{"id":3782,"date":"2024-02-15T10:00:57","date_gmt":"2024-02-15T09:00:57","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3782"},"modified":"2024-02-09T12:22:21","modified_gmt":"2024-02-09T11:22:21","slug":"in-dementia-does-truth-matter","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2024\/02\/15\/in-dementia-does-truth-matter\/","title":{"rendered":"In Dementia, Does Truth Matter?"},"content":{"rendered":"<p><strong><em>Review of \u2018I\u2019m Not From Here (Yo No Soy de Aqu\u03af)\u2019<\/em><\/strong><strong> Directed by Maite Alberdi and Giedre Zickte, Chile, 2016<br \/>\n<em>Film Review by Robert Abrams, M.D., Professor Emeritus of Psychiatry, Weill Cornell Medicine, New York<\/em><br \/>\n<\/strong><\/p>\n<p><em>I\u2019m Not From Here<\/em> is an arresting short film directed by the Chilean team of Maite Alberdi and Giedre Zicte. Despite its slow pace, perhaps reflecting the tempo of aging, this film is full of substance and heart.<\/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\/Oyz1xh4tHMo?si=-zJugLk6onjc0Cwi\"  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>Set in a Chilean care home, the film pointedly asks whether cognitively impaired individuals should be urged to acknowledge their actual lived realities, or left to interpret the world as they perceive it. \u00a0This is a question confronted by staff in care homes everywhere, places in which the phrase \u201cI\u2019m not from here\u201d may be one of the most frequent plaintive expressions to be heard.<\/p>\n<p>How to respond to \u201cI\u2019m not from here\u201d and similar revisions of reality in a compassionate way is addressed in the film\u2019s portrayal of its central character. The importance of community in care homes is also noted. Inasmuch as care homes a<em>re<\/em> communities, they can provide peer-to-peer psychological support, the therapeutic potential of which is frequently unrecognized.<\/p>\n<p>In the film\u2019s opening scene, Mrs. Josebe, an older widowed woman of firm, decisive character, outlines the story of her life to a fellow resident in a reasonably cogent sequence. \u00a0Using faded photos and old yellowing documents, she begins by describing her joyful, easy-going youth in a Spanish Basque town, followed by a move to Chile, where she married and raised her own family.<\/p>\n<p>Teasingly, she asks her listener how old he thinks she might be. \u00a0He hesitates, knowing that such inquiries are intended to elicit a flattering response. Gradually it becomes apparent that Mrs. Josebe does not actually know her own age, and although she provides the year of her birth, she also does not know the present date.<\/p>\n<p>From this point her cognitive decline becomes increasingly evident. \u201cAt home do they know I\u2019m here?\u201d she asks one of the workers. By now she is convinced that she is just a \u201cvisitor\u201d to Chile and to this care home, thereby coupling her growing memory impairment with psychological defenses. Her forgetfulness about her age allows her to think of herself as younger than those around her, and she recoils from the other residents\u2019 vulnerabilities without realizing that they are historically her own.<\/p>\n<p>When she telephones her daughter, Mrs. Josebe is told that she must understand that she has been at the home for nearly a year, not, as she believes, for a single day. Although her daughter\u2019s tone had not been harsh, after that call Mrs. Josebe becomes distraught and further disoriented.<\/p>\n<p>But by the end she is seated outside on a fine day, chatting happily with one of the residents. She adheres to the belief that she still lives in her childhood village in Spain and is just passing through Chile. Nevertheless, Mrs. Josebe is, de facto, a member of the care home community, even if the pleasure she can derive from life there is predicated on her belief that she is a temporary visitor.<\/p>\n<p>It can be observed that all of Mrs. Josebe\u2019s impactful encounters, hostile or friendly, take place in a communal context. She has been defining her identity and character\u2014proudly Basque, independent, sharp-spoken, no-nonsense\u2014both with and against her fellow residents. One can speculate how poorly she would fare living mostly alone or with a daughter who, however well-meaning, would tell her repeatedly that she is confused and must strive to appreciate the true nature of her circumstances.<\/p>\n<p>This film advances the view that asking at least some individuals with dementia to accept the truth of their conditions could well be futile and result in avoidable suffering. After recovering from the disturbing conversation with her daughter, Mrs. Josebe is seen to be living comfortably and unchallenged within her own understanding of reality. She might now be able to engage with others and avoid the loneliness that had been predicted for her earlier in the film.<\/p>\n<p>There are several caveats: First, resolutions like this one may not be permanent, consistent with the dynamic nature of dementia and its progressive decline. Then, some dementia-related delusions are associated with significant behavioral disturbance and may require different approaches.<\/p>\n<p>Still, this film offers prescient lessons about the psychological well-being of individuals with dementia. The significance of community and the value of resident-to-resident interactions for mutual support are demonstrated; but the greater emphasis is placed on questioning the purpose of reflexively correcting cognitively impaired residents\u2019 interpretations of the world and their positions in it. After all, in the most expansive view of reality, isn\u2019t truth largely subjective, and are we not all transients in life?<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Further Reading<\/strong><\/p>\n<p><em>The Eternal Memory<\/em> was shortlisted in 2024 for the Oscars, in the best documentary feature film category. <a href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2023\/10\/31\/enduring-love-everlasting-memories\/\"><strong>Read Khalid Ali&#8217;s interview with Maite Alberdi about <em>The Eternal Memory<\/em>, conducted in October 2023 at the London Film Festival<\/strong><\/a>.<\/p>\n<p>Khalid Ali also reviewed her 2020 film, <em>The Mole Agent<\/em>, which was Chile\u2019s submission to the Oscars. It was shortlisted for best international film. <strong><a href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2021\/02\/01\/growing-old-behind-closed-doors-film-review\/\">Read Ali&#8217;s review on the\u00a0<em>Medical Humanities <\/em>blog<\/a><\/strong>.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Review of \u2018I\u2019m Not From Here (Yo No Soy de Aqu\u03af)\u2019 Directed by Maite Alberdi and Giedre Zickte, Chile, 2016 Film Review by Robert Abrams, M.D., Professor Emeritus of Psychiatry, Weill Cornell Medicine, New York I\u2019m Not From Here is an arresting short film directed by the Chilean team of Maite Alberdi and Giedre Zicte. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2024\/02\/15\/in-dementia-does-truth-matter\/\">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-3782","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>In Dementia, Does Truth Matter? - Medical Humanities<\/title>\n<meta name=\"description\" content=\"Professor Robert Abrams reviews Maite Alberdi and Giedre Zickte&#039;s film, I\u2019m Not From Here (Yo No Soy de Aqu\u03af), in today&#039;s film review.\" \/>\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=3782\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"In Dementia, Does Truth Matter? - Medical Humanities\" \/>\n<meta property=\"og:description\" content=\"Professor Robert Abrams reviews Maite Alberdi and Giedre Zickte&#039;s film, I\u2019m Not From Here (Yo No Soy de Aqu\u03af), in today&#039;s film review.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3782\" \/>\n<meta property=\"og:site_name\" content=\"Medical Humanities\" \/>\n<meta property=\"article:published_time\" content=\"2024-02-15T09:00:57+00:00\" \/>\n<meta name=\"author\" content=\"Chris Pak\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Chris Pak\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3782#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3782\"},\"author\":{\"name\":\"Chris Pak\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/#\\\/schema\\\/person\\\/0e11c1a9a0f1f9f2aa898a719652c44c\"},\"headline\":\"In Dementia, Does Truth Matter?\",\"datePublished\":\"2024-02-15T09:00:57+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3782\"},\"wordCount\":903,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/#organization\"},\"keywords\":[\"film review\"],\"articleSection\":[\"Film and Media\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3782#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3782\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-humanities\\\/?p=3782\",\"name\":\"In Dementia, Does Truth Matter? 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