A diagnostic bind: movie mania and John Nash's schizophrenia
John F. Nash Jnr died together with his wife Alicia on May 23, 2015, when their taxi lost control in New Jersey. He was 86 years of age. Obituaries in the world's leading newspapers and journals attest to his genius, his extraordinary scientific contributions both in impact and in breadth (he made seminal contributions in economics, mathematics, political science, nuclear strategy, evolutionary biology, and game theory) and the multiple tragedies that marked his life, and not only his psychiatric illness. As captured by the New York Times (2) his life story was 'one of dazzling achievement, devastating loss and almost miraculous redemption' That profile was captured in the 2001 film 'A Beautiful Mind' a film that received multiple Oscar nominations and was awarded four. The publicity emphasized how John Nash had triumphed in receiving the 1994 Nobel Prize for Economics over schizophrenia. While the film is evocative and poignant and offers hope for those with schizophrenia, it may offer false hope if Nash did not have schizophrenia. We will argue that Nash was more likely to have had a bipolar disorder. The diagnosis of bipolar disorder is often missed, risking failure to provide appropriate treatment. Nash's story is therefore worthy of some diagnostic consideration. First, a context. Nash's psychotic episodes occurred prior to the introduction of DSM III and his diagnosis may well have been influenced by definitions of schizophrenia applied in that earlier era, and when it was judged that U.S. psychiatrists risked overdiagnosing schizophrenia. The more prescriptive criterion based DSM III 1980 decision rules for schizophrenia were likely to have reduced any such overdiagnosis in the 1980s, and the revised 1987 (DSM III R) criteria even more so. The definitive reference to Nash's life and his psychiatric treatment is provided in a biography (3) published by Sylvia Nasar in 1998. Any challenge to the diagnosis needs to be circumspect, and no disrespect is intended to the Nash family in this attempt to review his diagnosis, nor is any challenge offered to Nasar, whose detailed biography respects diagnoses made by the psychiatrists who treated Nash. On several occasions, however, Nasar does contemplate whether the diagnosis of schizophrenia was correct but, as an economist, it is hardly surprising that she would not have accepted the clinical judgments of the time. Therefore, the present editorial is best read as a general reminder that psychiatric diagnoses are still uncertain, being based on symptoms and signs that are not necessarily diagnostically specific. This uncertainty is regrettably overlooked by the media and in artistic depictions, in this case a movie portraying a mental disorder in a public person as highly respected as John Nash. We take the liberty of depicting the problem of diagnostic uncertainty by reference to John Nash's illness. Nash was born in 1928 and had his first episode of psychosis in 1959, when aged 30, the year that his second son was born and his mother was hospitalized with severe depression. The onset was marked by his conviction that abstract powers from outer space (and possibly foreign governments) were communicating to him via The New York Times (3) He stated that he was 'forming a world government' told a student that he was putting him in charge of Asia, and declared that he was 'scheduled to become Emperor of Antarctica' (3) Nasar wrote that Nash recalled a 'growing sense of revelation regarding a secret world that others around him were not privy to' and later reported, 'I thought I was a Messianic godlike figure' (3) Determined to establish this 'international organization' he began to 'stay up, night after night. .writing' (3) with his desk covered with paper written on with multiple colored inks. He wrote, for instance, to the UN, the Pope, and the FBI, where he stated that, as the Prince of Peace, he led a movement for 'world peace' (3) In the early stages of his illness, his mood reflected 'heightened awareness, insomniac wakefulness and watchfulness' while he believed that he was on the
Acta psychiatrica Scandinavica