Learning
From a Troubled Genius
When 25 Years Ago the Author Met John Nash, the
Nobel-Winning Schizophrenic,
She Behaved Badly. She's Beginning to Understand Why.
By Miriam Davis
Special to The Washington Post
Tuesday, December 18, 2001
His shorts were a bright plaid, glaringly different from the pattern on his
shirt. On his feet he wore red sneakers. On the self-consciously earth-toned
Princeton campus of 1976, he stood out.
"Who's that?" I asked my friends in the math department about the
odd-looking
figure who hung around the math area, which faced the biology lab where I'd
begun working on my doctorate.
"Oh, that's Nash," came the reply.
"Who's he?" I persevered.
"He's crazy, but he won't hurt you." End of discussion.
That was my introduction to math genius John Nash -- years before he was
awarded his Nobel prize in economics, years before his recovery from
schizophrenia, years before the release of the film version of his biography,
"A Beautiful Mind," which is scheduled to arrive in theaters in
January. And
years before I began to care about the stigma of mental illness.
I didn't question my friends' dismissiveness. Nash's illness reduced him to
insignificance for me, as it did for so many others.
Like them, I grew accustomed to seeing "The Ghost of Fine Hall," as he
was
known, in and around the math department where he had been a fixture for
years -- a department in which he no longer had any formal affiliation but
where all knew of his former glory. Outside Princeton, many academics assumed
he was dead.
The trouble was that I saw this dead man walking everywhere on campus. He
could hardly be missed. Hunch-shouldered, arms hanging, he wandered the
grounds wearing a vacant expression and the same mismatched plaids in all
weather, regardless of season. He muttered to himself and made no eye
contact. His appearance was so unsettling that I never said hello or bothered
with a half-smile. I never wondered who he really was beneath the off-putting
exterior, why he was there, whether he had a family, what his background was.
I simply tried to steer clear.
It took me 20 years to realize that in writing him off as almost subhuman,
I'd fallen into the smug ignorance of most Americans. Sixty percent of them,
according to one comprehensive national survey, want to distance themselves
from people with schizophrenia.
As a grad student in the 1970s, I was, as
they say, part of the problem.
Surgeon
General's Report
I came to Washington in 1982 to become a health policy wonk and later became
an independent medical writer. The topic of mental health did not reach my
professional radar until 1998, when I was tapped to help draft and edit the
first-ever surgeon general's report on mental health.
The project began with a call from the project's senior scientific editor,
University of Maryland psychiatry professor Howard H. Goldman. This report,
he told me, was a watershed event. Never before had a surgeon general focused
on mental health and mental illness. The current surgeon general, David
Satcher, saw the document as an opportunity to draw attention to illnesses
that were as real and disabling as heart disease and cancer but had rarely
been treated as such. Would I be interested?
I hedged, not eager to commit to a topic of marginal interest. Even after I
reluctantly agreed, I had no way of knowing how absorbing the assignment
would become.
I began by editing chapters from experts. One part, "Outcome of
Schizophrenia," explained that popular assumptions about schizophrenia --
including that it follows an inevitable downhill course to total dysfunction
-- were based on a century-old description. Newer research that
systematically tracked patients over decades found that half to two-thirds of
people with schizophrenia improve or recover. Schizophrenia was not a life
sentence, especially with treatment, rehabilitation and support from family
and friends. In fact, the expert wrote, "some people with schizophrenia can
experience a remission of their symptoms and return to a high level of
functioning."
That was news to me.
To illustrate the point, the author cited the story of a certain John Nash,
the 1994 Nobel prize winner in economics. I re-read this descriptor with
astonishment, wondering briefly if this could possibly be the same figure I
recalled from graduate school days. I then pushed the question from my mind.
But a few weeks later, curious to know more, I bought Sylvia Nasar's 1998
biography of the troubled genius. As I leafed through the book, I came upon a
picture of Nash from Princeton -- which had been taken while I had been there
in the 1970s. In black and white, there was the indelible image: Nash wearing
mismatched plaids, that same hollow stare in his eyes.
His biography transported me back to the Ivy League campus -- and back even
further to the history of its illustrious math department. In 1950 Nash
earned his doctorate there in a branch of mathematics known as game theory, a
system for assessing competing strategies and outcomes in such areas as
economics, political science and sociology. It was his work in this field
that, more than 40 years later and long after his terrible battle with
schizophrenia, would win him the Nobel prize.
In graduate school, I remembered, I had spent nights over wine and beer with
math students, watching them crack jokes and scrawl unfathomable equations on
napkins. I recalled their awkwardness, their crooked glasses, greasy hair and
body odor. Yet the biography made clear that even within the quirky and
cloistered world of the math department, Nash was a loner. He was withdrawn
and inaccessible even before the onset of his mental illness.
But, as Nash's biography relates, it wasn't until after he left Princeton for
his first faculty post at the Massachusetts Institute of Technology (MIT)
that he began a precipitous mental slide. In 1959, when he gave a lecture to
the American Mathematical Society, Nash rambled incoherently. To listeners,
the lecture seemed to certify him, in the most conspicuous way, as a madman.
Nash's wife made the painful decision to have him committed to McLean
Hospital outside Boston. Psychiatrists diagnosed paranoid schizophrenia. So
began a 30-year nightmare of delusions, hallucinations and disorganized
thoughts and speech -- the hallmarks of one of the most feared mental
disorders.
Many of the treatments he received have long since been discredited. In 1961
doctors at a Princeton-area hospital subjected him to six weeks of insulin
coma therapy -- daily injections that sent his blood sugar plummeting and
rendered him comatose, followed by forced feedings of glucose to revive him.
Recoiling at what he called being "tortured," Nash would drop even
apparently
effective medications upon discharge, prompting a new cycle of troubles and
treatments.
In 1960, convinced he was a political prisoner, Nash traveled to Europe,
determined to hand in his passport at a U.S. embassy. Initially he was talked
out of it; later he simply threw the document away.
Prize
Fight
I expected little more than a good read from Nash's biography; what I got was
a lesson about the shattering impact of schizophrenia. But I didn't stop to
think about my own behavior toward Nash until I got to the account of the
battle over his nomination for the Nobel prize.
The Royal Swedish Academy of Sciences awards the Nobel prizes after secret
negotiations by several committees. But what happened to Nash was such an
indictment of the participants that some later felt compelled to reveal the
story.
When Nash's candidacy was first considered in the late 1980s, the selection
committee immediately expressed concern about incurring embarrassment if they
awarded the prize to someone with schizophrenia, even though Nash's work in
game theory was finished in 1951, several years before the onset of his
illness.
The committee dispatched a scout to Princeton with one mission: to determine
whether the rumors that Nash was recovering were true. Nash was eccentric,
the member reported back, but no longer crazy. His recovery had begun
gradually in the 1980s -- no one knows precisely why or how. But the key
ingredients, in his biographer's view, were likely the gentle support of his
wife and the sheltered Princeton campus. One day, the story goes, Nash
suddenly turned to a professor to whom he'd never spoken before and remarked
that he'd seen the man's daughter quoted in the newspaper.
The committee proceeded with Nash's application, but not without resistance.
One member claimed to be skeptical of the value of Nash's work on game
theory, despite the fact that it was already being applied on an
international scale in commerce and diplomacy. When the nomination came
before the full body for a vote, Nash was awarded the Nobel prize in one of
the closest votes in the Academy's history. Debate was so bitter that it
delayed the usually punctual news conference to announce the winners.
After reading this, I realized that if members of the Academy -- so educated,
so worldly, so refined -- could so nearly let a personal history of mental
illness blind them to an individual's accomplishments, then others could,
too. Including me. Even if my long-ago reaction to Nash was instinctive,
unlike the committee's prolonged consideration, it was no less disturbing, no
less a violation of a person's worth.
Shame
of Mental Illness
Why had I thought only of avoiding Nash when I passed him years before? Why
had I reacted with revulsion, not empathy? Why had I not stood up to those
who ridiculed him, who dismissed him as a freak?
These thoughts became enmeshed in my writing of the 1999 surgeon general's
report.
Stigma, I wrote, is "the most formidable obstacle to future progress in the
arena of mental illness and health. . . . It is manifested by bias, distrust,
stereotyping, fear, embarrassment, anger and/or avoidance.
"Stigma leads others to avoid living, socializing or working with, renting
to, or employing people with mental disorders, especially severe disorders
such as schizophrenia. . . . It reduces patients' access to resources and
opportunities (e.g., housing, jobs) and leads to low self-esteem, isolation
and hopelessness. It deters the public from seeking, and wanting to pay for,
care. In its most overt and egregious form, stigma results in outright
discrimination and abuse. More tragically, it deprives people of their
dignity and interferes with their full participation in society."
It's right there in print. Little did anyone know I was at that point writing
a kind of self-critical autobiography.
But still, no dogmatic report can translate realizations into personal
behavior.
As passionate as I've become about the plight of mental illness, I'm no
Mother Teresa. I do not now run over and greet wild-eyed strangers I see on
the street; they still make me uneasy. But now I am willing to pay slightly
higher taxes or insurance premiums if that's what's needed to get them
adequate psychiatric care -- far more humane and effective these days than
what Nash experienced. And I know now their humanity is inextricably
connected with mine.
As I was writing the section of the surgeon general's report dealing with the
consequences of stigma, I felt almost as though I were shaking myself free of
a lifelong hangover. Even if my insensitivity toward Nash made no difference
to him at the time, it had tacitly endorsed others' disregard of him and
condoned a kind of social injustice.
Gradually, my ignorance and apathy about mental illness evolved into empathy.
But that transformation did not occur solely by educating myself. It took
Nash's story to rouse me. It took recognizing that I was part of the problem.
I'm still working on it.
Freelance medical writer Miriam Davis is working with
co-author Howard H.
Goldman on a book about the stigma of mental illness.
A
Beautiful Mind - the story of John Nash.
John
Nash's Nobel Prize Speech - autobiography.
