By Shankar Vedantam
Washington Post
Wednesday, December 24, 2003; Page A13

A recent report criticizing the funding priorities of the federal government's National Institute of Mental Health has reignited controversy over the organization's direction and destiny -- with the top official at the institute echoing some of the criticism himself.

The percentage of funds devoted to severe mental illnesses has shrunk even as the institute's budget has doubled, according to the report issued last month by psychiatrist E. Fuller Torrey's Treatment Advocacy Center, the Public Citizen Health Research Group and other mental health experts.

The report has created sharp divisions among the many mental health experts, advocacy groups and professional organizations that have stakes in the agency's mission and direction, and has illustrated the growing gap between scientific and popular visions of mental health research. Ultimately, the issue may be decided not within the NIMH but on Capitol Hill.

"If you are a psychologist out there studying people with schizophrenia and bipolar disorder, it's hard work," Torrey said in an interview. "It's infinitely easier and much more pleasant to study the romantic lives of your college students or how the students decorate their dorm rooms."

Like many of the disorders they treat, the difference between the positions of Torrey and other mental health experts lies in the details: What constitutes a serious mental disorder? What is the best way to measure the impact of a disorder? What basic neuroscience or behavioral research is relevant to a disorder?

Torrey's six disorders, for instance, are a small fraction of the total number described in the American Psychiatric Association's Diagnostic and Statistical Manual, which now runs to nearly 1,000 pages. The psychiatrist, whose sister suffers from severe schizophrenia, said the six serious disorders cost the United States at least $41.2 billion a year, more than half of the direct costs of all mental illnesses. The serious illnesses are relatively rare, but extremely disabling. Someone with persistent major depression, Torrey said, cannot hold a job and "stays in bed for 13 hours a day, and a trip to the store is all they can manage -- and they have to think for a couple of hours before they can do even that."

The serious disorders are also a major cause of deprivation and poverty: Of 400,000 homeless people in the United States, Torrey said about 130,000 have one of the six serious mental disorders. Implicit in the report is a criticism of the psychiatric establishment, which Torrey and his co-authors said is more interested in treating the milder disorders of richer people.

Kraut noted that, like Torrey, he has not hesitated to take his concerns to Congress, saying it is right that disagreements between Torrey and the other groups be resolved through scientific and political debate. "It's not Fuller's NIMH," he said.

Source: http://www.washingtonpost.com/wp-dyn/articles/A26270-2003Dec23.html