Wednesday, June 10, 2009

Abram Hoffer Dies

Abram Hoffer Dies

In case you don't know who he is--from the obituary in the May 30, 2009 British Columbia Times-Colonist:
He challenged the then-dominant view of schizophrenia as a psychological disorder caused by poor mothering, and contributed importantly to the formation of the field of neuropsychopharmacology. He co-authored research on the genetics of schizophrenia with the renowned geneticist, Ernst Mayer. He co-discovered the first effective lipid-lowering agent, the B vitamin niacin. He developed a controversial treatment for acute schizophrenia based on the principles of respect, shelter, sound nutrition, appropriate medication and the administration of large doses of certain water-soluble vitamins, in the process carrying out among the first controlled clinical trials in psychiatry. He advanced a plausible biochemical hypothesis to explain the cause of schizophrenia and how niacin and vitamin C could eliminate its symptoms and prevent relapses. Intrigued by the concept of metabolic “models of madness,” he and his research colleagues, notably his close collaborator Humphry Osmond, studied the properties of the hallucinogens and pioneered the use of LSD, which in conjunction with skilled compassionate psychotherapy, was found to be an effective treatment for alcoholism. His work with alcoholism led to a close friendship with Bill W., the founder of Alcoholics Anonymous. He organized a self-help organization for people with schizophrenia, Schizophrenics Anonymous. Participants at SA meetings occasionally exchanged the friendly greeting, “Salutations and hallucinations!” His colleague and friend, the American chemist Linus Pauling, championed the biochemical model for treating schizophrenia that was developed in Saskatchewan and provided a conceptual underpinning for the notion that large doses of certain naturally occurring substances can favorably alter disordered brain biochemistry, coining the term “orthomolecular psychiatry.”
My brother was treated with Hoffer and Osmond's methods back in the early 1980s--and there was enormous progress, at least for several years--to the point where, had I not known of my brother's struggle with schizophrenia, I would not have realized that he was mentally ill. The improvement was that dramatic. It did not last, for a variety of reasons, but I do suspect that Hoffer and Osmond were on to something, even if the exact details of the mechanism were not completely correct.

Unfortunately at the time, the psychoanalytic model for schizophrenia was at its height, and some very positive results and intriguing theories were largely ignored by the profession. In the last twenty years, the realization that schizophrenia is biochemical or structural in nature has again taken hold. I have confidence that in another 20-30 years, we will have a good understanding--and maybe even a cure for it. For those struggling with it, either in themselves, or in loved ones--you'll just have to wait. We're not spending enough researching a disease that, until deinstitutionalization, was the single largest cause of hospital bed-days in North America. (Now it's one of the largest causes of homeless people sleeping on park benches, in homeless shelters, and on steam grates.)

UPDATE: A reader who is a professor of social work tells me that social work grad programs had largely abandoned psychoanalysis in the 1970s, and his perception is that psychoanalysis was already in decline within psychiatry by the 1970s. Hobson and Leonard's Out of Its Mind points out that experiments done in the 1960s and early 1970s were also showing that psychoanalysis did not work for psychotics. Psychoanalysis with medications was about as effective as medications alone.

He also tells me that one of the reasons that Hoffer & Osmond's work was largely ignored was:

1. They had done a lot of research about LSD--and this created a negative view of them.

2. No one was much interested in trying to replicate their results with patients. That's sort of the kiss of death for scientific research.

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