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Review Of The Soloist

Elizabeth Simmons

Wake Forest University

CNS 770: Classification of Mental Disorders

Dr. Johnson

January 22, 2023

Review Of The Soloist

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The movie The Soloist is a look into the life of Nathaniel Ayers. The viewer learns pretty

quickly that Nathaniel is a talented musician living on the streets. LA Times reporter Steve

Lopez finds Nathaniel interesting and begins writing a column about Nathaniel. As the two men

spend more time together it becomes clear that Nathaniel has a mental illness. Steve sees the

talent Nathaniel possesses and attempts to help him by getting him into an apartment, connecting

him with a famous musician mentor, and eventually getting him a solo concert. Nathaniel did not

ask for help or indicate that he wanted anything other than to play music. The movie highlights

how much of a struggle living with mental illness in America can be, the importance of

autonomy within friendship, and how community support can improve quality of life.

Diagnosis Of Schizophrenia

To be diagnosed with schizophrenia (F20.9) a person, in this case Nathaniel, a middle

aged man, has to meet certain criteria (American Psychiatric Association Publishing, 2022).

Nathaniel meets criteria A of delusions, hallucinations, and disorganized speech (American

Psychiatric Association Publishing, 2022). Nathaniel experiences delusions that date back to his

time at Julliard as a teenager. When he is onstage he hears voices criticizing his musical abilities.

Nathaniel has been choosing to be homeless for years because of hallucinations. When he was

living in an apartment with his sister he heard and saw images saying she was going to kill him.

When Nathaniel hears music, he has visual hallucinations of the music as bursts of color. From

the time Steve and Nathaniel meet, Nathaniel has disorganized speech. He talks fast, jumps

around in topics, he asks Steve who is standing beside him on the ground if Steve is in a plane

flying overhead. He rambles and mumbles about Beethoven.

Nathaniel meets criteria B heaving a significant level of disturbance across multiple areas

of his life (American Psychiatric Association Publishing, 2022). He meets criteria C of having
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disturbances for greater than 6 months (American Psychiatric Association Publishing, 2022). He

is unemployed, appears to have no friends, and is not in touch with his family related to his

mental health for almost three decades. He leaves Julliard as a young man after a delusional

episode while on stage. He remembers his friend group but does not stay in touch with them. He

moves back in with his mother until he has a hallucination episode causing him to scare her. He

moves to California where he lives in an apartment with his sister until he has another episode.

Because of his frequent outburst like the one over a cigarette butt in the street, he is not able to

hold a job. He goes days with what appears to be white makeup on his face.

Nathaniel meets criteria D of having no other diagnosed disorder (American Psychiatric

Association Publishing, 2022). He does not appear to have depressive or manic states. He meets

criteria E because he is not under the influence of drugs or alcohol (American Psychiatric

Association Publishing, 2022). He meets criteria F because there is no indication that he was

diagnosed with autism spectrum disorder as a child (American Psychiatric Association

Publishing, 2022). At the end of the movie it does appear that Nathaniel is in partial remission

because he is attending a concert with his sister and is living in the apartment Steve helped him

get.

Relationship With Steve

The relationship between Steve and Nathaniel starts as a professional reporter/subject one

and moves into a friendship. The more time Steve spends with Nathaniel the more he cares for

him fostering his desire to help Nathaniel. Nathaniel does not ask for help and at times refuses

Steve’s ideas.

The viewer gets glimpses of Steve’s life outside of his relationship with Nathaniel. Steve

has an ex wife and a college age son. There is tension between Mary (the ex wife) and Steve that
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seems to be the result of Steve not being emotionally mature. It seems that Steve and his son do

not have a close relationship. There could be a case made that since Steve is not being successful

in his personal life, he is trying to “fix” Nathaniel’s life.

Despite being “mugged 14 times”, Nathaniel seems to be getting along being homeless.

Steve feels that Nathaniel should not be living on the streets of Skid Row. So, he talks with Dave

from the Lamp Community Center and is able to get Nathaniel a small apartment. Nathaniel is

not happy about the situation. He would rather live outside because the voices he hears are not as

loud. Nathaniel starts by using the space as a place to practice cello. Eventually he begins to

spend the night at the apartment.

Steve wants to help Nathienal with his music so he sets up a meeting with Graham

Claydon from the LA Philharmonic. Graham does help Nathienal with his music but also pushes

for Nathaniel to have a concert. Nathaniel’s delusions and hallucinations are triggered by being

on stage. Nathaniel knows that he will not be able to play in a concert setting but is talked into it

by Graham and Steve. Graham was so out of touch with Nathaniel and Steve should have been a

better advocate for Nathaniel in regards to Graham.

Steve seems to have genuine concern for Nathaniel, however his help is not always

Nathaniel friendly. Steve could have been more impactful had he taken the time to learn how a

person with schizophrenia functions. None of Steve’s actions toward Nathaniel have been

malicious, but could have been different to yield a more Nathaniel focused result.

Types Of Help

Steve feels that if Nathaniel were to be involuntarily committed to a psychiatric facility,

he would receive medications that “fixed” him. Dave, the director of the Lamp Community

Center, disagrees with Steve. Dave appears to have an expertise in mental illness, addictions, and
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the homeless community of LA. He tries to explain that having a diagnosis does not mean

anything. He tries to explain that medications are not an easy “fix”. Steve defies Dave’s advice

and has Nathaniel talk with a psychologist. Nathaniel tells Steve he does not want the medication

because it makes music sound off.

When Steve goes to Dave to get Nathaniel the apartment, Dave asks if Nathaniel really

wants it. Steve replies that he does. However, Nathaniel never asked for the home and initially

did not want it. Nathaniel even tells Steve that he does not want to die in the apartment. He needs

the freedom of the city. The apartment does serve as a safe place for Nathaniel when the police

raid Skid Row. When Nathaniel appears to be in partial remission, he does have a place to live.

Dave takes the stance that having a diagnosis and medication are not what everyone with

a mental illness wants or needs. He is about meeting people where they are and honoring their

desires. Steve takes the stance that giving Nathaniel a “normal” life is what is best despite what

Nathaniel wants. Both stances can be right. Autonomy is important, but to fit into society certain

rules have to be followed. A perfect approach would be to accept all aspects of a person while

the person accepts basic community standards. Being aware that personality is not cookie cutter,

not everyone has a diagnosis, and those with a diagnosis can be a valuable part of society.

Useful Interventions

Schizophrenia is not the same for everyone. Interventions should be individualized

(Reichenberg & Seligman, 2016). Safety should be the first consideration, especially during an

acute episode (Reichenberg & Seligman, 2016). This could be in the form of a hospitalization,

partial hospitalization, or a day program until previous functioning is achieved (Reichenberg &

Seligman, 2016). Nathaniel overall does not appear to be in immediate danger. A partial day
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program that uses cognitive behavior therapy, skills training, hobby exploration, and family

counseling could be helpful for Nathaniel.

Medications can be used to help symptoms but it should be noted that current research

points to even with medication compliance symptoms can still reoccur (Reichenberg &

Seligman, 2016). Medication compliance can be low related to a stigma associated with use

among those with schizophrenia (Reichenberg & Seligman, 2016). Some report the side effects

of the medication being too undesirable. Others start to feel better and discontinue the

medication. It was not noted in the text, but being able to afford the medication on a regular basis

could impact if the person will take it as prescribed. Nathaniel stated he does not like the

medication he has been prescribed in the past. This could be a possibility for him if he was

willing to work with a provider to find something that works without changing his relationship to

music.

Discussion

The movie The Soloist is a glimpse into the world of mental illness, friendship, and what

a helpingful relationship looks like. Nathaniel, with the help of a support system, can live a safe

life full of music while having schizophrenia. With some guidance for an expert like Dave, Steve

can continue to have a meaningful relationship with Nathaniel. Had the movie continued

interventions for Nathaniel could have been explored. This movie is based on a real story, it

would be possible to do a follow up movie about Nathaniel and Steve.

References

American Psychiatric Association Publishing. (2022). Diagnostic and statistical manual of

mental disorders: Dsm-5-Tr.
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Reichenberg, L. W., & Seligman, L. (2016). Selecting Effective Treatments A Comprehensive

Systematic Guide to Treating Mental Disorders (5th ed.). Wiley.

Wright, J. (2009). The Soloist. Paramount Pictures.