Fiddling Around with Eternal Sunshine

Viewing "Eternal Sunshine of the Spotless Mind" through a psychiatrist's lens

Posted Feb 25, 2019

Introduction

I provide a monthly didactic at Rutgers Robert Wood Johnson Medical School called “FIDLER” (hence the title of this blog) that is centered around a feature-length film that we flip as a fictional case study of mental illness. The objective is not to render diagnoses per se as it would run the risk of stigmatizing individuals with mental illness (films universally provide inaccurate portrayals of mental disorders). Instead, the selected film serves to stimulate discussion over social media to educate learners as well as inform the public about mental illness. The following blog is a pre-posting of our discussion.

Synopsis

To celebrate Valentine’s Day (belatedly), we’ll focus on Eternal Sunshine of the Spotless Mind (2004), a science fiction romantic comedy that follows an estranged couple who have erased each other from their memories. The film uses a nonlinear narrative to explore the neurobiology of memory (1). As of this posting, the film holds a 93% rating on Rotten Tomatoes and a score of 8.3 out of 10 on IMDb.

How it relates to the field of psychiatry

As depicted in the House (House M.D.) episode “Words and Deeds,” Dr. House recommends using electroconvulsive therapy (ECT) on a patient with Takotsubo cardiomyopathy (Broken Heart Syndrome). The plan was to remove the patient’s memories of a lost love so as to alleviate his depression. This narrative closely parallels our selected film whereupon discovering Clementine had hired a New York City firm (Lacuna, Inc.) to erase memories of their relationship, Joel became depressed and decided to undergo the procedure himself. Was this a metaphor of ECT?

As previously mentioned, the objective of these blogs is not to render diagnoses (or treatments) per se as it would run the risk of promoting the stigma of mental illness. While misrepresented in House and ill-referenced in the film (by me), this underscores the important quality of educating through various forms of media in that we can get as much from what media get wrong as what they get correct. ECT does not target specific areas of the brain such as the hippocampus (memory). While memory loss may be a side effect of ECT, such effects are non-selective, usually transient, and impact memories around the time of the procedure itself (anterograde) and not previously established memories as depicted in both the TV show and film. In House, the number of ECT sessions required to cause retrograde amnesia as a side effect would have been 10x the number needed (8-10) to alleviate the character’s depression in the first place.

Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe affective states (major depressive and bipolar disorder). Under the supervision of a multidisciplinary team (psychiatrist, anesthesiologist, and a nurse), the patient is administered brief electrical stimulation of the brain while under general anesthesia (and muscle paralysis). The electrical stimulus initiates a time-limited seizure that exerts the procedure’s therapeutic (e.g. antidepressant) effect.    

While indicated for several conditions, ECT is typically used when other treatments have been unsuccessful (2). Extensive research has found ECT to be highly effective for the relief of major depression. Clinical evidence indicates that for individuals with but severe depression, ECT will produce substantial improvement in approximately 80% of patients (3).

In the US, ECT’s effectiveness in treating severe mental illnesses is recognized by the American Psychiatric Association, the American Medical Association, and the National Institute of Mental Health.

In the film, Joel’s metaphorically receiving ECT wasn’t to erase his memories per se but instead intended to alleviate a depressive disorder thus allowing him to “rediscover” his love for Clementine who is also battling severe depression. Informed readers/viewers must decide; are works like these to be taken verbatim or should they be refocused through the lens of a psychiatrist so as to raise awareness of disorders such as depression while avoiding promoting the stigma of mental illness? 

The characters in of Eternal Sunshine of the Spotless Mind are very complex. For greater detail of their psychiatric formulations, join the conversation on Twitter on 1/28/2019 at 6:00 EST by following the hashtag #FIDLERsunshine.

References

https://en.wikipedia.org/wiki/Eternal_Sunshine_of_the_Spotless_Mind

American Psychiatric Association Task Force on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. American Psychiatric Association, Washington, DC 2001.

William McDonald, M.D., Emory University School of Medicine; Laura Fochtmann, M.D., Stony Brook Medicine https://www.psychiatry.org/patients-families/ect