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September 4, 2003

Richard Carmona, M.D., M.P.H., F.A.C.S. The Surgeon General
Office of the Surgeon General
5600 Fishers Lane
Rockville, MD 20857-1750 USA

Re:   What Would you Testify Under Oath if Subpoenaed To Do So?/Are Mental Illnesses Biologically-Based Brain Diseases

Dear Dr. Carmona:

I am writing to request a response to the Pasadena Hunger Strikers' July 28, 2003, call for you to provide valid scientific evidence establishing "mental illnesses are biologically-based brain diseases."[1]  As you know, the claim that mental illnesses are biologic brain diseases underpins the virtually exclusive reliance on psychotropic medications in the treatment of people diagnosed with mental illness.  This claim also underlies the forced medication of tens of thousands if not hundreds of thousands of people each year through court orders and, many times that, through other coercive means.[2]  

If you were required to answer under oath, what would you say? 

Both NAMI and the APA have responded[3], but the Hunger Strikers are now into Day 20 of their Fast for Freedom in Mental Health and have yet to hear from you.  NAMI did not respond substantively, but the APA did, citing to a report issued by your predecessor:

The answers to your questions are widely available in the scientific literature, and have been for years. I suggest you begin your review with Surgeon General David Satcher's report, "Mental Health: A Report of the Surgeon General."

However, a panel of impeccably credentialed professionals appointed to review the APA's response found the following with respect to your predecessor's report:

Mental Health: A Report of the Surgeon General (1999) is explicit about the absence of any findings of specific pathophysiology:

 p. 44: "The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic, or general medical, disorders, since there is no definitive lesion, laboratory test, or abnormality in brain tissue that can identify the illness."

 p. 48: "It is not always easy to establish a threshold for a mental disorder, particularly in light of how common symptoms of mental distress are and the lack of objective, physical symptoms."

 p. 49: "The precise causes (etiology) of mental disorders are not known."  (emphasis added).

 p. 51: "All too frequently a biological change in the brain (a lesion) is purported to be the ‘cause’ of a mental disorder … [but] The fact is that any simple association – or correlation – cannot and does not, by itself, mean causation."

 p. 102: "Few lesions or physiologic abnormalities define the mental disorders, and for the most part their causes remain unknown."[4] 

Twenty days ago, the Freedom Fasters began their hunger strike in an attempt to get you, the American Psychiatric Association and NAMI to acknowledge the simple truths to fair, reasonable and legitimate questions.  Both the APA and NAMI as much as admitted they had no evidence supporting their public pronouncements.  Now it is up to you to respond to the Freedom Fasters.  What would your response be under oath?  Isn't it your responsibility as the Surgeon General of the United States to respond?





James B. Gottstein, Esq.

VP-Operations/Chief Operating Officer


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MindFreedom/Support Coalition International

[2] Such as evicting someone from their housing if they don't take "their medication."

[3] Attachments B and C, respectively.

[4] Attachment D.