The movie A Beautiful Mind (Howard, 2001) tells the story of John Nash, a mathematical genius who suffered from schizophrenia. The movie begins when Nash is working on his PhD at Princeton in the 1950s. Treatment for schizophrenia was different in the 1950s than it is now. This paper, which addresses the treatment of Nash, will be written as if Nash was being diagnosed and treated today and not 50 years ago. The movie was based on the book by Sylvia Nasar.
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Nasar's depiction of Nash's life is less sanitized and much more detailed than the story that is told in the Ron Howard film, which seems like a "feel good" story of schizophrenia and avoids any mention of his bisexuality and facts of Nash's life.. There are other differences as well. For example, in the movie, Nash has visual hallucinations. According to the book, Nash hears voices that tell him what to do, but he does not have visual hallucinations. Since this paper is based on the movie, this paper will use the visual hallucinations as a symptom of Nash's illness.
Schizophrenia is characterized by hallucinations, delusions, disorganized speech, and grossly disorganized or catatonic behavior (American Psychiatric Association, 2000, section 295). John Nash displayed all of these symptoms. His closest friend, Charles, exists only in Nash's mind and is not a real person. Nash also displays disorganized behavior, although in his mind, it is organized.. For example, as Nash's illness progresses and he becomes more involved in his hallucination that he is breaking codes for the CIA, the walls of his office become covered in newspaper clippings and pages from magazines. To any one else, this would look like a disorganized mess. To Nash, this was a system of organization.
The delusional behavior is less obvious, at least at first. Nash was a true genius. Ordinarily, making statements like "Einstein was wrong" or that "Adam Smith (the 18th century economist whose theories are the cornerstone of capitalism) was wrong" would be considered a sign of a delusion of grandeur. However, Nash won a Nobel Prize for developing a theory which showed that Adam Smith was not necessarily correct. Thinking that he was smarter than Einstein and Smith, or, for that matter, his instructors at Princeton, was not necessarily delusional behavior for John Nash.
Nash was clearly deluded, however, about the nature of his work, which was described by his assistants as relatively routine, nothing special. He was not selected for a highly secretive project that would save the United States from attack. The fate of the world did not rest on his shoulders.
Other symptoms of schizophrenia include a flat affect (little or no emotional expression), alogia (loss of speech), and avolition (loss of goals or motivation) (APA, section 295). As portrayed by Russell Crowe, Nash showed all of these symptoms. His avolition, like his disorganization, was a matter of perspective. To those around him, Nash had lost his motivation to complete his dissertation and, later, to be a teacher. In reality, Nash was preoccupied with his delusions. There was an apparent loss of motivation that would be more accurately described as a misplaced motivation.
Finally, the DSM also specifies that "For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset" (APA, section 295). This criteria describes Nash's ragged personal appearance, his work history, and the problems in his marriage. DSM-IV also requires that these symptoms must be present for at least 6 months. For John Nash, these symptoms lasted from at least when he was in graduate school, if not before, and continued for the rest of his life.
It is unclear exactly what causes schizophrenia, although it appears that a combination of genetic and environmental factors are involved (National Institute of Mental Health [NIMH], 2005). The movie does not go into great detail about Nash's early life. There is no mention of schizophrenic behavior in Nash's parents or in any relatives, and genetic science in the 1950s was not as developed as it is today. There is also an apparent relationship between psychosocial stressors and schizophrenic relapse (Jibson & Tandon, 2002). As a student in a highly competitive field, Nash would have been under a great deal of psychological stress. This stress seemed to subside with treatment. However, later in the movie, the stress of trying to live a normal life led to another break through, and Nash begins to hallucinate again.
The movie paints a somewhat optimistic picture of Nash's life with schizophrenia. He eventually is allowed to return to Princeton in a limited capacity and eventually wins the Nobel Prize. Obviously, not all schizophrenics can look forward to such a positive prognosis. The movie also leaves the impression that the patient can somehow overcome schizophrenia by willpower. In the movie, Nash compares it to being on a diet and choosing not to indulge in his fantasies.
This is, in my opinion, an inaccurate and potentially dangerous depiction. In fact, one of the problems with schizophrenia is that the patient believes that he or she has overcome the disease and no longer needs to take medication or seek treatment. When the patient stops treatment, the symptoms reoccur, as they did for Nash. Perhaps a genius mind would be able to overcome this cycle and choose not to follow the hallucinations and delusions. The average person probably could not.
The prognosis would be much worse if the patient stopped treatment. Nash explained the he stopped taking his medication because he couldn't have sex with his wife. Sexual problems are a known side effect of Risperidone, one of the medications used to treat schizophrenia, although this medication would not have been available in the 1950s. Other side effects of this medication are anxiety, feeling tired during the day, dizziness, constipation, nausea, dyspepsia, rhinitis, rash, an accelerated heart rate, reduced salivation, weight gain, and other complications (Risperdal package insert). With these side effects, it is understandable why a person might discontinue treatment, especially if he or she did not think treatment was still necessary. Nash received electroshock therapy, an even more dramatic form of treatment.
In addition to the physical and mental aspects of schizophrenia, this disease also has a significant impact on the person's social life. In the movie, Nash is allowed to return to Princeton, where he can enjoy the company of students and other people. He is accepted by the students and faculty who seem to be very understanding of his illness. In real life, people are much more wary of inpiduals who hear voices, have delusions, or who have a noticeable mental illness. This stigma usually leads to isolation and loneliness. The inability to keep a job because of these behaviors would also lead to poverty.
Nash's life is an example of how schizophrenics can overcome and be successful. It is realistic because it is based on actual events. It is not, however, a realistic portrayal for the typical schizophrenic.
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