April 12, 2002

“Beautiful Mind” inspiration visits Vanderbilt, delivers lecture

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John Nash spoke to Dr. Herbert Meltzer last week at a seminar with residents, graduate students and faculty of the Psychiatry department. (photo by Dana Johnson)

“Beautiful Mind” inspiration visits Vanderbilt, delivers lecture

Dr. Herbert Y. Meltzer said he was intrigued by the life of John Nash Jr., long before the Nobel laureate’s struggles with schizophrenia were dramatized in the Academy Award-winning movie, “A Beautiful Mind.”

“There is nobody else in recorded history who has (Nash’s) degree of brilliance and schizophrenia,” said Meltzer, professor of Psychiatry and Pharmacology who has studied the disease for more than 30 years. “It’s been a fascinating experience to get to know him.”

Last week, Nash, his wife Alicia and his son John Charles Nash, who also has schizophrenia, accepted Meltzer’s invitation to visit Vanderbilt and speak about their experiences. During the four-day visit, Nash, a Princeton University mathematician who shared the 1994 Nobel Prize in economics, gave lectures in mathematics and economics, and toured the Vanderbilt campus and research facilities.

A CBS News crew taped a Psychiatry Department seminar given by John and Alicia Nash, and interviewed Meltzer for a program on schizophrenia that will be broadcast April 21 on the CBS News Sunday Morning program. The program will air locally at 8 a.m. Sunday on WTVF-Channel 5.

Nash apparently recovered spontaneously from schizophrenia—without the aid of medication—in the mid 1980s, more than 20 years after he first became ill. “I gave up my delusions gradually,” he said. “I decided to ignore certain voices.”

Recovery from schizophrenia is not unheard of, Meltzer said. Some people with schizophrenia can regain rational thought and shed their delusions, particularly as they grow older. Strong social support of the kind Nash received from his wife, family and colleagues at Princeton also can increase the chances for recovery, Meltzer added.

In Nash’s case, “his extraordinary intellect … and extraordinary endeavor on Alicia’s part … enabled him to do it without medication,” Meltzer said. “Most people need medication. The nature of the biological processes which account for this degree of improvement remains a mystery.”

Meltzer said he asked the Nashes to visit because “I want to acquaint the university community in Nashville with the story of schizophrenia and one’s ability to make a substantial recovery.”

“Some people with schizophrenia are capable of contributing significantly to society, even world-class scientific accomplishments which have a huge impact, as is the case with Nash.”

Meltzer said he also hoped Nash’s visit would draw attention to Vanderbilt’s efforts to better understand the disease. “Ultimately, the long-term goal is to prevent the onset of schizophrenia by early detection of people at risk, and appropriate interventions,” he said.

About 1 percent of the population experiences schizophrenia, a severe mental illness characterized by disordered thinking, paranoia, delusions and auditory hallucinations—“hearing” voices. To heighten the dramatic effect, Nash’s character in the movie “saw” people who weren’t there, although Nash himself did not experience visual hallucinations.

Meltzer said the movie accurately portrayed how Nash lost the ability to think logically and do economics or mathematics at a high level. Schizophrenia is primarily “a cognitive disorder, a disorder of learning, memory, attention and decision making,” he said.

A new generation of medications, like Clozaril, has dramatically improved treatment of the illness by enabling patients to recover their cognitive abilities, Meltzer said. Earlier drugs, such as Thorazine, helped stop hallucinations but did little to improve attention or memory, he added.

While at Case Western Reserve University in Cleveland, Ohio, in the early 1990s, Meltzer and his colleagues directed the study that established the role of Clozaril in the treatment of schizophrenia when other medications fail. The work, which Meltzer has continued since coming to Vanderbilt in 1996, also suggests that Clozaril significantly reduces the high rate of suicide —about 10 percent—among people with schizophrenia, he said.

Meltzer said recent work conducted with Dr. Robert M. Kessler, professor of Radiology and Radiological Sciences, is showing how drugs like Clozaril block receptors in the brain for dopamine and serotonin—neurotransmitters that play a role in schizophrenia and other major mental illnesses.

Using functional PET (positron emission tomography), a brain scanning technique, the researchers have found that Clozaril-like drugs, including Zyprexa, Risperdal and Seroquel, produce a different pattern of dopamine receptor blockade in cortical and limbic (“emotional brain”) areas.

“That’s the paradox of schizophrenia,” Meltzer said, “too little dopamine in the cortical area and too much dopamine in the limbic system. The newer drugs…increase dopamine function in the cortex, which is important for memory and learning, but reduce excessive dopamine function in the limbic system.

“Our research at Vanderbilt shows that this is due, in part, to their ability to block serotonin 2A receptors,” Meltzer said. Elaine Sanders-Bush, Ph.D., professor of Pharmacology and Psychiatry, “is one of the world’s experts on this receptor and is working with us to determine its role in schizophrenia,” he said.

Two other leading researchers with an interest in schizophrenia will arrive at Vanderbilt this summer: Pat R. Levitt, Ph.D., new director of the John F. Kennedy Center for Research on Human Development; and John C. Gore, Ph.D., professor of Radiology and Radiological Sciences and Biomedical Engineering who will direct the Vanderbilt Imaging Research Center.

Levitt is chairman of neurobiology at the University of Pittsburgh, and Gore directs the nuclear magnetic resonance research center at Yale University. Along with current Vanderbilt faculty including Sohee Park, Ph.D., associate professor of Psychology, “we have the ingredients to make this one of the great centers” in schizophrenia research, Meltzer said.

“I think that during the next decade we can achieve enormous progress in controlling this illness,” he added. “The outlook for patients with schizophrenia is quite hopeful because of new research and making those advances available to people.”

While Nash does not need medication, he said he supports his son taking the drugs. Yet he said, “The ultimate good would be if the mind could learn to function sanely—to think—without depending on drugs.”

“We’re not yet ready for the time when most people with schizophrenia will be treated without medication,” Meltzer responded. “The good news is that we are living in an era when more effective and better tolerated medications are being introduced at an unprecedented rate.”