"On Healing" April 2002

Posted on Mon, Apr. 29, 2002
With John Nash: A kind of connection
By Dan Gottlieb

Ever since I became familiar with the story of John Nash, in some ways I identified with him. As a quadriplegic, I felt many parallels between his brain and my body. Because I have no sensation below my chest, I must be extra attentive to the needs of my body; I cannot take it for granted.

Like many with schizophrenia, Nash has a history of hallucinations. He is able to use his mind to determine what is real and what is a product of the illness. From the beginning, I saw him as somewhat fragile and at risk in light of all the public exposure that came with his Nobel Prize, and the far greater publicity that accompanied A Beautiful Mind, the book and then the Oscar-winning movie about his life. So when I was asked to interview Nash in front of a live audience - a discussion that will be broadcast today at noon - I agreed, on one condition.

I wanted to meet beforehand. Because I felt protective, I didn't want him to be exposed to a stranger asking personal questions in front of a large audience. And since schizophrenia can take many forms, I thought meeting him might mitigate the risk of embarrassment for both of us.

My first job in this field, nearly 30 years ago, was on a small locked psychiatric unit in Southwest Philadelphia where many patients had schizophrenia. My first patient was named Norma, and she had carried a diagnosis of schizophrenia since before I was born. She could become quite agitated, even threatening, but during her rare lucid moments, we had a good relationship. I think she understood that I was a rookie and didn't really know what I was doing. I looked forward to our sessions because, with her, I didn't have to pretend I was competent. Because there was no pretense, we could just hang out. Sometimes I listened to her delusions and sometimes she listened to my confusion. Norma was in her 70s and had no hope for recovery. I was in my 20s and had a bright future. Norma and I were on opposite ends of the social continuum. And we liked each other.

•

Schizophrenia is a form of psychosis (lack of contact with reality) frequently called a formal thought disorder. Generally accepted as a disease of the brain with a substantial genetic component, schizophrenia affects both thought and perception. In addition to the well-publicized hallucinations and delusions, schizophrenics can have bizarre behavior, confused thinking, or difficulty interpreting their own as well as others' emotions. Many schizophrenics also are unable to experience empathy or emotional connection with others.

One of my many fears was that Nash would be incapable of abstract thinking. Certainly, as a mathematician he was capable of some types of abstract thinking. But for this interview to be interesting and informative, Nash would have to be able to reflect upon some of his experiences. As our first meeting approached, my anxiety rose.

A week before the interview, we met at a restaurant near his home in Princeton. My first impression was that he looked like his 72 years. He was thin, gray and a bit rumpled, very much a professor. But his most striking feature was his physical awkwardness - almost fragility, which drew me in as we sat across the table from each other.

Nash had no interest in small talk and made very little eye contact throughout our dinner. Nevertheless, he seemed both kind and gentle. My fears about his ability to introspect dissipated when he said, almost spontaneously: "I am quite sad. After all, this is the twilight of my life." Once I got over the odd bluntness of that statement I felt relieved that Nash was able to reflect on his emotions; the coming interview would probably go better than I had feared. Driving home, however, I realized there was a bigger reason for my relief. Until that moment at dinner, I had been nervous at the prospect of publicly interviewing a famous genius who was also an unmedicated schizophrenic.

When Nash told me how he was feeling, I realized I was with a person, like myself, who is sometimes sad. It was his expression of sadness that helped me see his humanity - and remember mine. After all, the other reason I was nervous was my ego told me I was at risk. And because of the demands of my ego, I forgot that I was spending the evening with a fellow human being who, like the rest of us, was vulnerable. I experienced many emotions during that ride home, but two of the most powerful were affection and frustration. Once I saw this man's heart, I felt closer to him. I was frustrated because I knew he would likely never be able to have a reciprocal relationship with me.

That combination of affection and frustration was familiar. Shortly before my ex-wife died some time ago, I tried to reconnect with her. We had been divorced for about three years and her health - she had multiple sclerosis and significant cognitive impairment - was deteriorating rapidly. We had married when we were quite young and loved each other very much. In many respects, we still did. But when I saw her that spring day, her eyes were glazed over. I have always felt that if you look deeply into someone's eyes, you can see the person's heart and eventually feel understanding and connection. Because of her impairment, I could no longer see her heart. Our human connection, our intimate understanding of each other, was gone.

When Nash arrived at the Free Library of Philadelphia, where we were presenting, I was on stage checking the microphones. Happy to see him, I smiled and said hello and asked how his trip had been. He offered an awkward wave. Once the interview began, I realized that he would be unable to access deeper emotions. For example, when I asked him if he felt he was different from others, I wanted to know if he was lonely. But he responded by talking about how "people are more divergent as they age." When I asked him about suffering when he was most ill, he responded by talking about the nature of grandiose delusions, and how this grandiosity was almost pleasurable. He reminded the audience that when one feels he is among the most important people in the world, he is not suffering.

In Nash's case, of course, there was some truth to that statement. His discovery, known as the "Nash equilibrium" - a mathematical prediction for how various opposing players will think cooperatively in a complex situation - has been applied to everything from sports to politics, diplomacy and war, and won him a share of the 1994 Nobel Prize in Economics.

Although the symptoms of schizophrenia vary widely from one person to another, Nash is unusual in some other respects as well. His illness was triggered in his late 20s, whereas it more commonly appears in the late teens and early 20s. And he is quite unusual in managing to live with this disease in the absence of medication. Also worth noting is the unusually strong network of support - Nash's wife, his academic colleagues, and the community of Princeton - that quite likely played a role in his slow recovery to the stable place he is in now.

As a culture, we tend to turn away from people who look or act differently, or merely fail to make eye contact. We pretend they are not in there, or we make jokes about them. The fallout from this kind of attitude can be seen in the differing insurance coverage for physical and mental illness. It likely is at least partly responsible, as well, for Congress' repeated failure to require parity in funding for diseases of the body and diseases of the mind. And it is, to some extent, because of those societal decisions that many people are on the streets or in prison simply because of schizophrenia. Were it not for the tenacity of his wife, Alicia, and the rest of his support system, Nash could have been one of the horrible statistics. Sure, making a connection with someone who is mentally ill is difficult. But it can be done.

As the interview progressed, Nash struggled. We talked about his marriage, his feelings about his son's schizophrenia, and when he first realized there might be something wrong with his mind. We talked about his involuntary hospitalizations, his career, medications, and what he wanted to do with the rest of his life. Although he was unable to answer most of my questions directly, he was surprisingly open to any line of inquiry. It was almost as though he was trying to communicate his humanity using circular and dispassionate language. But when he returned to the theme of the sadness that had come up so suddenly at our first meeting, I saw beyond his tangential thinking and into his heart. Nash wanted more. He wanted more research into the cause and cure of schizophrenia. He wanted his son to suffer less and achieve more. He wanted to accomplish more in the field of mathematics. When he talked about being in the "twilight" of his life, I realized he wanted more life.

Just like the rest of us.

•

Toward the end of Norma's hospitalization three decades ago, I brought my 2-month-old daughter, Alison, to work. As I was standing on the ward with this pink bundle in my arms, I noticed Norma in the "day room" gesturing and looking somewhat out of control, her eyes clouded over as usual. We made brief eye contact. Slowly she began to calm down and, over the next several minutes, shuffled toward me, a foot at a time. When she finally approached, her eyes were perfectly clear. She looked at me and held out her arms. I placed my child in her hands and watched as Norma held her close and was incredibly gentle and sweet. Then Norma gave Alison back to me and returned to the day room, where she began posturing.

Those who live or work with schizophrenia are not surprised by this story. They understand that schizophrenia is a brain disorder. Like most mental illnesses, it is not a disorder of the soul.

I don't know whether Norma was helped by my therapy or whether John Nash felt any kind of connection with me. But when I was able to make eye contact with them, I became more human.

Posted on 4/17/2002
God weeps when enmity rules the day
By Dan Gottlieb

Once again there is war in the holy land. Listen to the language, the words infused with hate. There is an old Jewish saying: "People plan and God laughs." Perhaps there is a similar saying in Islam. The message is that we can never assume we know the outcome of something. But the phrase God laughs strikes me. Sometimes I try to picture God laughing. If God does have emotions, what is she or he feeling now? Is this God's war? Certainly not. It is a war of people who feel out of control. People who are filled with terror and desperation.

And hatred.

Hatred demands constant attention. Hatred also impairs judgment and affects one's vision. People who hate eventually see in the enemy only evil, no humanity. When people hate, eventually the battle is about the hatred. Hatred can cause us to be blind to what we are doing and why we are doing it. It is easy to hate and it is hard to stop hating. And we know hatred is contagious. When hatred grows to group hatred - we all know what happens then.

Shortly after Sept. 11, I spoke to a 17-year-old Muslim girl in Philadelphia and asked her if she had experienced any discrimination since the terrorist attacks. She said: "Only once. I was on the subway platform and I saw a woman staring at me with hatred in her eyes." At first this young lady seemed fairly casual about the incident, but when I asked her what she had felt at that moment, she began to cry: "I felt as though her evil stares were going right into my heart and hurting me."

I wondered, too, what was happening in the heart of the woman who was hating.

We have all experienced hatred. It usually happens after we have felt victimized by someone or something. And when we express our hatred, we in turn hurt others. When we hate, it is easy to hurt.

When I work with couples, both usually begin the process being quite clear about their victimhood - they are able to say how they have been their partner's victim, and why. They recite and repeat their injuries in great detail. It's pretty natural. And then they use that to justify their rage, hatred or righteous indignation. It is much harder for them to see themselves as perpetrators - people who cause serious injury to a fellow human being.

Things do not begin to change until people finally understand not only that they are capable of harming others but that they have actually done so. Beyond the guilt and regret, they frequently feel great sadness - and grief. It is almost as though they are mourning the death of the illusion of innocence, or of goodness. It is hard to see ourselves as perpetrators. That's why we work so hard to find evil in others - so we can express our hatred and not see ourselves as hateful.

The truth is: We hurt people. They hurt people. In families, in communities and maybe in the world, real peace will come when we can grieve one another's losses and understand how deeply we have hurt others. To some extent this is what has happened in Germany in recent years. As a people, they experienced palpable grief and regret for the killing of millions more than a half-century before.

According to a Buddhist story, a monk was held up at knifepoint one evening in New York. His life was threatened and his valuables taken. The monk was frightened, then angry, and then he wished revenge. As he walked home, more emotions cascaded over him. By the time he arrived at his monastery, he was weeping. A fellow monk, upon learning what had happened, asked why he was weeping. "I am weeping," the monk replied, "because I realized that if I had been born in that man's life and lived his circumstances, I would have been the one with the knife. I weep for his suffering."

With the holy land at risk of destruction, I pray for the emergence of someone with both power and wisdom. Someone with the compassion to care and the courage to be humble. And I pray for the hatred to give way to the profound grief that I know is waiting to erupt, and then to heal.

Maybe we should have a new saying: "People hate and God weeps."

Posted on Mon, Apr. 1, 2002
We need to take ourselves less seriously - and be silly
By Dan Gottlieb

No one really knows the roots of April Fools' Day, so I can offer a theory without too much fear of rebuttal. Almost every culture has a holiday in which people dress up, wear masks, and be fools. Notice I didn't say act like fools. The masks give us permission to be the fools we know we are. That's why we love clowns - they are clumsy, silly and funny-looking, which is how we frequently feel.

We have at least three holidays like this: Halloween, Mardi Gras, April Fools' Day. We need a lot of practice to deal with our silliness.

One of my favorite jokes is about a fool. It seems this fellow hears about a cruise to Europe for $15. He quickly goes to the dock and pays his fee. He is led to a large galley at the bottom of the ship, where he sees long benches of people who are holding oars. He is shown to his spot on the bench, and once he grabs the oar, a very large man enters the galley holding a drum. With each beat of the drum, the "crew" pulls the oars. This continues day and night for several weeks. When they finally arrive in Europe, our beleaguered fool turns to the person next to him and says: "Excuse me, but this is my first cruise. How much do you tip the drummer?"

The joke works (I hope!) because we can all identify with the fool. All of us have been in situations where we have made bad decisions, said stupid things, or not understood the rules. All of us have been fools.

Young children are comfortable with their silliness. They enjoy making repetitive strange noises, talking to insects and laughing frequently. They giggle, not because anything is particularly funny, just because giggling seems right at that moment. Remember grammar school? Little children are very, very happy. That's why we love them. That's also why they annoy us.

Things change when children become adolescents. Adolescents still have the ability to act and feel silly, but suddenly that silliness feels shameful. So adolescents work very hard to pretend they are cool, and they make fun of kids who are not as successful at hiding their silliness.

This is why the awkward children get alienated. All the kids can identify with the awkwardness and, because of shame, need to keep their distance.

As we all know, things get worse when we become adults. Not only do we pretend we are cool, we pretend we are smart. Now that's silly!

When we have children, for example, we try to convince them that we know what we are doing. Truth is, almost no parents know what they are doing but almost all parents pretend they do. We pretend we are more knowledgeable, more wise, less insecure and more in control then we really are. All of this pretending seems very silly to me. I think everyone knows we are pretending, but if they bring the issue up, then everyone will know everyone else is silly. So we pretend.

Several years ago I was in a session with a family of two parents and three boys between the ages of 12 and 16. During the session, the 16-year-old, after being distracted for about 10 minutes, blurted out: "I think I figured out what's wrong with you people - you're parents!" Then he graced us with his new insight: "I think when you become parents something comes out of the sky and sucks something out of your head!" I told him I was shocked that he had access to this secret information and I accused his parents of betraying the parental oath. I didn't know if I was poking fun at him or myself. Probably both.

Years ago there was a very silly movie called The History of the World - Part I.

In one scene Moses, played by Mel Brooks, came down from the Mount with three tablets. "God has given us 15 Commandments!" he proclaims before dropping one of the tablets, whereupon he adds: "Actually that was 10 Commandments! God has given us 10 Commandments!" Since seeing that movie, I've wondered what would have been on that third tablet. Probably the 11th commandment would have been: "Thou shalt not take thyself too seriously!"

My friend and colleague Dr. Dori Middleman is a wonderful example of someone who is honoring the 11th commandment. She recently discovered she had a small tumor on her pituitary gland and is scheduled for brain surgery. After researching her condition quite seriously and settling upon a course of action, she didn't know what else to do. So yesterday she threw herself a Pituitary Party.

"Traditionally," she wrote in her invitation, "brain tumors have been viewed as undesirable, somewhat dreaded, and even potentially life-threatening. They've gotten a bum rap, in my opinion. I think they give life a purpose . . . and give their bearers something to talk about, but better yet, laugh about."

She asked all her friends to help her have fun with her brain tumor. The cake was shaped like a pituitary gland. One of her friends responded to the invitation by saying: "You need this party like a hole in the head!"

Now that I think about it, I might not be right about everybody having very silly insides and very serious outsides. I might not be right about everybody. But the fact that you read to the end of this column says that I am probably right about you.

Happy April Fools' Day!

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