NAMI 2007 Convention: Interview with E. Fuller Torrey
E. Fuller Torrey, M.D.
This is number five in a series of blogs made possible by the encouragement and financial support of The HealthCentral Network. All represent interviews with senior officers of NAMI [National Alliance on Mental Illness] or other luminaries that attended the NAMI 2007 annual convention. These interviews cover a wide range of topics that should be of interest to everyone that is involved in one fashion or another with mental health issues.
* * *
E. Fuller Torrey, M.D. is a psychiatrist and researcher investigating the causes and treatment of schizophrenia and bipolar disorder. He is the Associate Director for Laboratory Research at the Stanley Medical Research Institute, President of the Treatment Advocacy Center, and Professor of Psychiatry at the Uniformed Services University of the Health Sciences. He is also an author or co-author of 20 books including "Surviving Schizophrenia: A Family Manual" and "Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families and Providers". He has written hundreds of papers and book chapters on mental illness and has appeared on programs such as Oprah, 20/20, 60 Minutes, Dateline, and the PBS series "The Brain", among others.
In preparing for our interview, I learned that Dr. Torrey's sister was diagnosed with schizophrenia 50 years ago when she was preparing to enter college in 1957. Coincidently, in 1956, I received the same diagnosis at the age of 13. In those days, and for many years thereafter, the prevailing theory was that schizophrenia was a behavioral problem caused by neglect or psychological abuse by the parents or family, most especially the mother. The term schizophrenogenic mother was in common use. In my case, however, just 5 days after my symptoms first appeared, my mother took me to a psychiatrist who had been trained in Germany and Switzerland and believed that the causes of schizophrenia were biological. My doctor took a significant risk for that day and age and treated me with Thorazine ®, the first of the anti-psychotics.
"I did my training in medicine in Montreal at McGill [University] where Hans Leyman was," Dr. Torrey replied. "Hans Leyman was the first one in North America who used Thorazine ® in patients with schizophrenia. And he was one of the main lecturers in psychiatry in my freshmen course. I was introduced very early on to the whole history of the implementation and accidental discovery of the first generation anti-psychotics."
At both McGill University and later at Stanford University School of Medicine, where he did a residency in psychiatry, Dr. Torrey was exposed to the concept of a biological approach to treating mental illnesses.
"...I started out my first five years in an administrative job," Dr. Torrey said, "especially coordinating research that we were doing in other countries, and then I went on to the wards of St. Elizabeth's [Hospital in Washington, DC] where I worked for eight years with people with severe mental illnesses. During that time, I wrote the first edition of Surviving Schizophrenia, and was very actively advocating for people with severe mental illnesses. And that was back in the mid 70's, so it's been a while."
In fact, Dr. Torrey has been involved in advocacy for patients with mental illness for close to 30 years. And he's actively challenged the old convictions that schizophrenia is the result of bad parenting. He's a long-term proponent of the view that schizophrenia is a disease of the brain and has a biological cause. The cause has not yet been identified, but he has spent years doing collaborative research to find it.
"In my real life, I'm a researcher and that's what I spend most of my time doing," Dr. Torrey said..."We are both doing a lot of research and supporting a lot of research. The Stanley Medical Research Institute supports about $40 million a year, which is all on schizophrenia and bipolar disorder. And I'm involved directly in research on post-mortem brains. This is what gets me out of bed in the morning because I think we have the potential to understand both schizophrenia and bipolar disorder in a way that we have not had in the past. I'm very optimistic that we're approaching an understanding, not in all cases, but in a significant number of cases."
Dr. Torrey and his colleagues have been looking very intently at infectious agents as possible causes of both schizophrenia and bipolar disorder.
"Probably there are four [infectious agents] that have really come to the front of it," he continued. "My first choice is Toxoplasma gondii, which is a parasite that is carried by cats... This is an area of great interest. The other infectious [agents] are viruses...cytomegalovirus, which is a herpes virus; herpes simplex viruses (HSV1 and HSV2); and endogenous retroviruses."
Dr. Torrey has published a number of papers on the evidence linking infectious agents to schizophrenia and bipolar disorder. Most recently, he and Dr. Robert Yolken co-edited six papers on Toxoplasma gondii as a possible cause of schizophrenia that were published in the June 2007 issue of Schizophrenia Bulletin. These presented work from both their laboratories and from other researchers.
I asked him to elaborate on the potential connection between cats and schizophrenia.
"Well, Toxoplasma gondii is carried by cats," he explained. "We've done two studies on exposure to cats in childhood of people who have schizophrenia and it was increased. We now have a total of 46 studies that have been done looking at antibodies against Toxoplasma gondii in individuals with schizophrenia and they [antibodies] are clearly increased. If we're right on this, we are guessing that the transmission takes place probably early in childhood. We've not proven it yet, so you should not go home and kill your cat. And if you are over the age of 30 and you have a nice cat, that's fine. On the other hand, if you want to minimize any chances in your children, then getting a cat for a young child is probably not the right thing to do."
"Although the theory that an infectious agent can cause schizophrenia or bipolar disease is not proven and there are skeptics, it is gaining more attention," Dr. Torrey observed. "It seems reminiscent of the time before it was proven that stomach ulcers are actually caused by a bacterium, Helicobacter pylori. That's a very good story, actually, where everyone thought that stomach ulcers were caused by stress. We often use that story because we've been working on the infectious aspects of schizophrenia and bipolar for 20 or 25 year now. Once the ulcer story came out, suddenly people were more believing. If an ulcer could be caused by an infectious agent, then almost anything could."
In my family, not only do I have schizophrenia, but so did my grandfather, aunt, and uncle. I asked Dr. Torrey about the relationship between genetics and schizophrenia.
"We know genes are involved," he said. "We don't think genes cause it, but do know genes are involved as predisposing and it's perfectly consistent with an etiology of infectious agents...We're looking at the interaction of the genes with the infectious agents and we do have some research along those lines. Most of the work we're doing, but we're also supporting some of it. There is some preliminary data that people with certain genotypes and schizophrenia are more likely to be infected with Cytomegalovirus, for example. But most of the research I do focuses on infectious agents and has for a number of years...Most of it, I might add, is done with my colleague, an infectious disease specialist named Dr. Robert Yolken. He runs our laboratory at Johns Hopkins Stanley Laboratory of Developmental Neurovirology. I've worked with him since 1979 and I must say that, without him, almost none of this would have gone forward."
I was curious about the type of basic research supported by the Stanley Medical Research Institute.
"We support $40 million, of which $30 million goes for treatment trials for development and $10 million goes to the infectious work, neuropathology, and collection of post-mortem brains that we make available to researchers all over the world without charge. And now the third area that we're focusing on is biomarkers, where we're trying to develop some kind of diagnostic test...We think the technology is there. With a little luck, and with a little money behind it, there isn't any reason why we shouldn't be able to develop that."
I asked Dr. Torrey whether he envisions a third generation of neuroleptics.
"I certainly envision other kinds of anti-psychotics becoming available. We, in fact, have treatment trials with drugs that are effective against some of the infectious agents that we're looking at. So I fully expect that we're going to have drugs that are effective against some of the infectious agents ... And I think we're going to have different kinds of drugs in the future. We won't just have dopamine and serotonin related drugs...Obviously, the more we have the better so we'll have more choices because not everybody responds to the same medications."
In my case, it took 10 years to find the right combination of medications to control the symptoms of my schizophrenia. Now days, there are so many choices that I suspect it must be a challenge to pick the right drugs.
"But I think that one of the lines of research that is being pursued by drug companies as well as by us is to see if we can develop some predictors to see who is going to respond to which drug using genetic profiles among other things. And I don' think that's unrealistic...So if you took a genetic profile, you'd be able to immediately rule out some of the classes of drugs. But I think that it's coming."
Although Dr. Torrey is 69 years old, he has the passion and energy for his work of a much younger man. I asked him about what kind of hours he works.
"I work long hours. Always have. I'm taking off a little more time now. My wife is now retired so we do some traveling. But I've always worked very long hours mostly because much of what I do, I don't consider work. I've been fortunate most of my life doing things that I would do even if they weren't paying me. And I get very excited about being able to move forward on research on these diseases."