John Nash and Schizophrenia - Essay Example

John Nash and schizophrenia Case study “A beautiful mind” is a movie based on the life of an American mathematician, Josh Nash who suffers from schizophrenia. The film depicts John Nash as an arrogant and awkwardly socially inept mathematician who has spent most of his time making discoveries in mathematics. It is only halfway during the movie that the audience is able to discover that many of the situations and places occurring during this movie are only in josh’s beautiful mind. The illusions are what lead to the discovery that John Nash is suffering from a psychological condition known as schizophrenia (Parker & Parker, 2004). John Nash, as per the movie, is a male student of mathematics who attains the rank of a professor at Cambridge University but it is his anti-social behaviour that makes him appear strange and distance at first until the discovery that he is mentally disturbed. At the beginning Josh stars as a mathematics graduate student at Princeton. He undergoes weeks of shock therapy with an aim of helping him with his condition. He is then released to the care of his wife Alicia who plays a pivotal role to try and assist him with his pre-existing condition. Alicia helps Josh to get back his mental acuity and regain his status at the University which leads him to acquire a Nobel peace prize for Economics. John Nash is diagnosed with paranoid schizophrenia which is a mental disorder with characteristics such as abnormal thinking, hallucinating, delusions and social withdrawal. He suffers disorganized thinking, disturbed perceptions and inappropriate actions and emotions. A person with this condition often believes that he or she is being persecuted (Narahari, 2009). The cause of this condition is not yet known but some forms of schizophrenia are associated with genetics and an increase in dopamine levels in the brains of those affected. In the film, Josh develops mental disorders when working for the department of defence agent. His assignment involves looking at patterns in magazine articles and newspapers in an effort to botch a Soviet Union plan ostensibly. His paranoia is heightened by the attempt of assassination by the Russians. This however is however all in John’s mind. His condition becomes erratic. It is the wife who calls a psychiatric hospital to come and restrain Nash who this whole time thinks that he is being kidnapped by the Soviet Union. The antipsychotic drugs given to Nash after undergoing shock therapy affect his relationship with Alicia as well as his intellectual capacity, as such, he decides to abandon them secretly which triggers a relapse of the psychosis. His abnormal behaviour that depicts a psychological disorder is also shown when he is bathing his son in the bath tub. He is distracted and wanders off, on realizing this, the wife runs inside the house to confront Nash and barely saves the drowning baby. Nash says that Charles, a friend, was watching the baby. This is all in his head, including Marcee who Josh realises later that she is just an illusion as she has remained the same age since he met her. All these are what lead to the diagnosis of schizophrenia. Diagnosis of Nash using the DSM-5 The film depicts Nash as having all the positive signs of schizophrenia. He sees people outside stalking him during his teaching session. This is a sign of paranoid schizophrenia. A diagnosis simulation was carried out using Nash’s biography and parts of the film. After watching the film, many psychiatrists doubted the diagnosis of Nash. They were torn between whether he was suffering from Schizophrenia and Schizoaffective disorder or bipolar disorder. The DSM-5 uses the following symptoms to diagnose schizophrenia. This was the case with the John Nash declaration of having schizophrenia. For somebody to be diagnosed with schizophrenia as per the DSM-5, two or more of the following symptoms should be present for a significant period of time during a month period: delusions, hallucinations, disorganised speech, grossly disorganised behaviour and negative symptoms that include alogia or avolation as well as affective flattening. The manual further stipulates that for a significant period of time after the onset, level of function in the following areas is decreased, self care, interpersonal relationships and work (Davis &Siever, 2004), . This was evident in the John Nash’s case as his work and interpersonal relationship especially with his family was grossly affected. The manual also identifies continuous signs of disturbance that persist for more than months and includes the appearance of the above mentioned signs for at least one month. John had hallucinations for quite a long time. Nash’s condition was also not associated with any psychological effects of a substance or a medical condition associated with a mental disorder. Nash suffered from severe agitation, delusions of grandeur and other bizarre symptoms. From the first time he was admitted at the hospital, there was a common agreement among the psychiatrists that he was psychotic. In the hospital, Josh continued to hallucinate about foreign conspiracies and his ability to decode certain messages and codes. The presence of elevated mood, delusions of grandeur and frenetic discourse add to the complications of distinguishing of psychosis and affective behaviour. According to the Diagnostic and Statistical Manual for mental disorders, DSM-5, and the Clinical Descriptions and Diagnostic Guidelines, it is necessary to quantify the presence of distinct psychotic episodes and the affective symptoms as well as establishing a life-time based hierarchy for them. Silvya Nasar in the biography about Nash that contributed to the film has described in detail each year of his life with the description of psychotic symptoms and other bizarre occurrences. According to this biography, it is difficult to determine whether John was indeed suffering from psychosis or a bipolar disorder. The discontent that has been echoed by clinicians over his diagnosis stems from the confusion of what indeed was ailing Josh and if it was schizophrenia, what subtype it was. OPCRIT diagnosis (operational criteria checklist for psychotic illnesses) This is a type of diagnosis that was made by experts from Schizophrenia program from the University of Rio using practical experience with Schizophrenic and psychotic patients. Information was collated after reading Nash’s biography and watching the film. All the symptoms present were recorded by the most experienced researcher and each item discussed among the authors of OPCRIT. The reason behind using this system was the complicating diagnosis subtleties present in his case. This system is split into 90 items with the first 16 relating to clinical and demographics. The next assess appearance and behaviour, 26-31 referring to language and ways of thinking, the next deal with affect and such like characters, 54 to 71 observe abnormal beliefs and ideas while 72-77 assess patients altered perceptions and finally the abuse of dependence on drugs and features of the conducted interview such as the credibility of the sources. This system was designed to be used by trained clinicians. The most probable diagnosis of Nash was acquired through ascertaining that there lacked evidence for thoughts racing, or increase in sociability and that psychotic symptoms predominating in spite of the occurrence of occasional affective disruptions. This was for simulation 1. For simulation 2, thoughts racing and increasing sociability were scored. Affective and psychotic symptoms were identified (Parker & Parker, 2004). What can be learnt from this is that variation of thoughts racing and increased sociability is not enough to change the diagnosis of schizophrenia into schizoaffective disorder. However, altering the scoring for the relationship between psychotic and affective symptoms from the first choice of psychotic symptoms dominate the clinical picture. Psychotic and affective symptoms do not dominate the global course of the disease or hallucinations occurring for at least two weeks (Sommer & Slotema, 2012). Contrasting scores for delusions of grandeur, accelerated thinking and loss of inhibitions which is not appropriate to social setting and having shorter duration than other social psychotic symptoms does not only maintain the diagnosis of schizophrenia, as in the John Nash’s case, but also reinforces reports from experienced clinicians that some symptoms can occur in the diagnostic categories that are schizophrenia, schizoaffective disorder and bipolar mood disorder for example the presence of delusions with abnormal content which is not specific to any of the disorders and should as such be treated with caution when providing a diagnosis (Shultz & North, 2007). Treatment The approaches used to treat schizophrenia are usually a combination of several therapies. These therapies are used to reduce the symptoms but not to cure the disorder. They include Medication treatment, Antipsychotic medication, psychological treatment, rehabilitation, cognitive behavioural psychotherapy, community and family support and individual psychotherapy. The film showcases insulin shock therapy as a way of treating Nash’s condition. He received 50 treatments of insulin and was released with ongoing medical treatment. The treatment caused him to have decreased social and cognitive function such that he could no longer be intimate with the wife or do his mathematical assignments. As such, he stopped taking his medication and this led to a recurrence of schizophrenia. The film shows that medications are of paramount importance in reducing the symptoms of schizophrenia but have side effects as well. Nash was at first put in a psychiatric hospital where he received anti psychotic medication (Kupper &Tschacher, 2006). Nash stopping his medication had serious effects to his health and trickles down to the safety of his family. He got hallucinations of Parcher asking him to finish his wife, it is after this incident that he thinks critically about his family and later goes to the hospital and commits to therapy. New antipsychotic medications are better equipped to reduce the effects. However, it might seem unethical to issue them to the patients as they present serious side effects such as serious muscle spasms, drowsiness, restlessness, tremor and dry mouth and even cause blurred vision (Kellerman, 2008). Cognitive behavioural psychotherapy it is argued that it is the most effective since people are taught new and adaptive ways of thinking and behaviour. It helps the patient perform effectively through reducing the symptoms and focus is emphasised on the important aspects of life. Nash could also have gone through rehabilitation which is a non medical intervention that helps patients with social skills. Counselling helps patients get back to their normal lives and function well in the society. The recent changes in DSM-5 sought to address the limitations in the DSM-IV such as the definitions of various disorders with regard to psychotic disorders setting clarity between schizoaffective disorder and schizophrenia and in appropriate special treatment for conditions such as hallucinations (Parnas &Henriksen, 2014). The revisions objectives were to enhance clinical utility and elimination of schizophrenia subtypes. The changes therefore affect how diagnosis is made and how treatment will be issued significantly as schizophrenia diagnosis and treatment was dependent on the stipulations in the previous manual. The changes will provide clearer separation schizophrenia with mood signs from schizoaffective disorder. It will be easier to identify schizophrenia using the dsm-5 manual as compared to the dsm- 4. It will substantially improve the stability of diagnosis and enhance clinical utility. References Davis, K., &Siever, L. (2004, March 1). The Pathophysiology of Schizophrenia Disorders: Perspectives From the Spectrum. Kupper, Z., &Tschacher, W. (2006, October 14). Perception of Causality in Schizophrenia Spectrum Disorder. Shultz, S., & North, S. (2007, June 15). Schizophrenia: A Review. Parnas, J., &Henriksen, M. (2014, September 27). Disordered Self in the Schizophrenia Spectrum: A Clinical and Research Perspective. Sommer, I., &Slotema, C. (2012, February 24). The Treatment of Hallucinations in Schizophrenia Spectrum Disorders Parker, J. N., & Parker, P. M. (2004). Paranoid Schizophrenia - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego: ICON Group International Inc. Narahari, Y. (2009). Game theoretic problems in network economics and mechanism design solutions. London: Springer. Kellerman, H. (2008). The psychoanalysis of symptoms. New York: Springer. Read More