The symptoms of
scurvy include swollen, inflamed or bleeding gums, loose teeth, tender joints,
absorption of blood from vessels into surrounding tissues, anaemia, general
debilitation and, eventually, death. The cause is a deficiency of ascorbic acid
- vitamin C. James Lind conducted a famous experiment in 1749 and published
findings showing the link between scurvy and vitamin C in 1753 (though its
unclear whether he appreciated the connection himself). In fact, the cure for
scurvy was known well before Linds time. But the British Admiralty didnt
mandate lemon juice for ship rations until 1795.
The symptoms of
schizophrenia include delusions, hallucinations, disorganised speech and
disorganised or catatonic behaviour. According to Abram Hoffer, the cure is
nutritional - in particular, large doses of nicotinic acid (niacin) or
nicotinamide (niacinamide) - vitamin B-3. It was in the early 1950s that Hoffer
first postulated the link, but despite the success of his clinical trials the
treatment is still not part of accepted psychiatric practise.
Discovery
Hoffer recounts
his experiences in the research and orthomolecular treatment of schizophrenia.
Orthomolecular psychiatry, Hoffer writes, is the use of optimum (often large)
doses of molecules naturally present in the body to treat mental illness. Orthomolecular medicine can be contrasted
with toximolecular medicine the use of toxic chemicals to treat disease
(12). Considering the truism that all substances are poisons given the right
dosage, this seems a somewhat artificial distinction. Hoffer lays great stress
on the rhetorical claim that mental illnesses are not caused by deficiencies of
drugs, ignoring the fact that if a drug mimics a compound lacking in the brain,
the disease can indeed be regarded as a deficiency of that drug. However, drug
treatment of schizophrenia is notoriously problematic; drugs that calm the
hot symptoms of schizophrenia (e.g. psychosis) also tend to exacerbate the
cool symptoms (e.g. depression), resulting in an understandable lack of
patient compliance with drug treatment. Moreover, as Hoffer writes, patients
arent cured generally they must continue drug treatment for the rest of
their lives. Hoffers results with clinical trials and personal experiences of
vitamin B-3 treatment indicate that patients given the B-3 treatment improve
quickly and dramatically, and that hospital readmissions can be avoided by
continuing the treatment after discharge. Eventually, vitamin treatment may
also be discontinued. Hoffer does not advocate that patients on the B-3
treatment should go off their drug treatments (this, he writes, is a common
misconception about orthomolecular psychiatry). Rather, drug treatment should
be continued at least until the effects of vitamin treatment become apparent,
and drug treatment should always be discontinued under supervision, in the
approved, incremental manner.
This section of
the book is packed with experimental method and results. At times one wonders
just who Hoffers intended audience is: the information here does not seem
detailed enough to convince a psychiatrist, and yet may at times be too
detailed for the interest or understanding of the less scientific reader. It
left me with the desire to search out independent support for the conclusions
Hoffer makes from his data, though these conclusions are persuasively
delivered. (More on this in the Controversy section).
Recovery
In this section Hoffer describes his
diagnostic tests for schizophrenia, and his own categorisation of schizophrenic
syndromes by their underlying metabolic disorder. These include cerebral
allergy generally a food allergy with the brain as the main site of allergic
reaction, mineral deficiencies and toxicities (e.g. psychotic reaction to lead
poisoning), hallucinogens, vitamin deficiencies, and vitamin dependencies.
Those who are immediately sceptical about the link between mental illness and
vitamin deficiency (as I have to admit I was) would do well to consider the
story of pellagra. Pellagra, Hoffer writes, was a disease difficult to
distinguish from schizophrenia, until it was discovered that it was caused by
dietary deficiency. Once vitamin B-3 was identified as the anti-pellagra
vitamin, those who recovered with small doses of B-3 were reclassified as
pellagrics, those who didnt remained diagnosed as schizophrenic. Thus, Hoffer
writes, schizophrenia by definition remains the classification for a cluster
of badly understood illnesses.
Hoffer goes on to
describe the treatment for each of the schizophrenic syndromes. This section
contains information about dosages and appears to be geared to physicians,
though it is still interesting to read. Hoffer illustrates his treatment
outlines with reports of the results on various patients. More traditional
treatments are also covered, including ECT, tranquillisers, anti-anxiety agents
and antidepressants.
Controversy
Hoffers earlier analysis of his results is
so persuasive that it really makes you wonder why there is so much controversy
surrounding the use of vitamins in the treatment of mental illnesses, and
vitamin B-3 for schizophrenia in particular. Actually, a literature review
seems to indicate that research into hypotheses about and treatments of
schizophrenia involving vitamins and nutrition is increasingly prevalent. But
theres still not much on B-3. In fact, there have been difficulties
replicating Hoffers results. Hoffer puts the lack of support for his findings
down to the medical establishments enslavement by old ideas. Physicians are
hampered in the use of innovative treatment ideas by a lack of information on
one side standard medical journals are closed to revolutionary ideas and
the threat of censure by colleagues and regulatory bodies on the other.
In theory, the battle between Hoffer and
the medical establishment seems impossible to resolve. Hoffers account of his
successes is persuasive in his favour, and there are any number of reasons why
experiments aiming to replicate his results have failed, other than the
inefficacy of the treatment. But there are other explanations for experimental
success than the efficacy of treatment, and we rely on the independent replication
of results to weed these out. After some failures, it seems as though the
subject of B-3 treatment of schizophrenia has been dropped. In practise,
though, the dilemma may be pre-emptively resolved by well-informed consumers
patients, their families and friends, who have more to gain and less to lose
by innovative treatment than physicians. Though vitamin B-3 may not be the
complete answer to schizophrenia, the issues Hoffer raises about the role of
nutrition in mental illness and schizophrenia, and the reaction of the medical
establishment to new research in this area, are of great importance and
interest.
©
2002 Aislinn Batstone
Aislinn Batstone is a Ph.D. candidate
at Macquarie University, Sydney. Her research interests include metaphysics,
philosophy of logic, and the philosophy of neurobiology and mental illness.