Schizophrenia is a type of severe mental condition considered to be the most chronic and incapacitating. It is linked to abnormalities of the structure and function of the brain, disorganized deeds and speech, hallucinations and delusions. As such, patients exhibit a broad array of troubles in their ability to hear, see and consequently the ability to process information from their surroundings. Besides, they experience disruptions in their behaviors, emotions and normal thought processes. There is no established cause of schizophrenia with existing evidence showing that there are multiple influences involved. The condition has substantial consequences for the affected persons, their family and the entire community. In this sense, therefore, this essay will discuss schizophrenia with a particular focus on the real life of John Nash who suffered from the condition. The story of Nash, a famous mathematician, is presented in the movie, A Beautiful Mind. It is evident from the film that the facets of schizophrenia have a profound impact on John, his family and the public in numerous ways. By examining key scenes in the movie as well as recent studies and literature, the paper will explain various aspects of the disease such as the etiology and pathophysiology; mental health assessments, interventions and treatment; impact and the associated stigma. The story of John is just too good and fascinating to pass up as it embodies an individual who was very brilliant, but had a side which was dark, schizophrenia, that dragged his mind to an imaginary realm.
The Aetiology and Pathophysiology of Schizophrenia
At the start of the movie, the audience is introduced to a young introverted and focused man who is a graduate student in the Math Department at Princeton University. It is evident from the initial scenes that Nash is different from his classmates mainly because of his lack of being social. This is made clear when he talks to his fantasy roommate, Charles (Howard, 2017). This is the first indication in the movie that one could use to say that Nash has a mental illness. It is not clear in the film what the etiology of his condition is but a viewer can deduce a thing or two from ensuing scenes. Evidently, Nash has some kind of hereditary issue affecting the brain that may have been inherited by the son, whom it is said is as well hearing voices (Howard, 2017). As such, since Nash’s son seems to be developing alike symptoms, one may postulate that there is some genetic link causing the condition in Nash. Besides, influences in his environment like the pressure to come up with a great discovery might have set off his condition as the symptoms begin manifesting at a later stage in life when he is presented with some demands (Howard, 2017). It is, therefore, possible to assert that genetic and environmental factors may be interacting to cause schizophrenia in Nash. The pathophysiology of the disease is evident in a number of symptoms that this main actor exhibits such as delusional thinking, visual and auditory hallucinations, bizarre behavior, feelings of paranoia and a distorted acuity of reality. These are evident in his conversations with imaginary figures like Charles and Parcher as well as his fantasy encounter with Marcee.
Recent research indicates that the causes of schizophrenia are yet to be understood, but its etiology is considered to be multifactorial. As seen in the movie, multiple susceptibility genes interact with various environmental influences to bring about the condition, validating recent studies (Häfner, 2014). In particular, the disorder has a profound genetic constituent that has a high heritability of around eighty percent. This implies that about eighty percent of the variation in the trait associated with the condition may be due to genetic factors (Haller et al., 2014). Genes such as ZNF804A and NRGN have been linked to an augmented risk of developing the disorder (Williams et al., 2010). Also, several environmental influences may act together with the susceptibility genes to upsurge the likelihood of developing the illness. These connections are currently being investigated in the field of epigenetics (Haller et al., 2014).
The interaction between the genetic and environmental factors result in alterations in the neuroplasticity which are developmentally mediated. Padmanabhan and Keshavan (2014) assert that the alterations manifest in a cascade of circuit and neurotransmitter abnormalities as well as weakened connectivity, explaining why Nash was experiencing a distorted perception of reality, delusions and hallucinations. Current research indicates that these neuropathological changes usually set in around the early years of adolescence. Declines in the gray-matter seem to take place in the initial phases of schizophrenia and have been linked to poorer disease outcomes (Padmanabhan & Keshavan, 2014). Besides, the initial changes of the condition have been associated with upsurges in the turnover of presynaptic dopamine turnover and rises in glutamatergic activity. These observations indicate the necessity of early diagnosis and involvement directed at the pathophysiological processes of schizophrenia.
Mental Health Assessments, Treatment and Interventions that Support Recovery from Schizophrenia
The main mental health assessments featured in the movie that lead to the diagnosis of schizophrenia include psychological, social and behavioral functioning. This is evident when Nash behaves in a bizarre manner when giving a speech pertaining his mathematical research (Howard, 2017). He experiences a delusion that makes him to be taken to a psychiatric hospital. Nash’s wife and the psychiatrist also visit his office only to discover countless bits of paper obtained from magazines and newspapers which are connected in imaginary patterns using frantic lines (Howard, 2017). This, therefore, makes the doctor conclude that Nash is suffering from of advanced schizophrenia. As such, the psychiatrist decides on a pharmacological intervention in which Nash is given antipsychotic drugs as well as an insulin shock therapy to manage the condition (Howard, 2017). Later on in the movie, it is evident that Nash learns how to manage his symptoms without medication. This is coupled with practical support from his wife and friends who house him and get him a job respectively, supporting his recovery.
Recent research and literature indicate that schizophrenia has been identified as a very complex condition that has an array of symptoms which can also be present in other disorders. As such, according to Pinna et al. (2015), current research points out that a crucial stage during its assessment is to identify other diseases that may be present before coming to a correct diagnosis. The assessment ought to involve various specialists such as psychiatric nurses, psychoanalysts and social workers among others. Typically, assessment entails neuropsychological testing; psychopathology that monitors both positive and negative symptoms; blood tests; structural brain assessment; a measure of the body mass index; evaluation of substance use; cardiovascular tests; analysis of familial history; existence of depression as well as academic and social functioning among others (Pinna et al., 2015). These assessments are necessary for each patient.
Since the precise causes of schizophrenia remain unknown, most interventions and treatments are directed towards helping a patient manage or stop their symptoms. As such, the people affected receive person-centered care that incorporates the patient’s immediate needs, background and culture (Dixon, Holoshitz & Nossel, 2016). The interventions and treatments aim at lessening symptoms, supporting recovery goals and improving the ability to function as well as enhance the quality of life. The first approach to treatment for the condition involves pharmacological interventions as seen in the movie. A patient is given antipsychotic medication that is usually perceived as being effective in the management of the positive symptoms of the disorder. These drugs act on the brain’s neurotransmitters and as such help to control positive symptoms like delusions, hallucinations and thought dysfunction (Bevan et al., 2013). Second, psychological therapy is used along with the pharmacological interventions. This entails both cognitive behavioral therapy and cognitive remediation therapy which are essential in managing symptoms and improving the coping strategies (Bevan et al., 2013). Besides, they also help in mitigating the psychological effects of schizophrenia. Third are psychosocial interventions that comprise of family interventions, assertive community treatment, coordinated specialty care and supported employment (Substance Abuse and Mental Health Services Administration, 2018). It is clear in the movie that psychosocial interventions play a crucial role in supporting the recovery of Nash.
The Impact of Schizophrenia on the Individual, Their Family and the Community
The movie does an exceptional job in highlighting the impact of schizophrenia on a person, their family and the public. On an individual level, it is evident that the disorder has a massive impact on Nash. After being diagnosed with Schizophrenia, Nash becomes wholly withdrawn from everything and everyone; he is seen not venturing outside his house (Howard, 2017). Nash is also unable to cultivate his relationships and this is evident when his wife decides to divorce him though later on, she takes him back to provide him with care. He also has difficulties associating with individuals around him. This is evident even before diagnosis whereby he declares that he is more content and comfortable with dealing with numbers than people (Howard, 2017). Nash also loses his job due to his condition making him wander around Europe and the United States though he later gets support.
The movie also highlights the burden of the disease on family. Alicia, Nash’s wife, feels the burden of taking care of both Nash due to his incapacitating ability and their son who has just been born. It is evident from the movie that Alicia is understandably dejected over the fact that his husband is not the guy she married any longer and this results in a divorce, hence family breakdown (Howard, 2017). The condition even has a huge impact on Nash’ marriage as their bedroom matters worsen. Nash’s relationship with his family is worsened when Alicia finds their son almost drowning when his husband is bathing the child (Howard, 2017). This is because Nash suffers an episode of hallucination while bathing the newborn, putting him in an unsafe situation.
It is also evident from the film that schizophrenia has an impact on the community. The relationship between Nash and the public is disrupted by the indiscreetness of the symptoms of his condition. This is particularly because the community around him perceives him as being so brilliant but the bizarre deeds he exhibits appear incongruent. As such, he is no longer able to provide his teaching services to the community as his symptoms cannot permit him, though later on with necessary support he gets back on track.
Current research indicates that the disorder has a profound impact on patients as it completely disables them. In particular, schizophrenia affects the daily life of patients in a troublesome manner altering their lives completely as seen in the case of Nash. The early symptoms make a person withdrawn and this is usually characterized by pushing away friends and losing an interest in activities they once enjoyed like music and sports (Tracy, 2016). Besides, early cognitive impairment may result in difficulties in thinking making a person not to thrive at school. Recent research also indicates that as a person gets older, the indicators of schizophrenia become more pronounced making it hard for one to work resulting in unemployment and even homelessness in extreme cases (Tracy, 2016). Besides, it is difficult for patients to cultivate relationships due to withdrawal symptoms as well as unsuitable mood behaviors. To conclude this, episodes of remission in which the patients do not experience the symptoms make their lives a complete bizarre (Tracy, 2016).
With regards to the impact on family, current research shows that families of people suffering from schizophrenia experience a myriad of challenges. First, families suffer objective burden that comprises of the practical, everyday problems and difficulties associated with having a family member who has a mental health illness, such as disruption of domestic routines and loss of income (Koujalgi & Patil, 2013). Second, families are also subjected to subjective burden that entails the emotional and psychological effects of the disease on members of the family, like feelings of worry and grief. Flyckt, Fatouros-Bergman and Koernig (2015) assert that the stresses of disease exacerbations combined with inadequate social and coping abilities also entail subjective burden.
When it comes to the community, people who have schizophrenia often respond improperly in social situations and react sluggishly than normal persons due to a decline in cognitive and social skill functions. The patients usually have dulled emotional effects which makes them tend to be unresponsive or uncaring to people in the community and also lose interest in socializing. As such, other individuals find it hard to relate with them and they tend to be isolated from the community. Besides, people with the disorder might have insights, talents, good work ethics or abilities to contribute to the community but their condition makes them not able to do so most of the time. As such, Chaiyakunapruk et al. (2016) state that the disorder is, without doubt, a net cost to the community. People with the disorder can reach a point they can no longer uphold productive employment due to their incapacities. The cost of the disease is also high as a lot of money is spent in addressing its various aspects (Chaiyakunapruk et al., 2016). It is possible to note that a good comprehension of the burden that schizophrenia presents on the patients, their families and the society is important in helping to address the needs of people suffering from the condition.
Stigma and Discrimination Associated with Schizophrenia
Stigma and discrimination represent chronic adverse interactions with the surroundings that most individuals who have schizophrenia experience on a regular basis. They contribute substantially to the burden of the condition and also present significant hindrances to recovery. The movie portrays stigma as a set of negative attitudes, perceptions and thoughts that people have of Nash. This is evident in various instances in the film in which the actions of people around Nash exhibit some form of stigma. To begin with, the bizarre mannerisms and weird behavior that Nash has due to his condition, put some of his friends and students off, and hence do not want to associate with him (Howard, 2017). Also, friends at school ridicule him for writing mathematical formulae on window panes and putting on a knitted hat always. There is also a scene in the movie when Nash’s friends take advantage of his situation. In this particular scene, the friends dare him to approach and speak to an unfamiliar girl who reacts by slapping him (Howard, 2017). As such, Nash turns out to be the brunt of his colleagues’ jokes. All these scenes depict some type of labeling and stigma that Nash experiences because of schizophrenia.
Current research shows that individuals with schizophrenia face some form of stigma. According to Li et al. (2017), stigma denotes a set of stereotyped negative views, attitudes, thoughts as well as incorrect fears that the society, the press, health workers and even employers have regarding schizophrenia and which affects the lives of people suffering from the condition. It entails inadequacies in knowledge as well as problems of attitudes and behavior and may be exacerbated by a scientifically incorrect emphasis that professionals lay on the biogenetic models of disease. Li et al. (2017) point out that different forms of stigma ranging from self-stigma, public stigma to label avoidance have overwhelmingly defeating effects for patients.
According to the mainstream health system, stigma is one of the most significant challenges affecting people with schizophrenia (Li et al., 2017). Some entities even point out that stigma is worse than the symptoms of the condition itself. This is primarily because it has an adverse impact on the patient’s psychological health, augmenting feelings of seclusion and culminating in poor self-esteem, reduced self-efficacy and thoughts of hopelessness (Li et al., 2017). Besides, research shows that the adverse impact of stigma can work through the inner emotions, perceptions and beliefs of the stigmatized individual, even beyond the effects brought about by direct discrimination (Koschorke et al., 2014). In this sense, therefore, the stigmatized person ends up with anger, despair, fear, apprehension, remorse, embarrassment and this may prevent recovery. Grover, Singh & Mattoo (2016) point out that stigma makes patients avoid seeking help or even using mental health services for fear of being labeled “a mental patient” and to avoid the adverse effects associated with stigma, hence obstructing recovery.
Stigma also has very real practical consequences such as social exclusion, limited opportunities for education and employment as well as substandard housing as is evident in the movie (Li et al., 2017). All these lower the quality of life for people with schizophrenia. Other consequences associated with stigma are disinclination for marital relationships and poor quality of care (Koschorke et al., 2014). A recent literature review revealed that stigma is associated with more secrecy, withdrawal as a strategy of coping, less mastery, decreased support and lowered social functioning which all result in an impaired quality of life (Grover, Singh & Mattoo, 2016). The society ought to offer people with schizophrenia guidance and support that they require in overcoming the effects associated with stigma. Measures such as cultivating self-esteem and coping skills as well as providing practical assistance to access education and employment can help mitigate the effects of stigma (Li et al., 2017). A better comprehension and identification of determinants of stigma may guide in determining appropriate strategies to lessen stigma and assist prevent its adverse effects.
The movie, A Beautiful Mind, is an excellent and truthful example of what people living with schizophrenia experience, as portrayed through the real life of the brilliant Nash. The film is able to depict the intricacies of the condition to the viewers correctly and hence educate them about what is known concerning the disorder. Besides, the great acting helps inform the audience pertaining what it is like to live with schizophrenia. The essay has managed to explain the etiology, pathophysiology, mental health assessments, interventions and treatment, impact and the associated stigma of schizophrenia. The paper has linked all these to recent research and literature. However, Nash’s case is extraordinary and deviates significantly from current research in that he somehow was able to learn on his own how to put his condition into remission devoid of medication. As much as current research shows the significance of cognitive behavioral therapy in managing schizophrenia, it suggests that it is effective when used concurrently with pharmacological interventions. In this sense, therefore, extensive research still needs to be conducted into the issue to understand Nash’ case and this could give a clue about better future interventions for schizophrenia.
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