My latest paper. This is on paranoid schizophrenia and uses the case of John Nash to illustrate certain aspects of the disorder. Hope you enjoy, and as always, please do not steal or plagiarize 🙂 Thank you!
Overcoming Paranoid Schizophrenia: The Inspiring Case of John Forbes Nash, Jr.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), schizophrenia occurs somewhere between 0.5% and 1.5% of the population (American Psychiatric Association [APA], 2000). John Forbes Nash, Jr. was one of these individuals diagnosed with paranoid schizophrenia in 1959 as discussed by Sylvia Nasar (2001). Nasar wrote a very detailed biography of Nash which will be utilized for the background information and symptoms discussed in this paper. Nash was at the height of his disorder in the late 1950s and during the entire 1960s decade when he was in his thirties (Capps, 2004a).
The height of his symptoms appears to have started in 1958 when he showed up to a New Year’s Eve party dressed as a baby, almost entirely naked besides a diaper and sash across his chest. He carried a milk bottle and spent much of his evening sitting on his wife’s lap (Nasar, 2001). Shortly after this he began to tell others in the mathematics department at MIT that he was receiving messages from powers in outer space or from foreign governments via The New York Times, and that the encrypted messages were only meant for him and could not be decoded by anyone else. Nash began writing letters to various ambassadors and foreign embassies across the globe. He had told a friend, Martin, that he was forming a world government and that he was putting together a committee to help him run it. He said that once it was in place, he would become the Emperor of Antarctica (Capps, 2004a). Nash also began to stay up late each night and write letters to the U.N., the pope, and the FBI (Nasar, 2001). He believed that he was going to found an international organization. Not only did he write to these government-related individuals and organizations, but also to colleagues and friends. He would write in a paranoid manner, in many different colors of ink, and at least once mentioned that he believed that his career was being ruined by aliens from outer space.
At some point he began to notice what he believed to be a pattern around the MIT campus (Nasar, 2001). He saw men in red ties walking around campus, and later aroundBoston, who seemed to be signaling to him and to be part of “a crypto-communist party” (Nasar, 2001, p. 242). Nash was hospitalized and told friends who visited him of his grandiose delusions; that he had ideas in his head that he could not control, that there was a conspiracy “among military leaders to take over the world,” of which he was in charge, and that he was the left foot of God and that God was walking on the earth” (p. 258). He seemed to believe that there were secret numbers that only “the initiated” were aware of (p. 258). Nash left his job as a professor at MIT in July 1959, only 2 months after his release from the hospital, with the delusion that he had some kind of special knowledge and wanted to cut all social ties (Nasar, 2001). He travelled toEuropeand attempted to renounce his American citizenship and become the “first citizen of the world,” which did not end in success (p. 271). However, not only did he wish to renounce his citizenship, but also desired refugee status. In addition to these delusions of world government and conspiracy, he continued to develop more delusions revolving around God and religion. According to Nasar (2001), Nash felt in one moment as though he was the left foot of God, but at other times he believed that he was the center of the universe. He often believed that he was a religious or messianic figure of great and secret importance, and would often open up several bank accounts under false names across the world (Capps, 2004a; Nasar, 2001). Nash was deported back to theUnited Statesand he went toPrincetonwhere he wandered and spent much of his time alone; quite aloof from others.
While atPrinceton, starting in 1960, he was described as having “dark hair to his shoulders and a bushy black beard, [and] he had a fixed expression, a dead gaze” (Nasar, 2001, p. 285). Some of the students recall that he wore what appeared to be a Russian peasant garment, carrying around a notebook, and talking to squirrels. He would make a plethora of phone calls, often full of content that was nonsense, numerology, dates, and world affairs. One day he showed up on campus with scratches and told them that “Johann von Nassau [the name he called himself] had been a bad boy” and that “They’re going to come get me now” (p. 287). Nash was then hospitalized yet again.
After his release in July 1961, he seemed to improve for a small period of time, but he began to get angry, restless, and began to obsess over numerology and his time in the asylum, as well as fearing that his food had been poisoned and that there were magic and dangerous numbers (Nasar, 2001, p. 302). By July 1962 he was very ill again, obsessing over asylum, conspiracies involving the Catholic Ecumenical Council, and making obsessive phone calls and writing incomprehensible messages on blackboards at the Institute for Advanced Study. He was hospitalized yet another time, and upon release he began to improve again. However, by February of 1964 he was experiencing restlessness, and told his sister that he was attempting to not return to his delusions. He returned toEuropewhere he still believed he was a special religious figure and where he began to hear voices, also referred to as auditory hallucinations, which seemed to be other mathematicians who were against his ideas. He later returned to theUnited Statesagain where he experienced delusions that he was a Palestinian refugee and that “certain truths were ‘visible in the stars,’” but the old grandiose delusions were no longer visible or prominent (p. 326). Up until this time, his delusions were more often grandiose and their theme seemed to be conspiracy, politics, and the role of numbers and mathematics in it all. However, instead of retaining these delusions, he began to experience persecutory delusions revolving around numerology, death, and fear. He believed that Jewish people were the root of all of his personal problems, that he must ask Jews, Arabs, and mathematicians to mend all wrongs and that he must turn to certain organizations for help in doing this, such as foreign governments and churches. He was also afraid of death by Armageddon, and heard voices that frightened him. He is reported as once saying, “My head is as if a bloated windbag, with Voices which dispute within” (p. 328). He eventually began to wander the Princeton campus starting in the early 1970s and was known as the Phantom of Fine Hall, which was the Mathematics building atPrinceton. There he would write on the chalkboards and “was very withdrawn, very quiet….Haphazardly dressed, with his gray hair long, his expression blank, he would wander up and downNassau Street. Teenagers would taunt him…shouting rude things directly into his startled face” (p. 342). Nash “was terrified, anxious, preoccupied, and persecuted” (Weiden, 2002, p. 390). One theme that remained the same throughout the entirety of the height of his struggle is that of the role of numbers and mathematics in his delusions and auditory hallucinations. Ultimately, this was the end of the height of his symptoms, as he began to slowly and almost miraculously improve over the next 10 to 20 years.
There have been many theories posited about how these problems began to develop in Nash’s life, as his case has been analyzed by numerous individuals in the field (e.g., Capps, 2005; Fink, 2003; Funaki, 2009; Weiden, 2002). Nash has always been known to be a bit eccentric or odd, and he was also seen as narcissistic prior to his experience with his mental illness (Capps, 2004b; Nasar, 2001). In the late 1940s when Nash was attendingPrinceton, one fellow student described Nash as being,
…very interested that everyone would recognize how smart he was, not because he needed this admiration, but anybody who didn’t recognize it wasn’t on top of things. If anyone wasn’t aware, he would take a little trouble to make sure he found out. (Nasar, 2001, p. 67)
Nash liked to brag about his accomplishments and wanted people to know how intelligent he was. However, he had indeed accomplished a lot by the time he was diagnosed in 1959. He received his PhD in 1950 at the age of 23, which is much younger than most individuals who receive this degree (Capps, 2003). His doctoral thesis was on game theory in which he approached the problem in an original way, and he was later given a Nobel Prize in 1994 for his contribution to game theory and what is known as Nash Equilibrium (Capps, 2011; Nasar, 2001). He is intelligent and is almost always labeled a “genius” (Nasar, 2001). It is interesting to note that Nash’s delusions and hallucinations often involved mathematics, numbers, and other mathematicians opposing his ideas throughout the height of his illness. These themes seen in his illness were clearly observable before he was diagnosed with schizophrenia, as he was a mathematician who worked with numbers and competed with others in the field. Nasar (2001) also discusses his oddities and eccentricities prior to his diagnosis and experience with schizophrenia. She states,
Most of the graduate students were slightly odd ducks themselves, beset by shyness, awkwardness, strange mannerisms, and all kinds of physical and psychological tics, but they collectively felt that Nash was even odder. “Nash was out of the ordinary,” said a former graduate student from his time. “If he was in a room with twenty people, and they were talking, if you asked an observer who struck you as odd, it would have been Nash. It wasn’t anything he consciously did. It was his bearing. His aloofness.” Another recalled, “Nash was totally spooky. He wouldn’t look at you…He had no affect. It was a mixture of pride and something else. He was so isolated…” (p. 72-72)
His peculiarities existed before he was ever diagnosed, and it was obvious from a young age, according to his sister, Martha (Nasar, 2001). He had always been rather bright, but he was not interested in the normal childhood things. Instead, he would rather experiment with electronics and chemicals. For example, when Nash was 15 years old, one of the few friends that he did have, Herman Kirchner, built explosive devices with Nash (Capps, 2003). As a youth he also exhibited a high level of intelligence (Nasar, 2001). Nash had already read “Men of Mathematics” by E.T. Bell by the time he reached high school and he had already been able to prove the Fermat theorem from mathematics. Clearly, his oddities and intelligence were both pre-existent, but they developed into something more serious with time.
There are many factors that could have aided his development of a mental disorder and the fluctuations seen during his illness. Even as early as childhood Nash encountered at least one incident that likely had a profound impact on his mind and life (Nasar, 2001). Nash, Kirchner, and another boy had been making homemade explosives together, as previously mentioned, and one of these devices exploded in Kirchner’s lap one day leading to his death (Capps, 2003). This also led to his other friend being sent off to a private school far away, and so Nash seemed to lose 2 of his friends in close proximity, which likely impacted him negatively even as an adolescent. Capps (2005) also discusses some of the later events that precipitated the mental illness Nash experienced. Before Nash married Alicia, he had dated another woman named Eleanor Stier in 1952-1953 and fathered an illegitimate son with her who was born in 1953. Nash kept this a secret for years, and 2 months after he finally announced the existence of his illegitimate son to his parents, his father died of a heart attack. This occurred in late 1956. There is speculation as to whether or not he might have blamed himself, but no one knows for certain. Nash was not satisfied with his position at MIT and would rather teach at Harvard “because of the prestige” (Nasar, 2001, p. 235). After his marriage to Alicia, she became pregnant and gave birth to another son in 1959. According to Capps (2005), some of Nash’s colleagues at the time stated that the pregnancy made Nash feel left out; as though he was no longer of primary importance to his wife. In addition to the items mentioned by Capps in his 2005 article, it has been shown that Nash was up for tenure at MIT around the end of the 1950s (Nasar, 2001). This may have been another stressor in his life. Furthermore, he was not awarded the Field Prize in Mathematics and he felt as though he had not lived up to the ambitious standards he had set for himself. Nash states, “At the time, I had some recognition. I was making some progress professionally, but I wasn’t really at the top. I didn’t have top-level recognition [emphasis added]” (PBS, 2002). In 1958 Nash turned 30, which made him feel a bit fearful and anxious because “…mathematicians consider their calling a young man’s game, so thirty signals something far more gloomy” and in his own eyes he had yet to prove himself great (Nasar, 2001; PBS, 2002). Clearly he did not feel as though he was amounting to anything much at the time and this was likely stressful to him. All of these factors and events might have played a role in his development of schizophrenia because of the stress that they caused in his life.
Shortly after these stressors in the late 1950s, Nash was officially diagnosed with paranoid schizophrenia. In a Public Broadcasting Service (PBS) documentary from 2002, Alicia Nash, John’s wife, claimed that his personality seemed to change within a one week period. However, his condition appears to have slowly deteriorated over time in more subtle ways (Weiden, 2002). Nasar (2001) describes a young man who was already slightly awkward, odd, eccentric, and possibly overly ambitious. As mentioned above, these personality traits and stressors likely aided in his development of a mental disorder.
Nasar (2001) claims that his first visible, blatant signs of his “slide from eccentricity into madness” came about when he was 30 years old and a professor at MIT (p.16). This is when he began to tell his colleagues that The New York Times had an encoded message that only he could decode. His colleagues thought that he was joking. He had not shown any other signs prior to this occasion, so there was no reason to worry because he was indeed a misunderstood, eccentric mathematician. However, letters began to show up in the office addressed to various embassies and government leaders which claimed that he was going to usher in a one world government and become the Emperor of Antarctica. He began to believe that men in red ties were out to get him and that he was the left foot of God, etc. These are clearly grandiose and paranoid delusions. Right before his first hospitalization, he went to give a talk at Yale and it was a disaster. He was disorganized, cryptic, and nothing he said made sense to anyone. One person recalls that, “Everyone knew something was wrong. He didn’t get stuck. It was his chatter. The math was just lunacy” (p. 246). The audience was rather rude and Nash seemed quite depressed according to one student. He would have periods of lucidity, but began to slip deeper into his delusions. During his first hospitalization, he was given Thorazine and he seemed to improve. However, it has been said that he had not improved in reality, but rather managed to hide his delusions long enough that the staff released him. After his release, he continued having paranoid and grandiose delusions that continued to escalate in stature. He attempted to drive to Washington, D. C. to hand-deliver notes to the ambassadors and embassies from various nations, and eventually flew toEurope to try to renounce his American citizenship. He was hospitalized three more times in which he was given insulin coma therapy (ICT), Stelazine, and Thorazine. The ICT was administered to Nash for 6 weeks and seemed to be effective. In fact, they said that he was in remission.
From July of 1961 until the summer of 1962 he seemed to be in remission, but once again he returned to his delusional thinking and was placed in a hospital again. It was also during this year that Alicia divorced Nash. He was treated with Thorazine and within 2 weeks he seemed much better. He started therapy and stayed on the medication and things seemed to improve, but again the following year he began to deteriorate. It was at this time that he began to see himself as a secret and important messianic figure and began to hear voices of other mathematicians who were against his ideas. He believed that a machine was inserting words into his brain. He was hospitalized one final time and upon release attempted to live a life without Alicia. He began to see a new therapist and was prescribed a low dose of Stelazine, another antipsychotic, which he voluntarily took. He began to see Eleanor and spend time with his first son, and he got a job atBrandeisUniversity. One colleague from Brandeis claims that Nash was quite zombie-like when he began working at Brandeis, but he eventually became more normal and began to interact with people more often. He was even able to write a paper that was published a short while later. However, only a year later he began to deteriorate again.
Nasar (2001) suggests that he might have “become overconfident and had stopped taking his medication” (p. 319). This was the last time he took antipsychotics. After this he began to be paranoid and to experience persecutory delusions more than he had in the past. He somehow went from mainly grandiose delusions starting in 1959 to mostly persecutory ones starting in 1966. After this he went many years with these delusions and obsessions with numerology. This is the period of time when he would wander around town or around the campus atPrinceton, writing mysterious messages on chalkboards, and being called the Phantom of Fine Hall. He also believed that the American Mathematical Society was ruining his career, and that “…various persons, posing as sympathizers, were conspiring, with malevolent intent to have him incarcerated in a mental institution” (p. 325). However, this was the period of time when Alicia came back into his life again. According to Nasar (2001), she allowed him to move back into her home as a boarder in 1970. Others in thePrincetonmathematics community were also supportive of him at this time. Nash developed a daily routine and settled down inPrinceton. He was still struggling with his disorder, but he had people supporting him. Over time he began to speak to some students who were not frightened by him. He never returned to antipsychotics or to a hospital. Alicia did not believe it to be the right treatment for Nash anymore. In fact, she believed that he needed friendship, safety, and freedom. Alicia said that she believed he needed to improve in a “normal” environment, not in a mental institution. Eventually Nash began to seem normal again. The first sign of his remission outside of a hospital and medicine was in 1983, and by 1994 when he received his Nobel Prize he was in remission with hardly any symptoms at all. He claims that he willed his recovery. Alicia claims that it was simply from “living a quiet life” (p. 349).
It seems as though John Nash was most impacted by 4 factors: stress, medication, a social support system, and will-power. At one of the most stressful times during his life, the late 1950s, he developed paranoid schizophrenia. The medication and ICT seemed to significantly improve his mind and his functioning when he took it. He told a friend once that he stopped taking his medication because he could not hear the voices when he was on his medication (Nasar, 2001). However, when he went off of his medication, he did begin to deteriorate again and go back into his delusions. When he was on his medication he was able to function so well that he published 2 scholarly papers, which is a significant accomplishment for someone who has been diagnosed with paranoid schizophrenia (Nasar, 2001, p. 318). It appears as though the medication did significantly improve his level of functioning. In the end, however, he stopped taking his medication and within another 10 years or so he was almost back to a normal level of functioning. The other notable factor was support. When Alicia was not in his life, he seemed deteriorate quickly. When she and others were prominent figures in his life, supporting him, he was able to eventually come out of his psychosis. The fourth and final factor seems to be his will-power. Nash claims that he willed himself out of this disorder in the end, saying in his autobiography,
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. So at the present time I seem to be thinking rationally again in the style that is characteristic of scientists. (Nash, 1994, para. 28)
The impact of will-power did indeed seem to make his symptoms fluctuate. His delusions went from grandiose to persecutory to more or less obsessing over numerology. As his delusions went from persecutory to obsession over numerology, he began to be able to interact more with others more frequently. He chose not to take his medication and claims to have chosen to reject his thinking habits and eventually he did recover, somewhat miraculously.
John Nash’s multiaxial assessment may look something like the following:
Axis I Paranoid Schizophrenia
Axis II Narcissistic tendencies
Axis III No Diagnosis
Axis IV Death of father; Marriage; Wife’s pregnancy; Work-related stress;
Job dissatisfaction; Pending tenure; Unhappiness with level of achievement
Axis V GAF = 51 (upon first admission)
Nash fits a diagnosis of paranoid schizophrenia quite well. For well over a month, in fact well over 10 years, Nash experienced more than one delusion, as well as hallucinations (APA, 2000; Nasar, 2001). Nash experienced bizarre, grandiose and persecutory delusions, such as aliens ruining his career; government conspiracies; his creation of a one world government; his becoming the Emperor of Antarctica; being the left foot of God and a secret, important messianic figure; and many others as well (Nasar, 2001). Clearly these are bizarre delusions because they are not likely things that are truly occurring in his life. His experience with delusions of grandeur and of persecution is a key part of his paranoid type diagnosis (APA, 2000). The DSM explains that paranoid schizophrenia is often characterized by persecutory or grandiose delusions, and sometimes both are evident, as is the case for John Nash. His delusions were themed, as is often the case. Throughout the height of his disorder, he experienced a constant theme involving mathematics and numbers (Nasar, 2001). During the beginning half of his disorder, he experienced more grandiose themes, such as leading the world into a one world government, creating an international organization, becoming the Emperor of Antarctica, being the left foot of God, and being a highly important messianic figure. These are clearly grandiose because he believes that he is an important or powerful figure, and has assumed that identity (Sue, Sue, & Sue, 2005). Oftentimes, grandiose delusions may affect behavior and lead the individual to act upon their beliefs and behave dangerously or irresponsibly (Lindenmayer & Khan, 2006). Nash did exactly that at several points during the height of his disorder. He once drove to Washington, D. C. in order to hand-deliver letters about creating his one world government to ambassadors (Nasar, 2001). He flew toEuropeseveral times as well to act upon his beliefs. In addition to this, he quit his job at MIT right before he was going to receive tenure and then refused a job at theUniversityofChicagobecause he was going to become the Emperor of Antarctica. These are very irresponsible behaviors and some of them could have led him into dangerous situations. Eventually, during the second half of the height of his disorder, he began to have auditory hallucinations and thought insertions in the form of persecutory voices of other “mathematicians” who opposed his ideas, as well as other voices also (Nasar, 2001). He explained that while he was inRome, he believed that a machine was inserting thoughts into his mind. Auditory hallucinations and thought insertions are characteristic of schizophrenia, especially the paranoid type (APA, 2000). During this period of time, he also experienced persecutory delusions (Nasar, 2001). These revolved around numerology, death, and fear. He believed that Jewish people were the root of all of his personal problems and was afraid of death by Armageddon, for example. This clearly seemed to have a religious theme to it, as well, with his fear of Armageddon and his belief that Jewish people were to blame for his problems. Religious themes are quite typical of schizophrenia, according to the DSM.
According to the DSM, some features that are associated with paranoid schizophrenia are anxiety, anger, aloofness, and argumentativeness (APA, 2000). These individuals likely experience issues in their interpersonal interactions and may act in a superior or patronizing manner. John Nash certainly showed these features as well. He was showing these tendencies within at least 10 years prior to diagnosis. He was described as aloof, awkward, and as acting superior before he was ever diagnosed with paranoid schizophrenia (Nasar, 2001). However, after the onset of symptoms and diagnosis of the disorder his aloofness increased, he became anxious, his personal relationships were intensely strained, and he believed, at least at the beginning of his disorder, that he was various important figures and likely felt somewhat superior to others because of that. Nash once told a colleague that he stopped taking his medication because it made the voices stop (Nasar, 2001). It has been speculated that Nash believed that “…taking away his delusions and hallucinations would be taking away his genius, his most treasured gift” (Weiden, 2002). This is significant because it suggests that Nash believed the voices to be real, and he believed that they were something important. This is further verifiable by observing a comment he once made. A colleague asked him how he, as a genius mathematician who followed logical thinking and reasoning, could believe all the bizarre delusions that he had believed. Nash responded, “Because…the ideas I had about supernatural beings came to me the same way that my mathematical ideas did. So I took them seriously” (Nasar, 2001, p. 11).
There are 2 more factors that confirm his diagnosis of paranoid schizophrenia. The first is that Nash was diagnosed with paranoid schizophrenia at the age of 31, and according to Sue, Sue, and Sue (2005) the common onset of paranoid schizophrenia is in one’s 30s. The second factor is that research has found that people with paranoid delusions tend to externalize their problems (Sue, Sue, & Sue, 2005). John Nash had many problems leading up to his diagnosis, as mentioned previously (Nasar, 2001). These issues and stressors appear to have developed into full blown schizophrenia in 1959. It seems quite likely that John Nash was externalizing his problems.
There is one first disorder that may be discussed, which is Delusional Disorder. Delusional Disorder involves delusions, but these delusions are nonbizarre, meaning that the delusions are situations that could happen in real life (APA, 2000). However, the delusions that John Nash had were clearly bizarre. It is not likely that he was a secret messianic figure; that he was going to become the Emperor of Antarctica; that he was receiving secret messages from aliens in The New York Times; or that Jewish people were the cause of his life problems. These are not things that are going to happen to a normal individual. Clearly these are bizarre and not nonbizarre, which automatically suggests that Nash does not have Delusional Disorder, but rather something else. There have been other theories as to what disorders Nash actually had. According to Max Fink (2003), John Nash was improperly diagnosed as a paranoid schizophrenic and should have been diagnosed instead with a manic depressive illness with a paranoid thought disorder. However, this does not seem likely. This description given by Fink (2003) sounds similar to schizoaffective disorder or mood disorder with psychotic features. The DSM explains that “If psychotic symptoms occur exclusively [emphasis added] during periods of mood disturbance, the diagnosis is Mood Disorder With Psychotic Features” (APA, 2000, p. 310). However, from the presentation of his symptoms, he appears to be experiencing the psychotic symptoms and then developing mood-related symptoms such as “depression” or “mania.” Nash did appear to have manic-like episodes, such as when he flew toEurope and stayed for weeks at a time (Fink, 2003). However, these seem to occur because of his psychotic symptoms. For example, Nash began to develop delusions that he was supposed to create a world government and that he would become the Emperor of Antarctica (Nasar, 2001). These delusions developed and then he acted upon them, driving to D. C. to deliver letters to ambassadors and flying toEurope to renounce his American citizenship and convince other foreign leaders to join him in his quest to form a world government. There was not evidence, though, that Nash had a decreased need for sleep, was more talkative than usual, had a flight of ideas, was distractible, had increased goal-directed activity, or was excessively involved in pleasurable activities, like one would see in a manic or hypomanic episode (APA, 2000; Nasar, 2001). In fact, Nash describes his own experience,
…not in terms of highs and lows, bouts of mania followed by disabling depression, but rather in terms of persistent dreamlike state and bizarre beliefs [emphasis added] in terms not dissimilar to used by other people with schizophrenia. He has spoken of being preoccupied by delusions, of being unable to work, and of withdrawing from the people around him. Mostly, however, he has defined it as an inability to reason. (Nasar, 2001, p. 350)
Another study using the Operational Criteria Checklist for Psychotic Illness (OPCRIT) suggests that John Nash was rightfully diagnosed with schizophrenia rather than a mood disorder (Martins, Gil, Belmonte de Abreu, & Lobato, 2004). They examined Nash’s case and found no evidence for thoughts racing or increased sociability, for example. They also found that the psychotic symptoms dominated his case, even though there were some “occasional affective disruptions” (Martins, et al., 2004, Method section, para. 10). Their findings using the OPCRIT suggest that schizophrenia was the most probable diagnosis because of the psychotic symptoms that dominated his illness.
However, some may say that it does sound as though he may have schizoaffective disorder based on his mood-related symptoms. This is not likely the case, though. His delusions and hallucinations did remain constant with or without mood-related symptoms, which fit one of the criteria for schizoaffective disorder (APA, 2000; Nasar, 2001). But, the individual must also have periods of either a major depressive episode, a manic episode, or a mixed episode that lasts for a substantial portion of the disease (APA, 2000). Nash himself, as quoted previously, did not experience either highs or lows, although he had described himself as being lonely or sad in letters to friends and family on some occasions (Nasar, 2001). Instead, Nash felt delusional and out of touch with reality, which is key to his diagnosis with schizophrenia rather than schizoaffective; he did not experience the long periods of highs and/or lows associated with the mood-related part of schizoaffective disorder (e.g., Nasar, 2001, p. 323-331).
Multiple Levels of Analysis
Level one. There is not much in John Nash’s case that suggests a biological or genetic cause for his illness. One of the signs that points at a biological basis for his disease, however, is that he was born with a temperament that was rather introverted and solitary. Nasar (2001) describes Nash as having a “schizoid temperament” (p. 30). This may suggest that he was simply odd and eccentric, which he certainly was. He was described as odd, eccentric, aloof, and a number of other things by his sister, colleagues, and friends (e.g., Nasar, 2001, p. 32-33). However, perhaps these tendencies were simply the beginning stages of an individual with schizophrenia. Nash’s younger son, John Charles, was diagnosed with paranoid schizophrenia in the 1970s (Nasar, 2001). This would suggest that it is highly likely that Nash did indeed have schizophrenia as well. Research has suggested that those individuals who have a close blood relative with schizophrenia are at a higher risk of developing schizophrenia as well (Sue, Sue, & Sue, 2005). The fact that John Charles was also diagnosed with paranoid schizophrenia suggests that there is indeed a biological basis for the development of Nash’s disorder (Nasar, 2001). However, there is not much else known about his family mental history or genetics.
Level two. John Nash had narcissistic tendencies (Nasar, 2001). He wanted others to notice him, to know about his accomplishments, and to give him the attention he believed he deserved. These narcissistic thought patterns and beliefs may have added to the stress in his life. As mentioned previously, Nash was clearly intelligent and had accomplished a number of things by the time he was 30. He had gained his PhD by the time he was 23, he was teaching at MIT, and in July 1958 he was featured in Fortune magazine’s new series as one of the brightest young math stars of the time (Nasar, 2001; PBS, 2002). However, his narcissistic thought patterns might have had 2 outcomes; namely, he was disappointed in his accomplishments, believing that he had not achieved enough when he worked at MIT instead of Harvard and when he did not receive the Fields Medal in 1958 (Nasar, 2001). This thought pattern and subsequent belief and feeling of not being good enough likely added to the stress in his life, and may have aided in his development of schizophrenia. One other issue that may have been brought on by his narcissistic thoughts and beliefs involved Alicia’s pregnancy. When Alicia was pregnant with John Charles, others said that Nash felt as though he was of secondary importance to Alicia after she became pregnant. Nash wanted to be the center of attention, and when he was not getting it in the mathematics field or from his wife, this was likely a stressor and aided in his development of a mental disorder.
Nash was also an odd and eccentric person in general. Nasar (2001) seems to suggest that Nash might have had some odd ways of thinking prior to his diagnosis. One of Nash’s classmates describes that most people “…would discount a lot of what Nash said. A lot of the things he said were so far out, you didn’t want to engage him…You wouldn’t know what he was talking about” (Nasar, 2001, p. 73). This same classmate said that Nash on at least one occasion talked about Martians taking over the earth. In addition to this, Nash often used his ideas about game theory in real life situations as though his friends and dates were research subjects. He would place a girl he was dating in a room with a male friend. Nash would then treat the girl poorly and watch how the male friend reacted toward the girl (Capps, 2003). Capps (2003) suggests that “The power to create the game and to manipulate its outcome probably contributed to his sense of grandiosity” (p. 374). Nash obviously had slightly awkward ideas about socialization and relationships. It was said that he would not look at people and he was very odd, but people believed that underneath all of his eccentricities Nash really did care for and appreciate people (Nasar, 2001, p. 73). But, ultimately his thought patterns and beliefs were a little askew from the norm.
Level three. Nash had a lot of interpersonal issues, perhaps because of his strange ideas and beliefs and his narcissistic tendencies, but one cannot be positive which developed first. Nash did not have many friends growing up (Nasar, 2001). However, he lost two of the friends that he did gain, one to death and the other to a change in schools. This was likely stressful enough for Nash, but there has also been some speculation as to whether or not Nash was partially blamed for the death of his one friend, which, if true, could have also added to his stress level. He was seen as aloof and narcissistic, and many individuals simply left him to himself. Nash struggled interpersonally, dating women but also developing close relationships with men at the same time. Some suggest that Nash may have been confused about his identity, specifically his sexual identity (Capps, 2003; Nasar, 2001). According to Nasar (2001), Nash struggled with commitment and he was confused about who he was. Nash did indeed struggle to commit and to hold a stable relationship. He had an illegitimate son with Eleanor Stier but refused to marry her or to pay child support. Nash kept his first son a secret for years. When he finally did tell his parents about his first-born son, his father had a heart attack two months later and died. According to Nasar, Nash did not show any grief and it is debatable whether or not he felt as though he was to blame for the death of his father. However, Nasar (2001) reports that Nash was shocked by his father’s sudden death because he believed that his father would get well after having been sick for over a year. These events likely caused further stress in his life, especially if he felt as though he was the reason his father died. He may have also felt as though he had yet again failed in his life, fathering a child out of wedlock and keeping the child a secret. However, this is just speculation. Nash has not suggested whether he felt this way or not.
As was mentioned previously, after Nash married Alicia and she became pregnant with his second son, Nash felt as though he had become of secondary importance to Alicia (Nasar, 2001). This was also likely stressful to Nash because he may have felt as though she did not love him as much once she became pregnant; her focus would soon be on the child and not on him, and Nash craved attention. According to some, after his marriage Nash was also still dealing with confusion about his sexual identity (Capps, 2003; Nasar, 2001). He seemed interested in a colleague named Paul Cohen and seemed to chase after him, but Cohen would ridicule Nash and simply found Nash’s interest in him interesting and nothing more (Capps, 2003). There were rumors that “blamed disappointed love and the intense rivalry with a younger man [Cohen] for Nash’s breakdown” (Nasar, 2001, p. 238). This is again simply speculation, but if Nash did have feelings for someone who did not reciprocate them, but rather ridiculed him, then this might have also added to Nash’s stress level and ultimately aided in his development of a mental illness. Clearly Nash struggled with relationships, whether it was with family, at work, or elsewhere, and this may have been distressing to him.
Level four. Nash was seen as abnormal throughout the time prior to his illness as well as during his experience with schizophrenia (Nasar, 2001). He was, in a way, deviant even among the other eccentric individuals in the mathematics department. In this way he broke norms. He seemed to believe that the norms did not apply to him. For example, he would talk about Martians, he would not look people in the eyes, he would not answer a question if he believed it to be foolish, and he would pace through the halls whistling Bach’s Little Fugue, and often rode his bicycle on the lawn making figure eights over and over (Nasar, 2001; PBS, 2002). His abnormality did not seem to bother him, but it is possible that it did indeed have an impact on him because he did not have many social ties and this might have left him stressed as well. He may not have known how to have a stable relationship with others because he had always been so eccentric and different than others. But, this may have caused him stress and discomfort, and may have also begun to have an impact on his daily life. He may have desired to change his eccentricities and therefore his lifestyle and relationships, but could not do it, which likely caused further stress and anxiety. Other factors, such as the loss of his father, his marriage to Alicia and her subsequent pregnancy, were also likely to have disrupted his daily life and caused him stress because they would change his lifestyle. It is possible that he liked his eccentricities and did not want to change his lifestyle, however, it is equally likely that he deeply wanted to change, either of which would likely cause anxiety and stress.
Nash was not happy with his job at MIT either. He believed that he belonged at a more prestigious school such as Harvard (Nasar, 2001, p. 235). According to Nasar (2001), he was up for tenure at MIT right before he was diagnosed with paranoid schizophrenia, which might have also left him feeling stressed and anxious. What is also interesting about this is that Nash believed that MIT was not prestigious enough for him and he harbored these attitudes that he was better than others, which is rather maladaptive. He believed that he had to achieve certain things, and he seemed to have an attitude that if he did not achieve these certain things, he was not doing well enough. His success in the eyes of others was not sufficient, but his attitudes were likely maladaptive. He seemed to have too many expectations all at once and this also would have added to the stress in his life at the time.
Level five. World War 2 ended in 1945, but John Nash feared that theUnited States was going to go to war again and that he would be drafted (Nasar, 2001). In 1950, the Korean War began and President Truman called for a draft. Nash was extremely fearful that he would be drafted and wrote to individuals he knew from various companies and universities and they all wrote him letters of deferment saying that he was irreplaceable and the work that he did was essential for national security. Nasar (2001) suggests that Nash’s fear of being drafted went deeper than what it seemed on the surface and that the discipline and “loss of autonomy” one finds in the military would be threatening to Nash (p. 125). She further suggests that his fear continued far beyond the years when he was eligible for the draft and that it “…eventually reached delusional proportions and helped to drive him to attempt to abandon his American citizenship and seek political asylum abroad” while at the height of his schizophrenic delusions (p. 126). This is an interesting theory that may have some merit after all. Nash did have politically themed delusions and he supposedly did not like politics, so it is interesting that his supposed extreme fear of being drafted may have been projected onto his delusions during his schizophrenia. Nash’s fear of the draft may have been so strong that it also caused him a significant amount of stress in his life.
One additional environmental/global factor is the presence of McCarthyism in the late 1950s. According to Nasar (2001), McCarthyism was at its peak around 1954, only a few years before Nash was diagnosed with schizophrenia. Its impact on him is clear because once he started having delusions in the late 1950s and earlier 1960s, he began to notice men in red ties all around the campus and inBostonwho were from the communist party and were out to get him. Additionally, he was also very suspicious and paranoid, not letting people into his office on many occasions, and he also believed that there was a governmental conspiracy. Once again, he did not like politics, but perhaps he feared the impact of spies in theUnited Stateseven before he was diagnosed with schizophrenia. In 2012, the NSA released declassified letters that John Nash sent to certain individuals within the organization in 1955 about a machine he invented or desired to invent that would help to decipher enemy codes during war time. This was before Nash was diagnosed with schizophrenia or began to show clear signs of the disorder, so it seems as though he was fairly lucid and was interested in national security even before his diagnosis. This involvement and thoughts of national security may have continued to develop during the course of his illness. However, it is interesting to note the impact that war, the draft, and McCarthyism had on adding to Nash’s level of stress and eventually contributing to Nash’s delusions during the height of his schizophrenia.
Further speculation. Out of the 5 levels discussed, level 2 and 3 seem to be the most compatible with the John Nash case. Nash clearly had some distortions in his thought processes, even though he was a genius, and he struggled interpersonally. I believe that the two of these are interrelated. He already had these eccentric and strange thoughts, behaviors, and actions, and this probably led him to have strained relationships with others because he was so eccentric and narcissistic that he did not know how to handle others and others did not understand him, and he therefore tended to remain aloof. Many of these stressors that I have discussed throughout this section clearly played some sort of role in his stress level, but I believe that his predisposition to eccentric thoughts and actions, and his narcissism mixed with his identity confusion and interpersonal struggles were the most stressful on Nash. Losing his father, believing that he lost the love of his wife, and his perceived inability to be successful were likely some of the hardest factors for Nash to overcome and were therefore likely the most stressful.
The “abnormality paradigm” is based on 4 items. The first item is deviance. Within the context his life, John Nash was indeed deviant in some ways. According to his sister, colleagues and friends, Nash was always out of the ordinary (Nasar, 2001). As a child he had very few friends and preferred to spend his time alone reading or experimenting on electronics or with chemicals. While it is not abnormal for a child to be shy, Nash’s behavior seemed to go beyond the normal shyness commonly seen in childhood. He seemed to prefer to be alone, and he never grew out of his odd, aloof behavior. Even while getting his PhD in the late 1940s Nash was described as aloof and very odd. It was said that he was even stranger than the others in the mathematics department, which was a noticeable thing considering these individuals were also quite odd themselves. Nash would not look at people in the eye, would talk about Martians, would ride his bike in figure eights over and over, and would pace the hallways whistling the same song, Bach’s Little Fugue. He stood out and was seen as extremely odd and eccentric. In this he was deviant. The rest of the mathematics department was also eccentric, but Nash seemed to far surpass them and was therefore abnormal. During the height of his symptoms he was also seen as abnormal by the mathematics department and society as a whole. He would talk about conspiracies, one world government, becoming the Emperor of Antarctica, and his math began to stop making sense. He developed an obsession with numerology, but it did not make logical sense to those around him within the mathematics field or anywhere else for that matter. Society tends to believe that conspiracies, secret missions from God, secret one world government plots, and someone being the left foot of God or a special messianic figure are all rather impossible or nonsensical. Nash believed in these things and more, and it made him stand out even more. His aloofness, strange behaviors and beliefs were certainly viewed as abnormal because no one else around him believed in these things and no one else could understand what he was saying. Within the context of society and American culture, he was certainly deviant.
The second item to consider is distress. Nash personally still does not find his experience with schizophrenia as particularly distressing personally. In his 1994 autobiography for the Nobel Prize, Nash says, “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” (para. 29). At another time he told a colleague that he went off of his medication because the voices went away, as though he wanted them to continue (Nasar, 2001). Indeed, he believed that because they came through his mind, in the same way his mathematical and logical reasoning did, they were just as reliable and real as the logic and math. Nash did not seem personally distressed by his schizophrenia most of the time. One can speculate that his eccentric behavior may have started to distress him and add to his already high levels of stress, but it is simply conjecture. Nash was not obviously or openly distressed by his eccentric behavior or his schizophrenia most of the time, but others were. Before his diagnosis, one person said that he was “spooky,” another said that you could not feel comfortable around him, and that he was certainly capable of frightening people (Nasar, 2001, p. 73). When Nash showed up to the 1958 New Year’s Eve party dressed as a baby, people began to think that something was very wrong, his costume was “disturbing” and that he had gone “too far” (p. 240). When Nash gave his talk at Yale and the math was just “lunacy,” others were “disturbed” and knew that something serious was happening (p. 246-247). There are many more instances of Nash’s behaviors disturbing, worrying, or upsetting others as well. While his own behavior did not bother him necessarily, it certainly seemed to distress others to the point where they believed he was having a mental breakdown and his wife had him hospitalized.
The third item is dysfunction. Nash functioned normally in his academic pursuits and career pursuits before he was first hospitalized, but his eccentric behaviors were enough to impair his interpersonal relationships. He was highly intelligent, a genius, who had received his PhD early and who had been featured as a rising and brilliant young math star in Fortune magazine (Nasar, 2001). His eccentricities in no way interfered with his ability to do well academically or in his career. He achieved a lot within a few short years. However, he did struggle interpersonally, showing that his odd behaviors did get in the way. He never had many stable friendships and his relationship with Eleanor, his sons, and his parents was rather rocky. After the onset of schizophrenic symptoms, Nash was impaired in all areas of his life. Nasar (2001) describes his increasing aloofness, the breakup of his marriage to Alicia, the suffering of his relationships with his two sons, the loss of his job and the inability to keep a job afterward, and the lack of academic progress, except in times of temporary remission. His daily life was in shambles because he was in and out of the hospital and was very aloof and secretive much of the time during the height of his schizophrenia.
The fourth and final item is danger. However, John Nash was never seen as a danger to himself or to others. Most of his time was spent in a dreamlike state according to Nash’s autobiography in 1994. According to Nasar (2001), while Nash told a friend that “he didn’t see his life was worth living and saw no reason why he should not do away with himself. There is no evidence that Nash ever came close to acting on this thought” (p. 308). Nash may have felt upset that he was going through this, but as Nasar notes, he never acted on this feeling. Nash was not a danger to others and he did not appear to ever truly be a danger to himself.
Nash could easily be labeled “abnormal” at any point in his life because he had those deviant behaviors that did not and do not align with societal norms. However, the most deviant points in his life were during his schizophrenia. His behaviors and thoughts were distressing to others and they caused him much dysfunction in his life (Nasar, 2001). Nash was not able to keep his job or his family for a large part of his illness, and he was very aloof, secretive, and strange. He is abnormal because much of his life has not been in line with the norms of society and his eccentricities occurred frequently and were very noticeable and sometimes severe. He did not really “fit in” before or during his schizophrenia. He still continues to hear occasional voices to this day, and in that respect he is still likely abnormal because most people do not hear voices. John Nash is eccentric, but based on societal norms and understanding, his behaviors have always gone beyond the norm into what is considered “abnormal.”
Typically one of the first steps in treating paranoid schizophrenia is giving the individual an antipsychotic medication, such as Thorazine, clozapine, risperidone, or others (Sue, Sue, & Sue, 2005). These types of medications can reduce symptoms, but dosage levels and side effects must be monitored carefully. Thorazine, a type of phenothiazine, was the first antipsychotic medication available. According to Sue, Sue, and Sue (2005), phenothiazines are still often considered the most effective medication in treating schizophrenia. In the 1990s, new antipsychotic drugs, like risperidone and clozapine, were released. These drugs had fewer side effects than the others and were supposedly effective in many patients who could not use the original medications. Antipsychotics are used to help control the hallucinations and distorted thought patterns seen in schizophrenic patients. It is believed that there is a large biological factor behind schizophrenia, and so it is treated with medication. In one study that surveyed schizophrenic patients, 93% reported that they were currently taking medications, but only 15.5% of the schizophrenic patients reported that medication alone was the most effective treatment for their disorder (Coursey, Keller, & Farrell, 1995). In the case of John Nash, medication did seem to work effectively (Nasar, 2001). Nash improved when he stayed on his medication, but would then deteriorate when he went off of it. Nash was given Thorazine on two separate occasions and Stelazine on another occasion. He voluntarily continued the use of Stelazine after he was released from the hospital at one point and went on to publish 2 scholarly articles during his remission. However, when he went off of the medication, he began to deteriorate again. Clearly, medication had an impact on Nash’s behavior.
Cognitive Behavior Therapy (CBT) and Psychosocial Therapy
One study that surveyed schizophrenic patients found that 91% of them were or had been to individual psychotherapy and around 70% reported that therapy had brought positive changes to their lives (Coursey, Keller, & Farrell, 1995). Many patients reported that therapy involved “Getting in touch with my feelings” or understanding how people affect one another and giving practical advice (p. 289). Therapy of this kind is quite common in patients with schizophrenia. Many of the psychosocial interventions involve helping the individual address issues that have a negative impact on their ability to work or to socialize, such as odd appearance, speech, and attire (Sue, Sue, & Sue, 2005). In addition, therapy may address family issues. Family interventions often deal with communication issues, coping and problem solving skills, learning strengths and weaknesses of the individual with schizophrenia as well as the other family members, and learning about schizophrenia and the signs of relapse. Nash went through some individual and group therapy, but it is not clear what the sessions addressed (Nasar, 2001). Nash also received quite a bit of support from his family, even without therapy, which may have also aided in his later remission.
One treatment that is not common for schizophrenic patients is CBT, but it may be useful according to some research (Kuller & Björgvinsson, 2010). This study by Kuller and Björgvinsson (2010) suggests a type of CBT called cognitive behavior therapy for psychosis, or CBTp. CBTp is based on an attempt to normalize the patient’s symptoms. They explain that while this might sound counterintuitive, the purpose is the reduction of the distress experienced from their symptoms. The authors state that,
As with most forms of CBT, the patient learns to identify automatic thoughts, core beliefs, and behaviors related to those thoughts and beliefs. The treatment process is collaborative; the clinician neither challenges nor colludes with the patient’s beliefs. In fact, it is not always necessary to convince the patient that they have a mental illness (Turkington, Kingdon et al., 2006). The treatment emphasis is reduction of emotional distress and improved psychosocial functioning. (Kuller & Björgvinsson, 2010, p. 313)
The authors provide a case study of a man they call “Michael,” who experiences delusions, auditory hallucinations, somatic hallucinations, and negative symptoms of schizophrenia. They find that after 30 sessions of CBTp Michael has improved, his symptoms have been reduced, and he is able to function in his daily life with his family. This type of therapy may be helpful in that it helps reduce the distress and dysfunction that a person experiences due to their schizophrenia. While it is not widely used, Kuller and Björgvinsson (2010) suggest that it should be used more often because it may be able to help individuals with schizophrenia effectively address their ability to reality test, their struggles with functioning, and the mood and anxiety issues that they experience. John Nash did receive some type of therapy, but it is not clear what the sessions addressed (Nasar, 2001). It is not likely that Nash received CBT because it is not normally recognized as an effective or viable treatment for schizophrenia (Kuller & Björgvinsson, 2010; Nasar, 2001). However, one could suggest that in his own way Nash practiced CBT on his own. Nash claims that he willed his remission into happening, saying that he was able to begin to “intellectually reject” his distorted thought patterns (Nash, 1994, para. 28; PBS, 2002). He may have been able to do this a little on his own, but one can only speculate.
John Forbes Nash, Jr. is a genius mathematician who developed paranoid schizophrenia at the height of his career (Nasar, 2001). It is evident that a number of life events and stressors likely played a role in his deterioration, however biology is also likely a factor.
His symptoms were that of paranoid schizophrenia and treatments were effective for a while. Nash, however, did not stay on his medication which inevitably led to the return of his symptoms. Nash lived through a period of at least 20-30 years with on-and-off symptoms, but began to recover almost miraculously. By the time he was 66 years old when he received the Nobel Prize in economics, Nash was considered to be in remission. According to Nash, he willed his recovery. However, we may never know the true cause of his remission. The case of John Nash is an inspiring and intriguing one, and much can be learned from it.
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