Mental Health in Movies: A Critical Analysis of the Portrayal of Schizophrenia in “The Soloist”

Over the years, there have been various movies and television series depicting the living circumstances of individuals living with mental health conditions. However, some of these depictions have been criticised by the public and movie critics for over-dramatizing the severity of mental health conditions portrayed. Dramatizing the severity of mental health conditions portrayed can create negative connotations associated with them such as characteristics of “madness” and the “horrors” of psychiatric treatments (Stuart, 2006). Negative connotations derived from inaccurate portrayals of mental health conditions pose negative implications to not only healthcare professionals but also to the quality of life of individuals living with mental health conditions and their care partners (Corrigan, 2004). Drawing upon insights from psychiatry and clinical psychology, I deep dive into the accuracy of one of such mental health condition (schizophrenia) depictions in a contemporary film – The Soloist, a 2009 film starring Robert Downey Jr and Jamie Foxx.

The Soloist: A Film Summary

The Soloist chronicles an unlikely friendship between Nathaniel Ayers – a cellist prodigy who developed symptoms of schizophrenia – and Steve Lopez, a journalist for the Los Angeles Times in the United States of America. When Nathaniel was an adolescent, he studied in a prestigious conservatory – The Juilliard School – that specialised in cultivating mastery in the performing arts (e.g., drama, music, dance). After displaying delusions and hallucinations which severely impaired his daily functionality and ability to concentrate in recitals, he eventually dropped out in the second year in Juilliard and adopted a homeless lifestyle in Skid Row, a location infamous for sheltering homeless individuals. Then, he chanced upon Steve who was desperately searching for an interesting tale to pen down as a journalist. The film documents the developing unique friendship between Nathaniel and Steve. Throughout the times they spent together, there were countless obstacles and tribulations which threatened their developing friendship, caused by symptoms of schizophrenia on Nathaniel’s side and the lack of understanding about schizophrenia on Steve’s side. Despite these challenges, the film concludes with a mutual understanding and an important lesson between the two, expressed by Steve’s final statement, “… by witnessing Mr Ayers’ courage, his humility, his faith in the power of his art [playing the cello], I’ve learned the dignity of being loyal to something you believe in.”.

A Clinical Analysis of The Soloist’s Portrayal of Schizophrenia

 According to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V; American Psychiatric Association, 2013), schizophrenia is marked as a complex mental health condition with the presence of psychosis as its core diagnostic symptom and varied positive symptoms (i.e., overt expressions of irregular/unusual perceptions/behaviours not seen in typical individuals) and negative symptoms (i.e., lack of various qualities observed in typical individuals). Positive symptoms of schizophrenia comprise of delusions, hallucinations, disorganised thought and speech, and disorganised behaviours; negative symptoms of schizophrenia comprise restricted affect (e.g., anhedonia) and avolition (i.e., inability to initiate goal-directed behaviours) often expressed as asociality (Nolen-Hoeksema, 2017). In the film, there is evidence to conclude that Nathaniel displays all positive symptoms classified under the DSM-V. When applicable, timestamps for occurrences described in this article were cited for ease of reference.

Delusions

Delusions refer to strongly held but implausible beliefs, differentiated with self-deceptions in three domains: implausibility, preoccupation with such beliefs, and acting upon these beliefs when threatened with conflicting evidence (Winters & Neale, 1983). In Nathaniel’s life, he is perpetually flooded with persecutory delusions. Persecutory delusions refer to irrational beliefs about threats, being conspired against, and the anticipation of danger (Freeman et al., 2001). The presence of persecutory delusions in Nathaniel’s life is evident in his fear that his sister was attempting to poison his food and kill him, citing from his words, “That’s hydrochloric acid. If I eat that, it’ll burn me up inside and kill me like a dog.” (Foster et al., 2009, 1:26:00). He displayed signs of intense anxiety and acted upon his delusions by feeding his sister the food she had prepared for him, appearing unconvinced and continued this behaviour despite contradicting evidence that the food was not poisonous (Foster et al., 2009, 1:26:18).

Research suggests that persecutory delusions are not only one of the most common forms of delusions, but also associated with the most distress (Bentall et al., 2008; Freeman et al., 2001). As observed in Nathaniel’s case, deflecting persecutory delusions can be difficult, as individuals experiencing these delusions are largely resistant to compelling facts that contradict their beliefs (Strauss, 1969).

Hallucinations

The most frequently recurring positive symptom in Nathaniel’s life relates to hallucinations, which refer to imagined perceptual experiences not precipitated by the influence of drug substances, sleep deprivation, and stressful events (Nolen-Hoeksema, 2017). Hallucinations can manifest in different types of senses (i.e., auditory, tactile, somatic, visual) and are often tied to experiences associated with criticism and threat (Aleman & Larøi, 2008). In Nathaniel’s life, predominantly auditory hallucinations, and some visual hallucinations, flooded his perceptual experiences. 

Auditory Hallucinations

Instances of auditory hallucinations in Nathaniel’s life were evident on various occasions in the film, from prodromal hallucinations beginning in his recital with a group of musicians in Juilliard (“They can hear your thoughts, Nathaniel.”; Foster et al., 2009, 46:10) and in his place of residence (“I’ll never leave you, Nathaniel.”; Foster et al., 2009, 1:09:40) to acute hallucinations when he was delivering a small recital as a request from Steve (“Nathaniel, you never have been here.”; Foster et al., 2009, 1:24:30). Nathaniel’s auditory hallucinations largely varied in message content (e.g., “Run away, Nathaniel.”, “You’ll never get out of there.”, “Hide for me here, Nathaniel.”) and the gender of the messenger, which is consistent with research suggesting different manifestations of auditory hallucinations as a core characteristic of schizophrenia (McCarthy-Jones et al., 2012). Moreover, his self-concept was threatened by the debilitating nature of these hallucinations, ultimately citing, “You’re of no consequence.” (Foster et al., 2009, 1:36:30).

Interestingly, one of the aforementioned hallucinations (“They can hear your thoughts, Nathaniel.”) appears to coincide with the delusion of thought broadcasting, which refers to a false belief that one’s intrapsychic cognitions are projected for others to witness (Nolen-Hoeksema, 2017). This occurrence was highlighted in a research study that illustrated the complex nature of and close alignment between hallucinations and delusions (Morrison, 2001). Auditory hallucinations are the most common form of hallucination, accounting for 74% of individuals diagnosed with schizophrenia (Sartorius et al., 1986).

Visual Hallucinations

Various instances of visual hallucinations in Nathaniel’s life were evident when he was performing on stage, where he would vision his band members scorning him when he was in Juilliard (Foster et al., 2009, 46:10) and his audience mocking him when he was performing (Foster et al., 2009, 1:24:30). These hallucinations hindered his confidence and directed his attention away from accurately playing the cello. 

Altogether, severe and debilitating hallucinations, as observed in Nathaniel’s case, are associated with greater depressive symptomatology and lower self-esteem, further impairing the functionality of individuals living with schizophrenia (Smith et al., 2006).

Disorganised Thought and Speech

Often referred to as formal thought disorder (i.e., loose association, derailment), individuals living with schizophrenia often experience incongruity and disorganization whilst conversing, transitioning through conversation topics with little to no logical coherence (Andreasen, 1979). In Nathaniel’s life, his conversations with Steve were often incoherent. For instance, in their initial encounter, a simple remark by Steve about Nathaniel’s violin led him to an endless chatter unrelated to Steve’s remark (“You can’t play music in the winter in Cleveland, because of the ice and the snow. That’s why I prefer Los Angeles to Beethoven City, because it never rains in Southern California… I’m flabbergasted about the statue. Aren’t you flabbergasted about this?”; Foster et al., 2009, 9:34). On a separate occasion, jumpy sentences were evident in his remark about living in an apartment (“I don’t need an apartment. Beethoven lives out in the freshness of air. He’s the leader of Los Angeles. “Angeles” means “angels”. You can’t... hold down angels…”; Foster et al., 2009, 1:06:40). Altogether, cognitive disorganization appears to be a prominent characteristic of individuals living with schizophrenia, contributing to the impairment of quality social interactions for these individuals (Addington & Addington, 1999).

Analysis of Schizophrenia Myths

To further ascertain the accuracy of the portrayal of schizophrenia in The Soloist, it is also important to scrutinise misconceptions which could have been (but were not) perpetuated by the film. 

Common Misconceptions About Schizophrenia Perpetuated by the Media

One of the common misconceptions of schizophrenia perpetuated by the media concerns the overrepresentation of hallucinations associated with “virtual monsters” bundled with overwhelmingly macabre messages (Owen, 2012). In The Soloist, Nathaniel’s hallucinations remain exclusively auditory, avoiding such dramatizations.

Another common misconception concerns the causation and treatability of schizophrenia (Owen, 2012). According to various movie critics, contemporary media tend to over-emphasise the role of familial factors and traumatic life events in precipitating schizophrenia, and that schizophrenia can simply be cured with the presence of an empathic individual (Swaminath & Bhide, 2009). In The Soloist, there appears to be no specific causal factor in Nathaniel’s development of schizophrenia. Additionally, he appears to be highly resistant to the idea of seeking treatment, continually rejecting the idea that he has schizophrenia which is a prominent trait of individuals with schizophrenia (Lysaker et al., 2003). The presence of Steve – a perceived empathic friend – may soothe him temporarily but does not alleviate any positive symptoms he possesses.

Lastly, another common misconception concerns the epidemiological development of schizophrenia (Owen, 2012). Frequently, individuals with schizophrenia in films are depicted to be vagrants, lack familial support, and generally come from low social classes (Owen, 2012). Even though these generalisations are true for Nathaniel, he came from a prestigious music background, playing the cello at Juilliard. This was emphasised in the film, which allures viewers with the melodious violin tunes produced by Nathaniel at the beginning of the film. Overall, the unique background of Nathaniel exemplified the fact that schizophrenia does discriminate – everyone can be susceptible to schizophrenia (Lacro et al., 2002).

Altogether, The Soloist accurately portrays symptomatology associated with schizophrenia in a clinically nuanced manner. Under the DSM-V, the diagnosis of schizophrenia is established with the presence of two (or more) of the following symptoms: delusions, hallucinations, disorganised speech, disorganised or catatonic behaviour, and negative symptoms, where the former four were highlighted in the film, impairing the daily functioning of Nathaniel’s life (American Psychiatric Association, 2013).

Consequences of Misrepresentation

The failure to denigrate inaccurate portrayals of schizophrenia is costly. Studies revealed that excessive exposure to media content about mental health conditions (e.g., schizophrenia) from a young age not only cultivates long-term misconceptions about the false associations between criminality and these conditions but also predisposes viewers to display intolerance or implicit prejudice towards individuals living with mental health conditions (Granello & Pauley, 2000). Concerned about social stigmatization, individuals recovering from schizophrenia may experience difficulties reintegrating into society when faced with prejudice, contempt, or fear from the public (Stuart, 2006). 

In essence, the depiction of schizophrenia in The Soloist is, based on this article’s analysis, effective in providing the audience with an overarching preface to the life of an individual living with schizophrenia. Contrasting films which perpetuated stigmatization of mental health conditions through the presentation of misconceptions, The Soloist accurately depicts schizophrenia’s underlying symptoms and continually emphasises how individuals living with mental health conditions can experience normalcy. 

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