{"id":3360,"date":"2022-05-24T10:00:02","date_gmt":"2022-05-24T09:00:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3360"},"modified":"2022-05-20T10:40:58","modified_gmt":"2022-05-20T09:40:58","slug":"finding-hope-in-dementia","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2022\/05\/24\/finding-hope-in-dementia\/","title":{"rendered":"Finding Hope in Dementia"},"content":{"rendered":"<p><strong>Film Review by Professor Robert Abrams, Weill Cornell Medicine, New York<\/strong><\/p>\n<p><em>Vortex<\/em> is everything its title implies\u2014a 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\u2019s mother from Alzheimer\u2019s disease and his recognition of the near-universality of this condition in families like his own (the dedication is to \u201call those whose brains will decompose before their hearts\u201d).<a href=\"#_ftn1\" name=\"_ftnref1\"><sup>[1]<\/sup><\/a> But the film is primarily fictional, a story, its roles played by actors who portray an Alzheimer\u2019s 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\u2019s apartment; but the stifling, oppressive atmosphere thus created became a fitting stage for an unfolding tragedy.<\/p>\n<p>The story itself is filled with sadly ironic elements. The woman with Alzheimer\u2019s disease [Fran\u03dboise 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 <em>Psyche<\/em>. 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, St\u00e9phane [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\u2019s former identity. Professional expertise and Intellectual achievement obviously afford no protection from the destructive power of dementia.<\/p>\n<p>&nbsp;<\/p>\n<style type=\"text\/css\">\r\n       .errordiv { padding:10px; margin:10px; border: 1px solid #555555;color: #000000;background-color: #f8f8f8; width:500px; }#advanced_iframe {visibility:visible;opacity:1;}#ai-layer-div-advanced_iframe p {height:100%;margin:0;padding:0}<\/style><script type=\"text\/javascript\">  var ai_iframe_width_advanced_iframe = 0;  var ai_iframe_height_advanced_iframe = 0;var aiIsIe8=false;var aiOnloadScrollTop=\"true\";\r\nif (typeof aiReadyCallbacks === 'undefined') {\r\n    var aiReadyCallbacks = [];  \r\n} else if (!(aiReadyCallbacks instanceof Array)) {\r\n    var aiReadyCallbacks = [];\r\n}    function aiShowIframeId(id_iframe) { jQuery(\"#\"+id_iframe).css(\"visibility\", \"visible\");    }    function aiResizeIframeHeight(height) { aiResizeIframeHeight(height,advanced_iframe); }    function aiResizeIframeHeightId(height,width,id) {aiResizeIframeHeightById(id,height);}<\/script><iframe loading=\"lazy\" id=\"advanced_iframe\"  name=\"advanced_iframe\"  src=\"https:\/\/www.youtube.com\/embed\/-L-ZcCFePAs\"  width=\"560\"  height=\"315\"  frameborder=\"0\"  border=\"0\"  allowtransparency=\"true\"  allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\"  style=\";width:560;height:315;\" ><\/iframe><script type=\"text\/javascript\">var ifrm_advanced_iframe = document.getElementById(\"advanced_iframe\");var hiddenTabsDoneadvanced_iframe = false;\r\nfunction resizeCallbackadvanced_iframe() {}function aiChangeUrl(loc) {}<\/script>\n<p>&nbsp;<\/p>\n<p>The use of split screens throughout the entire film adds to the viewer\u2019s unease about what is to happen. The split-screen device is particularly apropos in <em>Vortex<\/em> because so much emotion in the film is conveyed by facial expression, most notably from the Alzheimer\u2019s-stricken woman, whose speech is necessarily sparse; and from St\u00e9phane, 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\u2019 reactions to each other&#8211;their sadness, anger, and love. The viewer shudders when one side of the screen goes dark.<\/p>\n<p>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: \u201cI need to hope or I am nothing.\u201d<\/p>\n<p>In a paper nearly twenty years old but still influential, Mark Sullivan argues that at the end of life, hopelessness is a an \u201cattachment to a form of hope that is lost.\u201d<a href=\"#_ftn2\" name=\"_ftnref2\"><sup>[2]<\/sup><\/a> 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\u2014anything 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\u2019s scheme of human development.<a href=\"#_ftn3\" name=\"_ftnref3\"><sup>[3]<\/sup><\/a> But in dementia, which neither Sullivan nor Erikson consider, the sublimatory defense of looking beyond one\u2019s own life is no longer accessible. So what can be done? <em>Vortex<\/em> 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.<\/p>\n<p>There is in fact a considerable amount of both affectionate physical contact and emotional validation in <em>Vortex<\/em>, mainly in a series of moving scenes with St\u00e9phane and his mother, and some also between husband and wife. The woman with Alzheimer\u2019s 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 <em>Vortex<\/em>, 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.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References <\/strong><\/p>\n<p><a href=\"#_ftnref1\" name=\"_ftn1\">[1]<\/a> Interview of Gaspar No\u00e9 by Dennis Lim of the New York Film Festival, October 1, 2021. <a href=\"https:\/\/www.youtube.com\/watch?v=zXtkuWMe1Tw\">https:\/\/www.youtube.com\/watch?v=zXtkuWMe1Tw<\/a>.<\/p>\n<p><a href=\"#_ftnref2\" name=\"_ftn2\">[2]<\/a> Sullivan, M. Hope and Hopelessness at the End of Life. <em>American Journal of Geriatric Psychiatry<\/em> <strong>11<\/strong>, 393-405 (2003).<\/p>\n<p><a href=\"#_ftnref3\" name=\"_ftn3\">[3]<\/a> Slater, C.L. Generativity Versus Stagnation: An Elaboration of Erikson&#8217;s Adult Stage of Human Development.\u00a0<em>Journal of Adult Development<\/em>\u00a0<strong>10,\u00a0<\/strong>53\u201365 (2003). https:\/\/doi.org\/10.1023\/A:1020790820868.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Film Review by Professor Robert Abrams, Weill Cornell Medicine, New York Vortex is everything its title implies\u2014a 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 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2022\/05\/24\/finding-hope-in-dementia\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":345,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[206],"tags":[15099],"class_list":["post-3360","post","type-post","status-publish","format-standard","hentry","category-film","tag-film-review"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Finding Hope in Dementia - Medical Humanities<\/title>\n<meta name=\"description\" content=\"&#039;Vortex is everything its title implies\u2014a terrifying eddy of misfortune from which its victims are powerless to escape.&#039;\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3360\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Finding Hope in Dementia - 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