How Realistic Is 'A Beautiful Mind'?

Jan. 17, 2002 -- Mental health experts are applauding A Beautiful Mind for creating a better understanding of schizophrenia, although some say the Hollywood version of John Nash's life does sometimes take liberties with medical realities.

In the movie, Russell Crowe plays Nash, a brilliant mathematician who came up with the game theory of economics and won the Nobel Prize, decades later, in 1994. At age 31, he develops schizophrenia and suffers a mental breakdown.

Because of his hallucinations and bizarre behavior, Nash is eventually placed on anti-psychotic drugs. But in the film, he stops taking the drugs after finding that they dull his senses, emotions and sex drive. Instead, he gets a handle on the disease through sheer force of will.

About 1 percent of the population will develop schizophrenia in their lifetime, and more than 2 million Americans suffer from it in a given year. Experts say that only one in five will recover completely — and they probably won't be able to do it through willpower alone.

"Crowe does a brilliant job of portraying the mannerisms, and some of the behaviors of a schizophrenic — the best I have ever seen on the screen," Dr. Ken Davis, chairman of psychiatry at Mount Sinai School of Medicine in New York, told ABCNEWS.com. "On the other hand, the notion that willpower can really overcome schizophrenia is ludicrous."

Drugs, Therapy and Emotional Support

Contrary to public perception, schizophrenia is not the same as having a split personality or a multiple personality. People with schizophrenia have trouble distinguishing between what is real and what is imaginary, and may be withdrawn or have trouble expressing normal emotions in social situations. To manage the illness over a lifetime, most schizophrenics rely on a combination of medications, therapy and the support of friends and family.

In the film, Nash relies on anti-psychotic drugs during the worst periods of his illness, and his illness flares up when he is not taking them, then seems to improve.

"The truth is, the vast majority of schizophrenics will only have partial recovery, and that only with the help of the medication," ABCNEWS' Dr. Tim Johnson said. "But [medication is] not so useful in controlling or helping the social isolation that so many schizophrenics experience."

Some doctors are worried that schizophrenic patients who see the film might come to believe they're smart enough to beat their illness without medication.

"I have not seen the movie, but many of my patients have," said Dr. Adelaide Robb of Children's National Medical Center in Washington. "I do not think that patients should go off medication and rely on willpower. People who are highly intelligent cannot just will away psychotic symptoms."

A Positive Message

Despite Nash's rejection of medication, one doctor said the movie does send a positive message about willpower.

"Some individuals with schizophrenia suffer needlessly from the idea that they have absolutely no control over the illness," said Dr. Steve Lamberti, an associate professor of psychiatry at the University of Rochester in Rochester, N.Y. "While one cannot simply will the disease away, many people do learn to cope effectively with schizophrenia."

Although in the movie, Nash copes with his symptoms by ignoring his hallucinations, another active way to exercise willpower is to participate actively in treatment, Lamberti said.

Davis said Nash is an unusual case because he ultimately learned to ignore his hallucinations.

"Although he continued to believe his delusions he would not let them consume him," Davis said.

Voices More Common Than Visions

In the movie, Nash sees nonexistent "people" and carries on conversations with them. It makes for glitzy filmmaking, but it's certainly not what your average schizophrenic experiences, experts say.

"The movie's portrayal of Dr. Nash seeing and conversing with life-like 'people' is not what most individuals who sufferfrom schizophrenia experience," Lamberti said.

Instead, most schizophrenics are besieged by one or more voices that seem to come out of thin air. Those who do have visual hallucinations tend to see things that are distorted, almost "cartoonish," not lifelike as they were in the film, Johnson said. The movie was on target when it came to delusions, which are typical for schizophrenics, experts say.

Nash believed he was doing top-secret government work that could save the United States and that he was being followed by Russians. Doctors would call the former a grandiose delusion and the latter a paranoid delusion, Lamberti said. Both types are common.

Medicine Can’t Cure All

While in a mental institution, Nash is treated with insulin coma therapy, in which patients are given insulin to induce a comatose state that lasts about 15 to 60 minutes. The results, as shown in the movie, are horrific.

The treatment has been discredited and is no longer used.

"The difficulty in the treatment, and side effects, as well as its inability to sustain remission, led to its disuse," Davis said.

Insulin therapy ended, in part, because of the introduction of anti-psychotic drugs.

In the movie, Nash has hallucinations and delusions even when taking his medications. When he doesn't take them, he loses control.

But the medications aren't able to address some of his negative symptoms, such as difficulty concentrating, social withdrawal and lack of motivation.

"The movie's message that medications are an important part of treatment, although they aren't a cure-all, is an accurate message," Lamberti said.

Doctors say it is also significant that Nash seems to benefit from the loving support of his wife, played by Jennifer Connelly, and by being in the familiar environs of Princeton University while he is recovering.

"An environment that is structured, predictableand supportive is helpful for most individuals with schizophrenia," Lamberti said. "The movie also showed how important familysupport is to those who suffer from schizophrenia. The importance of family support has been increasingly recognized in the field of psychiatry over the past 20 years, and new forms of family education and treatment have been developed."