John Nash Case Conceptualization in A Beautiful Mind

Devon De Paola

Psych 270: Abnormal Psychology

Dr. Nester L. Lopez-Duran

GSI: Hannah Becker

April 9th, 2021

Personal Information

The movie A Beautiful Mind, released to the public in 2001, is an American biographical

drama film based on the life of the American mathematician John Nash. John Nash was a Nobel

Laureate in Economics and an Abel prize winner. John Nash made fundamental contributions to

game theory, differential geometry, and the study of partial differential equations. His work has

provided insight into the factors that govern chance and decision-making inside complex systems

found in everyday life. John Nash was a white, male, 20 to 22 year old student, attending

Princeton University to complete his doctorate in governing dynamics. Later in his career he

became an analyst at Wheeler Lab, located on the MIT campus in Cambridge, Massachusetts.

The movie starts off in Nash’s days as a graduate student at Princeton University in 1947. He

arrives as a co-recipient, with Martin Hansen, of the Carnegie Scholarship for mathematics. The

movie follows the course of Nash’s life, starting at his first moments at Princeton and follows

throughout his life and his struggles with Schizophrenia. Beth Daley’s biography (2016) about

John Nash, she mentioned the following:

While still in graduate school (April 1950), Nash published his first paper, “The

Bargaining Problem,” in the journal Econometrica. He expanded on his mathematical

model for bargaining in his influential doctoral thesis, “Non-Cooperative Games.” Nash

thus established the mathematical principles of game theory, a branch of mathematics that

examines the rivalries between competitors with mixed interests (para. 3).

In 1959, Nash began showing clear signs of mental illness, and spent several years at psychiatric

hospitals being treated for Schizophrenia. We see moments in the beginning of the movie where

Nash starts to act paranoid or flustered, he does not have or develop close personal relationships

with people, he is obsessed with conspiracy theories, and experiences daily hallucinations and
delusions without realizing what they are. John hallucinates two people, Charles Herman, his

roommate, and William Parcher, who works for the CIA. John believes that Parcher has recruited

him to work with top secret information about the Russians. Charles and Parcher become very

big characters in Nash’s life and throughout his battle with Schizophrenia. He became so

obsessed with the idea of being the person that discovered something that no one had touched

base on before, something new and unknown to everyone. Him striving for such a hard to reach

concept put extreme pressure and stress on Nash, which eventually caught up to him in the forms

of delusions and hallucinations.

Diagnostic Information

John Nash’s symptoms and experiences best align with Schizophrenia. According to the

DSM-5 criteria for Schizophrenia, the patient must experience the following symptoms;

delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and

negative symptoms. Throughout the movie we are able to see many examples of where John

Nash experiences these symptoms. Nash experiences delusions when he is in his room in the

dark and his wife, Alicia, comes in and turns on the lights. This causes John to get up

immediately and yell at her to “turn the lights off!” and “why would you do that” (Howard, 2001,

1:01:00). Nash reacts this way because he believes that the Russians are watching him. This is

the first time Alicia realizes that something is wrong with her husband. A couple years later,

Nash is forced down by doctors, as they are taking him to a psychiatric ward, he believes that

they are working for the Russians. He starts screaming, yelling for help, and frantically moving

his body (Howard, 2001, 1:06:38). After Nash is committed to the psychiatric ward, Alicia

finally goes to visit him and he asks her to whisper because “they (the Russians) may be
listening, there may be microphones” (Howard, 2001, 1:15:00). Nash is now out of the

psychiatric ward and he is on new medications, he seems to be improving; until one night, he

hallucinates a soldier running into the woods behind his house and he follows him. He is then

met by Parcher and surrounded by soldiers that lead him to a shed behind his house that he

believes to have a military base in it. The next day Alicia hears radio static coming from the shed

and goes to see what it is, she opens the door and the inside walls are covered in newspaper

articles, magazines, string and pins, and frantic and indecipherable writing everywhere (Howard,

2001, 1:35:45). His decoding is an example of thought derailment as he is jumping from one

thought to the next trying to make connections that don’t exist. This is when Nash starts to

experience bad symptoms again, as he is giving his infant son a bath and he leaves him in the tub

with the water running. Nash goes to close the window without watching the baby, Alicia runs

upstairs and has to pull the baby out of the water before it is too late. Nash tries to explain

himself by saying,

“Charles was in there watching the baby and no one else could see Charles because he

was injected by a cloaking serum and only John could see him because of a chemical that

was released into his bloodstream when his implant dissolved” (Howard, 2001, 1:36:00).

John Nash also experiences many hallucination episodes throughout the movie. His first real

hallucination is his roommate Charles Herman, a fiction of John’s imagination. We also find out

that while “working with” William Parcher, who is also one of Nash’s hallucinations, he was told

to put confidential letters in this mailbox of a secret house, when Alicia goes to find the house,

she finds an abandoned house with all of his letters jammed into an old and rusted over mailbox

in the driveway (Howard, 2001, 1:13:52). When Alicia comes to visit him in the psychiatric

ward, she tells him that Parcher is not real and shows him his letters that he thought were being
sent out. Nash goes back into his cell and starts trying to claw out the implant that he believed

the government had put in him. This causes him extreme physical harm to his forearm (Howard,

2001, 1:17:52). He experiences an episode where all of his hallucinations surround him at once,

telling him to hurt Alicia because “she knows too much” (Howard, 2001, 1:38:11). He

impulsively pushes her against the wall because Nash thinks Parcher is going to shoot her. Nash

experiences affective flattening when he is holding his crying kid and he is just sitting there with

an almost lifeless demeanor (Howard, 2001, 1:25:30). The hallucinations subside until many

years later when he returns to the Princeton campus and tries to enter the library without

permission. He is refused at the door which triggers another grossly disorganized episode, Nash

starts yelling in the middle of the quad. He is fighting with Parcher who is calling him a failure

and that he needs to go back to being a soldier. Nash fights back and yells, “I am not a soldier!”

and “you are not real” (Howard, 2001,1:50:11).

The developmental history and course of the disorder started in graduate school. We see

Nash being a little more on the socially awkward side and doesn’t know how to read and process

social cues. There is a scene where he approaches a woman at the bar and bluntly asks her what

he has to do to get her to sleep with him (Howard, 2001, 0:15:00). Nash would have multiple

specific episodes. At first they would last a short amount of time, but as the Schizophrenia

progressed and got worse, the episodes would get longer. Nash would have episodes where he

would hallucinate gaming scenarios and codes in his head that would only last the short amount

of time. But his longest episodes were his hallucinations of Charles and Parcher, that started in

graduate school and lasted the majority of the rest of his life. His worst episode was when he

hallucinated that he was in a car chase with Parcher and the Russians and they were being shot

at. This episode was what started the majority of his impairing delusions. While in the
psychiatric ward, Dr. Rosen is talking to Alicia about Nash and says, “What is more likely, that

your husband was a mathematician with no military training is a government spy fighting the

Russians, or that he has lost his grip on reality” (Howard, 2001, 1:11:15).

Schizophrenia greatly impaired Nash, before he was able to decipher what was real and

what wasn’t, he was unable to have or keep personal relationships. Nash is talking to Charles on

the roof and says, “The truth is I don’t like people much. And they don’t much like me”

(Howard, 2001, 0:08:19). This is true, until he meets Alicia and becomes work partners with Sol

and Hansen. It affected his work and academic life as he did not attend classes in graduate

school, nor did he attend his own lectures that he taught at MIT.

John Nash could be diagnosed with OCD. Schizophrenia and OCD have similar

symptoms and can often get misdiagnosed. In some studies, research has shown that “obsessions

can transform into delusions.” And that “OCD and symptoms of OCD can be associated with the

development of a psychotic disorder over time” (Solem, 2015, paras. 1-2). Some symptoms of

OCD include aggressive thoughts and losing control, harming yourself or others, and extreme

obsessions or compulsions (Eisen, 2017, para. 1). Nash harms himself when he is trying to

remove the implant from his arm and harms others when he pushes Alicia against the wall.

Obsessions and compulsions interfere with daily activities and cause significant distress. When

Nash spends all day in his office, doing “classified work,” he is spending his whole day trying to

decode messages that don’t exist. People with OCD may or may not realize that their obsessions

and compulsions are excessive or unreasonable, but they take up a great deal of time and

interfere with their daily routine and social, school or work functioning. The onset age for OCD

is before the age of 25, usually in the childhood or adolescent years; the onset age for

Schizophrenia is typically mid- to late 20s. John Nash shouldn’t be diagnosed with OCD because
he struggles with the ability to grasp what is real and what is not, he has difficulty establishing

and maintaining relationships, and experiences hallucinations and delusions. People experiencing

delusions will usually not recognize the irrationality of their thoughts; whereas people

experiencing an obsession are usually aware of the irrationality and are simply unable to control

it.

Causes Literature Review

Possible causes and mechanisms of Schizophrenia are still developing and being

researched. In 2019, Simona A. Stilo, who works for the National Institute for Health Research

(NIHR), wrote about her findings of “Non-Genetic Factors in Schizophrenia. She specifically

focuses on social factors, such as trauma, as possible causes of Schizophrenia. Trauma and social

adversities in different forms, either during childhood or adulthood, have been extensively

investigated as potential risk factors for Schizophrenia.

“In a meta-analysis of case-control, prospective, and cross-sectional cohort studies,

reported strong evidence that childhood adversity (defined as sexual abuse, physical

abuse, emotional/ psychological abuse, neglect, parental death, and bullying) was

associated with increased risk for psychosis in adulthood” (Stilo, 2019, para. 9).

A robust link between childhood trauma and schizophrenic symptoms has been found with

childhood trauma being associated with the most severe forms of positive symptomatology in

adulthood, particularly hallucinations, and affective symptoms. Nash shows clear signs of social

discomfort and does not know how to read social situations, but we don’t know if he experienced

any trauma while growing up.

 In 2016 a study was conducted by the Maryland Psychiatric Research Center, to observe

Familial Aggregation and Heritability of Schizophrenia. In this study researchers focused on

family as a possible cause of the disease. Ample evidence suggests that schizophrenia is subject

to strong familial predisposition, implying that both genetic and shared environmental factors

contribute significantly to the phenotypic variance of the disorder. In the article it mentions,

“the age-specific prevalence of Schizophrenia was statistically significantly higher in

individuals with affected first - and second - degree relatives with Schizophrenia than in

the general population” (Chou, 2016, para. 13).

Pregnancy and birth complications could also be causal factors for Schizophrenia. In the article

written by Stilo, she mentions, “Four main pathogenic mechanisms have been suggested as

involved: fetal malnutrition, prematurity, hypoxic-ischemic events, and maternal infections

during pregnancy or delivery” (Stilo, 2019, para. 7). We don’t know the medical history of

Nash’s family members, but Schizophrenia is very inheritable and genetic, so it is possible that

someone in his family has also suffered from the disease.

The topic of genetics being a causal factor of the disease is talked about in an article

published by the United Kingdom National Health Service. Schizophrenia tends to run in

families, but no single gene is thought to be responsible. “It's more likely that different

combinations of genes make people more vulnerable to the condition. However, having these

genes does not necessarily mean you'll develop schizophrenia” (NHS, 2019, para. 2). Evidence

that the disorder is partly inherited comes from their twin studies. The results of the studies show

that in identical twins, if a twin develops schizophrenia, the other twin has a 1 in 2 chance of

developing it, too. This is true even if they're raised separately. In non-identical twins, who have
different genetic make-ups, when a twin develops schizophrenia, the other only has a 1 in 8

chance of developing the condition.

Susan Chow, a researcher for News Medical Life Sciences, wrote an article examining

how chemical and neural mechanisms could be possible causal factors of Schizophrenia. She

talks about the dopamine hypothesis and the glutamate hypothesis. Dopamine is a

neurotransmitter found in the brain that plays a role in the mesolimbic pathway and the positive

symptoms of schizophrenia. Chow writes,

“The involvement of dopamine in the mechanisms of schizophrenia was first introduced

due to the ability of phenothiazines, a class of dopamine antagonist drugs, to reduce

psychotic symptoms. Similarly, amphetamines tend to aggravate psychotic symptoms due

to their dopamine agonist effect” (Chow, 2019, para. 4).

Another neurotransmitter, glutamate, and the NMDA glutamate receptor have also been

suggested to play a role in the pathophysiology of schizophrenia. “This came about due to the

low number of glutamate receptors observed in the brain of people that had been diagnosed with

schizophrenia” (Chow, 2019, para. 6). While in the psychiatric ward, Nash was treated with

insulin shots and electroconvulsive therapy, which alters dopamine signaling in the brain.

Treatment Literature Review

Treatments that have been recently used and researched include individual

psychotherapy, electroconvulsive therapy, psychosocial therapy, and medications. Individual

psychotherapy includes Cognitive Behavioral Therapy (CBT), which is talked about in a 2016

article, published by the Society of Clinical Psychology. CBT for schizophrenia involves

establishing a collaborative therapeutic relationship, developing a shared understanding of the

problem, setting goals, and teaching the person techniques or strategies to reduce or manage their

symptoms. In the article, it mentions that,

“therapy is usually conducted in individual sessions and is time-limited (typically several

months). The goal is not to “cure” schizophrenia, but rather to improve the person’s

ability to function independently, manage their schizophrenia, and to reduce the distress

they experience in their daily life” (SOCP, 2019, para. 1).

Specific CBT approaches used in treating schizophrenia include cognitive restructuring,

behavioral experiments / reality testing, self-monitoring and coping skills training. Nash talks

with Dr. Rosen, his psychiatrist, after he stops taking his pills. They talk about trying to figure

out what is best for him, if that’s staying at home, or being recommited.

In an article published in 2018 by Mayo Clinic, information about Electroconvulsive

Therapy (ECT) is provided. Electroconvulsive therapy (ECT) is a procedure in which electrodes

are attached to the person's scalp and, while asleep under general anesthesia, a small electric

shock is delivered to the brain. ECT seems to cause changes in brain chemistry that can quickly

reverse symptoms of certain mental health conditions. “Each shock treatment causes a controlled

seizure, and a series of treatments over time leads to improvement in mood and thinking” (Mayo,

2018, para. 2). While at the psychiatric ward, Nash is given insulin shots and electroconvulsive

5 times a week, for 10 weeks.

In an article written by Laurent Morin, in 2017, he writes about a study that he conducted

about Psychosocial Therapy, but more specifically, the importance of rehabilitation interventions.

Rehabilitation interventions have been developed to improve functional outcomes and to

promote recovery. Rehabilitation or psychosocial interventions have been developed to

complement psychotherapy and psychopharmacological treatments. Morin writes,

 “indeed, drug treatments and supportive therapies do not have a specific effect on

cognitive impairment, insight, social skills, and interaction disorders, whereas

rehabilitation tools especially target these dimensions” (Morin, 2017, para. 13).

Many tools can be used in the field of rehabilitation, such as cognitive remediation and

psychoeducation. Cognitive remediation aims to limit the impact of cognitive impairment on

everyday functioning. Psychoeducation aims to help patients and their families understand the

disease and treatment, cooperate with caregivers, live healthier lives, and maintain or improve

their quality of life. Dr. Rosen helps to keep Alicia, Nash’s wife, well informed about the

symptoms of Schizophrenia. He explains to her how the disease is specifically affecting Nash

and his life, in the hopes that she will help and support her husband.

Another treatment is medication, more specifically, antipsychotics. In a 2021 article,

Kathleen Smith writes about how medication is an essential component of treating

schizophrenia. Medication can help relieve symptoms of schizophrenia such as delusions,

hallucinations, and disorganized thinking by blocking certain chemical receptors in the brain.

Smith writes that, “the most commonly prescribed types of medications for schizophrenia are

antipsychotics, and there are two classifications of antipsychotics, typical and atypical” (Smith,

2021, para. 1). Atypical antipsychotics are also known as second generation antipsychotics.

These medications are generally the first course of medication because they have a lower risk of

serious side effects. Typical antipsychotics were the first generation of antipsychotics that were

developed; They can be effective in managing symptoms but also can cause short-term and

long-term side effects. Nash started taking prescribed antipsychotics during his stay in the

psychiatric ward. He stopped taking those specific pills a couple years later, but was put on a

typical antipsychotic.
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