Monday, March 30, 2015

Hollywood Madness!

Hollywood has been less than realistic in its depiction of mental illness.  This can be seen clearly in two films, A Beautiful Mind (2001) and As Good As It Gets (1997).

A Beautiful Mind (2001) is a biopic of Nobel Award-winning mathematician John Nash.  The film opens at Princeton, where Nash is studying mathematics.  Nash is clearly withdrawn and unsocial.  He tends to avoid eye-contact with his fellow students. He often grins to himself as if he is enjoying a private joke.   Nash claims, in his defense, that people don't like him and he would do better to avoid them.  This, however, is not a notion supported within the film.  Those around Nash mostly express admiration of the math prodigy.  At first, students and teachers simply assume that he is too obsessed with his work to have interest in social interaction.   Even his most serious rival is generous in his assessment of Nash, who he simply sees as "mysterious."

Nash continues to keep to his own thoughts until he meets his new roommate, Charles.  He becomes relaxed enough with Charles, who is funny and encouraging, to divulge to him his more intimate feelings and aspirations.  The film surprises viewers when it is later exposes Charles to be imaginary.  By then, Nash has fabricated other imaginary acquaintances, including Charles' young niece Marcie and a Department of Defense agent named William Parcher.  On the basis of these delusions, Nash is diagnosed with schizophrenia.

People with schizophrenia do have difficulty telling the difference between what is real and what is imagined, but they do not have the spectacular hallucinations depicted in the film.  A schizophrenic person will not see, hear and touch people who do not exist.  Their hallucinations are generally auditory, usually represented by a chorus of voices.  The voices serve no purpose other than to berate the schizophrenic.  Louis Sass, Professor of Clinical Psychology at Rutgers University, explained, "[I]f I were schizophrenic, I might hear John and Mary saying, 'Okay, so why is Louis doing that now?' and then Mary would say to John, 'Oh, he's just a jerk, he always does that kind of thing.' They go back and forth, but sort of a commentary, often critical, on my ongoing behavior."  This critical commentary is only slightly evident in the film.  When Nash tries to ignore Charles, Charles tells him, "It's never going to work.  It's pathetic.  I'm ashamed of you."  A schizophrenic will not see a person who isn't there, but he may see an object, let's say a tree stump, and misinterpret it as being a person.  A schizophrenic described seeing a line of cars in the street and believing it was a giant caterpillar.  But auditory hallucinations are not as dramatic as the visual hallucinations that dominate the film.  A filmmaker will sacrifice the truth for drama every time.

Like most schizophrenics, the real-life Nash did hear voices that mocked and argued with him.  At times, he thought the voices were coming from angels.  He came to believe that he was the Pope and the angels wanted him to come up with a mystical number that would prove the existence of God.  Grandiose delusions and paranoid delusions are common with the schizophrenia sufferer.  Nash's greatest delusion among many delusions was a longstanding belief that he was finding messages from extraterrestrials hidden in newspapers.  A friend and colleague asked Nash, "[H]ow could you, a mathematician, a man devoted to reason and logical proof. . . how could you believe that you are being recruited by aliens from outer space to save the world?"  Nash replied, "Because. . .the ideas I had about supernatural beings came to me the same way that my mathematical ideas did.  So I took them seriously." 

In his portrayal of Nash, Russell Crowe exhibits clumsiness as an early sign of the disorder.  He becomes anxious and distracted after he loses at a board game called Weiqi.  When he stands up, he clumsily knocks over the game board.  This is misleading.  Medication for schizophrenia impairs coordination as a side effect, but the illness itself is not responsible for these type of actions.  Crowe is more authentic in his failure to look directly at other people.  It is due to deficits in attention processing that schizophrenics often fail to demonstrate common eye tracking.

As the story continues, Nash grows increasingly violent and paranoid.  Frustrated by the slow progress of his work, he smashes his head through a window pane and pushes an oak desk out of a third-story window.  He reaches the climax of his violence and paranoia when he is confronted by a psychiatrist, Dr. Rosen, and becomes so aggressive that he must be restrained.  Dr. Rosen decides that he must forcibly institutionalize Nash to remove him from stressful environments.  The doctor initially medicates him with an antipsychotic, Thorazine, but after a violent episode, in which Nash slits open his wrists in search of an imaginary government implant, he subjects him to electroshock therapy five times a week for ten weeks.

Nash can no longer rationalize his delusion when he realizes that one of his imaginary friends, the little girl Marcie, never grows old.  This is pivotal in getting Nash to cooperate with treatment.  The antipsychotics enable him to ward off the delusions, but they paralyze his intellect and make him sexually impotent.  This man, who once found great meaning in his work, feels lost and depressed when he is forced to stay home and do nothing.  His wife, having lost the trust and intimacy that she once had with her husband, grows distant from him.  Nash eventually refuses to take his medication, which triggers a relapse of his psychosis.  Parcher, the imaginary Department of Defense agent, now returns with a whole team of codebreakers, who set up their headquarters in his garage.  These delusions distract Nash while he's caring for his infant son.  The infant, who is left unattended in the bathtub, nearly drowns.

In working through this crisis, Nash abandons his medication.  Nash and his wife decide to do their best to live with the peculiarities of his disease.  Nash allows the delusions to persist, but he fights off their control of him.  He later explains to a friend that he has simply become used to ignoring them.    The film was roundly criticized for simplifying schizophrenia in the same way that Rain Man (1988) simplified autism.  New York Times critic A.O. Scott criticized the film for turning Nash into nothing more than a "shy, lovable genius."  Dr. Ken Davis, chairman of psychiatry at Mount Sinai School of Medicine, said, "[T]he notion that willpower can really overcome schizophrenia is ludicrous."  

A Beautiful Mind is similar to Silver Linings Playbook (2012), in which Bradley Cooper stops taking his medication and controls his behavior through force of will.  Silver Linings Playbook manages in its depiction of bipolar sufferer to focus on manic episodes and completely ignore depressive episodes.  It makes sense from an entertainment standpoint.  Manic episodes are so much fun that we should put a bunch of those in the film.  Depressive episodes are so terribly dreary that we should just leave those out.  But it simply isn't accurate.

The message of A Beautiful Mind is that people with schizophrenia can be productive and successful with the proper support, but that support is defined as social support rather than medical support.  This is an issue that has been debated by experts in the field.  Dr. Steve Lamberti, an associate professor of psychiatry at the University of Rochester, is the one lone medical authority who defends the film.  He alleges that the schizophrenia sufferer does have some control over the illness.  He said, "While one cannot simply will the disease away, many people do learn to cope effectively with schizophrenia." Lamberti added, "An environment that is structured, predictable and supportive is helpful for most individuals with schizophrenia. . . The importance of family support has been increasingly recognized in the field of psychiatry over the past 20 years, and new forms of family education and treatment have been developed."

As Good As It Gets (1997) also emphasizes the importance of social support.  The main character, Melvin Udall, is tactless and self-obsessed.  He spends his day concentrating on his work and offers little in the way of social interaction.  He panics when another person reaches out to touch him.  He must regularly wash his hands with steaming hot water and a freshly unwrapped bar of antiseptic soap.  He checks and rechecks his door locks.  He goes to the same diner every morning, sits at the same table, and orders the same breakfast.  He sets aside the diner's utensils in favor of wrapped, disposable utensils.  He cannot walk down the street without avoiding cracks in the sidewalk.  His obsession with avoiding germs causes him to keep away from coughing children and to put on disposable plastic gloves before he touches a pay phone or opens a cab door.  In packing for a trip, he is fussy about folding and organizing his clothing.  Melvin, we learn, has been diagnosed as suffering from obsessive-compulsive disorder.

A person afflicted with obsessive-compulsive disorder experiences a continuous cycle of intrusive thoughts that urge them to perform various rituals.  The person knows that these rituals are meaningless and unreasonable, but avoiding the urge to perform them incites overwhelming stress and anxiety.  These intrusive thoughts tend to consume a great deal of their time and interfere with their daily lives.  They can, if allowed, get out of control and take over a person's life.

Hollywood usually depicts people with this disorder with violent or comically affected behavior.  The latter was evident in the television series Monk, which derived inexhaustible comedy from the quirky behavior of obsessive-compulsive detective Adrian Monk.  Like Melvin, these characters typically display grouchy dispositions.  They are sarcastic, bitter, and testy.  However, such behavior is not related to OCD, but a similarly named disorder known as Obsessive-Compulsive Personality Disorder.  This is a personality style characterized by a harsh conscience and rigid behaviors.  These people have, based on their orderliness, parsimoniousness, and obstinacy, what Freud described as an "anal character."  Dr. Michael Jenike, a Harvard psychiatry professor, maintains, "No personality type is associated with OCD."  It is in fact the rituals, like avoiding cracks on a sidewalk, that strictly put Melvin in the OCD category.

The National Institute of Mental Health reports that several medications have been proven helpful for people: clomipramine, fluoxetine, fluvoxamine, sertraline, and paroxetine.  The institute also recommends therapy in which "the patient is exposed to whatever triggers the obsessive thoughts, and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety."  Growing evidence indicates that OCD represents abnormal functioning of brain circuitry, most likely involving a part of the brain called the striatum.

Melvin, though, is not receiving treatment.  He admits to having seen a "shrink," but the man became so frustrated and exhausted with Melvin that he stopped treating him.  Melvin emphatically refuses to take medication, at one point saying, "My doctor. . . told me that in 50 to 60 percent of the cases, a pill really helps.  I hate pills.  Very dangerous things, pills.  I'm using the word 'hate' here about pills."

Melvin befriends Carol, a waitress, and Simon, a neighbor who is recovering from injuries that he suffered in a robbery.  His fixations diminish as he focuses on these other people.  He doesn't think to avoid sidewalk cracks or recheck his door locks.  Melvin tells Carol that she makes him "want to be a better man."

The protagonists of A Beautiful Mind and As Good As It Gets are similar in many ways.  They are both work-obsessed.  They both do poorly interacting with other people.   They both find social talk exhausting.  They both find that they can be drawn out of their shell by a loving woman.  The films even include similar scenes in which the woman quietly caresses the man's cheek and kisses him.  The filmmakers set aside medical treatment to focus on personal relationships.  Film critic Darren Mooney called this a "conventional life-affirming narrative."  It is much like the overused plot in which a depressed widow or a bitter divorcee meets a wonderfully nurturing person and learns to love again.  A film cannot present satisfying drama when, ultimately, the hero is a prescription.  Filmmakers are willing to serve a story's dramatic needs by advocating personal strength and human contact as cures more effective than medication.  It doesn't matter to them if this significantly distorts reality. 

Mental health issues are complicated.  When it comes to the care and treatment of mental health patients, the efficacy of medical science to bring about results remains questionable.  No magic pill can be used to rid a person of these terrible disorders.  But medication and therapy are far more useful than Hollywood films indicate.  It is more important to know that love will not cure bipolar disorder, schizophrenia, autism, or OCD.

Reference Sources 

The American Experience (2002).  A Brilliant Madness.  A Yellow Jersey Films production.  Downloaded March 15, 2006, from

Biondo, Brenda (1998, June 19-21).  OCD: The Doubting Disease.  USA Weekend Health.

Fuertes, Janine R.  As Good as it Gets?: An Examination of the Mechanism and Mode of Treatment of Obessive-Compulsive Disorder.  Bryn Mawr College. 

Schizan (anonymous schizophrenic) (2002, April 7).  A Beautiful Mind - A nice, brilliant, but misleading movie.  Downloaded from 

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