Introduction
The Diving Bell and the Butterfly, released in 2007, was
directed by Julian Schnabel and is based on the book of the same
name. The film won a Bafta for best screenplay, a Golden Globe and
an award for best director at Cannes Film Festival. In French with
English subtitles, it tells the true story of Elle magazine
editor-in-chief, Jean-Dominique Bauby, who suffered a brain stem
cerebrovascular accident at the age of forty-three. He consequently
developed locked-in syndrome, a rare neurological condition
characterised by quadriplegia and an absence of verbal
communication but with preservation of eye movements and
intellect.
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Bauby’s book was dictated by the blinking of his left eye in
response to a translator who would recite the letters of the
alphabet, a task requiring an extraordinary amount of patience, and
it tells the story of his experiences from the moment he regained
consciousness in hospital. The book was published in France in
March 1997, ten days before Bauby died of pneumonia. Unusually for
a film, we spend a great deal of time seeing things solely from
Bauby’s direct perspective. This makes The Diving Bell and the
Butterfly a particularly instructive experience for any mental
healthcare professional seeking to better their empathic
skills. |
The Film
The film opens with the blurry opening of Bauby’s eyes as he
regains consciousness in a hospital room. We find ourselves sharing
his view of the world as he wakes up to his new surroundings. We
hear his internal voice attempt to answer the first questions from
staff before realising that they cannot hear him because he cannot
speak aloud. Very rapidly, his struggle to be understood becomes
the viewer’s struggle as we are quite literally trapped inside his
head. From his personal viewpoint, we experience the various
professionals who come to help him, some better than others at
empathizing with him. In this context, we can feel the relief when
a speech and language therapist brings him a method that she
believes will help him to communicate. Initially negative, Bauby
soon finds a positive outlook on his situation and states that;
“apart from my eyes, two things aren’t paralysed…my imagination and
my memory”. In his mind, these are the two things symbolically
represented by the Butterfly, which remain free to roam, whereas
his body he represents as a Diving bell, in which his mind is
trapped.
All of the devices used in filming succeed in putting us firmly
in the protagonist’s place and this is the only viewpoint we are
given for the first 15 minutes of the film before we begin to see
Bauby from the outside, as a separate person. This technique has
the effect of trapping us inside his body too, until we are
released and able to view the world from our usual (in film,
multiple) perspectives. This moment occurs for him and us at the
point at which he is taken from his room for the first time and
wheeled down a corridor, seeing his image reflected in a pane of
glass as he is taken to a balcony and the fresh air. From this
point on, we move between his perspective of the world and our
own.
The fact that Bauby must rely solely on his left eye to
communicate, and that he manages to express so much with it,
reminds us of just how much can be transmitted by non-verbal cues
in people with poor or non existent verbal speech. But most
impressive of all is the real time experience we are given of the
blinking alphabet dictation method that allows his thoughts to be
heard and his book to be written. We are left in no doubt as to the
enormous effort, determination and perseverance that was required
to bring this story to its audience.
As well as his progress in the hospital, the film pieces
together some of Bauby’s life before his cerebrovascular accident,
with the help of intermittent flashbacks. One such flashback allows
us to see the tender and close relationship he has had with his
ageing father, which sets the scene for a particularly moving
moment later on when his father phones him in hospital and tries to
talk through his translator about his deepest feelings. Throughout
the film he receives a series of visits from friends and family,
each revealing a different reaction to his appearance and to the
communication difficulty. One friend, who had been held hostage in
Beirut for four years, sees a similarity between his own experience
of confinement and Bauby’s entrapment in his body advising him to
“hold fast to the human inside of you and you’ll survive”. His
mistress is unable to visit him in contrast to the mother of his
children, from whom he is separated, so that the film is also about
the different reactions that his loved ones have to his
condition.
Relevance to the field of Mental Health
The Diving Bell and the Butterfly offers the viewer a clinical
case study of a rare neurological condition called locked-in
syndrome. It presents us with a patient centered view of the
extraordinary experience involved in living with such a disability
whilst highlighting his experience of the professionals he
encounters. The Diving Bell and the Butterfly is already
recommended viewing for speech and language therapy students, but I
believe it should be seen as widely as possible by anyone who cares
for patients with any degree of impaired speech and movement, some
of who find themselves within the mental health care services.
In particular, the film reminds healthcare professionals of our
responsibility to treat every individual in our care with respect
and dignity, using our empathic skills to put ourselves in others
shoes, whether or not they can speak to us or communicate their
thoughts effectively. The film is very good at demonstrating how
small actions by a care assistant can have a huge effect on Bauby,
when one turns on the TV, which is showing children’s cartoons, as
she leaves his room, and another turns off the TV when it is
showing a football game that Bauby is actually enjoying enormously.
In both cases, he is powerless to get his needs met. These scenes
might offer a perfect starting point for teaching students from a
variety of backgrounds about how to develop empathy in a
therapeutic setting.
For anyone wanting more detailed clinical information about this
condition, it is discussed in a review article published in the BMJ
in 2005 (Smith E, Delargy M. Locked-in syndrome. BMJ 2005; 330:
406-09). For another excellent patient centered account of
locked-in syndrome and the distinction between it and persistent
vegetative state, the BMJ published a very good clinical review, in
2005, written by a young man called Nick Chisholm, who suffered a
series of brain stem cerebrovascular accidents after suffering
concussion during a rugby match. As both the articles explain,
locked in syndrome is caused by a lesion in the brain stem,
commonly caused by a vascular incident, trauma or by extensive
demyelination which affects the brain’s peripheral connections. As
such, I would highly recommend this film for anyone interested in
neuropsychology or neuropsychiatry.
At a time when the topic of teaching medical students empathic
skills is being increasingly discussed, this film offers one of the
best opportunities yet for stepping in to a patient’s shoes and
experiencing life from the other side of the bed.
Any medical students interested in exploring the relationship
between medicine and film further, may want to visit one of the
many free events taking place, during May, at locations around the
UK as part of Medfest 2011,
the first national medical film festival, whose theme is ‘the Image
of Doctors’.
* More information about The Diving Bell and the Butterfly can
be found at IMDB
as can a short trailer
.
* The DVD is available on
amazon.co.uk.
* Minds on Film is written by Dr Joyce Almeida.
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