Accessibility Page Navigation
Style sheets must be enabled to view this page as it was intended.
The Royal College of Psychiatrists Improving the lives of people with mental illness

MINDS ON FILM

RSS Logo RSS 2.0

May 2011 Posts

04/05/2011 09:18:43

The Diving Bell and the Butterfly

Introduction

The Diving Bell and the Butterfly, released in 2007, was directed by Julian Schnabel and is based on the book of the same name. The film won a Bafta for best screenplay, a Golden Globe and an award for best director at Cannes Film Festival.

In French with English subtitles, it tells the true story of Elle magazine editor-in-chief, Jean-Dominique Bauby, who suffered a brain stem cerebrovascular accident at the age of forty-three. He consequently developed locked-in syndrome, a rare neurological condition characterised by quadriplegia and an absence of verbal communication but with preservation of eye movements and intellect.

The Diving Bell and the Butterfly


Bauby’s book was dictated by the blinking of his left eye in response to a translator who would recite the letters of the alphabet, a task requiring an extraordinary amount of patience, and it tells the story of his experiences from the moment he regained consciousness in hospital. The book was published in France in March 1997, ten days before Bauby died of pneumonia. Unusually for a film, we spend a great deal of time seeing things solely from Bauby’s direct perspective. This makes The Diving Bell and the Butterfly a particularly instructive experience for any mental healthcare professional seeking to better their empathic skills. 

The Film

The film opens with the blurry opening of Bauby’s eyes as he regains consciousness in a hospital room. We find ourselves sharing his view of the world as he wakes up to his new surroundings. We hear his internal voice attempt to answer the first questions from staff before realising that they cannot hear him because he cannot speak aloud. Very rapidly, his struggle to be understood becomes the viewer’s struggle as we are quite literally trapped inside his head. From his personal viewpoint, we experience the various professionals who come to help him, some better than others at empathizing with him. In this context, we can feel the relief when a speech and language therapist brings him a method that she believes will help him to communicate. Initially negative, Bauby soon finds a positive outlook on his situation and states that; “apart from my eyes, two things aren’t paralysed…my imagination and my memory”. In his mind, these are the two things symbolically represented by the Butterfly, which remain free to roam, whereas his body he represents as a Diving bell, in which his mind is trapped.

All of the devices used in filming succeed in putting us firmly in the protagonist’s place and this is the only viewpoint we are given for the first 15 minutes of the film before we begin to see Bauby from the outside, as a separate person. This technique has the effect of trapping us inside his body too, until we are released and able to view the world from our usual (in film, multiple) perspectives. This moment occurs for him and us at the point at which he is taken from his room for the first time and wheeled down a corridor, seeing his image reflected in a pane of glass as he is taken to a balcony and the fresh air. From this point on, we move between his perspective of the world and our own.

The fact that Bauby must rely solely on his left eye to communicate, and that he manages to express so much with it, reminds us of just how much can be transmitted by non-verbal cues in people with poor or non existent verbal speech. But most impressive of all is the real time experience we are given of the blinking alphabet dictation method that allows his thoughts to be heard and his book to be written. We are left in no doubt as to the enormous effort, determination and perseverance that was required to bring this story to its audience.

As well as his progress in the hospital, the film pieces together some of Bauby’s life before his cerebrovascular accident, with the help of intermittent flashbacks. One such flashback allows us to see the tender and close relationship he has had with his ageing father, which sets the scene for a particularly moving moment later on when his father phones him in hospital and tries to talk through his translator about his deepest feelings. Throughout the film he receives a series of visits from friends and family, each revealing a different reaction to his appearance and to the communication difficulty. One friend, who had been held hostage in Beirut for four years, sees a similarity between his own experience of confinement and Bauby’s entrapment in his body advising him to “hold fast to the human inside of you and you’ll survive”. His mistress is unable to visit him in contrast to the mother of his children, from whom he is separated, so that the film is also about the different reactions that his loved ones have to his condition.

Relevance to the field of Mental Health

The Diving Bell and the Butterfly offers the viewer a clinical case study of a rare neurological condition called locked-in syndrome. It presents us with a patient centered view of the extraordinary experience involved in living with such a disability whilst highlighting his experience of the professionals he encounters. The Diving Bell and the Butterfly is already recommended viewing for speech and language therapy students, but I believe it should be seen as widely as possible by anyone who cares for patients with any degree of impaired speech and movement, some of who find themselves within the mental health care services.

In particular, the film reminds healthcare professionals of our responsibility to treat every individual in our care with respect and dignity, using our empathic skills to put ourselves in others shoes, whether or not they can speak to us or communicate their thoughts effectively. The film is very good at demonstrating how small actions by a care assistant can have a huge effect on Bauby, when one turns on the TV, which is showing children’s cartoons, as she leaves his room, and another turns off the TV when it is showing a football game that Bauby is actually enjoying enormously. In both cases, he is powerless to get his needs met. These scenes might offer a perfect starting point for teaching students from a variety of backgrounds about how to develop empathy in a therapeutic setting.

For anyone wanting more detailed clinical information about this condition, it is discussed in a review article published in the BMJ in 2005 (Smith E, Delargy M. Locked-in syndrome. BMJ 2005; 330: 406-09). For another excellent patient centered account of locked-in syndrome and the distinction between it and persistent vegetative state, the BMJ published a very good clinical review, in 2005, written by a young man called Nick Chisholm, who suffered a series of brain stem cerebrovascular accidents after suffering concussion during a rugby match. As both the articles explain, locked in syndrome is caused by a lesion in the brain stem, commonly caused by a vascular incident, trauma or by extensive demyelination which affects the brain’s peripheral connections. As such, I would highly recommend this film for anyone interested in neuropsychology or neuropsychiatry.

At a time when the topic of teaching medical students empathic skills is being increasingly discussed, this film offers one of the best opportunities yet for stepping in to a patient’s shoes and experiencing life from the other side of the bed.

Any medical students interested in exploring the relationship between medicine and film further, may want to visit one of the many free events taking place, during May, at locations around the UK as part of Medfest 2011, the first national medical film festival, whose theme is ‘the Image of Doctors’.

* More information about The Diving Bell and the Butterfly can be found at IMDB as can a short trailer .

* The DVD is available on amazon.co.uk.

 

 

 

Login
Make a Donation

 

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.

 


*
  You can now follow Minds on Film on Twitter @psychfilm

 

 

Other College blogs you may wish to catch up on: