With or Without Antidepressants, An Ongoing Dilemma

Film Review by Khalid Ali, Film and Media Correspondent
‘Farah’ (Hassiba Freiha, Kenton Oxley, Lebanon, 2022), released in Lebanese cinemas on 24th November 2022, Winner of Jury Award at Chelsea Film Festival, New York

A recent systematic review postulated that the serotonin theory as an underlying biochemical basis for depression is not substantiated by robust evidence.[1] This review caused significant debate with some academics arguing that the review should not be extrapolated into an assumption that ‘antidepressants’ don’t work. Professor Christopher Davey called for a balanced interpretation of that systematic review.[2]

 

'Farah' Film Poster
‘Farah’ Film Poster

The above controversy is intelligently depicted in the story of ‘Lina’ (Stephanie Atala) a medical student in the soon-to-be released Lebanese film ‘Farah’. During her first year in medical school in America, Lina is struggling with low mood, anxiety and recurrent nightmares adversely affecting her academic performance. When Lina’s panic attacks escalate, and psychotic symptoms of auditory and visual hallucinations dominate her daily life, she is flown back to Beirut to be looked after by her father Nabil (Majdi Machmouchi). Back home, Lina is prescribed a new antidepressant drug ‘Xapa’, referred to by the public as ‘Joy’. Soon side effects of ‘Xapa’ such as paranoid delusions, confusion and disorientation impair Lina’s grip on reality. Lina attempts to find salvation by reflecting on memories of her deceased mother ‘Farah’ (Hassiba Freiha). Revisiting long hidden family secrets leads Lina on a precarious journey. It transpires that Lina’s mental illness is intricately linked to Farah’s  trauma. Eventually Lina loses trust in everyone; her father, her nanny Gita (Josyane Boulos) and the unnamed reporter (Youssef Boulos) trying to unveil the harmful effects of ‘Xapa’ now being sold as an illegal psychedelic drug in Beirut’s black market. Is the reporter real or a figment of Lina’s imagination? Is her mental deterioration a progression of psychosis not responding to medications, or is her life spiralling out of control due to the harmful effects of ‘Xapa’?

Hassiba Freiha and Kenton Oxley, 'Farah' co-directors, receiving the Jury Award for Best Feature at Chelsea Film Festival (New York)
Hassiba Freiha and Kenton Oxley, ‘Farah’ co-directors, receiving the Jury Award for Best Feature at Chelsea Film Festival (New York)

Unfolding as a taut psychological thriller, the film challenges the viewer to empathise with Lina, Farah, and Nabil as they are all victims of the stigma of mental illness, and ineffective pharmacological treatment. The film starts with Lina’s mental health crisis, an escalating global phenomenon; one in three medical students suffers from anxiety and depression worldwide.[3],[4]

Linda’s healing comes in the form of non-pharmacological approaches delivered by Dr Salam (Pierrette Katrib). Meditation, yoga, creative writing, talking therapy and a healthy diet transform Lina’s thoughts and behaviour.

In making the film, the co-directors were inspired by their lived experience and observed events among family members and friends. Hassiba attributes her understanding of the science of mental health and epigenetics to reading Bruce Lipton’s book ‘The Biology of Belief,’[5] and interviewing Katinka Blackford, author of the book ‘The Pill That Stelas Lives’ where Katinka describes her journey with mental illness and medications.[6] Hassiba and Kenton wanted to ‘humanise’ ‘Farah’ characters and trigger a discourse about a holistic approach to mental illness that considers pharmacological as well as non-pharmacological approaches to ‘healing’ rather than focusing only on treating symptoms.

While dealing with hard hitting subjects such as the stigma of mental illness, the limitations of ‘drug therapy’, Big Pharma, the clever script written by Hassiba still portrays an intimate character study of a troubled family. The plot unexpected twists and turns allows the viewer to enjoy the film as mainstream entertainment as well as offering space for specialist audience to reflect on the nature and prognosis of psychotic depression. Meticulous attention to detail is perceived in the authentic portrayal of the ‘Serotonin syndrome’[7] affecting Lina in a nightclub.

Kenton pays homage to Alfred Hitchcock in the intertwined narrative used in ‘Farah’ building up towards an illuminating climax. The original music score composed by Aidan Lavelle, and a song from Boy George add a cosmopolitan feel to the film’s soul. Freiha as a script writer, co-director and actor is a multi-talented artist to look out for. The oxymoron title ‘Farah’ reflects the film’s multi-layered themes; ‘Farah’ is the Arabic word for ‘Joy’, ‘Joy’ is the street name of ‘Xapa’, and ‘Joy’ is a missing emotion from the film characters’ lives. If you are looking for an intelligent, thought-provoking psychological thriller, don’t miss ‘Farah’.

 

References

[1] Moncrieff, J., Cooper, R.E., Stockmann, T. et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry (2022). https://doi.org/10.1038/s41380-022-01661-0.

[2] Christopher Davey. The chemical imbalance theory of depression is dead – but that doesn’t mean antidepressants don’t work. Christopher Davey for the Conversation. The Guardian Wednesday 3rd August 20222. https://www.theguardian.com/commentisfree/2022/aug/03/the-chemical-imbalance-theory-of-depression-is-dead-but-that-doesnt-mean-antidepressants-dont-work.

[3] Quek T, Tam W , Bach X Tran B, et al. The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. Int J Environ Res Public Health 2019; 16(15): 2735. doi: 10.3390/ijerph16152735.

[4] Puthran R, Zhang M,Tam W, et al. Prevalence of depression amongst medical students: a meta-analysis. Med Educ 2016; 50(4): 456-68. doi: 10.1111/medu.12962.

[5] Bruce Lipton, https://www.brucelipton.com/

[6] The Pill That Steals Lives. By Katinka Blackford, Newman John, Blake Publishing Ltd. 2016. ISBN 9781786061331.

[7] Serotonin Syndrome, https://www.mind.org.uk/information-support/drugs-and-treatments/antidepressants/side-effects-of-antidepressants/#SerotoninSyndrome accessed on 15th November 2022.

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