: Side Effects

Side Effects

Stephen Tang and Mabel Tsui

side-effects-coverDirector: Steven Soderbergh; starring: Jude Law, Rooney Mara, Channing Tatum and Catherine Zeta-Jones; Roadshow, 2013, 106 mins, available on DVD, $39.99

Side Effects, it initially seems, is a movie about the immorality of the pharmaceutical industry and those complicit in its excesses and evils.

Emily (Rooney Mara) has enjoyed the good life her investment banker husband Martin (Channing Tatum) was able to provide for her until he was arrested and sentenced to jail for insider trading. The film starts with his release and the young couple are looking forward to a new start in life. Then Emily deliberately crashes her car into a brick wall. Taken to hospital, she is assessed by psychiatrist Dr Jon Banks (Jude Law) who suspects Emily attempted suicide. He is persuaded not to treat her as an inpatient and instead prescribes an unnamed SSRI (Selective Serotonin Re-uptake Inhibitor) to help with her depression. Martin, asking what the medication does, is told that ‘it helps stop the brain from telling you you’re sad’. This commonly-used explanation is much nicer than the reality: that we don’t really know how SSRIs work for depression, or whether they’re effective at all.

Unfortunately, that reality occurs here: shortly after taking the SSRIs, Emily nearly puts herself in the path of an oncoming train. She also shows and complains of the common side effects of SSRIs – nausea, poor concentration, low sex drive and a general lack of improvement. Dr Banks prescribes the new antidepressant Ablixa, championed by Emily’s enigmatic former psychiatrist Dr Victoria Siebert (Catherine Zeta-Jones) to a stultifyingly passive Banks who accepts without question the benefits of Ablixa as well as an Ablixa promotional pen. The pen is only one of the many examples of the lengths director Steven Soderbergh went to in order to portray the reality of the industry. Another impressive example is the website set up to ‘promote’ the fictional Ablixa — http://www.tryablixa.com, complete with product information and an optimistic catchline, ‘Take Back Tomorrow.’

Ablixa brings about a remarkable change in Emily — scenes of the couple enjoying life are shown in a dream-like sequence. It could easily be footage lifted from any number of US television antidepressant ads, from which we are graciously spared in Australia, where the side-effects (dry mouth, dizziness, diarrhoea, death…) are rapidly muttered over scenes of idyllic slow-motion reality. Cut to a scene of Emily and Martin having vigorous, satisfying sex. ‘Whoever makes this drug is going to be fucking rich’, says Martin, post-coitally.

Life seems good. However, like all drugs, Ablixa comes with its own set of side effects, one of which is sleep-walking and odd sleep behaviours (parasomnias), such as setting the table and preparing breakfast in the middle of the night. Is this reason for Emily to discontinue the drug? She thinks so but Martin isn’t convinced, so satisfied is he with Emily’s progress on Ablixa. Unfortunately, he is shortly afterwards stabbed and killed by Emily while she is in one of her drug induced sleep-walking episodes.

Emily stands trial for his murder. Is she, as Dr Banks claims, a ‘victim of circumstance and biology?’ The case ignites public interest and scrutiny in the role of Ablixa, as well as Dr Banks’ professional and personal life. This provides a useful backdrop which reinforces the theme of society’s (over)dependence on pharmaceutical drugs, references to which have already been liberally dispensed. All throughout the film, doctors, patients and pharmaceutical representatives name-drop drugs with an alarmingly casual familiarity.

And yet, the picture painted is not of soulless multinational megacorporations intent on making money at the cost of lives. The effect is more subtle, more human. Dr Banks seems sincere in his belief that his patients are being healed through his use of medication. He, after all, strives towards ‘better living through chemistry’, something he says to a nurse after reaching for a can of highly caffeinated energy drink to help him through a long shift in the emergency department. Of course, there is an equally human dark side. The incentives offered to both doctors, patients and their families are insidiously powerful and make it very easy to ignore the considerable risks – medically, ethically and personally.

However, the film is not content merely to wrestle with this tension. In the second half, the assumptions created by this linear moral narrative about ‘Big Pharma’ come crashing down. The film becomes more and more psychological thriller, with Soderbergh cleverly building on the ethical and moral vulnerabilities of those whose lives are dependent on the power of medication, in some form or another. The beliefs, expectations and relationships created by the pharmaceutical culture in turn create the conditions in which another set of noxious representations, intentions and relationships has been growing unnoticed, like a strain of antibiotic-resistant bacteria.

Soderbergh, in his final film before retirement, is astute in exploring this question of control through the lens of psychiatry and the realities of work as a mental health clinician. Psychiatry is about understanding behaviour in its normal and abnormal forms. However, the critical psychiatry movement has long claimed that such understanding occurs by legitimising and sustaining power imbalances. Psychiatry, it is claimed, is ultimately about control. Side Effects demonstrates that such control is not necessarily unilateral (only from doctor to patient). The film realistically depicts the vulnerability of mental health professionals, whose everyday practice is not necessarily driven by objective clinical science but often by gut feelings and subjective impressions which can be exploited by their own blind-spots as well as the multiple motives of others — some true, some false, some conscious, some unconscious. If such practice takes place in an environment contaminated by the promises made by the pharmaceutical industry, the outcomes can be hazardous to the wellbeing of both patient and doctor. Deception (either verbally — telling lies, or behaviourally — pretending), allegations, psychiatric restraint, and even the label of mental illness itself become, like drugs, mere tools to achieve some other, bigger (and possibly ulterior) objective.

The film hurtles towards its denouement, providing a rapid-fire case study of unethical psychiatric practice (spoiler: the good doctor does not sleep with his patient, but everything else is up for grabs). Dr Banks no longer has time to look empathically concerned (or was he just confused?) as he, Emily and Dr Siebert become increasingly desperate to seek redemption while the terrain of power and truth shift unpredictably, threatening mutual destruction.

Although the film resolves with both a visual and narrative sense of symmetry, it arrives at a somewhat hasty and contrived conclusion. It is as if Soderbergh realised his prescription turned out to be so potent, and so toxic, for each of the characters that he struggles to stop his intervention and return to some kind of normal rhythm. Still, Side Effects worked as indicated: exposing the risks of power, influence and insecurity — as well as pure, undiluted greed — in a pharmaceutically-infused society, and leaving us not feeling much better as a result.

STEPHEN TANG is an associate lecturer at the Australian National University College of Law and a PhD (Clinical Psychology) candidate at the ANU Research School of Psychology. MABEL TSUI is a PhD candidate at the Queensland University of Technology School of Law.

(2013) 38(4) AltLJ 282
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