Читать книгу Schizophrenia: A Case Study of the Movie A BEAUTIFUL MIND - Second Edition - Francine R Goldberg PhD - Страница 7

The film opens in September, 1947, as the Chairperson of Princeton University’s mathematics department, Professor Helinger, welcomes the incoming class of mathematicians. Although the significant players are not formally introduced, non-verbal behavior introduces the two who stand out from the group. One demonstrates a feeling of superiority by leaning on the edge of the table with his back to many of the students who are seated on chairs around the table. The other demonstrates a feeling of uneasiness by placing himself behind the entire group, somewhat like an outsider, his hands fidgeting and his eyes mostly fixed the floor. Both students demonstrate a keen awareness of each other.

As John Nash, the person who positioned himself behind the group, and some of the other major players are introduced, it is learned that John is one of the two recipients of a prestigious prize, the Carnegie Scholarship. John is described as a “mysterious genius” by his major competitor, Martin Hansen, the other recipient of the Carnegie Scholarship. Martin’s information infers that John’s behaviors have, in fact, been noted to be strange, peculiar and perhaps, mystifying. Martin’s does not infer that these behaviors are due to a mental illness.

Martin’s inferences are a reminder of the long delays that occur in the diagnosis and treatment of people with schizophrenia, due to various reasons like, patients and family members may not recognize subtle symptoms while abnormal thoughts and behaviors may be attributed to substance abuse, stress or other factors. Stigma, lack of health insurance, or other barriers to accessing medical care may also play a role…Whatever the reasons, the duration of untreated psychosis is thought not only to predict initial treatment response in patients with schizophrenia, but may also affect long-term outcomes. More specifically, it has been found that the less time psychosis goes untreated, the more likely it is that antipsychotics would produce a response, including relief from positive symptoms like hallucinations and negative symptoms like social withdrawal, which will be discussed in more detail later in this e-book (Health Letter-J, 2008. P1).

Because treatment occurs so late in the disease process when the presence of positive symptoms becomes obvious, researchers worldwide have been testing drugs, omega-3 supplements, and psychotherapy – with mixed results - taking on the challenges of early detection or even prevention of schizophrenia, perhaps in the prodromal phase. This phase involves an intensification of social difficulties and muted or fleeting psychotic symptoms, such as strange thoughts, odd perceptions, or hearing or seeing something that is not there. The hope is that early intervention efforts might alter the disease course in a way that would improve outcomes and prevent disability. However, preventing schizophrenia is still more dream than reality (Harvard Mental Health Letter - B, 2009, pp. 4-5).

Observational note for later discussion: John demonstrates a unique ability to see patterns with a pattern rising off the glass and synchronizing with patterns on Neilson’s tie. Perhaps this may be related to the characteristic of schizophrenia in which there is an assault on one’s senses and, therefore, when one sees something, it may look very bright, distorted in color or shape.

In time the scale does tip toward mental illness. John Nash has reached the age coupled with the conditions that surround a schizophrenic break. He has the stress of a new, unfamiliar and competitive environment. His social isolation becomes painfully apparent, i.e., his major competitor humiliates him by his inference that John can be mistaken for a waiter rather than a student of mathematics. John retreats to his room from that situation only to experience further isolation as he looks from his window at students on the outside interacting with one another. At this moment of high stress, a positive symptom of schizophrenia emerges, a hallucination.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (DSM-IV-TR) (American Psychiatric Association, 2000, p.299), the symptoms that characterize schizophrenia fall into two groups:

Positive - an access or distortion of normal functions, such as, thinking and ideas (delusions), perception and sensations (hallucinations and illusions) and language and communication (disorganized or bizarre speech).

Negative - a deficit or loss in normal functioning, such as, the range and degree of emotions (flat affect), the fluency and productivity of thought and speech (alogia) and the initiation of goal-directed behavior (avolition).

A hallucination is a false sensory perception in the absence of a real external stimulus. It may be induced by emotional and other factors such as drugs, alcohol, and stress. It may occur in any of the senses, thus a person may experience seeing, hearing, touching, smelling and/or tasting something that does not exist (Kaplan and Sadock, 1991, p.202).

So, at a time of high stress from competition and social isolation, John experiences the friendship of Charles via auditory and visual hallucinations. This friendship/hallucination appears to help John survive as it eases John’s painful isolation and allows John some social moments and some social drinking, away from mathematics. John uses this opportunity to state to himself, through the image of Charles, that, “…I don’t like people much and they don’t like me.” Through the image of Charles, John, is able to say to himself that he will not find the “higher truth” in something as boring as mathematics.” In addition, a delusion of grandeur is emerging, i.e., he believes he is superior to the professors and the theorists to be studied in text books as he refers to them as “lesser mortals.”

A delusion is a false belief, based on incorrect inference about external reality, not consistent with an individual’s intelligence and cultural background that cannot be corrected or reasoned.

Delusions of grandeur are exaggerated ideas of one’s importance or identity (Kaplan and Sadock, 1991, p. 219).