Introduction
The Aviator is a biographical film about the American
billionaire,
Howard Hughes, that presents an extremely well researched and
accurate portrait of the development of his obsessive compulsive
disorder (OCD), from its first emerging symptoms, to his struggle
with severe symptoms in middle age. It tells the story of his
lifetime achievements as a filmmaker, an aviator, a record breaker,
a playboy and a successful entrepreneur. These successes were
probably aided by his extreme perfectionism and his determination
to attend to every small detail in a project, something the film
illustrates brilliantly.
The film, directed by Martin Scorsese in 2004, with Leonardo
DiCaprio playing Hughes, won 5 Academy Awards.
|
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| Scorsese consulted with OCD specialist, Dr Jeffrey
M. Schwartz MD, an Associate Research Professor of Psychiatry at
the UCLA School of Medicine and a medical advisor to the UK’s
national Obsessive Compulsive Disorder charity OCD-UK, on every aspect of DiCaprio’s
portrayal throughout the filming.
On the DVD with bonus features, there is a 15-minute film about
the condition presented by Dr Schwartz in which several patients
recount their own experiences of the illness. Di Caprio reveals, in
an interview on the bonus disk, that he spent a significant period
of time with a sufferer, before filming, in an attempt to
understand what lay beneath the compulsive behaviour of excessive
hand washing. DiCaprio also admits that he rediscovered some
obsessional behaviour from his own childhood, involving cracks in
pavements, when preparing for the part. This resulted in him
sometimes taking ten minutes to walk from the studio door to the
set.
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The Film
Lasting for 163 minutes, this is an epic film
but one well worth the investment in viewing it. It tells the
story of the early life of Howard Hughes from the 1920s to the
1940s and records the history of his OCD from the first subtle
signs to the full blown incapacitating episodes in which he was
almost certainly suffering from depression as well.
The film opens with shots of his mother
bathing his naked body as a boy and telling him that he is not safe
from disease, giving the viewer clues about a strong family history
of OCD (which was in fact also present in other relatives) as well
as early parenting influences in the causation of his OCD.
The Aviator beautifully depicts the
grand age of the Hollywood studios with all of their glamour and
shows the many famous actresses of the day with whom Hughes had
sexual relations. However his personal isolation and difficulty in
finding intimacy is particularly well enacted, especially in his
relationships with Katharine Hepburn and Ava Gardner. Through
their eyes we are given insight into how the early symptoms of his
illness become apparent and how OCD can adversely affect the
partner in a close relationship.
A significant focus of the film is on Hughes’
contribution to the aeronautical industry and his involvement in
the birth of modern aviation as we now know it. His
meticulous attention to detail and extreme perfectionism, coupled
with his technical vision, are shown transcending the real
limitations imposed by his OCD. This is a film that demonstrates
just what can be achieved despite such a serious mental
illness.
In contrast, his excessively controlling
behaviour, in all of his personal relationships is shown as causing
him huge difficulties. His ability to employ staff to carry
out his compulsions, an extraordinary facet of his illness, is an
unusual feature of his mental ill-health made possible only by his
great wealth.
The most severe episode of his OCD is
brilliantly illustrated near the end of the film in the scene
showing him living as a naked recluse in his screening studio. His
nakedness at this point in the film has powerful echoes of his
nakedness as a boy at the beginning of the story, being washed
clean of germs by his mother.
Relevance to the field of mental health
For anyone interested in learning more about
OCD, this film provides tremendous insight into the thoughts and
compulsions that can cause sufferers so much distress. It
also illustrates the fact that depression may arise in association
with untreated OCD and can contribute to the burden of illness.
The Aviator helps us to imagine how it might feel to be
close to someone with OCD who has not yet sought help.
Our understanding of this illness has grown
significantly since the decades represented in The
Aviator, when frontal lobotomy was the treatment of last
resort for the condition. Although the role of early influences is
acknowledged, the majority of scientific research now supports the
view that in a significant proportion of sufferers it is a brain
disorder. It is also well recognised that stressful events
and major life changes can bring on or worsen the symptoms of OCD,
something that is well illustrated in the film.
Fortunately cognitive behavioural treatments
have been developed in the past two decades that are very effective
in treating the symptoms, using either exposure and response
prevention (3 out of 4 people are helped significantly) or
cognitive therapy (very effective for mild OCD on its own).
Additionally, there are thought to be problems
with a neurotransmitter, serotonin, which is deficient in certain
brain areas of people with OCD. This explains the use of certain
drugs in the SSRI group of antidepressants, which increase
available levels of serotonin, in the treatment of moderate to
severe OCD, even when depression is not present. People who find
relief with medication alone (around 6 out of 10 people) tend to
relapse when it is stopped, unless it is combined with cognitive
behavioural therapy.
The film portrays clearly that Hughes’
obsessive compulsive symptoms fluctuated significantly in severity
in response to the stresses and traumas in his life, especially his
near fatal plane crash. But even during the worst episodes of
his earlier life, he was able to suppress the symptoms fairly
effectively when totally absorbed in a task. The complete
focus and absorption required to fly a plane seemed to overcome his
symptoms and gave Hughes some of the happiest experiences in his
life. This makes sense to us now because effective treatments
involving mindfulness in the present moment and distraction into
activity are known to help lessen some of the symptoms of OCD.
I believe that this film offers the viewer an
opportunity to gain an empathic understanding of the suffering that
individuals with severe OCD might experience. Indeed, one
wonders what further achievements Howard Hughes might have made in
later years had he been able to access the treatments available
today, when he had first developed symptoms.
These issues were examined in a recent
prospective, long-term follow up study of children and adolescents,
seen at the specialist OCD Clinic for Young People at the Maudsley
Hospital, London. Published in the August 2010 issue of The
British Journal of Psychiatry, the authors concluded that
“early recognition and treatment of OCD in childhood might prevent
chronicity“ and urging “a need for increased recognition at the
earliest stages of the disorder” (Long-term outcomes of
obsessive-compulsive disorder: follow-up of 142 children and
adolescents N. Micali, I. Heyman, M.Perez, K. Hilton et al;
The
British Journal of Psychiatry (2010) 197,
128-134.).
The Royal College has a good
leaflet on obsessive compulsive disorder for anyone wanting
further information on the symptoms and treatments available.
Further information about The Aviator
can be found at IMDB, as can a short
trailer.
The DVD is available to purchase at
amazon.co.uk (either with 2 discs and bonus features or one
disc without the extras).
Minds on Film blog is written by Dr J Almeida.
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