Schizophrenia: A Beautiful Mind, Assessment Example

Abstract

This paper uses the character in the Film of ‘A Beautiful Mind’ in order to discuss the concept of schizophrenia from a psychology viewpoint.  The paper is divided into six discrete parts: (1) That of the Introduction that provides a background of the film in context with the disorder of schizophrenia. (2) A disorder description – What this disorder is from the psychological perspective.  (3) Client Background – A description of the main character in the film and how the illness was reflected from a number of different vantage points. (4) Concern – The symptoms of the illness and the type of treatment options available. (5) Diagnostic impressions – Examination of different diagnostics and those that were ruled out, including recommendations for treatment. (6)Assessment Summary – Summary of the key points.

Introduction

The film of ‘A Beautiful Mind’ told the story of the Nobel Prize winner and mathematician John Nash.  The lead part played by the actor Russell Crowe.  Nash was a graduate of Princeton University and a brilliant mathematician.  He spent his life working towards an original mathematical theorem or algorithm. He was a relatively secluded individual but later suffered from mental illness and the disorder of schizophrenia.  It was this loss of a grip on reality that drove him to the depth of despair and he spent a long time in isolation from the academic world until he made a recovery in the 1970’s. He returned to teaching and conducting research and in 1994 received the Nobel Prize in Economics.

Schizophrenia has been described as a serious mental illness that makes it difficult for individuals to think in a logical manner and have a true grip on what is reality.  They may behave normally in social situations but live part of their life out in a fantasy world.  The illness is a complex one and may take on a number of variable forms.  It is widely held to be genetic by nature and may be brought on by adverse environmental conditions.  This may impact adults at any time of life and equally may impact men or women.  The symptoms may be slow in developing  but tell tale signs are isolationism, inability to work, difficulty with social situations and making friends.  Other signs include difficulty in sleeping, feeling of depression and anxiety brought on by the inability to concentrate.  As the disease progresses you move into the realm of hallucinations, delusions and losing touch with reality, bizarre behaviour and social isolation. ( Weinberger, D.R.  2011)

There are no medical tests that can diagnose schizophrenia; it ultimately requires a psychological interview involving family and friends.  The illness may be treated by medication and drugs and may require a prolonged hospital stay, subject to severity. Anti-psychotic drugs can have nasty side effects and as such this is a managed situation.  Although a mental illness, as in the case of  John Nash you may have a very high intellect.  People diagnosed with the illness have been seen to respond favourably to medication, however this is a long term treatment and symptoms may recur if you do not continue with the medication.  Nash proved that by recognising the problem, seeking professional help and taking medication it was possible to return to a relatively normal life.

Disorder description

The mental illness of Schizophrenia often impacts late childhood or young adulthood. Although it can equally occur at any time in adult life. There is mainly a hereditary genetic footprint and as such if you have a family history of the disease you are immediately at risk.  People diagnosed with Schizophrenia are normally placed on medications for life i.e. anti-psychotic drugs and often this is a long period of treatment.  Supporting therapies are also introduced in order to help the medication process. The illness is essentially a brain disease that interferes with the normal routine functioning of the brain.  The causes of the illness have not been properly determined but researchers have created links to damage in a child’s nervous system development.  Early medication focused upon blocking the dopamine effect and introduced such drugs as Thorazine and later Zxprexa.  These drugs were hailed as a major breakthrough when they were introduced in the 1990’s (Birchwood, M. J. 2001)

Dr. Shoepp has advanced the treatment by looking at a new drug called LY2140023 aimed at the neurotransmitter glutamate; the area of the brain responsible for memory and perception .  This drug is currently still in clinical trials and not expected to be released until 2012. It is also hoped that this will aid diseases like Alzheimers and Parkinsons.

Client Background

Professor John Nash, as played by Russell Crowe in the movie ‘ A beautiful mind’ was a brilliant mathematician. Nash suffered from paranoid schizophrenia but developed a number of important mathematical theorems, particularly into the forces that govern chance.  His mathematical theories won him the Nobel Memorial prize in Economics in 1994.  Professor Nash was a senior researcher in Mathematics at Princeton University.  The film broadly depicts the life of Nash and the struggle he had combating paranoid schizophrenia.  Nash spent long periods of involuntary time in a New Jersey hospital where he received treatment for his illness.  Nash stated that he found these periods to be a de-humanising experience where he experienced dream like delusional states but in between this he had lucid periods where he was able to turn his attention to mathematical research.  (IMDB, 2011)

In his early years Nash was considered to be a mathematical genius and despite being accepted by Harvard University he was snapped up by Princeton who awarded him the John F Kennedy Fellowship.  Nash earned his Doctorate in 1950 and during his time at Princeton he developed his Equilibrium Theory.  He went on to develop a number of other important mathematical theories.  Nash had a child with a nurse called Eleanor Stier whom they named John David Stier.  Nash considered marrying her but he ultimately decided against it and left them.

In 1951 Nash went to The Massachusetts Institute of Technology (MIT), as an instructor in the Faculty of Mathematics.  Nash  met Alicia Lopez-Harrison at MIT, being a student from El Salvador, who he later wed.  It was Alicia who committed Nash to a mental hospital in 1959 for treatment related to paranoid schizophrenia.  The two became divorced in 1963  and Nash was finally discharged from hospital in 1970.  (Kadlecek, 2011)

Concern

Alicia admitted Nash to hospital because of his frequent bouts of paranoid schizophrenia.  He would imagine that  all people who wore red ties were communists  and were conducting a conspiracy against him. He began to talk about fictitious characters who represented a threat to his life.  It was when he was admitted to the MacLean hospital in 1959 that he was officially diagnosed with paranoid schizophrenia.  He was treated over a very long period of time with medications for paranoid schizophrenia.  He was described as having a lack of motivation for life and suffered bouts of severe clinical depression.  Upon his discharge from hospital in 1970 he acted oddly and resigned from MIT where he drew out his pension and moved out to Europe where he tried to claim political asylum. He equally tried to renounce his US citizenship  but he got in trouble with the French Police in Paris where at the request of the US embassy he was deported and returned to the USA.

From 1961 to 1970 Nash was treated at the Trenton hospital in New Jersey where he underwent extensive treatment with psychotic drugs.  Nash complained that the drugs prescribed were overrated and insufficient consideration was made about the disturbing side effects that they created.  Despite this Nash made a steady recovery over a considerable long period of time. Nash attributed his illness was a result of extreme unhappiness and his continued striving for importance and recognition. Nash stated that it was not until 1964 when he started to hear voices and learnt to develop his own process of rejecting them.   Nash is today working on Advanced Game theorems . (Kadlecek, 2011)

Diagnostic Impressions
When examining a patient for mental illness  the initial physical examination will consist of a general physical examination in  three main processes: (1)  A basic observation of the patient including such items as – the ability to hold a conversation, the persons walk and stance, skin tone and voice intonation (2) Checking of blood pressure and signs of anemia or areas of swelling on the legs (3) Examination of the main organs of the body – heart, lungs, liver, kidneys etc.  For those considered to have psychiatric disorders the examination will cover a further neurological examination.  Psychotic disorders are often associated with impaired vision, losing touch with reality and delusionary behaviour. (Throughtheeyes.org, 2011)

Psychotic disorder often illustrate the following types of characteristics

• A psychosis that demonstrates a loss of touch with reality and sense of delusions
• Illusions and false perceptions i.e. a stick on the floor viewed as a snake
• Hallucinations – visual or auditory stimulus i.e. hearing voices in the head, odd pictures not associated with normal reality
• Delusions – false beliefs based upon some perceived reality
• Grandiose delusion – elevated stature thinking of oneself as a god like figure
• Somatic delusion – a false belief about some part of your anatomy, you may consider one arm is longer than the other for example
• Paranoia – irrational distrust of others or feeling of persecution. With Nash the example is the people with red ties that he thought was a communist conspiracy.

Recommendations For Treatment

The Five Axis Diagnosis

The DSM-IV was first developed and published by the American Psychiatric  Association  and embodied within the Statistical  Manual of  mental disorders.   The Five Axis diagnostic system  provides the ability to take  a comprehensive and statistical evaluation of the patient’s mental state.  The method is split into the following axis of analysis:-

Axis 1 – Psychiatric diagnoses

Here the psychiatric diagnosis are listed  ( which excludes personality disorder and mental retardation).

Axis 2 – Developmental diagnosis

This includes mental retardation and personality disorders.  Also includes maladaptive personality features and other personality disorders

Axis 3 –  Physical Diseases

Lists all of the physical diseases regardless of whether or not they are related to or impact the mental state of the patient.  A general medical condition may relate to the mental disorder in a number of different ways and may indicate a deterioration of mental symptoms

Axis 4 – Psychological stress Factors

These examine all of the stressors impacting the patient either in the past or the present.  These are the influencing factors  that relate to psychological or environmental problems

Axis 5 – Global functioning of the patient

A wide evaluation of how the individual copes with the present life situation. How well they are in tune with reality.  This leads to the determination of a ‘Global Assessment of Functioning’ or GAF score and is a determining factor in the measure for deciding whether hospital treatment is required.

Figure 1 : The GAF Index Score

Based upon the observational reports of Professor Nash we can determine the following Axis Report:

The diagnosis was determined on this best fit description

Behavior is considered influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas

At this point it was ruled out that Nash was in danger of hurting himself or others. The GAF index however indicates a deteriorating condition where hospital intervention is required and suitable anti-psychotic medication is required. (Hunter, 2008)

Treatment Options

In the first instance Nash was prescribed with Thorazine which is a drug that exerts a calming influence and attempts to slow you down.  Later this included insulin (a.k.a. hypoglycemic) coma therapy and various other anti-psychotic drugs.  Nash complained that the drugs were not really a contributory factor to his eventual cure and in fact the side effects that they produced were more conducive to mental illness.  This film did not get this right as it focused more upon the therapeutic qualities of the drugs than the self-help administered by Nash and his determination to beat the illness.

Client Assessment Summary

In simplistic terms Neuroscience may be defined as a scientific process or study into the behavioural condition of a person’s brain cells. The brain cells stimulate other bodily functions by the collection and dissemination of information from millions of nerve cells around the body.  This can sometimes result in behavioural dysfunctions. In this sense the dysfunctions of the brain and spine may be considered as medical problems. Psychologists are more concerned with understanding the behavioural conditions resulting from neurological and cognitive functions

During the 19th Century it was considered that there was a strong link between serious mental disorder and violent behaviour. The violence is considered to be in the minority grouping of those patients with mental disorders and there has been strong links associated with behavioural dysfunctions through substance abuse or noncompliance with medical applications. Research conducted by Dr.E.F. Torrey[1]  in the United States looked at a cross-section of mental illness patients with violent or aggressive tendencies. In 1990 the National Association for the Mentally Ill in the USA studied some 1400 Families with Mental illness and violence. From this research they discovered a link that the majority of cases resulted from three distinct types of psychological conditioning i.e. Schizophrenia, Bipolar Disorder and Acute Depression.

Neuroscience and Schizophrenia.  Neuropsychology can provide important information about the behavioural conditions and symptoms of brain damaged patients. It is often possible to detect conditions of brain abnormalities that provide clues to certain behavioural conditions. Schizophrenia is a relatively common ailment and statistics indicate the potential for 1:100 people to be impacted in their lifetime. It can appear at any time and take on a number of different forms.  Not all cases have been linked to violent or criminal behaviour but there are statistics involving homicides. Many of those afflicted have hallucinations and hear voices talking to them.  They feel as if their actions are being controlled by an external force.

It has been held that the study of social cognition in Schizophrenia may help to augment both the clinical and behavioural examination of the disorder. The use of non-social information processing models may help in the facilitation and explanation of the social dysfunction. (Charney, D.S. 2011)

Bipolar Disorder  Medication is now available as a maintenance treatment for those with bipolar disorder. Research has shown that a high proportion of patients do not comply with the treatment. Clinicians believe that there is a need for ‘psychoeducation’ in order to explain the importance of maintaining medication. Many patients find it difficult to accept that they have a mental or psychological illness. This causes them to rebel against the treatment program.

References

Daniel R. Weinberger, P. H. (2011). Chizophrenia. New York: Wiley Blackwell.

Dennis S. Charney, E. N. (2011). Neurobiology of Mental Illness. In E. N. Dennis S. Charney, Neurobiology of Mental Illness (p. 303). Oxford: Oxford University Press.

Hunter, W. S. (2008). Psychological abstracts, Volume 90, Issue 9. University of Michigan: American Psychological Association.

IMDB. (2011, 12 5). A beautiful mind. Retrieved from IMDB: http://www.imdb.com/title/tt0268978/

Kadlecek, J. (2011, 11 25). Sylvia Nasar Discusses Her Book, ‘A Beautiful Mind;’ Psychiatrist Roberto Gil: Schizophrenia and Recovery. Retrieved from Columbia News: http://www.columbia.edu/cu/news/02/01/beautiful_mind.html

J. Birchwood, M. B. (2001). Schizophrenia. Philadelphia PA: Taylor and Frances.

Throughtheeyes.org. (2011, 12 5). The eyes of a diagnosis. Retrieved from Throughtheeyes.org: http://www.throughtheeyes.org/files/the_axes_of_a_diagnosis.pdf

[1] Edwin Fuller Torrey, M.D.  is an American psychiatrist and schizophrenia researcher