A woman called me as a clinical psychologist to ask for advice on how to deal with her husband’s bizarre delusions. She said that her husband was experiencing a disconnection from reality as well as withdrawal from people. She brought her husband John Nash to the center the next day for help. He didn’t want to talk with me at first and told me he thought he wasn’t in need of therapy. I learned a great deal about him after he agreed for me to see him for a few sessions.
I was also able to identify some of John’s major problems by analyzing the cognitive and behavioral notions that he expressed in our sessions. Alicia’s (John’s) wife had mentioned that Nash talked to imaginary persons, sometimes yelling, before the therapy started. Nash revealed to his therapist that he had other problems in his life. He was socially awkward and anxious, and didn’t care what people thought of him. He also said that he had hallucinations of people and was constantly impacted by false delusions.
Aside: In the 2001 film “A Beautiful Mind”, John Nash is both afflicted with delusions and persecution. John shouts at the group of Princeton University graduate students from the balcony when he is chatting off with Charles (a character who only exists inside John’s head). He says, “I don’t have time to waste memorizing the weak beliefs of lesser mortals.” The people laughed, thinking that he only spoke to himself. This scene was important because it illustrated how delusions could cause social barriers between people who were affected by them and those who weren’t. It also showed the disconnection John had from reality. John is thrown into another episode when he tells Alicia he believes someone is after him. John comes to her and demands she shut off the light because he thinks he, his wife, are in peril. He is yelling, and yelling again at one of the hallucinated people he has been seeing. She is franticly asking who he was talking to. John’s obsession with paranoia can be seen in this scene. Alicia was able to notice it, and she interpreted the behavior as unusual.
I used DSM-5 to diagnose John’s paranoid schizophrenia based on the information I had about him. Schizophrenia is a psychotic disorder which disrupts the individual’s thinking and feelings. Nash’s paranoid beliefs that someone was out to harm Nash were clear signs of a serious cognitive distortion. DSM-5 says that schizophrenia is diagnosed by the presence of delusions, hallucinations or disorganized speech for at least one full month, as well as negative symptoms. John showed false delusions during our sessions. He also had hallucinations about imaginary characters, which he learned recently were not real. His speech was disorganized, and he spoke in a way that was inconsistent with his thoughts. He spoke of his experiences with social withdrawal, both from fellow graduates and also in regards to what other people thought of him. Both of these are common negative symptoms associated with schizophrenia. The DSM-5 also states that for a patient to be diagnosed with schizophrenia, they must show impaired interpersonal functioning, decreased self-care or reduced function at work. John told me that his hallucinations and delusional thinking caused him to have frequent conflicts with his spouse. The problem is that John knows it’s a serious one and does not wish to argue. But his delusions make him unable to change them in the heat of an argument. DSM-5 states that schizophrenia must have been present continuously for at least 6 months. John said in his consultation that he’s been experiencing symptoms his entire life. I diagnosed Nash with schizophrenia paranoia because of the repeated discussions about Nash’s intense fear that someone was constantly after him.
When I was forming my opinions about his possible treatment, I asked whether he’d experienced any psychological triggers that may have contributed to episodes of extreme unrealistic thinking. The intense pressure he felt to publish his idea and his distress were two aspects of his personality that he described as being a strain. The movie shows Nash being socially outcast by his fellow graduate students. This might have also contributed to the onset of schizophrenic disorders. He has even revealed that he is under a lot of pressure when interacting with other people. When he is in an argument with his spouse, he will often hear and see three different people. Nash has a tendency to display psychotic symptoms after he engages in socially difficult interventions. This suggests that there are possible psychosocial causes for his episodes.
John was not presenting with any medical conditions during the sessions. However, he told me about a time when he had an episode where his hallucinations and delusions led him to harm himself. This behavior is common in schizophrenia. John’s delusional behavior led him into a physical injury with a sharp opposition. Even though he didn’t admit to having any injuries recently, his behavior was so alarming that I decided to recommend him alternative therapy options to suit his specific needs.
Psychological treatments can help people with schizophrenia cope with the illness and live a better life. Having met John personally and having discussed his case with him, I believe that cognitive psychotherapy or Cognitive Behavioral Therapy would be best to help treat John’s symptoms. I’ve recommended that he give Ellis’ Rational-Emotive Therapy a try. This goal-oriented form of therapy is designed to rid clients of pessimistic and negative thinking. This therapy encourages rational thinking and helps individuals to view life in a more realistic way. Albert Ellis created the A-B-C Model, which is at the core of this therapy. This prototype can be explained by saying that “A represents ‘activating event’, which is related to rational or non-rational ‘beliefs (B)”. These beliefs have ‘consequences (C), and if they are irrational then these emotional disturbances may result. This model is designed to help clients better understand their feelings, thoughts, and behavior in order to increase their happiness. RET is based on the belief that clients should not be bothered by negative events. It also teaches them to view situations in a positive light. Albert Ellis supports the theory by stating that “men’s views on things are what disturbs them, not the actual events”. I think this form of treatment would also be beneficial for John Nash. It could help him stop being affected by his delusions. By changing his obstructive perspectives, he’ll be able identify more positively with the positive aspects of life.
Stress Inoculation Training or SIT is another form that I suggest. This therapy model, developed by American psychotherapist Donald Meichenbaum aims to improve coping mechanisms and teach people new and more effective methods of dealing with stress and other life challenges. SIT helps individuals identify triggers, and learn to rationally handle difficult situations. SIT can be broken down into 3 phases: 1) conceptualization 2) skill development and rehearsal 3) application. The conceptualization step is when a therapist attempts to identify triggers of stress and anxiety. This second part of the therapy involves cognitive restructuring and behavior activation. The therapist also helps the patient feel better. The client can practice skills that they learned by role playing or applying them. This method is believed to work because SIT helps patients become more resilient to stress. SIT helps clients identify the effects of stress on their behavior and adjust accordingly. John Nash may benefit from SIT because it allows him to identify his psychotic episodes and learn new coping strategies. This therapy can also reduce the distress caused by his hallucinations and delusions.
Rational Emotive Therapy (RET) is best for this particular client because of the important differences between CBT. RET is a continuous process of working on the problematic notions associated with schizophrenia. RET works on a much longer term basis, and because it is a constant battle to find a solution, its effects will only get stronger with time. SIT, in contrast, is more focused on dealing with the stressors that arise at the time and not as effective for addressing the underlying issues of schizophrenia. The RET program can also reduce stress because the schizophrenic delusions, or Nash’s, do not dominate the client’s daily life.
John Nash suffers from paranoid schizophrenia and his life has fallen apart for no apparent cause. My first thought was to use cognitive psychotherapies. I had diagnosed John with paranoid-schizophrenia. SIT and RET both work well to help John. However RET is better suited for Nash’s needs. It teaches Nash to replace negative thinking with rational, realistic thought paths, teaches him to be less disturbed by life events, and helps Nash to resolve emotional and behavioral issues caused by positive schizophrenic symptom. John Nash is likely to benefit from further therapy sessions. He can also overcome this debilitating illness with effort.
