Film

Steven Schlozman

• Publisher: Emerald Publishing Limited
• Year: 2020
• ISBN:
  9781838673116
• Topic: Medicina
• Subtopic: Teoría, práctica y referencia médicas

Our world is inundated by film. Our best stories are told on movie screens, on televisions, on smartphones and laptops. Film argues that on-screen storytelling is the most ubiquitous format for art to intersect with health and well-being, offering a way for us to appreciate, understand and even celebrate the most nuanced and complex notions of what it means to be healthy through the stories that we watch unfolding. Clinicians use film to better understand their patients, and individuals use film to better understand themselves and each other.
Using case histories and based on academic research from a range of disciplines, this book explores how film can be used by clinicians and healthcare practitioners to better understand patients; by individuals to better understand themselves and others; and – perhaps most important of all – by societies as a tool in the fight against the stigma of illness. This book not only makes the case that film keeps us healthy, but also tells us how. After all, nothing quite moves us like the movies.

1

DEPICTIONS OF ILLNESS IN MODERN CINEMA AND TELEVISION

As I have already noted, because I am a physician, it makes the most sense for me to construct this book through a somewhat medical lens. We will therefore begin by discussing the myriad ways that specific illnesses are depicted on screen. A unifying feature of virtually all scholarship exploring the relationship of art to healing is the extent to which artistic depictions of suffering can foster understanding of illness and health.

We are hard pressed, for example, to offer a cohesive and encompassing definition of illness, but we have much less room for disagreement when we witness illnesses in the context of a compelling on-screen narrative. Depictions of sickness in movies and television can foster understanding, sympathy, and empathy. Moreover, it appears that the willingness to include stories of sickness has increased in the film canon over the last few decades.

This is especially the case for emotional suffering. Past representations of these issues have long been relegated to largely stigmatizing depictions. We have seen through much of modern cinema our share of psychotic murderers, personality disordered relationship-wreckers, substance abusing sociopaths, and anxiety ridden anti-heroes. However, there is evidence that the tide is slowly shifting. Increasingly we are seeing carefully nuanced films that still manage to convey the dramatic appeal that psychological conditions bring to a story but that also introduce more authentic layers of complexity that allow us to better understand and experience empathy for the characters to whom we are introduced. The 2015 film Silver Lining Playbook is a perfect example of this new breed of film. Consider the fact that this remarkable movie manages to convey the challenges of bipolar disorder in Bradley Cooper’s character and perhaps borderline personality disorder in Jennifer Lawrence’s character while at the same time creating a bond between the audience and the characters. This is a far cry from the fairly one-sided and terrifying depictions in past films such as the portrayal of borderline personality disorder in Fatal Attraction or the homicidal rage in wonderful but for our purposes highly flawed stories such as Psycho or Cape Fear.

Throughout this chapter, we will discuss films that have been instrumental in helping us to better understand psychological suffering and especially specific psychiatric disorders, and then we will move to a discussion of non-psychiatric illnesses. I will also offer examples of the ways that films have served as potent therapeutic tools. Importantly, we will not limit our survey to recent films or to the relatively narrow focus of simply outlining the criteria for specific conditions and then applying these criteria to the characters in the movies we discuss. Instead, where possible we will examine movies that feature characters who are both medically diagnosable and at the same time lend themselves to thematic interpretations for their struggles.

Given the fact that literally thousands of pages have been written about the depiction of emotional challenges in film and television, our discussions will focus on the merits of only a few films. These particular films uniquely impact our understanding of and empathy for conditions such as depression and bipolar disorder. In later chapters, we will discuss filmic depictions of autism, anxiety, psychosis, and substance abuse. For this chapter, I have chosen unipolar depression and bipolar disorder because they are among the most common psychiatric disorders in the general population. We will then move to an examination of on-screen narratives that focus on non-psychiatric illnesses. It is my hope that these films will inspire readers to look for similar thematic trends in the increasing breadth of on-screen entertainment that our modern world offers. To this end, at the conclusion of this chapter, I will offer suggestions for additional films that address a host of different conditions.

MOOD DISORDERS AND FILM

Mood disorders constitute a wide range of psychiatric diagnoses. These include clinical depression, sometimes called unipolar depression, and the much less common condition of bipolar disorder, also called manic depressive illnesses. When examining on-screen depictions of mood disorders, it is a curious but understandable observation that there are more films about bipolar disorder even though the rate of unipolar depression in the general population is estimated to be at least 15 times more common than manic depressive illness. Perhaps this is best explained by the symptoms themselves. Whereas unipolar depression is more often characterized by low energy, decreased emotional expression, increased sleep and potential suicidality, mania, the core feature of bipolar disorder, features dramatic flourishes such as grandiose ideas, promiscuity and impulsive behavior that some would argue are better suited for on-screen storytelling. To some extent, the over-representation of bipolar disorder in films and television programs might lead some to believe that depression is much less common than mania. This is an example of the ways that art of all kinds, but especially widely consumed art, can affect public perceptions.

Consider the 2007 film Michael Clayton. The movie is universally celebrated as a riveting legal thriller that hinges on the titular protagonist, played by George Clooney, convincing his clearly manic law partner portrayed by Tom Wilkinson to stop sabotaging an important if highly unethical lawsuit that their firm is defending. In fact, the central crisis of the film is precipitated when Wilkinson’s character strips off his clothes in court and announces that he is Shiva, the god of death. The viewer is then informed that Wilkinson’s character suffers from bipolar disorder and that he is in the midst of a manic episode. There is also a feeling that the current manic episode stems from a hardened and honest appraisal that Wilkinson’s character is conducting regarding his participation in the more ruthless aspects of what is legally allowed by his profession but that he nevertheless has increasingly experienced as ethically highly suspect. In other words, his mania occurs in the context of his life experiences. It does not occur in a vacuum. The causes of his behavior allow for an interpretation of his worsening health. The viewer is thus able to appreciate the fact that his psychiatric symptoms are drawn from the unique social milieu of his particular world.

However, the clearly manic behavior demonstrated in the opening courtroom scene is substantially less subtle than the much more informative and nuanced scene that occurs later in the film. At this point, Clooney’s character is trying to convince his psychiatrically suffering law partner to get help. His partner is calm at first, but it takes little for him to veer toward the agitated behavior that is more characteristic of mania. Additionally, he is holding more than a dozen loaves of bread and describes the bread as “the best bread” he’s ever had. He is not at first behaving in a way that would cause anyone to worry for him, but he becomes more agitated than his circumstances warrant when Clooney’s character confronts him. This particular scene allows the film to demonstrate the subtleties of mania as well as the more obviously dramatic aspects of manic episodes.

Michael Clayton is an important film because it allows the viewer to recognize that people with even severe bipolar illness can be extremely high functioning and at the same it emphasizes the damage that can occur if the disease is not properly addressed. In other words, both empathy as well as understanding are fostered by the careful and nuanced portrayal of mania throughout the film. This is a theme that we will continue to come back to over and over throughout this book. Film creates displacement. Recall that we defined displacement in the introduction of this book: It is a defense mechanism that allows us to more comfortably and even honestly examine aspects of ourselves that are otherwise difficult to embrace. As it turns out, there is evidence that the more compelling a film happens to be, the greater the extent to which viewers will relate to and be curious about how to help the protagonist (Caputo & Rouner, 2011).

I have used Michael Clayton professionally in work I have done with patients who have a hard time reconciling the lack of entirely diminished functioning in the setting of what is still clearly dangerously manic behavior. Mr Wilkinson‘s character is clearly suffering when he lashes out at Mr Clooney’s character. Nevertheless, even within this state, he is able to construct sound and potent legal arguments. His suffering is not demonstrated by his inability to think. His reasoning is very much intact. Rather, his condition is defined by his grandiosity on display in the setting of his utter lack of insight into his outlandish expectations. Individuals with these challenges and perhaps especially their families have found Michael Clayton useful when they attempt to reconcile the very high-level functioning of someone who is nevertheless still significantly in danger from the ongoing destructive behavior characteristic of mania.

Interestingly, there are substantially less films that focus on depression despite the fact that depression is a much more common experience among viewers. Approximately 15% of a given population of adults will suffer from depression whereas only 1–3% will suffer from bipolar disorder. This is not due to a prejudice toward depression, but rather through the natural drama that conditions such as mania bring to a story. Depression, with its low energy, poor concentration, and increased feelings of guilt, does not necessarily lend itself as readily to a compelling plot. One might even hypothesize that the overwhelmingly higher number of films featuring mania when compared to depressive symptoms has led the general public to assume that mania is in fact more common. To my knowledge, this has not been formally studied, but it is certainly my experience in teaching with film that even medical students tend to overestimate the amount of bipolar disorder based on the over-representation of this condition in on-screen storytelling. Nevertheless, there are in fact many marvelous films that manage to portray the effects of depression on the person suffering from depression as well as on those around them. Ironically, many of these films are billed as comedies or at least as drama–comedy mixes. Although this has not been directly addressed in the literature, it seems to me that there are two main reasons for the seemingly odd juxtaposition of comedy with the melancholia that characterizes depression. First, to make depression palatable in a dramatic, on-screen format, comedy might help to inject relief from what can otherwise be a drab, off-putting, or pessimistic story despite the best intentions of the storyteller. It is also the case that some of the symptoms of depression itself might seem, in entirely innocent and authentic fashions, to be at least somewhat humorous. The rigidity of depression, coupled with the frequent belief among those who are depressed that that nothing can be done to make matters better, can readily conjure the pacing neurotic characters that directors such as Woody Allen have made famous (Tutt, 1991). However, it is also possible that by making these stories at least somewhat humorous, we connect with the depressed characters in ways that would otherwise seem nearly impossible. Current films that fall into this category include Its Kind of a Funny Story, The Squid and the Whale, and Little Miss Sunshine.

But what about films that do not take a comedic approach to depression? The challenge for these stories involves the simultaneous creation of empathy for a condition that many have suffered and at the same time would rather not actively contemplate. People who have been depressed generally might not want to consider how they felt once the depression has lifted. As noted earlier, depression affects roughly 15% of the general population. That number suggests that there is a very high likelihood that those watching on-screen narratives that feature depression will be familiar with the themes of the story through personal experience. These issues make a dramatic and enticing portrayal of depression that much more challenging. The 2009 movie Helen is a good example of a film that managed to walk this difficult tightrope. The story involves a successful and much respected professor of music slowly and dangerously drifting into an increasingly dire and suicidal depression.

Helen is notable for the seeming lack of reason offered for the main character’s depression. Her own husband notes that he can’t understand why she feels so sad. He reminds her of the love that she receives from both family and professional colleagues, and he appears to suggest that her depression makes little sense given how fortunate her life has been. The film in fact received a good deal of press from several major publications precisely because the story resisted offering an interpretable narrative for her depression. “She’s not sad,” one doctor says to the husband. “She’s ill.” To this end, Helen speaks to the bewilderment among those who suffer depression as well as to those who try to make sense of why the depression is occurring. Helen’s lack of health begs for an explanation, but, as with most cases of clinical depression, there are no clear reasons why she has succumbed to this particular illness. While some viewers might find this kind of ambiguity uncomfortable, many who have written about the film noted that it was exactly the absence of reasons for the depression that creates empathy for Helen. This is not to say that depression itself lacks meaning. The meaning of the illness to the person with depression is not the same as making sense of the illness. That message, in and of itself, creates a powerful story, in part because it challenges us to accept the inexplicable and at the same time to remember that the absence of explanation does not necessarily equal futility. (We will come back to these concepts in the final chapter of this book.) Therefore, in ways that are similar to Michael Clayton, Helen creates empathy and understanding. I have known patients who have taken solace in the paradoxically hopeful message that Helen offers, reminding them that even in the absence of understanding the reasons for their depression, there are ample and proven treatment options.

MEDICAL ILLNESSES

Before we discuss the depiction of non-psychiatric illnesses in film, it is important to note that the heading “Medical Illnesses” is a bit of a misnomer. Psychiatric illnesses are by definition also medical illnesses. To separate psychiatric illness from medical illness is to fall prey to the dualism that often stigmatizes psychiatric suffering. Nevertheless, much of the literature exploring these issues in media use the phrase “medical illnesses” and that is the reason the term is used here. It is also the case that virtually every film that focuses on medical suffering has at least some element of emotional suffering as well. The separation of these films into psychiatric and medical categories is thus somewhat artificial. This will become apparent as we move forward with our discussions, but for now it is useful to discuss these topics as separate entities.

A sometimes overlooked but extremely well-regarded film for the purposes of this discussion is the 1985 biographical film Mask. This movie tells the true story of Roy (Rocky) Dennis, a teen born with severe craniofacial dysplasia. This condition is characterized by abnormal facial bone growth that results in a rather striking and often painful appearance. “Craniofacial” simply means that it is primarily the head and the face that are affected, and “dysplasia” is a medical terms for abnormal growth. Eric Stoltz received numerous accolades for his breakout role as Roy, and Cher, playing Roy’s mother, was equally celebrated. Briefly, the film follows Roy’s coming of age as he relishes his first crush, pushes back against doctor’s predictions, and generally enjoys life as best he can. Critical appraisal for the film includes the apt observation that the story is almost “too Hollywood to believe,” and yet interviews with Roy’s family and friends have shown that the film rarely veers from an accurate depiction of Roy’s triumphs and tribulations. Rusty Dennis Mason, Roy’s mother, has been forthright in numerous interviews that she was told that her son would die far before adolescence, that he would be severely cognitively impaired, and that his limitations would be debilitating and overwhelming (https://www.chicagotribune.com/news/ct-xpm-1986-05-11-8602030023-story.html).

Nevertheless, Roy is gifted intellectually and creatively, lives well into adolescence, never loses track of his hopes, his aspirations, and his limitations. In fact, he actively incorporates his plans for the future together with an honest appraisal of the challenges he’s bound to face, including the near certainty of an untimely and early death. To this end, Mask represents the central tenets of resiliency that researchers have noted correlate well with greater wellness, better coping, and ultimately full and satisfying lives even in the setting of severe adversity. Generally speaking, resilience is defined as the ability to accept and to make reasonable, honest, and authentic adjustments in the face of adversity (Schlozman, Groves, & Weisman, 2004). As one might expect, much of the literature exploring resiliency stems from investigations into how individuals cope with medical illness. In Mask, Roy knows that others stare at his disfigurement. He is aware when others defend against their discomfort with the way Roy looks by engaging in the reductionism of thinking of Roy as a representation of a rare disease. One of the most enjoyable scenes in the films occurs when a younger and less comfortable clinician treats Roy as little more than a specimen. Roy accepts this clinician’s approach with just the right amount of amusement and disdain. After the younger doctor finishes his examination, an older and more experienced physician who has long known Roy engages Roy as a unique individual who has incorporated his illness into his sense of self (https://www.youtube.com/watch?v=fc0uxTiUDrE). To this end, Mask is the rare narrative depiction that manages to represent illness with appropriate pathos and honesty and at the same time preserves a sense of hope. The film is itself resilient to the metaphoric sickness that often afflicts movies that attempt an authentic but nevertheless one-sided approach to devastating illnesses. Empathy for Roy comes not from sympathy for his condition, but instead from admiration toward his willingness to accept the fact of his condition and at the same time to relish the life that he has. Multiple studies have shown that ...

Table of contents

• Cover
• Title
• Introduction – Why Film?
• 1. Depictions of Illness in Modern Cinema and Television
• 2. Vignettes Describing the Therapeutic Utility of On-Screen Entertainment
• 3. The Health Benefits of Community Engagement in Film
• 4. Health Benefits of Individual Engagement with Film
• 5. Techniques for Healthcare Professionals to Utilize Film
• 6. Solutions to the Lack of Access to Film
• 7. The Potential for Cinema to Unexpectedly Reduce the Stigma of Illness
• 8. Future Directions and Conclusions
• References
• Index