As the 21st Century plugs away, the demographics of aging are undeniable in the U.S. and other developed nations. We are living longer while advances in nutrition and health care mean that more of us are living better. One side effect of this is how middle age seems to creep older and older. If people expect to live to be 90 or 95, then they are not literally at mid-life until they are close to 50. And the term “middle aged” often implies over 50 nowadays. As we keep hearing, 50 is the new 40, and 40 is the new 30, and so it goes. But age denial and reversal are finite, not infinite. The movie Amour, by filmmaker Michael Haneke, starring Jean-Louis Trintignant, Emmanuelle Riva and Isabelle Huppert, offers a stark example of this finitude as it depicts an older French couple who face their own aging, disability and, eventually, death.
My husband and I saw Amour, after its nomination for an Academy Award for Best Picture. The New York Times called it a masterpiece. Indeed, the theater was full. But I was surprised I did not see more people approximately our age: mid-life adults. Instead, the theater was filled with older people on the verge of the situations portrayed in the film. I speculated that people my age and younger do not wish to think about the possibility of our parents, spouses, or ourselves becoming disabled in old age and needing care.
The major themes of Amour are two-fold: aging with a debilitating condition that brings decline and hastens the final path towards death, and caring for a loved one who is on that final path.
The story is quite simple. Anne and Georges are an upper-middle-class couple, both apparently retired musicians, who live in a lovely old apartment of typical French urban style. Anne experiences a mild stroke one morning at the breakfast table that leaves few after-effects, but having observed her, Georges becomes concerned. Anne soon has a more serious stroke that leaves one side paralyzed and after a brief hospital stay and a failed surgery to clear her carotid artery, she returns home in a wheelchair. At this point, it appears that the loving and stoic Georges provides all of the care she needs, and we see him helping her transfer from chair to chair, chair to bed, and to the bathroom. He leaves her alone to attend a funeral and she is seated on the floor when he returns. The couple’s daughter visits periodically, chats and offers advice, but never is shown to help.
Finally we learn that Anne has had a third stroke that affects her speech and her ability to control her elimination or feed herself. Georges hires first one, then two “nurses” to come in and bathe, feed, and care for Anne, but only part-time. We see him coaxing her to eat and drink, learning to change her diaper, and telling her intimate, sweet stories. In a film shot almost entirely within their apartment, devoid of background music to soften the silence, we see that it all begins to be too much for this loving man as his wife’s condition deteriorates.
A fairly realistic story, Amour captures several important universal truths about caregiving.
- First, caregiving is a rather insidious process that often begins as an extension of a normal reciprocal relationship, but then becomes more and more the major function of their interaction. We see Anne and Georges’ loving everyday relationship continue through her deteriorating condition, but we also see that he spends more and more time and effort on her needs as the film and her condition progress.
- Second, caregiving has the potential to become exhausting to the caregiver, and to place his or her health and mental health at risk. This message is very clear in the film, as we see the caregiver Georges, who is quite old himself, looking more fatigued as time passes, his movements subtly slowing. He fails in his struggle to keep his temper at one point when he slaps her when she refuses to eat. Were Anne not relatively petite and slim, or were their roles reversed, the physical tasks he managed with her would have been nearly impossible.
- Third, caregiving for someone with serious impairments, whether mental or physical, is best attempted with openness to help and support. Yet because of the insidiousness of the process and a worldview that insists independence is best, people involved do not always seek help and support. They may even reject what is offered. In Amour, Anne and Georges isolate themselves in a nest of privacy and do not communicate much with others. Towards the end of the film, we learn that he no longer answers his phone. We understand that Anne, recently an attractive, put-together and accomplished older woman, does not wish to be seen by others in her new state. Georges seems to go along with this so that they are enveloped in a world populated only by one another and a few paid helpers with whom they engage quite formally.
From the perspective of a gerontological social worker, it is safe to say that Anne would have benefitted from more social stimulation and supportive counseling. She expresses her disinterest in living, a clear sign of depression, although the viewer of the film can empathize with this feeling. Frankly, she also might have felt better had her husband not been her main physical caregiver. She could sense the fatigue he experienced and the physical and emotional strain on him. The matter-of-fact kindness and strength of relative strangers who are competent, respectful and accustomed to helping the sick and disabled can sometimes be a comfort to those needing the help.
The caregiving husband, Georges, would have benefitted from respite, from empathic moral support, and from more assistance to help with Anne’s daily care, sooner than he gets it in the film. By the time their daughter half-heartedly tries to intervene to help him, it is too late. He is emotionally and physically drained and cannot reasonably respond to her offer nor envision how anyone could help them.
Beyond these important messages about caregiving, there is another even more universal and important theme underlying the movie: the later part of the cycle of life often includes declining health and strength and increasing dependence on others. Old age sometimes brings seriously debilitating illnesses or conditions, particularly in the months to several years prior to death. Life with strokes, cancer, Alzheimer’s disease, and any number of other serious acute or chronic conditions can become a messy business. It is a simple fact that people with these conditions begin to need help and care. Even without any specific medical condition, if we live long enough, physical challenges will eventually catch up with us.
Anne and Georges react to the real changes to her body and mind, to the physical realities and stresses. But they also seem to be deeply affected by stigma associated with becoming weak, dependent and less in control of one’s body. This shame and embarrassment, and all the efforts to hide or deny the effects of age-related conditions and situations, can make matters worse.
As I was writing this, I came upon an essay in the New York Times “Opinionator” column, “You are going to die,” (January 20, 2013) by Tim Kreider. His thinking and mine have intersected at this important issue. I will quote here just a brief portion of his excellent piece: “Aging and death are embarrassing medical conditions, like hemorrhoids or eczema, best kept out of sight. Survivors of serious illness or injuries have written that, once they were sick or disabled, they found themselves confined to a different world, a world of sick people, invisible to the rest of us.”
We are all growing older. We cannot expect to remain as strong and quick as we were at earlier ages. This is obvious, yet we like to avoid the thought; we do not always accept it deep in ourselves. Further, it’s a fact that some of us may die peacefully in our sleep, with all of our abilities intact, independent and able till the end. But many of us may decline gradually, in less appealing ways, losing this capability and that, requiring help to dress and bathe and eat, and yes, even to use the toilet. There is no shame in this; it should not be a secret.