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How do you film a delusion?

Canadian director David Cronenberg's 2002 film, "Spider," tells the story of a man with chronic schizophrenia whose present dysfunction is linked to circumstances when he was a preteen. Dennis Cleg (Ralph Fiennes) was sent to a public mental hospital after a tragic event when quite young. But now, as the film opens, after years of confinement, he is being outplaced to a residential board and care facility in the East London neighborhood where he was raised. Back in old familiar haunts, Dennis finds himself increasingly preoccupied by painful, unbidden recollections of his childhood.

Dennis' reveries, alternating with scenes of his present life throughout the film, are presented in a series of vivid, lengthy flashbacks in which the adult Dennis is a ghostly witness standing unseen next to his parents and himself as a 12-year-old. His mother (Miranda Richardson) had nicknamed him "Spider." Young Spider is withdrawn and friendless, bound closely to his mother at an age when boys normally prefer to go off with their buddies. Mom also finds comfort in being with Spider; it makes up a bit for her loneliness. Then, possibly in desperation, she starts to doll herself up and drink more, in an effort to rekindle romance with her husband, Bill (Gabriel Byrne), who has shown signs of infidelity. Her tete-a-tetes with Spider dwindle. One day he is taken aback to find her preening in front of a mirror in a blue slip. He begins to misperceive his mother as a tart like one who frequents Dad's favorite pub. No doubt already psychotic, he forms the delusion that Dad has killed his brunette mother and taken up with this bottle-blonde floozy, "Yvonne" (also played by Ms. Richardson). Spider accuses them both of being murderers, and ultimately seeks revenge by turning on the unlit gas stove one night while Yvonne slumbers drunkenly nearby. She dies as a result, but when Dad drags her body outdoors, her appearance is transformed into that of Spider's Mom.

The story does not unfold as straightforwardly as my synopsis suggests. Cronenberg and screenwriter Patrick McGrath, who adapted his own novel, use the same strategy as the makers of the most popular recent film about a person with schizophenia, "A Beautiful Mind," insofar as they draw us into the action as it is perceived by the psychotic person. We see Dad strike Mother a deathblow with a shovel when she discovers him in sexual throes with Yvonne. Thus, I thought at first that Dad had killed Mother and taken up with another woman, despite the clue provided by having Ms. Richardson play both roles. Only later--in a scene by the garden shed when Dad seems so gentle as he expresses to Spider his puzzlement over his son's accusations--did I begin to realize the truth: When we see Dad kill Mother and bury her body with Yvonne's help, these events can only have been a delusion in young Spider's mind.

Depicting schizophrenia poses major problems for a filmmaker, because its defining features are disorders of thinking and perception--symptoms that a camera can't see. This problem can trip up anyone who wishes to portray schizophrenia honestly. Many directors decide to rely exclusively on the schizophrenic character's manifest behavior and quirks of speech that may suggest a disorder of thinking processes and make no attempt to represent their inner experiences more directly. Think of Geoffrey Rush's manic but disorganized conduct in "Shine," Janet Margolin's clanging speech in "David and Lisa," or Sean Gullette's tightly wound paranoid frenzies in "Pi." Other filmmakers employ surreal artistry or magical realism to suggest bizarre inner experience: for example, Salvador Dali's scenes of the protagonist's fugue experiences in Alfred Hitchcock's "Spell-bound." Ron Howard also uses visual gimmickry to represent some of John Nash's delusional insights in "A Beautiful Mind."

Trouble is, surrealism misses the mark. The problem lies in the nature of the symptoms. Delusions may be highly complex, yet unaccompanied by visual or other sensate perceptions (except, in some cases, for geometric or other arcane symbols). Hallucinated voices are typically disembodied from visual human forms and emanate from the spatial hemisphere behind the patient. Visual phenomena tend to be shadowy, ill formed, darkly diaphanous. Other hallucinations can be tactile (especially sexual) or olfactory (foul odors are common). One can easily understand a filmmaker's desire to use the medium to go beyond the surface conduct of the psychotic protagonist. But given the nature of the inner experiences, how can one portray them authentically and at the same time maintain narrative and visual coherence? The other alternative, depicting only behavioral correlates of inner experience, leaves the viewer, like the psychiatrist, still on the outside looking in.

As far as actions go, no one could ask for more than Fiennes delivers here. It helps that he has a thin body build, like many schizophrenic persons. Fiennes gets posture and movement right: the awkward stiffness and impoverishment of activity seen so commonly in schizophrenia, features also compounded at times by antipsychotic drug side effects. He is the first actor I've seen who mumbles, like many symptomatic schizophrenics, subvocalizing their thoughts and voices. Fiennes also conveys a sense of deep apprehension, a wild fearfulness like a deer at night caught in a headlight beam. As his character's recollections of the events culminating in his mother's death weigh in upon him more and more, Fiennes ratchets up the level of anguish; the fervor of his compulsive efforts to ward off bad feelings and thoughts by scribbling nonsense hieroglyphics in his notebook; and, toward the end, the increasing paranoid concern that Mother will seek revenge on him as he begins to misperceive the woman who runs the board and care home (Lynn Redgrave) as his mother (also briefly played at this point by Ms. Richardson).

Not content with Fiennes' gifted performance, Cronenberg goes further, employing several strategies to portray Dennis' internal experience. First, in the sequence when Dad "kills" Mom, he substitutes complex realistic scenes for young Spider's delusional thoughts and, in the process, puts the audience in the schizophrenic protagonist's shoes, as Ron Howard did in "A Beautiful Mind." Now we are on the inside looking out. But the cost of aligning our (false) view of reality with that of the schizophrenic character is the misrepresentation of schizophrenic symptoms. Imaginary, complex, lifelike scenes do occur normally in some highly creative, visually oriented people, partial complex seizures, delirium, and hysterical hallucinations. But they are very unusual in schizophrenia. To his credit, Cronenberg limits use of this conceit to one instance (Dad killing Mom), and be always keeps the adult Dennis on the sidelines as a nonparticipating witness to this and all his other reveries. In contrast, Howard had Russell Crowe (as Nash) repeatedly cozy up to imaginary friends and coconspirators in scenes that are more grossly inauthentic. Nor does Cronenberg light up his movie like a Disney sitcom, the way Howard did much of the time in "A Beautiful Mind." Instead he uses dark, shadowy, bilious green lighting and spare music to convey the morbid sense of foreboding experienced by the adult Dennis. The transitions between scenes of Dennis' current life and childhood reflections are seamless. Indeed, the fluidity of the boundary between past and present increases as the movie progresses. In this manner Cronenberg subtly shows Dennis' breakdown--his increasing confusion of humdrum current reality with tormenting recollection and reverie.

Some lay viewers have complained that Fiennes' Dennis is inaccessible, too lacking in ordinary emotional expression to comprehend. In a similar manner, some reviewers of "A Beautiful Mind" said that Russell Crowe did not clearly articulate inner emotions. Such critics betray their lack of clinical knowledge. Persons with schizophrenia often have great difficulty accurately expressing emotions in ways others can fully understand and empathize with. So the screen portrayal of schizophrenia poses yet another dilemma: The more authentic the acting, the tougher it may be to attract and sustain viewer interest.

People have also complained that the portrayal of schizophrenia in "Spider" is gratuitously stigmatizing, that it does not reflect the more "normal" conduct of many patients with this disorder. It is true that some patients have little or no symptomatic residue between psychotic episodes. And proper treatment often can mitigate hallucinations, delusions, and bizarre behavior in people with chronic schizophrenia. In particular, the film might nourish popular fears about mentally ill patients being violent and dangerous. When properly treated, persistently mentally ill people are not more dangerous than the general population. The plain fact is, however, that many persons suffering from chronic schizophrenia and allied psychotic disorders are not taking medication.

A recent survey of the professional literature conducted by the Treatment Advocacy Center, an independent nonprofit organization dedicated to removing barriers to the treatment of severe mental illness, makes it clear that untreated severely mentally ill individuals are decidedly more dangerous than the general population. Because many people with mental illness live with or close to family, it is not surprising that relatives are the most frequent victims of the violent acts their psychotic kin commit. That said, the instance of completed matricide by a psychotic youth is rare indeed. I could find just a single case report along the lines of this story in a literature search covering the past 30 years.

It may not trouble anyone but a few psychiatrists that schizophrenic experience is misrepresented in "A Beautiful Mind." The fact that the course of John Nash's illness was highly exceptional rather than typical (only about 5%-10% of people with schizophrenia undergo permanent, spontaneous remission) is glossed over. The story suggests that enduring love can win the day in this disorder. While no one doubts the importance of a caring family to provide stability and emotional support for schizophrenic patients, the implicit suggestion that love can conquer this disease is misleading in the extreme.

But "A Beautiful Mind" is a Hollywood "feel-good" film, while "Spider" is murky and problematic. Like schizophrenia itself, this movie does not feel good. Dennis Cleg does not adapt well to change. He broods about old family dynamisms, real and imagined. He may not be taking his medication. He's getting worse and no one's the wiser. This is not an uplifting film, but it is frank and does not misrepresent the disease.

DR. ROLAND ATKINSON is a professor of psychiatry at Oregon Health and Science University, Portland. For more reviews, visit his Web site at www.AtkinsonOnFilm.com.

Share your thoughts with Dr. Atkinson by e-mailing him at cpnews@elsevier.com.
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Title Annotation:Reel Life
Author:Atkinson, Roland
Publication:Clinical Psychiatry News
Date:Dec 1, 2003
Words:1743
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