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Movie Portrayals of Coma Often Inaccurate, Misleading

Breaking News - May 2006 - Week 3

(May 17, 2006)

Healthcare in  the News

-- Hollywood may do a masterful job of portraying many of life's gravest ills, but when it comes to depicting comas, the film industry deserves two thumbs down, a new study contends.

Picture of an image of the brain

The study from the Mayo Clinic finds that, overall, motion pictures inaccurately represent the comatose state. Study findings were published in the journal Neurology.

"What we found was there were only two movies that were accurate," says Dr. Eelco Wijdicks, a neurologist at the Mayo Clinic in Rochester, Minn. "Generally, there is a pattern of inaccuracy. It's an enormous caricature."

Dr. Wijdicks continues, "Patients in a coma and their neurologists are portrayed inaccurately, and so are almost all awakenings after coma. This was not only true for Hollywood motion pictures, but also for international films."

Coma as Portrayed by Hollywood

In the study, Dr. Wijdicks' team reviewed 30 American and foreign films that had characters in prolonged comas. They evaluated accuracy based on appearance of the comatose patient, complexity of care, cause of coma, probability of awakening, and appropriate compassionate discussion between the physician and family members.

Their finding: Only two of the films - Dream Life of Angels and Reversal of Fortune - offered a reasonably accurate portrait of a coma.

Among the problems the researchers spotted was a patient suddenly awakening after many years in a coma without physical or mental problems. Coma patients were often portrayed as "Sleeping Beauty," with no feeding tubes or loss of muscle tone. The "Sleeping Beauties" also had perfect grooming with deep tans.

Furthermore, in all but one movie, coma patients were shown with their eyes closed. In reality, patients in comas often have their eyes open, or can open their eyes in response to speech and pain, the researchers note.

Another point noted by the researchers: In the majority of the films analyzed, physicians caring for comatose patients were poorly represented as cavalier, sarcastic, detached, or uncompassionate.

Among the movies that offered flawed depictions of a coma, the researchers said, were: Kill Bill: Vol. 1, Rocky II, Dead Zone, and 28 Days Later.

Unrealistic Expectations for Real Life?

The researchers showed clips of 22 scenes from 17 of the movies to 72 people who had no medical training.

"More than a third of the time, the viewers weren't able to identify important inaccuracies in these scenes," Dr. Wijdicks says. "We are concerned that these movies can often be misinterpreted as realistic representations."

One comedy reviewed by the researchers showed a coma patient tapping out a message in Morse code with his finger. Thirty-one percent of the laypeople watching thought this was possible, the researchers report.

The researchers also asked study participants how strongly they agreed with this statement: "If my family member would be in the same situation, it is possible that I would remember what happened in the scene and allow it to influence any decisions that I would make."

Thirty-nine percent said these inaccurate movie scenes would likely influence their real-life decisions.

"We understand that making motion pictures is an art form and that entertainment is a very important component of that art form," Dr. Wijdicks says. "But this misrepresentation in both US and foreign movies is problematic."

A similar study published last year by US researchers in the British Medical Journal was critical of American TV soap operas' portrayal of comas, saying the public could draw false conclusions about the serious nature of an actual coma.

One expert agrees that the way comas are portrayed in films can lead to unreal expectations for recovery of coma patients in real life.

"This article adds to the growing evidence that media portray health-related issues in a misleading way," says Dr. David Casarett, a physician at the Philadelphia VA Center for Health Equity Research and Promotion, who authored the study on soap operas and comas.

"Although we all know, at some level, that movies are not real, the impressions that they create are nevertheless quite vivid," Dr. Casarett says.

"We know that Uma Thurman didn't really wake up suddenly and walk out of the hospital (in Kill Bill: Vol. 1), but that image is hard to forget," Dr. Casarett says. "That image, and others like it, can create unrealistic expectations of recovery and survival."

Remember: It Is Just a Movie

Dr. David L. Katz, an associate professor of public health at Yale University School of Medicine, says he thinks movies should stick to make-believe, and people should look for help from real-world doctors.

"When media purport to convey reality, they should do it accurately," says Dr. Katz, who is also director of the university's Prevention Research Center. "But when the emphasis is on entertainment, the public should know not to rely on movies as guidance when it comes to medical decision-making in the real world."

Dr. Wijdicks acknowledges that as art, movies are not limited to textbook portrayal of events. "You can say that it's an art form, entertainment is the key here, and you should not criticize it," he says. "You might say, 'So what? Did you expect anything else?'"

"We're not here to criticize screenwriters or an art form, but we want them to appreciate the serious situation of those in a coma and to be sensitive to how they might be leading viewers astray," Dr. Wijdicks adds.

"The influence right now of motion pictures that portray coma is negative," says Dr. Wijdicks. "Inaccuracy concerns me because the public sees an unrealistic portrayal of a neurologic disease that could lead to improbable expectations from a family of a patient in a coma; for example, that it will be just a matter of time till the patient awakens and everything will be fine and dandy. Also, often movies could be used for teaching purposes, so accuracy is important in that setting."

Dr. Wijdicks proposes several solutions to better portray coma in motion pictures:

  • Screenwriters might use coma less in motion picture comedies, as this genre could potentially tend toward ridicule of a catastrophic illness, including the agony of a family during a patient's prolonged coma and rehabilitation.
  • Actors portraying those in a coma might visit neurology intensive care units or neurology rehabilitation centers to observe patients in a coma or rehabilitating after a coma.
  • Producers might have the screenplay reviewed by a neurologist, a neurology nurse specialist, or other medical professional who specializes in neuroscience.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.


What Is Coma?

According to the National Institute of Neurological Disorders and Stroke (NINDS), coma is a profound or deep state of unconsciousness. An individual in a state of coma is alive but unable to move or respond to his or her environment.

NINDS states that coma may occur as a complication of an underlying illness, or as a result of injuries, such as head trauma.

According to the Brain Injury Association of America, persons in a coma appear to be asleep, but cannot be awakened, and they have no meaningful response to stimulation.

A persistent vegetative state (commonly, but incorrectly, referred to as "brain-death") sometimes follows a coma, says NINDS.

Individuals in a persistent vegetative state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function (such as breathing and circulation) and normal sleep patterns.

Spontaneous movements may occur, and the eyes may open in response to external stimuli. A person in this state may even occasionally grimace, cry, or laugh.

Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands.

Other facts about coma from the Brain Injury Association of America include:

  • A coma is a continued unconscious state that can occur as part of the natural recovery for a person who has experienced a severe brain injury.
  • While in a coma, a person can continue to heal and progress through different states of consciousness.
  • Persons who sustain a severe brain injury and experience coma can make significant improvements, but are often left with permanent physical, cognitive, or behavioral impairments.
  • A coma can last days, weeks, months, or indefinitely. The length of a coma cannot be accurately predicted or known.
  • Physicians may not be able to state how long a person will be in a coma or what the person will be like when they come out of the coma. There is no treatment physicians can use to make a person come out of a coma. Likewise, there is no test physicians can use to predict when a person will come out of a coma or what a person’s recovery will be like.

Always consult your physician for more information.


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