A Bethesda psychiatrist, nationally known for his outspoken opposition to the use of antipsychotic drugs in the treatment of mental patients, is under investigation by Maryland's Commission on Medical Discipline for comments he made in an appearance on the Oprah Winfrey TV show.

Dr. Peter Breggin has been told to appear Tuesday night at a closed-door meeting before a state medical society panel to respond formally to a complaint lodged against him by the National Alliance for the Mentally Ill. The organization said it had received reports that, as a result of Breggin's televised comments in April, mental patients across the country have stopped taking their prescribed medication.

The investigation centers on Breggin's remarks to Winfrey that people who seek psychiatric advice should avoid doctors who want to prescribe medication immediately.

Breggin, who is fighting the complaint, contends that his First Amendment rights are being trampled upon. He said he was being "harassed by the establishment," which he says has long been hostile to his unconventional views on the treatment of the mentally ill.

The medical society will forward the results of its investigation to the Commission on Medical Discipline, which has the power to reprimand doctors or lift their medical licenses.

Specialists in the field of medical ethics said they viewed the complaint against Breggin as highly unusual, one that appears to pit a doctor's right to express his views against his ethical responsibility to avoid causing harm to patients. But even some of Breggin's detractors said they had never heard of the investigation of such a complaint against a doctor.

Breggin's attorney, Ralph Temple, called the investigation "absurd" and "unprecedented," and said it could have "a very chilling effect on doctors publicly debating issues of public health."

At issue specifically are remarks Breggin made when asked by Winfrey how he would advise a troubled person to select a psychiatrist.

"You judge the therapist," Breggin said, according to a transcript of the April 2 show. "Find the little part in you that loves yourself and see if you're being loved by your therapist. See if that person cares for you, supports you. If that person offers a drug, don't even say, 'No, thank you.' You can take the prescription and go. Don't fight about it, don't get in trouble, but go. Don't take the drugs. And relate to people who care for you as a person. That's the whole key. That's the starting point."

Later, Breggin added, "You have to be very cautious and especially avoid anyone who's diagnosing you, offering you drugs, offering you a hospital or has biology or electroshock attached to his associations."

James Howe, past president of the National Alliance for the Mentally Ill, filed the complaint against Breggin shortly after the program aired last spring. He said yesterday that his organization, made up of 50,000 families of the mentally ill, received reports from members that some mental patients who heard Breggin's remarks had discontinued their medication.

In some cases, Howe alleges, patients ended up being hospitalized. He said the organization had been told that a Montana patient's decision to stop taking his medication led to his suicide. But Howe has not provided evidence -- either names or details -- of any patients his organization says may have been harmed.

Howe contacted Dr. Thomas Krajewski, the highest ranking state mental health official in Maryland, about Breggin's remarks. Krajewski summarized Howe's complaint in a letter to the commission by saying Breggin "told all psychiatric patients to stop taking their medication."

"I would never say anything like that. I'm too sophisticated for that," said Breggin. "I was talking specifically about the selection of doctors."

Margaret Anzalone, executive director of the Commission on Medical Discipline, said she is prohibited by law from commenting on the investigation. Michael Murray, director of operations for the Medical and Chirurgical Faculty of the State of Maryland -- the state medical society -- said the complaint against Breggin was "unusual," but he would not discuss what provision of the law Breggin may have violated.

Howe said he believes Breggin has, in effect, irresponsibly prescribed a course of treatment for patients he has not seen.

Breggin, a one-time psychiatric fellow at Harvard Medical School and for several years a full-time psychiatric consultant at the National Institute of Mental Health, has a psychiatric practice in Bethesda. He has been involved in patient rights issues and has written extensively about the dangers he sees in antipsychotic drugs and electroshock therapy, both of which he views as causing unnecessary brain damage. He is a strong advocate of psychoanalysis and other forms of verbal therapy.

Breggin's views have made him a controversial figure in the psychiatric world, but he has some strong supporters both there and in Congress, and more than 30 of them have written to the medical society in Maryland to urge that the complaint against him be dismissed.

Robert Levy, a lawyer who follows mental health issues for the American Civil Liberties Union, said he was shocked that Maryland officials would pursue a complaint against a doctor expressing his views in a public forum. "He's not treating patients there," said Levy. "He has a right to express his opinions under the First Amendment."

Levy added that while Breggin's views may be somewhat outside the mainstream of thought in the mental health community, they are by no means unique and are in fact shared by a number of other psychiatrists.

Dr. Howard Zonana, a specialist on psychiatry and the law at Yale University, said that while he does not agree with Breggin, he thinks it is healthy for the psychiatric profession to hear his views. He agreed that many legitimate psychiatrists "don't think much of medication."

"I can't think of any case where idiosyncratic views got someone in trouble," said Zonana. "I've not heard of a case where someone went on {television} and said something outlandish and got drummed out of the corps."

Zonana said the National Alliance for the Mentally Ill has a "vested interest" in advancing the view that many psychological disorders are biologically based, and therefore are best treated with drugs. Zonana said the importance of biology, which has because widely recognized in the psychiatric community in recent years, "has allowed families to feel less guilty."

But Zonana and other legal specialists noted that the complaint -- that patients were harmed by Breggin's remarks -- is a serious matter.

Barbara Mishkin, a Washington lawyer who is an specialist on health issues, said that Breggin could not have been considered to have had a doctor-patient relationship with members of a television audience. But she noted that doctors have been disciplined for publicly advocating drugs and treatments that are known to be dangerous.

"There is no simple answer to this," she said. "It's really on the fringes of a number of different issues."