FOREST OF SWORDS: Patient Shows Up as Doctor

Forest of Swords is a documentary in progress by Filmmakers Helen S. Cohen and Mark Lipman.  The film is an intimate portrait of the recovery of Dr. Grace Dammann and family from catastrophic injury. The filmmakers have followed Grace and her family on camera from the day of her first discharge from the hospital. One wouldn't think of this material as rejuvenating or humorous but in the hands of this subject and these filmmakers both are true. Through this handling emerges a picture of what resilience is and how it nurtures healing.

In May of 2008, just before Memorial Day, Grace was in a violent motor vehicle collision on the Golden Gate Bridge.  This resulted in a coma for 6 weeks and the shattering of nearly every bone in her body as well as other injuries. Her 14 year old daughter and family dog were present in the vehicle and were physically remarkably unharmed.  

To date, Grace has endured over two years of surgery, and rehabilitation medicine.  Hers is a story of support through concentric circles of interlocking family and friends. These circles range from myriad individuals (see caringbridge.org) to the global reach of the San Francisco Zen Center, creative luminaries and medical professionals. Grace has lived to tell the story from the edge of life and from both sides of the doctor patient relationship. Both the edges of life and the doctor patient relationship are daily part of the applied bioethics known as clinical medical ethics. 

In the fiction "medical film genre" many works turn on physician's needing to heal themselves (FRANKENSTEIN, Whale 1931), becoming better doctors in the process (THE DOCTOR, Roberts 1992), and communities healing physicians (CITY OF JOY, Jaffe 1992).  FOREST OF SWORDS brings to the party an important conceptual shift.  In Grace's story we see a patient, who happens to be a physician, become her own agent for healing.  This is important because deep inside of every seasoned medical doctor is a recognition that every patient is the key to their own recovery or tolerance of illness. The question that FOREST OF SWORDS begins to answer is how patients, clinician's and families might best tap that vital energy. 

To be honest Grace's life and persona before the accident was remarkable. His Holiness the Dalai Lama presented Grace the “Unsung Heroes of Compassion" award in 2005 for her care of thousands of AIDS patients, during the era when HIV/AIDS was always a death sentence.  How Grace and her family became a part of Isabel Allende's extended family is reflected in the author's 2008 memoir sequel, The Sum of Our Days.  Grace's unique spirit and genius inform the power of FOREST OF SWORDS.  

Be warned, this is not looking like a film for wimps or the faint of heart.  It makes the strong argument that the best hope for resilient recovery from injury is a foundation of a connected and intentional life.  If you can swing it you ought to be working on that foundation both before and after injury.  As Grace would say "showing up” every day is key.  The film, whose working title is Forest of Swords, is about life and recovery.  

FOREST OF SWORDS (DVD) (working title) Directed by Helen S. Cohen and Mark Lipman. Open Studio Productions. USA. In production (2010) To learn more about this film, previews and to support its development see http:www.openstudioproductions.com/independent.html

See Film/Bioethics Literacy section on this blog for more on "doctors as patients" and the Medical Film Genre. (Lighten Up Slides: slides 61 and 62 define the medical film genre, slide 70 medical film genre filmography and slide 71 medical film genre videography)


CHILD OF GIANTS: Lange & Dixon's Legacy

CHILD OF GIANTS is a documentary about being the child of two creative masters of the last century; photographer Dorothea Lange and painter Maynard Dixon. It is an honestly crafted work. It brings depth to the artist, honoring their work, without idolizing them. Tom Ropelewski, a screenwriter known for romantic comedies, recognized in Daniel Dixon's handling of his life with extraordinary parents a really good story. Daniel, an advertising copy writer, had a way of telling stories that translated tragedy into "matter of fact" and sometimes humor. Daniel's is the main narrative voice in the story. His perspectives are augmented by his brother's, other family members' and his parent's art. The oldest child often has more understanding of their parents, in hind sight, than others. It is not easy to be the offspring of people whose destiny is to change the way we see the world. Often the parents don't know what their destiny is; they just do what they do with passion, while walking a tight rope over an ocean of uncharted waters.

Dorothea Lange was some twenty years younger than her husband Dixon. Her early experience with her own parents’ marriage hadn't left her a big fan of convention. She was a feminist before the word was coined. Like her contemporary visual artist women colleagues, Freda Kahlo and Georgia O'Keefe she was a force to be reckoned with. Also, like them, her partners of necessity had to revel in the uniqueness of her creative character and be unintimidated by it. Maynard Dixon was not the hand maiden husband to the great genius of Dorothea Lange. She was his equal. Neither sacrificed much for the other's career; the children suffered for both.

Among the greatest challenges in raising children with an understanding of oppression is insuring they do not become victims of it. There are critical points in children's lives were they need to be secure, that they are the center of the universe. But when your mother is busy advancing a new art form which has the power to document a call for justice in a turbulent time of history, it's pretty clear you are not the center of the universe. When your father disappears for months at a time to paint the vanishing indigenous peoples and lands of the south west, it's rather like telling children there is no Santa Claus at the wrong point in their development.

Dorothea watched the great depression unfold from the window of her studio in San Francisco. When given the opportunity to use her skill to express something of meaning about the depression she did so with singular elegance, creating icons which changed policy and arguably ushered in the error of the concerned photographer. During the internment of Japanese Americans she used the camera again as an organ of human consciousness, creating enduring images of strength and shame.

In medicine we know how you describe a problem affects how you handle the problem. As in the HIV/AIDS epidemic, what you call a thing determines how you respond to it. If it is seen as a narrow outbreak or an isolated economic depression in rural areas -- government has little need to intervene. A whiny baby gets Tylenol and is sent home; an inconsolable febrile child gets a lumbar puncture and admitted. When evidence of wide scale suffering and despair is undeniably documented as in Dorothea's photographs of the depression, the narrative cannot be ignored.

Modern medical ethics is usually taught by the principle based method. In this method one learns to analyze the tension between major ethical principles, particularly beneficence, autonomy, and justice. An alternative to principal based moral reasoning is casuistry. Casuistry uses cases or stories to enhance moral reasoning. The density of visual works of Lange and M. Dixon in the film demonstrate how their visual narrative was able to bring otherwise distant stories to the eye line of masses of Americans. This proximity of visual narrative affected moral reasoning around social policy. Dorothea found greater meaning in her work than in her marriage. The marriage broke up at a time when people were rarely divorced. The Dixon boys were destabilized once again.

In general, all children have a problem forgiving parents for destroying the family romance; children of giants or not. Forgiveness begins to happen when you are a parent yourself. Child of Giants is a story of how Daniel and John were both damaged and nourished by the eccentricities and strengths of their parents, and then forgave them their humanity. It is said that the developmental tasks of life's end include communicating to those whom you love some specifics. Daniel Dixon died before seeing the final cut of CHILD OF GIANTS. However, it seems that in the process of making the film, Daniel's final developmental tasks were achieved. It is our good fortune that filmmaker Tom Ropeleski had the good sense and skill to create this documentary. After all, the legacy of a great artist should be that they inspire more great artists.

CHILD OF GIANTS. DVD. Directed by Tom Ropeleski. USA. 2010.


MIRAL: Roots of Peace

MIRAL is a cross cultural, inter-generational film about preparing people for Peace; particularly those who have been oppressed by war. Peace in the world of bioethics is a “good,” which can only be held by humanity as a whole -- not the individual. It is important to understand that Peace is likely to be found in a collective unconscious which transcends our divisions. Peace exist in the territory that connects us, not that which separates us.  

Miral, a seventeen year old girl derives from the characters of three other women in the film. These women are reminiscent of universal stories from the era before God was considered male. Universal stories resonate within the human core and contain archetypes. Archetypes are imprints that exist in our psyches. Those of us who work with dying people encourage personal narratives; how many times we hear King Lear and his daughters! Archetypes are a way in which human beings make sense of complex experiences. Artists tend to express these core experiences in ways that translate across culture. The term archetypes comes from the Greek word archetypos, meaning "first of its kind."  Archetypes derive from icons. Icons are Gods and their doppelganger Monsters.   

When God was a woman, she had three parts: Creation, Love, and Destruction.  Nadia is Miral's mother. Nadia was a victim of sexual violence, which resulted in the creation of Miral. Nadia's indomitable spirit of resistance was manifested by her gnawing off parts of herself to escape the trap in which she was caught; until predictably there was nothing left.  Hind el Husseni  as a young Palestinian woman, turned a corner in the blue dawn light of Jerusalem to find 55  children hungry and displaced by the Deir Yassin massacre. This massacre destroyed an Arab- Palestinian village during the civil war that just preceded the end of British rule of Palestine & Israel in 1948.  Hind's first statement to the children in the school she founded is always, "I love you." Not unlike Maria Montessori Hind sets about the task of educating children for Peace. Fatima, a nurse is fired for freeing patients who would be taken as prisoners of war.  This injustice radicalizes Fatima to extremism. Fatima meets Nadia in prison while serving 3 life sentences for a bomb that did not go off. Fatima's brother, who works at the home for children with Hind, cares for Nadia at his sister’s request. He then marries Nadia, raising her baby, Miral, as his own and educating her at Hind's school.  Nadia, Hind, and Fatima contribute parts of Miral, "a common red flower that grows by the side of the road.”   Hence creation, love and destruction bring the roots of Peace.     

MIRAL is a good film for those interested in bioethical issues because it deals with ethical conflict at global, historical and personal levels.  In Fatima, it has a direct reference to ethical conflict in a health care provider. It demands a review of the Declaration of Human Rights which is an important part of the origin of the field of modern bioethics. Miral's ethical conflict is truly tripartite between, beneficence (what knowledge brings and she has been impeccably educated); autonomy (respect for the right to act in her own self-interest) manifested by her love for Hani who at the time is embracing acts of sabotage which risk life; and justice (equipoise in distribution of risk and burdens) for a people displaced for centuries (Jewish people) and a people being refugeed to accommodate them (Palestinians).   

Julian Schnabel is a Jewish American painter and clearly consummate film director. He is the son of a 1948 Hadassah president and so is hardwired to attempt to do good against the odds. He and Palestinian writer, Rula Jebreal, bring her semi-autobiographical novel to the screen. The film's collaborative process reflects the struggle and goals about which it speaks. In this film steeped in war, Schnabel's apt creative capacity shows no graphic violence. A bulldozer wrecking a Palestinian home rips tears from us as we add our reactions to the shots of the impotent members of the refugee camp. Our emotional temperature is changed with the use of film craft: shifting color, saturation, grain and focus. The films words are spare, visuals are modern, and the music decisive.  An homage to EXODUS (Preminger, 1960) in handling of geography and innovation of storytelling,   Mr. Schnabel and film family have created a film both epic and specifically intimate.  We identify with Miral's adolescent evolution to Peace agency and more importantly, we want to be her.     

MIRAL.  35 mm. Directed by Julian Schnabel. Venice/France/USA.  2010. The Weinstein Company.  (112 min)  

For more Film / Bioethics Literacy on this site see: "Lighten Up" slides, 0.045, 0.046 (How film changes culture), .053 (Read All Tracts), 0.057 (lighting what is it saying). 

also cf. LA MISSION: Prototype for the Peace Genre  on this site May 2010 


NOWHERE BOY: Open Adoption and Autonomy

NOWHERE BOY is a coming of age story about triumph over destructive losses to find wholeness and direction for a young man.  His is the story not of an icon so much as a typical example of changes of thinking that hallmark a generation. This is an ordinary story, of an ordinarily confused adolescent, seeking to clarify those things which constitute acting in his own best self-interest.  In bioethics, such self-interest is serviced by respect for the principle of autonomy.  The fact that the young man is John Lennon, is in a way incidental. Skilled documentary filmmaker cum fiction director, Sam Taylor-Wood, convincingly argues it is the boy’s tough process that made the creative "John Lennon.”

In the story, John has been adopted by an aunt and uncle. He has grown up without knowing his birth mother or father. The death of his uncle, whom he adored, catalyzes waves of desire to connect the dots between sketchy early childhood memories and his current reality.  He needs to know his birth parents. Denial of this need causes rebellious actions, expulsion from school and other attempts at individuation. This film is an infinitely more subtle handling of ethical issues around adoption than the strong but comedic film THE KIDS ARE ALL RIGHT (Cholodenko, 2010).

Most of the last century, the norm in adoption was to protect the unenlightened self-interest of involved adults through closed adoption. In closed adoption children have no contact with birth parents once adopted. The unadoptable were institutionalized or placed in foster care, as illustrated in CIDER HOUSE RULES. (Hailstrom, 2000).  Modern physician’s ethical consultation around pregnancy is supposed to explore all medically indicated options; birth with rearing, birth with adoption, and abortion.  Through Matt Greenhalg's script craft and deftly delivered performances by Kristin Scott Thomas, David Threlfall, Josh Bolt, and Ophelia Lovibond, ethical conflicts between these options are expressed through characters.  For instance, John's Aunt Mimi initially is the embodiment of the approach of closed adoption.

In the past 25 years, coinciding with the bioethics of protection of the rights of vulnerable persons, the rights of adopted children and birth mothers relinquishing children under duress are more fully being considered. In NOWHERE BOY, both adolescent John and his mother, a manic depressive scarred from the burdens of relinquishing her son, are both vulnerable persons In the case of adopted and foster children, the rearing parents are the guardians of those children's autonomous rights. Mimi acts as proxy for John. There has been an inherent ethical conflict for the rearing parents in the face of little scientific information about the developmental outcomes of children in closed adoption.  The demands of adopted children led to legal remedies which allowed for adoptions to be opened and outcomes to be evaluated. Along with his creative talent, John Lennon’s genius may have included his demanding open adoption for himself forty years before those legal challenges occurred.

With the expanded knowledge of outcomes in different forms of adoption come opportunities for individual and societal moral growth. The bioethical principle of beneficence is the obligation to do good with knowledge.  What we have learned from open adoption is related to acceptance or rejection of differences between biological and adoptive parenthood. Virtually all researchers currently agree: insistence that biological and adoptive parenthood are the same leaves adoptive children with no venue to express grief, anger, or fears about abandonment and rejection from either parent.  If parents are unreceptive to the needs of their children to express how they feel, then loss of self-esteem has been observed. John lost self-esteem when his aunt was unable to allow him to express grief around his uncle's death or his mother's rejection.

John’s relationship with his aunt is in contrast to the one with his mother. John's access to his birth mother, who loves music and teaches him in turn to play an instrument, provides him with a tool for self-expression.  John's passion for expression eventually enables his birth mother and his rearing mother, who are sisters, to complete developmental tasks in their own relationship.  It bears stating that the lyrical, visual and narrative demonstration of John's passion for music, and his process of creativity are as well done as any artist biographic film. The scenes of John learning to play the banjo and write music are layered and reminiscent of Citizen Kane’s wife’s opera debut.

Dedicated to Anthony Minghella, this film has three hallmarks of a Minghella collaboration: A love triangle - uniquely between the birth mother, adoptive mother and John; all parties are eligible for redemption, and finally the work is visually breathtaking.

Nowhere Boy. 35 mm. Directed by Sam Taylor-Wood. USA The Weinstein Company. October 8, 2010. (97 min)


INCEPTION: Transhumanist Dreams Resolve Grief

INCEPTION is a science fiction thriller, about a transhumanistic capacity to access and influence the mind by tapping the subconscious through dreams. It's billed as a film about corporate espionage. I say it's a film about resolving universal human issues around grief and sudden death through highly developed dream therapy.

The Hettle Rule is operant in this blog. Paul Hettle is a filmmaker and an important film educator.  I went to film school after I was a physician.  Hettle's style of teaching is the opposite of the medical education model. The Hettle Rule is: "Only acknowledge the positive while screening footage". This is his way of encouraging more of what he wants to see. He totally ignores horrendous errors, not wanting to inadvertently reward them.   Though it was the 1990s, this was a twenty-first century way of teaching.   The Minghella Corollary to the Hettle Rule is: "Never assume that anyone doesn't need to know when they are hitting on all cylinders, be they Oscar winning directors, cinematographers, actors or producers." There is so much good in the film INCEPTION, applicable to bioethics screen reflection, that I am compelled to think about it and to encourage others to do so as well.

INCEPTION is embroidered with references to the combined applied science technologies of medicine, psychiatry, psychology, architecture, chemistry, physics and sculpture.  With training in all of these, those of my household took an hour post-screening to be sure we had the plot straight and that it was consistent. We did and it was. This film is very likely going to be a major cultural phenomenon. Missing it will be like having missed M*A*S*H (Altman 1970).  INCEPTION is a good film for teaching clinical ethical issues. Its story turns on tension between key plot points: 1) lack of full understanding about the science underlying dream probing technology and 2) applying the science of dream probing technology without full informed consent of those at risks. There is also more than a passing nod to issues around world energy supply, depression, suicide, and intergenerational prolonged grief.

INCEPTION's application of film art and science is strong.  It is reminiscent of the first viewing of THE SIXTH SENSE (Shyamalan, 1999). These films build a world and a language which the viewer has to learn and follow.  You need to be awake and stay awake, start to finish. The rapid rate of cuts and images on the screen speak loudest to a post internet generation. However, the directorial and script structures honor classic film styles. The recurrent visual of "the maze" is homage to NORTH BY NORTHWEST (Hitchcock, 1959) protagonist, Roger O. Thornton, trapped like a mouse in a maze, in the extreme long shot on the grounds of the United Nations.

Classic film grammar is also used in INCEPTION but with a twist. The twist is that the script kaleidoscopes classic techniques.  An example would be the classic film technique known as the Griffith Escape. A simple version of the Griffith Escape: the camera cuts between the damsel in distress tied to the railroad track, the speeding train, and the cavalry in route to her rescue. The closer the train gets the shorter the interval between the cuts, heightening suspense approaching the climax. The plot of INCEPTION raises each shot to the power of four in the escape, demanding the viewer to function not in three dimensions but sixteen. The Kaleidoscope geometry expands likewise to heighten the sense of resolution. Bookending of themes, at the beginning and end of the story, are similarly mathematically assembled.  Further, each actor is moving in 4 story lines, simultaneously and together as an ensemble.  Albert Einstein would have loved this film for its ability to bend time and space. INCEPTION is a platform not only for exploration of a fictional technology, but also of film technology's influence on individuals and cultures.

Science fiction and horror films are often used to teach bioethics.  The prototypical film example is the monster built by Frankenstein (Whale, 1931). In Frankenstein, we see both scientist and society taught the lesson not to play God. The same lesson about new technology has been continuously taught over seventy years.  INCEPTION differs from much of horror and science fiction. This film explores the conflicts and dangers of a new technology without demonization of the technology itself. Instead, it shows how such access to the mind might serve humanity and enhance individual growth; as a dream therapist may do.

Transhumanism is a philosophical movement linked to bioethics, largely through the principle of beneficence; the obligation to do good with scientific knowledge. Transhumanism is known for exploring ethical issues around science beyond last century's negative portrayals. Though operant in much medical and other life-enhancing applied sciences, futurist films serve as the philosophy’s most frequent venue for re-examination of cultural attitudes around science and technology.  The film, INCEPTION, is an example of a complex exploration of cultural concerns around thought manipulation through dream technology and offers an atypical resolution. The resolution is the dissolution of the wall that separates the idea from the application; the concept from the reality. INCEPTION is about the expansion of human potential beyond its known physical and psychological limitations, complete with the inherent risks and benefits of the tasks.

INCEPTION. 35 mm. Directed by Christopher Nolan. USA. Warner Brothers. July 16, 2010 (148 mm)

For more Film/Bioethics on this site see: "Lighten Up" slides, 0.019, 0.020 (Informed Consent), .032 (Aristotelian Plot Curve), 0.059 (Camera Angle), 0.060 (Meaning of Shot Size to the Viewer).


ARMY WIVES: Aristotle Would Have Watched TV

Those who are looking at this blog for only reference to art house films, and heavy documentaries will be disappointed. Television is what is closest to the average person. The average person is where morality and ethics derive.

I have been tracking the development of ARMY WIVES since its first episode. Inherent in its story line related to war, knew it would of necessity deal with ethical themes. ARMY WIVES is an ensemble cast. It is the story of four women, and a man who are spouses of active duty army personnel. They are raising their families on an army base in the USA. They are of different socioeconomic backgrounds and they become friends. Last night’s episode deals with loss, grief and redemption on the domestic front.

Season 4, Episode 7, May 23, 2010 10 PM PDT Lifetime:
In this episode in the ‘A’ story line a pregnancy is lost by a couple who dearly wanted another child. The husband, who has seen active duty, has the strength to explore his own grief and feelings of inadequacy to support his and his wife’s pain. The second army wife, the closest friend of the woman who has lost her pregnancy, is struggling with issues around her husband’s absence in family life. He is often altered in his character, related to his secret missions. She is choosing between divorce and living through it and moves to a compromise -- an acceptable action for her moral tension. The third army wife, a nurse cum paramedic, struggles to reconcile the loss of her son to a reenlistment and fears that he will not finish college, ( loss of a dream for her progeny), and may have worsened post traumatic stress disorder or die in combat. The fourth Army wife, who has lost her eldest daughter to a bombing on domestic soil some episodes ago, now sends her daughter off to college. She chooses to regain something she lost, when she became an army wife, her own education. She dropped out of Harvard Law School and now wants to return to study law at the university near the army base where she lives.

Information flow and changes in technology, medicine, and ecology shift at warp speed. It is important to see how artist and media synthesize and influence morality in this shifting milieu. In particular, the genre melodrama is closest to the hearts of the majority of the people. In many ways, television is the equivalent to the Greek Poetics of Aristotle - yes the Greek plays. At the end of the day, many look at television and deal with aspects of their own lives that would be too painful to access without the distance of the screen. This is one of the ways that film and television work. It is also the reason that bioethicist and clinical medical ethicist especially need to understand how film and television communicate.

Season 4, Episode 7, May 23, 2010 10 PM PDT Lifetime

(For more on Film/Bioethics on this site see "Lighten Up" - slides 29 - 36, and in the reference slides at the end for Aristotle, On Man in the Universe, Walter J. Black. New York, 1943.)


LA MISSION : Prototype for the Peace Genre

I am not sure how much power a film has to have to not be slotted into the “Ethnic Film” genre, which restricts the market of its distribution. I am sure that the Bratt Brother’s LA MISSION (2009) has more than enough power to properly title its theme and genre. Written and directed by Peter Bratt, LA MISSION is about transitions from violence to an agent of Peace. Starring Ben Bratt, (co-producer) the main character embodies the film’s subtitle quote of a Spanish expression, “from the thorn emerges the flower.”

Peace in the world of bioethics is a universal “good,” and as such can only be held by the humanity as a whole -- not the individual. LA MISSION is about corralling passionate spirit and channeling it toward Peace. This film is not only about a Latino family, a black woman, low riders, gay teenagers, gentrification, gang bangers, medicine men, indigenous peoples, parents struggling to do what is best for their children, women who are victims of violence, city bus drivers , healthcare systems or healthier lifestyles; though it stars all of these.

The Bratt brothers are part of some exceptional company in the Latino Ethnic film genre - LA FAMILIA, LA MISMA LUNA, PAN’S LABYRINTH and THE SEA INSIDE, to name a few. But they have also created a cross cultural-cross genre film. Like other brilliant Latino, and black film productions. LA MISSION is not yet marketed broadly, so its universality is stealth. It’s hard to get a film like LA MISSION made, harder to get it promoted. Its audience is limited by an R rating; a bias against content tamer than the DVD’s being watched on most highschoolers hand held devices at lunchtime.

LA MISSION’s script is seamless down to the meaning of the posters on the walls of the lead character’s garage. It makes a strong argument for the writer-director hyphenate. The visuals are stunning, as would be expected from Japanese-American cinematographer Hiro Narita, set in the hues of San Francisco’s Mission neighborhood. The acting is gripping at every level also not unexpected from Benjamin Bratt but the rest of the cast pushes even his bar. Finally, this film is hot! It has all of the essentials of the best Hollywood drama. However, La Mission also goes to the head of the line for films important in clinical ethics. It looks at cross-cultural concerns in health promotion, violence prevention, and grief mediation.

In the case of LA MISSION I suggest we take a page from other parts of the struggle for Peace; we create a movement to pass the word. Assign it if you teach. Demand it in your local theater. If it is playing near you and you have 10 bucks to spare, see this movie. Defy the attempt of last century film marketing and critics to dice and slice our humanity. Pass the word -- the Peace film genre has arrived and its prototype is LA MISSION.

LA MISSION. 35 mm. Directed by Peter Bratt. USA. Screen Media Ventures. 2010 (117 min)