Film gives clear picture of schizophrenia

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Perhaps Hollywood cutie Russell Crowe can succeed where countless mental-health professionals have failed in helping people understand schizophrenia.

In the film "A Beautiful Mind," Crowe plays Princeton University math professor John Nash, a tormented genius who eventually triumphs over schizophrenia through medication and sheer determination to maintain a truce with the demons that haunted him as a younger man.

To many mental-health experts, the film is the first to get it right. It presents a rarely seen but common outcome of the disease: recovery, or, at least, high-level management of its symptomatic delusions and hallucinations.

And experts say it's a welcome departure from mainstream depictions of the mentally ill that cast people with schizophrenia as either oddballs with "split personalities" — think Jim Carrey in "Me, Myself & Irene" — or dangerous paranoids, such as Edward Norton in "Fight Club" (1999). Almost as bad, they say, the disease has always been portrayed as a degenerative, lifelong illness.

"And that was never true," said Sylvia Nasar, whose 1998 National Book Critics Circle Award-winning biography of Nash became the basis for "A Beautiful Mind."

"The news of that hasn't gotten out in a big way."

While the film has been criticized for either eliminating or fictionalizing parts of Nash's life, mental-health experts praise its truthful portrait of his schizophrenia. Depictions of schizophrenia in popular culture have consistently perpetuated damaging misconceptions — for example, that schizophrenia causes personalities to cleave and multiply. In reality, the most common symptoms of schizophrenia are audible hallucinations — hearing voices. Schizophrenia is a neurological disorder most often treated with a combination of drugs and therapy.

"When you think of schizophrenia, it is not a single picture," said Wayne Fenton, deputy director at the National Institute of Mental Health. It can be mild or severe, a continual downward spiral or an intermittent course with a few episodes and long periods of remission.

Roughly 15 percent of patients achieve long-term recovery without medication. This seems to be the case with Nash, though he clearly benefited from antipsychotic drugs during the acute phases of his illness, according to his biographer. His schizophrenia was episodic and didn't fully emerge until he was in his 30s, when he had already completed the work that would earn the Nobel Prize. All this gave him better odds for recovery.

Others do not fare as well. More than 20 percent attempt suicide, and about half of those succeed. On a given day, there are five times more schizophrenics in the nation's jails and prisons than in psychiatric facilities, said Fenton. Perhaps two thirds of those living on the streets are schizophrenic.

To manage the illness over a lifetime, the vast majority need medications, therapy and a supportive environment. And with those benefits, more than half of the nonviolent individuals eventually function normally, said Raquel Gur, director of neuropsychiatry at the University of Pennsylvania School of Medicine's Schizophrenia Research Center.

Nash's story is that of a man who journeys to hell and back. A mathematics genius, he was abrasive and eccentric even when sane. (Crowe's portrayal is considerably nicer than that in Nasar's biography.)

Nash developed the game theory of economics in his doctoral thesis. But in his late 20s he was overcome with delusions and hallucinations. At times, he felt he was a Palestinian refugee, the future emperor of Antarctica, a Japanese shogun, a denizen of purgatory, "the Left Foot of God," a target of government persecution, a mouse.

In and out of institutions, on and off medication, he struggled for about 25 years.

Then, miraculously, he was better. When he was awarded the Nobel Prize in 1994, he was able to journey to Stockholm, give a talk on his theory of a nonexpanding universe, and conduct a relaxed, 10-minute conversation with the king of Sweden.

The experts say, however, that there's no such thing as real "recovery" from schizophrenia — rather, people can be stabilized.

Treatments have changed since Nash was hospitalized in the '50s. His insulin therapy — being forced into a coma and seizures — has long since been discontinued as brutal and ineffective. Later, he took the anti-psychotic Thorazine.

The book about Nash asserts that his refusal to take any anti-psychotic drugs after the 1970s may have saved him from developing serious side effects.

Nash, instead, was determined to logically "solve" the problem of his debilitating illness. Through sheer discipline, he began to ignore the cadre of hallucinations that had run his life for a decade.

Nash's approach came at a time when the pharmaceutical industry was coming out with more effective drugs whose side effects were milder than those he had initially been placed on.

Today, there have been major advances, and mental-health experts say newer anti-psychotics such as Zyprexa, Seroquel and Geodon do not have the debilitating side effects of some of the older drugs.

Material from the Los Angeles Times, Washington Post and Knight-Ridder newspapers was included in this story.

About schizophrenia

Who has it: About 1 percent of the U.S. population has been diagnosed with the disease. It affects some 2 million adults.

Onset: It usually strikes in the late teens or early 20s. Men often exhibit symptoms earlier than women.

Symptoms: Can include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior and emotional "flatness" or disconnectedness.