Schizophrenia: John Nash John Nash

Schizophrenia: John Nash JOHN NASH In the movie A Beautiful Mind, Russell Crowe portrays John Nash, a brilliant but eccentric graduate student of mathematics at Princeton University. From the beginning of the movie his eccentricities are clear. In class he sits apart from the other students.

At a social, he comments on the mathematical equation that produced the design on another student's tie, and then insults the other recipient of the fellowship he won by assuring him that there wasn't a single original thought in either of the papers thus written by the other fellow. We then immediately meet Nash's roommate, a profligate young man who jumps about on the furniture and seems to live only to drink. It is not until sometime later that we find out that Nash has no roommate.

In spite of Nash's obvious social awkwardness, he possesses a fair amount of charm. He tells his imaginary roommate that he is "quite well balanced" -- he has an equally heavy chip on both shoulders. However, he already believes himself to be special, too gifted to waste his time attending lectures and reading textbooks. In the opening scene, a professor tells the class that it was mathematicians who broke the Japanese code during World War II, and mathematicians who designed the atomic bomb, linking fine mathematical minds to national security.

In the movie, his meeting with the Army when they hire him as a secret code-breaker is quite elaborate. He is asked to view the army's preliminary data, and the wall of that room is covered with numbers. He detects patterns invisible to others. His delusion makes him an important person with specialized knowledge and skills crucial to the safety of his country. He believed he was implanted with a radium diode so they could track him. He believed visitors were escorted in to see him by military police.

Whether these comments are biologically accurate or artistic license the viewer cannot tell, but Nash did attend Princeton just after World War II when it had become evident that the United States had a formidable new enemy in its former ally, the U.S.S.R. In spite of Nash's eccentricities he manages to fall in love, marry, have a child, and become a tenured professor at M.I.T. In spite of these accomplishments, paranoid schizophrenia gradually takes hold of him and dominates his life.

He comes to believe that he has been hired by a secret government agency to detect coded secret message in common publications such as TIME Magazine. His wife is shocked to go into his workshop and find that the walls are covered with meaningless notes which nonetheless appear to hold great meaning for Nash. In addition to his imaginary roommate he imagines an imaginary government agency and a little girl. Eventually, Nash accomplishes something most Schizophrenics cannot do.

After a series of shock and drug therapy that does not help him, he cognitively understands that neither his roommate, the government nor the little girl really exist, and he wills himself to ignore his delusions. He returns to teaching, but when people come to visit his classroom, he checks with others to make sure the person is really there. Although his schizophrenia is not really cured, he is able to find a way to minimize its effects.

John Nash comes to believe that he has learned to control his schizophrenia to the point that he can live a relatively normal life. DIAGNOSIS The Diagnostic and Statistical Manual requires that specific symptoms be present over six months or more in order for a diagnosis of schizophrenia. Some of those symptoms include: delusions, or a false system of beliefs; hallucinations; disrupted speech; and severely disorganized or even catatonic behavior. A person must show two of these four symptoms to receive a diagnosis of schizophrenia.

Other symptoms, such as failure to practice basic hygiene and a flat affect, are common. The symptoms must have a significant and negative impact on the person's life. The differential portion is important; the symptoms must not be caused by some physical illness or developmental difference (APA). Schizoaffective disorder can be ruled out for Nash because his schizoid episodes are not tied to a severe mood disorder such as bipolar. Schizophreniform disorder is not an appropriate diagnosis because Nash has shown symptoms for some years (APA).

John Nash did meet the criteria for schizophrenia, paranoid type. He developed an elaborate system of hallucinations complete with a variety of people including military officers and his secret "controller," as well as his hyperactive roommate and the little girl, the imaginary daughter of his imaginary roommate. His symptoms endured over time and interfered with his life in significant ways. Sometimes it caused nearly complete breaks with reality, and in one instance, he attempted to kill his baby son.

He imagined his first hospitalization to be part of an elaborate plot against his activities as a spy. Eventually, it seems possible that Nash's schizophrenia was episodic, going into remission sometimes while recurring at others. Because this is possible, it seems possible that he does not control his schizophrenia to the level he believes he does. He does not present as having disorganized schizophrenia, and he is not catatonic. He does not have a history of a developmental disorder that might look like schizophrenia, such as autism.

The most valuable diagnostic tool in Nash's case, however, is his history, which includes delusions that he has had time to carefully construct and refine. TREATMENT In the movie, the approach Nash's psychiatrist wants to use is to tap into the man's considerable intelligence and help him use that intelligence to realize what is reality and what is hallucination. Nash resists this approach as strongly as he can at first, believing it all part of a vast spy network aimed at him.

Nash's psychiatrist might have chosen a more psychodynamic approach, looking for early crises in his life to explain his breaks from reality, but recent research suggests this approach may have limited usefulness, as there is some evidence that the early groundwork for later schizophrenia may begin in the second trimester of pregnancy in the structure of the developing brain (Bower, 1996). This suggests that schizophrenia has a strong physical component that should not be ignored in treatment. However, Nash's schizophrenia is also interactive with the environment (Humphrey-Beebe, 2003).

HE imagines himself to be a code-breaker because of his mathematical background, and his other delusions relate to the current events of the time -- the intensifying Cold War with the U.S.S.R. Recent research suggests that drug treatment early in the development of schizophrenia may actually slow the progress of the structural brain changes that accompany schizophrenia. Thus, while medication cannot prevent schizophrenia from developing, it may have the potential to alter its future path to the benefit of the patient (Thompson, 2002).

In Nash's case, neither the medications of the time nor shock therapy seemed to have any appreciable effect on his schizophrenia. He came home from the hospital, and in spite of taking his medication, believed that he was being relentlessly pursued both by the government agent, who had become menacing, and foreign agents. However, he cognitively knew that these people were not real and began to resist the hallucinations.

It would be interesting to know whether the combination of this cognitive approach and newer drugs to manage schizophrenia could have helped him in his struggles to sort hallucination from reality. Humphrey-Beebe (2003) noted that people with schizophrenia who received support via telephone for their disorder were more likely to get their prescriptions filled and cooperate in other ways with their treatment. Nash's wife, Alicia, realizes this, and guides him to re-involve himself in the world of mathematics. Encouraging Nash to remain.