This is the third blog in my short series about elderly
residential care.
Introduction
The Savages, written and directed by Tamara
Jenkins, and described as a tragicomedy, was released in 2007. It
tells the story of two middle aged siblings, Wendy and John,
estranged from their father Lenny for many years, who are suddenly
faced with his physical and cognitive decline in older age, which
demands their involvement. The film explores the different
responses of the two siblings to this enforced caring relationship
in light of the revelations about their father’s abusive
relationship to them both as children. Of interest to Old Age
Psychiatrists is the suggestion that Lenny is suffering from a
dementia associated with Parkinson’s Disease, allowing for a
discussion about the possible differential diagnosis.
The filmThe Savages opens in
a retirement village in Sun City, Arizona, where Lenny Savage,
played by Philip Bosco, is living with his long time girlfriend
Doris, who has a home healthcare professional, Eduardo, to assist
her with her daily living. When Lenny fails to flush the toilet
after Eduardo asks him to do so, and Lenny writes an insult on the
bathroom wall with his faeces, alarm bells start ringing. Shortly
after this Doris dies and her family call Wendy, played by Laura
Linney, to inform her of the crisis. Both siblings John, played by
Philip Seymour Hoffman, and Wendy are deeply engrossed in their own
lives on the east coast of the USA where John is a professor of
drama and Wendy a playwright yet to find financial backing. Neither
have settled relationships and both seem to struggle with a life
outside of their work. As they meet in Arizona to visit their
father, they learn that he has no legal right to live in his
girlfriend’s home and that he has been admitted to hospital for
tests after suffering from episodes of faintness and the faecal
smearing incident. On their first visit to see Lenny in hospital,
John and Wendy find him restrained in bed because he was attempting
to pull out his intravenous line and to get up from bed despite
being unsteady and having falls. The doctor informs them that their
father does not have vascular dementia but most likely a dementia
associated with Parkinson’s disease, which accounts for his masked
face and blank stare, his disinhibition, aggression and fluctuating
disorientation.
John decides to find a nursing home for Lenny near
to where he lives and although Wendy considers that they should try
to look after their father or find him a supported living
placement, she is reluctantly persuaded that residential care is
the only realistic option. Once a residential placement has been
sorted out by John, Wendy is tasked with bringing her father to
Buffalo, New York state, by plane from Arizona. This is a painful
scene that brings home the reality and potential difficulties of
traveling any distance with someone who suffers from a
significantly disabling dementia, as Lenny becomes perplexed and
agitated when in the unfamiliar surroundings of the aircraft cabin
and cannot move about freely. Once admitted to the Valley View home
in Buffalo, Lenny shows his complete lack of understanding about
his circumstances, believing it to be a hotel. Wendy’s guilt cannot
be assuaged and she attempts to get her father admitted to ‘a much
nicer’ residential home. However, this requires Lenny to ‘pass an
interview’ that proves he is not cognitively impaired. Of course he
fails this test but remains unaware and unaffected by the heated
emotional discussion that follows between Wendy and John as the
latter tries to get his sister to accept their father’s disability
and his consequent care needs. The film follows the siblings as
they deal with Lenny’s death and the period that follows it as they
move forward positively in their individual lives, able to mourn
for their father, whilst being released from their traumatic
childhood experiences.
Relevance to the field of Mental Health
The Savages offers an excellent
opportunity to consider the issue of care for an elderly person who
may not have any close biological family ties. In contrast to the
first film in this movie series,
A Simple Life, that portrayed the bond
of employer and employee proving strong enough to support an ageing
housekeeper after her move into a care home, The Savages
deals with estranged adult children forced into the caring role by
duty. As more people in our society live longer and suffer from
dementia in greater numbers, these issues are likely to become
increasingly important for professionals to consider and
understand, as not everyone has family members prepared to take on
the unpaid role of personal carer. The need for greater support of
people suffering with dementia in the community is acknowledged in
the UK and a recent initiative by Public Health England and the
Alzheimer’s Society is encouraging people to learn more about
dementia in order that they might befriend someone with the
illness. This initiative is called
Dementia Friends and more information can be
found on the Alzheimer’s Society website.
The other topic of psychiatric interest in this
film is Lenny’s tentative diagnosis of dementia related to
Parkinson’s disease. This provides the opportunity for learning
about dementia in Parkinson’s disease and Lewy-body dementia. As
Lenny has a masked face with a blank stare, disinhibition,
aggression, apathy, faintness, unsteadiness with falls and
fluctuating disorientation it might be argued that he most likely
has dementia with Lewy bodies as the cognitive change precedes the
development of the classic Parkinsonian movement disorder. In
contrast, dementia in Parkinson’s disease usually presents first
with the classic movement disorder and later with the cognitive
impairment. However, both conditions are caused by the presence of
Lewy bodies in various areas of the brain and their location
determines the symptoms that are seen. The Alzheimer’s society has
a good information page about dementia with Lewy bodies
(DLB
)and the Alzheimer’s
Association in the USA has a good page outlining
the difference between both DLB and dementia in Parkinson’s
disease. In addition, for mental health professionals, a detailed
article on
Dementia with Lewy bodies by I G McKeith,
published in BJPsych in 2002 (The British Journal of Psychiatry
(2002)180: 144-147) might be useful to read.
The Savages is a sad and painful film to
watch as it deals with a difficult subject that many people wish to
avoid until it visits their own circle of family or friends.
However, by the end of the film there is a positive sense that the
adult siblings have found a stronger and more meaningful
relationship with each other as a result of being forced to
confront the care of their father before his death and that this
may also have helped them to find better fulfillment in their lives
generally. As a depiction of the guilt suffered by adult children
often associated with placing a parent with dementia into
residential care The Savages is essential viewing.
• More information about The Savages can
be found at IMDB as
can a short trailer.
• The Savages can be purchased from
amazon.co.uk.
• Minds on Film is written by Consultant
Psychiatrist, Dr Joyce Almeida
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