In 1962, he arrived for his psychiatric residency at the Massachusetts Mental Health Center (an institution “long known as the ‘Psycho’ because of its previous name, the Boston Psychopathic Hospital”). There a white-haired, rotund, Santa Claus look-alike “quickly divested me of any remaining pretensions about ‘curing’ patients,” Mosher says. This man, who became Mosher’s mentor, exhorted his psychiatric residents to forget about doing things to patients. Instead he urged them to be with the suffering individuals — understanding, accepting, and forming relationships with them. “His encouragement to relate to schizophrenics as people with very serious life difficulties, to treat them with dignity and respect, and to attempt to see things as they saw them was a critical piece of my subsequent development,” Mosher asserts.
But Mosher also confronted evidence that the culture of the psychiatric hospital militated against such attitudes. “[D]ecisions that made the staff, not the patients, more comfortable were rationalized, and physical treatments such as electroshocks were applied to relational problems.” By the time his residency ended, he had developed two conflicting sets of attitudes. The first was that “human relationships could be therapeutic for even those whose distancing maneuvers were most masterful” — that is, schizophrenics. On the other hand, he thought the realities of life in the mental hospital thwarted the formation of such relationships.
Mosher had no intention of spending his career in psychiatric hospitals. He envisioned a path that would lead him to prominence as a psychiatric researcher, and as the first step to that end, he won a position as a “clinical associate” at the National Institute of Mental Health (NIMH). Beginning in 1964, he worked in the institute’s Family Studies branch, scrutinizing families with schizophrenic offspring.
“Research on twins and schizophrenia had been done since the early 1900s,” he says. “The Germans were the first to do it.” By 1960, according to Mosher, some authorities were asserting that in almost two-thirds of the cases in which one identical twin was schizophrenic, the other identical twin shared that condition. If true, this would have represented strong evidence of a genetic cause, since identical twins share the same genetic makeup. By the time Mosher arrived at the institute, however, he says critics had begun to cast doubt on the trustworthiness of the twin studies. Newer and methodologically sounder studies were showing a much lower “concordance rate.”
The group that Mosher joined wasn’t studying such statistical correlations but was rather trying to understand what happens in cases of discordant identical twins — that is, those in which one twin is crazy but the other isn’t. “We would bring both twins and their families into the clinical center for two weeks or so and study them as a group.” What they found, Mosher says, is that in these families, the twin who grew up to be schizophrenic “was basically treated differently from his or her twin in a variety of ways.”
Today Mosher looks back on this research and sees “lots of problems” in it. The study he worked on included only 16 pairs of twins. The way they were selected to be studied was questionable, and other biases might have influenced the work. But the work “did generate some interesting hypotheses,” Mosher says. And the two years he was involved with it gave him credentials as a promising young psychiatric researcher.
For his next step up the professional ziggurat, Mosher persuaded the National Institute of Mental Health to send him to London, then one of the yeastiest centers of creative ferment in the psychiatric realm. During his year there, he soaked up a broad range of intellectual influences. As a therapist, he saw couples at the British National Health Services’ Tavistock Clinic. “Then I would run out to Anna Freud’s clinic and spend an afternoon in her so-called borderline group, where they would discuss cases according to Freudian theory,” he recalls. He spent time at the Maudsley Hospital with a famous psychiatric geneticist named Eliot Slater, “very, very biological in his orientation.” Nothing, however, left a deeper impression than the time Mosher spent with R.D. Laing and the controversial experiment in which Laing was then immersed.
A charismatic Scot who’d become a British Army psychiatrist by the age of 20, Laing had burst into international prominence with the 1960 publication of a book called The Divided Self. “It attempted to make the process of going mad intelligible to ordinary people,” writes one of Laing’s biographers. Schizophrenia, in Laing’s view, was an attempt to cope with an unbearable situation. Mosher had read The Divided Self when it first appeared, and he had thought it matched his own experiences with patients so closely “that I wondered why it was causing a stir.”
In June of 1966, Laing brought the young American up to date on developments at Kingsley Hall. This East London building, owned by the Quakers, had housed Mahatma Gandhi during his negotiations with the British in the early 1930s, and it had reclaimed the spotlight when the Quakers made it available to a group called the Philadelphia Association, whose membership included Laing. The previous fall (in 1965), “They had assembled people who had been labeled as having serious problems,” Mosher explains. “The original notion was that the professionals would live there with the people who were (as they would say) ‘less together.’… The environment itself would be the therapeutic instrument…an egalitarian community where the boundaries between the sane and the insane were not defined by status.”
By the time Mosher arrived in London, some of the original ideals had fallen by the wayside. “Most of the professionals didn’t live there very long,” he recalls. “They didn’t like the constant intrusion of the crazies. They had no privacy.” A constant stream of visitors also trooped through, and Mosher says, “It became like a zoo — where the visiting American firemen would come to look at the animals in the cages.” He says Kingsley Hall’s residents eventually rebelled, declaring that no one could enter the facility unless invited by a resident. For several months, Mosher was excluded, but he was later invited back, and he often spent an evening a week there.