ne out of 100 people, across different countries and cultures, suffers from schizophrenia. Schizophrenia is not a rare disease but is less well known and retains a stigma other mental disorders are, slowly, overcoming. Pharmaceutical companies now appeal directly to consumers who feel depressed or anxious because more people today accept these medical conditions without embarrassment. The absence of an advertising campaign for antipsychotic medications possibly reflects the shame still attached to schizophrenia (who will admit to hearing voices or receiving messages from aliens?). It also reflects a sad reality: Most schizophrenics suffer a decline in their socioeconomic status, have poor buying power, and are not good advocates for better treatments because of the debilitating nature of their disease.
Lack of societal knowledge about schizophrenia is compounded by how Hollywood and the news media portray the illness. In those rare instances that schizophrenia comes to the attention of the media, it is often linked to scary violent or bizarre behaviors. Why focus on those symptoms? Are schizophrenic patients more violent than other psychiatric patients? Are they more violent and aggressive today than they were in the past? There is little evidence to support such skewed representations.
Given past schizophrenia depictions, the award-winning movie "A Beautiful Mind," the story of Dr. John Forbes Nash, 74, an extraordinarily brilliant mathematician who won the Nobel Prize in economics in 1994 but who also suffered from schizophrenia, comes as a refreshing departure from the usual portrait of this illness. The movie focuses less on violence and schizophrenia but more about the extraordinary story of one man's ability to overcome the disease's delusional aspects, which are dramatized quite ingeniously in the film. While I hope the film raises awareness about schizophrenia, the movie, unfortunately, also creates some misconceptions about the disease.
Although the movie is based on the life of Dr. Nash, the screenplay writer took great artistic freedom in portraying the man's life. Some changes simplify the narrative, while others contribute to fallacies about the disease. The movie's name, "A Beautiful Mind," was taken from the biography of Dr. Nash by Sylvia Nasar, a former New York Times economics reporter and holder of the Knight Chair at Columbia's Graduate School of Journalism. The book is thoughtful and includes accurate information about schizophrenia, its symptoms, prognosis, and treatment. It also had an honest and unapologetic description of the man's extraordinary genius and weaknesses.
The movie, however, focuses on Dr. Nash's genius and disease and omits some of the more unpleasant parts of his life, such as his rather abusive relationship with a woman with whom he had a son before he married Alicia Larde, who is depicted in the film.
Regardless of the biographical exclusions, John Nash, in reality and in the movie, is unlike other schizophrenic patients. He has a superior intellectual capacity, while most schizophrenic patients suffer from impaired cognition. These cognitive symptoms (poor information processing and attention, incoherent or disorganized thought processes) are usually present, to a lesser degree, before the onset of the most obvious symptoms, such as hallucinations and delusions. Dr. Nash had cognitive difficulties during the years his illness was most symptomatic. But during his 20s, and later on in his 60s, his cognitive functioning was outstanding. In the movie, however, Dr. Nash is shown to have hallucinations and delusions during his 20s, the time of his life when he actually did the seminal work that earned him, ultimately, the Nobel Prize.
The real Dr. Nash did not develop his first symptoms of schizophrenia until his early 30s, unlike the majority of patients with schizophrenia, who first present with symptoms in their late teens or early 20s. It is the delayed onset of the illness, no doubt, that allowed him to establish his academic career and the networks of friends and relatives who supported him during decades of psychosis. The movie erred in showing the time course of his illness, but it did portray the support of Princeton University and his wife in helping him deal with his illness. Princeton allowed Dr. Nash to work while he was quite ill with his disease.
The movie also shows how Dr. Nash did not take medication or receive any treatment for most of his life. His reluctance to take medication is similar to the unwillingness experienced by most schizophrenics, due to either lack of insight into their own illness (why take medications if I do not believe that I am sick in the first place?) or drug side effects. Different are, however, the consequences that Dr. Nash, the cinematic version and the real man, had to endure compared with typical schizophrenics. Deprived of medications and treatment, many schizophrenics lose, if they ever had them, jobs, family, friends, financial stability, and homes. It is not just a coincidence that homelessness is so common among schizophrenics. The real and fictional Dr. Nash kept ties with professionals, family, and friends because they were very tolerant of his symptoms. They were able to see the person beyond the illness. They sheltered him from the devastating consequences of this illness.
"A Beautiful Mind" shows further how John Nash was able to "reason" his way out of psychosis. But a movie audience might think schizophrenics could also overcome the disease based on Dr. Nash's unusual ability to do so. Although some new research suggests cognitive behavioral therapies can be useful in the treatment of schizophrenia, they should not be the only treatment. Even the powerful intellect of Dr. Nash struggled for three decades before emerging from psychosis. Dr. Nash might have been one of a small minority of patients whose symptoms improve later in life, without drugs. Today, psychiatrists agree, medications, with a milder side effect profile, are the center of a treatment that hopes to improve the quality of life of this 1 percent of the population. These drugs decrease hallucinations and delusions, yet many patients relapse and suffer from schizophrenia for their entire lives. More research is needed to better understand and treat the disease.
The movie "A Beautiful Mind" may have some flaws, but it brings public attention to the issue of schizophrenia and how, with support and treatment, some schizophrenics can lead more productive lives. In my career, I have worked with many schizophrenics: cases of courageous struggle and painful misery, of dismal disappointment and incredible success, often known only to patients and those close to them. There is nothing beautiful about schizophrenia for those who suffer from it. But beyond their schizophrenic symptoms, each in his or her own way has a beautiful mind.
Dr. Roberto B. Gil is assistant clinical professor of psychiatry and director of the schizophrenia research unit at the New York State Psychiatric Institute. Robin Eisner, editor of In Vivo, provides editorial guidance for Point of View contributions.