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.