Butting Heads over 'A Beautiful Mind'

From the WebMD Archives

March 15, 2002 -- Things are getting ugly in Hollywood over the facts behind the Oscar-nominated biopic A Beautiful Mind. Starring Russell Crowe and Jennifer Connelly, the movie tells the life story of John Nash, a mathematical genius who suffered from schizophrenia for much of his life but who in his later years received the Nobel Prize for work he'd done decades earlier.

Representatives of the movie's distributor, Dreamworks SKG, charge that someone is going to great pains to plant stories in the media about Nash's dark side. They say distributors of other movies nominated in the same Oscar categories as "A Beautiful Mind" are working behind the scenes to expose Nash as being anti-Semitic, among other things, in order to hurt the film's chances of winning awards.

No doubt, the on-screen version of Nash is a simplified and cleaned-up version of the actual Nash. And the medical accuracy of how the on-screen Nash gains some measure of control over his mental illness, some mental-health experts say, is similarly softened and simplified.

Drama Is Not Reality

"The portrayal of Nash in the film is realistic for someone who has a great deal of intelligence and insight, but unfortunately, most patients don't have that," says David Garver, MD, professor in the department of psychiatry and behavioral science at the University of Louisville in Kentucky and a spokesman for the American Psychiatric Association.

"Nash had both visual and auditory hallucinations, and these become what seem to him like real people, and that is exceptionally rare in schizophrenia, which usually involves only auditory hallucinations or voices telling them to do something or severely criticizing them," Garver says. "Then [Nash] realizes that one of the people, a little girl, never ages. He uses that insight -- what he sees as reality isn't real -- to control his symptoms."

Although Nash's intelligence sets him apart from others with the same illness, it's true that self-awareness can play a role in the treatment of schizophrenia.

"In very rough terms, you see that about a third of patients have a milder form of the disease, and in those patients their awareness that they have a disease can help them stay on medication," says Vishwajt L. Nimogaonkar, MD, a specialist in schizophrenia research at the University of Pittsburgh in Pennsylvania. "Another third have lapsing illness, meaning that for some of the time their symptoms are not under control. A final third will never understand what is happening."

The Side-Effect Problem

In the movie, after Nash is hospitalized for his illness, he receives insulin-shock therapy and begins taking one of the first-generation antipsychotic medications. The side effects of the drugs are too much for him, though, and before long, he stops taking the medication.

"What is true of Nash's side effects in the movie is true of nearly every schizophrenia patient, but some have far worse side effects than others," says Garver.

The good news is that newer drugs have far fewer side effects.

"It used to be that 50% to 60% of patients would have disabling side effects from medications when we were using such drugs as [Thorazine] and [Haldol]," says Garver. The side effects of older drugs included muscle stiffening, sexual problems, thought problems, and oversedation, to name a few. New drugs like Risperdal, Zyprexa, and Zeldox are much improved, he says. These drugs appear to partially restore thought function lost to the illness in some patients.

Eventually, Nash arrives at a combination treatment that restores some level of function to his life.

"In the movie, we see him returning to some level of functioning and great improvement over the worst of the psychosis," says Garver. "He can function at some level, but not always independently. And that's true of other patients. Though about one third never come out of their psychotic state."

Dispelling Misconceptions

At one point in the film, Nash's illness threatens the safety of his infant son. But Nimogaonkar says it is vital that people understand that people with schizophrenia are not necessarily dangerous.

"It's not an illness that makes you predisposed to violence," he says. "They are no more prone to violence than the rest of the population."

And Garver wants to make sure that people really understand that Nash is an exceptional case because of his high IQ.

"My concern about the movie is that it showed him being able to partially reconstitute without medication, at least partly," says Garver. "But medication is a critical mainstay to help people regain a reasonable level of recovery."