Understanding Living With Schizophrenia

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The World Health Organisation defines “schizophrenia as a severe mental disorder, characterised by profound disruptions in thinking, affecting language, perception and the sense of self.” (WHO, 2019) The aim of this assignment is to discuss and analyse the mental health experience of John Nash, a Nobel Prize recipient in Economics, using the 2001 biographical drama, A Beautiful Mind, directed and produced by Ron Howard, featuring Russell Crowe as John Nash (Howard, 2001).

Development of Illness

In 1947, at the young age of 19, John Nash, who was attending Princeton University, started to exhibit signs of psychosis with the appearance of his “roommate”, Charles, played by Paul Bettany. Unbeknownst to John at the time, Charles was a hallucination, which brings one to believe that John was possibly having an ‘episode’ when Charles pushed the desk out of the window (Howard, 2001).

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In 1953, John’s hallucinations next manifested in the form of William Parcher, played by Ed Harris, from the Department of Defence. The hallucination of Parcher instigated John’s delusion into him being a code breaker for the Department of Defence. During his time as a “code breaker”, John became involved with Jennifer Connelly’s character, Alicia, who then would become his wife (Howard, 2001).

After not seeing seeing him for around five years, Charles re-enters Johns life with his niece Marcee, played by Vivien Cardone. Johns brain creates Marcee to explain the natural progression of life and how circumstances can change, which continues to concrete the fact that Charles, and now Marcee, are real. After an episode with Parcher, John became increasingly agitated and paranoid, with his visual delusions having him believing that there are Russian’s after him. This is portrayed in the movie when he is continuously looking out windows for the “Russian’s”, he’s skittish, always looking over his shoulder and when he tells his wife she needs to go to her sisters. Just as John is unaware of his mental health condition, so is Alicia (Howard, 2001).


John was involuntarily hospitalised in October of 1954 after Alicia, his wife, realised that there was something not right. Dr Rosen, played by Christopher Plummer, is the psychiatrist who diagnoses John with schizophrenia. John starts to question the reality when his wife shows him the unopened envelopes which he had be supplying to the Department of Defence, which leads him to discover that the implant has gone (Howard, 2001). In my opinion, from then on John realises he is mentally unwell and needs help, he is not seen to be fighting the medical staff when they are getting him ready for his ICT.

The current legislation governing mental health in Queensland is the Mental Health Act 2016 (MHA). As John doesn’t realise that he has a mental health problem, it is depicted in the movie that Alicia, his wife, was the one to contact Dr Rosen and initiated his care as an involuntary patient. As described in the MHA a treatment authority is a lawful mandate to provide treatment to a person who has a mental illness and does not have the capacity to consent to treatment as explained in Part 4 section 18 of the MHA (Mental Health Act 2016 (QLD)).

In the movie John was in restraints due to punching Dr Rosen, and then put into isolation for observation. The use of restraints, whether they are mechanical, seclusion or physical, is regulated by the MHA and can only be used is approved by the chief psychiatrist (Mental Health Act 2016 (QLD)).

The use of Insulin Coma Therapy (which was used as treatment on John would have been regulated under the country’s Mental Health Act. Now a days, if John was being treated, he would be treated with Electroconvulsive therapy which is tightly monitored under Division 3 – Electroconvulsive therapy, of the MHA. To receive this therapy the person must be an adult, who is able to give informed consent to the treatment or if in unable to give informed consent there has to be approval from the tribunal under section 509 the performance of the therapy (Mental Health Act 2016 (QLD)). In Division 4, part 11, section 240 of the MHA 2016, insulin induced coma therapy has been prohibited with two (2) years imprisonment imposed if this therapy is administered (Mental Health Act 2016 (QLD)).

John is treated with Insulin Coma Therapy (ICT). IST was developed by a man named Manfred Sakel in the 1930’s. Sakel theorised that the insulin antagonised the neuronal effects of the adrenal system, which was the physiological cause of the patient’s illness. The patients would undergo IST, therefore inducing a coma, five to six times a week and would continue until the patient had either a “satisfactory psychiatric response” or fifty to sixty comas had been induced. The doctor would administer 10-15 units of insulin a day, they would increase the dose daily by 5-10 units until the patient displayed severe hypoglycaemia. To arouse the patient from the induced coma they would administer glucose either via a nasal tube or intravenously. There was a mortality rate of about 1% of patients and there was always the possibility of brain damage; interestingly a majority of patients emerging from the treatment were grossly obese (Jones, 2000).

As effective as ICT was, today Electric Convulsive Therapy (ECT) in used instead. With the deliberate inducement of a seizure on the Central Nervous System (CNS) for a predetermined duration of time, ECT is used to treat patients who have certain neuropsychiatric illnesses. Patients with acute needs receive treatment three times per week and may require multiple treatments as a maintenance program. Clinical improvements can characteristically occur within the first few treatments, with a positive reaction to treatment of 70%-90%, it has even been effective in those who have been resistant to treatment. ECT is the alternation of electricity being passed through electrodes; which causes intense changes in the brain’s neurotransmitters (Sobey & Tracy, 2018).

Intervention and Recovery

With the introduction of antipsychotic drugs, and the development of psychological treatments and the insight from individuals who have been diagnosed and recovered from schizophrenia, the perception or stigma around schizophrenia are slowly beginning to change. Increase in research over the last two decades has clinicians optimistic for a comprehensive strategy to decrease the morbidity of this illness. People who are treated in the first-episode of schizophrenia found it beneficial to include cognitive behaviour therapy, family support, supported employment and education services on top of psychosocial treatments, helped to increase the participation at work, school and social functioning (Lieberman, Dixon, & Goldman, 2013).

Under a new model of comprehensive care for First-Episode Schizophrenia the proactive treatment of early psychosis incorporates reducing the length of the active symptoms through quick diagnosis and a strict regiment of pharmacological needs to be adhered too; maintaining treatment at set out and preventing relapse; assimilating pharmacological management as well as psychological therapies with a recovery approach which can also include other mental health professionals to help with the disease management approach to the illness; finally making sure that the patient is offered social and vocational services, treatment for substance abuse if needed, education for the supporting family members, coping strategies for dealing with past and psychosis trauma, as well as having as safety plan organised in case of a suicide attempt (Lieberman, Dixon, & Goldman, 2013).


It has been more than a century since Kraepelin defined schizophrenia as an illness leading to clinical deterioration and it has been sixty years since the first effective treatment of schizophrenia using antipsychotic drugs (Lieberman, Dixon, & Goldman, 2013).


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