Caramel, to be precise: a delicious film from Lebanon that gives a brief insight into the lives of five women friends. Unlike in Sex and the City, there isn’t any on-screen sex in this film. Nevertheless, the main protagonists in these two newly released films would, I suspect, recognise many of their own challenges in each other’s stories. Like all women of a certain age in the UK- somewhere between 15 and 50 to judge bythe cinema queues- I enjoy the openness, the bawdy humour, the fashion and the sentimentality that is Sex and the City. But I also recognise, in the experiences of Carrie, Samantha, Charlotte and Miranda, the stories of both patients and friends.
These stories are, occasionally, to do with carefree and casual sex, wild parties, and falling in love. More often however- perhaps because I and my friends are no longer as young as we used to be, and because my patients generally come to see me with difficulties rather than gossip- the stories I hear are about the pain of loss: the loss of a wanted pregnancy, a child, a partner, a parent, their or a loved one’s health, or, all too often it seems, about frustrated attempts to have a child or even to find someone to have a child with. I hear about relationships that bring pain, of elderly relatives whose decline is slow and heartbreaking and where endurance and love is the only option available. I hear about, and have the privilege of caring for men and women living with, rather than feeling cured of cancer, no matter how well meaning and encouraging the news that, medically at least, and at least sometimes, the cancer is gone. And I hear from people in need of simple human kindness and for whom little is forthcoming.
I can’t share any of these stories with you or, in any detail, with the medical students I teach. But, fortunately, all of these experiences and more are explored between them in these two films about the lives of two groups of women friends. I’m going to assume that you’ve already heard more than enough about Sex and the City. So, instead, I’ll tell you a little about Caramel in the hope that you will be tempted to experience the whole, bittersweet tale for yourself: a medical humanities offering stolen shamelessly from its director Nadine Labaki.
Caramel, by the way, gets it’s name from the sticky, thick, richly coloured caramel that beauticians like Layal- one of the films main protagonists- use to rip unwanted hair from various parts of their clients’ bodies. The desire to remove naturally occurring, hormonally-induced body hair is shared by a number of diverse cultures, in places as far flung as India, New York, Beirut and the UK. Exceptions do occur, with said hormonally-induced hair considered sexually attractive rather than abhorrent in a number of cultures. What is it, I wonder, that makes so many women, and increasingly men, willing to submit to the painful and less than dignified process of waxing, or in this case sugaring. Why indeed is so much time, effort and medical attention dedicated to addressing perceived physical imperfections of all varieties. Are these medical problems or merely reflections of culturally determined aesthetic ideals?Are these concerns- about being too fat, too thin, too old or too hairy- merely aconsequence of a consumerist society where, once the essentials needs in life are met, the shopping wish-list becomes increasingly trivial and egocentric? Or are they instead a reflection of the increasing medical focus on measuring and re-measuring in an attempt to move everyone, every patient, to the ideal? The ideal weight, the ideal alcohol consumption, the ideal cholesterol, the ideal amount and type of sex.
Which brings me back to another story line in Caramel, and one, coincidently that was mirrored by a legal case in France, recently reported around the world. In both film and fact, the groom was the bride-to-be’s second, rather than first, sexual partner. In Caramel, Nisrine is taken by her friends to a discreet surgeon who, with two stitches, repairs the broken hymen that would otherwise have betrayed her secret. Disturbingly, for me at least, this hitherto confident, feisty, bride-to-be becomes- at least for the duration of the procedure- a sad caricature of the worst of what it sometimes means to be a patient: frightened, ultimately alone, and humiliated by the nature of her ‘illness’. Nasrine is, metaphorically, aged in front of the viewer’s eyes by a cure intended to restore her to her former, intact, innocent and youthful self.
Meanwhile in France recently, a young Muslim groom was granted an annulment of his marriage because he discovered, on his wedding night, that his bride had lied to him when she said she was a virgin. The Times newspaper headline read ‘Outrage’, reflecting the feelings of many in France that such an issue could be used to ‘repudiate a bride’. Supporters of the decision said the case was not about religion but claimed instead that the woman’s lie meant that the marriage contract had been entered into under false pretences. Ideal sex, indeed the only type of sex that could be countenanced by this groom within marriage and on his wedding night, was that undertaken with a virgin bride. For Nisrine, the role of medicine was to ensure that this ideal, idealised wedding night sex was available to her groom. Surgical repair of the hymen is not an operation, I believe, that is available to women in the UK on the NHS. Is it freely available elsewhere or only under the auspices of helpfully discrete private doctors? Should it be?
After watching Caramel and reading about the law case in France I am left less rather than more certain about how I would answer that question. My feminist Western upbringing does indeed leave me outraged at the idea that this women was rejected as a life partner simply because she had had sex before marriage. I would nevertheless hesitate before claiming that this feeling of mine gives me, or any other doctor, the right to decide whether the wedding nights of other Nasrines should hold in store the rejection and humiliation endured by the young French woman who hoped her lie would remain undiscovered.
There are other less controversial but equally compelling stories in Caramel: the story of Rose, an aging woman who struggles with the demands and the sacrifices that caring for her demented sister entails; the losing battle of Jamal, the postmenopausal model/actress who feigns a menstrual period in order to assert her right to the boons of youth; the innocent romance of Rima, a young woman whose sexual identity as a lesbian finds a consensual outlet in the sensuous act of washing the hair of a female client.
So, why not go see Caramel. Or take your students to see it. Unlike the viewings of Sex and the City you’ll find plenty of men in the audience. Anyway, welcome to the first blog of the BMJ journal Medical Humanities.