On the beautiful mind

The mind can be thought of as the subjective experience of our stream of consciousness. What happens when our mind tells us that we can see and hear things that aren’t there? What happens when we start to lose touch with reality? This is psychosis and one of the most debilitating psychotic disorders is schizophrenia. The film “A Beautiful Mind” offers us a glimpse of the devastating effects of schizophrenia and how a remarkable man rose to overcome it, eventually triumphant as he accepts a Nobel Prize.

It is the late 1940s, and John Forbes Nash, Jr (played by Russell Crowe), having won the prestigious Carnegie Prize for Mathematics, had just arrived at Princeton University as a graduate student. From the start, it appears that the introverted Nash is not a people person and is excruciatingly awkward with the opposite sex. Nevertheless, he confides in his newfound roommate Charles Herman.

Nash is not content with the mundane part of university life – classes, preferring to devote his time and energy into the completion of his thesis, which he hopes will be a masterpiece. He then finds the inspiration for his novel idea in a bar – as his friends fight over how to tackle a particular blonde. He calls his idea “governing dynamics” and it is now known as the Nash Equillibrium in his honour. Wikipedia summarizes this theory in a succinct manner:

Stated simply, Amy and Bill are in Nash equilibrium if Amy is making the best decision she can, taking into account Bill’s decision, and Bill is making the best decision he can, taking into account Amy’s decision.

With his graduate studies complete, Nash accepts a job at the Massachusetts Institute of Technology. However, he is preoccupied with cracking numbers that he sees in newspapers and magazines in his office, causing him to neglect his teaching responsibilities. Despite this, he was able to fall in love with and eventually marry his student Alicia Larde (played by Jennifer Connelly).

He then believes that he was recruited by the Department of Defense in the Pentagon to decipher Soviet communication codes which are placed in the mass media. There, he encounters a shady man in a top hat, William Parcher who is later revealed to be a Pentagon official. Nash accepts his covert assignment and receives an implant in his forearm from the Department of Defense which allegedly functions as a listening device. Nash becomes increasingly fearful, especially after he believes he was chased by Russian operatives. His paranoid behaviour (turning off the lights, suspicion of people outside his house) alarms his wife. On his return to Princeton, he sees Charles Herman and his niece Marcee who is a young girl. As Nash is about to deliver a lecture, he is brought involuntarily into a psychiatric hospital.

It is then revealed that Nash had been living alone all the while at Princeton. His roommate Charles, his niece and even William Parcher were all hallucinations. Nash even tries to dig out the implant in his forearm with his bare hands, but fails as no such device was planted in the first place. His covert assignment about thwarting Soviet communications was only an elaborate delusion.

Nash is then subjected to a series of insulin shock therapies (which are no longer used today) and started on antipsychotics. His symptoms seem to subside and he is subsequently discharged, but nevertheless, problems soon arise at home. As a result of his antipsychotics, Nash feels his mind has become slow and he struggles with his calculations. He also loses his libido which strains his relationship with his wife. Nash decides to stop taking his pills, hoarding them in a desk drawer instead. Predictably, his paranoid symptoms and hallucinations return.

Nash’s relapse is finally realized by his wife when she noticed he had almost drowned their infant son. He then sees and hears William Parcher instructing him to kill her. She calls for his psychiatrist, but ultimately decides to live with his condition. Nash begins to gain insight that his hallucinations, especially the young Marcee, “never seem to get old”. He then starts to ignore his hallucinations even though they continued to haunt him.

In his later years, it appears that Nash is taking the “newer antipsychotics”. He accepts a teaching position back in Princeton, and in 1994 wins the Nobel Prize in Economics for his in “governing dynamics”, also known as game theory.

So, how accurate is the portrayal of schizophrenia in this film? As far as psychiatry is concerned, the film depicts Nash as having hallucinations (perceiving something through your 5 senses when there is nothing there) that are concurrently auditory and visual. These are actually rare, and the real Nash only heard voices (auditory hallucinations are the most common type of hallucination in schizophrenia). He starts to have persecutory delusions (that the Soviet are out to get him) and delusions of reference (believing that there are special codes in the newspapers that only he can decipher). His behaviour becomes erratic and he withdraws socially. The hallucinations and delusions also affect his work and relationship with his wife.

As mentioned earlier, insulin shock therapy is no longer used today. It was once used to treat schizophrenia, by method of injecting large amounts of insulin to induce coma and seizures. This was phased out by the developlment of antipsychotics and electroconvulsive therapy. Typical antipsychotics such as Haloperidol are effective in treating the hallucinations and delusions of schizophrenia but do cause the cognitive impairment and sexual dysfunction depicted in the film. More commonly, they cause extrapyramidal side effects which are problems with muscle tone and coordination. Newer “atypical” antipsychotics are also used today and they have less extrapyramidal and cognitive side effects but can cause weight gain and lead to metabolic syndrome.

In real life, it appears that Nash never took the supposed “newer antipsychotics”, it was added because the screenwriters were worried that it could send the wrong message to the public on the medication compliance. In the past, schizophrenia was traditionally seen as a chronic deteriorating illness (Emil Kraepelin), but this view is now changing. It is now believed that up to 20% of schizophrenics who suffer from acute episodes recover completely. A further 20% have recurrent acute episodes and 40% have a chronic illness. With the advance of biopsychiatry, the prognosis of schizophrenia has improved. Furthermore, Nash most probably suffered from the paranoid schizophrenia subtype, with its relative absence of catatonic and negative symptoms. This is the subtype of schizophrenia with the best prognosis.

Finally, the impact of schizophrenia on the family is dramatically shown in the character of Alice Larde, Nash’s wife who has to live with the paranoia and abnormal behaviour of a schizophrenic. Although in the film she was portrayed as a supporting wife, the real Alicia Larde divorced Nash, only to remarry him when he won his Nobel Prize in 1994. That’s why supportive psychoeducation on schizophrenia and mental illness is crucial for the recovery of patients. Without good social support, schizophrenics are less likely to be compliant and more likely to relapse.

Mental illness is still seen as stigma in society which paralyzes its sufferers. I think that the film “A Beautiful Mind” is a rare film that is both powerful, inspirational and has great value in educating the public on mental illnesses such as schizophrenia in order to erode this stigma.

The Catcher in the Rye

Being in a rural area is different. I don’t know why anyone would choose to live here. I mean there’s nothing to do at night, and few places to eat. It’s not like I like nightlife in the first place, but knowing that there’s nothing out there come dark sucks.  Worse still, life crawls along at a snail’s pace – people get lazy. I miss civilization. The only upside is I have some spare time to read Catcher in the Rye, by the enigmatic author J.D. Salinger who once admitted this novel has autobiographical elements.

The title of the novel comes from a peculiar fantasy of the protagonist, when a misheard lyric of a poem (Robert Burns‘ Comin’ Through the Rye) reminds him of children playing in a rye field near a cliff and how he would like to be their protector, catching them if they come near the edge.

It is a remarkable novel, narrated by our protagonist, Holden Caulfield, a 16 year old boy who comes from an apparently well family and recently dropped out from an elite prep school named Pencey. He is a middle child and we know his father is a wealthy lawyer. His older brother D.B. is a successful writer in Hollywood. Although he seems to have everything, his view of life is cynical and he is discontent with it.

Most of the story takes place in New York City after he has been kicked out from school, and we are given a startling ground’s eye view at life in the Big Apple circa the 1940s. But it is the adolescent themes of depression, sexuality, alienation and angst that really drives the story. His depression probably stems from the loss of his younger brother Allie due to leukemia and his witnessing of a boy’s apparent suicide after being bullied at school. Holden also seems misanthropic towards the other boys at his prep school and pretty much everyone else except his little sister, Phoebe. He calls almost everyone who ticks him off a “phony”. This lack of social connection has an obvious effect on him. Throughout the novel, Holden is filled with bouts of loneliness and depression.

There’s an unabashed account of Holden’s sexuality here as well. We are told of the girls he has been involved with. We know he thinks about sex constantly. We know he is a virgin and became hesitant when he has an encounter with a hotel prostitute. Later on, we also know he has homophobia when an ambiguous advance by a former teacher freaks him out.

Although the story takes place in the setting of only a few days, it is highly detailed as Holden’s seems to have an inability to concentrate; his thoughts are rapidly shifting from one idea to another. Holden’s thoughts are almost completely about himself and his feelings of angst towards other people. Towards the end of the novel, Holden develops hallucinations and paranoia in addition to his depression.

Finally, the novel ends as we find out where Holden is telling this story from. He’s been sick and has been spending time in mental hospital, but he’ll be back in school in the fall. Then he admits that he has been missing some of the people he has condemned in his story – his old schoolmates from Pencey. He ends with a poignant warning:

“Don’t ever tell anybody anything. If you do, you’ll start missing everybody”.

I’m intrigued as to what psychiatric diagnosis Holden would have. He has depression, hallucianations, difficulty sleeping and sometimes racing thoughts. A case could be argued for post-traumatic stress disorder (following the loss of his younger brother), bipolar disorder or even schizophrenia. (I’ll leave it to after I finish my psychiatric posting)

What I really like from this book is how stylized the narrative is; dark, slightly narcissistic with a punch of humour and highly idiosyncratic. It’s liberal use of profanity and slangs makes Holden Caulfield seem not only real, but relatable. I’m downright surprised how much I like this broody and seemingly unlikable character. To the author’s credit, lthough the novel is set 60 years ago, the adolescent themes are so well depicted here that they appeal to generations of readers to this day.

What’s Wrong With Being An Introvert?

Analytical psychology is a subset of psychotherapy that was introduced by Swiss psychiatrist Carl Jung (pronounced “yuung” as in the vowels in the word “book”). From this school of thought, the idea of psychological types was brought into the collective consciousness of human culture. Humans can be divided into two broad groups – introverts and extroverts and it is one of four dimensions of personality assessed by the popular psychometric instrument, the Myers-Briggs Type Indicator (MBTI).

According to Jungian theory, where we get our “mental energy” defines whether we are introvert or extrovert. Hence, in introversion, this mental energy is directed inwards, towards a person’s own thoughts. While the concept of “mental energy” is no longer used today, we can redefine introversion as a person who is more concerned with and interested in his own thoughts or feelings rather than the external world.

The world seems to be dominated by egregious extroverts who are unable to fathom that there are people who actually need time alone. As an introvert myself, I find it highly offensive to see that we introverts are always being pushed by extroverts in order to adopt their lifestyle. It’s even worse to see other introverts being pressured to be more outgoing. The American Psychiatric Association has even proposed that introversion be included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Such blatant stigmatization on introverts is unwarranted.

In charismatic churches that feed on extroverted energy, introversion is frowned upon. An extrovert in class told me how he admired the sociability of such Christians and looked down upon those that are more reserved and quiet. Others have said that “quiet people” are selfish, arrogant or hard to approach. I’ve even heard students making outrageous claims that being “quiet” will lead to autism. Being an introvert does not mean not asking questions in class, or not being able to speak well in ward rounds. Other factors such as shyness (which is not synonymous with introversion), self confidence and anxiety come into play. There’s a big difference between solitude and loneliness.

Perhaps in the modern world extroversion is overestimated. While it’s true that extroverts get their energy from relating to other people, that doesn’t necessarily make them good company. Nor are they always the best people at delivering messages — although viewed as natural communicators, if they are always on “send,” others can struggle to “receive” the message and get a word in.

Introversion does have it advantages. We are less impulsive with our speech than extroverts, and usually think through our actions before we leap. I prefer socializing with one or two close friends rather than in large groups or parties, but that doesn’t mean I’m unfriendly. I enjoy spending time alone, whether studying or playing, but that doesn’t mean I’m misanthropic. For me, it’s suffocating to be constantly around people and I need time alone with my own thoughts to recharge. And ultimately, I hope introverts out there realize, there’s nothing wrong with that.

The Secret Powers of Time

This is a really enlightening talk by American psychologist Phillip Zimbardo, who is perhaps most famous for his Stanford Prison Study. In this captivating animated talk he outlines his idea on how time perspectives define human culture and conflict.

So are you present-hedonistic or future-oriented? 🙂