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 5th
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
