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 aren’t cured – generally they must continue drug treatment for the rest of their lives. Hoffer’s 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 Hoffer’s 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 didn’t 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

Hoffer’s 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 there’s still not much on B-3. In fact, there have been difficulties replicating Hoffer’s results. Hoffer puts the lack of support for his findings down to the medical establishment’s ‘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. Hoffer’s 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.