Patients’ perspectives on schizophrenia: A Beautiful Mind, the movie

john_forbes_nash_jr__by_peter_badge

John Forbes Nash, Jr. photographed by Peter Badge

An old movie by now, Ron Howard’s 2001 highly awarded “A Beautiful Mind” graciously stands the test of time when it comes to great movies about severe mental illness illustrating the patient’s perspective.

This biographical movie shows the life story of John Forbes Nash, Jr., a Nobel Memorial Prize Laureate in Economics.

Nash, a brilliant mathematician, was diagnosed with schizophrenia in his early thirties. The movie follows Nash from his starting at Princeton as a young graduate student, to his late sixties, ending with Nash leaving the auditorium in Stockholm after accepting the Nobel Prize.

Directed by Ron Howard and starting Russell Crowe as John Nash, winner of four Oscars and 4 Golden Globes, A Beautiful Mind is in a category of its own.

There are few movies that manage to win universal applause while also providing an accurate, non-romanticized record of the mental angst and despair that are part of severe mental illness.

A Beautiful Mind manages to do all the above in an elegantly and deeply-touching manner. Furthermore, the movie offers a unique, insider view on what schizophrenia feels like from the patient’s perspective. The movie not only illustrate what hallucinations are but also the quid pro quo relationship between hallucinated perceptions and a delusional interpretation of reality. The world as seen through Nash’s eyes in the mists of his psychosis is a terrifyingly confusing and threatening place. Things are connected in ways that are meant to be secret.  Nash believes that he is both given permission and has the unique ability to see these connections. The expected secrecy is a good explanation why no one else can see what he sees.

The Reality of Illusion

In a sense, we all fabricate our realities. The way we know that our brand of “reality” is indeed real is by confronting it with the “realities” of other people out there. Family, friends, co-workers, the neighbor next door…  Do our realities match? Bingo. Chance is that we are seeing it as it is; that our subjective reality matches the objective reality, whatever that is.

Nash is an able builder of his own reality. He lives in a complex word, full of abstract meaning and symbols, which may be invisible to the untrained eye. But lack of visibility does not equal nonexistence. That is his first challenge.

Further, it just so happens that part of Nash’s reality is genuinely secret. Thus, Nash does not the benefit or those checks and balances that most of us have; he misses out on the opportunity to confront and match his subjective perceptions to re-calibrate and fine tune his reality check. This is his second challenge.

Add to that grave disappointment rooted in tremendous expectations fertilizing a mind which strength is in moving fluidly between concepts that do not seem to be even remotely related. A mind who remains organized in the most disorganized way, so to speak.

And that is when John Nash’s tenuous reality breaks down into paranoia and hallucinations.

Of note, while auditory hallucinations are frequent, the visual hallucinations that carry on a good part of the movie are in fact rare in schizophrenia. In Nash’s own words:

Something like [visual hallucinations] this may appear in the movie [A Beautiful Mind], but of course the delusion pattern in the movie is going to be somewhat different, because the person sees things that aren’t there. It’s not just ideas or the idea of a plot or something, he thinks he sees certain persons. I never saw anything.

As the story unfolds there is no surprise to see that Nash only finds further confirmation of his paranoid fears in the fact “they” are successful in locking him up.

The plot thickens in a gut sickening way. Viewers themselves are bewildered and traumatized by the too many overlapping and self-concealing layers of whatever reality is. Being inside Nash’s mind is no easy treat, even when that actually happens from the comfort and safety of the spectator’s seat.

What is it “really” that a good treatment for schizophrenia does? 

We further understand why many psychiatric patients make the decision to not take their medications. Following insulin-shock therapy and a full course of anti-psychotic medications Nash’s beautiful mind seems shattered to pieces. It is like an extravagantly colored, unreal Flamingo – Bird of Paradise combination of a majestic bird, who once used to fly close to the sun, got his long wings suddenly clipped. The bird once soaring aimlessly in the deeps of the sky is now orderly but also mindlessly dragging his feet in the mud.

It is important to note that this rather dire perspective of the effects of treatment is in fact not supported by John Nash’s own recollection of that period.

And it did happen that when I had been long enough hospitalized that I would finally renounce my delusional hypotheses and revert to thinking of myself as a human of more conventional circumstances and return to mathematical research. In these interludes of, as it were, enforced rationality, I did succeed in doing some respectable mathematical research.

The movie bluntly documents the devastating effects of schizophrenia on Nash’s personal and professional live. The struggle to take/not to take medications, the challenge of facing one’s demons without medication support, with the predictable yet still heart-wrenching return of the nightmarish hallucinations, the ambiguous relationship with the hallucinated reality itself, despite repeated reality “infusions” provided by family, friends and doctors – we see all of it in its terrible glory. And we get to understand.

The End?

A Beautiful Mind closes with an old Nash who, after painstakingly realigning the pieces of his life’s puzzle, is honored by his Princeton fellow professors. The movie closes with Nash seeing three of his old hallucinated friends/tormentors as he leaves the auditorium in Stockholm after receiving his Nobel prize.

After being treated early on with medications John Nash’s schizophrenia course is one of partial recovery.  Nash eventually chooses to stay off medications – this decision leads to”25 years of partially deluded thinking” in Nash’s own words.

Nash does attain a stable state off medication, but it appears that his symptoms do not completely go away – instead they decrease in intensity and go into partial remission. This illustrates the fact that the prognosis of schizophrenia is not universally dire and stability without medications can be achieved in specific cases. The movies also makes the counterpoint that Nash lost many years of productive life to his untreated psychosis before he reached a final state of relative stability.

Further reading:

1. “John F. Nash Jr. – Biographical”. Nobelprize.org. Nobel Media AB 2013. Web. 30 May 2014

Note: For an educational question and answer version of this post you can go here.

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