by E. Fuller Torrey
Review by Matt Lee on Dec 19th 2001
The manual Torrey has written is a toolbox of information and
contacts, written for the everyday lay reader with an interest
in the practical side of schizophrenia. It presents as part of
that genre of writing that we might call 'medical empowerment',
where users or providers outline the background to their concerns,
in this case schizophrenia, as well as describing practical methods
for negotiating the varieties of treatments and social implications.
It focuses on North America alone and so the details Torrey gives
of practical issues and possible solutions is limited in scope
and means the book is of little use outside of North America.
It is also inevitably going to have a relatively short shelf life.
The edition I reviewed was from 1995 and is already 6 years out
of date and I would suspect that in order for such a manual to
fulfill its function adequately it would need updating and reviewing
every two to three years. The book then is limited in its remit,
useful mainly for North Americans and then only after noting that
some of the details will be redundant. One questions remains then.
Is it a good manual; can it do what it intends to, which is enable
people to 'survive' schizophrenia.
The first thing to note when reading Torrey's manual is his apocalyptic
tone with regard to schizophrenia, a tone which is part of an
overall polemical attitude that is quite aggressive and often
questionable. The first chapter of the work is entitled 'dimensions
of the disaster' and traces a history of schizophrenia in the
last century in North America. This 'disaster' is not, however,
simply schizophrenia itself, although Torrey is clear that being
'afflicted' by schizophrenia is itself a disaster for both the
schizophrenic and everyone around them. The real 'disaster' with
which Torrey opens his work, however, is the closure of the asylums
in North America. Hospitalisation has been reduced too much, according
to Torrey, and there is now a crisis in the treatment of schizophrenics
for which the main solution seems to be a radical increase in
hospitalization. This advocacy of the hospital is a central point
in his polemic but that is not the focus of Torreys polemic. The
main focus is any suggestion that schizophrenia is anything other
than a massively debilitating brain disease treatable with drugs.
Torrey is a primary advocate of this medical model and does so
in such a way that any discussion or challenge to such a model
is seen as not only ludicrous but often as dangerous to the schizophrenic.
This is particularly the case with 'insight-oriented psychotherapy'.
Such treatment is "not only negligent, it is malpractice"
The polemical tone of Torrey's work comes throughout the work
and the text is littered with side swipes at psychoanalysis, Thomas
Szasz, R.D.Laing, anti-psychiatry and the National Institute for
Mental Health (NIMH). It is also littered with the phrase 'schizophrenia
is a brain disease' and at no point tolerates any deviation from
this basic model, even though the manual itself deals in large
part with the medical social situation of the schizophrenic. Despite
schizophrenia being a 'brain disease' the chapter on neurology
(Chapter 6) is a cursory overview of the competing theories. Torrey
presents 4 main theories, 5 minor theories and 6 'obsolete theories',
none of which inspires much confidence in the rather blunt and
absolutist way in which he reduces schizophrenia to brain disease.
Moreover the history of psychiatric theories of schizophrenia
is not one of increasing clarity of theory but, as anyone who
begins to examine the area will find, rather one of ongoing waves
of 'fashionable' theories, each of which seems to last a generation
or two before being moved onto the shelf of minor or obsolete
Torrey clearly revels in the argument but his polemic is too strident
to be convincing. He attempts to offer a route through the maze
of treatments and practices on offer in North America and through
so doing highlights the crisis in social and medical policy that
exists in that country. He does not inspire any confidence, however,
in his own approach. The crucial issue of the social implications
of schizophrenia is reduced, in essence, to a practice of finding
the 'right' doctor or the 'right' treatment. Torrey's own role
within the debate appears to blind him to the fact that schizophrenia
is a major site of social struggle, possibly the most urgent site
of such struggle in our attempt to grapple with 'biotechnologies'
and our ability to affect ourselves through medicine.
Torrey himself has taken charge of one of the largest 'brain banks'
in the world, as a result of private funding, and now controls
a large part of the budget for research into schizophrenia in
North America. His preferred organisation, the National Alliance
for Mentally Ill, is a particular group within the debate, largely
family orientated and inevitably partisan in its approach. The
final chapter in his book, 'How to be an advocate' reads as a
form of recruitment manifesto for NAMI but does so not through
putting the policy differences clearly but rather through writing
a history in which, in some sort of inevitable evolution, the
only real advocacy organization is now the NAMI. At this point
Torrey's clearly political - with a small 'p' - agenda comes to
the fore and yet at no point does he step back from the controversy
and attempt a more objective account of the issues. In the end
the manual is marred fundamentally by this partisanship. A manual
should aim to be an objective tool. It should not be a way to
garner support for a particular policy with regard to schizophrenia.
Torrey uses his position within the medical profession - even
down to the 'M.D.' after his name on the cover - to give a veneer
of authority and objectivity to his manual but this is an objectivity
that he singularly fails to deliver.
2001 Matt Lee
University Of Sussex (PhD researcher, Philosophy)