Standing on a concrete island in downtown San Fancisco, David Oaks yells into a bullhorn the climactic line from the film "Network": "We're mad as hell and we're not going to take it anymore."
The line would be a cliche if it weren't for one thing: Oaks means to be taken literally.
On this sunny day, as thousands of mental-health professionals stream into the air-conditioned cool of the Moscone Center for the 156th annual meeting of the American Psychiatric Assn., Oaks and his cadre of supporters are quite mad, thank you. They are former patients in what many would call a dysfunctional mental-health system.
For The Record
Los Angeles Times Thursday October 30, 2003 Home Edition Main News Part A Page 2 National Desk 1 inches; 50 words Type of Material: Correction
Mental health -- The Los Angeles Times Magazine article Sunday on the use of drugs to treat mental illness, "Losing the Mind," incorrectly identified psychiatrist Loren Mosher as the former director of the National Institute of Mental Health. He was the institute's chief for the Center for Studies of Schizophrenia.
For The Record
Los Angeles Times Sunday November 16, 2003 Home Edition Los Angeles Times Magazine Part I Page 6 Lat Magazine Desk 1 inches; 44 words Type of Material: Correction
The article on the use of drugs to treat mental illness ("Losing the Mind," Oct. 26) incorrectly identified psychiatrist Loren Mosher as the former director of the National Institute of Mental Health. He was the institute's chief for the Center for Studies of Schizophrenia.
As protesters carry signs that read "Psychiatrists Cure Dissent, Not Disease" and "Self Help Works," Oaks invokes his holy trinity of social activists--Martin Luther King Jr., Cesar Chavez and Justin Dart, the father of the Americans with Disabilities Act. "We're calling for a nonviolent, global revolution of self-determination and empowerment," he says, eyes dancing. "The inmates are ready to take over the asylum."
Soft-spoken and even-keeled in private, Oaks unleashes his rage publicly by tapping into the trauma he experienced as a patient in the mental-health system. In the 1970s, while he was a student at Harvard University, Oaks was diagnosed as schizophrenic. He was institutionalized and forcibly medicated. He recovered, he says, by rejecting drugs and getting support from family and friends. "I was put on Haldol and Thorazine, and it was torture," he tells the San Francisco crowd. "They took a wrecking ball to the cathedral of my mind."
Oaks, now 48, is executive director of MindFreedom Support Coalition International, a Eugene, Ore.-based umbrella group for the "Mad Pride" movement. The grass-roots campaign, also known as "MindFreedom," includes so-called psychiatric survivors and dissident psychiatrists who reject the biomedical model that defines contemporary psychiatry. They say that mental illness is caused by severe emotional distress, often combined with lack of socialization, and they decry the pervasive treatment with prescription drugs, sales of which have nearly doubled since 1998. Further, they condemn the continued use of electro-convulsive therapy--or ECT, also known as electroshock--which they say violates patients' human rights.
Theirs is a philosophy born of "being chewed up and spit out by the system," says Oaks, and their views pit them against nearly everyone within the medical establishment, including American Psychiatric Assn. members, the pharmaceutical companies that increasingly fund drug development and testing, and even the National Alliance of the Mentally Ill, a prominent advocacy group.
Broadly speaking, those organizations believe that decades of research have proven that schizophrenia, bipolar, severe depression and other mental disorders are biological illnesses of the brain caused by some undiscovered combination of genetic, neurochemical and social factors. They believe that, along with psychotherapy, these illnesses should be treated with drugs (and sometimes a panoply of drugs) that target the biochemical mechanisms of psychiatric disorders.
"Our brains are biological organs by their very nature," says Dr. Paul Appelbaum, past president of the American Psychiatric Assn. "Any disorder is in its essence a biological process."
Given the expertise and money involved in those organizations, Oaks and his allies would seem to face hopeless odds. MindFreedom operates on the fringe of the mental-health community; its protest in front of the Moscone Center drew all of 100 people. Oaks admits that he has no evidence to dispute the medical-scientific model of mental illness. What he and his small army do have is look-in-the-mirror evidence about their recovery from mental illness, often accomplished by not taking medication. They also trumpet evidence that, notwithstanding the experts' medical degrees and their "miracle" drugs, confirms that the nation's mental illness system is in crisis. Consider:
* Four of the 10 leading causes of disability worldwide are neuro-psychiatric disorders, according to a 2001 World Health Organization study.
* The National Institute of Mental Health estimated in its most recent study in 1995 that the annual cost of mental illness in the U.S., including medical care and lost productivity, was $185 billion.
* Only about one in five Americans with major depression receives adequate care, according to a recent Journal of the American Medical Assn. study.
* More than 30,000 Americans committed suicide in 2001, 10,000 more than those killed in homicides that year.
"The system is broken," says Robert Whitaker, author of "Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill." "The so-called triumph of the psychiatric-pharmaceutical model has produced the horrible outcomes we have today."
Given those outcomes, can anyone completely dismiss the experiences of people who have lived with, and overcome, mental illness?