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An Exploration of how Film Portrays Psychopathology: the Depiction of PTSD in Waltz with Bashir. Health Humanities Seminar The University of Nottingham Nottingham, England. 28 th June 2013. Dr. Ahmed Hankir Dr. Mark Agius. Aims:

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    1. An Exploration of how Film Portrays Psychopathology: the Depiction of PTSD in Waltz with Bashir.Health Humanities SeminarThe University of NottinghamNottingham, England. 28th June 2013 Dr. Ahmed Hankir Dr. Mark Agius

    2. Aims: • Signpost my own personal trajectory and broach on what has piqued my interest in cultural psychiatry and the health humanities: my background, Clare College (Cambridge University) and the vibrant cosmopolitan city of Manchester. • To provide you with salient information on Lebanon and the impact that the Sabra and Shatila massacres had on the Lebanese, the Palestinians and the Israelis. • A brief overview of PTSD • Art Therapy (cinematherapy, and bibiliotherapy) Medfest and the portrayal of mental illness in film. • An analysis and discussion of Ari Folman’s Academy Award nominated animated documentary film Waltz with Bashir.

    3. This presentation is punctuated with slides that contain scenes from popular mainstream motion pictures. I will test your knowledge in film so to galvanise you lest my talk is soporific and you all succomb to slumber!

    4. SPIEL!

    5. Life is indeed darkness, save when there is urgeAnd all urge is blind, save when there is knowledgeAnd all knowledge is empty, save when there is workAnd all work is in vein, save when there is loveAnd when you work with love, you bind yourself to yourself and to other and to God…Khalil Gibran, The Prophet

    6. AN EXPLORATION OF HOW FILM PORTRAYS PSYCHOPATHOLOGY: THE ANIMATED DOCUMENTARY FILM WALTZ WITH BASHIR, THE DEPICTION OF PTSD AND CULTURAL PERCEPTIONS. • Ahmed Hankir(1) & Mark Agius(2,3,4) • The Royal Oldham Hospital, Oldham, England, UK • South Essex Partnership University Foundation NHS Trust, UK • Department of Psychiatry University of Cambridge, UK • Clare College Cambridge, UK • PsychiatriaDanubina, 2012;Vol .24, Suppl. 1, pp 70-76 Abstract With the inauguration of the UK’s first ever Medical Film festival MedFest in 2011 there has been resurgence in the interest of the association between psychiatry and film. The festival in 2012 was titled “HealthScreen”: Understanding Illness through Film and its aim, according to the founder Dr Kamran Ahmed, was, 'To stimulate debate of the social, political and ethical implications of portrayals of health and illness on our screens' (1). Waltz with Bashir is a 2008 Israeli animated documentary film written and directed by Ari Folman. It portrays the protagonist (Folman) in search of his lost memories of his experience as a soldier in the 1982 Lebanon War and his attempt to both decipher them and reconcile himself with them. 2012 marks the 30th year commemoration of the Sabra and Shatilla tragedies. Waltz with Bashir vividly depicts the massacres of Palestinians in the Sabra and Shatilla refugee camps in Beirut through the lens of an ex-IDF serviceman and the harrowing effects that PTSD has on him. Waltz with Bashir was nominated for an Academy Award for Best Foreign Language Film however despite the popularity of the film and much critical acclaim it is officially banned in Lebanon. The authors are mindful of the devastating effects that the atrocities have had on the mental health of all those who were involved, the Lebanese, Palestinians and also the Israelis. The purpose of this presentation is to explore how the film Waltz with Bashir portrays PTSD and how it has influenced cultural perceptions.

    7. Meeting of Psychiatry Research Groups. September 2012. Clare College, Cambridge University. Organisers Dr. Mark Agius and Dr. Rashid Zaman.

    8. Dr. Rashid Zaman Consultant Psychiatrist and Hon. Fellow, University of Cambridge and Dr. Ahmed Hankir. Clare College, Cambridge University, September 2012.

    9. The Double Helix Noble Prize Laureates in Physiology or Medicine (1962) Professor James Watson and Professor Francis Crick. Discoverers of the Structure of DNA. Clare College, Cambridge.

    10. 2013 Cambridge/Luton Biennial International Conference in Mental Health 5-7th September 2013 Clare College, University of Cambridge Cambridge, England, UK • Talks from many eminent psychiatrists in the world and much, much more… • Competitions for PhD students and medical students • All inclusive cost £537 (dinner each night, Gala dinner, breakfast, lunch, refreshments throughout the conference and accommodation). • http://www.bcmhr-cu.org/ (conference details posted later) • For further information contact: • Dr. Mark Agius; ma393@cam.ac.uk

    11. ‘Oh, so you think the darkness is your ally? You merely adopted the dark. I was born in it, moulded by it, I didn’t see the light until I was already a man. By then, it was nothing but blinding to me. Your shadows betray you because they belong to me. Bane, The Dark Knight Rises

    12. UK Jewish Film Festival 1st – 18th November 2012 “UK Jewish Film Festival promotes awareness of international Jewish life and cultures for an inclusive audience.”

    13. The 16th UK Jewish Film Festival went national for the first time and screened at five cities around the UK throughout November 2012 . The festival’s wide-reaching programme in CORNERHOUSE in Manchester included documentary, quirky French comedy and award-winning drama.

    14. “The UK Jewish Film Festival remains one of the highlights of the screen calendar.”Empire “There’s always a mix of the serious and the hilarious.”The Guardian

    15. CORNERHOUSE MANCHESTER CORNERHOUSE is Manchester’s international centre for contemporary visual arts and independent film. It was founded in1985 and has been at the forefront of Manchester’s vibrant cultural scene ever since. CORNERHOUSE’s patrons are Oscar winning director Danny Boyle and Oscar winning actress Dame Helen Mirren.

    16. An Ode to Manchester: Vibrant City of Culture...

    17. “My father’s people say that at the birth of the sun and of his brother the moon, the mother died. So the sun gave to the earth her body from which was to spring all life and he drew forth from her the breast the stars and through them into the night sky to remind him of her soul…” The Last of the Mohicans

    18. Operation Peace for Galilee: Introduction • 1982 Israel-Lebanon War dubbed Operation Peace for Galilee. • BashirGemayal leader of the Phalange party in Lebanon and president elect assassinated. • 2,000 Palestinian souls perished in the Sabra and Shatila Palestinian refugee camps in West Beirut as a result of the atrocities perpetrated by members of the Phalange party. • 2012 marks the 30th year commemoration of the Sabra and Shatila massacres in Lebanon.

    19. Waltz with Bashir • Waltz with Bashir 2008 animated documentary film inspired by true events and written and directed by Ari Folman. • Nominated for an Academy Award for best foreign language film. • Despite positive reviews Waltz with Bashir is officially banned in the Lebanon. • Depicts the Sabra and Shatila massacres through an Israeli veteran’s lens. Ari Folman served a tour of duty in the Lebanon in 1982 and is the protagonist of the film. • Memories of those dark days have not faded and still influence attitudes and discourse today.

    20. What people have said about Lebanon… “Everything seemed possible in Beirut then-- every kind of person, every idea and identity…”Professor Edward Said, Professor of Comparative Literature Columbia University, The ‘Voice of Palestine’.

    21. Greatest novel in the Arabic language of the 20th century. The book was banned in author Tayeb Saleh’s country of origin the Sudan for being too salacious and lascivious which was in violation of the sanctity of Islamic propriety. Book was first published in 1966 in Beirut, Lebanon.

    22. Pity The Nation… Pity the nation that is full of beliefs and empty of religion.Pity the nation that wears a cloth it does not weave,eats a bread it does not harvest,and drinks a wine that flows not from its own wine-press. Pity the nation that acclaims the bully as hero,and that deems the glittering conqueror bountiful. Pity a nation that despises a passion in its dream,yet submits in its awakening. Pity the nation that raises not its voicesave when it walks in a funeral,boasts not except among its ruins,and will rebel not save when its neck is laidbetween the sword and the block. Pity the nation whose statesman is a fox,whose philosopher is a juggler,and whose art is the art of patching and mimicking. Pity the nation that welcomes its new ruler with trumpeting,and farewells him with hooting,only to welcome another with trumpeting again. Pity the nation whose sages are dumb with yearsand whose strong men are yet in the cradle. Pity the nation divided into fragments,each fragment deeming itself a nation Lebanese poet/mystic Khalil Gibran

    23. Pity the Nation: an Alternative Account of Sabra and Shatila Massacres Foreign Correspondent Robert Fisk

    24. Dr. Swee Ang, ‘The Angel of Beirut’: her book From Beirut to Jerusalem. Another Alternative Account of the Sabra and Shatila Massacres…

    25. From Left to Right: Mr Hazem Badih, Dr. Ahmed Hankir, Dr. Swee Ang, Dr. Asad Khan, Dr. Zakaria Hankir. Talk on the 30th year commemoration of the Sabra and Shatila Massacres. Labib Medical Centre, Sidon, Lebanon, 15th of September 2012.

    26. Lebanon is now, once again, boasting a spectacular opulence courtesy, in no small measure, of the efforts of the assassinated billionaire tycoon and former Prime Minister of Lebanon Rafic Hariri (the International airport in Beirut bears his name).

    27. Beirut: the ‘Paris’ of the Middle East In 2009, the New York Times ranked Beirut the No. 1 travel destination worldwide due to its unique nightlife and hospitality.

    28. Lebanon The Spectacular Roman Ruins of Baalbeck… The romance of the ancient Phoenician port of Byblos… The interminable streets of Down town Beirut… The irresistible allure of the Beach Resort in Tyre… The luster of beaches…

    29. Crossing Boundaries: Elective Opportunities in the Lebanon, the Abouzahr Elective Scheme of Phoenicia (AESOP) Dr Labib Abouzahr, Mr Mouin Abouzahr, Dr Hazem Badih, Dr Ahmed Hankir Dr Labib Abouzahr Sr Founder of LMC Ancient Phoenician Port of Sidon, Lebanon Labib Medical Center, Sidon, Lebanon • CEO of LMC: Dr LabibAbouzahrJr, MD, FRCSC • MD degree American University of Beirut • Residency training in General Surgery and Cardio-Thoracic Surgery at the University of Toronto • Fellow of the Royal College of Physicians & Surgeons of Canada (FRCSC) with certification in General Surgery (1994) & Cardiothoracic Surgery (1997) • Attending surgeon at Sunnybrook Health Sciences Centre & Lecturer at the University of Toronto, 1998-9 • Assistant Clinical Professor, McMaster University & Hamilton Health Sciences, 1999-2005 • CEO & Chief-of-Staff at Labib Medical Center (2005-) • Founder and Chief of Cardio-Thoracic Surgery unit at Clemenceau Medical Center (Affiliated with Johns Hopkins International) (2005-) • Teaching awards (for teaching students & residents) from University of Toronto & the Canadian association of General Surgeons • Labib Medical center (LMC) is a hospital situated in the ancient Phoenician port of Sidon, Lebanon • Dr. Labib Kamel Abouzahr founder of LMC in 1973. Dr. Abouzahr Sr was Chief Surgeon and Chief Executive Officer (CEO) of LMC. • Dr Abouzahr Sr general surgeon and graduate of the American University of Beirut. Received specialty training at Fordham Hospital in New York. • Labib Abouzahr Jr FRCSC, CEO & Chief of Staff incumbent, Mr Mouin Abouzahr General Director, Mr Hazim Badih FRCSI Medical Director, • AESOP enables medics to compare and contrast the disparate healthcare systems in the Mediterranean and the UK. • AESOP provides medics with hospital accommodation, daily meals, sponsorship to attend international conferences in Beirut, the dazzling capital city of Lebanon and much, much more… • http://www.labibmedicalcenter.com/ • Contact: ahmedzakaria@doctors.org.uk Dr Labib Abouzahr Jr Mr Mouin Abouzahr, General Director of LMC

    30. Elective Opportunities in Lebanon World Journal of Medical Education and Research Issue 1 Hankir, A ; Albazi, M. p.91-93 Elective Opportunities in Lebanon: the Abouzahr Elective Scheme of Phoenicia (AESOP). World Journal of Medical Education and Research Issue 1 Hankir, A ; Yaacoub, G; Abouzahr, L. p. 94-96

    31. “I’ve seen things you people wouldn’t believe. Attack ships on fire off the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhauser Gate. All those moments will disappear like these tears in the rain. Time to die…” Blade Runner

    32. Post Traumatic Stress Disorder (PTSD) Severe anxiety disorder which may develop as a consequence of exposure to any event which results in psychological trauma. Symptoms of this condition include re-experiencing the original trauma(s) through flashbacks or nightmares, anger, hypervigilance and difficulty falling or staying asleep. The DSM and ICD diagnostic criteria require that the symptoms last more than one month and cause impairment of social, occupational, and other important areas of functioning.

    33. C.S Myers The Lancet 1915 Shell Shock ...everyone had a ‘breaking point’: weak or strong, courageous or cowardly- war frightened everyone witless...

    34. Reference to Film... “Insanity is much like gravity, all it takes is a little push...” ‘The Joker’ Batman, The Dark Knight

    35. PTSD: Treatment and Epidemiology PTSD can be treated using psychological methods such as CBT and Eye movement desensitization and reprocessing (EMDR), as well as medical treatment with combinations of antidepressants and antipsychotics. It is known that sophisticated armies, such as that of the USA, do suffer important rates of PTSD. Interestingly and controversially, the British Army does not appear at present to suffer severe rates of PTSD. Another sophisticated army is the Israeli Defense Forces, but unlike in British servicemen, Israeli veterans did experience PTSD in significant numbers.

    36. “The path of the righteous man is beset on all sides…” Ezekiel 27:17

    37. Who is he?

    38. Film and Psychiatry “If you really want to understand a man, you have to slip into his shoes and walk around in them…” Atticus Finch, To Kill a Mocking Bird Cinema offers an unrivalled medium for entertainment, but also a unique interface for education. Indeed public opinion is heavily influenced by vivid images in the form of adverts, documentaries, and feature films. Film, as alluded to in the epigraph of this slide, can provide viewers with a precious qualititative insight into the psyche of people with psychopathology so that we may “Slip into their shoes and walk around in them”. By virtue of cinema, we can learn more about what mental illness is like from the inside and this in turn can help us to better understand what it is like to have a psychiatric disorder.

    39. Medfest MedFest was founded in 2011 as the UK's first ever Medical Film Festival. The purpose of Medfest is to explore the relationship between medicine and cinema. The aim of the 2012 festival was, 'To stimulate debate of the social, political and ethical implications of portrayals of health and illness on our screens‘

    40. Royal College of Psychiatrists: Minds on Film The Royal College of Psychiatrists has a section on its website entitled Minds on Film. According to the website, ‘Minds on Film is a monthly blog that explores psychiatric conditions and mental health issues as portrayed in a selection of readily available films.’

    41. Cinematherapy (Niemiec & Wedding, 2008): Deterring Substance Abuse/Misuse “Every time he put the bottle to his mouth, he wouldn’t suck from out of it but it would suck from out of him until he was yellow and wrinkled and not even the dogs would recognise him...”

    42. Cinematherapy (Niemiec & Wedding, 2008) : Inculcating values “The whole world is in chess, any move can be the death of you, do anything except for remain where you started and you can’t be sure of your end. None of us are sure of our end really or what hand will guide us there, a king may move a man, a father may claim a son, that man can also move himself and only then does that man truly begin to play his own game. Remember, howsoever you are played or by whom, your soul is in your keeping alone even though those who presume to play you be kings or men of power. When you stand before God you cannot say, ‘But I was told by others to do thus, or, ‘that virtue was not convenient at the time. Remember that...”

    43. The Health Humanities... 'To restore the human subject at the centre -the suffering, afflicted, fighting, human subject - we must deepen a case history to a narrative or tale...' (1985)

    44. Jung’s Archetype ‘the Wounded Healer’ and Autobiographical Narrative: 2012 RCPsych Morris Markowe Award Winning Article, ‘Doctors Go Mad Too’ by Dr. Claire Polkinghorn …As a psychiatrist, I had hoped that I was pretty good at empathising with my patients. However, the last nine months of my life has taught me more about mental illness than years of clinics, ward-rounds, home visits or reading psychiatric literature. I have been signed off sick with a depressive illness, was detained under the mental health act and spent six weeks in an NHS psychiatric hospital…

    45. Poet David Holloway’s Moving Autobiographical Narrative, ‘The ‘Colours’ of Schizophrenia’. Cutting Edge Psychiatry in Practice Issue 1

    46. ‘The Verses of Madness’: Schizophrenia and Poetry. BMJ Case Reports. Hankir, A; Holloway, D; Agius, M; Zaman, R Abstract In the early 19th century Lombroso introduced the concept of ‘hereditary taint’ to describe the co-existence of ‘madness’ and creativity. In a more recent investigation, Rust et al reported a study designed to test the traditionally assumed relationship between creativity and schizophrenia. They uncovered an association between creative originality and the positive cognitive aspects of schizotypal thinking. Poetry is not only the ‘product’ of psychopathology but it can also be utilised as a form of therapy: ‘My name is David Holloway, I am a 32 year old poet/blogger with paranoid schizophrenia. A poet called Charles Bukowski has described poetry as the 'ultimate psychiatrist', and I am a firm believer in this. The strongest part of my personality is my belief in the power of love. My recovery has relied heavily on medication, diet and exercise. However it is the power of poetry that has been my true inspiration.’

    47. Dr. Ahmed Hankir, Poet David Holloway 2012 International Symposium of Poetry and Medicine, London, England

    48. ‘The soldier must make the decision, the man must live with the consequences...’