Thursday, June 9, 2011

Case Study: John Forbes Nash, Jr.

John Nash won the Nobel Memorial Prize in Economic Sciences in 1994, but for most of his life he balanced his mathematical genius against his struggle with schizophrenia. By many accounts, he spent most of his time in delusion, unaccountable to his actions, which were mostly bizarre and maladapted exaggerations of normal human behavior. Although the exact etiology of his illness is mere speculation as it intersects with medical science, his distress was overtly reflected in bizarre behavior and mannerisms typical of schizophrenics. Ultimately, by his awareness and conscious design, he chose to revoke the claims of his delusions and "generate his own transformation" (Meyer, Chapman & Weaver, 2009, p. 103). Unlike many individuals with schizophrenia, he has maintained a full remission for over 20 years.

Overview of Presenting Problem

Both John Nash's history with schizophrenia and intellectual brilliance began at a young age. According to Nasar (2001), Nash was "a singular little boy, solitary and introverted" (p. 4). He was socially avoidant, academically above average, yet under achieving. His parents forced him to participate in social activities although he neither enjoyed nor perpetuated the continuance of such involvement. He developed bizarre behaviors such as grass eating, animal torture, and inappropriate chemical experiments, and his teachers report consistent daydreaming and an inability to follow directions.

As an adult Nash spent several years in delusion, perpetuating relationships with nonexistent characters and enacting acutely erratic behavior. Once Nash charged into a New York Times office and accused them of intercepting encrypted messages destined for him (Meyer, Chapman & Weaver, 2009). His wife corroborates erratic behavior with evidentiary accounts of writing on walls, elaborate narrative referring to himself with a different name, writing nonsensical postcards, and making aggravating and persistent phone calls to former colleagues (Nasar, 2001). He was committed to psychiatric hospitals multiple times, and received several weeks of insulin-induced shock therapy (Meyer, Chapman & Weaver, 2009).

Components of Schizophrenia

Biological

Recent research clarifies the biological component of schizophrenia's complex neurodevelopmental basis, which includes abnormalities in neurotransmitter transmission as well as the structural components of the neural system (Feist & Feist, 2008). In the case of John Nash, genetic factors were likely implicated, considering his son, John Charles Nash also suffers from paranoid schizophrenia. Although the paternal Nash was rarely present in the younger Nash's life, he identifies with his father, which may be construed as a psychodynamic component of the disease. According to Feist and Feist (2008), contemporary research emphasizes the biological role in the disease as a predisposition to abnormal responses that can lead to social withdrawal as was so typical with Nash, from early childhood and throughout adulthood.

Although evidence points to a substantial, although partial genetic component, it is essential to consider the possible environmental factors that interact and affect the inherited predisposition. In the case of John Nash, as there are no accounts of such, one can only speculate on any contributing environmental factors such as viruses, toxins, and prenatal and postnatal injuries. The exact role of genetics in schizophrenia still eludes medical science, although its contribution may be a common denominator in a range of associated disorders (Hansell & Damour, 2008). In Nash's case, stress seemed to be an underlying component and exacerbating factor contributing to the severity of his illness (Meyer, Chapman & Weaver, 2009).

Emotional

Capps (2003) discussed the underlying conflict in Nash regarding his homosexuality. Freud made such claims in his work with a patient with similar homosexual tendencies and concurrent persistent schizophrenia, from which the patient later attained a remission. According to Freud, homosexual tendencies caused severe repression, which could predispose an individual to paranoid schizophrenia (Hansell & Damour, 2008). Freud believed there may be a biological predisposition for such a progression into the disordered and delusional thinking of this disease (Capps, 2003). Capps (2003) explores the connection between Nash's delusions and experiences and emphasized his tendency to express and reflect bisexual confusion within his delusions. Nash has not discussed such proclivities in detail, and any speculation can be generalized only to the schizophrenic population rather than to Nash specifically.

Cognitive

In the case of John Nash, he used his acute cognitive abilities to override his hallucinations and delusions. By directing himself to resist their imploring attention-seeking behavior, he practiced not believing in them and induced his own remission. According to Hansell and Damour (2008), in the positive symptoms of schizophrenia, individuals are not able to block irrelevant stimuli, which may create a conducive internal environment for giving extraordinary credence to hallucinations and delusions. Further complications arise when individuals try to explain such delusional experiences to themselves (Capps, 2003).

Nash cognitively circumvented his disordered delusional state by understanding its nature. Nash made a conscious effort to ignore the auditory and visual delusions, and made effort to think rationally. He enlisted the help of his mathematical studies as a focal point and
induced a full remission in the 1990s. According to Nash, 
Gradually I began to intellectually reject some of the delusionally-influenced lines of thinking which had been characteristic of my orientation. This began, most recognizably, with the rejection of politically-oriented thinking as essentially a hopeless waste of intellectual effort (Frängsmyr, 2005).
Behavioral

In the behavioral paradigm, the focus is on learning how to respond and act normally within the scope of social norms and the spectrum of expected and accepted behavior (Feist & Feist, 2009). In large part, schizophrenia is caused by conditioning, and biological factors predispose individuals to abnormal responses (Hansell & Damour, 2008). Nash received an abundance of attention for his disorganized speech and bizarre actions as he responded to delusional characters, which became a significant force in his life. For Nash, realizing the characters were, in actuality, nonexistent enabled him to disregard them. He neither tried to eliminate the delusional characters, nor engaged them in further conversation, he simply allowed them to continue without his involvement.

Nash modified his behavior by understanding and accommodating his delusions. By addressing the cognitive component of his disease, he directed his behavior in a more acceptable and expected fashion. Nash said,
So at the present time I seem to be thinking rationally again in the style that is characteristic of scientists. However this is not entirely a matter of joy as if someone returned from physical disability to good physical health. One aspect of this is that rationality of thought imposes a limit on a person's concept of his relation to the cosmos (Frängsmyr, 2005).
Conclusion

It is certain that Nash induced his own remission from schizophrenia, although through further investigation, it is apparent his disease did not abate; the delusions and hallucinations continued for him. Considering the biological, cognitive, emotional, and behavioral components, apparently Nash enlisted traces of each component in his battle toward re-engaging in the more rational character of human existence. Re-engaging was not without suffering losses, even parts of himself. Regarding refraining from his own madness, Nash gives this example:
A non-Zoroastrian could think of Zarathustra as simply a madman who led millions of naive followers to adopt a cult of ritual fire worship. But without his 'madness' Zarathustra would necessarily have been only another of the millions or billions of human individuals who have lived and then been forgotten (Frängsmyr, 2005).
For all intents and purposes, Nash managed to leave behind remnants of his madness, and lead with brilliant mathematical genius, possibly because of, and maybe despite his madness.


References

Capps, D. (2003). John Nash's delusional decade: a case of paranoid schizophrenia. Pastoral Psychology, 52(3), 193-218. doi: 10.1023/B:PASP.0000010023.58529.95

Feist, J., & Feist, G. J. (2009). Theories of personality (7th ed.). New York, NY: McGraw Hill.

Frängsmyr, T. (2005). Les prix nobel: the nobel prizes 2004. Stockholm: Nobel Foundation.

Hansell, J., & Damour, L. (2008). Abnormal psychology (2nd ed.) [PDF]. Hoboken, NJ: Wiley.

Meyer, R. G., Chapmen, L. Kevin, & Weaver, C. M. (2009). Case studies in abnormal behavior. (8th ed.). Boston: Pearson/Allyn & Bacon.

Nasar, S. (2001). A beautiful mind: the life of mathematical genius and Nobel laureate John Nash. New York: Simon & Schuster.

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