The Portrayal of Paranoid Schizophrenia in a A Beautiful Mind - Movie Review Example

RUNNING HEAD: PORTRAYAL OF PARANOID SCHIZOPHRENIA IN A BEAUTIFUL MIND Portrayal of Paranoid Schizophrenia in A Beautiful Mind Name: Course: Institution: Date: Portrayal of Paranoid Schizophrenia in A Beautiful Mind Introduction A Beautiful Mind is a 2001 American film that depicts the life of Nobel laureate John Forbes Nash. The film was directed by Ron Howard, starting Russell Crowe as Nash and was based on the autobiography of Nash by Sylvia Nasar. It covers a significant period of the mathematical genius’ life, documenting his life as a brilliant math student at Princeton University up to winning the Nobel Prize in Mathematics in 1994 in his old age due to his work on game theory while at Princeton. However, the main focus of the film is John Nash’s struggle with paranoid schizophrenia. This essay will discuss the portrayal of paranoid schizophrenia in the film A Beautiful Mind. The essay will first outline the diagnosis of the mental condition and show it various symptoms as depicted in the film. The essay will then discuss the treatment options for paranoid schizophrenia and some of the psychosocial, ethical and labeling or discriminatory issues surrounding the treatment and management of the condition as portrayed in the film. The essay will then conclude by offering recommendations on how improved outcomes can be realize din the management and treatment of paranoid schizophrenia. Diagnosis According to the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), the primary clinical diagnosis (Axis 1) for John Nash in A Beautiful Mind is a psychotic disorder-paranoid schizophrenia (American Psychiatric Association 1994, Capps 2004). Schizophrenia is a mental state that makes it complicated for an individual to have normal emotion reactions such as thinking in a logical manner or telling the difference between truth and fiction (Ceusters & Smith 2009, Mueser and McGurk 2004). When it develops, it is usually referred to as psychosis as the affected person remains out of touch with reality (Zhou & Liang 2007). As indicated by his close friends, his wife and his doctor in the film, Nash displays symptoms consistent with paranoid schizophrenia such as psychosis, apathy, social withdrawal and impaired cognitive function (Mueser & McGurk 2004). Symptoms In the film, Nash displays a variety of symptoms consistent with the diagnosis of paranoid schizophrenia. From a young age as a student, he begins displaying signs of paranoia before he is admitted and diagnosed for paranoid schizophrenia. The major symptom of paranoid schizophrenia depicted in the film is Nash’s auditory and visual hallucinations. A hallucination is a sensory perception for which there is no external stimulus (American Psychiatric Association 1994). Nash sees, hears and communicates with three distinct characters that exist only in his imagination. These characters are William Parcher of the United States Department of Defense, a former Princeton roommate Charles and his (Charles’) niece Marcee. The viewer is made to believe that these characters are real before it is revealed by Doctor Rosen to his wife Alicia that they are imaginary after he is hospitalized. In the film, the scenes showing Nash’s conversations with his friend Charles and his niece also depict to the viewer the conviction that paranoid schizophrenics have in their delusions and the impact on their personal lives. It is through the encouragement of the imaginary Charles and his niece, who Nash shows affection for, that he proposes to and marries Alicia. Another symptom of schizophrenia depicted in the film is delusions. Delusions are false beliefs based on an external reality such as a firmly held belief by the schizophrenic despite the lack of proof or logical argument to support the belief or the presence of the same to the contrary (American Psychiatric Association 1994). People suffering from paranoid schizophrenia often hold false but strong beliefs which they feel are entirely real. These beliefs lead to distortions about the individual’s power, knowledge, abilities or even their identity. Nash believes that he has been recruited by Parcher as part of a Department of Defense project to decipher enemy (Soviet) communications which he does and delivers to a secret mailbox. The imaginary Parcher might be considered as appealing to Nash’s sense of grandiosity and as a representation of Nash’s distorted view of his abilities. In the film, it is also apparent that Nash believes that his teaching job at MIT (The Massachusetts Institute of Technology) is below him and beneath his talents and abilities and thus working for the government on a top secret project would fulfill his grandiose delusions- another symptom of psychotic disorders such as paranoid schizophrenia. Closely related to the delusions, another symptom of psychosis consistent with paranoid schizophrenia depicted in the film is paranoid delusions. Sufferers of paranoid schizophrenia such as Nash are also often under the belief that they are being persecuted, followed or targeted by a secret organization (Freeman 2007). In Nash’s hallucinations, he plays out an imaginary car chase and shootout between Parcher and Soviet agents and is under the false belief that he is being pursued by Soviet agents. Nash also displays impaired cognitive functioning as another symptom. This includes problems in attention and concentration, psychomotor speed, learning and memory and executive functions such as thinking and problem solving (Mueser & McGurk 2004). In the film, Nash has considerable difficulty in concentrating on his thesis in game theory as he battles with the side effects of antipsychotic medication. Other symptoms of schizophrenia portrayed in the film include Nash’s distinctive limp, which becomes more pronounced as his condition deteriorates and is even mocked by some students at Princeton (Elder et al 2009, Capps 2004). Nash also has little or no emotion in his voice (emotional apathy) and it is difficult to gauge his emotions from his speech. Nash is also socially withdrawn and is apparently awkward in social settings as demonstrated by his reluctance to initiate conversations at a party that he and Alicia attended. Treatment In A Beautiful Mind, several treatment options for persons suffering from paranoid schizophrenia are highlighted. After he is forcefully sedated and admitted to McArthur psychiatric hospital, Nash is subjected to insulin shock therapy to try and provide relief from the symptoms of paranoid schizophrenia. The treatment works by administering doses of insulin to the patient to induce hypoglycemic shock or a coma (Fennell 1996, Blythe 2007). The patient would then be brought out of the coma after a while (typically 20 minutes) using a sugar or glucose solution administered either nasally or intravenously. The rationale behind this technique was that it would help in subduing the patient’s paranoid delusions since after coming out of the coma the patient would experience periods of coherent thought and an improved mental state before relapsing to their delusional state (Blythe 2007). After repeated periods of treatment, insulin shock therapy would be expected to increase the lengths of these periods of coherent thought and improved mental state. However, despite the effectiveness of this technique, it had severe side effects such as causing epileptic fits, the risk of irreversible coma, dehydration and in many cases death. Insulin shock therapy would subsequently fall out of favor in psychiatric practice in the 1970s as safer treatment methods were introduced (Fennell 1996). In the film, insulin shock therapy is not very effective in helping Nash to subdue his paranoid delusions and he is placed on antipsychotic medication. After insulin shock therapy, Nash is placed on antipsychotic medication to help treat his paranoid schizophrenia. Some of the commonly used antipsychotic medications or first generation antipsychotics that were used to treat paranoid schizophrenia during the time in the film are Chlorpromazine, Haloperidol and Perphenazine. Modern, second-generation antipsychotics have been developed such as Clozapine and Risperidone (Josiassen et al 2005). However, the use of Clozapine has been associated with agranulocytosis- a loss of white blood cells. However, antipsychotic medication has several undesirable side effects for paranoid schizophrenics such as drowsiness, dizziness, blurred vision, increased heart rate and muscle spasms. Some antipsychotics when taken in combination have overall positive effects on the patient, such as Clozapine with Risperidone which has been shown in clinical studies to be well tolerated and safe in addition to the clinical advantages for unresponsive or unresponsive paranoid schizophrenics (Josiassen et al 2005). In the film, Nash’s medication only exacerbates his social withdrawal and causes him to become distant and irritable. It affects his cognitive and reasoning abilities as under medication, he is entirely unable to work. The medication also leads to a deterioration of his marriage. He is unable to become sexually intimate with his wife. He severely dislikes his medications and after a while, secretly stops taking them. The film demonstrates the risks of stopping antipsychotic medication as Nash relapses back to his hallucinations when his wife discovers him deciphering “hidden” Soviet codes in their shed after abandoning his infant son to almost drown while bathing him. While insulin shock therapy and antipsychotic medication are not very effective in helping Nash to overcome the symptoms of paranoid schizophrenia in the film, there are other more effective psychosocial treatment or intervention options for paranoid schizophrenics. Such psychosocial treatment options include cognitive behavioral therapy (CBT) where patients learn skills to cope with life’s challenges as a result of schizophrenia (Rathod et al 2008). Under CBT, patients under the care of a therapist learn social, daily functioning and problem solving skills which help them minimize stress and prevent hospitalizations. Other interventions include rehabilitation programs to help people with schizophrenia function better in their communities such as job counseling and communication skills (Rathod et al 2008, Greig et al 2007). The families of paranoid schizophrenics can also help in the management of the illness by learning problem solving skills and coping strategies to help them monitor the patient’s progress, ensure they take their medication and to access treatment facilities when the patient’s condition deteriorates. A more effective treatment option for people with paranoid schizophrenia is to take an active role in managing their illness. Patients should learn the basic facts about schizophrenia and its treatment and make informed decisions about their care. When they learn how to watch for the early warning signs of relapse, they can learn to prevent them by using coping skills to respond such as ignoring their hallucinations (Elder et al 2009). In the film, despite the advice of his doctor, Nash opts not to continue with his medication or to be committed to a psychiatric facility as this negatively affects his ability to think and perform his work. Instead, he chooses to simply ignore his hallucinations through coping skills such as ignoring the imaginary characters whenever they appeared and by asking those around him whether they could see who he was talking to when he was in doubt. Nash then gradually rehabilitates himself by first working in small social gatherings and building up his vocational ability until he is able to return to teaching and become a respected professor once again. Psychosocial Issues The film highlights several psychosocial issues related to paranoid schizophrenia. It depicts how the development of psychosis on Nash and how this affects his relationships with his family, friends and career. Initially, even before the deterioration of his mental state while at Princeton, Nash struggles to relate to his peers and it is evident that he is socially withdrawn. However, he is able to forge several relationships, such as a romantic relationship with one his students (Alicia) who eventually becomes his wife. But as Nash’s condition continues to deteriorate with the increasing intensity, frequency and persistence of the symptoms of paranoid schizophrenia, he becomes increasingly cold, selfish, removed and indifferent to the people around him (Sunghae 2005). Nash’s relationship with his friends and loved ones become strained due to his hallucinations. Nash shows a remarkable absence of interest in and empathy for those around him and a lack of emotional depth. His marriage and relationship with his wife deteriorates as she becomes terrified of his erratic and unpredictable behaviors and as he withdraws emotionally and physically from her while under medication. As his hallucinations intensify, he even abuses her and endangers the life of his infant child, leaving him almost to drown while bathing him in one instance and knocking him with Alicia to the ground while having a hallucination about Parcher assaulting them. As Nash’s hallucinations become more intense, his condition also begins to affect his work, his cognitive abilities. Nash is clearly a mathematical genius, but his abilities are severely affected by his hallucinations. While undergoing antipsychotic medication, Nash’s cognitive abilities are severely impaired and he is entirely unable to perform his teaching duties, which leads to a temporary disruption of his teaching career. Nash’s intellect is also impaired by the medications and the subsequent relapse as he becomes distracted from working on his thesis on game theory but is instead immersed in the delusion of deciphering hidden Soviet codes. The film demonstrates how paranoid schizophrenia can wreak havoc on the careers and lives of patients by causing them to lose their cognitive abilities and the ability to function in their careers as schizophrenia usually develops during the critical career forming ages in most patients (between 18 and 35 years) (Mueser & McGurk 2004). The film not only portrays the burden paranoid schizophrenia has on Nash but also on his close family and friends. The family of paranoid schizophrenics often bears the burden of the patient’s erratic behavior and delusions, such as the deterioration of his marriage and the risk he exposes his infant son to (Sunghae 2005, Perlick et al 2007, Huang et al 2008). In addition, as a result of impaired cognitive abilities, schizophrenics are also more likely to lose their jobs as they cannot function effectively in them and the resulting unemployment implies further financial burden on their families and loved ones (Sunghae 2005, Huang 2008). This is often in the form of expensive treatments or medications and the loss of income. While Nash is under medication in the film, it is apparent that he and Alicia experience financial difficulties due to his condition as a result of expensive medication. Paranoid schizophrenia leads to suffering not just on the part of the patient but also on their friends, family and loved ones. Labeling/Discrimination As earlier indicated, patients suffering from paranoid schizophrenia are often believed by people around them to be crazy. During his student days, as Nash’s condition began to worsen, his peers would refer to him as a “psycho” which triggered the hallucinations of his roommate Charles. Students at Princeton also mock Nash due to his distinctive walk, viewing him as crazy despite being a mathematical genius. Ethical Issues The key ethical issue surrounding paranoid schizophrenia highlighted in the film is the ethicality of the treatments for the condition. In the film, Nash is forcefully sedated and committed to a psychiatric facility against his will in addition to being subjected to insulin shock therapy against his will. While admitting a patient to a psychiatric facility against their consent and subjecting them to treatments such as insulin shock therapy is a subject of ethical controversy, patients suffering from conditions such as paranoid schizophrenia have limited insight with regards to their illness and often do not recognize that they are suffering from it (Meisel 2006, Fennell 1996). As Nash’s behavior also demonstrates, they are prone to violent and dangerous behavior and involuntary hospitalization may be in their best interests as the first step to treatment. Recommendations There are several recommendations that can be adopted to improve the outcomes of the treatment and management of paranoid schizophrenia. As shown in the film, the recovery model adopted should be supportive and safe to be effective. The patient should be informed at the earliest possible opportunity of their mental condition and be encouraged to accept it as the first critical step in treatment. The treatment options or interventions used to manage paranoid schizophrenia should also be safe and the patient should be helped to manage the side effects of the antipsychotic medication which is frequently part of the treatment regime. This would help prevent relapses such as the one Nash experienced in the film. The film also demonstrates the importance of support in managing paranoid schizophrenia. It is Alicia’s support that enables Nash to confront his mental condition and cope with the hallucinations. The friends and families of people suffering from schizophrenia should be educated on how to detect the relapse of symptoms and on strategies to ensure that patients adhere to their medication to support successful recovery (Elder et al 2009). While managing paranoid schizophrenia may be challenging for the family and friends of the patient, proper management practice demands that they be sensitized on the dangers associated with hallucinations and how to take precautions to manage these risks (Elder et al 2009). For example, Alicia should have taken precautions such as not leaving the infant alone with Nash as his relapse endangered the life of the infant on more than one occasion. With proper management, counseling and support, schizophrenics can make a full recovery and resume a normal life as Nash was able to in the film. Conclusion The film A Beautiful Mind portrays the symptoms and challenges of living with paranoid schizophrenia. Through the main character John Nash, the film depicts the main symptoms of paranoid schizophrenia as hallucinations and delusions and their negative effects on the patient’s personal and professional life in addition to the effects of the condition on their relationships with their friends and family. The film also shows how paranoid schizophrenia can be treated and managed through options such as the outdated insulin shock therapy and antipsychotic medication and the side effects of each of these treatment options. The film demonstrates that with proper management, paranoid schizophrenia can be managed if the patient is put on a proper recovery plan and receives the necessary support from family and friends to adhere to the plan. Despite the challenges associated with schizophrenia, Nash is able to go into full remission and even achieve his intellectual potential by winning the Nobel Prize. References American Psychiatric Association (1994). 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