A Beautiful Mind (69 page)

He has spoken of being preoccupied by delusions, of being unable to work, and of withdrawing from the people around him. Mostly, however, he has defined it as an inability to reason.
¹²
Indeed, he has told Harold Kuhn and others that he is still plagued by paranoid thoughts, even voices, although, in comparison to the past, the noise level has been turned way down.
¹³
Nash has compared rationality to dieting, implying a constant, conscious struggle. It is a matter of policing one’s thoughts, he has said, trying to recognize paranoid ideas and rejecting them, just the way somebody who wants to lose weight has to decide consciously to avoid fats or sweets.
¹⁴

While psychiatry has made progress in defining disease, definitions of recovery remain controversial. The absence of obvious symptoms, as George Winokur and Min Tsuang wrote, “does not necessarily mean that [individuals] are well, since they still may be suffering from a defect state that is stabilized and with which they have now learned to cope.” But such an assessment, possibly appropriate to Nash’s state in the late 1970s and early 1980s, seems overly pessimistic now. Both the perceptions of those who know Nash and his own indicate a more expansive, farreaching change. “John has definitely recovered,” said Kenneth Fields of Rider College, who has known Nash since the late 1970s and has had a great deal of firsthand experience with people who suffer from schizophrenia.

It would be more accurate to describe Nash’s recovery as a “remission.” And, it turns out, the remission, though miraculous, is not unique. Until a few years ago,
nobody knew much about the life history of people with schizophrenia. The only studies dated to the 1970s and were done by psychiatrists who worked at state hospitals. Since the only older people who were still there to be studied were still sick enough to require constant hospitalization, schizophrenia was viewed as a degenerative disease. Its assault on the brain was thought to continue, more or less evenly, until death.

Manfred Bleuler, a German psychiatrist, was the first researcher to systematically challenge this view.
¹⁵
In a twenty-year follow-up of more than two hundred patients, he found 20 percent “fully recovered.” Moreover, he concluded that long-lasting recoveries did not result from treatment and hence appeared to be spontaneous.

Then a German team at the University of Bonn did a long-term follow-up of patients who had been admitted to one of the city’s psychiatric hospitals during the late 1940s and early 1950s.
¹⁶
Going back to the records, they reviewed the diagnosis of schizophrenia and chose only patients whose histories and symptoms were consistent with modern definitions of the disease. There were about five hundred. Then they located the people or their families and, through interviews with the patients and people who knew them, created detailed portraits of what had happened to them.

Many — about a quarter — had died, mostly suicides. Some were still institutionalized, apparently unresponsive to any drugs or to electroshock treatment, which was used far more extensively than in the United States. Another group was living with their families, but still had symptoms, especially the negative symptoms of lethargy, lack of drive, and lack of interest and pleasure in life. But a surprisingly large group — perhaps a quarter — seemed to be symptom-free, living independently, with a circle of friends and jobs in the professions for which they had been trained or had held before they got sick. Most of these had not been under the care of a physician for years.

The researchers were extremely surprised. As news of the study results spread through the small global community of schizophrenia researchers, a team in the United States at the University of Vermont decided to undertake a similar long-term study. Despite their initial skepticism, their results were remarkably similar.
¹⁷
Ten years after the disease struck, most patients were still extremely sick. Thirty years later, however, a significant minority were leading fairly normal lives. Only about 5 percent conformed completely to the backward image. Most of those who committed suicide, it turned out, did so in the first ten years of the disease. These appeared to be people who got well enough between acute episodes to appreciate the awfulness of what lay ahead of them and succumbed to despair. And most of the damage to thinking and emotion from the disease seemed to occur in those years as well. After that, symptoms seemed to level out.

Subsequent research has somewhat tempered these optimistic conclusions.
¹⁸
All long-term studies are plagued by uncertainties about diagnoses and by differences over what constitutes “recovery.” A study by Winokur and Tsuang of 170
patients, perhaps the most rigorous, found that thirty years after the onset of the illness, just 8 percent could be considered well.
¹⁹

Thus, while Nash’s dramatic recovery is not unique, it is relatively rare.

While none of the studies was able to pinpoint factors that favored recovery, they suggest that someone with Nash’s history prior to the onset of his illness — high social class, high IQ, high achievement, with no schizophrenic relatives, who gets the disease relatively late in the third decade, who experiences very acute symptoms early and gets sick at the time of some great life change — has the best chance of remission.
²⁰
On the other hand, young men like Nash for whom the contrast between early achievement and the state to which they are reduced by the disease is greatest are also most likely to commit suicide. Since suicides are relatively rare for hospitalized patients, Martha may have saved Nash’s life by insisting, during the 1960s, that he be hospitalized. Whether or not insulin shock and antipsychotic drugs, which apparently produced the temporary remissions Nash experienced in the first half of the 1960s, increased the odds of a remission later in life is unclear. While a larger number of patients who got sick during the 1950s, when antipsychotic drugs became available on a wide scale, were among those who were symptom free in late middle age, early treatment with drugs wasn’t a particularly accurate indicator of what would happen later.
²¹
At the same time, Nash’s refusal to take the antipsychotic drugs after 1970, and indeed during most of the periods when he wasn’t in the hospital during the 1960s, may have been fortunate. Taken regularly, such drugs, in a high percentage of cases, produce horrible, persistent symptoms like tardive dyskinesia — stiffening of head and neck muscles and involuntary movements, including of the tongue — and a mental fog, all of which would have made his gentle reentry into the world of mathematics a near impossibility.
²²

Nash’s remission did not come about, as many people later assumed, because of some new treatment. “I emerged from irrational thinking,” he said in 1996, “ultimately, without medicine other than the natural hormonal changes of aging.”
²³

He described the process as one that involved both a growing awareness of the sterility of his delusional state and a growing capacity for rejecting delusional thought. He wrote in 1995:

Gradually I began to intellectually reject some of the delusionally influenced lines of thinking which had been characteristic of my orientation. This began, most recognizably, with the rejection of politically-oriented thinking as essentially a hopeless waste of intellectual effort.
²⁴

He believes, rightly or wrongly, that he willed his own recovery:
Actually, it can be analogous to the role of willpower in effectively dieting: if one makes an effort to “rationalize” one’s thinking then one can simply recognize and reject the irrational hypotheses of delusional thinking.
²⁵

“A key step was a resolution not to concern myself in politics relative to my secret world because it was ineffectual,” he wrote in his Nobel autobiography. “This in turn led me to renounce anything relative to religious issues, or teaching or intending to teach.

“I began to study mathematical problems and to learn the computer as it existed at the time. I was helped (by mathematicians who got me computer time).”
²⁶

By the late 1980s, Nash’s name was appearing in the titles of dozens of articles in leading economics journals.
²⁷
But Nash himself remained in obscurity. Many younger researchers, of course, simply assumed he was dead. Others thought that he was languishing in a mental hospital or had heard that he had a lobotomy.
²⁸

Even the best-informed saw him, for the most part, as a sort of ghost. In particular, with the exception of the 1978 von Neumann Prize — the result of Lloyd Shapley’s efforts — the recognition and honors routinely accorded scholars of his stature simply failed to materialize.
²⁹
One particularly egregious episode in the academic year 1987–88 illustrated just how powerfully the perceptions of Nash’s mental illness worked to reinforce his marginalized status, even in the field, economics, that he had helped to revolutionize.

Being elected a Fellow in the Econometric Society is, as one former president of the society put it, tantamount to getting one’s membership card in the club of bona-fide economic theorists.
³⁰
By 1987, there were some 350 living Fellows, including every past and future Nobel Laureate to date but Douglass North (presumably excluded because he is an economic historian, not a mathematical economist), as well as every leading contributor to game theory — Kuhn, Shapley, Shubik, Aumann, Harsanyi, Selten, and so forth — but not Nash.
³¹
In late 1988, Ariel Rubinstein, a recently elected Fellow, was surprised to discover this “historic mistake” and promptly nominated Nash.
³²

The nomination came too late for the November 1989 election. Further, the society’s bylaws required any candidate proposed by a sole sponsor to pass muster with the society’s five-member nominating committee — one of whose main tasks was, in any case, to “determine whether previous nominating committees had overlooked people” and to correct such oversights.
³³
As a result, the nomination was forwarded to the committee, which took it up in the spring of 1989. By then, Rubinstein, a game theorist who holds professorships at the University of Tel Aviv and Princeton University, was a member of the committee. The other members, all professors of economics, were Mervyn King at the London School of Economics (also a vice-chairman of the Bank of England), Beth Allen at the University of Minnesota, Gary Chamberlain at Harvard, and Truman Bewley at Yale.
³⁴

The proposal to put Nash on the ballot sparked an intense controversy between Rubinstein and the rest of the committee, one that dragged on for months. From the start, the issue was Nash’s mental illness. Mervyn King said in 1996: “People felt in some vague sense this was relevant.”
³⁵
Other committee members pointed out that Nash had no recent publications, was not even a member of the society, and was unlikely to participate actively, if elected.
³⁶
At one point Truman Bewley, the committee’s chairman, wrote to Rubinstein, “I doubt [Nash] would be elected, since he is well known to have been crazy for years,” dismissing the nomination as “frivolous.”
³⁷
When Rubinstein refused to back down, Bewley asked him to find out more about “the current status of Nash’s health.” After Rubinstein objected that no other candidates were being similarly investigated, Bewley made his own inquiries, calling, among others, his colleague at Yale Martin Shubik, who had known Nash in graduate school and had received some of Nash’s “mad” letters. Bewley reported back to the committee: “Regarding Nash, I inquired and learned that he is still crazy. Fellowship is an activity more than a reward for past work. The fellows are the ultimate governing body of the Econometric Society.”
³⁸

In June, the committee voted four to one to keep Nash off the November 1989 ballot. Rubinstein was the sole dissenter. Beth Allen recalled, “People were asked to give a rank ordering. Nash didn’t make it. Ariel had a fit. He insisted Nash be put on the ballot anyway.” Bewley made it clear that the matter was closed, a decision he later regretted. “It was the wrong decision,” he said in 1996.
³⁹
The episode is reminiscent of the Institute for Advanced Study’s refusal, for many years, to grant a mathematics professorship to the world-renowned logician Kurt Godel.
⁴⁰
But, in that case, there was considerably more justification, since the Institute’s tiny mathematics faculty feared that Godel’s well-known paranoia and terror of decision-making would hamstring its ability to conduct business, which included the selection of each year’s visiting scholars.
⁴¹

The crowning irony of this affair is that when Nash did get on the ballot, in the election for 1990 (because Rubinstein circumvented the nominating committee by submitting a joint nomination with Kenneth Binmore, at the University of Michigan, and Roger Myerson, at Northwestern University),
⁴²
he received, according to the Secretary of the society, Julie Gordon, “the overwhelming majority of the votes.”
⁴³

48
The Prize

You will have to wait to find out [the story of Nash s prize] in fifty years. We will never reveal it. — C
ARL
-O
LOF
J
ACOBSON,
secretary general Royal Swedish Academy of Sciences, February 1997