FREE EXPRESSION: AT WHAT PRICE?

DEPICTIONS OF PHYSICAL SUFFERING

FEINTS, JABS, LOW BLOWS, ROUNDHOUSES AND THE GENTLE ART OF THE COUNTERPUNCH

Eastwood's `Baby' hits below the belt

By Kristi L. Kirschner, a doctor and associate professor at Northwestern University's School of Medicine

March 6, 2005

"Watching `Million Dollar Baby,' you know it's special. The next day, the full weight of the movie's meaning and complexity hit you like a Mack truck. ... Like all great art, it lingers in your thoughts--and your heart." (Leah Rozen, "And the Oscar Should Go to... " People, Feb. 28, 2005)

I know I'm an outlier here--but I really don't get it.

A great movie should transform us, take its thematic material to new heights with a novel exploration of our humanity. This movie had that potential with themes of human ambition and determination, physical and social limitations, and finally, euthanasia. But it is mired in tired old cliches and overdrawn stereotypes, and misrepresents some important social realities for people with disabilities.

"It wasn't long before Axel's hindquarters started to give out on him ... Pretty soon ol' Axel couldn't barely walk from the pain. Daddy was so sick he couldn't hardly stand ... but one day he got Axel into his rig by hisself ... Daddy took a shovel and a forty-five with him ... Then Daddy drove up into the hills so's he could put his best friend down. Mama and us kids sat close on the floor waitin'. Near sundown the shot come through the trees ...

"Frankie, I want you to put me down like Daddy did Axel." ("Million Dollar Baby", p 91-92)

Such dialogue about suffering and euthanasia, excerpted here from the book that inspired the film, appeals to our cultural celebration of bodies without limits. Unfortunately, our bodies do have limits; such dialogue, reliant more on caricature than character development, keeps us culturally entrenched in negative, error-ridden old scripts about our humanity: Life with disability is worse than death, goes one such script. If it's considered a kindness to put our animals out of their misery, why won't we do the same for suffering people?

Though we are led to believe that Maggie receives the best care possible after her spinal cord injury, from my perspective as a rehabilitation physician, her "care" was abysmal--even neglectful (particularly as evidenced by a pressure sore so severe that she requires amputation of a limb). Her personal odyssey with disability is telescoped; we (and presumably she as well) are taken directly from intensive care to a place that best resembles a low-end chronic nursing facility. Nowhere is there a hint of the intensive work of rehabilitation that is routinely made available in this country to people in Maggie's situation. The simplest medical details--the brace, the location and appearance of her pressure sore, the placement of her tracheotomy tube--were troublingly inauthentic. But these errors are inconsequential in comparison with the lack of any true rehabilitative care. What could she have known about her potential life with high quadriplegia?

Where are the other patients, the peer visitors? Health care professionals appear only to deliver bad news--her leg must be amputated--or to sedate her to prevent her from biting her tongue and bleeding to death. There is no careful exploration of her suffering, no discussion about her despair. Who worked with her to challenge her preconceived ideas of bodies without limits?

Everyone, no matter how physically fit, will experience bodies that falter and fail at some point. Who wouldn't have challenged her suicidal ideation if she wanted to die just because she wasn't any good at boxing or when her body aged and she could no longer fight (as would inevitably happen). Maggie clearly needed support in imagining possibilities that were outside her experience. She needed help in understanding how the visit from her cold, callous family might also contribute to her despair. In short, Maggie deserved the usual support services that help patients to repair the broken narrative of life when acute unexpected disability occurs.

What if, despite maximum support, Maggie were to persist in her desire to die? Was her only option to have "Frankie put her down like Axel" or to try to bleed to death by biting her tongue? She lives in America , where the competent patient has the right to refuse medical treatment--even life-sustaining treatment. She could have had her ventilator withdrawn with the support of her health care team, skilled in the use of proper sedation. She didn't need to suffer the air hunger and physical pain that is inflicted on her at the end as Frankie clumsily disconnects her from the ventilator and then struggles to draw up a syringe of epinephrine--a stimulant that likely caused an excruciatingly painful death. Her death was cruel and inhumane--worse, in fact, than animal euthanasia.

This movie falters on themes of disability and humanity in other ways. Brain injury is a very serious problem in our country. Do we really need another movie that extols boxing, an activity whose very purpose is to inflict head injury and the participants are disproportionately disadvantaged, poor, and exploited by others? It's also interesting how Danger, the man who is "lesser than" in the movie--both cognitively and physically--is used for comic relief or pity. And finally, it is troubling that the movie indemnifies vigilante euthanasia and Frankie walks away, without any legal repercussions for his actions.

Let me be clear here--this is not about artistic freedom of expression. Clint Eastwood has the right to tell the story he wants to tell, and others (like me) have the right to react to it.

The arts are the single most important and powerful venue for influencing social thoughts and attitudes. They reflect as well as shape our culture and therefore have a responsibility to do so with authenticity, or at least with reasonable credibility and fidelity. Great art is always transformative. Think about how "Uncle Tom's Cabin" awakened our country to the wrongful rhetoric of those who rationalized slavery, as well as the similar power of "To Kill a Mockingbird" in the 1960s. "Million Dollar Baby" is not in this company. When a movie perpetuates negative stereotypes and misinformation that harm a group and thereby harms us all, it should not be honored as among the "best."

Copyright© 2005, Chicago Tribune