John Forbes Nash
Schizophrenia is a famous disorder but no case has quite reached the notoriety of the illness of John Forbes Nash Jr. (JFN) the Nobel laureate. The case study of John Nash is unique not just because of the fame of the patient but also because the patient recovered. Recovery from Schizophrenia has long been believed to be impossible and like many other debilitating diseases Schizophrenia was thought to be progressive. Perhaps JFN is unique since brilliant minds are thought to be somewhat immune to a complete breakdown but even if so JFN has shifted psychiatric theory just as he did in economics with his game theory. Since the case of JFN has had such an effect on views of Schizophrenia, the correlations between generally accepted criteria and the Nash case are important. Therefore, this essay will examine the components of Schizophrenia in relation to JFN’s illness.
Background
JFN grew up in a Virginia coal town the son of an engineer. He was withdrawn and introverted. His mother and father did their best to overcome this by pushing him into social activity. However, John Jr. preferred to be alone. His mental ability was soon discovered. His mother taught him to read at age four so he skipped a year of elementary school. Essentially JFN never fully integrated with his peers throughout his life. He always felt separate from others even in Princeton among mathematical geniuses just like himself. Even those individuals thought John was odd. Despite this problem, JFN excelled in school and during his Princeton period, he became interested in game theory. This interest led to his making a dramatic impact on the mathematics of economics. This eventually netted him a Nobel Prize given to him during the remission of his Schizophrenia.
Biological Components
Hansell and Damour (2005) explain that in Schizophrenia the biological components are put into two categories. The two categories are proximal (immediate) and predisposing (distal). The immediate causes are related to brain function or brain structure abnormalities including neuropsychological and neurophysiological problems. Factors of predisposing nature are ones that are underlying causes like genetic abnormalities or viral infections. In the case of JFN, the abnormalities of viral infection or other birth trauma were ruled out as is stated in this quote:
While viral exposure in utero or a subtle birth injury might have played a role in his later mental illness, there is no available record or memory to suggest any such trauma.
Nasar (1998, p. 115)
Apparently, John was born healthy and the birth was a natural one without anesthesia. (Nasar, 1998)
Schizophrenia Immediate Causes
Hansell and Damour (2005) go over many of the immediate causes believed to be links between symptoms in cases of schizophrenia and different abnormalities. Through PET (positron emission tomography), SPECT (single-photon emission computed tomography) and MRS (magnetic resonance spectroscopy) scans, hypofrontality (less active prefrontal cortex) has been identified in Schizophrenia patients. The hypofrontality syndrome hints at a tie between negative symptoms of schizophrenia and dysfunction in the prefrontal cortex. Neurochemical imbalances are another of the areas of study. The most promising of findings appears to be in abnormal neurotransmission. The neurotransmitters dopamine, serotonin, glutamine and gamma-aminobutyric acid are being studied and linked to symptoms in Schizophrenia. Dopamine has been the main subject of study since antipsychotic drugs were found to reduce amounts of dopamine and thus reduce or stop hallucinations and delusions. However, an important item to note is that dopamine is only one part of the causes of Schizophrenia and recent studies suggest multiple neurotransmitter causes. Brain structure is also an area of study and through MRI and CT scans, enlarged lateral ventricles have been found in the brains of Schizophrenics.
Nasar (1998) describes graphically the insulin therapy the JFN went through. Insulin is known to reduce dopamine secretion in the brain. The therapy does work in terms of reducing or stopping delusions and hallucinations, however, the treatment is severe in nature. In the early morning, JFN was given an insulin shot and by mid-morning, he was comatose from lack of blood sugar. The nurse would then give him glucose through a nose tube or intravenously. This would induce slow and painful awakening. The insulin therapy often caused seizures with occasional broken bones and some patients would not come out of the comas. At least one young man died from insulin therapy in JFN’s hospital. Later JFN would complain that he had lost a lot of his mathematics memory because of the insulin treatments.
Schizophrenia-Predisposition
Hansell and Damour (2005) point to the fact that even birth in winter and spring may give a pre-disposition to Schizophrenia. The reason may be the higher influx of viruses during winter months. Besides this factor, complications in the birth or during pregnancy as well as any drug use may increase the chances of becoming Schizophrenic. In addition, genetics do in fact have a role in the development of Schizophrenia. The risk of developing Schizophrenia is most apparent in the family relationship of Monozygotic (MZ) twins and the offspring of parents who both had Schizophrenia.
In JFN’s immediate family, there were no incidents of Schizophrenia. JFN was also born in June leaving out the weak theory of winter viruses during birth. However, JFN’s son developed Schizophrenia after graduating from Rutgers University with a mathematics degree. This lends substantial fuel to the theory of genetic predisposition. Perhaps one more pre-dispositional factor was inherent in JFN and this was his left-handedness reported by his fourth grade teacher. JFN’s father was against this happening and JFN was forced to write with his right hand and even sent to handwriting class to cure both his left-handedness and his atrocious handwriting. Cadena (2007, ¶2) has this to say about brain dominance:
In fact, with Schizophrenia spectrum disorders, it is not uncommon to find a marked degree of intellectual disability coupled with ambidextrous tendencies based on fluctuations in cerebral, or brain, dominance. (p. 1)
Since brain dominance has been shown to be a factor in Schizophrenia this may be significant in JFN’s case. Yanguiling (2008) substantiates this possibility with the fact that 20% of math geniuses who took an aptitude test at Iowa University were left-handed.
Emotional Component
Weinberger (2000) points out those patients with frontal lobe injuries have disordered emotions, which are out of context to situations. Not only are the emotions inappropriate but there is a lack of will and motivation. These symptoms are remarkably similar to the negative symptoms in Schizophrenia patients. Studies have shown a decrease in pre-frontal activity in the brains of Schizophrenia patients compared with normal individuals. This led Weinberger (2000) to surmise that the brain may overload from behavioral demand and shutdown as a protective measure or in the opposite may go into overdrive to make up for the lack of ability to cope with demands.
Nasar (1998) report seems to agree in JFN’s case that a kind of overdrive brain activity happened in the onset of his Schizophrenia. The feeling that Nash had always had of being isolated from others and beyond their comprehension was intensified. This perhaps led him to paranoia type behavior.
Cognitive
Hansell and Damour (2005) explain that within the positive symptoms of Schizophrenia over attention may be an important factor. This is an inability to screen out irrelevant stimuli. Researchers call this impaired sensory gating and may be because of dopamine levels.
In JFN’s illness this seems very significant as Nasar (1998) points out by telling of a situation where one of JFN’s colleagues asked Nash as a logical mathematician how he could possibly believe in alien contact. Nash replied that this was because the ideas came to him in the same way as his mathematical ideas.
Conclusion
The emotional, biological and cognitive factors of Schizophrenia are plain enough and yet the exact causes still elude researchers. However, in examining the case of John Forbes Nash Jr. the propensity of the illness seems apparent in lifestyle and mental functions of his childhood. The most important factor in JFN’s case that is very apparent to this author is JFN’s ability to concentrate to extreme degrees. JFN would focus on one thought or one physical object and literally think it to death. The report of his parents that he once rode an elevator up and down until the elevator broke is evidence of this. (Nasar, 1998). This is a clear indication that JFN had an impaired sensory gating. The ironic part of this is that of course this was his genius. The lack of a clear dominance in right or left-brain is perhaps a part of the sensory gating impairment. Over attention is very significant and again possibly a brain dominance symptom. In the case of JFN
the possibility that he actually over-thought so much that he literally impaired or vastly reduced normal brain function through lack of use. Perhaps control is the key to not only the recovery from Schizophrenia as in JFN’s case but also in the prevention of the onset of the disease. Children at risk should be identified and then perhaps through mental rehabilitation the disease of Schizophrenia could be eliminated completely.
References
Cadena, C. (2007). Right brain, left-brain: how cerebral dominance is affected by schizophrenia spectrum disorder. Retrieved December 21, 2008 from http://www.associatedcontent.com/article/
498709/rightbrain_leftbrain_how_cerebral_dominance.html?cat=72
Hansell, J. & Damour, L. (2005). Abnormal psychology. ISBN 0-471-38982-X, WIE ISBN 0471-65821-9, [Electronic Edition]
Nasar, S. (1998). A beautiful mind / Sylvia Nasar. Simon & Schuster, New York, NY.
Weinberger, D.R. (2000). Schizophrenia: the cancer of mental illness. Retrieved December 21, 2008 from http://www.loc.gov/loc/brain/emotion/Weinberg.html