In Context
Film Actors acting out neurology Lancet Neurol 2015
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Published Online March 6, 2015 http://dx.doi.org/10.1016/ S1474-4422(15)70040-2
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state is shown extraordinarily well. He is seen propped up in a wheelchair with spare facial mimicry and a few functioning muscles left, barely enough to operate a voice box. Prostheses were made, to show the interossei atrophy and a simian hand. The incipient foot drop and fall is accurately shown early in the film, but before he is confined to a wheelchair he unfortunately ends up with a walk which fits better in Monty Python’s Ministry of Silly Walks sketch. Redmayne commands the camera not only with his nearly identical look but also his rapidly developing full dependency. There are telling scenes where his immobile body in a wheelchair is toted up stairs, shaking with every bump. Sometimes neurological disease requires a behavioral portrayal. Hollywood fears Alzheimer’s disease; therefore, the disorder is over-represented in films. In Still Alice, Julianne Moore plays a 50-year-old professor of linguistics who develops cognitive impairment; screenplays on dementia often shortsightedly show deteriorating, angry, highfunctioning, intellectuals, and cinema apparently has no other way to put it. Still Alice is based on a well-researched fiction book and, through the Alzheimer’s Association—the banner of which appears in the film—Moore spoke with women who had been diagnosed with this disease early on. The film stops at the early stage and does not venture into the later realities. Moore registers either an anxious disorientation—a jogging scene is well done—or absentmindedness and she is particularly good at mirthless smiles and vacant stares. But when anosognosia sets in, Still Alice may not be still Alice after all. Ultimately, the question probably should not be how the actor renders neurological disease but does the film—as a whole—show the blight and sorrow of a relentless disorder? Theatrical license is allowed but that does not mean rules do not apply. Consistently showing comatose actors as sleeping beauties ready to awaken without any residual handicap does not serve the public and is seriously misleading. Linking seizures or sleepwalking with murder makes for good filmmaking but may stigmatise. The labels deception, falsehood, poetic drama, and stylistic liberties are all hard to separate from each other but become clearly debatable when there is a perceived calculated method to avoid facts. With these two important recent films about serious neurologic disease we should congratulate the actors and committed film teams. Advice from experts in neurology seemed to have worked in these films. It does not have to be perfect; it can be slightly off the wall or underwritten, as long as it ‘feels right’. Filmmaking is an art, but so often is neurological care.
Sony Pictures
Seeing neurologic disease played out on the screen is disquieting. Everything changes forever and, when not acute, the decline is inexorable. These films are far from pleasurable to watch. A common reaction of neurologists is to squirm at the enacting of neurologic conditions they may see every week. There have been several actors who have played people with progressive neurological illness, but this is an unprecedented year, with Oscar wins for Eddie Redmayne, who portrays Stephen Hawking in The Theory of Everything, and Julianne Moore, who acts out early-onset, familial Alzheimer’s disease in Still Alice. But there has been more. In St Vincent (2014), Bill Murray is very good at demonstrating aphasia, with halting speech and neologisms—something that other renowned actors have not been able to do, settling instead merely for facial contortions and moans and groans. In Abuse of Weakness (2014), Isabelle Huppert portrays the actual event and consequences of an intracerebral hemorrhage. Each repositioning of her body is exhausting due to her major handicap and she graphically shows the high risk of falls as a result of spasticity. But how does an actor reach a level of accuracy that would satisfy a neurologist? And is this important? Is it not more relevant that actors serve the story and not perfectly imitate the disorder? Should we not assume that the screenplay is created to convey the gestalt of the disability and therefore is fundamentally different from reality? Should fiction films really become a testimonial for patient organizations or even medical institutions? It is surprising how many actors show the beginning of weakness with arm or leg flutters, and how many imitate a seizure as if in death throes. Advice is sought by filmmakers, but to get it right (or true enough) requires impartial expert information and a team willing to listen. But what methods do actors use to emulate the manifestations of neurological disease? One of the most impressive preparations dates back to Marlon Brando’s debut in The Men (1950), which focused on the matrimonial ordeal of postwar paraplegics. Brando spent months in a wheelchair surrounded by men with paraplegia. He tried moving around with heavy leg splints and, to look the part, buffed up his upper torso. The preparation by Eddie Redmayne for The Theory of Everything is equally impressive. Inquisitive about the nature of the decline, he obtained information from the Institute of Neurology, London, UK, and observed patients with amyotrophic lateral sclerosis and their families. As a result of working with a vocal coach, he is particularly good at displaying the loss of clarity of speech and the progression to full inarticulate speech. His progression to a near locked-in
Eelco Wijdicks
www.thelancet.com/neurology Published online March 6, 2015 http://dx.doi.org/10.1016/S1474-4422(15)70040-2
1
Film Actors acting out neurology Lancet Neurol 2015
Getty Images
Published Online March 6, 2015 http://dx.doi.org/10.1016/ S1474-4422(15)70040-2
FameFlynet
state is shown extraordinarily well. He is seen propped up in a wheelchair with spare facial mimicry and a few functioning muscles left, barely enough to operate a voice box. Prostheses were made, to show the interossei atrophy and a simian hand. The incipient foot drop and fall is accurately shown early in the film, but before he is confined to a wheelchair he unfortunately ends up with a walk which fits better in Monty Python’s Ministry of Silly Walks sketch. Redmayne commands the camera not only with his nearly identical look but also his rapidly developing full dependency. There are telling scenes where his immobile body in a wheelchair is toted up stairs, shaking with every bump. Sometimes neurological disease requires a behavioral portrayal. Hollywood fears Alzheimer’s disease; therefore, the disorder is over-represented in films. In Still Alice, Julianne Moore plays a 50-year-old professor of linguistics who develops cognitive impairment; screenplays on dementia often shortsightedly show deteriorating, angry, highfunctioning, intellectuals, and cinema apparently has no other way to put it. Still Alice is based on a well-researched fiction book and, through the Alzheimer’s Association—the banner of which appears in the film—Moore spoke with women who had been diagnosed with this disease early on. The film stops at the early stage and does not venture into the later realities. Moore registers either an anxious disorientation—a jogging scene is well done—or absentmindedness and she is particularly good at mirthless smiles and vacant stares. But when anosognosia sets in, Still Alice may not be still Alice after all. Ultimately, the question probably should not be how the actor renders neurological disease but does the film—as a whole—show the blight and sorrow of a relentless disorder? Theatrical license is allowed but that does not mean rules do not apply. Consistently showing comatose actors as sleeping beauties ready to awaken without any residual handicap does not serve the public and is seriously misleading. Linking seizures or sleepwalking with murder makes for good filmmaking but may stigmatise. The labels deception, falsehood, poetic drama, and stylistic liberties are all hard to separate from each other but become clearly debatable when there is a perceived calculated method to avoid facts. With these two important recent films about serious neurologic disease we should congratulate the actors and committed film teams. Advice from experts in neurology seemed to have worked in these films. It does not have to be perfect; it can be slightly off the wall or underwritten, as long as it ‘feels right’. Filmmaking is an art, but so often is neurological care.
Sony Pictures
Seeing neurologic disease played out on the screen is disquieting. Everything changes forever and, when not acute, the decline is inexorable. These films are far from pleasurable to watch. A common reaction of neurologists is to squirm at the enacting of neurologic conditions they may see every week. There have been several actors who have played people with progressive neurological illness, but this is an unprecedented year, with Oscar wins for Eddie Redmayne, who portrays Stephen Hawking in The Theory of Everything, and Julianne Moore, who acts out early-onset, familial Alzheimer’s disease in Still Alice. But there has been more. In St Vincent (2014), Bill Murray is very good at demonstrating aphasia, with halting speech and neologisms—something that other renowned actors have not been able to do, settling instead merely for facial contortions and moans and groans. In Abuse of Weakness (2014), Isabelle Huppert portrays the actual event and consequences of an intracerebral hemorrhage. Each repositioning of her body is exhausting due to her major handicap and she graphically shows the high risk of falls as a result of spasticity. But how does an actor reach a level of accuracy that would satisfy a neurologist? And is this important? Is it not more relevant that actors serve the story and not perfectly imitate the disorder? Should we not assume that the screenplay is created to convey the gestalt of the disability and therefore is fundamentally different from reality? Should fiction films really become a testimonial for patient organizations or even medical institutions? It is surprising how many actors show the beginning of weakness with arm or leg flutters, and how many imitate a seizure as if in death throes. Advice is sought by filmmakers, but to get it right (or true enough) requires impartial expert information and a team willing to listen. But what methods do actors use to emulate the manifestations of neurological disease? One of the most impressive preparations dates back to Marlon Brando’s debut in The Men (1950), which focused on the matrimonial ordeal of postwar paraplegics. Brando spent months in a wheelchair surrounded by men with paraplegia. He tried moving around with heavy leg splints and, to look the part, buffed up his upper torso. The preparation by Eddie Redmayne for The Theory of Everything is equally impressive. Inquisitive about the nature of the decline, he obtained information from the Institute of Neurology, London, UK, and observed patients with amyotrophic lateral sclerosis and their families. As a result of working with a vocal coach, he is particularly good at displaying the loss of clarity of speech and the progression to full inarticulate speech. His progression to a near locked-in
Eelco Wijdicks
www.thelancet.com/neurology Published online March 6, 2015 http://dx.doi.org/10.1016/S1474-4422(15)70040-2
1
