http://www.usatoday.com/usatonline/20020304/3909657s.htm
USA Today - March 4, 2002 Page 13A
Mind drugs may hinder recovery
By Robert Whitaker
The movie A Beautiful Mind, nominated for
eight Academy Awards, has brought welcome
attention to the fact that people can and
do recover from schizophrenia, a severely
disabling disorder that affects about one
in 100 Americans. Unfortunately, the film
fabricates a critical detail of John Nash's
recovery and in so doing, obscures a
question that should concern us all: Do the
medications we use to treat schizophrenia
promote long-term recovery -- or hinder it?
In the movie, Nash -- just before he receives
a Nobel Prize -- speaks of taking ''newer
medications.'' The National Alliance for
the Mentally Ill has praised the film's
director, Ron Howard, for showing the
''vital role of medication'' in Nash's
recovery. But as Sylvia Nasar notes in her
biography of Nash, on which the movie is
loosely based, this brilliant mathematician
stopped taking anti-psychotic drugs in 1970
and slowly recovered over two decades. Nasar
concluded that Nash's refusal to take drugs
''may have been fortunate'' because their
deleterious effects ''would have made his
gentle re-entry into the world of mathematics
a near impossibility.''
His is just one of many such cases. Most
Americans are unaware that the World Health
Organization (WHO) has repeatedly found that
long-term schizophrenia outcomes are much
worse in the USA and other ''developed''
countries than in poor ones such as India
and Nigeria, where relatively few patients
are on anti-psychotic medications. In
''undeveloped'' countries, nearly two-thirds
of schizophrenia patients are doing fairly
well five years after initial diagnosis;
about 40% have basically recovered. But
in the USA and other developed countries,
most patients become chronically ill. The
outcome differences are so marked that WHO
concluded that living in a developed country
is a ''strong predictor'' that a patient
never will fully recover.
Myth of medication
There is more. In 1987, psychologist
Courtenay Harding reported that a third
of chronic schizophrenia patients released
from Vermont State Hospital in the late
1950s completely recovered. Everyone in
this ''best-outcomes'' group shared one
common factor: All had weaned themselves
from anti-psychotic medications. The
notion that schizophrenics must spend a
lifetime on these drugs, she concluded,
is a ''myth.''
In 1994, Harvard Medical School researchers
found that outcomes for U.S. schizophrenia
patients had worsened during the past 20
years and were now no better than they
were 100 years earlier, when therapy
involved plunking patients into bathtubs
for hours. And in 1998, University of
Pennsylvania investigators reported
that standard anti-psychotic medications
cause a specific area of the brain to
become abnormally enlarged and that this
drug-induced enlargement is associated
with a worsening of symptoms.
Comprehensive care succeeds
All of this has led a few European
physicians to explore non-drug
alternatives. In Finland, doctors treat
newly diagnosed schizophrenia patients
with comprehensive care: counseling,
social-support services and the
selective use of anti-psychotic
medications. Some patients do better on
low doses of medication, and some
without it. And they report great
results: A majority of patients remain
free of psychotic symptoms for extended
periods and hold down jobs.
John Nash's recovery from schizophrenia
is a moving story. But we are not well
served when the movie fibs about the
anti-psychotic drugs' role in his
recovery. If anything, his story should
inspire us to reconsider
anti-psychotics' long-term efficacy
with an honest, open mind. That would
be a first step toward reforming our
care -- and if there is one thing we
can conclude from the WHO studies, it
is that reform is vitally needed.
Perhaps then we could even hope that
schizophrenia outcomes in this country
would improve to the point that they
were equal to those in poor countries
such as India and Nigeria.
Robert Whitaker is the author of Mad in
America: Bad Science, Bad Medicine, and
the Enduring Mistreatment of the
Mentally Ill.
http://IanGoddard.net
"To lengthen thy life, lessen thy meals." Ben Franklin
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