Weeks ago, nominations for the fourth annual HOME (Health Oriented Motion-picture Excellence) Award given to the best health themed movie of the year were announced in the Huffington Post. Representing a quite diverse group of films, these nominees included Meryl Streep’s “Florence Foster Jenkins” who developed syphilis from her first husband on her wedding night, “Ma Ma” dealing with breast cancer treatment and survivorship, “Deadpool” which portrayed the skin toxicity of cancer therapy, and “Manchester by the Sea”.
Its authenticity in dealing with the complexities of mental health issues afforded “Manchester by the Sea” the winner of my HOME award for Best Picture. This excellent film was written and directed by Kenneth Lonergan, with outstanding performances by Casey Affleck as the character Lee Chandler, Kyle Chandler as Lee’s brother Joe Chandler, and Michelle Williams as Randi, Lee’s ex- wife. There are actually two important health themes in this Oscar nominated movie.
Many Americans are plagued by depression, and this mental health issue dominates the plot with authentic performances illuminating this severe disorder. Casey Affleck’s character, who suffers from alcohol abuse, undergoes a traumatic home accident, which leads to severe depression, self recrimination, and post-traumatic stress disorder (PTSD).
Over 20 million Americans suffer from depression which diminishes quality of life and human functionality. When surveyed, 1 in 11 American adults have symptoms of depression, as do 1 in 11 adolescents ages 12 to 17! It is so common that drugs to treat depression are among the biggest selling medicines in America.
Risk factors for depression include many conditions. Women are more susceptible than men, and depression is common post delivery of babies, and in menopause. Depression is also often seen in people with PTSD, anxiety disorders, after sexual abuse or trauma, bipolar disease., and co-occurring disorders such as abuse of alcohol or drugs are typically seen. It can also be an unfortunate side effect of medications such as blood pressure control medications and sleeping pills. A family history of depression or mental disorders, and obesity can make one more susceptible. As an associated condition, depression is also often seen in patients with heart disease, diabetes, stroke, cancer, vitamin deficiency and endocrine diseases. Statistically, depression is more common in people lacking health insurance, the unemployed, people previously married, and individuals with less than a high school education.
Therapy for depression is multi-factorial. It requires a team to help patients to overcome this illness. Primary care physicians must help to identify patients who are depressed and initiate the processes of diagnosis and therapy. After confirming the diagnosis, many primary physicians and their nurse practitioners simply order antidepressant medications and evaluate the effects.
But a more comprehensive approach for severe depression is often needed. This includes referral to a psychiatrist, psychologist and/or neurologist for more sophisticated medicine, counseling, cognitive-behavioral intervention, psychoanalysis, possible electro-convulsive therapy (ECT) and diagnostic testing to explore treatable associated conditions making the depression worse.
Could these treatments have helped Casey Affleck’s character Lee Chandler? Undoubtedly they could have and I wondered throughout the film why Lee Chandler did not use them. I kept feeling his frustration and also kept thinking: just get some help!
So here are Dr. Cary’s tips for you about depression.
· Always share with your primary care physician any feelings you have about depression or anxiety or difficulty dealing with situations in your life. If your doctor does not respond, get a referral to a specialist or get a second opinion.
· Always ask for a referral to a neurologist, psychologist or psychiatrist to help manage depression. Remember that mental health services are a covered benefit of all health plans under the Affordable Care Act. Check with your insurance company to be sure how much care your plan covers.
· Get all the facts about depression so you can ask the best questions of your doctor and get better treatment. Be sure to ask about exercise, eating, sleeping, and avoiding exposure to alcohol and illicit drugs.
· If you are not getting better, get a second opinion For more tips on getting second opinions, see Dr. Presant’s 10 Commandments for Second Opinions in my book and website Surviving American Medicine.
· Be aware of the suicide hotline 800-273-8255.
The second health theme in this motion picture is serious cardiac disease occurring at a young age (under 55 years of age). Joe Chandler dies at a young age of heart disease. Joe was aware of his serious condition and had planned for his demise by completing his will and making decisions about who would care for his teenage son.
Including this theme in the film reminds audiences of the importance of cardiac disease. Heart disease is the leading cause of mortality in America, with over 600,000 people dying annually. The age range of fatal cardiac disease is most common in older individuals, but 9% of cardiac deaths occur in people under 55 years of age.
The causes of cardiac disease, are not limited to coronary artery disease, which accounts for only about 60% of cardiac deaths. Among all ages, the other causes include high blood pressure, elevated cholesterol, smoking, diabetes, obesity, physical inactivity, alcohol abuse, and congenital diseases.
Among patients with early cardiac deaths under the age of 40 (which possibly are relevant to the early cardiac disease portrayed in Manchester by the Sea), causes include hypertrophic cardiomyopathy (causing sudden death in athletes), congenital abnormalities of the coronary arteries or other heart structures, long QT syndrome which leads to an abnormality in heart rhythm, myocarditis which is an inflammation of the heart due to viruses or infections, and other arrhythmias.
And here are Dr. Cary’s tips for you about cardiac disease.
· Be aware of the symptoms of heart disease and let your doctor know if you have any of them: chest pain, discomfort in the upper body (chest, arms, neck, stomach), shortness of breath, a loss of ability to do exercise, nausea, light-headedness, dizziness, palpitations or fainting.
· Prevent heart disease by getting active exercise, eating a health diet and keeping a normal weight, don’t smoke, don’t abuse drugs or alcohol, have your doctor check your blood sugar to detect diabetes early, make sure your doctor checks your cholesterol, know your family history of any heart disease or death at early ages, and ask your doctor about prevention of heart disease by taking baby aspirin daily or cholesterol-lowering statins.
· Get a checkup by your doctor annually to detect high blood pressure, heart murmurs, unusual heart rhythms, and/or heart enlargement.
· Keep records of your examinations, blood pressure, weight, blood sugar, and blood cholesterol in your home medical record. For help in setting up your home medical records, see my book and website Surviving American Medicine.
We should all appreciate this excellent film “Manchester by the Sea”. And we should also use this film to increase our awareness of depression and cardiac disease. This film joins the previous winners “Dallas Buyers Club” (2013), “Still Alice” (2014) and “Concussion” (2015) as motion pictures that not only entertain, but also make us think about our health, wellness, and medical care.