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A beautiful mind. (Comments).

The film, A Beautiful Mind, tells the story of John F. Nash, a man who baffled schizophrenia for many years, managed to continue with scholarly work in mathematical theory, and went on to win a Nobel prize in economics. The film told us relatively little about the kind of treatment he received after refusing further institutionalization following his first bout of delusions. This refusal to return to hospital coincided with the process to reduce and close psychiatric hospitals.

Courtney M. Harding, a psychiatrist at Boston University's Center for Psychiatric Rehabilitation, takes issue with the film's portrayal of Nash's recovery as a unique phenomena (New York Times, March 11, 2002). Harding claims that it is not unusual. "What most Americans and even many psychiatrists do not realize is that many people with schizophrenia -- perhaps more than half -- do significantly improve or recover. That is, they can function socially, work, relate well to others, and live in the larger community. Many can be symptom-free without medication."

Nash continued to produce scientific papers published in scholarly journals even while struggling to control his delusions. These became less frequent and less intense over time. He continued to contribute to his field well beyond the age at which most mathematicians are productive.

In his own words, written in 1994: "So at the present time, I seem to be thinking rationally again in the style that is characteristic of scientists."

Dr. Harding believes that too many mental health professionals are trained to take a pessimistic view of schizophrenia and that this is not borne out by experience. Even the esteemed bible of psychiatry, the Diagnostic and Statistical Manual - D.S.M.-IV, maintains the long-standing negative approach to the illness, he points out.

Harding says that too many underfunded programs reinforce this gloomy view, with their overcrowded activity rooms, shelters, and large mental-health caseloads. They provide medication that works to reduce the symptoms in the majority of cases, but they accomplish little else.

Harding points to a Vermont hospital which was one of the pioneers of de-institutionalization. They found that for many patients medication alone was not enough to allow them to leave hospital. Working with the patients, the staff developed a comprehensive and flexible program of psychosocial rehabilitation that helped patients develop social and work skills, cope with daily living, and regain confidence. They created a community system to help patients after discharge. They found that many patients who hadn't responded to medication alone were well enough to go back into their communities. Follow-up studies indicated most were markedly improved, and years later, many were free of symptoms.

Other long-term studies elsewhere in the world also indicate that most people diagnosed with schizophrenia were improving and recovering. These studies contradict earlier research which was based on short term follow-ups.

Key factors in these positive outcomes are home, jobs, and integration into the community. Development of an attitude of optimism, and a desire for self-sufficiency are also important elements in rehabilitation. All of these were present in Nash's case. He had a supportive family, Though scholarly communities can be intensely competitive, they also have a tolerance for eccentric behaviour and this may have contributed to his ability to deal with his problems.

A Beautiful Mind, provides the picture of an exceptional man and suggests, however weakly, that there is hope for others dealing with schizophrenia. Recovery is possible, symptoms can be overcome, and a productive life can be lived.

The film may assist us in dealing with the major barriers so far deterring people with schizophrenia, prejudice and pessimism, and attitudes that support the current tendencies to keep services and funding for the mentally ill at the lowest possible level.

As Harding points out, scientific evidence indicates that people with schizophrenia can lead more satisfying and productive lives than they are presently encouraged to do. We should overcome these prejudices and offer them both the services and the community settings that will enable them to do so. As the movie, A Beautiful Mind demonstrates, we are all enriched when human potential is realized.

--L.K.
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Title Annotation:John F. Nash
Publication:Community Action
Article Type:Brief Article
Geographic Code:1USA
Date:Mar 18, 2002
Words:679
Next Article:Cost of dying is biggest item in health care costs, actuaries tell Romanow.
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