Snigdhaa Rajvanshi
In an interview with The Guardian, people suffering from Alzheimer’s disease described Still Alice as “[….] a shockingly accurate representation of [my] own experience.” (Seymour, 2018). Hitting the silver screens in December 2014, Still Alice is the motion picture adaptation of its namesake novel written by Lisa Genova. Starring Julianne Moore as the protagonist, the movie won many awards including Academy Award for best actress and an Oscar nomination for the same. This movie is not alone in portraying the struggles of dementia and Alzheimer’s disease on the big screen. However, this movie stands out due to its specific focus on rare Early Onset Alzheimer’s disease and the subsequent effects it has on the life of the patient and their families. Given the popularity and critical acclaim of the film, along with the lack of knowledge about Early Onset Alzheimer’s in the general population, it becomes important to analyze how accurate this movie was in portraying this disease. This blog post thus aims to analyze the clinical accuracy of the movie’s portrayal including the potential causes, symptoms, and progression of the disease.
The story of Still Alice revolves around a renowned and celebrated Linguistics professor at Columbia University, Dr. Alice Howland. Alice is shown to be diagnosed with Early Onset Alzheimer’s disease shortly after her fiftieth birthday. Her symptoms start out as unable to compete in ‘words with friends’ (an online crossword puzzle game) despite her linguistics background and progress to a state of complete dependence. Alice’s age and gender speak accurately for the onset of her disease and the increased risk of women developing Alzheimer’s. Although this risk is hypothesized to be related to loneliness in women due to their higher life expectancy (Hooley et al., 2021), this rationale does not align with Alice’s lifestyle which included a loving marriage and three supporting children. However, the movie does a remarkable job of focusing on the genetic factor of the disease and how its heritability affects the family of the patient. Alice is shown to have inherited the disorder from her absent father. Congruent with Alice’s age, she appears to have a mutation of the gene Presenilin 1 (PS1) on chromosome 14 and gene Presenilin 2 (PS2) on chromosome 1 (Hooley et al., 2021). Being autosomal dominant, these genes have extremely high heritability. Alice is shown dealing with her diagnosis and the guilt of passing on the disease to her children at the same time. The movie again highlights the disease’s increased prevalence in women than men by showing Alice’s daughter positive for the disorder and not her son. In addition to that, Alice is shown to be a frequent consumer of sleeping pills. Benzodiazepines, which include anxiety prescriptions and sleeping pills (Harvard Health Publishing, 2018) have been concluded to increase the risk of developing Alzheimer’s at later stages by around fifty percent (Hooley et al., 2021). The movie accurately underlines Alice’s regular use of benzodiazepines as a potential risk factor in the presentation of her disorder along with her genetic predisposition.
The movie explores various symptoms of Alzheimer’s. Alice is shown to have regular memory lapses which get more intense as the movie (and also her disorder) progresses. Alice is shown to start by forgetting simple words and events, from feeling lost in her own university to forgetting the way to the washroom in her own house and finally not remembering her occupation and place of work. Alice is also shown to have difficulty remembering her youngest daughter and correctly recalling her older daughter’s name. Alice is shown to forget the names of regular things like a highlighter and is portrayed to have an increased dependence on her phone to help her remember things, as have seen in many Alzheimer’s patients (Seymour, 2018). Alice is shown to repeatedly ask her husband the same questions over and over again and is shown to be easily distracted as they get ready to go on a run together. Alice also experiences changes in her mood and personality. At the beginning of the movie, Alice appears to be a talented, articulate, and calm person. However, as her disease progresses, Alice experiences anxiety and outburst of aggression on various occasions, both of which are also frequently observed in Alzheimer’s patients (National Institute on Aging, 2017). People with Alzheimer’s have difficulty following multi-step instructions. Alice is shown to have difficulties following her own recipe, getting dressed, etc. She is also unable to follow the video instructions she left for herself, for when her disorder got worse. Alice makes various attempts to follow the instructions and is ultimately not able to follow through due to her short attention span. Alice is also shown to have difficulty fitting into a conversation with her family and exhibits “empty” speech (Hooley et al., 2021), for example, Alice states “It is hot in here”, which while being grammatically correct, lacks meaning to the ongoing conversation. The movie includes various shots of Alice wandering around her house aimlessly, which is a common symptom of her disorder. In addition, increased sleeping, weight loss and loss of bladder and bowel control are present themselves in the later stages of the disease (National Institute on Aging, 2017). Alice is shown to go from an active individual to a person with irregular sleep patterns and is shown to grow increasingly weaker. She is shown to need help walking and performing daily tasks. Alice is also shown to have low bladder control when she could not find her way to the bathroom. This also speaks to the decreased concern for personal hygiene experienced by Alzheimer’s patients (Hooley et al., 2021).
While the movie presents a variety of symptoms accurately, it also is incongruent with reality in some areas. Primarily, the progression of Alice’s Alzheimer’s is extremely fast and unrealistic as she goes from a fully functioning professor to a person who can barely speak in a little over a year. While the progression of Early Onset Alzheimer’s is faster and more intense than Late-Onset Alzheimer’s, Alice’s progression was “too fast by almost any standard” (Sifferlin, 2015). Secondly, studies show that people with lower levels of educational background are more likely to develop Alzheimer’s (Hooley et al., 2021). However, in a conversation with her neurologist, Alice’s high level of education is termed to be one of the potential risk factors for her disease, making the movie go completely against the empirical evidence and reality.
Still Alice also does a relatively good job at exploring how Alzheimer’s affects family dynamics and the emotional turmoil brought on by the diagnosis. While to movie goes horribly wrong in portraying some aspects of the disease, it does a remarkably good job at presenting the symptoms, progression, and consequences of Early Onset Alzheimer’s. The movie, finally, does a great job at generating awareness around the topic, as was intended (Seymour, 2018) by the movie’s creators and the actress herself. The movie also does a beautiful job at sparking the necessary conversation around the disorder and addressing the needs and support required by the people with this diagnosis and the challenges faced by the families of these patients without painting either in an evil light. In a true Hollywoodization of the disorder, Still Alice brings forth to the limelight, the ‘art of losing’.
References
Harvard Health Publishing. (2018, June 14). Two types of drugs you may want to avoid for the sake of your brain - Harvard Health. Harvard Health; Harvard Health. https://www.health.harvard.edu/mind-and-mood/two-types-of-drugs-you-may-want-to-avoid-for-the-sake-of-your-brain
Hooley, J. M., Nock, M., & James Neal Butcher. (2021). Abnormal psychology. Pearson.
National Institute on Aging. (2017, May 16). What are the signs of Alzheimer’s Disease? National Institute on Aging. https://www.nia.nih.gov/health/what-are-signs-alzheimers-disease
Seymour, T. (2018, February 22). Still Alice is “shockingly accurate” – people living with dementia give their verdict. The Guardian; The Guardian. https://www.theguardian.com/film/2015/feb/10/still-alice-alzheimers-accurate-dementia-sufferers-verdict
Sifferlin, A. (2015, February 19). What the Year’s Health Films Got Right—And Wrong. Time. https://time.com/3695430/how-accurate-are-health-films/
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