The Whale

I finally saw this movie as it hit my subscription networks. It is an interesting story from many perspectives that is expertly told and acted. It raises several perspectives relevant to psychiatry but thankfully that explicit connection was left out of the production.  As the final credits rolled – I noticed that it was adapted from a play.  This is the closest I would come to seeing a play.  I do not think that I am constitutionally able to watch plays. They all seem contrived, overacted, and at times require a level of immediate and shared imagination that I do not possess.  I prefer solid ground as a jumping off point – even if things go awry from there.

The stark reality of this film is the home of Charlie (played by Brendan Fraser).  We meet him as he is teaching an online course in creative writing and see a typical Zoom interface. Charlie is the only one without a visual display.  He explains that his camera is broken. The scene cuts to his home. It is a dismal setting.  We see that Charlie is massively obese, barely able to ambulate and then with great effort, and in very poor health. At one point his nurse and friend Liz (played by Hong Chau) enters and tells him that he has hypertension and congestive heart failure to the point he needs to be seen emergently or he will be dead in a few days.  His poor health is displayed many times as he starts laughing but that rapidly turns into a cough and then chest pain. Over the course of the story, we learn that Charlie was not always like this but after losing his lover Alan to suicide he began overeating and gained a massive amount of weight. We see him binge eating at several points in the film – in one case biting off a fourth of a large meatball and cheese sub sandwich and obstructing his own airway to the point that Liz had to jump on his back to dislodge the food. After chastising him she picks the remaining sandwich off the floor and hands it to him.

The food theme is prominent over the several days duration of the film. Charlie gets a pizza delivered every day and he leaves the money in the mailbox.  The delivery driver talks with him through the door and eventually they address each other by their first names. At the last delivery the driver asks Charlies repeatedly if he is OK and appears to walk away.  As Charlie opens the door, he notices the driver is off to his left looking at him and appearing mildly shocked. Neither of them speaks but Charlie goes back in the house obviously upset and binge eats the pizza along with several additional items he adds from his refrigerator.

Charlie’s self-destructive eating and the associated self-loathing is a prominent theme throughout along with the expression of disgust.  He actively seeks confirmation that he is disgusting on a physical basis but only gets it spontaneously from his daughter Ellie (played by Sadie Sink).  Ellie is an angry teenager, performing suboptimally in school and she directs much anger at Charlie for abandoning her at 8 years of age when he left for the relationship with Alan.   Charlie actively seeks a relationship with her and at one point promises her a large sum of money just to spend more time with him, even though the time he has left is measured in days. He repeatedly apologized for his “bad decisions” in the past and emphasizes that he wants to try to make things right.  He would go as far as helping her write essays that might allow her to pass to the next grade in high school.

Two other characters are introduced over the course of the film.  Thomas (played by Ty Simpkins) shows up at Charlie’s door one day as a Christian missionary. He presents himself as a person intent on saving Charlie through God and Christianity.  He comes into dialogues with both Liz and Ellie.  Liz pointedly tells him to stay away from Charlie - that there are people who do not need to be saved.  She also points out the significant flaws in the local church that Thomas is affiliated with. Her father is the pastor of that church and Alan was her brother. Her father tried to arrange a marriage for Alan and described his suicide as a tragic accident. In his conversation with Ellie, Thomas discloses enough details of his life and why he might be estranged from his parents that Ellie is able to track them down. That eventually leads to reconciliation.

Charlie’s ex-wife Mary (played by Samantha Morton) appears toward the end of the film. There is a detailed discussion of the mistakes that were made and Mary’s chance meeting of Alan in a WalMart parking lot.  Even though there is a lot of tension, there is still an obvious level of caring between Charlie and Mary. Mary discusses Charlie’s unflagging optimism as one of his attributes that she misses. At some point it becomes obvious that the large sum of money that Charlie intends to give to Ellie may have come at a cost to his own health.  He has no health insurance and Liz points out what additional services he could have received.  Charlie refuses medical care and emergency services based on the cost, although that refusal is also consistent with his self-destructive path. He hears Liz describe the stress that he is putting her through but is unfazed.

Throughout the film, an essay about Moby Dick is referred to. The basic message of the essay is that the author can deny aspects of his own life and introspection about it – by focusing on killing whales. We eventually learn that this essay was written by Ellie when she was in the 5^th grade.  Charlie asks people to read him the essay when he is in a medical crisis with chest pain, shortness of breath, and diaphoresis.  He finds it comforting.  He also retypes the essay and gives it to her for school and she becomes enraged when she finds out. Charlie emphasizes that he only meant to show her that he appreciated her intelligence and creativity.

At a psychological level, Charlie is dependent and self-effacing. His motivation appears to be trying to correct past mistakes, especially abandoning Ellie, even though that was a complicated process that he was only partially responsible for. His reaction in these problematic scenarios is to accept the blame and go far beyond that to see himself as a disgusting person and ultimately a physically disgusting person (his characterization) that he produced by excessive eating.   

Several reviewers commented on the empathy in the film, but I really did not see any. Nobody seems interested in what happened to Charlie and how he got into this predicament – only that he is in it. They are attached to Charlie for various reasons but also out of their own self-interest.  As in real life, a lot of emotion happens in those settings as people are frustrated with Charlie when he does not accept their advice.

A relevant psychiatric dimension is the issue of involuntary treatment. In these last days of his life we see that Charlie has very high blood pressure, congestive heart failure, and possible angina that necessitate emergency care. Liz confirms that she has discussed his situation with an emergency medicine physician who concurs with her opinion.  Charlie even Googles his numerical blood pressure to confirm that it is an emergency. And through the film, he says he will not be treated and Liz agrees that she will not force the issue. But suppose that she wanted to.  What might happen in this situation?  Charlie could be transported to the ED, treated, and agree with admission for stabilization. He has no apparent psychiatric diagnosis, but it does not take too much imagination to see how any extended dialogue would get into the area of self-care and self-destruction to the point that the attending physician would consider an emergency hold. It is not uncommon to see people who have secluded themselves and not taken care of themselves admitted to inpatient psychiatric units with as many medical problems as Charlie. Suicide by food or lack of self-care is less dramatic than other methods but it can produce the same result.

Would Charlie be seen as depressed?  Probably – but is that the real problem? Moral injury seems to be a more proximate cause superimposed on a man who accepts all of the bad things happening in his life as his fault and reacts according. It allows him a veneer of optimism, while never having to confront the realty that human relationships are more complicated than that.  

Psychiatric speculation aside, this is a complex film that you must see.  The writing and acting is excellent.  The interpersonal drama has unique dynamics and is first rate.  I hope to see all these actors in other projects. It is a well thought out story line – right down to Charlie’s Zoom exit from his creative writing class. And importantly there is a clear message that there are all kinds of people out there struggling through life as best as they can every day. Those struggles may prove resistant to the insights and best advice from others.   

 

George Dawson, MD, DFAPA