Second opinion: Reel reflection on the stigma attached to Alzheimer’s

Birdman, one of the most riotously entertaining yet serious movies of the past decade, deservedly won a clutch of Oscars. Dealing with ageing, the fear of irrelevance and the nature of art, it wore these themes lightly, bearing us aloft through the imaginative direction of Alejandro González Iñárritu, skilled camerawork, humour and a superb script.

It was unfortunate for Still Alice, the film about early-onset Alzheimer's disease, to appear in the same Oscar line-up, as it compares unfavourably from a cinematic perspective. With the production values and directorial flair of a made-for-TV movie, it is almost oppressively tasteful, from the elegant brownstone house to the period clapboard dwelling beside the deserted beach.

The soundtrack, Fauré-esque piano and string trio music by Ilan Eshkeri, was comparably elegiac, but also intrusive and flirting with schmaltz. Surely for the central couple, academics in their 50s, one might have expected a little Talking Heads, Eagles or Joni Mitchell?

Alec Baldwin was painfully miscast as a caring and conscientious husband: one expected the louche and coarse character we know and love from 30 Rock and Blue Jasmine to burst out at any moment with news of yet another extramarital affair or Ponzi scheme.

It is a pity that these aspects detracted from both the serious theme of the movie and the remarkable central performance of Julianne Moore. Both reflect a growing awareness that much of the work and context of Alzheimer's disease over the past 40 years has leaned heavily on the perspective of the family and carers, and that we need to move the subjective experience of the person with Alzheimer's disease more firmly centre stage.

The rather heavy-handed and worthy movies Iris and Away From Her are emblematic of the former approach, and the much more interesting The Iron Lady and brilliant Nebraska are more revealing of the inner experience.

Key value

The key value of this later cinematic wave is to assert our shared humanity, to remind us of the likelihood that many of us will age with some cognitive deficits, and to rebuff some of the apocalyptic negativity that still surrounds the syndrome of dementia.

This was highlighted recently by the repellent dismissiveness with which the novelist Joanna Trollope spoke of dementia in terms of "going gaga and becoming helpless and a burden" (see iti.ms/1Bz4TCB).

In the film, Alice reflects the stigma of Alzheimer’s disease by blurting out that she wished that she had cancer instead because she could open up and talk about it to friends in a socially acceptable way.

Unpicking this social negativity has wider consequences, especially in terms of service provision and support. If we do not identify with this common fate, we unconsciously turn away from it, and fail to desire and promote services that can provide support and direction for those affected by dementia.

This is particularly the case for early-onset dementia, with the smaller numbers affected, the complications of work, family and genetics, and the ageist fall-out of perceptions of “an old person’s disease”.

Our sympathetic engagement with Alice is mirrored by our relief when her planned suicide goes awry, and there is an interesting resonance in that it is her aspiring daughter (Kristen Stewart), bruised in the harsh selection processes of theatre, who best picks up the emotional trail, united by love and shared vulnerability. The movie lapses only occasionally into a dichotomous view of dementia, for example, when Alice visits a nursing home with severely demented residents while in the early stages of her diagnostic process.

Vitality

The worth of this film was further underlined at the panel discussion after a special screening at the

Irish Film Institute

in Dublin.

The most telling contributions were from two people with early-onset Alzheimer’s disease whose vitality and presence were a rebuke to reductionist views of life with the illness. Ronan Smith, who works in theatre production, gave a telling warning about assuming set pathways in the journey with the illness. “Not only is my future narrative untold,” he said, “but mine is also unwritten.”

Such a vision of ownership and potential is novel and cries out for a powerful artistic realisation. It would be wonderful if González Iñárritu could embellish it with some of his magic from Birdman in a future movie.

A version of this column originally appeared as a British Medical Journal blog. Prof Des O'Neill is a consultant in geriatric and stroke medicine. His book, Ageing and Caring: A Guide for Later Life, is published by Orpen Press.