Schizophrenia: Symptoms and Treatment in a Beautiful Mind

The film A Beautiful Mind chronicles the adult life of John Nash Jr., a Nobel Prize recipient widely regarded as a brilliant mathematician who greatly influenced modern economic theory. The film focuses on Nash's decades long struggle with paranoid schizophrenia after he receives a diagnosis in 1958. Although it is well known that Nash was diagnosed with schizophrenia in real life, I will use this paper to discuss specific symptoms portrayed in the film, and consider how his treatment and environment contributed to his relative recovery later in life.

In the film, we follow Nash's long decent and subsequent recovery from schizophrenia as it spans his early 30's until his winning the Nobel Prize in 1994 in his 70's. We meet his character on the campus of Princeton, where he is pursuing his doctorate degree in Mathematics. We can see that Nash is a little different than his colleagues, and while charming, he has difficulty conforming to the social norms expected from his fellow students and professors. In dogged pursuit of an original idea, Nash is portrayed as a stubborn and driven outsider, an eccentric with questionable interpersonal skills. He is often disheveled, wandering the university halls talking to himself, or feverishly scrawling math equations on library windows. During his early years on campus, we see he has difficulty eating regular meals or maintaining consistent personal hygiene. His only close friend is his roommate Charles, who helps keep him grounded and focused.

Despite some of these challenges, Nash's dissertation on Game Theory is considered genius and groundbreaking. He graduates from Princeton and is offered a prestigious job at the Rand Corporation. He also teaches at MIT and here he meets and marries graduate student Alicia Larde Lopez-Harrison. Nash excels at his job, and he is soon contacted by a United States Department of Defense agent, William Parcher. Agent Parcher believes Nash's exceptional abilities as a code-breaker can help detect Russian attempts to infiltrate American democracy. Nash becomes fixated and determined in his high stakes mission, but it is isolating due to the classified and top secret nature of the work. Danger and intrigue explode in this part of the firm, and Nash increasingly becomes convinced he will be killed by Russian operatives. As viewers, we believe his paranoia is well founded, fearful for him and his family as it seems the Russians are closing in. In a chaotic chase scene Nash's panic climaxes and he screams at his wife to call the police. In a plot twist, Alicia calls a psychiatric hospital, and Nash is brought into care involuntarily. We soon understand that Nash's DOD code-breaking operations are not real, but a part of his mental illness. Nash, at age 30, appears to experience adult onset paranoid schizophrenia.

Schizophrenia is a serious and chronic mental disorder characterized by a breakdown in thought, feeling, and behavior. Often someone who suffers from schizophrenia experiences a psychotic episode where what is real and what is imagined is hard to distinguish. Symptoms fall into two classifications, both negative and positive. Negative symptoms include a lack of normal cognitive, emotional, or social responses, a flat affect, or a disinterest in interpersonal relationships. Positive symptoms include delusions, hallucinations, and disorganized thinking and behavior. In order to be diagnosed with schizophrenia, a person must experience at least one of these symptoms for 6 months or longer. Psychologists must rule out mood disturbance, brain trauma, and drug use (American Psychiatric Association, 2013). In the following paragraphs we will discuss the symptoms Nash exhibits in the film, and if the symptomatic presentations are realistic.

Nash experiences a psychotic break from reality during his tenure at MIT and the Rand Corporation, however there were early signs of his illness during his time at Princeton. Nash's character is clearly functional he has an exceptionally high IQ and is pursuing a difficult math degree at a prestigious institution. However, Nash experiences difficulty working with others and following social norms. When he feels like his intellect is not understood by one of his advisors he throws a desk out of his dorm window. Meeting and dating women do not come easy to Nash either. His flat affect and inappropriately direct tone with several women earn him a few slaps across the face. He has difficulty making eye contact and has detectable psychomotor retardation. At this point in the film Nash comes across as an eccentric but lovable genius, but his early symptoms are consistent with, and foretelling of, his later diagnosis.

As Nash graduates from Princeton, he publishes his groundbreaking paper on Game Theory and lands a prestigious position at Rand Corporation and MIT. He meets and marries his wife Alicia, and for several years he continues to be functioning as an employee and a husband. As time passes, the film portrays Nash as more disheveled, unshaven, disorganized, and consumed with his top secret DOD code-breaking work. We see papers crumpled and overflowing out of his briefcase, he is constantly cutting out newspaper clippings, and he commonly misses appointments or dates because time gets away from him. However, like his colleagues and wife, we as the viewer believe he is deteriorating because of the classified work is stressful.

By 1958 Alicia and Nash have a son, when soon after he is admitted into a psychiatric hospital. Here we learn the extent of Nash's break from reality, and his more attenuating symptoms are discovered. We learn his roommate Charles and Agent Parcher are not real, rather they are part of his long lasting and pervasive delusions and hallucinations. (The film takes some dramatic liberties by utilizing visual hallucinations as opposed to the more common auditory hallucinations. Nash spoke publicly later in life stating his hallucinations were auditory). We find there is no record of Nash having Charles as a roommate, and it becomes evident he has suffered from hallucinations for at least 10 years. The additional hallucination of Agent Parcher is an indicator that he is getting worse over time, and it is clear that Nash meets the criteria of having symptoms for 6 months or longer.

The paranoid delusions are also a cornerstone to Nash's diagnosis. He believes he is a highly valuable asset to the American government in the fight against Communist Russia. The belief that he is being followed and that they are trying to kill him is a common delusion among those who suffer from paranoid schizophrenia, and the film is highly realistic in this manner. It is also worth noting that Nash has a difficult time believing he is illit takes him months to understand his reality is imagined, also a common symptom of schizophrenia.

In the film, Nash is treated with deep insulin shock therapy (DIST) in the psychiatric hospital when he is first admitted. Developed in the 1930's, DIST emerged as one of the major treatments for schizophrenia until it was discredited in the late 1950's (Jones, 2000). We see Nash strapped onto a table, as various medical professionals administer insulin. His body experiences violent seizures and falls into a coma, a procedure believed to cure him of imbalances that were thought to cause schizophrenia. This procedure is hard to watch, and deeply upsetting to Nash and his wife. When he is sent home we also see he is prescribed a pill he is supposed to take daily. The film does not go into detail, but based on the year and the dosage we can guess the pill is most likely a first-generation antipsychotic.

The film highlights another important and realistic component of mental health treatment; medication adverse effects. Both DIST and early generation antipsychotics were unpleasant and their side effects great. We see Nash experience flat affect, mood disturbance, and sexual dysfunction. He complains he is unable to think clearly and develop new areas for research, which cause him to secretly discontinue taking his medication. After some time off the antipsychotic and a refusal to receive another round of DIST, his delusions and hallucinations return. This part of the film is highly congruent with reality and proves to be an opportunity for viewers to understand the struggle with medication adherence in this patient population.

Nash, with the support of his wife, ultimately decide to discontinue treatment in order to avoid many of the adverse side effects. He believes he can cognitively overcome his mental illness by understanding his hallucinations and delusions are not real. Although Nash does not return to complete health, he is able to manage his schizophrenia, return to work, and contribute to society. This case may be an outlier as far as positive long-term outcomes. Many people with schizophrenia need medication to lead a meaningful life, and there is some possibility that the film may promote false hope in suggesting treatment is not necessary. However, there are longitudinal studies indicating not all patients need antipsychotics continuously throughout there lives to significantly recover (Harrow, Jobe, & Faull, 2012).

The consequences of the illness on Nash's career and family are highly realistic and help shed light on the far reaching struggles associated with schizophrenia. The film does an excellent job in highlighting the burden a psychiatric illness can put not only on the patient, but on their loved ones as well. Nash's illness, untreated prior to diagnosis, is extremely disruptive and scary. He slowly becomes unable to preform in his job, and his behavior at home is unpredictable. Although some clarity and stability come with the diagnosis, Nash and his family reel from the side effects of treatment. He exhibits an almost catatonic affect, is unable to think clearly, and is unable to preform his duties as a husband and father. Nash experiences relapses because he stops taking his medication, a common and difficult aspect of this particular mental illness, and the family is thrown into disarray again. Until Nash gets his symptoms under control without treatment, something he ultimately was able to do, Alicia struggles with the burdens of taking care of their child, running the house, earning an income, and watching over Nash. The film does a good job of portraying how isolating a severe mental illness diagnosis is for the patient and the support system, and how difficult and long the recovery can be. It is also worth noting that the support of Alicia and Nash's colleagues most likely had a profound effect on his prognosis. More favorable risk and protective factors and better neurocognitive skills are associated with longer periods of recovery (Harrow, et al, 2012).

A Beautiful Mind is a well-crafted film portraying the intricacies and realities of living with paranoid schizophrenia to broad audience. Although John Nash's case is unusual in some respectshis above average intellect and strong support systemthe film realistically presents classic positive and negative symptoms. The film also presents general treatment and therapy in an accurate historical context, and explores Nash's specific individual choice to not receive treatment. In doing so, the film was able to portray many of the complexities associated with mental illness, and address certain stigmas and misconceptions associated with paranoid schizophrenia.

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