However, when the subject matter pertains to the devastating mental disorder schizophrenia, it’s important that the makers of the entertainment are conscientious about how the disease is portrayed. There’s already a lot of stigma about schizophrenia in society, including the misguided notion that schizophrenics are running around with uncontrollable, violent alter egos.

Movies like Me, Myself & Irene (promotional photo shown above) don’t do the schizophrenic community any favors. Other movies, like The Soloist, appear to have given much more thought to the complexities of this disease.

In this post, I’ll try to give a simple explanation of what schizophrenia is and how it affects people’s lives, then I’ll do a rundown of movies and books that tried to depict schizophrenia and either failed miserably or made a respectable effort.

In short, no one can tell us why schizophrenia occurs or what exact biology is responsible. We know what schizophrenia looks like: it’s a breakdown of thought and emotion leading to significant social dysfunction. I think it is safe to say that schizophrenia must be characterized by at least two of the following:

1. Hallucinations. (You hear things [most common], see things, smell or taste things that no one else can sense but you.)

2. Delusions. (You may feel like you’re being persecuted in ways that seem bizarre to others; e.g. “I can’t go out in public because the CIA wants me dead and they have people outside my house watching me.”)

3. Disorganized thinking or speech. (Your train of thought is nearly impossible to follow because your speech is incoherent and you switch tracks mid-thought.)

4. Disorganized or catatonic behavior. (Your behaviors are illogical or inappropriate, or you have a flat affect.)

Paintings of cats done by 20th century artist Louis Wain, over a period in which he developed schizophrenia. The effect of the disease on his perception is apparent in his art.

A combination of factors, from genetics to environment to drugs, have been suggested to explain why schizophrenia afflicts people. A genetic link is almost certainly involved, with over 40% of schizophrenics’ identical twins also having the disease (as compared to the 6.5% risk shared by first-degree relatives). Urban living during child- or adulthood has been shown to increase the risk of schizophrenia two-fold. Cannabis use has even been implicated as having a causal role in schizophrenia development. Half of the world’s 24 million schizophrenics use drugs and/or alcohol to excess, but it is difficult to say how much of this behavior can be attributed to coping mechanisms.

So, I never set out to do a study on the depiction of schizophrenia in entertainment media. But I did come to realize that I’ve seen a number of movies and read a novel that all gave unique representations of this disorder…some of those representations were enlightening, and some were cringe-worthy. Below, I will grade works of art and describe what they did right, or, what they did very, very wrong.

1. Me, Myself & Irene. To be fair, I think I’ve only ever enjoyed 20-25% of Jim Carrey’s
movies. Me, Myself & Irene falls into that 75-80% that is almost unwatchable. The synopsis is that Carrey plays the role of a state trooper who is mild-mannered and lovable, until he goes off of his medicine and becomes abusive and violent. The movie that was “pure fun” for Carrey was viewed by the National Alliance for Mental Illness (NAMI) as “irresponsible.” The premise is that Carrey has “advanced delusionary schizophrenia with involuntary narcissistic rage” and is a “schizo” (according to his love interest in the movie, Rene Zellwegger).

What the audience sees is a guy who is normal and likable while on his medication, but when he’s off of it, he poops on his neighbor’s lawn, suckles at a stranger’s breast, and generally has uncontrolled rage. This, unsurprisingly, did little to help the societal stigma that schizophrenics are violent, dangerous people to be feared. In fact, if anything, Carrey’s character in the movie is closer to being a crude, insulting depiction of someone with dissociative identity disorder (aka multiple personality disorder), rather than someone with schizophrenia.

“We’re certainly not out to make fun of anybody,” Carrey said of the film. No, you’re just propagating negative stereotypes about a horrible disease by targeting the very age group with the peak incidence of the disorder, and telling the world that these people are dangerous (and maybe not so much worth helping, since that wouldn’t be as funny). The movie made $150 million worldwide, so a lot of people got the message.

Grade: F-

2. A Beautiful Mind. It was clear to me that this movie was making a more serious, sincere attempt at depicting schizophrenia. The main character, John Nash, was a real person, an actual schizophrenic, and a Nobel laureate at that. The real John Nash was plagued by paranoia, such as the idea that everyone who wore red ties was part of a communist conspiracy against him. He saw himself as having a special purpose, with schemers and enemies trying to persecute him.

Director Ron Howard goes to great lengths to make the viewer understand the all-consuming paranoia that a schizophrenic can feel. And Russell Crowe garners incredible sympathy for schizophrenics with his role. However, it seems like it was only for entertainment purposes that John Nash was seen to vividly hallucinate multiple individuals with constant personalities that stay with him for years and years. Not only that, but the John Nash of the film thinks everyone else sees his hallucination-people and is shocked to find out that others don’t accept reality as he understands it.

A true schizophrenic is much more likely to have auditory hallucinations, which he doesn’t expect others to hear, than to have “imaginary friends” that he believes are fully real. Still, there’s a reason multiple high school teachers made me watch this movie: it takes schizophrenics seriously, and depicts them as people you can respect and even begin to empathize with, even if the movie does take certain creative liberties in the name of entertainment value.

Grade: C+

3. The Soloist. Also based on a true story, The Soloist portrays Nathaniel Ayers, a  prodigy musician who develops schizophrenia and becomes homeless. Ayers inspires numerous newspaper columns (written by Robert Downey, Jr. in the movie), and I won’t ruin the ending for you, but rest assured that you will laugh with, cry over, and root for Jamie Foxx‘s Ayers.

Although the movie only has a Rotten Tomatoes score of 56% (i.e. it’s deemed “rotten” by movie reviewers), this is mostly attributed to a “lack of narrative focus.” The outstanding performance by Foxx is vibrantly complex and, moreover, clinically accurate. Efforts are made throughout the movie to reference Ayers’s childhood and to show the gradual build of his schizophrenic tendencies even from a young age, when he chooses to live in his basement and always be surrounded by his instruments.

Foxx plays a schizophrenic who is both believable and lovable in The Soloist.

One of the most beautiful things about this movie is that before you know anything about Ayers’s illness, you know about his incredible gift for music, and he’s inherently likable because his love of music is so pure. Even once the viewer starts to see the rapid, unexpected shifts in Nathaniel’s moods or the rambling, topic-jumping nature of his monologues, it’s impossible to write him off as just “crazy” — his insights about his home city of Los Angeles are spot-on, and he asks compassionate and worldly questions during his conversations with LA Times columnist Steve Lopez (played by Downey, Jr.). Even Nathaniel’s hallucinations are exclusively auditory (as is most common with schizophrenia) and his voices tell him that others can hear his thoughts (a belief commonly held by schizophrenics).

Clearly, people did their research into the nuances of schizophrenia before setting out to make this film. One could criticize the nature and believability of the friendship between Ayers and Lopez, but I think this movie does much to propagate a view of schizophrenia that makes more room for compassion, kindness, and aid, and leaves little space for fear and ostracism.

Grade: A

This post is getting long, but I just want to make one more plug for a novel that is truly spectacular in that it not only represents a schizophrenic in a factual, dynamic way, but it makes this representation through the eyes of this schizophrenic’s identical, mentally healthy twin brother. In this novel, I Know This Much Is True by Wally Lamb, the narrator goes through life as the privileged twin, preferred by their stepfather and more quick to make friends, but he is also fiercely protective of his less socially adept brother. As his brother develops schizophrenia, a progression which is written with attention to the typical age of onset and early signs of the disease, the healthy twin shoulders increasing amounts of the burden of care for his brother.

This novel does a stellar job of showing the reader that schizophrenia is far from a disease of the individual; schizophrenia affects everyone in a schizophrenic’s life, and even people outside of it. Add to that the fact that the identical twin brother is mentally sound, and thus suffers from the worry of becoming sick and the guilt of not being sick, and you have a book that paints an impressively complete picture of life with this disorder. Selected for Oprah’s Book Club in 1998, I Know This Much Is True is an intensely emotional, comprehensive, and profound read. Don’t be put off by the daunting 928 pages – it’s worth the time, and I definitely give it an A.

In summary, watch whatever you want, read whatever you want, but when it comes to at-risk groups in our society, know what’s real and what’s just for your amusement.

Stay nerdy

Picchioni MM, & Murray RM (2007). Schizophrenia. BMJ (Clinical research ed.), 335 (7610), 91-5 PMID: 17626963

van Os J, & Kapur S (2009). Schizophrenia. Lancet, 374 (9690), 635-45 PMID: 19700006

Large M, Sharma S, Compton MT, Slade T, & Nielssen O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of general psychiatry, 68 (6), 555-61 PMID: 21300939

What would you say if I told you I could explain Edward Cullen (everything but his hair, that is) using science?

1. “Your skin is pale-white and ice cold.” Edward Cullen is strikingly pale and sometimes uncomfortably cold to the touch – as much would be expected in a guy with anemia. Because of his anemia, Edward has an abnormally low number of red blood cells, or decreased red blood cell function. So, logically, he is pale with a low red blood cell count and, since red blood cells carry oxygen, his deoxygenated tissues feel colder than a normal human’s would. However, although his skin “like marble” may be a source of discomfort in Edward and Bella’s romantic relationship, there is hope yet: scientists have just recently cured a mouse model of sickle cell disease (a type of anemia) using genetic manipulation techniques.

2. “I’ve never wanted a human’s blood so much, before.” Part of what charms Edward so much about Bella is her super delicious-smelling blood, and there you have the crux of their incompatibility. The sympathy that Twilght fans feel for Edward is duly heightened when they intuit that he suffers from porphyria. This disease can be acquired or inherited, and is defined by a defect in heme synthesis. Heme plays a role in keeping blood oxygenated and red, two things evidently defective in cold, pale Edward. What’s more, certain types of porphyria can cause people to experience intense skin irritation while in sunlight. A potential long-ago treatment for porphyria? Drinking human blood, of course.

3.”I don’t sleep.” “Ever?” “No, not at all.” Insomnia is no joke, folks. The side effects of insufficient sleep include irritability, anxiousness, and impaired memory. Insomnia is just one obvious potential explanation for Edward’s persistent brooding moods. And, although Edward’s is probably a severe case (he doesn’t even have a bed in his room), having insomnia really doesn’t make him all that special: according to the National Center on Sleep Disorders Research, 1 in 3 adults suffer from this disorder occasionally. Thankfully, there are plenty of natural and man-made treatments for insomnia — just this month in the journal Sleep, scientists identified a drug doxepin that made it significantly easier for chronic insomnia sufferers to fall asleep and stay asleep. Take heart, Edward.

4. “His skin…literally sparkled, like thousands of tiny diamonds were embedded in the surface.” Perhaps I should’ve been more surprised when I learned that the vampires in Twilght sparkle, but, I wasn’t — it’s probably because I work with zebrafish. You see, there actually is a type of shiny skin cell, although they’re found in certain sea creatures (e.g. some fish, squid, and octopus species), and not in humans. The cells are called iridophores and they are full of guanine crystals that reflect light. So, you know, through some magic of genetic engineering, Edward has the genes to make iridophores (hey, his family is really rich). Because this is the trait of Edward’s that is least damaging to himself or others, I’m cool with it.

As I said earlier, science can’t explain Edward’s hair, but this site can help you recreate the look for yourself:

With posts like Prions and the “science” of zombies, Women defy biology to avoid giving birth on Halloween, and now this one, Try Nerdy is clearly feeling a bit of a Halloween vibe. Indeed, lest I be accused of supporting Team Edward, it seems only fair I cover the science of werewolves soon…because that Team Jacob can be viscous.

Stay nerdy!
Xu J, Peng C, Sankaran VG, Shao Z, Esrick EB, Chong BG, Ippolito GC, Fujiwara Y, Ebert BL, Tucker PW, & Orkin SH (2011). Correction of Sickle Cell Disease in Adult Mice by Interference with Fetal Hemoglobin Silencing. Science (New York, N.Y.) PMID: 21998251

Stölzel U, Stauch T, & Doss MO (2010). [Porphyrias]. Der Internist, 51 (12) PMID: 21104216

Krystal AD, Lankford A, Durrence HH, Ludington E, Jochelson P, Rogowski R, & Roth T (2011). Efficacy and Safety of Doxepin 3 and 6 mg in a 35-day Sleep Laboratory Trial in Adults with Chronic Primary Insomnia. Sleep, 34 (10), 1433-42 PMID: 21966075

Clearly inspired by her personal experiences, Genova‘s novel centers around Alice: Harvard psychology professor, wife, and mother. At 50 years of age she is highly respected amongst her colleagues as a world-renowned linguistics expert, and her problems seem no worse than would be expected – she wants to find more time to spend with her husband, and one of her three adult children wants to move to L.A. and take her chances on acting. However, when Alice starts forgetting little things here and there, like where she last had her Blackberry (and who doesn’t have this problem on occasion?), she tries to explain it away as menopause or maybe even a brain tumor. What she doesn’t expect is to be diagnosed with early onset Alzheimer’s Disease, which rapidly progresses and devastates her mental function.

Ultimately losing her professorship and the ability to recognize her family, Lisa Genova‘s Alice might bring you to tears, but in some ways that’s the point, and Genova has done her job - she makes you aware of the reality of this heartbreaking disease, and convinces you that it could happen to anyone at any level of society. For less than $5, it’s worth getting this novel for the appreciation it gives you towards neurodegeneration research. And maybe it will be as unforgettable an addition to your bookshelf as it was to mine.