Hauntingly Accurate Portrayals of Severe Mental Illness at a Theater Near You

[Warning: The following post discusses key plot elements of two films currently in theaters - Melancholia and Martha Marcy May Marlene.  Although the post purposefully does not give away the ending of the films, be advised that potential spoilers abound.]

In October, I wrote a well-received post about the inaccurate and downright offensive portrayal of clinical psychology in the film 50/50.  As that film continues to rack up praise for its screenplay (including being named the best screenplay of the year by the National Board of Review and the Washington DC Film Critics Circle this past week), it is abundantly clear that few were troubled by - or even aware of - the inaccuracies in the film.  Although Hollywood's lack of understanding of those who treat mental disorders is disheartening,  two high profile films released this fall demonstrate surprisingly nuanced and accurate portrayals of those who suffer from mental disorders.

The first, and more obvious, of these films is Melancholia.   Dubbed a "psychological disaster film" by promotional materials and critics alike, the film centers on Justine, a young woman suffering from a severe subtype of depression.  Justine is played impressively by Kirsten Dunst, who sheds the innocence and radiance that she displayed in hit films like Bring It On and Spiderman in order to play a tortured and profoundly unlikable woman with melancholic depression.  The film in many ways plays to those familiar with clinical depression as a journey through the diagnostic criteria and associated features of  depression.  Justine is unable to get joy from anything (the technical term for which is anhedonia), even her wedding, which is the setting for the film's first half.  She is so depleted of energy that she wanders through her wedding like a zombie (fatigue, another key feature of a depressive episode).  In fact, she must retreat for a nap halfway through the reception (hypersomnia is the term for excessive sleeping, which characterizes some of those with severe depression).  She speaks, moves, and reacts slowly (psychomotor retardation).  And as becomes apparent in the film's second half, she constantly thinks about negative thoughts (rumination); shows no change in emotion even when tragedy strikes (constricted affect); and even welcomes the end of the world (passive suicidal ideation).

So why is Justine so depressed?  That question is not overtly addressed by the film, but it does provide some insights.  At her wedding we meet her insanely self-centered, cold, and distant mother and her bizarrely aloof and eccentric father.  While both characters border on caricature, the film is savvy to portray Justine's parents as likely suffering from mental problems themselves, as clinical depression has been found to be highly heritable by decades of research.  Although the film does not show us the cause of Justine's depression, it definitely shows us the consequences.  She displays profound acts of cruelty toward her doggedly devoted sister, husband, and boss and pays dire consequences.  Few individuals with clinical depression do things as extreme as Justine, but the notion of stress generation (the often unintentional self-selection into, or creation of, environments that perpetuate further depression) is well supported by research.

Melancholia is directed by Lars Von Trier, the extremely controversial Danish auteur whose bizarre comments about Nazism and graphic images of misogyny in prior films have harshly divided critics and audiences alike.  Distasteful as he may be in many ways, it is hard not to be moved by his stunning visual representation of depression.  We see Dunst sinking into murky water while wearing her wedding dress, moving in slow motion through a vast field, and trying to run but being held back by an ever-expanding system of roots.   Only a person who has been in the depths of depression themselves (as Von Trier has publicly admitted to) could craft images so hauntingly accurate.  It is a shame that Von Trier did not trust the power of his own story and images and felt the need to compound the story with the impending cataclysm that serves as the context for the film's second half.  Although this device generates some effective drama, his decision to have a planet named Melancholia emerge from its hiding place behind the sun and engage on a collision course with earth is a metaphor for the onset of severe depression that is about as subtle as being hit over the head with a two-by-four.

The second, and better, of these films is Martha Marcy May Marlene.  Dubbed a "psychological horror film" by promotional materials and critics alike, the film centers on Martha, a young woman suffering from severe posttraumatic stress disorder (PTSD).  In one of the strangest and most successful casting experiments that Hollywood has carried out in recent times, Martha is played by Elizabeth Olsen, the younger sister of the once cloying and now vapid Olsen twins. Elizabeth Olsen had never appeared in a film before Martha, but you would never know from her performance, which is truly masterful.    As Von Trier did in Melancholia, writer-director Sean Durkins gives Martha all of the essential diagnostic characteristics of PTSD.  Martha has experienced a traumatic event, as she has been living for an undisclosed time in a sadistic cult that has abused her sexually, emotionally, and physically and cut her off from the outside world.  She continues to re-experience the various traumas through flashbacks.  She is hypervigilant to potential danger in her environment.  She experiences extreme emotional numbing.  She avoids talking about the traumatic experiences at all costs.  Although the words "posttraumatic stress disorder" are never presented in the film, the symptoms of PTSD seep into every scene.

Just as A Beautiful Mind (despite its flaws as a film and a biography) takes you into the experience of psychosis by inducing in the viewer the sense of what it might feel like to find out that everything you thought was real wasn't, Durkins blurs what is present and what is past, what is reality and what is nightmare.  The result is the viewer experiencing a shred of what Martha herself is experiencing, which is a form of extreme dissociation (the psychological term for the disconnection from self and surroundings that is common in individuals who have experienced severe trauma).  Unlike in Melancholia, we know what caused her present psychological strife.  What the film does not communicate as clearly, however, is how she ended up in the cult.  It gives hints about elements of her background that may have contributed (most notably, a history of rejection and trauma), all of which are highly consistent with the literature on trauma.  The film also shows the effects of PTSD in vivid detail.  Martha has lost all sense of appropriate behavior, is suspicious and resentful, and she drives away the only ones willing to help her.

Another key element that binds Melancholia and Martha is their depiction of the social support system of the individual with severe mental illness.  Neither Justine or Martha appear to have any close friends, but each have an older sister who display an almost saint-like devotion to helping them.  Both women (played by Charlotte Gainsbourg in Melancholia and Sarah Paulson in Martha) make huge sacrifices for their ill sister and pay a high price (interestingly, in both films this high price is exemplified by a climactic explosion of verbal abuse from the ill sister toward the caretaking sister).  Both women have husbands (Kiefer Sutherland in Melancholia and Hugh Dancy in Martha) who are accommodating and warm at first, but soon begin to despise the ill women for their lack of self-efficacy and the effect they have on their sisters.  The sisters and their husbands represent two common types of support often received by the severely mentally ill - the ones who thinks (misguidedly) that unconditional love can cure even the most serious of mental illnesses and the ones who are empathetic but before long decide that enough is enough.

Neither Melancholia or Martha are easy to watch, which is largely due to the fact that they are so successful at conveying the experiences of the profoundly painful mental disorders at their center.  They are, however, works of haunting beauty and at times are profoundly moving.  But be forewarned, their designations as "psychological disaster" and "psychological horror" films, respectively, are apropos.  Although there are few traditional thrills and chills to be had, the experiences of these women are horrifying and the consequences are tragic, much as they are for many experiencing the disorders being conveyed.