Diseases and ailments of all sorts are things not alien to the human society, so much so that they are often regarded as part of the many experiences of being a living being. As such, these diseases have been studied extensively by medical practitioners over the years and have been labeled, characterized and classified. As a result, many a treatment have been devised by these geniuses to help the human condition. These diseases can be classified, roughly, as psychological diseases and physical diseases. The latter has to do with diseases and ailments that affect the physical body and can, most times, be seen and touched. The former has to do with the mind or psyche of an individual whereby only the symptoms of this class of disease manifest.
This ailment of the psyche is the chief concern of this essay; schizophrenia to be precise and we shall use the protagonist ( John Nash) in the movie “A Beautiful Mind” as a case study. By way of methodology, we shall explain the meaning of schizophrenia, touch on the features and sub-types of the disorder then on to the causes and criteria for diagnosing the disorder. After this we shall take a look at the protagonist and how he meets the criteria for the diagnosis of one of the disorder’s sub-type (paranoid schizophrenia) taking into account the symptoms he manifested as observed in the movie and then the treatments administered for the disorder and finally the conclusion.
Schizophrenia is a psychotic disorder (or a group of disorders) marked by severely impaired thinking, emotions, and behaviors. Schizophrenic patients are typically unable to filter sensory stimuli and may have enhanced perceptions of sounds, colors, and other features of their environment. Most schizophrenics, if untreated, gradually withdraw from interactions with other people, and lose their ability to take care of personal needs and grooming. The prevalence of schizophrenia is thought to be about 1% of the population around the world; it is thus more common than diabetes, Alzheimer's disease, or multiple sclerosis. In the United States and Canada, patients with schizophrenia fill about 25% of all hospital beds. The disorder is considered to be one of the top ten causes of long-term disability worldwide.
The course of schizophrenia in adults can be divided into three phases or stages. In the acute phase, the patient has an overt loss of contact with reality (psychotic episode) that requires intervention and treatment. In the second or stabilization phase, the initial psychotic symptoms have been brought under control but the patient is at risk for relapse if treatment is interrupted. In the third or maintenance phase, the patient is relatively stable and can be kept indefinitely on antipsychotic medications. Even in the maintenance phase, however, relapses are not unusual and patients do not always return to full functioning. The English term schizophrenia comes from two Greek words that mean "split mind."
It was observed around 1908, by a Swiss doctor named Eugen Bleuler, to describe the splitting apart of mental functions that he regarded as the central characteristic of schizophrenia. Recently, some psychotherapists have begun to use a classification of schizophrenia based on two main types. People with Type I, or positive schizophrenia, have a rapid (acute) onset of symptoms and tend to respond well to drugs. They also tend to suffer more from the "positive" symptoms, such as delusions and hallucinations. People with Type II, or negative schizophrenia, are usually described as poorly adjusted before their schizophrenia slowly overtakes them. They have predominantly "negative" symptoms, such as withdrawal from others and a slowing of mental and physical reactions (psychomotor retardation).
There are five subtypes of schizophrenia:
Paranoid The key feature of this subtype of schizophrenia is the combination of false beliefs (delusions) and hearing voices (auditory hallucinations), with more nearly normal emotions and cognitive functioning (cognitive functions include reasoning, judgment, and memory). The delusions of paranoid schizophrenics usually involve thoughts of being persecuted or harmed by others or exaggerated opinions of their own importance, but may also reflect feelings of jealousy or excessive religiosity. The delusions are typically organized into a coherent framework. Paranoid schizophrenics function at a higher level than other subtypes, but are at risk for suicidal or violent behavior under the influence of their delusions.
Disorganized schizophrenia (formerly called hebephrenic schizophrenia) is marked by disorganized speech, thinking, and behavior on the patient's part, coupled with flat or inappropriate emotional responses to a situation (affect). The patient may act silly or withdraw socially to an extreme extent. Most patients in this category have weak personality structures prior to their initial acute psychotic episode.
Catatonic schizophrenia is characterized by disturbances of movement that may include rigidity, stupor, agitation, bizarre posturing, and repetitive imitations of the movements or speech of other people. These patients are at risk for malnutrition, exhaustion, or self-injury. This subtype is presently uncommon in Europe and the United States. Catatonia as a symptom is most commonly associated with mood disorders.
Patients in this category have the characteristic positive and negative symptoms of schizophrenia but do not meet the specific criteria for the paranoid, disorganized, or catatonic subtypes.
This category is used for patients who have had at least one acute schizophrenic episode but do not presently have strong positive psychotic symptoms, such as delusions and hallucinations. They may have negative symptoms, such as withdrawal from others, or mild forms of positive symptoms, which indicate that the disorder has not completely resolved. The risk of schizophrenia among first-degree biological relatives is ten times greater than that observed in the general population. Furthermore the presence of the same disorder is higher in monozygotic twins (identical twins) than in dizygotic twins (nonidentical twins).
The research concerning adoption studies and identical twins also supports the notion that environmental factors are important, because not all relatives who have the disorder express it. There are several chromosomes and loci (specific areas on chromosomes which contain mutated genes), which have been identified. Research is actively ongoing to elucidate the causes, types and variations of these mutations. Most patients are diagnosed in their late teens or early twenties, but the symptoms of schizophrenia can emerge at any age in the life cycle.
The male/female ratio in adults is about 1.2:1. Male patients typically have their first acute episode in their early twenties, while female patients are usually closer to age 30 when they are recognized with active symptoms. Schizophrenia is rarely diagnosed in preadolescent children, although patients as young as five or six have been reported. Childhood schizophrenia is at the upper end of the spectrum of severity and shows a greater gender disparity. It affects one or two children in every 10,000; the male/female ratio is 2:1.
One of the reasons for the ongoing difficulty in classifying schizophrenic disorders is incomplete understanding of their causes. It is thought that these disorders are the end result of a combination of genetic, neurobiological, and environmental causes. A leading neurobiological hypothesis looks at the connection between the disease and excessive levels of dopamine, a chemical that transmits signals in the brain (neurotransmitter). The genetic factor in schizophrenia has been underscored by recent findings that first-degree biological relatives of schizophrenics are ten times as likely to develop the disorder as are members of the general population. Prior to recent findings of abnormalities in the brain structure of schizophrenic patients, several generations of psychotherapists advanced a number of psychoanalytic and sociological theories about the origins of schizophrenia.
These theories ranged from hypotheses about the patient's problems with anxiety or aggression to theories about stress reactions or interactions with disturbed parents. Psychosocial factors are now thought to influence the expression or severity of schizophrenia rather than cause it directly. As of 2004, migration is a social factor that is known to influence people's susceptibility to psychosis. Psychiatrists in Europe have noted the increasing rate of schizophrenia and other psychotic disorders among immigrants to almost all Western European countries. Black immigrants from Africa or the Caribbean appear to be especially vulnerable.
The stresses involved in migration include family breakup, the need to adjust to living in large urban areas, and social inequalities in the new country. Another hypothesis suggests that schizophrenia may be caused by a virus that attacks the hippocampus, a part of the brain that processes sense perceptions. Damage to the hippocampus would account for schizophrenic patients' vulnerability to sensory overload. As of 2004, researchers are focusing on the possible role of the herpes simplex virus (HSV) in schizophrenia, as well as human endogenous retroviruses (HERVs). The possibility that HERVs may be associated with schizophrenia has to do with the fact that antibodies to these retroviruses are found more frequently in the blood serum of patients with schizophrenia than in serum from control subjects.
According to the DSM IV, there are six criteria for the diagnosis of this disorder; criterion A which includes the presence of symptoms such as delusion, hallucination, disorganized speech, grossly disorganized or catatonic behavior and negative symptoms; affective flattening, alogia and avolition. To or more of the above mentioned symptoms ought to be noticeably present for a period of one month. Criterion B involves some form of social or occupational dysfunction which means that an individual must exhibit difficulties in keeping up with average functioning level at work as well as interpersonal relations.
Criterion C requires the disturbances to persist for a period of six months. Criterion D involves the exclusion of schizoaffective and mood disorders while Criterion E has to do with the exclusion of substance abuse or general medical condition. That is the disturbance is not due to a medical condition or substance abuse. Lastly, Criterion F is the relationship to a persuasive developmental disorder which means that this developmental disorder is not a symptom but the presence of such makes schizophrenia symptoms more pronounced.
The onset of John Nash’s schizophrenic condition is unknown but we could guess that it was imminent from his childhood hood as he mentioned to his imaginary friend; Charles, in the movie that his first grade teacher told him he was born with “two helpings of brain and half a helping of brain” we can infer from this that he had more success with books than he did with people. As pointed out in the movie, his psychiatrist mentioned that his ailment must have started while he was at Princeton, where he met Charles, one of his hallucinations. John Nash and delusions.
As stated in the DSM IV, A symptom of paranoid schizophrenia is the preoccupation with one or more delusions. As seen in the movie, Nash is preoccupied with the belief (delusion) that people don’t like him much as he mentioned to Charles and William Parcher; both his hallucinations. Again, Nash has delusions of being a secret government aide that is helping the U.S. find bombs throughout the country that were placed there by the Russians. This delusion is born of the fact that Nash hallucinates that Parcher places a device inside his arm that allows him to see a code under an ultra-violet light.
This device allows Nash to gain entrance to a secret location where he is to leave the cracked codes. It is important to note that the kind of delusion peculiar to paranoid schizophrenia is that of “grandeur”. In the movie, Nash almost brags about how important his work is and that no one else can do it because he is the “best natural code-breaker” Hallucinations.
Nash’s hallucinations include Charles; his roommate at Priceton, his niece Marcee and William Parcher a top secret government agent whom Nash breaks secret codes for. This hallucination of Parcher is the key factor in Nash's delusional thinking that he is a “spy”.Parcher gives him assignments to break codes and drop them off at the location mentioned above but in reality this secret location is an abandoned, dilapidated mansion, and the key- pad that Nash types his code into no longer functions. Nash's code breaking abilities are partly made possible by his hallucinations. The codes pop out of the paper to him and everything makes sense. Even though the codes are imaginary since there was no secret- code- breaking- project underway, Nash figures out mathematical formulas and actually modifies a theory that had been accepted in its field. He says that he can't do his work without the hallucinations. Disorganized Speech.