(This is a follow-up - by Mike Miller - to the summary of the "Coast to Coast" TV program covered in Issue #32 of this newsletter)

I finally had a chance to talk with Dr. Carol North. If you remember, we were discussing her case the other day because she had been the subject of a television program. She had been psychotic for 8 years when she suddenly recovered fully after dialysis treatment. She has now been well for 18 years and is a psychiatrist and a professor in a major psychiatry department.

Dr. North's opinion of the research on dialysis treatment of schizophrenia is that it was often of poor quality and sample sizes were often too small. She suggested that it would help if researchers would do a longer term follow-up of treated and sham control patients to see if some of the treated patients stay well. She believes that if the treatment really works, the sham patients would relapse at a higher rate while the dialysis patients would stay well. For some reason, Dr. North did stay well even without repeated treatments. She has known other people who recovered from psychosis after dialysis treatments. In every one of those cases, the patient needed repeated treatments to stay well. One woman she knew would relapse and then would need another dialysis treatment.

Dr. North does not know what caused her illness, nor does she know how dialysis helped her. She believes that the nearness in time of the treatment and disease remission suggests it was not just a coincidence. But we can't say for sure. It's always a problem to interpret an individual case.

She has normal kidney function, and there has been no relapse. Why not? If the dialysis removed some chemical from her blood, how did the chemical get there in the first place? If it was there for eight years (the duration of her psychosis), her body was probably producing it. Why didn't her body produce more after the dialysis removed the chemical? This is a mystery that Dr. North cannot answer. We just don't know how dialysis helped her, or if it helped her. It certainly seemed to.

At this point, Dr. North's best guess is that she had some kind of neurological condition. This condition may still be with her. I hope it isn't. She told me that her symptoms would definitely have qualified her for a diagnosis of schizophrenia, but she is very much unlike most schizophrenia patients--most don't recover with dialysis treatment and most can't function anywhere as well as she did while she was ill.

You can read her story in her book:

AUTHOR North, Carol S. TITLE Welcome, silence : my triumph over schizophrenia / Carol S. North -- New York : Simon and Schuster, c1987

Best wishes,

Mike Michael B. Miller, M.S., Ph.D., M.P.E. Department of Psychiatry (Box 8134) Washington University School of Medicine