Most of us have no direct experience of psychiatry or severe mental illness. So our attitudes and experiences are shaped by what we are exposed to: mass media portrayals. Reality rarely makes good drama (remember Big Brother?) so film and television content makers take some significant liberties with their depictions.
The power of cinema can’t be underestimated – just look at the difficulty electroconvulsive therapy (ECT) has faced at the hands of One Flew Over the Cuckoo’s Nest. This highly effective and safe treatment for severe depression continues to bear the scars of its past. Even in 2011, patients routinely cite this 1975 film as a reason for not considering this therapy.
Similarly, most younger people have little daily contact with people over 65, apart from infrequent contact with their grandparents. As such, their perceptions of older people, ageing and dementia are likely to be drawn from portrayals in the mainstream media.
Consider the last time you saw an elderly character on television. If this was during a commercial, chances are they were promoting health insurance, funeral services or incontinence pads. If your experience was during an actual program, the character was likely frail, hospitalised, a hapless victim of crime, befuddled, or demented. Or perhaps all of the above.
There are currently more than 165,000 Australians living with dementia. With the ageing of the population this number is expected to double by 2030. It’s a condition that causes boundless suffering – not only to the patients themselves but to the carers who see their loved ones decline cognitively, functionally and behaviourally as the disease runs its course.
Globally, the annual costs attributed to dementia are equivalent to the GDP of Turkey.
Despite their prevalence, dementing illnesses are rarely portrayed in cinema. Over the past decade, only ten films featuring dementia and Alzheimer’s disease story-lines have had a mainstream box-office release in either the United States or the United Kingdom. Between them, they grossed a little over $120 million dollars (two-thirds of which was accounted for by The Notebook).
All ten films tended to paint sympathetic images of dementia. Carers in (Iris, Away From Her, The Notebook) are almost saintly in their self-sacrifice. While sufferers, such as Dame Iris Murdoch in Iris, tend to be shown as bearing their burden with good grace and acceptance.
As a psychiatrist for the elderly I can tell you that these portrayals are by no means typical of either the patient or carer experience in this wide spectrum of disorders. For someone preparing for the journey with the illness, viewing these films alone would do little to prepare them.
The small screen
Cinematic depictions of dementia are rare but they appear quite commonly on television, with portrayals tending to fall into two categories. In the first, the disease creates a crisis for a lead character, one of whose parents has usually been diagnosed with the illness (House: Episode 20, season 3; The West Wing: episode 78).
More commonly, dementia sufferers are regular characters on prime-time television, almost invariably within sitcoms but occasionally in “dramadies”. These characters provide comic relief, either as a lead character (think of Betty White in The Golden Girls and William Shatner in Boston Legal) or as a recurrent secondary character such as Grandpa, from The Simpsons. These characters are figures of fun; their memory lapses more comic than tragic.
From a plethora of negative portrayals of dementia on the small screen an unlikely champion has emerged: Mother and Son, which screened on the ABC between 1984 and 1994.
While undeniably a comedy, this program struck a more appropriate balance between humour, pathos and despair than most other series that have come before or after. Genuinely funny moments were counterpointed with the dynamic realities of carer stress, altered family dynamics, frustration and burnout.
Mother and Son is a more realistic portrayal of these issues than many films that attempted to explore this same territory in a more dramatic format.
Out of sync with reality
The perception of our aged citizens as being frail, confused and thus incompetent reinforces a pervasive ageism within our society. The elderly themselves are exposed to these negative portrayals of ageing. They see their suffering trivialised and thus receive the message that that their lives are not worthwhile.
Dementia has struggled to achieve the attention it deserves from policy makers. While negative, unrealistic and trivialised portrayals of dementia remain so pervasive and influential in our televisual and cinematic consciousnesses, it’s unlikely to ever gain prominence in the hierarchy of budget allocations.
There is a gulf between fiction and reality, and it’s time we woke up to this.