartre, Maurice Merleau-Ponty, and others. “Their thing was, basically, enjoy yourself because you may not wake up tomorrow morning,” Mosher explains. “And they had a very straightforward attitude of accepting people for what they are and not judging and categorizing and putting them in pigeonholes. Just try and be there and be the best you can be in whatever you’re doing. When people are dying all around you every day and there’s nothing you can do, that’s good solace, if you will.”