Sunday February 27, 2011

Health in the movies

By TAN SHIOW CHIN
starhealth@thestar.com.my

The sense of frustration and triumph of those struggling with sickness have been aptly captured in many films that have been brought to us by Hollywood over the years.

FOR movie fans out there, tomorrow will be an interesting day as the 83rd Academy Awards gets underway at 8.30am (5.30pm, Feb 27, in Los Angeles, California).

We will find out which movies are deemed the best of 2010 by the Hollywood movie industry in 24 categories ranging from Best Picture and Best Actor/Actress to Cinematography and Film Editing.

What does this have to do with health, you might ask.

King George VI (Colin Firth, right) delivering his radio broadcast without stammering, with the help of Logue (Geoffrey Rush) in The King’s Speech

It so happens that two of this year’s Best Picture nominees feature health-related conditions as an integral part of their story.

They are The King’s Speech (featured below) and Black Swan.

The King’s Speech focuses on how the United Kingdom’s King George VI overcame his stammering problem, while Black Swan is about a disturbed ballerina who slowly loses her grip on reality as she tries to perfect her performance of the deceitful, seductive Black Swan in the ballet Swan Lake.

Illnesses, mental health issues and developmental disorders are fertile fodder for movie-makers as they provide a solid hook around which to build a story, and are usually guaranteed to elicit emotional responses from audiences.

Schizophrenia not only affects the patient, but also their family members, as shown by Nash (Russell Crowe, left) and his wife Alicia (Jennifer Connelly) in A Beautiful Mind .

Often, these films are inspired by or based on real people and their lives.

Many such movies have won or been nominated for an Oscar over the years. We take a look at some of them here:

The Three Faces of Eve (1957)

Won: Best Actress in a Leading Role (1958) – Joanne Woodward

This film is based on the true case of Christine Costner Sizemore, an American woman who suffered from multiple personality disorder, now called dissociative identity disorder (DID).

Dustin Hoffman (right) quite accurately portrays the typical behaviour of a person with autism in Rain Man – avoiding eye contact, exhibiting little emotion, and repetitive behaviour. However, it should be noted that not all autistic people have savant abilities, nor are all savants autistic.

Woodward plays Eve White, a timid housewife who suffers from frequent headaches and blackouts. During her sessions with psychiatrist Dr Curtis Luther (Lee J. Cobb), two other distinct personalities emerge under hypnosis – sexy, outgoing Eve Black, and the stable Jane.

After realising that the cause of her split personalities is due to a traumatic childhood incident, only Jane’s personality is left in the body and she goes on to have a normal, happy life.

While the movie seems to show a fairly quick resolution of the disorder, the fact is DID takes many years to treat.

Sometimes, treatment does not focus so much on merging the personalities into one, but on treating the symptoms of the disorder to allow the patient to live a functional life.

The number of personalities a patient might manifest can range from two to over 100. Sizemore actually had over 20 distinct personalities in real life.

Tom Hanks won an Oscar for his portrayal of Andrew Beckett in the film Philadelphia, one of the first mainstream Hollywood movies to tackle the issue of HIV/AIDS and homosexuality.

Most mental health professionals believe that DID is caused by some form of trauma in the person’s past, as the movie shows.

Rain Man (1988)

Won: Best Picture (1989); Best Actor in a Leading Role – Dustin Hoffman; Best Director – Barry Levinson; Best Writing, Original Screenplay.

Nominated: Best Art Direction (Set Decoration); Best Cinematography; Best Film Editing; Best Music, Original Score.

Hoffman stars as the autistic Raymond Babbitt, whose existence is newly discovered by his brother Charlie (Tom Cruise) after their father dies and leaves his multi-million dollar fortune to him.

Charlie takes Raymond on a road trip from the Ohio mental institution he lives in to California, in his bid to get half of the inheritance.

Along the way, he discovers Raymond’s savant abilities in memory recall and mathematics, and even takes advantage of his abilities to gamble in Las Vegas.

Many movies focusing on health issues are inspired by real people or events, like the movie Awakenings, which was based on Dr Oliver Sacks’ non-fiction book of the same name.

Hoffman quite accurately portrays the typical behaviour of a person with autism – avoiding eye contact, exhibiting little emotion, and repetitive behaviour.

However, it should be noted that not all autistic people have savant abilities, nor are all savants autistic.

Like Raymond, savants demonstrate genius-level abilities in one or more areas – like music, art and mathematics – in sharp contrast to their impaired functioning in daily life.

The character was inspired by real-life savant Kim Peeks, who however, was not autistic.

My Left Foot (1989)

Won: Best Actor in a Leading Role (1990) – Daniel Day-Lewis; Best Actress in a Supporting Role – Brenda Fricker

Nominated: Best Picture; Best Director – Jim Sheridan; Best Writing, Screenplay Based on Material from Another Medium.

Based on the true story of spastic quadriplegic Christy Brown (Day-Lewis), My Left Foot is about how he overcame his limitations to become a painter, poet and author.

Able only to control his left foot and only make guttural sounds, Brown is mistakenly believed to be mentally retarded until he is 10-years-old.

But his mother (Brenda Fricker) sees there’s more in him, and teaches him to write and draw with his left foot.

Spastic cerebral palsy is the most common type of cerebral palsy. Most people tend to assume that patients with cerebral palsy are mentally challenged, but as this movie shows, these people can have normal, and even, above-average intelligence.

As it is a lifelong disorder, the main goal of treatment is to enable the patient to live as independently as possible through physical and occupational therapy, and medication.

It is quite possible for a cerebral palsy patient to live independently or with only some help, depending on the severity of their condition.

Awakenings (1990)

Nominated: Best Picture (1991); Best Actor in a Leading Role – Robert De Niro; Best Writing, Screenplay based on Material from Another Medium.

Starring Robin Williams and De Niro, this movie is about a doctor who discovers a way to “wake up” a ward full of comatose patients who have encephalitis lethargica, or the sleepy sickness.

Based on a non-fiction book by Dr Oliver Sacks recounting his efforts to treat patients with the condition in the 1960s, the movie shows how Dr Malcolm Sayers (Williams) – the fictional Dr Sacks – comes up with the idea to use the then-new drug L-dopa to treat the patients, and the effects that the drug and their long comatose state has on the patients, and those around them.

Awakenings shows us the most severe manifestation of the disease, where patients enter a coma-like state called akinetic mutism.

More typical symptoms include high fever, headache, double vision, delayed physical and mental response, and lethargy.

As mentioned in the movie, there was an outbreak of encephalitis lethargica cases between 1917 to 1928 around the world, the effects of which were patients like those shown.

The cause of the illness is unknown, and treatment is still with L-dopa or other similar drugs, although the effects, as shown in the movie, can be shortlived.

Lorenzo’s Oil (1992)

Nominated: Best Actress in a Leading Role (1993) - Susan Sarandon; Best Writing, Screenplay Written Directly for the Screen

This movie is based on the real-life story of two parents who are determined to find a cure for their son’s rare degenerative brain disorder after being told by doctors that there is no treatment for the disease.

Lorenzo has adrenoleukotrophy, which is an inherited disease that slowly damages the myelin sheath on the body’s nerves, as well as the adrenal glands, through the accumulation of very long-chain fatty acids (VLCFA) in the body.

This results in progressive disability as more and more nerves become damaged as the disease advances.

The movie shows the most common, and most severe, form of the disease.

At the time of Lorenzo’s diagnosis, there was no treatment for the disease, and there is currently still no cure for it.

However, his parents — Augusto (Nick Nolte) and Michaela Odone (Sarandon) — discover that the progression of the disease can be slowed down by taking a special blend of oils, which is now called Lorenzo’s Oil.

This oil, combined with a diet low in VLCFA, worked for Lorenzo by slowing down the progress of the disease.

However, it has been found that this treatment does not work for all patients, and research is currently ongoing to determine the reasons behind this, and hopefully, improve the treatment.

Philadelphia (1993)

Won: Best Actor in a Leading Role (1994) – Tom Hanks; Best Music, Original Song – Streets of Philadelphia

Nominated: Best Makeup; Best Music, Original Song - Philadelphia; Best Writing, Screenplay Written Directly for the Screen

Philadelphia was one of the first mainstream Hollywood movies to tackle the issue of HIV/AIDS and homosexuality.

Inspired by the real-life story of Geoffrey Bowers, who sued his law firm for unfair dismissal in one of the first AIDS discrimination cases in America, Hanks plays attorney Andrew Beckett, who is starting to display visible signs of AIDS.

A closet homosexual, Beckett is unfairly dismissed by his law firm because of his health status, and decides to sue them for their actions.

The movie shows the many misconceptions about the disease, and the unwarranted discrimination against those with HIV/AIDS, including the belief that HIV is passed on through skin contact.

Homophobic lawyer Joe Miller (Denzel Washington) initially also has misconceptions about how HIV is contracted, but changes his attitude when a doctor explains to him how HIV is really passed on.

Miller eventually represents Beckett in his lawsuit, and comes to know and accept Beckett as a friend.

A Beautiful Mind (2001)

Won: Best Picture (2002); Best Actress in a Supporting Role - Jennifer Connelly; Best Director - Ron Howard; Best Writing, Screenplay Based on Material Previously Produced or Published.

Nominated: Best Actor in a Leading Role – Russell Crowe; Best Editing; Best Makeup; Best Music, Original Score.

Starring Russell Crowe as Economics Nobel laureate John Forbes Nash Jr, this movie is based on the life of the brilliant mathematician, who has schizophrenia.

The hallucinations, paranoia and delusions of grandeur experienced by Nash in the movie are typical symptoms of paranoid schizophrenia. These symptoms severely affect his ability to function as a normal member of society, and even prove to be dangerous to those around him.

As the movie is from Nash’s point of view, it gives an insight into the way a schizophrenic patient sees his world, and how real his symptoms feel to him.

The movie also shows how family members – in this case, his wife Alicia (Jennifer Connelly) – are affected by the disease, and the hardship they have to undergo.

The problems with treatment and patients not complying with their medication are also highlighted.

While A Beautiful Mind is not an entirely accurate portrayal of Nash’s life, it gives a true picture of the disease and the effects it can have on patients and their families.

The King’s Speech (2010)

Won: To be announced tomorrow.

Nominated: Best Motion Picture of the Year (2011); Best Performance by an Actor in a Leading Role – Colin Firth; Best Performance by an Actor in a Supporting Role – Geoffrey Rush; Best Performance by an Actress in a Supporting Role – Helena Bonham Carter; Best Achievement in Directing – Tom Hooper; Best Achievement in Art Direction; Best Achievement in Cinematography; Best Achievement in Costume Design; Best Achievement in Editing; Best Achievement in Music Written for Motion Pictures, Original Score; Best Achievement in Sound Mixing; Best Writing, Screenplay Written Directly for the Screen.

The Duke of York (Colin Firth), who later becomes King George VI, has stuttered, or stammered, since he was a child.

Unfortunately, his disability is a big issue as he is required to speak frequently in public.

He seeks the help of many doctors, but has no success dealing with his stutter until he meets Australian speech therapist Lionel Logue (Geoffrey Rush).

The movie is a fairly accurate portrayal of the events it shows, starting from the speech filled with stuttering that the duke delivers at the close of the 1925 British Empire Exhibition, to the smooth-flowing radio broadcast he made with Logue’s help after the 1939 announcement that the British Empire is at war with Germany.

Many of the techniques used by Logue, who was considered ahead of his time, are still being used today to help stutterers.

However, while the film suggests that the duke’s stutter was caused by nervousness and emotional distress, research has shown that stutterers are not more prone to nervousness or anxiety than people who speak smoothly.

Many children stutter, but eventually grow out of it, and the true cause of continued stuttering into adulthood is not really known.

It is thought that factors like genetics, child development and neurophysiology might play a role in the condition.