The Soloist— An Ethical Dilemma of Schizophrenics

The society has never fully pardoned the pain the schizophrenics have been suffering: from social prejudices to perfunctory mental hospital intakes and such, the rights of the mentally ill have been severely disenfranchised. Especially when it comes to non-compliant patients, should the treatment be enforced against their free will? Even though it is the most ideal to provide therapy sessions and treatments right away for recovery, the humanitarianism view would render the freedom upon the patients to choose. The movie The Soloist has provided insights into the above dilemma.

Steve Lopez, a columnist looking for some fresh material, ran into Nathaniel Ayers in Pershing Square in Los Angeles. A bizarre-costumed man was playing his violin under a statue of Beethoven with a wheelbarrow in the distance filled with his all his possessions, which fascinated Lopez and he decided to write a story on this homeless musical frantic. In their relation to each other, Lopez quickly found out his suffering from schizophrenia while he was showing the positive symptoms: disorganized thoughts like word salad with abruptly shifted topics. His sympathy was soon evoked after having realized that Nathaniel was experiencing a psychotic phase which is the second stage characterized by positive, negative, and disorganized symptoms. Lopez sent Nathaniel to the Lamp Community in Los Angeles, a shelter for the homeless and mentally ill. Lopez wanted to rescue Nathaniel from his mental crisis to prevent him from being in danger on the streets of Los Angeles. However, Lopez was not in control of the situation since Nathaniel didn’t want any of his help at all. At the end of the day, all Nathaniel ever needed was some genuine social connections since he had lost contact with his family and especially his sister. Thus the treatments besides cognition therapy, are focused on social connections like family-oriented aftercare and social skills training. All Nathaniel had was his broken violin and his music dreams, which stayed with him in the existence of solitude. At this point, he refused the help as a way to retain his last piece of sanity for the indignity. “Having more social connections can change brain chemistry and help Nathaniel”. Indeed, the inclusion of a friend like Lopez was already the savior for Nathaniel to rebuild his social bonds.

It is noticeable that there are two very different emotions coming together in Lopez. First of all, with utilitarianism, he wanted to find a proper story for his column and thus approached Nathaniel. Consequently, when he ran his own page, he did not hesitate to take care of Nathaniel, but also establish a spiritual relationship with him. But as Nathaniel pinned his hopes on Lopez, he began to reflect on their relationship: “Do I need to be Nathaniel’s savior?” Lopez couldn’t bear to leave him in the dirty streets. He gave Nathaniel the key to a new apartment and even hired a musician to teach him the cello. In addition, he managed to introduce Nathaniel to therapies and medications to set him free from the torment of schizophrenia. However, none of this was under the consent of Nathaniel himself. In the article written by Latha, K. S., under the capability of the patients,

All treatment requires informed consent. There is a presumption that all patients have capacity unless demonstrated otherwise. A capable individual has the right to decline treatment, even if this decision may negatively affect his or her health or otherwise reduce his or her life span. (p.7)

Granted, the normal public would be bewildered by Nathaniel’s rejection while wondering why he chose to stay homeless and reject the help in return for nothing. The truth is that even though Lopez was kind enough to help, he forgot to respect Nathaniel’s personal choices. According to the essay, Nathaniel had full capacity: after the argument with Lopez, he understood what a recommended treatment was, as well as its benefits, risks, and consequences; last but not least, Nathaniel was also able to make choices on his own (p.8). In Nathaniel’s point of view, Lopez could be his friend, but he didn’t have the right to take his fate by the throat. As for his uneasiness, his vagrancy, and his madness, they were his own beauty, and his world belonged to those auditory hallucinations. Being plagued by schizophrenia, he was constrained by society; his voices were full of contradictory reproaches, withdrawal, and obsession. But he had his own set of senses, he didn’t need to immerse himself in other people's world; however, he couldn’t completely ignore the reality. What he truly desired was not a unified God but someone who could look at his world with warmth and respect.

In conclusion, the movie has well-depicted a schizophrenic’s lot. From the prodromal state to the psychotic phase, the movie has already foreshadowed these elements. Ever since a teenager, Nathaniel had shown social withdrawal and was so wrapt in music that he would hide in the basement to practice music while his family was holding family events upstairs. Nathaniel became the pride of his family when he successfully got accepted in the Juilliard School of Music. However, the next year, he began to hear auditory hallucinations which continually undermined him and eroded his confidence. The symptoms that were active in this stage were exhibited: positive symptoms like disorganized thoughts, irrelevant responses, spelling names, and so on. However, coming back to reality, not everyone could be kind-hearted enough like Lopez to help out the schizophrenics; most people still harbor adverse prejudices and misunderstandings towards the group. When people see somebody with bizarre behaviors like Nathaniel, they would probably stay away and keep their distance. What’s more, not everyone is lucky enough like Nathaniel. At least he has a music dream while other schizophrenics’ hopes are simply doused by the mental illness itself as well as societal neglect. Not to mention being homeless, it is one disaster after another since symptoms might worsen; the homeless environment is a very hazardous place for the patients since they could be addicted to drugs that are prevalent on the streets as well as getting physically abused in the shelter for their mental illness.

References

Latha, K. S. (2010). The noncompliant patient in psychiatry: The case for and against covert/surreptitious medication. Mens Sana Monographs, 8(1), 96. https://doi.org/10.4103/0973-1229.58822