July 18, 2004
L.R. Mosher, Innovator at Mental Health Institute, Dies at 70
r. Loren R. Mosher, a former National Institute of Mental Health official who developed a drug-free approach to treating schizophrenia and argued that psychiatrists should rely less heavily on antipsychotic medications, died on July 10 at a clinic in Berlin. He was 70.
The cause was liver disease, his wife, Judith Schreiber, said.
In the 1960's and 70's, as psychiatrists were beginning to prescribe powerful new antipsychotic drugs to treat schizophrenia, Dr. Mosher advocated using little-known alternative therapies instead. From 1968 to 1980, while chief of the Center for Studies of Schizophrenia at the mental health institute, he began a long-term study that compared drug-free treatments with conventional hospitalization.
Through decades of research, he found that patients who were randomly assigned to live in a psychotherapeutic, residential setting with few medications did just as well as patients given drugs. In some cases, when the person had never taken any medication, he found the outcome was even better.
"Loren believed that you couldn't just give drugs to someone who is in deep distress and ignore them," said Dr. David Cohen, a professor of social work at the School of Social Work at Florida International University and a former colleague of Dr. Mosher. "He said that there was therapeutic value in just being with someone and bearing the discomfort of it. Just giving the patients drugs would only distance yourself from them."
The centerpiece of Dr. Mosher's research project was a 12-room house in San Jose, where one psychiatrist and a live-in staff cared for a group of about half a dozen young schizophrenics. The center, called Soteria, or "deliverance" in Greek, had a no-drugs rule unless patients became violent or suicidal. Staff members shared cooking and normal household chores with the patients and were encouraged to view them as their peers.
The goal, Dr. Mosher later wrote, "was to provide a simple, home-like, safe, warm, supportive, unhurried, tolerant and nonintrusive environment."
Dr. Mosher was convinced that supportive, social relationships could help his patients rebound from psychosis. He viewed the illness as a coping mechanism, a response to years of various traumatic events that caused the person to retreat from reality.
"Basically what they're saying is: 'Hey, folks, I'm out of here. I'm constructing this world as it pleases me, and I don't need to pay attention to that world out there. I'm going to live in this one because that one out there hurts,' " he said in a 2003 interview with the San Diego Weekly Reader.
By 1974, Dr. Mosher had opened a second residential treatment center in San Jose called Emanon. Both centers lasted until the early 90's, when financing dried up. But they inspired more than a dozen similar residential centers in Switzerland, Germany, Norway, Italy and other parts of Europe.
In his later years, Dr. Mosher wrote and spoke widely about his cynicism toward the pharmaceutical industry's influence on physicians. He resigned from the American Psychiatric Association in 1998, citing an "unholy alliance" between psychiatrists and drug makers.
Born in 1933 in Monterrey, Calif., Loren Richard Mosher earned his undergraduate degree from Stanford and his medical degree from Harvard. In the 1960's, he did early research at the mental health institute, studying sets of identical twins in which one had schizophrenia and the other did not. He focused on their family lives and upbringing, seeking to identify psychosocial factors that might have brought on mental illness.
Dr. Mosher was a clinical professor of psychiatry at the University of California at San Diego medical school. Throughout his career, he wrote more than 100 scientific articles and reviews. In 1989, he published a book, "Community Mental Health: Principles and Practice," which has since been translated into five languages.
His first marriage to Irene Mosher, ended in divorce in the early 70's.
In addition to his wife of 16 years, Judith, who lives in San Diego, he is survived by two sons, Hal, of Fairfax, Calif., and Tim, of Los Angeles; a daughter, Missy Galanida of Los Angeles; two brothers, Roger, of San Francisco, and Harold, of Casper, Wyo.; and one granddaughter.