Type responses to questions in the response boxes

     
A Beautiful Mind
Overview

A Beautiful Mind is the story of John Nash, a real mathematical genius who began
having symptoms of schizophrenia upon entering graduate school at Princeton University
in 1948. Peers viewed Nash as odd, eccentric, and lacking in basic social skills. Nash
often skipped class, wrote mathematical formulas on windows, and spent many hours
pursuing an “original idea” befitting his intellectual abilities. Most interpersonal
interactions were with Charles (his roommate) and two or three other fellow students.

Once he began teaching, John met a young woman, fell in love, got married, and had a
child. The Cold War was at its peak. With his ability, John was able to decode messages
intercepted from the “enemy.” Soon after, a government secret agent hired him to look for
hidden messages in newspapers and magazines. His entire life became consumed with
this “mission.”

Over time, it became apparent that John’s mission was a delusion. Furthermore, it became
clear that the secret agent and his college roommate Charles were hallucinations. Initially,
John was treated with insulin shock therapy; later, his treatment was with medications.

It is important to note that the movie A Beautiful Mind skips many years (1960s--1980s)
of the life of the real John Nash, which were quite tumultuous. He and Alicia divorced,
although they eventually remarried. Nash had a relationship with another woman, which
produced a son, John David. His son with Alicia, John Charles, was diagnosed with
paranoid schizophrenia.

After decades of fighting the symptoms of his disease, Nash received the Nobel prize for
his mathematical discoveries.

For the purposes of this exercise, you are a nurse working with the Nash family as
depicted in the film during the time when his illness was at its worst.

Client name: John Nash

Psychiatric diagnosis: Schizophrenia
DSM-IV-TR criteria:

1. Two or more of the following characteristic symptoms:

 Delusions
 Hallucinations
 Disorganized speech (e.g., frequent derailment, incoherence)
 Grossly disorganized or catatonic behavior
 Negative symptoms (i.e., flat affect, alogia, avolition)
2. Disturbance of one or more major areas of functioning, such as work,
interpersonal relations, or self-care markedly below the level achieved prior to
onset of symptoms

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3. Continuous signs of the disturbance persist for at least 6 months

4. Not due to another psychotic or mood disorder, substance, medical condition, or
pervasive developmental disorder such as autism

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Type responses to questions in the response boxes

Date: 09-24-2019

Your name: Darlyn I. Amplayo

Name of the client: John Nash

Name of the movie: A Beautiful Mind

What is the chief complaint? (In the client’s own words and report of others)

Response:
John reports his activities of working for the government, decoding spy messages in
newspapers and magazines, and trying to help his country as real and actual events.
Because he is paranoid and suspicious, he may be reluctant or unwilling to give any
information.

John’s wife, Alicia, reports that John is engaged in “imaginary” activities, such as
cutting out articles, posting them in the shed, and coming and going all hours of the
night. He is hypervigilant and suspicious of everyone and everything. He is
secretive with her, refusing to share much information about his activities. He talks
to himself or can be heard talking to “someone else” when no one else is there. He
isn’t doing well at work and is failing to complete most normal daily activities.

Based on the above information and a close viewing of the movie, what questions would
you raise during history taking? What are some possible answers? You might base your
questions on the:
History of the client’s illness
Past psychiatric history, treatment, and treatment outcomes
Psychosocial history

Response:
1. When did John first have symptoms or problems? How long has this been going
on?

-During graduate school, John’s first major hallucination was of his roommate,
Charles. Later, he had a hallucination of Charles’ niece. Both remained with him
over many years, even after he realized they were not real.

-Following graduation, he did some decoding work for the government, followed by
his second major, long-lasting hallucination (believing that he was a secret agent),
and the delusional belief that the government had hired him to find and decode
secret messages in magazines and newspapers.

2. What previous treatment has John had? Was treatment successful?

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-Early in the course of his illness, John received insulin shock therapy, which was
not particularly effective and was abandoned as a treatment modality.

- Initial medications prescribed for John did not effectively rid him of
hallucinations, but did improve some of his symptoms and functional abilities. Side
effects (such as impotence) were intolerable, so he quit taking the medications. Very
soon, his psychotic symptoms intensified, and he began cutting out articles and
using the shed as a “command post” for his secret operations. One day he left his
son in the tub, placing him in danger of drowning. He also shoved his wife and child
to the floor, believing they were in danger (the result of his hallucinations).

- As the years progress, hallucinations persist, even though John knows they are not
real. He has gained weight (possibly from medication) and has a shuffling gait.
Others around John ridicule him

3. What kind of support does John have?

- In the movie, Alicia is supportive throughout John’s life. He maintains contact

with Martin (from college), who tries to help him integrate into life at Princeton
again. Overall, however, John is fairly seclusive and isolated from others.

-The movie also demonstrates the stigma of having a psychiatric disorder. Others
ridicule John and his behavior;colleagues and the academic world shun him for
years.

4. What strengths does John demonstrate?

- His intellectual abilities are an asset. He can recognize that Charles’ niece “never
gets any older,” which proves to him that she is not real.
-Alicia’s support and their relationship is a stabilizing influence for John.

What other observations do you have about the client’s behavior?

Response:
John has some peculiar mannerisms/gestures (e.g., putting his hand on his head,
pointing). Early in the movie, John is very confident in his abilities; later, his self-
esteem becomes quite low after years of symptoms and social isolation. At one
point, John physically cuts his arm (without regard to his safety) trying to remove an
“identification number” he thought was implanted there.

In your opinion, is the diagnosis discussed above accurate?

Response:
Yes

What DSM-IV-TR criteria support (or negate) this diagnosis?

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Type responses to questions in the response boxes

Response:
. John has symptoms of psychosis: delusions, hallucinations, and grossly
disorganized thinking/behavior.
2. John demonstrates negative signs of schizophrenia: lack of volition or goal-
directed activity, flat affect.
3. The disorder has caused disruption in major life areas (work, relationships, and
self-care).

What treatment plan would you outline?

Response:
Atypical antipsychotic medications to improve symptom control with minimal side
effects; involvement in meaningful, productive activity; increased social contact;
family education

With what expected outcomes?

Response:
-John will interact with others. 
-John will distinguish reality from unreal experiences (delusions and hallucinations).
John will express thoughts and feelings to others.
- John will comply with prescribed treatment, including medications.
-John will maintain a functional daily routine.
-John will maintain a balance of rest, sleep, and activity.
- John will seek or accept assistance when indicated.

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