ABeautifulMind:TheLifeofJohnNash

DavidJ.Matchey
InpartialfulfillmentoftherequirementsforPSYC353
Dr.GabrieleJones

JohnForbesNash,Jr.,istheNobel-prizewinningAmericanmathematicianwhowas
thesubjectofthemotionpicture,ABeautifulMind.Inthefilm,JohnNashbeginsasa
newlyarrivedgraduatestudentatPrincetonwhowantstocomeupwithatrulyoriginal
ideaforhisthesispaper.Hestrikesupafriendshipwithhisroommate,Charles,anda
fewotherpromisingstudents.Hedevelopsamathematicaltheoryinmathematical
economicsandacceptsanawardtoattendMIT.Someyearslater,hereturnsto
Princetonasateacher,andtherehemeetsAlicia,hisfuturewife.Hisformer
roommate,Charles,andCharles'niecearealsothere.Hemeetsagovernmentagent
calledParcher,whoinvitedNashtothePentagontoparticipateinthedecryptionof
Sovietcodes.Nashisabletodecipherthecodejustbylookingatit.Parcheralso
urgesNashtosearchthenewspapersforevidenceofaSovietplot.AfterNashis
chasedbytheRussiansamidgunfire,hisbehaviorbeginstobecomemoreerraticand
unpredictable.Atthispoint,Aliciaseeksthehelpofapsychiatricinstitution.Nash
believesthatheisbeingwatchedbyahostilegroupofpeople,whosedatehimand
takehimtoapsychiatrichospital.NashtookthisasconfirmationthattheSovietswere
outtogethim.Alicia,inadesperateattempttogetthroughtoNash,findsthe"Top
Secret"documentsthatNashhadputinadropboxandconfrontshimwiththem.After
this,JohnNashiswillingtobelievethathehasbeenhallucinating,andthatthesecret
missionhebelievedhewasonwasalladelusion.Afteraseriesofinsulinshock
therapy,Nashisputonaregimenofantipsychoticdrugsthatmakehimfeelsome
unwantedsideeffects.Hesecretlystopstakingthedrugs,butwhenhishallucinations
causeadangertohisinfantson,Aliciatriestoflee.Johnthenrealizesthatthelittlegirl,
Charles'neice,nevergetsanyolder,andtellshiswifethat.Theythendecidetotryto
livewithhiscondition,Nashbyignoringhishallucinations.Hestillexperiencesthem,
buttheynolongerhavecontroloverhislife.
JohnNashfitstheDSM-IVclassificationofParanoid-typeSchizophreniabecause
ofhispreoccupationwithoneormoredelusions--hisbeliefthathewasaspecial
governmentagentmathematician--andfrequentauditoryhallucinations.Itshouldbe
notedthattherealJohnNashdidnotexperiencevisualhallucinations,onlyauditory
ones.Healsodoesnothavedisorganizedspeech,disorganizedorcatatonicbehavior,

orflatorinappropriateaffect.Thismentaldisorder,paranoid-typeschizophrenia,
wouldbelistedunderAxisI:Clinicaldisorders.Sincehisschizophreniawasthemain
problem,andhedidnotseemtohaveanypersonalitydisorders,nothingwouldbelisted
underAxisII.Hedidnothaveanymedicalconditions,soAxisIIIisalsoleftblank.
UnderAxisIV,thethingsthatariseaspsychosocialstressorsarethebirthofhis
child,thedeathofhisfather,andhisfailuretobeawardedaprestigiousprizeinthefield
ofmathematics.HismarriagetoAliciaandherpregnancyalsoservedtocausehima
considerableamountofstressanditwasnotedthathewasbehavingerraticallyand
strangely(Capps,2005).
UnderAxisV,theGlobalAssessmentofFunctioningscale,IwouldgivehimaGAFof
25becausehisdelusionsandhallucinationsconsiderablyaffectedhisbehavior,which
wasmarkedbyasignificantimpairmentinjudgement.
OneofthethingsabouttherealJohnNash,asopposedtothemovieNash,was
thathisconditionwassaidtohaveimprovedafterhismother'sdeath.Helivedwith
hismotherinRoanoake,Virginia,andthoseweresaidtobetheyearswhenhewas
intheworstshapeofhislife.Aftershedied,hispsychosisseemedtohaveresolved
itself(Carlin,2006).AlsointerestingisareportthatNash,shortlybeforehismental
breakdown,wasdressedupastheNewYear'sbabyandspenttheevening"sipping
milkwhilecurledupinhislover'slap"(Carlin,p.440).Nash'sbreakdownattheage
ofthirty,however,occurredwhilehiswifewaspregnantwithhisfirstbaby.Some
psychologistsbelieveNash'sschizophreniawasatransformationofegoisticidealsin
theFreudiansense,sincehisidealsweretopleasehismother.
TherealNashbegantoshowsymptomsofschizophreniain1958.Hewasadmitted
toamentalinstitutionin1959andwasdiagnosedwithparanoidschizophreniaandmild
depression.Hissymptomsbecameworseandhebecameaggressive,promptinghis
wifetodivorcehim.Heremainedinandoutofhospitalsuntilhismotherdiedin1970,
andhiswifedecidedtogetbacktogetherwithhim.Sincethattime,hehasrefusedto
takeanyantipsychoticmedication(Comer,2007).
Schizophreniacomesinmanyforms,andcanincludedelusions,hallucinations,flat
orinappropriateaffect,anddisorganizedthinkingandspeech.Nash'sparticularform
ofschizophreniaincludeddelusionsofgrandeurandauditoryhallucinations.According
tothediathesis-stressperspective,Nashmayhaveinheritedabiologicalpredisposition
todevelopschizophrenia.Then,duetoextremestress(perhapsthepressureof
performingwellanddevelopinganewmathematicaltheoreminNash'scase),the
schizophreniadevelops.ThefactthatNash'ssonalsodevelopedschizophrenia
(Comer,2007)confirmsthatschizophreniaismorecommonamongrelativesofpeople
withthedisorder.
Biologicallyspeaking,Nash'sbrainmayhaveadefectthatallowsthetransmission
oftoomanymoleculesofdopamineintothesystem.Anytreatmentwithmedication
shouldbewithanantipsychoticdrugthatactsasadopamineagonist,thatimproves
theactivityofdopamineinthesystembyregulatingit.Sinceschizophrenia,sincethe
1950s,hasundergonearevisioninthewayscientistsapproachit,itispossiblethatthe
interactionofserotoninanddopaminehaveaneffect.Nashcouldbenefitfromcertain
atypicalantipsychotics,whichbindtoreceptorsforbothdopamineandserotonin.In
themovie,thelossoflibidowasdemonstratedasasideeffectoftheseantipsychotics
(Keltner,2007).

ItmayalsobepossiblethatNashhasanabnormalbrainstructure.Thisisnot
somethingthatcanbeeasilyremedied,ifatall.Researchershavefoundthatmany
peoplewithschizophreniahaveenlargedventricles,thebraincavitiesthatcontain
cerebrospinalfluid(Comer,2007).Thismaybeasignthatcertainpartsofthebrain
havenotdevelopedsufficientlyenoughandthatbloodflowtocertainareasofthebrain
isaffected.
ItcouldhavebeenthecasethatNashhadaschizophrenogenicmother,sinceshe
wasaheavydrinkerofwhiskeyandcouldhavebeenbothcontrollingandrejecting
atthesametime.Owingtothepsychodynamicperspective,JohnNashcouldhave
regressedtotheegostateofprimarynarcissism,inwhichhewasself-centeredand
onlyrecognizedhisownneeds.Duringtheperiodwhenhelivedwithhismother,
hewrote:"apparentlyI'msimplypassingtimevisitingmymother,butactuallyI've
beenunderpersecutionswhichI'mhopingwillcease"(Carlin,2007).Atthispoint
hisdelusionswereattheirmostextreme.Duringthispartofhisdisorder,Iwould
recommendapsychosocialtreatmentprogram(Oltmanns,2007)thatincludea
communityorJohn'sfamily(hiswife).Asatherapist,Iwouldprovidethemwith
informationaboutschizophrenia,howitshowsitselfandwhatthesymptomsare,so
thattheycanunderstandthenatureofNash'sproblem.ThenIwouldmakesurethe
familyworkedonproblem-solvingandcommunicationinatypeof"familyintervention"
(Oltmanns,2007).Nash,however,seemedtohavegainedcontroloverhisdelusions
byhimself,andthatiswhyIwillnowspeakaboutthenatureofhisdelusionsandthe
wayhemanagedtoovercomethem.
Nash'sdelusionsweresuperficiallypolitical(thesecretagentcomplex),butCapps
(2005)notesthattheyarereligiousandsexualwithmessianicandpersecutorythemes.
TheyareanattemptbyNashtorecoverfromeventsthathappenedearlyoninhislife.
Whenhewasaboyofabout15years,oneofhisfriendsdiedbyapipebombthatNash
mayormaynothavehadahandinbuilding,andthesurvivorguiltiswhathewastrying
torecoverfrom.Nash'sdelusions,overtime,becamelessemotionallychargedand
morecognitiveinnature.Thiswasreflectedinhisabilityforself-deprecatinghumor
(Capps,2005),thekindsuchasdisplayedinhis60MinutesinterviewwithMikeWallace
wherehesaidhewas"disillusionedwithhisillusions"(Capps,2005).
JohnNash'sself-recovery,asheoutlinedinhis60Minutesinterview,waslikegoing
onadiet(Capps,2005).Hesaidthatthedelusionalthoughtsareattractive,asthey
givehimasenseofbeingconnectedtoamoreattractive,alluringstateofbeing,but
thathedidnotwanttotakethemseriously.Hestillhadahighopinionofhismental
gifts,whichisconsiderednarcissistic.However,hisegosustainedseveralblows,such
ashisfailuretobeawardedtheFieldPrizeinmathematicsandhispresentationofan
unsolvedtheoremthathadhimlaughedoutofthepresentationhall.Nashsuccumedto
hisillnessbecause,whilehemayhavebeengeneticallypredisposedtoschizophrenia,
hewasactuallysufferingfromacuteidentityconfusion.Hisintensefriendshipwith
othermalesthatborderedonhomosexuality,andthebirthofhissecondchild,whomhe
nicknamed"babyEpsilon"whileinthementalhospital,supportErikson'sviewthatthis
isdemonstratedbyapersontakingupthepositionofthepatient(Capps,2005).
TheprimarytreatmentoptionforJohnNash,althoughheseemstobegettingalong
finewithoutit,ismedication.Iwouldreferhimtoapsychiatrist,andthatpsychiatrist
(inthepresentday)wouldprobablyprescribeanewerantipsychoticlikeGeodon.

Thisantipsychoticdrugwouldalsoworkwellinconjunctionwithantidepressantand
antianxietymedication.Theolderantipsychotics,likeHaldol,whiletheytakecareof
thedelusionsandhallucinationsassociatedwithschizophrenia,aredopaminereceptor
blockersandworkwellincontrollingthepositivesymptomsofschizophrenia.Iwould
liketoputNashonamedication,anewerantipsychoticlikeSeroquelorZyprexa,that
takescareofboththepositiveandnegativesymptomsofschizophrenia.Thesework
onboththeserotoninanddopaminereceptorareasofthebrainandtherebycovermore
groundwithwhatisknownaboutthepossiblecausesofschizophrenia.
Compliancewiththetreatmentregimenisalsooneofthemainproblemsinpatients
withschizophrenia(asdemonstratedbytherealJohnNash'snotwantingtotake
medication--asopposedtothemovieJohnNash,whoreportedcontinuingtotake
hisantipsychoticpills).Iwouldproposeatreatmentplanofpsychotherapyand
psychosocialsupporttherapies,sincewhilethepillsmaytakecareofthepsychosis,
Nashmaystillhavetroublefunctioningnormallyinsociety.Hiscopingskillsand
communicationneedtohaveamediuminwhichtodevelopandbesustained.
Psychotherapy,however,maynotbethemosteffectivetreatmentoptionin
conjunctionwiththemedication.Modeling,education,adviceandlimitsettingwould
bethemosteffectivepartsofpsychotherapy.Becauseitproducesslightlybetter
resultsthanplainoldpsychotherapy,IwouldalsoliketoincludeNashingrouptherapy
sessions.ThesewouldservetohelpNashfocusonreal-lifeplans,socialinteractions
andcooperationwithdrugtherapy,withthegoalofplacingNashinmorereality-based
environmentsandcuttingdownonsocialisolation.
Family-basedtherapyisalsoanoption,sincehehaswithhimhiswife,Alicia.When
thefamilyisencouragedtoconveneameetingwheneversymptomsarise,thereis
alesserchanceofrelapse.AdailyroutineshouldbeestablishedforNashtofollow,
makingsurethathestaysonhismedicationandgetstheappropriateamountofsocial
interaction.Iwouldstresspatienceandunderstandingwiththefamilyandadvisethat
communicationswithNash,thepatient,arebriefandconcise.
JohnNashisabrilliantperson,andwhilehesuffersfromschizophrenia,heseems
tobefunctioningwell,evenwithouthismedication.Ibelievehismaybeaspecialcase
inpsychology,sincemanywithschizophreniadonotperformaswellashe.Hewas
awardedtheNobelPrizeinEconomics,andcontinuestoworkinmathematicalgame
theory.Hehaspublishedmanyscientificstudiesaswell.Asatherapist,Iwouldsimply
liketohaveachancetotalkwithhimabouthisbeliefs,delusionsandhallucinations,in
thenameofscientificinquiry.InJohnNash'sownwords,"Ihavehopesofbeingableto
achievesomethingofvaluethroughmycurrentstudiesorwithanynewideasthatcome
inthefuture."(Nash,1995)

References:

Capps,D.(2005).JohnNash:ThreephasesinthecareerofaBeautifulMind.Journal
of Religion & Health, 44, 363-376.RetrievedDecember1,2007fromAcademicSearch
Premierdatabase.

Carlin,N.S.(2007).TheEvolutionofJohnNash'sMaleMelancholia:FromHonorto
HopetoHumor.Pastoral Psychology, 54 (5),439-456.RetrievedNovember29,2007
fromAcademicSearchPremierdatabase.

Comer,R.J.(2007).FundamentalsofAbnormalPsychology,FifthEdition.NewYork:
Worth.

Keltner,N.L.(2007).Reviewof'ABeautifulMind'.Perspectives in Psychiatric Care, 43

(2),110-111.RetrievedDecember1,2007fromPsycINFOdatabase.

Nash,J.F.(1995).Autobiography.The Nobel Prizes.Stockholm:NobelFoundation.

RetrievedDecember2,2007fromhttp://nobelprize.org/nobel_prizes/economics/
laureates/1994/nash-autobio.html

Oltmanns,T.F.,Martin,M.T.,Neale,J.M.,&Davison,G.C.(2007).CaseStudiesin
AbnormalPsychology,7thEdition.NewJersey:JohnWiley&Sons,Inc.