A Beautiful Mind (57 page)

In truth, this was too much to expect. As Seymour Krim, a beat writer in New York, wrote in 1959 in his essay “The Insanity Bit” about his own experiences in mental hospitals, that work “in a flip factory is determined by mathematics; you must find the common denominator of categorization and treatment in order to handle the battalions of miscellaneous humanity that are marched past your desk with high trumpets blowing in their minds.”
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Very soon after that assurance was given, or perhaps even before, Nash was transferred from Payton to Dix One, the insulin unit.
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Ehrlich, the psychiatrist at Princeton Hospital who had recommended Trenton, was convinced that Nash would benefit from the treatments available at Trenton.
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Whether Alicia, Virginia, or Martha gave explicit consent for insulin coma therapy is not clear. “I don’t remember whether the family had to give further permissions beyond the commitment,” Baumecker recalled. “In those days you could do just about anything without asking anybody.”
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Martha recalled that she was consulted: “That was a drastic decision. We were extra wary of anything that might affect his mental abilities. We discussed this with doctors.”
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The insulin unit was the most elite unit within Trenton State Hospital.
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The
unit had two separate wards — one with twenty-two male beds, the other with twenty-two female beds.
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Danskin later described it as looking like “the inside of the Lincoln Tunnel.”
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Its chief had the eye and ear of the hospital’s directors. It had the most doctors, the best nurses, the nicest furnishings. Only patients who were young and in good health were sent there. Patients on the insulin unit had special diets, special treatment, special recreation. “All the best of what the hospital had to offer was showered on them,” said Robert Garber, who was a staff psychiatrist at Trenton in the early 1940s and later president of the American Psychiatric Association. He said, “The insulin patients got a hell of a lot of TLC. In the family’s eyes, insulin had great appeal. Patients’ relatives were overwhelmed.”
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For the next six weeks, five days a week, Nash endured the insulin treatments.
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Very early in the morning, a nurse would wake him and give him an insulin injection. By the time Baumecker got to the ward at eight-thirty, Nash’s blood sugar would already have dropped precipitously. He would have been drowsy, hardly aware of his surroundings, perhaps half-delirious and talking to himself. One woman used to yell, “Jump in the lake. Jump in the lake,” all the time. By nine-thirty or ten, Nash would be comatose, sinking deeper and deeper into unconsciousness until, at one stage, his body would become as rigid as if it were frozen solid and his fingers would be curled. At that point, a nurse would put a rubber hose through his nose and esophagus and a glucose solution would be administered. Sometimes, if necessary, this would be done intravenously. Then he would wake up, slowly and agonizingly, with nurses hovering over him. By eleven in the morning, Nash would be conscious again. And by the late afternoon, when the whole group would walk over to occupational therapy, he would be among them, the nurses bringing along orange juice in case anyone felt faint.

Very often, during the comatose stage, patients whose blood-sugar levels dropped too far would have spontaneous seizures — thrashing around, biting their tongues. Broken bones were not uncommon. Sometimes patients remained in the coma. “We lost one young man,” recalled Baumecker. “We’d all become very alarmed. We’d call in experts and do all kinds of things. Sometimes patients would get very hot and we’d pack them in ice.”
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Good, firsthand accounts of the experience are difficult to find, in part because the treatment destroys large blocs of recent memory. Nash would later describe insulin therapy as “torture,” and he resented it for many years afterward, sometimes giving as a return address on a letter “Insulin Institute.”
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A hint of how unpleasant it was can be gleaned from the account of another patient:

Breaking through the first sodden layers of consciousness … the smell of fresh wool … they make me come back every day, day after day, back from the nothingness. The sickness, the taste of blood in my mouth, my tongue is raw. The gag must have slipped today. The foggy pain in my head … this was my unbroken routine for three months … very little of it is clear in retrospect save the agony of emerging from shock every day.
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It’s true, as Garber said, that insulin patients were coddled compared to others at Trenton. Insulin patients got richer and more varied food. They got special desserts. They had ice cream every night at bedtime. Most had ground privileges and permission to go out on weekend visits. All the patients gained weight. That was considered a good sign. The doctors on the ward were proud that their patients were in good physical health. “People would put on a lot of weight because of the insulin,” recalled Baumecker. “The low blood sugar would make it necessary to give them a lot of sugar and the sugar had a lot of calories. For some of these spindly, skinny schizophrenics it wasn’t such a bad thing.”
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But patients often hated it. Nash’s subsequent obsession with his diet and weight may well have stemmed from this experience of being “force-fed.”

Treating schizophrenic patients with insulin coma was the idea of Manfred Sackel, a Viennese physician who thought of it during the 1920s and used it on psychotic patients, especially ones with schizophrenia, in the mid-1930s.
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His notion was that if the brain were deprived of sugar, which is what keeps it going, the cells that were functioning marginally would die. It would be like radiation treatments for cancer. Some practitioners who used it in the 1950s, when the first effective antipsychotic drugs became available, took the view that insulin shock was more effective than antipsychotics, especially with regard to delusional thinking.
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No one understood the mechanism, but two large-scale studies in the late 1930s found that insulin-treated patients had better and more lasting outcomes than untreated individuals, but evidence for insulin’s efficacy was hardly overwhelming.
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It was in any case riskier and far more involved than electroshock, and by 1960, insulin shock therapy had been phased out by most hospitals as too dangerous and expensive when compared with electroshock. The conclusion was that insulin wasn’t worth the investment of time and money or the risks.

The treatments produced at least temporary improvement in many patients, according to Garber:

They’d see everybody hovering over them, very concerned about them, a feeling of loving camaraderie. I always thought that was very therapeutic. For the first time, somebody cared. Patients became more outgoing, more active. They got to go out on weekend visits. They got ground privileges. I think it helped. Patients were brighter, more alert, more conversational.
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While Nash later blamed the treatments for large gaps in his memory,
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he also told his cousin Richard Nash, whom he visited in San Francisco in 1967, that “I didn’t get better until the money ran out and I went to a public hospital.”
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•  •  •

As dangerous and agonizing as it was, insulin was one of the few treatments available for serious illnesses like schizophrenia which, until the middle of the century, often meant lifelong incarceration. And, like other state hospitals, Trenton was a laboratory for every “cure” that came along. Before the war, Garber recounted:

[We] treated all patients with the tools that were available. Colonic irrigation was still used. So was fever therapy. We had a strain of malaria that we would inoculate patients with. Later on we used a typhoid strain. We’d inject a typhoid vaccine and within hours patients would experience nausea, vomiting, diarrhea and fevers of 104 to 105. We’d do that for eight or ten weeks, two or three days a week. We did it to take the starch out of disturbed patients.

At Trenton the first order of the day, when I arrived at the hospital supervisor’s office at 8
A.M
. was to see who could be moved out of seclusion to make room for another eight to fifteen patients who needed to be secluded. [The rooms] were ten by twelve, lined with glazed tiles, with terrazzo floors. There was a toilet and a sink and a drain in the middle of the floor so that if a patient, say, smeared feces around the room, we could hose it down.

You would do anything to give yourself a handle to bring the patient under control.
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After six weeks, Nash, whose insulin treatments were judged to be effective, was transferred to Ward Six, the so-called rehab or parole ward.
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There was group therapy every day, some recreation, and occupational therapy. “This was the cream of the patient crop,” Baumecker recalled. “There were only about fifteen beds. Other wards had thirty patients per room. Patients got individual attention, went on trips, and were allowed to go home on visits.”
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Nash actually began to work on a paper on fluid dynamics while he was on Ward Six. Baumecker recalled, “The patients made fun of him because he was always so up in the clouds. ’Professor,’ one of them said on one occasion, let me show you how one uses a broom.’ ”
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Alicia visited Nash every week. Once he was allowed out on passes, she took him to her folk-dancing group and out to Swift’s Colonial Diner.
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It was the highlight of Nash’s week.

He seemed to be in remission, clearly no longer a threat to himself or others. Baumecker recommended him for discharge, pointing out that, contrary to the popular belief, “We had to discharge people as fast as we could to get the census down.”
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He was discharged on July 15, a month after his thirty-third birthday.
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A few months after Nash got out, Baumecker called the Institute for Advanced Study and asked to speak to Oppenheimer about whether Nash was now sane. Oppenheimer replied, “That’s something no one on earth can tell you, doctor.”
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41
An Interlude of Enforced Rationality
July 1961–April 1963

When I had been long enough hospitalized… I would finally renounce my delusional hypotheses and revert to thinking of myself as a human of more conventional circumstances.

—
J
OHN
N
ASH,
Nobel autobiography, 1995

A
MAN EXPERIENCING
a remission of a physical illness may feel a renewed sense of vitality and delight in resuming his old activities. But someone who has spent months and years feeling privy to cosmic, even divine, insights, and now feels such insights are no longer his to enjoy, is bound to have a very different reaction. For Nash, the recovery of his everyday rational thought processes produced a sense of diminution and loss. The growing relevance and clarity of his thinking, which his doctor, wife, and colleagues hailed as an improvement, struck him as a deterioration. In his autobiographical essay, written after he won the Nobel, Nash writes that “rational thought imposes a limit on a person’s concept of his relation to the cosmos.”
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He refers to remissions not as joyful returns to a healthy state but as “interludes, as it were, of enforced rationality.” His regretful tone brings to mind the words of Lawrence, a young man with schizophrenia, who invented a theory of “psychomathematics” and told Rutgers psychologist Louis Sass: “People kept thinking I was regaining my brilliance, but what I was really doing was retreating to simpler and simpler levels of thought.”
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It is possible, naturally, that Nash’s feeling reflected an actual dulling of his cognitive capacities relative not just to his exalted states, but to his abilities before the onset of his psychosis.
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The consciousness of how much his circumstances in life, not to mention his prospects, were altered compounded his distress. At thirty-three, he was out of work, branded as a former mental patient, and dependent on the kindness of former colleagues. Excerpts from a letter to Donald Spencer written around the time of Nash’s release from Trenton on July 15 suggest how modest Nash’s view of reality had become:

In my situation and anticipated situation a fellowship … with the idea being that I am expected to be doing research work and studies, etc. seems a better prospect… than a standard academic teaching position. For one thing, much of the conceivable worry over … the implications of my having been in a state mental hospital would be thereby by-passed.
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With the help of Spencer, who was on the Princeton faculty, and several members of the permanent mathematics faculty at the Institute for Advanced Study — Armand Borel, Atle Selberg, Marston Morse, and Deane Montgomery — a one-year research appointment at the institute was arranged.
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Oppenheimer found six thousand dollars of National Science Foundation money to support Nash.
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Nash’s application, datecl July 19, 1961, stated that he wished to “continue the study of partial differential equations” and mentioned “other research interests, some related to my earlier work,” as well.
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