What is important about Nash’s story, for families around the world

Yesterday I got a message from a young man, a part of which was- My whole life is put at stake. My parents are planning for divorce, all due to this paranoia and papa’s stubbornness. I was thinking to get some legal help but I think that will also be like going too hard for him.

Symptoms of distress that manifest as paranoia, hallucinations, delusions, or anything else are extremely taxing for families to deal with, and this message was written by a young man in his early twenties to me, as he desperately tries to hold the family together, in the hope that somehow they would jointly tide over the struggles of one person, and support him. however, the ‘papa’ is adamant both about treatment of any sort- medical, dialogic or anything else. He has a confirmed diagnosis- yet there is no way anyone can have a reasonable situation with him.

John Nash

This brings me to the context of Nash’s story, dramatized for the world by the award winning film, A beautiful mind. What needs to be remembered about him is that notwithstanding his schizophrenia diagnosis, for which he was medicated for 25 years, he actually stopped his medication in 1970– and that is never brought out easily. His wife divorced him once, but married him again, at a later date. She played an important role and as someone said in a recent article that I read, she appealed to his emotional side, rather than his logical/mathematical brain.

I quote from the same article, as follows, while the whole article can be read from the link above, in blue-green.

Family and schizophrenia

Frieda Fromm-Reichmann was a psychoanalyst of German descent, who was forced into exile by Nazism and worked in the USA from 1935. At the end of the 1940s she presented a theory that schizophrenia was the result of growing up with a cold and distant mother. Her theory was never proved through empirical studies, which would not have been easy to do.

Later on this theory was criticised from different perspectives. People said that there could be a number of reasons for an unsuccessful interaction between a mother and her mentally ill child. In addition, by portraying a parent as the reason for their child’s schizophrenia is a way of attributing blame and can prevent a parent from giving the help and support that is required.

The view of schizophrenia as a result of unsuccessful family relationships had many advocates particularly in the USA in the 1940s and 1950s. However, this theory was later abandoned, partly because of subsequent empirical research.

When neuroleptics started to be administered in depot form, it was discovered that treatment could prevent relapses. In the 1970s a group of British researchers showed that the risk of relapse was also affected by the emotional climate in the home environment. A high level of expressed emotions (EE) could increase the risk of relapse, particularly if they were negative, critical expressions of emotions or excessive devotion.

As a result of these studies, a new kind of family therapy was developed that focussed on helping relatives find a supportive way of communicating. This kind of family work has shown to produce good results, unlike family therapy that focuses on conflict.

Returning back to the Indian context, in India we are at a stage of infancy in the advocacy about mental health, and bringing all sides of it to a level playing field. Those who work in mental health from past experiences themselves are only a handful in number and they are extremely marginalized- the dominant voices, understandably belong to psychiatry, which is always on a high tide, thanks to the media, which loves mental health, yet only knows psychiatry as its representative.

The reason for me writing this blog post is to highlight two facts about John Nash’s life which are pertinent from the point of view of caregivers- one that through a supportive environment and by focusing on the functional aspects of a person, rather than their dysfunctional side (and who does not have a dysfunctional side in their personality) one can overcome most symptoms of schizophrenia. Love is an important device to utilize intelligently- yet not in an overly controlled manner the way most people do.

The second fact of Nash’s story is that he was NOT ON MEDICATION since 1970. In other words- thanks to the fact that he could continue in his line of work (mathematician, academic), be socially acknowledged for it (what could be bigger than a Nobel), be supported by his family (wife divorced and remarried him later!). How many families are willing to let their loved ones go off medication? That is the trick question, which everyone needs to consider. So in addition to going off psychiatric medication he was also in an employment. Rehabilitation via finding work, appropriate to one’s skill-set are among the surest pathways for recovery. Everyone needs to work – please mark this.

On the other hand, on a parting note, I will say that even in families where I have been involved, the only real outcomes emerge when families as a whole come into therapeutic conversations, and not individuals come for therapy. In India we have yet to reach that stage in mental health, though it may have been reached in allied domains of children, domestic violence or feminist counseling. Unless families enter the process, of empowering everyone concerned within the family-fold their problems and ‘mistakes’ will continue haunting the most weak people- who will show mental illnesses of this or that classification. Family therapy is not even a concern in India, and that is my concern. And whatever two penny bit counseling is offered to families it is largely done by psychiatry, as psycho-education, whose very purpose is to ensure compliance to drug therapy, as a first line of treatment, rather than address the underlying distress, and its sources.

Advertisements

Published by

prateeksha sharma

Recovery Specialist in Mental Suffering- via counseling. Non Profit Founder. Love to write, tend to dogs, manage a little garden. Largely a hermit. Equally as much- classical musician with fingers in many pies. Parallel work in applied musicology-in particular pedagogy. Also...a Phd researcher

7 thoughts on “What is important about Nash’s story, for families around the world”

  1. Thank you for making it clear the state of mental health treatment in your country. it is shocking, considering the rate of ‘progress’ India’s socio-economic climate is going through and no doubt the effects of that on people’s aspirations, expectations and relationships. not all bad it has to be said, but a different set of pressures that i imagine introduces different dynamics. of course, familial traditions in almost every other country differ somewhat than those in western Europe and the North American continent. this is often seen in a positive way and familial fragmentation negatively. the former is desired i the sense of its natural impact on a person’s emotional and mental struggle. but it takes greater extended acknowledgement and a shifting of traditional values to consider the potential conflicts contingent with familial dynamics and assist people to find a workable solution. some families find this through struggle and good motivation, some through a wider mentality towards evaluation of living beings, which you would expect to be broader in Indian culture. maybe that’s a naive understanding.

    one of your statements illustrates a dynamic that has historically been imposed upon people who struggle with mental illness. this is not to comment on the whole article or what you are aiming for, but this superimposed dynamic seems endemic in all approaches world-wide.

    ‘haunting the most weak people – who will show mental illnesses of this or that classification’

    yes it can be said that sufferers may appear weaker by means of greater susceptibility, or increased sensitivity, but is that only the appearance of the effects of their illness? someone fighting cancer or AIDS may well be in a physically weaker state, but would we class them as weaker in our estimations of their mental conditions or as people?

    this is where i maintain the greatest blockade to effective mental health treatment is LACK OF OWNERSHIP. in other words, the whole ‘them and us’ dynamic that presupposes that people who face mental difficulties, even psychosis, are somehow deficient in comparison with a ‘normal’ (the fallible concept central to all psychiatry) person who does not suffer the same mental difficulties. and presumably faced with every potential experience they cold encounter, would never face as they are ‘normal’. what fosters this gross denial of human nature?

    could this be said of John Nash?

    central to all treatment and consideration should be ‘what facets of encountering these mental difficulties exhibits positive attributes,’ not simply in the coping, but in reactions, sensitivities, communications towards those around them? surely this is the entire point of the movie?

    if official services which are supposed to carry more responsibility with greater research and knowledge, they should be obliged to foster equanimity in the considerations regarding the experience of someone who is more likely having to find extra reserves in coping with their everyday experience. any service NOT promoting this would only sustain the blockades to understanding and supporting such an individual within their primary supportive environment. not that family is always the primary supportive environment. sadly we cannot force people to be broader-minded if they do not wish to be, but i suspect most families would wish to be. the difficulties faced by a sufferer are the difficulties we all face. ownership does not extend merely to family and close associates, but to all of us. and it has to be said, how much we have to learn about our own bigotries and prejudices, by each person who’s outlook cannot conform to some superimposed ‘norm.’

    Mental Health services bear PRIME responsibility for this. if it is not apparent within professionals to whom concerned people turn, then where does it come from? we like to imagine it doesn’t exist but John Nash (off medication since 1970) and millions of other people’s lives are living testament that coping and managing successfully, with or without family or medical support does exist.

    what we should be asking is how and what does that tell us about the power of human capacity under the greatest impositions, mentally, medically and emotionally? Owning those qualities and insecurities as the potential experience for every person living (including, honestly, how many practitioners finally face similar struggles) and promoting them is the only way MH services can be in a position to help families find positive mentality towards these struggles.

    A.Kenton – author of ‘Four Jammy Biscuits Saved My Life Today.’

    Like

  2. Thank you Adrian for bringing up, what could have been construed differently from what the intention is.

    In saying that those who are classified as ‘mentally ill’ as the ‘most weak’ – it is in no way to undermine their intelligence or their abilities, but to say that they are the most vulnerable. I find that in a family, which is let’s say very verbally violent, one child may adapt to the behaviour by an avoidance reaction whereas another child may become depressed. Now the ability of both children to respond is different. So their vulnerabilities are different and they adapt to the same situation differently. This is what I am suggesting.

    I never, ever believe that those who are or have been ‘mentally ill’ have any form of deficiency in them nor do I think they are incapable of doing anything what another person is capable of. In fact I am the most extreme radical in this situation, because I think that people who have been ex-sufferers will someday make the best therapists! that is one of the key pillars of the new approach in counseling that i am working at- for having been there myself I understand the psychosis and the depression of another fairly well myself.

    Be assured there is nothing lacking in anyone, with a label, given by another.

    Like

    1. Hi Prateeksha, i did not meant to implicate you by your statement. it’s apparent from your post that you are in favour of experience being benefitted from in practice.

      what i wanted to convey is the overall lack of ownership within MH. Hence the somewhat bigoted, suspicious and belittling culture of misrepresentation and side-stepping in my country. such an ‘advanced’ system that gives mealymouthed acknowledgement towards service-user input while at the same time undermining it. this shows the true prejudicial and self-serving culture that is now in utter crisis, yet still will not entertain true critical analysis of its practices from outside it’s predominantly intellectual and academic foundation. with the ‘weakest’ (actually far stronger than anyone who prevents true service-user involvement) suffering the consequences; not those in highly paid positions of authority, who seem clueless as to how to instigate a change of culture.

      the very foundation on which MH is delivered and its underlying prejudices needs critical scrutiny before ANY service can recommend how families can more positively view sufferers amongst them. sadly that means telling some people who have studied and practiced and been highly rewarded and credited for that dedicated practice for years, that they’ve been doing it all wrong. and that critical awareness has to come from people they are prejudiced against. where else? who else can tell them?

      many will be appalled at being accused of prejudice, affirming how many patients they have helped in their long careers – but can this be demonstrated? and how many have been adversely affected by their approach? are these things recorded or are the sufferers scapegoated? those who see themselves as not ill always have this get-out clause. hence lack of ownership. this is the endemic disease that needs routing out of all mental health practice. now i know there are non-prejudicial individuals and progressive practitioners doing good work, but this is not the ‘norm’ in MH. the factual norm would curl the Mona Lisa’s hair.

      Like

  3. Dear Adrian

    To be honest, I have not yet figured which country you come from. But that does not take away from the veracity of your words. Service-users, if that is a phrase I want to use for myself or say, ex-users face the same or similar discrimination in most parts of the world. Therefore i feel there is a need to them to align their energies together and stop looking at those with university based knowledge to be their saviours, representatives or spokes-people even if they come from critical perspectives.

    I must share with you that there is a very fascinating line of reasoning that has been developed by two, mutually independent groups of therapists- one is Michael White from Australia, the founding father of the narrative therapy practice and the other is the Collaborative Model of Counseling, which is part of a (post modern) tradition being developed in many parts of the world, whose principal advocates are people coming from a social constructionist perspective. In particular Harlene Anderson, Tom Andersen. Though one is a person of psychology, another psychiatry, the approaches they are referring to- from the point of view of training of new therapists are extremely wonderful.

    But you are right again that the work done by such paradigm shifting people is very minuscule as compared to what is needed in the world. But as far as therapy training is concerned, these people are very confined to just one part of the world- alas. And therefore people like me have to get up and take a different view of situations, in my little way.

    Like

    1. Thanks for that information Prateeksha. i will look into them. i am sure there are movements around the globe where individuals are taking more inclusive approaches. initiatives like this are inspiring but most statutory regimes that people in general access here are hamstrung by policy, to implement even the smallest developments and recommendations they agree upon.

      apologies i was not clear. i live in the UK which has seen the implementation of the ‘National Service Framework’ – obliging all services large and small to involve ‘service users’ the now generic term for past/present patients who accessed services (yes i hate it too, it’s symptomatic of a system that seeks to make life convenient for itself. eradicate terms like this and we are faced simply with people) in all aspects of the design, management and delivery of mental health care.

      all it has done is result in marginalising of critical contributors in favour of more compliant volunteers that do not seek to disrupt existing regimes, but gain personal esteem from being a member of the club. NHS NSF implementation managers (installed to promote SU involvement) have even ignored or minimised input from individuals and large critique groups but done so in such a political way as to appear to have their consent. even actively inciting devision. and often only putting issues before such people after decisions had already been ratified amongst service-providers.

      i only mention this as a warning for any other developing system that might see the benefit in following suit. it amounts to – once they could ignore you without consultation, now they can ignore you and say it is after consultation. which is worse? we only have to imagine what kind of professional that calls upon to implement this approach?

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s