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film

Romanticizing Tubercolosis

21 Mar, 17 | by amcfarlane

Radu Jude (Director of ‘Scarred hearts’) and the Screening Room Editor of Medical Humanities, Khalid Ali, met at the London Film Festival, October 2016.

Our screening editor, Dr Khalid Ali (Khalid.ali@bsuh.nhs.uk), here writes about the importance of Romanian director Radu Jude’s new film Scarred Hearts (Romania, 2016) and interviews him at the London Film Festival in the podcast included below.

Each year on the 24th of March, several organizations around the world celebrate ‘International Tuberculosis Day’. It serves as a timely reminder that TB still remains an international epidemic claiming the lives of an estimated 1.4 million people, making TB one of the top 10 fatal diseases, and the emergence of 480,000 multidrug-resistant TB cases annually according to the Global Health Observatory data report- 2015. Before ‘Streptomycin’ was discovered as an effective anti-tuberculous drug in 1944, TB was a devastating disease with an inevitable death sentence. Radu Jude, award winning Romanian film director, revisits the TB epidemic in the early twentieth century in Scarred Hearts. The film is based on the life of Max Blecher (1909-1938), a Romanian writer who wrote the book Inimi Cicatrizate based on his own affliction with TB.

Scarred Hearts is a close examination of the life of Emanuel (Lucian Tedor), a Jewish Romanian young man in his twenties from a privileged background in the turbulent times of WWII, who falls ill with Pott’s disease (TB of the spine). Emanuel is admitted to a sanatorium, were he spends years bed-ridden, contemplating life, love, and illness. While meditating and writing his books and essays, Emanuel meets and befriends fellow patients and nurses. His encounters with the sanatorium’s resident doctor are short and traumatic; one such encounter happens when the doctor evacuates an abscess from his back with little analgesia, if any. The days go by slowly in his confined solitary world, while some nights are livened by ‘carnal activities’ with a young, female nurse, and another patient affected by TB. With the war exploding outside, boredom and melancholy set in in the dark corners of the sanatorium. The budding companionship and friendly exchanges with other inpatients over smoking, drinking alcohol, and playing cards, make the sanatorium a safe refuge for creativity in writing literature and composing essays, human interactions, friendships, and love. Some patients even decide to stay in the hospital indefinitely, and take up voluntary roles caring for other patients, showing altruism and human sacrifice. Self-management in chronic conditions is a relatively new concept in medical literature; however, Emanuel in 1930s Romania embodied the essence of self-management in ‘surviving a bed-bound existence with resilience and hope’. The socio-economic dimension of TB in today’s world plays an important factor in making it a universal public health and social challenge. Co-ordinated health and social interventions are as much needed today as they were in the mid 1930s.

Throughout history, TB has been given several names:  consumption disease, The White plague (a seventeenth-century TB epidemic in Europe and North America), Phthisis (a term which appeared in Greek literature around 460 BC, and was used by Hippocrates), Scrofula (TB of the lymph glands), and Pott’s disease. It was also referred to as the ‘Romantic disease’ as a lot of its sufferers were young adults at the time of the Romantic movement in European art, literature, and philosophy. Throughout history several notable literary figures suffered from TB; Jane Austen, Emily Bronte, John Keats, Anton Chekov, Franz Kafka, Khalil Gibran, and George Orwell are some examples. However, Max Blecher stands out in documenting his journey with TB in Inimi Cicatrizate.

It is interesting to note that Max Blecher was studying medicine in Paris when he had spinal TB. He was forced to abandon studying medicine, and become institutionalised in hospital settings until his untimely death at the age of 28. As a medical student and a writer, he had several qualities which are essential in both vocations; keen observation, building a rapport with those around him by actively listening to them, and transforming all those interactions and experience into a coherent form of story-telling. It goes without question that ‘empathy’ was a driving force in his analysis of the physical and emotional facets of illness. He was indeed bed-bound, but his eyes and ears were wide-open to the suffering and misery around him. Documenting his thoughts and philosophy in writing might have helped him stay sane, hanging on to some form of well-being in the bleakest of circumstances. Mother Theresa once said ‘The biggest disease today is not leprosy or tuberculosis, but rather the feeling of being unwanted’. Reminding ourselves on Friday 24th March 2017 of the global impact of TB, its sufferers are no longer alone or unwanted.

Listen to the interview with Radu Jude, director of Scarred Hearts:

Film review: Arrival

19 Jan, 17 | by cquigley

 

What can aliens teach us about being human?

 

Review of Arrival, my film of 2016 (USA, 2016, directed by Denis Villeneuve)

By: Dr James Hartley, Foundation Year 2 at Brighton and Sussex University Healthcare Trust

 

The above question is one that is commonly asked in the sci-fi genre. Think Sigourney Weaver’s portrayal of homo sapiens eternal desire for survival when pitted against “the perfect organism” in Alien, or Scarlett Johanson’s exploration of the human experience in Jonathon Glazer’s abstract extra-terrestrial-thriller Under the Skin. In Arrival, the latest outing from talented Canadian director Denis Villeneuve, based on a short story by author Ted Chiang, the study goes more than skin-deep and profound questions are raised that have relevance to us not only as humans but as clinicians.

Twelve alien space crafts with the appearance of giant obsidian eggs have landed on our planet. Within each machine there is a gravity-bending corridor that, every 18 hours, opens itself, inviting visitors from planet earth. Dr Louise Banks (Amy Adams), a highly regarded linguistics professor, is tasked by the US military to establish a dialogue with the life forms within. As Colonel Weber (Forest Whitaker) puts it: ‘What do they want? Where are they from?’ Her partner for the challenging task is Physics jock, Ian Donnelly (Jeremy Renner). Using linguistic science as their weapon, the duo battle with the 7-legged ‘heptapods’ and their inky ‘logographic’ scrawls. In the global backdrop, there is a growing unease amongst certain nations about the true nature of the intergalactic guests and to complicate matters further, Dr Banks is struggling with a growing intensity of traumatic memories and visions. The film builds to an emotional climax and ends as any good cerebral drama should; answering some questions whilst leaving others open for further thought.

Language and the role it plays in our thinking is the beating heart of the film. Defined as “the method of human communication[i]”, language is something that many of us take for granted. At 18 months old, humans already have a vocabulary of 50-100 words, and by age 5, some of us are able to practice the art of literacy, lending permanence to our thoughts and cognitions. But how does language influence our thoughts? And is it even possible to ‘think’, without language? In linguistic circles, these questions sum up a theory known as the ‘Sapir-Whorf hypothesis’. Whilst the theory is not without contention there does appear to be a growing body of evidence demonstrating the powerful effect of language on thought.  In their study into the effects of Korean and Chinese language on visual interpretation, Rhode et al (2016) showed a statistical difference in “attentional bias”. Korean speakers were more likely to focus on information in the background of an image (‘ground information’), whilst Chinese speakers better recalled information pertaining to ‘salient figures’ in an image. The authors postulate that the formal structures of language itself underpin these differences. In Arrival’s take on the Sapir-Whorf hypothesis, Dr Bank’s growing adaptation to the non-linear constructs of heptapod language allows her to perceive the world in a different light altogether – an eloquent, if somewhat hyperbolic, demonstration of the differences seen in Rhode’s 2016 study.

Thinking of language in a medical context, we can appreciate the impact of pathology on language in stroke syndromes. There are a number of language deficits that occur depending on the site of vascular brain damage. Wernicke’s and Broca’s aphasia are two ‘textbook’ examples (Harding M, 2014). The effect that these deficits can have on one’s cognition is demonstrated powerfully in the documentary film ‘My Beautiful Broken Brain’, which tells the story of Lotje Sodderland, a young Londoner who suffered an intra-cerebral haemorrhage in 2011. I was fortunate enough to see the film and meet Lotje, when she visited Princess Royal Hospital in October 2016 as part of the ‘World Stroke Campaign’. In the film Lotje presents the world around her after her stroke as surreal and frightening, comparing it to a David Lynch film. Lotje’s stroke had affected her temporal and parietal lobes, causing severe aphasia and changing her perception of the surrounding world forever. In an article for The Guardian, which Lotje dictated via siri following three years of intensive rehabilitation following the stroke, she explained that losing the ability to speak, read or write had left her “unable even to contemplate the idea of fear…as if I had become fear itself” (The Guardian, 2014). In a strange resemblance to Dr Bank’s familiarity with heptapod’s ‘non-linear logograms’ in Arrival, Lotje describes her new-found perception as lacking in ‘left-to-right’ patterns. In a further echo to Dr Banks character awakening at the end of the film, Lotje describes her new world as “a kind of rebirth; unexpected and painful, but also more vivid, filled with purpose, meaning and potential”. Not withstanding the significant differences that exist between Denis Villeneuve’s fictional screenplay and Lotje’s challenging reality; both Dr Banks and Lotje’s stories demonstrate the power of language in its influence on the mind.

Arrival is one of the most interesting and emotionally arresting films of 2016. It is refreshing to see a big budget Hollywood film not shying away from exploring a thought-provoking idea based on solid scientific grounding. In addition to highlighting the importance of language in human cognition, the film also delivers another topical message; the merits of compassion, understanding and tolerance in ‘trumping’ over wall-building and divisiveness, a message more pertinent than ever in our current socio-political climate and one I hope we can carry forward into 2017.

 

References:

  1. Rhode, a.k., voyer, b.g. and gleibs, i.h. (2016) ‘does language matter? Exploring chinese–korean differences in holistic perception’, 7.
  2. Harding, m. (2014) dysarthria and dysphasia. Medical information. Patient. Available at: http://patient.info/doctor/dysarthria-and-dysphasia (accessed: 3 january 2017)
  3. Sodderland, l. (2016) ‘i felt as if i had become fear itself’: life after a stroke at 34. Available at: https://www.theguardian.com/society/2014/nov/22/it-felt-as-if-i-had-become-fear-itself-life-after-a-stroke-at-34 (accessed: 20 december 2017)

 

Recommended further reading:

http://blogs.bmj.com/medical-humanities/2016/05/03/the-screening-room-the-aftermath-of-stroke/

 

Address for correspondence: james.hartley@bsuh.nhs.uk

Film Review: On Call

10 Oct, 16 | by cquigley

 

picture1

 

Revisiting empathy- Medicine and asylum seekers 

Review of On call – France, 2016, directed by Alice Diop

Showing at the BFI- London Film Festival on Wednesday 12th, and Friday 14th October 2016, London

http://www.bfi.org.uk/lff

Reviewed by Dr Khalid Ali, Screening Room Editor

 

In the current international refugee crisis, no country is immune from facing directly or indirectly the impact of millions of people being displaced from their countries of origin. Health and social care professionals are at the forefront of dealing with refugees from all over the world. On Call is a documentary film showing several encounters of asylum seekers in a clinic in Avicenne Hospital close to Paris. The clinic is an exceptional facility offering consultations without pre-booking for newly arrived immigrants. Dr Jean Pierre Geeraert provides medical advice for physical ailments, counselling for psychiatric problems, and completes certificates for social benefits, and housing requests for African and Asian refugees. Each consultation is unique in its specific details, but the common underlying factors are the hopelessness, discrimination and frustration that these unfortunate people experience on a daily basis.

These patient stories poignantly illustrate that health is a reflection of physical, mental and social well-being, and as such a doctor needs to be an expert physician, psychiatrist as well as a social worker. Dr Geeraert is almost single-handed in trying to sort out his patients’ refugee visas, their work permits, and housing appeals. His frustration is evident as his genuine desire to help is met with total indifference from immigration departments and social security offices. The ever-so-brief consultation sessions do not allow him the much-needed time to explore what ‘really matters to his distraught patients’. He resorts to regularly referring them for clinical psychology support.

Maintaining a note of authenticity, the film shows Dr Geeraert as a human being as well as a professional doctor; he can be annoyed by a patient who repeatedly begs him to save his life. He cannot be ‘Dr Nice’ all the time; he gets bored, and upset by some patients and the receptionist in the clinic. However trivial his shortcomings may be, he still embodies the true essence of ‘empathy’ by listening to patients, by acknowledging their fears and anxieties, and by encouraging them to share their most traumatic experiences without being embarrassed. Winning his patients’ trust does not come easily; it has grown over many years. His genuine commitment and dedication is rewarded by humane gestures of recognition from his regular clients in the form of little souvenirs that they can afford to buy.

In the 1940’s, Marjory Warren (http://www.bgs.org.uk/index.php/geriatricmedicinearchive/203-biographies/2437-marjory-warren) called for the establishment of a new speciality, namely Geriatrics Medicine, and advocated for training doctors in the holistic management of older people who were locked away in old workhouses. In the current turbulent times, it is crucial that disadvantaged citizens of the world, asylum seekers, are recognized as patients with special physical, mental, spiritual and social needs. Perhaps eminent organizations such as the Worshipful Society of Apothecaries of London through their Course in Conflict and Catastrophe Medicine’(http://www.apothecaries.org/faculty-of-the-conflict-catastrophe-medicine/course-in-conflict-catastrophe-medicine) should champion a call for training and education of doctors in a new specialty of Refugee Medicine across the wider international arena. Several NGOs have already established professional medical networks to support refugees in affected areas around the world; Doctors of the World (https://www.doctorsoftheworld.org.uk/) and Doctors 4 Refugees (https://www.doctors4refugees.org/) are notable examples. Doctors can no longer practice in silos, they need to adapt and respond to evolving international crises and challenges affecting their patients and them.

Address for correspondence: Khalid.ali@bsuh.nhs.uk

 

Film review: Julieta

24 Aug, 16 | by cquigley

 

Julieta, Spain, 2016, directed by Pedro Almodovar

In UK cinemas from 26th August 2016

 

Reviewed by Dr Franco Ferrarini, Gastroenterologist with a special interest in functional gastrointestinal disorders and their treatment with hypnosis

 

The opening shot of Pedro Almodovar’s ‘Julieta’ shows a pulsating red cloth that looks like a curtain; as the camera slowly pulls back, we realize that it is actually a lady’s dress. From the outset, we know that we are about to enter one of Almodovar’s favourite arenas, namely the ‘women’s world’. However, ‘Julieta’ is definitely less “Almo-dramatic” than his previous films; it plays as a mystery tale, but there are no victims, no villains and no murder investigation. Nor do we get the usual humour, the defiance and the provocative style that usually permeate Almodovar’s films.

Julieta (Emma Suarez), is a good-looking, well-off woman in her mid-fifties, who is happily planning a vacation with her lover Lorenzo (Dario Grandinetti). Accidentally she runs into Beatriz (Michelle Jenner) who tells Julieta of a recent encounter with Ania, Julieta’s estranged daughter (Imena Solano, Priscilla Delgado and Blanca Parés, at different ages). Julieta abandons her planned journey, and starts writing a diary conceived as a letter to her daughter Ania. Using a series of detailed flashbacks, Almodovar narrates Julieta’s earlier life, starting with her as a 20 year old woman falling in love with Xoan (Daniel Grao) while on a train journey. The two lovers get married soon after their first encounter, and Julieta gives birth to Ania. After Xoan’s death, Ania mysteriously disappears at the age of 18. Repeated attempts by Julieta to get in touch with Ania end in vain. Using a sequence of emotional scenes, Julieta’s feelings of guilt and bewilderment over Anias’ disappearance are poignantly portrayed. Julieta’s torment is masterfully underlined by Lucian Freud’s self-portrait (1985) hanging on a wall in her house, acting as a metaphor for most of Freud’s paintings, the continuous suffering of everyday life.

‘I sometimes have the impression that reality is simply there to provide material for my next film’, Almodovar famously stated. Using imaginative plotting in his films, he underlines the ominous consequences of the unsaid on human lives; the original title of ‘Julieta’ was ‘Silencio’ Spanish for ‘Silence’. A tragic mis-communication between Julieta and Ania, orchestrated by Xoan’s housekeeper, explains Ania’s disppearance, in a plot twist reminiscent of Alfred Hitchcock’s ‘Rebecca’ https://en.wikipedia.org/wiki/Rebecca_(1940_film).

The role of nature and fate in dictating the tragic life course of some human beings saturate the film. Nature, specifically sea water, bestows both survival means and death (Xoan is a fisherman who dies in his ship during a storm). Fate is at play in the train trip of young Julieta where she met Xoan for the first time: she had just rejected the advances of a depressed passenger (Tomas del Estal), who commits suicide fas a result. We are all at the mercy of fate, with significant consequences stemming from the apparently insignificant choices that we make. But even if we do not make those seemingly trivial choices, fate can cruelly hit, for example with a neurodegenerative illness, such as multiple sclerosis that affects Ava (Inma Cuesta), Xoan’s lover, forcing her to give up a career as a sculptor.

Cognitive loss, as in coma and to a lesser degree in dementia, is also explored: Xoan’s wife has been in a vegetative state for years, and Julieta’s mother Sara (Susi Sanchez) is affected by dementia. Both Xoan and Julieta’s father (Joaquin Notario) react similarly to their wives’ cognitive loss by looking for other women.

A subtle message is appreciated when Julieta visits her bedridden mother who has dementia; talking to her, combing her hair, and helping her get dressed is followed by clear improvement in the mother’s wellbeing.

Almodovar’s hard core enthusiasts may be disappointed as ‘Julieta’ is very different from his previous films. Nevertheless, it can be appreciated as Almodovar’s cinematic development into a more reflective and mature look on life.

 

Address for correspondence: francoferrarini.ff@gmail.com 

Film review: Crying with Laughter

11 Aug, 16 | by cquigley

 

Crying with Laughter, UK 2009

Written and directed by Justin Molotnikov, available on DVD

Trailer https://vimeo.com/channels/wellington/17373244

 

Reviewed by Professor Robert Abrams, Professor of Psychiatry, Weill Cornell University, New York

 

One can debate about what might be the central message of Crying With Laughter, the production with an oxymoronic title written and directed by Justin Malotnikov—a film that is itself both dark and reassuring. In fact there must be several such messages, but to this reviewer, Crying With Laughter is mainly a stirring testament to the therapeutic power of reconstructive memory. However, this assertion requires quite a bit of explanation and reference to the film’s story line. Warning:  massive spoiler alert.

Crying With Laughter opens with screenshots of a hapless failure of a man. Joey Frisk is a thirty-something-year-old Scottish stand-up comedian who is just about always drunk, profane and seemingly bent on self-destruction. He offends nearly everyone in his world, and while he’s loud and brash, he’s not even all that funny as a comedian. He owes money to his landlord, and he’s estranged from his wife. He’s the living embodiment of Freud’s concept of a “death instinct’—a man driven by a potent if unconscious current of self-defeat. He becomes human and grounded only in the moments when he lovingly and protectively embraces Amy, his sweet 6-year-old daughter.

Soon he is in very serious trouble. As part of his comedy routine he threatens the landlord to whom he is in arrears. When the landlord is in fact assaulted within inches of his life, Joey, who has no alibi, is the prime suspect. The situation is so dire that the viewer is compelled to wonder: what is it that is driving Joey to drink, to promiscuity and to a succession of ever-greater blunders? Is he just immature, a perpetual adolescent, suffering from arrested development? If there is a particular underlying sorrow or trauma he is re-living, or a past transgression for which he is punishing himself, why does he not see it?

A distinctly sinister former schoolmate whom Joey barely remembers, Frank, now befriends him, giving him and his daughter shelter. Frank then lures a reluctant Joey to a school “reunion”. What Frank actually intends is to kidnap a former teacher and execute revenge for a traumatic past secret. Unfortunately the frail teacher now lives in the throes of dementia. Throughout this encounter, Joey remembers neither Frank nor the old schoolmaster with any clarity.

One of the extraordinary and moving truths in the film emerges at this point: there can be no meaningful punishment of helpless and elderly demented individuals for the misdeeds of their past—not only because the revenge is in itself cruel and an “injustice”, but because its recipients cannot appreciate what is happening, and the whole enterprise has no possibility of providing “closure” for the victim. An unforgettable cinematic moment is forged by the incompatibility between the imagined school-master of the past—intimidating and manipulative—and the present image of a helpless old man. By any measure, the window of opportunity for confrontation has closed, and the belated effort to avenge the wrong only results in a deeper misery for all.

Without disclosing too many details of the secret that connects the three doomed characters for the reader, the film skillfully reveals why Joey had no conscious memory of the troubling past. Justin Molotnikov (film writer and director) has a deeper understanding: the powerful repression of traumatic memory that led Joey to “forget”—except for the fact that the willful sabotaging of his own life happened to have been his way of remembering. Even Joey’s choice of career seemed derived from an effort to neutralize the events that took place years earlier in that school: “I had to be funny”, he suddenly realizes.

Over the course of Frank’s rageful but futile scheming, Joey begins to appreciate the “interior fatality” of self-punishment that he has been living out; what had made Frank bitter had led Joey to become a self-created buffoon. Joey finds out that personal freedom can be gained whenever one’s own truth is uncovered and squarely faced. It might even be said that he has undergone a de facto psychoanalysis, or perhaps only a successful purge of the inevitable residua of traumatic memory: misdirected anger and unwarranted guilt. Either way, Frank has unknowingly given him a gift of incalculable value.

Much of what makes this film so satisfying to watch is attributable to the superb performances of the two principal actors, Stephen McCale as Joey Frisk, and Malcolm Shields as his counterpart in suffering, Frank Archer. Joey is wonderfully relatable, and even at his worst, he is also endearing, naïve and innocent. And who cannot recognize in himself at least a kernel of that self-destructiveness and immaturity that Joey had in such abundance? Frank, whose features are distorted into a permanent grimace, is in his bleak obsession as paralyzed in life as Joey had been, and he stands proxy for the destructive force of unresolved grievance.

However one chooses to characterize Joey’s transformational healing process, by the end of the film he unquestionably emerges as a changed man. He is an adult, a reliable sober citizen, more devoted to his daughter than ever. Few closing scenes could be more beautifully, poetically hopeful: in this one Joey walks, buoyantly and confidently, between neatly ordered parallel rows of trees under the brightest sunshine of his life.

Address for correspondence: rabrams@med.cornell.edu

Film review: The Carer

3 Aug, 16 | by cquigley

 

‘To age or not to age- that is the question’- review of The Carer – 5*

UK, Hungary, 2016, directed by János Edelényi

Starring: Brian Cox, Coco Konig, Emilia Fox, and Roger Moore

In general release in the UK cinemas from 5th August 2016

https://www.regentstreetcinema.com/programme/the-carer/

 

Reviewed by Dr Khalid Ali, Screening Room Editor

 

Watching The Carer at its European premier in Edinburgh International Film Festival in June 2016, I was strongly reminded of the ‘mirror neuron’ theory which postulates the ‘firing of a neuron in an observer that is exactly firing in the brain of another person performing a particular action- (https://en.wikipedia.org/wiki/Mirror_neuron). The eminent Italian neuroscientist Vittorio Gallese argues that ‘mirror neurons’ explain the underlying ‘emotions of empathy with film characters’ that viewers experience when watching a film. In ‘Neurocinematic science’, film audience engages fully and connects with ‘life unfolding on the silver screen’ in an ‘Embodied simulation’ (http://www.huffingtonpost.com/entry/mirror-neurons-and-why-we_b_3239534).

I had a strong sense of understanding and relating to the trials and tribulations of Sir Michael Gifford (Brian Cox) a veteran Shakespearean theatre actor who is suffering from the unkind advance of old age. Recurrent falls due to early Parkinson’s disease is one of many daily humiliations; bowel and bladder accidents, forgetfulness, bad temper and isolation in his country mansion are few others. His daughter, Sophia (Emilia Fox) recognizes the urgent need for a 24 hour ‘carer’ to help with his daily activities. Dorottya (Coco Konig), a young Hungarian refugee, a carer in a nearby nursing home, is offered the job of caring for him after a grilling interview by Sophia. Unbeknown to everyone, Dorottya is a young amateur actress aspiring to join the prestigious London Academy of Music and Dramatic Arts.  Living with Sir Gifford is not ‘a walk in the park’; she has to survive the daily challenges; language barriers are insignificant compared to his snobbery, arrogance, and cantankerous behavior.

Slowly the two find a common ground in Shakespearean plays; one of the most moving scenes is when Dorottya helps Sir Michael after an embarrassing bowel accident by quoting Shakespeare while cleaning him up. Outings to the local pub and an impromptu visit to the nursing home where Dorottya used to work, and performing scenes from ‘King Lear’ to the residents strengthen the bond between them. Their burgeoning fondness for each other is met with suspicion from his daughter, and old time friend and manager Milly (Anna Chancellor). The inevitable confrontation between Sir Gifford, Dorottya and his family happens when he insists on accepting a lifetime achievement award which will be broadcast live on national TV. His family and private physician, Dr Satterthwaite (Andrew Havill) are seriously worried that he will subject himself to national mockery if he falls over or forgets his lines in the live awards ceremony. Collectively they dismiss his capacity to make decisions and hold him hostage in his mansion. What follows is a delightful and powerful testament to the resilience of old age fuelled by creativity and a touch of recklessness.

Never before have the four Giants of Geriatric Medicine, a term coined by Bernard Isaacs (1924-1995) (http://www.bgs.org.uk/index.php/geriatricmedicinearchive/203-biographies/2220-a-giant-of-geriatric-medicine-professor-bernard-isaacs-1924-1995) , been so poignantly portrayed in film; falls, immobility, incontinence and confusion are so masterfully played by Brian Cox, CBE, in a tour-de-force performance.

In today’s world where ageing is viewed negatively as a ‘demographic time bomb, and a financial burden’ it is refreshing to find a film where ageing is not a ‘curse’. Intergenerational dependency is sensitively handled; Dorottya teaching Sir Gifford how to use a mobile phone while he teaches her how to hone her acting skills is a master-stroke. Nurturing creativity and embracing new technology can contribute to the well-being of both the older person as well as their carers.

In addition to its genuine exploration of ‘physical and psychological health in old age’, the film also manages to handle other serious issues such as ‘Capacity in senior citizens’; where time and time again families and doctors neglect the wishes of an older person claiming they are ‘acting in their best interests’ as an excuse for not seeking their opinion.

In a film exploring the world of a retired Shakespearean actor, a plethora of ‘quotable one liners’ is to be expected. However the final speech has to be repeatedly viewed to appreciate its nuance, wisdom and playfulness. Another fact the film masterfully puts forward is the notion that ‘old people are neither angels nor demons’ they are not aliens, they are similar to younger generations as fellow human beings struggling with everyday life, trying to make the best of difficult times and circumstances.

The frustration of the motor and non-motor symptoms of Parkinson’s disease is keenly observed; an eye-opener for doctors and other professionals caring for people with Parkinson’s disease.

The film is a ‘labour of love’- from its writers Tom Kinninmont, the late Gilbert Adair, and director János Edelényi. Targeting primarily an ‘older audience’, The Carer might well be 2016 sleeper hit that attracts a wider audience from all age groups; The Best Exotic Marigold Hotel meets Quartet meets Youth. Watching The Carer, I was convinced that ‘mirror neurons’ exist and explain the strong emotions of empathy I experienced with the characters on the silver screen. I was reminded once more that films have the power to ‘teach doctors how to communicate with and care for patients, their families and carers’.

To see a trailer of the film: http://www.imdb.com/video/wab/vi3754669081/

Podcast of interview with writer Tom Kinninmont:

 

Address for correspondence: Dr Khalid Ali, Khalid.ali@bsuh.nhs.uk

Film Review: Notes on Blindness

13 Jul, 16 | by cquigley

notes-on-blindness-01

Image courtesy of Curzon Artificial Eye

 

Seeing blindness in the eye:

Film review of Notes on Blindness, UK, 2016, directed by Peter Middleton and James Pinney

Currently in UK cinemas

Review by: Dr Khalid Ali, Screening room editor

Literary work exploring visual impairment and blindness has always been rewarded by great critical reception–All the light we cannot see winning the Pulitzer Prize in 2015 (https://en.wikipedia.org/wiki/All_the_Light_We_Cannot_See), and Blindness by Jose Saramago (https://en.wikipedia.org/wiki/Blindness_(novel) rewarding its writer with the Nobel Prize in Literature in 1998.

Documenting his experience with visual impairment, the late Emeritus Professor of Religious Education, John Hull (1935-2015) used audio-recordings since 1980, the year he lost his eyesight, to document what it means to be blind. His autobiographical recordings were published in the book Touching the rock: An experience of blindness in 1990. The film Notes on Blindness uses those recordings lip-synched by professional actors to recreate John Hull’s experience in one of the most poignant films to date in 2016. Through John’s words–‘I am concerned to understand blindness, to seek its meaning to retain the fullness of my humanity’–we hear him question eloquently the nature, perception, and impact of sensory deficits. Through his journey into understanding his ‘deep blind world’, the audience is invited to appreciate the significance of the little pleasures of life, such as the sound and smell of rain drops, and the touch of a newly born child. Using poetic references to children’s fairy tales, John Hull identifies with the blind Prince in Rapunzel, and wonders whether his tears will bring  sight back to his eyes.

John’s reflections on blindness present several themes for discussion, including mindfulness, hope, self-management in disability, identity, and family bonds. These themes are illustrated using a stunning collage of visual imagery, and a beautiful score that touches the audience’s heart and mind.

In spite of the film’s dream-like contemplation on life’s little miracles and wonders, Notes on Blindness effectively manages to portray the harsh realities of disability and the suffering endured by John and his family. His young son cannot understand what it means for his father to be blind; his mother is frustrated by having to connect with his new ‘self’, and the agony of missing his children’s smiles at Christmas. The fascinating depiction of a blind world of ‘isolation, and separation’ that drowns its sufferer in a huge flood is one of the most imaginative and moving scenes I have seen in film.

Notes on Blindness reminded me of the eminent Egyptian writer and educationalist Taha Hussein (1889-1973) who fought blindness from the age of 3 years to become the Dean of Arabic Literature (https://en.wikipedia.org/wiki/Taha_Hussein). Both John Hull and Taha Hussein had strong-willed wives who provided unconditional love and incredible support to their husbands to continue their respective academic pursuits.

Liberation comes in the form of knowledge and understanding, in acknowledging that it is futile not to accept facts and reality, and the realisation that ‘surrendering is death’. Using familiarity, predictability, finding one’s own territories, resilience and determination, along with inviting students into his world of theology, John regains control of his personal and professional life.

A great message that the film presents is the fact that ‘medicine as we know it’ cannot provide the answer to everything; the power of faith and spirituality are key to well-being and peace in humans. ‘Faith is a shield against the ups and downs of human life’.

‘Coming to terms with disability’ is an understatement in terms of describing Notes on Blindness. The film is an exciting journey into the world of a ‘pioneer thinker’ who ultimately ‘saw blindness’ as a gift to understand his world and the world around him. In 2003, John Hull was awarded the ‘Global love of life’ award for his international contribution to disability.

 

 

Address for correspondence: Khalid.ali@bsuh.nhs.uk

Recommended reading and listening

  1. The possibilities are endless- film review, http://blogs.bmj.com/medical-humanities/2014/10/27/dr-khalid-ali-stroke-music-and-love-a-review-of-the-possibilities-are-endless-film-5/
  2. https://soundcloud.com/bmjpodcasts/bringing-cinema-to-those-with-visual-impairment-reporting-from-the-panorama-of-the-european-film

Film Review: The Fugitive Doctor in ‘River’

30 Jun, 16 | by cquigley

 

‘River’, Canada, Laos, 2015, directed by Jamie M. Dagg

Screen_Shot_2016-04-27_at_18.26.59

Released on DVD and digital download on 18th July 2016

Reviewed by Dr Khalid Ali

Doctors and crimes of professional misconduct have been the focus of films such as ‘Coma, USA, 1978’, and ‘Shutter Island, USA, 2010’, while  doctors volunteering in NGOs in troubled zones were the subject of films such as ‘Sleeping sickness Germany, 2011’ and more recently ‘The last face, USA 2016’.

‘River’, a new Canadian film, combines the two themes in its storyline; John Lake ‘Rossif Sutherland’ is an American volunteer doctor in Laos who accidentally kills an Australian citizen in a drunken rage. In his attempt to flee the crime scene, John goes through a harrowing journey across the Mekong River. He tries to get the support of his fellow doctors in the NGO; one of them, Dr Stephanie (Sara Botsford) faces the moral dilemma of whether she should be a whistle-blower and report him to the authorities or should help him escape, while another doctor Douangmany (Douangmany Soliphanh) takes advantage of John’s desperation and uses him as a drug-mule. The loopholes in the legal system between Thailand and Laos give John an opportunity to escape prison. Struggling with his professional role as a doctor who should be saving lives, but an infallible human being at the same time, John approaches the American Embassy in Vientiane for help.

Public interest in doctors’ criminal offences fuelled the media exposure of extreme cases such as the notorious Harold Shipman, and the recent news of Dr Pramela Ganji who was convicted by New Orleans jury in a 34.4 million fraud scheme (1).

The film raises serious questions about the ability of the legal system to exercise ‘equity and fairness’ when operating in a foreign environment such as Laos that is not accountable to regulations set by Western professional bodies. The requirements set by the General Medical Council (GMC) and the British Medical Association (BMA) in England are clear in mandating a ‘code of conduct and practice’ that a doctor should declare a criminal conviction (2, 3).

In addition to its exploration of accountability and violations in healthcare professionals, the film works extremely well as a gripping action thriller winning the best film award at the Academy of Canadian Cinema and Television. Rossif reprises the role of a doctor in turmoil following in his father Donald Sutherland’s footsteps who played a doctor in the cult comedy MASH (USA, 1970).

‘Whistleblowing’ is another thought-provoking theme the film raises; Rodulson argues that reading and appreciating Homer’s the Iliad can support medical students’ understanding of ethical dilemmas (4). ‘River’ achieves a similar feat by portraying a challenging ethical and moral situation where a doctor is ‘trying to do the right thing’.

References

  1. https://www.justice.gov/opa/pr/new-orleans-jury-convicts-company-owner-and-doctor-roles-34-million-fraud-scheme, accessed Wednesday 29th June 2016.
  2. http://www.gmc-uk.org/guidance/ethical_guidance/21184.asp, accessed Wednesday 29th June 2016.
  3. https://www.bma.org.uk/advice/employment/contracts/criminal-record-checks-and-declarations/criminal-convictions-declaration, accessed Wednesday 29th June 2016.
  4. Rodulson V, Marshall R, Bleakley A. Whistleblowing in medicine and in Homer’s Iliad. Med Humanities 2015; 41: 95- 101.

 

Dr Khalid Ali, Screening room editor

Address for correspondence: Khalid.ali@bush.nhs.uk

The Screening Room: a review of the Lebanese film Ghadi

18 May, 16 | by cquigley

Ghadi New Poster

Music overcoming disability –  Ghadi, Lebanon, 2013, directed by Amin Dora

Reviewed by Dr Reem Gaafar, a Sudanese doctor, writer, filmmaker and graphic designer

 

A special screening will take place at the Polish Cultural Centre, 238 King Street, Hammersmith, London W6 0RF, Sapphire Room, 2nd Floor, at 8pm Friday 3rd June 2016. To book tickets khalid.ali@bsuh.nhs.uk

To buy copies of the film, please email eskaff@thetalkies.com

 

Ghadi, a 2013 film from Lebanon tells a poignant story: In a small town called Al Mshakal, there lived a young boy named Leba. Leba had a stutter, and was subjected to bullying and humiliation from his schoolmates, until a mysterious music teacher, Mr. Fawzi moved into town with his piano as well as nightly Mozart recitals. Using music lessons and improvised speech therapy, Mr. Fawzi helped Leba grow out of his stutter. Years later, Leba becomes a music teacher himself. His music attracts his childhood crush Lara into his classroom, and one Sunday afternoon, into his life. Their happy marriage is crowned with two beautiful daughters, but the family’s blissful life is disturbed by the obtrusive local community urging Leba and Lara to try for a baby son. The so-called caring community lived on gossip and backbiting with dishonesty flowing through the cobbled streets like a dark, murky river.

Eventually, a baby boy is conceived, but to the couple’s distress he is expected to be born with special needs. Leba has serious concerns: should the child be born or not? Is it fair to bring such a child into the world? He seeks advice from Mr. Fawzi, his childhood teacher and friend. Mortified by Leba’s doubts, Mr. Fawzi advises him to name the child immediately, to give him a presence, an existence, and the right to live. A few months later, Ghadi is born with Trisomy 21 (Down’s syndrome) becoming the most handsome boy in the neighborhood.

In today’s world of modern technology and advanced medicine, it has become relatively common for a couple to face the impending reality of bringing a ‘different’ child into the world. Basic ultrasound, amniocentesis and chorionic villous sampling can detect as early as 10 weeks a child with congenital and chromosomal anomalies, genetic disorders of metabolism, and various growth abnormalities. First trimester screening for Down’s syndrome has become routine in the developed world (Huang et al, 2015), and screening for anomalies at 18-20 weeks is becoming regular practice in the developing world. The course of action that follows the discovery of an aberration, however, is not at all globally agreed upon.

Many factors – religious, legal, educational, social and others influence the expecting couples’ decision to undertake the screening procedures in the first place, and to continue or terminate the pregnancy. Studies suggest that health professionals are more likely to lean towards termination of abnormal pregnancies than the general lay person (Drake, Reid and Marteau, 1996, Norup, M, 1998), and that a third of women who have a sibling with Down’s syndrome would consider termination if their prenatal screening proved they were carrying a child with chromosomal aneuploidy (Bryant, Hewison and Green, 2004). However, some individuals remain uncertain about terminating a fetus with Down’s syndrome compared to other conditions such as spina bifida and hemophilia (Bell and Stoneman, 2000). Some parents and/or health professionals think it is justified to not provide children with Downs’ syndrome the necessary medical and social care they need. Some families hand over the responsibility of these children’s care to public health systems through adoption (Julian-Reyniar et al, 1995).

On the other hand, advances in medicine and technology are allowing everyone, including the disabled, to live longer and healthier lives. Disability activists are now calling for women to resist the pressure to abort a disabled fetus, believing that such acts oppress the rights of the disabled, as well as adversely affecting all women (Saxton, M. and Davis, L., 2013).

While prenatal screening is being increasingly offered in the Middle East, the attitudes of both lay people and doctors are still unknown concerning abortion in general, and aborting a potentially-disabled fetus in particular. It is to be expected that these attitudes are based on cultural and religious beliefs and the laws that govern them. The Middle East and North Africa (MENA) region is predominantly Muslim, and the local laws rely heavily on the different interpretations of Islamic ruling in this matter, as well as on those laws inherited from colonial times. Abortion laws range from liberal to very restrictive, but the position of selective abortion relating to Down’s syndrome is not at all clear. Only Tunisia and Turkey have laws that allow abortion without restriction based on underlying reason (Dabash, R and Roudi-Fahmi, F, 2008, Hessini, L, 2007).

Ghadi spends his days and nights at the family’s home singing his peculiar songs, irritating the neighbourhood even more than Mr. Fawzi’s Mozart recitals used to. Eventually, Leba is faced with an ultimatum: either to send Ghadi to a specialist institution, or face the prospect of eviction with his family from their hometown. Desperate for a way out, Leba, helped by the village outcasts, succeeds in conjuring an elaborate plan to convince everyone that Ghadi is an ‘angel’ who can grant local people their wishes and punish them for their sins. In an unexpected twist of events, the townsfolk transform into honest, law-abiding citizens in fear of the wrath of ‘Ghadi, the angel’.

The film suggests that in spite of Leba’s initial apprehension and the community’s rejection of Ghadi, the pro-life decision for children with special needs ultimately turns out to be the correct and rewarding decision for all. Down’s syndrome is now officially recognized globally with a whole week dedicated annually to increasing awareness.

Special thanks to Amin Dora and Elyssa Skaff for kindly facilitating this review.

Address for correspondence: gaafar.reem@outlook.com

References

Bell, M. and Stoneman, Z.  (2000). Reactions to Prenatal Testing: Reflection of Religiosity and Attitudes Toward Abortion and People With Disabilities. American Journal on Mental Retardation: January 2000, Vol. 105, No. 1, pp. 1-13.

Bryant, L., Hewison, JD and Green, M., (2005). Attitudes towards prenatal diagnosis and termination in women who have a sibling with Down’s syndrome. Journal of Reproductive and Infant Psychology, Volume 23Issue 2, 2005, pg. 181 – 198, DOI: 10.1080/02646830500129214

Dabash, R and Roudi-Fahmi, F., (2008). Abortion in the Middle East and North Africa. Population Reference Bureau, USA. Online, available at

http://gynuity.org/resources/read/abortion-in-the-middle-east-and-north-africa-en/

Drake, H., Reid, M. and Marteau, T. (1996). Attitudes towards termination for fetal abnormality: comparisons in three European countries. Clinical Genetics, 49: 134–140. doi: 10.1111/j.1399-0004.1996.tb03272.x

Hessini, L., 2007. Abortion and Islam: policies and practice in the Middle-East and North Africa. Reproductive Health Matters, vol. 15, no. 29, pg. 74-84

Huang, T., Dennis, A., Meschino, W., Rashid, S., Mak-Tam, E. and Cuckle, H., (2015). First trimester screening for Down syndrome using nuchal translucency, maternal serum pregnancy-associated plasma protein A, free-β human chorionic gonadotrophin, placental growth factor, and α-fetoprotein. Prenatal Diagnosis, Vol 35, pg. 709 – 716, DOI: 10.1002/pd.4597

Julian-Reynier, C., Aurran, Y., Dumaret, A., Maron, A., Chabal, F. Giraud, F. and Aymé S, 1995. Attitudes towards Down’s syndrome: follow up of a cohort of 280 cases. J Med Genet 1995;32:597-599 doi:10.1136/jmg.32.8.597

Norup, M. (1998), Attitudes towards abortion among physicians working at obstetrical and paediatric departments in Denmark. Prenat. Diagn., 18: 273–280. doi: 10.1002/(SICI)1097-0223(199803)18:3<273::AID-PD256>3.0.CO;2-5

Saxton, M. and Davis, L., (2013). Disability rights and selective abortion. Chapter 7: The disability studies reader, pg. 87 – 99. 4th edition, Routledge, New York USA

The Screening Room: Cannes Film Festival Preview

11 May, 16 | by cquigley

 

Cannes, films and Medicine

The forthcoming Cannes Film Festival (11-22nd May 2016) is described by its director Thierry Fremaux as ‘A celebration of cinematographic art’ http://www.festival-cannes.fr/en.html. If you are lucky enough to be attending the glittering, entertaining and thought-provoking extravaganza, here are five films in the official selection exploring the lives of patients and doctors in extremis.

First is Jean-Pierre and Luc Dardenne’s ‘The unknown girl’ reflecting on the professional and moral dilemma a doctor faces after a young girl she refused to admit to hospital, dies in suspicious circumstances. A man’s existential crisis at the face of terminal illness is the focus of Xavier Dolan’s ‘It’s only the end of the world’. The turbulent life of international relief doctors surviving daily humanitarian catastrophes is the subject of Sean Penn’s ‘The last face’.  The private life of a neurologist going through a mid-life crisis and the complicated relationships with his wife, and family are dissected in ‘Sierra-nevada’ directed by Cristi Puiu. ‘I, Daniel Blake’, the new film from Ken Loach delves into the substantial divide between health and social care faced by a carpenter who falls ill, and struggles to navigate the bewildering world of welfare support. Showcasing films from Belgium, Canada, USA, Romania, and the UK respectively, the above films offer a rich cinematic experience that embodies the ever growing bonds between medicine and humanities.

 

Address for correspondence: Dr Khalid Ali, Screening Room editor, Khalid.ali@bsuh.nhs.uk

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