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


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03/10/2016 09:20:40



ConcussionConcussion, written and directed by Peter Landesman, was released in the USA in 2015. The film tells the true story of how Chronic Traumatic Encephalopathy (CTE) was identified  and named in 2002 by forensic neuropathologist, Dr Bennet Omalu (played by Will Smith), while he was working in Pittsburgh, USA. Omalu identified CTE as an entity after studying the deaths of several retired American football players. He realised that these former players had suffered significant psychiatric morbidity in the years after their retirement from the game. This discovery has contributed to a greater understanding of the long-term effects of repeated concussions in those competing in contact sports and has influenced attitudes to the management of concussive episodes on the field in a wider number of sports such as rugby, ice hockey and horse racing as well as in American football. There has also been a particular focus on the management of concussion in school age children, with more stringent pitch side assessments that prevent participants from re-entering a game until they are assessed as having fully recovered from a concussion under supervision.

As well as telling the story of his scientific discovery, the film also depicts the enormous struggle that Omalu, an immigrant from Nigeria, and his few supporters faced when trying to report their findings to the scientific community and the wider world of sport, as his results appeared to threaten the corporate interests of the National Football League (NFL). As such, Concussion is a film about whistleblowing and Omalu has been likened to ‘David’ as he took on the NFL seen as ‘Goliath’. Although this aspect of the film is presented in the style of a classic Hollywood drama, the film still succeeds in raising the profile of an important and ongoing issue, namely how hard it may be to tell truth to power.

The film has been nominated for several awards, including a Golden Globe nod in 2016 for Will Smith.

The Film

Concussion opens with the death of former American football player Pittsburgh Steelers centre Mike Webster at the age of 50. His postmortem is carried out by Omalu in his very particular style of working. Webster's pre-morbid psychiatric difficulties are noted by Omalu and when another retired player presents with psychiatric problems before his early death too, the pathologist starts to look for a common neuropathology.

As Omalu suggests a connection between the repeated head traumas suffered in the course of playing American football and the microscopic findings post mortem, he begins to find his work obstructed and colleagues turning against him. When he loses his research funding he is so determined to continue that he uses his own monies. It is only when a former football team doctor joins him and supports his research that he is able to take his findings forward and present them to the wider scientific community. Omalu’s resilience and determination are admirable but his ultimate satisfaction does not occur without a test of his character and of his close personal relationships.

Relevance to the Field of Mental Health

Concussion in sport is now increasingly recognised as something that needs more research, particularly into its long-term effects. The International Concussion and Head Injury Research Foundation, (ICHIRF) is a London based not-for-profit organisation that has been created to carry out independent research into concussion and head injury. In its research project Concussion in Sport it aims to ascertain whether there is an increased incidence of neuro-degenerative disorders (such as Alzheimer’s disease, Parkinson’s disease and Chronic Traumatic Encephalopathy) in retired sportsmen and sportswomen who have competed in contact sports and sustained concussions, and whether these disorders might onset at an earlier age in this population. The study is currently recruiting both retired athletes and controls and it involves an online questionnaire (this takes about 15 minutes) every year for at least the next 4 years.This research foundation works closely with the charity called The Concussion Legacy Foundation in America, whose website has a wealth of material for learning more about the subject and in particular some very good information about CTE.

Earlier this year the NFL finally acknowledged a link between playing American football and CTE (read this Frontline article written by Jason Breslow in March 2016) following the research findings of Boston based neuropathologist, Dr Ann McKee. In her research, McKee found evidence of CTE in 90 out of 94 brains she examined postmortem of former NFL players. In a fascinating 46 minute Frontline video interview, she describes her work and her consultations with the NFL about the effects of repeated mild brain trauma that takes place during the course of a football game. She recounts how she had first encountered Omalu’s evidence in a poster presentation at an Alzheimer’s disease conference and later how she was asked if she would examine the brain of a football player by the co-founder of The Concussion Legacy Foundation, former wrestler Chris Nowinski. The evidence is now so strong that current players are much more aware of the risks that playing presents and last year Chris Borland, a promising player for the San Francisco 49ers, quit at the age of 24 after fearing for the effects of repeat concussions on his health (see BBC report).

For anyone involved in providing medical support to players during competitive contact sports, there is a useful Pocket Concussion Recognition Tool on the BMJ website taken from the Concussion Statement on Concussion in Sport, published in the British Journal of Sports Medicine 47 (5), 2013, by McCrory at al, which provides clear guidance on screening anyone who is suspected of having suffered a concussion.

This film highlights a topical and very important issue that is especially relevant to anyone working in the field of Acquired Brain Injury or Sports Medicine.

• More information about Concussion can be found at IMDB, as can a short trailer.

Concussion is available on DVD at or for streaming on Amazon video.

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

30/08/2016 12:28:29

My Beautiful Broken Brain


My Beautiful Broken BrainMy Beautiful Broken Brain is a documentary directed by Sophie Robinson and Lotje Sodderland, which was released for streaming on Netflix in March 2016. The film chronicles the experiences of the then 34 year-old filmmaker, Lotje Sodderland, after she suffered a haemorrhagic stroke affecting her parietal and temporal lobes in November 2011. This was later found to have been caused by a malformation of blood vessels present from birth. She was left initially unable to speak, read and write or to sequence thoughts and actions in a coherent way. The stroke also left Sodderland with a profoundly altered self-awareness and perceptual disturbances that included the exaggeration of sounds and seeing heightened colours in her right visual field, which was also significantly restricted. These visual impairments are brilliantly portrayed using special effects in many ‘point of view’ shots throughout the film. My Beautiful Broken Brain came about at the instigation of Sodderland who, in the first two weeks after waking from an induced coma in intensive care, grasped that she was a filmmaker and realised that she could use the medium to record valuable memories of her daily life.

There is a very good article written by Sodderland about her experiences and the making of the film published in The Guardian Weekend Magazine in 2014. My Beautiful Broken Brain is so valuable to clinicians because it is underpinned by the authority of the lived experience of the filmmaker, showing us what it actually felt like to her as she suffered her acquired brain injury as well as charting the many challenges of her neuro-rehabilitation.

The Film

My Beautiful Broken Brain begins with a narrated account by Sodderland of her stroke accompanied by images that express the feelings she had retrospectively of those moments. Woken in bed one night with an excruciating headache, knowing that something was seriously wrong, she somehow managed to get out of her flat in East London and into a nearby hotel where staff subsequently found her collapsed in the toilet. The filming begins within two weeks of her stroke, using her own iPhone and then proceeds over the next year with the help of director Sophie Robinson with whom Sodderland had collaborated in the past. Sodderland sees the film as a means of making sense of her story by recording a linear narrative that she could review as and when she needed it. Her brother, Jan, and other friends provide an understanding of the person Sodderland was before her stroke, namely bright, energetic, articulate, very sociable and extremely good at multi-tasking. She was a passionate reader and an expert communicator. The film depicts the total assault that has occurred on all of these aspects of her person that render her so bereft in the immediate weeks after the stroke. Sodderland describes her predicament fearfully “I can’t write at all or be clever at all…’s terrifying”. She also experienced an altered sense of time, noting that “Time is elongated and transient” and she felt sufficiently strange to compare the experience to living in a David Lynch movie. As a result, Sodderland recorded and sent a series of video messages to the famous director, which ultimately resulted in Lynch becoming an executive producer on the film and meeting up with Sodderland in person.

The documentary moves through the first year after Sodderland’s stroke chronologically, using much footage from her personal iPhone videos as well as special visual effects, to record her progress, including a three month admission to a Neuro-Rehabilitation ward, enrolment in a research study using transcranial direct current stimulation to aid post stroke recovery, the set back of a grand mal seizure and, later on, to Sodderland’s first foreign holiday in France. At all times the film offers us insight into how she is feeling about her altered place in the world through the interface of her ‘new brain’ as well as through the objective opinions of those closest to her.

Relevance to the Field of Mental Health

My Beautiful Broken Brain is an incredibly compelling film to watch. Most useful to all health professionals is its first person portrait of the post stroke period of recovery. It should be essential viewing for anyone working in the field of Acquired Brain Injury. Of particular interest is the understanding, brought by various professionals during Sodderland’s rehabilitation, of her cognitive deficits and how these are worked on. My Beautiful Broken Brain gives the viewer the chance to observe closely someone struggling with nominal aphasia, emotional lability, the inability to write meaningful words on a page, and also with the strangeness of being able to touch type again, but not to be able to read the words that have just been typed.

It is well recognised that there is an increased risk of seizures in the year following such a haemorrhagic stroke but Sodderland’s grand mal fit may also have been triggered by the transcranial direct current stimulation administered to her as part of the research study she joined (the study subsequently excluded people in the first year after a stroke). There is an article entitled Review of Transcranial Direct Current Stimulation in Poststroke Rehabilitation written by Feng, Bowden & Kautz in the journal called Topics in Stroke Rehabilitation, in 2013 Jan-Feb;20(1):68-77 (abstract available) that offers the opportunity for further discussion and learning on these topics.

As a personal video diary that conveys an intimate portrait of recovery after stroke, My Beautiful Broken Brain exceeds expectations because most of all it is a film filled with hope, courage and the acceptance of a new and altered life that was not chosen by Sodderland but that is now her reality. This is a perfect reminder that it is always the whole person that we must understand and engage with whenever we support someone in his or her recovery. I could not recommend this film more highly.

  • More information about My Beautiful Broken Brain can be found at the film’s website, as can a short trailer.
  • My Beautiful Broken Brain is available to stream on Netflix.

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

23/05/2016 10:39:08

The Wolfpack

IntroductionThe Wolfpack

The Wolfpack, directed by Crystal Moselle, was released in 2015. It is a documentary film that charts the lives of the six Angulo brothers who grew up with their mother and sister largely confined to their New York apartment by their father. One brother describes their father “as a land owner and we are the people working on the land”. They learned about the world through repeatedly watching films on DVD with one brother explaining that “movies opened up another world”. They spent much of their time reenacting scenes, using intricately handmade costumes, from their favourite movies such as Reservoir Dogs, The Dark Knight and Pulp Fiction. Home schooled by their mother, the brothers were only allowed out into the community accompanied by their father a handful of times and sometimes not even every year. When one of the brothers, at the age of 15, decides to go outside alone their whole life changes and their confinement ends. The filmmaker, Moselle, first encountered them walking down a Manhattan street in 2010 dressed as characters from Reservoir Dogs sparking a fascination with the brothers that led to her making the documentary.

The film won 7 awards, including the Sundance Film Festival Grand Jury Prize 2015 and the Edinburgh International Film Festival award for Best Documentary Feature Film. More information is given in an excellent interview by Tom Shone, published in the Telegraph newspaper in August 2015.

The Film

The Wolfpack tells the brothers’ story through a collage of early home movie footage and the interactions and excursions filmed by Crystal Moselle as their biography is brought up to date. What is immediately striking is how similar the brothers look and that, at the wish of their father who was a Hare Krishna devotee, they all have long flowing hair. It is also interesting that the Angulo boys seem very appropriate and measured in their behaviour towards each other, the filmmaker and to their parents. It seems that Moselle was the first person they had ever experienced visiting their apartment. The back story of their parents’ earlier life emerges gradually and the eventual interviews with their, initially camera shy, father reveal his strong opinions about his own powers and purpose but also his paranoid view of New York society. When he moved to America from Peru, it emerges that he had planned to settle the family in Scandinavia because he approved of the social support offered in those countries. Their mother seems to be suffering from her husband’s influence too and this creates some uncomfortable tensions for the viewer as the story unfolds.

The film moves into a different section once fifteen year old Mukunda decides to go out into the community alone, wearing a mask that had been made for the re-enactment of a movie scene. Police soon detain him as his visits into various shops concern the public and he ends up being admitted to a psychiatric ward for assessment, which he really enjoyed. On returning back home with regular psychotherapy sessions set up, Mukunda refuses to be controlled by his father and the brothers’ confinement comes to an end. All of the brothers are offered psychotherapy. The film then records their first forays into the community doing the things that many adolescents do, such as going to the cinema or going to the beach. The scene in which the brothers experience a swim in the sea for the first time is extraordinary in that it brilliantly captures the complete novelty and fear involved in this strange new adventure. One of the brothers cannot follow the others in to the water and stays on the sand despite their encouragement and reassurance. Everything is new and unknown, yet familiar through the films that they have watched endlessly. Always dressing alike and initially resembling the characters in the film Reservoir Dogs with suits and sunglasses on, the brothers acquired the nickname of The Wolfpack. Perhaps because they live in New York, their eccentricity of appearance was seen as ‘cool’ rather then ‘strange’ and this has surely been an important factor in their integration into that society in recent years. Towards the end of the film some glimpses are given of one of the brothers as he moves out of the family apartment and finds a job, although this leaves the viewer hungry for more information and full of unanswered questions about the plight of the whole family.

Relevance to the Field of Mental Health

The Wolfpack is a documentary that offers the opportunity to discuss the safeguarding of children and the extent to which family life choices can be defined as eccentric or as emotionally abusive; normal or abnormal. Could this situation have existed in the UK or in other countries around the world? It also provides a fantastic framework for a discussion about how children acquire healthy social and emotional skills growing up and whether these can in part be met by a large family group of siblings. Their mother appears as a kind, caring but seemingly passive presence although her crucial role as their educator was the source of finance for the whole family. All of the brothers have since cited her influence, alongside the movies, as critically important to them in surviving their confinement and in coping with the difficult relationship with their father. It is interesting that the brothers chose to watch extremely violent films (and important to note that many of the films viewed by the young brothers are rated 18+) and yet they do not immediately appear to have difficulties with the control or expression of aggression, although it is perhaps too early to be sure of their ability to handle conflict outside of the family. They have stated that they were surprised when they found the world outside their flat is not quite as they’d seen it in the movies and one of the brothers has talked about being surprised to see members of the public greeting each other openly with hugs and kisses.

The Wolfpack is a fascinating documentary film that draws you in to the intimate experiences of the Angulo brothers growing up, providing a developmental history and challenging the viewer to imagine how such an experience might feel. It leaves you wondering just how the brothers will forge a life in the world outside in future years and surely begs for a sequel to be made that can update their extraordinary story.

• More information about The Wolfpack can be found at IMDB, as can a short trailer.

The Wolfpack is available on DVD from or for streaming on Amazon video.

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

29/02/2016 10:00:33

Love & Mercy


Love and MercyLove & Mercy, directed by Bill Pohlad, was released in the USA in June 2015. The film is a biopic of the life of Brian Wilson, the highly creative and talented musical force behind The Beach Boys, whose mental health deteriorated in the mid 1960s as the group produced their Pet Sounds album. The film uses two different actors to play Wilson - Paul Dano as the younger man and John Cusack as the older - allowing the film to span a significant portion of his life with a clear distinction between ‘before’ and ‘after’ the onset of his mental illness. Love and Mercy shows the signs and symptoms of his developing mental illness and also examines the treatment he received from psychologist Dr Eugene Landy. Of particular interest is that Wilson was involved in the making of Love and Mercy and when asked in an interview for Rolling Stone, in June 2015, (Brian Wilson’s Better Days by Jason Fine) about how he felt on seeing the film, responded, “It was hard to watch the first time," Wilson admits. "I felt exposed. But it's a factual film. Whatever the film shows, it was much worse in real life." 


The Film

Love & Mercy opens with the young Brian Wilson trying to compose some music, talking aloud to himself as he wonders what would happen if he were to lose that ability. The film then flashes forward to the older Brian in a car salesroom wanting to buy a Cadillac from sales assistant Melinda Ledbetter. They sit in a car together and he writes on a card for her the words ‘Lonely, Scared, Frightened’, which she only reads when he has left the showroom. After a short time alone in the car Brian’s minders join them and Melinda learns the identity of her slightly strange customer. The film proceeds to cut between scenes from Brian’s twenties, composing and recording songs with The Beach Boys, and scenes in his later life when he was under the total control of therapist Eugene Landy. His increasing attraction to Melinda, who Landy initially permits him to ‘date’ for a while, appears to awaken something in him.

In the earlier time frame, Brain’s relationship with his father is portrayed as very difficult, and several characters refer to the beatings the father gave all of the brothers when they were children. His father seems to be struggling with his own feelings of depression and is locked in a critical, competitive musical battle with Brian, his most sensitive son. After Brian suffers a panic attack on a flight home from a concert he asks to stay at home and compose rather than join the band on tour. His brothers and cousin reluctantly agree. It is then that Brian experiences the first symptoms of his psychotic illness, and soon after that, he attempts to ‘clear his head’ by taking LSD. He begins to compose songs that are sadder and more complex in their composition, much to the dismay of his cousin in particular. His symptoms worsen steadily and are particularly acute in a scene in the swimming pool at his home where the band are meeting to discuss their musical direction. Brian’s paranoia is revealed then when he states that Phil Spector is bugging the house and insists on having a discussion in the deep end of the pool because he believes that it is the only safe place to be. Despite this behaviour, which must be taken in the context of the ‘psychedelic sixties’ in Los Angeles, only one brother actually expresses real concern about his mental state at this time, perhaps explaining why alcohol and drugs initially became the means to self medication, rather than obtaining formal psychiatric help.

The later life story proceeds with the chilling depiction of Landy’s total control over Brian’s life, especially as the relationship with Melinda starts to deepen. She is warned off by Landy and subsequently resolves to free Brian when he pleads with her to help him, whilst also revealing to her that he hears voices. Melinda contacts Brian’s brother Carl, providing him with some written evidence of the abusive relationship Landy has developed with Brian, resulting in a successful lawsuit which prevents Landy from having any contact with Brian. This paves the way for Brian’s relationship with Melinda to develop romantically. The film closes with the real Brian Wilson performing the title track to the film, which he composed, called ‘Love & Mercy’.

Relevance to the Field of Mental Health

Love & Mercy is a film about living with mental illness (Brian Wilson was finally diagnosed with schizoaffective disorder). It is a biography of great relevance to mental health professionals, as Wilson’s story gives a sense of the tensions in the relationship with his bullying father, the delayed diagnosis of his psychosis, his self-medication with illicit drugs and alcohol, unorthodox treatment with a controlling therapist and his eventual improvement aided by the support and love of the woman who uncovers the abuse and eventually becomes his second wife. As such, the film invites the viewer to consider all of the factors that may have played a part in the genesis and course of Wilson’s psychotic disorder. In an interview for ABILITY magazine in 2006, he discussed in some detail the symptoms of his schizoaffective illness, including auditory hallucinations, extreme anxiety, depression and paranoia, which he began to experience at the age of 25. Wilson states that he suffered these symptoms for 15 years before seeking professional help, using cocaine and heroin in an attempt to manage them.

There is a leaflet on schizoaffective disorder at the Royal College of Psychiatrists website that provides a helpful overview of the condition. There is also a good account of the historical development of the concept in an article written by David J. Castle in Advances in Psychiatric Treatment Jan 2012, 18 (1) 32-33, called Schizoaffective disorder.

The psychologist, Eugene Landy, that Wilson consulted was pioneering a model of care called ’24 hour therapy’, which involved taking complete control of the life of the person concerned. However, this practice fell short of acceptable professional standards when it included controlling and varying the administration of the drugs prescribed by Wilson’s psychiatrist, controlling who Wilson could see at any particular time and in the ultimate conflict of interests, appointing himself as Wilson’s business manager and executive producer. Melinda Ledbetter and Wilson’s family became increasingly concerned by the hold Landy had on him and they finally took legal steps to end the relationship. As a result, Landy lost his license to practice Psychology in California in1989. This aspect of the film has particular relevance to mental health professionals, as it offers an opportunity to consider how vulnerable mental illness can make people and how important it is to safeguard those individuals who may lack the mental capacity to make important life decisions for themselves at any particular point in their life. For further information on the UK policy on safeguarding, visit the UK government website and search for the policy document entitled Safeguarding policy: protecting vulnerable adults (available to download from The Office of Public Guardian).

Now 73, Wilson states that he continues to hear derogatory voices but battles with them more successfully to block them out, especially when he is performing. It seems that his mental state continues to fluctuate but that any depressive episodes are usually noticed and dealt with quickly with the support of his wife, Melinda. He takes long-term medication and believes that his wife and family plays a very important part in the maintenance of his mental stability such that he is able to engage actively and successfully in the world of music again.

Additionally, Love & Mercy has a superb soundtrack, which reproduces many of The Beach Boys’ famous tracks and portrays the recording processes in fascinating detail. For anyone interested in understanding Wilson’s particular musical ability there is an informative blog entitled Was musical memory the secret to Brian Wilson’s genius?, by Victoria Williamson, vice chancellor’s fellow for music at the University of Sheffield, published in The Guardian newspaper in January 2016. In the blog Williamson explores whether Wilson’s musical talent may be related to the fact that he hears musical phrases playing constantly in his head. This rare phenomenon becomes even more interesting when considering that he suffers from persistent auditory hallucinations of a derogatory nature, which first started to appear entangled with musical phrases, as depicted in the film.

This is a powerfully moving film about a life lived with a psychotic illness that offers any mental health professional the opportunity to enhance their empathic understanding of how it feels to suffer from such a condition.

• More information about Love & Mercy can be found at IMDB, where a short trailer can be viewed.

Love & Mercy is available on DVD from or for streaming on Amazon video.

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

28/01/2016 09:01:10

The Age of Loneliness


Following my blog last November on the film Still Life which considered the topic of loneliness, I want to continue exploring this subject by presenting the excellent hour long BBC documentary film called The Age of Loneliness, directed by Sue Bourne that was screened on terrestrial TV in January 2016. It is a compelling film that examines loneliness in UK society today through the testimony of a number of individuals, who recount their personal experiences direct to camera. They range in age from a nineteen year old University student to a woman aged one hundred years and the film features people at many different life stages between these two poles. The film also includes several people suffering with mental health problems. The breadth of this examination makes The Age of Loneliness especially valuable viewing for all mental health professionals and provides an empathic experience for the viewer who will find it hard not to be moved by some of the accounts presented.

The FilmThe Age of Loneliness

I will let the film speak for itself as it moves from person to person telling their stories of loneliness. For a balanced view, the film also hears from someone with a positive experience of a life lived alone in a very remote setting, highlighting that there is an important distinction to be made between social isolation and loneliness, although they are commonly spoken of as the same entity.


Relevance to the Field of Mental Health

The Age of Loneliness offers another good platform, perhaps alongside a viewing of Still Life, to discuss the issue of loneliness and its relationship to many different mental illnesses. Most importantly it highlights that loneliness is not just a problem for older adults, but can affect all age groups. The mental health charity Mind has some very good pages about Loneliness on their website, with suggestions for overcoming the problem and getting support. The Mental Health Foundation, another UK charity, produced a document entitled The Lonely Society? in 2010, which is freely available to download. The report was compiled using the results of a survey of 2,256 people as well as many interviews with mental health professionals and organisations involved in offering advice and support to individuals at risk of loneliness and social isolation.

With particular focus on older age adults, there is a useful resource that would complement further learning and exploration of the topic with specific reference to the older population. The Age UK Loneliness Evidence Review by Susan Davidson and Phil Rossall, updated in July 2015, is freely available to view from the Age UK website. The review examines the research on loneliness in later life and aims to serve as an evidence base for the topic.


The Age of Loneliness can be viewed in just one hour but will stay with the viewer for much longer.


• More information about The Age of Loneliness can be found at its website, where a short trailer is available.


The Age of Loneliness is currently available to stream on BBC iPlayer in the UK for the next few days or it is available to buy as a video download for £1.89 from the BBC Store


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

18/12/2015 14:33:13



With the holiday season in mind, I have a different film to present that does not focus on mental illness but offers plenty of psychological ‘food for thought’ on the topic of identical twins. Twinsters is a modern day tale set in the digital age that mirrors Shakespeare's 'A Comedy of Errors'. Two twins separated at birth and unknown to each other are reunited after a chance encounter online. What is so extraordinary is that this is a true story.

Twinsters is a documentary film directed by Samantha Futerman and Ryan Miyamoto, which was released in 2015. The film tells the incredible story of two young women in their mid-twenties, identical twins born in Korea, who were separated and given up for adoption at birth. One, Samantha Futerman, was raised by a family in America and the other, Anaïs Bordier, as the only child of a couple in France. Neither set of parents was aware that their adopted daughter was a twin. Through an accidental sighting on the Internet the pair are made aware of each other and the film follows them as they make written contact for the first time, see one another using Skype and later meet in person in London. With the twins telling their story direct to camera, the viewer is treated to an intimate sharing of the emotions involved in their extraordinary experience.

The Film

Twinsters opens with Sam detailing the series of events that started early in 2013 when she received a message via social media from a stranger asking her to contact his friend Anaïs, after seeing a YouTube video in which Sam had appeared. It seemed that she had a ‘double’ somewhere in the world that looked exactly like she did. The direct messaging between Sam and Anaïs began with tentative enquiries about their date and location of birth and it is significant to note that neither had any information about having been born a twin. The moment that they both see each other for the first time over the Internet via webcam is incredibly touching. Very quickly they feel a strong desire to meet each other face to face. Before this takes place they both agree to a DNA test to clarify the exact nature of their relationship. The initial meeting takes place in London where Anaïs is a fashion student. It is during this visit that they receive the result of their DNA test, which confirms that they are indeed identical twins. Neither of them was in any doubt.

After both families have also met, Anaïs visits Sam in Los Angeles to sample her lifestyle and they both attend the California Twin Studies Institute for physical and psychological testing. The twins start to learn more about each other and the different views they hold about being adopted. It seems that Anaïs has struggled more with this than Sam, who sets out to give her twin a more favourable view of their predicament. With this in mind, Sam persuades Anaïs to travel with her to Seoul to attend a conference for Korean adoptees. There they seek more information about their birth mother using contacts that Sam had previously made when researching her origins. However, the two adoption agencies involved inform them that their birth mother is unable to acknowledge that she had given birth to twins or that she had ever given any children away for adoption. Despite this disappointment, Sam and Anaïs are able to meet with the two foster mothers who cared for them during their first months of life. This is both a moving and a poignant experience for the twins but especially for Anaïs, who had constructed a personal narrative of abandonment in the early months of her life stating that she was really only born when her French parents took her home. As Sam and Anaïs part at the airport in Korea, the film leaves us wondering how the twins will manage to maintain their newly developed and incredibly close bond whilst living in two different continents. Their pain at this separation is palpable.

Relevance to the Field of Mental Health

Twinsters presents a fascinating account of Sam and Anais’ unknown twinship as it is discovered. It offers the opportunity to consider the role of ‘nature’ and ‘nurture’ in the shaping of their personalities. Both are highly creative individuals who are working in fashion design and acting respectively. The contrast between the upbringing of Sam, who was raised in an American family with two older brothers, the biological sons of her adoptive parents and Anaïs, who was the only child of her French parents, is touched on. Always describing herself as feeling ‘lonely’, Anaïs is revealed as scoring much higher on the trait of moodiness than Sam when tested at the California Twin Studies Institute. In contrast, Sam scores higher on extraversion than Anaïs. Apart from these differences their psychological test results appear to be almost identical, as do the basic physical parameters such as height and weight.

This is a hugely enjoyable documentary telling an incredible story that could only have happened in the Internet age. It invites the viewer to imagine what the main protagonists may be feeling as their emotional journey unfolds and such empathic experiences are always useful for those of us working in the field of mental health. But the film also challenges the viewer to contemplate how we might feel if we suddenly discovered an unknown duplicate of ourselves living somewhere else in the world.

Season’s Greetings to all of my readers!

• More information about Twinsters can be found at IMDB, and a short trailer is available on the film’s Facebook page.

Twinsters is currently available for streaming on Netflix in the UK or to rent or buy on iTunes. It can also be purchased on DVD (Region 1 only) from

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

23/11/2015 10:33:46

Still Life

IntroductionStill Life

Still Life was written and directed by Uberto Pasolini and released in the UK in February 2015.  The film centres on a council worker called John May, played brilliantly by Eddie Marsan, whose job it is to try and trace any relatives of individuals who have died alone in the London borough where he works. This illuminates exquisitely the struggle May has with his own demons of loneliness as one wonders whether anyone would do the same for him. Still Life won 17 awards, including one given to Eddie Marsan for best performance in a British Feature Film at the Edinburgh International Film Festival in 2014 and one given to Pasolini for Best Director at the Venice Film Festival in 2013.



The Film

Still Life opens with council worker May trying to track down the relatives of some recently deceased people, and when he succeeds in making contact, asking whether they would like to attend the funeral. Repeatedly it seems that these deceased lonely people have ended up isolated at the end of their lives for a reason, as any family that May traces never wants to be involved. May ends up as the only mourner at their funerals and makes the effort to bring some meaning to the ceremonies by contributing a few personal pieces of information that he has obtained by sifting through the deceased’s personal belongings. It becomes clear that May is himself living an intensely solitary life; his parents are dead, and he is perhaps overly preoccupied with giving the deceased a proper send off because he anticipates that he may face a similar predicament in his own future. He collects photos of the deceased in an album kept at his home, rather like collecting stamps, which he attends to with some relish. He routinely eats tuna and toast for his evening meal and is extremely organised, bound by routines that one suspects have been in place for decades.


It is when dealing with the case of a man Billy Stoke, who has died in the nearby block of flats to May’s that he is deeply unsettled by the proximity this death has to his own life. Perhaps triggered by guilt that someone could die alone, in squalor, so near to where he lives, May doubles his efforts to trace Billy’s family. He is motivated by a desire to understand the reasons for Billy’s lonely death, apparently suffering from alcohol dependence. However, his boss delivers some harsh news to John: the council is making him redundant with immediate effect. John pleads successfully for the chance to finish this one last case before he leaves the job. He traces and then visits one of Billy’s past partners, a woman living in Whitby, who informs him that the deceased had a problem with violence and aggression and had left a wife and daughter before meeting her. The woman reveals that she too had a daughter with Billy, after they separated, who he had never known. May learns that Billy’s troubles seemed to start as a soldier serving in active conflict and that he developed the symptoms of post-traumatic stress disorder after returning home. May finally locates Billy’s daughter, Kelly, and they strike up a friendship, which appears to promise some romantic possibilities for two lonely individuals. They arrange to meet again and Kelly finally agrees to attend her father’s funeral. They plan another meeting after the burial ceremony.


The end of Still Life is poignant and certainly plays with our emotions but I will not reveal it.



Relevance to the Field of Mental Health

Still Life considers one of the important topics of our time, loneliness. It offers several portraits of this human predicament and seeks to bring some understanding as to how the situation may have arisen for these different individuals. It highlights that loneliness is often a consequence of a mental illness, such as Billy’s post-traumatic stress disorder that contributed to his estrangement from family, alcohol dependence and homelessness. It also illustrates the association with the obsessional personality of the main protagonist, May, as his difficulty forming an intimate relationship leads to him living a rigid and increasingly solitary existence after the death of his parents.


For all professionals working in the field of mental health, this film offers a profoundly empathic experience of the sadness associated with loneliness and examines the reality of death in the context of life lived in solitude. Who mourns the unbefriended? A deeper understanding and appreciation of the effects of loneliness on both physical and mental health are essential if we are to find strategies to combat this problem in our society. As the Campaign to End Loneliness demonstrates, this is a pressing issue that requires our attention now. The campaign’s website provides much useful information about the topic that would complement a viewing of the film.


I would encourage everyone to watch this excellent low-key but powerful film.



•               More information about Still Life can be found at IMDB.


•              Still Life is available on DVD and to stream from


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

19/10/2015 10:17:11

Un’ora sola ti vorrei (For One More Hour with You)

IntroductionUn’ora sola ti vorrei

For One More Hour with You is the first documentary film made by Italian filmmaker Alina Marazzi. It was released in 2002 and is fifty five minutes long. The narration is available in both Italian and English versions on the DVD, as the filmmaker speaks both languages. By editing found footage from her grandfather Ulrico Hoepli’s remarkable home movie archive and photographic stills, Marazzi’s film is a deeply personal exploration of her mother Liseli’s life, one which ended tragically in suicide at the age of thirty three when the filmmaker was just seven. Marazzi narrates, reading the words written in her mother’s diaries and letters, making choices about the images that accompany these words and there are also photographs of Liseli’s medical records from her admissions to various psychiatric clinics, all of which create an incredible cinematic memory. For One More Hour with You won awards for best documentary at the 2002 Torino Film Festival and at the 2003 Newport International Film Festival.


The Film

For One More Hour with You opens with an audio recording (in unsubtitled Italian) made by the filmmaker’s mother Liseli and father Antonio, laid down on a 45 rpm gramophone record, in which they humorously act out the role of strict parents with their children. It accompanies some home movie footage that includes the first shots of Alina Marazzi when she was very young. At the end of the recording Liseli sings the first line of the song that gives the film its title. What follows is primarily the story of Liseli’s life from early childhood through marriage and motherhood to the last five years of her life in which she spent time in Italian and Swiss psychiatric clinics. The film examines Liseli’s relationship with her own mother as she struggles to live up to the expectations of the time, in the patriarchal environment of an Italian bourgeois family of the 1950s and 60s. Her love of her husband and the birth of their two children seem to give rise to feelings of inadequacy as Liseli compares herself with her own mother’s ‘gold standard’ of relating and parenting. A move to America, away from her important social networks, appears to trigger the beginnings of her depressive illness. Shortly after returning to Italy Liseli is admitted to a psychiatric hospital, and in the remainder of the film time is given to detailing her inpatient treatment. Her letters describe her feelings about the therapy she receives, including her willingness to try Insulin treatment and narcotherapy as well as commenting on the discussions she has with her individual psychotherapist about the role of her parents in the genesis of her illness. There is particular poignancy added by the film’s images of the postcards that the young Alina sent to her mother during her stay at the Swiss clinic. But most moving are the words that Liseli writes to her husband Antonio, telling him that she is desperate to leave the hospital and come home to her family as she “can’t take it any more”. Finally, perhaps as a distancing device, the painful truth of Liseli’s suicide, whilst in a clinic near to Milan, is reported through an image of the newspaper cutting that describes it.


Relevance to the Field of Mental Health

For One More Hour with You offers an opportunity to experience the challenge we always face as mental health professionals of knowing how to understand what is really going on in someone’s thoughts when their external appearance may not provide us with that information, or when they are bound by social norms that prevent them from expressing their innermost feelings. The contrast between the photographic depictions of Liseli and her written words, at certain times in her life, is striking. But essentially For One More Hour with You paints a picture, recounts a personal history, that perhaps allows for discussion about the origins of mental illness. Such as, when are the seeds of a mental illness first detectable? Does Liseli’s statement that she feels different from other people as an adolescent indicate that something might have been beginning to go wrong for her some years before her formal diagnosis. And was the move to America the trigger for her first depressive illness? Might her illness have been avoided without that relocation or would it have happened anyway?

But more than anything else, For One More Hour with You is a sensitive and very compelling biographical film tribute made by a daughter in search of her mother. The quest to find the essence of her mother is palpable and there is a sense that life is once more breathed into Liseli by the filmmaker through the whole process. Marazzi has been quoted as saying ‘I penetrated the magic of cinema, which allows us to call up that which is not and to make it present.’ (Pietro Roberto Goisis, ‘Quest for a Lost Mother: Alina Marazzi’s Un’ora sola ti vorrei’ in Projected Shadows: Psychoanalytic Reflections on the Representation of Loss in European Cinema, edited by Andreas Sabbadini (London and New York: Routledge, 2007), 21-34 (23).)

For all professionals working in any of the schools of psychotherapy, this film offers an enriching experience and I would highly recommend it.


• More information about For One More Hour with You can be found at IMDB.


For One More Hour with You is available on dvd from


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


28/09/2015 11:44:56

The Falling

IntroductionThe Falling

The Falling, written and directed by Carol Morley, was released in the UK in April 2015. Inspired by events that have taken place in several girls’ schools in the past decades, this psychological drama is set in 1969 and examines an epidemic of fainting and twitching amongst a group of 16 year-old pupils that begins after the tragic death of a popular but rebellious girl, Abbie Mortimer. With accomplished performances from Maisie Williams as Lydia and Florence Pugh as Abbie, this coming of age story explores collective grief in a close community constrained by the social and emotional norms of 1960s Britain. The Falling was filmed in a real school although Morley manages to create a somewhat strange and fantastical atmosphere, enhanced by the brilliant film music and songs composed by Tracey Thorn.


The Film

The Falling opens with an idyllic rural scene at a girls’ school, in which best friends Lydia and Abbie are forced to acknowledge the changes in their close bond now that Abbie has begun to have sexual relationships with boys. Lydia subsequently learns that Abbie is involved with her brother Kenneth too and this makes her feelings of rejection all the more painful, despite her best friend’s protestations that it will not damage their friendship. Set in the context of the rule-bound controlling environment of their school, in which even the length of Abbie’s skirt is measured by a teacher during a lesson, her rebellious behaviour is shown to be a major influence on the other girls in her group.

Unfortunately, Abbie becomes pregnant and her health is seriously affected resulting in her ultimately tragic sudden death witnessed by Lydia and the member of staff who had set them both after school detention. Lydia is devastated by her loss and unable to get the emotional support that she needs to process her feelings from her mother Eileen, who suffers from agoraphobia, or from anyone at school. With the anger and sadness of her grief unresolved, Lydia suffers a fainting episode at school in front of her class. Other pupils follow in having similar attacks, beginning the narrative that this epidemic may be infectious in some way. When a member of staff also has an attack, the affected girls are seen by a doctor for an examination but no medical reason is found to explain the episodes. There is only one pupil within the group who stays free of any fainting. She skeptically expresses the view that these attacks have no physical basis.

Lydia later begins a dangerous exploration of her developing sexual feelings with her brother, perhaps also seeking a feeling of closeness to Abbie by replicating her relationship with Kenneth. However, when her mother discovers them together in bed in their home, a bubble is burst that takes the film into its final scenes.


Relevance to the Field of Mental Health

The Falling offers an opportunity to consider the topic of hysteria, currently referred to as a conversion disorder, which is classified as a dissociative (conversion) disorder in ICD-10 and falls within the Somatic Symptom Disorders in DSM-V. As Lydia is the first sufferer in the outbreak of fainting and twitching, and given that she was present when her best friend died, it might be argued that the precipitating factor for the outbreak is clearly one of loss. The fact that Lydia’s symptomatic presentation echoes those she sees Abbie suffer during her sudden death, might illustrate one of the psychoanalytic theories of conversion, namely that it serves as an identification with the lost object. In addition, Lydia’s difficult relationship with her emotionally unavailable mother, and later with her brother, are clearly important when considering the predisposing and perpetuating factors for her ongoing attacks. The film would certainly provide a platform to teach about the construction of a psychodynamic formulation for Lydia.

Watching the film alongside a reading of the article entitled Conversion disorder: the modern hysteria by Colm Owens and Simon Dein in Advances in Psychiatric Treatment Feb 2006, 12 (2) 152-157, would provide a useful basis for discussion about and comparison with how the DSM and ICD systems of classification deal with this group of disorders (although the 2006 article obviously deals with the earlier DSM-IV classification one could review both DSM-IV and DSM-V together examining the changes that have recently been made within that system).


• More information about The Falling can be found at IMDB, as can a short trailer.


The Falling is available to pre-order on dvd from


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


10/08/2015 11:20:43

The Outcast


The Outcast on DVDThe Outcast, directed by Iain Softley, is a two-part BBC Drama, which screened on terrestrial UK TV in July 2015. It is based on a novel by Sadie Jones, who also wrote the screenplay about the coming of age of a boy called Lewis, living in the Surrey commuter belt of the 1940s and 1950s, who suffers the tragic early loss of his mother. The story is told in two parts, the first episode starts with Lewis aged ten, played by Finn Elliot, and the second when he is nineteen, played by George MacKay. It focuses on Lewis’ immediate relationships with his family as well as with his childhood peers and the local community as he tries to make sense of his overwhelming loss. Both of the central performances by Eliot and MacKay are extremely accomplished. MacKay, in particular, succeeds in conveying a damaged adolescent vulnerability that makes the drama so watchable and very valuable as a learning opportunity.

The Drama

The Outcast begins with Lewis, aged ten, living happily with his mother Elizabeth in a glorious rural setting whilst his father, Gilbert, is away fighting in the war. Once reunited with his father Lewis struggles with the lack of warmth in their relationship. He is also aware of the attempts his mother makes to rebuild their family after the separation brought about by the war. Unfortunately a tragedy destroys any hope of this when Elizabeth, having drunk some gin, accidentally drowns when having a picnic by the river with Lewis. He tries but fails to rescue her. His father cannot understand Lewis’ inability to give an account of events and the son feels blamed in some way for his mother’s death. His father soon marries again and Lewis struggles to cope with his stepmother, Alice, who wants to replace Elizabeth and to heal him. But she struggles in her relationship with her new husband as well as with Lewis and begins to drink increasing amounts of alcohol. As Lewis ages he becomes increasingly unhappy. Tormented by flashbacks of the accident, he is teased and bullied by peers about his loss and finds it difficult to cope with his emergent sexual feelings. These stresses cause him to feel sad, hopeless and isolated, the outcast of the title. Along with his increasing anger, these feelings become unbearable until he finds some relief from them by cutting his arm, causing his immediate family much dismay. Outside of the home Lewis acts out his anger in a serious and very damaging way that results in a prison sentence. The second episode of the drama centres on the period immediately after being released from prison when he tries to rebuild his life and relationships.

The secondary characters, in the form of Gilbert’s boss Dickie and his family who live nearby, also have an important contribution to make to the story, as Lewis uncovers the hidden physical abuse of Kit, Dickie’s youngest daughter, by her father. She is the one friend that Lewis retains from early childhood and is the only person who remains sympathetic to him throughout all of his difficult times. Their bond becomes more understandable as we become aware that she too is suffering the on-going trauma of physical abuse by her father and Lewis is the only person willing to fight to reveal it.

Relevance to the Field of Mental Health

This two-part drama offers an excellent platform for discussion and learning about the subject of deliberate self-harm in adolescence. Set in the 1940s and 1950s, when the style of parenting in the UK was such that children were expected to be ‘seen but not heard’, the absence of an emotionally sensitive therapeutic intervention after Lewis’ traumatic loss is particularly well captured. However, the presentation of his emotional suffering and its causes are universal and can be transported into the present day as the following useful articles demonstrate. The first is called Self-harm in adolescents by Alison Wood (Advances in Psychiatric Treatment Oct 2009, 15 (6) 434-441), available in full, and the second article called Young people who cut themselves: can understanding the reasons guide the treatment? by Barry Wright, Naomi Hooke, Stephan Neupert, Chan Nyein, Suzy Ker (Advances in Psychiatric Treatment Nov 2013, 19 (6) 446-456), available in abstract.

The other storyline concerning the hidden physical abuse of Kit by her father, which occurs within a middle-class, well-off family also provides an excellent opportunity to discuss how such cases can be detected and managed. It would also allow discussion about the differences and similarities in societal attitudes to this issue between the 1950s and the present time given that children are now encouraged to report their experiences to a service such as ChildLine.

  • More information about The Outcast can be found at the programme’s website, including some clips.
  • The Outcast is available to watch on BBC iPlayer in the UK (for the next week) and can also be purchased on DVD at
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida.



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About this blog


Minds on Film is a 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.


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