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Historical descriptions of mental illnesses and individuals experiencing psychopathic symptoms have been documented since classical times. Behavioural conditions that imitated schizophrenic symptoms existed from ancient Greece, Rome, and the Middle Ages (Jeste et al, 1985, cited in Walker et al, 2004). Schizophrenia gained recognition at the start of the twentieth century, when Bleuler renamed 'dementia praecox' (McKenna, 1997), meaning dementia or mental illness of the young, which was introduced by Kraeplin (Howells, 1991, cited in Walker et al, 2004), and established the term schizophrenia. The term which derives from the Greek words for to cut (schizo) and mind (phrenia)is nowadays considered to be an intricate condition ( Howells, 1991, cited in Walker et al, 2004).Therefore, it can be assumed that schizophrenia denotes the tearing of an individual's mind and emotional consistency (Bleuler, 1911, cited in Walker et al, 2004). Schizophrenia, ranging from the biological to the behavioural symptoms that it consists of, has challenged the field of psychology in terms of providing a scientific explanation. Up to today, researchers have not been able to distinguish an isolated factor that accounts for all individuals living with schizophrenia. However, schizophrenia in today's media production is quite popular as a representation of mental illness. For instance, the motion picture A Beautiful Mind focuses on John Nash, a noble prize winning mathematician, who was diagnosed with paranoid schizophrenia at the age of thirty. The following article will focus on the fundamental attributes of schizophrenia (etiology, symptoms and treatments), as well as, providing a critical evaluation of the motion picture A Beautiful Mind in terms of whether it provides an accurate and realistic portrayal of schizophrenia.
According to the DSM IV (Am. Psychiatric Assoc., 2000, cited in Walker et al, 2004), in order for an individual to be diagnosed with schizophrenia he/she must be experiencing the precursors and symptoms present in the mental condition for a period of six months or more. The distinguishing symptoms of schizophrenia include hallucinations, delusions, speech that is disorganized, behaviour that is extremely confusing or catatonic, and symptoms that are negative. When an individual diagnosed with schizophrenia experiences negative symptoms he/she experiences alogia (inability to speak) and/or emotions that are flat. In order for an individual to be diagnosed with schizophrenia, he/she must be coping with the above symptoms for over a period of one month. However, if an individual experiences delusions that are peculiar and ludicrous or auditory hallucinations which consist of ongoing commentary or two voices taking part in discourse, only one additional symptom is needed to diagnose schizophrenia. It must be noted that in order for an individual to be diagnosed with schizophrenia he/she must be experiencing vocational and interpersonal dysfunction. Furthermore, there must be an absence of symptoms part of mood disorders, such as, manic episodes (American Psychiatric Association (APA), 2000, cited in Walker et al, 2004).
In addition to the symptoms stated above, the DSM IV includes four subtypes in its description of schizophrenia which are the following: paranoid, catatonic, disorganized, and undifferentiated. A constant and recurring obsession with hallucinations or delusions is considered to be a symptom indicative of paranoid schizophrenia. This is the subtype with the best diagnosis. However, for an individual to fit the criteria for paranoid schizophrenia he/she must not experience disordered vocalization or any kind of negative symptoms. Catatonic schizophrenia mainly involves movement irregularities, alogia, and echolalia ( repetition of words that are spoken by another individual). The subtype labelled disorganized is composed of disorganized speech, disordered behaviour, and blunted emotions (flat affect) but without any behaviour part of the catatonic subtype. The last subtype of schizophrenia, known as undifferentiated subtype includes individuals living with schizophrenia who do not meet any of the criteria part of the other three categories stated above (American Psychiatric Association (APA), 2000, cited in Walker et al, 2004).
The precursors of schizophrenia appear at any time in an individual's life. They can either be unexpected and abrupt or they could have a gradual onset (Lieberman et al, 2001, cited in Walker et al, 2004). Most of the noted cases of schizophrenia state that individuals tend to start experiencing symptoms of the illness in the late years of adolescence to early years of adulthood (20-25) (DeLisi, 1992, cited in Walker et al, 2004) with males being diagnosed an average of four years prior to females (Riecher-Rossler&Hafner, 2000, cited in Walker et al, 2004). Numerous variables affect the time of onset and development of the illness. The most important of these variables, however, are environmental and genetic factors. For instance, it has been shown that environmental and circumstantial stressors can trigger the onset or worsen the course of schizophrenia (Norman & Malla, 1993, cited in Walker et al, 2004).
The choice of treatment for schizophrenia is considered by psychiatrists as a challenge,due to the need to organize and integrate circumstantial, biological, psychological, and social factors influencing the illness. Regardless of the voluminous advances made in acquiring knowledge about schizophrenia the pharmaceutical treatment used to treat schizophrenia have not been altered for over thirty years ( Shore & Keith (Eds.), 1993). The archetypal treatments used for schizophrenia vary from pharmaceutical and psychosocial treatments to community and family support. However, the most suitable results are seen when a combination of these treatments is used (Walker et al, 2004). Anti psychotic pharmaceutical treatment can be segregated into two categories. The first generation anti psychotics were presented in the 1950s and were effective mostly on the positive symptoms of schizophrenia (hallucinations, delusions). However, their side effects include a variety of movement anomalies that might have an early or late onset. Due to these side effects second generation anti psychotics were later introduced (Sadock & Sadock, 2000, cited in Walker et al, 2004).
When combined with pharmaceutical treatment, psychological therapy session can prove to be more effective than medication on its own. This is due to the fact that psychological therapies assist both the individual living with schizophrenia along with his family to cope effectively with the illness (Bustillo et al., 2001, cited in Walker et al, 2004). It is more likely for the person diagnosed with schizophrenia to encounter a relapse if he/she lives in a setting where his family members communicate by the use of negative emotions. However, psychological therapy in a family setting helps these negative emotions to be encountered in a controlled setting where a solution can be found. This type of therapy can also assist in teaching an individual living with schizophrenia to express appropriate interpersonal skills and become more suitable for handling an occupational setting in the future (Butzlaff & Hooley, 1998, cited in Walker et al, 2004).
Fictional and non-fictional motion pictures and television productions have a chief role in moulding the perceptions and viewpoints of individuals part of a community (World Health Organization (WHO), 2005). They also have a very strong influence on the feelings and attitudes those individuals adopt towards mental illness and individuals living with a particular mental illness. The depiction of mental illness by the media is commodious and quite often creates specific stigmas and stereotypes. Individuals diagnosed with a mental illness are often displayed as being violent and belligerent. They are also shown more often as being objects for observation unable to live a meaningful or successful life and be part of a community. On the other hand, psychiatrists are illustrated as being dishonest, malevolent, and conceited. Furthermore, media productions focusing on a mental illness usually portray a distorted image of the treatments used in mental health facilities. For instance, a popular choice in motion pictures is the use of psychological therapies and ECTs as mental health treatments. The portrayal of these treatments allows the audience to enter the psyche and emotions of a Hollywood character, however, in most cases they are very unrealistic ( Pirkis et al, 2005).
A media representation of an individual diagnosed with schizophrenia, directed by Ron Howard, is A Beautiful Mind. The film focuses on the life of Noble Prize winner John Forbes Nash
(Charles, 2003), an exceptional mathematician who was diagnosed with paranoid schizophrenia at the age of thirty (Welsch & Adams, 2005). From the beginning of the film, John Nash is portrayed as an arrogant and narcissistic person who isolates himself from the individuals around him( Richman, n.d., cited in Ikeda, 2002). Focusing on his goal of discovering something great, he prefers to spend most of his time away from his obligatory classes and in the library writing his theories on glass windows (Butler, 2002). It is his best friend Charles who seems to help him have confidence in himself and stay focused on his goals (Welsch & Adams, 2005) It is during his final semester at Prinston University that John discovers the Game Theory and is offered a Job at MIT as a teacher (Butler, 2002). It is at MIT that he falls in love with his student Alicia and decides to marry her. Unfortunately, Nash has been living with schizophrenia from the beginning of his studies at Princeton. However, his wife realized this only after he became preoccupied with hallucinations of being part of a government organization focusing on pinpointing and interpreting hidden codes placed in various newspaper articles by individuals part of the Soviet (Richman, n.d., cited in Ikeda, 2002).
Eventually, his paranoid behaviour and beliefs of persecution caused his wife to admit him to a mental health facility where he was diagnosed with schizophrenia and administered first generation anti psychotic medication and adrenaline shocks. It is during this that the audience understands that his room mate, Charles, and everything else he has been seeing is purely imaginary (Richman, n.d., cited in Ikeda, 2002). After he is released fro the facility and returns home, he realizes that his life has changed in many ways. Firstly, he experiences sexual dysfunction and loss of sexual drive. Secondly, he is not able to focus and sees everything in a hazy manner. Lastly, he realizes that he is loosing his ability to work efficiently and later decides to stop taking his medication. The main struggle he faces throughout the film is that of understanding what is imaginary and what is real. However, due to the fact that the film is a Hollywood production, Nash eventually realizes that his delusions are not real through his love for Alicia and mathematical solutions (Butler, 2002).
Although the film is a touching depiction of what an individual living with schizophrenia goes through, there is a controversy whether the film is a realistic portrayal of schizophrenia. According to Butler (2002), the film A Beautiful Mind faces the issue at hand with consciousness, sympathy, and with a serious attitude, while, taking into account the stigma and side effects produced by the illness and medication. The motion picture also portrays John's sexual dysfunction and motor abnormalities in a realistic way, as well as, helping the audience get rid of the stereotypes that might exist centred around the belief that individuals living with schizophrenia are homeless or suicidal by showing a brilliant intellectual living with the illness (Butler, 2002). The film focuses on showing the audience John's awkward interpersonal skills and his inability to understand what conversational skills are needed and when. The director also focuses on helping the audience understand the confusion that an individual living with schizophrenia goes through in his/her attempt to identify what is real and what is imaginary. Apart from the fact that, A Beautiful Mind,is a Hollywood production and tries to commercialize the entertainment film as much as possible, it conveys the importance of social and family support in schizophrenia's recovery process. However, it must be stated that, even though, the motion picture is correct in its focus of family support, it is an exaggerated portrayal of how effective the support is. For instance, it very unlikely that an individual can overcome a mental illness just because he has family support. Furthermore, the use of adrenaline treatment in the film has not been evident in any literature on schizophrenia, while, the presence of his wife at the time of the treatment is highly untrue and unethical. The use of this treatment was mainly for reasons of entertainment, and untruthfully causes the audience to acquire a negative stereotype towards clinicians and uses of treatment. A treatment that has been used for paranoid schizophrenia, in particular, is electro convulsive treatment (ECT), however, the results were quite poor (Kendler, 1980, cited in McKenna, 1997). Furthermore, while it might be considered unrealistic that Nash was diagnosed at the age of 30, due to the fact that most individuals are diagnosed by age 25, Kraepelin (1913, cited in McKenna, 1997) states that paranoia has an onset at age thirty to forty. It can also be stated that the film puts a lot of emphasis on the remission of Nash's schizophrenia without medication being the solution to schizophrenia, however,
Therefore it can be concluded that while the film, A Beautiful Mind, discards the stereotype of individuals with Schizophrenia, it over dramatizes particular issues like being able to endure the illness without medication and presents false accounts of treatments used. It also creates false stereotypes towards psychiatrists and should not be thought of as a suitable apparatus for teaching psychology students about schizophrenia. Therefore, I do not believe that the film is a realistic portrayal of schizophrenia, putting greater emphasis on selling the film to audiences rather than showing the realistic properties present in an individual living with schizophrenia.