América, directed by Erick Stoll and Chase Whiteside, USA 2018
Showing on Saturday and Sunday 9th and 10th June at Sheffield Doc Fest,
Review by Professor Robert Abrams, Professor of Old Age Psychiatry, Weill Cornell Medicine, New York
Toward the end of the arresting film, América, a tour de force that depicts nearly every emotional high and low of caregiving, a frail, forgetful old abuélita (grandma) asks the most devoted of her three grandsons, Diego, if there are people who ‘end up with nothing.’ Diego responds that we all enter the world that way. América then completes the question by clarifying her meaning: ‘Alone, abandoned, with no one that loves you.’
We learn at the beginning of the film that América’s son, Luis, has been jailed for elder abuse and neglect; América had been found by neighbors, alone and bleeding after a fall. She is now moved to the house of a grandson, Rodrigo. A second grandson, Diego, quits his job as a surf instructor and rushes back to their Mexican hometown of Colima to help Rodrigo care for their grandmother while Luis is in prison.
Diego, who has the lightest physique of the three grandsons of América, does the heavy lifting as both caregiver and day-laborer. Throughout the film, the greatest delight for the viewer is the manifest sincerity of Diego’s affection for his frail grandmother, his genuine happiness in their brief moments of intimacy, elevating such everyday obligations as feeding, bathing, toileting, even manually extracting feces, to the level of paeans to filial love. At one point, after América correctly recognizes from an old photo that Diego is her grandson, not her youngest son (as she otherwise insists), he rewards her with a smiling embrace, and she responds: ‘What a joy you are. You have so many memories of us.’ And she is right; for América, Diego is the conservator of their joint memories. When Diego performs a daredevil balancing act dangling from a tree, and America protests anxiously, he responds: ‘Your love protects me.’ And he, too, is right; Diego and América are each sustained by their mutual affection.
But Diego’s brothers approach caregiving very differently. Rodrigo, the most robust physically of the three, believes that América has no grip on reality and ‘understands only basic instincts.’ With his more intuitive understanding of dementia, Diego counters that América lives her own reality. There are conflicts with the third brother, Bruno, as well.
The ‘équippo,’ the dream of a team of three athletic brothers united in their care for their beloved abuélita, is now seriously threatened, illustrating the tensions that frequently erupt among siblings sharing caregiving responsibilities. The camera repeatedly shows how some of the mangoes falling from a tree hit the ground split and bruised, suggesting in a single image both the fragility of América, who is constantly at risk of recurrent falls, as well as the threatened unity of the brothers.
A clinical supervisor in my psychiatric residency once explained to me that the strong emotional reactions to patients that are recognized by the physician or therapist are not properly considered to be countertransference; instead, the term ‘countertransference’ refers only to those reactions of which the therapist or physician is not consciously aware. Moreover, he said, the most dangerous of all countertransference phenomena are one’s poorly understood good intentions; and this caution applies equally to everyday life situations. Here, Bruno’s good intentions are reflected in his zeal to help América regain her strength and walk independently, but he is oblivious to the fact the he is actually badgering and abusing her, let alone the reasons why he is behaving in this way. Concerned passers-by in the park who witness what Bruno is doing call the police. We have been shown another pitfall of caregiving, this time how the line between protection and abuse can easily be blurred, regardless of one’s conscious motivations.
Two of the grandsons, Diego and Bruno, are finally united in their determination to protect and support América, and to shield her from one of the most basic of human fears, the one that she has expressed herself, that of dying with ‘with no one that loves you.’ By the film’s end, the viewer, having witnessed the full gamut of the characters’ caregiving experiences, feels uniquely empowered to reflect on the extent of their success.