At Princeton University, John Nash struggles to make a worthwhile contribution to serve as his legacy to the world of mathematics. He finally makes a revolutionary breakthrough that will eventually earn him the Nobel Prize. After graduate school he turns to teaching, becoming romantically involved with his student Alicia. Meanwhile the government asks his help with breaking Soviet codes, which soon gets him involved in a terrifying conspiracy plot. —A Beautiful Mind, 2001
Donnie Darko doesn’t get along too well with his family, his teachers or his classmates; but he does manage to find a sympathetic friend in Gretchen, who agrees to date him. His only other companion, a large bunny named Frank –which only Donnie can see, may or may not be a true ally. —Donnie Darko, 2001
A mentally ill young woman falls in love with an eccentric man who models himself after Buster Keaton. —Benny and Joon, 1993
These are but three examples of Hollywood produced films with characters that claim to represent the mental illness schizophrenia. Hollywood and fiction writers in general, are doing a better job at portraying some aspects of mental illness but there is still a ways to go yet.
Schizophrenia has often been misconceived in popular media as a type of Dr. Jekyl/Mr. Hyde split but Schizophrenia is not Dissociative Identity Disorder (formerly known as Multiple Personality Disorder). People with schizophrenia do not have two or three people living inside them, they don’t all talk to themselves, or have invisible friends.
So what is Schizophrenia?
Schizophrenia is a chronic, severe, and disabling brain disorder. It is a disorder of thought, which is the defining characteristic that distinguishes it from other psychotic disorders. People with schizophrenia have difficulties thinking in a clear, focused, organized way.
Some people will have only one acute episode of schizophrenia; others may have many episodes during a lifetime, but lead relatively normal lives during the interim periods. However, most people with chronic schizophrenia have a continuous or recurring pattern of illness. These individuals do not fully recover normal functioning and typically require long-term treatment and rehabilitation, generally including medication, to control symptoms and reduce the impact of the illness on daily functioning.
Since no one can actually look into the brain of another to see their thinking patterns, the thought disorder is inferred through the display of disorganized communication patterns. Thoughts may come and go rapidly; the person’s thinking may go off on tangents with only marginal connection between the ideas (tangential thinking); or the person may talk almost continuously, jumping from one topic to another (flight of ideas). The person may be unable to process information, or connect thoughts into logical sequences, so thoughts (and conversation) become disorganized and fragmented.
Like other psychotic disorders, some people with schizophrenia will display unusual behavior, often in response to hallucinations or delusions.
Hallucinations are disturbances in perception. Although auditory hallucinations (hearing voices that other people do not hear) are the most common, they can occur in all 5 senses: auditory (sound), visual (sight), tactile (touch), gustatory (taste), and olfactory (smell). Visual hallucinations are rare.
Delusions are strongly held, false beliefs. They may be persecutory, paranoid, or grandiose.
Roughly one-third of people with schizophrenia experience delusions of persecution, or false and irrational beliefs that they are being cheated, harassed, poisoned, conspired against, or persecuted. Grandiose delusions may focus on being a famous person, having a fortune, or possessing special powers.
Sometimes the delusions experienced by people with schizophrenia are quite bizarre; for instance, believing that a neighbor is controlling their behavior with magnetic waves; that people on television are directing special messages to them; or that their thoughts are being broadcast aloud to others.
When a person with this disorder fails to understand that the hallucinations and delusions are symptoms (not reality), they tend to act in response to the symptoms with fear, anxiety, withdrawal, and odd or unusual behavior.
For example, putting foil on windows to block mind controlling magnetic waves, refusing all but prepackaged food to avoid poisoning, and insisting on seeing a lawyer to gain access to their vast fortunes are all examples of unusual behavior. If placed within the context of the symptoms of the mental illness, they can actually make sense. This, I think was some of the brilliance behind the producers of “A Beautiful Mind. we know going into the film that the story was based on a real life person. The notion that a renowned mathematician could be recruited by the man in black (FBI or CIA) seemed more than reasonable. So yes, John Nash was portrayed as a bit of a social outcast and somewhat anal in his note taking and research, but seriously, how many scientists do you know who aren’t anal? It wasn’t until the camera lens pulled back a bit, when we could see his physical deterioration, and the danger he presented to his wife and child, that we began to suspect that all was not right. The behavior made sense when you viewed it, understood it within the patient’s context.
Violence and Schizophrenia: News and entertainment media tend to link mental illness and criminal violence; however, studies indicate that except for those persons with a record of criminal violence before becoming ill, and those with substance abuse or alcohol problems, people with schizophrenia are not especially prone to violence.
Most individuals with schizophrenia are not violent; more typically, they are withdrawn and prefer to be left alone. Most violent crimes are not committed by persons with schizophrenia, and most persons with schizophrenia do not commit violent crimes.
Substance abuse significantly raises the rate of violence and illegal behavior in people with schizophrenia but also in people who do not have any mental illness. People with psychotic symptoms, especially paranoia, which can become worse if medications are discontinued, may also be at higher risk for violent behavior. When violence does occur, it is most frequently targeted at family members and friends, and more often takes place at home.
So, how well did A Beautiful Mind, Donnie Darko and Benny & Joon portray schizophrenia?
We’ll continue the discussion in Part II of Mental Illness for Fiction Writers: Schizophrenia.