Movies inaccurately represent comas

A new study by a Mayo Clinic neurologist finds that, overall, motion pictures inaccurately represent the comatose state. Findings will appear in the May issue of the journal Neurology.

"What we found was there were only two movies that were accurate," says Eelco Wijdicks, M.D. "Generally, there is a pattern of inaccuracy. It's an enormous caricature. Patients in a coma and their neurologists are portrayed inaccurately, and so are almost all awakenings after coma. This was not only true for Hollywood motion pictures, but also for international films."

Dr. Wijdicks, a Mayo Clinic neurologist, and his son, Coen Wijdicks, currently a graduate student at Rush University, reviewed 30 movies released from 1970 to 2004 with actors depicting prolonged coma. They evaluated accuracy based on appearance of the comatose patient, complexity of care, accurate cause of coma, probability of awakening, and appropriate compassionate discussion between the physician and family members. The researchers then showed 22 scenes from 17 movies to a panel of neurointensitivists and neuroscience nurses who were asked to evaluate accuracy in the same categories. Finally, the researchers showed the same scenes to 72 nonmedical viewers for their assessment of accuracy.

Dr. Wijdicks commends two movies, "Reversal of Fortune" and "The Dreamlife of Angels" for portraying well the agony of waiting for a comatose patient to awaken and accurately depicting the patient and the complexity of care. However, the researchers say the other 28 movies they analyzed portrayed coma incorrectly. For example, inaccurate portrayals show miraculous awakenings -- often within seconds and as if from a terrible nightmare -- with no cognitive deficits or other long-lasting effects from the coma.

Dr. Wijdicks explains that the actors portraying comatose patients in the movies that depicted coma poorly do not have feeding tubes, do not have contractures and are not tracheotomized. They also remain in a normal, muscular, tanned, perfectly groomed appearance, which Dr. Wijdicks says trivializes prolonged coma to simply a "Sleeping Beauty" type state of sleep. In the majority of the films analyzed, physicians caring for comatose patients were poorly represented as cavalier, sarcastic, detached or uncompassionate, he reports.

Dr. Wijdicks acknowledges that as art, movies are not limited to textbook portrayal of events. "You can say that it's an art form, entertainment is the key here, and you should not criticize it," he says. "You might say, 'So what? Did you expect anything else?'

"We're not here to criticize screenwriters or an art form, but we want them to appreciate the serious situation of those in a coma and to be sensitive to how they might be leading viewers astray."

Dr. Wijdicks' concern lies primarily in what he found in the second part of his movie study, which revealed that lay viewers could not always identify inaccuracy in the depiction of coma in movies. The majority was unable to identify inaccuracy in 36 percent of the scenes; 39 percent of the viewers also thought the movies would influence their decisions about a coma in real life.

"The influence right now of motion pictures that portray coma is negative," says Dr. Wijdicks. "Inaccuracy concerns me because the public sees an unrealistic portrayal of a neurologic disease that could lead to improbable expectations from a family of a patient in a coma; for example, that it will be just a matter of time till the patient awakens and everything will be fine and dandy. Also, often movies could be used for teaching purposes, so accuracy is important in that setting."

Dr. Wijdicks proposes several solutions to better portray coma in motion pictures:

• Screenwriters might use coma less in motion picture comedies, as this genre could potentially tend toward ridicule of a catastrophic illness, including the agony of a family during a patient's prolonged coma and rehabilitation.
• Actors portraying those in a coma might visit neurology intensive care units or neurology rehabilitation centers to observe patients in a coma or rehabilitating after a coma.
• Producers might have the screenplay reviewed by a neurologist.

Dr. Wijdicks' current research focus is coma, including the public perspective of coma. This is the first of a series of studies.

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