John Nash Schizophrenia

“A Beautiful Mind”, tells of John Nash and his experience with a psychological disorder, starting during graduate school through to his later life as a Nobel prize winner. Nash displays multiple symptoms beginning with disorganized behaviour presented as agitated walking and fidgety hand movement. Along with this, Nash exhibits the negative symptom of asociatlity exposed through his lack of close relationships with friends and family along with his inappropriate comments and inability to connect with the opposite sex. However, Nash’s most prominent symptoms were delusions and hallucinations, beginning with visual and auditory hallucinations of his roommate Charlie, followed by Charlie’s niece Marcee, and later William Parcher a defense agent.

He had a combination of persecutory, grandiose, and referential delusions manifested as the belief that he was a spy assigned to decode confidential Russian messages. For example, he believed that he was being targeted and often perceived that men in black suits were actually people following him. Additionally, he viewed his “mission” as being all important and often saw specific messages related to his decoding assignment within newspapers. Based on the symptoms the most likely diagnosis for this disorder is schizophrenia.
As for the course of this disorder, the age of onset was in his early 20’s, starting with an episode that lasted two to three years without treatment. After the first treatment, one more episode occurred due to the discontinuance of medication but, his hallucinatory symptoms continued throughout the rest of his life. Overall, the severity of his disorder was extremely high as it interfered with his career, his personal life with his wife, and lead to hospitalization.
In regards to treatment, Nash was initially hospitalized against his will, sedated, and restrained as the severity of his hallucinations caused him to believe the hospital staff were Russian’s holding him hostage. He was given antipsychotic medication, which he neglected to take due to the side effects of blunting his intelligence and limiting his ability to be intimate with his wife. He was also given insulin coma therapy five times per week during his hospitalization. The treatment was effective until Nash discontinued his medication use, causing his symptoms to reoccur. Following this, he made the decision not to restart medication and used willpower and his wife and colleagues support to ignore his hallucinations and maintain a normal lifestyle.
The etiology of Nash’s schizophrenia can be well explained by the neurobiological model which highlights the role of neurotransmitters and brain structure and function.

Initial studies on the role of neurotransmitters suggested that excess dopamine activity is related to the onset of schizophrenia. Research regarding dopamine is mainly related to the positive and disorganized symptoms of the disorder, which is specifically relevant to Nash’s case. Though he did portray negative symptoms in the form of asociality, his main symptoms, delusions, and hallucinations were positive, and so excess dopamine activity is an adequate explanation. Further confirmation is demonstrated when Nash is put on a regimen of antipsychotic medication that functions by blocking dopamine receptors and experiences a decline in his positive symptoms. Additional research also suggests that underactivity of dopamine in the prefrontal cortex may be the main cause of negative schizophrenic symptoms, which would explain the slight asociality that Nash did portray. Within the prefrontal cortex, low levels of the neurotransmitter glutamate also lead to an increase in dopamine action, causing the disorganized symptoms like the fidgety movements that Nash presented. In regards to brain structure, one of the main connections between schizophrenia and the brain is enlarged ventricles. This is particularly important in Nash’s case as enlarged ventricles are correlated with poor medication response which

may explain Nash’s resistance to medication. Two other brain structures related to schizophrenia are the frontal and temporal lobes. Relating these structures back to Nash’s case highlights the reduction in frontal lobe gray matter mainly in the form of dendritic spines. These spines are responsible for neuron communication and a lack of them leads to a disconnection that can explain his irregular body movements. Specific temporal areas that relate to the course of Nash’s disorder are a smaller than normal hippocampus found in people with schizophrenia, and its connection with the H-P-A axis. As a result of Nash’s extreme stress to formulate an “original idea” at school, and the tendency of people with schizophrenia to be reactive to stressful situations the combination may have lead to a reduction in his hippocampal volume.
Though the neurobiological model assists in explaining the course of Nash’s disorder, there are several areas in which the model and his symptoms do not exactly match. A significant fragment that lacks explanation is Nash’s ability to will away his delusions and hallucinations, without the help of antipsychotic medication to alter the function of overactive dopamine receptors. Along with this, there is no explanation as to why Nash experienced the specific types of delusions and hallucinations that he did. For instance, why were his hallucinations primarily visual and auditory, and his delusions persecutory and referential? The model does assist in the understanding of why he maintained predominantly positive symptoms, but not the particulars of those symptoms. In addition, there were a few points suggested in this model that did not adequately match with the course and symptoms presented in this movie. One of the main cases of this involves factors related to the prefrontal cortex. In a substantial amount of the research completed, it is stated that people with schizophrenia often show a poorer performance on memory and information related neuropsychological tests due to the reductions in the prefrontal gray matter. However, Nash was highly intelligent and maintained his ability to decode and hold bits of information throughout his time as a grad student at Princeton, and as a professor. It is highly likely that Nash actually maintained a high level of activation within his prefrontal cortex despite the theories displayed in the neurobiological model.
At the end “A Beautiful Mind” John Nash becomes a successful professor, a loved husband, and a Nobel prize winner, all while living with schizophrenia. With this in mind, what is the relationship between the social and familial support the main character received and the decline in schizophrenic symptoms? Many empirical studies have supported notions that proper social support from family, friends, and colleagues, can result in a positive mental health outcome.
In one study, researchers used a multidimensional scale of perceived social support to test the effect that different types of support had on adults in the Asian population (Vaingankar, Edimansyah, & Siow, 2012). Participants in this study had been previously diagnosed with schizophrenia and were asked to self-rate their perception of the social support they received from three different areas: family, friends, and significant others (Vaingankar et al., 2012). According to the results, a correlation existed between higher perceived social support among at least one of the three support groups and a lower rate of episode reoccurrence (Vaingankar et al., 2012). Those participants who stated higher than normal support in all three support groups also displayed substantially less symptom reoccurrence, likely due to the facilitation of confidence and coping mechanisms (Vaingankar et al., 2012). This evidence relates to Nash and his experience with schizophrenia, because throughout the course of his disorder he received support from his wife who stayed with him through treatment, and later on support from his colleagues when he rejoined to the workforce and became part of a collegiate community. As a result of Nash eventually having support from multiple areas it is likely that this inhibited some symptom reoccurrence. Another study took a slightly different approach by analyzing patients with schizophrenia who received different levels of social support following their first episode of schizophrenia, and reviewed their outcomes eighteen months later, and then again five years later (Erickson, Beiser, & Iacono, 1998). The patients were interviewed by a psychiatrist at the initial stage to receive a diagnosis and give insight to a baseline score, and then again at both the eighteen month and five-year mark about their social network, and current mental health status (Erickson et al., 1998). Similar to the first study described, those patients who had a broader or more supportive social network at or during the onset of their disorder, had greater functioning roles in society five years after the initial interview (Erickson et al., 1998). Due to Nash’s had connections within the university during the onset of his schizophrenia and the effort he made to rejoin the community following the peak of his symptoms, he was able to adapt better to social norms and carry out a regular lifestyle. This outcome runs parallel to the outcomes presented within this second study.
Finally, in a third study, subjects with schizophrenia were asked to depict drawings of their different social networks using different colours for different relationships (Kaz'mina, Poliakov, & Krupysheva, 1998).

Along with this subjects were required to draw themselves in relation to these networks using distances to describe how close they were to the specific group (Kaz'mina et al., 1998). Following this, they completed a questionnaire regarding their networks, used to describe each member. The illustrations were later analyzed and described to find that those who depicted themselves closer to their social networks, were less symptomatic when interviewed for a follow-up one year later (Kaz'mina et al., 1998). In relation to Nash, these results point out that by attempting to regain a social network by working out of the library at the university and teaching again, he was able to gain stronger community bonds, and reduce his

symptoms.
Over All, John Nash’s ability to maintain a relationship with his wife throughout the course of his disorder, and his efforts to reinstate himself into the community while dealing with schizophrenia, enabled him to adapt to his symptoms and ultimately reduce them.