Assignment 3.

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Assignment 3.1: The Soloist

Michelle White

Wake Forest University

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The 2009 movie “The Soloist,” starring Jamie Foxx and Robert Downey Jr, is a

hauntingly beautiful portrait of a mentally ill man, his intense passion for music, and the

struggles of the people who care about him and wish to help him. It is a harrowing portrayal of

schizophrenia that provides audiences with as close of an experience with the disorder as one can

get without actually becoming mentally ill themselves. The film asks difficult questions and

doesn’t shy away from making commentary on social issues. “The Soloist” also presents the

important theme that mentally ill individuals do best when they have a person they trust in their

corner with a genuine interest in them and their wellbeing.

One of the movie’s main figures, Nathaniel Anthony Ayers Jr, is one of the most accurate

portrayals of schizophrenia available in media. He meets all of the DSM-V criteria for the

condition. Criterion A states that the individual must exhibit “two (or more) of the following,

each present for a significant portion of time during a 1-month period (or less if successfully

treated). At least one of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3.

Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or

catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition)”

(American Psychiatric Association, 2013). Nathaniel demonstrates delusions when he believes

the soup his sister has made for him is poisoned and when he indicates that he believes that Steve

Lopez is his god (Joe Wright, 2009). He consistently experiences auditory hallucinations during

the film, including hearing voices during orchestra practice and in his apartment that call his

name and tell him things like “they’re all looking at you,” “run away,” and “they can hear your

thoughts” (Joe Wright, 2009). While these are the most prominent of Nathaniel’s symptoms that

meet criterion A, he also exhibits behaviors that fall under 3. Disorganized speech and 4. Grossly

disorganized or catatonic behavior. Throughout the film, Nathaniel’s speech will ramble from
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Beethoven to Chicago to not being able to play music in winter weather to Los Angeles (Joe

Wright, 2009). He runs out into traffic to pick up discarded cigarettes, yells at cars driving by,

and enters an almost catatonic state where he ignores or can’t hear anyone talking to him while

playing the violin (Joe Wright, 2009).

Furthermore, Mr. Ayers meets the schizophrenia criteria B through F, as specified by the

DSM-V. Criterion B states, “For a significant portion of the time since the onset of the

disturbance, level of functioning in one or more major areas, such as work, interpersonal

relations, or self-care, is markedly below the level achieved prior to the onset” (American

Psychiatric Association, 2013). Throughout most of the movie, Nathaniel is experiencing

homelessness, has no job, does not have significant relationships with others (except Steve

Lopez), and struggles with elements of hygiene (Joe Wright, 2009). Criterion C reads,

“Continuous signs of the disturbance persist for at least 6 months. This 6-month period must

include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e.,

active-phase symptoms) and may include periods of prodromal or residual symptoms. During

these prodromal or residual periods, the signs of the disturbance may be manifested by only

negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated

form (e.g., odd beliefs, unusual perceptual experiences)” (American Psychiatric Association,

2013). Based on the flashbacks that we see in the film, it is evident the Nathaniel has been

experiencing symptoms continuously since he was young adult – possibly starting with seeing a

burning car through his window (Joe Wright, 2009). This also contributes to the DSM-V

specifier of “Continuous” which specifies that the client has “symptoms fulfilling the diagnostic

symptom criteria of the disorder are remaining for the majority of the illness course, with

subthreshold symptom periods being very brief relative to the overall course” (American
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Psychiatric Association, 2013). Criterion D states, “Schizoaffective disorder and depressive or

bipolar disorder with psychotic features have been ruled out” (American Psychiatric

Association, 2013). Nathaniel does not exhibit the depressive or manic symptoms associated

required to meet the criteria for those disorders. Criteria E reads, “he disturbance is not

attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or

another medical condition” (American Psychiatric Association, 2013). Throughout the film,

Nathaniel expresses a dislike of cigarettes and does not display any evidence of utilizing drugs –

additionally, the scene with his sister and the soup implies that Nathaniel is off his medications

and conversations later on in the movie confirm his refusal to take medications (Joe Wright,

2009). Finally, Criterion F states, “If there is a history of autism spectrum disorder or a

communication disorder of childhood onset, the additional diagnosis of schizophrenia is made

only if prominent delusions or hallucinations, in addition to the other required symptoms of

schizophrenia, are also present for at least 1 month (or less if successfully treated)” (American

Psychiatric Association, 2013). At no point in the film does it state that Nathaniel has autism

spectrum disorder.

As part of Criterion B, Nathaniel’s interpersonal skills have been greatly impacted for a

significant period of time as a result of his symptoms. During the film, his only friend is a

reporter named Steve Lopez. Initially, a Julliard alum living on the streets with mental illness

was just another article for Steve. It felt a bit exploitative and way for Steve to avoid writing

stories he wasn’t interested in. However, after seeing how music affected Nathaniel, Steve began

to see the articles as a way of helping Nathaniel and better his station in life. In many ways, Mr.

Lopez is helpful to Mr. Ayers. His articles result in a cello being sent to Nathaniel, money being

put by the LA government toward the Skid Row area, Nathaniel receiving an apartment, and
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Nathaniel getting the opportunity to see a professional orchestra play (Joe Wright, 2009).

However, Steve tends to view Nathaniel in the same manner he would a regular friend and

forgets to consider his needs that accompany his schizophrenia. Steve regularly gets frustrated

with Nathaniel and snaps at him. He doesn’t understand Nathaniel’s need to not leave his cart, he

tries to encourage Nathaniel to live in an apartment without addressing Nathaniel’s fears of not

hearing the city noise, and he forces Nathaniel not to stand outside the LA Times building (Joe

Wright, 2009). At other moments, Steve only views Nathaniel as a mentally ill person without

any autonomy – not as a true friend. He schemes ways to force Nathaniel to meet with a

psychiatrist or take medication for his disorder (Joe Wright, 2009). Additionally, many of the

helpful things Steve does for Nathaniel end up backfiring in one way or another. The cello came

with strings attached – being stored instead of truly given to Nathaniel and being pressured to

stay at LAMP. The fifty million dollars put toward the Skid Row area by the government is used

to fund mass police round-ups and arrests instead of resources for the homeless (Joe Wright,

2009).

Steve only becomes a true friend to Nathaniel at the very end of the film – when he

simply shows up to support Nathaniel, instead of having a biased agenda. In this way, Steve

becomes more similar to LAMP director David at the end of the film. Throughout “The Soloist,”

Steve and David were often at odds over what was best for Nathaniel. Though they are similar in

the respect that they want Nathaniel to be safe, to have his basic needs met, and to recover to

some extent, this is where the similarities end. Steve wants to essentially strong-arm Nathaniel

into safety, having needs met, and recovery. He is pretty manipulative in securing Nathaniel an

apartment and even goes so far as to suggest staging an assault to have Nathaniel committed and

put on medication for two weeks (Joe Wright, 2009). Until the end of the movie, Steve believes
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that there is some miracle solution for Nathaniel. Whether it be medication, getting cello lessons,

performing a recital, or something else, Steve believes that Nathaniel can get back to “normal.”

David, on the other hand, takes a much different approach. While he might seem anti-

diagnosis and anti-medical model at first, he simply focuses more heavily on the sociocultural

elements of the situation. While preparing for a group session, David tells Steve that the people

at LAMP have been diagnosed and medicated for more disorders than he can imagine and that it

hasn’t done them any good (Joe Wright, 2009). This isn’t dismissive of the importance of

diagnosing, but is a reflection of the principle of Maslow’s Hierarchy. How can these individuals

begin to confront mental illness when they lack housing, medical care, food, water, safety,

income, transportation, and so many other necessities for life? David is arguing that it is

pointless to specifically treat a mental health disorder when these other unmet needs are going to

hinder that progress. In this respect, his view of the potential for Nathaniel’s recovery is more

realistic. He wants to provide for Nathaniel’s needs rather than fix his schizophrenia and allow

Mr. Ayers to deal with his mental health on his own terms – even that means never really

addressing his mental health symptoms. Nathaniel will never achieve the level of normal that

Steve hopes for. Even if Nathaniel does eventually take medications and get some his symptoms

under control, the main priority should be that he has his necessities and a level of autonomy. It

leads one to think very critically at the “diagnosing controversy” in the counseling field and

lends itself as strong support for the wellness model. Diagnosis in counseling needs to take social

determinants of health into account and needs to provide guidance for treatment of the whole

person.

Now, all of this is not to say that certain interventions and techniques can’t be used in

attempt to help Nathaniel. As Nathaniel is particularly averse to the idea of medication,

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interventions will have to focus around psychosocial methods. Mr. Ayers could potentially

benefit from one-one-one sessions with a counselor or from group therapy that utilizes cognitive

behavioral therapies. These sessions could be beneficial for teaching Nathaniel methods for

coping with the auditory hallucinations and his delusions. CBT can be “an important adjunct to

medication, especially for those who do not respond to medication, by learning to manage both

positive and negative symptoms of the disorder” (Reichenberg & Seligman, 2016, p.85). Group

therapy, in general, could also be helpful for Nathaniel. It could provide him a support network

of others that understand his struggles and would help with his functioning in terms of

interpersonal relationships. Finally, family-focused interventions could also be a useful tool for

Mr. Ayers. In the film, Nathaniel is able to reconnect with his sister after many years and gains a

bit of clarity over events that recently transpired (mainly his fight with Steve) (Joe Wright,

2009). It is obvious that his sister’s presence provides comfort. Reichenberg & Seligman share

that family-focused psychoeducational programs have demonstrated reductions in relapses and

rates of re-hospitalization, along with increases in medication compliance (Reichenberg &

Seligman, 2016).

While no film is perfect, “The Soloist” does a fantastic job of giving audiences a look

into the world of urban homelessness, mental illness, and the power of human connection.
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References:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental

Disorders (DSM-5®). American Psychiatric Publishing.

http://ebookcentral.proquest.com/lib/wfu/detail.action?docID=1811753

Joe Wright. (2009). The Soloist.

Reichenberg, L. W., & Seligman, L. (2016). Selecting effective treatments: A comprehensive

systematic guide to treating mental disorders (Fifth edition). John Wiley & Sons, Inc.