Finding Hope in Dementia

Film Review by Professor Robert Abrams, Weill Cornell Medicine, New York

Vortex is everything its title implies—a terrifying eddy of misfortune from which its victims are powerless to escape. It is all about the ravages of dementia, the destruction of the human mind and its effect on those who love the person so afflicted. The film has some aspects of a documentary, inspired by the death of the director’s mother from Alzheimer’s disease and his recognition of the near-universality of this condition in families like his own (the dedication is to “all those whose brains will decompose before their hearts”).[1] But the film is primarily fictional, a story, its roles played by actors who portray an Alzheimer’s patient, her husband and her son. Shot in Paris during the height of the Covid-19 pandemic in the winter of 2020-2021, it was partly for the health of the film crew that the camera ventured only rarely from the dark, cluttered rooms of the couple’s apartment; but the stifling, oppressive atmosphere thus created became a fitting stage for an unfolding tragedy.

The story itself is filled with sadly ironic elements. The woman with Alzheimer’s disease [Franϛoise Lebrun], whose name, like that of her husband, is rarely used, is a former psychiatrist. Her medical license has no doubt expired but she still prescribes antipsychotic medications in inappropriately high doses for her husband and herself. Her husband [Dario Argento] is an academic working on a vaguely conceived book on film and dreams to be titled Psyche. Although not diagnosed with dementia himself, his descriptions of his book project are imprecise and repetitive; clearly he is no longer the scholar he once had been. We also learn that he is in fragile health. A son, Stéphane [Alex Lutz] does his best to advise and help, but he is in an uncertain recovery from heroin addiction and under court-ordered supervision as he attempts to be a single parent to his own young son. The greatest irony of all may be the frequently running backdrop of taped scientific and philosophical discourses on grieving and mental disorders, presumably relics of the wife’s former identity. Professional expertise and Intellectual achievement obviously afford no protection from the destructive power of dementia.

 

 

The use of split screens throughout the entire film adds to the viewer’s unease about what is to happen. The split-screen device is particularly apropos in Vortex because so much emotion in the film is conveyed by facial expression, most notably from the Alzheimer’s-stricken woman, whose speech is necessarily sparse; and from Stéphane, who makes disastrous decisions for himself, but is in an anguish of frustration with his father, who has been ignoring his pleas to bring in help or move with his wife to an assisted-living facility. Without the split screen, the camera would need to shift constantly from face to face to show the characters’ reactions to each other–their sadness, anger, and love. The viewer shudders when one side of the screen goes dark.

But to what end does one witness for over two hours the inexorable decline of this once-vibrant personality, the pain of her husband and the futile struggles of their son to intervene? For this viewer, the rewards of the film have everything to do with addressing the problem of how to find hope at the end of life, especially under the limitations imposed by dementia. As the husband says at one point, for himself, but also for his wife: “I need to hope or I am nothing.”

In a paper nearly twenty years old but still influential, Mark Sullivan argues that at the end of life, hopelessness is a an “attachment to a form of hope that is lost.”[2] He goes on to say that, assuming an intact mental capacity, the person with a terminal illness can find hope by turning away from the lost causes of cure or recovery and redirecting his attention to family, spirituality, art, science—anything that has meaning to the individual and will survive the self. That may be what the husband is trying to accomplish with his book, creating a legacy and reaching for generativity, the penultimate psychological achievement in Erik Erikson’s scheme of human development.[3] But in dementia, which neither Sullivan nor Erikson consider, the sublimatory defense of looking beyond one’s own life is no longer accessible. So what can be done? Vortex suggests that a person with end-stage dementia can still hope, but in a special direction: It will be for continued experiences of intimacy, dignity and tactile comfort.

There is in fact a considerable amount of both affectionate physical contact and emotional validation in Vortex, mainly in a series of moving scenes with Stéphane and his mother, and some also between husband and wife. The woman with Alzheimer’s disease is never so far gone as to refuse the love and comforting she so demonstrably requires, and she is somehow able to offer the same to her husband and son when it matters most. But although every viewer might not agree that finding a path to hope in dementia is the implied message of Vortex, photos of the characters at the height of their youth and beauty shown at the end of the film accentuate the magnitude of their losses and the need for hope in some form. When I saw the film in a New York theatre, its impact was such that the audience sat immobile for a long time after the final credits rolled and the lights came back on. Perhaps we were all imagining a time when the lights in our own lives might be dimmed.

 

References

[1] Interview of Gaspar Noé by Dennis Lim of the New York Film Festival, October 1, 2021. https://www.youtube.com/watch?v=zXtkuWMe1Tw.

[2] Sullivan, M. Hope and Hopelessness at the End of Life. American Journal of Geriatric Psychiatry 11, 393-405 (2003).

[3] Slater, C.L. Generativity Versus Stagnation: An Elaboration of Erikson’s Adult Stage of Human Development. Journal of Adult Development 10, 53–65 (2003). https://doi.org/10.1023/A:1020790820868.

(Visited 94 times, 1 visits today)