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People & Events: A Definition of Schizophrenia

The movie A Beautiful Mind (2001) portrayed mathematician and Nobel Prize winner John Nash's schizophrenia as a series of ominous hallucinations: an imaginary student occupies Nash's room while he's an undergraduate at Princeton; imaginary spies trail him; imaginary operatives sit him down in elaborate, science-fiction-style rooms to give him essential orders only he can hear.

%"If someone walked in a room with those kinds of symptoms, all of us in this business would send him for an MRI to see if he had a brain tumor, or had a reaction to a drug or something," says E. Fuller Torrey, M.D., author of the best-selling book, Surviving Schizophenia. "This was not a real version of schizophrenia. It was Hollywood's version."

Hollywood, as usual, is easy pickings. But popular filmmakers are not the first ones to misinterpret the disease. Here's a brief list of what schizophrenia is not, despite popular misperceptions. It's not a "split personality," such as the personalities portrayed in Sybil or The Three Faces of Eve. These movies depict people suffering from a mental disorder called a dissociative identity disorder, which is far less common than schizophrenia and usually brought on in women by sexual or physical abuse in childhood.

Persons with schizophrenia are not retarded; in fact, some, like Nash, are intellectually gifted. They are not confused in the same way someone with a brain trauma or Alzheimer's disease is confused. When his disease was in full bloom, Nash managed to travel extensively in Europe and America, solicited legal help, and even learned sophisticated computer programs. Schizophrenia does not shatter the rational world. Many people with schizophrenia, including Nash, engage in complex flights of thought. His belief that the world was a rational one slowly began to evolve into his belief that everything had some meaning that only he could divine, a common feeling among people with schizophrenia. The disease is also not bipolar disorder, formerly referred to as manic-depression, which affects mood more than thought.

%Listing what schizophrenia is not is easier than coming up with a precise definition of what it is. None of the disease's symptoms -- paranoia, auditory hallucinations, a physical apathy, extreme agitation, heightened awareness, an extreme coldness to others -- solely defines the disease. "The definition is really problematic, because in a way, to define something, you have to know what the essence of it is," says Dr. Louis Sass, professor of clinical psychology at Rutgers University and author of the book Madness and Modernism. "And it's not clear what the essential thing in schizophrenia is."

Without a single essence, schizophrenia is a constellation of idiosyncratic symptoms. Hallucinations do occur, but they are usually auditory rather than visual. Voices, sometimes singular, sometimes in conversation, often accompany and comment on the everyday life of a person with schizophrenia. Delusions are also common, and those around Nash saw numerous examples. When the University of Chicago offered him a prestigious chair, he thanked them for the kind offer, but said he had to decline, explaining he was scheduled to become the Emperor of Antarctica. One day early on in his illness, Nash went into another professor's office, drew a potato-like shape, and said, "This is the universe." Then he pointed to smaller shapes he drew to the right of the potato. "This is the government," he continued. "And this is heaven. And this is hell."

%The disease often scrambles thoughts, sentences, and even words that can sometimes tumble out chaotically, like loose puzzle pieces dumped from a box. While his disease was full-blown, Nash was known for leaving incoherent mathematical equations on the chalkboards of Princeton. A person with schizophrenia often appears hollowed out emotionally, seeming flat and socially detached.

Nash is often described having paranoid schizophrenia, a sub-category that adds delusions of persecution and unwarranted jealousies. Nash once wrote a letter to a mathematician stationed abroad in four colors of ink, complaining that his career was being destroyed by extra-terrestrials.

While the word "strange" is often used to describe the disease and those who suffer from it, a better word might be "enigmatic." A general consensus is that it's triggered by biological factors, similar to multiple sclerosis or Alzheimer's disease -- but the triggers are not yet understood. And why the disease throttles one person and floats by another is not understood. Drugs have no impact on some sufferers and seem to cure others, but there is scant understanding as to why they work or don't work.

One schizophrenia expert and writer, Manfred Bleuler, described the disease as " a gulf that defies description." Adds Dr. Sass: "There's something mysterious about it. It's hard to put into words. So we fall back on words like 'bizarre.'"

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