• Robb G. Best

Beautiful Minds

Hollywood doesn’t have the best track record portraying mental illness. From the harmless, almost charmingly quirky weirdos of Benny and Joon to the axe-wielding maniacs haunting many a horror flick, mentally ill people are seemingly always either romanticized or villainized, with little middle ground. And hey, what about the ending of A Beautiful Mind, where brilliant economist John Nash manages to logic himself out of his schizophrenia-induced delusions? There’s some wild movie magic, right?

While the film certainly takes liberties with the actual John Nash’s life, painting a rosier or more exciting picture of a man without much actual resemblance to Russell Crowe, the script is careful to include a line implying that Nash achieved this stable, rational frame of mind with a little help from psychiatric drugs. And therein lies the actual Hollywood distortion: the real-life Nash spent those final decades of his life totally unmedicated.

In 1994, as part of an autobiographical piece for his Nobel Prize, John Nash summarized his road to mental wellness, recalling how he spent part of the fifties in and out of mental hospitals (against his wishes), and explaining,

“…after my return to the dream-like delusional hypotheses in the later 60's I became a person of delusionally influenced thinking but of relatively moderate behavior and thus tended to avoid hospitalization and the direct attention of psychiatrists.

Thus further time passed. Then gradually I began to intellectually reject some of the delusionally influenced lines of thinking which had been characteristic of my orientation.”

Although Nash lamented that relying so strongly on rationality limited some of his wilder flights of scholarly fancy, he was able to live the rest of his life outside the walls of psychiatric hospitals.

What gives? Did Nash have some kind of genius superpower? Almost certainly not. According to a recent study, it may come down to cognitive insight.

Researchers at Penn Medicine surveyed 228 people, each with either schizophrenia or schizoaffective disorder, using the Beck Cognitive Insight Scale. This is a specially designed questionnaire meant to measure how reflective an individual is, and whether or not they question their interpretations of experiences. (Sample item: “If someone points out my beliefs are wrong I am willing to consider it.” Do not agree at all? Agree slightly? Agree a lot? Agree completely?)

The study found that high cognitive insight, that is, a high threshold for self-reflection, was a good predictor of neurocognition, while low cognitive insight, that lack of internal questioning, was linked with poorer neurocognition. What’s more, people who improved their cognitive insight skills were able to then boost their neurocognition, suggesting that this may in fact be a cause and effect link.

“The relationship between the two is important because it presents a promising opportunity to improve outcomes for individuals diagnosed with schizophrenia, many of whom experience long periods of disability, not to mention the 1.5 million new people who are diagnosed with schizophrenia worldwide every year,” explained Paul M. Grant, PhD, a senior author of the study.

Grant has also helped to develop a type of cognitive therapy aimed specifically at schizophrenic patients. It focuses on goal strategy, resiliency, and positive thinking, and a June 2017 study found it got results when applied to people really struggling to function with schizophrenia.

Of course, the medication line was added to A Beautiful Mind for a reason. The writers worried about accidentally sending the message that meds don’t matter—a potentially dangerous theme. And it’s certainly true that not every mental health problem can be solved by some serious self-reflection.

Still, for the millions of people facing life with this oft-stigmatized disorder, the news about cognitive insight offers a little beacon of hope. And that’s beautiful indeed.

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