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13/07/2018 15:32:01

A Fantastic Woman


A Fantastic Woman is a feature-length Chilean film, in Spanish with English subtitles, directed by Sebastian Lelio. It was released in 2017. The screen play was written by Sebastián Lelio and Gonzalo Maza and deals with the difficulties of sudden bereavement for a transgender woman in a relationship with an older man. In the lead role is a real transgender woman Daniela Vega, playing Marina, who has received much praise for her performance. Not an actress before this film, Vega was initially hired by the director as a script consultant to provide insight into the Chilean transgender community. During this period of consultation Lelio decided to offer Vega the lead role. Vega’s musical performances are her own.

A Fantastic Woman is the first transgender character lead film to win an Academy Award (an Oscar) for Best Foreign Language Film of the Year in 2018.


The Film

The film is set in Santiago and opens with an older man, Orlando, having a massage in a Turkish Bath club called Finland. He walks to a bar where he watches a singer finish her set. The singer is his lover, Marina, a transgender woman much younger than Orlando’s fifty seven years. He takes her for a meal for her birthday and then back to his apartment that she now shares. Their sexual passion for each other is evident. When Orlando wakes in the night feeling unwell, Marina is worried. He is confused and collapses. She takes him to the hospital but not before he has a fall down the stairs next to the apartment sustaining an injury to his forehead and limbs. Unfortunately Orlando dies soon after his arrival at the emergency department and Marina is told he has suffered an aneurysm. His death is sudden and completely unexpected.

Marina is thrown immediately into the role of bereaved partner but with no recognised authority. Added to her helpless position, she is suspected of having a possible role in his death as evidenced by his superficial injuries. When she contacts the family they make it clear that her involvement is not wanted and they show no understanding of the love she shared with Orlando. The medical staff contact the police with suspicions and Marina is visited whilst at work the next day by a member of the sexual offences team. She questions Marina as to whether Orlando paid her and then demands that she be subject to a full physical examination. The humiliation of undergoing such a procedure is palpable but Marina realises that to refuse would lead to worse consequences.

Her quest to say good-bye to her lover, at both the funeral and then the wake, forms the main narrative of the story. The family ask her to leave the apartment they shared as soon as possible and when she doesn’t, her bags are packed and left outside the front door by Orlando’s adult son Bruno. The dog that Orlando gave to Marina within their relationship has disappeared too. Marina’s request to have her dog back represents the other struggle she engages with, to retain something of the life she had shared with Orlando.

When Marina defies the family’s wishes and appears at the funeral she finds herself hijacked by Bruno and two other men. They threaten her in the most brutal manner and dump her in a rough part of the city. Despite this, Marina appears at the crematorium just after the ceremony and manages to see Orlando’s body just before he is cremated, aided by a visual hallucination of him guiding her way to the basement of the building. Throughout the film Marina is seen to use day dreaming fantasy to cope with perhaps unbearable emotions and struggles.


Relevance to the Field of Mental Health

A Fantastic Woman is an important film to watch for anyone seeking a better understanding of the issues facing the transgender community. As mental health professionals it is crucial to be aware of and sensitive to these matters and this film offers an excellent learning opportunity. Additional reading of the recent position statement issued by the Royal College of Psychiatrists in March 2018 entitled Supporting transgender and gender-diverse people might be useful.

In particular, the film explores and brilliantly represents the transphobic hatred and discrimination directed at Marina. The scene in the car when she has been hijacked by Bruno and others will not fail to bring discomfort to the viewer offering an empathic experience of the visceral fear that such violence so often brings and perhaps confronts us with uncomfortable emotions that are the lived reality for so many individuals in our communities.

Marina’s strength and resilience are impressive as she struggles to manage her own personal grief whilst being obstructed so deliberately by Orlando’s family. Her ability to process the sudden bereavement is seen to be so much more complicated because she is a transgender woman.

I would urge everyone working in the mental health profession to watch this film at a time when transgender issues and rights are in focus and perhaps under increasing threat in certain parts of the world. To quote the director Lelio; “I think that this film is about the limits of empathy. In other words, what are we willing to allow, as individuals and as a society. Who defines what is legitimate or not in terms of love, and who claims that right, and with what motives.” He goes on to suggest that there is a trick to this film, quoting Lelio again; “you think that you are watching Marina and the film, when in reality, it’s the film that’s watching you, and asking you what side you’re on, and what your stand is.”

This is the challenge that A Fantastic Woman puts before us and it is most definitely a film for our time.


  • More information about A Fantastic Woman, can be found at IMDB, as is a short trailer.
  • A Fantastic Woman, is available on DVD or to stream at
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida
08/01/2018 12:16:49

Kingdom of Us

Kingdom of UsIntroduction

Kingdom of Us is a full-length documentary film made for Netflix lasting 109 minutes, directed by Lucy Cohen, and released in the UK in October 2017. The film follows the Shanks Family over a number of years as they try to process the tragedy of Paul Shanks’ suicide in 2007, leaving his wife Vikie to care for their seven children then aged between six and sixteen. Kingdom of Us won the Grierson Documentary Film award 2017 at the London Film Festival.




The Film

The story presents clips from old VHS home movie recordings, starting with the return home to the house of Mum and Dad Shanks with their youngest newborn daughter Pippa. Historical home video is edited with more recent filming of the family in a ‘fly on the wall’ format as well as with direct to camera interviews that took place six, seven and eight years after the suicide. This provides access to the intimate scenes of daily life in which the family struggle to process the horrors of what happened to husband and father Paul. As we are introduced to each of the children, we learn that five of the seven are diagnosed on the autistic spectrum, presenting additional challenges for emotional processing. The family is observed viewing the old home movies, in various different settings, in an attempt to piece together their previous relationships with father Paul, who had filmed each child every year at the time of their birthday as well as at other family events. This footage also offers the viewer the chance to build up an impression of Paul aided by the commentary from various family members, most particularly his wife, that tells of a man driven to protect and control his growing family by moving them to a rural setting in which they could grow up together and away from what he perceived to be the many ‘bad influences in society’. It seems that he also wanted everything to be perfect for his family. He kept a detailed diary some of the time, in what his wife describes as an ‘all or nothing’ pattern. When he was writing, he filled pages with copious amounts of small neat script but at other times, when in a different mood, he wrote nothing.

The film gradually reveals information that brings a greater understanding of Paul’s mental state in the weeks leading up to his suicide, but also that he had suffered from ‘difficult moods’ for a long period of time. Especially striking is the home video footage that shows Paul suffering from an episode of low mood, with his head in his hands, in which some of his young children repeatedly ask him why he is sad and ask if he is crying. On review of this footage they find it distressing that they cannot remember being aware of his sadness at the time. Indeed one of them articulates poignantly the feeling that if she’d realised her father was suffering, she might have been able to do something about it. However, it soon becomes clear that Vikie had tried hard to encourage Paul to seek help for his mental difficulties but he refused, and that she had asked for a six month separation to reflect on their relationship. Paul, however, had responded by requesting a divorce and it was only four weeks before completion on the sale of their house that he killed himself. It is especially distressing to hear that Paul became troubled by increasingly paranoid thoughts in these last weeks of his life. Two of the children share the distressing memory with Vikie of finding a notepad, after his death, in which Paul had written a detailed account of his plans to kill all of the family before committing suicide. It is hard to imagine how such a revelation can ever be processed fully and their struggle with this is all too apparent.

Throughout Kingdom of Us, the thread of music and performance weaves between father Paul (who in earlier years worked as an entertainer at Butlin’s Holiday Camps) and many of the children who sing, dance and play instruments. This creative outlet appears to be an important therapeutic tool for several of them and connects them deeply with their father’s musicality as a part of the grieving process. In the later part of the film, eight years after the suicide, the focus shifts to the youngest daughter Pippa, who becomes increasingly depressed and reluctant to eat. She feels disconnected from her siblings and struggles with her reality that she cannot really remember her father. She expresses the fear that she is excluded from their collective grieving because she cannot share in the memories that they recall. Most distressing is her musing that she may be destined to be like her father and genetically carries his demons. Thankfully she eventually agrees to seek help, and through an inpatient admission that finally brings everyone together for some family therapy, Pippa begins to recover from this episode of ill health.


Relevance to the Field of Mental Health

Kingdom of Us is a completely compelling immersive experience that is valuable viewing for anyone interested in mental health. As a unique account of grief after suicide in one family it is a very important resource. It highlights the complex nature of family relationships that are determined by each individual personality as well as so many other factors. As a showcase for parenting in such circumstances, Vikie has been brave to expose herself to scrutiny but she offers the viewer so much as a result. Her strength and resilience are clear although her own personal grief is allowed to appear as she begins to see the older children launch into adulthood and acquires more space for personal reflection.

This is a film about weathering the storms of life that come as a consequence of mental ill health in a close family member and it considers how such tragic events shape and scar children growing up with them. I could not recommend this film more highly.



  • More information about Kingdom of Us, can be found at IMDB.

  • Kingdom of Us, is available to stream at Netflix, as is a short trailer.

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


07/08/2017 11:30:50

Manchester by the Sea

Manchester by the SeaIntroduction

Manchester by the Sea is written and directed by Kenneth Lonergan. It was released in the UK in 2016 and has since won 115 awards. These include two Academy Awards in 2017 for best performance by an actor in a leading role (Casey Affleck, who is outstanding as Lee Chandler) and best original screenplay; a Golden Globe in 2017 for best performance by an actor and two BAFTAs in 2017 for best leading actor and best screenplay to name only a few of them. The film provides a harrowing but compelling account of a family’s tragedy over many years and it explores the tensions that can exist between individual need and the expectation that family ties may bring.


The Film

The story centers on Lee Chandler, a troubled, socially isolated, man who is working in Boston as a janitor when the film opens. He is unexpectedly summoned back to his hometown of Manchester-by-the-Sea when his brother Joe dies suddenly. Lee finds himself staying in his brother’s home and being responsible for his brother’s son Patrick, who is 16 and still at school. Some of these scenes provide the lighter interludes to the film and also contrast Patrick’s less complicated experience of grief with that of his uncle. The family’s back-story is fleshed out using flashbacks throughout the film. These show glimpses of the playful relationship that Lee had with his young nephew some years before as well as showing how his brother Joe had been a strong and supportive presence for Lee through the toughest of times that led to the breakdown of Lee’s marriage. In these scenes, we learn that Joe too was divorced from his wife and that she had a serious problem with alcohol. I have chosen not to give further details of the tragic events suffered by Lee, as the build up to their revelation is intrinsic to the emotional power of the film, except to state that he was only able to cope with them by moving away alone to live and work in Boston.

As the story of his earlier family life continues, the account of his struggle to care for Patrick unfolds in parallel and Lee embraces the parenting as best he can. Although he appears to make some progress in his role as a carer, Lee cannot seem to overcome a fundamental resistance within himself that prevents him from considering the possibility of resettling in Manchester-by-the-Sea, the location of his past traumas. However, despite this drive to flee, Lee’s internal conflict about the choice he must eventually make concerning Patrick is almost palpable as the film reaches its conclusion.


Relevance to the Field of Mental Health

Manchester by the Sea provides a powerful portrait of grief, but additionally adds the complication of both recent and past losses suffered by the main protagonist, Lee. This makes the film especially useful for mental health professionals wanting to teach or learn about prolonged grief disorder (as defined in ICD-10) or persistent complex bereavement disorder (as defined in DSM-5). In May 2017, the BMJ published an infographic on the subject of abnormal grief in the Practice Pointer section of the journal, which accompanied the article entitled Disturbed grief: prolonged grief disorder and persistent complex bereavement disorder by Paul A Boelen & Geert E Smid (BMJ 2017; 357 doi: This would be a very valuable resource to use alongside a viewing of the film when thinking about Lee’s presentation. Also available on the linked webpage is a podcast about helping patients with complex grief, featuring an interview with the authors of the article.

Spending time immersed in this film will undoubtedly provide an empathic experience of the numbness, hopelessness, rage and despair that accompany the main protagonist as he struggles to find a way through the tragic losses he has suffered whilst at the same time trying to deal with the expectations placed upon him by his dead brother. This makes the film immensely valuable to any health professional that might encounter patients suffering with abnormal grief in the course of their work and I cannot recommend it more highly.


  • More information about Manchester by the Sea can be found at IMDB, as can a short trailer.

  • Manchester by the Sea is available on DVD and to stream at

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


24/10/2017 16:25:07



Resurface is a short documentary film, lasting twenty six minutes, directed by Joshua Izenberg and Wynn Padula, that was released in the US in September 2017 on Netflix. The film examines the work of a Californian organisation called Operation Surf, founded by Van Curaza, a former big wave surfer, which offers instruction and mentoring in the art of surfing to war veterans suffering from both physical and mental disabilities acquired as a result of active combat. The ‘ocean therapy’ as it is named is designed to help the wounded veterans with their recovery, offering a purpose, setting physical goals and providing the camaraderie that many lost when they left the military.

It has won two awards, including a Special Jury Mention for Best Documentary Short at the Tribeca Film Festival 2017.


The Film

The story initially focuses on an Iraq war veteran called Bobby Lane and includes interviews with him and his partner. Together they describe some of his symptoms of Post Traumatic Stress Disorder and recount just how close he came to committing suicide before he got the opportunity to try one last experience that he had always been keen on having, which was to surf. After his first session, he was hooked and through Operation Surf he began to experience a steady recovery aided also by his medication. His engagement in the task of self-improvement was so positive that he soon became not only an accomplished surfer but also a mentor for others coming into the programme. From Bobby’s story, the film moves on to show other veterans having their first experiences in the ocean, some of who have extraordinarily severe physical disabilities. Some are double or triple amputees and one veteran featured has significantly impaired vision and hearing.


Relevance to the Field of Mental Health

Resurface effectively portrays the complete absorption of each veteran in the task of learning to be on a surf board and finally mastering the skills required to stay there. These are individuals who have relished the physical demands of being in the military before they were disabled and they clearly respond to the unexpected possibility of conquering a very challenging physical task once again. The full immersion of these individuals in the process seems to be a most exquisite exercise in mindfulness, with complete focus on the present moment being required in order to achieve the goal of catching that first wave. As the film unfolds, the positive effect on the veterans is evident as they regain a powerful purpose in their lives.

The charity, Amazing Surf Adventures, has a number of initiatives in America offering ‘surf therapy’ to veterans and in the UK it resulted in a joint venture called Op Surf UK, in 2016 in Cornwall which was supported by the Endeavour Fund and by Help For Heroes Sports Recovery.

Watching Resurface is a life affirming experience that showcases the power of social networks, interpersonal relationships and physical exercise to support individuals who are struggling to cope with life. As there is increasing awareness within society of the important therapeutic role that social interactions and physical exercise can play in the management of many mental health problems, this film serves as a powerful reminder of just how effective meaningful activity can be. In the field of mental health the film is a perfect reminder that we must always challenge those in our care to use a wide range of therapeutic options as part of their recovery.


  • More information about Resurface, can be found on IMDB and a short trailer is available on Netflix.

  • Resurface, is available to stream on Netflix.

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


04/05/2017 17:27:48



Lilting is the first full length film written and directed by the Cambodian born British director Hong Khaou. It was released in the UK in 2014. It is a study of grief that brings together Richard and Junn, respectively the British lover and Chinese Cambodian mother of Kai, a young man killed suddenly in an accident. Despite both living in London, Richard and Junn do not share a common language to communicate the complexity of their feelings and emotions as Junn has never learnt to speak English. She is also unaware of her son’s gay relationship. Beautifully filmed and with exquisite performances by Ben Wishaw as Richard and Pei-Pei Cheng as Junn this is a deeply powerful examination of the role that language and culture play in our ability to understand others, especially in the context of grief.

The film was nominated for a BAFTA film award in 2015 and won a Cinematography award at the Sundance Film Festival in 2014.


The Film

Lilting opens with Kai visiting Junn in the room of her residential care home. It quickly becomes clear that this is a flashback. Junn seems sad and lost. When Richard visits Junn in the residential home they struggle to connect without a common language but Richard is confronted by her indifference towards him. Richard learns that Junn has a ‘suitor’ in the form of Alan, another resident at the home, who gives Junn flowers every day despite having no ability to talk with her. As Richard is determined to see more of Junn, he arranges to pay a female friend Vann, who speaks various Chinese dialects, to translate for him and they visit the residential care home together. Initially, Richard introduces Vann as someone who can assist Junn and Alan with communication, but the opportunities also emerge for Junn and Richard to discuss Kai. Junn has no understanding of the relationship her son had with Richard and several flashbacks reveal that Kai had arranged for his mother to move into the residential home because he could not have her in his home without her knowing about his homosexuality. Crucially, the flashbacks also reveal that Kai had planned to come out to his mother just before he died.

Richard has the need to share his grief with the one other person closest to Kai but knows that he can’t do this until she understands the true nature of his intimate relationship with Kai. As part of his own grieving process Richard seeks closeness with Junn and perseveres in visiting her until he feels able to invite her back to the home he and Kai shared where he can give her Kai’s belongings. Before the truth is revealed, Richard is drained by having to stifle the outward expression of his most painful sadness. The final scene that takes place in Richard’s home brings the long awaited revelation by Richard that he and Kai were in a gay relationship and that Kai had been ready to tell her this just before he died. By this time, Junn and Richard seem to have forged a more positive bond.


Relevance to the Field of Mental Health

Lilting is a subtle and gentle film that immerses the viewer in the lives of the two main protagonists and of their emotions as they struggle to process the sudden loss of the person that was closest to them. As such, it highlights that grieving is a uniquely personal process governed by so many factors and not restricted to any distinct time period and that is almost universally assisted by a need to share sadness and memories of the lost one. Funerals are a ritualised way of bringing people together to do just such a collective remembering whilst also acting as a celebration of life. Secrets and hidden relationships inevitably get in the way of any shared grieving. In Lilting this is perfectly illustrated by the painful realisation Richard has that he must ultimately comply with Junn’s wishes to have Kai’s ashes before she knows the true nature of her son’s relationship with Richard.

The issue of language is always centre stage in Lilting, something that is so relevant in our current multi-cultural society in which understanding others may be made more challenging by any language barriers. The observations presented about the use of translators in the scenes with Vann are particularly pertinent when Richard says something and immediately asks that it not be translated, realising just in time that it’s the wrong message to give. However, Vann also shows that there are hazards to translating emotionally charged messages when she cannot help herself from saying something to Junn that was not requested and causing upset to her as a result. In addition to this, the film demonstrates how much we can communicate non-verbally when someone is speaking a language that we do not understand. Deliberate choices are made during certain scenes of the film that leave the viewer without a translation into English for what is being said by Junn and yet still offering a strong sense of what she is feeling. In this way the film gives very useful tuition on what it is like to conduct an interview through a translator.

The relationship between Alan and Junn in the residential home offers the opportunity to reflect on the nature of intimacy when there is a fundamental lack of knowledge available about a person’s background, culture, values and experiences and when these cannot be explored through common language in an ongoing way. The physical comfort that both gain from holding hands, hugging, dancing and kissing clearly meets a deep need for both elders but is it possible for a more intimate bond to develop beyond this? This question is answered when Vann the translator offers Alan and Junn the chance to talk and question each other more honestly, bringing a reality to their relationship that had previously not been possible. Once they know each other better, it is Junn who decides to end the liaison.

These issues of communication and language are key to the work mental health professionals must do and this film provides an excellent reminder of just how hard it can be to understand another person when we do not share our first language and must rely on translation by an intermediary.

I would highly recommend this film.


  • More information about Lilting, can be found at IMDB, as can a short trailer.
  • Lilting, is available on DVD and to stream on amazon.
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida


06/04/2017 18:03:58

Minds on Film Index - 7 Years On

Minds on Film Blog - 7 years onTo mark almost seven years of Minds on Film, here is an updated index of blogs in the archive. As before, they are organised by specific psychiatric conditions or particular mental health issues.








Alcohol dependence 

Alzheimer’s disease

Anterograde amnesia


Acquired Brain Injury

Assisted suicide

Adult autism & Asperger Syndrome

Bipolar disorder/Schizoaffective disorder

Bulimia nervosa

Carer stress

Cerebrovascular accident

Challenging the stigma of mental illness

Childhood autism

Deliberate self-harm



Developmental delay in childhood

Dissociative disorder

Divorce - the effects on teenage children

Domestic violence

Drug addiction


Employment and mental health

Epilepsy and psychiatric illness

Grief for the loss of a child

Growing up in Care

HIV related dementia

Homelessness and psychiatric morbidity

Huntington’s disease


Learning disability

Locked in syndrome


Mental Capacity, DOLS and the rights of persons with disabilities


Morbid jealousy

Obsessive compulsive disorder

Paranoid psychosis

Personality disorder

Problem gambling


Mental Health & acute trauma/disasters

Residential care for older adults


Schizoaffective disorder

Sexuality - in later life


Suicide/Attempted suicide

Tourette’s syndrome

Transgender issues

Uncomplicated Grief

Unemployment and psychiatric morbidity

Unusual family experiences

Vascular Dementia

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

13/02/2017 10:14:43

Life, Animated

Life, AnimatedIntroduction

Life, Animated is a documentary film released in 2016, directed by Roger Ross Williams, based on a book of the same name written by Ron Suskind. In it Suskind tells the story of his son Owen, who was diagnosed with autism at the age of three and who discovered a passion for Disney’s animated films, which later provided him with a means to communicate with his family and to make sense of his emotions more effectively. As the director is quoted as saying in an Oscar-contender interview at, “It’s really a film about the power of actual story, Owen is someone who was raised on myth and fable”. 

The film is nominated for Best Documentary Feature in the 2017 Academy Awards and has already won eleven other awards. 


The Film 

Life, Animated opens with some home video footage of Owen, a chatty young toddler, play-fighting with his father Ron in their yard. He has an older brother Walt with whom he enjoys watching television. But everything changes as Owen approaches his third birthday and suddenly becomes mute and inconsolable, resulting in a diagnosis of autism. The family observes that Owen still finds comfort in the animated films he had previously enjoyed and can continue to share this activity with his sibling. When his parents make the incredible discovery that they can communicate directly with Owen if they become a character in one of his Disney films they start using the scripts to engage with him in conversation. This is precisely how their son first begins to talk again after more than a year of silence. As Owen learns all of the scripts from each film by heart it becomes clear that he is using the films to communicate and express his feelings and emotions. Once at school, it emerges that Owen is especially identified with the supporting characters in many of the films and he becomes one with these ‘Sidekicks’. Owen has a talent for drawing and skilfully reproduces the characters he loves on paper and he learns to read and write using the credits at the end of each film. His identification with the ‘Sidekicks’ is helpful when he is forced to deal with being bullied at school. The film uses some exquisite animated scenes uniquely created to supplement the account of Owen’s earlier experiences, including with his ‘Sidekicks’, and these animations grow in complexity from black and white drawings to full colour as they depict his own emotional development. Life, Animated also contains numerous clips from the relevant Disney films that are so important to Owen in negotiating major challenges and transitions in his life. This is most poignantly illustrated by his watching of Dumbo as he packs up his things to move out of the family home after his graduation and then the viewing of Bambi (the scene in which Bambi’s mother dies) after his parents leave him in his flat for the first night. 

Life, Animated includes clips from home video to show excerpts from Owen’s life at all stages through his childhood into young adulthood but these are continually interspersed with filming of his current life. These contemporary scenes build through his final session of the Disney club he founded at his high school, his graduation, some therapy sessions to prepare him for his move into his own accommodation, the actual relocation and once there his experience of breaking up with his girlfriend of several years, Emily. This breakup presents Owen with a huge emotional challenge and the film depicts his struggle with anxiety and loss very honestly. The viewer is left with no doubt as to the challenges ahead for him, whilst at the same time the film details Owen’s transformation into an ambassador for autism exemplified by an invite to speak at a conference in Paris. Here he shares his passion for Disney films and his family’s use of them in helping him to escape from a state of mutism to a place where he can communicate effectively enough to obtain work in his local cinema complex. This makes a fitting conclusion to the film. 

Relevance to the Field of Mental Health 

Life, Animated is a documentary film that highlights the therapeutic power of the creative arts. The Suskind family’s story helps to underline the positive benefits they found in sharing in the affinity or passion of their autistic son in order to open up a medium for communication that allowed them to connect with him socially. The exaggerated expressions on the faces of the characters in animated films encouraged him to learn about the emotions and feelings of both himself and others and the scripts gave him a means of saying what he felt. It is hard not to be moved by watching Owen engrossed in the scene in which Bambi painfully calls out for his lost mother just after his parents have delivered him to his first night alone in his supported living accommodation. 

This is a very positive film to watch but it also doesn’t shy away from capturing something of the exhaustion that Owen’s parents experience as they must join him endlessly in his Disney world in order to communicate with him, or of his brother’s sense of responsibility as he wonders what the future holds once he is solely responsible for Owen’s wellbeing. It certainly demonstrates the powerful and positive effect that strong family bonds, with a huge capacity for love, kindness and endless tolerance, provide for someone like Owen suffering from autism. 

Ron Suskind has written an interesting account of his experiences in a New York Times article titled ‘Reaching my autistic son through Disney’, published in March 2014 and Ron and his wife Cornelia have created an informative website also called Life, Animated, in which they offer insights into the techniques that they have found beneficial during their parenting of Owen. There is a particular focus on the passions, which they call Affinities that those with Autism Spectrum Disorders often have. There are some personal resources based on their experiences with Owen and the website also includes input from the psychologist Dr Dan Griffiths, who supported the Suskinds in developing the concept of ‘Affinity therapy’. 

Life, Animated provides a beautifully crafted individual case study of autism that gives important insight into what it is like living with the disorder and, if viewed alongside a visit to The National Autistic Society website, it would provide an excellent learning experience that follows on perfectly from my last blog on Asperger syndrome in considering the Autism Spectrum Disorders. 


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

  •  Life, Animated, is available to stream from Amazon video and is on DVD. 

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

09/01/2017 12:03:12

Asperger’s Are Us

Asperger's Are Us

Asperger’s Are Us is described as a coming of age documentary and is the directorial debut of Alex Lehmann. It is an inspiring and entertaining film about four friends diagnosed with Asperger syndrome, which means that they are on the high-functioning end of the autism spectrum. The quartet, formed of Noah Britton, Michael Ingemi, Ethan Finlan and Jack Hanke, first met a decade earlier at a summer camp for teenagers with Asperger’s where their close friendship coalesced around their mentor Noah, who was older and working at the camp to support others with his condition. The four found a shared interest in humour and performing and out of this arose the comedy show that shares the title of the film. This documentary follows them as they prepare to stage their last public show before their young adult lives take them in different directions. Netflix acquired the worldwide rights to screen Asperger’s Are Us in March 2016. 

The Film 

Asperger’s Are Us begins by introducing us to the four friends, providing some background on each man in turn, and highlighting their individual characteristics. The young man who perhaps features most in the film calls himself New Michael (he calls his father Old Michael) rather than his given name of Aaron. The film gives a sense of the struggles that New Michael’s parents have had throughout his childhood and adolescence as they are interviewed several times. Noah, the oldest man of the troupe and originally mentor to the others, is very engaging as he provides a somewhat droll commentary and continues to be the apparent motivator for the group. Jack is introduced within his family home as he contemplates leaving home in the USA to go to Oxford University in the UK, where he has been awarded a prestigious scholarship for a year. His family outline that Jack doesn’t like to be touched and Jack appears slightly lost as his father attempts to ruffle his hair playfully. Lastly, the quietest member of the quartet is Ethan who admits to having a pronounced interest in trains. 

The film is structured as a timeline that records the troupe’s progress as they prepare for the final theatre performance of their comedy show. The hazard of rehearsing with a condition that impairs focus is well portrayed and yet their commitment to their material is very apparent. The humour tends to favour word play and is often dry, deadpan and absurd. Very little of the actual show features, but there is enough to demonstrate the nature of their humour and how it relates to their unique relationship with the world. The film even captures some members of the audience walking out during the show, demonstrating that the humour isn’t to everyone’s taste. However, the powerful bond that the four friends share is palpable and this is touchingly displayed in the film. It also has a particularly satisfying conclusion by providing a brief summary of how the men’s lives have developed more than a year after this final performance together.  

Relevance to the Field of Mental Health 

This is a feel good film about friendship and the therapeutic power of creativity in four young men who have been diagnosed with Asperger’s. It is especially interesting that they have found a social connection through humour and the collective purpose of performance. As those on the autistic spectrum, including with Asperger syndrome, characteristically struggle to use or understand facial expressions, tone of voice, abstract concepts and jokes and sarcasm, the development of a comedy routine becomes all the more impressive and interesting. 

The film provides an excellent educational resource for broadening understanding about Asperger syndrome and viewing it could usefully be combined with browsing the following resources. The website of The National Autistic Society has some very helpful information on Asperger syndrome and a very good short video titled ‘What is autism’. There is also a useful factsheet at the Royal College of Psychiatrists website with information for parents and carers about Autism and Asperger syndrome. 

Most of all, I recommend this film for its ability to portray its subjects without pity or negativity about their disability despite showing some of the challenges that they face. It seems that this is just what the four friends would wish. They are quoted as saying that their show is not an autism awareness campaign but a pure comedy act designed to entertain. What a fun way to start the year! 

  •  More information about Asperger’s Are Us, can be found at IMDB, as can a short trailer. 

  •  Asperger’s Are Us, is available to stream from Netflix and from Amazon video. 

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

14/11/2016 09:39:59


This animation contains adult themes of a sexual nature and nudity. It is rated 15.



Anomalisa is a feature-length stop-motion animation film directed by Charlie Kaufman and Duke Johnson, its screenplay written by Kaufman and based on an earlier radio play that he wrote in 2005. It has been very well received by critics, was nominated for an Academy Award in 2016 and has received 20 awards. Stop motion is a painstaking technique of animation, which involves taking approximately 25 photographs per second of a puppet or scene as minute changes are made to them (an article written by Tim Martin in The Telegraph newspaper, in March 2016, provides a good understanding of this method of animation as he considers Kaufman and Johnson’s production).

Anomalisa is a psychological drama centred on the main protagonist Michael Stone (voiced by David Thewlis), an author and motivational speaker in the field of customer service. He is suffering from mid-life depression and is searching for a special person that will make him happy as he struggles with a sense of boredom and a feeling that everyone is the same. The feeling of ‘sameness’ is represented in the film by all of the characters, except for that of Michael and Lisa (who is voiced by Jennifer Jason Leigh), being voiced by the same male actor (Tom Noonan). In addition, all of the puppet faces have the same central features, except for those of Michael and Lisa.

The Film

The soundtrack that accompanies Anomalisa’s opening credits presents us with a cacophony of voices of increasing intensity. We see Michael on an airplane travelling to Cincinnati. He takes some prescribed medication just before landing and also looks at an angry letter from a former girlfriend. As he walks through the airport terminal, Michael blocks out the voices around him by listening to some calming music through headphones. The viewer might observe the similarity of the faces that surround Michael. Once Michael is in a taxi driving to The Fregoli hotel, the attentive viewer may become aware that the driver also has the same face and voice as the people chattering in the airport terminal. The taxi driver spots that Michael has a British accent, asks where he is from, and urges him to visit the local zoo. Michael informs him that he actually lives in Los Angeles and then asks if there is a toy store near to his hotel. Once in his hotel room, Michael makes a phone call home to his wife Donna and their son Henry. The lack of emotional connection with his family is palpable. He tries to rehearse his presentation for the following day but his thoughts soon turn once again to his former girlfriend Bella, still living in Cincinnati. He calls her, wanting to apologise for the way in which he abruptly ended their relationship many years before, and tells her that he misses her. He asks her to meet him in the bar of the hotel. He tells Bella that he thinks he has psychological problems and she comments on his drinking habit. Michael suggests that they go upstairs to his room, which shocks and angers Bella prompting her to leave the bar immediately. Gaining no satisfaction from the meeting, Michael seems sadder and more alone than ever.

He goes out to the suggested toyshop in search of a gift for his son, but discovers that the taxi driver has actually sent him to a sex shop. Here he finds an antique Japanese doll, a sex toy, which he buys despite it being so obviously inappropriate as a gift. Back in his room and after a shower he has a strange perceptual experience while looking at his face in the bathroom mirror and at the same time hears the voice of someone else nearby which frightens him. He runs out of his room knocking on doors nearby. It is then that he meets two women Emily and Lisa, who are booked to see him speak at the customer services conference the following day. Michael invites them to have drinks in the bar and he becomes instantly attracted to Lisa, in part because of her lovely voice (which is distinct because it is actually voiced by a female actor). Lisa has had past trauma and is marked by a scar on her face. Michael invites her back to his room and seduces her by trying to counter her lack of self-esteem related to her disfigured face and her feelings of alienation. She sees herself as different, an anomaly, and Michael creates a name for her and the film in Anomalisa. He feels that Lisa is ‘the special one’ for him, the person who might release him from his entrapped and boring life. After having sex they go to bed and sleep. Michael has a torrid nightmare in which he experiences fear and paranoia and expresses the belief that everyone is the same one person, except for him and Lisa. Once awake and during their breakfast the next morning he hears Lisa’s voice differently, overlaid by the same male voice of all of the other characters, reprising the taxi driver’s recommendation to visit the local zoo. At this point he begins to feel different and suspicious about her. Michael accuses her of being controlling and seems to become more agitated, even as he discusses plans to leave his wife for her. He is so distressed that he finds himself unable to perform at the conference presentation a little later. The film ends with him returning home to his wife and son and asking her "who are you Donna, who are you really?"

Relevance to the Field of Mental Health

This is a film about mid-life depression, which also hints at a rare delusional disorder called the Fregoli syndrome, in which the person believes that everyone is actually the same person in disguise. It is classed as one of the Delusional Misidentification Syndromes (DMS) and the signs and symptoms usually occur in the context of other disorders, most commonly schizophrenia, affective disorders, substance misuse, organic brain disorders and traumatic brain injury. More recent studies using neuroimaging suggest that these DMS may be associated with identifiable lesions in the right frontoparietal and adjacent regions of the brain.

In the extra features on the DVD, Kaufman acknowledges that his interest in the Fregoli syndrome was sparked by reading an article about the condition, which inspired him to incorporate the concept into his script although he denies that Michael’s character actually suffers from the syndrome (more about this is outlined in an article written by Julia Llewellyn Smith in The Telegraph newspaper in March 2016).

Anomalisa is an intriguing animation, which powerfully conveys emotion and psychological crisis through its puppets in a most remarkable way, including a sensitively portrayed scene of sexual encounter. At times the film leaves the viewer unsure of what they are seeing and perhaps lacking trust in knowing what is real and what is not real in the protagonist’s world. This filmic experience might open up a window on the world of someone suffering from abnormal perceptions and in particular of the bizarre Fregoli delusion. The film will sharpen the viewer’s powers of observation and I cannot recommend it more highly, especially as it invites any mental health professionals to consider a more unusual and challenging diagnostic formulation in the context of Michael’s mid-life depression.


  • More information about Anomalisa can be found at IMDB, as can a short trailer.
  • Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida

03/10/2016 09:20:40



ConcussionConcussion, written and directed by Peter Landesman, was released in the USA in 2015. The film tells the true story of how Chronic Traumatic Encephalopathy (CTE) was identified  and named in 2002 by forensic neuropathologist, Dr Bennet Omalu (played by Will Smith), while he was working in Pittsburgh, USA. Omalu identified CTE as an entity after studying the deaths of several retired American football players. He realised that these former players had suffered significant psychiatric morbidity in the years after their retirement from the game. This discovery has contributed to a greater understanding of the long-term effects of repeated concussions in those competing in contact sports and has influenced attitudes to the management of concussive episodes on the field in a wider number of sports such as rugby, ice hockey and horse racing as well as in American football. There has also been a particular focus on the management of concussion in school age children, with more stringent pitch side assessments that prevent participants from re-entering a game until they are assessed as having fully recovered from a concussion under supervision.

As well as telling the story of his scientific discovery, the film also depicts the enormous struggle that Omalu, an immigrant from Nigeria, and his few supporters faced when trying to report their findings to the scientific community and the wider world of sport, as his results appeared to threaten the corporate interests of the National Football League (NFL). As such, Concussion is a film about whistleblowing and Omalu has been likened to ‘David’ as he took on the NFL seen as ‘Goliath’. Although this aspect of the film is presented in the style of a classic Hollywood drama, the film still succeeds in raising the profile of an important and ongoing issue, namely how hard it may be to tell truth to power.

The film has been nominated for several awards, including a Golden Globe nod in 2016 for Will Smith.

The Film

Concussion opens with the death of former American football player Pittsburgh Steelers centre Mike Webster at the age of 50. His postmortem is carried out by Omalu in his very particular style of working. Webster's pre-morbid psychiatric difficulties are noted by Omalu and when another retired player presents with psychiatric problems before his early death too, the pathologist starts to look for a common neuropathology.

As Omalu suggests a connection between the repeated head traumas suffered in the course of playing American football and the microscopic findings post mortem, he begins to find his work obstructed and colleagues turning against him. When he loses his research funding he is so determined to continue that he uses his own monies. It is only when a former football team doctor joins him and supports his research that he is able to take his findings forward and present them to the wider scientific community. Omalu’s resilience and determination are admirable but his ultimate satisfaction does not occur without a test of his character and of his close personal relationships.

Relevance to the Field of Mental Health

Concussion in sport is now increasingly recognised as something that needs more research, particularly into its long-term effects. The International Concussion and Head Injury Research Foundation, (ICHIRF) is a London based not-for-profit organisation that has been created to carry out independent research into concussion and head injury. In its research project Concussion in Sport it aims to ascertain whether there is an increased incidence of neuro-degenerative disorders (such as Alzheimer’s disease, Parkinson’s disease and Chronic Traumatic Encephalopathy) in retired sportsmen and sportswomen who have competed in contact sports and sustained concussions, and whether these disorders might onset at an earlier age in this population. The study is currently recruiting both retired athletes and controls and it involves an online questionnaire (this takes about 15 minutes) every year for at least the next 4 years.This research foundation works closely with the charity called The Concussion Legacy Foundation in America, whose website has a wealth of material for learning more about the subject and in particular some very good information about CTE.

Earlier this year the NFL finally acknowledged a link between playing American football and CTE (read this Frontline article written by Jason Breslow in March 2016) following the research findings of Boston based neuropathologist, Dr Ann McKee. In her research, McKee found evidence of CTE in 90 out of 94 brains she examined postmortem of former NFL players. In a fascinating 46 minute Frontline video interview, she describes her work and her consultations with the NFL about the effects of repeated mild brain trauma that takes place during the course of a football game. She recounts how she had first encountered Omalu’s evidence in a poster presentation at an Alzheimer’s disease conference and later how she was asked if she would examine the brain of a football player by the co-founder of The Concussion Legacy Foundation, former wrestler Chris Nowinski. The evidence is now so strong that current players are much more aware of the risks that playing presents and last year Chris Borland, a promising player for the San Francisco 49ers, quit at the age of 24 after fearing for the effects of repeat concussions on his health (see BBC report).

For anyone involved in providing medical support to players during competitive contact sports, there is a useful Pocket Concussion Recognition Tool on the BMJ website taken from the Concussion Statement on Concussion in Sport, published in the British Journal of Sports Medicine 47 (5), 2013, by McCrory at al, which provides clear guidance on screening anyone who is suspected of having suffered a concussion.

This film highlights a topical and very important issue that is especially relevant to anyone working in the field of Acquired Brain Injury or Sports Medicine.

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

Concussion is available on DVD at or for streaming on Amazon video.

• 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 retired consultant
psychiatrist based in the UK.

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


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