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The Royal College of Psychiatrists Improving the lives of people with mental illness

MINDS ON FILM

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07/08/2017 11:30:50

Manchester by the Sea

Manchester by the SeaIntroduction

Manchester by the Sea is written and directed by Kenneth Lonergan. It was released in the UK in 2016 and has since won 115 awards. These include two Academy Awards in 2017 for best performance by an actor in a leading role (Casey Affleck, who is outstanding as Lee Chandler) and best original screenplay; a Golden Globe in 2017 for best performance by an actor and two BAFTAs in 2017 for best leading actor and best screenplay to name only a few of them. The film provides a harrowing but compelling account of a family’s tragedy over many years and it explores the tensions that can exist between individual need and the expectation that family ties may bring.

 

The Film

The story centers on Lee Chandler, a troubled, socially isolated, man who is working in Boston as a janitor when the film opens. He is unexpectedly summoned back to his hometown of Manchester-by-the-Sea when his brother Joe dies suddenly. Lee finds himself staying in his brother’s home and being responsible for his brother’s son Patrick, who is 16 and still at school. Some of these scenes provide the lighter interludes to the film and also contrast Patrick’s less complicated experience of grief with that of his uncle. The family’s back-story is fleshed out using flashbacks throughout the film. These show glimpses of the playful relationship that Lee had with his young nephew some years before as well as showing how his brother Joe had been a strong and supportive presence for Lee through the toughest of times that led to the breakdown of Lee’s marriage. In these scenes, we learn that Joe too was divorced from his wife and that she had a serious problem with alcohol. I have chosen not to give further details of the tragic events suffered by Lee, as the build up to their revelation is intrinsic to the emotional power of the film, except to state that he was only able to cope with them by moving away alone to live and work in Boston.

As the story of his earlier family life continues, the account of his struggle to care for Patrick unfolds in parallel and Lee embraces the parenting as best he can. Although he appears to make some progress in his role as a carer, Lee cannot seem to overcome a fundamental resistance within himself that prevents him from considering the possibility of resettling in Manchester-by-the-Sea, the location of his past traumas. However, despite this drive to flee, Lee’s internal conflict about the choice he must eventually make concerning Patrick is almost palpable as the film reaches its conclusion.

 

Relevance to the Field of Mental Health

Manchester by the Sea provides a powerful portrait of grief, but additionally adds the complication of both recent and past losses suffered by the main protagonist, Lee. This makes the film especially useful for mental health professionals wanting to teach or learn about prolonged grief disorder (as defined in ICD-10) or persistent complex bereavement disorder (as defined in DSM-5). In May 2017, the BMJ published an infographic on the subject of abnormal grief in the Practice Pointer section of the journal, which accompanied the article entitled Disturbed grief: prolonged grief disorder and persistent complex bereavement disorder by Paul A Boelen & Geert E Smid (BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2016). This would be a very valuable resource to use alongside a viewing of the film when thinking about Lee’s presentation. Also available on the linked webpage is a podcast about helping patients with complex grief, featuring an interview with the authors of the article.

Spending time immersed in this film will undoubtedly provide an empathic experience of the numbness, hopelessness, rage and despair that accompany the main protagonist as he struggles to find a way through the tragic losses he has suffered whilst at the same time trying to deal with the expectations placed upon him by his dead brother. This makes the film immensely valuable to any health professional that might encounter patients suffering with abnormal grief in the course of their work and I cannot recommend it more highly.

 

  • More information about Manchester by the Sea can be found at IMDB, as can a short trailer.

  • Manchester by the Sea is available on DVD and to stream at amazon.co.uk.

  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

 

04/05/2017 17:27:48

Lilting

LiltingIntroduction

Lilting is the first full length film written and directed by the Cambodian born British director Hong Khaou. It was released in the UK in 2014. It is a study of grief that brings together Richard and Junn, respectively the British lover and Chinese Cambodian mother of Kai, a young man killed suddenly in an accident. Despite both living in London, Richard and Junn do not share a common language to communicate the complexity of their feelings and emotions as Junn has never learnt to speak English. She is also unaware of her son’s gay relationship. Beautifully filmed and with exquisite performances by Ben Wishaw as Richard and Pei-Pei Cheng as Junn this is a deeply powerful examination of the role that language and culture play in our ability to understand others, especially in the context of grief.

The film was nominated for a BAFTA film award in 2015 and won a Cinematography award at the Sundance Film Festival in 2014.

 

The Film

Lilting opens with Kai visiting Junn in the room of her residential care home. It quickly becomes clear that this is a flashback. Junn seems sad and lost. When Richard visits Junn in the residential home they struggle to connect without a common language but Richard is confronted by her indifference towards him. Richard learns that Junn has a ‘suitor’ in the form of Alan, another resident at the home, who gives Junn flowers every day despite having no ability to talk with her. As Richard is determined to see more of Junn, he arranges to pay a female friend Vann, who speaks various Chinese dialects, to translate for him and they visit the residential care home together. Initially, Richard introduces Vann as someone who can assist Junn and Alan with communication, but the opportunities also emerge for Junn and Richard to discuss Kai. Junn has no understanding of the relationship her son had with Richard and several flashbacks reveal that Kai had arranged for his mother to move into the residential home because he could not have her in his home without her knowing about his homosexuality. Crucially, the flashbacks also reveal that Kai had planned to come out to his mother just before he died.

Richard has the need to share his grief with the one other person closest to Kai but knows that he can’t do this until she understands the true nature of his intimate relationship with Kai. As part of his own grieving process Richard seeks closeness with Junn and perseveres in visiting her until he feels able to invite her back to the home he and Kai shared where he can give her Kai’s belongings. Before the truth is revealed, Richard is drained by having to stifle the outward expression of his most painful sadness. The final scene that takes place in Richard’s home brings the long awaited revelation by Richard that he and Kai were in a gay relationship and that Kai had been ready to tell her this just before he died. By this time, Junn and Richard seem to have forged a more positive bond.

 

Relevance to the Field of Mental Health

Lilting is a subtle and gentle film that immerses the viewer in the lives of the two main protagonists and of their emotions as they struggle to process the sudden loss of the person that was closest to them. As such, it highlights that grieving is a uniquely personal process governed by so many factors and not restricted to any distinct time period and that is almost universally assisted by a need to share sadness and memories of the lost one. Funerals are a ritualised way of bringing people together to do just such a collective remembering whilst also acting as a celebration of life. Secrets and hidden relationships inevitably get in the way of any shared grieving. In Lilting this is perfectly illustrated by the painful realisation Richard has that he must ultimately comply with Junn’s wishes to have Kai’s ashes before she knows the true nature of her son’s relationship with Richard.

The issue of language is always centre stage in Lilting, something that is so relevant in our current multi-cultural society in which understanding others may be made more challenging by any language barriers. The observations presented about the use of translators in the scenes with Vann are particularly pertinent when Richard says something and immediately asks that it not be translated, realising just in time that it’s the wrong message to give. However, Vann also shows that there are hazards to translating emotionally charged messages when she cannot help herself from saying something to Junn that was not requested and causing upset to her as a result. In addition to this, the film demonstrates how much we can communicate non-verbally when someone is speaking a language that we do not understand. Deliberate choices are made during certain scenes of the film that leave the viewer without a translation into English for what is being said by Junn and yet still offering a strong sense of what she is feeling. In this way the film gives very useful tuition on what it is like to conduct an interview through a translator.

The relationship between Alan and Junn in the residential home offers the opportunity to reflect on the nature of intimacy when there is a fundamental lack of knowledge available about a person’s background, culture, values and experiences and when these cannot be explored through common language in an ongoing way. The physical comfort that both gain from holding hands, hugging, dancing and kissing clearly meets a deep need for both elders but is it possible for a more intimate bond to develop beyond this? This question is answered when Vann the translator offers Alan and Junn the chance to talk and question each other more honestly, bringing a reality to their relationship that had previously not been possible. Once they know each other better, it is Junn who decides to end the liaison.

These issues of communication and language are key to the work mental health professionals must do and this film provides an excellent reminder of just how hard it can be to understand another person when we do not share our first language and must rely on translation by an intermediary.

I would highly recommend this film.

 

  • More information about Lilting, can be found at IMDB, as can a short trailer.
  • Lilting, is available on DVD and to stream on amazon.
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

 

06/04/2017 18:03:58

Minds on Film Index - 7 Years On

Minds on Film Blog - 7 years onTo mark almost seven years of Minds on Film, here is an updated index of blogs in the archive. As before, they are organised by specific psychiatric conditions or particular mental health issues.

 

 

 

 

 

Adoption

Ageing

Alcohol dependence 

Alzheimer’s disease

Anterograde amnesia

Anxiety

Acquired Brain Injury

Assisted suicide

Adult autism & Asperger Syndrome

Bipolar disorder/Schizoaffective disorder

Bulimia nervosa

Carer stress

Cerebrovascular accident

Challenging the stigma of mental illness

Childhood autism

Deliberate self-harm

Dementia

Depression

Developmental delay in childhood

Dissociative disorder

Divorce - the effects on teenage children

Domestic violence

Drug addiction

Dyslexia

Employment and mental health

Epilepsy and psychiatric illness

Grief for the loss of a child

Growing up in Care

HIV related dementia

Homelessness and psychiatric morbidity

Huntington’s disease

Insomnia

Learning disability

Locked in syndrome

Loneliness

Mental Capacity, DOLS and the rights of persons with disabilities

Mindfulness

Morbid jealousy

Obsessive compulsive disorder

Paranoid psychosis

Personality disorder

Problem gambling

PTSD

Mental Health & acute trauma/disasters

Residential care for older adults

Schizophrenia

Schizoaffective disorder

Sexuality - in later life

Stalking

Suicide/Attempted suicide

Tourette’s syndrome

Transgender issues

Uncomplicated Grief

Unemployment and psychiatric morbidity

Unusual family experiences

Vascular Dementia

Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

13/02/2017 10:14:43

Life, Animated

Life, AnimatedIntroduction

Life, Animated is a documentary film released in 2016, directed by Roger Ross Williams, based on a book of the same name written by Ron Suskind. In it Suskind tells the story of his son Owen, who was diagnosed with autism at the age of three and who discovered a passion for Disney’s animated films, which later provided him with a means to communicate with his family and to make sense of his emotions more effectively. As the director is quoted as saying in an Oscar-contender interview at indiewire.com, “It’s really a film about the power of actual story, Owen is someone who was raised on myth and fable”. 

The film is nominated for Best Documentary Feature in the 2017 Academy Awards and has already won eleven other awards. 

 

The Film 

Life, Animated opens with some home video footage of Owen, a chatty young toddler, play-fighting with his father Ron in their yard. He has an older brother Walt with whom he enjoys watching television. But everything changes as Owen approaches his third birthday and suddenly becomes mute and inconsolable, resulting in a diagnosis of autism. The family observes that Owen still finds comfort in the animated films he had previously enjoyed and can continue to share this activity with his sibling. When his parents make the incredible discovery that they can communicate directly with Owen if they become a character in one of his Disney films they start using the scripts to engage with him in conversation. This is precisely how their son first begins to talk again after more than a year of silence. As Owen learns all of the scripts from each film by heart it becomes clear that he is using the films to communicate and express his feelings and emotions. Once at school, it emerges that Owen is especially identified with the supporting characters in many of the films and he becomes one with these ‘Sidekicks’. Owen has a talent for drawing and skilfully reproduces the characters he loves on paper and he learns to read and write using the credits at the end of each film. His identification with the ‘Sidekicks’ is helpful when he is forced to deal with being bullied at school. The film uses some exquisite animated scenes uniquely created to supplement the account of Owen’s earlier experiences, including with his ‘Sidekicks’, and these animations grow in complexity from black and white drawings to full colour as they depict his own emotional development. Life, Animated also contains numerous clips from the relevant Disney films that are so important to Owen in negotiating major challenges and transitions in his life. This is most poignantly illustrated by his watching of Dumbo as he packs up his things to move out of the family home after his graduation and then the viewing of Bambi (the scene in which Bambi’s mother dies) after his parents leave him in his flat for the first night. 

Life, Animated includes clips from home video to show excerpts from Owen’s life at all stages through his childhood into young adulthood but these are continually interspersed with filming of his current life. These contemporary scenes build through his final session of the Disney club he founded at his high school, his graduation, some therapy sessions to prepare him for his move into his own accommodation, the actual relocation and once there his experience of breaking up with his girlfriend of several years, Emily. This breakup presents Owen with a huge emotional challenge and the film depicts his struggle with anxiety and loss very honestly. The viewer is left with no doubt as to the challenges ahead for him, whilst at the same time the film details Owen’s transformation into an ambassador for autism exemplified by an invite to speak at a conference in Paris. Here he shares his passion for Disney films and his family’s use of them in helping him to escape from a state of mutism to a place where he can communicate effectively enough to obtain work in his local cinema complex. This makes a fitting conclusion to the film. 


Relevance to the Field of Mental Health 

Life, Animated is a documentary film that highlights the therapeutic power of the creative arts. The Suskind family’s story helps to underline the positive benefits they found in sharing in the affinity or passion of their autistic son in order to open up a medium for communication that allowed them to connect with him socially. The exaggerated expressions on the faces of the characters in animated films encouraged him to learn about the emotions and feelings of both himself and others and the scripts gave him a means of saying what he felt. It is hard not to be moved by watching Owen engrossed in the scene in which Bambi painfully calls out for his lost mother just after his parents have delivered him to his first night alone in his supported living accommodation. 

This is a very positive film to watch but it also doesn’t shy away from capturing something of the exhaustion that Owen’s parents experience as they must join him endlessly in his Disney world in order to communicate with him, or of his brother’s sense of responsibility as he wonders what the future holds once he is solely responsible for Owen’s wellbeing. It certainly demonstrates the powerful and positive effect that strong family bonds, with a huge capacity for love, kindness and endless tolerance, provide for someone like Owen suffering from autism. 

Ron Suskind has written an interesting account of his experiences in a New York Times article titled ‘Reaching my autistic son through Disney’, published in March 2014 and Ron and his wife Cornelia have created an informative website also called Life, Animated, in which they offer insights into the techniques that they have found beneficial during their parenting of Owen. There is a particular focus on the passions, which they call Affinities that those with Autism Spectrum Disorders often have. There are some personal resources based on their experiences with Owen and the website also includes input from the psychologist Dr Dan Griffiths, who supported the Suskinds in developing the concept of ‘Affinity therapy’. 

Life, Animated provides a beautifully crafted individual case study of autism that gives important insight into what it is like living with the disorder and, if viewed alongside a visit to The National Autistic Society website, it would provide an excellent learning experience that follows on perfectly from my last blog on Asperger syndrome in considering the Autism Spectrum Disorders. 

 

  •  More information about Life, Animated can be found at IMDB, as can a short trailer. 

  •  Life, Animated, is available to stream from Amazon video and is on DVD. 

  •  Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida 

09/01/2017 12:03:12

Asperger’s Are Us

Introduction 
Asperger's Are Us

Asperger’s Are Us is described as a coming of age documentary and is the directorial debut of Alex Lehmann. It is an inspiring and entertaining film about four friends diagnosed with Asperger syndrome, which means that they are on the high-functioning end of the autism spectrum. The quartet, formed of Noah Britton, Michael Ingemi, Ethan Finlan and Jack Hanke, first met a decade earlier at a summer camp for teenagers with Asperger’s where their close friendship coalesced around their mentor Noah, who was older and working at the camp to support others with his condition. The four found a shared interest in humour and performing and out of this arose the comedy show that shares the title of the film. This documentary follows them as they prepare to stage their last public show before their young adult lives take them in different directions. Netflix acquired the worldwide rights to screen Asperger’s Are Us in March 2016. 

The Film 

Asperger’s Are Us begins by introducing us to the four friends, providing some background on each man in turn, and highlighting their individual characteristics. The young man who perhaps features most in the film calls himself New Michael (he calls his father Old Michael) rather than his given name of Aaron. The film gives a sense of the struggles that New Michael’s parents have had throughout his childhood and adolescence as they are interviewed several times. Noah, the oldest man of the troupe and originally mentor to the others, is very engaging as he provides a somewhat droll commentary and continues to be the apparent motivator for the group. Jack is introduced within his family home as he contemplates leaving home in the USA to go to Oxford University in the UK, where he has been awarded a prestigious scholarship for a year. His family outline that Jack doesn’t like to be touched and Jack appears slightly lost as his father attempts to ruffle his hair playfully. Lastly, the quietest member of the quartet is Ethan who admits to having a pronounced interest in trains. 

The film is structured as a timeline that records the troupe’s progress as they prepare for the final theatre performance of their comedy show. The hazard of rehearsing with a condition that impairs focus is well portrayed and yet their commitment to their material is very apparent. The humour tends to favour word play and is often dry, deadpan and absurd. Very little of the actual show features, but there is enough to demonstrate the nature of their humour and how it relates to their unique relationship with the world. The film even captures some members of the audience walking out during the show, demonstrating that the humour isn’t to everyone’s taste. However, the powerful bond that the four friends share is palpable and this is touchingly displayed in the film. It also has a particularly satisfying conclusion by providing a brief summary of how the men’s lives have developed more than a year after this final performance together.  

Relevance to the Field of Mental Health 

This is a feel good film about friendship and the therapeutic power of creativity in four young men who have been diagnosed with Asperger’s. It is especially interesting that they have found a social connection through humour and the collective purpose of performance. As those on the autistic spectrum, including with Asperger syndrome, characteristically struggle to use or understand facial expressions, tone of voice, abstract concepts and jokes and sarcasm, the development of a comedy routine becomes all the more impressive and interesting. 

The film provides an excellent educational resource for broadening understanding about Asperger syndrome and viewing it could usefully be combined with browsing the following resources. The website of The National Autistic Society has some very helpful information on Asperger syndrome and a very good short video titled ‘What is autism’. There is also a useful factsheet at the Royal College of Psychiatrists website with information for parents and carers about Autism and Asperger syndrome. 

Most of all, I recommend this film for its ability to portray its subjects without pity or negativity about their disability despite showing some of the challenges that they face. It seems that this is just what the four friends would wish. They are quoted as saying that their show is not an autism awareness campaign but a pure comedy act designed to entertain. What a fun way to start the year! 

  •  More information about Asperger’s Are Us, can be found at IMDB, as can a short trailer. 

  •  Asperger’s Are Us, is available to stream from Netflix and from Amazon video. 

  •  Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida 


14/11/2016 09:39:59

Anomalisa

This animation contains adult themes of a sexual nature and nudity. It is rated 15.

Anomalisa


Introduction

Anomalisa is a feature-length stop-motion animation film directed by Charlie Kaufman and Duke Johnson, its screenplay written by Kaufman and based on an earlier radio play that he wrote in 2005. It has been very well received by critics, was nominated for an Academy Award in 2016 and has received 20 awards. Stop motion is a painstaking technique of animation, which involves taking approximately 25 photographs per second of a puppet or scene as minute changes are made to them (an article written by Tim Martin in The Telegraph newspaper, in March 2016, provides a good understanding of this method of animation as he considers Kaufman and Johnson’s production).

Anomalisa is a psychological drama centred on the main protagonist Michael Stone (voiced by David Thewlis), an author and motivational speaker in the field of customer service. He is suffering from mid-life depression and is searching for a special person that will make him happy as he struggles with a sense of boredom and a feeling that everyone is the same. The feeling of ‘sameness’ is represented in the film by all of the characters, except for that of Michael and Lisa (who is voiced by Jennifer Jason Leigh), being voiced by the same male actor (Tom Noonan). In addition, all of the puppet faces have the same central features, except for those of Michael and Lisa.


The Film

The soundtrack that accompanies Anomalisa’s opening credits presents us with a cacophony of voices of increasing intensity. We see Michael on an airplane travelling to Cincinnati. He takes some prescribed medication just before landing and also looks at an angry letter from a former girlfriend. As he walks through the airport terminal, Michael blocks out the voices around him by listening to some calming music through headphones. The viewer might observe the similarity of the faces that surround Michael. Once Michael is in a taxi driving to The Fregoli hotel, the attentive viewer may become aware that the driver also has the same face and voice as the people chattering in the airport terminal. The taxi driver spots that Michael has a British accent, asks where he is from, and urges him to visit the local zoo. Michael informs him that he actually lives in Los Angeles and then asks if there is a toy store near to his hotel. Once in his hotel room, Michael makes a phone call home to his wife Donna and their son Henry. The lack of emotional connection with his family is palpable. He tries to rehearse his presentation for the following day but his thoughts soon turn once again to his former girlfriend Bella, still living in Cincinnati. He calls her, wanting to apologise for the way in which he abruptly ended their relationship many years before, and tells her that he misses her. He asks her to meet him in the bar of the hotel. He tells Bella that he thinks he has psychological problems and she comments on his drinking habit. Michael suggests that they go upstairs to his room, which shocks and angers Bella prompting her to leave the bar immediately. Gaining no satisfaction from the meeting, Michael seems sadder and more alone than ever.

He goes out to the suggested toyshop in search of a gift for his son, but discovers that the taxi driver has actually sent him to a sex shop. Here he finds an antique Japanese doll, a sex toy, which he buys despite it being so obviously inappropriate as a gift. Back in his room and after a shower he has a strange perceptual experience while looking at his face in the bathroom mirror and at the same time hears the voice of someone else nearby which frightens him. He runs out of his room knocking on doors nearby. It is then that he meets two women Emily and Lisa, who are booked to see him speak at the customer services conference the following day. Michael invites them to have drinks in the bar and he becomes instantly attracted to Lisa, in part because of her lovely voice (which is distinct because it is actually voiced by a female actor). Lisa has had past trauma and is marked by a scar on her face. Michael invites her back to his room and seduces her by trying to counter her lack of self-esteem related to her disfigured face and her feelings of alienation. She sees herself as different, an anomaly, and Michael creates a name for her and the film in Anomalisa. He feels that Lisa is ‘the special one’ for him, the person who might release him from his entrapped and boring life. After having sex they go to bed and sleep. Michael has a torrid nightmare in which he experiences fear and paranoia and expresses the belief that everyone is the same one person, except for him and Lisa. Once awake and during their breakfast the next morning he hears Lisa’s voice differently, overlaid by the same male voice of all of the other characters, reprising the taxi driver’s recommendation to visit the local zoo. At this point he begins to feel different and suspicious about her. Michael accuses her of being controlling and seems to become more agitated, even as he discusses plans to leave his wife for her. He is so distressed that he finds himself unable to perform at the conference presentation a little later. The film ends with him returning home to his wife and son and asking her "who are you Donna, who are you really?"


Relevance to the Field of Mental Health

This is a film about mid-life depression, which also hints at a rare delusional disorder called the Fregoli syndrome, in which the person believes that everyone is actually the same person in disguise. It is classed as one of the Delusional Misidentification Syndromes (DMS) and the signs and symptoms usually occur in the context of other disorders, most commonly schizophrenia, affective disorders, substance misuse, organic brain disorders and traumatic brain injury. More recent studies using neuroimaging suggest that these DMS may be associated with identifiable lesions in the right frontoparietal and adjacent regions of the brain.

In the extra features on the DVD, Kaufman acknowledges that his interest in the Fregoli syndrome was sparked by reading an article about the condition, which inspired him to incorporate the concept into his script although he denies that Michael’s character actually suffers from the syndrome (more about this is outlined in an article written by Julia Llewellyn Smith in The Telegraph newspaper in March 2016).

Anomalisa is an intriguing animation, which powerfully conveys emotion and psychological crisis through its puppets in a most remarkable way, including a sensitively portrayed scene of sexual encounter. At times the film leaves the viewer unsure of what they are seeing and perhaps lacking trust in knowing what is real and what is not real in the protagonist’s world. This filmic experience might open up a window on the world of someone suffering from abnormal perceptions and in particular of the bizarre Fregoli delusion. The film will sharpen the viewer’s powers of observation and I cannot recommend it more highly, especially as it invites any mental health professionals to consider a more unusual and challenging diagnostic formulation in the context of Michael’s mid-life depression.

 

  • More information about Anomalisa can be found at IMDB, as can a short trailer.
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

03/10/2016 09:20:40

Concussion


Introduction

ConcussionConcussion, written and directed by Peter Landesman, was released in the USA in 2015. The film tells the true story of how Chronic Traumatic Encephalopathy (CTE) was identified  and named in 2002 by forensic neuropathologist, Dr Bennet Omalu (played by Will Smith), while he was working in Pittsburgh, USA. Omalu identified CTE as an entity after studying the deaths of several retired American football players. He realised that these former players had suffered significant psychiatric morbidity in the years after their retirement from the game. This discovery has contributed to a greater understanding of the long-term effects of repeated concussions in those competing in contact sports and has influenced attitudes to the management of concussive episodes on the field in a wider number of sports such as rugby, ice hockey and horse racing as well as in American football. There has also been a particular focus on the management of concussion in school age children, with more stringent pitch side assessments that prevent participants from re-entering a game until they are assessed as having fully recovered from a concussion under supervision.

As well as telling the story of his scientific discovery, the film also depicts the enormous struggle that Omalu, an immigrant from Nigeria, and his few supporters faced when trying to report their findings to the scientific community and the wider world of sport, as his results appeared to threaten the corporate interests of the National Football League (NFL). As such, Concussion is a film about whistleblowing and Omalu has been likened to ‘David’ as he took on the NFL seen as ‘Goliath’. Although this aspect of the film is presented in the style of a classic Hollywood drama, the film still succeeds in raising the profile of an important and ongoing issue, namely how hard it may be to tell truth to power.

The film has been nominated for several awards, including a Golden Globe nod in 2016 for Will Smith.

The Film

Concussion opens with the death of former American football player Pittsburgh Steelers centre Mike Webster at the age of 50. His postmortem is carried out by Omalu in his very particular style of working. Webster's pre-morbid psychiatric difficulties are noted by Omalu and when another retired player presents with psychiatric problems before his early death too, the pathologist starts to look for a common neuropathology.

As Omalu suggests a connection between the repeated head traumas suffered in the course of playing American football and the microscopic findings post mortem, he begins to find his work obstructed and colleagues turning against him. When he loses his research funding he is so determined to continue that he uses his own monies. It is only when a former football team doctor joins him and supports his research that he is able to take his findings forward and present them to the wider scientific community. Omalu’s resilience and determination are admirable but his ultimate satisfaction does not occur without a test of his character and of his close personal relationships.

Relevance to the Field of Mental Health

Concussion in sport is now increasingly recognised as something that needs more research, particularly into its long-term effects. The International Concussion and Head Injury Research Foundation, (ICHIRF) is a London based not-for-profit organisation that has been created to carry out independent research into concussion and head injury. In its research project Concussion in Sport it aims to ascertain whether there is an increased incidence of neuro-degenerative disorders (such as Alzheimer’s disease, Parkinson’s disease and Chronic Traumatic Encephalopathy) in retired sportsmen and sportswomen who have competed in contact sports and sustained concussions, and whether these disorders might onset at an earlier age in this population. The study is currently recruiting both retired athletes and controls and it involves an online questionnaire (this takes about 15 minutes) every year for at least the next 4 years.This research foundation works closely with the charity called The Concussion Legacy Foundation in America, whose website has a wealth of material for learning more about the subject and in particular some very good information about CTE.

Earlier this year the NFL finally acknowledged a link between playing American football and CTE (read this Frontline article written by Jason Breslow in March 2016) following the research findings of Boston based neuropathologist, Dr Ann McKee. In her research, McKee found evidence of CTE in 90 out of 94 brains she examined postmortem of former NFL players. In a fascinating 46 minute Frontline video interview, she describes her work and her consultations with the NFL about the effects of repeated mild brain trauma that takes place during the course of a football game. She recounts how she had first encountered Omalu’s evidence in a poster presentation at an Alzheimer’s disease conference and later how she was asked if she would examine the brain of a football player by the co-founder of The Concussion Legacy Foundation, former wrestler Chris Nowinski. The evidence is now so strong that current players are much more aware of the risks that playing presents and last year Chris Borland, a promising player for the San Francisco 49ers, quit at the age of 24 after fearing for the effects of repeat concussions on his health (see BBC report).

For anyone involved in providing medical support to players during competitive contact sports, there is a useful Pocket Concussion Recognition Tool on the BMJ website taken from the Concussion Statement on Concussion in Sport, published in the British Journal of Sports Medicine 47 (5), 2013, by McCrory at al, which provides clear guidance on screening anyone who is suspected of having suffered a concussion.

This film highlights a topical and very important issue that is especially relevant to anyone working in the field of Acquired Brain Injury or Sports Medicine.

• More information about Concussion can be found at IMDB, as can a short trailer.

Concussion is available on DVD at amazon.co.uk or for streaming on Amazon video.

• Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida


30/08/2016 12:28:29

My Beautiful Broken Brain

Introduction

My Beautiful Broken BrainMy Beautiful Broken Brain is a documentary directed by Sophie Robinson and Lotje Sodderland, which was released for streaming on Netflix in March 2016. The film chronicles the experiences of the then 34 year-old filmmaker, Lotje Sodderland, after she suffered a haemorrhagic stroke affecting her parietal and temporal lobes in November 2011. This was later found to have been caused by a malformation of blood vessels present from birth. She was left initially unable to speak, read and write or to sequence thoughts and actions in a coherent way. The stroke also left Sodderland with a profoundly altered self-awareness and perceptual disturbances that included the exaggeration of sounds and seeing heightened colours in her right visual field, which was also significantly restricted. These visual impairments are brilliantly portrayed using special effects in many ‘point of view’ shots throughout the film. My Beautiful Broken Brain came about at the instigation of Sodderland who, in the first two weeks after waking from an induced coma in intensive care, grasped that she was a filmmaker and realised that she could use the medium to record valuable memories of her daily life.

There is a very good article written by Sodderland about her experiences and the making of the film published in The Guardian Weekend Magazine in 2014. My Beautiful Broken Brain is so valuable to clinicians because it is underpinned by the authority of the lived experience of the filmmaker, showing us what it actually felt like to her as she suffered her acquired brain injury as well as charting the many challenges of her neuro-rehabilitation.

The Film

My Beautiful Broken Brain begins with a narrated account by Sodderland of her stroke accompanied by images that express the feelings she had retrospectively of those moments. Woken in bed one night with an excruciating headache, knowing that something was seriously wrong, she somehow managed to get out of her flat in East London and into a nearby hotel where staff subsequently found her collapsed in the toilet. The filming begins within two weeks of her stroke, using her own iPhone and then proceeds over the next year with the help of director Sophie Robinson with whom Sodderland had collaborated in the past. Sodderland sees the film as a means of making sense of her story by recording a linear narrative that she could review as and when she needed it. Her brother, Jan, and other friends provide an understanding of the person Sodderland was before her stroke, namely bright, energetic, articulate, very sociable and extremely good at multi-tasking. She was a passionate reader and an expert communicator. The film depicts the total assault that has occurred on all of these aspects of her person that render her so bereft in the immediate weeks after the stroke. Sodderland describes her predicament fearfully “I can’t write at all or be clever at all…..it’s terrifying”. She also experienced an altered sense of time, noting that “Time is elongated and transient” and she felt sufficiently strange to compare the experience to living in a David Lynch movie. As a result, Sodderland recorded and sent a series of video messages to the famous director, which ultimately resulted in Lynch becoming an executive producer on the film and meeting up with Sodderland in person.

The documentary moves through the first year after Sodderland’s stroke chronologically, using much footage from her personal iPhone videos as well as special visual effects, to record her progress, including a three month admission to a Neuro-Rehabilitation ward, enrolment in a research study using transcranial direct current stimulation to aid post stroke recovery, the set back of a grand mal seizure and, later on, to Sodderland’s first foreign holiday in France. At all times the film offers us insight into how she is feeling about her altered place in the world through the interface of her ‘new brain’ as well as through the objective opinions of those closest to her.

Relevance to the Field of Mental Health

My Beautiful Broken Brain is an incredibly compelling film to watch. Most useful to all health professionals is its first person portrait of the post stroke period of recovery. It should be essential viewing for anyone working in the field of Acquired Brain Injury. Of particular interest is the understanding, brought by various professionals during Sodderland’s rehabilitation, of her cognitive deficits and how these are worked on. My Beautiful Broken Brain gives the viewer the chance to observe closely someone struggling with nominal aphasia, emotional lability, the inability to write meaningful words on a page, and also with the strangeness of being able to touch type again, but not to be able to read the words that have just been typed.

It is well recognised that there is an increased risk of seizures in the year following such a haemorrhagic stroke but Sodderland’s grand mal fit may also have been triggered by the transcranial direct current stimulation administered to her as part of the research study she joined (the study subsequently excluded people in the first year after a stroke). There is an article entitled Review of Transcranial Direct Current Stimulation in Poststroke Rehabilitation written by Feng, Bowden & Kautz in the journal called Topics in Stroke Rehabilitation, in 2013 Jan-Feb;20(1):68-77 (abstract available) that offers the opportunity for further discussion and learning on these topics.

As a personal video diary that conveys an intimate portrait of recovery after stroke, My Beautiful Broken Brain exceeds expectations because most of all it is a film filled with hope, courage and the acceptance of a new and altered life that was not chosen by Sodderland but that is now her reality. This is a perfect reminder that it is always the whole person that we must understand and engage with whenever we support someone in his or her recovery. I could not recommend this film more highly.

  • More information about My Beautiful Broken Brain can be found at the film’s website, as can a short trailer.
  • My Beautiful Broken Brain is available to stream on Netflix.

Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

23/05/2016 10:39:08

The Wolfpack

IntroductionThe Wolfpack

The Wolfpack, directed by Crystal Moselle, was released in 2015. It is a documentary film that charts the lives of the six Angulo brothers who grew up with their mother and sister largely confined to their New York apartment by their father. One brother describes their father “as a land owner and we are the people working on the land”. They learned about the world through repeatedly watching films on DVD with one brother explaining that “movies opened up another world”. They spent much of their time reenacting scenes, using intricately handmade costumes, from their favourite movies such as Reservoir Dogs, The Dark Knight and Pulp Fiction. Home schooled by their mother, the brothers were only allowed out into the community accompanied by their father a handful of times and sometimes not even every year. When one of the brothers, at the age of 15, decides to go outside alone their whole life changes and their confinement ends. The filmmaker, Moselle, first encountered them walking down a Manhattan street in 2010 dressed as characters from Reservoir Dogs sparking a fascination with the brothers that led to her making the documentary.

The film won 7 awards, including the Sundance Film Festival Grand Jury Prize 2015 and the Edinburgh International Film Festival award for Best Documentary Feature Film. More information is given in an excellent interview by Tom Shone, published in the Telegraph newspaper in August 2015.

The Film

The Wolfpack tells the brothers’ story through a collage of early home movie footage and the interactions and excursions filmed by Crystal Moselle as their biography is brought up to date. What is immediately striking is how similar the brothers look and that, at the wish of their father who was a Hare Krishna devotee, they all have long flowing hair. It is also interesting that the Angulo boys seem very appropriate and measured in their behaviour towards each other, the filmmaker and to their parents. It seems that Moselle was the first person they had ever experienced visiting their apartment. The back story of their parents’ earlier life emerges gradually and the eventual interviews with their, initially camera shy, father reveal his strong opinions about his own powers and purpose but also his paranoid view of New York society. When he moved to America from Peru, it emerges that he had planned to settle the family in Scandinavia because he approved of the social support offered in those countries. Their mother seems to be suffering from her husband’s influence too and this creates some uncomfortable tensions for the viewer as the story unfolds.

The film moves into a different section once fifteen year old Mukunda decides to go out into the community alone, wearing a mask that had been made for the re-enactment of a movie scene. Police soon detain him as his visits into various shops concern the public and he ends up being admitted to a psychiatric ward for assessment, which he really enjoyed. On returning back home with regular psychotherapy sessions set up, Mukunda refuses to be controlled by his father and the brothers’ confinement comes to an end. All of the brothers are offered psychotherapy. The film then records their first forays into the community doing the things that many adolescents do, such as going to the cinema or going to the beach. The scene in which the brothers experience a swim in the sea for the first time is extraordinary in that it brilliantly captures the complete novelty and fear involved in this strange new adventure. One of the brothers cannot follow the others in to the water and stays on the sand despite their encouragement and reassurance. Everything is new and unknown, yet familiar through the films that they have watched endlessly. Always dressing alike and initially resembling the characters in the film Reservoir Dogs with suits and sunglasses on, the brothers acquired the nickname of The Wolfpack. Perhaps because they live in New York, their eccentricity of appearance was seen as ‘cool’ rather then ‘strange’ and this has surely been an important factor in their integration into that society in recent years. Towards the end of the film some glimpses are given of one of the brothers as he moves out of the family apartment and finds a job, although this leaves the viewer hungry for more information and full of unanswered questions about the plight of the whole family.

Relevance to the Field of Mental Health

The Wolfpack is a documentary that offers the opportunity to discuss the safeguarding of children and the extent to which family life choices can be defined as eccentric or as emotionally abusive; normal or abnormal. Could this situation have existed in the UK or in other countries around the world? It also provides a fantastic framework for a discussion about how children acquire healthy social and emotional skills growing up and whether these can in part be met by a large family group of siblings. Their mother appears as a kind, caring but seemingly passive presence although her crucial role as their educator was the source of finance for the whole family. All of the brothers have since cited her influence, alongside the movies, as critically important to them in surviving their confinement and in coping with the difficult relationship with their father. It is interesting that the brothers chose to watch extremely violent films (and important to note that many of the films viewed by the young brothers are rated 18+) and yet they do not immediately appear to have difficulties with the control or expression of aggression, although it is perhaps too early to be sure of their ability to handle conflict outside of the family. They have stated that they were surprised when they found the world outside their flat is not quite as they’d seen it in the movies and one of the brothers has talked about being surprised to see members of the public greeting each other openly with hugs and kisses.

The Wolfpack is a fascinating documentary film that draws you in to the intimate experiences of the Angulo brothers growing up, providing a developmental history and challenging the viewer to imagine how such an experience might feel. It leaves you wondering just how the brothers will forge a life in the world outside in future years and surely begs for a sequel to be made that can update their extraordinary story.

• More information about The Wolfpack can be found at IMDB, as can a short trailer.

The Wolfpack is available on DVD from amazon.co.uk or for streaming on Amazon video.

• Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

29/02/2016 10:00:33

Love & Mercy


Introduction

Love and MercyLove & Mercy, directed by Bill Pohlad, was released in the USA in June 2015. The film is a biopic of the life of Brian Wilson, the highly creative and talented musical force behind The Beach Boys, whose mental health deteriorated in the mid 1960s as the group produced their Pet Sounds album. The film uses two different actors to play Wilson - Paul Dano as the younger man and John Cusack as the older - allowing the film to span a significant portion of his life with a clear distinction between ‘before’ and ‘after’ the onset of his mental illness. Love and Mercy shows the signs and symptoms of his developing mental illness and also examines the treatment he received from psychologist Dr Eugene Landy. Of particular interest is that Wilson was involved in the making of Love and Mercy and when asked in an interview for Rolling Stone, in June 2015, (Brian Wilson’s Better Days by Jason Fine) about how he felt on seeing the film, responded, “It was hard to watch the first time," Wilson admits. "I felt exposed. But it's a factual film. Whatever the film shows, it was much worse in real life." 

 

The Film

Love & Mercy opens with the young Brian Wilson trying to compose some music, talking aloud to himself as he wonders what would happen if he were to lose that ability. The film then flashes forward to the older Brian in a car salesroom wanting to buy a Cadillac from sales assistant Melinda Ledbetter. They sit in a car together and he writes on a card for her the words ‘Lonely, Scared, Frightened’, which she only reads when he has left the showroom. After a short time alone in the car Brian’s minders join them and Melinda learns the identity of her slightly strange customer. The film proceeds to cut between scenes from Brian’s twenties, composing and recording songs with The Beach Boys, and scenes in his later life when he was under the total control of therapist Eugene Landy. His increasing attraction to Melinda, who Landy initially permits him to ‘date’ for a while, appears to awaken something in him.

In the earlier time frame, Brain’s relationship with his father is portrayed as very difficult, and several characters refer to the beatings the father gave all of the brothers when they were children. His father seems to be struggling with his own feelings of depression and is locked in a critical, competitive musical battle with Brian, his most sensitive son. After Brian suffers a panic attack on a flight home from a concert he asks to stay at home and compose rather than join the band on tour. His brothers and cousin reluctantly agree. It is then that Brian experiences the first symptoms of his psychotic illness, and soon after that, he attempts to ‘clear his head’ by taking LSD. He begins to compose songs that are sadder and more complex in their composition, much to the dismay of his cousin in particular. His symptoms worsen steadily and are particularly acute in a scene in the swimming pool at his home where the band are meeting to discuss their musical direction. Brian’s paranoia is revealed then when he states that Phil Spector is bugging the house and insists on having a discussion in the deep end of the pool because he believes that it is the only safe place to be. Despite this behaviour, which must be taken in the context of the ‘psychedelic sixties’ in Los Angeles, only one brother actually expresses real concern about his mental state at this time, perhaps explaining why alcohol and drugs initially became the means to self medication, rather than obtaining formal psychiatric help.

The later life story proceeds with the chilling depiction of Landy’s total control over Brian’s life, especially as the relationship with Melinda starts to deepen. She is warned off by Landy and subsequently resolves to free Brian when he pleads with her to help him, whilst also revealing to her that he hears voices. Melinda contacts Brian’s brother Carl, providing him with some written evidence of the abusive relationship Landy has developed with Brian, resulting in a successful lawsuit which prevents Landy from having any contact with Brian. This paves the way for Brian’s relationship with Melinda to develop romantically. The film closes with the real Brian Wilson performing the title track to the film, which he composed, called ‘Love & Mercy’.

Relevance to the Field of Mental Health

Love & Mercy is a film about living with mental illness (Brian Wilson was finally diagnosed with schizoaffective disorder). It is a biography of great relevance to mental health professionals, as Wilson’s story gives a sense of the tensions in the relationship with his bullying father, the delayed diagnosis of his psychosis, his self-medication with illicit drugs and alcohol, unorthodox treatment with a controlling therapist and his eventual improvement aided by the support and love of the woman who uncovers the abuse and eventually becomes his second wife. As such, the film invites the viewer to consider all of the factors that may have played a part in the genesis and course of Wilson’s psychotic disorder. In an interview for ABILITY magazine in 2006, he discussed in some detail the symptoms of his schizoaffective illness, including auditory hallucinations, extreme anxiety, depression and paranoia, which he began to experience at the age of 25. Wilson states that he suffered these symptoms for 15 years before seeking professional help, using cocaine and heroin in an attempt to manage them.

There is a leaflet on schizoaffective disorder at the Royal College of Psychiatrists website that provides a helpful overview of the condition. There is also a good account of the historical development of the concept in an article written by David J. Castle in Advances in Psychiatric Treatment Jan 2012, 18 (1) 32-33, called Schizoaffective disorder.

The psychologist, Eugene Landy, that Wilson consulted was pioneering a model of care called ’24 hour therapy’, which involved taking complete control of the life of the person concerned. However, this practice fell short of acceptable professional standards when it included controlling and varying the administration of the drugs prescribed by Wilson’s psychiatrist, controlling who Wilson could see at any particular time and in the ultimate conflict of interests, appointing himself as Wilson’s business manager and executive producer. Melinda Ledbetter and Wilson’s family became increasingly concerned by the hold Landy had on him and they finally took legal steps to end the relationship. As a result, Landy lost his license to practice Psychology in California in1989. This aspect of the film has particular relevance to mental health professionals, as it offers an opportunity to consider how vulnerable mental illness can make people and how important it is to safeguard those individuals who may lack the mental capacity to make important life decisions for themselves at any particular point in their life. For further information on the UK policy on safeguarding, visit the UK government website and search for the policy document entitled Safeguarding policy: protecting vulnerable adults (available to download from The Office of Public Guardian).

Now 73, Wilson states that he continues to hear derogatory voices but battles with them more successfully to block them out, especially when he is performing. It seems that his mental state continues to fluctuate but that any depressive episodes are usually noticed and dealt with quickly with the support of his wife, Melinda. He takes long-term medication and believes that his wife and family plays a very important part in the maintenance of his mental stability such that he is able to engage actively and successfully in the world of music again.

Additionally, Love & Mercy has a superb soundtrack, which reproduces many of The Beach Boys’ famous tracks and portrays the recording processes in fascinating detail. For anyone interested in understanding Wilson’s particular musical ability there is an informative blog entitled Was musical memory the secret to Brian Wilson’s genius?, by Victoria Williamson, vice chancellor’s fellow for music at the University of Sheffield, published in The Guardian newspaper in January 2016. In the blog Williamson explores whether Wilson’s musical talent may be related to the fact that he hears musical phrases playing constantly in his head. This rare phenomenon becomes even more interesting when considering that he suffers from persistent auditory hallucinations of a derogatory nature, which first started to appear entangled with musical phrases, as depicted in the film.

This is a powerfully moving film about a life lived with a psychotic illness that offers any mental health professional the opportunity to enhance their empathic understanding of how it feels to suffer from such a condition.

• More information about Love & Mercy can be found at IMDB, where a short trailer can be viewed.

Love & Mercy is available on DVD from amazon.co.uk or for streaming on Amazon video.

• Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

 

 

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About this blog

 

Minds on Film is a blog that explores psychiatric conditions and mental health issues as portrayed in a selection of readily available films.

Please note that this blog may contain plot spoilers. Any views expressed are purely my own.

Dr Joyce Almeida

Dr Almeida is a consultant
psychiatrist working in the private sector in the UK.

 


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