Abstract
A selection of films and books is offered this month for your holiday consideration. The film A Beautiful Mind is important enough to warrant two reviews because of its potential to influence attitudes to schizophrenia over a wide audience.
With best wishes for the festive season.
Jo Beatson
Director: Ron Howard, Producer: DreamWorks, 2001,
This is a powerful and striking movie that chronicles the life and experiences of the brilliant Nobel Laureate John Nash, who suffered from paranoid schizophrenia for most of his adult life. The film documents his premorbid oddness and grandiosity, his illness and subsequent deterioration, and his successful attempts at salvaging his dignity and regaining a place in academia. Russell Crowe has received well-deserved adulation for his role as John Nash and his intense and impressive performance communicates the emotional torture and at times sheer terror experienced by Nash. Crowe also communicates the genius of Nash – a man possessed with boundless curiosity and an indefatigable drive to devise ‘games’ and provide solutions to mathematical puzzles. This total absorption in mathematics and its applications become central elements in Nash's psychosis. This is a man bent on uncovering codes and finding solutions to problems – a man with an unfailing belief in mathematics as a method of understanding life more generally.
One of the problems that confronts film directors and scriptwriters is the need to compress and select key elements of written works, in order to keep the audience engaged and involved with the film. A Beautiful Mind is very successful at engaging the audience, but as is typical of such adaptations of books (in this case that of the biography of John Nash by Sylvia Nasar [1]), some of the key elements of Nash's story are missing. We are not informed much about Nash's early life, although it is clear from the start of the film that this is an intellectually precocious man whose lack of social perspicacity and competence is equally impressive. Nor are we informed much of Nash's ‘lost’ years (1970s to 1990) before he was eventually awarded the Nobel Prize in Economics in 1994.
One such episode that is noted in the book but does not appear in the film was that in his earlier years, Nash worked for the Rand Corporation – a right-wing thinktank. The late 1940s and 1950s has been characterized as the heyday of virulent anticommunism; many people were caught up in the paranoid ambience of the time but Nash was more centrally involved and this information was for me, a crucial and important omission in understanding his psychosis.
There were a number of impressive elements in this film that are worthy of comment. First, Crowe conveys the psychiatrically ill Nash as handicapped by negative symptoms, persistent positive symptoms and the side-effects of medication. Nash is still able to struggle – albeit sometimes futilely – against the adversities of illness, ignorance and stigma (including active ridicule) but supported by his wife and some colleagues, and using distraction as best he can. Second, a major strength of the film is the way in which Nash's wife and the film's audience are confronted by evidence that begins to challenge his systematized, paranoid delusional system. Initially, one could believe that Nash has been labelled incorrectly as ‘insane’ and it is easy to believe that he has fallen victim to psychiatry as a form of social control. His wife is willing to listen to him explain how he has dropped off his messages in a sealed bag to a certain mail-box. When she finds all his mail still sealed she realizes that he may be ‘insane’. Third, it eventually transpires that three ‘lead’ characters are extensively elaborated visual hallucinations – ‘the government ringmaster intelligence agent’, the little girl and Nash's room mate; the latter is particularly shocking to the audience. Some colleagues thought this was overdone, but on the whole I think the dramatization of these ‘phenomena’ is effective and conveys the ‘lived-in’ experience of Nash.
Debates abound about the origins of psychosis. Some theories give little credence to the content of the psychotic symptoms and their relationship to the person's life story. Arguably this has been due to the lack of empirical support for psychodynamic treatments, the success of antipsychotic medications and more broadly, the emergence of the biological paradigm in understanding psychopathology – one that essentially converts the content of positive symptoms into form – viewing content as epiphenomena.
New Cognitive Behaviour Therapy treatments emerging from the UK have demonstrated efficacy in the treatment of positive symptoms in a series of randomized controlled trials. The new therapies ‘normalize’ the patient's experience by examining how and under what circumstances people might experience psychosis (e.g. sensory deprivation, stress, drug-taking, and so on); help the person challenge and evaluate their delusional beliefs; and understand the possible meaning of these beliefs for the person. An example of where challenging could occur is the poignant scene in the film where Nash obtains some insight and realizes that the little girl never gets any older – she remains the same age. Two of the three visual hallucinatory figures are friendly and positive and this would seem to be meaningful for someone who appears often lonely and gauche in everyday life.
To conclude, this impressive film uses dramatic licence to portray a man suffering though his mental illness. Not many individuals are geniuses and have the ability to win the Nobel Prize, but every person, irrespective of whether or not they have psychosis, has a story to tell. This film communicates to us the importance of listening to the person's story, however bizarre, and the importance of attempting to understand the apparently un-understandable as a beginning to treatment.