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



Helen is a film about depression. It was written and directed by Sandra Nettelbeck and released  at the Sundance Film Festival in 2009. Inspired by the death of a depressed childhood friend through suicide, Nettelbeck researched the topic over many years before producing the screenplay. With excellent performances by all of the main actors this is an important film that contributes to a much needed wider understanding of depressive illness.

Helen offers a deeply realistic portrait of the symptoms that sufferers of depression may experience and the efforts that are often made to manage the illness, which may involve a variety of treatment options, including electroconvulsive therapy. The film brilliantly highlights the sense of isolation that people with depression may have. It also depicts well the impotence and frustration that partners can feel as they witness their loved one becoming more distant and disconnected within their relationship, affording a valuable empathic experience of life with a partner or parent suffering from depression.


The Film

The film opens with silent footage from an early home movie featuring David, Helen and her young daughter Julie playing on a beach. This is followed by a quote by Andrew Solomon, himself a sufferer of depression and author of a book called The Noonday Demon: An Atlas of Depression published in 2001 (New York Times review). It states:  “Two and a half years ago, Hell came to pay me a surprise visit.”. This sets the scene for the story that follows.

We first meet Helen, played by Ashley Judd, as she comes home to a surprise birthday party with friends and family to find a giant bow on a new piano. Even in this opening scene there are hints of Helen’s unhappiness that prepare us for what follows as she is seen in a room away from the guests, head bowed. She works as a professor of music at university and lives seemingly happily with her second husband of ten years, David, played by Goran Visnjic, and her teenage daughter Julie, played by Alexia Fast. In another early scene, one of her students at the university called Mathilda, played by Lauren Lee Smith, is seen struggling to compose cello music to some video footage when Helen encounters her late at night on campus. This meeting reveals that Mathilda has issues of  frustration and low self esteem. But Helen’s illness first becomes obvious when she leaves a dinner party in a restaurant with friends to go home, telling no one. When David gets back later she tells him that she doesn’t feel well and from that point on her descent into illness proceeds steadily. A visit to the doctor results in some medication being prescribed and a warning to ‘keep an eye on her’. But without a positive response to the antidepressants, and a disturbed sleep pattern, Helen is found holding a knife to her chest by her husband in the middle of the night. After taking her to the hospital for an informal admission to the psychiatric ward, David expresses his inability to understand why his wife could be unhappy. The doctor replies “Your wife is not unhappy. She is ill.” David also learns that Helen suffered from an episode of depression several years before they met. A compulsory admission follows later and a recommendation for electroconvulsive therapy.

In hospital, Helen meets her former student Mathilda, who is also an inpatient in the same ward, suffering from acts of self-harm, anger and depression. They forge a bond of mutual understanding which develops beyond discharge and results in Helen leaving her home and husband to lodge with the much improved Mathilda while Helen continues to struggle with her chronic depressive symptoms. Mathilda takes her on a trip to stay in a house by the sea that was left to her at the age of eight after Mathilda’s mother committed suicide. This brings greater awareness of the childhood traumas that may have shaped Mathilda’s disturbed behaviour and depression. During this visit, Helen tries to drown herself and is rescued by Mathilda. A confused kiss takes place between the pair which feels laden with transferential overtones for both the mother and daughter figure that they represent for each other.

On returning to Mathilda’s city apartment, Helen is visited by her daughter Julie and this seems to jolt her into seeking help once again. This time she returns to the hospital for electroconvulsive therapy that had been recommended by doctors earlier. After a course of treatments, realistically portrayed, Helen begins to recover. It is then that she makes contact with her husband and the family is finally reunited. However, when Helen revisits Mathilda in her apartment, she finds a worrying situation but is powerless to prevent the tragic consequences that follow.

Relevance to the field of Mental Health

Helen provides a very good foundation for a discussion about depression, deals with the issue of suicide, and also considers various treatment options. With two of the main characters presenting a portrait of depression, Helen offers an opportunity for learning about recurrent depressive disorder and depression associated with Borderline Personality Disorder. Readers may find it helpful to access the NICE guidance on depression in adults (CG90) for more information about the treatment of the illness alongside a viewing of the film.

The treatment options shown include medication, voluntary and compulsory inpatient admission and the administration of electroconvulsive therapy (ECT), which is the treatment intervention that is ultimately responsible for Helen’s recovery. This provides an excellent basis for learning about the role of ECT in the management of depression and there is a good factsheet at The Royal College of Psychiatrists website that could be used to enhance this.

The film uses many scenes in darkened rooms, where the viewer struggles to see what is happening. This effectively reflects the hopeless isolation that many with severe depressive disorder describe, when they talk about not being able to see a way out of their situation and which may lead to a contemplation of suicide. The viewer experiences both Helen and Mathilda attempt suicide, making this an excellent film for teaching about this difficult topic.  An article, freely available online, that may be helpful to those working in mental health settings called Suicide following discharge from inpatient psychiatric care by Mike J. Crawford was published in Advances in Psychiatric Treatment (2004) 10: 434-438 provides very relevant background reading.

In contrast to Helen, Mathilda is seen seeking out destructive violent sexual encounters that cause her pain and self-loathing as well as acts of deliberate self harm in a repeated attempt to feel something and fill her emptiness. Understanding about this portrait of depression associated with borderline personality disorder might be enhanced by a reading of the article entitled Recent developments in borderline personality disorder by Anthony P. Winston published in Advances in Psychiatric Treatment (2000) 6: 211-217, available in full online.

Helen is a compelling film that engages the viewer wholeheartedly in two fictional case histories of depression. As there are so few films focusing in this way on the detailed portrayal of this illness and its treatment, Helen is essential viewing for anyone interested in working in the field of mental health.

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

  • Helen can be purchased at, but is only available as a region 1 import from the USA. It is also available on Lovefilm instant.

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

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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.