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February 2011 Posts

01/02/2011 11:45:18

A Song for Martin



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.

A Song for Martin

 

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.
 
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.

 

23/02/2011 08:15:30

Memento

Introduction

Memento, directed by Christopher Nolan, is based on a short story by his brother, Jonathan Nolan, called “Memento Mori”. The film was released in 2000 and is described by Nolan as “a psychological thriller about a guy who can’t make new memories and who is looking for revenge”. It belongs to the neo-noir film genre, with some of the characteristic features of bleakness, alienation, paranoia, the presence of a femme fatale and the lack of a happy ending.

In an interview about the film, Nolan explained that he was very interested in the process of memory and in the way it can be distorted. He also stated that, in making Memento a film about an unreliable amnesic narrator, he had “attempted to put the audience into the head of the protagonist and make them experience some of his confusion, uncertainty and paranoia”. It is precisely for this reason that I believe Memento has much to offer the mental health practitioner, especially anyone working with individuals suffering from memory impairment.

 

Memento

Because memory is so deeply entwined with our sense of identity and is one of the means by which we understand our world, this film explores how it might feel to be unable to trust what we know about ourselves, and others that we meet. Because it uses a complex and unorthodox form of story telling, Memento challenges us, requiring a greater than usual degree of concentration and use of our own memory, in pursuit of the truth. Indeed, the film invites multiple viewings as we strive for greater understanding, again giving us the experience of a person trying to work out the world they are perceiving, when handicapped by an impairment of memory.

The Film

On this occasion, I do not intend to give a detailed description of the plot but rather to outline the complex structure of the storytelling as a guide to orientate viewers to the complex way the film plays with memory and time. Anyone wanting an “unspoiled” viewing of the film should stop reading now and return to the blog after watching it.

 

Memento is essentially a film of two parts, one filmed in colour and the other in black and white, intertwined together in alternating sequences that set out to explain the events leading up to the opening scene. The film’s opening sequence, in colour, takes place quite literally in reverse and is the only scene to do this. In it, we witness the revenge killing of Teddy, a policeman, by Leonard, the protagonist who suffers from anterograde amnesia. The sequences filmed in colour, tell the story backwards in short segments that play forwards, whereas the black and white sequences tell a storyline that unfolds in the conventional (that is moving forward in time) way. We discover that the black and white scenes preceded the colour sequences in chronological time. Often in the colour scenes we are thrust into the action with Leonard, sharing his lack of understanding about what he is doing in any particular place. We very soon learn that the strategy he uses to keep track of events, people and objects, and to attempt to make sense of his world, is to take polaroid photos which he then annotates. For the really important things that he wants to remember, he has them tattooed on various parts of his body. The final black and white scene seamlessly merges with the last colour sequence, bringing the whole film to an end as a complete piece of storytelling, but perhaps failing to provide all of the answers that the viewer may be seeking after the first viewing.

 

Ultimately, Memento is like a puzzle whose pieces can only be reassembled with the help of an intact memory. In contrast to Leonard, we can use our memory of previous scenes to inform our understanding of the consequences of his actions in the scene that we are currently watching.

 

Relevance to the field of Mental Health

Memento specifically explores the condition of anterograde amnesia and reflects the difficulty that sufferers have in appreciating the passage of time as they struggle to exist with very limited recent memory. For anyone wanting to gain a better understanding of what it might feel like to suffer from such a disability, this film captures some of the aspects of confusion and perplexity very well. By making the viewer unsure of what to trust in what they see through Leonard’s eyes, Memento can help the viewer to appreciate why such an individual may experience paranoia.

 

The film can also offer a starting point for a discussion about the different strategies that may be employed to prompt the sufferer into recalling recent experiences (autobiographical memories). There are many different rehabilitation techniques used to help individuals with anterograde amnesia. Some involve the use of compensatory techniques like mobile phone alerts or written notes and diaries, others consist of intensive training programmes involving the active participation of the person with their family members. Work by clinical neuroscientists in Cambridge, UK, comparing written versus visual aids for memory retrieval in memory impaired individuals, has begun to suggest that the recording of a pictorial, person-centred view of events, using a wearable camera, whose images are re-viewed later on a computer screen, may be an effective way to improve autobiographical recollection and one that is superior to a written diary (Berry E, Kapur N, Williams L et al; Neuropsychological Rehabilitation. 2007; 17(4-5):582-601; The use of a wearable camera, SenseCam, as a pictorial diary to improve autobiographical memory in a patient with limbic encephalitis: a preliminary report).

 

For anyone wanting to compare the fictional character of Leonard with a real person suffering from the same condition, the well-known case of the English musicologist, Clive Wearing, who has a severe form of anterograde amnesia, offers further insights into the disability. He is unable to remember more than 10-30 seconds at a time and has no detailed memories of his life before herpes simplex encephalitis damaged the hippocampi in his brain (one of the areas of the brain involved in laying down memories) more than 20 years ago. He is only able to recognise his wife, who he married the year before his illness. What is especially interesting is that he retains his previous ability to play the piano, because this involves procedural memory (involving other brain areas such as the basal ganglia and cerebellum). He featured in a BBC documentary about how humans experience time, which can be viewed via the Wellcome Collection website.

 

Another famous amnesic patient, an American man named Henry Molaison, died in 2008 at the age of 82. An excellent account of his life with anterograde amnesia, caused as a result of neurosurgery for epilepsy, is available in The Telegraph obituary published in February 2011. He was studied extensively for many years, and was particularly interesting because he retained his intellectual abilities and personality but was unable to live independently or to hold down a job. Leonard, in the film, illustrates just how vulnerable and open to exploitation someone is without a functioning short-term memory, which can help us to understand why someone with this condition might require supervised care, of some sort, throughout his or her lifetime.

 

Memento is a film that requires us to use our memory to the full, at the same time as giving us the experience of being in the world without it. I would definitely recommend this film to anyone interested in memory and its disorders.

 

 

 

 

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About this blog

 

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

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

Dr Joyce Almeida

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

 


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