Monday, January 7, 2008

John Nash: Beautiful But Not Rare, Recovery

The end of "A Beautiful Mind," the Oscar-nominated movie based loosely on the life of Nobel Prize winner John Forbes Nash Jr., depicts the Princeton mathematician's emergence from the stranglehold of paranoid schizophrenia, the most feared and disabling of mental illnesses. Moviegoers who have watched the cinematic metamorphosis of actor Russell Crowe “from the disheveled genius who furiously covers his office walls with delusional scribblings to the silver-haired academic perfectly at home in the rarefied company of fellow laureates in Stockholm“ might assume that Nash's recovery from three decades of psychosis is unique.

But mental health experts say that while Nash's life is undeniably remarkable, his gradual recovery from schizophrenia is not.

That contention is likely to surprise many people, including some psychiatrists, who continue to believe the theory, promulgated a century ago by Sigmund Freud and his contemporaries, that the serious thought and mood disorder is a relentless, degenerative illness that robs victims of social and intellectual function, invariably dooming them to a miserable life in a homeless shelter, a prison cell or, at best, a group home.

Psychiatric researchers who have tracked patients after they left mental hospitals, as well as a growing number of recovered patients who have banded together to form a mental health consumer movement, contend that recovery of the kind Nash experienced is not rare.

"The stereotype everyone has of this disease is that there's no such thing as recovery," said Washington psychiatrist E. Fuller Torrey, who has written extensively about schizophrenia, an illness he has studied for decades and one that has afflicted his younger sister for nearly half a century. "The fact is that recovery is more common than people have been led to believe. . . . But I don't think any of us know for sure how many people recover."

The notion that Nash's recovery is exceptional "is very pervasive even though the facts don't support it, because that's what generations of psychiatrists have been taught," said Daniel B. Fisher, a board-certified Massachusetts psychiatrist and activist who has fully recovered from schizophrenia for which he was hospitalized three times between the ages of 25 and 30.

"Many of us who have spoken about our recovery are confronted with the statement that you couldn't have been schizophrenic, you must have been misdiagnosed," added Fisher, 58, who holds a PhD in biochemistry and went to medical school after his hospitalizations.

The belief that recovery from schizophrenia occurs only occasionally is belied by at least seven studies of patients who were followed for more than 20 years after their discharge from mental hospitals in the United States, Western Europe and Japan. In papers published between 1972 and 1995, researchers found that between 46 and 68 percent of patients had either fully recovered “they had no symptoms of mental illness, took no psychiatric medication, worked and had normal relationships“ or were, like John Nash, significantly improved but impaired in one area of functioning.

Although the patients received a variety of treatments, researchers speculate that the improvement may reflect both an ability to manage illness that accompanies age coupled with the natural decline, beginning in the mid-forties, in the levels of brain chemicals that may be linked to schizophrenia.

"One reason nobody knows about recovery is that most folks don't tell anybody because the stigma is too great," said Frederick J. Frese III, 61, who was hospitalized 10 times for paranoid schizophrenia in his twenties and thirties.

Despite his illness, Frese, who considers himself "definitely not fully recovered but in pretty good shape," earned a doctorate in psychology and was, for 15 years, director of psychology at Western Reserve Psychiatric Hospital in Ohio, the state's largest mental hospital. Frese holds faculty appointments at Case Western Reserve University and Northern Ohio Universities College of Medicine.

He has been married for 25 years and is the father of four children as well as past president of the National Mental Health Consumers Association. These achievements are hardly consistent with the prognosis Frese was given at 27, when a psychiatrist told him he had a "degenerative brain disorder" and would probably spend the rest of his life in the state mental hospital to which he had recently been committed.

© Sandra G. Boodman

Source: Beautiful But Not Rare Recovery

The movie "A Beautiful Mind" portrays the Nobel Prize winning mathematician John F. Nash, Jr., as having recovered from schizophrenia as a result of taking newer medications. This distorted take on the story of Nash's recovery has a few critics wondering whether drug company promotion now includes product placement in movies. Nash stopped taking anti- psychotic drugs a good two decades before the newer versions became available.

In fact, Nash's slow recovery over the course of many years appears to have been drug-free, according to his biographer Sylvia Nasar, whose book of the same name forms the basis of the movie. "Nash's refusal to take the anti-psychotic drugs after 1970, and indeed during most of the periods when he wasn't in the hospital during the 1960s, may have been fortuitous," she wrote. "Taken regularly, such drugs, in a high percentage of cases, produce horrible, persistent symptoms like tardive dyskinesi-- stiffening of head and neck muscles and involuntary movements, including of the tongue--and a mental fog, all of which would have made his gentle re-entry into the world of mathematics a near impossibility." (A much lower rate of these side effects is the chief advantage of the newer medications.) Nasar calls Nash's recovery "not unique" but "relatively rare," suggesting that the word remission might be more accurate.

This commonly accepted medical viewpoint was contradicted in a commentary for The New York Times, entitled "Beautiful Minds Can Be Reclaimed." Psychologist Courtenay M. Harding objected to the movie portrayal of Nash's recovery as unusual, claiming that many people with schizophrenia, perhaps more than half, do significantly improve or recover. "Many can be symptom-free without medication. They improve without fanfare and frequently without much help from the mental health system," she wrote, "Many recover because of sheer persistence at fighting to get better, combined with family or community support."

The research Harding cites to support her statements was conducted in the mid-1950s when Thorazine was the new anti-schizophrenia drug. George Brooks, clinical director of Vermont State hospital, observed that Thorazine was not enough to allow many of the patients to leave the hospital. He designed a flexible support system that began in the hospital and extended into the community so that discharged patients could continue to receive social support. Thirty years later, a follow-up study of the people who had been through this program found that 62-68% were either significantly improved or fully recovered. The most amazing finding, says Harding, was that 45% of all who participated in Dr. Brooks's program no longer had signs or symptoms of mental illness three decades later.v

© Healthfacts: Maryann Napoli

Source: Movie Misrepresents Recovery of John F. Nash Jr.