Few delusions in Crowe depiction

An authority on schizophrenia talks about John Nash, 'A Beautiful Mind' and the disease it depicts.

Conversations

March 24, 2002|By Patricia Meisol | Patricia Meisol,Sun Staff

Dr. William T. Carpenter Jr. , 65, is a leading world researcher on causes and treatments for schizophrenia at the University of Maryland School of Medicine. The author of more than 200 clinical articles, he has directed the Maryland Psychiatric Research Center in Catonsville for 25 years. Researchers at the center have produced leading theories about the nature of the disease and tested treatments in clinical trials. At present they are investigating why most people with the disease are unable to work.

Delivering a paper two years ago on recovering from schizophrenia, he shared the dais with John Nash, the Princeton mathematician and 1994 Nobel laureate whose battle with the mental illness was the basis for the movie A Beautiful Mind.

The movie has become the odds-on favorite to win the best picture Oscar at tonight's Academy Awards, and has been praised for its depiction of the illness, which affects 1 percent of Americans. Dr. Carpenter spoke with The Sun on the eve of the Oscars.

What did you think of the movie?

I don't fancy myself a movie critic. From the point of view of our profession, it's nice to have a view of someone with the disease who is not a homicidal maniac. It's an awful disease, and it was presented in a way in which you can have empathy with the person who suffers from it.

It is a movie, I know. He didn't have visual hallucinations. He was caught up more in hearing voices than in seeing things. But it seemed to me they did a clever job of depicting voices -- when he is in the Department of Defense helping them break a code, there's a man on the balcony. There's the little girl. The roommate. It was a way to depict it.

One of the things that struck home, that is compatible with a person with this disease, was the garage scene when his wife found him [cutting up newspapers he thought contained secret codes]. People can get so caught up in believing, doing, organizing their life around their delusions.

How did you come to know Nash?

I sat on a panel with him. I got to know John Nash a little bit that weekend he presented. At the time, the gossip was who was going to play him in the movie: Tom Cruise, Russell Crowe. I read the book on the way there. I was supposed to discuss recovery, which he doesn't claim.

The character of Nash seems so unrealistic. Who recovers from schizophrenia? Doesn't the disease only worsen?

First of all, schizophrenia is a syndrome that probably has several different diseases in it. People who suffer from schizophrenia, there's a lot of variability. What's true of one may be true of a subgroup but not of others.

Second thing is that the traditional view that it starts early and runs a downhill course and leaves everybody in a defective mental state in the end is a very inaccurate picture. We've known for a long time it only occasionally runs a downhill course There is a tendency with aging for the illness to become less intense.

Nash was diagnosed with paranoid schizophrenia. What form of the disease is it?

It is one of the best forms. Everybody diagnosed with schizophrenia gets paranoid beliefs. What distinguishes the paranoid form is, it tends not to get disorganization of thought or the loss of emotional drive. So some patients, people you might see on the streets, where they are very disorganized, exhibit bizarre behavior, hear voices, have false beliefs, often lose drive and emotional reactivity.

The parts of the illness that cause the biggest problem in the long term are not the voices and false beliefs. It's the lack of drive, emotion and more subtle cognitive impairments.

I think Nash stayed emotionally alive and engaged and did not get distorted. He did have hallucinations and false beliefs. They, of course, can ruin your life, if frequent and intense, as his apparently were. But if they get to where they are less intense, the other functional capacities haven't gone away.

Eighty percent of schizophrenics are unemployed, but I see people every day who work with machinery and hear voices but their performance is fine. It might be a little bit like, "How can I work with a headache?" Despite having false beliefs, there was a chemist who did extremely well in his work until he stumbled across a chemical dictionary in his boss' office and found one word in it he thought was left for him. [He took it as an insult to his mother.] All of a sudden he was out of a job.

The most common form this takes is people get direct messages from TV. They understand it as a direct communication to them. You thought it was a commercial for beer drinking. Another person sits there uncoding it, realizes it's a message to them, that they should kill themselves.

What treatments are you developing?

The treatments we have for schizophrenia are rather effective for some components, but we don't have anything close to being able to restore people to the life they had before they became ill. We are eager to discover the cause and treatment based on what's going wrong in the brain.

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