Using A Beautiful Mind, a film about the troubled life of Nobel laureate John Forbes Nash as its focal source, this paper considers the difficulties people with mental illness struggle with in perceiving and experiencing reality. Relationships among the concepts of genius, madness, and alternate reality conceptualization are explored to establish perspective for a model illustrating the progression of paranoid schizophrenia. The importance of empathy in treating mental illness and the role that psychiatric mental health advanced practice nurses play in managing the care of people with paranoid schizophrenia are underscored. Topics for additional research are suggested.