E. FULLER TORREY HAS BRAINS.
He has lots of brains. They arrive at the rate of about one a week, packed in dry ice and FedExed to him by coroners around the country. On this March day, he has 398 brains, some whole, some sliced, some diced, some floating in jars, some stored at minus-70 degrees in 52 freezers at his "brain bank" in Bethesda.
He opens one of the freezers and pulls out a metal box covered with a dusting of snowy frost. It contains 100 thin slices of brain, each mounted on a glass slide.
"This is frontal lobe tissue," he says. "That's just part of the frontal lobe of one brain."
He closes the freezer and walks into an office where a technician in a white lab coat sits at a machine that looks like a high-tech version of the devices used to slice salami in a deli.
"This is a machine that cuts frozen brains," Torrey says. "She puts a slice of brain tissue on there and then cuts it thinner than a postage stamp and puts it on a slide. She does this all day long and she does it very, very carefully."
Most of Torrey's brains comes from people who suffered from severe mental illness -- schizophrenia or depression or manic-depression. About half are the brains of people who committed suicide. Torrey sends sections of the brains to scientists around the world who are studying the biology of mental illness. Meanwhile, he and some colleagues are doing research of their own, investigating Torrey's controversial hypothesis that schizophrenia might be caused by a viral infection, possibly an infection spread by cats.
But the most interesting brain in Torrey's lab is not stored in a jar or a freezer. It is located in Torrey's skull, beneath his shaggy, graying hair.
It is a brain that stores memories of his 63 years -- his work as a doctor in Ethiopia, Alaska and the South Bronx, his five tempestuous years as an administrator at the National Institute of Mental Health, his seven years as a staff psychiatrist on wards full of psychotics at St. Elizabeths Hospital, his 16 years of volunteer work with homeless schizophrenics in Washington shelters.
Torrey has produced 16 books, works of science and history and a few witty but angry attacks on his chosen profession, psychiatry, some of them bearing titles that struck his colleagues like a thumb in the eye -- "Freudian Fraud" and "Witchdoctors and Psychiatrists."
His books and speeches and op-ed articles have made him perhaps the most famous psychiatrist in America. Within his profession, though, he has been widely attacked as a dissident, a gadfly, a troublemaker. But then something happened: A wealthy couple with a mentally ill son put their fortune behind Torrey's efforts.
Now, Torrey runs a foundation that distributes more than $20 million a year, which makes the aging gadfly second only to the federal government as a source of grant money for the study of schizophrenia and manic-depressive illness.
Giving away money, he notes, has done wonders for his reputation.
"I've never had so many friends," he says. "When I have millions of dollars to give away, people who wouldn't speak to me 10 years ago have decided that maybe they should speak to me. I'm alarmingly respectable now."
When Torrey was an undergraduate at Princeton in the late 1950s, his mother called him to report that his sister Rhoda, then a high school senior, had begun hallucinating and screaming "The British are coming!"
He accompanied his mother as she took Rhoda to various psychiatric hospitals, where he heard alleged experts report that her delusions were caused by the psychic trauma of their father's death more than a decade earlier.
"Even at the time, knowing very little about it, that seemed absurd to me," he says. "It looked like she had a very severe brain disease."
She did. She had a particularly severe case of schizophrenia, a mental illness characterized by delusions and hallucinations. Since then, Rhoda has been in and out of mental hospitals for her entire adult life. Watching her ordeal is a major reason why Torrey has spent much of his life studying schizophrenia.
He'd always wanted to be a doctor. He just didn't know what kind of doctor. After medical school at McGill University in Montreal and an internship in San Francisco, Torrey joined the Peace Corps in 1964 and was dispatched to Ethiopia. He loved it.
"I got to practice some real medicine," he recalls. "I saw patients who had leprosy. I saw a patient who'd been gored by a water buffalo. I saw a young boy who'd been herding his sheep and came over the hill and unfortunately there was a lion sleeping there and you could see lion's paw marks across his chest. He was a very scared little boy, but he did fine."
Back in the United States, he spent a year as a doctor in a federally funded medical clinic in the South Bronx. After that, he did his psychiatric residency at Stanford University. While there, he earned a master's degree in anthropology, doing a comparative study of therapists from Ethiopia, Borneo and California.
That study later served as the basis for "Witchdoctors and Psychiatrists," a droll book that concluded that the two groups "get about the same results." The book's first sentence gives a good idea of the general tone:
"Psychotherapy, the world's second oldest profession, is remarkably similar to the first."
In 1970, Torrey landed a job as assistant to the director of the National Institute of Mental Health in Bethesda.
"Almost from Day One I was in trouble," he says with a smile that suggests that he isn't particularly penitent.
What caused the trouble was his propensity for speaking -- and writing -- heresy. Torrey attacked his Freudian colleagues who claimed that schizophrenia was caused by bad mothers. He suggested it was a brain disease and he was right, although that wouldn't be proved for another decade. He also suggested that psychiatrists ought to use their medical training to treat schizophrenics and other severely ill patients and let the "worried well" tell their troubles to, as he likes to put it, "social workers or bartenders or hairdressers."
His polemics were barbed enough to irritate even those colleagues who shared his views. "He makes caricatures of things he doesn't agree with, which can be very painful," says Richard Wyatt, the chief of neuropsychiatry at NIMH. "He's usually right, but his caricatures can be difficult to handle."
When Torrey advocated that psychiatrists who had been trained on government grants should be compelled to spend two years working in federal medical clinics, the heads of 15 university psychiatry departments came to NIMH to suggest that he be fired.
He wasn't fired, but he soon decided that he wanted to take a sabbatical as far as possible from the battles of the NIMH bureaucracy.
"I went to the Indian Health Service and I said, 'What is your most remote location?' " he recalls.
That turned out to be St. Paul's, a tiny island off the coast of Alaska, home to about 500 impoverished Aleuts. Torrey moved there in 1975 with his wife, Barbara, and their two children, to spend a year as the island's sole doctor.
It was a frozen, windswept, treeless island but he enjoyed it. "It was a very good year for my kids," he says. "They learned that everybody does not live the way people live in Bethesda."
Article, Book, Demotion
When he returned from Alaska in 1976, Torrey did something that shocked his colleagues at NIMH: He volunteered to work as a ward psychiatrist at St. Elizabeths, the ancient asylum in Southeast Washington.
"My friends were convinced that I'd gone psychotic, because that was the lowest-status thing you could do," he says. "A surprising number of the staff either had substance abuse problems or had lost their license in a state or two."
At St. Elizabeths, Torrey earned a reputation as a doctor who worked well with the most psychotic people.
"He did a marvelous job with these very sick patients," recalls Roger Peele, who was his boss at the hospital. "If I had somebody that nobody else could handle, I'd send them to Fuller."
"He truly, truly, truly cared about the patients he worked with," says former St. Elizabeths psychiatrist Judith Nowak.
At St. Elizabeths, Torrey became curious about the hospital's most famous patient -- Ezra Pound, the American poet charged with treason after making propaganda broadcasts for Mussolini during World War II. Declared insane, Pound lived at St. Elizabeths from 1946 to 1958, when he was released and sent back to Italy, where he died in 1972. Torrey asked to see Pound's records and was told they were off-limits.
With help from friendly lawyers, Torrey gained access to Pound's psychiatric file. Reading it, he concluded that the poet had never been insane.
"Everyone who looked at him said, 'This guy's not psychotic,' " he says.
Pound had been saved from a treason trial by the intercession of Winfred Overholser, who had been the superintendent of St. Elizabeths. Overholser admired Pound's poetry and permitted him to live in a private room at the hospital, where he wrote three books, received visits from literary celebrities and enjoyed conjugal relations with his wife and several mistresses.
In 1981, Torrey exposed Overholser's coddling of Pound in an article in Psychology Today that he later expanded into the book "The Roots of Treason," which was a finalist for the National Book Critics Circle award for biography.
But the lords of St Elizabeths were not thrilled with Torrey's revelations. A few days after the Psychology Today article appeared, he was demoted from a division director at the hospital to a mere ward doctor.
Tag Team Lobbying
The place was packed with big gray mail bags.
When Laurie Flynn walked into the office of the National Alliance for the Mentally Ill for her first day as executive director in 1984, she found a pile of mailbags, each of them stuffed with letters.
It was all because of E. Fuller Torrey.
Torrey had just published "Surviving Schizophrenia," a guide for patients and their families. When he appeared on Phil Donahue's TV show to promote it, he urged people seeking help to contact the alliance, which was then a fledgling organization with fewer than 50,000 members, most of them the parents of mental patients. The result was this avalanche of mail.
"Nobody had ever said the word schizophrenia on popular television, and people came out of the woodwork seeking help," Flynn recalls. "For many years, mothers were told they were the cause of the problem, and here comes Fuller Torrey saying, 'Wait a minute, this isn't the family's fault. These are brain diseases.' Here was a psychiatrist saying, 'I know what you're going through because my sister has the problem.' It's hard to overemphasize what a hero he was back in the early days."
Torrey donated the royalties of "Surviving Schizophrenia" to the alliance and he hit the hustings to organize, helping to build the group into a powerful lobbying organization with more than 220,000 members.
"Weekend after weekend," Flynn says, "he went out to states where members were organizing chapters and he rallied the troops. Nobody did it better."
When they lobbied together for the alliance's agenda -- more research money and better treatment for the mentally ill -- Flynn and Torrey played good cop/bad cop. Torrey was the acerbic verbal bomb-thrower. Flynn was the soft-spoken centrist.
The Torrey-Flynn tag team won some victories, including increased federal funding for research on mental illnesses. But their partnership collapsed in December 1999. That's when the group published Torrey's scathing attack on NIMH, in which he charged that the agency spent too little money for research on severe mental illnesses while funding studies on such topics as "Coping With Change in Czechoslovakia" and the mating habits of the eastern bluebird.
Predictably, NIMH responded with a news release saying it was "proud of its portfolio of research on mental illness." Not so predictably, Flynn was bombarded by calls from her allies on Capitol Hill, who felt that Torrey's report made them look like fools for supporting increased funding for mental illness research.
"I realized I'd made a huge mistake," she says. "Having a report like this was very damaging."
Last year, Torrey wrote a second scathing attack on NIMH's research, but Flynn's group refused to endorse it. That didn't stop Torrey. He's planning a third jeremiad on the subject.
"I honestly feel that you can't change things in this town unless you make a lot of noise," he says. "It's a question of strategy and Laurie and I disagreed."
"Ten years ago, we were outside the door pounding to get in," Flynn replies. "Now we're at the table and people expect us to have good manners. But Fuller is still -- and always will be -- outside the door, pounding to get in."
A Vaccine for Schizophrenia? When his college-age son was diagnosed with schizophrenia in the late '80s, Ted Stanley read a dozen books on the subject. The one that impressed him most was Torrey's "Surviving Schizophrenia."
"He's a good writer and a good thinker," Stanley says.
Stanley is a rich man, head of a mail-order company that sells collectible knickknacks and classic literature bound in leather. In 1989 he wrote to Torrey, saying he wanted to donate $50,000 to mental health work and asking what he should do with it.
When they met for dinner in Washington, Torrey suggested that the best way to spend the $50,000 was to hire somebody to lobby the government to spend more for research on mental illness. So Stanley donated the money to the National Alliance for the Mentally Ill to hire a lobbyist.
A couple years later, Stanley and his wife, Vada, asked Torrey: "Suppose we donated a million dollars a year. Then how would you spend it?"
Torrey suggested they fund research projects, so they set up the Stanley Foundation and put Torrey in charge of it. Over the past decade, the Stanleys have donated ever-increasing sums to the foundation, spending more than $100 million to fund research on schizophrenia and other severe mental illnesses. This year the foundation will spend $21.3 million on dozens of research projects around the world. Soon its annual spending will increase to more than $30 million.
"We are supporting a quarter of the research on schizophrenia and half the research on manic-depression in both the United States and Europe," Torrey says.
For years, Torrey refused Stanley's offers to pay him for running the foundation. He was collecting a federal pension and his wife works at the National Academy of Sciences, so he told Stanley he didn't need any money. But with his wife planning to retire soon, he recently agreed to accept a $115,000 salary.
Now Torrey runs the foundation and its brain bank, which has shipped 100,000 sections of brain tissue to researchers on several continents. But what excites him most is his research into a theory that has obsessed him for nearly three decades -- that schizophrenia might be caused by a viral infection.
"I developed this delusional system," he says wryly, "that this is an infectious disease. So I've got to figure out what the infection is and prove it; otherwise everybody will be sure I'm crazy."
His theory is that schizophrenia is brought on by a virus that invades the brain -- possibly in utero, possibly in childhood -- then lies dormant for years before damaging several parts of the brain involved in learning, memory and emotion. The theory is based on the fact that schizophrenia, which affects about 1 percent of Americans, is not evenly distributed around the world. It is, Torrey says, particularly prevalent in places where cats are common house pets. Perhaps cats, already well known as carriers of the parasite that causes toxoplasmosis, might also carry something that causes or triggers schizophrenia.
It's just a theory, as yet unproved but, as Herbert Pardes, a former director of NIMH, says: "it's a reasonable hypothesis, one of several reasonable hypotheses."
And it's a hypothesis that gets plenty of research funding. The Stanley Foundation gives about $1.3 million a year to a group of researchers at Johns Hopkins University who have been collaborating with Torrey on this research for more than a decade.
If Torrey's theory is correct, someday there might be a vaccine for schizophrenia.
"Twenty years from now," he says, "I'll be surprised if we can't do that."
Treatment by Force The protesters carried a fake hypodermic needle as tall as a giraffe.
There were about 40 of them, picketing Torrey's office at the Stanley Foundation in Bethesda in October 1999, waving signs that read, "Forced Drugging Is Torture." They were former mental patients, members of Support Coalition International and MadNation, two groups that are battling Torrey over the forced treatment of psychotics.
In recent years, Torrey has emerged as America's most prominent spokesman for the idea that the government should compel the insane to take the anti-psychotic drugs that can relieve their illness. A million Americans who suffer from schizophrenia or manic-depressive illness are homeless, and thousands commit violent crimes, Torrey says, because they don't take the drugs that could relieve their delusions and hallucinations.
"A large percentage of people with these diseases lack awareness of their illness," he says. "They don't know they're sick."
In a career filled with intellectual combat, it might be his most controversial stand, drawing fire from civil libertarians and former psychiatric patients who have attacked him as a "fascist" and a "Nazi."
"He is now a polemicist who is interested in coercive treatment with drugs which have horrible side effects," says Loren Mosher, a psychiatrist who once worked with Torrey at NIMH. "Would you like to have the local mind-police come to your house and give you a shot?"
"If it's not voluntary, it's not truly treatment," says David Oaks, a former mental patient and leader of the Support Coalition. "Dr. Torrey has never been on the other end of the needle. I've been on the other end of the needle. These drugs can feel like chemical torture to people who don't want to take them."
The National Alliance for the Mentally Ill sides with Torrey on forced treatment, but Flynn says she sympathizes with former patients who oppose it. "Forced treatment is not pretty," she says. "It certainly saves lives, but for the individual involved it is a powerful experience that frequently involves handcuffs."
Torrey says that he not only preaches forced treatment, he has practiced it. He tells the story of a homeless schizophrenic he treated in a Washington women's shelter in 1984. Hearing voices that weren't there, she had left her middle-class family to sleep in the woods behind a school. She refused Torrey's offer of anti-psychotic drugs but asked him if he had any pills for her sinus problems. He gave her the anti-psychotic pills and told her they were sinus medicine.
His subterfuge violated the code of medical ethics, he admits. But the woman got better and moved off the streets into a group home.
"I substantially improved the quality of her life and got her into a house," he says. "Anybody who believes that was not justified, I'd be happy to argue with them."
The Man With Two Brains
Right now, Fuller Torrey is a man with two brains. One's in his head and the other's in his hands.
He's standing on a stage at the National Museum of Health & Medicine, lecturing to high school anatomy students. He has brought a brain from the brain bank and calls the students up to look at it and touch it. They gather and gawk. The brain is a light brown pile of squiggly tissue. The human body's most majestic organ looks a bit like a pile of bait that's been frozen and thawed a few times. A couple brave kids don rubber gloves and gingerly pick it up.
"It feels nice and firm now, but in your skull it's much softer," Torrey says. "If you die in the summer and it's 90 degrees and they don't find you for a few days, the brain turns to soup. I find that very disconcerting -- that's my brain."
The kids aren't paying much attention to his words. They're young and they're more interested in the yuck factor of this brain. But Torrey is older, more conscious of mortality. There's a lot of work he still wants to do.
"Somehow," he says to nobody in particular, "the realization that this wonderful organ that contains all your thoughts and memories just sort of melts away is pretty disconcerting."