Canadian Psychiatric Association

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Guest Editorial
Culture and Psychiatry, or “The Tale of the Hole and the Cheese”
Morton Beiser
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In Review
Cultural Consultation: A Model of Mental Health Service for Multicultural Societies

Laurence J Kirmayer, Danielle Groleau, Jaswant Guzder, Caminee Blake, Eric Jarvis

(PDF)

Why Should Researchers Care About Culture?
Morton Beiser

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Culturally Competent Psychotherapy
Hung-Tat Lo, Kenneth P Fung

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Original Research
Spirituality and Religion in Canadian Psychiatric Residency Training

Andrea D Grabovac, Soma Ganesan

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Are Mental Health Services for Children Distributed According to Needs?
Régis Blais, Jean-Jacques Breton, Mylène Fournier, Marie St-Georges, Claude Berthiaume

(PDF)

A Random-Assignment, Double-Blind, Clinical Trial of Once- vs Twice-Daily Administration of Quetiapine Fumarate in Patients with Schizophrenia or Schizoaffective Disorder: A Pilot Study
KN Roy Chengappa, Haranath Parepally, Jaspreet S Brar, Jamie Mullen, Ann Shilling, Jeffrey M Goldstein

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Review Paper
Essential Fatty Acids and the Brain

Marianne Haag

(PDF)


Brief Communication
Symptom Outcome 1 Year After Admission to an Early Psychosis Program

Jean Addington, Erin Leriger, Donald Addington

(PDF)


Book Reviews
(PDF)

A Beautiful Mind.
Reviewed by
Vivian Rakoff, MA, MBBS, FRCPC

Staying Human During Residency Training. 2nd edition.
Reviewed by
Emmanuel Persad, MBBS, FRCPC


Letters to the Editor
(PDF)

La mémoire est une faculté qui oublie

Clinical and Family History Markers of Bipolar II Disorder

Re: Clinical and Family History Markers of Bipolar II Disorder

Effect of Olanzapine on the Liver Transaminases

Book Review


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A Beautiful Mind. Sylvia Nasar.1998. New York: Simon and Schuster. 461 p. US$25.00


Reviewer rating*: Very Good

Review by: Vivian Rakoff, MA, MBBS, FRCPC
Toronto, Ontario

Straight off, this is a very good book. It tells a long, complicated story about a complex man and his complex illness. Nasar approaches him with respect but without any tinge of romanticizing or softening his difficult personality, or of glamorizing his story as the tale of a “misunderstood genius.” She tells the story at detailed length, with a dogged scholarly modesty (the bibliography is as large as any literary PhD thesis). One imagines that she decided early in her writing that she would not strive for sparkle and brilliance, which may have seemed narcissistically competitive with a protagonist who had enough brilliance for a faculty of biographers. Similarly, although a mental illness is the core of the story, she avoids anything approaching psychobabble. She doesn’t interpret Nash but slowly portrays him enduring his journey—a journey that resembled one of Northrop Frye’s classic heroes on a quest in a romance. He begins in daylight and clarity, enters a dark kingdom of confusion and trial, and emerges at the end, chastened and apparently benignly altered, into daylight again.

Although Nash’s story hinges on what was diagnosed as a “schizophrenic” illness—an illness with a horribly egalitarian sweep affecting the rich, the poor, the smart, and the stupid in all societies in the world—his disease, like Nash himself, is not typical of anything but himself. It is true that he displayed an odd personality, clumsiness in personal relationships, thought disorder, hallucinations, and idiosyncratic ideas—not unlike other people with schizophrenia—but the beautiful mind that decompensated and appears to have recovered to a major degree is not in the realm of the democratic. His delusions were often as complex as his great achievements.

The same power that allowed him to solve complex abstract mathematical problems with amazing originality generated his bizarre paranoid ideas, and his delusions of grandeur were pathetically close to the grandeur of his intellect. Edmund Wilson applied a mythical metaphor to such gifted, damaged creative souls: he compared them with Philoctetes, the mythical archer who had both an invincible bow and an unhealable wound. Although some individuals with schizophrenia recover, there are few who do. Likewise, they rarely go on to become even as modestly productive (in his own terms) as Nash appears to have done. They seldom resume intimate relationships, as Nash did by remarrying his loyal, long-suffering wife, by acting as a mentoring parent to his son with schizophrenia, and by attempting to reestablish a bond with his older son. In ordinary human relationship terms, the recovered Dr Nash, after receiving the Nobel Prize, somehow launched into a new personhood—a gentler, more socially aware man than the brilliant smart-ass who produced his most remarkable achievements.

The unusual nature of Nash’s clinical career makes one question the diagnosis of schizophrenia. Certainly, he displayed affective disorder patterns, which may have placed him in the category of the many affectively disordered writers and artists whom Jamison described. Further, he was sufficiently bizarre before he developed psychosis and was labelled as an individual with a “personality disorder”—albeit a type of gifted personality disorder that long ago might have been labelled “creative psychopathy.” However, none of these alternative diagnoses truly describe his condition, and we are left with the leaky grab-bag of “schizophrenia.” One can fudge the diagnostic problem by resorting to the label “the schizophrenias.” But that pluralized rubric dramatizes the issue. Are we dealing with a symptom complex that is the final common pathway of multiple causes, or are we dealing with a disease entity, unitary in its etiology and, with luck, having a unitary cure in the future? The person who solves this puzzle will almost certainly journey to Stockholm as Nash did.

Nasar’s great achievement is that she makes a person such as Nash understandable to the educated but unspecialized reader. I am certainly no mathematician, but I discovered the intensely abstract domain of Nash’s mathematical achievements: the universe as a metaphor, a Platonic model of relations and meanings removed from their pragmatic shadows. Like a great poet, a mathematician such as Nash perceives connections and significance that most individuals barely apprehend. Nasar, on the other hand, also clearly maps the moment when the Daemon plummeted effectively to earth, the occasion when Nash’s esoteric contributions to game theory were used to structure the auction of television and radio rights to entirely pragmatic corporations bidding for their prize in the concrete marketplace of the bottom line.

In following Nash’s life, we learn much as we do in reading a great realist novel. We learn about the world of the institute of advanced study at Princeton, the way fellowships and medals are awarded, and brilliantly, the details of the working of a Nobel Prize committee. Nash’s contexts are wonderfully realized, but his essential mystery remains—the mystery of mathematical creativity, of profound intellect, and of the mysterious illness that fragments all gifts of thought, scholarship, and inventiveness.



*Reviewer Rating Scale/ Échelle d’évaluation du réviseur

Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé

 


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