You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

The Screening Room

Death By Suicide: The Beginning After the End

23 May, 17 | by amcfarlane

The Levelling, directed by Hope Dickson Leach

On general release in UK cinemas now

Review by Professor Robert Abrams, Weill Cornell Medical College, New York

Even before you view The Levelling, a film written and directed by Hope Dickson Leach, its title gives off a disquieting aura; you feel you are about to enter the maelstrom of a fearsomely destructive force. And so you are. The word “levelling” itself connotes complete destruction or possibly rageful retribution. One can only hope that there might also be a corresponding coda of reconstruction and healing.  The viewer of this film is ultimately witness to both: a saga of suffering known to clinicians as complicated grief, and its protracted resolution, of which some of the details will be outlined here.  But the viewer’s worst fears are realized at the beginning, in the primal mayhem of a drunken party that plays along with the opening credits.

In the next scene a young woman, Clover Catto (Ellie Kendrick), is returning home to the family dairy farm from University for the funeral of Harry (Joe Blakemore), her younger brother. Harry shot himself to death, even though their father Aubrey (David Troughton) insists it was an accident after a night of drinking. Aubrey is indeed a difficult man, described with considerable understatement as “not an easy father.” He is neglectful of animals and indifferent to people, especially it seems, to his daughter. Whenever confrontation with emotion becomes unavoidable, he recoils: “You have to get up, get out of bed, and milk the bloody cows.”

Determined to understand what happened, Clover surveys the flood-ruined wreck of a farmhouse in search of memories. She blames her ostrich-like father for her brother’s unexplained changes of personality, but Aubrey is inured to any suggestion of feeling or loss.

At least in one way her father had got it right. Clover is not a good fit for farm life. She cannot abide the killing of animals or cruelty; she cannot eat them, either; a commercial cattle farm is no place for a person with these sensibilities, even for one training to be a veterinarian. No respect for any form of life and no emotional attachments, whether human or bovine, are allowed in Aubrey’s world.

Father and daughter have been divided, one might say imprisoned, by a mutual feeling of abandonment and injustice. But Aubrey is still the most important man in Clover’s life, hate becoming psychologically equivalent to love once the algebraic negatives are removed. In the Catto family’s no-communication bubble, Clover had hoped for nothing as keenly as to be loved by her father; her father had privately yearned for her to be the one to initiate a rapprochement, had wanted Clover to want to return home, to support her troubled, probably mentally ill brother, and to shore up Aubrey himself as well.

What is the relevance of this film for readers of Medical Humanities? The Levelling deals with a conundrum seen often enough in clinical practice—and also in life: the consequences of suicidal death for the living. Death by suicide entails a double death, exactly as described by the clergywoman-therapist in the film, encompassing both the death of the person and the death of the “person you thought you knew.”  Healing is necessarily intricate, and it is accurately and sensitively presented in this otherwise disturbing film.  The Levelling can be summed up as a chilling depiction of what psychiatrists now consider to be “complicated grief.”  Complicated grief is a syndrome of greater severity, complexity and persistence than ordinary grief.  It is a condition in which the circumstances of the death interfere drastically with mourning.  Thus the survivors must deal first, before anything else, with the traumatic aspects of loss, with shock, anger, and their own sense of injury; this principle applies to the aftermath of a suicide or to any premature or unnatural death. Acknowledging the traumatic aspects of the event itself and then the personal meaning of the death is a foundational precondition for any meaningful process of bereavement.  For now, the clergywoman-therapist tells Clover, “This is about you.”

The melancholic beauty of the music in The Levelling and the camera’s focus on an untidy farm are fitting backdrops to a messy, circuitous and wrenching emotional path to healing from complicated grief. The brilliance of the film lies in its measured manner, the way we slowly become privy to the source of the characters’ anger and sorrow, their journey from death and destruction to a long-delayed but never-too-late recognition of their love for each other. “Levelling” in the end implies a new beginning on an even playing field.

Address for correspondence: rabrams1717@gmail.com

Auditory Hallucinations, Agoraphobia and Extremism as Portrayed by Actor Ahmed Magdy

3 May, 17 | by amcfarlane

In this podcast, our Screening Room editor, Khalid Ali, explores the role of film in shining a light on mental illlness, dysfunctional families, and the rise of religious fanaticism with Egyptian director Ahmed Magdy.

Recently introduced to acting, Ahmed talks about his portrayal of three challenging characters: a young man imprisoned in his mother’s house in Gate of Departure (Karim Hanafy, 2014), an extremist who converts from Islam to Christianity in The Preacher (Mawlana) (Magdi Ahmed Ali, 2016), and a man troubled with persistent auditory hallucinations and a legacy of inherited mental illness in Ali, the Goat and Ibrahim (Sherif El Bendary, 2016).
Ahmed Magdy studied Law in Ain Shams University, but pursued his passion for film by taking part in Egypt’s independent cinema scene since 2008. He produced and directed a couple of independent films, and directed his own short, Caika Bel Crema (A Cream Cake, 2008).

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:

London Human Rights Watch Film Festival

6 Mar, 17 | by cquigley

 

Film activism: London Human Rights Watch Film Festival- 6-17 March 2017,

https://ff.hrw.org/london

Introduction by Khalid Ali, Screening room editor

Film events have recently become a platform for standing up against social injustice, and racism; the Oscar ceremony on Sunday 26th February was a powerful statement from film makers uniting against violation of human rights. On the same night, London’s Trafalgar Square hosted a public screening of the Iranian film ‘The salesman’ demonstrating London’s diversity and support for the film director Asghar Farhadi in boycotting the Oscar ceremony in response to Donald Trump’s travel ban.

Between the 6th and 17th of March 2017, London once more shows its unwavering support of championing human rights by hosting the 21st edition of the London Human Rights Watch Film Festival. The films shown are particularly relevant for healthcare professionals as they shine a light on human stories from the front lines; narratives of doctors, nurses as well as patients deprived of their basic human rights in healthcare institutions and let down by oppressive regimes. Showing 16 documentary films, the festival engages its audience in debating a rich variety of topical global concerns. From the daily challenges of an Arab nurse in war-torn Iraq in ‘Nowhere to hide’, to the harrowing stories of young Moroccan and Yemeni girls forced into child marriage, and subsequent physical and mental traumas in ‘Child mother’, to the fight for humane care and justice by young Russian women sectioned in psychiatric units in ‘We’ll be alright’ and a Chinese terminally ill patient with work-induced leukaemia in ‘Complicit’, the LHRWFF portrays universal stories of hope and defiance.

Here is an introduction form the festival team:

‘In an era of global advances by far-right forces into the political mainstream, more than half the program explores individuals and groups exhibiting courageous resilience in challenging times, and celebrates the push for progress and transparency.

Revolutionary voices take centre stage in four titles, including our opening night film, the Oscar nominated ‘I am not your Negro’ by Raoul Peck- a stunning profile of US civil rights era writer James Baldwin, whose prophetic words, narrated by Samuel L. Jackson, bring us rapidly to the present. In ‘Girl unbound’, Maria Toorpakai becomes Pakistan’s finest woman squash player, despite Taliban death threats. In ‘Joshua’, Joshua Wong, a teenager from Hong Kong, orchestrates fearless student-led stand-off with the Chines government in the fight for democracy. And the infectious uncompromising humour of Egyptian comedian Bassem Youssef is the powerful string that draws back the curtain on his government’s crackdown on the rights of its citizens in ‘Tickling giants’.

Three of our films highlight inspiring collective action- from ‘500 years’, where the highly organised street protests of Mayan activists bring the truth to light in the courts of Guatemala; to ‘The apology’, where octogenarians, often referred to as ‘comfort women’, continue to demand accountability for the sexual exploitation by the Japanese army during World war II. Also screening is ‘Complicit’, which follows critically poisoned factory workers as they fight Chinese electronic giant Foxconn for acknowledgement, justice and health care.

Urgent and evolving issues of migration are explored in three titles that uncover the emerging reality of daily life as a refugee. In ‘The good postman’, the aging residents of a tiny Bulgarian town are split on whether to welcome or reject Syrian families fleeing war.

‘Lost in Lebanon’ takes a close look at the reaction of a country of 4 million inhabitants to the arrival of 1 million refugees. And in the highly emotive and deeply personal closing night film, ‘Nowhere to hide’, we accompany an Iraqi nurse and his family whose lives are suddenly turned upside down is their country is once again torn apart by war.

As always, the festival will host in-depth discussions after the screenings with film makers, protagonists, Human Rights Watch researchers and activists to offer you, the audience, a unique opportunity to ask questions and engage with topics covered in each film’.

The Human Rights Watch Film Festival Team

Vimeo trailer: https://vimeo.com/202960330

Recommended reading

  1. http://blogs.bmj.com/medical-humanities/2016/03/07/khalid-ali-london-human-rights-film-festival-9-18-march-2016/
  2. http://blogs.bmj.com/medical-humanities/2016/06/17/film-review-stories-from-arab-women-during-the-spring-revolutions/

Address for correspondence

Khalid.ali@bsuh.nhs.uk

Film Review: It’s Only the End of the World

8 Feb, 17 | by cquigley

It’s only the end of the world, directed by Xavier Dolan, Canada, France 2016.

In UK cinemas from 24th February 2017

Reviewed by Dr Franco Ferrarini

 

Louis (Gaspard Ulliel) is a 34-year-old gay playwright who feels an urgent need to meet his family after 12 years of estrangement, to tell them about his terminal illness and impending death. Unfortunately, instead of the help and compassion he is looking for, he is met by a climate of anger, violence and indifference; his sister Suzanne (Léa Seydoux) blames him for not taking her away from the family home, his brother Antoine (Vincent Cassel), the man with bruised knuckles, envies and resents his success, and his mother Martine (Nathalie Baye) keeps cooking huge amounts of food, in a futile attempt to keep her dysfunctional family together. The only person who shows empathy towards Louis, the lack of which lingers over the whole narration, is his sister-in-law Catherine (Marion Cotillard in an outstanding performance), a sensitive and shy woman who is clearly oppressed by her husband Antoine. Catherine and Louis exchange silent glances as their own means of communication, and sharing of each other’s emotions in a way words could not provide. Apart from Catherine, the rest of the family do not understand, or even try to understand Louis’s tragedy. The narrative goes on with the cuckoo-clock watching over Louis reminding him that he is running out of time. The recollection of past moments in flashbacks provides a flicker of light in this otherwise dark homecoming day.

Adapted from the 1990 play by Jean-Luc Lagarce “Just la fin du monde”, Xavier Dolan’s film is mainly based on close-ups and dialogues and virtually no action. The story-telling style reminds us of Gille Deleuze’s ‘time-image theory’ where we can appreciate the flow of time either directly, without the intermediary of motion (time–image) by means of dialogues, monologues, flashbacks or memories, or indirectly, by observing the motion of objects or people (motion-image) (1).

The theme of lack of communication is at the film’s heart, a common finding in many modern families (Camille’s song “Home is Where it Hurts” (played in the soundtrack seems particularly appropriate).  In our ever-connected society everybody is, so to say, friends with people whom he’ll never meet and ‘will never be there for’ (2). Virtual ‘Face book friends’ are not there when they are truly needed, they cannot listen or help in times of trouble. It seems that today’s society is very similar to Louis’s family, where everyone is self-centered, and the presence of others can be an annoyance to everybody’s shouted solipsism, a cause of envy and subsequent rage.

The lack of empathy shown by Louis’s relatives, and Catherine’s inability to use words to express her feelings, are two issues that are particularly relevant to physicians. The metaphor in the film reminds us that we need to sharpen our skills in empathy; if we just sit back and listen idly to what our patients say we might miss vital information about their diagnosis, but more importantly we might miss a lot about the patient herself/himself. We might understand which kind of disease the patient has, but certainly not connect with the patient who has a certain disease. A clinical behaviour based on true empathy helps us grasp not only what patients say, but what they are not able to say. Patients’ inability to express their feelings as well as their symptoms is highly prevalent in the general population; alexithymia has been diagnosed, for example, in 17% of an adolescent Italian population (3). Empathy can be learned (4, 5), and should be taught in medical schools.

The film struck a chord with the festival audience winning the Grand Prix and the Ecumenical Jury Prize in Cannes Film Festival in 2016. It is a different film for viewers who are used to action-packed block-busters; it excels in analyzing non-action in the life of a modern day family, and in doing so provides food for thought, reflection and empathy.

 

References

  1. https://monoskop.org/images/6/68/Deleuze_Gilles_Cinema_2_Time-Image.pdf (accessed Feb 3 2017).
  2. Placebo, Too many friends, from the album Loud Like Love, Universal Music, Virgin EMI, 2013.
  3. Scimeca G et al. The relationship between alexithymia, anxiety, depression, and internet addiction severity in a sample of Italian high school students. Scientific World Journal 2014; 2014:504376. doi: 10.1155/2014/504376.
  4. McDonagh J and Ljungkvist V. Learning empathy: medical school and the care of the dying patient. Journal of Palliative Medicine 2005, 2(4): 383-89.
  5. Bearman M et alLearning Empathy through Simulation: A Systematic Literature Review. Simul Healthcare 2015; 10:308-19.

 

Email for correspondence: francoferrarini.ff@gmail.com

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: Dubai International Film Festival

2 Jan, 17 | by cquigley

United by film in United Arab Emirates

An overview of Dubai International Film Festival (DIFF), 7-14th December 2016, https://dubaifilmfest.com/en/page/223/diff16.html

Dr Khalid Ali, Screening room editor

Cinema can be a contemporary mirror of our society as film-makers tell their stories reflecting on universal political, social, and economic challenges. Health and well-being were prominent themes in the panorama of world cinema in Dubai International Film Festival (DIFF) 2016 which screened 156 films from 57 countries.

For a geriatrician, I was immediately drawn to films which explored the world of old people amongst their families and carers in their colourful but harsh realities; ‘104 wrinkles’ (Lebanon, 2016, Hady Zaccak) is a sensitive documentary where the director Zaccak follows his grandmother Henriette for 26 years, observing her physical and cognitive decline, but also celebrating the bonds of love and filial duty in caring for her. ‘We are just fine like this’ (Tunisia, 2016, Mehdi M. Barsaoui) is a playful short film about an old man struggling with the advance of dementia, and his grandson’s mischief. Two elderly women facing cruel nature, climate change and a dwindling economy trying to earn a living by collecting honey was the subject of ‘Honey, rain and dust’ (United Arab Emirates, 2016, Nujoom Alghanem).

Mental health featured highly in DIFF and the awards category: ‘Mamsous- Deranged’ (United Arab Emirates, Kingdom of Saudi Arabia, 2016, Shatha Masoud) followed three patients struggling with anxiety, depression, side effects of medications, and the stigma of mental illness. In view of its authentic portrayal of real patients and imaginative narrative style, the film was awarded the best short film award. ‘Like crazy’ (Italy, France, 2016, Paolo Virzi) is an elegantly told humorous road journey, Thelma and Louise style, of two female patients running away from a mental institution. Auditory hallucinations, bereavement, loss and friendship of two mentally ill men seeking cure in another road journey formed the background story of ‘Ali, the goat and Ibrahim’ (Egypt, UAE, France, and Qatar, 2016, Sherif El Bendary) which earned its leading character Ali (Ali Sobhi) the best actor award. Domestic violence and long-lasting psychological trauma experienced by children were sensitively handled in ‘Animal- Hayawan’ (UAE, 2016, Nayla Al Khaja).

The year 2016 was notable for films made by women exploring women’s issues worldwide; DIFF was no exception in focussing on the feminine agenda; ‘Miss Sloane’ the opening night film (USA, 2016, John Madden) had ‘Jessica Chastain’ as the determined woman of the title lobbying for strict laws on gun acquisition in the USA. Two more American films delved into women’s psyche; ‘Certain women’ (USA, 2016, Kelly Reichardt), and ‘20th century women’ (USA, 2016, Mike Mills).  Similarly Arab cinema shone a spotlight on women’s trials and tribulations in a male-dominated world: ‘A day for women’ (Egypt, 2016, Kamla Abu Zekry) followed a group of ladies who come together in a public swimming pool one day a week dedicated to women only, and ‘One week, two days’ (Egypt, Sudan, 2016, Marwa Zein) which dissected the problem of primary infertility.

The global threat of rising extremism was analysed in ‘Mawlana- The preacher’ (Egypt, 2016, Magdy Ahmed Ali), and ‘Layla M’ (Netherlands, Belgium, Germany and Jordan, 2016, Mikje De Jong).

Tolerance, empathy, and understanding different cultures in a global dimension were discussed in ‘Foreign body’ (France, Tunisia, 2016, Raja Amari), ‘Zainab hates the snow’ (Tunisia, France, Qatar, Lebanon and UAE, 2016, Kouther Ben Hania), ‘Solitaire- Mahbas’ (Jordan, Lebanon and Egypt, 2016, Sophie Boutros), ‘The choice’ (UAE, 2016, Eman Alsayed), and ‘Lisa’ (UAE, 2016, Ahmed Zain).

The festival audience award went to ‘Heartstrings’ (France, 2016, Michel Boujenah) which told the story of a 12 year old girl losing her eyesight to progressive macular degeneration and how her passion for music, and empathy and compassion from a school friend restored her well-being.

Lenny Abrahamson (Oscar nominated director, https://en.wikipedia.org/wiki/Lenny_Abrahamson ) in conversation with William Mullally gave a moving account of his approach to marginalised characters in society, and the importance of empathy, listening and understanding in storytelling.

Over the course of 2017, I will be sharing with the ‘Screening room’ readers, and ‘Medical Humanities online podcast’ listeners’ DIFF film reviews, and interviews with Hady Zaccak (director of 104 wrinkles), and Ahmed Magdy (actor in ‘Ali, the goat and Ibrahim’ and ‘Mawlana- The preacher’), and highlights from Lenny Abrahamson’s conversation. In a new section ‘Talk to her’, I will be posting discussions with emerging women directors from the Arab world: Shatha Masoud (director of ‘Mamsous- Deranged’, Nayla Al Khaja (director of ‘Animal- Hayawan’), and Marwa Zein (director of ‘One week, two days’).

Brecht once said ‘Art is not a mirror with which to reflect reality, but a hammer with which to shape it’. The same notion applies to film as a force for education and change.

Wishing you all a very happy New Year.

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

 

image1

Hady Zaccak – director of ‘104 wrinkles’ – talks to Khalid Ali

 

image2

Masoud Amralla Al Ali (artistic director of DIFF) with Khalid Ali – opening night of DIFF

 

image3

Lenny Abrahamson talks to William Mullally 

diff-image-4

Madgy Ahmed Ali, Dora, Ahmed Madgy and Reham Haggag – film director and cast of ‘Mawlana: The Preacher’ 

Film Review: Dear Zindagi

14 Dec, 16 | by cquigley

 

Julia Roberts meets Sigmund Freud in Goa: A review of Dear Zindagi, directed by Gauri Shinde, India 2016, 4*

Currently in general release in UK cinemas 

Reviewed by Dr Khalid Ali, Screening room editor

Bollywood cinema has secured its international box-office appeal with a well known formula of combining action, melodrama, song, and dance in one film. Indian director Gauri Shinde adapts this winning formula in her new film Dear Zindagi- Deal life, but adds a contemporary message of exploring serious subjects namely the stigma of mental illness, doctor-patient relationships, and the role of mindfulness in well-being.

A recent prevalence study published in the Lancet Psychiatry showed that 4.7% of Indian women suffer from a major depressive illness, and 4.1% suffer from anxiety disorder (Baxter AJ, et al., 2016). In addition the magnitude of mental disorders is expected to increase by 23% in India by 2025, warranting an urgent need for a co-ordinated program of prevention, early diagnosis and effective management (Charlson FJ, et al., 2016).

Kaira (Alia Bhatt) is a young beautiful cinematographer who has it all; beauty, brains, and wealth. However an unexpected series of personal and professional failures put a halt to her thriving career. In a story line reminiscent of Julia Roberts’ travels to India in the Eat Pray Love 2010 film (https://en.wikipedia.org/wiki/Eat_Pray_Love), Kaira relocates back to her parents’ home in Goa in an attempt to make sense of the meaning of life and relationships. Insomnia and family pressure to find a husband drive Kaira to suffer from anxiety and possible depression. Ashamed of the stigma of mental illness, she seeks help from a ‘brain doctor’ in secret. Dr Jehangir Khan (Shah Rukh Khan) is a charming clever clinical psychologist whose in-depth analysis of dreams makes him the modern day ‘Sigmund Freud’. The theories of Sigmund Freud relating to the ‘subconscious’ through dream analysis are cleverly illustrated with the ‘brain doctor’ helping Kaira figure out that her suppressed childhood traumas of abandonment maybe the underlying cause for her fear of commitment.

Dr Khan also shares with the young patient his own traumatic experience of choosing clinical psychology as a career to the dismay of his parents. Blurring of the boundaries between patients and health-care professionals in a therapeutic encounter is another topical subject that ‘Dear Zindagi’ shows without any prejudice. Similar themes were explored in films as far back as Alfred Hitchcock’s ‘Spellbound’ 1945 (https://en.wikipedia.org/wiki/Spellbound_(1945_film)), and as recent as Steven Soderbergh’s 2013 film ‘Side effects’ (https://en.wikipedia.org/wiki/Side_Effects_(2013_film)).

Through long probing but friendly sessions of cognitive behavioural therapy (CBT), both clinical psychologist and patient eventually come to terms with their hidden demons. In revisiting happy childhood memories, and connecting with nature, they practise ‘mindfulness’ as a way out of their unhappiness.

It is refreshing to find a Bollywood film with a charming lead actress, Alia Bhatt in a career defining role that could easily land her the title of ‘India’s Julia Roberts’, that still manages to discuss serious subjects of mental illness and stigma, and simplifies without trivializing the benefits of ‘talking therapy’ and ‘mindfulness’.

See trailer here.

© Disney Entertainment, UK. All rights reserved

References

  1. Baxter AJ, Charlson FJ, Cheng HG, et al 2016. Prevalence of mental, neurological, and substance use disorders in China and India: a systematic review. Lancet Psychiatry 3 (9): 832-41.
  2. Charlson FJ, Baxter AJ, Cheng HG, et al 2016. The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies. Lancet 388 (10042): 376-89.

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

Film review: Mannequin

7 Dec, 16 | by cquigley

image1

 

The Banality of Evil – Review of Mannequin, Egypt, 2015, directed by Dr Mina Elnaggar

 

Reviewed by Professor Robert Abrams, Weill Cornell Medical College, New York

 

Mannequin is a short, terrifying film with ambitions as large as its 7-minute running time is brief. The action starts immediately: An unnamed man who must have his wife’s dress retailored as a birthday gift has evidently placed an advert for a seamstress. When Mofida, the young woman who has responded to his advert, arrives at his home, he starts behaving oddly. The mood turns voyeuristic and sinister when he begins to make demands of her, including that she must wear and model the dress. The viewer now senses that Mofida might be used as an alter ego for the man’s wife, an inert substitute, as if she were indeed a lifeless mannequin. We watch with fascination and fear as an ordinary transaction changes over to the deceitful entrapment of an innocent woman.

Several questions are raised: What circumstances could justify the evil intentions this man appears to harbor? What internal conflict he is attempting to resolve?
The film can be viewed below.

 

Now that some details have been clarified, there is more to consider. We know that there are truths that are so unbearable that outright denial must be marshalled, and often that denial is framed in a uniquely personal way. This man’s wife has presumably been unfaithful, a circumstance he re-enacts by dousing Mofida with men’s cologne when she has put on the dress. Why someone who has been (or believes that he has been) betrayed by his wife chooses a particular style or format of disavowing is the province of psychoanalysis, not elucidated here.

But this is also where Mannequin reaches for a deeper understanding of the nature of vengeance. Although the implications are not immediately apparent, in only a few minutes it becomes clear that this film is depicting a perversion of anger and grief. The director, Mina Elnaggar, seems to grasp that narcissistic rage arises from a perceived threat to the narcissist’s self-worth. In the mainstream psychiatric view, a person with pathological narcissism might experience infidelity as a grave threat to his integrity, reacting with extreme anger or devaluation of the unfaithful partner as a way of avoiding emotional pain (Pincus AL, Lukowitsky MR. Pathological Narcissism and Narcissistic Personality Disorder. Annual Review of Clinical Psychology. April 2010. 6:421-446). Here, in a variant of pathological narcissism, the cuckolded man further engages in a kind of “undoing”, a defensive revision of reality wherein it is no longer his wife who has wronged him, but a randomly found young woman; and while his victim might pay dearly for him being betrayed, the man seeks to avoid suffering himself. Also, in this delusional world, violence against others is acceptable if they are viewed as dehumanized mannequins; but if the mannequins resist, they just might have to be rendered lifeless again.

One of the defining characteristics of adulthood is the ability to distinguish between fantasy and reality. In essence, fantasy is the notion that one can control the world, with no restrictions placed on one’s libidinal urges, but this happens only in psychosis, pathological narcissism, sociopathy, or films.

In Mannequin, the protagonist is in a desperate flight from the immutable reality of whatever his wife has done that has been so damaging to his core identity. What the film does show, as a kind of reward to the viewers for tolerating the convoluted thoughts and images, is that unprocessed narcissistic rage is a zero-sum game, a desperate, losing position that can only enfeeble, rather than strengthen or vindicate the self. The elaborate avoidance of pain leads only to more pain for all concerned.

Mannequin provides a thought-provoking inquiry into a very dark domain. Its central character seizes control over the life of his victim as he cruelly manipulates her, but in fact it is he who is being controlled by unconscious motivations of which he is unlikely to be aware.  From there, it is not a great leap to recognize that vengeance born of narcissistic injury can become murderous, but will still be impotent, whether on an individual or a global scale.  If this man’s denial or undoing—call it what you will– had been satisfying, he would not need to repeat it, a point that is eerily hinted at in the film.  Mannequin, despite its short span and familiar, ordinary setting, manages nothing less than to shock the viewer to a deeper appreciation of the underpinnings of human violence.
Address for correspondence: rabrams@med.cornell.edu

 

 

Interview with Dr Mina Elnaggar- actor, film director and producer

 

image1

 

Can you introduce yourself to the readers?

I am a clinical nutrition specialist, but before that I used to work in the forensic department at MUST University. I worked in several theatre performances inside and outside of Egypt, such as ‘No time for art’ directed by Laila Soliman; in addition to the ‘Cairo trilogy’ with the BBC radio 3 directed by John Dryden; plus some interesting roles in TV and film in Egypt.

What was the reason behind your choice of a mentally-disturbed person as a main character and what were your cinematic influences?

I was always passionate about theatre and cinema since childhood, but I never studied either in an academic format. Most of my studies were independent self-driven attempts. I was fortunate to attend several theatre/ film workshops where I gathered loads of useful information. I am a big fan of Daoud Abdel Sayed (https://en.wikipedia.org/wiki/Daoud_Abdel_Sayed). His 1991 film ‘Kit Kat’ (https://en.wikipedia.org/wiki/Al-Kit_Kat) was one of the films that left a big impression on me as well as ‘The Land of Fear’ (http://www.imdb.com/title/tt0233234/plotsummary?ref_=tt_ov_pl). But my real influence was theatre. That was my real source of inspiration in making my own films. For example breaking the fourth wall was one of the tools I applied in ‘Mannequin’ to engage the viewers – whether to empathize with the victim or be a silent witness.

How did your film work support your interaction with patients?

Working with film and acting has several psychological aspects that runs fluidly back and forth; as an actor I have to dig deep and uncover my personal truths and convictions, and in doing that I was able to widen my perspective. In return, I was able to deal more flexibility with patients and understand their urges and needs. Honestly I believe that every person (doctor or otherwise) should have a go at acting because it makes you better understand yourself. Acting helps you to identify your own personal journeys in a civilized manner.

Films take you to different realities and help you plunge into different worlds. A film can also help release the pressure of everyday life stressors.

Which films do you encourage your students/ patients to watch and why?

I tell them to watch any types of films and not just art films; I also encourage them to go to performances, theatre, galleries, and any place that provides a form of art to exercise their creative muscles

 

 

Film Review: Doctor Strange

7 Nov, 16 | by cquigley

The theme for the next issue of Medical Humanities is Science Fiction. There are many online articles already available on the theme (see Related Reading below). The blog will feature a series of reviews and original pieces on Medical Humanities and Science Fiction over the next weeks.

 

picture1

A Superhero inside you…

 

Review of Doctor Strange, USA, 2016, directed by Scott Derrickson, in UK cinemas now.

Reviewed by Dr Khalid Ali, Screening room editor.

 

Can a blockbuster film telling the story of a Marvel Superhero ask serious existential questions about mortality in a character-study narrative in addition to providing edge-of-the-seat popcorn entertainment? Doctor Strange, the 14th film from the Marvels Cinematic Universe (MCU), responds to that question with an emphatic Yes, and makes the viewer eager to see part 2 in the not so distant future. Dr Stephen Strange, played with abundant charm and wit by Benedict Cumberbatch, is an egotistical, highly driven brain surgeon who is called upon to operate in the most complicated life threatening neurosurgical emergencies. An unexpected turn of fate in the form of a car accident causes serious damage to his hands, preventing him from operating. A series of surgical interventions fail to restore his hand function. His quest for super-natural recovery takes him on a journey of self-discovery around the world, and an ultimate Superhero transformation.

The key to Doctor Strange’s redemption as a human being comes with a hefty prize; he must choose between saving his career as a surgeon and ‘saving the entire universe’. Even though he is an accomplished surgeon, Doctor Strange still needs a mentor in the form of ‘The Ancient One’, played impeccably by Tilda Swinton, to help him unravel the mysteries of the universe. The values of apprenticeship, such as listening and following advice are extremely challenging to a highly qualified surgeon who is used to the rules of strict mentorship and to being obeyed. Through the journey of the reluctant student and his benevolent master, serious questions about the sanctity and purpose of life, the nature of religion, and philosophy are posed.

In spite of the fact that the theme of ‘One chosen man saving humanity’ has been explored before in films like The Matrix, Superman and Spiderman, Doctor Strange still manages to look and feel original with mind-blowing time and space bending special effects. The co-existence of kind and caring traits alongside an evil personality in one doctor have formed the backstory of Dr Jekyll and Mr Hyde, and Mary Shelly’s Frankenstein. However, Doctor Strange takes the theme of good vs. evil to a whole new level by expanding the personal struggle to explore the basic nature of human existence – our purpose in life, spirituality and faith, and man’s everlasting quest for eternity.

Several scenes will be familiar to an audience with a healthcare professional background: Cardio-Pulmonary Resuscitation (CPR) features twice, in one scene graphic details of how to perform peri-cardiocentesis (evacuation of blood from around the heart) are shown, and in another highly imaginative scene, the dying patient being resuscitated leads the CPR procedure. In addition to the physical dimension of the CPR act, a parallel exploration of who determines a patient’s best interests when it comes to making the ultimate ‘Do not Attempt Resuscitation’ (DNAR) decision. The scene of a key figure dying, and using their power to stretch time to enjoy a few more seconds of living, is a powerful metaphor for the value of life of patients in their terminal stages. It is also a call for doctors to truly appreciate the significance of their irreversible judgement when they stamp that DNAR order. An inherent ethical and moral dilemma faces Dr Strange when he is about to kill for the first time; he questions his convictions as a ‘doctor sworn to save lives’ who is about to take away forever a human life.

Are doctors so different from Superheroes? Both save lives and care for humanity. They might wear different uniforms; doctors mostly wear white coats, while Superheroes wear trademark costumes like Doctor Strange with his ‘Cloak of levitation’. The story of Doctor Strange reminds us that doctors are as vulnerable as most other human beings, and are prone to accidents, personal and professional setbacks and tragedies. A redeeming fact though remains in that both doctors and Superheroes still have the power to overcome adversary, and save themselves and potentially others. One life saved is as worthy and as valuable as saving millions of lives. So if you happen to be a doctor, search for the Superhero inside of you.

 

Film trailer

Film poster and trailer are included with permission from Disney Entertainment, UK.

 

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

 

Related Reading – check out these Science Fiction titles online first at Medical Humanities:

Doctors in space (ships): biomedical uncertainties and medical authority in imagined futures http://bmj.co/2eOU0K0

The medical science fiction of James White: Inside and Outside Sector General http://bmj.co/2eiM5kA

Human life as digitised data assemblage: health, wealth and biopower in Gary Shteyngart’s Super Sad True Love Story http://bmj.co/2eOQijk

Zombie Tapeworms in Late Capitalism: Accelerating Clinical and Reproductive Labor in Mira Grant’s Parasitology Trilogy http://bmj.co/2eUKenw

Rewinding Frankenstein and the Body-Machine: Organ Transplantation in the Dystopian Young Adult Fiction Series Unwind – Original Article http://bmj.co/2fnd0ji

Towards A Structure of Feeling: Abjection and Allegories of Disease in Science Fiction ‘Mutation’ Films http://bmj.co/2eUMdbA

 

Medical humanities blog homepage

Medical Humanities

An international peer review journal for health professionals and researchers in medical humanities. Visit site



Creative Comms logo

Latest from Medical Humanities

Latest from Medical Humanities