For the next six weeks, five days a week, Nash endured the insulin treatments.25 Very early in the morning, a nurse would wake him and give him an insulin injection. By the time Baumecker got to the ward at eight-thirty, Nash’s blood sugar would already have dropped precipitously. He would have been drowsy, hardly aware of his surroundings, perhaps half-delirious and talking to himself. One woman used to yell, “Jump in the lake. Jump in the lake,” all the time. By nine-thirty or ten, Nash would be comatose, sinking deeper and deeper into unconsciousness until, at one stage, his body would become as rigid as if it were frozen solid and his fingers would be curled. At that point, a nurse would put a rubber hose through his nose and esophagus and a glucose solution would be administered. Sometimes, if necessary, this would be done intravenously. Then he would wake up, slowly and agonizingly, with nurses hovering over him. By eleven in the morning, Nash would be conscious again. And by the late afternoon, when the whole group would walk over to occupational therapy, he would be among them, the nurses bringing along orange juice in case anyone felt faint.
Very often, during the comatose stage, patients whose blood-sugar levels dropped too far would have spontaneous seizures — thrashing around, biting their tongues. Broken bones were not uncommon. Sometimes patients remained in the coma. “We lost one young man,” recalled Baumecker. “We’d all become very alarmed. We’d call in experts and do all kinds of things. Sometimes patients would get very hot and we’d pack them in ice.”26
Good, firsthand accounts of the experience are difficult to find, in part because the treatment destroys large blocs of recent memory. Nash would later describe insulin therapy as “torture,” and he resented it for many years afterward, sometimes giving as a return address on a letter “Insulin Institute.”27 A hint of how unpleasant it was can be gleaned from the account of another patient:
Breaking through the first sodden layers of consciousness … the smell of fresh wool … they make me come back every day, day after day, back from the nothingness. The sickness, the taste of blood in my mouth, my tongue is raw. The gag must have slipped today. The foggy pain in my head … this was my unbroken routine for three months … very little of it is clear in retrospect save the agony of emerging from shock every day.28
It’s true, as Garber said, that insulin patients were coddled compared to others at Trenton. Insulin patients got richer and more varied food. They got special desserts. They had ice cream every night at bedtime. Most had ground privileges and permission to go out on weekend visits. All the patients gained weight. That was considered a good sign. The doctors on the ward were proud that their patients were in good physical health. “People would put on a lot of weight because of the insulin,” recalled Baumecker. “The low blood sugar would make it necessary to give them a lot of sugar and the sugar had a lot of calories. For some of these spindly, skinny schizophrenics it wasn’t such a bad thing.”29 But patients often hated it. Nash’s subsequent obsession with his diet and weight may well have stemmed from this experience of being “force-fed.”
Treating schizophrenic patients with insulin coma was the idea of Manfred Sackel, a Viennese physician who thought of it during the 1920s and used it on psychotic patients, especially ones with schizophrenia, in the mid-1930s.30 His notion was that if the brain were deprived of sugar, which is what keeps it going, the cells that were functioning marginally would die. It would be like radiation treatments for cancer. Some practitioners who used it in the 1950s, when the first effective antipsychotic drugs became available, took the view that insulin shock was more effective than antipsychotics, especially with regard to delusional thinking.31 No one understood the mechanism, but two large-scale studies in the late 1930s found that insulin-treated patients had better and more lasting outcomes than untreated individuals, but evidence for insulin’s efficacy was hardly overwhelming.32
It was in any case riskier and far more involved than electroshock, and by 1960, insulin shock therapy had been phased out by most hospitals as too dangerous and expensive when compared with electroshock. The conclusion was that insulin wasn’t worth the investment of time and money or the risks.
The treatments produced at least temporary improvement in many patients, according to Garber:
They’d see everybody hovering over them, very concerned about them, a feeling of loving camaraderie. I always thought that was very therapeutic. For the first time, somebody cared. Patients became more outgoing, more active. They got to go out on weekend visits. They got ground privileges. I think it helped. Patients were brighter, more alert, more conversational.33
While Nash later blamed the treatments for large gaps in his memory,34 he also told his cousin Richard Nash, whom he visited in San Francisco in 1967, that “I didn’t get better until the money ran out and I went to a public hospital.”35
• • •
As dangerous and agonizing as it was, insulin was one of the few treatments available for serious illnesses like schizophrenia which, until the middle of the century, often meant lifelong incarceration. And, like other state hospitals, Trenton was a laboratory for every “cure” that came along. Before the war, Garber recounted:
[We] treated all patients with the tools that were available. Colonic irrigation was still used. So was fever therapy. We had a strain of malaria that we would inoculate patients with. Later on we used a typhoid strain. We’d inject a typhoid vaccine and within hours patients would experience nausea, vomiting, diarrhea and fevers of 104 to 105. We’d do that for eight or ten weeks, two or three days a week. We did it to take the starch out of disturbed patients.
At Trenton the first order of the day, when I arrived at the hospital supervisor’s office at 8 A.M. was to see who could be moved out of seclusion to make room for another eight to fifteen patients who needed to be secluded. [The rooms] were ten by twelve, lined with glazed tiles, with terrazzo floors. There was a toilet and a sink and a drain in the middle of the floor so that if a patient, say, smeared feces around the room, we could hose it down.
You would do anything to give yourself a handle to bring the patient under control.36
After six weeks, Nash, whose insulin treatments were judged to be effective, was transferred to Ward Six, the so-called rehab or parole ward.37 There was group therapy every day, some recreation, and occupational therapy. “This was the cream of the patient crop,” Baumecker recalled. “There were only about fifteen beds. Other wards had thirty patients per room. Patients got individual attention, went on trips, and were allowed to go home on visits.”38
Nash actually began to work on a paper on fluid dynamics while he was on Ward Six. Baumecker recalled, “The patients made fun of him because he was always so up in the clouds. ’Professor,’ one of them said on one occasion, let me show you how one uses a broom.’ ”39 Alicia visited Nash every week. Once he was allowed out on passes, she took him to her folk-dancing group and out to Swift’s Colonial Diner.40 It was the highlight of Nash’s week.
He seemed to be in remission, clearly no longer a threat to himself or others. Baumecker recommended him for discharge, pointing out that, contrary to the popular belief, “We had to discharge people as fast as we could to get the census down.”41 He was discharged on July 15, a month after his thirty-third birthday.42 A few months after Nash got out, Baumecker called the Institute for Advanced Study and asked to speak to Oppenheimer about whether Nash was now sane. Oppenheimer replied, “That’s something no one on earth can tell you, doctor.”43
41
An Interlude of Enforced Rationality July 1961–April 1963
When I had been long enough hospitalized… I would finally renounce my delusional hypotheses and revert to thinking of myself as a human of more conventional circumstances.
—JOHN NASH, Nobel autobiography, 1995
A MAN EXPERIENCING a remission of a physical illness may feel a renewed sense of vitality and delight in resuming his old activities. But someone who has spent months and years feeling privy to cosmic, even divine, insi
ghts, and now feels such insights are no longer his to enjoy, is bound to have a very different reaction. For Nash, the recovery of his everyday rational thought processes produced a sense of diminution and loss. The growing relevance and clarity of his thinking, which his doctor, wife, and colleagues hailed as an improvement, struck him as a deterioration. In his autobiographical essay, written after he won the Nobel, Nash writes that “rational thought imposes a limit on a person’s concept of his relation to the cosmos.”1 He refers to remissions not as joyful returns to a healthy state but as “interludes, as it were, of enforced rationality.” His regretful tone brings to mind the words of Lawrence, a young man with schizophrenia, who invented a theory of “psychomathematics” and told Rutgers psychologist Louis Sass: “People kept thinking I was regaining my brilliance, but what I was really doing was retreating to simpler and simpler levels of thought.”2
It is possible, naturally, that Nash’s feeling reflected an actual dulling of his cognitive capacities relative not just to his exalted states, but to his abilities before the onset of his psychosis.3 The consciousness of how much his circumstances in life, not to mention his prospects, were altered compounded his distress. At thirty-three, he was out of work, branded as a former mental patient, and dependent on the kindness of former colleagues. Excerpts from a letter to Donald Spencer written around the time of Nash’s release from Trenton on July 15 suggest how modest Nash’s view of reality had become:
In my situation and anticipated situation a fellowship … with the idea being that I am expected to be doing research work and studies, etc. seems a better prospect… than a standard academic teaching position. For one thing, much of the conceivable worry over … the implications of my having been in a state mental hospital would be thereby by-passed.4
With the help of Spencer, who was on the Princeton faculty, and several members of the permanent mathematics faculty at the Institute for Advanced Study — Armand Borel, Atle Selberg, Marston Morse, and Deane Montgomery — a one-year research appointment at the institute was arranged.5 Oppenheimer found six thousand dollars of National Science Foundation money to support Nash.6 Nash’s application, datecl July 19, 1961, stated that he wished to “continue the study of partial differential equations” and mentioned “other research interests, some related to my earlier work,” as well.7
In late July, Alicia’s mother brought John Charles, a big, handsome two-year-old, to Princeton. Nash called the reunion “a big occasion for me since I haven’t seen our little boy all during 1961!”8 Then, at the beginning of August, Nash attended a mathematics conference in Colorado where he ran into a number of old acquaintances and went on a day-long excursion with Spencer, an enthusiastic mountaineer, to climb Pike’s Peak.9
Nash and Alicia were living together once more, but not especially happily. The turbulence of the two previous years had produced an accumulation of hurts and resentments, and the resulting coldness lingered and was exacerbated by new conflicts over money, childrearing, and other issues of daily living. None of this was made easier by the fact that Nash’s in-laws now lived with them. Carlos Larde’s health had deteriorated markedly, and he and his wife Alicia moved to Princeton that fall. The two couples shared a house at 137 Spruce Street.10 It was a great help that Mrs. Larde cared for Johnny while Alicia went to work, but living together created another layer of strain, especially for Alicia.
They tried to make the best of it. Nash attempted to care for his son, picking him up at nursery school and the like. They socialized with the Nelsons, the Milnors, and a few others. Once or twice, they drove up to Massachusetts to visit John and Odette Danskin, who had moved there the previous fall, and to see John Stier.11 The visits were rather fraught and Eleanor used to call John Danskin afterward to complain about Nash. On one visit, apparently, Nash had come with a bag of doughnuts. “Eleanor kept saying, ’How cheap!’ ” Odette recalled.12
In early October, Nash attended a most historic conference in Princeton.13 The conference, organized by Oskar Morgenstern, and attended by virtually the entire game-theory community, amounted to a celebration of cooperative theory. There was little mention of noncooperative games or bargaining. But John Harsanyi, a Hungarian, Reinhard Selten, a German, and John Nash, dressed in odd mismatched clothing, mostly silent, were all there.14 This was the first time these three men had met, and they would not meet again until they traveled to Stockholm a quarter of a century later to accept Nobel Prizes. Harsanyi remembers asking one of the Princeton people why Nash said so little during the sessions. The answer, Harsanyi recalled, in a conversation in Jerusalem in 1995, was “He was afraid he would say something strange and humiliate himself.”15
Nash was able to work again, something he had not been able to do for nearly three years. He turned once more to the mathematical analysis of the motion of fluids and certain types of nonlinear partial differential equations that can be used as models for such flows. He finished his paper on fluid dynamics, begun while he was in Trenton State hospital.16 It was titled “Le Problème de Cauchy Pour Les Equations Differentielles d’une Fluide Générale”-and published in 1962 in a French mathematical journal.17 The paper, which Nash and others have described as “quite a respectable piece of work”18 and which the Encyclopedic Dictionary of Mathematics called “basic and noteworthy,” eventually inspired a good deal of subsequent work on the so-called “Cauchy problem for the general Navier-Stokes equations.” In the paper, Nash was able to prove the existence of unique regular solutions in local time.19
“After Nash’s hospitalization he came out and seemed OK,” Atle Selberg recalled. “It was good for him to be at the IAS. Not everybody on the Princeton faculty was very friendly. It’s true that he didn’t speak. He wrote everything on blackboards. He was perfectly articulate in writing. He gave a lecture on Navier-Stokes equations — which concern hydrodynamics and partial differential equations — something I don’t know much about. He seemed fairly normal for a while.”20
He was most at ease in one-on-one encounters where his sense of humor came to his aid. Gillian Richardson, who was on the staff of the institute’s computer center from 1959 to 1962, recalled eating lunch with Nash in the institute dining hall and Nash’s saying all sorts of dry, wry things about psychiatrists. One time he asked, “Do you know a good psychiatrist in Princeton?” — adding that his own psychiatrist “ ‘sat on a throne way above’ him, and he wondered if I knew one who didn’t share that peculiarity.”21
Nash showed up in French 105, the third-semester French course at the university, one day and asked Karl Uitti if he could audit it. He struck the French professor as “the typically dreamy and out-to-lunch mathematician.”22 Nash attended quite regularly and kept up with the work. He seemed less interested in picking up conversational “tourist French” than in acquiring “a sense of French structure,” Uitti recalled, adding, “He was quite pro-French. He liked the language and the people.”
Uitti and Nash became rather friendly and met outside class, and on a number of occasions with Alicia. At some point, Uitti asked Nash why he was learning French. Nash answered that he was writing a mathematical paper. “There was only one person in the world who would be able to understand it and that person was French. He wanted, therefore, to write the paper in French,” Uitti said. Uitti could not recall Nash’s intended audience; chances are it was either Leray, who was at the institute that year, or Grothendieck. After the paper was published, Nash gave it to another member of the Institute to read. The next time he saw the man, Nash asked him, “Did you detect the sexual overtones?”23 Uitti commented in 1997:
That was the time that de Gaulle was in power and strong pressure was being exerted on French scientists to deliver their papers in French. Nash always struck me as very well-bred, very courteous. I’m certain that there was in his mind a sense of respect for whomever he was writing the paper for. It was sweet of him and I liked him for it.24
Nash asked Jean-Pierre Cauvin to edit a draft of the paper.25 Cauvin, w
ho was doing quite a bit of translation work at the time, recalled Nash’s telling him that “Paris was the center for this kind of mathematics.” Nash also turned to a French undergraduate, Hubert Goldschmidt, for help.26
Nash had not given up the idea of returning to France. He submitted the Cauchy paper to the Bulletin de la Société Mathématique de France on January 19. He was, Cauvin thought, more withdrawn and subdued than ever, and in retrospect it is clear that he was thinking a great deal about leaving Princeton. Very likely, he got in touch with Grothendieck at the Institut des Hautes Études Scientifiques. In April Oppenheimer wrote to Leon Motchane, director of the IHES, to ask Motchane to formally invite Nash to spend the first half of the academic year 1963 — 64 there.27 Oppenheimer also asked Leray, who was at the institute that year, to see if he could provide a grant from the Centre de la Recherches Nationale Scientifiques for the second half of the year.28 At the same time, he noted that Nash would have been welcome to continue at the Institute for a second year: “If [Nash] asked to stay here for the autumn, I think that my colleagues would probably accede; but that is not his choice.”
Nash did not suggest that Alicia go with him to France, and this time Alicia did not try to dissuade him. Nor did she offer to go. It was clear that, by some mutual and unspoken agreement, the marriage was over and they were going to go their separate ways.