A Beautiful Mind (Film)

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In A Beautiful Mind (2002) Russell Crowe portrays real-life Nobel Prize-winning mathematician John Nash. He delivers a thoughtful, measured and moving performance directed by Ron Howard. Nash was a student in 1947 reading mathematics at Princeton University. He delivered a paper on game theory (the mathematics of competition) that overthrew the accepted ideas about economics, only for his mind to later succumb to what was then diagnosed as paranoid schizophrenia. Nash, with the considerable help and forbearance of wife Alicia (Jennifer Connolly), fought his disease and continued his mathematical work (still teaching even by the age of 73). He won the Nobel Prize in 1994. As a testament to the high heritability of schizophrenia his son, also a mathematician, reportedly had schizophrenia. The latter point is not mentioned in the film. Despite the romanticisation necessary to sell the movie to a studio and an audience, the film is reasonably realistic although it concentrates on visual hallucinations (rather than the more frequent auditory hallucinations of schizophrenia) for cinematic effect. Howard very prudently took pains to carefully research his film. He took advice from leading psychiatrists such as Professor Max Fink to avoid most errors that typically litter other directors' work on mental illness. Professor David, professor of neuropsychiatry at the Institute of Psychiatry reviewed the film (BMJ, Vol 324, 491) and comments on the psychopathology behind paranoid delusions. He links the success mathematical ability of Nash to the psychology of aberrant connections between events thus: "For someone who could produce mathematical formulae to explain apparently random behaviour and who could reduce human interaction to the rules of a game, it was a small step to seeing meaningful patterns in the random outpourings of newspapers and magazines - hidden messages from Soviet spies, warnings of Armageddon." The psychiatrist in the film, Dr Rosen (played by Chistopher Plummer) delivers the standard treatment of the day - insulin shock therapy combined with antipsychotics. The insulin shock therapy looks horrific with ten weeks of therapy with five treatments per week. According to the film insulin is administered intramuscularly and the resulting hypoglycaemia is allowed to induce bilateral convulsions. This is not quite what I had understood insulin therapy to be. Elsewhere in these pages is an account of insulin coma therapy by the contemporaneous UK doyen of physical treatments, Dr William Sargant. In his book the fits are a 'complication' of treatment i.e. an unwanted side effect.

In the film the precise nature of the oral treatment for schizophrenia is not mentioned although two kinds of tablets, presumably an antipsychotic (perhaps chlorpromazine marketed in the US as thorazine) and an antiparkinsonian drug are seen to be administered. After release from hospital the side effects of the drugs (fogging of his mathematical mind and sexual side effects) lead Nash to stop compliance. His relapse is described with the recurrence of paranoid delusions about the Cold War and the vivid reappearance of visual and auditory hallucinations. Nash's hallucinations are remarkably consistent in form through the years of his illness and Rosen deduces that some of his college colleagues (such as a biology stduent room-mate seen earlier in the film) were in fact hallucinatory in nature. Thus Nash is accompanied in the film by a trio of halucinatory characters that never quite leave him - a CIA supervisor, his college room-mate and a little girl who is his room-mate's niece. There is one very scary moment in the film where his insight is so impaired off medication that his ability to parent is dangerously diminished. He is looking after his son is in the bath. The water is running and whilst Nash believes that his ex-room-mate is looking after his son he wanders elsewhere in the house. The waters...
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