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As Nash begins to have intimacy issues with his wife (well he becomes aware of the preexisting issues at any rate), Marcee makes an appearance. Marcee develops as the niece of Charles. Almost instantaneously, Nash is able to bond with Marcee in a way that he is not able to in real-life interactions. This relationship fills an emotional void that exists in essentially every other interpersonal interactions and perhaps, gives him courage in the upcoming uncertainties marriage and children holds.

The next hallucination makes an appearance nearly 5 years later. This time the figment is a government "Big Brother" type who seeks Nash's assistance in matters of national security. This manifestation may be the result of Nash's sense of fulfillment upon his successful assistance in a code breaking situation with the department of defense. This hallucination first creates a greater purpose to Nash's work and life, but then becomes a source of persecution and a threat. We see this role develop in correspondence with the news that Nash will become a father. Perhaps this is the manifestation of those fears associated with parenting as well as the fear Nash has of becoming mediocre and producing derivative work.

Symptomatic developmental history

Symptom/Observable Problematic Behavior

Though the probability of previous symptoms is high, evaluation of this case only begins as the patient enters his doctoral program - age 30. At this point, social awkwardness and limited ability for normal interactions can be noted. But most notably, this time demonstrates the onset of an intense hallucination in the appearance of Charles Herman, Nash's roommate. The hallucinatory presence of Charles remains reliably random throughout the entirety of this study, although appearances seem to coordinate around times of uncertainity and stress. We can therefore reasonably conclude that this particular hallucination may seek to fill a void where loneliness exists. Charles first appears as Nash is watching other students interact as he sits alone in his room working. Charles functions as a sort of sounding board for Nash and a source of encouragement. Charles seems to appear at times where Nash is craving advice, at any rate. This is, as far we know, the only hallucination for a period of about 5 years

Advanced Symptoms

Early warning signs exist in Mr. Nash's case and they include the following:

  • Socially awkward behavior
  • mild paranoia that can at this point be considered as only suspicious
  • tends to become visibly anxious and fidgety around others
  • Occasional manifestations of said anxieties in physical tics; e.g. wringing of hands, shifty eye movement/limited eye contact and sweeping his brow with hand
  • Obsessive behavior concerning work and the quest to find original idea
  • Poor time tracking skills

  • Hallucinations
  • Delusions
  • Negative Symptoms
  • Loss of Function

Patient Information

Pertinent Information

A Beautiful Mind: Case Analysis of John Nash

DSM-5 identifies schizophrenia as such:

Hallucination:

The patient is a Caucasian male of 30 years old. By the end of this study he will be in his late seventies. He started a PhD. Program at Princeton University in 1948 as the receiptiant of the prestigious Carnegie scholarship. Upon completion of this program, Mr. Nash accepts a job with Wheeler Laboratories where he utilizes his expertise in mathematics to analyze data. In 1979 he returns to teach at Princeton University. He wins the Nobel Prize in 1994. Mr. Nash is married with one child.

"Perception like experiences that occur without an external stimulus."

Types include:

  • Auditory

  • Visual

  • Somatic

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1,2, or 3:

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Grossly disorganized or catatonic behavior

5. Negative Symptoms

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations or self-care, is markedly below the level achieved prior to the onset.

Delusions:

By: Leslie Barrett

"Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence."

The following presentation is based on the character of John Nash as his life is portrayed in the movie "A Beautiful Mind". We will examine the life and mental illness of this extremely intelligent mathematician and the effects his illness had on his life, as well as develop a treatment plan.

Breakdown of Symptoms

Hallucinations

Delusions

Treatment

Treating John Nash Now

  • Paranoid

  • Persecutory

  • Grandiose

Visual Hallucinations

  • Charles, Parcher, Marcee and various others

Auditory Hallucinations

  • Hears voices in library, etc.

Somatic Hallucinations

  • Implanted Chip

In the film, Nash's treatments are as follows:

One thing can be certain, just as treatments have grown and developed exponentially in the medical field, so too have they in the field of psychology. The modern take on Schizophrenia is that there is no actual cure, rather there exist a variety of ways by which one can learn how to live WITH the illness. Most practitioners would agree that a combination of treatment will produce the best possible outcome. In utilizing a combination suitable to the patient and severity of the disease, one can create a customized plan of treatment thereby producing optimal results.

Loss of Function

These treatments appear to be unsuccessful in the film as evidenced by Nash's insistence that they are being spied upon in the hospital and the self-mutilation to expose the non-existent implant. And while the medication could be considered successful as it minimized hallucinations, it should be deemed as overall unsuccessful as it greatly increased the loss of functioning. Nash found it difficult to work while medicated or to see patterns as he had previously. His grooming also took a hit and he became despondent to his wife and child.

Therapy

  • Hospitalization with accompanying sedation
  • Insulin treatments - resulting in insulin shock therapy and corresponding coma
  • medication once insulin treatment complete

Pharmaceutical Treatment

Again, through specific and customized treatment plans and accompanying therapeutic models, optimal results and success can be achieved. Therapy can be delivered in a variety of ways including:

  • Individual Therapy
  • Group Therapy
  • Family Therapy

Some models that have proven useful in Schizophrenic cases include:

  • Cognitive Therapy
  • Behavioral Therapy
  • Cognitive Behavioral Therapy

It should be noted that prevalence of these symptoms seem to be precipitated by stressors, i.e. start of doctoral program, intensification of relationship with Alicia, pressure from Department of Defense, and impending fatherhood.

The use of a couple of different medications have proven helpful in patients experiencing symptoms of Schizophrenia. Anti-psychotic and Anti-terror drugs have been shown to reduce these symptoms while still maintaining functionality. True, some of these medications can produce a sedative-like state, but the proper selection of medication and it's dose can reduce those effects.

  • Symptoms affected interpersonal relations as evidenced in social and academic examples and also in romantic relationship with Alicia
  • Symptoms affected ability to work coherently
  • Symptoms limited normal responsibilities of home life, including child care.
  • Grooming habits decline as condition worsens.

Other Treatments

The lack of successful treatment led Nash to explore other options. Through enormous self-discipline, Nash is able to distinguish between reality and his hallucinations to regain normal function. By accepting his illness as a part of himself and utilizing his strengths, he is able to rationalize things like Marcee never aging as a way to differentiate between true and false realities. With the support of his wife and colleagues, Nash is able to live a somewhat normal life. Instead of "battling" against his mental illness, Nash accepts it. He regains function to the level of being able to return to teaching and the eventual winning of the Nobel Prize in 1994.

Treatment Plan

There are a variety of other tools to help someone struggling with Schizophrenia lead a fulfilling and productive life. These options tend to focus on regaining and maintaining a standard of functionality suitable of everyday life as well as coping mechanisms during difficult times. Their main aim is to ensure that having a mental illness does not prevent one from living his or her life; its all about learning to live with mental illness. Some options include:

  • Social Skills Training
  • Support Groups
  • Rehabilitation
  • Vocational Training
  • Supported Employment
  • Finance Management
  • Life Stress Coping Training
  • Self-help groups
  • Crisis Management

Cognitive Behavioral Therapy

Ok, so now that we know how the patient was treated decades ago, what new developments could we offer Mr. Nash in the form of treatment. In what ways could this treatment have revolutionized his life had it been available?

If I were to have John Nash as a client, I would work hard to develop a treatment plan best suited for his particular case. It would be important to work with the client in the development of this plan so a truly productive therapeutic relationship could be formed. By working together in the beginning, we establish that Nash does have control over his life. That is an important mindset as we implement various stages of treatment. This aligns beautifully with the Cognitive Behavioral Therapy Model. Along with this model of therapy, Anti-psychotic drugs will be prescribed to lessen the intensity and frequency of the symptoms. This medication will be closely monitored and adjusted as needed. Family therapy will be a key aspect. Vocational Training will be utilized as well as, life stress and coping strategies. Group-type therapy will be suggested and closely evaluated, as Nash struggles with this in particular but the potential for a major benefit is quite possible.

This model is well suited for John Nash for a multitude of reasons. It allows an examination by both parties of contributing factors to Schizophrenic symptoms. In doing this, we learn ways to potentially avoid, or at least be better equipped to deal with, severe aspects of the illness. In Nash's case, this would especially help as many of these manifestations are triggered by stress and fears. This approach also offers a rationality of sorts to the thought process, which is more than ideal for this case. We work together to understand the thoughts and feelings and resultant actions. John actually demonstrates a rudimentary form of CBT on his own by way of the rationalization of Marcee never aging.

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