Exploring Disease Representation in Movies Antonio Perciaccante, MD1, Philippe Charlier, MD2,3, Alessia Coralli, BSN4, Saudamini Deo, PhD2,OttoAppenzeller,MD5,6, and Raffaella Bianucci, PhD7,8,9

1Department of Medicine, San Giovanni di Dio Hospital, Gorizia, Italy; 2Section of Medical Anthropology (UVSQ, DANTE Laboratory EA 4498), UFR of Health Sciences, Montigny-Le-Bretonneux, France; 3Museum of Quai Branly – Jacques Chirac, , France; 4AAS 2 Bassa Friulana – Isontina, Distretto Alto Isontino, Cormons, Italy; 5New Health Enhancement and Marathon Clinics Research Foundation, Albuquerque, NM, USA; 6New Mexico Museum of Natural History and Science, Albuquerque, NM, USA; 7Legal Medicine Section, Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy; 8Warwick Medical School, Microbiology and Infection Division, University of Warwick, Warwick, UK; 9UMR 7268, Laboratoire d’Anthropologie bio-culturelle, Droit, Etique & Santé (Adés), Faculté de Médecine de Marseille, Marseille, France.

J Gen Intern Med 34(11):2351–4 Frequently reported illnesses are neurological diseases, DOI: 10.1007/s11606-019-05254-6 which affect considerably the quality of life of the patients © Society of General Internal Medicine 2019 and their relatives. There have been references to ischemic stroke, senile dementia, cerebral hemorrhage, epidemic en- cephalitis, cerebral palsy, post-traumatic paraparesis, and he , also known as Oscars, are given amyotrophic lateral sclerosis as reported in biopics on Lou Academy of Motion Picture Arts and Sci- T annually by the Gehrig and . ences . To celebrate the 90 years of this prestigious prize, and to References to infectious diseases (scarlet, yellow, typhoid highlight the relationship between and medicine, fevers, bubonic plague, measles, pneumonia) occur mostly in we analyzed the report of 554 films, which received nominations of the 1930s and , when they were the most “ ” 1 to Oscar for Best Picture since the first edition in 1929. common causes of mortality. Moreover, five films set at the To perform an accurate analysis, three authors independently beginning of the twentieth century refer to tuberculosis, ’ evaluated the movies plots to searching references to illnesses whereas HIV infection is reported mostly in movies set in or other aspects related to the medicine. The cases of disagree- the , when the disease was at its peak and highly ment have been discussed with a group of further three authors. stigmatized. War wounds excluded, we found that among the nominated Surprisingly, two of the most widespread diseases of twen- films, medicine references are reported in the plot of 105 tieth and twenty-first centuries are under-represented: we (18.9%) (Table 1). Medicine references are present in twenty found nine references to oncological diseases, and only three (21.9%) of ninety-one awarded films. The distribution of films references to heart diseases (respectively only 8.5% and 2.8% referring to medicine is reported in Figure 1. of the films referring to medicine). Our analysis shows that the most represented diseases are the We further report references to mutism and deaf-mutism, psychiatric (21.9%) ones followed by neurological ones (13.3%), amnesia, insomnia, hemophilia, carbon monoxide poisoning, alcohol addiction (13.3%), and infectious diseases (13.3%). and two rare diseases such as the Proteus syndrome and the Psychiatric diseases continue to have significant emotional picnodysostosis, in “The Elephant Man” and in “Moulin and social impact but the methods of their treatments have Rouge,” respectively. Only few references can be found to always been a topic of ethical debate. It is interesting to note metabolic diseases such as gout and diabetes mellitus. the references to passive-aggressive behavior, anxiety, deliri- From the onwards, some movies deal with important um, and the use of questionably ethical treatment such as themes, such as euthanasia, clandestine abortion, medical “ electro-shock therapy and lobotomy in One Flew Over the malpractices, and relationship between environmental pollu- ’ ” Cuckoo s Nest. tion and cancer. Interesting are also the depictions of psychiatric diseases, Lastly, we wish to underline the plots of some films dealing such as schizophrenia, depression, post-traumatic stress, with medicine and ethics in medicine; the biopic “The Story of obsessive-compulsive, and bipolar disorders. Significant men- Louis Pasteur” describes Pasteur’s discoveries; “The Citadel,” tal disabilities were brought to public attention by the movie a film, in which the protagonist, a Scottish doctor, initially “ ” , in which the protagonist suffered from Savant dedicated to cure miners affected by tuberculosis changes his syndrome. mind after a meeting with a colleague and decides to solely A strong medical and social impact have also alcohol and serve the rich hypochondriacs. drug addictions; the last are prevalent in films from the Our analysis confirms that medicine and disease are an onwards. intrinsic part of humanity and, hence, serve as quasi-infinite Published online August 13, 2019 source of inspiration for film-makers of past and present alike.

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Table 1 Films with Medical References Received Nomination for “Oscar for Best Picture”

Year of Winner Title Director Cast Medical references nomination 1930 Not The Patriot Paranoid personality 1932 Not Arrowsmith Bubonic plague 1934 Not Little Women George Cuckor Scarlet fever 1935 Not The Barretts of Wimpole Sidney Franklin Undisclosed illness street 1936 Not Captain Blood Gout 1937 Not The Story of Luis Pasteur Asepsis, vaccinations 1938 Yes The Life of Emile Zola William Dieterle Paul Muni Carbon monoxide poisoning 1939 Not The Citadel Robert Donation Medical ethics 1939 Not Jezebel Yellow fever Hanry Fonda 1940 Yes Gone with the Wind Measles Pneumonia Typhoid fever 1940 Not Dark Victory Bette Davis Brain tumor 1942 Not William Wyler Bette Davis Heart attack Herbert Marshall 1943 Not The Pride of the Yankees Sam Wood Amyotrophic lateral sclerosis 1943 Not Random Harvest Mervyn LeRoy Ronald Colman Post-traumatic amnesia 1943 Not The Magnificent Ambersons Tuberculosis 1943 Not Kings Row Sam Wood Ethics and medicine Unnecessary legs amputation 1944 Not The Song of Bernadette Tuberculosis 1946 Yes The Lost Weekend Bill Wilder Alcoholism Depression 1946 Not Spellbound Amnesias 1946 Not Michael Curtiz Pneumonia 1946 Not The Bells of St. Mary’s Leo McCarey Tuberculosis Ingrid Bergman 1947 Not The Razor’s Edge Edmund Goulding Alcohol addiction 1947 Not The Yearling Clarence Brown Gregory Peck Unspecified neonatal deaths 1948 Not Johnny Belinda Jean Negulesco Jane Wyman Deaf-mutism 1949 Not The Snake Pit Anatole Litvak Schizophrenia 1952 Not A Streetcar Named Desire Vivien Leigh Alcohol addiction 1953 Yes The Greatest Show on Earth Cecil B. DeMille Post-injury harm paralysis Cornel Wilde 1953 Not Josè Ferrer Picnodysostosis 1955 Not The Country Girl Alcohol addiction Bing Crosby 1955 Not The Caine Mutiny Panic attacks Josè Ferrer Paranoid personality 1958 Not Peyton Place Marco Robson Alcohol addiction 1959 Not Taylor Alcoholism Cancer 1961 Not Sons and Lovers Oedipus complex Pneumonia Cancer 1961 Not Elmer Granty Richard Brooks Alcoholism 1966 Not Ship of Vivien Leigh Opioid addiction 1966 Not Lean Myocardial infarction 1967 Not Who’s Afraid of Virginia Alcohol addiction Woolf? 1970 Not Z Costa Gravas Post-traumatic cerebral hemorrhage 1971 Not Love story Ali MacGraw Leukemia 1972 Not Franklin J Schaffner Michael Jayston Hemophilia Janet Suzman 1974 Not Uterine cancer 1975 Not The Conversation Obsessive-compulsive disorder 1975 Not Lenny Alcohol and drug addiction 1976 Not Dog Day Afternoon Diabetes mellitus 1976 Yes One Flew Over the Cuckoo’s Miloš Forman Passive-aggressive behavior Nest Anxiety Delirium

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Table 1. (continued)

Year of Winner Title Director Cast Medical references nomination

Epilepsy 1977 Not Taxi Driver Chronic insomnia 1978 Yes Hall Woody Allen Necroses 1979 Yes The Deer Hunter Micheal Cimino Robert De Niro Post-traumatic stress disorder 1980 Not All That Jazz Bob Coronary artery disease 1981 Yes Ordinary People Post-traumatic stress disorder Timothy Hutton 1981 Not The Elephant Man Protheus syndrome 1982 Not On Golden Pond Mark Rydell Katharine Hepburn Amnesias 1983 Not Sidney Lumet Paul Newman Medical malpractice 1983 Not Pollack Dustin Hoffman Depression Jessica Lange 1984 Yes James L. Brooks Shirley MacLaine Cancer 1984 Not Bruce Beresford Alcohol addiction 1985 Yes Amadeus Milos Forman Tom Hulce Depression F. Murray Abraham Alcohol addiction 1986 Yes Out of Africa Syphilis Robert Redford 1987 Not Children of a Lesser God Deaf-mutism 1989 Yes Rain Man Dustin Hoffman Savant syndrome 1990 Yes Bruce Beresford Jessica Tendy Senile dementia 1990 Not Born on the Fourth of July Tom Cruise Post-traumatic paraparesis Alcohol addiction 1990 Not My Left Foot Daniel Day Lewis Cerebral palsy 1991 Not Awakenings Penny Marshall Robert De Niro Letargia due to epidemic encephalitis 1992 Not The Prince of Tides Chronic depression Barbra Streisand Dissociative state 1994 Not Jean Campion Mutism 1995 Yes Forrest Gump Curve spine Marginal intelligence 1995 Not Four Weddings and a Funeral Deaf-mutism 1997 Yes Anthony Mingella Euthanasia 1997 Not Shine Manic syndrome Schizophrenia 1998 Not James L. Brooks Jack Nicholson Obsessive-compulsive disorder 2000 Not M. Night Shyamalan Munchausen syndrome 2000 Not The Green Mile Tom Hanks Bladder infection Brain tumor 2000 Not The Cider House Rules Lasse Hallström Tobey Maguire Clandestine abortion 2001 Not Chocolat Lasse Hallström Juliette Binoche Diabetes mellitus 2001 Not Erin Brockovich Environmental pollution and risk of cancer 2002 Yes A Beautiful Mind Schizophrenia 2002 Not Moulin Rouge! Tuberculosis 2003 Not The Mours Nicole Kidman Bipolar disorder Uterine fibroma 2005 Yes Clint Eastwood Post-traumatic paralysis Euthanasia 2005 Not Finding Neverland Marc Forster Johnny Depp Tuberculosis/lung cancer 2005 Not The Aviator Martin Scorsese Leonardo Di Caprio Obsessive-compulsive disorder 2005 Not Ray Taylor Hackford Blindness Opioid addiction 2007 Not Babel Alejandro González Deaf-mutism Iñárritu Cate Blanchet Koji Yakusho 2007 Not Little Miss Sunshine Jonathan Dayton Opioid addiction Valerie Faris 2010 Not Precious Obesity

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Table 1. (continued)

Year of Winner Title Director Cast Medical references nomination

HIV Down syndrome 2011 Yes The King’s Speech Stutter Geoffrey Rush 2011 Not Black Swan Self-harm Vincent Cassel 2011 Not The Fighter David O. Russell Drug addiction 2011 Not Winter’s Bone Depression 2012 Not Coma 2013 Not Silver Lining Playbook David O. Russell Bipolar disorder 2013 Not Beasts of the Southern Wild Quvenzhané Wallis Undefined heart disease Dwight Henry 2013 Not Amour Jean Louis Stroke Trintignant Carotid artery stenosis 2014 Not Jean Marc Vallée Matthew HIV McConaughey AIDS 2014 Not The Theory of Everything James Marsh Eddie Redmaine Amyotrophic lateral sclerosis 2014 Not The Wolf of Wall Street Martin Scorsese Leonardo Di Caprio Drug addiction 2014 Not Philomena AIDS 2014 Not Alexander Payne Alcohol addiction 2017 Yes Moonlight Trevante Rhodes Opioid addiction Janelle Monàe 2017 Not Manchester by the Sea Alcohol addiction Michelle Williams 2018 Yes Mutism 2018 Not Three Billboards Outside Martin McDonagh Frances McDormand Pancreatic cancer Ebbing, 2018 Not Phantom Thread Daniel Day Lewis Mushroom poisoning Vicky Krieps 2019 Not A Star is Born Bradley Cooper Bradley Cooper Tinnitus

Corresponding Author: Antonio Perciaccante, MD; Department of Medicine, San Giovanni di Dio Hospital, Gorizia, Italy (e-mail: [email protected]).

Compliance with Ethical Standards:

Conflict of Interest: The authors declare that they do not have a conflict of interest.

REFERENCES 1. Academy Awards. Official website http://awardsdatabase.oscars.org/ search/results. Accessed March 01, 2019.

Figure 1 Percentage of films with reference to medicine during the Publisher’sNote Springer Nature remains neutral with regard to different decades. The figure shows the percentage of films referring jurisdictional claims in published maps and institutional affiliations. to medicine, calculated as: (number films with medicine references number films which received nomination to “Oscar for Best Picture”) × 100.