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

The Savages

 

This is the third blog in my short series about elderly residential care.


Introduction

The SavagesThe Savages, written and directed by Tamara Jenkins, and described as a tragicomedy, was released in 2007. It tells the story of two middle aged siblings, Wendy and John, estranged from their father Lenny for many years, who are suddenly faced with his physical and cognitive decline in older age, which demands their involvement. The film explores the different responses of the two siblings to this enforced caring relationship in light of the revelations about their father’s abusive relationship to them both as children.  Of interest to Old Age Psychiatrists is the suggestion that Lenny is suffering from a dementia associated with Parkinson’s Disease, allowing for a discussion about the possible differential diagnosis.

The filmThe Savages opens in a retirement village in Sun City, Arizona, where Lenny Savage, played by Philip Bosco, is living with his long time girlfriend Doris, who has a home healthcare professional, Eduardo, to assist her with her daily living. When Lenny fails to flush the toilet after Eduardo asks him to do so, and Lenny writes an insult on the bathroom wall with his faeces, alarm bells start ringing. Shortly after this Doris dies and her family call Wendy, played by Laura Linney, to inform her of the crisis. Both siblings John, played by Philip Seymour Hoffman, and Wendy are deeply engrossed in their own lives on the east coast of the USA where John is a professor of drama and Wendy a playwright yet to find financial backing. Neither have settled relationships and both seem to struggle with a life outside of their work. As they meet in Arizona to visit their father, they learn that he has no legal right to live in his girlfriend’s home and that he has been admitted to hospital for tests after suffering from episodes of faintness and the faecal smearing incident. On their first visit to see Lenny in hospital, John and Wendy find him restrained in bed because he was attempting to pull out his intravenous line and to get up from bed despite being unsteady and having falls. The doctor informs them that their father does not have vascular dementia but most likely a dementia associated with Parkinson’s disease, which accounts for his masked face and blank stare, his disinhibition, aggression and fluctuating disorientation.

 

John decides to find a nursing home for Lenny near to where he lives and although Wendy considers that they should try to look after their father or find him a supported living placement, she is reluctantly persuaded that residential care is the only realistic option. Once a residential placement has been sorted out by John, Wendy is tasked with bringing her father to Buffalo, New York state, by plane from Arizona. This is a painful scene that brings home the reality and potential difficulties of traveling any distance with someone who suffers from a significantly disabling dementia, as Lenny becomes perplexed and agitated when in the unfamiliar surroundings of the aircraft cabin and cannot move about freely. Once admitted to the Valley View home in Buffalo, Lenny shows his complete lack of understanding about his circumstances, believing it to be a hotel. Wendy’s guilt cannot be assuaged and she attempts to get her father admitted to ‘a much nicer’ residential home. However, this requires Lenny to ‘pass an interview’ that proves he is not cognitively impaired. Of course he fails this test but remains unaware and unaffected by the heated emotional discussion that follows between Wendy and John as the latter tries to get his sister to accept their father’s disability and his consequent care needs. The film follows the siblings as they deal with Lenny’s death and the period that follows it as they move forward positively in their individual lives, able to mourn for their father, whilst being released from their traumatic childhood experiences.

 

Relevance to the field of Mental Health

The Savages offers an excellent opportunity to consider the issue of care for an elderly person who may not have any close biological family ties. In contrast to the first film in this movie series, A Simple Life, that portrayed the bond of employer and employee proving strong enough to support an ageing housekeeper after her move into a care home, The Savages deals with estranged adult children forced into the caring role by duty. As more people in our society live longer and suffer from dementia in greater numbers, these issues are likely to become increasingly important for professionals to consider and understand, as not everyone has family members prepared to take on the unpaid role of personal carer. The need for greater support of people suffering with dementia in the community is acknowledged in the UK and a recent initiative by Public Health England and the Alzheimer’s Society is encouraging people to learn more about dementia in order that they might befriend someone with the illness. This initiative is called Dementia Friends and more information can be found on the Alzheimer’s Society website.

 

The other topic of psychiatric interest in this film is Lenny’s tentative diagnosis of dementia related to Parkinson’s disease. This provides the opportunity for learning about dementia in Parkinson’s disease and Lewy-body dementia. As Lenny has a masked face with a blank stare, disinhibition, aggression, apathy, faintness, unsteadiness with falls and fluctuating disorientation it might be argued that he most likely has dementia with Lewy bodies as the cognitive change precedes the development of the classic Parkinsonian movement disorder. In contrast, dementia in Parkinson’s disease usually presents first with the classic movement disorder and later with the cognitive impairment. However, both conditions are caused by the presence of Lewy bodies in various areas of the brain and their location determines the symptoms that are seen. The Alzheimer’s society has a good information page about dementia with Lewy bodies (DLB )and the Alzheimer’s Association in the USA has a good page outlining the difference between both DLB and dementia in Parkinson’s disease. In addition, for mental health professionals, a detailed article on Dementia with Lewy bodies by I G McKeith, published in BJPsych in 2002 (The British Journal of Psychiatry (2002)180: 144-147) might be useful to read.

 

The Savages is a sad and painful film to watch as it deals with a difficult subject that many people wish to avoid until it visits their own circle of family or friends. However, by the end of the film there is a positive sense that the adult siblings have found a stronger and more meaningful relationship with each other as a result of being forced to confront the care of their father before his death and that this may also have helped them to find better fulfillment in their lives generally. As a depiction of the guilt suffered by adult children often associated with placing a parent with dementia into residential care The Savages is essential viewing.

 

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

The Savages can be purchased from amazon.co.uk.

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

 

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Comments

Re: The Savages
These blogs are very informative, and have stimulated me to watch these movies. The blogs underline the power of movies as a medium, able to get across messages in a personal way that make a strong impact. The blogs on their own show some of the same qualities, and can stand on their own. My concern is that these blogs only reach a very small readership. Can WHO use them, possibly by creating a link?
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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.