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The arts get real about dementia
‘I noticed something about dementia, which is that, however bleak it is, it also often involves comedy’
Tomorrow night, fans of the ITV soap Emmerdale will be in mourning as the series says goodbye to one of its most popular characters, vicar Ashley Thomas, who will bow out after 20 years following a battle with dementia. But sad as it is, the show has much reason to celebrate the success of the storyline: a shining example of the power of soaps in depicting social issues, it has been hailed as one of the most accurate screen depictions so far of the realities of the condition.
Two years ago, Thomas, played by John Middleton, was diagnosed with early-onset vascular dementia following a head injury in a car accident. Since then, his decline has been depicted in a manner both humane and unflinching, and played out in increments.
Of particular note was a special episode last December told solely from Ashley’s point of view. Unusual camera angles and time-jumps were used to demonstrate Ashley’s state of confusion, and regular actors were replaced by unfamiliar faces to replicate how difficult it was for the character to recognise his family and friends. It immersed the viewer in his suffering in a way that felt more like the stuff of cinema than soap opera.
“Soaps [have tended] to introduce a disability and then kill the character off,” says Kathryn Smith from Alzheimer’s Society, noting the particularly sensitive way that
Emmerdale has dealt with dementia. This contrasts with other recent examples in Coronation Street and
EastEnders, where characters with dementia have been brought in as plot devices and then disposed of – electrocuting themselves with a toaster and in the bath, respectively – in ways that might be considered sensationalist or scaremongering. “What’s impressive with
Emmerdale is that they showed the gradual impact on Ashley’s life and family,” says Smith. “It wasn’t just about him but how difficult it was for his family, especially in the later stages. But, essentially, they showed Ashley living well with dementia.”
Indeed, Alzheimer’s Society deemed the portrayal so convincing that they now use the December point-of-view episode as a training tool for staff who work directly with people with dementia, as a representation of what it might be like to live with the condition.
Of course, Emmerdale is an entertainment show and has a duty to balance reality and drama. For that reason, the producers decided to focus on stroke-related vascular dementia, as opposed to Alzheimer’s, since the symptoms, including sudden confusion, rapid mood swings and less fluent speech, develop suddenly. As Middleton notes, it tends to lend itself “to a more dramatic way of storytelling”.
But, says Emmerdale’s series producer Iain MacLeod, they were careful not to over-dramatise it: “The risk is that you take too much artistic licence and end up getting it wrong or offending people. But in the case of vascular dementia, the symptoms are so varied that you don’t need to embellish anything. You just tell it straight and it will be really interesting television.”
Emmerdale is just one example of how culture is finally getting to grips with a condition that strikes to the heart of society. There are currently 850,000 people in the UK living with dementia, a figure that is consistently rising due to our ageing population; Alzheimer’s Society have predicted that by 2051 more than two million people will have the condition. Yet until recently, the disease rarely got any dramatic airtime and instead mostly manifested itself on screen in the crass, generalised comic stereotype of the doddering oldo person, from Dad’s Army’s Godfrey to June Whitfield’s Mother in Absolutely Fabulous. Not that humour can’t elucidate dementia, when used correctly. David Baddiel’s hit stand-up show My Family: Not the Sitcom, which has just returned for a second West End run, does just that. It focuses on his relationship with his father, who has Pick’s disease, a rare form of dementia, the symptoms of which include incessant swearing, irritability and sexual disinhibition. Baddiel talks at ease and with respect about some of the more frightful experiences undergone by his father and those caring for him – though it is also a warm show, stoked throughout with love for his family.
For Baddiel, who has just become an ambassador for Alzheimer’s Society, the show has a very real educational intent. “Because a silence surrounds the disease, we get a very monotone idea of what dementia is – essentially an old person staring vacantly into space – and actually there are many wild and whirling varieties. People with dementia are still people and not just defined by the disease. I thought my dad was a very strong example of that,” he says.
The show is also for him, night in night out, cathartic: humour has proved an essential coping mechanism, he says. “I noticed something about dementia, which is that, however bleak it is, it also often involves comedy. In my father’s case, he became so completely uninhibited and just started saying whatever he liked to anyone. Which just was, and remains, funny,” he says.
“There’s a silence that surrounds dementia – a shame – and comedy about it at least means that that’s being challenged, because it’s out in the open. Secondly, it stops people being so terrified. Terror is only made worse by silence, and the only real weapon we have against things that are genuinely terrifying is laughter,” he says.
Baddiel also recently made a documentary for Channel 4 on the subject, The Trouble With Dad, in which he talked about the progression of his father’s disease and the impact it has had on his family. “At a deeper level, it was about families, and about maleness – about men trying to care for each other. Which I also think we don’t see that much of.” Indeed, in portraying at close quarters the relationship between Baddiel and his brother Ivor and how they responded to their father’s diagnosis, the documentary arguably helped open out the subject to a male audience in particular, puncturing the bravado that exists among men around weakness and debilitation.
What’s clear from both the praise afforded Emmerdale and the popularity of Baddiel’s show is that the world is crying out for more conversations about dementia – and more nuance. Smith says that misrepresentations of dementia come in a number of forms. First of all, she says “quite often when dementia is portrayed on TV it is shown as a natural part of ageing and an old person’s disease, and neither of those things are correct”. Meanwhile, “one of the worst things that TV can do is portray any disability or disease as a completely lost cause. That is not helpful,” she adds.
Equally, though, it does no good to understate the consequences of dementia and portray the condition as mere memory loss, without any of the real physical debilitation and mental anguish. Such a misguidedly soft-focus portrayal can be seen in Hollywood weepie The Notebook, where an older version of the main character displays very few symptoms of the condition and remains verbally fluent.
By contrast, there was a forensic quality to the distressing 2014 drama Still Alice. Something of a breakthrough in Hollywood, it depicted a university professor (played by Julianne Moore, who won an Oscar for her efforts) and her family as they adjusted to her diagnosis of early-onset Alzheimer’s.
Moore’s devastating portrayal of her character’s slide towards mental incapacity aside, the film did a good job of targeting society’s harmful attitudes to those living with the illness. Its call to arms is a speech given by Alice where she rails against the perception of people with dementia as being “incapable, ridiculous, comic”. The only fault perhaps is a certain highsheen visual glossiness that keeps us the audience one step removed from the grim reality.
One film that certainly can’t be accused of glossiness in its depiction of dementia, however, is 2011’s The
Iron Lady, a biopic of Margaret Thatcher starring Meryl Streep, in which the story of her political career is framed by utterly bleak scenes of a dying Thatcher, debilitated by vascular dementia. It may be uncomfortable viewing but, as Smith says, is far from being gratuitously demeaning: depicting a figure like Thatcher succumbing to dementia has a valuable purpose.
“One of the big problems is the stigma attached to [dementia],” she says. “[Seeing] famous people such as Margaret Thatcher and Terry Pratchett with dementia [helps] the general public to see that it’s a very common disease that could happen to anyone and that it’s nothing to be ashamed of.”
As for Emmerdale, tomorrow night it will say goodbye to Ashley in a manner that keeps things balanced right up to the very end. “It’s a brutal illness, and it strips away everything that is you,” says MacLeod. “But it can also be lighthearted and funny and absurd; there can be joyous moments. It would be a disservice to make [the final episode] too miserable. We wanted to show a good death.”