Half a day at the movies: film studies in the VTS course

INTRODUCTION

For the last 3 years in our GP Vocational Training sessions we have been showing a full-length film once a term. We were already including the arts in the curriculum in the form of visits to galleries and theatres and discussions of literary novels. The hope is that this kind of educational experience will promote a greater empathy with patients as well as broadening the general education of the GP registrars and SHOs.

Film has been widely used in the form of short extracts to trigger a discussion about particular practice situations (for example, a dying patient, unwanted pregnancy, family dysfunction and breaking bad news).¹ Students have been found to respond very readily to scenes, mainly from mainstream films that resonate with problems that they have encountered in the hospital or GP setting. But we wanted to do something rather different.

To begin with we wanted to show classic films which were good enough to be widely acclaimed as works of art. That is, films which could take their place alongside classic works of literature, drama, music and painting. For the same reason we also wanted to show each film from beginning to end. You can analyse a work of art and examine individual details but you have to experience it as a whole to begin with. We wanted to show our trainee GPs the best that the cinema had produced over 100 years of existence. That meant good scripts, good acting, beautiful evocative photography and skilful direction. Films with as near as possible a single presiding auteur, generally the director, tended to be preferred. If the whole production was touched by genius, so much the better. We wanted the films to be entertaining, indeed entrancing. Seduction is an important part of what cinema is about. But we felt that as our course has a serious purpose (training GPs, we reminded ourselves) the films should also have a serious underlying theme or intention which might in some way help those who saw them to reflect on the human situation and become more helpful empathetic doctors for their patients. So films that we felt to be pure entertainment, however blissful, were firmly, if regretfully, ruled out.

What sort of films satisfied our criteria? As you might expect, they were mostly in black and white and made between 1935 and 1960. Oh yes, and in foreign languages with English subtitles. What did we hope to achieve? Let me summarise our objectives.

Our objectives:

• To give the registrars an artistic experience that they would otherwise have missed. To show them something that they might want to see again and which might stay with them for life;

• To help them see that the characters so brilliantly brought to life on the screen were not very different from the patients they engage with in the surgery. As a result they might be able to view some difficult patients with greater tolerance, sympathy and respect. They might be enabled to stand back a little from the symptoms and signs and see their patients as fellow human beings trying to make sense of their lives and their emotions. The films do not show medical scenes and are not really about doctors, although in one of them (Wild Strawberries) the central character happens to be a doctor;

• To share our own pleasure in these great films with our group.

We were not attempting:

• To provide talking points to illustrate clinical problems;

• To make people better doctors or better human beings;

• To teach communication skills;

• To improve the doctors' ability to handle ethical problems.

METHOD

We showed one complete film each term. The films were selected by the course organisers (with one exception). They were projected from video or DVD onto a large screen to provide total immersion in the cinema dream world. So far we have shown a different film each time, although in the course of 3 years there has been a turnover of registrars and SHOs. This has given the course organisers the chance to sample the impact of a variety of different films. After tea, we had an unstructured spontaneous discussion of the film.

Films shown so far:

1. Wild Strawberries, directed by Ingmar Bergmann, Sweden (1958)

2. La Grande Illusion, directed by Jean Renoir. France (1940)

3. Citizen Kane, directed by Orson Welles US (1941)

4. Il Postino, directed by Michael Radford Italy (1994)

5. Les Enfants du Paradis, directed by Marcel Carné, France (1945)

6. Pather Panchali, directed by Satyajit Ray, India (1956).

A BRIEF DESCRIPTION OF EACH FILM

Wild Strawberries (1958)

In this early Ingmar Bergman classic, an elderly microbiologist (wonderfully played by the veteran Swedish director Victor Sjöstrom) travels to his old university to be given a special award. He is a crusty old fellow who lives with his loyal and adoring housekeeper. Despite his emotional coldness, the doctor is troubled by his distant relationship with his son and the shaky state of the son's marriage. He also has chilling premonitions of his own death, which Bergman represents in some very arresting surreal scenes. Dr Borg decides to travel in his old car (a magnificent 1937 Packard) and his daughter-in-law offers to accompany him. In the course of the long drive the old doctor reviews his life: this is an early example of a ‘road movie’ with an inner as well as an outer journey. They revisit a number of scenes from earlier stages in his life, including the summerhouse by the lake where he had family holidays and fell in love with his cousin, only to lose her to a bolder more sensual rival. We see flashbacks of these happy and painful scenes of his youth. The old man and his daughter-in-law begin to understand each other better. They give a lift to three students, a vivacious young girl (Bibi Andersson, who also plays the lost sweetheart in the flashbacks) and her two rival boyfriends. The old doctor enjoys the company of these young people who treat him with affection and respect. Back on the road, they pick up another couple whose marriage is clearly a disaster. Their cruel sarcastic behaviour shocks the others (and reminds Borg of his own failed marriage).

They visit Borg's elderly unsentimental mother. The car is refuelled by an appreciative ex-patient who remembers when Dr Borg was a young country GP. Finally they arrive at Lund where Borg receives his degree to the delight of his young friends. Discussions take place with his son and daughter-in-law that encourage some hope that their marriage might be saved.

In a final dream sequence we see the old man back at the summerhouse, greeting his parents who wave to him from the distance. The last scene shows him dying peacefully having reached the end of his life's journey.

La Grande Illusion (1939)

Here is a film about the experience of some French officers in a German POW camp during the first Word War. They include an upper class pilot, a lieutenant of working-class origin (Jean Gabin) a Jewish officer from a rich banking family and a music hall actor. We seem them digging an escape tunnel and putting on a vaudeville show. Their dinner table is greatly improved by gourmet food parcels sent by the Jewish officer's family. Then they are moved to another more secure prison in a Colditz-like castle where the commandant is an aristocratic Prussian, brilliantly played by Erich von Stroheim, with his neck enclosed in a surgical brace that comically symbolises his mental rigidity. He likes and respects Boieldieu, the pilot, who, despite being technically an enemy, is a member of his own class. The others he regards with lofty contempt.

The film is of course well scripted and beautifully shot. Although its underlying mood is serious, many of the scenes are very funny and some are quite stirring. All the characters arouse our sympathy, even the stiff German officer because of his courtesy and his mourning for a vanished age when war was conducted by gentlemen. Renoir shows how complicated human loyalties and affinities can be. The upper class officers have a closeness that transcends nationality and war; the Frenchmen are all comrades but their positive feelings for each other are disturbed by differences of social class, race, religion, wealth and temperament.

Citizen Kane (1941)

This is a very famous film which frequently tops the lists of the best movies of all time. The director (Orson Welles at the brilliant beginning of a flawed career) also plays the central role of the millionaire newspaper editor, Charles Foster Kane. The film is structured as an enquiry into the life of the recently dead celebrity to try and find out what drove him and what sort of man he really was. There is a mock newsreel which reviews the external facts: separated from his parents as a child, inheriting a fortune, buying a newspaper and converting it into a sensational scandal sheet, running for president, being caught out in a love affair, retreating to a grandiose castle with his mistress, amassing a fantastic art collection and finally dying alone in the midst of all his wealth. A journalist interviews various key figures in Kane's life in order to find out more, and further scenes of his life both private and public are revealed in flashback. There is an apparent psychological explanation of Kane's character but Welles later dismissed this as ‘dollar book Freud’. Kane remains an enigma and we are left to draw our own conclusions. Welles' performance is outstanding and the film introduced many cinematic innovations especially in the use of camera fluidity, deep focus and montage. Even if you don't rate it as the best film of all time it is an overwhelming experience and an essential part of anyone's cinema education.

Il Postino (1994)

This film is an odd one out that, left to ourselves, we would never have included. However, one of the registrars pleaded its cause very strongly and in the end we agreed to show it and didn't regret the decision. The film tells the story of a shy young postman living on an idyllic but backward Italian Island, in the 1950s, who falls in love with the prettiest girl in the village. He finds himself delivering letters to a literary celebrity, the Chilean poet Pablo Neruda who has had to go into exile for his political views. The poet (beautifully played by the great French character actor Phillipe Noiret), begins to take an interest in the young man and teaches him about poetry. As a result he is able to woo his sweetheart with poetry and they get married. The postman poet is played with wistful longing by Massimo Troisi who sadly died soon after the picture was finished. The haunting music by Luise Enrique Bacalov won an Oscar.

Les Enfants du Paradis (1945)

In the latter years of the second world war and in the teeth of the Vichy regime in France, the director Marcel Carné and his script writer Jacques Prévert recreated the ‘Street of Crime’ and it's music hall theatre ‘Les Funambules’ from the Paris of the 1830s. In this dream world we are mesmerised by the relationships between a brilliant but tormented mime artist, a mysterious slightly older woman with whom he is in love, a pretty soubrette carrying a torch for the mime artist, an ambitious young actor who longs to play Shakespeare, and a cynical gangster who also writes plays. The cast includes the celebrated actress and model Arletty and Jean-Louis Barrault whose mime performances are unforgettable.

Pather Panchali (1955)

The film follows the fortunes of a little family in living in rural Bengal. The father is a benign but unworldly scholar who is often absent in what seem to be hopeless attempts to make a little money. The mother tries desperately to make end meet. The little boy (Apu) and his elder sister are full of curiosity about the village and the world beyond. An extremely aged Auntie completes the household. The film is full of poetry and has images of striking beauty. There is humour and also heartbreak before the end in which we see them setting off for a new life in the city.

WHAT DO THESE FILMS HAVE TO SAY TO US?

Do the films have particular messages that may be helpful in coping with real life human (doctor–patient) relationships?

Some examples:

• We need to examine our lives while there is still time to change. If we try and overprotect ourselves from painful feelings we may end up feeling cold and alone. (Wild Strawberries.)

• We all share the human predicament. Life would be better if we could be friendly and have respect for each other's feelings. But there are so many prejudices which get in the way. They make us feel hostile and we limit our compassion to people of our own subgroup, whether it is nationality, rank, race or religion. If we can't escape from this prison, the ‘war’ will never end. (La Grande Illusion.)

• The urge for power and control over other people may be overwhelming. But great power may lead to frustration and loneliness rather than emotional fulfilment.

• Looking at someone's life from different angles and exploring his background can enhance our understanding; but ultimately who exactly we are remains rather mysterious. (Citizen Kane.)

• Poetry is open to everyone. A shy young person can learn to express his feelings through the power of words. Finding an understanding father figure may be just as important. (Il Postino.)

• Why is love so difficult? Why does the person I love most in all the world have eyes only for someone else? There is something of the theatre about all human interactions. We are all trying to perform for an audience of one.’ (Les Enfants du Paradis.)

• Seen through a child's eyes the world is a magical place. But why are grown ups so troubled? For the mother, it is difficult to be kind and considerate when she feels totally responsible for the family and everyone else seems so self-centred and unaware of her needs. (Pather Panchali.)

THE NEXT STAGE

Our general impression is that the films have been well received, once the group members got over the shock of looking monochrome images and having to read subtitles. Each was followed by a lively unstructured discussion, mainly centred on the characters and their relationships. The first part of Les Enfants du Paradis was so compelling that the group insisted on seeing the second half the following term. At our latest end-of-term evaluation session there was a unanimous vote for the film sessions to continue.

So far we have not made any detailed notes of the discussion or attempted to evaluate the audience's responses to the films.

In the next year we intend to show one of the films each term and record the discussion. We will then follow this up with some interviews, with the aim of getting qualitative accounts of how the films were received and what thoughts and feelings they generated. We hope to present the results of this research in a year's time.