Le médecin face au toxicomane (1980)
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Générique principal
Contenus
Thèmes médicaux
- Pharmacologie. Thérapeutique. Toxicologie
- Empoisonnement. Intoxication
- Psychiatrie. Pathologies psychiatriques. Psychopathologie. Phrénopathies. Psychoses. Anomalies mentales. États psychiques et mentaux morbides. Désordres émotionnels et comportementaux
Sujet
The film looks at the position in which general practitioners find themselves and the attitude they should adopt when face to face with drug-addicted patients.
Genre dominant
Résumé
Through interviews and fictional re-enactment, the film presents new drug-addiction practices, has specialists comment on the challenges of caring for these patients and reminds viewers of the legislative framework concerning the consumption of psychoactive substances.
Contexte
Health: In the 70s, the development of drug consumption in Western countries became a public health issue. French society: At this time, young people were struck by unemployment and counterculture was developing. Culture: The books Go Ask Alice by Beatrice Sparks and We Children of Bahnhof Zoo by Christiane Felscherinow were released in 1971 and 1978 respectively. The second book was made into a film in 1981. In the TV series Affaire vous concernant, the programme "Dans le métro de Paris", which aired on Antenne 2 on 6 May 1982, showed a sequence where a young woman inhales a psychotropic substance in front of the camera.
Éléments structurants du film
- Images de reportage : Oui.
- Images en plateau : Non.
- Images d'archives : Non.
- Séquences d'animation : Non.
- Cartons : Non.
- Animateur : Non.
- Voix off : Oui.
- Interview : Oui.
- Musique et bruitages : Oui.
- Images communes avec d'autres films : Non.
Comment le film dirige-t-il le regard du spectateur ?
Intended for general practitioners, the film places its target audience in the presence of colleagues, who share their experience, and doctors specifically qualified to care for addicts. Furthermore, the film places emphasis on the environment in which drug addicts live, an environment typically inaccessible to general practitioners: the city with its popular spots for trafficking or taking drugs, for being alone or socializing.
Comment la santé et la médecine sont-elles présentées ?
Medicine is portrayed as a chain of complementary responsibilities. Many doctors are interviewed in their offices and speak readily about their knowledge and experience. These interviews enable general practitioners to be confident when sitting face to face with drug-addicted patients because they know that their specialized colleagues are there to provide them with advice and to take over if need be. The film notably does not shy away from the psychological challenges involved in caring for addicts with unpredictable behaviour.
Diffusion et réception
Où le film est-il projeté ?
In cinemas during screenings reserved for health professionals
Communications et événements associés au film
Programme brochures
Public
Health professionals, especially general practitioners and medical students
Audience
Descriptif libre
Re-enactment of an Overdose
Title card: "Aside from the interviews, all of the scenes in the film have been re-enacted by actors based on authentic accounts". The opening credits appear before a master shot of a street at nighttime. An illuminated sign for a pharmacy appears in the left edge of the camera’s frame. The sudden appearance of two bright headlights signals an approaching car. As it comes nearer, a blue revolving light can be made out on the roof of the car. When the car turns in the direction of the left side of the camera frame, the letters “SOS”, painted on the side of the car, can be read. The tires screech as the car navigates tight street corners. In the driver’s seat, a man speaks into a small radio: “I’ll be there in three minutes. I’ll call you once I get there”. The car comes to a stop in a gravel drive in front of an opulent house with large windows and wisteria covering the outer walls. By placing the scene in such a wealthy setting, the film undoubtedly seeks to show that drug addiction touches all social classes. A young woman greets the doctor a he steps out of the vehicle and has him follow her. An outside-inside matching cut shows them entering the house and making their way through the living room filled with several silent bystanders before eventually entering a bedroom where a young man in shirtsleeves is lying on a bed. Commentary: "For us general practitioners, drug addiction is not a problem we are confronted with all day long, far from that. We encounter this problem in a very direct way — essentially in the context of an emergency phone call, an overdose… but it certainly is not common”. The doctor rummages in his bag. Cutaway shots show the male and female bystanders appearing to be lost for words. The doctor tells them that they need to call an ambulance. (02.47)
The Position of General Practitioners when Dealing with Drug-Addicted Patients
Cut followed by a chest shot of a man seated at a desk with neat rows of books behind him. The text "Médecin praticien" [General practitioner] appears in the bottom centre of the frame. He is in fact the one providing the commentary. He continues, “The second occasion is when people suffering from somatic illnesses, a form of hepatitis or an abscess come to see us. During the medical consultation, we notice that the patients have injected themselves with something”. The angle of the camera changes (it’s slightly higher) as it moves closer, capturing the man in a shoulder shot. “The third case is when parents phone because they have just discovered that their child is doing drugs. They call us, their family doctor, because they know that we know who they are, that we listen and that we will respect doctor-patient confidentiality”. This is illustrated in the following sequence with a close-up of a woman in her sixties on the phone who mentions the strange behaviour that she has been noticing in her son: “He comes home late, he’s losing weight, we can’t seem to talk to one another. I’m sure he is on drugs". While she remains in the field of view, female commentary drowns out the telephone conversation: "Our role is to listen to the parents’ distress, to play down the situation, to help parents re-establish contact with their teenagers”. The face of the woman speaking appears on-screen along with text indicating that she is a psychologist. She continues, “It’s a sort of empty pit that quickly fills with distress and especially a discredited image of themselves. Parents question the relationship they have built with their child and even the life they lead”. According to her, parents have two attitudes: they either feel guilty or act defensively by blaming the people their child spends time with or even society. “It is important to restore the image they have of themselves so that they can establish a different relationship with the young addict. Shot of a family dining room. The camera leaves the table in order to follow the mother looking for her son who has secluded himself in his bedroom. Her complaint must have overcome the noise of the electric guitar that resonates from his headphones in the dark room. (04.20)
At his desk, the general practitioner explains that the case he finds the most difficult to handle is the one involving an addict who comes to see him with the goal of obtaining a prescription “either overtly or on some pretext”. In the waiting room, a woman behaves nervously as she rummages through her purse, lights a cigarette with tense movements and looks worried. “This situation is very hard to bear because, on one hand, it is someone who is truly suffering and who we cannot send away. It is important to listen, but we can’t play their game and become their accomplice. In any case, we must not prescribe them these products. It would be a relief for them — and for us, but if we give in the first time, they will forever ask us for the same thing, and each time we’ll be obliged to give in and end up becoming their supplier.” A woman appears on-screen accompanied by a brief text indicating that she is “Un médecin directeur – Centre anti-poisons – Lyon” [Doctor Director – Poison Control Centre – Lyon]. She is seated behind a desk covered with piles of paper and further cluttered with two telephones. “I believe that practitioners need to understand that they play a role in the cause of drug addiction and in its treatment. Practitioners distribute medications, however, they can’t be indifferent to the aberrant use of these medications – medications or drugs, I don’t think we should separate them too much from one another.” She continues, “GPs are the first to be solicited. They therefore need to position themselves when they come face to face with addicts. Behind their request for products is a cry for help that is much more human than medicinal”. (6.41)
Addicts in the City
There is a crowd in the street. Some people are busy whereas others appear to be waiting. Chords are strummed on a guitar to the recognizable melody of Bob Marley’s No Woman No Cry, a huge reggae hit released in 1979. The camera focuses on the hand of a black man holding a joint between two fingers. A backward travelling shot reveals that the person who is smoking the joint is sitting on the ground next to a street musician seated on a cement bench. A group of passers-by have gathered around them to listen to the song. Reggae plus a joint, these are two symbols that call to mind Rastafarianism, a political and cultural movement that had great success with Western youth at the time and is associated with the practice of smoking marijuana, a substance considered in France to be toxic. The film incidentally identifies a phenomenon whose spread, illustrated here by its appearance in public space, encourages drug use. Text temporarily indicates that the following commentary is provided by a general practitioner from a reception centre. “It is not products that cause addiction. As doctors, we also cannot overlook the damage that abusing toxic products can cause to the bodies and psychology of addicts. We must reduce these products strictly to their medical effects, regardless of whether they are legal or illegal.” The backward travelling shot continues, moving farther and farther away from the street musician and his audience. His voice reverberates as the camera reaches the entrance of a building. A slight pan to the right reveals a young man standing hunched up against the wall of an entrance hall, rubbing his nose as if he has just snorted some drugs.
The commentary is heard again: "There are three groups of products that cause specific problems: opiates, natural or synthetic, cause overdoses, respiratory troubles or, more frequently as a result of using syringes, hepatitis, blood poisoning, etc.” A man sitting at his desk is on the telephone. With his free hand, he rummages in the briefcase placed on the glass surface of his desk, takes out a tube, opens it and tips it on its side. Several pills spill out. A low angle shot from under the glass surface shows the man picking them up and quickly swallowing them as he continues his conversation on the phone. The commentary continues its enumeration: "Barbiturates cause problems linked to their overdose such as skin or neurological conditions and, lastly, solvents (ether and trichloroethylene), whose acute and chronic toxicity must be stressed.
The second group of products pose psychological problems: acid, LSD 25 with its auto- or hetero-aggressive panic attacks and major psychostimulants (coca, cocaine, amphetamine and all the appetite suppressants) often overdosed with psychological or psychiatric consequences of a paranoid nature”.
Views of a motorway exit are seen followed by a pan of the façade of a large building. The commentary continues: "And finally, misused tranquillizers, nonbarbituric hypnotics, laxatives and especially drugs for correcting the side effects of neuroleptics. The last group of products pose the least medical problems: all the by-products of Indian hemp, hash, weed, sometimes causing anxiety.” A travelling shot in an underground car park shows rows of parked cars and then a slight pan to the right reveals, between two cars, a young man sitting on the ground next to a cement pillar holding a tissue to his face. Here, the mise-en-scène shows that drug addiction takes place in the cracks and nooks of urban landscapes. Viewers are struck by the different places: the entrance of a building, a car park, dark public spaces hidden from onlookers and makeshift sites for an internal voyage. The film shows the social distress into which addiction plunges. “The succinct overview is deliberate because at a pinch any product can become the object of addiction and, consequently, the imagination of addicts eludes any attempt at formal classification.” (09.03)
Portrait of a Drug Addict
A chest shot captures a doctor in his office. “It is interesting to distinguish between drug use that is purely social and that which is somewhat personal.” The latter is intended to “calm anxiety” whereas the former involves “doing what your friends do”. The camera returns to the psychologist who adds, "It is important to go beyond what takes place in the doctor’s office. You have to try to understand what the patient’s life is like at any moment of the day”. What follows is a way of fulfilling her wish: the re-enactment of a scene where a drug addict shoots up. Close-ups of the hand show the preparation involved and the materials used, which are placed on a Persian rug: a spoon, a penknife, powder, a lighter, an ashtray, drinking glasses and a syringe. Male voice-over explains that he began testing “the different products” when he was 25 years old. It was not the drugs that led him to become an addict but “a great void” that pushed him to meet addicts and to become one himself. “I felt like I entered an environment where everyone was equal.” The young man is seen sitting on the floor of a room as he continues his methodical preparation. In his case, the search for something else was associated with a fascination for decline at a time when he had stopped his studies and his family had fallen apart. “Given the fact that my adolescence had been extremely rigorous and balanced, I think that I needed to have a crisis – and a violent one at that.” The purpose of getting high is less about “briefly escaping from the world” than it is about toying with what is unhealthy and suicidal. Surpassing this fascination leads to liberation. The young man’s voice is calm and his words are carefully chosen. Likewise, his behaviour on-screen is calm. He looks softly at the syringe as if he was looking at a pet and licks the tip of it with pleasure. A close-up of his arm shows the injection and then another captures his face filled with serenity and encircled by a bluish light at the moment he savours its effects. “My psychotherapy, I did it with illicit products. I was able to clearly and distinctly analyse everything that was taking place in my psyche thanks to the products.” Music begins to play: worrying electronic sounds that clash with the peaceful portrait. (13.46)
Drugs and the Law
The camera returns to the first general practitioner. He admits that he feels helpless when it comes to drug addiction and is conscious that a strictly medical response does not suffice. A police van is seen driving at night. Police officers climb out and inspect papers. The people stopped, gathered in a nook, are indistinct. The officer inspects the arm of one of them. Commentary: "The law of 31 December 1970 cannot be ignored by doctors”. On the steps of a courthouse, a lawyer speaks as he is filmed using a low angle shot. The law in question concerns the legal framework for the sale and use of drugs. It provides for court-ordered care and socio-medical check-ups for drug users. Criminal action worsens for users who have been caught once again committing a crime. A woman appears along with text which reads “Un consel juridique – Assocation d’aide aux adolescents” [legal advisor for an association aiding teenagers]. She believes that the law distinguishes between the use of illicit products and licit products such as alcohol. In the last case, law intervenes when behaviour influenced by alcohol becomes dangerous. For the first case, “what is incriminated is not behaviour but a substance. As a result, an occasional user, without any drug addiction problems, will be subject to the law”. The next sequence takes place in a prison. Wire mesh and a metal gate overlap in the depth of the field of view. “Prison is without a doubt harmful for drug addicts. It keeps them in a distressing state of dependence.” A travelling shot uses a subjective camera technique to show the process by which an inmate has fingerprints taken, receives bedding and is escorted to a prison cell. A vertical pan reveals bunkbeds within the cell. (17.25)
Conditions for Rehabilitation
The camera returns to the doctor from the poison control centre. "Doctors are not God and they will not become the father of the ill. They are there to help those fighting with drug addiction to orient themselves, possibly towards a specialist.” The camera cuts to a man sitting on heat radiators in a hallway. Text temporarily appearing in the bottom of the frame reads “Un chef de service de consultation psychiatrique – Urgences psychiatriques” [Head of the Psychiatric Consultation Department – Psychiatric Emergencies]. He mentions the procedure for caring for patients suffering from drug addiction: withdrawal treatment "but especially post-detoxification, social reintegration and psychotherapeutic care. This is illustrated with a sequence showing a young woman alone in a room. She is smoking nervously, appears to be restless, and eventually looks out the window at a sunny garden that she cannot explore. The camera returns to the head of the Psychiatric Consultation Department. "Contrary to what all addicts claim, problems relating to physical or physiological weakness remains very limited in treatment via withdrawal. However, psychological weaning is of particular importance and that is why psychotherapy is one of the key elements of rehabilitation.” The doctor insists on how important it is that the request for rehabilitation come from the addict. This request, however, is often masked by ambivalent behaviour and must be carefully analysed. For instance, addicts may ask a doctor for treatment in the hope of gaining access to toxic products, they may be sent by an examining magistrate to avoid prison or they may have been convinced to seek treatment by their family who can no longer tolerate their behaviour. “All of these requests that are more or less found in each case of addiction are not genuine. It is when addicts themselves become aware that they are enslaved to drugs and can no longer bear it that they will have the courage to make a sincere effort. In these case alone, addicts can even receive withdrawal treatment outside of the hospital”. (21.36)
A General Practitioner’s Best Approach
A music group on a stage made up of young, hippie-like musicians plays space music with enthusiasm. Why is this band shown? Undoubtedly to encourage viewers to distinguish between the cultures developing in the new generation, to admit that their practices which aim to foster happiness do not necessarily imply resorting to psychoactive substances. Commentary elaborates on the psychological implications of treatment. A man appears accompanied by text that reads “Un medecin chef de l’intersecteur – toxicomanie – Marseille” [Head of a French sub district for organising child psychiatric care – Marseille Drug Addiction]. “It is important that subjects not be reduced to drug addicts, that they not be thrown back into drug dependency, and this must be the case from the very beginning.” He mentions "symptomatic remissions" which do not correspond to positive change. This concerns the doctor who can be led to adopt, notably by the addict’s family and in particular his or her mother, a "complicit attitude". Is this to say that “the family” looks to speed up the end of the rehabilitation in order to bring an end to the suffering? Another family doctor adds that doctors must not rush the psychological approach to treatment because they risk not being heard by the patient who is looking for products. Once rehabilitation has begun, "what doctors must pay very close attention to is that they do not perceive an addict’s relapse as betrayal. They must abandon the idea of curing their patients and instead aim for improvement”. (26.52)
Parallel editing sequence alternatively showing a high angle shot of Lyon with its parcels of land longitudinally crossed by its rivers and the track or maze in car racing video games. The cuts from one shot to the next are abrupt despite the fact that they have a similar grid-like pattern. Quick cuts with electronic noise interrupt the space music played by the group seen in an earlier sequence. Is this suggesting that the journey of a drug addict – always shown within an urban context in this film – is comparable to that of a pawn in a video game, both living life in the fast lane while having to navigate traps? Commentary is made by the first general practitioner shown in the film: "Family doctors who decide to provide care to an addict should expect that it will take up a great deal of their time and energy. And as busy as we are throughout our work days, we are not certain to be able to respond as we should”. The doctor is filmed driving a car while speaking. This mise-en-scène brings to mind the film Portrait d’un psychiatre shot in 1970 by Pierre Desgraupes or even the film Médecin de campagne shot in 1968 by Alain Tanner. It plays with the idea that the person behind the wheel, in the cosiness of his driver’s seat, is able to speak with confidence and depth while simultaneously watching the road that he is used to driving up and down. The final words are given by an anonymous voice-over: "The problem that drug addiction poses for the general practitioner is very complex. This film does not claim to have resolved it. Its sole objective is to ask questions, to open up avenues for future reflection.” This is a conclusion that paves the way for a future debate with the doctors for whom the film was made. The final shot is of the young drug addict, seen earlier in the film, staring into the camera. This stare calls out to viewers, inviting them to consider him as a "subject” as one of the doctors in the film recommended. Closing credits.
Notes complémentaires
Références et documents externes
Contributeurs
- Auteurs de la fiche : Joël Danet
- 2 Traducteurs_vers_anglais : Sherry Stanbury
