March 4

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Commentary by Vera Hassner Sharav

March 4, 2002 

Mind Drugs May Hinder Recovery


Robert Whitaker, author of Mad in America, adocumented critique of the mistreatment of schizophrenic patients in the U.S.,has an Op Ed today in USA TODAY (below) in which he objects to thefabrication of facts in the movie, A Beautiful Mind.

"John Nash’s recovery from schizophrenia is a movingstory. But we are not well served when the movie fibs about the anti-psychoticdrugs’ role in his recovery. If anything, his story should inspire us toreconsider anti-psychotics’ long-term efficacy with an honest, open mind."


Mind drugs may hinder recovery

By Robert Whitaker

The movie A Beautiful Mind, nominated for eightAcademy Awards, has brought welcome attention to the fact that people can and dorecover from schizophrenia, a severely disabling disorder that affects about onein 100 Americans. Unfortunately, the film fabricates a critical detail of JohnNash’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 NobelPrize — speaks of taking "newer medications." The National Alliancefor the Mentally Ill has praised the film’s director, Ron Howard, for showingthe "vital role of medication" in Nash’s recovery. But as Sylvia Nasarnotes in her biography of Nash, on which the movie is loosely based, thisbrilliant mathematician stopped taking anti-psychotic drugs in 1970 and slowlyrecovered 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 nearimpossibility."

His is just one of many such cases. Most Americans areunaware that the World Health Organization (WHO) has repeatedly found thatlong-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 patientsare doing fairly well five years after initial diagnosis; about 40% havebasically recovered. But in the USA and other developed countries, most patientsbecome chronically ill. The outcome differences are so marked that WHO concludedthat living in a developed country is a "strong predictor" that apatient never will fully recover.

Myth of medication
There is more. In 1987, psychologist Courtenay Harding reported that a thirdof chronic schizophrenia patients released from Vermont State Hospital in thelate 1950s completely recovered. Everyone in this "best-outcomes"group shared one common factor: All had weaned themselves from anti-psychoticmedications. The notion that schizophrenics must spend a lifetime on thesedrugs, she concluded, is a "myth."

In 1994, Harvard Medical School researchers found thatoutcomes for U.S. schizophrenia patients had worsened during the past 20 yearsand were now no better than they were 100 years earlier, when therapy involvedplunking patients into bathtubs for hours. And in 1998, University ofPennsylvania investigators reported that standard anti-psychotic medicationscause a specific area of the brain to become abnormally enlarged and that thisdrug-induced enlargement is associated with a worsening of symptoms.

Comprehensive care succeeds
All of this has led a few European physicians to explore non-drugalternatives. In Finland, doctors treat newly diagnosed schizophrenia patientswith comprehensive care: counseling, social-support services and the selectiveuse of anti-psychotic medications. Some patients do better on low doses ofmedication, and some without it. And they report great results: A majority ofpatients remain free of psychotic symptoms for extended periods and hold downjobs.

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 reconsideranti-psychotics’ long-term efficacy with an honest, open mind. That would be afirst step toward reforming our care — and if there is one thing we canconclude from the WHO studies, it is that reform is vitally needed. Perhaps thenwe could even hope that schizophrenia outcomes in this country would improve tothe point that they were equal to those in poor countries such as India andNigeria.

Robert Whitaker is the author of Mad in America: BadScience, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill.

© Copyright 2002 USA TODAY, a division of Gannett Co.Inc.

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