ARTICLE IN BRIEF
In a new book, Dr. Eelco Wijdicks looks at how neurology and neurologic disease are depicted in film.
Hollywood does not always do justice to neurologic illness. Just think of “Kill Bill,” where The Bride (Uma Thurman) emerges from a five-year coma looking like a million bucks and raring to avenge her attempted murder. Is it a wickedly entertaining bit of cinema? Yes, absolutely. Is it medically accurate? Not so much.
But many films do, in fact, portray neurologic disease with surprising depth, sensitivity, and accuracy — a fact that Eelco F. M. Wijdicks, MD, PhD, a professor of neurology at the Mayo Clinic College of Medicine in Rochester, MN, hopes to highlight with his new book, Neurocinema: When Film Meets Neurology, published Nov. 14 by CRC Press.
Dr. Wijdicks, who is also chair of the division of Critical Care Neurology and an attending neurointensivist at the Mayo Clinic Hospital, has written extensively about coma and brain death, as well as the way these conditions are portrayed in film, including in movie reviews for Neurology Today. “I love my job and I love movies, so it was only a matter of time before the two would meet,” he said. “I try to see about 200 films a year. My passion has to with world cinema and films that are about major humanistic themes, human interactions, the blights and precariousness of human life and how it's dealt with.”
Dr. Wijdicks recently spoke with Neurology Today about the ways neurologic illnesses are commonly portrayed on the silver screen, and why Neurocinema should interest the neurological community and lay audiences alike.
WHEN DID YOU START LOOKING AT AND WRITING ABOUT FILM THROUGH THE LENS OF NEUROLOGY?
About a decade ago, I started doing research for a chapter on popular culture and coma and thought it would be interesting to see how coma was used in cinema and how the public would perceive it. That article sparked my interest in how neurology is represented in film. I found 125 movies that represented neurologic disease or themes. My focus isn't film criticism per se. I'm more interested in bringing an important movie to the fore and having people look at it and talk about what the consequence of neurologic disease is for families and their loved ones.
WHAT WERE YOU LOOKING FOR IN YOUR REVIEWS?
I wanted to see how the neurologic disorder is shown, how the practice is represented, and how documentaries handle the seriousness of the disorder. I also wanted to see if these so-called “neuromovies” could have some educational value for neurology residents. I wasn't so much interested in how actors render neurologic disease or if there was accuracy in how neurologic disease was represented, but it turns out that there's accuracy in a large majority of films. You cannot expect an actor to play Parkinson's disease, multiple sclerosis, or ALS perfectly, but I was still surprised at how good it all looks.
The main purpose of the book is just to urge readers to see the films and think about them and talk about them. Some are landmark films, some are not-so-great and even problematic, but they are still essential to see.
WHAT DID YOU FIND FROM THIS REVIEW OF MORE THAN 100 MOVIES?
This book proves that film, from a neurologic perspective, can provide a great insight. Contrary to what one might think, the major take-home message is that neurologic representation of disease with its social consequences is quite good. In about one-third of the 125 reviewed and rated films, the portrayal is superb, and there is teachable material for neurologists and other health care workers in over half of the films. There also has been a significant increase in accuracy over the years.
“The Diving Bell and the Butterfly” is one of the iconic films in this collection. It shows what locked-in patient Jean-Dominique Bauby would have seen in his condition. Jean-Dominique's visual field is shown through the lens of the camera; blinking is imitated by having the cinematographer move large objects in front of the camera.
“The Intouchables” is a more complex film about the challenges of being paralyzed from a high cervical spinal cord injury, and describes in great detail the physical care and emotional challenges of a person with this condition. Pain after a spinal cord injury is well depicted, among other challenges in medical care.
“Amour” shows us the cruel change in a loving relationship brought about by a major stroke, and shows the difficulties of caring for a patient with a major stroke. Emmanuelle Riva plays a stroke victim astonishingly well, and she shows difficulty with transfers and overall full dependency.
There are also many great documentaries that have neurology in them. For example, “Do You Really Want to Know?” is the first documentary that addresses the symptoms of Huntington's disease and its penetrants in families, and goes through the difficult decisions three families have to make.
Documentaries can also bring back what seems like a forgotten neurologic disease. Two documentaries recall the devastating long-term consequences of poliomyelitis. “A Paralyzing Fear” presents a historical assessment of the polio epidemics, and describes the academic struggles — the so-called “polio wars” — in some detail, while “Martha in Lattimore” is about a polio patient who lived for 60 years in an iron lung. She chose to remain in the iron lung in order to avoid a tracheostomy and more complex care.
“The Crash Reel” is a fine documentary about recovery from traumatic head injury in a young athlete. It is a unique look at the rehabilitation of traumatic head injury, but also explores its long-term effects, particularly in individuals who seem to have completely recovered physically.
YOU MENTIONED THAT SOME OF THESE MOVIES OFFER FLAWED REPRESENTATIONS OF NEUROLOGIC ILLNESS. WHAT ARE SOME OF THE COMMON MISTAKES?
When looking at these films, a person in a persistent vegetative state often looks like a “sleeping beauty” (“Talk to Her”; “Firelight”). Seizures are mostly associated with madness and seen in criminals (“The Terminal Man”; “The Aura”). We have representations of patients becoming a better person after a head injury, which of course in the real world is exactly the opposite most of the time (“Regarding Henry”). There is a film on sleepwalking, but only sleepwalking that creates murder (“Side Effects”). So there are a number of misrepresentations and exaggerations that will cause many of us to roll our eyes, even if we accept theatrical license.
I also have a chapter on neurology in science fiction, and there it becomes interesting because some of the examples may seem deceptively real. There are many films in which the line between what is science fiction and what is currently possible seems to be getting closer. But there's also some ridiculousness. For instance, there are two films (“Lucy”; “Limitless”) that claim we only use 10 to 20 percent of our brains, and that a pill could get it to 100 percent. But as neurologists, we all know we use 100 percent of our brains.
Another film, “The Cell,” suggests that there may be a future technique — sort of a super functional MRI — that could have one person enter the mind of another person. And “Brain Waves” is about the replacement of defective areas of the brain with new brain activity. The film suggests that not only can EEG activity be captured, stored, and transplanted, but also that EEG represents thoughts and memory. Neurologists may have a lot of explaining to do after seeing these films with friends.
WHAT ABOUT THE DEPICTION OF NEUROLOGISTS IN THESE FILMS?
There is this stereotype of a neurologist as an intellectual, aloof neuroscientist — a head-scratcher with a bowtie. It looks very close to our counterpart, the psychiatrist. In some films, the neurologist comes across as denigrating and arrogant, and that is not much different than representations of other physicians, really. This begs the question, is this how directors and screenwriters see us as neurologists?
For example, the neurologist in “Iris” tells the title character that her dementia is “implacable.” When Iris asks what he means, he says it's “inexorable.” Then, when she tells him it won't win, he counters, “It will win.”
“Declaration of War” features a pediatric neurologist who is not overflowing with compassion, to say the least. She barges into the hospital room with her entourage, looks at the child, tells the parents he needs a CT scan, leaves, and has an assistant explain the details. Later, she uses inexplicable medical jargon and has a pompous attitude, totally confusing the distraught parents.
But, there are not that many neurologists represented in these films. It's often not entirely clear if the physician in the film is a neurologist. Sometimes it's just a physician or a family doctor.
SHOULD DIRECTORS AND SCREENWRITERS CONSULT WITH PHYSICIANS MORE WHEN MAKING A FILM ABOUT NEUROLOGIC ILLNESS?
I know there are organizations that do provide scientists and physicians the opportunity to explain biology to the screenwriter. Of course, the screenwriter and director should have their prerogative to decide what to do with these suggestions. It's not really our task to interfere with that, and we may need to accept that entertainment trumps reality.
But if neurologic disease is a major theme in the movie, it is useful to have a neurologist be part of it. If there's any surprise, I think my surprise is that there is a lot of good out there.
MANDATORY VIEWING: 10 FILMS ABOUT NEUROLOGIC ILLNESS
In Neurocinema, Dr. Eelco Wijdicks lists his 10 favorite films about neurologic disease, which he said should be required viewing for neurologists, as they contain teachable material and a high degree of accuracy.
- “The Death of Mr. Lazarescu” (2005): Sent to the hospital after experiencing an intense headache that turns out to be a subdural hematoma, lonely Mr. Lazarescu (Ion Fiscuteanu) is shuttled from hospital to hospital as a string of doctors refuse to treat his symptoms because he is an alcoholic. “The film is all about compassion fatigue,” Dr. Wijdicks said.
- “Amour” (2012): Anne (Emmanuelle Riva) and Georges (Jean-Louis Trintignant) are an elderly couple enjoying their golden years, but their bond is tested when Anne experiences a stroke. “It is about how to appreciate the spouse's ordeal, how to offer assistance, and how to organize care for stroke patients after they are dismissed from the hospital,” Dr. Wijdicks said.
- “The Intouchables” (2011): When wealthy aristocrat Philippe (François Cluzet) becomes a quadriplegic, he hires a brash African, Driss (Omar Sy), to be his caretaker.
- “The Diving Bell and the Butterfly” (2007): Based on the memoir by former Elle editor Jean-Dominique Bauby, the film delivers a glimpse of life through the eyes of a person with locked-in syndrome. “There are lessons to be learned about how to best communicate with patients and the tremendous challenge of rehabilitation,” Dr. Wijdicks said.
- “My Left Foot” (1989): Based on the memoir of the same name, My Left Foot tells the story of Christy Brown (Daniel Day-Lewis), who, due to severe cerebral palsy, can only control his left foot. “The film celebrates creativity and intelligence,” Dr. Wijdicks said.
- “You Don't Know Jack” (2010): Based on the life of assisted suicide advocate Jack Kevorkian, the film follows Dr. Kevorkian (Al Pacino) as he breaks the law to assist in the deaths of several patients with neurologic illnesses. “The film, unfortunately, perpetuates the idea that there is a general lack of end-of-life care in hospitals and that doctors are ‘cowards Based on a true story, British novelist Iris Murdoch,’” Dr. Wijdicks commented.
- “Iris” (2001): Based on a true story, British novelist Iris Murdoch (Judi Dench), and her husband, John Bayley (Jim Broadbent), cope with the ravages of Alzheimer's disease.
- “Memento” (2000): Following a traumatic accident, brain-injured Leonard (Guy Pearce) can no longer form new memories, but he remains determined to piece together the circumstances of his wife's murder. “The closest resemblance to a real patient is Henry Molaison, who developed anterograde memory impairment after epilepsy surgery,” Dr. Wijdicks said.
- “The Crash Reel” (2013): Documentarian Lucy Walker chronicles the 15-year rivalry between pro snowboarders Kevin Pearce and Shaun White — until a half-pipe crash finds Pearce struggling to recover from a traumatic brain injury. “The film is about recovery potential,” said Dr. Wijdicks. “Athletes want to go back but they rarely do. The tremendous duress of the parents is also portrayed well.”
- “Declaration of War” (2011): When their son is diagnosed with a malignant brain tumor, two young parents vow to fight back against his illness.