Awakenings

Awakenings tells the tale of Dr Malcolm Sayer and his efforts to treat catatonic patients who survived an epidemic of encephalitis lethargica. This film, with its compelling and poignant story, can be explored from a number of perspectives.

With an expert cast comprising of the likes of Robin Williams, Robert De Niro, and Julie Kavner, the portrayal of the characters was naturally one of the main elements that contributed to the audience’s experience of the film. Williams, at his most restrained, brings to life the role of socially inept neurologist Malcolm Sayer wonderfully, but it is De Niro’s performance as newly “awakened” Leonard Lowe which really captivates. Depicting the progression from awakening to dyskinesia to the eventual return to a catatonic state, De Niro is unafraid to portray the more unsightly Parkinsonian symptoms, made all the more evocative with the way he captures Leonard’s struggle for autonomy and freedom. Dr Sayer and Leonard’s burgeoning relationship after the latter awakens is undoubtedly heart-warming to watch; however, their increasingly strained relationship culminating in Leonard’s attempt to leave the hospital was played by their actors so well that as the audience, we empathize with both Leonard’s need to be free of the confines of the hospital and Dr Sayer’s growing realization that the drug is losing its effectiveness on his patients.

De Niro's uncanny efforts to immerse himself in the Leonard's remarkable pathology and his relationship with Dr Sayer

When Leonard’s attempt to leave was thwarted, we see his resistance become increasingly physical. This behaviour can, in part, be explained by the frustration-aggression hypothesis, which posits that unresolved frustration triggers a readiness to aggress (Berkowitz, 1989). In the context of the film, Leonard’s frustration stems from his inability to go for a walk as and when he pleases, to be free. The hospital staff is seen as coming in between him and his goal. This causes him to lash out at them in retaliation, in line with the hypothesis. Alternatively, Leonard’s hostile behaviour is consistent with the side-effects associated with the drug L-dopa (Hoglund et al., 2005), which could provide another explanation for his aggression and paranoia towards Dr Sayer and the rest of the staff. Despite this, the need for freedom does not appear to be a theme isolated to just this particular arc in the film; early in the movie, Lucy, not yet awakened, walks to the window instead of the water fountain as Dr Sayer and the nurse Eleanor had thought. This lends insight into the inner workings of the patients, highlighting not a will to survive, but a will to live.

Dr Sayer attempts to understand Lucy's motivations

As the rest of the patients awaken during the movie, it becomes easier for both the audience and the hospital staff to see them as people with their own personalities and feelings. By the end of the movie, the patients have reverted to their catatonic states, but not all is it once was. Gone was the original ambience of the “Garden ward”; the patients were now receiving more than just basic care, with the staff treating them as individuals capable of dignity and worthy of respect. As a psychology major, this prompts a discussion on how we view patients in persistent vegetative states in real life: Are we not much like the nurses and caretakers of the Garden ward, as they are at the beginning of the film? Should we not strive to treat such patients more like their families do, like Leonard’s mother did? And to a greater extent, how to we define personhood? As the film highlights, just because we do not perceive a person as being conscious does not mean that they are unaware of their surroundings. One’s inability to care for themselves or communicate does not warrant half-hearted treatment and support.

Aside from the physical portrayal of Leonard's symptoms, it was interesting to see how the progression of his illness was depicted through close-ups of his writing his name, something that seemed to be recurring throughout the movie. In addition to this, Dr Sayer notices a spike in Leonard's EEG readings in response to his name being called out. Indeed, a person's name is very much tied to their sense of identity, leaving one to wonder, what must it feel like when all you have left is your name?

The progression of Leonard's disease as depicted by his name

Final Thoughts

At its core, Awakenings celebrates the joy of life and the healing exchange that can occur between doctor and patient when caring, rather than curing, is the emphasis of treatment. The title of the film also carries a double meaning as the hospital staff undergo an awakening of sorts themselves, with the staff exhibiting more care towards the patients after having interacted with them as normal individuals. Although the effects of L-dopa eventually sent Leonard careening helplessly back to his original state of immobility, his presence does manage to inspire Dr. Sayer to break free of his shell deepen his relationship with Eleanor. Furthermore, the content of the film was thought-provoking and does leave the audience with several questions:

1. How do we define recovery? Is it measured by fully regaining prior function, or do we instead consider small but incremental progress?
2. What is the ethicality of administering trial drugs on comatose or catatonic patients? Granted, Dr Sayer did obtain consent from the patients' guardians, but how would their relationship to the afflicted affect their decision?
3. The administering of L-dopa did result in the patients waking up, but what could then be done for individuals who wake up to a disrupted and derailed life? Should it still be administered, with the knowledge that the effects are only temporary?

Sayer highlights one of the dilemmas present in the film

Although there were problems with L-dopa, it does provide grounds for the discussion on what other seemingly impossible diseases may be cured. Ultimately, the film reminds us of the preciousness of the little things we take for granted in life, such as feeling, fantasy, risk, love, and wholeness.

References

Berkowitz, L. (1989). Frustration-aggression hypothesis: Examination and reformulation. Psychological Bulletin, 106(1), 59.

Höglund, E., Korzan, W. J., Watt, M. J., Forster, G. L., Summers, T. R., Johannessen, H. F., ... & Summers, C. H. (2005). Effects of L-DOPA on aggressive behavior and central monoaminergic activity in the lizard Anolis carolinensis, using a new method for drug delivery. Behavioural brain research, 156(1), 53-64.

Cinema Paradiso

Cinema Paradiso tells the tale of renowned Italian film director Salvatore Di Vita, chronicling his life in the small town of Giancaldo from childhood until his ultimate departure in early adulthood.  The following post will explore several themes and concepts that were prominent in the film.

Death and All His Friends

The movie revolves around a few of the great inevitabilities in life, including heartbreak and death.  Told in the form of a flashback, it is the news of Alfredo’s death that provides the impetus for Salvatore’s reminiscence.  As the audience soon discovers, death has also claimed his father in the recent war.  As a young boy, Salvatore (then affectionately referred to as Toto) develops an interesting relationship with Alfredo, a projectionist at Cinema Paradiso.  At times, Alfredo would appear as a mentor to Toto, guiding him through the inner workings of the projection room at Paradiso; during others, it seemed as if man and boy were both of the same age at heart.  

Alfredo: Mentor, confidante, friend.

Undoubtedly, Alfredo was seen as a father-figure in Toto’s life.  Whether this relationship was due to the death of Toto’s father was not made clear in the film; however, this is typical in children who have experienced the loss of a parent, as there tends to be a shift from grief reactions to a search for acceptance and of replacement persons (Yates, 1985).  Taking into account a number of factors including developmental constraints, bereavement and grief manifest themselves differently in children than they do in adults.  According to Nagy (as cited in Yates, 1985), a child’s comprehension of death can be categorized into three different stages: whereby death is seen as reversible (Stage 1), whereby death is understood to be final but is something that only happens to others (Stage 2), whereby death is perceived as final, inevitable, and associated with the cessation of bodily activities (Stage 3).  It is likely that young Toto falls under Stage 3 of this model as he demonstrated the understanding that his father was dead and would not be returning from the war, even as his mother continued to hold out hope to the contrary.  Although the death of his father did not appear to have a lasting impact on Toto, it could be that Toto and Alfredo’s relationship began as a means for the boy to cope with the loss.

Monkey See, Monkey Do

Under Alfredo's tutelage, Toto learns the know-hows of being a projectionist. From casual observation to becoming Cinema Paradiso's very own projectionist after Alfredo's accident, Toto's acquisition of this skill is reflective of the Observational Learning model. According to Bandura (1974), observational learning involves four processes: attention, memory, initiation, and motivation. Toto had watched Alfredo at work on numerous occasions and could even replicate his actions to a certain degree, indicating attention and memory. Initiation refers to one's physical and mental ability to reproduce the model's actions, which Toto did indeed demonstrate. Finally, an individual must possess the necessary motivation to execute the action, and Toto was more than willing to operate the equipment in the projection room; thus resulting in successful reproduction of Alfredo's actions.

“Tell me and I forget, teach me and I may remember, involve me and I learn.”

Today: Tomorrow’s Nostalgia

Nostalgia is a theme that pervades the film from start to finish.  Toto’s nostalgia is clustered and undefined. He sees much in his childhood that he has since lost: a sense of belonging both to a family and a community, his lost-love, Elena, and his youthful passion.  However, these distinct ideas are all subsumed under the cinema because it is the context that made them all possible. For this reason, it is the cinema and its facility for moments of collective transcendence that affects this feeling of nostalgia in the audience.  

Nostalgia is oftentimes akin to a double-edged sword, with a pleasant experience capable of resulting in either positive or negative feelings.  Alfredo knew that Toto would not be able to move on to greater things if he kept reliving his time at Paradiso and Giancaldo. Boym (2002) identified two distinct types of nostalgia, restorative nostalgia (involving a desire to relive special moments) and reflective nostalgia (involving the acceptance that the past is behind us).  At the end of the film, Salvatore is visibly emotional upon viewing Alfredo’s film reel, which contains all of the romantic scenes the priest had ordered to be cut from movies.  As he savours the emotions evoked from the recollection of his time in Giancaldo, it is safe to assume that Salvatore is experiencing reflective nostalgia.  Reflective nostalgia revels in the fact that a memory is untouched by the present, existing solely within our minds for us to experience.  

"There is no greater sorrow than to recall a happy time when sorrow." -Dante

Despite its earlier classification as a form of psychosis, nostalgia has been shown to counteract loneliness, boredom and anxiety (Batcho, 2013).  It has also been known to increase one's sense of social support and connections, as well as enhancing an individual’s self-regard.  Ultimately, it is one’s attitude toward the past that influences its impact on us.

References

Bandura, A. (1974). Behavior theory and the models of man. American Psychologist, 29(12), 859. Retrieved from

http://www.uky.edu/~eushe2/BanduraPubs/Bandura1974AP.pdf

Batcho, K. I. (2013). Nostalgia: retreat or support in difficult times?. The American Journal of Psychology, 126(3), 355-367.

Boym, S. (2002). The future of nostalgia. Basic Books. Retrieved from https://books.google.com.my/books?id=7BbTJ6qVPMcC&lpg=PR7&ots=XVCJdG8jSK&dq=The%20Future%20of%20Nostalgia%2C%20Svetlana%20Boym&lr&pg=PA3#v=onepage&q&f=false

Yates, A. (1985). Bereavement: Reactions, Consequences, and Care. Archives of Pediatrics & Adolescent Medicine, 139(7), 678. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK217849/