Book Review

A Beautiful Mind

N Engl J Med 1998; 339:205-206July 16, 1998

Article

A Beautiful Mind
By Sylvia Nasar. 459 pp., illustrated. New York, Simon & Schuster, 1998. $25. ISBN: 0-684-81906-6

It is a common belief that once schizophrenia has bored its way deep into a person's mind, the losses are irretrievable. But over the past decade or so, many patients have had their lives greatly enhanced by the new antipsychotic medications; others, admittedly few, improve in midlife without any treatment whatsoever. One person who seems to have had a substantial midlife improvement is Professor John Nash, who was first brought to the general public's attention by Sylvia Nasar in a 1994 New York Times article. Not only was Nash improving after having been severely ill with paranoid schizophrenia for 30 years, but also he had just won the Nobel Prize in Economics for his stunningly original contributions to game theory. Knowledge of his successful struggle with psychosis brought hope to the millions of people with schizophrenia, their families, and those involved in their care. It also raised intriguing questions about the relation between mental illness and creativity.

Although artistic imagination has been associated, often controversially, with madness for thousands of years, there are now at least twenty studies demonstrating that the increased rates of mental illness in highly creative groups are almost invariably due to manic–depressive illness or other forms of mood disorders. No empirical studies have linked schizophrenia with creativity. Generally, if people with severe forms of schizophrenia have creative ideas, the illness is too debilitating for the creativity to be expressed in a productive, coherent, or sustained manner. Yet on rare occasions, important and original thinking may come from some aspects of schizophrenia. There are people, with less severe or atypical forms of the illness, who see the world in a way it has not been seen before. And rarely, when the world that they can understand is, in turn, newly understood and appreciated by others, we acknowledge that it has been created by genius.

In A Beautiful Mind, Nasar tells the painful yet ultimately remarkable story of Nash and the world around him. Nash, although always a person given to isolation, appears to have won the fierce loyalty of a surprisingly large number of people. The most important of these, his former wife, Alicia, continued to care for him during his many years of psychotic breakdowns, despair, and intellectual isolation.

On one level, Nash's story is a historical road map of some of the most important scientific scenes of this century. Post-World War II Princeton and its Institute for Advanced Study was home to an extraordinary collection of minds and personalities, including those of Albert Einstein, Kurt Gödel, Robert Oppenheimer, and John von Neumann. The last, with his collaborator Oskar Morgenstern, had developed a systematic mathematical description of games as an approach to rational thinking about economics. They described the zero-sum, two-person game that assumes total conflict or “perfect competition.” In their model there was, of necessity, a complete winner and a complete loser. In essence, they described an all-out war between the participants.

Challenged by the flaws and gaps in this approach, Nash, then a first-year graduate student, developed various approaches to the “bargaining problem.” How do parties bargain or compromise to solve a problem? We strike deals out of self-interest. His thinking and the mathematical foundation of his work became, in turn, the foundation of much of modern theoretical and experimental economics. It was Nash's notion that spawned what later became known as the problem of the “prisoner's dilemma.”

Neither Nash's work nor his personal life was able to progress smoothly. Within a few years, he was overtly psychotic. Nash had always been odd, but over time, his behavior became increasingly bizarre and inappropriate. His mullings became utterly incomprehensible, and his actions disturbingly erratic. His delusions and hallucinations were severe, and he was involuntarily committed to psychiatric hospitals on several occasions. The severe symptoms of his schizophrenia lasted 30 years. But gradually, those who knew him noted that he was improving.

It was perhaps no coincidence that the Nobel prize committee, which, not unlike the United States Supreme Court, deliberates in rather arcane secrecy, began at this time considering his past achievements for the highest honor in economics. Nasar, with admirable sleuthing and tenacity, was able to delve into the politicking surrounding the deliberations of the committee. Full of intrigue, the committee became an arena for principle, stubbornness, personal persuasiveness, and not surprisingly, extraordinary pettiness. Although being a bit mad was certainly no disqualification for receiving the Nobel prize, it was quite another thing to award it to a man who was very mad and who could easily embarrass himself or, more disconcertingly, the Nobel Foundation. To the committee's credit, it did award the prize to Nash, who immediately demonstrated his rationality: the afternoon he received the Nobel prize he commented that he hoped it would improve his credit rating.

Nasar has written an intriguing account of a fascinating man, of a “beautiful” mind, and of terrible madness. She has also written a deeply moving love story, an account of the centrality of human relationships in a world of nightmare and genius.

Richard J. Wyatt, M.D.
National Institute of Mental Health, Washington, DC 20032

Kay Redfield Jamison, Ph.D.
Johns Hopkins School of Medicine, Baltimore, MD 21205