In A Beautiful Mind (Howard, 2001) Russell Crowe plays John Nash, a highly intelligent mathematician who struggles to make friends and to bond with others because he suffers from paranoid schizophrenia. Throughout the film, it becomes clear that his auditory and visual hallucinations coupled with his delusions of persecution become worse as his stress-induced obsession to find a “truly original idea” takes its course. As such, the psychiatric diagnosis I have come to is schizophrenia. This is evidenced by Nash’s recurrent hallucinations (visual and auditory), his delusions of persecution and grandeur, his sensitivity to natural light, and his grossly disorganized or catatonic behavior. Nash is frequently seen twitching, babbling confusedly and rapidly, and losing interest in his personal appearance. Most troubling to his wife and friends is Nash’s development of the flat affect, whereby he has difficulty having any emotion at all. For example, he tells his imaginary roommate Charles that his first-grade teacher once told him that he had “two helpings of brain, but only half a helping of heart.”

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In light of this information, I would raise questions about Nash’s past psychiatric history. Has he experienced hallucinations before? Are the auditory hallucinations getting worse, that is to say are they getting more intense, lengthening in duration, or causing him to have serious problems functioning in everyday society? What caused him to develop these symptoms? There are some clues that might provide us with tangible answers to these questions. Nash’s decline into severe paranoid schizophrenia persists for at least six months. By the continually dazed expression on his face, it is clear that Nash has never experienced this type of mental disorder before. He is as surprised as his wife to learn that Charles, for example, is a figment of his imagination. In light of the aforementioned information, I would conclude that the diagnosis of paranoid schizophrenia is correct.

What may have caused Nash to develop paranoid schizophrenia? The question is deceptively simple. Although Nash does not suffer from another psychotic disorder or from mood swings, he is diagnosed with paranoid schizophrenia because of the repeated hallucinations, both auditory and visual, which make it increasingly difficult for him to work, to focus on his family and friends, and to basically function on an everyday basis. It is possible that Nash had a biological predisposition to schizophrenia, which is triggered by stress and stressful situations (competing with his peers at school, learning that his wife was pregnant, etc.). We have to rule out a number of possible causes. Firstly, there is no history of Autism Spectrum Disorder in his family. Secondly, he does not suffer from any other mental disorder. Thirdly, his disorder cannot be caused by substance abuse, since we rarely see him drink and never see him smoke drugs.

There are many facets to the treatment therapy I would advise Nash to take. Firstly, it is important for Nash to see a personal therapist on a daily basis in order to discuss his hallucinations and to find ways of dealing with them constructively. With his therapist, Nash can voice any concerns he has with his hallucinations and persecution paranoia. Secondly, Nash’s immediate family needs to be surrounded by a strong support network and needs to have educational resources at its disposal in order to understand the nature of the disorder and to find methods of identifying symptoms and managing them without getting too emotionally or psychologically upset. Thirdly, Nash needs to take medication (anti-psychotics) on a regular and consistent basis. Fourthly, Nash needs to take part in a series of social skills training workshop where Nash can work on his communication skills, develop a stronger sense of empathy, and learn how to better pinpoint facial expressions and body signals. Finally, Nash requires a hobby or a job in order to “feel important,” one of the chief problems he struggles with. He would benefit from workshops that would teach him a vocation, which would raise his self-esteem and make him more confident about himself as a man, a husband and father, a mathematician and a patient.