Part II: THE IMITATION GAME meets HOW I CAME TO HATE MATH/ Comment J'ai Détesté Les Maths Moral Relativism vs Beneficence and Justice: Maths and Economics

HOW I CAME TO HATE MATH/ Comment J'ai Détesté Les Maths is a film Directed by Olivier Peyon and written along with Amandine Escoffier. It  is a documentary whose initial purpose seems hijacked by historical events. Its parallel to the fictional historical biopic thriller, THE IMITATION GAME, screened at the Mill Valley Film Festival 2014, need be made.

The MATH story, like in THE IMITATION GAME, begins lightly with young people who are awkward. Some of them, like Alan Turing,  grow into the lovely eccentricity that those who both love and understand maths often bear. Peyton’s film tours the world of elite global mathematics prize winners and its retreats. The viewer has the feeling of watching young Einsteins. The film is initially a celebration of Maths.

After showing the rarefied air which the theoretical mathematicians breathe, MATHS eases viewers into the world of technical applications of maths. Finally, the story leads to the economic crisis of our current millennium and the misleading mathematical modeling which wrought it.

Mathematicians, on camera, own the horrific results of their science.  It is reminiscent of Einstein after the the theory of relativity was weaponized. A nausea is shared by many clinicians and other applied scientists as they wade through memory of disasters sometimes mediated by applied theory, particularly when ethical parameters were absent.

“Is there any definable method for deciding whether any given mathematical assertion is true or not?”  The procedure for seeking this answer required stating a hypothesis, like any other science.  "If it were true," Toulman paraphrased  Alan Turing,  ”Any method of 'routinizing' mathematical proof can be thought of as a mechanical process.” Then the question was one of 'simple' technology “What sort of a “machine” would be needed to carry out such a proof?”   This was how the computer was theorized and developed.  It happened that the resources to build the machine arrived in the form of WWII.  However, the drive, well before the War, was Turing's theory needing proof. It happens that  the military remains one of a few venues where mathematics gets funded. The use of science and medicine in war is a bioethical issue.

“What happened with mathematical modeling?”  the last third of HOW I CAME TO HATE MATHS asks.
When Scientific theory jumps to technology, there is always a risk that those who best know the Science will loose or relinquish control of it. It is the fundamental basis of Bioethics that Scientist and Applied Scientist should resist the temptation to abandon their work to those less knowledgeable of their fields. Bioethics is not only a field for medical doctors, clinical medical ethics is only a subset.

HOW I CAME TO HATE MATH asserts, mathematicians recognized errors in economic mathematical modeling earlier than has been admitted by financiers. In the blame game, the common person's behavioral finance is often pointed out while financiers and maths models are ignored.  As in other situations of bioethical conflict, the first step is recognizing a conflict and then exploring it. Taking responsibility is  requisite for the minds knowing the field to explore the  conflict, as happens in the film HOW I CAME TO HATE MATH.

Not too far away from the applications of the Turing Machine, or mathematical economic models we have seen similar loss of control of the fields of medicine and public health. Misuse of the technology ( knowledge) related to quarantine, perhaps for political capital, during epidemic scares,  come to mind. The murder of polio vaccine workers by extremist when the vaccine program was used as a shield for covert military activity also is an example.

The logic of immorality is always flawed and bears consequences. However, detailed moral analysis may also bear negative results. The difference is made,  as in all science and ethics,not only by intention of but attention to details.  The people watching have to be able to recognize what they see. Biological Science receiving federal funding requires those learning to use it  have some training in Bioethics that is, graduate students. Apparently,  maths departments have no ethical educational obligation imposed by financiers. Maths and computer science have major bioethical  context in this and the last century.   Recognizing mathematical modeling’s role in a  devastating economic collapse of the world’s economy does not  excuse the greed of financiers, it only recognizes the bioethical issue. 

Even when those who know the science do their best at moral consideration, monitoring of consequences is paramount, in war and in peace. Having spent the last half of his life on Peace, Einstein would agree.  Hats if to the filmmakers of HOW  I CAME TO HATE MATHS, and the mathematicians they interviewed,  for the jerky C- turn made in the last third of this film. Don’t be fooled by the cute beginning. HOW I CAME TO HATE MATHS chronicles a whiplash in history that threatens to break a century’s neck.

References:

How I Came to Hate Math / Comment j'ai détesté les ma (35mm) Directed by Olivier Peyon.(2013) Documentary. France (103 min)

How I came to  Hate Math  trailer www.youtube.com/embed/QVKtLkNF_PA" accessed October 16, 2014

The National Association of Retirement Plan Participants http://www.narpp.org/

Enstein, A., Nathan, O., Heinz, N. Einstein on Peace. Simon. 1960

Punjwani, S. K. (2014). Understanding Underpinnings of
Act of Violence against Polio Workers: A Case Study of Pakistan. In I. Needham,
M. Kingma, K. McKenna, O. Frank, C. Tuttas, S. Kingma, et al., Fourth
International Conference on Violence in Health Sector; Towards Safety, Security
and Wellbeing of all (pp. 80-83). Amesterdam: Kavanah, Dewingeloo & Oud
Consultancy.

GOING THE DISTANCE meets SURFING FOR LIFE

Bioethical issues in Traumatic Brain Injury 

GOING THE DISTANCE: JOURNEYS OF RECOVERY is a documentary film about the lives of survivors of Traumatic Brain Injury. Directed by multi-Emmy Award winning filmmaker David L. Brown, the project is seeking funding for its finishing phase. This film has had multiple previews in collaboration with brain injury advocates.  It has also been used in therapeutic TBI groups to gauge the communities' take on their depiction. An earlier film by the same director, SURFING FOR LIFE, reinforces that Brown, like any good film auteur, finds different ways of telling stories whose elements are significant to him. 

SURFING FOR LIFE deals with optimizing life from childhood through aging. It explores our relationship with water or what evolutionary biologists J. W. Nichols calls the ‘Blue Mind.’  GOING THE DISTANCE also deals with maximizing people's potential, after the have acquired brain injury. Not surprisingly, some of the films protagonists also have a restorative relationship with water. 

David L. Brown’s films have a solid optimism to them. That’s right, GOING THE DISTANCE is an optimistic film about TBI. The project follows four people through a narrative spanning roughly eight years. The work has the weight of longevity, diversity and the drama of living on the edges between life, death and rebirth. With four main characters, instead of one, the film is racial, gender, and age cohort inclusive. Permutations and combinations leave every viewer identifying with some part of the story. 

Why is Traumatic Brain Injury of particular bioethical concern?  There are tensions between beneficence, autonomy and justice manifest in issues around the epidemic incidence of TBI. The principle of beneficence, doing good with our science, services medical indications.  We now have plenty of neuroscience to support how these injuries occur at the cellular level and the best ways to prevent and deal with the sequelae. Yet, there are organizational and geopolitical barriers to clinicians and survivors accessing, or utilizing that information. Justice is facilitated by equipoise. Equipoise is the equitable distribution of burdens and benefits. Organizational and geopolitical factors often impede equipoise in the prevention and management of TBI. 

Among the important new science is a better understanding of ‘neuroplasticity,’ Dr. Albert Ray considers neuroplasticity the operating system for the nervous system.  It is the mechanism whereby the physical anatomy and physiological workings of our nervous system happen, both in normal and pathological conditions. It is what makes the brain programmable and re-programmable. 

After a period of intense neurological rest, recruitment and retraining of undamaged brain tissue improves functional capacity.  That recruitment process results from neuroplasticity, or reshaping parts of the brain, to assume tasks abandoned in the aftermath of the traumatic injury. Neuroplasticity fuels the work of occupational, physical and speech therapist and those acting in their stead. When forced to prognosticate, professionals do so within the parameters of the resource stressed systems in which they work. For instance they might cautiously say," A person with this initial assessment, receiving therapy weekly, can expect 'X' amount of functionality in one a year." GOING THE DISTANCE is a story about best chances to exceed those expectations.

Other manifestations of conflicts between beneficence and justice affect veterans returning from war zones with undiagnosed TBI as well as Post Traumatic Stress Disorder, car accidents, repetitive concussions from sports, violent assaults and motor vehicle accidents.  All of these disproportionately affect the young, very old,  poor, and people of color.  Adequate activities of known therapeutic benefit and prevention are often unattainable because of cost and lack of trained resources. Though brilliant acute trauma and neurosurgical care occurs in most urban centers in the USA, the follow up care is lacking. TBI, is a health and healthcare disparity issue. 

Traumatic Brain Injury also results in bioethical tensions between beneficence and the principal of autonomy, or the right to do what is in one’s own enlightened self-interest.  Most agree parents are appropriate surrogate decision makers for their children. Substituted judgment in adults, particularly young adults, with brain injury is wrought with uncertainty regarding extent of damage to a person’s decisional capacity. In this way TBI, like dementia, is a moving target. Dementia and TBI are related in other ways as well.

There is compelling data that negative cognitive effects are among the most disabling of post-concussion symptoms following moderate and severe TBI. These effects unfold slowly, sometimes over years and lead to high incidences of dementia. Deficits occur in attention, memory and "executive function," These deficits show up as impulsiveness, mental fatigue, frustration, depression, pain, self-medication, substance abuse and loss of employment. Justice suggest,” those with the most burden should have the most benefit.” In the most developed nations, minds which operate “like steel traps,” are adored. TBI survivors rarely have those kinds of minds and are often not well accommodated by legislative measures, including the application of the American Disability Act. 

The film CRASH REEL gives a good example of autonomy conflicting with beneficence. An extraordinary athlete, champion snow boarder, struggles with his late stage cognitive and physical limits. The recently completed film, STATES OF GRACE (reviewed elsewhere on this blog) like CRASH REEL, is about another person with uncommon capacity facing extraordinary adversity. There is much to learn from these films but it is not the story of GTD. 

 GOING THE DISTANCE is about ordinary people riding waves of adversity, while attempting the boring things of daily life. They use “what they’ve got."  What they have is family, friends and advocates.  By example, GTD gently makes the point that those without support have rougher rides and may drown in the surf. GOING THE DISTANCE is a documentary about quiet heroes focused not on what they cannot do in TBI recovery, but what they can.  

Viewing:

GONG THE DISTANCE (Digital) directed by David L. Brown ( 2014) pending release USA.  62 mins  http://www.goingthedistance.info

SURFING FOR LIFE  (Video) directed by David L. Brown (1999) USA  68 min.  http://www.surfingforlife.com/ 

THE CRASH REEL (2013) directed by Lucy Walker http://thecrashreel.com/  HBO Films  USA 108 mins

STATES OF GRACE ( 2014) directed by Helen Cohen and Mark Lipman (USA) distribution pending 71 mins.

Reading: 

Nichols, W. J. Blue Mind. Little, Brown and Company, 2014.

Ray, A. Neuroplasticity, Sensitization, and Pain. in Comprehensive Treatment of Chronic Pain by Medical, Interventional and Behavioral Approaches. ed. Deer, T.R.;Leong,M.S; Ray, A.L. et. al. ; American Acad- emy of Pain Medicine. Springer Inc. 2013.p 759-768,

Shively S1, Scher AI, Perl DP, Diaz-Arrastia R. Arch Neurol. Dementia resulting from traumatic brain injury: what is the pathology? 2012 Oct;69(10):1245-51http://www.ncbi.nlm.nih.gov/pubmed/22776913 accessed December 12, 2014

Carmichael, S. (2010). Translating the frontiers of brain repair to treatments: Starting not to break the rules. Neurobiology of Disease, 37(2), pp. 1-10.

EVERYTHING COMES FROM THE STREETS: Chicano Low Riders and Bioethics.

Last fall at the San Francisco Latino Film Festival there was a preview of the spectacular documentary, Everything Comes from the Streets. This film is an example of excellent programming on the part of that festival. This year the SF Latino Film Festival runs from September 12 - 22, 2014.

Everything Comes from the Streets is a documentary directed by Alberto Lopez Pulido and co-produced by Mr. Pulido, Kelly Whalen and Rigo Reyes.  It is a story about the significance of Low Riders in Chicano culture. A beautifully shot film, it carefully handles the struggle for identity and civil rights, particularly in the Chicano community. My interest in Low Rider Culture was re-ignited when it was used in the San Francisco based film La Mission (Bratt, 2009), which was the first film blogged on this website.

A Low Rider is both a car and the person who drives it. Low Riders, the cars, are rigged by the expertise of community developed mechanical physicists, operating under the cloak of local driveways and garages. Materials for the work historically come from salvage yards, not only deriving from cars, but the hydraulics of discarded airplanes. The rigging results in the rear of the car riding lower to the ground than the original factory specifications.  This aesthetic preference is also the restructuring that makes the car float, slowly down the roads, cruising on parade. This film illustrates why these vehicles need to be on parade. They are extraordinary pieces of artwork, expressing creative, cultural and engineering pride. There is more to this particular cultural icon than the cars themselves. 

Everything Comes from the Streets traces Low Riders from their roots in East Los Angeles and Espanola, New Mexico. The visual home of the film is San Diego County.  After the first Low Riders hit the streets in the 1950's, organizations began to spring up in support of them; the cars, the people who drove and their admirers.  These social "Car Clubs" developed structures that were also able to support community based social change. Additionally, the Low Rider movement had a specific contribution to Chicana feminism. By the 1970s, women, as well as men, were frequently involved in the same mechanics, redesign of their own vehicles for display, expression of creativity, pride, and organized community responsibilities. 

In the late 1970's, Chicano pride became a threat to the USA status quo. The film illustrated this reality in the San Diego area.  There, city ordinances were selectively enforced to prohibit Low Riders from Cruising and gathering audiences. This abuse of law violated the constitutional right of the Chicano community to peacefully assemble.  Collateral congestion and random legal offenses were inaccurately attributed to organized Car Club cruising. Low Rider Culture was misrepresented as synonymous with gang culture, particularly in the 1979 film, Boulevard Nights.  This representation fueled an even more skewed perception of Low Riders.

Disruption of under-resourced ethnic communities of color, under the guise of "urban renewal," was the norm in the 1960's and 1970's. Being organized, Car Clubs were logically part of community leadership that struggled, and still do struggle, against attempts to dilute Chicano identity and deny the community a geographic venue. With surprising good humor, Everything Comes from the Streets speaks to resisting oppression based on race and class. 

Why should Bioethicist care about Everything Comes from the Streets? The empirical Two Tiered Assessment of Shared Decisional Capacity reviews, Disclosure and Barriers to Disclosure during the process of informed consent, in medicine and clinical research. Clinicians should be aware of common barriers to shared decisional capacity. Examples of those barriers are: physical states including pain; psychological distress like grief, post-traumatic stress syndrome, depression/anxiety; educational differences (language and literacy) and patients’ perception of institutional chauvinisms. Institutional chauvinisms include the major "-isms."  Examples are ageism, sexism, genderism, classism, colonialism, professionalism and racism.  People tend to shut down communication and understanding when they recognize chauvinisms are being applied to them, with or without intention. 

Barriers to shared decisional capacity are barriers to good clinical medical ethical care of patients -- That's why Everything Comes from the Streets is important to Bioethicists. Once barriers are identified, clinicians can work to counter the negative effects.  In the case of institutional chauvinisms, clinicians demonstrating a commitment to learn about a person's family, spiritual needs, struggles and icons of culture, (FaSSI), may help to remove barriers to shared decisional capacity.   Born from the Chicano community, the film Everything Comes from the Streets is about family, spirit, struggle and cultural icons and can help improve goals of more ethical medical care.  

references:
Everything Comes from the Street directed by Alberto Lopez Pulido (2014) http://everythingcomesfromthestreets.vhx.tv/watch (USA) 56min  

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

September Williams'  Bioethics Screen Reflections: LA MISSION : Prototype for the Peace Genre http://www.bioethicsscreenreflections.com/2010/05/la-mission-prototype-for-peace-genre.html?spref=tw

Regarding Shared Decisional Capacity, FaSSI and institutional chauvanisms see online: 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

THE LEGEND OF KORRA: BIOETHICS meets ANIME

The Legend of Korra is an anime, action, fantasy, steam punk comic drama series. Unlike live action film, it is difficult to understand who is the author of an animation. In live action film, the author is considered the director. Animation is a more collaborative process with a long list of creatives which tends to diversify the form. The Legend of Korra series is created by Bryan Konietzko and Michael Dante DiMartino who are also writers along with Bryan Konietzko and Tim Hedrick. The credits routinely list 4 directors and too many to count artist and voices. Blending of themes and form of production is an attribute reflected within this particular series. 

Avatar: The Legend of Ang (The Last Air Bender) which aired 2005-2008 was the forerunner of the Korra series. Many who started watching Avatar Ang are now in their twenties and remain devotees of the realm. The resurgence of a complex fantasy genre, expanded beyond the play of young children, may speak more about reality than the make believe worlds in constructs.

Korra appeals to people who are, or want to be, cross cultural. Fantasy is the activity of imagining things, especially things that are impossible or improbable. Fantasy is also closely linked to play. There seems to be a need for the play in creativity both in art and science. In order for the human mind to develop properly we know that children require play. In the past, children were less exposed to the harsh details of the “real world,” making it easier to figure out. The importance of play in the past may have been confined to developmental ages 2 to 10 years. However, the inundation of more complex exposures, ending childhood earlier, seem to have required more complex and prolonged play... I’m just sayin’. There is a resurgence of detailed fantasy story-lines in animation and in literature over the past twenty years. 

The Legend of Korra unfolds in a mythical world, at once futuristic and merging of ancient Asia, Inuit, and steam punk visuals. Characters are heterogeneous, including animals, spirits and human beings. The series deals with war and conflict. The strength to change conflict is dependent on diversity, the ability to be or do more than one thing. This is contrary to reality, which often focuses on singularity as a major attributes. In The Legend of Korra, Bison’s fly, people cross between worlds of spirit, human and the elements. Humans of this universe have psychokinetic capacity to merge with and animate the major elements, fire, water, earth and air.

Avatar Korra is a 17 year old girl, not male as is often more common in the fantasy genre. Girls and women have significant representation during critical points in the series. In Hindu, ‘Avatar’ loosely translates as an “incarnation of a higher being.”  There is only one Avatar on the earth at a time. Avatars are reincarnations of other Avatars. The power to psychokinetically bend (or move) all 4 major elements, Air, Fire, Water and Earth is the defining characteristic of an Avatar. They differ from other “benders” in the universe who generally only can move one of the elements, the one from the similarly named kingdom from which the person derives.  It is this synergistic bending of all elements, which empowers Avatar Korra to potential resolve universal conflicts and promote harmony. 

These Avatars differ from standard Super Heroes, say, of the Marvel or DC universe in other ways. Avatars are born children, not converted by science or tragedy. Avatars are well cared for by their families and communities, who are obligated to help them grow into their identities. Unlike Superman or Batman, they generally are not orphans, loners or hidden behind alternate identities. To learn to bend all 4 elements, Avatars must be trained by mentors. The most complex and cerebrally taxing bending is that of Air. In a real world, were children and adults are essentially latch key kids, the appeal of this fantasy is understandable. Korra is in training to bend air as the series opens. Villains are those who manipulate the elements for purposes other than peaceful. 

Persons born after 1985, are often referred to as the millennial generation, generation Y, or the fantasy generation. They watch screens for entertainment, information and socialization on a variety of devices. Screen narratives are currently watched at will and repetitively during much of their conscious lives. Television broadcast times are not retro but made archaic by technological access transcending confines of time and geography. Eighty-three percent of adults in the USA have cell phones, 35% of which are smart phones. Those who are Black and Latino reflect trends of higher usage and using their phones as their major source of Internet access and “watching.” This watching places people in realms other than realism continuously and simultaneous with the dwelling in the “real world.” That is to say technology allows parallel universes in the mind. 

There was a time in history where real dead people were not shown on screens amidst real wars. It may be that, reality is overrated in the minds development.” We still do not fully understand the positive power of immediate escape into fantasy on screen, but we do understand that it is important in early childhood.  In this time, when the evolution of brain capacity is being vastly accelerated, in ways which most schools are not designed to accommodate, one could argue that the current digital leap parallels speaking, counting and writing in its importance. It may be protective from the barrage of non-fantasy life dependent on the narrative line.

The task of Bioethicists is to seek the knowledge to understand the ‘good’ of screen fantasy because it is delivered by a ubiquitous technology. Its appeal well into generations of adulthood parallels unprecedented pressure to make sense painful realities. The question is how does screen fantasy improve coping for this generation? There must be a reason why so many are driven to “watch,” and particularly watch animation, and create it. 

The Legend of Korra blends humans with natural elements in the way that the born from Manga anime Ghost in a Shell creates cyborgs. The series minimalist sophistication indicates the need for more thought about the meanings of repetitive viewing and stimulation by animation. To do that, Bioethicist should consider watching viewing trends in The Legend of Korra. 

The Legend of Korra (television series) created by Bryan Konietzko and Michael Dante DiMartino ( 2012 - current) Nickelodeon Animation (33 episode: 24 minutes.) 

Williams, S. book review. Bioethics at the Movies by Sandra Shapshay. Journal of Bioethical Inquiry September 2010, Volume 7, Issue 3, pp 329-331

Ford, Paul J. in Bioethics at the Movie’s Existential Enhancement in Ghost in the Shell in Bioethics at the Movies by Sandra Shapshay. Baltimore : Johns Hopkins University Press, 2009.

http://www.pewinternet.org/2012/02/16/health-technology-and-communities-of-color/ Accessed July 10, 2014

http://www.psychologytoday.com/blog/beautiful-minds/201203/the-need-pretend-play-in-child-development. Accessed July 9, 2014

http://www.princeton.edu/futureofchildren/publications/journals/article/index.xml journalid=45&articleid=200&sectionid=1303

https://www.princeton.edu/futureofchildren/publications/docs/18_01_03.pd accessed July 7, 2014

Special thanks to Curd Williams-Hertz for flagging the Legend of Korra and Avatar: The Legend of Ang and the quote,” reality is over rated,” see curdwilliams-hertz.com

DALLAS BUYERS CLUB meets SCIENTIFIC INTEGRITY

DALLAS BUYERS CLUB  is a biopic about an unlikely hero, directed by Québécois Jean-Marc Valle and written by Craig Borten and Melisa Wallack. In case you get a call from your local AIDS-Walk coordinator, remember 50,000 cases of AIDS (Acquired Immune Deficiency Syndrome) still occur in the USA annually. Transmission is largely preventable with education, testing and early intervention. Ethnic peoples of color are disproportionately affected in new cases. Thirty-five years ago, I never imagined AIDS would be the defining disease of my career and then some.  After my AIDS-Walk call, I pulled out my notes on Dallas Buyers Club, which screened October, 2013 at the Mill Valley Film Festival. It has won three Oscars and too many to count other awards.

The year 2013, brought a number of film releases with main characters who had significantly degenerate moral fiber. You know them, good acting, sex, drugs, brutality prominent but few redeeming qualities.  Dallas Buyers Club (DBC) is not one of those films. Its lead character is definitely a degenerate, but develops moral fiber.  If “The Star” of a film is the person who undergoes the most change, Ron Woodroof (Matthew McConaughey) may be the star of the millennium. His character moves from self-serving reprobate to enlightened self-interest. In the process, he believably expands compassion for others. The compassion fall-out includes Jared Leto, (Rayon) who well plays a stereotype of a transgender woman whose script, in contrast to Woodroof’s, traverses only the narrow ground between dying and dying more.

Dr. Eve Saks (Jennifer Gardner) spoke particularly to me. She had that deer in the headlights feel to her -- as she decided to which side of the road she would jump -- with her patients, or with her retrograde moving profession. Her subtle portrayal of an overwhelmed newbie was reminiscent of my internship at Cook County Hospital, Chicago in 1985.  I saw 17 hospitalized patients with AIDS, within my first 35 days. Fortunately, I had good role modeling by Drs. Ron Sable, Renslow Sherer and Dr. Jonathan Mann. 

Among those 17 patients was an 8 year old girl with Leukemia, AIDS and tuberculosis - the later was diagnosed on autopsy, which brings me to the bioethical point. Four years before that autopsy, I was told in medical school that miliary or disseminated tuberculosis no longer existed -- that was then, this was now.  Diseases change and so should the manner of treating and studying them and their cures.  In medicine it’s not “location, location,” but “observation, observation.”

DBC is about how AIDS, science, research and Federal Drug Administration regulations were forced to change. The change was pushed by the autonomy of people who ran the most risk of dying from AIDS and their allies.  The principle of justice requires equipoise or the equitable distribution of burdens and benefits.  The job of clinicians is to understand and communicate the burdens and benefits so that individuals, who can, are able to exercise their autonomy. When there is no proven cure, those with life threatening illnesses and intact decisional capacity, now, can choose through the informed consent process, to run the risks of clinical research protocols, whose outcomes are as yet unproven.  Access to such trials is currently a health disparity. Navigating the clauses in the three proceeding sentences is the job of bioethics in new diseases, therapies and research.  This is how we learned that oral anti-virals could reduce HIV/AIDS vertical transmission from mother to child. 

Data safety monitors (DSM), augment institutional review boards and were given teeth during the rise of the AIDS epidemic.  DSM allowed tracking of acceptable burdens associated with research, on vulnerable persons while the studies are in progress.  DSM also can stop studies where the burdens outweigh the benefits, or the benefit is so clear that lifesaving therapies should not be with-held to complete the research.  This acceptability should be consistent with the 2013 World Medical Association amended Declaration of Helsinki on Medical research. Significantly this amendment references identifiable human material or data. This would recognize the privacy of genomic material correcting ethical violations associated with HeLa cells and other genetic technologies. Consider, non-small-cell lung cancer, the most ubiquitous cancer in the world.  In that case, we look at the value of Palliative Care, genomic-bio-marker driven therapy and clinical trials, all three at once. The criteria for treatment look like a menu at an over stocked diner, but bioethics helps to navigate them.   Such protocols would not be possible without changes in policy and procedure reflected by the struggles of those affected by HIV/AIDS and the bioethical analysis accompanying them.

Set in 1985, the story is sandwiched between the year before AZT was found effective (the first of the anti-viral drugs used in HIV/AIDS) and the year after, Robert Gallo and Luc Montagnier both discovered HIV-1 as the agent causing AIDS.  The footprints of the Dallas Buyers Club are everywhere.

references:

Dallas Buyers Club (35mm) directed by Jean-Marc-Vallee (2013) Focus Features (USA) 116 min

Some other films about the HIV/AIDS epidemic:

How to Survive A Plague (35mm) David France (2012) Sundance theatrical/IFC (USA) 109min

http://surviveaplague.com/

Philadelphia(35mm) directed by Jonathan Demme (1993) Tri Star (USA) 125 min

Yesterday (35mm) directed by Darrell Roodt(2004)HBO USA ( South Africa) 96 min ( Zulu, English  subtitled)

The Declaration of Helsinki http://www.wma.net/en/30publications/10policies/b3/  accessed July 16, 2014 2013

HIV/AIDS statistics USA http://www.cdc.gov/hiv/statistics/basics/ataglance.html accessed July 16, 2014.

World Association of Bronchoscopy and Interventional Pulmonology Academy : Small Sample Tissue Acquisition and Processing for Diagnosis and Biomarker-driven Therapy of NSCLC. Bioethical issues video commentary. http://www.wabipacademy.com/site/webcast/clinicalstem1/step40

http://www.wabipacademy.com/site/webcast/clinicalstem2/step36 accessed July 16, 2014

A SONG FOR YOU meets the SOUND OF MUSIC

A SONG FOR YOU is a documentary that goes down like the first draw of a good espresso, made more perfect by a bit of sweet steamed milk. Three sisters travel to the heart of their family’s greatest threats and strengths, retracing the family's escape from the Nazis. The story is an applaud for those who refused to let civilization fail. This film is the most recent collaboration between co-directors Sharon Karp and Sylvia Malagrino, veteran filmmakers whose works define resilience under the stress of humanitarian violation. A SONG FOR YOU premiered January11, 2014, at Chicago’s Gene Siskel Center. 

In 1943, preschooler Susie Karp climbed the Pyrenees with her parents, to escape Nazi occupied France. The Karp family owe their lives to the kindness of strangers, particularly rural French Resistance fighters, The Maquis.  The Maquis ferried the family through the final leg of the journey into Spain and ultimately to North America. The escape took five perilous years of fear and persistence.  

This film differs from THE SOUND OF MUSIC and other stories of the genre reflecting such escapes from tyranny.  Susie, like her parents, is a first generation holocaust survivor.  Her two younger sisters, born in Chicago after the escape, are second generation survivors. There is a phenomenon of Family Culture Post Traumatic Stress, observed in circumstances of humanitarian violation. This stress often affects generations in the family who did not directly endure the primary assaults.  Susie served as the bridge between her parents and her siblings.  She and her parent’s primary trauma became integrated across generations, to her younger sisters. Culture is how people define themselves, The Karp Family culture was defined by the embedded fears of impending disaster, related to the perils of the escape. A SONG FOR YOU addresses the need for the sisters, after the deaths of their parents, to understand the cross generational phenomenon that punctuated their upbringing. 

A SONG FOR YOU is not sad, but gripping largely because of its elegant film craft. Modern European geography is used as the backdrop for historical recollection and a vehicle for emotional engagement. Relative stability of the landscape and cultures of the European Holocaust, mirrors the resistance to the consequences of heinous atrocities perpetrated there. 

All family sagas are a matter of interpretation of primary and secondary memories by the relatives.  Karp Family archival films, recordings, documents and songs illustrate those memories. The survival of the supporting documentation, matches the strengths of the family whose life is depicted, A SONG FOR YOU becomes a song for us. 

A Song For You. (2014) directed by Sharon Karp and Sylvia Malagrino. Media Monster USA (80 min.)

For More information about A Song for you and Sharon Karp’s work see http://www.mediamonster.net/

For More information about A SONG FOR YOU and  Silvia Malagrino’s work see  http://www.silviamalagrino.com/

MR BANKS MEETS HITCHCOCK: Death and Childhood Trauma

SAVING MISTER BANKS is a fictional story about P. L. Travers, the author of the book, Mary Poppins. The Travers character works through childhood trauma, while attempting to maintain creative control over her book during its adaptation to a Disney film. Mrs. Travers is successful in the former but not the latter. Both of these key themes have bioethical if not clinical ethical implications. Mr. Banks is directed by John Lee Hancock and co-written by Kelly Marcel and Sue Smith. Emma Thompson plays Mrs. Travis majestically while Tom Hanks portrays Walt Disney. Mr. Banks is ultimately about honoring the good in a person while not forgetting their fallibility or even real versus perceived cruelty. The film is subtle in this expression. 

The fictional Travers-Disney relationship unmasks Mrs. Travers' need for emotional transformation. The film reminds me of the sensibility of the recent movie HITCHCOCK. Both works pivot on a unique nonsexual relationship between historically revered male and female creative collaborators. Both illustrate concerns with the film industries potential corruption of original written source material. Bioethical issues relate to "the artist's right to write," and pitfalls of having other people tell your stories. MISTER BANKS also underscores ways in which creativity can be therapeutic. 

This film is worth seeing for the performances. Thompson's Travis is strong in an understated way. The portrayal is aided by the actor's access to audio tapes of the real Travis' working sessions during Mary Poppins' pre-production. She definitely undergoes the only major change in the story, as others run their intended agendas around her. Hanks' Disney is a simple principled man, whether or not one agrees with the principles. 

There is one person of color in the film and he is a bartender. It's a small cast, a tight story with few locations. There are characters who are peripheral to Disney; workers who are drivers, secretaries, and lyricists. Mrs. Travers, even when antagonistic, at least interacts with these workers in the film, unlike Disney. These little bits allude to Disney's political background which was in reality far to the right of the real Mrs. Travers. In the context of childhood trauma, enough shadow is cast to warrant questions about Disney's tensions with his father. His father was a known socialist. Walt abandoned his father’s values, but apparently learned his work ethic. It is the sharing of the conflict between Disney and his father which aids the Travers character's epiphany about the influence of her own upbringing. 

Like Hitchcock's films, SAVING MISTER BANKS is about terror arising deep in childhood fears. It is also about the defenses people muster to escape those fears; helpful or malignant. This movie rejuvenated my desire to better understand the longtime concern and effects of Disney works dealing with psychological implications of death and loss; an arena in which these films have always been oddly involved. SAVING MISTER BANKS is absolutely not a children's film, though it is mostly about children's lingering fears in adults. Also like Hitchcock's psychological thrillers and mysteries, MISTER BANKS is a rough exploration of death's implications for those left behind. 

Saving Mr Banks (35mm) directed by John Lee Hancock (2013) Walt Disney Studios Motion Pictures. (USA) 125 min. 

See for cross reference on this website bioethicsscreenreflections.com website post re: Writing other People's stories THE HELP (2012) THE WORDS (2013) and re: Childhood Trauma: NOWHERE BOY (2010)

THE BUTLER: Awards vs Dignity

Director Lee Daniels' The Butler is an historical fiction film. It is inspired by many men and women. It tells the story of Cecil Gaines (Forest Whitaker) and his family. Cecil is a Black man born in the Southern United States during the Jim Crow era. He becomes a member of the White House staff, serving presidents Eisenhower through Reagan.  Though the media touts the films focus as dismantling institutional racism, I read the film's main theme as even more universal. 

The Butler illustrates a conflict between a man and his eldest son.  The former began his life in well-founded fear while the latter with a sense of the right and obligation to struggle for dignity illustrating tensions between paternalism and autonomy.  It is as common in families as in the doctor-patient relationship. The paternalism-autonomy issue is a good one to consider in terms of bioethics as it is an issue of competing goods, not simply black and white, good or bad. This is not only the story of a Black American family, but of many families where one generation is born prior and the next after, the Universal Declaration of Human Rights. 

The absence of any nominations for The Butler, from members of two major awards organizations, was an eyebrow raising event driving me to consider if the films story, not its craft, was the reason for its exclusion from nomination. The Butler is one of four films with major theatrical releases in 2013 which tell stories of persons primarily of African descent. As a group The Butler, Twelve Years a Slave, Mandela: Long Walk to Freedom and Fruitvale Station have transcended the narrow distribution genre of "ethnic film."  Some members of film awards nominations committees may not have gotten 'the memo.'  Of note, the Weinstein Company distributed three out of the four films.  There had been hopes that the awards season would share the enthusiasm of these film's broad audiences with unprecedented nominations; as happened in 2006 when we were graced with: The Pursuit of Happiness, Dream Girls and The Last King of Scotland.  Close, but no cigar for The Butler, leaving me to consider why. 

Was it film craft? The Butler's director, lead actors and cinematographer have been recognized previously by awards and their work as an ensemble represents some of the best expression of cinema. Visuals were classically and appropriately delivered by award winning veteran cinematographer Andrew Dunn, (Gosford Park, LA Story, the Madness of King George,) and film editor Joel Klotz (Precious).  Several of the sequences represent some of the strongest film imagery in history.  For instance, a montage of a White House supper party  being prepared and served by an all Black wait staff including Cecil, rapidly intercut with shots of college students including Cecil's son Louis being, trained in passive resistance,  facing attacked while desegregating a lunch counter.  A second example, Cecil is present, standing ready to serve during a White house concert of Cellist Pablo Casals. Through lighting, Cecil's transformed into the image of a racist stereotype art form reminiscent of Jim Crow, Zip Coon or Uncle Tom.  Further, the score of Rodrigo Leao catapults many of the films visuals into the range of legendary opera, reflecting the complex inner emotions of the main characters.   

Lead character portrayals include the Gaines family: Cecil (Forest Whitaker), Gloria (Oprah Winfrey), Louis (David Oyelowo), Charlie (Elijah Kelley) and Carter (Cuba Gooding Jr.)   These are compellingly real; as if they lived around the corner in any working class Black community in the U.S.A.  The men who portrayed presidents  Eisenhower, Kennedy, Nixon, Reagan (Robin Williams, James Marsted, John Cusack, Alan Rickman) were also exceptional.  The wardrobe, makeup and set design artist supporting the film represented a tour de force moving through decades of style.  

The Butler's lack of awards recognition is clearly not because of film craft. The ensemble having received past awards shouldn't matter either. We have examples of multiple awards for more dubious activities recently.  Only the story is left to blame.  Director Lee Daniels and screenwriter Danny Strong created an eminently emotionally accessible historical fiction which transforms degradation into resilience, for the average person. It also depicts multidimensional characters, several of whom are women. Clearly, the goal of this film is to make people feel good about the struggle for human, civil and worker’s rights. It's a Peace Genre Film, much like the film La Mission; a story of father and son's conflict at the crossroads between the past and the future. Both films ultimately choose the more progressive route.  La Mission was not nominated for Oscars or Golden Globes either. Perhaps this was a case of bad luck being released in such a competitive field. I suspect there is more of an apolitical or political phenomenon a foot. 

My most worrisome bioethical concern is that the story of The Butler contradicts the vast expression of negativity and degenerate nature reflected in many recent films despite the race of the major characters. Rejection by film trend makers of Peace Genre Films, particular when war is being waged on so many fronts, can't be a good thing. The pessimistic violent trend both reflects and fosters the pain of this period in history. It is to Mr. Daniels credit that given the resources to do whatever he chose, he chose to make The Butler an homage to the spirit which elevates humanity. The Butler is readily available on a variety of digital media. People will and should continue to view it.  

Lee Daniels' The Butler doesn't deny inhuman levels of physical and emotional brutality, seen in many other films this year and last; it simply denies these realities an ultimate platform. Better to forego nominations for awards than to forego an opportunity to foster dignity. 

Lee Daniels' The Butler (35mm) directed by Lee Daniels. USA. The Weinstein Company. 2013.

Additonal information about films referenced in this  piece are accessible online. 

For more information on Peace Genre Films see on this website: 5/23/2010 post: LA MISSION: Prototype for the Peace Genre

For more information on film literacy and bioethics on this website see link to:  Lighten Up - Dying on Screen: Film and Bioethics Literacy Slides

VIEWING ACROSS GENERATIONS, GENRES and PLATFORMS: Heroes, Aging, Dying

The recent loss of Nelson Mandela’s physical life pushed me to write the first essay in the three topic series I have planned for a while. The topics are 1) Heroes and Super Heroes, 2) Aging and 3) Dying on film.  As it happens, his life made significant contributions in each of these areas.   My hope is to juxtapose the different ways these ethical tensions are made accessible on the screen across generations, genres and platforms; adults x children, drama x comedy, live action x animation, film x television, large screen x small screen. The goal is that various age cohorts and clinicians will consider moving out of their comfort zones and view new formats and genres.  Hopefully better screen literacy will help cross cultures and generations and provide better bioethics and clinical medical ethics. Away we go into Bioethics Screen Reflections for 2014!

MANDELA: LONG WALK TO FREEDOM (HEROES & SUPER HEROES)

I saw the United States premiere of MANDELA: LONG WALK TO FREEDOM at the Mill Valley Film Festival on October 9, 2013. I have been thinking about the film for two months, having read the autobiography, from which it was adapted nearly twenty years before. LONG WALK TO FREEDOM, directed by Justin Chadwick and screenplay written by William Nicholson, had an enormous task; to follow the lead of an eminently literate, political humanist in a film genre which contradicts the main character’s essence.   Actor Edris Alba plays Mr. Mandela wielding the full scope of self-reflection, commitment and fallibility. 

If a hero has to be perfect, then no one can aspire to the job. If a film must be flawless, all would be unwatchable.  Super Heroes save others and are endowed with powers making them godlike. The ability for individuals to identify with Mandiba’s fallible human character in the film will likely be of more value, in inspiring others to leadership, than simply heaping accolades in memorial to his considerable uniqueness. His fallibility does not detract from his human hero status, nor did it prevent him from freeing himself and in so doing enabling others to do so as well. This is the true mark of the human hero story. They are usually recruited to struggles reluctantly; forced to overcome apparent insurmountable obstacles with a group of confidants (or at very least one.) Think Don Quixote.

There are at least two bioethical conflicts illustrated by this film; One being a beneficence concern and the other a justice concern. The need to depict a significant leader without portraying him as a god is a beneficence issue. Unfortunately it is anathema for a film about a hero. It may be difficult for audiences to get their heads around.  This even though, our science and humanities knowledge tells us when men are deemed greater than human, the outcome for human development is poor. Mr. Mandela walked that line cautiously and so tried the film.

The issue of equitable distribution of benefits and burdens, or justice, is raised in key relationships between Mandiba and his family; in side of prison; ultimately those who were exiled and those who stayed on the home front. It is a fundamental issue in those who commit themselves to humanitarian struggle that they are public beyond the apparent immediate needs of their families, though in service of both.  Sorting out whether you are to provide for the care of your family or be the agent of their care is an issue in many careers sharing borders with struggle.

It is an important part of film literacy for viewers and teachers of bioethics to understand the role of genre. Audiences defined genre. The ways in which they respond to how films "present" stories, creates the marketed. The strength of the allegiance of the filmmakers to genre defines the works monetary potential and so production potential. Projected monetary success determines the probability of a film seeing the light of projection. The often noted hypocrisy of the major film industry products is in fact determined by what viewers support and do not support. The standard changes only when viewers demand it.

The 'Biopic' or biography-picture genre focuses on the ‘star.’  The star of a film is the character who undergoes the most change. By this standard one could argue actor Naomie Harris’ Winnie Mandela portrayal would make her the star of this film. Mandiba is shown confident, pensive and rational throughout the first two-thirds of the film. It is through her suffering that he begins to struggle with the details of the ethical conflicts associated with the effects of the demands of choosing a life of struggle, on family.  However, she is more than family, she is a comrade in arms so shares the same conflict. 

LONG WALK TO FREEDOM works against its genre, because the nation of South Africa is the true primary character, not Mr. Mandela.  The films difficulty deepens because the filmmaker and screenwriter had to make a star movie out of the story of a man whose historical record shows he did not cast himself as a star, but as a drafted leader in a cadre of equally strong heroes.
I suspect there was enormous hand wringing over the film’s diminished depiction of the cadre to which Mr. Mandela historically belonged; giving only a passing nod to the extraordinary likes of Oliver Tambo, Brahm Fischer and Walter Sisulu. The movement for one person one vote in South Africa was not dependent on Mr. Mandela alone. Would that it and struggles to come be so simple. The longing of the average person for simplicity sends patrons to the theater. It is our job to use film as a device helping people understand more deeply and finding resonance of the work within themselves. This has been the purpose of all storytelling throughout human history. When we see these issues in clinics with overwhelmed parents, in colleagues and so on, suggest films that may help.

It is hard to make a film whose main character seeks to defy the adoration of the chosen genre, but I am glad Chadwick struggled to do so with MANDELA: LONG WALK TO FREEDOM. 

Mandela Long Walk to Freedom (35mm) directed by Justin Chadwick. UK. The Weinstein Company. 2013.

For further information read:
Mandela, Nelson. Long Walk to Freedom. Little Brown & Co. 1994.
A brief history of the African national Congress.  http://www.anc.org.za/show.php?id=206     accessed December 12, 2013

Zoe Elton. Mandela: Long Walk to Freedom /http://www.mvff.com/ ; accessed December 13, 2013

Museum of the African Diaspora was the sponsor of the MVFF screen of MANDELA LONG WALK TO FREEDOM see: http://www.moadsf.org/

LA GENT DEL RIO (THE RIVER PEOPLE) meet NEBRASKA: END OF LIFE TASK

The 5th annual San Francisco Latino Film Festival, Cine+Mas was held September 12-27, 2013. It was a marvel of the best international and national films I’ve seen in a long while.  I was moved by many of the works but the sensibility of the documentary film LA GENTE DEL RIO was profound as my first watching the birth of neo-realism.

An Argentinean film, LA GENT DEL RIO’s directors are Martin Benchimol and Pablo Aparo. It is the story of the people from an aging declining town as told through the voices of its people who are similarly described.  Situated a hundred kilometers from Buenos Aires, the town’s life was seasonal in the past. People came during the summers to swim in and cross the river.  Over the years these transients, dare say rag-tagged visitors, were accused of bringing vandalism to the town. Much of the towns peoples focus became talking about and understanding of what the river people have to do with the fading of the town’s opulence. Eventually, a private policeman is hired who sets up a sentry booth on the town square and patrols to prevent and monitor the river people. In the process the town’s people, through their own presentations lay bare the plight of aging in small, no longer prosperous, rural communities.

On the heels of being so taken by LA GENT DEL RIO, I saw NEBRASKA, Alexander Payne’s most recent film. Remarkably it is filmed similarly, in the neo-realist homage black and white sensibility.   The bioethical themes match the beneficence and autonomy issues associated with caring for the aging, dying and cognitively impaired people in declining small towns.  Both films are life reviews of individuals and the place where they live. Life review is a way of working through end of life tasks.

NEBRASKA is shot on location in a small town in the state for which it is named, and over the highways of four Midwestern USA regions.  The extras, even those with spoken lines are mostly drawn from the streets and bars of this one small town.  Beside the extras, the stars were also brilliant too; Bruce Dern, Bay Area Local Will Forte, Bob Odenkirk, June Squibb and Stacy Keach.  They share the feeling of The River People depicted at the tip of South America, accentuating the universal process of aging in this century.

In the tradition of the Mill Valley Festival there were two separate opening films for this the 36th Festival. NEBRASKA was opening across from the remake of the 1947 film the SECRET LIFE OF WALTER MITTY.  I chose to see NEBRASKA, instead of MITTY because I studied medicine in that state at Creighton University and cared for people in the region. Further, Alexander Payne previously has made bioethics relevant films, particularly CITIZEN RUTH and THE DESCENDANTS. NEBRASKA did not disappoint; raising concerns about the ecology of aging, relevant to Baby Boomers, their elders and children.

LA GENT DEL RIO. (35mm) directed by Martin Benchimol and Pablo Aparo,  Argentina.  Independent. 2012.

NEBRASKA (35mm) directed by Alexander Payne. USA. Paramount. 2012. 

BEASTS OF THE SOUTHERN WILD: Bioethics and Neorealism

Beasts of the Southern Wild is nothing short of a miracle in that it ever made it to the screen. It is an act of cultural, film industry and moral defiance. As a fantasy documentary, it crosses every genre expectation. The plot describes a culture where the humans run toward the neighborhood of the Bathtub, on a fictional Island in the Louisiana bayou, where the waters rise and engulf them over and over again.  The hero of the story is a six year old girl named Hush Puppy (Quvenzhane Wallis),  who has only a memory of a mother and whose father ( Dwight Henry) is a rough man who is nearing the end of his life.  With no sentiment, the culture of the Bathtub is simply survival not change. The story is unique in many ways, not the least of which is its film grammar.  Director-writer, Benh Zeitlin and writer Lucy Alibar have in their "oh so this century" take dared to cross cultures in every way.  Though mysticism is usually a cop-out for those who do not understand the culture being portrayed, this team defies that norm.

Beasts of the Southern Wild raises questions about beneficence, autonomy and justice. Is it ethical for people to live in a place we know will flood over and over again? Does a parent have the right to raise a child in a place which is so harsh in the name of maintenance of the child's culture when there are other options?  Where is the equipoise or justice in having the youngest members of a culture continually suffer the most burden and loss? Somehow we as viewers find ourselves cheering for the unconventional resolutions the film offers.

Created with non-professional actors, using location and historical stock footage, finally finding the visual story in the editing, Beasts of the Southern Wild is truly a new Neorealist film.  Like the Italian Neorealist films, its themes are the lives of poor and working, rural people, struggling to withstand massive oppression. In this case, the relentless environment of the Bathtub is the oppressor with a cameo by modern medicine as its cousin.   There are scenes reminiscent of Rossellini's Open City.  Tragic frailty, like in some Italian Neorealist work, is met with courage, strength and the hope inherent in children.  Enormous credit goes to Beasts of the Southern Wild for the nod to the relationship between social and ecological justice; a universal tale using only tools that could be mustered in the 21st century. 

Beasts of the Southern Wild. ( 35 mm)  directed by Benh Zeitlin. USA. Fox Searchlight. 2012.
Open City. (35 mm)  directed by Roberto Rossellini. Italy. Minerva Film Spa. 1945

THE RELUCTANT FUNDAMENTALIST MEETS WATERMELON MAN

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

MILL VALLEY FILM FESTIVAL

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.

http://www.musicolog.com/kieslowski_manycolours.asp

Tricolor: Blue. (35 mm) directed by Krzysztof Kieślowski (1993) France, Poland, Switzerland. Mirmax/MK2 Diffusion.

THE HELP: Racism v. Justice and the Right to Protest

The film, THE HELP is a historical fiction, close enough to the truth to raise moral concern.  It is mostly about the development of a book revealing the impact of racism on black and white families. The film is adapted from the Kathryn Stockett novel set in Jackson, Mississippi during the early 1960s. It's the rising phase of the civil rights movement. The story is viewed primarily through the eyes of women.  Central to THE HELP is unequal risk of harm to black women when compared with white women.

To the films credit, intentional or not, it also stimulates moral questions about the ethical conflicts inherent in the telling of other peoples' stories. Ethical concerns include adaptation from traditional oral storytelling, to novels, plays and films.  Necessarily, these adaptations raise worries about ownership of the intellectual property conveyed. In bioethics, we would consider these issues primary conflicts between the principles of autonomy (the right to do what is in one’s own best self-interest) and justice (the obligation to insure equal distribution of risks and benefits.   Finally, audiences believe in the accuracy of historical fiction. They are not dissuaded from this belief by the above the line statement, "based on..."   Those whose characters have been captured in fiction films are often angered by the ways in which they have been distorted by creative license.  Historically, artists have had the right to re-write history, even in ethically charged situations. 

THE HELP has an outstanding ensemble cast of both black and white women. In the film, Abline (Viola Davis) is a black woman who works as a domestic for a white family. She has done this kind of work since she herself was an adolescent.  The child in the family, a girl who is maybe three years old, is being emotionally and physically abused by her own mother. The mother of is viciously insecure. Abline cares for this child's health and dignity leaving her absent from the needs of her own family and community.  Abline's autonomy is thus compromised. In Abline's absence, her own son's life is brutally taken as a direct result of racism. Yet, Abline continues to maximize her humanity with regard to the child she cares for in the white family.  Davis eloquently, expresses the double bind black women, and others working as domestics, find themselves in.  Abline is forced to act against her self-interest, assuming a high risk while doing so.

A Kennedy era white college graduate, Skeeter (Emma Stone) returns home to Memphis after having obtained a university education. Compared with her hometown peers, Skeeter is a feminist.  She struggles to want what her white southern culture demands for her, a man and a family. Those wants don't stick.  She really prefers a writing career. Skeeter's broader exposure leaves her questioning by the racism, sexism and classism of her childhood friends.  Like a good creative opportunist, in the film, she sees in Abline the story that can make her publishing mark; telling the story of black maids in their own words. This insight occurs in immediate context of the murder of Meager Evers, the African American, WWII Veteran and civil rights leader.

The character of the publisher (Mary Steamvirgin) insists that Skeeter not just edit but write part of the book. This is a small homage to the intellectual property conflict. The publisher's demand forces honesty about the strength of the bond between domestics and the children they care for. Skeeter's mother (Allison Janney) is dealing with cancer, imposing on her the end of life task of looking at her own inadequacies. Chief among these inadequacies is the moral cowardess she showed through vicious racism directed at the black woman who raised Skeeter (Cicely Tyson).  

THE HELP is a film tied to Steven Spielberg's DreamWorks Studio. There is a long drama between the film industry and the struggle around racism. In 2000, Spielberg refused to receive the "D.W. Griffith Lifetime Achievement Award" of the Director's Guild of America unless the name was changed. Once having leveraged change of the award's name to the "DGA Life Time Achievement Award", he spoke of the elephant in the room during his acceptance speech.  Paraphrasing, he believed "You can honor the evolution of film grammar, without honoring the name of a known racist.”   We don't always get genius in the package we want, but we don't have to be happy about that fact. The history of the struggle against racism has been a series of small changes with occasional big peaks. Having a filmmaker of Mr. Spielberg's heft stand against racism is significant in an industry that has so much power.  He also mentioned “that yet to occur moment when an African American director first wins the DGA Lifetime Achievement Award.” What a tragedy it would be if that director was forced to reject the honor - because it was named after a racist.

How is THE HELP relevant to the applied bioethics called clinical medical ethics? Justice is the most complex of the three ethical principles which influence ethical medical care.   Beneficence and autonomy are thought to be the other most relevant principles. Justice, though we know it when we see it, seeing it is rare.  We speak more of injustice. Injustice is defined as: designation of risk and benefits to specific persons in a way that causes them disproportionate harm.  Racism is a typical manifestation of injustice. Injustice almost always exists on a geopolitical historical scale. This scale is hard to manage in a clinical setting but we see its repercussions daily; post-traumatic stress, loss of self-worth, depression and diseases of health disparities. Among these diseases are: tuberculosis, cancer, diabetes, cardiovascular disease, HIV/AIDS, and substance abuse.  Injustice blocks learning, motivation and frequently causes death at the hands of self or others. The fundamental transhumanistic/public health principle underpinning clinical medicine is the obligation to use science to strive for better and longer life.  If injustice impedes meeting this obligation, it is logical that justice could reverse the harm. Hence, clinical medical ethicists find injustice so difficult to manage; we are dragged into the fight for justice.

Viola Davis' portrayal of Abline's grief from the death of her son, takes a bite out of the American public's heart, like none since Cicely Tyson's son was taken from her in ROOTS (1977).  I saw THE HELP at a small neighborhood theater in a mostly Asian community of San Francisco.  A blockbuster movie was opening on the screen in the empty adjacent theater.   On that Saturday night, there was a music festival in Golden Gate Park a few blocks away, drawing thousands. Yet, THE HELP had a fairly full, predominantly neighborhood Asian audience. The mostly Latina domestic hotel workers on strike downtown, demonstrated outside of a major Cineplex where THE HELP was screening. Their placards truthfully stated, "We are the Help!"  People identify with the characters in this film across racial and ethnic lines. Many viewers are connected by class or family history.

While Viola Davis' Abline is unrelenting, direct, unapologetic, controlled and rational, Octavia Spencer's portrayal of Minny provides brilliant comic and common sense relief.  In Spencer's hands, Minny is reminiscent of Hattie McDaniel in GONE WITH THE WIND (Flemming, 1939); speaking lines McDaniel could only have wished to speak. Those who argue that racism in America has been done to death on film should note this fact: in February 2012, Black history Month, Minny or Mammy remains the preferred African American woman big screen portrayal compared with the rarer, Abline roles. 

There have been more strides in small screen narratives toward expanding the types of roles for African Americans and other peoples of color. The film, DANCING IN SEPTEMBER (Rock-Blithewood, 2000) promotes this phenomenon. Films other than THE HELP, like LA MISMA LUNA/UNDER THE SAME MOON (Riggen, 2007), have improved understanding of racism, sexism and classism directed at women. The unconscionable cost of making and distributing good film continues to preclude some of the most socially relevant creative works from being viewed cross racially. This is unfortunate as film has quickly, and more broadly, influenced change in the moral spectrum than any other art form. For now, those who struggle for justice are thankful enough for THE HELP.

THE HELP (35mm) directed by Tate Taylor. (2011) USA. Touchstone Pictures. 146 min.

Roots (miniseries) produced by Stan Margulies. (1977) USA. ABC. 8 episodes / 720 min.

GONE WITH THE WIND (35 mm) directed by Victor Flemming and others (1939) USA. MGM/Warner Bros. 238 min.

DANCING IN SEPTEMBER (35 mm) directed by Reggie Rock Bythewood (2000) USA. HBO. 106 min.

LA MISMA LUNA/UNDER THE SAME MOON (35 mm) directed by Patricia Riggen. (2007) USA. Fox Searchlight Pictures/The Weinstein Company. 106 min.

MY WEEK WITH MARILYN: Commodification, Frailty and Injustice

In an exchange of a few weeks ago about a recently dead star, I made the comment that I stand by: "If you consider a person a God, when they fall to the ground they are a Monster." People, in general should just be people; just equal.  To be considered more or less than a person is an injustice.  Marilyn Monroe was a woman who was frequently treated more or less than a person and so unjustly.   In her youth as a foster child, she was less. In her stardom, she was more. Approaching her death she was less again. 

My week with Marilyn (Michelle Williams) is based on two books by Colin Clark. It is adapted for the screen by writer Adrian Hodges and director Simon Curtis. The film shows Marilyn as frail and dependent.   It is under these circumstances that she spent time with Colin Clark (a young gofer for Sir Lawrence Olivier during the period when movie The Prince and the Showgirl was being made.

Smart people do not tolerate injustice well, when trapped they will chew off their paw to get out of a trap.  History is replete with examples, among them Marilyn Monroe. Until fame changes, its price won't. Fame is unsustainable because, in the language of Bioethics, the people who make fame use people as a commodity.  This commodity model is a slave model. When one slave dies the fame industry buys another.

Norma Jean Baker was 36 years old when she died.  Any college student with interest in child and family psychology could understand how Norma Jean Baker came to be found dead in August 1962 from probable suicide.  She was set up for the fall through rejections and abuses during her early years, followed by rejections and abuses during her years of fame. 

The Norma Jean Baker well depicted in the My Week With Marilyn was frail, vulnerable and misunderstood by all but a "lackey."  There is also an homage to Marilyn Monroe in The Help (Taylor, 2011). In this film it was also "the help"   that understood and protected her.  In both films she was married to a man she loved, but feared would not love her if he knew her truths. In both films she was pregnant but unable to be a viable mother. In both films she turned to working class people for support; her acting coach, production assistant, body guard, maid.  The outcome in The Help homage to Marilyn Monroe would have been so much more a better fate than the one actual befalling the real woman. Accuracy in historical biographies often takes a backseat to narrative, but these threads of Marilyn's reality stream through all her biographical leads.

Marilyn Monroe, though often reflected as dependent and frail, lived a dichotomous life. She supported and identified with working class and poor people. She was allied to significant forces in the left political and art movement; Arthur Miller, the Actors Studio as cases in point.  She openly supported   banning nuclear bombs, racial equality, human and civil rights. Her personal sexuality was in the feminist vein.  Further, she abhorred the HUAAC, just as openly as she embraced her causes. As a star, her job was to be a sexual commodity, yet as factory worker her photos are thought to have been a part Rosie the Riveters' evolution.  In her personal life, her fertility was at odds with her sexuality and her love relationships tenuous.  This woman's life was a perpetual double bind of competing interest.

Bioethical Conflict is considered irresolvable. If resolvable, it likely was not a real conflict.  Norma Jean Baker was caught in a real ethical conflict. Like many famous people, she died without resolution: Wealth and Fame, allowed her to do good. Fleeing Wealth and Fame would doom her to the poverty of self and finances from which she came.  My Week With Marilyn  is a road map to and for the fallen star.

My Week With Marilyn. (35 mm) directed by Simon Curtis. USA. The Weinstein Company. 2011. (101 min)

The Help (35 mm) directed by Tate Taylor. USA. Touchstone Pictures. 2011. (146 min)

The Prince and the Showgirl (35 mm) directed by Lawrence Olivier.  USA.
Warner Bros. 1957 (115 min)

EXTREMELY LOUD AND INCREDIBLY CLOSE: More on Bioethics & Peace Genre

Extremely Loud and Incredibly Close helps to further clarify the Peace Genre Film. It shows that Peace Genre Films contain all the elements of tragedy, violence, self hate, and despair without surrendering to them. In 2010, I began this blog with the identification of the Peace Genre Film.   La Mission (Bratt, 2010) was the prototype. Among core components of this genre are corralling passionate spirit and channeling it toward Peace.  Peace Genre Films are not about one section of humanity but about all of humanity. Humanity is reflected by the cross racial, ethnic and cultural people in the film.

Author Jonathan Safran Foer's book is adapted for screen by writer Eric Roth and Director Stephen Dawdry.  Instead of beckoning viewers to embrace decades, as in Roth's earlier Forest Gump and Benjamin Button, this story deals only with a paltry two years.  These are the two years after a child’s father and hundreds of others die simultaneous violent deaths. It is a story of a child's perception, complicated grief, guilt and redemption. Without the epic time span, but adorned with exquisite cinematography, Incredibly Loud and Extremely Close delivers the force of a magnum opus with simplicity.  A man (Tom Hanks), and his son Oskar ( Thomas Horn), believe in the lost mythical sixth borough of New York City. They are engaged in a scientific process they pretend will locate the borough when all hell breaks loose.

Mass deaths shake the collective consciousness to the core. How is it that the individual consciousness frequently does not measure the quake?  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. The arch rival of peace is Hate. Hate is manifest in war, terrorism and torture among other venues.   As a corollary, hate also is held by humanity as a whole. The magic of this film is the believable portrayal of Oskar  suspends disbelief, turning hate into peace; water into wine.

Oskar is shown to have characteristics of extreme sensitivity, untamable intellect, obsessive physical stamina and unique adaptive mechanism to stress. These characteristics are reminiscent of the wonders of Autism Spectrum children or is it the human spectrum? There are a number of reasons to think that autism, in an alternate universe, is a superpower.  Post 911 period seems as much an alternate universe as any. Converting abnormal to supra-normal expands the humanity of the film beyond, race, class, ethnicity and disability.  In the past year, television has introduced Autism Spectrum youths in the Science Fiction series Alpha's and the prime time melodrama Parenthood. This inclusivity appears seamless in this film.
  
Oskar's unique skills allow him to fly under the radar of many who would otherwise be guarded with a strange inquisitor.  The adults around Oskar display a fragility. They include his widowed mother (Sandra Bullock), his mute grandfather ( Max Von Sydow) and a divorcing wife (Viola Davis). The device enabling Oskar’s final dialog with his dead father is in the hands of the estranged wife.   These adults both protect and allow Oskar  to process his grief and theirs.  The guardians' relationships to each other are eloquently foreshadowed by subtle consistency in lighting and delivery tone.  This happens in much the way a good clinical team provide the a consistent  message of support to those suffering from grief. 

This is a  film narrative of enormous depth, exquisite construction and profoundly linked ensemble.  While showing the origin of post traumatic stress syndrome in hate, Extremely Loud and Incredibly Close is a Peace Genre Film because it underscores not only what mass tragedy takes but what cannot be stolen from the human spirit.
Extremely Loud and Incredible Close. 35 mm. Directed by Stephen Dawdry. USA. Warner Bros. 2011. (129 min)

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

Read on this blog site read:
LA Mission:Prototype for the  Peace  Genre ( 2010 blog)
Bioethics/Film Literacy: Lighten Up slides on lighting,  slides .055 to .060 on shots size and actor position, to convey tone.

Also Read:
Foer, J S.  ( 2005) Extremely Loud and Incredibly Close. Houghton Mifflin.  Boston. pp 368