introduction
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
amazon.co.uk, 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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