It's a disease that creates a private hell for 250,000 Canadians. Doctors say there's no simple cure —but Dr. Abram Hoffer says his pill can treat
DR. ABRAM HOFFER, a psychiatrist who looks the part with a perpetual air of faint melancholy and hauntingly brooding eyes, is in the middle of a highly esoteric war raging among North American psychiatrists. What started the fight is his claim that the six fat pills he is holding in the photograph at right will, if taken daily, help "cure” schizophrenia. Each pill contains fifty milligrams of niacin, a vitamin known as B3, which is a variant of nicotinic acid, commonly extracted from yeast.
But schizophrenia has been traditionally regarded by psychiatrists as one of the most complex of all mental illnesses — hard to diagnose and even harder to treat. And so, by arguing that it is relatively easily diagnosed and simply treated. Abram Hoffer. director of psychiatric research for the province of Saskatchewan, and his collaborator, Dr. Humphrey Osmond, have apparently committed what amounts to professional heresy. Last March, Hoffer even compounded the crime when he announced that he had treated chronic schizophrenics, otherwise doomed to linger on in the back rooms of mental hospitals, with an enzyme called DPN — and obtained what, to the layman, appear to be miraculous results, though Hoffer, as a scientist, would shudder at the use of the word “miraculous.”
Schizophrenia, a condition that does not always involve a split personality, is one of mankind’s half dozen most common mental illnesses. At some time in their lives about a quarter of a million Canadians will develop schizophrenia, either briefly or chronically. The symptoms are strange and frightening. Schizophrenics may believe they are someone else because they have decided they don’t like their real selves, hut it’s more likely they’ll experience suicidal or near-suicidal depressions, hear nonexistent voices, perhaps believe someone dropped an atom bomb in the backyard or that their spouse is poisoning them. They’ll often withdraw from the real world in favor of a fantasy world populated by people no one else can see. A woman schizophrenic may become sexually aggressive; a man may become sexually passive.
And at any given time this tormenting illness. which strikes at least one person in a thousand, fills about half the nation’s mental and psychiatric-treatment beds. It is the nation’s number-one mental-health problem. Aldous Huxley once called schizophrenia “the plague of the twentieth century,” but there is evidence that it is as old as mankind — some of history's magnificent eccentrics were possibly sufferers. And it seems to attack men and women at roughly the same rate.
Hoffer and Osmond say their treatment works in most cases when used along with other, more traditional, procedures, including electric shock treatments and tranquilizers. They don't claim total cures. But they do say, and have been saying for almost ten years, that schizophrenics treated with niacin return to normal more quickly, need less treatment, suffer relapses less frequently and commit suicide less often than schizophrenics who are not treated with niacin.
THE HAUNTED WORLD OF MARY M.
SHE USED TO THINK the black bugs crawling over the kitchen floor and the sycophantic men and women in her living room by day were there because she drank too much. At times she even saw a docile white rabbit sitting companionably on the drain board as she cooked—and everyone knows Harvey is the alcoholic’s friend.
But when, six years ago, she quit drinking, Harvey and the bugs and the people in the living room stayed. Worse, the radio began talking about her and the front door constantly banged to and fro as unseen, menacing strangers marched in and out. Her four children — the eldest only twelve — complained, ‘‘Mummy doesn't love us any more.” and her husband wearily refused to believe she’d given up drinking. And so she began to devote hours to devising a way to kill him and remain undetected. She’s much better now — though on bad days the bugs are back and the door bangs — and she has three years of treatment from Dr. Abram Hoffer (see facing page) behind her. Today she’s a member of the local branch of Schizophrenics Anonymous, at whose meetings she is known as Mary M.
Drinking, say some psychiatrists, is a not uncommon handmaiden to schizophrenia: once the delusions start, they can set up stress that is eased by liquor. And then it becomes more comfortable to blame the hallucinations on the drink because it’s less frightening to admit to being an alcoholic than to accept the fact of mental illness. Mary M. is typical of many paranoid schizophrenics.
But this is only one of four common kinds of schizophrenic.
A second is the catatonic, like the first man ever treated by the Saskatchewan group with niacin. This patient found the reality of his hallucinations so terrible that he withdrew into a comatose state that was almost near death. Today, fourteen years later, he is a happily married businessman.
The third, or gradual, kind of schizophrenic becomes sick almost imperceptibly and often becomes a delinquent, a vagrant or perhaps a prostitute. The personality changes are slow but insidious and therefore often go unrecognized as symptoms. Dr. Abram Hoffer is, after four years, still treating one teenaged girl, the daughter of wealthy Americans, who has twice relapsed into a condition in which she has difficulty learning (although her IQ is above average). She also swings wildly between suicidal depressions and mad elation, and is promiscuous.
The fourth common type of schizophrenic suffers some of the symptoms of the other three, particularly the hallucinations, and often reverts to the behavior of infancy as well.
The classic “split personality” is far less common than most laymen think, though all schizophrenics may believe they are someone else. Such personality “splits” are most common, however, among paranoid schizophrenics, like Mary M.
In the cases described, the schizophrenics received the controversial niacin treatment. But even Dr. Hoffer admits they might have been what psychiatrists call “spontaneous” cures, or improvements. “By themselves, dramatic cases prove nothing,” he says.
It sounds absurdly simple, and that’s Hoffer’s main problem. The traditional belief among psychiatrists is that schizophrenia is caused by some disturbing or traumatic experience in infancy; Hoffer and Osmond say it is at least partly caused by faulty body chemistry. They have not been able to prove this theory, but their biochemical experiments, they say. at least tend to support it. At the same time, however, other scientists who have tried in vain to duplicate these experiments say Hoffer and Osmond are mistaken in their conclusions.
In the low-key world of scientific conflict this may be tantamount to saying Hoffer and Osmond — both internationally known and respected for pioneering the use of the hallucinogenic drug LSD in treating alcoholics — are either foolish, inept or incompetent research scientists. And yet. according to Hoffer. all he and Osmond have been saying is, “Look, fellow psychiatrists, our treatment works and our case records prove it. So why don't you set aside the scientific arguments and try the treatment, too?”
His complaint is that too few psychiatrists have accepted the invitation. He says. “Fewer than half the psychiatrists in the U.S. and Canada have bothered. And those who have bothered don’t always follow our treatment procedures. Then they attack us when their results don’t match ours.
“The trouble with most practising psychiatrists,” Hoffer continues, “is that they have been brainwashed by the disciples of Freud who have been responsible for much of the teaching of psychiatry since the late 1930s in North America. And Freudians are reluctant to admit that at least some mental illnesses may be physical, not psychological.”
Hoffer’s war, in a sense, is all part of a larger conflict within psychiatry. On one side are those who believe most mental illnesses should be treated with analysis; on the other, a growing army of psychiatrists, doctors and scientists who say, like Hoffer, that mental sickness is often caused by malfunctions in the body chemistry.
Hoffer’s stance is easily explained: he held a doctorate in biochem-
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Root cause of the disease, they theorize, is body chemistry
istry long before first becoming a medical doctor, then a psychiatrist. Since then, he has built up an impeccable list of scientific qualifications: apart from directing psychiatric research for the Saskatchewan government, he is also associate professor of psychiatry at the University of Saskatchewan, in Saskatoon, and has published scores of learned papers on the role of biochemistry in psychiatry, once as a coauthor with Sir Julian Huxley.
Humphrey Osmond. Hoffer's collaborator. is an effervescent, gregarious man with the kind of rumpled. Oxbridge charm publicly crystalized in the person of Malcolm Muggeridge. Both Osmond and Hoffer are fortyeight, and they worked together for ten years in Saskatchewan before Osmond left, first to return to England, and then to become director of the New Jersey Neuro-Psychological Institute. The theories they have been propounding with almost religious fervor can. in gross oversimplification, be summed up this way:
□ They believe (but admittedly cannot prove) that all the half dozen known kinds of schizophrenia have a common root: a malfunction in the body chemistry.
□ They believe (but admittedly cannot prove) that schizophrenia is at least partly caused by a specific malfunction that turns adrenalin — that exciting secretion from the brain w'hich courses through our veins in time of crisis or danger or excitement — into a kindred substance called adrenochrome. And they have actually satisfied most scientists that adrenochrome. when injected into humans, causes hallucinations and depressions similar to the symptoms of the most common forms of schizophrenia. (In 1951 they became their own first guinea pigs, and injected themselves and their wives with adrenochrome. Hoffer became temporarily paranoid and depressed and believed he was being followed; Osmond became elated: Rose Hoffer says she became “impossible to live with. I was so depressed.")
□ They believe that nicotinic acid, basically a vitamin known as B3, stops the body producing adrenochrome. So over the years they have treated three hundred and fifty schizophrenics — most of whose illnesses had been diagnosed by other psychiatrists — with fairly massive doses of B3. commercially available under the name of niacin. As a vitamin, niacin is taken at the rate of up to fifty milligrams a day. Hofier and Osmond administer massive first doses, then prescribe three grams a day for periods of years. It costs the patient about three dollars a month.
□ And though they still haven’t succeeded in producing biochemical evidence to substantiate the adrenochrome theory, they claim — and say their case histories arc proof — that the treatment works in most cases. Most significantly, they treated one hundred and four chronic schizo-
phrenics who had been ill and in and out of hospital for between two and thirty years. All were unable to work or lead normal lives. Of that one hundred and four, Hofter says sixty-
seven are now well and able to work, and twenty-three are “much improved.” “They suffer relapses from time to time and need further hospital treatment, but to a much lower degree than less severe schizophrenics not treated with niacin.” says Hoffer. C Last year a Swedish biochemist suggested that since niacin helps the body
produce an enzyme called DPN ( Diphosphopyridinc Nucleotide), perhaps doses of the enzyme itself might be even more useful in treating schizophrenics. Last November. Hoffer began to treat a score of chronic schizophrenics with DPN. The results, he says, were astounding. Even Dr. Brian O'Regan, chairman of the psychiatric
section of the Saskatchewan College of Physicians and Surgeons and himself something of a skeptic about Hoffer's claims, says. “The results he obtained with DPN are quite remarkable.” Some of these patients now appear well. One or two have been discharged from hospital, where they had spent years. All are still taking niacin to provide a continuation of treatment.
These DPN experiments are obviously Hoffer's most exciting and im-
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“We know the treatment works, even if we don’t know why”
“A man who bears watching”
Doctors who oppose the adrenochrome-niacin-DPN treatment theories are hard to pin down. Psychiatrists who are frankly scornful or skeptical when talking privately are reluctant to be quoted publicly. One psychiatricresearch scientist, highly placed in U. S. government health circles, who. Hoffer says, has been violently critical, refuses to be quoted on the grounds that he would first have to make a further study of the literature on the subject, but adds, “1 don't have time to do that at present.” Some psychiatrists and biochemists say they are unimpressed by the scientific validity of work published by Hoffer and Osmond. Biochemist T. L. Sourkes, of the Allan Memorial Institute in Montreal, says, “I have tested his [Hoffer’sj claim that schizophrenics’ blood contains an excess of adrenochrome. So have three other major laboratories in the U. S. and Denmark. We all found his results w'cre incorrect.” Dr. Sourkes. not being a psychiatrist, makes no comment on w'hcther niacin is effective in treating schizophrenia.
Dr. Heinz Lehmann, professor of psychiatry at McGill University, says equivocally that Hoffer “is certainly a man who bears watching,” and that “it's not impossible” he has discovered something. Dr. R. A. Cleghorn, director of the Allan Memorial Institute of Psychiatry in Montreal, says, “Some people have tried giving schizophrenics this nicotinic acid, but the patients have refused to take it after a while because of the side effects. It causes blushing all over the body.” (Hoffer and Osmond deny there are any side effects from the nicotinic acid preparation called niacin.)
Another professor of psychiatry says Hoffer suffers from “monomania” and believes “the rest of the world (of psychiatry) is persecuting him.” Hoffer is uncomfortably aware of this accusation, and says flatly, "I am not a paranoid. But I am frustrated be-
portant achievement yet. But he minimizes its significance now, because DPN will not be readily available for a year or more: it is not yet being produced in quantity.
Again, the DPN injections are based on the theory that it is effective because it stops the body from producing adrenochrome. Says Hoffer, “Our theory that the body produces the hallucinogen adrenochrome may be inaccurate, and if it is I'm scientist and man enough to want to know it. But it's the most reasonable hypothesis Osmond and I have been able to reach. Besides, we've proved that niacin and DPN work, and it wouldn't he the first time medical science has known something works — Aspirin for instance -— without being able to prove why. All we have to do now is persuade other doctors to try the treatment."
More are doing so: four major
mental hospitals in the U. S. are planning to introduce niacin treatment for schizophrenics on an experimental basis, and Hoffer says there is growing support for his theories in Europe, particularly eastern Europe.
cause all we’re saying in effect is that ours is a promising, likely treatment for schizophrenia, and we can't get it generally accepted even on that basis. Maybe some of the dramatic cures aren't good scientific evidence, but there was one dentist in California who was turned down when he asked doctors in a mental hospital to treat
his schizophrenic son with niacin. So he crumbled the tablets and spread the powder on jam sandwiches and then took the sandwiches to the hospital for the boy each day for a month. By then the boy was well enough to go home.”
The criticism of his work Hoffer finds most difficult to take is one
which pays him tribute as a psychiatrist while discounting his w'ork as a scientist. A psychiatrist who has worked with him says, “Hoffer makes a schizophrenic believe that he can be cured. He gives the patient niacin and perhaps it does help, but mostly it's Hoffer doing his job so well that — dammit — the patient does get well, at least as well as a schizophrenic can ever be said to he.”
But if psychiatrists are reluctant to try niacin, they are even more resist-
“If Abe Hoffer weren’t so dogmatic, he’d get more support”
ant to the Hoffer-Osmond contention that the diagnosis of schizophrenia is relatively simple. They long ago produced what is known as the H.O.D. (Hoffer-Osmond Diagnosis) test, in which suspected schizophrenics arc asked to reply “true" or “false" to statements that range from, “Most people hate me,” through, “My hands
and feet are too big for me,” and, "I feel as though my mind has left my body,” to, "More people admire me now than ever before.”
Their contention is that all schizophrenics suffer from a perceptual impairment; that their senses feed incorrect information to the brain and the brain is unable to make normal
deductions about the external world. The H.O.D. test is designed to measure the degree of perceptual impairment. This aspect of their work probably pains orthodox psychiatrists most of all. For they are being precise about the definition of a mental illness, and that takes courage in a field as wildly imprecise as psychiatry.
Says Dr. O’Regan, of the Saskatchewan College of Physicians and Surgeons, “Some psychiatrists believe Abe Hoffer’s diagnoses of schizophrenia are inaccurate.” (Most of Hoffer’s patients’ schizophrenic conditions were first diagnosed by other doctors.) He adds, "Saying that schizophrenia is easily diagnosed and treated is a bit like a doctor claiming, T have a cure for fever,’ when everyone knows all fevers are different because they're symptomatic of different illnesses. If Abe Hoffer weren’t so dogmatic he'd probably get a lot more support. After all, he's being positive and assertive about a mental condition that is hard to define. Four psychiatrists can examine one patient and it’s not impossible they’d all reach a different diagnosis, and only one of them might say it's schizophrenia.”
The schizophrenics Hoffer and Osmond have treated with niacin and DPN have no such reservations. Many of them still regularly visit the fifth floor of the University Hospital in Saskatoon, where Hoffer works in a cramped office. Adjoining it are the laboratories where Hoffer and his staff have labored in vain to prove conclusively that schizophrenics’ bodies do produce the hallucinogen adrenochrome. “Once we can do that, if we can ever do that, no one will be able to scoff,” he says.
“It seems he is helping”
More than twenty of Hoffer’s patients have set up in Saskatoon an organization called Schizophrenics Anonymous, modeled on Alcoholics Anonymous. Others serve on the board of an embryo group called Schizophrenics Anonymous International, whose aim is to promote SA groups around the world. Hoffer and Osmond themselves are officers of the American Schizophrenic Foundation, an organization set up in the U. S. about a year ago to help find a cure for schizophrenia. One of its trustees, Toronto companv director Donald Webster, says, “Our aim isn't to promote the theories of Hoffer and Osmond, though their work is very significant and there's an increasing amount of scientific evidence to support them. In fact. I believe there may be many different strains of schizophrenia not yet recognized as such, all responding to different biochemical treatments. Hoffer's work may just be the top of the iceberg, though it seems he is helping a great many schizophrenics at the moment.”
In fact, there are more than two hundred men and women in or near Saskatoon whose mental ills have been diagnosed as due to schizophrenia and who have received — and apparently benefited from — niacin treatment. Most of them still take it regularly, buying the vitamin (no prescription is needed) from a half a dozen city drugstores where niacin tablets are known to pharmacists as “Hoffer’s pilis.” To these people it is incredible that anyone should ever wonder whether Abe Hoffer is a fool or a genius. One patient, a woman, says, “Any doctor who doesn't bother to try niacin on a schizophrenic patient has no soul, no compassion. If they had ever suffered as I and most schizophrenics have suffered, they’d try anything.” ★