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

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28/01/2016 09:01:10

The Age of Loneliness

Introduction

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

Twinsters

IntroductionTwinsters

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 amazon.co.uk.

• 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 amazon.co.uk.

 

•              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 amazon.co.uk

 

• 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 amazon.co.uk.

 

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

 

10/08/2015 11:20:43

The Outcast

Introduction

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 amazon.co.uk.
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida.
01/06/2015 10:54:57

Rory O’Shea Was Here

Introduction
Rory O’Shea Was Here

Rory O’Shea Was Here, directed by Damien O’Donnell, was released in the UK in 2004 and was originally titled Inside I’m Dancing. It tells the story of two young men, Michael (played by Steven Robertson) and Rory (played by James McAvoy), both confined to wheelchairs for different reasons, who form a friendship in a residential home and subsequently set out to experience independent living in the community. It won five awards, including the Audience Award at the Edinburgh International Film Festival in 2004. It is loosely based on a real story written by someone who worked for Dublin’s Centre for Independent Living in the 1990s. As there has been increased focus on Mental Capacity and the Deprivation of Liberty Safeguards in England since the Supreme Court Judgement in March 2014 sought to set out an acid test for defining deprivation of liberty, this film offers a perfect opportunity to discuss a number of issues raised by the change in application of the legislation. It also provides the viewer with an empathic understanding of the realities of life in a wheelchair, which is both moving and funny.

The Film

Rory O’Shea Was Here opens with Michael seated in the lounge of his residential care home, observing as an accident is about to happen to a member of staff. It then becomes clear that he has very poor speech as a result of cerebral palsy and he cannot make himself understood to warn staff about the hazard he has seen in the room. His frustration is palpable. Michael seems isolated in the home and lacking in a peer group but this all changes when Rory O’Shea arrives with his gelled, spiked punk hair, nose piercing and a punchy attitude that distracts from the truth about his poor prognosis. He introduces himself sarcastically to the other residents as “Rory, Duchenne Muscular Dystrophy”, already demonstrating angrily that his identity is defined by his diagnosis. At first Rory mocks and teases Michael, seeing him as the perfectly behaved young man who is popular with staff. However, Rory’s rebellious personality attracts Michael and their friendship takes off when Rory demonstrates that he can understand Michael’s speech better than anyone else. Michael needs him to communicate with the world and finds strength in their partnership, showing his appreciation by copying Rory’s gelled hair style, to the surprise of home manager Eileen (played by Brenda Fricker). Rory, who has ,earlier in life, had the experience of living in the community without a disability, tries to educate Michael in the ways of drinking, meeting women and being free.

As they share more about their lives, Rory learns that Michael’s father is a senior member of the judiciary, who failed to support him financially and abandoned all contact with him because of his disability. As their friendship deepens, Michael learns that Rory has been trying to obtain an Independent Living Allowance (ILA) that would enable him to live in the community supported by a full time carer. Michael accompanies him to a hearing in which Rory is once again unsuccessful in obtaining an ILA. After this, Rory hatches a successful plan to blackmail Michael’s father into providing money for a flat in the community for him. He also engineers the need to be Michael’s companion and communicator as they seek to obtain the ILA, this time for Michael. With that agreed the young men find a suitable flat and then seek a personal assistant who can provide the care they both require. They choose an attractive young woman that they met previously in the pub, played by Romola Garai. She helps to support the men in establishing a home but with some painful romantic consequences for Michael. Rory remains rebellious and confrontational as he battles with a disease that he knows will seriously limit his life span and the ending of the film brings this to a difficult conclusion, with a direct effect on Michael’s own choice about where he finally chooses to reside.

 

Relevance to the Field of Mental Health

The Mental Capacity Act Deprivation of Liberty safeguards (DOLS) and Best Interests is a very important topic at present. I offer this film as an accompaniment to the recent article published in BJPsych Advances May 2015, 188-195 (abstract) entitled Best Interests, mental capacity legislation and the UN Convention on the Rights of Persons with Disabilities by Brendan D. Kelly in which the author compares the key principle of ‘Best Interests’ in England & Wales, Northern Ireland and Ireland and the similar concept of ‘benefit’ in Scotland, examining how the various legislation is operationalised in each place. The film provides a perfect platform to discuss such issues and the legislation. The film highlights the difficulties of assessing mental capacity when an individual has significant communication problems and very little experience of life outside of a residential care home setting.

Aside from this focus, Rory O’Shea Was Here offers the opportunity to consider what life is like for those people who are confined to a wheelchair, reliant on others for the majority of their personal care. This understanding is important for all students across a wide range of disciplines who are engaged in caring for and working with such individuals.

 

• More information about Rory O’Shea Was Here can be found at IMDB, as can a short trailer.

Rory O’Shea Was Here is available to purchase and stream from amazon.co.uk

•  Thanks to my OT colleague ZC for this film recommendation.

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

 

 

01/07/2015 17:09:52

Still Alice

Introduction

Still AliceStill Alice, directed by Richard Glatzer and Wash Westmoreland, was released in cinemas in the UK in February 2015. The film is based on a novel written in 2007 by Lisa Genova about a renowned linguistics professor diagnosed with early-onset Alzheimer’s disease as she struggles to hold on to the defining aspects of her self as her condition worsens. In the film, Dr Alice Howland is played by Julianne Moore in a truly poignant and empathic performance, which brought well deserved recognition in the form of an Oscar for Best Performance by an Actress in a Leading Role in the 2015 Academy Awards, a Golden Globe in 2015 and a BAFTA award for Best Leading Actress in 2015, to name but three of the thirty four awards the film collected. Moore is very well supported by the other cast members, in particular Alec Baldwin, who plays her husband John.

 

Still Alice has been very well received by critics and also by those with Alzheimer’s disease (this February 2015 article by Tom Seymour in The Guardian provides a verdict from those with dementia), making it of particular interest to all mental health professionals, carers and families of those with Alzheimer’s disease.

 

The Film

Still Alice opens with Professor of linguistics at Columbia University, Dr Alice Howland, giving a guest lecture, which one senses she has given before, on her particular research interest within the topic of developmental linguistics. She pauses, literally lost for a word, whilst in full flow, dismissing her stumble on having drunk too much champagne and the moment passes. She is fifty years of age. Back at home she jogs through Columbia University’s campus, where she teaches, and finds herself suddenly unsure of her direction. With blurry, shallow focus shots evoking the sense that she has no idea where she is, Alice becomes frightened and panicky until she begins to regain her orientation and is able to run home. She is visibly shaken by the experience and is aware that something is wrong but doesn’t share her concerns with her family at this stage.

Instead, Alice consults a neurologist who takes a history, carries out a basic cognitive test and suggests an MRI scan (which proves to be normal) followed by a PET scan, which shows signs confirming his suspicion that Alice may have early onset Alzheimer’s disease. The neurologist asks to see her husband, John, and confirms the diagnosis to them both. A genetic test follows to determine whether she has the heritable form of the disease. She tests positive for the gene and their children must be told. At a family meeting, Alice reveals her diagnosis and then explains the risk to her children. She tells them that she has been prescribed Aricept and that she is now using numerous strategies to maintain her health and cognitive function. Shortly after this, Alice hears from her eldest daughter Anna that she too is positive for the familial form of Alzheimer’s disease, Tom is negative and her youngest daughter Lydia has declined the test. After these revelations, Alice is confronted by her boss with negative student feedback that indicates Alice’s teaching has become increasingly disorganised and difficult to follow. She reveals her diagnosis to him and this results in the end of her job as an academic. Alice becomes involved with the Alzheimer’s Association and prepares a talk to deliver to an audience about her experience of living with the disease, using a typewritten script that she highlights as she reads out the sentences. She delivers an incredibly moving presentation, describing the struggle of trying to hold on to those aspects of her life that meant so much to her previously and that defined her as a person. With huge support from her husband, Alice is helped to manage at home.

One of the things that Alice decides to do is to continually test her knowledge of key personal data such as her address and the name of her eldest daughter using her smart phone. She then records a video file on her laptop with instructions to her future self that she should follow when she can no longer answer these key questions. However, when the time comes, and she finds the video file on her laptop by accident, Alice is actually unable to follow the instructions easily. Her constant need for supervision and support becomes apparent and she is not left alone from that point onward. Her daughter Lydia moves back from Los Angeles to be at home again as a main carer, in part because Alice’s husband has been offered an important job opportunity in another city about two hours away by plane. The film closes with Lydia reading some poetry to Alice and asking her if she understands the theme. Alice replies with one word ‘Love’.

 

Relevance to the Field of Mental Health

In researching the role, Julianne Moore spoke to a number of people with early onset Alzheimer’s disease to gain an intimate understanding of their feelings and functioning, which clearly informs the authenticity of her performance and makes it so valuable to watch. One of those people called Wendy Mitchell, who Moore thanked in her BAFTA speech, lives in the UK. Mitchell features in an interactive resource on the BBC website called Living at home with dementia, which provides an extremely useful accompaniment to the film. Mitchell, diagnosed at 57 with Alzheimer’s disease, is quoted as saying about Still Alice “It was a shockingly accurate reflection of my own experience.”

This film provides an incredibly intimate personal portrait of early onset Alzheimer’s disease that challenges the viewer to experience what it might feel like to lose certain cognitive functions, in particular memory, from a previous position of competent engagement in the world. That Alice is a middle class academic, who seems to be making sensible choices with regard to lifestyle (she is a non-smoker who eats a healthy diet and takes regular exercise), makes her intellectual decline all the more poignant as she struggles to come to terms with her diagnosis and subsequent loss of certain cognitive functions. This film encourages us to reflect on the nature of the self and what makes us who we are. It asks us how much cognitive function can we lose before we cease to be that person we once were. Is Alice Still Alice by the end of the film? This question might provide the platform for an interesting debate.

This is simply a film that must be watched.....by everyone.

  • More information about Still Alice can be found at IMDB, as can a short trailer.
  • Still Alice is available to pre-order on dvd from amazon.co.uk and it will be released on 6th July 2015.
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida.

 

05/05/2015 14:34:09

Minds on Film Index - 5 yrs on

 Minds on Film Clapper Board

To mark five years of Minds on Film, here is an updated index of blogs in the archive, organised by specific psychiatric conditions and mental health issues that have been covered so far.

 

 

 

 

Adoption

Philomena

Flesh & Blood

 

Ageing

Granny’s Got Game

Philomena

Les Invisibles

 

Alcohol dependence

The Christmas Choir

When a Man loves a Woman

Smashed

 

Alzheimer’s disease

A Song for Martin

Mr Alzheimer’s and Me

Still Alice

Wrinkles

 

Anterograde amnesia

Memento

 

Anxiety

Tarnation

Two days One night

 

Acquired Brain Injury

The Crash Reel

 

Assisted suicide

The Sea Inside

 

Bipolar disorder/Schizoaffective disorder

Tarnation

Tulisa - My Mum and me

Passionflower

 

Bulimia nervosa

Sharing the Secret

 

Carer stress

A Song for Martin

Tulisa - My Mum and me

Amour

Canvas

Helen

The Savages

 

Cerebrovascular accident

The Diving Bell and the Butterfly

Amour

A Simple Life

 

Challenging the stigma of mental illness

A New State of Mind: Ending the Stigma of Mental Illness

Two days One night

 

Childhood autism

After Thomas

 

Dementia

A Song for Martin

Longtime Companion

Amour

Wrinkles

The Savages

Still Alice

Mr Alzheimer’s and Me

 

Depression

The Aviator

Brassed Off

The Machinist

Control

Archipelago

Helen

Two days One night

A Single Man

Oslo, August 31st

 

Developmental delay in childhood

The Apple

 

Divorce - the effects on teenage children

Private Property

A Separation

 

Domestic violence

Tyrannosaur

 

Drug addiction

Down to the Bone

Oslo, August 31st

Trapped in a purple haze

 

Dyslexia

Like Stars on Earth

 

Employment and mental health

Two days One night

 

Epilepsy and psychiatric illness

Control

 

Grief for the loss of a child

Ordinary People

 

Growing up in Care

The Unloved

 

HIV related dementia

Longtime Companion

 

Homelessness and psychiatric morbidity

The Christmas Choir

 

Huntington’s disease

Huntington’s disease short films

 

Insomnia

The Machinist

 

Learning disability

Flesh & Blood

 

Locked in syndrome

The Diving Bell and the Butterfly

 

Mindfulness

Spring, Summer, Autumn, Winter

 

Morbid jealousy

El or This Strange Passion

 

Obsessive compulsive disorder

The Aviator

Matchstick men

 

Paranoid psychosis

Take Shelter

 

Personality disorder

Grizzly Man

 

Problem gambling

Owning Mahowny

 

PTSD

Birdy

In Our Name

 

Mental Health & acute trauma/disasters

The Impossible

 

Residential care for older adults

A Simple Life

Wrinkles

The Savages

 

Schizophrenia

Spider

Birdy

The Soloist

My son, my son, what have ye done

Canvas

 

Sexuality - in later life

Beginners

Les Invisibles

 

Stalking

Enduring love

 

Suicide/Attempted suicide

Brassed Off

Control

Helen

A Single Man

 

Tourette’s syndrome

Matchstick Men

 

Transgender issues

Transamerica

 

Uncomplicated Grief

Summer Hours

 

Unemployment and psychiatric morbidity

Brassed Off

 

Vascular Dementia

Amour

 

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

 

02/04/2015 09:02:55

Smashed

Introduction

Smashed, directed by James Ponsoldt, was released in the UK in December 2012. It tells the story of a young married childless couple, Kate and Charlie Hannah, whose relationship centers around drinking alcohol. Kate, played very convincingly by Mary Elizabeth Winstead, manages to function as a primary school teacher until several alcohol related harmful incidents cause her to question this lifestyle and she seeks sobriety. Unfortunately this choice has implications for her husband Charlie, played by Aaron Paul (of Breaking Bad fame), who remains addicted and sees no reason to change, putting their relationship under great strain.

Smashed was very well received by critics and audiences, and got some extremely good reviews from former addicts who commented on its authentic portrait of alcohol dependence. It is particularly useful as an educational film for patients seeking help and for professionals engaged in providing that support and treatment.

The Film

Smashed opens with Kate taking a quick drink as she showers before heading off to work as an infant school teacher. She notes that she’s wet the bed again too. When she reaches the school car park, she takes a swig from her flask to get her started for the day. Her husband Charlie works from home as a rock music journalist and leads a less pressured existence, so he stays sleeping in bed, finding it hard to get up. Kate appears to be coping fine until she finds herself unexpectedly vomiting in front of her class of young children, some of whom ask if she is pregnant. Kate sees this as an immediate solution to her dilemma and lies to them confirming that she is indeed pregnant. The news travels fast to the principal, a woman who cannot have her own children, and so becomes invested in Kate’s seemingly positive news. However, a male colleague, Dave Davies, who is a recovering alcoholic, quickly detects the truth about Kate and offers her a route to sobriety through attendance at his Alcoholics Anonymous group, without betraying her trust. Kate is initially unsure about seeking help in this way, but after a drunken night out on the ‘wrong side of town’ involving the consumption of crack cocaine and a night sleeping rough, she finds the motivation.

When she first accompanies Dave to his AA group she meets an older woman, Jenny, who becomes her mentor and a positive influence in her life. Unfortunately Dave flirts clumsily with Kate on the way home after the meeting, Kate deals with this firmly and effectively, stating her loyalty to Charlie. As Kate begins to feel pride in her sobriety, her relationship with Charlie suffers because of his continued drinking and the lifestyle that is associated with it. Kate decides to visit her mother for the first time in years and Charlie insists on going with her. Kate’s mother is revealed as a drinker, embittered by the breakup of her own marriage and the sobriety of her ex-husband who now has a new family. The tensions in their mother-daughter relationship are very apparent.

When Kate is finally forced to reveal the truth about her non-existant pregnancy to the principal at school, she loses her job, causing a brief relapse of her drinking. However, she gets back on track with the help of Jenny and Dave and faces the reality about the impossibility of marriage to Charlie if he continues to drink. The final scene jumps forward a year when the couple meets again after Kate has been sober for a year. Charlie, who is still drinking, wants to give their relationship another try but she sees that he has not changed and knows that it is over for her.

 

Relevance to the Field of Mental Health

With increasing recognition of the role that excess alcohol consumption plays in the physical and mental ill health of individuals, this film portrays a very important problem that currently faces our society.

Smashed gives a compellingly believable presentation of two individuals with alcohol use disorders and follows Kate through her attempt to get help using Alcoholics Anonymous. The film could be used to teach about the subject, perhaps alongside a reading of a recent Clinical Review published on 21st February 2015 in the BMJ, written by Ed Day, Alex Copello and Martyn Hull, called Assessment and management of alcohol use disorders (BMJ2015;350:h715). The article is aimed at GPs and non-specialist hospital doctors and an abstract is freely available as well as a 30-minute discussion about the topic with the authors of the review (which can be heard as an audio track on soundcloud).


Psychiatrists might find it informative to read two recent articles in BJPsych Advances on the subject of drug and alcohol addiction, by Jason Luty. The first entitled Drug and alcohol addiction: new pharmacotherapies (10.1192/apt.bp.114.013367) and the second called Drug and alcohol addiction: do psychosocial treatments work? (10.1192/apt.bp.114.013177). There is also a recent CPD online learning module called Alcohol-related brain damage that would provide an additional useful resource.

Lastly, the charity Alcohol Research UK funds high quality research into alcohol-related harm and hosts many useful resources at their website.

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

Smashed is available to purchase from 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 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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