Film/Video/TV Annotations


The Diving Bell and the Butterfly


MediumFilm
KeywordsCaregivers, Communication, Disability, Doctor-Patient Relationship, Hospitalization, Illness Narrative/Pathography, Narrative as Method
SummaryJulian Schnabel’s film version of Jean-Dominque Bauby’s memoir, The Diving Bell and the Butterfly (see annotation), is a re-imagining of the book that offers new approaches to teaching, even while it misses some of the aspects of the book that are so critical to educating medical and nursing students about the experiences of patients. Like Bauby’s book, Schnabel’s movie tells the story of a high-level editor at French Elle who has a stroke and is paralyzed except for the ability to blink one eye and to move his head slightly. Bauby (Mathieu Amalric) awakens from a coma to find himself in a hospital and unable to move or, at least at first, to communicate.

A speech therapist (Marie- Josée Croze) teaches him how to blink in response to letters as she reads through the alphabet, so that letter by letter Bauby can communicate. Friends and family learn this method, and eventually Bauby decides to write a memoir of his experiences using this technique. His publisher finds an amanuensis to transcribe the portions of the book that he first memorizes and then communicates to her painstakingly. The film portrays the process of writing the book, Bauby’s experiences in the hospital with health care professionals, family, and friends, and also some past experiences, such as caring for his aging father and taking a trip with a girlfriend to Lourdes.
CommentaryMore than just a medium that medical and nursing students can relate to, the film The Diving Bell and the Butterfly offers many useful lessons on the experiences of patients in hospitals and dealing with chronic illness. For those who have read the memoir (and even more for those who have taught it), there are some disappointing omissions and additions. However overall the film provides a useful supplement to (not a replacement for) the book. The film doesn’t offer nearly the range and depth of descriptions of Bauby’s difficulties with physicians and other health care professionals and staff that make the book so useful in medical education.

Missing from the film is the book’s typology of patients (patients in for rehab after accidents are “tourists,” while Bauby and others living there permanently are the “broken winged birds, voiceless parrots, ravens of doom, who have made our nest in a dead-end corridor of a neurology department”). Neither do we find Bauby’s detailed critiques of thoughtless health care workers and his empathic realization of how difficult their jobs are, the racket of the hospital environment, nor the torture of being left unattended for hours when his urinary catheter has detached and he is soaking wet and the alarm on the feeding tube beeps incessantly.

The book provides many opportunities for students to discuss ways in which health care professionals can deal more sensitively and effectively with patients and some of the most significant of these are watered down in the film. The ophthalmologist who, in the book, begins sewing one of Bauby’s eyes shut without first explaining to him what he was doing and why, appears in the film, but he explains to Bauby what he’s doing as he goes along. In the film, the ophthalmologist’s arrogance manifests in his thoughtlessly discussing a recent ski trip. We miss the important critique of a physician who doesn’t introduce himself and explain the imminent procedure, let alone make sure that the patient understands. Also missing from that scene is Bauby’s angry response and the ensuing discussion of his calibrated use of anger—“to keep my mind sharp, to avoid descending into resigned indifference”—that could help clinicians to understand and deal more effectively with patients’ anger. Because of these omissions and others, the book stands as the ideal teaching text for clinicians and students.

What the film offers that is not found in the book is a powerful means of opening up discussions about treating chronically ill patients through the phenomenon of Bauby’s means of communication. In the first instance of this, the camera is trained on the speech therapist’s face as she reads through the alphabet, noting the letters Bauby chooses by blinking, and parses out words and sentences. Bauby’s ex-girlfriend (Emmanuelle Seigner), who plays a key role in caring for him, masters the process, as does a woman sent by the publishing company to assist Bauby in writing his book. The focus of the camera on the faces of these caring listeners, their repetition of the alphabet and confirmation of the letter he has blinked to choose, and the measured formulation of the words becomes almost hypnotic as these scenes repeat throughout the film, slowly unfolding words into the wit and lyricism of Bauby’s prose (often quoted verbatim from the book itself). This almost obsessive emphasis on process, which is a fascinating unfolding of creativity rather than a deadening labor, serves as a powerful metaphor for treating patients who are chronically ill, who will get better by increments, who will sometimes get worse before they get better, or simply get worse. It teaches the value of persistence and patience and valorizes the attentiveness with which these caregivers enable the agency that Bauby has despite his paralysis.

In addition to Schnabel’s crafting of a moving meditation on the deliberate process of caring for the chronically ill (as well as representing many of the book’s important descriptions of patients’ experiences, such as the loneliness of Sundays in the hospital), the film includes one of Bauby’s commentaries on narrative itself as a voiceover, the story of Mr. L. In this briefly imagined play script, a man who is very much like Bauby overcomes his paralysis and throws off the bedcovers at play’s end. In the film as in the memoir, Bauby sends up this narrative of recovery. He knows that he will not regain his former mobility and that the narrative of recovery is insufficient to encompass his experience. Both the book and the film, in different ways, offer narratives of experience that go beyond conventions and suggest ways that students and practicing clinicians can work more sensitively with patients.
DirectorJulian Schnabel
Leading ActorsMathieu Amalric, Marie-Josée Croze, Emmanuelle Seigner
StudioPathe and others
Year2007
Color/BWColor
Running Time112 minutes
Based OnThe Diving Bell and the Butterfly
Video SourceTouchstone Home Entertainment
Annotated by Garden, Rebecca
Date of Entry 07/08/08