The little knowledge I have about schizophrenia, through my courses and from academic literatures, and hearing the achievement of Dr. John Nash, is my main reason for choosing this book. Outlook of someone suffering from schizophrenia are generally not promising, they tend to live their life in a very chaotic manner with persistent symptoms. Literatures have shown that only a small number of schizophrenic sufferers survive the impact of the illness and only a smaller number of the survivors regain clarity. With this back ground knowledge about the illness, I was amazed and astonished with the achievement of John Nash as told by Sylvia Nasar in “A Beautiful Mind”, a biography of John Forbes Nash. I think that Sylvia Nasar explained the progression of Dr. Nash’s illness in a way that a lay person would be able to understand the devastating effect of the disease. Dr. Nash behaviors, appearance and interactions fits the stereotypical behaviors of a scientist, especially that of a mathematician. His colleagues have always regarded him as weird, different and eccentric. (Cite Sylvia) He had won the recognition, respect and had reached the apex of his profession by his late twenties. He was respected all over the world, traveled extensively giving lectures at various universities, taught, met and mesmerized famous mathematicians of his day with his work. (Cite Sylvia)
Dr. Nash’s Illness and Treatment Experience
In her book Sylvia Nasar reports that Dr. Nash first illness proclaimed itself on the afternoon of January 20th, 1959 in the lounge of the mathematics department of Massachusetts Institute of Technology (MIT). (Cite Sylvia) His colleagues confused the visible sign of his illness thinking that he was partaking in a private joke at their expense, his usual eccentric behavior, not realizing that he was exhibiting episode of paranoid schizophrenia. He had a grandiose belief that he was a messianic figure of great but secret importance. (Cite Sylvia) He began to see encrypted messages in newspaper stories. He was involuntarily committed to the McLean Hospital, a private hospital for wealthy patients affiliated with the Harvard Medical School in Boston. This was the beginning of his numerous hospitalizations. He received injections of Thorazine, but the main treatments offered were psychotherapy, group therapy, and counseling. (Cite Sylvia) Thorazine was only regarded as an initial aid in preparing the way for psychotherapy. Dr. Nash initial hospitalization was brief, for about 50days, enough for him to respond to the medications and therapy.
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Dr. Nash hated being in the mental hospital because of the influence that medication and the environment which prevented him from doing his work. It did not take long for him to relapse and was hospitalized again this time to a public funded psychiatric hospital. This time for six weeks, five days a week, Nash was injected with insulin to induce a comatose state without his permission. It was believed then that starving the brain of sugar would kill the defective brain cells. (Cite Sylvia) For someone who receives insulin, if blood-sugar levels dropped too low, the person would suffer spontaneous seizures, sometimes biting their tongues and occasionally breaking bones. Nash described the treatment as torture. I believe that insulin treatment when Dr. Nash was hospitalized was state of the art treatment for schizophrenia. I believe that his friends and family wouldn’t have agreed for him to receive this treatment if they feel that it would have an adverse effect on his health. Some treatment of schizophrenia at that time was very brutal and the great concern was that those treatments would do something to his brain power. Doctors who raised the idea of electroshock therapy were successfully thwarted by Nash’s friends, family and colleagues. (Cite Sylvia) Together they managed to convince them of the obligation of protecting Nash’s grey matter for the good of humanity.
In preparing for this paper, I discovered that the treatment options available to Dr. Nash were antipsychotic drugs, which were still new to the market, electroshock (ECT), insulin coma, and lobotomy. The optimal treatment was believed to be chlorpromazine, although many psychiatrists still looked to ECT for its benefits. It was an easy decision for them to go with insulin. When he was released from the hospital, he was much improved. His thoughts were under control and he was able to once again work on a scientific paper. For the next 30 years he would make a series of temporary recoveries, return to his home, lapse and then be forced back into a mental hospital. Dr. Nash was not very compliant with his medications regiment.
The author documented in detail the years leading up to Mr. Nash’s schizophrenia, including his father’s death, the birth of an illegitimate son, his arrest for indecent exposure, his marriage and lack of recognition which through literatures and various studies might be sources of great stress, factors that have been known to trigger this illness if the person is genetically predisposed. Psychiatrists who treat people suffering from schizophrenia explain what they believe people experience, they believed that they imagine commands from unseen voices, lose capacity to feel or to think logically. Some people feel that those closest to them avoid or ignore them, or pretend that they didn’t notice what they did and be embarrassed by their behavior. (Cite Sylvia)
Interaction of culture, effort to accept or resist, treatment reflecting cultural values.
Mr. Nash never felt or agreed that he was ill. At the news conference announcing his Nobel, he insinuated that he had made some irrational choices in the past and saying that people know what they know. The closest he came to accept his illness as narrated by Sylvia Nasar was the few times that he mentioned the likely cause of his mental illness, when he blamed it on the argument he had with one of his contemporaries about Quantum theory. Mr. Nash claimed that the argument was possibly overreaching and psychologically destabilizing. (Cite Sylvia)
Was something missed when he was growing up in Bluefield, West Virginia? John Nash was a solitary, lonely little boy who stayed indoors to read when others were outside playing. He had no close friends. He talked a lot, daydreamed, and had trouble following directions, though he was reported to have carried out scientific experiments in his room at age 12. He was considered snobbish and odd by his peers in college. Obviously vast majority of people who have these strange and solitary temperaments never succumb to severe mental illness. (Cite Sylvia)
John Nash cultural values were reflective in the way his psychosis was displayed. He imagined he had a central role in combating threats to world peace that powers from outer space were communicating with him through the New York Times. He thought that his bridge partner could read his mind, and he noticed that men were wearing red neckties in an effort to send him signals about a crypto-communist party. In a letter (written in four colors of ink) he complained that space aliens were ruining his career. He believed that he was to become Emperor of Antarctica and that Life magazine’s cover photo of Pope John 23 was really one of him, his favorite prime number. He referred to himself as the “Prince of Peace” and “The Left Foot of God.” In one of his numerous unintelligible letter to famous and some world leaders he stated “If all the atomic powers of the security council of the United Nations did an action, and they were numbered 0, 1,2,3,4 then one would be able to say nobody did it, everybody did it, all did itâ€¦” This correlate with the way I think a mathematician will see the world around them and John’s believe of superiority to anyone else. His illness was cognitively constructed in the context of a scientist, especially a high ranking world renowned college professor.
Idioms of distress defined as the ways in which individuals “express, experience, and cope with feelings of distress” In the early stages of Mr. Nash illness, I believed the effects of his schizophrenia were an antecedent to his behavioral change. When the changes were ignored this caused a negative impact on his life and health. Due to the unsettling and erratic nature of his condition, normal duties were difficult. Hallucinations and delusions stopped him from normal activities like working / teaching, eating, shopping or taking care of himself. He began to show signs of extreme paranoia his wife described his behavior as erratic, as he began speaking of characters, imagining in his mind that some of his colleagues were putting him in danger. (Cite Sylvia) He believed that all men who wore red ties were part of a communist conspiracy against him. He wrote letters to numerous mathematicians complaining that his career was being ruined by aliens from outer space. He rejected an attractive job offer from the University of Chicago. He wrote back thanking them for the offer, explaining that he could not accept it because he was about to be crowned Emperor of Antarctica. These erratic behaviors fit well into what Castillo explained as cultural based idioms. Research mathematicians in Princeton are competitive, rude, introverted, irritable and not trained to show conventional social graces. That is the culture that Dr. Nash lived, knows and used to excel in before his illness.
John Nash illness had all the five principal symptoms found in people with psychosis delusions, hallucinations, negative symptoms, disorganized speech, and disorganized behavior.
The most common delusions in schizophrenia are those of persecution (someone is following, spying upon, or trying to harm them); (Cite Sylvia) John Nash had many such delusions, such as those about space aliens and feared he was being spied on and hunted down. He believed that he was a messianic figure of great but secret importance being a religious figure. (Cite Sylvia)
A hallucination is a sensation that the person only imagines which can involve any of the five senses, hallucinated sounds being the most common in schizophrenia. (Cite DSM) At one time, John Nash heard voices “like telepathic phone calls.” Illusions that messages were being sent to him through television or newspapers. He began to believe that a great many things that he saw, a telephone number, a dog trotting along the side walk, a Hebrew letter, a birthplace, a sentence in the New York Times had a hidden significance. (Cite Sylvia)
One of the negative symptoms shown by Dr. Nash was a lack of volition. Dr. Nash was unable to work for many years because his attention was so preoccupied by his delusions that he could not do any math or concentrate to do his research work in mathematics. When severely psychotic, Dr. Nash’s behavior was occasionally disorganized-for example, adding salt and pepper to his tea. For a period of time while residing at Princeton, he was seen as the Phantom of Fine Hall, a mute figure who scribbled strange equations on blackboards in the mathematics building and searched anxiously for secret messages in numbers. (Cite Sylvia) He would go into restaurant’s bare feet, he was unkempt with long black hair to his shoulders and bushy black beard. He had a fixed expression a dead gaze. (Cite Sylvia)Pg 285 After resigning his M.I.T. post, an unpopular move that was strongly disapproved by his colleagues, he went to Europe, wandering from city to city and he even tried to give up his United States citizenship. His wife and colleagues began to receive postcards with odd messages, many concerning numbers. (Cite Sylvia)
Someone suffering from psychosis may become extremely excited, engaging in frenetic activity that often does not appear goal-oriented. (Cite DSM) Dr. Nash was reported to have stayed up on numerous nights without sleep writing unintelligible equations and pacing up and down the hallway of the apartment.
According to Castillo, culture affects the clinical reality of mental illness through culture based diagnosis. John Nash’s psychiatrist because they were from the same culture agreed on the nature of his illness and causes, though due to John’s psychosis, he never believed that he was sick. The way an illness is treated is also dependent on the culture where the client resides. The culture based treatment refers to appropriate treatment for an illness as defined by the cultural meaning system or clinical paradigm. The treatment philosophy at McLean was no one can be social and crazy at the same time. (Cite Sylvia) New patients no matter their diagnosis were subjected to the milieu therapy, an intensive five-day- a- week psychoanalysis treatment. Thorazine was only regarded as an initial aid in preparing the way for psychotherapy. Freudianism was in vogue at McLean. Cite Sylvia Pg 259
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As absurd as it now seems, Dr. Nash’s psychiatrists thought that Mrs. Nash’s pregnancy was part of the problem and hoped that he would improve after the baby’s birth. (Cite Sylvia) Psychoanalysis was in vogue and the acclaimed means of treating schizophrenia at that time. Things were explained by fetus envy it was always assumed to be the mother’s fault. When Alicia consulted a psychiatrist for advise when John Nash’s illness was getting out of hand and Alicia was beginning to feel overwhelm, the psychiatrist was more interested about her upbringing, her marriage, her sex life than on offering practical advice on how to cope. It was a Freudian time. Cite SylviaPg. 250.
Dr. Nash’s story is the tragedy of any person with schizophrenia. Incurable, incapacitating and extremely difficult to treat, schizophrenia plays terrifying tricks on its victims. For Dr. Nash as tragic as one might see his case, his early academic achievement, genius and the network of family and friends who valued that genius, wrapping themselves protectively around him and providing him with a safe haven while he was ill. (Cite Sylvia) There were the former colleagues who tried to get him work. The sister who made heartbreaking choices about his treatment, the loyal wife who stood by him when she no longer was his wife, Princeton university administrators, together they made sure that Nash did not wind up, as so many victims of schizophrenia do, a patient in a state hospital, a homeless nomad or a suicide. (Cite Sylvia) Dr. Nash was afforded greater compassion, understanding and patience from his colleagues, family and especially his wife Alicia. She was more worried about Dr. Nash and their future together and her immediate overwhelming instinct was to prevent the university community from abandoning or forgetting him. (Cite Sylvia)
It was reported that even as Dr. Nash ideas became more influential no one connected the Nash game theory to Dr. Nash that was wondering the Princeton grounds. Most of the young mathematicians and economist who made use of his ideas simply assumed that he was dead. Member of his profession who knew otherwise but were aware of his tragic illness, sometimes treated him as if he were. Cite Sylvia (Pg 20). According to Kleinman, (1988), the way mental illness have meaning is through cultural significance, meaning how the illness is projected onto the person by the surrounding society, which then structure the person’s experience of suffering. The individual is forced to live with the meaning imposed by the culture. An example of this was when in 1989 a proposal to place Nash on the ballot of the econometric society as a potential fellow of the society was treated by society officials as a highly romantic but essentially frivolous gesture and rejected. (Cite Sylvia) They viewed him as a mentally ill person that is worthless but failed to remember his contribution to their profession even though he never studied economics.
John was reportedly to have complained bitterly from time to time of his inability to concentrate and to remember mathematics which he attributed to shock treatments. He sometimes told others that his enforced idleness made him feel ashamed of himself, worthless. (Cite Sylvia) John must have felt less of a man because he was unable to provide for his family. He now depended on Alicia to provide for the family in a society where this was not the norm. He was raised in an era where the man was the bread winner. He grew in this environment and he was even doubtful of his ability to fit into the role of a provider before the onset of his illness after his father’s death.
Gender race class/privileges/ access to insurance/money.
I imagine that Dr. Nash must have felt less of a man because he was unable to provide for his family. Alicia, the wife and the mother of a small child, now has to provide for her family in a society where this was not the norm. Dr. Nash was lucky to have the support of colleagues, friends, some of who were his classmates at various universities that he attended and family supports (mother, sisters and a devoted wife). He had access to the best psychiatric hospital arranged by MIT psychiatric service in consultation with the president of the university, who had earlier aggressively recruited him to join the faculty. (Cite Sylvia) As a faculty member he had access to this facility and the family at time had the means to supplement the cost of his hospitalization.
Race and class were reflected in this memoir when word got out that Dr. Nash had been hospitalized at an overcrowded, underfunded and understaffed state institution. His friends and some of his colleagues were shocked that Dr. Nash a legendary figure / mathematician was incarcerated at a state hospital notorious for its overcrowding and aggressive medical treatments. They felt that he did not belong there and it is a national interest that everything possible be done to bring Dr. Nash back to his original productive self. Cite Sylvia
Use in the encompass of the concept of recovery section.
The support of Nash’s wife Alicia and the few close friends he had were paramount to his recovery and living with schizophrenia. Alicia early acceptance of Dr. Nash’s illness rather than denying that it existed and to understand the life experiences of a person with schizophrenia played a pivotal role in Dr. Nash recovery or remission. According to the author, Dr. Nash recovered gradually with the passage of time. Encouraged by his wife, Alicia, Dr. Nash worked in a setting where his eccentricities were accepted. Alicia Nash believed that Dr. Nash should live at home and stay within Princeton’s mathematics community even when he was not functioning well. In a place like Princeton, if Dr. Nash acts strange, he would be among a couple of dozen that does that every day and would fit the culture compared to living in Roanoke, Va., where Nash’s mother and sister lived where he might be ostracized and stigmatized. This is seen as a positive road to recovery because the care provided at a community level, with active family and community involvement contributes significantly to helping the person regain confidence in society (WHO, 2008). Nash’s journey from insanity to sanity was only made possible because of the unconditional support of his wife, Alicia, his determinations to be well, his rejection and hatred of being institutionalized, his passion for his work and the hope of gaining his pre-sickness social norms. (Cite Sylvia) In fact without Alicia, Nash would not have survived to experience the recovery that he has. This was evident as Nash’s schizophrenia progressed, his social network got smaller and Alicia became the most important person in his life.
For patients, suffering from schizophrenia, is a balancing act between a true existence in the present, and the stray flights from delusions inflicted by the mind and thoughts filled with paranoid tormentors. It is a fight to be in charge of their own feelings, opinions and intellect, soiled with periods when they wander into a psychotic imaginary world at times alluringly comfortable while at other times suffocating in their frightening powerlessness. Not many people suffering from this illness will have a happy ending like John Nash. A lot of people suffering from this illness are wondering around undiagnosed and gradually become paralyzed by the whims of their delusions. A lot has changed within healthcare since Dr. John Nash fell ill, particularly in the field of psychiatry. The 21st century has heralded considerable advances in schizophrenia research and these have contributed to refinement in modern anti-psychotic drugs.
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