The Decline of Orthomolecular Psychiatry

Abram Hoffer and Linus Pauling at the symposium, "Adjuvant Nutrition in Cancer Treatment," Tulsa, Oklahoma, November 1992.

Abram Hoffer and Linus Pauling at the symposium, “Adjuvant Nutrition in Cancer Treatment,” Tulsa, Oklahoma, November 1992.

We have written before on both the orthomolecular psychiatry of Linus Pauling and the birth of orthomolecular medicine, which has its roots in nutritional (later called orthomolecular) psychiatry. This post delves further into how orthomolecular psychiatry came to be, as well as its marginalization out of the scientific mainstream.

It all began with Albert Hofmann, the Swiss scientist who, in 1938, famously synthesized LSD and discovered its psychedelic properties. After several trials, some on himself, Hofmann developed the hypothesis that LSD mimics the effects of psychosis.

Hofmann’s idea inspired two English psychiatrists, Dr. Humphry Osmond and Dr. John Smythies, to further his research in the late 1940s. Using mescaline (derived from the peyote cactus) as their basic compound, the duo took Hofmann’s work a step further, eventually conjecturing that schizophrenics suffered from an overdose of an endogenous (made in the body) toxin that was similar in structure to mescaline and LSD.

Finding no sympathy in England – at the dominated by Freudian thought – Osmond and Smythies took their work to Saskatchewan, Canada, relocating there in late 1951. Once in Canada, Osmond met Abram Hoffer, a fellow psychiatrist with whom he would collaborate for decades. Together, Hoffer and Osmond ran the psychiatric sciences and therapies divisions of the psychiatric hospital in Weyburn, Saskatchewan, which housed a number of schizophrenic patients.

Hoffer and Osmond eventually discovered the toxin that Osmond and Smythies had suspected was causing the psychoses present in schizophrenics: adrenochrome, a byproduct of the body’s metabolic oxidization of adrenaline and noradrenaline. The next step in helping their patients, the doctors felt, was to find some way to alleviate the psychoses brought about by schizophrenia. This led them to nicotinic acid, also known as vitamin B3 or niacin. Niacin, they learned, was known anecdotally to help patients with neuropsychiatric disorders. This fit with the fact that pellagra, a disease caused by a deficiency of niacin, sometimes presents with psychiatric symptoms.

Eager to test their theory that vitamin B3 could help alleviate mental disease, Hoffer and Osmond began experimentation, dosing their schizophrenic patients with large amounts of niacin by adding it to their daily diets in the first double-blind tests performed in psychiatry. Once the experimentation was finished, Hoffer and Osmond followed their patients for ten years, measuring the effectiveness of their added-vitamin therapy in terms of readmission rates and ability to find outside employment once released from the hospital.

In 1962 Hoffer and Osmond published the book Niacin Therapy in Psychiatry, the text that introduced Linus Pauling to the duo’s megavitamin work. The book revivified his interest in the biochemical basis of mental illness, which he had been studying for a decade, having previously learned that phenylketonuria is a molecular disease in much the same way as sickle-cell anemia.

By the time Pauling read the niacin book, anecdotes about megavitamin therapy, as it was then called, had begun to spread. Additionally, it had already been discovered that niacin could lower cholesterol levels. When added to his prior knowledge, these facts led Pauling to find the evidence presented in the book compelling enough to merit further investigation. The final ingredient to Pauling’s interest appeared the next year, when Dr. Irwin Stone introduced Pauling to the potential health benefits of large doses of Vitamin C. .

It wasn’t until 1967 that Pauling coined the term “orthomolecular,” using it in print for the first time in a paper titled “Orthomolecular Methods in Medicine.” In 1968 Pauling wrote his more famous paper on the subject, “Orthomolecular Psychiatry,” published in the journal Science. Pauling, of course, went on to found the Institute of Orthomolecular Medicine with Art Robinson in 1973, (soon after renamed the Linus Pauling Institute of Science and Medicine) and co-edit the book Orthomolecular Psychiatry: Treatment of Schizophrenia in the same year. Around this time, Pauling also began broadening his theory of orthomolecular medicine to include the whole body, not just the mind.


But what happened to Hoffer and Osmond? The answer to this question plays a part in understanding why many doctors today still refuse to consider orthomolecular medicine a legitimate form of treatment.

In 1967 Hoffer and Osmond formed both the Canadian Schizophrenia Foundation and the American Schizophrenia Association. The two doctors had recently been encountering a great deal of resistance to the publication of their ideas, so they started their own journal, the Journal of Schizophrenia, in the same year. They asked Pauling to serve on the editorial board; Pauling agreed, participating in that capacity for the rest of his professional life.

In 1973 orthomolecular psychiatry was dealt a serious blow by the American Psychological Association Task Force. That year, the group published a report titled “Megavitamin and Orthomolecular Therapy in Psychiatry,” condemning the practice as unsupported at best and “deplorable” at worst. Hoffer and Osmond were subjected to humiliation and orthomolecular psychiatry was deemed unworthy of study or application. The following year, Pauling responded to the report, pointing out a number of flaws, including errors in methodology, lack of research, confusion of focus, and bias:

Orthomolecular psychiatry is the achievement and preservation of good mental health by the provision of the optimum molecular environment for the mind, especially the optimum concentrations of substances normally present in the human body, such as the vitamins….The APA task force report Megavitamin and Orthomolecular Therapy in Psychiatry discusses vitamins in a very limited way (niacin only) and deals with only one or two aspects of the theory. Its arguments are in part faulty and its conclusions unjustified.

But Pauling, Hoffer, and Osmond’s expressions of outrage at perceived mistreatment by the APA weren’t enough to overcome further obstacles that lay ahead. For one, in the mid-1970s, orthomolecular psychiatry, rather than sticking to megavitamin doses, expanded to include diet in the treatment of mental health, as well as avoiding stimulants like nicotine. However, no consensus was reached within the community with regard to precise standards for the practice, so recommendations varied from doctor to doctor, making the efficacy of orthomolecular psychiatry difficult to evaluate.

The mainstream introduction of tranquilizers and the phasing out of electroconvulsive therapy in the treatment of mental illness also proved a barrier to the orthomolecular community. Tranquilizers, unlike megavitamins, were immediately successful in alleviating symptoms, making orthomolecular medicine, which took time to work, appear ineffective by comparison.

Eventually, whenever a patient would ask about megavitamin or orthomolecular therapy as an alternative treatment, many doctors would simply cite the APA report, claiming that it had disproven orthomolecular methods. After a while, most patients simply stopped asking.

The American Schizophrenia Association eventually became the Huxley Institute for Biosocial Research, still led by Abram Hoffer. Dr. Hoffer asked Pauling to serve on its board of directors but Pauling declined, by then more interested in pursuing Vitamin C in the treatment of cancer and colds.  The flagging in his energy for the discipline of orthomolecular psychiatry was indicative of the lack of momentum within the field, a situation that persisted for the remainder of Pauling’s life.

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Humphry Osmond, the Original Psychedelic Psychiatrist

Humphry Osmond (front row seated, far left), with the Paulings and others at a gathering in Tulsa, Oklahoma. June 1972.

Humphry Osmond (front row seated, far left), with the Paulings and others at a gathering in Tulsa, Oklahoma. April 1972.

Dr. Humphry Fortescue Osmond, while never a direct collaborator of Linus Pauling’s, was nonetheless a professional influence in his life and a friend. Alongside Dr. Abram Hoffer, Osmond helped to establish orthomolecular psychiatry, the precursor to the larger body of work on orthomolecular medicine that consumed Pauling for close to three decades. Later in life, Pauling and Osmond wrote numerous letters back and forth, in which Osmond often shared interesting articles on the uses of vitamin C, schizophrenia, nutrition, and orthomolecular medicine.

Osmond is famous to both the medical community and to the public for related, yet separate reasons. In the field of medicine, Osmond, along with Abram Hoffer, is best known for his work in orthomolecular psychiatry. Working together, the two doctors performed extensive studies on schizophrenic patients in psychiatric hospitals in Saskatchewan, Canada, using niacin (vitamin B3) and ascorbic acid (vitamin C) as potential cures for the disease. Osmond is also known for his work with lysergic acid diethylamide, or LSD, in the treatment of alcoholism and as a way for psychiatrists and psychologists to experience something approximating what he believed to be the state that schizophrenics experience as they struggle with their illnesses.

To the public however, Humphry Osmond will forever be known as the man who coined the term “psychedelic” and the man who “turned on,” in the words of the famous LSD advocate Timothy Leary, acclaimed British author Aldous Huxley, a man with whom he developed a close friendship. In the early 1950s, Huxley approached Osmond after reading an article on his research with mescaline; Huxley expressed a desire for Osmond to run a human trial of the drug with Huxley as subject. Osmond wasn’t fond of the proposal, not relishing “the possibility, however remote, of finding a small but discreditable niche in literary history as the man who drove Aldous Huxley mad.” Despite his misgivings, Osmond dosed Huxley with 400 mg of mescaline in 1953.  The result was recorded in Huxley’s cult hit The Doors of Perception (1954), a book that both takes its name from William Blake’s poem “The Marriage of Heaven and Hell” and inspired the name of the legendary 1960s rock band, The Doors.

Later, when discussing his flight of hallucinogenic fancy, Huxley, writing to Osmond, penned this bit of verse:

To make this mundane world sublime, / take half a gram of phanerothyme.

The word phanerothyme, cobbled together from the Greek, translates roughly to “manifest spirit.”

In response Osmond wrote some poetry of his own, in the process coining a term that soon spread around the world:

To fathom Hell or soar Angelic, / just take a pinch of psychedelic.

Psychedelic – again from Greek etymology – translates to “mind-manifesting.” By 1957 Osmond had introduced the word to the medical community as a way to describe the euphoric, perception-altering, mind-expanding effects of hallucinogenic drugs like LSD, mescaline, DMT, and psilocybin. Previously the only well-known description of this concept was “psychotomimetic,” a mimicry of the symptoms of psychosis.


Humphry Osmond was born in July 1917 in Surrey, England, gaining his primary and secondary education from Haileybury, a long-established boarding school in Hertfordshire. After Haileybury, Osmond earned his medical degree from Guy’s Hospital Medical School, London, in 1942, and from there joined the Royal Navy, commissioning as a surgeon-lieutenant and training to be a ship’s psychiatrist.

After the Second World War concluded in 1945, Osmond returned home and accepted a position as a resident psychiatrist at St. George’s Hospital, Tooting. It was here that he met his future wife, Amy “Jane” Roffey, and his first major research partner, Dr. John Smythies. Together, Smythies and Osmond performed a number of studies in the late 1940s on the chemical composition and effects of the drug mescaline – a hallucinogenic derived from the peyote cactus – having been inspired by the work of Albert Hofmann, who had discovered the hallucinogenic properties of LSD a decade prior.

From their research, Smythies and Osmond hypothesized that because the experience of subjects on mescaline seemingly mimicked the symptoms of schizophrenia, and that because mescaline is structurally related to adrenaline, it could be possible that schizophrenics were over-producing a chemical related to both mescaline and adrenaline. They called this hypothesis, fittingly, the “M-hypothesis.” The idea, when presented to the British psychiatric medical community – which at the time was dominated by Freudian thinking – was not well received. Feeling isolated in the UK, in 1951 Humphry and Jane Osmond, along with John Smythies, immigrated to Canada, where Osmond had been offered a job as the clinical director of the psychiatric hospital in Weyburn, Saskatchewan.

"How to Live with Schizophrenia," by Abram Hoffer and Humphry Osmond, 1966.

“How to Live with Schizophrenia,” by Abram Hoffer and Humphry Osmond, 1966.

It was at Weyburn that Osmond met Dr. Abram Hoffer, director of psychiatry at the hospital, with whom Osmond would collaborate for the next decade. Working together with the patients at Weyburn and at neighboring hospitals, Osmond and Hoffer developed what became known as the “Hoffer-Osmond Adrenochrome-Hypothesis.” Using the M-hypothesis as their basis, Osmond and Hoffer claimed that it was adrenochrome, a byproduct of adrenaline that is structurally similar to mescaline and other hallucinogens, that schizophrenics were overproducing.  In theory, schizophrenics were suffering from their disease either as a result of their bodies producing too much adrenochrome or through an inability to properly metabolize adrenaline.

Working from this hypothesis, Osmond and Hoffer next searched for a way to reduce the overproduction of adrenochrome, hoping to find a cure for schizophrenia as well as additional evidence for their idea. Learning that niacin might limit the production of adrenaline, they decided to dose their schizophrenic patients with “megavitamin” amounts of B3, adding it to their diets in the first double-blind studies ever conducted in the field of psychiatry. The results were encouraging: according to their studies, the recovery rate for the schizophrenics that they treated over the next few years doubled from 35% to 75%.

In addition, the Osmond and Hoffer studies provided data that added to the finding that niacin could reduce cholesterol, a result that was replicated and confirmed by the Mayo Clinic in 1956. This finding is now globally accepted and niacin is presently used in the treatment of high cholesterol all over the world.


An example of Hoffer's "memos," October 1976.

An example of Hoffer’s “memos,” October 1976.

In 1967 Linus Pauling – who had learned of Hoffer’s work on niacin two years before – read the Osmond and Hoffer studies and, finding the subject interesting enough to pursue further, wrote to the duo asking for more information.  The data that he received was eventually included by Pauling alongside his own theories in his seminal paper, “Orthomolecular Psychiatry” (published in Science in 1968) as well as in the book that he co-edited with Dr. David Hawkins, Orthomolecular Psychiatry: Treatment of Schizophrenia (1973). Over time, Pauling expanded his orthomolecular theory from the study of the mind to include the whole body, thus creating the field of orthomolecular medicine.

This initial contact between Drs. Pauling and Osmond led to a nearly thirty-year correspondence between the two men, with Osmond regularly sending to Pauling selected copies of his “memos” – commentaries in which Osmond would paste a news article onto the left side of a sheet of blank paper, then cover the right side and the back with prodigious, elegant essays on the context, significance, and meaning of the article. (These memos were collected into a book, Predicting the Past, and published in 1981). Osmond made special effort to forward to Pauling those memos concerning ways in which orthomolecular medicine was being used around the world as well as any material on mental illnesses.

Exchanges between the two men were often personal as well as professional. For example, after learning of Ava Helen Pauling’s trouble with cataracts, Osmond sent Dr. Pauling any information that he could find on the ocular malady, of which Osmond was also a sufferer. Osmond also wrote letters filled with his thoughts on Pauling’s activism and increasing celebrity, including a letter in which he agreed with Pauling’s negative assessment of physicist Edward Teller, a major advocate for U.S. nuclear armament and the hydrogen bomb, as well as a letter congratulating Pauling on his 1977 appearance on NOVA.


1972i.4-cropped

In 1961 Osmond was appointed Director of the Bureau of Research in Neurology and Psychiatry at Princeton University. While there, he continued his research into schizophrenia as a physical illness. In 1970, hallucinogenic drugs like mescaline, LSD, and DMT were declared controlled substances, and studies on the effects of these drugs on psychiatric patients was curtailed.

In 1971 Osmond resigned his position at Princeton and moved to Alabama, where he taught at the University of Alabama, Birmingham as a professor of psychiatry. He worked there alongside his old friend, John Smythies. Osmond also consulted at Bryce Hospital in Tuscaloosa, the oldest and largest in-patient psychiatric hospital in Alabama. He retired from the university and the hospital in 1992. A decade later, by then an octogenarian, Osmond granted an interview for a documentary on the history of LSD, titled “Hofmann’s Potion.” Not long after, in February 2004, Osmond died of natural causes at his daughter’s home in Appleton, Wisconsin. Abram Hoffer wrote an obituary on the event of Osmond’s passing, which was featured in the British newspaper, The Guardian.

Some of Humphry Osmond’s more well-known books include The Chemical Basis of Clinical Psychiatry (with Abram Hoffer, 1960); How to Live with Schizophrenia (with Hoffer, 1966); Psychedelics: The Uses and Implications of Hallucinogenic Drugs (with Bernard Aaronson, 1970); and Models of Madness, Models of Medicine (with Miriam Siegler, 1974). A complete bibliography of his works can be found here.

Remembering Abram Hoffer

Abram Hoffer and Linus Pauling, November 1992.

Abram Hoffer and Linus Pauling, November 1992.

“As a physician, I am ambivalent about my association with the medical fraternity.  I am happy to be in a profession which has discovered so much information in the field of disease and health, but I am unhappy and distressed with such an association which almost invariably rejects at first hand the discoveries and views of scientists which it will eventually embrace with equal fervor.  Is there no end to this irresponsible hostility of physicians towards scientists such as Linus Pauling?  But this is the way it is.”

-Abram Hoffer, May 1986.

The Canadian physician Abram Hoffer, a pioneer of orthomolecular medicine, died in May 2009 at the age of 91.  The Hoffer name is stamped throughout the Ava Helen and Linus Pauling Papers as, in many respects, his career mirrored the final decades of Linus Pauling’s own work.

Hoffer’s career achievements are summed up nicely in this obituary published by the CNW Group:

Abram Hoffer became a pioneer of progress early on his career, challenging the dominant view at the time that schizophrenia was the result of poor mothering, and was instrumental in the authoring of research on the genetics of this common mental illness with the renowned geneticist Ernst Mayer. After co-discovering the first effective lipid-lowering agent, Vitamin B3 (niacin), the native of Saskatchewan became equally as instrumental in the development and execution of the first controlled clinical trials in psychiatry. This resulted in the creation of the then-controversial treatment of acute schizophrenia through principles of respect, shelter, sound nutrition, appropriate medication and the administration of large doses of water-soluble vitamins. In particular, Dr. Hoffer identified through research that large doses of Vitamin B3 (niacin) and Vitamin C could eliminate the symptoms of schizophrenia and reduce relapses. He dedicated his life to curing-not palliating-schizophrenia.

Hoffer’s breakthroughs in the medical understanding of schizophrenia paralleled similar work being conducted by Linus Pauling.  As Pauling noted in 1991

Dr. Hoffer, over 40 years ago, developed the basic principles of megavitamin therapy, a part of orthomolecular medicine.  I devised the word ‘orthomolecular’ to describe substances, such as vitamins, that are present in the human body, and are required for life.  I proposed, in 1968, that significant improvement in health and in the control of disease could be achieved by varying the concentrations of these substances in such a way that they would have their maximum effects.  Many physicians now call themselves orthomolecular physicians.

For the bulk of their association, Hoffer and Pauling, though inhabiting similar orbits, retained their independence from one another as researchers – each supported the other in various ways, but no scientific collaboration actually occurred.

This arrangement would change in the late 1980s as Hoffer became increasingly interested in the potential treatment of cancer using orthomolecular methods.  Based on his study of fifty patients Hoffer concluded that Pauling and Ewan Cameron’s hypothesis “that vitamin C in large doses did improve enormously the outcome of treatment for cancer,” was correct.  As he recalled in 2000

Linus asked me if I intended to publish the data. I replied that I did not. I added that in my opinion there was little point in trying to do so since it would be impossible to gain entry into any medical journal, that they would not accept any paper that dealt favorably with megadose vitamin therapy. The New England Journal of Medicine, which had published the Mayo Clinic attack on Pauling, refused to publish his rebuttal. Linus urged me to do a complete follow up study of every patient I had treated. I was flattered and agreed that I would. He said that he would see that the material would be published. But when I returned home I decided not to do the follow up. It would have meant an enormous amount of work. I thought that Dr. Pauling was being kind to me. Two years later I received a letter from Linus in which he said, bluntly, ‘Abram where is the study?’ I decided that he was serious about it.

Hoffer and Pauling’s shared interest in the vitamin C and cancer issue would result in two published papers as well as a book manuscript intended as a follow-up to Cameron and Pauling’s Cancer and Vitamin C (1979).  Despite Pauling’s enthusiasm for the project (“It is wonderful,” he wrote of Hoffer’s 1988 typescript. “It should have a great effect in convincing cancer patients, people in general, and even physicians that vitamin C has value in the control of cancer.”) the book and its unorthodox approach could not find a publisher, an issue further hampered by Pauling’s own flagging health.

Linus Pauling greatly admired Abram Hoffer’s work, to the point of declaring his support for a 1990 effort to nominate Hoffer for the Nobel Prize in Medicine.  Though both men are now gone, the record of their shared interests and collaboration remains extant in the Pauling archive.

For more information on the Hoffer-Pauling cancer work, see Pauling’s “Hoffer” research notebook listings or the finding aid description for their proposed book How to Control Cancer with Vitamins.  For more on Abram Hoffer, including a short film, see this memorial page.