HLTH510 MSE for John Nash Based on DSM-IV and DSM-V Criteria Assessment 3 Answer
UNIT CODE: HLTH310/510
MSE (Mental State Examination) is a procedure where different areas of mental problems and depressions are identified, analysed and dealt to understand the individual’s situation and plan a future course of action in the form of therapies and medication (McHale, 2011). The movie ‘A Beautiful Mind’ is based on the real life story of a great mathematician ‘John Nash’ who is considered as one of the most brilliant minds of his generation. He worked as a professor at various universities and was employed by several mathematical institutes. However, John developed schizophrenia and his mental disorder got in the way of his success when he isolated himself from the reality. He even won a Nobel Prize for his contribution to the field of mathematics and devoted his entire life to the field of education.
This paper presents a detailed MSE for John Nash based on DSM-IV and DSM-5 criteria to identify his behaviour patterns, perception and cognition, experiences, formulations and activities to understand the cause of his mental state in the form of schizophrenia. Here it is to be noted that instead of relying on any particular reasons to explain the issues, it is observation and analysis that fits as the best tools to achieve the objectives under MSE. A beautiful mind is one of the movies where the storyline is focused only on the mental state of human beings and aims to spread a social message for those dealing with the issues and the people around such patients who can help them to recover and come back to normal life.
Concept of MSE
MSE is a process of medical analysis to understand the mental status of an individual. It is to be noted that psychologically every person is different while some of the things associated with the society and the people around him or her remains similar (Arevalo-Rodriguez et al., 2015). Any mental state going against the basic society norms over a long period of time lands under the psychological issues that needs to be explored and addressed to ensure avoidance of self-harm, harm to others, loss of identity and functionality and overall well being of the individual (Creavin et al., 2016 and Lawton et al., 2016).
Keeping this background in mind, the situation and mental state of John Nash is analysed in the following sections, so that an appropriate assistance can be planned for John and addressing the associated risks.
DSM IV and DSM V Criteria
Considering DSM IV Axis, Under Axis I, all psychological diagnostic categories of paranoid schizophrenia are considered that are applicable in the case of John Nash (Schimelpfening, 2019). The prominent delusions and hallucinations along with prominent symptoms of the psychotic dimension are clearly seen in behaviour of John while he does not display the other characteristics of disorganized speech, grossly disorganized behaviour or negative symptoms. Coming to Axis II and III, there is no depiction of any personality disorder and general medical condition (Schimelpfening, 2019). However, Axis IV related to psychological and environmental factors seems to be affecting John in the form of stress starting from Princeton, stress of not getting the desired placement at Wheeler and stress of becoming a father. Axis V talks of global assessment of functioning scale (GAF) where on admission the GAF score falls between 21-30 clarifying the presence of hallucinations and delusions affecting the behaviour of the patient (Schimelpfening, 2019).
However, applying DSM 5 framework, we can see that John can be categorised being affected by schizophrenia on the basis of a major mood episode where delusional disorder separated from hallucinations result in diagnosis of the mental disorder. John is seen to be functioning proper in his daily life but reports several episodes of delusions making the diagnosis of schizophrenia under DSM 5 single axial framework possible and effective (Kress et al., 2018).
Throughout the movie, the problematic behaviour of John is characterized with hallucinations, delusions, and loss of function as he was shown to be having difficulty in distinguishing reality from unreal experiences. His first hallucination occurs while starting at Princeton but the second one developed after a period of 5 years (Parcher) along with a delusion that he is important to the Cold War battle with Russia. At the same time, he started feeling unrecognized and under appreciated in his career. Such delusions continued developing with his experience of life stressors and resulted in a continuous impact on his personality.
Considering his interpersonal behaviour depicted in the movie, it is quite clear that while remaining isolated and withdrawn from social conventions, John proved to be courageous in his behaviour.
John Nash is well groomed with an average build and normal psychomotor activity. There were no specific or notable movements in his body and therefore the movements and body language appears to be normal throughout the movie. However, it is clear that he preferred maintaining certain kind of distance with everyone and therefore fails to adhere to social conventions.
Speech and Language
Considering the speech of the selected character, John’s speech is noticeably fast and coherent in nature. It remains clear throughout while maintaining a good eye contact but sometimes proves to be monotonous for the audience. It si clear that John remained successful in expressing his feelings to his family and friends but most of the time he prefers to sit alone.
Mood and Affect (Feelings)
It is to be noted that mood is related to the feelings experienced over a long duration while affect is related to the current perceptions of the individual (Alisic et al., 2014).
When John got to know that he is about to become a father, his delusion was changed to a persecutory delusion from the previous state of grandiose delusion.
This is so as John had an over-inflated sense of knowledge, being genius and worth, while being an expert mathematician and expected acknowledgement of his special mind powers. He believed that he is an important part of the discovery and has a great talent leading to his delusion of being vital to the war in decoding Russian code. However, this is changed later to persecutory delusion where he believes that people will harm him and they are chasing him being vital to the war.
During this period he experienced loss of function at workplace and started losing his interpersonal relationships also. He was hospitalized for such condition and was given a combination of insulin treatment and medication to bring the situation under control.
John does not show any signs of self-denial and hostility to others. He is generally safe for self and others as well while remaining caring for his family and friends, but displays some anxious behaviour, depicting his memories of the personal stressors experienced in the form of various hallucinations and delusions. John’s movement to Princeton, preparing to ask Alicia for marriage and discovering of being a father act as precipitators of each delusion. Such stress exacerbated his hallucinations making them prominent in his mind as he started taking the help of these delusions as an emotional support during the moments of stress.
As already discussed, he is not aware of his mental health issues and fails to come out of the delusion leading to his isolation from social arena and real world. It is also to be noted that after taking 50 treatments of insulin, John experienced a loss of social and cognitive functionality where he failed to care for his family and do his mathematical work. After a while when he stopped taking the medicines, he realised that it is possible to rationalize away his hallucinations and delusions while he could control them through rationalization.
Thought and Content (Thinking)
John’s thought process remained coherent within the context of his workplace and occupation as he made sense to his listeners and was able to deliver a composed speech. It is further notices that John is depicting a pattern seeking behaviour in the form of watching a mugging, watching a football team, watching a cluster of pigeons fighting over the bread crumbs and extracting an algorithm for defining the movement of birds. Furthermore, his thought process seems to be very clear with goal directedness in his actions as he approaches the point of conversation directly.
John’s though process does not depict any though blocking ideas but there is a presence of false perceptions where is loose the association between the reality and his imagined world. There are several occasions of visual, auditory and sensory hallucinations with some non-bizarre delusions, for instance, when he considers the military is forcing him to decode the articles and news pieces.
Along with such a clear though process, John generally proved to be non-dangerous for self and others as well.
At the end of the story, John Nash is optimistic about his future life and makes an attempt to rationalize his thoughts and ignore the hallucinations. He is not guilty or looses the interest in his responsibilities, but tries to understand things and move ahead with the thoughts of rationalization. He is seen making some serious attempts to rise from his debilitating fall an regain his life and career. He is looking forward to ignore any psychotic episodes and gets the privilege of teaching again. He is looking forward to a better life where he is honoured by his fellow professors for his achievements in mathematics and even won Nobel Prize for his contribution to the field of study.
John cognitive symptoms are depicted in the form of poor execution of functions where (Santana et al., 2016) he does not speak a lot but once he does it is not with much of emotion showing the onset of schizophrenia. It is to be noted that John’s delusions are generally auditory in nature and the symptoms started showing late while remaining within the accepted range of onset of schizophrenia. His delusions are at peak wile giving a speech about his current research where he looses the alertness and orientation of time and place and ran out of the lecture.
Insight and Judgement
Considering the behaviour of John Nash throughout the movie, it is quite clear that his activity levels largely remains unchanged or unaffected despite of development of the disorder while there were medications to result in volition. There are occasional episodes of bizarre behaviour while any such instance is related to interaction with his delusions and hallucinations.
Taking this further, along with the on going treatment given to John, there are no initial insights into delusions or episodes of hallucinations. There is only some degree of insight available with the realization that Marcee never grows old and this can help in rationalization and perception that can help in identification of delusional thoughts and hallucinations.
Under a biopsychosocial model, the formulation is conceived of a genetic predisposition, result of interaction with environmental stressors leading to development of schizophrenia symptoms over a long period of time. The symptoms are reported in the form of three main hallucinations offering the need of fulfilling an emotive need experienced by the patient. These three hallucinations are reported as Charles (offering friendship and companionship), Marcee (offering unconditional love and support) and Parcher (offering a route to get acknowledged for his brilliance in the field of mathematics).
Further, the major delusion of the patient revolves around geo-political espionage and the concept of being a spy for the pentagon operating through the Parcher’s hallucination. This illusion proved to be grandiose as well as paranoid for the individual allowing him to be an important element for cracking Russian codes.
Stressors appeared in the form of personal life stressors of moving to Princeton, asking his wife for marriage and discovering that he is soon becoming a father. These stressors resulted in hallucination and delusions where the patient started considering these as a source of emotional support to fight the episodes of stressful events.
The difficulties in treatment arise in the form of a higher loss of functionality after being discharged from hospital due to high medications and insulin treatment. He faced tough time due to recurrence of schizophrenia after stopping the medicines and failed to manage his personal responsibilities like caring for his child and wife or perform in his field of expertise. However, he discovered that he could rationalize away his hallucinations and delusions and can control them by ignoring the situation.
John is able to avoid any relapse and control his situation through rationalizing his thoughts. This is important and he should continue doing so along with working and living in a supportive environment. His family especially his wife should focus on being supportive to him helping John to continue with his profession. There are studies showing that up to 60% of individuals with schizophrenia are capable of achieving remission through treatment. It is possible to focus on cognitive behavioural therapy (Bailey and Albin, 2014) to help John reassess his negative thought patterns and trying to replace them with more positive thoughts that will represent reality. It will help him to manage the symptoms without any medication but through therapy sessions (Bailey and Albin, 2014). Under these sessions the focus will be on the developmental theory where the issues are addressed by focusing on faulty thinking, wrong assumptions, and the inability of understanding the beliefs and distortions (Wright, 2009). Such therapy sessions will be beneficial for John in being optimistic and focus on positive real world thoughts while avoiding any self-consciousness in everyday social situations.
It is clear from the case of John that life stressors can become the cause of some serious mental disorders in an individual’s life leading to an impact on his social and occupational functioning. These stressors can become the cause of a paranoid schizophrenia leading to hallucinations and delusions as in case of John Nash in the movie. A detailed and proper but accurate diagnosis is required to provide proper medication and therapy to the patient and this can be achieved through a detailed analysis under various characteristics of DSM IV axis. Such a diagnosis will lead to a detailed mental health examination in the form of MSE analysis that can become the basis or foundation of a future therapy helping the individual to lead a normal life and become adequately functional in his social and occupational arena.