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

Longtime companion

Introduction

To mark World Aids day on 1st December 2011, and the thirty-year anniversary of the first identified cases, I wish to recommend Longtime Companion, directed by Norman René, and released in 1989. The title is taken from the words used by the New York Times obituary section, then unable to acknowledge a homosexual relationship, to describe a same sex partner of someone who had died. The film is set during the 1980s, in America, when the world witnessed the emergence of a new disease that we have come to know as Acquired Immune Deficiency Syndrome or AIDS, caused by a then unknown agent, now well known as Human Immunodeficiency Virus 1 or HIV-1.

Longtime companion
The film follows several New York gay men from 1981 until 1989 during which time the disease emerged and caused death and panic to spread rapidly through the group. As well as the historical account of a disease that has emerged in our time, this film is of particular interest to psychiatrists because it gives us a portrait of AIDS related dementia in one of the characters. As a final year medical student, in 1982, I worked on the medical firm at St Thomas’ Hospital when Terrence Higgins was admitted (the Terrence Higgins Trust was subsequently founded in his name), and witnessed my baffled seniors struggle to save him as he declined rapidly to death from untreatable opportunistic infections. He was one of the first people to die from AIDS in the UK. I have never forgotten him.

The Film

Through the interconnected lives of several gay men, Longtime Companion tells the chronological story of the beginning of the AIDS epidemic. Within the group, there are two well established partnerships: that between David and Sean, who writes a daytime soap opera and that between Howard, who stars in the soap written by Sean, and his partner Paul. The other single friends in the circle are Willy, who is a personal trainer, a young man called John and a lawyer called Fuzzy, on account of his facial hair. Howard and Paul live next door to Lisa, who is a friend of Fuzzy and part of the group. Willy and Fuzzy meet early in the film and begin a relationship. The affluent couple, David and Sean, have a beach house on Fire Island where they frequently invite their friends to stay. In 1981 the New York Times publishes news of a new ‘gay cancer’ called Kaposi’s sarcoma and all of the friends react in different ways to the report. In 1982, John develops pneumonia, deteriorates rapidly and dies soon after he is admitted to hospital. By 1983, the attitude to the illness among the group is very different and fear has taken hold. David and Sean are seen arguing over Sean’s fears that he might have the illness. In 1984, Paul becomes unwell and investigations in hospital reveal that he has toxoplasmosis. In the same year, Sean is hospitalised and during a visit to him from Willy, the film demonstrates brilliantly the fear that Willy has of contracting the disease from a kiss Sean gives him on the neck. By 1985, Sean is being nursed at home, by his partner David, and is now suffering from AIDS related dementia. David is trying to support Sean with his screenwriting in order to keep the extent of his illness hidden from the studio. At the same time Fuzzy tries to secure Howard a movie role when the producer has refused to cast him after hearing an untrue rumor that he has AIDS. By 1986, Sean has severe dementia and is bed bound, incoherent and incontinent. He dies soon after and Fuzzy offers support to David by phoning to find a ‘gay friendly’ funeral home that will deal with the body. The next scene, at a memorial service, takes place in 1987 when we discover the deceased is David. By 1988, Howard has been diagnosed as HIV positive and is fundraising for AIDS causes. The film ends in 1989 with Willy, Fuzzy and Lisa walking along the seashore contemplating how much their lives have changed, in the few years since AIDS has emerged. There is a final brief fantasy scene in which all of their lost friends return to the beach to be fleetingly reunited before disappearing once again and leaving the three friends alone on the empty shoreline.

Relevance to the field of Mental Health

Longtime Companion presents a number of relevant mental health issues that are related to infection with the Human Immunodeficiency Virus. These include the effect of repeated bereavements on those who lose close friends and or a partner from the disease; anxiety and panic about developing the illness in healthy, but at risk, individuals and finally it offers a portrait of HIV related dementia in one of the characters. As the film is set at the time when AIDS first manifest, when the mortality rate was 100%, there is an inevitable historical context to be taken into account in relation to the medical content.

Thankfully the intervening years have brought huge success in managing those who suffer from HIV infection, using highly active antiretroviral therapy (HAART). As a recent study in the UK has shown (BMJ 2011; 343:d6016), there is now a significantly improved life expectancy for those with HIV when antiretroviral therapy is started soon after diagnosis, transforming it into a chronic disease rather than what was usually a fatal illness.  However there is still no vaccine or cure and in current times the disease presents huge problems worldwide, especially in sub-Saharan Africa, where it is estimated that one in three people are living with the virus in the worst affected countries. In the UK the estimates suggest that between 80,000 - 90,000 people are living with HIV and that the two groups most affected are men who have sex with men and people who have moved to the UK from areas of the world with a high incidence of HIV. In this second group, heterosexual sex is the commonest cause for the spread of infection among men and women.

Since the mid 1990s, with the use of HAART in the treatment of those infected with HIV, the incidence of HIV associated dementia has declined and has been replaced by less severe HIV associated neurocognitive disorders (HAND). The impairments commonly seen include reduced attention and slower information processing and subtle changes are estimated to be present in up to 35% of people with HIV infection who are under the age of 40. When AIDS dementia does occur, it presents as a subcortical dementia associated with basal ganglia pathology whose severity appears to correlate with the levels of virus in the brain and cerebrospinal fluid. As increasing numbers of HIV positive people are now living longer, it is important to remember that HIV is a potential cause of anyone presenting with mild cognitive impairment or early-onset dementia. For some basic information about HIV related cognitive impairment, The Alzheimer’s Society has a good factsheet on the topic.

Any psychiatrists wanting to consider the subject area in greater detail might find interest in a book entitled Handbook of AIDS Psychiatry by M.A. Cohen, H.Goforth, J. Lux, S. Batista, S. Khalife, K. Cozza, J. Soffer. Oxford University Press USA. 2010, which was reviewed recently in the British Journal of Psychiatry by Derek Summerfield, Consultant Psychiatrist (BJP September 2011 199:259-260). There is also the earlier Comprehensive Textbook of AIDS Psychiatry Edited by Mary Ann Cohen & Jack M. Gorman. Oxford University Press. 2007, which was reviewed in 2009 in the British Journal of Psychiatry by Jose Catalan, Consultant Psychiatrist (BJP 2009 195: 277).

Longtime Companion is a film that puts a very personal face on the experiences of a close group of gay men as they struggled to face the frightening consequences of a new disease, one which proved a challenge to professionals from all branches of medicine then and, in different ways, is still doing so today.

  • Further information is available at IMDB, and the official trailer is available on You Tube.
  • Longtime Companion can be purchased at amazon.co.uk.

 

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About this blog

 

Minds on Film is a monthly 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.