|
David Horrobin is well known to many Canadian psychiatrists, particularly
those interested in biological psychiatry. Originally a scholar
from Oxford, he spent several years in Montreal and Atlantic Canada,
and was very active in psychiatric and psychopharmacological circles.
He founded 2 biotech companies that specialize in developing new
drugs for psychiatric and neurological disorders, of which 1 is
in Nova Scotia.
Here David Horrobin is the founding editor of Medical Hypotheses,
a leading journal for presenting new ideas and speculation in medicine.
His strength and claim to fame have always been radical speculations.
Imaginatively constructed, smoothly written, and easy to read, this
book is David Horrobin at his best. David draws on his extensive
knowledge of medicine and nutrition and his interests in biological
evolution and psychiatry.
By intriguingly sequencing observations and assumptions, he arrives
at radical hypotheses in this book. In essence, David postulates
that the origins of schizophrenia and the origins of humanity are
intimately related. He bases his speculations on a set of ideas
stretching from evolution to creativity.
David proposes that, at a particular point in evolution, a genetic
mutation took place that is related to an as-yet ill-defined abnormality
in phospholipid metabolism. As a result, brain size grew rapidly
and the changed metabolism led to an enormous increase in synaptic
complexity. An extraordinary neurobiological and psychological surge
ensued during the past 100 000 years. An abrupt increase in cognitive
ability increased our creativity and human inventiveness tremendously.
According to David Horrobin, however, abnormalities resulting in
the development of schizophrenia, and possibly other major psychiatric
disorders, also connected with such mutations. The same ancient
genetic mutation that is now presumably responsible for schizophrenia
did, in other human beings, generate exceptional skills and creativity—which
defines us as human beings and differentiates us from our nearest
relatives, the apes and the chimpanzees. Taking an evolutionary
approach, David describes how the first humans who originated in
Africa and migrated over Urasia and Australasia, presumably carried
with them the genetic gift of inventiveness, as well as the vulnerability
to schizophrenia. He alludes to the observation that families with
schizophrenia have not only more problems with family members—such
as more dyslexia, more bipolar disorders, more sociopathy, and more
criminals—but also more creative people. He mentions that such
families have more high achievers in every field, including music,
religion, the arts, and science.
The later chapters of the book describe David Horrobin’s own
research, suggesting that an effective treatment for schizophrenia
should include specific nutrients related to phospholipid metabolism.
It is here that the book becomes extremely timely, because recent
observations may support his earlier assumptions. David had speculated
earlier that phospholipid metabolism may be important in schizophrenia
and that schizophrenia patients are deficient in omega-3, as well
as omega-6 fatty acids. He postulated that fatty acids, such as
arachidonic acid and docosahexaenoic acid, are essential for the
normal functioning of the brain and that schizophrenia is related
to abnormal biochemistry of fat within the brain. The problems of
modern society may also then link to the reduction in the range
and amounts of essential fatty acids and other micronutrients found
in fresh food.
The pilot studies he coorganized seem to confirm the therapeutic
potential of these nutrients. These observations are timely: recent
reports from Harvard psychiatrists suggest the success of fish oil
in long-term treatment of patients with bipolar disorder, and a
large collaborative study in the US attempted to replicate this
interesting finding.
Orthomolecular movement focusing on nutritional treatment of mental
disorders, of course, has a long and active tradition in Canada,
associated particularly with the name of Abram Hoffer. Interesting
recent observations and pilot studies with micronutrients, coming
from Alberta, make such a line of speculations particularly intriguing.
David is brilliant in connecting several observations and assumptions,
some of them rather unusual. He then weaves together an intriguing
story. The difficulty is that more than a few of the ideas he takes
as given are questionable. For example, the assumption that creativity
and major psychiatric disorders (such as schizophrenia) come from
the same source is not well supported by other studies. Most observations
indicate that major mental disorders tend to stimulate the underlying
creativity rather than actually generate it. Similarly, the assumption
that schizophrenia is equally distributed all around the globe may
not be the result of ancient genetics but rather an artifact of
our blemished diagnostic and epidemiological approaches. David’s
speculations and generalizations range at times from tempting to
rather improbable; when you create a chain out of possible but questionable
assumptions, the resulting probability of a correct explanation
may rapidly decrease.
David’s evolutionary hypotheses are fascinating but hardly
testable. Even so, his hypotheses about nutritional treatment of
major mental disorders could be examined experimentally. The question,
however, is whether we psychiatrists are ready to test such hypotheses
correctly on reasonably homogeneous populations. Until then, David
Horrobin’s nutritional hypotheses will remain unproven but
certainly highly intriguing and stimulating.
|
