Clinical empathy plays a role in medical care, particularly in the psychiatric field where it is intuitive that the relationship between the patient and the doctor has a therapeutic meaning, too. Empathy is not easy to teach as it’s an innate personal skill (1). Screen fiction, movies and films can be helpful to reflect on this complex topic, as “it is through emotion, whose power is to disturb the equilibrium of psyche that screened fiction stirs people’s psyche […] the emotions aroused by cinema refer to a virtual world and therefore have the potential to increase the individuals’ self-awareness while making them feel relatively “safe”.
[Gramaglia, C., Jona, A., Imperatori, F. et al. Cinema in the training of psychiatry residents: focus on helping relationships. BMC Med Educ 13, 90 (2013). https://doi.org/10.1186/1472-6920-13-90%5D
For this reason we suggest a list of movies that allow a reflection on survivors’ feelings and emotions and the different ways in which everyone faces mourning. We will follow the model suggested by the psychiatrist Kübler-Ross, who has proposed 5 phases for the mourning process: denial, anger, depression, bargaining, acceptance.
Today we will focus on denial. What’s next? Stay in touch for the next phases, which we will publish in the next weeks.
1. DENIAL
Avoidance, confusion, elation, shock, fear
13 reasons why (2017) – this series, based on the book by Jay Asher, describes a group of survivors: each received a tape recorded by Hannah, the suicide victim, created to explain how all of them contributed to her suicidal act. None of these survivors expected to have a role in Hannah’s decision to end her own life, so when they receive the records, they go through confusion, shock, fear, and avoidance. According to the Kübler-Ross model, this series allows us to think about the denial phase. This TV show was controversial, especially for the decision to show the explicit suicide scene in a bathtub with Hannah cutting her own veins; for this reason, Netflix deleted it by releasing this public statement: «Our creative intent in portraying the ugly, painful reality of suicide in such graphic detail in Season 1 was, to tell the truth about the horror of such an act, and make sure no one would ever wish to emulate it. But as we ready to launch Season 3, we have heard concerns about the scene from Dr. Christine Moutier at the American Foundation for Suicide Prevention and others, and have agreed with Netflix to re-edit it. No one scene is more important than the life of the show, and its message is that we must take better care of each other. We believe this edit will help the show do the best for the most people while mitigating any risk for especially vulnerable young viewers». Many studies have been conducted in order to understand if the suicidal behaviour in young people changed after the episode of Hannah’s suicide aired. They all registered an augmentation of suicide and access to the Emergency Department (ED) for self-harm.
[Sinyor M, Williams M, Tran US, Schaffer A, Kurdyak P, Pirkis J, et al. Suicides in Young People in Ontario Following the Release of “13 Reasons Why.” Can J Psychiatry. 2019;64(11):798–804.
Sinyor M, Mallia E, de Oliveira C, Schaffer A, Niederkrotenthaler T, Zaheer J, et al. Emergency department visits for self-harm in adolescents after release of the Netflix series ‘13 Reasons Why.’ Aust N Z J Psychiatry. 2022;56(11):1434–42.]
Bram Stoker’s Dracula (1992) – In this 1992 version of Dracula, surely the closest to the book and probably one of the greatest, thanks also to the stellar cast and direction of Francis Ford Coppola, the theme of the survivors, or in this case The Survivor par excellence, given his eternal life, is addressed from the very first minutes of the film. Here, the first phases of the Kubler-Ross Grief Cycle are well represented: from the Denial, with the great shock of Prince Vlad Draculea returning from the battle against the Turkish infidels (we are at the end of the 15th century), who finds out about the suicide for love of his beloved. Denial soon gives way to the explosive Anger phase, particularly conveyed by the tactlessness of the priest present (whom no one would want at the bedside of a loved one, except that he is Anthony Hopkins) who is quick to tell the grieving man that the soul of his beloved cannot be saved, given the deed done, and will therefore burn eternally in the flames of hell. Nothing remains for the Prince, not even the consolation of the salvation of Princess Elisabeth’s soul. Denying God and the Church for which he fought, he unleashes the forces of evil, thus transforming himself into the vampire Dracula. He will consequently cross the centuries (‘I have crossed oceans of time to find you’), taking several lovers and victims but hoping to somehow find his beloved. He will, in fact, reach the modern era, when as a young Londoner he discovers the face of his Elisabeta and does everything he can to have her, only to realize too late that it was a selfish and destructive love that moved him and brought only more pain to his new (is she?) beloved. Only after centuries does he then arrive at Acceptance, which will also symbolically coincide with his death and, finally, the peace of his soul.
EPA Section of Suicidology and Suicide Prevention 