A partir del volumen 13 número 1 de 2017 la Revista de Medicina y Cine se encuentra alojada en

http://revistas.usal.es

Medicine and the Cinema: Making Sense of Death

Íñigo Marzábal Albaina1, Wilson Astudillo Alarcón2

1Departamento de Comunicación Audiovisual y Publicidad de la Universidad del País Vasco

2Centro de Salud de Bidebieta-La Paz. San Sebastián (Spain).

Correspondence: Wilson Astudillo. Bera Bera 31-Iº Izqda. 20009, San Sebastián (Spain).

e-mail: Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo.

Received 20 August 2007; accepted 4 January 2008


Towards the end of the seventies, Kermode published an extremely interesting and much debated essay -The Sense of an Ending- on the raison d’être of narrative fiction. According to this renowned critic, to make the radical contingency of life bearable we can only resort to fiction. Men, like poets rush into the middest, "in medias res", when they are born. They also die in "mediis rebus", and to find meaning in the space of our lives require fictitious agreements with the origins and purposes that can give meaning to life and poems1. We are merely an interval, a parenthesis, in the course of time. We believe we live in a state of permanent “crisis”; we believe we perceive that our own time here o earth contributes a “critical” epoch of transition, the end of something and the beginning of something new. Hence our need -to use the terminology of Kermode- for apocalypses able to organise our chaotic reality by establishing an origin (Genesis) consistent with an end (Apocalypsis). Hence too the profusion of eschatological plots that, from the finale, lend meaning to all that has gone before; of stories that reveal the experience of death, since what other radical ending is there but death itself.

Although the narrative analysed by Kermode belong to the sphere of written fiction, his intuitions can be extrapolated to the remit of the audiovisual. There has also been a type of cinema that has made death into a useful and meaningful occurrence, the true core of the story. With the appearance of death, everything becomes ordered: the wound is healed, the menace vanishes, and pain is ended: an exemplary death able to establish the law and offer a teaching. This reparative function of death was undoubtedly linked to a certain conception of the hero, since the hero is less of a person than a symbolic place. The hero is able to install order through exemplary action, such that her/his vanishing and replacement by dis-oriented, dis-centred, dis-placed characters is corresponded by a change in the portrayal of death and of the object upon which it acts: the body. At the ends of the whole spectrum are two great paradigms of this representation. On one hand, the ethereal body, whose prototypical story would be that of publicity: light bodies, soft bodies, fat-free bodies -almost without flesh- designer bodies, young people, beautiful people, desirable people, all of them immune to the ravages of time and experience. Bodies that are therefore beyond life and death; in short, unreal bodies. On the other hand, we have the dismembered, broken, slashed, raped and decomposing bodies that, in the hands of adventure, fantasy, and terror films, fill our screens; bodies that we can hardly bear to look at. If previously death was denied, in these films it is omnipresent, although it loses any kind of symbolic usefulness. This is the step from the narrative to what is spectacular. And all has now indeed become a spectacle. Death itself is no more than a narrative excuse, the motive of jokes and quips, of morbid fascination. We want to see everything and we want to see it now. We desire a feast for the eyes. The coy look has been replaced by detail. The true story has fallen beneath the weight of the fabulous and of special effects. The vacuum left by the hero has been filled by the fashion model and the serial killer.

Despite all the foregoing, and between the interstices of those prevailing discourses, there are still films that aim to restore to narratives their ability to transmit significant experiences with a view to making something meaningful out of death. They are aimed at those who survive in the narrative and at us, the spectators, who eagerly sit before that complex web of desires to witness transformation and the prosecution of ideals, of achievements and renegings, of reasons and emotions embodies in films. Hence the need to talk about films that escape the “frenzied visual festival” that seems to dominate contemporary cinema. Hence, too, the pertinence of this second monographic issue about Cinema and the End of Life. To narrate implies counselling and true counsel is less of a response than a proposition. It is from the story, from its plot, where indeed we begin to speculate; where we ourselves plot and advance hypotheses. This is because if anything is to be gained from narrative experience it is an antidote to the habit of constant and impetuous judgement. We should never judge before we have understood.

The articles offered in this issue are related to the teaching possibilities of the cinema, the benefits of humour as a helping element for the well-being of patients, the matter of death, and narrative and grief. Thus, Ortega et al., with the paper entitled Learning with the cinema: a bridge between reality and ideas in the process of dying, point out that this is very useful in training future physicians in communications skills and about the physician-terminal patient-family triad. They underscore the use of different scripts and the work to be done in cine forums based on the philosophy of learning among peers that reflect the opinions and feelings of patients and their families - the true protagonists in the process. They analyze two main aspects: 1) the different ways of dying: the ideal death and the undesired death, and 2) the role of death in which, if possible, it is accepted that it is possible to avoid suffering and to satisfy the needs of patients and their carers. A teaching guide to the film Wit by Mike Nichols (2001) is included2.

In their paper The cinema as an instrument for a better understanding of human nature, Astudillo and Mendinueta address the possibilities of the cinema as a powerful cultural tool for training spectators in new attitudes. It uses different elements -images, sound, literature and all of the Fine Arts- to challenge the intellect; stimulate emotion, and hence facilitate a better understanding of some elements of the human condition. The authors explain, in a very subtle way, how the cinema takes advantage of the empathy generated in the spectator towards the characters, and how spectators project their experiences so as to identify themselves with the situations they see until they feel as they were their own. The importance of mirror neurons to make us into social beings is reviewed, together with the need to learn cinematographic language in order to appreciate it within its true dimension3.

In their paper The cinema as an instrument for a better understanding of human nature, Astudillo and Mendinueta address the possibilities of the cinema as a powerful cultural tool for training spectators in new attitudes. It uses different elements -images, sound, literature and all of the Fine Arts- to challenge the intellect; stimulate emotion, and hence facilitate a better understanding of some elements of the human condition. The authors explain, in a very subtle way, how the cinema takes advantage of the empathy generated in the spectator towards the characters, and how spectators project their experiences so as to identify themselves with the situations they see until they feel as they were their own. The importance of mirror neurons to make us into social beings is reviewed, together with the need to learn cinematographic language in order to appreciate it within its true dimension3.

Marzabal, in The End: Death in the Cinema, highlights the importance of narrative and its moral function, which is to help unveil different aspects of human existence, not always known, and to cast light where before there were only shadows. In this sense, many directors have used films to dignify human existence. To accomplish his aims, the author looks at three films –The Elephant Man (1980), by David Lynch, Wit (2001) by Mike Nicholas and The Barbarian Invasions (2003) by Denys Arcand, where the traditional distinction between being and living, between being human and living humanely, is considered and an analysis id offered of the role of medicine in the task of providing the conditions for human existence to be dignified. Thus, the author delves into the issue of humanization and suicide, empathy and medicalized death, and learning and autonomous death so that each patient can be able to live his/her own death. To a greater or lesser extent, in this last segment of life those involved in caring for the patient also undergo a process of transformation, since these moments provide an opportunity to better assess such emotions (not always felt) as love and affection and human interaction: always an enlightening experience4.

Marzabal, in The End: Death in the Cinema, highlights the importance of narrative and its moral function, which is to help unveil different aspects of human existence, not always known, and to cast light where before there were only shadows. In this sense, many directors have used films to dignify human existence. To accomplish his aims, the author looks at three films –The Elephant Man (1980), by David Lynch, Wit (2001) by Mike Nicholas and The Barbarian Invasions (2003) by Denys Arcand, where the traditional distinction between being and living, between being human and living humanely, is considered and an analysis id offered of the role of medicine in the task of providing the conditions for human existence to be dignified. Thus, the author delves into the issue of humanization and suicide, empathy and medicalized death, and learning and autonomous death so that each patient can be able to live his/her own death. To a greater or lesser extent, in this last segment of life those involved in caring for the patient also undergo a process of transformation, since these moments provide an opportunity to better assess such emotions (not always felt) as love and affection and human interaction: always an enlightening experience4.

De la Fuente et al. analyze Shadowlands (1983) by Richard Attenborough to address the process of grief as a natural adaptive phenomenon that sometimes requires special help, because it may elicit alterations within the griever him/herself and with others. This film takes an honest look at the life of C. S. Lewis and the poet Helen Joy Gresham and their joyful and yet painful encounter with love and death. It is a fundamental film for understanding the grief, an essential part of palliative care, felt at the end of their lives and for understanding their family at this time5.

De la Fuente et al. analyze Shadowlands (1983) by Richard Attenborough to address the process of grief as a natural adaptive phenomenon that sometimes requires special help, because it may elicit alterations within the griever him/herself and with others. This film takes an honest look at the life of C. S. Lewis and the poet Helen Joy Gresham and their joyful and yet painful encounter with love and death. It is a fundamental film for understanding the grief, an essential part of palliative care, felt at the end of their lives and for understanding their family at this time5.

Finally, Aldarondo offers a different perspective. If in the above texts the films explored are based on fiction, Lightning over Water (1980) by Wim Wenders and The Wings of Life (2006) by Antonio Pérez Canet belong to that elusive genre which is the documentary. These films thus embody the suggestive dictum of Jean Cocteau that the cinema documents death doing its work. Neither Nicholas Ray nor Carlos Cristos are actors who, more or less, successfully interpret what the scriptwriter has created, but real human beings whose last breath is recorded by the inquisitive eye of the camera. Hence the ambivalence that they films elicit in the spectator. On one hand, we have the courage of both in offering a bona fide testimony of that almost unmentionable experience that is death, and, on the other, we note that it is almost impossible to disregard a certain sense of grossness, of obscenity, when facing that spectacularization (?) of death. This is what is addressed in Aldarondo’s contribution6.

Finally, Aldarondo offers a different perspective. If in the above texts the films explored are based on fiction, Lightning over Water (1980) by Wim Wenders and The Wings of Life (2006) by Antonio Pérez Canet belong to that elusive genre which is the documentary. These films thus embody the suggestive dictum of Jean Cocteau that the cinema documents death doing its work. Neither Nicholas Ray nor Carlos Cristos are actors who, more or less, successfully interpret what the scriptwriter has created, but real human beings whose last breath is recorded by the inquisitive eye of the camera. Hence the ambivalence that they films elicit in the spectator. On one hand, we have the courage of both in offering a bona fide testimony of that almost unmentionable experience that is death, and, on the other, we note that it is almost impossible to disregard a certain sense of grossness, of obscenity, when facing that spectacularization (?) of death. This is what is addressed in Aldarondo’s contribution6.

The Basque Society for Palliative Care thanks the Editors of the Journal of Medicine and the Cinema for their kind invitation to direct these two issues dedicated to the Medicine and the Cinema at the End of Life. They hope that the topics addressed will offer readers new ideas to cope with the different situations and circumstances that arise during this period of human existence. A discussion of the issues raised in a suitable forum should help to improve our understanding of the problems and should foster the development of more positive attitudes towards terminal patients, leading to a better medical understanding of their autonomy and the support required by their families. The cinema can be a great help to ensure that health care will become increasingly more integral and humanitarian.


References

  1. Kermode F. The Sense of an Ending. New York: Oxford University Press; 1968.
  2. Ortega Belmonte MJ, Rodríguez Membrive M, Sánchez Maldonado M, Bravo Muñoz E, Corredera Guillén A, del Águila Ojeda Rodríguez M, Ortega Torres V, Becerra Mayor V. Learning with the Cinema: A bridge Between Reality and Ideas in the Process of Dying. J Med Mov. 2008;4(3):113-121.
  3. Astudillo Alarcón W, Mendinueta Aguirre C. The Cinema as an Instrument for a Better Understanding of Human Nature. J Med Mov. 2008;4(3):131-136.
  4. Marzábal Albaina I. The End: Death in the Cinema. J Med Mov. 2008;4(3):122-130.
  5. Fuente Hontañón C de la, García Ugarte L, Gonzalez Fernán-dez A. Shadowlands (1993): Grief as a Process of Life, Sickness and Death. J Med Mov. 2008; 4(3): 99-107.
  6. Aldarondo R. Cinema as Relief and Final Goal. J Med Mov. 2008;4(3):108-112.