I saw the US premiere of Mira Nair's film, The Reluctant Fundamentalist, at the 2012 Mill Valley Film Festival.  The film is an adaptation of the novel by the same name written by Mohsin Hamid. It is the story of the radicalization of a young Pakistani born, Princeton educated, New York stock broker (Riz Ahmed.)    After the 911 attacks, he is increasingly racially and ethnically profiled. He is also being torn between the new culture he has tried to join and that of his ethnic origin.   One of my cinephile friends, as I recall, felt the reaction of the protagonist was not strong enough for the conditions depicted.  I was reminded of other films where people wake up and find their race means something more than any other part of them -- say than their occupation, education, parenting skills;  where race controls all life's entities.

It happens there have been many films which deal with the issue of racial profiling in the USA.  The trend was initiated by black filmmakers of the LA Rebellion from the 1960s to the 1980s; Burnette, Gerima, Dash.  Among the most relevant comparisons to 
The Reluctant Fundamentalist is the film by Melvin Van Peebles, Watermelon Man.

Race is a bioethical concern.  It is usually thought of as a matter related to the principle of justice. However, it historically has been an issue of beneficence, how we use and acquire scientific knowledge and choose to do research.  To begin with,
race is defined not by biology as was theorized in previous centuries but by sociology. The human genome project has put the biological theory of race pretty much to rest. What an expenditure of resources and intellect was required for that gift to this millennium. We now know the genetic difference within races is more different than between races. No longer can science be used as an excuse for the power differential of racism (nor, by the way, of genderism.)  It turns out; your race is what the common person considers your race to be.  By common I mean work force people who have daily contact with you, but not intimate knowledge; a bus driver, cashier, people who see you in passing. 

In Watermelon Man, a white insurance salesman named Jeff Gerber (Godfrey Cambridge) wakes up to find himself a black man. While running for his morning bus in an all white suburb, he realizes that everyone else finds him black as well.   As time goes by, Jeff is forced out of his suburban life. Responding to repeated mechanisms of oppression, he seeks internal strength by becoming increasingly drawn to Black Nationalism; conditioning himself for the battle to come. Interestingly, his path is leading him toward being a Moslem with a religious fundamental adherence, much as in
The Reluctant Fundamentalist

By some distance, the Jeff Gerber character travels further and with less compromise along the historically predictable defensive line than Mohsin Hamid's character.  The two stories share the same igniter for radicalization; racial profiling with social, even romance inhibitory, consequences.  Like Melvin Van Peebles' 
Watermelon Man, Mira Nair's film has an element reminiscent of black face. The latter is particularly cloaked in incongruent marketing pings attempting to make the storyline more palatable to a majority audience. This would not be so stark were it not a break from the director's usual "devil may care" courage as a director. However, Nair, as with everyone else, should be applauded for the addition of a coda of humanism and peace in the storyline. Film is different than a book; as characters evolve on-screen, viewers more strongly identify with them. In this case, we want that.  To its credit, this film pressures us to take our own pulse not just that of the Reluctant Fundamentalist.

The Reluctant Fundamentalist
. (35 mm) directed by Mira Nair. USA. IFC. 2012.128 min.

Watermelon Man. (
35 mm) directed by Melvin Van Peebles.  USA.  Columbia Pictures. 1970. (98 min)  Hamid, Moshin.  The Reluctant Fundamentalist. Harcourt, USA. ( 2007) p 224


A LATE QUARTET: Bioethics and Grief

A Late Quartet had its USA premiere at the Mill Valley Film Festival. It is directed by Yaron Zilberman and co-written with Seth Grossman. Set for release on November 2, 2012, it will be a force to contend with. Generally, I try not to be effusive when writing about films. In this case, I have to admit, I can't help myself. Of all of the films I've seen at the 35th Mill Valley Film Festival; this is the only one that moved me uncontrollably to tears. The feeling evoked is most reminiscent of the intimacy one feels when caring for individuals and their families at critical points in their lives, particularly births and deaths.  A Late Quartet is a story of passion in the context of both.

This is a smart script.  The characters represent instruments in the Quartet; two violins, a viola and a cello, in reality and in the story line. The characters entrances into the composition are guided by sheet music, at once familiar and seen as though for the first time.  Christopher Walken, who I had seen the day before in a perfectly wonderful performance with Al Pacino in Stand Up Guys, surpasses even himself. In this film, the full range of his sensitivities and skill are apparent.  For me, he will never again be a convincing gangster or grifter. Philip Seymour Hoffman, who defies type casting, plays a surprisingly warm, vulnerable husband, father and second violin. Wallace Shawn, the founder of the Quartet, finds himself spiraling out of control because he falls prey to his own personality.

This is a big film for the two women who co-star in it.  In a season with only a handful of strong women's characters, Catherine Keener and Imogeen Poots both play sharp crisp roles. They well reflect both strength and the texture of women stretching the boundaries of love in a way that is uniquely specific to our gender. These are women’s roles bearing the strengths of this century.

How is this film significant in terms of bioethics? Bioethics is an organized way of thinking about conflicts between; what we know about medicine, what individuals want for themselves and what the collective thinks the other two are worth. There is medicine in the storyline, as well as grief, life threatening challenges and autonomous wishes and the need for transcendence. This work takes its lead from the String Quartet No.14 in C♯ minor, Op. 131, by Ludwig van Beethoven, an atypical seven movement quartet that is intrinsically connected to death.  On his death bed, Schumann requested to hear it.  The film, like the quartet, looks at loss from multiple angles; loss of life, love, health, passion and creativity. However, the story emerges from this abundance of loss with perseverance of passion. Fore-shadowing prepares the viewer for each characters arc. Set in warm rooms and a small concert stage, A Late Quartet is both ambitious and elegant in the style of a true New York movie and its classical music scene. 

A device of bioethics is the examination of the stages of grief to resolve associated conflicts in the process. The classical view of grief is the Kubler-Ross 5: denial, anger, depression, bargaining and acceptance. Instead, the James Hallenbeck 5 identifies tasks to be tackled during the developmental stage of life's end. People who are dying and those who love them need to say and hear: I'm sorry, I forgive you, thank you, I love you and, when it's time, goodbye.  The idea is that without focus on these processes, transcendence is not possible. Transcendence is the goal of dying and loss. In A Late Quartet, the Hollenbeck 5 form the opus. 

Finally, a variation of the Hettle Rule is attributed to cellist Pablo Casal; seek what works well instead of what does not, as a vehicle for healing. If there is one film to see this year, it is the visually smart, emotionally accessible, musically astounding, A Late Quartet.

A Late Quartet (35 mm) directed by Yaron Zilberman. USA.  2012
scheduled for release on November 2, 2012.


SILVER LININGS PLAYBOOK: Mental Illness Meets a New Genre

One of the two opening films, at the 35th Mill Valley Film Festival, was Silver Linings Playbook. Both the director/screenwriter, David O. Russell and lead actor, Bradley Cooper, were available for the post screening Q & A. Silver Linings Playbook is about people with manic depression, obsessive compulsive disorder, borderline personality disorder, situational depression and stigmatization.  The work is adapted from Matthew Quick's comic novel. The alternative publishing origins underpin the well sculpted traits of the film's characters. Did I mention it is a comedy? In fact, to be more specific, albeit a 21st century version, its genre is musical comedy. Think of Tracy and Hepburn doing Singing in the Rain. 

Gotta talk about the performances on this one. Pat Jr. (Bradley Cooper) gives one of the most convincing ranges of a person with mental illness that I have ever seen and as a clinician of thirty years, I've seen a lot. Robert De Niro (Pat Sr.) follows closely in Cooper's wake. Jennifer Lawrence, pops out of her role as Mystique/Raven (X-Men) seamlessly into the just this side of psychotic -perfect match for Pat Jr. They make what could have been a small domestic comedy a full contender.  

There are eight major characters and three of them are people of color: Chris Tucker, John Ortiz and Anupam Kher.  These roles brilliantly link the mentally ill to other disparities in health and their risks.  Anupam Kher's role raises great questions about reverse transference, where the therapist sees himself in his sports loving client. Kher as a psychiatrist may step over some traditional boundaries and Pat Jr. joins him.   One might argue that Russell was following the lead of the source material on the ethnic distribution, however many writers and directors don't.   Russell says that he followed the talent in his casting choices. I give him credit for even more than that in this many ways progressive film.

By subtly magnifying simple behaviors in the main characters, viewers begin to realize that mental illness is just one extreme of the human range of function for family, friends and neighbors. With conservative estimates being that 22 million Americans are affected by mental illness annually, the refreshing view of this film is not "the mentally ill are among us," but instead, "the mentally ill are us."  There is only one person in the film who you can't diagnose and it's because she is a device. She has virtually no spoken lines and shows up only as a Mrs. Colombo or Maris Crane cameo.
Bioethicists have been closely linked to providing guidelines protecting persons with mental illness who may also have poor decision making capacity.  Without decisional capacity, there can be no informed consent. However, assessing decisional capacity may be difficult for those who do not often use stringent organized tools for doing so. Worsening matters; the higher the risk the more stringent the informed consent should be.  For instance, in placebo trials, people have to understand that they may or may not get an effective drug as a placebo in the control or experimental arm of a study.  This understanding can occur but not likely in a five minute informed consent procedure provided for most subjects or patients. 
The task of the clinician and research team is to determine whether the potential subject has a level of health literacy to understand complex concepts. Every day practice improves decisional capacity. Even the prescribing of an aspirin should have an attendant disclosure for the drug and assessment of decisional capacity and remedy for its absence. The patient gets practice with the small things but so does the clinician. When the big things, like cancer, pop up at least everyone knows the playing field of informed consent, mental ill or not. 
Sometimes, there is a question when mental illness is decompensated simultaneous with high risk problems but intermediate urgency calling for a rapid decision. (It's an easy call if there is a life threatening emergency - error on the side of life and sort it out later; unless an advance directive prohibits such action.)  State by state in the USA, there are protections and rules in place which generally take matters out of the hands of clinicians, as well as the person who is mentally ill.   Generally, these rules are a part of the probate court system in the form of conservator, temporary or permanent, or other proxy for making decisions.  
As is the case with the main character of Silver Linings Playbook, Pat Jr., there is an historical precedent for stigmatizing mental illness as causing higher levels of violent crimes than the general public. In reality, evidence supports that people with mental illness are involved in violent crimes for the same reasons as those without mental illness; in the same proportions, but not caused by the mental illness itself. The case of jealous rage would be a good example. 
Silver Linings Play Book, beyond the serious aspects around mental illness, supports the ever resilient premise the art of love prevails over all adversaries. This love is romantic love, family love and community love. Smultz? Yes, but did I mention, it's a musical comedy? 
Silver Linings Playbook. (35mm) directed by David O. Russell. USA. The Weinstein Company. 2012
(At the time of this publishing this film's scheduled release USA release date is November 21, 2012.)
For information About Stigmatization in Mental Illness see:
Chambless, Dianne. Beware the Dodo Bird: The Dangers of Over generalization. Clinical Psychology: Science and Practice Volume 9, Issue 1, Article first published online: 11 MAY 2006
For information about informed consent, capacity and health disparity see:  
Williams, September.  Pain Disparity: Assessment and Traditional Medicine in THE AMERICAN ACADEMY OF PAIN MEDICINE Textbook on Patient Management. 2012. Deer, T.R.; Leong, M.S.; Buvanendran, A.; Gordin, V.; Kim, P.S.; Panchal, S.J.; Ray, A.L. (Eds.) Springer SBN 978-1-4614-1559-6
Due: November 30, 2012



35th Annual Mill Valley Film Festival between October 4 and October 14. Here are the films that I'll be reviewing for bioethicsscreenreflections.com at MVFF 35.

October 4: Silver Linings Playbook

October 5: Argo

October 6: Flicker

October 7: Sessions

October 9: Rebel with a Cause, Whole Lotta Sole, Last Man on Earth

October 10: Happy Event, Tribute to Mira Nair & the Reluctant Fundamentalist
October 10: Rise of the Guardians ( will be covered by Fantasy BSR reviewers, Curd and Katie)

October 11: Lore, Not Fade Away

October 12: Rent a Cat, Like Someone in Love

October 13: It's a Disaster, Stand Up Guys

October 14: Life of Pi

THE WORDS: Creativity, Scientific Integrity & Cultural Evolution

THE WORDS is a film that brings a whole new meaning to the term character driven. Here, four different men play one principle character. He has different names, ages and stages of creative capacity portrayed by Bradley Cooper, Jeremy Irons, Ben Barnes and Denis Quaid. The character is in love with a story which has been translated into a literary work. There is an element of torment and ineptness in the love.  The moral muse of the male character is played by three women; Olivia Wiled, Zoe Saldana, and Nora Arnezeder. The capacity of this film to telescope one character and story into another is a marvelous Rubik's cube. Director Brian Klugman and co-writer Lee Sternthal should be well recognized for their facility in showing the multiple faces of this tale.  Each man in the film wants to own the story in question and does.

THE WORDS is important to bioethics because it illustrates that ownership of a narrative is complex; even more so when embroidered by its developmental consideration.  Literature, like science, resembles a value, like peace, more than property. Such values are owned by the collective not by the individual. We process all art through our own experience.  Isn't it what artists want us to do? What is really the harm of taking someone else's creative product as one's own?   Novels are usually solo creations. Other art forms, film, dance, drama and research are collaborative. How can they be considered to have only one author?  This delicate tangle of creative influences is often blown away by matters of law, abandoning obligations to understanding the moral significance of creative theft. Regulatory, societal devices co-modify creativity; confining it to the potential monitory product it yields.

A narrative has to be recorded in order to be owned under law, despite how its derived. The issue is chronology of registration as with patents, trademarks, publication copyright and other intellectual property registries. Theirs is also a question of order of authorship. Ownership in terms of moral authority to tell a story is more muddy. (See THE HELP on this blog.) In the eyes of the law, oral folk tales are not owned until published. Then they are owned by the publisher and editor. These stories exist for generations as the common property of the group of people who generate them, usually orally.  To paraphrase the late director of the game changing film BLUE, Krzysztof Kieślowski, the best of these narratives find resonance between people, breaking down isolation and becoming a part of culture. In this transcendence narratives can become universal.

There are only a few universal themes; love, birth, suffering, loss and death. Universal stories are common to all persons, if not to all living things. How a universal story differs in the telling is the key to intellectual property or legal ownership in literature. THE WORDS presents a new telling. The film is a constellation of stars without need for a sun. 

In contrast to literature, scientific integrity in research is dependent on reproducing the methods of other researchers to reach the same conclusion. Science is almost always collaborative. A hypothesis, ingeniously generated, is tested by attempts to disprove it. If the hypothesis cannot be disproved, that bit of information obtained is considered to be true. More experimental manipulation clarifies the amount of pressure a particular truth can withstand without becoming lost. The rules (laws and policies) defining research misconduct usually include: intentional fabrication, falsification, plagiarism  or other serious deviation from accepted practices of science in proposing, carrying out  or reporting results of research (Macrina, 1995). 

Bench researchers and other artist/craftsmen are both relatively low on the economic food chain. Their rewards for moral integrity are left largely unremunerated and errors in method swiftly found intolerable. Bad research results in dangerous medicines, medical implements, unsafe building structures and on and on. But the harm of plagiarism is broader than a mis-shaped commodity. Science is Art. Both are creative endeavors coming from a shared reservoir of human consciousness. Creativity is discouraged when it is not recognized. Plagiarism causes a creative post-traumatic stress syndrome, brilliantly depicted by Jeremy Irons in THE WORDS. Draining the creative reservoir limits creative growth and stifles prospects for cultural and intellectual evolution.  

THE WORDS (35 mm) directed by Brian Klugman (2012)  USA. CBS Films.  96 min.

For more understanding see: 
Macrin, Francis. Scientific Integrity: An introductory Text with Cases.  American Society of Microbiology. Washington, DC. 1995.  p 1-14

THE HELP (35 mm) directed by Tate Taylor. (2011) USA. Touchstone Pictures. 146 min.
Tricolor: Blue. (35 mm) directed by Krzysztof Kieślowski (1993) France, Poland, Switzerland. Mirmax/MK2 Diffusion.