# Portrayal of schizophrenia in “A Beautiful Mind” ## Introduction A Beautiful Mind (2001) is a movie based on a biography of the same name, by Sylvia Nasar, of the mathematician John Nash. John Nash studied at Princeton University where he developed a mathematical theory that inspired many other contributions to scientific knowledge. In 1994, he was awarded the Nobel Prize in economics for his foundational work in game theory. With all his accomplishments, however, Nash was afflicted with schizophrenia, a disease he battled throughout his life. This movie dramatizes the story of John Nash, his wife Alicia, and Nash’s hallucinations: Charles, Marcee, and Parcher. ## Synopsis The movie begins with John entering graduate school at Princeton. John goes through some stress due to his social ineptness and the pressures of producing graduate level work. He meets his roommate, Charles, who turns out to be a hallucination. After an epiphany one night, John works tirelessly to produce a theory that earns his placement at Wheeler Labs at MIT and what would eventually earn him the Nobel Prize. The movie then skips five years into the future to a time when John is feeling frustrated with the banality of the work being given to him. One night after leaving his building, he is approached by a person named Parcher who offers him a secret, code-breaking job for the Department of Defense. Parcher and the job turn out to be delusions as well and in the course of his work, which is really just feeding his delusions, he becomes paranoid. Eventually he thinks that Russians are following him. After John experiences a particularly strong hallucination of being with Parcher, chased, and shot at, he comes home late and locks himself in a room. The next day, while teaching a class, he is looking out the window, paranoid, while the entire class watches him. After class, he tells Parcher that Alicia is pregnant and he can’t work for him any more. Parcher tells him that he won’t protect him from the Russians any more. That night, Alicia finds John sitting in the dark and staring out of the window. He then gets agitated and tells her to pack her things and go to her sisters for her safety, By this point, Alicia has become concerned with John’s increasingly erratic behavior. Alicia worriedly calls someone and a psychiatrist has John brought to the hospital where he is diagnosed with paranoid schizophrenia. Shortly after John’s initial recovery, he relapses into schizophrenia, due to quitting his medication in reaction to its side effects. One afternoon, he almost lets his son drown in the tub and pushes his wife to the ground because of a hallucination. The sight of his wife getting into the car to leave with his son sparks his mind to recognize that his hallucinations aren’t real and he decides to use his will to try ignoring the hallucinations and delusions. With his marvelous ability to prevail over the hallucinations that plague him, as well as Alicia and John’s colleagues at Princeton helping him along, John travels the long and difficult road of recovery. Eventually, after gaining the respect of his colleagues and students, John is honored with the Nobel Prize in economics for his contributions to theoretical knowledge. ## Description During John’s prodromal phase, he exhibits symptoms of social ineptness and withdrawal. He described himself as having “a chip on both shoulders” (Glazer & Howard, 2001) and his peers perceived him as being odd due to his particularly eccentric mannerisms and speech. For these reasons and his extraordinary genius, he was rather acerbic with a particular peer that he viewed as a threat. This social stress and the pressure of being at Princeton may have triggered his predisposition to schizophrenia, because shortly after a trying social event, he experienced his first hallucination of the character Charles. This preceded his particularly pervasive active phase. During John’s active phase he experienced paranoid delusions, delusions of reference, hallucinations, continued peculiar behavior, and eventually disorganized speech, disheveled appearance, agitation, and affective flattening. His hallucinations, delusions of reference, and paranoid delusions became deeply intertwined with his life. The movie portrays his hallucinations as being a response to his feeling a lack of recognition from his peers and the intense drive he had to produce noteworthy work. His delusions of reference took the form of finding messages that were meant for him in newspapers and magazines. He would meticulously analyze the messages and compile them for his hallucination, Parcher. Eventually, in the course of what he thinks is a secret job working for the Department of Defense, he develops paranoid delusions that he is in danger and being followed by Russians. Over time, John takes less care to shave and his behavior becomes more peculiar. At one point, he has a hallucination of b eing chased and shot at, while with Parcher. After this episode, his symptoms worsen, as portrayed by his difficulty speaking during a presentation. His symptoms had accumulated to the point that he had scared his wife and she calls a psychiatrist who takes him as patient. After psychological treatment and medication, John enters a preliminary residual phase where he exhibits symptoms of social withdrawal, affective flattening, and avolition. This period was very stressful for Alicia and John was beginning to exhibit symptoms of depression due to his condition and lack of social interaction. His medication also had side effects of a mental fog disturbing his mathematical and the effect of preventing him from being able to comfort or satisfy his wife. The latter cause him to stop taking his medication, which results in a relapse of his hallucinations and delusions. John’s relapse resulted in continuing the chain of hallucinations and delusions of reference he had previously. He displayed catatonic behavior during which he was holding his son and completely oblivious to his presence and crying. After months of continued delusions, one day sparks an episode of agitation and he nearly drowns his son in the bathtub, thinking that Charles was watching him. Alicia tries to call John’s psychiatrist but his hallucination, Parcher, tries to kill Alicia and John accidentally pushes her down. This causes Alicia to leave the house, and presumably John, out of fear. In a breakthrough moment for John, he stops her from leaving after having finally come to understand that his hallucinations and delusions aren’t real. John then goes through treatment, again, but with the drive to overcome his illness. In what becomes John’s final residual phase and eventual remission, he still experiences negative symptoms of flat affect and slightly disorganized speech, however he does gradually regain his mathematical ability and becomes less withdrawn. His hallucinations persist, however, but in what might be the most remarkable part of this story, John is able to ignore his hallucinations and work toward a life of relatively normal behavior. This combined with the help of his wife and colleagues leads to the respect of his peers and eventually the Nobel Prize, all of which may have contributed to his well-being. ## Diagnosis John Nash, as portrayed in this film, appeared to be suffering from Continuous Paranoid Schizophrenia With Prominent Negative Symptoms. Since a typical experience for someone in John’s work environment might potentially include being recruited to work with classified information, one might not consider his delusions particularly bizarre. In addition, his hallucinations were not a running commentary or two voices conversing. For these reasons, two symptoms from Criterion A (characteristic symptoms) must be met for a diagnosis of schizophrenia. John obviously experienced both delusions and hallucinations, which would satisfy these criteria. Additionally, at various times in the course of his illness, John experienced episodic symptoms from Criterion A: negative symptoms (affective flattening, alogia, and avolition) during the residual phase after leaving the hospital, disorganized speech while presenting the National Mathematics Conference, and catatonic behavior while holding his child. Criterion B (social/occupational dysfunction) was met by his withdrawal from Princeton, disheveled appearance, and his tardiness on a date with Alicia and arriving at home late. While the last two symptoms may be isolated, one might interpret the portrayal of these two events as being indicative of a pattern of behavior, and therefore satisfying Criterion B. It is clear that the duration of his symptoms satisfy Criterion C (duration) of the DSM-IV-TR. Schizoaffective Disorder, Mood Disorder, substance interactions, medical conditions, and Pervasive Developmental Disorder can all be excluded as a cause of the overall disturbances. However, John did have a brief mood disturbance during the residual phase after his return home. Etiology While the movie does not go into any detail about the etiology of John’s schizophrenia, it does mention that stress triggers his delusions. The director’s commentary makes it clear that the filmmakers view John’s delusions and hallucinations as serving a purpose in John’s life. Analyzing the events in John’s life, as portrayed by the film, we can see that his delusions and hallucinations do serve a purpose. Specifically, they appear to provide an outlet for John’s frustrations with social situations and the stresses of work. Illness may have gone untreated for a long time, leading to more severe symptoms. ## Treatments John is given a few different treatments through the course of the movie. At first, they administered anti-psychotics and kept John in an institution for observation and care. However, due to his particularly strong active phase, they attempted insulin shock therapy. In addition, his psychiatrist attempted cognitive-behavioral therapy by teaching John that his delusions were not real. It took the concerted effort of his psychiatrist and his wife to help John come to the realization that his delusions and hallucinations were a real problem. This motivated him to try to fix the problem by putting himself on a “diet of the mind” (Grazer & Howard, 2001) while still taking medications. The movie portrays this, combined with a sort of social rehabilitation (John returns to the Princeton campus where his former colleague helps provide a safe environment), as allowing John to regain some social stability and eventually work around his mental illness by ignoring his hallucinations. ## Discussion The cast and crew of A Beautiful Mind put effort into treating schizophrenia accurately and with compassion in this movie. Director Ron Howard attempts to introduce every one of Nash’s delusions with an auditory component before presenting them on camera. In this way, he wanted to maintain accuracy to actual cases of schizophrenia. However, it seemed to be a much nuanced, subtle way to convey the auditory nature of hallucinations. Many people may miss this subtlety while watching the movie. In addition, there are many aspects of schizophrenia and John’s life that are glossed over or omitted. With regard to compassion, during Nash’s first encounter with the psychiatrist, one can easily empathize with how frightened he must have felt when being cornered. Once he was in the institution, one could almost feel the pain that John and Alicia must have been going through, especially the scene where John is undergoing insulin shock therapy. This speaks to the empathy with which the actors, writer, and director employed when filming this movie. In addition, the filmmakers were able to convey the pain and frustration that John, Alicia, and their peers, had to go through in the course of John’s illness. One poignant example, that shows how the filmmakers attempted to reduce the stigma surrounding schizophrenia, comes from a scene after John returned to Princeton. While walking between buildings, a student walks behind John, mocking him, as other students nearby laugh. John simply turns around and looks at him, then brushes it off and continues walking. Shortly later in the film, he is approached by a student in the library who seeks his advice and this leads to John sharing his thoughts on mathematics with some other students. Alicia is called in to watch, nearly in tears, as John happily shares with the students. Unfortunately, due need for dramatizations to be relatively brief and rather entertaining, several aspects of John Nash’s life were left out of the movie. Three exclusions are particularly noteworthy. The first directly parallels the need, and drawback, of movies to be primarily visual: while the hallucinatory characters Charles and Parcher were symptoms of the real John Nash, most of his symptoms were delusional and auditory in nature, as is the case with most schizophrenics (DSM-IV-TR, 2000). The second exclusion leads to a question of interest to psychiatric researchers: John Nash refused medication for most of his life, after 1970 (Nasar, 1998, p. 353). Nash believed that his eventual recovery was due to the natural effects of aging, but researchers wonder, in general, whether the remission due to medication can increase the chances of future remission. Nasar describes how John’s choice to decline medication may have allowed him to eventually reenter the mathematical community. At that time, an tipsychotic medications had the potential side effects of tardive dyskinesia. The filmmakers left this fact out of the movie, perhaps out of a desire to prevent the discouragement of taking medications. Lastly, Alicia had actually divorced John in 1963, just a few years after his hospitalization. He criticized her for hospitalizing her and threatened to divorce her. After 1970, Alicia allowed John to live in her home and they remarried in 2001. Ron Howard and Brian Glazer had a particularly excellent opportunity to portray schizophrenia accurately because their movie was based on a well-written, considerate, and accurate biography of John Nash. Without this foundation, they may have had a more difficult time producing an accurate portrayal of schizophrenia. Instead of guessing at what it must have been like, or gathering information on schizophrenia from different people, they were able to directly refer to the biography and John Nash himself, in order to learn the specifics of this particular case of schizophrenia. Nevertheless, attempting to portray the lifelong course of a mental illness in a movie will lead to opportunities for viewers to misinterpret, misunderstand, and stigmatize individuals with mental illness. Perhaps this cannot be avoided in movies, in general, but a responsible filmmaker should follow the example set by Howard and Glazer. # References List American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author. Grazer, B. (Producer), & Howard, R. (Director). (2001). A beautiful mind [Motion picture]. United States: Universal. Nasir, S. (1998). A beautiful mind. New York, New York: Simon and Schuster.