John Nash: Recovery Without Drugs
One of this year's keynoter's at the November 21-24 annual conference in Portland of the National Association of Rights Protection Advocacy (NARPA) is noted author Robert Whitaker. Following is a OP ED piece he wrote recently for USA Today. Below that is a public statement by psychologist and author Barry Duncan, PhD about this falsehood in "A Beautiful Mind," and its implications.
Mind drugs may hinder recovery
by Robert Whitaker
USA Today Forum March 4, 2002
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 antipsychotic 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 antipsychotic 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 antipsychotic 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 antipsychotic 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 antipsychotic 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 antipsychotic 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.
Source: USA Today archives
PUBLIC STATEMENT - March 6, 2002
From: Support Coalition International
To: Universal Studios, Imagine, and DreamWorks Pictures
The film "A Beautiful Mind" has an ugly distortion: Author Robert Whitaker revealed in a USA Today commentary on March 4th that John Nash's recovery was linked to his refusal to take psychiatric drugs called "neuroleptics."
Apparently bowing to political correctness, the filmmakers instead had Nash claim he was taking "newer medications" at the time he received his Nobel Prize. John Nash and his biographer have confirmed this statement is fictitious. Nash was drug free.
This film is helping millions admire the resilience of psychiatric survivors. But this film also seriously misleads the public. The fact is, many people -- like Nash -- recover without taking psychiatric drugs. By caving in to pressure, the film has become an advertisement for the psychiatric drug industry. Nash himself wonders if the fact that one of the film's writers is related to a psychiatric professional played a role in this distortion.
This film says it was inspired by Nash's life. But it dishonors his hard won victory.
On behalf of 100 grassroots groups advocating for the human rights of people diagnosed with psychiatric disorders, we request that Universal, Imagine and DreamWorks Pictures issue a public statement of apology and clarification about this distortion.
Sincerely, David Oaks, Director
Support Coalition International
http://www.MindFreedom.org
Does Drug Company Marketing Now Include Product Placement in the Movies?
By Barry Duncan, PhD, Psychologist and
Author of _The Heroic Client_
Have pharmaceutical companies learned that product placement in high grossing movies is an excellent way to influence public opinion? Have drug company advertising execs watched too many Heiniken/Swordfish commercials?
Consider the high profile and now Oscar nominated film "A Beautiful Mind." In the film, the mathematical genius John F. Nash played by Russell Crowe says, "I take the newer antipsychotics. They don't cure me, but they help." This is a totally fictionalized statement; By all accounts, Nash took no antipsychotic medication after 1970.
This of course predates the so-called "newer antipsychotics" by some 20 plus years. Consider the following corroborations of the fact that Nash did not take these drugs:
- Sylvia Nasar in her award winning biography
of Nash, "A Beautiful Mind," writes on page 353, "Nash's
refusal to take the antipsychotic drugs after 1970, and indeed during most
of the periods when he wasn't in the hospital during the 1960s, may have
been fortunate."
- Sylvia Nasar, once again, in a 1994 article
(The New York Times, Sunday, November 13, pp. 3, 8), "The Lost Years of
a Nobel Laureate" reports the impressions of arguably the two most
important persons in Nash's life: his wife (Mrs. Nash) and his sister (Mrs.
Legg). Talking about Nash's "miraculous remission," Nasar says,
"And as happens, for reasons unknown, in the case of some people with
schizophrenia, it was not, according to Mrs. Nash or Mrs. Legg, due to any
drug or treatment."
- John Hoey, MD, in the article, "The
Peculiar Genius of John Nash" published in the Canadian Medical
Association Journal in 1999 (160:870) said, "How to account for this
spontaneous remission -- Nash refused to take antipsychotic drugs after
1970-is a matter of conjecture and the price that Nash has paid for both his
illness and his recovery is a distressing calculation."
- And John Nash's own words in his 1994
autobiography on the Nobel
Prize Website:
"But after my return to the dream-like delusional hypotheses in the later 60's I became a person of delusionally influenced thinking but of relatively moderate behavior and thus tended to avoid hospitalization and the direct attention of psychiatrists."
- Finally, in a recent (February, 2002) phone interview, Nash was questioned about the impression the movie gave that his recovery was due to the newer medications. He was asked whether that impression was accurate or artistic license. Nash said it was artistic license.
So, from several sources, including Nash himself, Nash's amazing transformation was NOT due to any drug or treatment. The fictionalized statement in the movie, then, raises many questions:
How did such a statement get added to the script? Whose interests are served by such a statement? Did the expert, Max Fink, MD, influence this invented reality regarding Nash's life?
Or someone else? Who is the expert working for or affiliated with? Is he affiliated with any of the companies that produce the newer antipsychotics? Did the drug company pay for that inserted statement like other companies purchasing the placement of their products?
It is not coincidental that many articles and reviews of the movie close with information about the newer antipsychotics, commenting on their less serious side effects than the older varieties like Thorazine. For example, consider this excerpt from the Seattle Times (February 3, 2002):
"Nash's approach came at a time when the pharmaceutical industry was coming out with more effective drugs whose side effects were milder than those he had initially been placed on. Today, there have been major advances, and mental health experts say newer antipsychotics such as Zyprexa, Seroquel and Geodon do not have the debilitating side effects of some of the older drugs."
Setting aside the questionable scientific veracity of those marketing statements (new drugs always promise more effectiveness and less side effects only to be shown later to be comparable to their predecessors, e.g., tricyclic antidepressants v. SSRIs), the process through which one man's story of courage and determination fueled by hope and the love of his partner is channeled toward the marketing of "modern medical breakthroughs" is both remarkable and curious.
The justification that will be given for the fabricated line in the script will be fear of giving the "wrong message" about recovery from schizophrenia. "Experts" will say that cure without drugs is very rare and could give those suffering and their families a false hope that something other than drugs can help them.
However, it is not rare at all.
Longitudinal studies show that many actually share Nash's story and reclaim their lives with community support and the love of family and friends. This "right" message is particularly ironic because Nash actually had to escape treatment and psychiatry before making his unique personal recovery.
The influence and marketing acumen of the pharmaceutical industry is legendary and many reports of the insidious nature of conflict of interest, ghost writing practices, etc are filed with an alarming but often ignored regularity. The "right message" crafted in the film and promulgated in reviews and echoed by "experts" do those suffering and the public a great disservice. The film recasts Nash's personal story of redemption as an example of how important drugs are to any reclamation of one's life, instead of an inspiring account of how people can overcome the most oppressive treatments and severe psychological distress with their own resources and support systems. And I can't help but wonder, does drug company marketing now include product placement in the movies?
Barry Duncan, PhD Barrylduncan@cs.com
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