love and hate in dementia: the depressive position in the film iris

Film Essay

Love and hate in dementia: The depressive positionin the film Iris1

Daniel Anderson

Glan Traeth Day Hospital, 2 Alexandra Road, Rhyl, LL18 9EA, Wales –

[email protected]

Introduction

Film plays a major role in contemporary society, often providing us withglimpses into other worlds and lives to which ordinarily we would not haveaccess. Such is its influence that it can have a significant impact on popularopinion, and there is a heavy duty in the role of the director, writers andactors to achieve the right balance for fear of producing detrimental effectsand biases. It is important that film achieves the right balance betweendiscussing a particular issue without diluting it down to something mediocreor sensationalizing it beyond all realistic expectations.

The recent film Iris (Director: Richard Eyre, 2002, UK) has raised thechallenging issue of dementia. Central to this film is how a couple tries toadapt their relationship to the continuing demands placed upon them by thechanged personality and declining ability of a loved one with dementia.Dementia is a common and currently incurable condition which cruelly robssufferers and their loved ones of a common history together, personality,love, intimacy and, ultimately, life. It is considered by some to be a normalpart of becoming old, which it is not, but it is common and disturbingenough for it to be thought of in such ways as a means to avoid the distressof its underlying pathology and the distress of those who suffer with it. Insome respects it offers disturbing glimpses into our most raw and primitivefears of losing our minds, becoming incapacitated and dependent. It threat-ens to shatter our sense of unity within the ego, blurring demarcationsbetween what is self and non-self. Dementia should not be considered as asimple return to infancy through a reversal of human development, but itdoes share some similarities to infantile states that prove useful whenconsidering its nature in advanced states.

The stigma of a mental illness like dementia, and ageing per se, can evokepowerful reactions in those observing films about it which are taken back tothe wider community influencing opinions. Iris attempts to take thisonboard by examining the effects of dementia upon the sufferer, their rela-tionship and the wider community. Such is the powerful and distressing

1This paper has been translated by Giovanna Iannaco.

Int J Psychoanal (2010) 91:1289–1297 doi: 10.1111/j.1745-8315.2010.00324.x

Copyright ª 2010 Institute of PsychoanalysisPublished by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis

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effect of the reaction to this disorder, this film may aid in dispelling oractually generating the stigma of becoming demented.

The countertransference in dementia

There have been recent attempts to understand how we may react to thosewith dementia (Davenhill et al., 2003; Evans, 2008). This has been stimulatedby an awareness of carers’ emotional needs. It is estimated there are 6 millioncarers in the UK looking after someone with illness or disability, one millionof whom provide more than 50 hours of care per week (Balfour, 2008). Studiesconsistently demonstrate the impact of dementia upon these beyond that ofthe sufferer. Without adequate support carers will experience stress resultingin their own deterioration in physical and mental health (Williamson, 2008).

Dementia patients are sensitive to such changes in their carers, and willquickly pick up on cues in tone and body language, and yet not haveenough cognition to understand the reasons why their carer might be angry,or snappy at them. Frustration can soon follow resulting in behavioural andpsychological disturbance in dementia patients, breakdown in placementand sometimes the use of psychotropic medications (Williamson, 2008).

Carers must carry the burden of projections without identifying with them.This is a near impossible task to carry, which without adequate support canbecome overwhelming. Such projections though will often ‘hook’ on to some-thing unresolved with a carer and perhaps evoke similar feelings towardsparents or grandparents (Martindale, 1989). Such reactions to parental fig-ures can reignite old oedipal conflicts (Wylie and Wylie, 1985). This could betaken further as a means by which a carer could act out past unresolvedissues. Although this can be useful for patient and carer alike, it can some-times result in an extreme wish to please and not ‘let go’, leading to over-dependency and malignant regression on the part of the patient (Evans,2008). Evans (2008) described this as the ‘negative therapeutic reaction’ – afeature which Freud suggested could be part of aggression in the death drive.

The therapist or carer must be trained to take on projections regardingfear of loss, anger surrounding becoming older, failing bodily and mentalfunctions, growing dependence, impotency of self and difficult issues regard-ing the approach of death (Ardern, Garner and Porter, 1998). Martindale(1989) discussed the fear of therapists developing a dependency in elderlypatients that might overwhelm the therapist and lead to an unnecessary dis-tancing between patient and carer. Another tactic for managing this fear ata more societal level can be to see the elderly population as a burden.Garner and Ardern (1998) described the consequences as follows: ‘‘Bydenying an emotional life to the elderly the imagined pain and fear of oldage and life’s end can be conveniently denied for the rest of us’’ (p. 93).

Sometimes countertransference feelings can become particularly aggressiveresulting in hate. Winnicott’s discussions surrounding such feelings providea model for thinking about the challenges of caring for someone withdementia when expected to hold on to the less pleasant aspects of humansuffering (Winnicott, 1947). Although admitting to such feelings can feelshameful, they are normal and require a forum for discussion. There is a

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Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis

risk of such feelings interfering with the quality of care given if they are notdiscussed. Impatience with a patient’s slowness of movements or repetitionof language may lead to angry outbursts on the part of the carer, or lead, ina defence akin to a reaction formation, to over-compensation of thepatient’s slowness or simple ignorance of the patient’s repetitions. All mayresult in added shame and humiliation into the patient’s distress, furtherworsening their already impaired abilities (Evans, 2008).

One feature that seems noticeable to the countertransference to the elderlyand, specifically, to those with dementia is the extreme nature of suchreactions. Staff and carers can become prey to ‘‘therapeutic nihilism or,conversely, embark on heroic treatments that cause pain and distress to allconcerned’’ (Garner, 2002, p. 213). The tendency seems to be towards split-ting in our attitudes, either annihilating the very existence of such peoplewithin institutions or even their own homes, or becoming grossly emotion-ally over-involved and emotionally overwhelmed.

The particular aspects of stigmatization and dementia involve many ofthese aspects already discussed. The experience of the patient and carer isoften of exclusion and embarrassment. Dementia patients are notorious forbeing unpredictable, particularly within social situations where the multitudeof stimuli to process can become too much. Social exclusion may protectthe patient from embarrassment, but it may also protect our own embarrass-ments (Pointon, 2004). Behaviours can become less socially acceptable andmore disinhibited, sometimes provoking anger and aggression in those onthe receiving end of such behaviours and who do not understand the illness.This need to exclude continues even after the patient has become institution-alized. We do not wish to be confronted with the experience of being in anursing home, nor with the state of mind of the sufferers as they remind usof our own possible future.

Impact of the film upon the viewer

The film Iris resulted from the account of the same title by Iris’s husband(John Bayley) of her illness, which he wrote in 1998 shortly before her death in1999 (Vassilas, 2003). The film depicts the world-renowned writer IrisMurdoch and her decline into dementia. The film uses a technique that shiftsbetween two periods of time – the past when they were young and courtingeach other, and the present with her growing awareness of something beingwrong with her memory and her journey with dementia towards her death.

Other important characters in the film include their close friend Janet,who dies during the film, and Maurice who was one of Iris’s previous lovers.The GP and memory assessment clinic also feature in the film as part of herjourney through the medical system to receive a diagnosis. Towards the endthe GP plays a role in helping John to let go of Iris after holding on for solong, much to the detriment of his health, given how neglected and unsani-tary the house had become. At the end of the film Iris dies after beingadmitted into a nursing home.

The film literally takes the viewer on an emotionally-laden journey withIris, from her being aware of a problem through to her death. Much like Iris

Film Essay: The depressive position in Iris 1291

Copyright ª 2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91

herself, I found myself starting my journey with the film with curiosity andan unawareness of the future. My world was full of my own vicissitudes,mirroring Iris’s life prior to dementia. The film appeared as a curiosity thatmight be explored. My interest as an old age psychiatrist also gave me theexpectation that the film was unlikely to be a happy story and would proba-bly be distressing, such is the nature of dementia work. I held a fantasy thatthe film could offer me hope as a tool which my patients and carers couldenjoy and find reassuring.

At the start of the film a number of scenes that describe Iris’s and John’sintimacy in their relationship are shown including when they first met at theuniversity ball and how their own sexual relationship was explored. I toofelt invited into this growth, developing my own intimacy with their story asa couple and developing my own relationships with them. As part of thisIris had to give up her previous sexual partners to become monogamous toJohn, and I too felt compelled to become monogamous in my attention toher, to the exclusion of my world around me.

Further scenes depict Iris’s reluctance to allow John to read her novelsshe has just finished. Eventually she does let John, and consequently us, seeglimpses of her work, and by doing so she lets us into her inner world, fur-ther falling in love with the idea of glimpsing her creativity. I recall thissense of being allowed somewhere special and intimate, with Iris taking meto a place of fantasy. I hoped the film could offer a miracle and that Iriscould survive and not succumb to dementia. However, as her problemsstarted to surface, the film imposed a reality upon me through their realityand challenged my own denial of reality. I too had to let go and face herdeath in the same way as John, feeling some of his despondency and fear.I wanted to hold on to the hope that she might turn out fine, much as Johndid, and again, like John, I wanted to protect Iris from these changeshappening to her.

A number of scenes addressed this need to protect Iris, particularly duringher moments when she is being assessed by clinicians. John suggests to themthat she is tired and they should stop their investigations, or that she canbeat the dementia process despite them saying: ‘It will win’. John affirmsthat she is a person who can still be engaged in the process of her diagnosisand management when he declares to one clinician that she is ‘still a per-son’. I found myself during these moments positively agreeing with John,taking his side entirely, and was left feeling very critical of the care she wasreceiving as if it were too brutal and upfront.

One faculty of Iris that John does use to help maintain her determinationis through encouraging her to keep writing and use her abilities, as if thatwould somehow stop or reverse the dementia process. Although this couldbe seen as a denial of her current problems, Iris does seem to find hopewithin his words, which I too found tempting to agree with. John takes com-mand here as the containing object of Iris’s anxieties. The idea of soldieringon to fight the process gives hope to them and to us. Iris uses metaphors ofbeing a deprived animal or starved dog and sailing into darkness to suggesttorment and loss of control, dignity and humanity. I found it disturbing thatsomeone with such academic prowess and prior intelligence could be treated

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by dementia the same as anyone else, even though I already knew this. I wor-ried that I too would become like a ‘starved animal’, and I became disturbedby my own awareness of my limitations, vulnerabilities and inevitable death.

It was during this part of the film that my mood became increasinglyblack, and I found it hard to find hope within the film. At times I feared Icould also lose myself within it, and needed some time away from the filmto allow healing. I noted how I mirrored Iris’s decline and feared becominginaccessible to others. I struggled to find a means to communicate my expe-rience of the film to others. I noted how I had started to dislike the film,and wanted to escape its gloom.

The middle section of the film addresses the idea of Iris becoming increas-ingly inaccessible to John and others. Moments of clarity do still occur attimes, even at later stages. One such example occurs when John is reading toIris, perhaps driven by guilt for shouting at her in the previous scene forconstantly repeating his sentences and following him around the house. Irisdetects his annoyance and apologizes to him. At this moment Iris recallsthat she, too, wrote books. John questions her, wondering what secrets shemay still hold. I however was left uncertain if Iris does actually share anysecrets with John now. Gradually the hope of John or us learning her lan-guage ‘before the lights go out’ fades. Iris’s behaviour becomes increasinglyconfusing and unexpected. Her close friend Janet questions John aboutwhether she recalls her past, including her. During an important lecturescene, Iris makes reference to ‘every human soul (see)ing … pure forms suchas justice, temperament, beauty, and all the great moral qualities we hold.We are moved towards what is good by the faint memory of these forms’.The idea of that ‘faint memory’ seems important here, that perhaps suchmemories of what is good and of love can still exist even in the deeperstages of dementia.

As the story progresses Iris becomes increasingly bizarre and inaccessible,and my reactions to the film follow this extremeness. John has to shift froma position of being in love and desperately holding on to hope, and likewiseI too had to find a way of holding on to the film despite wanting to walkaway because of resentment and hatred of how the film was making me feel.The start of these extreme reactions occurs when John snaps at Iris after shehad been repeating: ‘It’s only the postman’ after the postman had deliveredher new book. Her state of anxiety, from this relatively benign situation,results in her clinging on to him to such a degree that he drops some crock-ery and angrily shouts back that it is indeed only the postman.

Later on this frustration is taken further into hatred. After Iris gets lostoutside she is returned to the house by her former sexual partner, Maurice.This seems to trigger in John a whole series of memories around his earlierresentment of her for sleeping with Maurice and others before and duringtheir early courting. It seems that John, through thinking of the past, isusing the memory of Iris’s past lovers as a transference of his denial of hiscurrent anger towards Iris and her diagnosis, and his resentment about car-ing for her. In a sense Alzheimer’s dementia is like Iris’s latest lover ofwhich John is jealous. The sense of transference feelings around Iris’s pastlovers and Iris’s current ‘lover’ (dementia) being used as a means to express



his current hatred and resentment at Iris is made more explicit when heexplodes at her while lying in bed with her. He finally expresses how muchhe loathes caring for her and, in a parallel process, how much we mightloathe watching her decline.

Despite this outburst, however, a number of differing scenes brings thefilm to the point where John can let Iris be admitted into a care home. Itseems as though up to this point John had always resisted this, taking onthe roles of protecting her and maintaining hope. It seems perhaps John wasunable to cope with the guilt of letting Iris go into a care home or the guiltof hating her needing his care. This process of letting her go to have a ‘goodenough’ death encourages us on a similar journey towards the end of thefilm. I too had to face the pain of her death and hopefully move beyondboth a state of desperate hope for enduring love, and resentment of her andwhat her predicament represented to me.

The scene following John’s outburst depicts Janet’s funeral. What becomesclearer is that through Janet’s funeral John comes to realize that Iris andperhaps he himself will soon die too. Janet’s funeral becomes key in aidinghim and us to let Iris go, and make amends for his and our previous hatred.It seems he would not want to live with his hatred being his last memory ofthem together, either as a couple living together, or of her being alive. I alsofelt a sense of needing to find a space to allow for ambivalent thinking, rec-ognizing my previous resentment of her and what her story had done to me,but it also allowed me to move away from the film while still being sensitiveto the predicaments of dementia sufferers.

This moment of reparation comes when John is driving Iris back homeafter the funeral. Iris is still in a very agitated state and falls out of the mov-ing car after grabbing the door handle. John looks for her in the under-growth. While doing so he is startled by a car horn and falls into the ditchtoo. He finds her at the bottom of the ditch near him, laughing out loud.She struggles to speak but does manage to articulate some words to say:‘I love you’. Even in her advanced presentation there can still be a momentwhen we can access the old Iris. She shares her love for him, perhaps con-firming to John that their relationship can survive, even after the previousscene when he expressed his hatred.

This also confirmed to me that my relationship to her, the film and todementia itself can survive and find something hopeful in the despair. Inher fall Iris also lost her ring which John finds on the ground. The ring,although worn down now, symbolized their marriage. It still survives and,symbolically given how it was found after this important moment, canendure the trauma that just occurred, much like the traumas of Iris havingdementia and of John and us feeling hate towards her. Iris’s affirmation thatshe loves him gives hope that they can survive, and have survived, and thatwe too can survive and hold in mind the needs of those with dementia.

The viewer’s journey to the depressive position

The process of the viewer mirroring Iris’s decline could be thought of as aborderline process resulting in two extremes: one depressing and overwhelm-

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ing, the other emotionally detached. Both can result in danger through theemotional burn-out of being overwhelmed, or ignorance and rejection ofthe plight of those affected. Viewers of the film could potentially take awaysomething of Iris’s distress and identify with it, which could inspire theminto striving to help dementia sufferers or at least have an improved aware-ness of their needs. That part which is taken away, however, could raise dif-ficult issues regarding past friends and family who needed care, which canbecome depressing. Likewise, the distress of the film may be dealt with at amore unconscious and defended level, suggesting that denial or at the leastrepression of the material could be taken as a means to ignore and evenreject the needs of dementia sufferers.

It is primarily Iris’s decline that provides the stimulus for such splits tooccur. She moves from a state of being entirely in control of and contentwith her life and her relationship to John, but, as problems with her mem-ory arise, this soon puts strain on her mental functioning and their relation-ship, and consequently on us watching this unfold. She moves into her ownparanoid–schizoid position, seeing the world as potentially threatening toher well-being as a proxy of the dementia threatening the stability of herworld. Relatively minor incidents such as a fox and cat fighting symbolicallydisplay how little she now understands of the world outside and also of herinternal world. Such polarized reactions decrease in their potency over timeas the dementia takes further hold of her, destroying what introjected objectsremain within her, leaving her in a state of seeming emptiness to thoseobserving her and trying to communicate with her. There are some doubtswithin the film whether that is true, through suggestions that her behaviourmight be understood as communications of memories if only the commonlanguage could be found before time runs out.

John takes on the difficult task of containing Iris’s split off and projectedanxieties. He manages this but at a cost to his own health and sanity. Heinitially exists within a state of denial, acting as a proxy ego defence for Irismaintaining hope for a miraculous improvement. This is continually chal-lenged by her increasingly inaccessible mind, bizarre behaviours, and by thevarious clinicians’ blunt statements such as ‘(the dementia) will win’. Theenergy required to maintain this hope is so enormous that John does dra-matically burn out, flipping into his own paranoid world where he believesIris could be having an affair with a former lover. It is through his transfer-ence to the past that he manages finally to express his hatred of Iris andwhat she is putting him through. However, by doing so, he is enabled toremember and take up a more ambivalent depressive position that canaddress the whole range of feelings towards her without feeling overwhelm-ingly guilty. Ultimately, it allows him to let go of her, so she and he canboth receive appropriate care, and allows her have a good enough deathwhich involves others carrying some of the burden for him.

The difficulty for stigma towards dementia and the role of this film withinthat process is whether the viewer can find a depressive ambivalent positionwhile watching the film. John does manage to achieve this after consideringthe meaning of their close friend Janet during her funeral. He is given a sortof ‘permisison’ to hate Iris when Iris ‘forgives’ him, saying ‘I love you’ after



she falls from the car after the funeral. Once he can see how love and hatesit within Iris, he finds himself better able to let go of her, and let her beadmitted to a care home in a way that does not seem massively rejecting oroverwhelming. Although Iris does die in care, I was left feeling that this wasthe right and most caring outcome for both him and her. John’s journey infinding his depressive position to allow him to let her go enables a morepeaceful death to occur for Iris, and paradoxically allows us to take awaysomething more hopeful, in that something of peace before and after deathcan be achieved.

The issue is whether the film does indeed take the viewer on such a jour-ney. The film does give us permission to express something of the resent-ment and dislike of seeing someone succumb to dementia, but cruciallytakes us to a point beyond this where this is used in a positive creativemanner. I personally was only able to find this creativity after a number ofviewings, although that may reflect my history as a carer and professionalworking within the dementia field. However, the film beautifully and sensi-tively creates and maintains enough consideration of both loving and hatingfeelings around dementia that it is possible for us viewing it to follow Johnon his own similar journey.

Conclusions

If this film is to challenge stigma, it must be able to connect with the wholerange of feelings that might exist in us towards those with dementia. Stigma,as is the case with projective identification, frequently depends upon split-ting to generate its effect. This fits in with our tendencies to demarcate andorder the world around us, producing ‘them-and-us’ mentalities. We see theworld as black and white, natives and foreigners, ill and healthy, mad andsane (Porter, 2004). Yet the ambivalent view would be to accept ownershipof both views which we all carry. It is by recognizing ourselves or the poten-tial for us to become them – that unpleasant part we have disowned andput into someone else – that we might start to shift stigma. The methods ata clinical level for this involve listening to the patient’s experience and com-municating that back to them (Mitchison, 2004). This essentially becomes atwo-way collaborative task rather than the traditional authoritarianapproach.

As a medium, cinema is one means of portraying dementia and the ser-vices and people that have evolved to treat it. It can have a major influenceupon popular opinion and expectations. Modern depictions have been kin-der to psychiatric disorders in general compared to the past, but the percep-tion of them as being dangerous or unwanted persists (Byrne, 2004).Cinema can create social changes and shift public opinion, and I personallythink it was brave of those making this film to attempt to provide anaccount of the experience based on a real personal experience. The filmremained true to the underlying psychopathology, both descriptively andpsychoanalytically. Inherent to the nature of the disorder is that it revertsto paranoid–schizoid ways of thinking, and the effect of seeing that ispotentially to generate or heal such splits in us when observing.

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The film works hard to maintain John in his depressive position, and triesto move other characters and us through to a similar place. I doubt thiswould always be possible for those who choose to watch the film, and ofcourse perhaps the very people the film is aiming to shift are the ones whowould choose not to watch it at all, such are their disgust and fear ofdementia. There are also those who would actively choose to watch the film,such is their personal or professional interest as in my own case, who againwould be likely to shift to a polarized view of feeling simply that they havepreviously seen too much of it to feel anything, or becoming overwhelmedin grief seeing the despair. Perhaps this is a limitation of this analysis, but insome ways it is also its greatest advantage, in that this particular insight intopotential polarized views is what I can offer to its understanding.

However, for those who are new to dementia and open-minded enough torealistically see a glimpse of what dementia might be like, I feel the film hasmuch to offer which could be beneficial to those with dementia and caringfor them, in terms of recognizing and accepting less palatable feelingstowards dementia, and understanding the inner world of someone withdementia. It does have enough of a horror impact to generate feelings ofshock and hatred, but also empathy, hope, acceptance and a desire to care.In this respect the film, through John’s resolute ability to keep Iris wholeand express both his love and hate towards her, offers the viewer a trulyhonest account of the experience of dementia.

References

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Vassilas C (2003). Dementia in literature. Advances in Psychiatric Treatment 9:439–45.Williamson T (2008). Dementia out of the shadows. Report published by the Alzheimer’s Society,London.

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love and hate in dementia: the depressive position in the film iris

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