Introduction
Based on a book by Ulla Isaksson about her own relationship with
her husband, this film, in Swedish with English subtitles, was
scripted and directed by Billie August. It is interesting to note
that the two actors in the main roles, Viveka Seldahl (Barbara) and
Sven Wollter (Martin) were married in real life, giving some added
poignancy to the film. Sadly, Viveka Seldahl died from cancer
shortly after the film was released in 2001. Both actors won the
equivalent of a Swedish Academy Award for their performance in
A Song for Martin.
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Unusually for ‘Minds on Film’, which normally
focuses on readily available films, this DVD is only available as a
Region 1 disc and as such can only be played on a multi-region DVD
player. However, I have chosen to discuss it because it presents a
very good portrait of Alzheimer’s Disease and the challenges that
face any caregiver.
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| A Song for Martin is also a film of
mid-life romance and second marriage, which is blighted a few years
later by the onset of Alzheimer’s Disease. It portrays the reality
of living with, and caring for, a loved one over several years, who
is suffering from a neurodegenerative disorder. |
The Film
The film opens with the rehearsal of an
orchestral work composed by Martin, who is conducting the orchestra
in which Barbara plays first violin. They are obviously attracted
to each other, despite both of them being married, and we watch in
the following scenes as they fall madly in love, separate from
their respective spouses and embark on a loving, intellectually
stimulating and truly satisfactory second marriage. We see them on
honeymoon, rejoicing in this late found romantic happiness despite
this being tinged with guilt for Barbara. In a significant scene,
the viewer witnesses them promise to be open and honest with each
other whatever the future brings.
A few years later, settled in their new home,
we watch Barbara and Martin at work together, with her contributing
to his composing, and we are shown the complex skills that are
required for his work. The first hint of problematic change occurs
when Martin struggles to remember the name of his manager and later
calls Barbara ‘Alice’, which was the name of his ex-wife. They
think nothing of these slips until Martin experiences a frightening
lapse of memory whilst shaving one morning and is unable to
recognize the bedroom. He fears that he has suffered a cerebral
haemorrhage, but a visit to his doctor fails to detect a problem
and the episode is attributed to overwork. A family gathering a
little later shows him playing the piano and interacting with his
grandchildren very capably.
The real problems begin as Martin is
conducting the first public performance of his new concerto, live
on television, when he freezes in the opening bars, confused and
unable to focus on the task. This leads to a CT brain scan and
assessment by a specialist who delivers the diagnosis of early
Alzheimer’s Disease. He is encouraged to carry on as normally as
possible with his work and family life. As a result, Barbara
attempts to support him in completing his next major project, which
is to compose an opera.
From this point on, A Song for Martin
follows the relationship between Barbara and Martin closely over a
number of years as his disease gradually progresses. We witness
Barbara struggling to ‘do the right thing’ but being unable to
contain her own needs and frustrations at times. Martin’s
perplexity is brilliantly portrayed when he is trying to grasp a
situation that should be familiar, but isn’t any longer
recognizable to him. It is painful to watch when Barbara’s decision
to revisit their honeymoon destination for a much-needed holiday
almost ends in tragedy and clearly indicates the next stage of his
illness.
With his increasing dependence on Barbara for
his personal care, Martin develops some difficult behavioral
symptoms, which end up leading to him being assessed in hospital,
confirming significant deterioration and resulting in the
recommendation for long term institutional care. My only gripe with
the film comes at this point when the specialist suggests that
Barbara should “forget he is your husband…he is not the man you
married”, advice Barbara certainly doesn’t follow. That apart, the
film poignantly explores Barbara’s guilt at ‘giving up as a
caregiver’ and brilliantly illustrates her loneliness when she
returns to an empty home from hospital, exhausted after years of
caring. The film ends with us seeing Barbara make a gradual return
to a more normal life and managing a lovely good bye to the husband
she adored, despite the fact that he remains in full time care, no
longer able to recognise her.
Relevance to the field of Mental Health
A Song for Martin tracks the development of Martin’s
Alzheimer’s Disease from its earliest signs to his final move into
care, providing us with a potted clinical history. It also
convincingly represents the emotional strain that his wife Barbara
suffers throughout the various stages of his illness. There are
situations that Barbara chooses to manage in a certain way that may
make some viewers want to shout out ”don’t say that” or “don’t do
that”. But for anyone who is involved in Old Age Psychiatry, there
will surely be numerous points in the film that bring back memories
of a real clinical situation, in which real people in difficulty
don’t always do or say the right thing.
There is excellent information for dementia
sufferers and caregivers about the disease at the
Alzheimer’s Society website and I can highly recommend the
Alzheimer’s Association’s
’10 signs of Alzheimer’s’ detection checklist, that could be
read in conjunction with a viewing of the film, to aid learning
about the diagnosis of Alzheimer’s Disease. The film does not shy
away from portraying several difficult to manage behavioral
problems, in the later stages of Martin’s dementia, and could
definitely serve as an excellent starting point for a discussion
about the stresses of care giving. This can be further explored
using the excellent page on the Alzheimer’s Society website called
Carers: looking after yourself.
The film illustrates the positive
encouragement given to Martin, at the time of diagnosis, to
maintain as normal a life as possible, for as long as possible,
although it also manages to highlight just how much this depends on
the stamina and capability of his wife. Martin is encouraged to
continue composing, giving him a sense of purpose and worth, long
after he has lost his previous level of ability.
There is an increasing awareness of the need
to maintain a positive approach to dementia care wherever possible,
encouraging the individual personality of the dementia sufferer to
be recognized throughout their illness. The book entitled “I’m
still here”, by American sociologist John Zeisal, Ph.D (2009;
Published by Avery, a member of the Penguin Group (USA) Inc.),
explores the non-pharmacological treatment of Alzheimer’s and takes
a decidedly ‘glass half full ‘ look at the disease. Zeisal is a
founder of the Artists for
Alzheimer’s™ programme in the USA, which has enabled thousands
of people living
with Alzheimer’s disease to have cultural
opportunities and artistic experiences.
Recognition of the need to reduce
anti-psychotic medication use for the behavioral and psychiatric
symptoms in dementia, outlined in the independently
commissioned report produced by Professor Sube Banerjee for the
Department of Health, in 2009, has led to an exploration of various
different non-pharmacological strategies, such as the use of
sensory rooms and aromatherapy massage. A few other initiatives,
which have been reported in the UK media in recent months include a
reminiscence room set up at a
care home in Wiltshire, UK, or the recent project developed by
Middlesex lecturer, Trish Hafford-Letchfield, who made
a short ‘mockumentary’ film of a royal visit to a day centre
for dementia sufferers in north London (with the aim of involving
people with dementia in the education of social workers and
nurses).
A Song for Martin gives the viewer an
opportunity to experience, close up, a life and an intimate
relationship affected by Alzheimer’s Disease. The film offers a
good starting point for anyone wishing to teach students, from a
variety of professional backgrounds, about dementia, with a
particular focus on the progression of the illness and its effect
on the main caregiver. I would certainly recommend it to anyone
wanting a career in Old Age Psychiatry.
More information about A Song for
Martin can be found at IMDB .
The Region 1 DVD is available on
amazon.co.uk.
Minds on Film is written by Dr Joyce Almeida.
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