I was the medical director of an ambulatory surgical center when “Philadelphia” came out, and I recall the executive director of the facility telling me at the time that we were not equipped to accept people with AIDS. Instead, she said, we should shovel them to a nearby hospital. This type of fear fueled prejudices and discrimination for years until “Philadelphia” and icons like Magic Johnson helped to change the discussion surrounding AIDS. The commitment to research and treatment that followed has culminated with an HIV-positive diagnosis’s no longer equating to a death sentence.
Today, we face another epidemic that has degraded lives within a huge swath of our society and another movie portraying how people suffer because of it. Jennifer Aniston will not receive the Oscar, lacking even a nomination for her performance in “Cake,” a movie about living with chronic pain, but in my opinion she deserves recognition. As a physician who has treated people suffering with chronic pain and addiction for 30 years, I can attest that Aniston, in the role of Claire, did an outstanding job and that her behavior and appearance in the movie ring true for a person in severe chronic pain.
Few people realize that the Institute of Medicine has documented 100 million Americans with chronic pain, more than those with heart disease, cancer and diabetes combined. People in pain are often stigmatized as people with AIDS were in an earlier era, dismissed as malingerers, mistakenly judged to be addicted, even labeled as lowlifes. The difficulty is that there is no cure for most severe chronic pain…
Hoping for a movie that could serve as a cultural touchstone to talk about these issues, I saw “Cake” on opening night at 7:00 pm. There were only 24 people in our 300-seat auditorium in my hometown of Salt Lake City, Utah. Granted, the Sundance Film Festival was in town, perhaps pulling potential viewers away, but I feared the low response mirrored the public’s lack of interest in the topic of chronic pain. This is supported by a recent survey by ResearchAmerica that reported only about 18% of Americans think chronic pain is a significant health problem.
Unfortunately, despite Aniston’s fine performance, “Cake” is no “Philadelphia” and is unlikely to spur the same sort of social movement for change. The movie’s primary lack is the context of the bigger story. It does little to portray the heroism of people who struggle daily with pain, their dignity routinely assaulted by family members and doctors who don’t believe them, friends who abandon them, and public and private insurance policies that will not pay for the interdisciplinary care that could help them. Perhaps another movie about a lawsuit demanding justice for pain sufferers who have been denied care could reach “Philadelphia” stature.
“Cake” does have its strengths, though. Claire’s alcohol use, pill overuse and eventual overdose are, unfortunately, accurately portrayed and far too typical of many people in severe pain.
“Cake” also gets the link between chronic pain and suicide right: fully half of people with chronic pain consider suicide, making Claire’s preoccupation with it frighteningly accurate. The CDC reports that about 40,000 deaths per year are from suicides. These, doubtless, include many people trying to escape pain…
Doctors usually have a different perspective than pain patients, but I haven’t been able to find any reviews for this movie from a pain patient. And I haven’t seen this movie, so I can’t offer one.