The Film
Through the interconnected lives of several gay
men, Longtime Companion tells the chronological story of
the beginning of the AIDS epidemic. Within the group, there are two
well established partnerships: that between David and Sean, who
writes a daytime soap opera and that between Howard, who stars in
the soap written by Sean, and his partner Paul. The other single
friends in the circle are Willy, who is a personal trainer, a young
man called John and a lawyer called Fuzzy, on account of his facial
hair. Howard and Paul live next door to Lisa, who is a friend of
Fuzzy and part of the group. Willy and Fuzzy meet early in the film
and begin a relationship. The affluent couple, David and Sean, have
a beach house on Fire Island where they frequently invite their
friends to stay.
In 1981 the New York Times publishes news of a new
‘gay cancer’ called Kaposi’s sarcoma and all of the friends react
in different ways to the report. In 1982, John develops pneumonia,
deteriorates rapidly and dies soon after he is admitted to
hospital. By 1983, the attitude to the illness among the group is
very different and fear has taken hold. David and Sean are seen
arguing over Sean’s fears that he might have the illness. In 1984,
Paul becomes unwell and investigations in hospital reveal that he
has toxoplasmosis. In the same year, Sean is hospitalised and
during a visit to him from Willy, the film demonstrates brilliantly
the fear that Willy has of contracting the disease from a kiss Sean
gives him on the neck.
By 1985, Sean is being nursed at home, by his
partner David, and is now suffering from AIDS related dementia.
David is trying to support Sean with his screenwriting in order to
keep the extent of his illness hidden from the studio. At the same
time Fuzzy tries to secure Howard a movie role when the producer
has refused to cast him after hearing an untrue rumor that he has
AIDS. By 1986, Sean has severe dementia and is bed bound,
incoherent and incontinent. He dies soon after and Fuzzy offers
support to David by phoning to find a ‘gay friendly’ funeral home
that will deal with the body. The next scene, at a memorial
service, takes place in 1987 when we discover the deceased is
David. By 1988, Howard has been diagnosed as HIV positive and is
fundraising for AIDS causes. The film ends in 1989 with Willy,
Fuzzy and Lisa walking along the seashore contemplating how much
their lives have changed, in the few years since AIDS has emerged.
There is a final brief fantasy scene in which all of their lost
friends return to the beach to be fleetingly reunited before
disappearing once again and leaving the three friends alone on the
empty shoreline.
Relevance to the field of Mental Health
Longtime Companion presents a number of relevant mental
health issues that are related to infection with the Human
Immunodeficiency Virus. These include the effect of repeated
bereavements on those who lose close friends and or a partner from
the disease; anxiety and panic about developing the illness in
healthy, but at risk, individuals and finally it offers a portrait
of HIV related dementia in one of the characters. As the film is
set at the time when AIDS first manifest, when the mortality rate
was 100%, there is an inevitable historical context to be taken
into account in relation to the medical content.
Thankfully the intervening years have brought huge
success in managing those who suffer from HIV infection, using
highly active antiretroviral therapy (HAART). As a recent study in
the UK has shown (BMJ 2011;
343:d6016), there is now a significantly improved life
expectancy for those with HIV when antiretroviral therapy is
started soon after diagnosis, transforming it into a chronic
disease rather than what was usually a fatal illness. However
there is still no vaccine or cure and in current times the disease
presents huge problems worldwide, especially in sub-Saharan Africa,
where it is estimated that one in three people are living with the
virus in the worst affected countries. In the UK the estimates
suggest that between 80,000 - 90,000 people are living with HIV and
that the two groups most affected are men who have sex with men and
people who have moved to the UK from areas of the world with a high
incidence of HIV. In this second group, heterosexual sex is the
commonest cause for the spread of infection among men and
women.
Since the mid 1990s, with the use of HAART in the
treatment of those infected with HIV, the incidence of HIV
associated dementia has declined and has been replaced by less
severe HIV associated neurocognitive disorders (HAND). The
impairments commonly seen include reduced attention and slower
information processing and subtle changes are estimated to be
present in up to 35% of people with HIV infection who are under the
age of 40. When AIDS dementia does occur, it presents as a
subcortical dementia associated with basal ganglia pathology whose
severity appears to correlate with the levels of virus in the brain
and cerebrospinal fluid. As increasing numbers of HIV positive
people are now living longer, it is important to remember that HIV
is a potential cause of anyone presenting with mild cognitive
impairment or early-onset dementia. For some basic information
about HIV related cognitive impairment, The Alzheimer’s Society has
a good
factsheet on the topic.
Any psychiatrists wanting to consider the subject
area in greater detail might find interest in a book entitled
Handbook of AIDS Psychiatry by M.A. Cohen, H.Goforth, J.
Lux, S. Batista, S. Khalife, K. Cozza, J. Soffer. Oxford University
Press USA. 2010, which was reviewed recently in the British Journal
of Psychiatry by Derek Summerfield, Consultant Psychiatrist
(BJP September 2011 199:259-260). There is also the
earlier Comprehensive Textbook of AIDS Psychiatry Edited
by Mary Ann Cohen & Jack M. Gorman. Oxford University Press.
2007, which was reviewed in 2009 in the British Journal of
Psychiatry by Jose Catalan, Consultant Psychiatrist (BJP 2009
195: 277).
Longtime Companion is a film that puts a
very personal face on the experiences of a close group of gay men
as they struggled to face the frightening consequences of a new
disease, one which proved a challenge to professionals from all
branches of medicine then and, in different ways, is still doing so
today.
• Minds on Film is written by consultant
psychiatrist, Dr Joyce Almeida
• Further information is available at
IMDB, and the
official trailer is
available on You Tube.
• Longtime Companion can be purchased at
amazon.co.uk.
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