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The Royal College of Psychiatrists Improving the lives of people with mental illness

Amour

IntroductionAmour - Minds on Film

Amour was directed by Michael Haneke and released in 2012. In French with English subtitles, it tells the story of Georges and Anne, a retired middle class couple in their eighties, living contentedly in their Paris apartment. With brilliant performances by the two main actors, Jean-Louis Trintignant as Georges and Emmanuelle Riva, herself aged 85, as Anne, Amour won the Palme d’Or at Cannes in 2012 and an Oscar in 2013 for Best Foreign Language Film. This is a chamber drama, filmed almost entirely in the couple’s apartment. It shows how suddenly their lives are changed when Anne has a stroke and it follows the couple and their daughter, played by Isabelle Huppert, as they all deal with the resultant deterioration in Anne’s physical and mental health. Amour is an incredibly important film for all health care professionals who will increasingly encounter a swelling elderly population presenting with the consequences of cerebrovascular pathology. But at its core, this film offers the viewer a stark reminder of the realities faced by informal carers day in and day out as they struggle to provide personal care for their loved ones suffering from dementia regardless of the underlying cause.This is a film about ageing in the context of a close, loving relationship that is tested by the suffering of one partner declining inexorably toward death.

The Film

Amour begins dramatically at the end of the story with scenes of police and a fire crew battering their way into a Paris apartment to find an elderly lady laid out dead on her bed which is strewn with flowers. The film then proceeds to fill in the events that led to this scene. At the start of the flashback we meet the main protagonists, Georges and Anne, attending a piano recital, played by one of Anne’s former pupils. The couple are clearly enjoying their retirement bound together by a shared love of classical music after a lifetime working as music teachers. This is the only time in the film that we see them outside the confines of their home. On returning to their apartment they find that they are victims of an attempted break in. This highlights their vulnerability, especially to Anne, but also demonstrates the mutually supportive relationship that exists between them.  The following morning at breakfast, Anne suffers a transient loss of awareness and responsiveness, a probable transient ischaemic attack or TIA. Frightened and perplexed by this event, Anne is encouraged to visit her doctor by Georges. This results in her having an operation on her carotid artery, which we learn fails to have a positive outcome. Whilst Anne is still in hospital, Georges is visited by their daughter Eva. In conversation with him, Eva reveals that her husband Geoff has had another extramarital affair, contrasting the nature of her marriage with her parents’ marriage. Eva asks her father if she can help in any way, but Georges tells her, “We’ve always coped, your mother and I”.

Before Anne returns from hospital, a hospital bed is installed in their bedroom and when we see her next, she is confined to a wheelchair, paralysed down her right side. The scenes that follow show how rapidly Georges must learn to be a carer, despite his own frailty and unsteadiness, and fulfill the many new tasks necessary to allow Anne to stay with him at home. Delighted to be back together, Anne asks Georges to promise that he will never allow her to be admitted to hospital again. The film brilliantly portrays the negotiation that then begins between the couple about the need for support versus Anne’s desire for independence in personal care tasks as the balance in their relationship changes. This is exquisitely demonstrated when Anne needs to call for help when on the toilet, shifting their intimate relationship into a new realm.

After Georges returns from attending a funeral of an old friend, he finds Anne on the floor in the hallway. She is low in mood and tells Georges that she does not want to go on living like this as she knows that she will only get worse. Georges clutches at her potential for improvement and will not believe her. A visit from her former pupil, now a successful pianist proves awkward as the musician finds it hard to adjust to Anne’s disability and she refuses to talk about it. Her depression is apparent. Some humour is introduced in the form of an electric wheelchair which provides Anne with some more independence around the apartment but this is short lived. Then a further stroke leaves her with trouble speaking (an expressive dysphasia) and the onset of dementia. During a visit from her daughter and son-in-law, Georges informs them that he is planning to pay for a carer to come in three times a week. This presents a huge challenge for Georges as he is forced to relinquish some control over Anne’s care but cannot bear to see one of the carers fail to deal with Anne in a sufficiently dignified and respectful manner, forcing him to dismiss her.

I will not describe in detail the final part of the film which follows Anne’s deterioration into the final stages of her dementia, when she requires full assistance in all areas of personal care. It is then that Georges takes a very particular decision to end their mutual suffering.

 

Relevance to the field of Mental Health

Amour offers a number of learning opportunities for those interested in or involved in caring for the elderly population. It provides a valuable lesson on the effect of sudden physical disability caused by stroke in an individual, which radically alters the balance within the longstanding relationship with their partner; it portrays an episode of post-stroke depression and then, after another stroke, it follows the onset of dementia with the subsequent deterioration demanding ever increasing levels of assistance with personal care. 

With its focus on the very private and intimate caring relationship between Georges and Anne after she has developed dementia, Amour offers an incredibly powerful portrait of the real stress that carers may experience, if they continue to want to provide the majority of the personal care required. It conveys the loneliness that informal carers often experience when looking after their loved one who can no longer converse meaningfully with them. Highlighting the emotional vulnerability that such a caring role can cause, this film must surely encourage health professionals to be attuned to the needs of the unpaid carers who support dementia sufferers in the community. Further information about the stresses that carers face can be found at the Alzheimer’s Society website.

The film also raises the complex issues around the final stages of life when an individual has expressed their own preference to stay at home until the end of their life. The issues of wider family are brought in very effectively in the person of Eva, their daughter, who is herself a busy musician living abroad and somewhat distant from her parents. Her right to express a view on her mother’s caring arrangements is sensitively explored as the tensions between the generations emerge, raising the very important question “who gets to choose what is best for an individual when mental capacity to make a particular decision about care is lost?”. This would be a perfect foundation for a discussion on The Mental Capacity Act in the UK and the process by which a Best Interests Decision is reached on behalf of a person lacking mental capacity for that particular decision. It also offers an opportunity to consider the use of Advanced Decisions to refuse treatment. These topics are explained clearly in a Factsheet published by the Alzheimer’s Society. The film’s ending will surely also generate much discussion.

As a portrait of vascular dementia, Amour provides a perfect case study. A very good article published recently in Advances in Psychiatric Treatment (2012), vol. 18, 372-380 entitled Vascular  dementia: a pragmatic review by Hugh Series & Margaret Esiri (abstract) would provide an excellent learning opportunity set alongside a viewing of the film. Additionally the full text of an article published in the British Journal of Psychiatry (2002),

180: 152-156 entitled Vascular dementia: a diagnosis running out of time by Robert Stewart may provide further useful background information.

I would highly recommend this film to all health professionals interested in working in Older Age Medicine or Psychiatry. But perhaps most important of all, Amour challenges the individual viewer to reflect upon their own attitudes to ageing and disability questioning how they would cope with the suffering of a loved one in a similar situation.

* More information about Amour can be found at IMDB, as can a short trailer.

* Amour can be purchased at amazon.co.uk

* Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

 

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About this blog

 

Minds on Film is a monthly blog that explores psychiatric conditions and mental health issues as portrayed in a selection of readily available films.

Please note that this blog may contain plot spoilers. Any views expressed are purely my own.

Dr Joyce Almeida
Dr Almeida is a consultant
psychiatrist working in the private sector in the UK.