Ever since I became familiar with the story of John Nash, in some ways I identified with him. As a quadriplegic, I felt many parallels between his brain and my body. Because I have no sensation below my chest, I must be extra attentive to the needs of my body; I cannot take it for granted.
Like many with schizophrenia, Nash has a history of hallucinations. He is able to use his mind to determine what is real and what is a product of the illness. From the beginning, I saw him as somewhat fragile and at risk in light of all the public exposure that came with his Nobel Prize, and the far greater publicity that accompanied A Beautiful Mind, the book and then the Oscar-winning movie about his life. So when I was asked to interview Nash in front of a live audience – a discussion that will be broadcast today at noon – I agreed, on one condition.
I wanted to meet beforehand. Because I felt protective, I didn’t want him to be exposed to a stranger asking personal questions in front of a large audience. And since schizophrenia can take many forms, I thought meeting him might mitigate the risk of embarrassment for both of us.
My first job in this field, nearly 30 years ago, was on a small locked psychiatric unit in Southwest Philadelphia where many patients had schizophrenia. My first patient was named Norma, and she had carried a diagnosis of schizophrenia since before I was born. She could become quite agitated, even threatening, but during her rare lucid moments, we had a good relationship. I think she understood that I was a rookie and didn’t really know what I was doing. I looked forward to our sessions because, with her, I didn’t have to pretend I was competent. Because there was no pretense, we could just hang out. Sometimes I listened to her delusions and sometimes she listened to my confusion. Norma was in her 70s and had no hope for recovery. I was in my 20s and had a bright future. Norma and I were on opposite ends of the social continuum. And we liked each other.
Schizophrenia is a form of psychosis (lack of contact with reality) frequently called a formal thought disorder. Generally accepted as a disease of the brain with a substantial genetic component, schizophrenia affects both thought and perception. In addition to the well-publicized hallucinations and delusions, schizophrenics can have bizarre behavior, confused thinking, or difficulty interpreting their own as well as others’ emotions. Many schizophrenics also are unable to experience empathy or emotional connection with others.
One of my many fears was that Nash would be incapable of abstract thinking. Certainly, as a mathematician he was capable of some types of abstract thinking. But for this interview to be interesting and informative, Nash would have to be able to reflect upon some of his experiences. As our first meeting approached, my anxiety rose.
A week before the interview, we met at a restaurant near his home in Princeton. My first impression was that he looked like his 72 years. He was thin, gray and a bit rumpled, very much a professor. But his most striking feature was his physical awkwardness – almost fragility, which drew me in as we sat across the table from each other.
Nash had no interest in small talk and made very little eye contact throughout our dinner. Nevertheless, he seemed both kind and gentle. My fears about his ability to introspect dissipated when he said, almost spontaneously: “I am quite sad. After all, this is the twilight of my life.” Once I got over the odd bluntness of that statement I felt relieved that Nash was able to reflect on his emotions; the coming interview would probably go better than I had feared. Driving home, however, I realized there was a bigger reason for my relief. Until that moment at dinner, I had been nervous at the prospect of publicly interviewing a famous genius who was also an unmedicated schizophrenic.
When Nash told me how he was feeling, I realized I was with a person, like myself, who is sometimes sad. It was his expression of sadness that helped me see his humanity – and remember mine. After all, the other reason I was nervous was my ego told me I was at risk. And because of the demands of my ego, I forgot that I was spending the evening with a fellow human being who, like the rest of us, was vulnerable. I experienced many emotions during that ride home, but two of the most powerful were affection and frustration. Once I saw this man’s heart, I felt closer to him. I was frustrated because I knew he would likely never be able to have a reciprocal relationship with me.
That combination of affection and frustration was familiar. Shortly before my ex-wife died some time ago, I tried to reconnect with her. We had been divorced for about three years and her health – she had multiple sclerosis and significant cognitive impairment – was deteriorating rapidly. We had married when we were quite young and loved each other very much. In many respects, we still did. But when I saw her that spring day, her eyes were glazed over. I have always felt that if you look deeply into someone’s eyes, you can see the person’s heart and eventually feel understanding and connection. Because of her impairment, I could no longer see her heart. Our human connection, our intimate understanding of each other, was gone.
When Nash arrived at the Free Library of Philadelphia, where we were presenting, I was on stage checking the microphones. Happy to see him, I smiled and said hello and asked how his trip had been. He offered an awkward wave. Once the interview began, I realized that he would be unable to access deeper emotions. For example, when I asked him if he felt he was different from others, I wanted to know if he was lonely. But he responded by talking about how “people are more divergent as they age.” When I asked him about suffering when he was most ill, he responded by talking about the nature of grandiose delusions, and how this grandiosity was almost pleasurable. He reminded the audience that when one feels he is among the most important people in the world, he is not suffering.
In Nash’s case, of course, there was some truth to that statement. His discovery, known as the “Nash equilibrium” – a mathematical prediction for how various opposing players will think cooperatively in a complex situation – has been applied to everything from sports to politics, diplomacy and war, and won him a share of the 1994 Nobel Prize in Economics.
Although the symptoms of schizophrenia vary widely from one person to another, Nash is unusual in some other respects as well. His illness was triggered in his late 20s, whereas it more commonly appears in the late teens and early 20s. And he is quite unusual in managing to live with this disease in the absence of medication. Also worth noting is the unusually strong network of support – Nash’s wife, his academic colleagues, and the community of Princeton – that quite likely played a role in his slow recovery to the stable place he is in now.
As a culture, we tend to turn away from people who look or act differently, or merely fail to make eye contact. We pretend they are not in there, or we make jokes about them. The fallout from this kind of attitude can be seen in the differing insurance coverage for physical and mental illness. It likely is at least partly responsible, as well, for Congress’ repeated failure to require parity in funding for diseases of the body and diseases of the mind. And it is, to some extent, because of those societal decisions that many people are on the streets or in prison simply because of schizophrenia. Were it not for the tenacity of his wife, Alicia, and the rest of his support system, Nash could have been one of the horrible statistics. Sure, making a connection with someone who is mentally ill is difficult. But it can be done.
As the interview progressed, Nash struggled. We talked about his marriage, his feelings about his son’s schizophrenia, and when he first realized there might be something wrong with his mind. We talked about his involuntary hospitalizations, his career, medications, and what he wanted to do with the rest of his life. Although he was unable to answer most of my questions directly, he was surprisingly open to any line of inquiry. It was almost as though he was trying to communicate his humanity using circular and dispassionate language. But when he returned to the theme of the sadness that had come up so suddenly at our first meeting, I saw beyond his tangential thinking and into his heart. Nash wanted more. He wanted more research into the cause and cure of schizophrenia. He wanted his son to suffer less and achieve more. He wanted to accomplish more in the field of mathematics. When he talked about being in the “twilight” of his life, I realized he wanted more life.
Just like the rest of us.
Toward the end of Norma’s hospitalization three decades ago, I brought my 2-month-old daughter, Alison, to work. As I was standing on the ward with this pink bundle in my arms, I noticed Norma in the “day room” gesturing and looking somewhat out of control, her eyes clouded over as usual. We made brief eye contact. Slowly she began to calm down and, over the next several minutes, shuffled toward me, a foot at a time. When she finally approached, her eyes were perfectly clear. She looked at me and held out her arms. I placed my child in her hands and watched as Norma held her close and was incredibly gentle and sweet. Then Norma gave Alison back to me and returned to the day room, where she began posturing.
Those who live or work with schizophrenia are not surprised by this story. They understand that schizophrenia is a brain disorder. Like most mental illnesses, it is not a disorder of the soul.
I don’t know whether Norma was helped by my therapy or whether John Nash felt any kind of connection with me. But when I was able to make eye contact with them, I became more human.