What films reveal about the moment of diagnosis

Annemarie Jutel is a Professor of Health in Victoria University of Wellington’s Graduate School of Nursing, Midwifery and Health and her husband Thierry is an Associate Professor of Film Studies in Victoria’s School of English, Film, Theatre and Media Studies.

Receiving a serious diagnosis is a dramatic moment, when life becomes indelibly divided into “before” and “after”. Simply receiving the name of a disease can upset life and expectations, and call into question previously taken-for-granted notions of identity and of status. It can be a moment of devastating recalibration.

Yet, at the same time, diagnosis is an important tool for medicine. It explains ailments, suggests treatment avenues, and predicts outcomes and possibilities for the patient. Diagnosis makes sense of a picture of disarray, pulling symptoms together to create a cohesive picture that makes sense in the context of a diagnostic plot, and identifying the players and their roles. It may change a person’s identity, or transform the person into a patient, a battler or even a survivor.

Diagnosis also operates as short hand, sketching in a word or short phrase, a complex and evocative picture. To say that someone has Alzheimer’s disease, for example, is to produce a kind of word art cluttered with neurofibrillary tangles, word omissions, functional disarray, filial burden, social isolation and genetic predetermination. It also retroactively organises a series of unconnected occurrences, feelings and experiences and lays out the terms of future events.

The power of the diagnostic moment to transform a person into a patient, a disorder into a disease and life into a battle explains the important place occupied by diagnosis in popular culture. Diagnosis is the topic and the narrative tool of fiction, mémoire and poetry, TV series, greeting cards and films. It is a moment of rare emotional and personal intensity and therefore a potent source of drama in narratives, including in television and cinema.

The use of a diagnosis to frame a narrative, develop or transform a character, or provide a turning point is a common device. By analysing its representation in film we emphasise the cultural significance of diagnosis as a life-transforming event.

Diagnostic revelations function in recognisable ways in western narrative cinema. They constitute a kind of turning point in the lives of characters, and in this capacity are ready-made plot elements around which the narrative can be launched or altered, the characters revealed to themselves and to viewers. The disclosure of a diagnosis is an intense moment where the tools of visual storytelling can be mobilised.

Everything in the reaction of the characters will take on meaning in the aftershock of the diagnosis. At the same time, however, the viewers contemplate how they process the information themselves.

In Still Alice, a 2015 film about a 50-year-old professor of linguistics who faces cognitive difficulties, a diagnosis is revealed to the viewer several times (once to Alice, once to Alice and her husband, and finally to the wider family, when Alice and her husband tell their children). The diagnosis functions in this film as a means of underscoring acceptance and sacrifice. The diagnosis of a familial type of Alzheimer’s disease, which one of Alice’s daughters will also be found to carry, reorganises relations within the family, as Alice loses all self-agency, but at the same time demonstrates strength and resilience in a strongly gendered melodramatic tradition.

Breaking Bad offers a contrasting example of the use of diagnosis to construct a visual narrative. In this Emmy award-winning television series, diagnosis provides a way to enable oppressed husband and failed scientist Walter White to discard social norms under the pretext of urgency and existential duty. The first scene features the doctor delivering the diagnosis of lung cancer with little hope for cure. High-school chemistry teacher Walter will recruit an errant student to help him manufacture methamphetamine to finance his treatment and secure his family’s future once he dies. He will break the law, become a drug lord, kill people, and assume a completely different set of values and behaviours while keeping the pretence of being the same person but afflicted by an incurable disease.

Diagnosis and prognosis in Breaking Bad are not sentences but liberation: the television series plays with our desire to see characters change, learn and overcome. “Growth, then decay, then transformation,” Walter pronounces in a lesson: the premise of the show is to cast his white, middle-aged and frustrated character into a set of circumstances in which his response to illness is to transgress social norms, paradoxically in the name of family.

The moment a diagnosis is revealed is profoundly social, providing it with powerful potential for narrative purposes. The richness of diagnostic scenes is in the many higher-level stories they can tell about the diagnosis. Is diagnosis seen as a moment of “truth” and of destiny? Or is it a moment of possibility? Where is power located in the doctor-patient interaction, and whose interests prevail? The revelation of a serious diagnosis is a moment at which other truths (unrelated to disease) are unveiled.

Annemarie and Thierry Jutel have recently published a paper about the diagnostic moment in film in BMJ Medical Humanities.

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