Schizophrenia remains one of the most serious chronic diseases, attacking 1 to 2% of the population. Forty years ago patients suffering from schizophrenia occupied half of all the mental hospital beds and one-quarter of all hospital beds. Today, most of the mental hospitals have shut down but they have not disappeared. By refusing to accept patients, and by discharging them before they are ready for independent living, they converted the community into the new mental hospitals. About half of the homeless people on our streets are schizophrenics, many of whom have been treated in mental hospitals or psychiatric wards, placed on tranquilizers, and then discharged to fend for themselves.
The main difference is that formerly they were treated in inadequate hospitals, which provided shelter, food, nursing care and some medical care. Patients were protected from society and society was protected from the more violent aggressive psychotic patients. These patients had little personal freedom. Today, the modern mental hospital, which is the streets with their rundown hotels, nursing homes, foster homes and so on, provides tranquilizers for some, pays no attention to food, provides little shelter and provides no protection for patients and for society. But they do have much more freedom to be sick, to roam, to refuse medication, to prey upon others, to be preyed upon by others.
The end results are the same. Patients do not recover. The recovery rate today is certainly under 15% which is one-third of the recovery rate achieved in 1850 in England and in the USA in the Dorothea Lynde Dix hospital in the eastern part of the country. In my opinion, the street schizophrenics today are no better off than they were in 1950. They suffered tremendously then from psychiatric ignorance from this socially rejected disease, and they suffer today from psychiatric refusal to examine a much better treatment called orthomolecular therapy.
Modern drugs, primarily tranquilizers, are very helpful in ameliorating the symptoms of the disease, but by themselves they can not and do not lead to recovery. Psychiatric chemotherapy is equivalent to chemotherapy practiced by oncologists for most forms of cancer, they do little good and cause a lot of harm. Psychiatric chemotherapy leaves the unfortunate patients with a dismal choice: (1) to remain naturally psychotic without the benefit of these drugs in reducing suffering or, (2) suffering the iatrogenic organic disease, the tranquilizer psychosis.
Tranquilizers, no matter how helpful, create a major dilemma for patients and their psychiatrists. Given to patients, they help reduce the frequency and intensity of the symptoms, but given to normal people they make them sick. Under the communist regime in Russia, dissidents were locked up in mental hospitals and given tranquilizers. They were using their peculiar definition of mental illness, i.e. a person who disagreed with the system. These people were made psychotic by the tranquilizers. When patients are given the same drugs they begin to get better, their symptoms are alleviated to some degree, they are more comfortable and their families being to feel hopeful again that they will recover. But as they become better or more normal, they begin to respond to these drugs as if they were normal, i.e. they become sick.
The tranquilizer psychosis created by these drugs includes psychiatric and physical symptoms. The psychiatric symptoms are apathy, disinterest, poor concentration and memory problems so they can not study and learn, personality deterioration, and inability to function without supervision. On the physical side they develop tardive dyskinesia, other types of neurological conditions, impotence, obesity, and skin problems. Patients are no more fond of these latter symptoms than they are of their natural schizophrenia, and many prefer to be psychotic rather than suffer the ravages of this iatrogenic disease.
Orthomolecular therapy provides patients with a third choice, to become normal and stay well.
The importance of clinical diagnosis
Early during my career as Director of Psychiatric Research I became aware of the need to diagnose schizophrenia accurately and reasonably quickly. Our research psychologists had spent at least $50,000 (in 1955 pre inflation dollars) and after examining the psychological and clinical literature had concluded that there was no accurate test for this disease. They also concluded that this was due to the fact that psychiatrists would not agree on a definition and stick to it. The clinical expression of the disease was so variable that it was extremely difficult to sort it out from other conditions. This has been true of medicine in general. The great disease, syphilis, had a similar wide spread set of symptoms and signs and until the serological tests were developed there was the same degree of uncertainty. The situation has not changed over the past forty years. We still do not have any good generally used tests. The MMPI, in my opinion, is clinically of little value for the clinical psychiatrist even though it is used widely by psychologists. And the criteria laid down in the American Psychiatric Diagnostic Manuals seem to be ignored.
I had decided to use the criteria, described so eloquently, by John Conolly, the superintendent of a mental hospital in England. He wrote the book Indications of Insanity. His definition was clear and elegant and is the best working definition of this condition. It was, he wrote, a disease of perception combined with an inability to tell whether these perceptual changes were real or not. I have used this definition since and I have found it most valuable. But unfortunately American psychiatry did not know about this definition and was raised on the definition described by E. Bleuler. Dr Bleuler's definition depended upon the presence or absence of thought disorder with very little emphasis given to perceptual changes. This still remains a basis for diagnosing except that a whole host of other factors have become operative, probably because it is so difficult to define accurately when thought disorder is present.
I also became aware many years ago that the diagnosis, like changes in clothing fashions, changed with the prevailing attitude toward this condition. Thus, in the early 1950's psychiatrists under the sway of psychoanalysis would not diagnose it unless there was evidence of latent homosexuality. I remember that at one clinical conference the psychiatrist presenting the case had diagnosed the patient schizophrenic and then added that he was homosexual. During the discussion I asked him whether in fact his patient had ever actually been homosexual. He replied that he had not, but he added he must be a latent homosexual since Freud had declared that this was the basis for paranoid schizophrenia.
When we were conducting the double blind experiments to test vitamin B-3 for treating schizophrenics I discovered that for a while we were no longer admitting any schizophrenic patients to the Munro Wing, the psychiatric ward of the General Hospital in Regina, Saskatchewan. However as the study ran for several years this dearth of patients that I could enter into the study was replaced by a shower of patients. I soon realized that there was enough resistance among the clinical staff to allowing their patients to be included in the study that they initially preferred to diagnose them depression or anxiety or psychopathy . But since these patients did not recover and relapsed after discharge, on readmission they were forced to make the correct diagnosis.
Another factor was the knowledge that schizophrenics did not respond to psychotherapy. Knowing this, psychiatrists, if they wanted to give psychotherapy and believed it had a chance would not diagnose their patients. I recall one patient, whom I interviewed after the resident had been treating her with psychotherapy for several months. As I was talking to her she kept on looking over my shoulder into the corner of the room at the ceiling. I asked her what was she looking at. She replied that her sister, who lived in Edmonton, was in the corner of the room at the ceiling level and she was looking at her. A few days after I informed the resident that she was hallucinating he changed the diagnosis and sent her to the closest mental hospital. Today psychiatrists know that psychotherapy alone is of little value. But they also know that drugs, although very helpful, do not really make schizophrenic patients normal. If, therefore, they have a patient that they really want to treat they will diagnose them as bipolar (manic-depressive), or depressed which most of them are, and can then use lithium or anti depressants. If they don't want to treat them, if they are especially difficult, or troublesome, or have a dislikable personality they will diagnose them as personality disorders. In any event the result is that patients who are schizophrenic, and who would respond to some treatment are ignored and banished to the modern mental hospital of our large cities, the city streets.
This case represents one such case.
Elizabeth came to see me December 18, 1995. Her family practitioner wrote in his letter referring her to me "She is a 28 year old with a long history of psychiatric illness with varied diagnosis including anorexia nervosa, borderline personality disorder, multiple personality disorder and these associated with suicide attempts and multiple hospitalizations". She had also been diagnosed depression.
About mid 1992 she began to suffer severe headaches, about two to three times per month, unrelated to her periods, often preceded by nausea and vomiting. She was given the usual variety of headache medication without any response, including fiorinal, demerol, gravol, tylenol, Imitrex by injection. Her general practitioner had reported to the neurologist that she was working as a nurse's aid, was a good worker, and hated missing work.
Early in 1993 a consultant reported that she had had an eating disorder which was not responding to treatment. For over three weeks she had fasted and had not drunk any fluids. She felt faint, had palpitations and was very tired. She had been a member of an Eating Disorder support group. When she was sixteen she would starve herself for up to 6 weeks. When she gained some weight she would resume her fasting. She had also used laxatives. Later she began to use medication such as ionamine to control her appetite. She would binge and vomit 3-4 times per week. Sometimes two times each day. She had been a very good student making A's and B's, a good athlete, was happy with school and with her family. There was no improvement in the hospital.
She was admitted again. In the meantime she had spent four months at a private facility for anorexics. She was committed with severe depression, auditory hallucinations and suicidal ideation. This admission she admitted she had been a victim of child sexual abuse, by her step father. She continued to hear voices but the psychiatrist in charge interpreted these as a projection of her own thoughts. He began to indulge in psychoanalytic speculations about the causes of her voices which he denied were hallucinations. For the first time the term personality disorder began to appear in her record. This is in striking contrast with the opinion of her general practitioner who had seen her as basically a normal, achieving person. She was diagnosed depression and placed on anti depressants.
April 7 to 20, 1995, she was assessed by psychologists, She reported hearing derogatory voices inside her head which had become louder in the past few years. She also heard voices from outside calling her and saw faces in several different places e.g. in flowers, in food and in a window. She reported she had been in four motor vehicle accidents from December to January 1994 due to blackouts when driving. It was suggested that she suffered from dissociative reactions but no diagnosis was made.
During my first interview, she complained she had been depressed and agitated for four years. She was less depressed while on Prozac but was still having problems with her eating disorder. A mental state examination revealed a large variety of perceptual symptoms including hearing voices, seeing visions. There were voices of several men. There was also a change in taste perception. She could not tell the difference from the hallucinations and real phenomena. She was also very paranoid and suspicious of her family and friends. I disregarded all the previous diagnoses which totally ignored her main symptoms and diagnosed her schizophrenia. The mean score for schizophrenia is around 65. Few patients with other diagnoses score over 30 and all normal people score less than 20. On the HOD test she scored extremely high, as follows Total 152, Perceptual 36, paranoid 9, depression 16 and short form 14. The odds she was schizophrenic were over 90%. I started her on niacin 500 mg tid, ascorbic acid 1 G tid, pyridoxine 250 mg od and zinc citrate 50 mg od. Orthomolecular therapy includes the combined use of diet, nutrients in optimum amounts and drugs as needed.
Three months later she was free of voices. A month later I heard from the referring physician to express his pleasure at seeing how well she now was. He added "She is almost unrecognizably improved". June 11, 1996 she and I estimated she was 80% better. She stated that she felt normal for the first time in five years. In July she continued her improvement. She had visited her mother with her three children and had enjoyed the visit. When she had been depressed and paranoid her psychiatrist had stated that she had a poor relationship with her parents. This was apparently not the case. Her HOD scores were now normal. She was still on niacin 4.5 G od, Prozac 20 mg od and the rest of the vitamin regimen.
From the time I had first seen her there was one more visit to the Emergency Department of the Hospital. In 1992 she was seen in the Emergency 6 times. In 1993 she was seen 12 times with one after an overdose of drugs. In 1994 she was seen 16 times after 9 overdose attempts and spent 95 days in hospital. In 1995 she was seen 16 times with 2 overdoses. (Fifty visits to Emergency Services over a four year period with 12 suicide attempts and a total of 101 days admitted to hospital.) She started orthomolecular treatment on December 18, 1995. So far (November 1, 1996) she has been seen once in the emergency services.
Assuming that each day in hospital costs $1000 and that each visit to the Emergency cost $100, the total cost of hospital care, not counting payment to physicians for services rendered, was $106,000, over a four year period. After these numerous admissions to hospital, after extensive treatment, she had not shown any improvement. But after she was properly diagnosed which led to the correct orthomolecular treatment, she was almost normal in a few months. From a person declared inadequate (personality disorder), who had suffered severe depression and migraine headaches she became the normal person she had been before she became ill, free of Migraine, free of depression. She is once more able to look after her children. She will probably remain well as long as she remains on the regimen.
Scientifically, when a phenomenon (this patient’s history of illness and repeated admissions) suddenly changes direction after a new variable has been added, one must assume that the change in direction arose from the application of the new variable. Consider the course of her illness as an object moving in a straight line. Several pressures are applied but the object remains on course. However when the course is abruptly altered after the application of a new force then one can conclude there has been a true effect of the new force on the course of the illness i.e. that orthomolecular treatment caused her marked improvement.
by Abram Hoffer For Doctor Yourself