Schizophrenia and 'the soloist'

Hello Dr. Dan,

I watched the movie, “The Soloist” tonight about Steve Lopez’ relationship with Nathaniel Ayers, the inspirational homeless musician in LA.  I’m thinking you may have seen the movie/read the book.  There are some very compelling scenes depicting some schizophrenic episodes with Nathaniel hearing voices that  clearly distract him from reality.  I’m wondering if, from your experiences and expertise, you can share your insights on the authenticity of the movie, especially regarding the relationship between Ayers and Lopez and the mental illness symptoms of many of the homeless people depicted in the film.

I’m a Theology teacher in a Catholic high school and in my Senior classes, we study homelessness—the realities, the impact, the causes and consequences.  I’m thinking that this movie may be useful.

I look forward to any insights you can offer me, Dr. Dan.

Peace and blessings,

Suzy Eyler

  Dear Susie Eyler,

As you may know, schizophrenia is one of the most disabling of all of the psychiatric disorders.  It affects over 2 million people in this country and about 15% of them are either on the streets or in prison.  Like we saw in the movie, first symptoms occur in men in their late teens and early 20s, later in women.  The hallucinations and delusions that you saw may be the most dramatic symptom of schizophrenia but far from the only ones. These symptoms make most with schizophrenia fearful and withdrawn, but sometimes they can become terrified of what happens in their minds.

And because those with schizophrenia look and act strange and appear timid and frightened, they are at high risk to become victims of violence, especially if they are in prison or on the streets. 

We have known for a while that schizophrenia is a brain disorder that is based in genetics, we are still pretty far from understanding the exact causes.  But that doesn't mean it's untreatable.  New medications are coming out every day with more awaiting approval from the FDA.  There have also been improvements in our understanding of what psychosocial treatments are more effective.  Some of the cognitive therapies are also showing promise.  And with good and consistent treatment, it is estimated that after five years 50% are improved enough that they are able to function independently.  Another 25% are improved but require ongoing supportive therapies.  Of the remaining 25%, about 15% of them are hospitalized.  Sadly, suicide accounts for the other 10%. 

But those statistics are for people who receive treatment.  People who have supportive networks to make sure they get the treatment they need.  And that is not the case with many people who have schizophrenia or other major mental illnesses.  They are left to the care of public institutions that are overburdened, underfunded and unable to effectively meet the needs of those who need their services most.

    Which gets us to Nathaniel Ayers in "The Soloist"

  Given the Hollywood requirement for both drama and relative simplicity, I think they did a pretty good job of portraying schizophrenia fairly.  But what they did beautifully was to portray the humanity behind the illness.

I discovered this as a brand-new psychologist in 1969 when my first patient, Norma, shuffled into my office for the first independent psychotherapy session of my career.  Norma had schizophrenia and had carried the diagnosis for 30 years.  I was 23 years old at the time!  Of course, I had to prove to both of us that I was a competent psychologist who would treat her.  As soon as we started talking, she nailed me.  She told me in her own confused way that I had no idea what I was doing and that I was making it up!  Of course, she was right.  But she wasn't angry or hostile about it as I might have been if the situation was reversed.  Instead, she was more playful which enabled me to get comfortable with the relationship we had rather than the one we were supposed to have.  Norma and I didn't communicate well with words, often we didn't understand each other's language at all, but there was a connection.  Sometimes when the words stopped, we looked in each other's eyes and smiled.

Norma never really got better, and a couple of years later, I heard that she died on the streets.  I cried as I would have hearing any friend had died.

20 years later I was working with a 20-year-old girl who was suffering with depression and an eating disorder.  One day she said "I feel like my soul is a diamond locked inside of a malignant tumor."  Hearing that, I thought of Norma and my eyes welled up with tears.

If Norma's mind was clearer, I am sure she could have said the same thing.  And my guess is that most people living on the streets could also say the same thing.

You see, in my mind, these are not street people or schizophrenics, these are people who experience their lives the same way my 20-year-old patient did.

And our responsibility as a community is to know that and do whatever we can to see that diamond.