Jeremy Clyman Psy.D.

Reel Therapy

The Soloist: Part II

Will the real schizophrenia please stand up?

Posted May 14, 2009

With a few forgivable missteps and obligatory dramatizations, The Soloist portrays schizophrenic Nathaniel Ayers, or as he prefers it, Nathaniel Anthony Ayers Junior, in a richly nuanced and clinically accurate manner.

First things first - does the film cover the basics? Personality traits guide schizophrenic subtype and, indeed the highly intelligent Nathaniel is a paranoid schizophrenic who constructs elaborate narratives pieced together by misperceptions of meaning. To another point, one does not catch schizophrenia like the flu and, indeed, Nathaniel does not wake up one morning with the sniffles and a bad case of schizophrenia. He is strange and inward from birth, choosing to live in the basement and always within close proximity to his musical instruments.

Check and check.

Next, comes the hard part. Does the filmmaker develop Nathaniel into more than just a cardboard cutout of mental illness? Our brains automatically oversimplify, categorize and prejudge, hence, the filmmaker must use creativity to trick us into being unassuming and unbiased. In Nathaniel's introductory scene there is evidence of this cleverness, as we first meet him with our ears. Before our eyes can peg his disheveled appearance as "crazy," we are seduced by his beautiful music. Next, in order for a fair and complex portrayal to unfold we must like Nathaniel. We do. We like him not just because he is played by the inherently likable Jamie Foxx, but because he exudes a childlike ability to love something completely - music.

Only now can we begin to understand realistic schizophrenia and how it is rife with contrasts and paradoxes that can result in a life of dispiriting sadness and surprising hope. On the one hand, his life is an emotional roller-coaster ruled by a pervasive sense of disorganization. Every aspect of functioning is compromised, as relationships, employment, even positive mood states seem to dissolve for Nathaniel faster than they can stick. When he isn't angrily diving into oncoming traffic to pick up charred cigarette butts, he wanders homelessly among the predators and drug addicts of Skid Row, Los Angeles. His estranged sister assumes he is dead. On the other hand, he is not dead. In fact, he feels quite fulfilled playing patched up instruments on street corners.

At the one hour mark, the film boldly moves into rarefied cinematic territory and offers a close-up of Nathaniel's inner-workings. The psychological complexities crystallize and we see that within a hornet's nest of deficits and distress lie a core of idiosyncratic strengths and undeniable beauty. His dirty fingernails move with grace over the musical strings; his nappy hair is meticulously combed; embedded within his incoherent mumblings about Beethoven and loose associations about airplane pilots are razor-sharp insights about the city and compassionate, sophisticated questions about Mr. Lopez.
Further, clinical symptoms are flushed out with a specificity that respects the research. Most filmmakers deviate from the true script of schizophrenia into a far less likely scenario in which the schizophrenic suffers visual hallucinations of monsters harboring nightmarish messages. Nathaniel's hallucinations remain exclusively auditory (the most common form) and manifest in a sincere voice with a simple message that others can hear his thoughts (thought broadcasting).

Check, check and check.

But the case study of Nathaniel is only one of two major narratives juggled by the film. The other plotline is the burgeoning friendship between Nathaniel and Mr. Lopez. Unfortunately, the film fumbles the reality of what it means to be an effective and appropriate support.

A problematic dilemma is that schizophrenics do not believe they are crazy. They are reality impaired in the same way that a blind person is visually impaired. Despite a general stance of affection and patience, all too often Mr. Lopez treats Nathaniel like any other friend and, therefore, unintentionally models what not to do. He bulldozes over Nathaniel's paranoid refusal to live in an apartment with chants of "you can do it;" he ponders deceptive ways of forcing Nathanial onto psychiatric medications; he does not discuss openly with Nathaniel a legal document that diagnoses him as a schizophrenic. These missteps cause difficulties in the same way that grabbing a blind man's walking stick cause difficulties. As a result, problems are prolonged and paranoia is reinforced.

In "I am Not Sick, I Don't Need Help!" David Schaich teaches an effective response to schizophrenic behavior that involves listening, empathy, agreement and partnering.  Mr. Lopez, as portrayed in the film, would have been wise to read it. Listening could have solved the apartment issue - all Mr. Lopez needed to do was assure Nathaniel that the apartment would not cut out the city noise. Empathy could have prevented the climactic fistfight - all Mr. Lopez needed to do explain the legal document clearly before letting Nathaniel read it on his own and develop predictably paranoid fears. Partnering could have solved the medication compliance issue - all Mr. Lopez needed to do was find common ground and say, for instance, "The hallucinations seem to disrupt your ability to play music - your favorite thing in life. Maybe we should at least discuss how medications can make you a more efficient musician." These concepts can help someone like Mr. Lopez speak the language of schizophrenia and, in turn, help schizophrenics like Nathanial live happier lives. On a recent NPR interview the real-life Mr. Lopez expressed his hope that Nathaniel, who continues to resist medication, might one day reconsider. Such reconsideration can flourish with a conversation between two trusting friends about what's in it for Nathaniel.

More Posts