Abstract
A selection of films and books is offered this month for your holiday consideration. The film A Beautiful Mind is important enough to warrant two reviews because of its potential to influence attitudes to schizophrenia over a wide audience.
With best wishes for the festive season.
Jo Beatson
Director: Ron Howard, Producer: DreamWorks, 2001
As a young man, the American John Nash was an awkward man but a brilliant mathematician. In his late twenties his behaviour and thinking became increasingly erratic, rapidly culminating in paranoid schizophrenia. He remained ill and disabled for nearly three decades, before making a slow and gradual recovery. In 1994, at the age of 66, he was awarded a Nobel prize for his work from 40 years earlier on game theory; his innovative extension to which had had a profound impact on such diverse areas of scholarship as economics, international trade and politics.
The highly successful film, starring Russell Crowe as Nash, was inspired by the prize-winning biography by Sylvia Nasar that first appeared in 1998 [1]. As mental health professionals, our interest in the film lies primarily in the messages that it conveys to the general public about mental illness, and it is around this theme that this review is based.
The parallels with Shine, the story of a gifted musician (David Helfgott) affected by mental illness, are inescapable. There too, brilliance combined with madness were portrayed by a famous actor. But whereas Shine may have distorted certain important aspects of the story in order to gain cheap dramatic impact [2], the film A Beautiful Mind appears to stick closer to the facts. Nevertheless, the release in fairly quick succession of two films that link exceptional creativity with mental illness clearly has the potential to foster unhelpful understandings, such as that a deep involvement with ineffable abstractions like music and mathematics leads to a weakened grip on reality, or that mental illness promotes ‘higher’ levels of consciousness. Nash himself said, at the time of his Nobel award, ‘So at the present time I seem to be thinking rationally again in the style that is characteristic of scientists. However, this is not entirely a matter of joy as if someone returned from physical disability to good physical health. One aspect of this is that rationality of thought imposes a limit on a person's concept of his relation to the cosmos.’ Nash and Helfgott are exceptional individuals, and their stories are exceptional; the sad fact is that when mental illness strikes talented persons, usually their ability to ‘perform’ is drastically affected. This was most clearly the case with Nijinsky, held by some to be the greatest ballet dancer ever, who practically never danced again after he developed a psychosis at the age of 29 [3].
A Beautiful Mind has some strong and original features. The portrayal of the main character is sympathetic, and to this extent the film encourages the audience to understand his strange experiences. While in real life Nash's hallucinations were exclusively auditory, this cinematic medium understandably has them as visual. The film gives the audience no clues as to what is real and what is hallucination. While the clinically astute can fairly quickly spot that the persecutory figures are unreal, it came as a shock to this reviewer that one of Nash's friends during his most disturbed period was equally unreal. The clever cinematic device of getting the audience to accept the reality of events is a powerful way of demonstrating the absolute subjective reality of the hallucinatory experiences – in a sense the film is saying: ‘Well, for a while there, you were believing them too’.
Trickier is the question of treatment. Nash's illness occurred in the era of the ‘old’ antipsychotic medications and insulin coma therapy, of which there is a disturbing and inaccurate scene. The film has Nash saying, in his Nobel acceptance speech, that he takes the newer medications, which, while they do not cure him, do help. This piece of psychopharmaceutical correctness is totally at odds with the biographic reality: Nash refused all antipsychotic medications from 1970 onward [1], p.353] fearing that they would interfere with the quality of his mind. Thus, the take-home messages concerning treatment appear to be mixed and to some degree contradictory. On the negative side is the portrayal of enforced treatments as unpleasant and mind-numbing, while on the positive side is the message of hope that recovery is possible even after long periods of severe illness, and the important roles of support and self-help. While adherence to literal truth is not a criterion for judging a work of art, it should be disturbing to us that the film leaves the viewer with the impression that much of the eventual happy ending was attributable to the newer, nicer, medications, even though these are indeed the mainstay of modern treatment. At the very least, this distortion serves to undervalue the other factors in Nash's recovery.
The film presents the all-too-familiar scenario of early psychotic symptoms going unrecognized, and a long period of illness before psychiatric treatment was sought. We may speculate whether treatment would have been instituted earlier today, with our sophisticated models of early intervention. It is not at all clear that it would; it is all too easy and tempting to rationalize bizarre behaviour in an eccentric genius.
Asked at interview how he recovered, Nash said ‘I willed it’, explaining that he took to arguing with the concept of the voices, and rejecting them. This remarkable instance of a form of cognitive-behavioural self-help is testimony to his intelligence, capacity for focused attention and to his determination to play an active part in his rehabilitation. Nash and his wife are reported to have ‘… felt the film did an excellent job to present the experience of having schizophrenia and the importance of adequate family support and medical treatment, which was more important than strict adherence to the events in their lives’ [4]. While the film does reflect the crucial support that Nash received from his wife, it gives lesser credit to other strong influences that helped him, such as his academic colleagues, who were extremely supportive, not least because of his outstanding contributions.