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


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02/04/2015 09:02:55



Smashed, directed by James Ponsoldt, was released in the UK in December 2012. It tells the story of a young married childless couple, Kate and Charlie Hannah, whose relationship centers around drinking alcohol. Kate, played very convincingly by Mary Elizabeth Winstead, manages to function as a primary school teacher until several alcohol related harmful incidents cause her to question this lifestyle and she seeks sobriety. Unfortunately this choice has implications for her husband Charlie, played by Aaron Paul (of Breaking Bad fame), who remains addicted and sees no reason to change, putting their relationship under great strain.

Smashed was very well received by critics and audiences, and got some extremely good reviews from former addicts who commented on its authentic portrait of alcohol dependence. It is particularly useful as an educational film for patients seeking help and for professionals engaged in providing that support and treatment.

The Film

Smashed opens with Kate taking a quick drink as she showers before heading off to work as an infant school teacher. She notes that she’s wet the bed again too. When she reaches the school car park, she takes a swig from her flask to get her started for the day. Her husband Charlie works from home as a rock music journalist and leads a less pressured existence, so he stays sleeping in bed, finding it hard to get up. Kate appears to be coping fine until she finds herself unexpectedly vomiting in front of her class of young children, some of whom ask if she is pregnant. Kate sees this as an immediate solution to her dilemma and lies to them confirming that she is indeed pregnant. The news travels fast to the principal, a woman who cannot have her own children, and so becomes invested in Kate’s seemingly positive news. However, a male colleague, Dave Davies, who is a recovering alcoholic, quickly detects the truth about Kate and offers her a route to sobriety through attendance at his Alcoholics Anonymous group, without betraying her trust. Kate is initially unsure about seeking help in this way, but after a drunken night out on the ‘wrong side of town’ involving the consumption of crack cocaine and a night sleeping rough, she finds the motivation.

When she first accompanies Dave to his AA group she meets an older woman, Jenny, who becomes her mentor and a positive influence in her life. Unfortunately Dave flirts clumsily with Kate on the way home after the meeting, Kate deals with this firmly and effectively, stating her loyalty to Charlie. As Kate begins to feel pride in her sobriety, her relationship with Charlie suffers because of his continued drinking and the lifestyle that is associated with it. Kate decides to visit her mother for the first time in years and Charlie insists on going with her. Kate’s mother is revealed as a drinker, embittered by the breakup of her own marriage and the sobriety of her ex-husband who now has a new family. The tensions in their mother-daughter relationship are very apparent.

When Kate is finally forced to reveal the truth about her non-existant pregnancy to the principal at school, she loses her job, causing a brief relapse of her drinking. However, she gets back on track with the help of Jenny and Dave and faces the reality about the impossibility of marriage to Charlie if he continues to drink. The final scene jumps forward a year when the couple meets again after Kate has been sober for a year. Charlie, who is still drinking, wants to give their relationship another try but she sees that he has not changed and knows that it is over for her.


Relevance to the Field of Mental Health

With increasing recognition of the role that excess alcohol consumption plays in the physical and mental ill health of individuals, this film portrays a very important problem that currently faces our society.

Smashed gives a compellingly believable presentation of two individuals with alcohol use disorders and follows Kate through her attempt to get help using Alcoholics Anonymous. The film could be used to teach about the subject, perhaps alongside a reading of a recent Clinical Review published on 21st February 2015 in the BMJ, written by Ed Day, Alex Copello and Martyn Hull, called Assessment and management of alcohol use disorders (BMJ2015;350:h715). The article is aimed at GPs and non-specialist hospital doctors and an abstract is freely available as well as a 30-minute discussion about the topic with the authors of the review (which can be heard as an audio track on soundcloud).

Psychiatrists might find it informative to read two recent articles in BJPsych Advances on the subject of drug and alcohol addiction, by Jason Luty. The first entitled Drug and alcohol addiction: new pharmacotherapies (10.1192/apt.bp.114.013367) and the second called Drug and alcohol addiction: do psychosocial treatments work? (10.1192/apt.bp.114.013177). There is also a recent CPD online learning module called Alcohol-related brain damage that would provide an additional useful resource.

Lastly, the charity Alcohol Research UK funds high quality research into alcohol-related harm and hosts many useful resources at their website.

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

Smashed is available to purchase from

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


02/03/2015 08:10:13

My Life: Mr Alzheimer’s and Me

Introduction In this blog I want to present a very different short film about dementia, directed by filmmaker Natasha Dack. It is made from the point of view of three children, all of whom have a grandparent suffering from either vascular or Alzheimer’s type dementia. The film is called Mr Alzheimer’s and Me and it was made for children as part of the excellent My Life series of documentary shorts, shown on the CBBC channel in the UK, on 4 February 2015. Dack was inspired by her son’s experience of his great-grandmother suffering from dementia in her 90s. She was keen to explore how these particular bonds between the generations are affected when the grandparent’s memory of their grandchildren becomes compromised.

The FilmMr Alzheimer's and Me

Watch the film’s trailer available on YouTube   

Mr Alzheimer’s and Me is currently available to stream or to download from BBC iPlayer, but only for the next week (although they will remain available to view for a further 27 days after download). The programme description is as follows:


My Life Series 6: 3. Mr Alzheimer's and Me
Josh, Ella and Hope all have one thing in common - they have a grandparent with dementia. It isn't easy having to be 'the grown-up' when their grandparents get forgetful. But all three of them are determined to help them as much as they can. They all have their different ways of coping, which they want to share with other kids going through the same thing, and have recorded personal moments with their grandparents on their own cameras. Josh is determined to help his [granddad] remember and secretly gathers mementos for a memory box. Ella decides to organize a sponsored walk to help raise money for research into the causes of dementia. Hope's granny gives dementia a character - Mr Alzheimer's - to help Hope come to terms with it all.


Relevance to the Field of Mental Health

This is a powerful short film, offering three individual family portraits of dementia as experienced by the grandchildren of each grandparent suffering from the illness. It also provides three useful clinical portraits from different stages of the disorder that could form the basis for learning about the presentation and progression of the illness. The scenes filmed by the children themselves provide an intimate portrait of their interactions and the bonds that they share with their grandparent. In some of Ella’s interactions with her granddad, his loss of understanding of the meaning in her questions is especially well captured. Some of the strategies the children use in the film, such as Josh’s construction of a memory box, are useful tools that can be employed in care settings as well as within the family home and could provide the inspiration for further discussion about the techniques that can be employed to improve the quality of life for people who are developing memory problems.

I hope that the BBC might consider making the film available for general use beyond the time that it is accessible on iPlayer, as I believe it is such a valuable resource.  Families in which an elder has just received the diagnosis of dementia might find it helpful to view with their children. It is also a wonderful learning resource for mental health professionals and educators, too, as there are increasing numbers of children who will encounter dementia within their families.

My Life: Mr Alzheimer’s and Me is available for the next week on BBC iPlayer (CBBC channel)

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




02/02/2015 09:12:29

Two Days, One Night

IntroductionTwo days, One Night

Two days, One Night, written and directed by brothers Jean-Pierre Dardenne and Luc Dardenne, was released in 2014. It is in French with English subtitles. It features a young Belgian mother called Sandra, played by Marion Cotillard, whose job is threatened after a period of absence due to depression and anxiety. The film follows her over a weekend in which she tries to persuade her work colleagues to allow her to keep her job instead of receiving a substantial bonus, the choice given to them by the management. Based on a number of actual employment cases in France, the Dardenne brothers have talked about a need to explore the cruelty of the workplace in which such tactics might be used, especially in recent times of austerity when employees may be pitted against each other in competition for jobs. As mental health stigma and discrimination are important issues in the UK, ones currently being highlighted by the Time to Change campaign, this is an enormously important film for all mental health professionals to watch and possibly to use in teaching about the issue. It has already won a number of awards for Marion Cotillard as Best Actress and for Best Foreign Language film and is nominated for a BAFTA award in 2015.

The Film

Two days, One Night opens one Friday afternoon with Sandra resting at home when she is woken by the phone ringing. What is not immediately clear but subsequently unfolds is that one of her good friends and work colleagues, Juliette, has called to inform her of a vote held that day at their workplace to decide whether Sandra should return to her job after a period of sick leave caused by depression and anxiety. It seems that in the vote her colleagues were asked to choose between allowing Sandra back to work or receiving a bonus of €1000 each. The foreman has untruthfully informed some of her colleagues that if they don’t vote for Sandra to lose her job one of them might have to go, so influencing the decision. Initially hopeless and anxious, Sandra reaches for her anxiolytic medication and takes a tablet. Her husband returns from work, hears the news and insists that she must fight for her job by asking for another ballot, this time a secret one, on Monday giving her the chance to speak to all of her workmates in person over the two days, one night of the weekend. The manager grants the ballot and the subsequent conversations between Sandra and her colleagues form the substance of the film.

Each of Sandra’s encounters with her colleagues is filmed in real time with hand held camera shots, which bring an authenticity to the encounters that is very effective in conveying the difficult emotions present in each encounter. Of course, each person has a need for the bonus and reacts differently to Sandra’s plea to forego it so that she may keep her job. One person reveals that the foreman told him that Sandra’s mental illness makes it likely that she’ll perform more poorly at work. Sandra faces the dilemma that the increasing stress of her situation is causing her an increase in anxiety and a need for more medication at the same time as trying to reassure colleagues that she is recovered and ready to return to work.

Once Sandra believes that she has not gained the support of more than half her workmates, she is overcome with hopelessness and takes an impulsive overdose of Alprazolam (the benzodiazepine she is prescribed for her symptoms of anxiety and panic). Just as she has done this, a colleague calls at her home to say that she has changed her mind and will support her and so Sandra confesses to taking the overdose and is immediately taken to hospital by her husband. By Monday morning of the ballot Sandra returns to work resigned to the possibility of either decision, as the numbers are very close in her estimation. The ending of the film poses an interesting dilemma for Sandra.

Relevance to the Field of Mental Health

Two days, One Night tackles a number of important mental health topics. With its compelling portrait of depression, anxiety, panic and an impulsive overdose of prescribed medication the film offers a good platform for teaching on these conditions. But it is particularly useful for considering the subject of stigma in the workplace and the ways in which people can be helped back, by employers and colleagues, to their jobs after a period of sick leave caused by mental illness. There are some excellent resources about this issue at the Work and Mental Health pages of The Royal College website, with sections for Workers, Employers, Clinicians and Carers. These pages could be used alongside a viewing of the film to explore the subject and provide a good teaching package. An article in Advances in Psychiatric Treatment published in 2003 entitled Work, employment and psychiatric disability by Jed Boardman (Advances in Psychiatric Treatment (2003) 9: 327-334), now freely available, also offers additional useful material on this topic that might inform a discussion (bearing in mind that it was written more than a decade ago when the economic climate was somewhat different).

In summary, this is a film well worth watching for mental health professionals seeing people who work in an increasingly harsh employment world, experiencing higher levels of stress whilst often having lower job security.

• More information about Two days, One Night can be found at IMDB, as can a short trailer.

Two days, One Night can be purchased from Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida


06/01/2015 08:58:49

A Single Man

A Single Man

A Single Man, directed by first time director Tom Ford, was released in 2009. Set on one day in 1962, it is based on the novel of the same name by Christopher Isherwood, and stars Colin Firth as George Falconer, a middle-aged English college professor living and working in Los Angeles. George is the single man of the title by nature of his homosexuality and because of the death of his lover, Jim played by Matthew Goode in flashback scenes, eight months earlier. Firth won Best Actor at the Venice Film Festival for the role in 2009 and a BAFTA for best actor in 2010. Tom Ford also won the Queer Lion award at the Venice Film Festival in 2009 (an award given to the Best Movie with LGBT Themes & Queer Culture).

As we observe recent negative legal changes pertaining to homosexuality in parts of Africa and in Russia, it is perhaps useful to be reminded of the reality of a closeted life for individuals living in intolerant societies as portrayed in A Single Man. It is interesting to note that, even in twenty first century America, there was some controversy about the marketing of the film, with accusations, by some, that the trailer and the cinema poster had been stripped of any gay content in an attempt to improve the film’s chances of receiving Academy Award nominations.

The Film

A Single Man begins with a dream sequence in which George is suspended naked and alone underwater before a snowy scene breaks through and he approaches the bloodied body of his lover, Jim, and their dog, both lying dead beside a car wreck. The soundtrack becomes dominated by an increasingly rapid heartbeat until George wakes in panic to the day in 1962 in which he decides he cannot go on any longer. His narration states this. The film presents the details of George’s day as he plans to end his life by suicide. He examines the hand gun he has kept in a drawer of his desk and calmly begins the process of placing keys, financial documents and suicide notes on his desk with the suit he wishes to be dressed in after death nearby and a written note asking that his tie be knotted in a particular way. Then he takes a call from his old English friend Charley, played by Julianne Moore, inviting him to dinner that evening.

George lives in an architect designed glass house, at once so open and transparent in contrast to the reality of the closeted life he is forced to live. He observes the family next door through his toilet window as the children play in the garden, compounding the differences between his life and theirs. George is resolved to complete his normal teaching commitments as a college professor that day and drives off from home as usual. In the lecture theatre, George appears unable to connect with his students when he attempts to discuss those individuals in society that are ‘invisible’ or different, except for one student, Kenny, who seems more attracted to George than to the subject of his lecture. Once he has finished teaching, George empties his work desk before preparing to drive away. But at his car he is stopped by his student Kenny, who asks if he is going away because he saw him clear his office. George gives nothing away about his inner thoughts. After leaving campus, George visits his bank to put his finances in order and to remove all of the contents from his safe box, including a naked photo of Jim. The photo triggers a flashback from their earlier life and indeed their relationship is pieced together through the various earlier scenes that are offered throughout the film.

On his way home George stops to buy some alcohol for his dinner with Charley that evening, and meets a young Spanish male gigolo. They share a cigarette and watch the sunset in the car park before George turns down an offer of sex to return home, seeming to enjoy all of these experiences with a newly heightened perceptiveness. It is this change in the quality of his interactions and observations that ultimately seem to beckon him back to the world of the living. However, back home before changing for his dinner date, George rehearses how he will shoot himself and cannot feel quite satisfied with any particular strategy. He arrives at Charley’s home to eat a beautifully prepared meal. They drink and dance to music from the past before she angers George by carelessly dismissing his relationship with Jim as not real or proper just as she expresses hope that they may be able to rekindle a long ago brief sexual encounter. After leaving her home he goes to a bar to buy a bottle of spirits but meets with Kenny who has been following him. They flirt and end up swimming naked in the sea before going back to George’s house where they both fall asleep. When George wakes he finds Kenny sleeping and holding George’s gun under his blanket to prevent George from using it. It becomes clear that Kenny had discovered the meticulous plans for suicide laid out on the desk. George retrieves the gun and locks it back in his drawer before burning all of his suicide notes. Sadly he then slumps on the floor, suffering a fatal collapse just as he has recognised that he might be ready to embrace life again.

Relevance to the Field of Mental Health

A Single Man presents a portrait of bereavement stifled by anti-gay sentiment that prevents George from attending his partner’s funeral or even being formally told of his death by Jim’s family. George’s recurrent flashbacks perhaps represent an attempt to work through the loss without the usual rituals, in a society where he is unable to openly talk about or share his grief with anyone. The only person he can tell is his old English friend Charley, who is struggling to deal with her own psychological distress and who is drinking heavily, after the breakdown of her marriage. Even worse, Charley persists in expressing an unhelpful desire to rekindle an early liaison with George despite his declared homosexuality and the recent loss of his partner Jim.

As the film examines the day in which George has decided to end his life, A Single Man offers a very good opportunity to discuss the topic of assessing suicidal risk, perhaps alongside a reading of the 2013 article by Alys Cole-King, Victoria Parker, Helen Williams and Stephen Platt, entitled Suicide prevention: are we doing enough? (Advances in Psychiatric Treatment (2013) 19: 284-291, abstract). In another relevant article published in Advances in Psychiatric Treatment in 2005, by Joe Bouch and John James Marshall, entitled Suicide risk: structured professional judgement (Advances in Psychiatric Treatment (2005) 11: 84-91) the case of UK government scientist Dr David Kelly’s unexpected suicide is discussed, and a comment is made as follows:

“First, suicide may not be predictable. Second, multiple risk factors are not always present in high-risk individuals. Only one or two risk factors present to a serious degree may be sufficient. Third, risk can escalate rapidly over a short period (and, if the outcome is not fatal, may just as quickly subside).”

As Mental Health professionals encountering bereaved individuals we must be sensitive to the unique nature of each person’s loss (whether actual or perceived) when seeking to assess their potential suicide risk and to be aware that masked symptoms of depression may hide their real intent. A Single Man offers a valuable portrait of such a presentation, which could usefully inform a teaching session on this important topic.

• More information about A Single Man can be found at IMDB, as can a short trailer.

A Single Man can be purchased from

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


01/12/2014 09:17:18


This is the second of two blogs about the topic of adoption.


Philomena, directed by Stephen Frears and released in 2013, is based on the book by journalist Martin Sixsmith called The Lost Child of Philomena Lee. The screenplay is written by Jeff Pope and Steve Coogan, who plays Sixsmith. The film tells the true story of Philomena’s long search for her son who was taken away for adoption as a toddler, without her consent, by the nuns at the convent where she was staying. After becoming pregnant as an unmarried teenager, Philomena had been sent to the convent to have her baby and subsequently to work for the nuns for several years afterwards in lieu of payment. Such features of the film have stirred some criticism from Catholic sources although the film has generally received much critical acclaim. Philomena is played by Judi Dench who, together with Coogan, shines in a most unlikely but compelling road movie which is at times both funny and sad. Coogan and Pope won a BAFTA for the Best Adapted screenplay in 2014 and Best Screenplay at the Venice Film Festival 2013. Judie Dench was awarded Best International Actress at the Irish Film and Television Awards 2014. The film was nominated for a total of four Oscars. Sixsmith wrote about his involvement with Philomena Lee in a Guardian article in 2009 at the time his book was published. The book gave impetus to many adopted Irish children to search for their lost families.


The Film

Philomena begins with the difficulties Martin Sixsmith faces as he loses his job as a government advisor. At a loss and initially planning to write a book on Russian history, he is approached by Philomena’s daughter at a party, by chance. She asks for his assistance in helping her mother trace the son Philomena has been searching for for the past fifty years. At first skeptical because Sixsmith doesn’t write ‘human interest stories’ he is persuaded to do so after becoming intrigued by the facts that are revealed on meeting with Philomena. This results in an agreement to work together to trace her son Anthony, begining with a visit to the convent in Ireland where Philomena had lived when her son was forcibly adopted away. When no information is forthcoming from the nuns, and they learn that all of the documents pertaining to the period were destroyed in a fire, Sixsmith and Philomena follow some very tenuous lines of enquiry that lead them to America. In a thrilling investigation using many of his old contacts, Sixsmith finally traces Anthony, renamed Michael Hess, who had become a legal counsel in George Bush senior’s government. Sixsmith also finds that Michael Hess was gay and closeted even as he worked for a staunchly homophobic Republican party. Unfortunately the saddest news follows that Michael died of AIDs at the age of 47. As Philomena tries to process this news, they continue their search for more information about Michael by tracing his long term partner, Pete Olsson. When they finally meet with him he shares that Michael had been searching for his mother for many years and had in fact visited the convent in Ireland on two occasions, requesting that he be buried there when he died. Philomena is able to return to Ireland and visit her son’s grave satisfied by the knowledge that he had never forgotten her, although saddened by the reality of having lost him twice.


Relevance to the Field of Mental Health

Philomena  provides more material for learning about the psychological issues often raised by adoption, but this time from the perspective of the parent who loses the child that is adopted away. In this particular story the adoption took place without consent and deprived Philomena, as a mother, of the chance to say goodbye or to refuse the adoption altogether. Many of the resources that I linked to in the previous blog about Flesh & Blood remain relevant for use with a viewing of Philomena, in particular the pages on Attachment Theory and research, at the fostering and adoption learning resources online library, funded by the Department for Education.

This is a very valuable film, not only as a piece of social history that depicts a different attitude to parental-child bonds, but also because it reveals the consequences of such events for individuals still alive today. Whilst Philomena Lee was fortunate to get help and support in tracing her lost son, other older adults who have not revealed the facts about such losses in their earlier life may experience similar yearning in later life that might cause them to become anxious or depressed. As Mental Health professionals encountering such individuals we must be sensitive to all possible losses when seeking to understand why someone presents with symptoms of mental illness at any particular time in their life. By taking a full history that includes an outline of their whole life story we stand a better chance of understanding some of the complex factors that may contribute to their illness presentation. For anyone working in Old Age Psychiatry, this is an important film to watch.


• More information about Philomena can be found at IMDB

Philomena can be purchased from

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



30/10/2014 14:51:24

Flesh & Blood

This is the first of two blogs about the topic of adoption.


IntroductionFlesh and Blood

Flesh & Blood is a full-length TV film, written by Peter Bowker and directed by Julian Farino. It was broadcast on BBC2 in 2002 and released on DVD in 2007. It features Christopher Ecclestone as an adult man, Joe, adopted at birth, who seeks out his biological parents after his own daughter is born, only to find out that they both have a learning disability and are totally unaware of his existence. Joe’s parents are played by two actors, Peter Kirby and Dorothy Cockin, who have a learning disability, with no formal training as actors before the filming, and who worked with an improvised script. The director reported that both actors enjoyed the experience although he is quoted as saying “they didn’t understand the structure of the story, but they did understand that they were pretending”. He also stated that learning disability organisations were consulted before production and were very supportive of the project.

The writer, Peter Bowker, has twelve years of experience, earlier in his life, in teaching individuals with special needs in a variety of settings, including in hospitals. He won the Royal Television Society Award for Best Writer in 2003 for the screenplay. Christopher Ecclestone won Best Actor at the same RTS Awards and the film won the Prix Europa award for TV fiction in 2003.


The Film

Flesh & Blood begins with Joe knocking on doors in Morecambe, in the Northwest of England, in an attempt to find his birth mother. When he succeeds in matching the name on his birth certificate with a mental health nurse, Joe believes that he has found his roots and can share the joy of his own baby daughter with her. However, at their first proper meeting, Barbara reveals her name had been used on his birth certificate to cover up the truth that two learning disabled inpatients, who had had a sexual relationship within the unit where she had been working, were actually his biological parents and were completely unaware of his existence. Joe finds that he is challenged by this news as he struggles to tell his wife, family and closest friends about the truth of his discovery and he becomes quite angry and aggressive toward his wife as he confronts his own prejudice. There are a variety of feelings expressed about learning disability by the other people close to Joe. The film also shows those in society working tirelessly to counter any negative views, when Joe volunteers at the local social club where his biological father, Harry, enjoys playing pool every week and Joe begins to befriend him. Joe finds himself really surprised when he learns that Harry has a job but then realises that this is absolutely as it should be. His encounter with Janet, his biological mother, proves more difficult as she has less ability to engage in conversation. Joe decides to arrange a family gathering for all of his family and friends to meet Harry and Janet at his home and it is during this event that Janet gets to hold Joe’s baby daughter, without the knowledge that this is her own grand daughter, with Harry sitting by Janet’s side. As a photo is taken of this important moment for Joe, a sense of integration and assimilation is reached in Joe’s personal journey to find his biological roots and a fuller understanding of his role as a husband and father.


Relevance to the Field of Mental Health

Flesh & Blood offers a very good platform for discussion about learning disability as well as the issue of adoption from the point of view of the adult adopted child seeking information about their biological origins. The film provides the perfect opportunity to consider the topic of mental capacity and consent in the context of sexual relationships between people with a learning disability. What makes this a valuable film for mental health professionals is the authenticity of the performances. As both of Joe’s parents are played by actors with a learning disability and their scenes are unscripted, the other actors respond to them spontaneously throughout the course of the filming, making the interactions feel much more real. Some of the scenes were filmed at the social club, which the actor playing Harry actually attended every week, as well as at the factory where he had worked for more than twenty years. For further information that could complement a viewing of the film, there is a good fact sheet available at The Royal College of Psychiatrists website and an excellent review article published in the British Journal of Psychiatry in 2000 by Sheila Hollins titled Developmental psychiatry - insights from learning disability (The British Journal of Psychiatry (2000)177: 201-206) now freely available on-line. It is interesting to remember that this article was written before the Mental Capacity Act of 2005.

Flesh & Blood also provides a good platform for discussion about the psychological issues often raised by adoption for the individual placed away from their biological parent or parents in early life. For those providing counseling and psychotherapy this may be an issue that causes individuals to seek help in adult life. More useful information is available at the Fostering and Adoption learning resources from Research in Practice website funded by the Department of Education in the UK. Here there is an interesting page on Attachment theory and research.

Although the circumstance of Joe’s adoption may surprise some viewers of the film, it is interesting to note the statement on the webpage of The National Archives:

Formal adoption, as we now know it, did not exist in England and Wales until 1927. Before then, adoptions were usually informal. In a few cases there was some legal documentation, but no central register.

This is a very valuable film for anyone interested in working in mental health and in particular with individuals who have a learning disability. The DVD contains a fascinating commentary by the director and Christopher Ecclestone, which includes much discussion about their experiences of working with the two learning disabled actors.

• More information about Flesh & Blood can be found at IMDB

Flesh & Blood can be purchased from

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



20/08/2014 13:23:38




Passionflower is the first full-length feature film written and directed by Canadian filmmaker Shelagh Carter. Released in 2011 and screened at a number of film festivals in Canada and the USA, where it won several awards, it has been made available for streaming on iTunes in August 2014. Passionflower tells the story of a young girl growing up with a mother who develops a mental illness and is closely based on Carter’s own childhood experiences. Her ability to use the creative processes of writing and directing in such an articulate way to describe her subjective childhood experiences offers a huge amount to the viewer. Superbly cast and set in Winnipeg in the 1960s, the film also offers an insightful commentary on the attitudes toward mental illness prevalent in that period.

I was fortunate to be able to meet with Shelagh Carter in March 2014 and to discuss the process of making such a personal film. I hope that our interview will make the viewing of the film all the more interesting and rewarding.

As Carter says in our interview:

The film is about forgiveness, it was a freeing act for me to do.”

Shelagh Carter

Press play to listen to the interview

The film

Passionflower begins with Sarah, aged about eleven, walking home from school clutching her report card. She seems pleased, in a self-contained way, but this all changes when she gets home and tells the good news to her mother, Beatrice, who fails to acknowledge the report at all but instead criticises Sarah’s appearance. Sarah, bruised but seemingly unsurprised by this response, picks up her cat, Rosie, whispering her grades quietly into her ear as she pours milk into the cat’s bowl. Later at dinner, when Sarah and her younger brother Thomas are forced to wait in silence, staring at the table filled with food until their father David returns home, a palpable sense of control and tension caused by Beatrice sets the scene for what follows. After eating, Beatrice plays some mellow music on the record player and invites David to dance with her in a sexually charged manner. Sarah is watching by the side of the room, the constant observer and narrator of the story. That night, at 4am, Sarah is woken by the sound of her mother’s distressed sobbing in another room. Again Sarah crouches out of sight to watch as her father tries to console Beatrice as he carries her back to bed. At a dinner party Beatrice behaves in an inappropriately flirtatious way toward the other men present whilst also being extremely rude to a female friend. Later that night, Sarah finds her mother lying curled up, naked and screaming with despair on the kitchen floor while Sarah crouches, crying and frightened close by until David arrives again to carry his wife back to bed. After these events, Beatrice takes to her bed, tired, irritable and depressed in mood and David asks a doctor to visit the home. Beatrice denies any significant problems and only admits to being “too emotional....I need to get some rest” and that she is not sleeping. A sedative is prescribed and a short break in hospital offered but Beatrice does not appear willing to consider this seriously. As the doctor leaves the house he asks Sarah if there is anything she wants to say, to which she replies, “I just want everything to be OK”.

Sarah makes a friend in Charlie, a boy in her school class who shares her love and talent for art and they each share a special place with the other, both locations have pictures of topless women displayed. Sarah uses the new images she sees to start drawing naked women and dressing them with her own fashion designs. Sarah tells Charlie that her mother was once a model and now makes her own clothes. Charlie replies that his mother is ‘just a Mom’. Sarah gets to observe Charlie’s loving relationship with his mother, which only serves to highlight the lack of affection she receives from her own mother.

Beatrice takes Sarah to visit her own mother who is resident in a long stay psychiatric institution and lacks coherent conversation but mentions passionflower in some poetry she recites. Beatrice becomes distressed after the visit and takes them for something to eat. Her mood changes dramatically when she makes eye contact with a man who comes into the diner causing her to announce, “we’re having an adventure”. On the way home, Sarah reminds Beatrice that Thomas must be collected from school, but after taking Sarah home, Beatrice drives off into the countryside oblivious of her responsibilities. Stopping on a deserted stretch of road, Beatrice takes her top off and rolls in the dirty road as the sound track goes silent. When she finally gets home late that night, David is distraught and angry and his mother, Constance, has arrived to support him. But still no action is taken to get help for Beatrice. Soon after, Beatrice seduces her friend’s husband in the house and Sarah comes home early from school to witness the adultery. Then Beatrice has the cat put down by the vet because its collar bell was annoying her but telling the children that Rosie was sick. Sarah is angry with disbelief that such a thing could happen and David’s mother finally suggests that a line has been crossed that requires immediate action.

At school, Sarah’s teacher discovers some of her naked drawings and recognises the artistic talent she has at the same time as acknowledging the inappropriateness of such material. David is summoned to the school despite Sarah initially blaming her friend Charlie for the drawings. David cannot reveal that there is anything ‘going on’ at home and just says “everything is fine”. By now, Sarah is sad and muddled and tells her father that she fears she will be “crazy like her Mum and Grandma”. He tries to reassure Sarah and finally acts to insist that Beatrice gets help in hospital, where she has a course of ECT to good effect but with consequent loss of memory for recent events. On returning home to a muted celebration, Beatrice immediately hugs Thomas but cannot offer any such affection to Sarah. In a painfully poignant moment Beatrice calmly tells Sarah “the storm is over dear”.

Relevance to the field of Mental Health

Passionflower is a film that examines the painful and challenging time in a family when the wife and mother of two young children starts to develop a mood disorder, leading eventually to her first psychiatric hospital admission at the end of the film. It captures the ‘moment of dawning’ as everyone begins to realise that Beatrice’s behaviour is seriously abnormal but also presents the huge difficulties faced by father and husband, David, whose lack of action, in an attempt to maintain ‘normality’, becomes increasingly problematic. The film shows so well the precarious position that children are in when being parented by an adult who is mentally unwell and not receiving treatment or support from outside the home. David’s struggle to acknowledge the strain the family is under as a result of his wife’s mental illness is subtly portrayed and his lonely position is acutely felt as

his loving and well meaning attempts to try and cover over the cracks for too long finally fail and the crisis of hospital admission becomes inevitable. It is the intimacy of this drama that is so valuable to the viewer.

By telling the story through the eyes of Sarah, who is on the verge of puberty, the topic of her developing sexuality is sensitively contrasted with her mother’s increasingly disinhibited attitude to her own body and sexual behaviour, characteristic of hypomania. The film also portrays certain painful moments of depressive despair and irritability in Beatrice, witnessed by her young daughter, which could be used for teaching about the way such experiences can affect family members, especially children, and how interventions may be structured to support each individual in those circumstances. 

This is a powerful and compelling film to watch. With the knowledge that Carter had to tell this story to complete her own process of recovery from her childhood experiences, the viewer becomes part of that process, in bearing witness to these events. In some ways the film places the viewer in lieu of a psychotherapist receiving a subjective account from midlife of troubling childhood memories. Perhaps the film could be used as a foundation for discussion on how one might work with such memories, using a variety of different approaches to individual therapy, in order to aid the process of healing and recovery. In this context a book that might be of interest is The Handbook of Individual Therapy, edited by Windy Dryden and Andrew Reeves; SAGE Publications Ltd; Sixth Edition edition (15 Nov 2013), which examines the theory and practice of a broad range of therapies available in the UK at present.

Passionflower offers the viewer an opportunity to enhance their understanding of what it might be like to live with someone who is mentally unwell and whose behaviour is unpredictable, when explanations and reassurances are not forthcoming. As such it is a most valuable learning tool for anyone interested in working in the mental health professions.

* More information about Passionflower can be found at the film’s website as can a short trailer.

* Passionflower is available for streaming on iTunes.

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



30/09/2014 15:48:11

2 films on Huntington’s disease



In this blog I want to present two freely available short films about Huntington’s disease (HD), an inherited progressive neurodegenerative disorder which causes abnormalities in movement and thinking and which is commonly associated with certain psychiatric conditions. In the first film, called Huntington’s Disease through Film, we hear about a Scottish family in which four adult children are positive for HD but are presenting at different stages of the illness. Three of them feature in the film. The film offers a really special insight into the clinical presentation of the movement disorder and speech impairment that manifests in HD. It also gives an important opportunity to understand how the sibling’s unaffected mother copes with the experience of caring for and supporting her children through her direct addresses to camera. The film was made by Mike Rea for The Scottish Huntington’s Association (SHA). The SHA is a charity which was established in 1989 by families living with the condition and has the aim of significantly improving the quality of life of everyone touched by Huntington’s disease. The charity also strives to increase knowledge about HD through training and education and this film is one such resource offered at their website. The second short film has been produced for the NHS Choices web pages about HD and is also posted on the Huntington’s Disease Association website. It features a 39 year old man, Lee, who has HD talking about how it affects him, and how his mother, who also suffered from HD, struggled with certain difficult behaviours. In this film, a consultant clinical geneticist presents information about the genetics and discusses some of the symptomatic treatments used.

The films

Huntington's Disease through Film from Mike Rea on Vimeo.



Relevance to the field of Mental Health

These are powerful short films, offering valuable clinical portraits of HD for anyone who is working in mental health services. Viewing the films alongside a reading of many excellent online resources about HD could offer an effective platform for learning about the condition. The Huntington’s Disease Association of England and Wales is a charity supporting people with HD which has a huge range of educational resources for patients, carers and the professionals involved in looking after them. They also won an award in 2014 for science communication at their website HDBuzz, which offers the latest HD research news ‘in plain, understandable language’. The HD society of America also has a huge amount of useful information on their website.

A reading of the article entitled Psychiatric and behavioural manifestations of Huntington’s disease by S Jauhur and S Ritchie published in Advances in Psychiatric Treatment in 2010  (Advances in Psychiatric Treatment (2010)16: 168-175) would provide an excellent additional resource for students and trainee psychiatrists alongside a viewing of these two short films. Readers seeking more information about the latest state of research into therapies for HD might be interested in a recently published review paper in the journal called Movement Disorders entitled Targets for future clinical trials in Huntington's disease: What's in the pipeline? by Edward J. Wild MD, PhD and Sarah J. Tabrizi MD, PhD (Movement Disorders; Special Issue: Huntington's Disease; Volume 29, Issue 11, pages 1434–1445, 15 September 2014) which has been made open access and is available at


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


01/08/2014 10:04:48

Granny’s Got Game

Granny's Got Game


Granny’s Got Game is a documentary film, directed by Angela Alford and released in 2013, featuring seven women in their seventies who are members of a North Carolina Senior basketball team called the Fabulous Seventies as they try to win a National Senior Games Championship. It follows them for the year leading up to this major championship and sees them through all of the ups and downs that they encounter as they seek to progress through the earlier stages of the competition. The film’s tagline, which is a quote from Benjamin Franklin, usefully sums up the philosophy of the film: “We don't stop playing because we grow old. We grow old because we stop playing”.

The film

Granny’s Got Game is constructed around monologues from all of the team members alternating with footage of them practicing or competing on court in various state and regional competitions on the way to the national championship in Texas. Initially this involves them giving some background about their sporting achievements as young women at high school and goes on to talk about their physical health issues, the role of the team in their lives and their friendships that have developed over time. Some have developed significant physical health problems or have suffered injuries on court, but even then they show a determination to remain connected to the team by sitting on the bench during team practice or playing with protective padding. They have been playing together for seventeen years and so the women are able to offer a significant historical perspective on the role of the team and basketball in their lives as they are negotiating growing older. They share many interesting insights about how they cope with the experience of ageing.

Relevance to the field of Mental Health

Granny’s Got Game provides the viewer with a wonderful example of the benefits that regular physical exercise in later life can bring, especially when it involves social contact with team mates that encourages the development of mutually supportive relationships. Indeed the film examines the nature of friendships formed in later life and presents a clear argument in support of the mental health benefits of maintaining or creating a social network as we age. The style of the documentary helps the viewer to connect with each of the women very quickly and to appreciate their different personalities in relation to the task of growing older.

There is an increasing public health need for individuals at all ages and stages of life to take a greater responsibility for their physical and mental well being. Regular exercise is recognised as being central to achieving and maintaining good health and preventing the development of many diseases. Within the World Health Organisation Global Strategy on Diet, Physical Activity and Health the recommendations for Physical Activity and Older Adults are worth quoting at length:

In order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs (Non-communicable diseases, which include a range of chronic conditions, such as cancer, diabetes, cardiovascular disease and hypertension), depression and cognitive decline:

1         Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.

        Aerobic activity should be performed in bouts of at least 10 minutes duration.

3         For additional health benefits, older adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.

4         Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.

5         Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.

6         When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

There is further useful information on the benefits of physical activity for older adults on the NHS choices website with some detailed guidelines about the 150 minutes a week recommended for better physical health. The webpage also includes an excellent short video about a playground designed for the over-60s somewhere in the UK in which users also link the social benefits of exercising with others outside of the home.

This is a wonderfully uplifting, at times moving, and compelling documentary film and I think anyone interested in working with older people would benefit hugely from watching it.


• More information about Granny’s Got Game can be found at IMDB and an extended trailer is available to view at Vimeo.

Granny’s Got Game can be purchased from itunes.

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


02/07/2014 10:45:00

The Savages


This is the third blog in my short series about elderly residential care.


The SavagesThe 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

• 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.


  You can now follow Minds on Film on Twitter @psychfilm



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