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

MINDS ON FILM

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10/08/2015 11:20:43

The Outcast

Introduction

The Outcast on DVDThe Outcast, directed by Iain Softley, is a two-part BBC Drama, which screened on terrestrial UK TV in July 2015. It is based on a novel by Sadie Jones, who also wrote the screenplay about the coming of age of a boy called Lewis, living in the Surrey commuter belt of the 1940s and 1950s, who suffers the tragic early loss of his mother. The story is told in two parts, the first episode starts with Lewis aged ten, played by Finn Elliot, and the second when he is nineteen, played by George MacKay. It focuses on Lewis’ immediate relationships with his family as well as with his childhood peers and the local community as he tries to make sense of his overwhelming loss. Both of the central performances by Eliot and MacKay are extremely accomplished. MacKay, in particular, succeeds in conveying a damaged adolescent vulnerability that makes the drama so watchable and very valuable as a learning opportunity.

The Drama

The Outcast begins with Lewis, aged ten, living happily with his mother Elizabeth in a glorious rural setting whilst his father, Gilbert, is away fighting in the war. Once reunited with his father Lewis struggles with the lack of warmth in their relationship. He is also aware of the attempts his mother makes to rebuild their family after the separation brought about by the war. Unfortunately a tragedy destroys any hope of this when Elizabeth, having drunk some gin, accidentally drowns when having a picnic by the river with Lewis. He tries but fails to rescue her. His father cannot understand Lewis’ inability to give an account of events and the son feels blamed in some way for his mother’s death. His father soon marries again and Lewis struggles to cope with his stepmother, Alice, who wants to replace Elizabeth and to heal him. But she struggles in her relationship with her new husband as well as with Lewis and begins to drink increasing amounts of alcohol. As Lewis ages he becomes increasingly unhappy. Tormented by flashbacks of the accident, he is teased and bullied by peers about his loss and finds it difficult to cope with his emergent sexual feelings. These stresses cause him to feel sad, hopeless and isolated, the outcast of the title. Along with his increasing anger, these feelings become unbearable until he finds some relief from them by cutting his arm, causing his immediate family much dismay. Outside of the home Lewis acts out his anger in a serious and very damaging way that results in a prison sentence. The second episode of the drama centres on the period immediately after being released from prison when he tries to rebuild his life and relationships.

The secondary characters, in the form of Gilbert’s boss Dickie and his family who live nearby, also have an important contribution to make to the story, as Lewis uncovers the hidden physical abuse of Kit, Dickie’s youngest daughter, by her father. She is the one friend that Lewis retains from early childhood and is the only person who remains sympathetic to him throughout all of his difficult times. Their bond becomes more understandable as we become aware that she too is suffering the on-going trauma of physical abuse by her father and Lewis is the only person willing to fight to reveal it.

Relevance to the Field of Mental Health

This two-part drama offers an excellent platform for discussion and learning about the subject of deliberate self-harm in adolescence. Set in the 1940s and 1950s, when the style of parenting in the UK was such that children were expected to be ‘seen but not heard’, the absence of an emotionally sensitive therapeutic intervention after Lewis’ traumatic loss is particularly well captured. However, the presentation of his emotional suffering and its causes are universal and can be transported into the present day as the following useful articles demonstrate. The first is called Self-harm in adolescents by Alison Wood (Advances in Psychiatric Treatment Oct 2009, 15 (6) 434-441), available in full, and the second article called Young people who cut themselves: can understanding the reasons guide the treatment? by Barry Wright, Naomi Hooke, Stephan Neupert, Chan Nyein, Suzy Ker (Advances in Psychiatric Treatment Nov 2013, 19 (6) 446-456), available in abstract.

The other storyline concerning the hidden physical abuse of Kit by her father, which occurs within a middle-class, well-off family also provides an excellent opportunity to discuss how such cases can be detected and managed. It would also allow discussion about the differences and similarities in societal attitudes to this issue between the 1950s and the present time given that children are now encouraged to report their experiences to a service such as ChildLine.

  • More information about The Outcast can be found at the programme’s website, including some clips.
  • The Outcast is available to watch on BBC iPlayer in the UK (for the next week) and can also be purchased on DVD at amazon.co.uk.
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida.
01/07/2015 17:09:52

Still Alice

Introduction

Still AliceStill Alice, directed by Richard Glatzer and Wash Westmoreland, was released in cinemas in the UK in February 2015. The film is based on a novel written in 2007 by Lisa Genova about a renowned linguistics professor diagnosed with early-onset Alzheimer’s disease as she struggles to hold on to the defining aspects of her self as her condition worsens. In the film, Dr Alice Howland is played by Julianne Moore in a truly poignant and empathic performance, which brought well deserved recognition in the form of an Oscar for Best Performance by an Actress in a Leading Role in the 2015 Academy Awards, a Golden Globe in 2015 and a BAFTA award for Best Leading Actress in 2015, to name but three of the thirty four awards the film collected. Moore is very well supported by the other cast members, in particular Alec Baldwin, who plays her husband John.

 

Still Alice has been very well received by critics and also by those with Alzheimer’s disease (this February 2015 article by Tom Seymour in The Guardian provides a verdict from those with dementia), making it of particular interest to all mental health professionals, carers and families of those with Alzheimer’s disease.

 

The Film

Still Alice opens with Professor of linguistics at Columbia University, Dr Alice Howland, giving a guest lecture, which one senses she has given before, on her particular research interest within the topic of developmental linguistics. She pauses, literally lost for a word, whilst in full flow, dismissing her stumble on having drunk too much champagne and the moment passes. She is fifty years of age. Back at home she jogs through Columbia University’s campus, where she teaches, and finds herself suddenly unsure of her direction. With blurry, shallow focus shots evoking the sense that she has no idea where she is, Alice becomes frightened and panicky until she begins to regain her orientation and is able to run home. She is visibly shaken by the experience and is aware that something is wrong but doesn’t share her concerns with her family at this stage.

Instead, Alice consults a neurologist who takes a history, carries out a basic cognitive test and suggests an MRI scan (which proves to be normal) followed by a PET scan, which shows signs confirming his suspicion that Alice may have early onset Alzheimer’s disease. The neurologist asks to see her husband, John, and confirms the diagnosis to them both. A genetic test follows to determine whether she has the heritable form of the disease. She tests positive for the gene and their children must be told. At a family meeting, Alice reveals her diagnosis and then explains the risk to her children. She tells them that she has been prescribed Aricept and that she is now using numerous strategies to maintain her health and cognitive function. Shortly after this, Alice hears from her eldest daughter Anna that she too is positive for the familial form of Alzheimer’s disease, Tom is negative and her youngest daughter Lydia has declined the test. After these revelations, Alice is confronted by her boss with negative student feedback that indicates Alice’s teaching has become increasingly disorganised and difficult to follow. She reveals her diagnosis to him and this results in the end of her job as an academic. Alice becomes involved with the Alzheimer’s Association and prepares a talk to deliver to an audience about her experience of living with the disease, using a typewritten script that she highlights as she reads out the sentences. She delivers an incredibly moving presentation, describing the struggle of trying to hold on to those aspects of her life that meant so much to her previously and that defined her as a person. With huge support from her husband, Alice is helped to manage at home.

One of the things that Alice decides to do is to continually test her knowledge of key personal data such as her address and the name of her eldest daughter using her smart phone. She then records a video file on her laptop with instructions to her future self that she should follow when she can no longer answer these key questions. However, when the time comes, and she finds the video file on her laptop by accident, Alice is actually unable to follow the instructions easily. Her constant need for supervision and support becomes apparent and she is not left alone from that point onward. Her daughter Lydia moves back from Los Angeles to be at home again as a main carer, in part because Alice’s husband has been offered an important job opportunity in another city about two hours away by plane. The film closes with Lydia reading some poetry to Alice and asking her if she understands the theme. Alice replies with one word ‘Love’.

 

Relevance to the Field of Mental Health

In researching the role, Julianne Moore spoke to a number of people with early onset Alzheimer’s disease to gain an intimate understanding of their feelings and functioning, which clearly informs the authenticity of her performance and makes it so valuable to watch. One of those people called Wendy Mitchell, who Moore thanked in her BAFTA speech, lives in the UK. Mitchell features in an interactive resource on the BBC website called Living at home with dementia, which provides an extremely useful accompaniment to the film. Mitchell, diagnosed at 57 with Alzheimer’s disease, is quoted as saying about Still Alice “It was a shockingly accurate reflection of my own experience.”

This film provides an incredibly intimate personal portrait of early onset Alzheimer’s disease that challenges the viewer to experience what it might feel like to lose certain cognitive functions, in particular memory, from a previous position of competent engagement in the world. That Alice is a middle class academic, who seems to be making sensible choices with regard to lifestyle (she is a non-smoker who eats a healthy diet and takes regular exercise), makes her intellectual decline all the more poignant as she struggles to come to terms with her diagnosis and subsequent loss of certain cognitive functions. This film encourages us to reflect on the nature of the self and what makes us who we are. It asks us how much cognitive function can we lose before we cease to be that person we once were. Is Alice Still Alice by the end of the film? This question might provide the platform for an interesting debate.

This is simply a film that must be watched.....by everyone.

  • More information about Still Alice can be found at IMDB, as can a short trailer.
  • Still Alice is available to pre-order on dvd from amazon.co.uk and it will be released on 6th July 2015.
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida.

 

01/06/2015 10:54:57

Rory O’Shea Was Here

Introduction
Rory O’Shea Was Here

Rory O’Shea Was Here, directed by Damien O’Donnell, was released in the UK in 2004 and was originally titled Inside I’m Dancing. It tells the story of two young men, Michael (played by Steven Robertson) and Rory (played by James McAvoy), both confined to wheelchairs for different reasons, who form a friendship in a residential home and subsequently set out to experience independent living in the community. It won five awards, including the Audience Award at the Edinburgh International Film Festival in 2004. It is loosely based on a real story written by someone who worked for Dublin’s Centre for Independent Living in the 1990s. As there has been increased focus on Mental Capacity and the Deprivation of Liberty Safeguards in England since the Supreme Court Judgement in March 2014 sought to set out an acid test for defining deprivation of liberty, this film offers a perfect opportunity to discuss a number of issues raised by the change in application of the legislation. It also provides the viewer with an empathic understanding of the realities of life in a wheelchair, which is both moving and funny.

The Film

Rory O’Shea Was Here opens with Michael seated in the lounge of his residential care home, observing as an accident is about to happen to a member of staff. It then becomes clear that he has very poor speech as a result of cerebral palsy and he cannot make himself understood to warn staff about the hazard he has seen in the room. His frustration is palpable. Michael seems isolated in the home and lacking in a peer group but this all changes when Rory O’Shea arrives with his gelled, spiked punk hair, nose piercing and a punchy attitude that distracts from the truth about his poor prognosis. He introduces himself sarcastically to the other residents as “Rory, Duchenne Muscular Dystrophy”, already demonstrating angrily that his identity is defined by his diagnosis. At first Rory mocks and teases Michael, seeing him as the perfectly behaved young man who is popular with staff. However, Rory’s rebellious personality attracts Michael and their friendship takes off when Rory demonstrates that he can understand Michael’s speech better than anyone else. Michael needs him to communicate with the world and finds strength in their partnership, showing his appreciation by copying Rory’s gelled hair style, to the surprise of home manager Eileen (played by Brenda Fricker). Rory, who has ,earlier in life, had the experience of living in the community without a disability, tries to educate Michael in the ways of drinking, meeting women and being free.

As they share more about their lives, Rory learns that Michael’s father is a senior member of the judiciary, who failed to support him financially and abandoned all contact with him because of his disability. As their friendship deepens, Michael learns that Rory has been trying to obtain an Independent Living Allowance (ILA) that would enable him to live in the community supported by a full time carer. Michael accompanies him to a hearing in which Rory is once again unsuccessful in obtaining an ILA. After this, Rory hatches a successful plan to blackmail Michael’s father into providing money for a flat in the community for him. He also engineers the need to be Michael’s companion and communicator as they seek to obtain the ILA, this time for Michael. With that agreed the young men find a suitable flat and then seek a personal assistant who can provide the care they both require. They choose an attractive young woman that they met previously in the pub, played by Romola Garai. She helps to support the men in establishing a home but with some painful romantic consequences for Michael. Rory remains rebellious and confrontational as he battles with a disease that he knows will seriously limit his life span and the ending of the film brings this to a difficult conclusion, with a direct effect on Michael’s own choice about where he finally chooses to reside.

 

Relevance to the Field of Mental Health

The Mental Capacity Act Deprivation of Liberty safeguards (DOLS) and Best Interests is a very important topic at present. I offer this film as an accompaniment to the recent article published in BJPsych Advances May 2015, 188-195 (abstract) entitled Best Interests, mental capacity legislation and the UN Convention on the Rights of Persons with Disabilities by Brendan D. Kelly in which the author compares the key principle of ‘Best Interests’ in England & Wales, Northern Ireland and Ireland and the similar concept of ‘benefit’ in Scotland, examining how the various legislation is operationalised in each place. The film provides a perfect platform to discuss such issues and the legislation. The film highlights the difficulties of assessing mental capacity when an individual has significant communication problems and very little experience of life outside of a residential care home setting.

Aside from this focus, Rory O’Shea Was Here offers the opportunity to consider what life is like for those people who are confined to a wheelchair, reliant on others for the majority of their personal care. This understanding is important for all students across a wide range of disciplines who are engaged in caring for and working with such individuals.

 

• More information about Rory O’Shea Was Here can be found at IMDB, as can a short trailer.

Rory O’Shea Was Here is available to purchase and stream from amazon.co.uk

•  Thanks to my OT colleague ZC for this film recommendation.

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

 

 

05/05/2015 14:34:09

Minds on Film Index - 5 yrs on

 Minds on Film Clapper Board

To mark five years of Minds on Film, here is an updated index of blogs in the archive, organised by specific psychiatric conditions and mental health issues that have been covered so far.

 

 

 

 

Adoption

Philomena

Flesh & Blood

 

Ageing

Granny’s Got Game

Philomena

Les Invisibles

 

Alcohol dependence

The Christmas Choir

When a Man loves a Woman

Smashed

 

Alzheimer’s disease

A Song for Martin

Mr Alzheimer’s and Me

Still Alice

Wrinkles

 

Anterograde amnesia

Memento

 

Anxiety

Tarnation

Two days One night

 

Acquired Brain Injury

The Crash Reel

 

Assisted suicide

The Sea Inside

 

Bipolar disorder/Schizoaffective disorder

Tarnation

Tulisa - My Mum and me

Passionflower

 

Bulimia nervosa

Sharing the Secret

 

Carer stress

A Song for Martin

Tulisa - My Mum and me

Amour

Canvas

Helen

The Savages

 

Cerebrovascular accident

The Diving Bell and the Butterfly

Amour

A Simple Life

 

Challenging the stigma of mental illness

A New State of Mind: Ending the Stigma of Mental Illness

Two days One night

 

Childhood autism

After Thomas

 

Dementia

A Song for Martin

Longtime Companion

Amour

Wrinkles

The Savages

Still Alice

Mr Alzheimer’s and Me

 

Depression

The Aviator

Brassed Off

The Machinist

Control

Archipelago

Helen

Two days One night

A Single Man

Oslo, August 31st

 

Developmental delay in childhood

The Apple

 

Divorce - the effects on teenage children

Private Property

A Separation

 

Domestic violence

Tyrannosaur

 

Drug addiction

Down to the Bone

Oslo, August 31st

Trapped in a purple haze

 

Dyslexia

Like Stars on Earth

 

Employment and mental health

Two days One night

 

Epilepsy and psychiatric illness

Control

 

Grief for the loss of a child

Ordinary People

 

Growing up in Care

The Unloved

 

HIV related dementia

Longtime Companion

 

Homelessness and psychiatric morbidity

The Christmas Choir

 

Huntington’s disease

Huntington’s disease short films

 

Insomnia

The Machinist

 

Learning disability

Flesh & Blood

 

Locked in syndrome

The Diving Bell and the Butterfly

 

Mindfulness

Spring, Summer, Autumn, Winter

 

Morbid jealousy

El or This Strange Passion

 

Obsessive compulsive disorder

The Aviator

Matchstick men

 

Paranoid psychosis

Take Shelter

 

Personality disorder

Grizzly Man

 

Problem gambling

Owning Mahowny

 

PTSD

Birdy

In Our Name

 

Mental Health & acute trauma/disasters

The Impossible

 

Residential care for older adults

A Simple Life

Wrinkles

The Savages

 

Schizophrenia

Spider

Birdy

The Soloist

My son, my son, what have ye done

Canvas

 

Sexuality - in later life

Beginners

Les Invisibles

 

Stalking

Enduring love

 

Suicide/Attempted suicide

Brassed Off

Control

Helen

A Single Man

 

Tourette’s syndrome

Matchstick Men

 

Transgender issues

Transamerica

 

Uncomplicated Grief

Summer Hours

 

Unemployment and psychiatric morbidity

Brassed Off

 

Vascular Dementia

Amour

 

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

 

02/04/2015 09:02:55

Smashed

Introduction

Smashed, directed by James Ponsoldt, was released in the UK in December 2012. It tells the story of a young married childless couple, Kate and Charlie Hannah, whose relationship centers around drinking alcohol. Kate, played very convincingly by Mary Elizabeth Winstead, manages to function as a primary school teacher until several alcohol related harmful incidents cause her to question this lifestyle and she seeks sobriety. Unfortunately this choice has implications for her husband Charlie, played by Aaron Paul (of Breaking Bad fame), who remains addicted and sees no reason to change, putting their relationship under great strain.

Smashed was very well received by critics and audiences, and got some extremely good reviews from former addicts who commented on its authentic portrait of alcohol dependence. It is particularly useful as an educational film for patients seeking help and for professionals engaged in providing that support and treatment.

The Film

Smashed opens with Kate taking a quick drink as she showers before heading off to work as an infant school teacher. She notes that she’s wet the bed again too. When she reaches the school car park, she takes a swig from her flask to get her started for the day. Her husband Charlie works from home as a rock music journalist and leads a less pressured existence, so he stays sleeping in bed, finding it hard to get up. Kate appears to be coping fine until she finds herself unexpectedly vomiting in front of her class of young children, some of whom ask if she is pregnant. Kate sees this as an immediate solution to her dilemma and lies to them confirming that she is indeed pregnant. The news travels fast to the principal, a woman who cannot have her own children, and so becomes invested in Kate’s seemingly positive news. However, a male colleague, Dave Davies, who is a recovering alcoholic, quickly detects the truth about Kate and offers her a route to sobriety through attendance at his Alcoholics Anonymous group, without betraying her trust. Kate is initially unsure about seeking help in this way, but after a drunken night out on the ‘wrong side of town’ involving the consumption of crack cocaine and a night sleeping rough, she finds the motivation.

When she first accompanies Dave to his AA group she meets an older woman, Jenny, who becomes her mentor and a positive influence in her life. Unfortunately Dave flirts clumsily with Kate on the way home after the meeting, Kate deals with this firmly and effectively, stating her loyalty to Charlie. As Kate begins to feel pride in her sobriety, her relationship with Charlie suffers because of his continued drinking and the lifestyle that is associated with it. Kate decides to visit her mother for the first time in years and Charlie insists on going with her. Kate’s mother is revealed as a drinker, embittered by the breakup of her own marriage and the sobriety of her ex-husband who now has a new family. The tensions in their mother-daughter relationship are very apparent.

When Kate is finally forced to reveal the truth about her non-existant pregnancy to the principal at school, she loses her job, causing a brief relapse of her drinking. However, she gets back on track with the help of Jenny and Dave and faces the reality about the impossibility of marriage to Charlie if he continues to drink. The final scene jumps forward a year when the couple meets again after Kate has been sober for a year. Charlie, who is still drinking, wants to give their relationship another try but she sees that he has not changed and knows that it is over for her.

 

Relevance to the Field of Mental Health

With increasing recognition of the role that excess alcohol consumption plays in the physical and mental ill health of individuals, this film portrays a very important problem that currently faces our society.

Smashed gives a compellingly believable presentation of two individuals with alcohol use disorders and follows Kate through her attempt to get help using Alcoholics Anonymous. The film could be used to teach about the subject, perhaps alongside a reading of a recent Clinical Review published on 21st February 2015 in the BMJ, written by Ed Day, Alex Copello and Martyn Hull, called Assessment and management of alcohol use disorders (BMJ2015;350:h715). The article is aimed at GPs and non-specialist hospital doctors and an abstract is freely available as well as a 30-minute discussion about the topic with the authors of the review (which can be heard as an audio track on soundcloud).


Psychiatrists might find it informative to read two recent articles in BJPsych Advances on the subject of drug and alcohol addiction, by Jason Luty. The first entitled Drug and alcohol addiction: new pharmacotherapies (10.1192/apt.bp.114.013367) and the second called Drug and alcohol addiction: do psychosocial treatments work? (10.1192/apt.bp.114.013177). There is also a recent CPD online learning module called Alcohol-related brain damage that would provide an additional useful resource.

Lastly, the charity Alcohol Research UK funds high quality research into alcohol-related harm and hosts many useful resources at their website.

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

Smashed is available to purchase from amazon.co.uk

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

 

02/03/2015 08:10:13

My Life: Mr Alzheimer’s and Me

Introduction In this blog I want to present a very different short film about dementia, directed by filmmaker Natasha Dack. It is made from the point of view of three children, all of whom have a grandparent suffering from either vascular or Alzheimer’s type dementia. The film is called Mr Alzheimer’s and Me and it was made for children as part of the excellent My Life series of documentary shorts, shown on the CBBC channel in the UK, on 4 February 2015. Dack was inspired by her son’s experience of his great-grandmother suffering from dementia in her 90s. She was keen to explore how these particular bonds between the generations are affected when the grandparent’s memory of their grandchildren becomes compromised.


The FilmMr Alzheimer's and Me

Watch the film’s trailer available on YouTube   

Mr Alzheimer’s and Me is currently available to stream or to download from BBC iPlayer, but only for the next week (although they will remain available to view for a further 27 days after download). The programme description is as follows:

 

My Life Series 6: 3. Mr Alzheimer's and Me
Josh, Ella and Hope all have one thing in common - they have a grandparent with dementia. It isn't easy having to be 'the grown-up' when their grandparents get forgetful. But all three of them are determined to help them as much as they can. They all have their different ways of coping, which they want to share with other kids going through the same thing, and have recorded personal moments with their grandparents on their own cameras. Josh is determined to help his [granddad] remember and secretly gathers mementos for a memory box. Ella decides to organize a sponsored walk to help raise money for research into the causes of dementia. Hope's granny gives dementia a character - Mr Alzheimer's - to help Hope come to terms with it all.

 

Relevance to the Field of Mental Health

This is a powerful short film, offering three individual family portraits of dementia as experienced by the grandchildren of each grandparent suffering from the illness. It also provides three useful clinical portraits from different stages of the disorder that could form the basis for learning about the presentation and progression of the illness. The scenes filmed by the children themselves provide an intimate portrait of their interactions and the bonds that they share with their grandparent. In some of Ella’s interactions with her granddad, his loss of understanding of the meaning in her questions is especially well captured. Some of the strategies the children use in the film, such as Josh’s construction of a memory box, are useful tools that can be employed in care settings as well as within the family home and could provide the inspiration for further discussion about the techniques that can be employed to improve the quality of life for people who are developing memory problems.

I hope that the BBC might consider making the film available for general use beyond the time that it is accessible on iPlayer, as I believe it is such a valuable resource.  Families in which an elder has just received the diagnosis of dementia might find it helpful to view with their children. It is also a wonderful learning resource for mental health professionals and educators, too, as there are increasing numbers of children who will encounter dementia within their families.

My Life: Mr Alzheimer’s and Me is available for the next week on BBC iPlayer (CBBC channel)

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

 

 

 

02/02/2015 09:12:29

Two Days, One Night

IntroductionTwo days, One Night

Two days, One Night, written and directed by brothers Jean-Pierre Dardenne and Luc Dardenne, was released in 2014. It is in French with English subtitles. It features a young Belgian mother called Sandra, played by Marion Cotillard, whose job is threatened after a period of absence due to depression and anxiety. The film follows her over a weekend in which she tries to persuade her work colleagues to allow her to keep her job instead of receiving a substantial bonus, the choice given to them by the management. Based on a number of actual employment cases in France, the Dardenne brothers have talked about a need to explore the cruelty of the workplace in which such tactics might be used, especially in recent times of austerity when employees may be pitted against each other in competition for jobs. As mental health stigma and discrimination are important issues in the UK, ones currently being highlighted by the Time to Change campaign, this is an enormously important film for all mental health professionals to watch and possibly to use in teaching about the issue. It has already won a number of awards for Marion Cotillard as Best Actress and for Best Foreign Language film and is nominated for a BAFTA award in 2015.
 

The Film

Two days, One Night opens one Friday afternoon with Sandra resting at home when she is woken by the phone ringing. What is not immediately clear but subsequently unfolds is that one of her good friends and work colleagues, Juliette, has called to inform her of a vote held that day at their workplace to decide whether Sandra should return to her job after a period of sick leave caused by depression and anxiety. It seems that in the vote her colleagues were asked to choose between allowing Sandra back to work or receiving a bonus of €1000 each. The foreman has untruthfully informed some of her colleagues that if they don’t vote for Sandra to lose her job one of them might have to go, so influencing the decision. Initially hopeless and anxious, Sandra reaches for her anxiolytic medication and takes a tablet. Her husband returns from work, hears the news and insists that she must fight for her job by asking for another ballot, this time a secret one, on Monday giving her the chance to speak to all of her workmates in person over the two days, one night of the weekend. The manager grants the ballot and the subsequent conversations between Sandra and her colleagues form the substance of the film.

Each of Sandra’s encounters with her colleagues is filmed in real time with hand held camera shots, which bring an authenticity to the encounters that is very effective in conveying the difficult emotions present in each encounter. Of course, each person has a need for the bonus and reacts differently to Sandra’s plea to forego it so that she may keep her job. One person reveals that the foreman told him that Sandra’s mental illness makes it likely that she’ll perform more poorly at work. Sandra faces the dilemma that the increasing stress of her situation is causing her an increase in anxiety and a need for more medication at the same time as trying to reassure colleagues that she is recovered and ready to return to work.

Once Sandra believes that she has not gained the support of more than half her workmates, she is overcome with hopelessness and takes an impulsive overdose of Alprazolam (the benzodiazepine she is prescribed for her symptoms of anxiety and panic). Just as she has done this, a colleague calls at her home to say that she has changed her mind and will support her and so Sandra confesses to taking the overdose and is immediately taken to hospital by her husband. By Monday morning of the ballot Sandra returns to work resigned to the possibility of either decision, as the numbers are very close in her estimation. The ending of the film poses an interesting dilemma for Sandra.

Relevance to the Field of Mental Health

Two days, One Night tackles a number of important mental health topics. With its compelling portrait of depression, anxiety, panic and an impulsive overdose of prescribed medication the film offers a good platform for teaching on these conditions. But it is particularly useful for considering the subject of stigma in the workplace and the ways in which people can be helped back, by employers and colleagues, to their jobs after a period of sick leave caused by mental illness. There are some excellent resources about this issue at the Work and Mental Health pages of The Royal College website, with sections for Workers, Employers, Clinicians and Carers. These pages could be used alongside a viewing of the film to explore the subject and provide a good teaching package. An article in Advances in Psychiatric Treatment published in 2003 entitled Work, employment and psychiatric disability by Jed Boardman (Advances in Psychiatric Treatment (2003) 9: 327-334), now freely available, also offers additional useful material on this topic that might inform a discussion (bearing in mind that it was written more than a decade ago when the economic climate was somewhat different).

In summary, this is a film well worth watching for mental health professionals seeing people who work in an increasingly harsh employment world, experiencing higher levels of stress whilst often having lower job security.

• More information about Two days, One Night can be found at IMDB, as can a short trailer.

Two days, One Night can be purchased from amazon.co.uk. Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

 

06/01/2015 08:58:49

A Single Man

Introduction
A Single Man

A Single Man, directed by first time director Tom Ford, was released in 2009. Set on one day in 1962, it is based on the novel of the same name by Christopher Isherwood, and stars Colin Firth as George Falconer, a middle-aged English college professor living and working in Los Angeles. George is the single man of the title by nature of his homosexuality and because of the death of his lover, Jim played by Matthew Goode in flashback scenes, eight months earlier. Firth won Best Actor at the Venice Film Festival for the role in 2009 and a BAFTA for best actor in 2010. Tom Ford also won the Queer Lion award at the Venice Film Festival in 2009 (an award given to the Best Movie with LGBT Themes & Queer Culture).

As we observe recent negative legal changes pertaining to homosexuality in parts of Africa and in Russia, it is perhaps useful to be reminded of the reality of a closeted life for individuals living in intolerant societies as portrayed in A Single Man. It is interesting to note that, even in twenty first century America, there was some controversy about the marketing of the film, with accusations, by some, that the trailer and the cinema poster had been stripped of any gay content in an attempt to improve the film’s chances of receiving Academy Award nominations.

The Film

A Single Man begins with a dream sequence in which George is suspended naked and alone underwater before a snowy scene breaks through and he approaches the bloodied body of his lover, Jim, and their dog, both lying dead beside a car wreck. The soundtrack becomes dominated by an increasingly rapid heartbeat until George wakes in panic to the day in 1962 in which he decides he cannot go on any longer. His narration states this. The film presents the details of George’s day as he plans to end his life by suicide. He examines the hand gun he has kept in a drawer of his desk and calmly begins the process of placing keys, financial documents and suicide notes on his desk with the suit he wishes to be dressed in after death nearby and a written note asking that his tie be knotted in a particular way. Then he takes a call from his old English friend Charley, played by Julianne Moore, inviting him to dinner that evening.

George lives in an architect designed glass house, at once so open and transparent in contrast to the reality of the closeted life he is forced to live. He observes the family next door through his toilet window as the children play in the garden, compounding the differences between his life and theirs. George is resolved to complete his normal teaching commitments as a college professor that day and drives off from home as usual. In the lecture theatre, George appears unable to connect with his students when he attempts to discuss those individuals in society that are ‘invisible’ or different, except for one student, Kenny, who seems more attracted to George than to the subject of his lecture. Once he has finished teaching, George empties his work desk before preparing to drive away. But at his car he is stopped by his student Kenny, who asks if he is going away because he saw him clear his office. George gives nothing away about his inner thoughts. After leaving campus, George visits his bank to put his finances in order and to remove all of the contents from his safe box, including a naked photo of Jim. The photo triggers a flashback from their earlier life and indeed their relationship is pieced together through the various earlier scenes that are offered throughout the film.

On his way home George stops to buy some alcohol for his dinner with Charley that evening, and meets a young Spanish male gigolo. They share a cigarette and watch the sunset in the car park before George turns down an offer of sex to return home, seeming to enjoy all of these experiences with a newly heightened perceptiveness. It is this change in the quality of his interactions and observations that ultimately seem to beckon him back to the world of the living. However, back home before changing for his dinner date, George rehearses how he will shoot himself and cannot feel quite satisfied with any particular strategy. He arrives at Charley’s home to eat a beautifully prepared meal. They drink and dance to music from the past before she angers George by carelessly dismissing his relationship with Jim as not real or proper just as she expresses hope that they may be able to rekindle a long ago brief sexual encounter. After leaving her home he goes to a bar to buy a bottle of spirits but meets with Kenny who has been following him. They flirt and end up swimming naked in the sea before going back to George’s house where they both fall asleep. When George wakes he finds Kenny sleeping and holding George’s gun under his blanket to prevent George from using it. It becomes clear that Kenny had discovered the meticulous plans for suicide laid out on the desk. George retrieves the gun and locks it back in his drawer before burning all of his suicide notes. Sadly he then slumps on the floor, suffering a fatal collapse just as he has recognised that he might be ready to embrace life again.


Relevance to the Field of Mental Health

A Single Man presents a portrait of bereavement stifled by anti-gay sentiment that prevents George from attending his partner’s funeral or even being formally told of his death by Jim’s family. George’s recurrent flashbacks perhaps represent an attempt to work through the loss without the usual rituals, in a society where he is unable to openly talk about or share his grief with anyone. The only person he can tell is his old English friend Charley, who is struggling to deal with her own psychological distress and who is drinking heavily, after the breakdown of her marriage. Even worse, Charley persists in expressing an unhelpful desire to rekindle an early liaison with George despite his declared homosexuality and the recent loss of his partner Jim.

As the film examines the day in which George has decided to end his life, A Single Man offers a very good opportunity to discuss the topic of assessing suicidal risk, perhaps alongside a reading of the 2013 article by Alys Cole-King, Victoria Parker, Helen Williams and Stephen Platt, entitled Suicide prevention: are we doing enough? (Advances in Psychiatric Treatment (2013) 19: 284-291, abstract). In another relevant article published in Advances in Psychiatric Treatment in 2005, by Joe Bouch and John James Marshall, entitled Suicide risk: structured professional judgement (Advances in Psychiatric Treatment (2005) 11: 84-91) the case of UK government scientist Dr David Kelly’s unexpected suicide is discussed, and a comment is made as follows:

“First, suicide may not be predictable. Second, multiple risk factors are not always present in high-risk individuals. Only one or two risk factors present to a serious degree may be sufficient. Third, risk can escalate rapidly over a short period (and, if the outcome is not fatal, may just as quickly subside).”

As Mental Health professionals encountering bereaved individuals we must be sensitive to the unique nature of each person’s loss (whether actual or perceived) when seeking to assess their potential suicide risk and to be aware that masked symptoms of depression may hide their real intent. A Single Man offers a valuable portrait of such a presentation, which could usefully inform a teaching session on this important topic.

• More information about A Single Man can be found at IMDB, as can a short trailer.

A Single Man can be purchased from amazon.co.uk.

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

 

01/12/2014 09:17:18

Philomena

This is the second of two blogs about the topic of adoption.


IntroductionPhilomena

Philomena, directed by Stephen Frears and released in 2013, is based on the book by journalist Martin Sixsmith called The Lost Child of Philomena Lee. The screenplay is written by Jeff Pope and Steve Coogan, who plays Sixsmith. The film tells the true story of Philomena’s long search for her son who was taken away for adoption as a toddler, without her consent, by the nuns at the convent where she was staying. After becoming pregnant as an unmarried teenager, Philomena had been sent to the convent to have her baby and subsequently to work for the nuns for several years afterwards in lieu of payment. Such features of the film have stirred some criticism from Catholic sources although the film has generally received much critical acclaim. Philomena is played by Judi Dench who, together with Coogan, shines in a most unlikely but compelling road movie which is at times both funny and sad. Coogan and Pope won a BAFTA for the Best Adapted screenplay in 2014 and Best Screenplay at the Venice Film Festival 2013. Judie Dench was awarded Best International Actress at the Irish Film and Television Awards 2014. The film was nominated for a total of four Oscars. Sixsmith wrote about his involvement with Philomena Lee in a Guardian article in 2009 at the time his book was published. The book gave impetus to many adopted Irish children to search for their lost families.

 

The Film

Philomena begins with the difficulties Martin Sixsmith faces as he loses his job as a government advisor. At a loss and initially planning to write a book on Russian history, he is approached by Philomena’s daughter at a party, by chance. She asks for his assistance in helping her mother trace the son Philomena has been searching for for the past fifty years. At first skeptical because Sixsmith doesn’t write ‘human interest stories’ he is persuaded to do so after becoming intrigued by the facts that are revealed on meeting with Philomena. This results in an agreement to work together to trace her son Anthony, begining with a visit to the convent in Ireland where Philomena had lived when her son was forcibly adopted away. When no information is forthcoming from the nuns, and they learn that all of the documents pertaining to the period were destroyed in a fire, Sixsmith and Philomena follow some very tenuous lines of enquiry that lead them to America. In a thrilling investigation using many of his old contacts, Sixsmith finally traces Anthony, renamed Michael Hess, who had become a legal counsel in George Bush senior’s government. Sixsmith also finds that Michael Hess was gay and closeted even as he worked for a staunchly homophobic Republican party. Unfortunately the saddest news follows that Michael died of AIDs at the age of 47. As Philomena tries to process this news, they continue their search for more information about Michael by tracing his long term partner, Pete Olsson. When they finally meet with him he shares that Michael had been searching for his mother for many years and had in fact visited the convent in Ireland on two occasions, requesting that he be buried there when he died. Philomena is able to return to Ireland and visit her son’s grave satisfied by the knowledge that he had never forgotten her, although saddened by the reality of having lost him twice.

 

Relevance to the Field of Mental Health

Philomena  provides more material for learning about the psychological issues often raised by adoption, but this time from the perspective of the parent who loses the child that is adopted away. In this particular story the adoption took place without consent and deprived Philomena, as a mother, of the chance to say goodbye or to refuse the adoption altogether. Many of the resources that I linked to in the previous blog about Flesh & Blood remain relevant for use with a viewing of Philomena, in particular the pages on Attachment Theory and research, at the fostering and adoption learning resources online library, funded by the Department for Education.

This is a very valuable film, not only as a piece of social history that depicts a different attitude to parental-child bonds, but also because it reveals the consequences of such events for individuals still alive today. Whilst Philomena Lee was fortunate to get help and support in tracing her lost son, other older adults who have not revealed the facts about such losses in their earlier life may experience similar yearning in later life that might cause them to become anxious or depressed. As Mental Health professionals encountering such individuals we must be sensitive to all possible losses when seeking to understand why someone presents with symptoms of mental illness at any particular time in their life. By taking a full history that includes an outline of their whole life story we stand a better chance of understanding some of the complex factors that may contribute to their illness presentation. For anyone working in Old Age Psychiatry, this is an important film to watch.

 

• More information about Philomena can be found at IMDB

Philomena can be purchased from amazon.co.uk.

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

 

 

30/10/2014 14:51:24

Flesh & Blood

This is the first of two blogs about the topic of adoption.

 

IntroductionFlesh and Blood

Flesh & Blood is a full-length TV film, written by Peter Bowker and directed by Julian Farino. It was broadcast on BBC2 in 2002 and released on DVD in 2007. It features Christopher Ecclestone as an adult man, Joe, adopted at birth, who seeks out his biological parents after his own daughter is born, only to find out that they both have a learning disability and are totally unaware of his existence. Joe’s parents are played by two actors, Peter Kirby and Dorothy Cockin, who have a learning disability, with no formal training as actors before the filming, and who worked with an improvised script. The director reported that both actors enjoyed the experience although he is quoted as saying “they didn’t understand the structure of the story, but they did understand that they were pretending”. He also stated that learning disability organisations were consulted before production and were very supportive of the project.

The writer, Peter Bowker, has twelve years of experience, earlier in his life, in teaching individuals with special needs in a variety of settings, including in hospitals. He won the Royal Television Society Award for Best Writer in 2003 for the screenplay. Christopher Ecclestone won Best Actor at the same RTS Awards and the film won the Prix Europa award for TV fiction in 2003.

 

The Film

Flesh & Blood begins with Joe knocking on doors in Morecambe, in the Northwest of England, in an attempt to find his birth mother. When he succeeds in matching the name on his birth certificate with a mental health nurse, Joe believes that he has found his roots and can share the joy of his own baby daughter with her. However, at their first proper meeting, Barbara reveals her name had been used on his birth certificate to cover up the truth that two learning disabled inpatients, who had had a sexual relationship within the unit where she had been working, were actually his biological parents and were completely unaware of his existence. Joe finds that he is challenged by this news as he struggles to tell his wife, family and closest friends about the truth of his discovery and he becomes quite angry and aggressive toward his wife as he confronts his own prejudice. There are a variety of feelings expressed about learning disability by the other people close to Joe. The film also shows those in society working tirelessly to counter any negative views, when Joe volunteers at the local social club where his biological father, Harry, enjoys playing pool every week and Joe begins to befriend him. Joe finds himself really surprised when he learns that Harry has a job but then realises that this is absolutely as it should be. His encounter with Janet, his biological mother, proves more difficult as she has less ability to engage in conversation. Joe decides to arrange a family gathering for all of his family and friends to meet Harry and Janet at his home and it is during this event that Janet gets to hold Joe’s baby daughter, without the knowledge that this is her own grand daughter, with Harry sitting by Janet’s side. As a photo is taken of this important moment for Joe, a sense of integration and assimilation is reached in Joe’s personal journey to find his biological roots and a fuller understanding of his role as a husband and father.

 

Relevance to the Field of Mental Health

Flesh & Blood offers a very good platform for discussion about learning disability as well as the issue of adoption from the point of view of the adult adopted child seeking information about their biological origins. The film provides the perfect opportunity to consider the topic of mental capacity and consent in the context of sexual relationships between people with a learning disability. What makes this a valuable film for mental health professionals is the authenticity of the performances. As both of Joe’s parents are played by actors with a learning disability and their scenes are unscripted, the other actors respond to them spontaneously throughout the course of the filming, making the interactions feel much more real. Some of the scenes were filmed at the social club, which the actor playing Harry actually attended every week, as well as at the factory where he had worked for more than twenty years. For further information that could complement a viewing of the film, there is a good fact sheet available at The Royal College of Psychiatrists website and an excellent review article published in the British Journal of Psychiatry in 2000 by Sheila Hollins titled Developmental psychiatry - insights from learning disability (The British Journal of Psychiatry (2000)177: 201-206) now freely available on-line. It is interesting to remember that this article was written before the Mental Capacity Act of 2005.

Flesh & Blood also provides a good platform for discussion about the psychological issues often raised by adoption for the individual placed away from their biological parent or parents in early life. For those providing counseling and psychotherapy this may be an issue that causes individuals to seek help in adult life. More useful information is available at the Fostering and Adoption learning resources from Research in Practice website funded by the Department of Education in the UK. Here there is an interesting page on Attachment theory and research.

Although the circumstance of Joe’s adoption may surprise some viewers of the film, it is interesting to note the statement on the webpage of The National Archives:

Formal adoption, as we now know it, did not exist in England and Wales until 1927. Before then, adoptions were usually informal. In a few cases there was some legal documentation, but no central register.

This is a very valuable film for anyone interested in working in mental health and in particular with individuals who have a learning disability. The DVD contains a fascinating commentary by the director and Christopher Ecclestone, which includes much discussion about their experiences of working with the two learning disabled actors.

• More information about Flesh & Blood can be found at IMDB

Flesh & Blood can be purchased from amazon.co.uk.

• 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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