Ryan Rienzo

CNS 770 DG
August 30th, 2015
Assignment 1.2
The Soloist
In my opinion, Nathaniel meets the A criteria for 295.90 Schizophrenia.
Throughout the films Nathaniel clearly displays the symptoms of Schizophrenia. He is
delusional and out of touch with reality. This is seen when he questions if Steve is driving
the airplane flying overheard while Steve is standing beside him. He had extremely
disorganized thinking and speech, making it very difficult to understand what he was
trying to say when he spoke. He would quickly jump from one though process to another,
with no logical connection between his ideas or topics. He also had very disorganized
and abnormal motor behaviors .In addition, he heard voices in his head, which made it
difficult for him to function properly.
All of these symptoms greatly impacted Nathaniels ability to behave
appropriately. He had social/occupational dysfunction, which ultimately led to his lack of
academic achievement at Julliard. He was unable to control the thoughts and voices in
his head, making it difficult for him to concentrate and perform. His interpersonal
relationships also suffered greatly. Those closest to him began to fear him due to his at
times aggressive outbursts. His inability to communicate logically hindered his ability to
form and maintain new relationships. Overtime his symptoms worsened and continued
to persist for years. His symptoms were not due to some pervasive developmental
disorder, mood disorder, schizoaffective disorder, or to the direct physiological effects of
a substance or a general medical condition.

Having failed out of Julliard, he did not graduate and thus did not obtain a
position as a professional musician despite his talent. Without a job or proper income,
Nathaniel became homeless and lived on the streets. Highlighted throughout the film
was Nathaniels inability to control his own thoughts and actions. Nathanial had a lack of
insight into his medical condition and did not wish to be medicated or seek treatment.
Without proper medical attention Nathaniel slowly deteriorated and lost his ability to
function properly in society.
Nathaniel and Steve Lopez had a relatively strong connection from the start. At
their initial meeting the two were able to establish rapport and have a conversation,
despite Nathaniels inappropriate affect and speech. Nathaniel was able to open up the
Steve and share that he attended Julliard, which started their whole journey together. As
the two grew closer it was become clear that Nathaniel and Steve cared for one another
deeply.
In some ways the relationship Nathaniel and Steve shared was healthy. They
were able to form a bond that fostered trust and friendship. Each in their own way, they
opened up about their struggles, their families, and their pasts. Although they grew
frustrated with one another at times, they were always able to forgive and move forward.
Both men also helped each other in several ways. Steve was able to get
Nathaniel back involved with music, his true passion, and was able to provide him with a
proper musical instrument. In addition, Steve was able to get Nathaniel off the streets
and in a safer place where he was indoors and had suitable sleeping arrangements.
With that being said, Nathaniel also helped Steve by teaching him the true value of
friendship and what really matters in life. He highlighted to Steve how important his exwife was to him, and aided in mending their broken relationship. Befriending Nathaniel

forever changed Steve, and although Nathaniel may not have realized it, he ironically
improved Steves life while Steve was so desperately attempting to better his.
However, their relationship was also unhealthy. Due to his irrational thinking
patterns and processing, Nathaniel began to view Steve as his God and had an
inaccurate perception of their relationship. He became somewhat dependent on Steve
and would constantly call him or show up at his place of work. He essentially put Steve
on a pedestal and was at times coerced by Steve to do things against his will. In several
different circumstances this resulted in Nathaniel having mental breakdowns. Steve was
also negatively impacted by their unique relationship at times. Although acting from a
compassionate place, Steve was overly forcefully and became easily frustrated with
Nathanial when he was unwilling to accept his help. Steve began to feel responsible for
Nathaniels wellbeing and began to resent him.
In the end Nathaniel and Steve learned that their friendship was most important.
This involved Nathaniel living his own life, by his own terms and Steve accepting that.
Despite his best efforts, Steve had to realize that Nathaniel was unwilling to seek
treatment and that he was content. The best and only thing Steve could do was offering
his friendship, and Nathaniel would do the same in return.
Steve and David Ellis had very different views on how to best help Nathaniel.
Steve was very clear from the start that he was a strong advocate for psychiatric
treatment and medication. He was adamant about Nathaniel seeing the medical staff at
the shelter, and was infuriated they were not seeing him. David Ellis saw things
differently. He attempted to explain to Steve that it was Nathaniels choice to not seek
treatment, and that he was unwilling to force someone against his or her will. Unless
Nathaniel was a risk to himself, he was not going to coerce him into treatment. This

further compacted the issue. Steve could not comprehend why they would not say he
was potentially a harm to himself so that he could be hospitalized, put on medication,
and thus treated. While David Ellis understood his point, he emphasized that even if
Nathaniel was placed on medication, he could not be forced to actually take them.
Although the men had differing approaches to helping Nathaniel they both were
concerned with his overall wellbeing. Steve and David realized the severity of the
situation and were both sources of support for Nathaniel. Ultimately all they wanted was
for Nathaniel to be happy and healthy. While both men wished the best for Nathaniel,
David had a more realistic approach for Nathaniels potential recovery. He was highly
educated in working with this population, and was more familiar with success rates.
Even if Nathaniel sought treatment and received medications, if it were against his will it
would not be beneficial. He realized that Nathaniel had no desire to be on medications,
and advised Steve to offer what Nathaniel actually needed, a friend.
The movie changed my perspective somewhat regarding the diagnosis
controversy in counseling. As David Ellis pointed out, all the residents at the shelter
were diagnosed, and what good did that do for them? It made me realize that receiving
or learning of ones own diagnosis is just a starting point, there are several other factors
involved for successful recovery. As highlighted in the movie, the persons own
willingness to change and acceptance is imperative.
There are several interventions that could be helpful for Nathaniel, I would
recommend medication, behavior therapy and social skills training. It was evident that
Nathaniel would benefit greatly from the use of conventional and atypical anti psychotic
medication. This would aid in controlling his irrational and illogical thoughts and
behaviors. This would also help him to create a balance between the neurotransmitters

in his brain reducing his delusions, hallucinations, mania and improve his overall
cognitive functioning.
In conjunction with medication, Nathanial could also benefit from psychosocial
interventions. To improve his functioning, he could partake in behavior or cognitivebehavioral therapy to become educated on techniques and skills to reduce his
symptoms. Due to his current living situation and difficult maintaining relationships,
social skills training would also be very effective. This would help to improve his overall
social skills and independent living skills. Nathanial clearly has issues being physically
inside an apartment, so this is something that would help him immensely.
To improve Nathaniels relationship with his sister and others I would also
suggest family education and counseling. This could help his sister to better understand
his disorder and teach her communication, problem-solving and coping skills. It would
also offer the family a safe environment for support and encouragement. Case
management would also be very important when working with Nathaniel. Due to the
chronic nature of his disorder, actively monitoring him would help to improve his success
rates. If Nathaniel were exposed to these interventions I feel that his overall quality of life
would improve and he would become a higher functioning, healthy adult.