“An ill heart, expressive of character rather than culture, guarantees three things. First, by holding the individual responsible, the largest offenders, diet and a sedentary populace, are given a pass. Second, this denial allows the medical system to treat individuals more than it treats institutions (school lunch programs, for example, or the Christmas ham), where the illness first gains traction. Third, the person who suffers a heart attack or learns in his fifties that he’s liable to have one unless he changes must disavow the social relations his family and his community have bred in him.”
In our culture, the onset of a myocardial infarction is depicted (we know it best from the movies) one way: a chest-clutching, chair-clattering, death-summoning heart attack that a man (seldom a woman) suffers in public, is ambulanced to emergency, and, if he survives, awakens to one or more of these three dramas: the unplumbed depth of his character, as in he’s never too old to learn; the unconditional love of a woman who cares for him; and the exposure of his relatives’ divided loyalties. There are genetic legacies to expect it, there are gender roles to enact it, and there are psychological wounds to graven it. Not surprisingly, for decades Hollywood screenwriters have used the infarct to wring out a morality tale whose outcome ennobles women’s love and retribution as well as men’s helplessness with this “male” disease. There may be no better example of the female-comeuppance, heart-expanding, heart-attack film than Something’s Gotta Give, a 2003 screwball comedy by writer/director Nancy Meyers.
In it, the fat, buffoonish, young-woman-addicted, hip-hop mogul Harry Sanborn, played by Jack Nicholson, runs athwart – and falls for – the giddy, sexually unfulfilled, tear-prone playwright Erica Barry, played by Diane Keaton. The movie is an elder fantasy, cinched by Jack and Diane’s “amazing” (Diane’s word) sex. Such simple-mindedness is not without complications, which include their oppositional natures, their initial arguments, Harry’s dating Erica’s daughter, and the central malady in the tale, his comically easygoing yet life-altering heart attacks.
Early on, we get Harry’s symptoms: the hand-on-the-heart wincing pain not long after Erica levels her disgust at his debasing women of her age, followed by another hand-on-the-heart moment when he’s lectured by Erica’s sister, a woman studies professor. Then, in the bedroom, clothed but humping Erica’s daughter, he has a full-blown attack. Balled on the ground, he’s turned over by Erica; he foams at the mouth. Disgusted, Erica initiates mouth-to-mouth resuscitation and pounds on his heart. It’s over the top, precisely not how one helps a heart patient. Director Meyers, of course, is using her license to enjoy the moment: women, Mother Teresas one and all, save even the worst men.
His arterial clot dissolved, Harry must recuperate, which, body-dumb, he’s disinclined to do, being mind-dumb as well. Eager for advice about his return to a randy sex life, Harry hears from the doctor, “After a heart attack, the rule of thumb is, if you can climb a flight of stairs, you can have sex.” Harry, unable to walk those stairs, breaks up with the daughter whose attraction to him sets the stage for Erica’s interest, defying emotional logic, the real female kind. The dopiness cascades with bumping-into intimacies and erotic glances until, suddenly, it’s grabby consummation. (Can’t directors do anything other than have the couple, post-coitus, fall back exhausted, sheet covering their chests?)
Oh yes, the other upshot of lust: they fall in love.
But it’s not love that’s the teacher: it’s the heart attack. Harry is changed by his anginal agony: later that night, he and Erica, insomniacs who are used to separate beds, sleep together for eight hours; he finds himself crying along with Erica at their newfound happiness; and, the last thing he expects, he (nay, any aged man) has fallen for an older woman.
Erica is equally surprised. “Your heart attack,” she says, “could be the best thing that ever happened to me.”
Eventually, Harry has two more chest-heavy events along with gurney-runs down fluorescent hallways, I/V-on-a-pole jangling alongside, into cardiac care. Neither is a heart attack but, rather, hyperventilation and an anxiety attack, which the attending physician tells him can “masquerade” as angina. Harry gives into the doctor’s new-age treatment: island-life visualization. It works. Relinquishing his playboy life, he sells his business, heads for the Caribbean, and realizes he’s in love with Erica for real, the first time in his life. That he and she will realize, all gooey and aflutter, that they reek of true love, in Paris, on a bridge over the Seine – after Harry’s post-infarct devotion is challenged by a young cardiologist who also falls for Erica – is the fairy tale embedded in Harry and Erica’s magnetizing fight in the film.
Something’s Gotta Give puddles shallow psychologies for women and men. First, New Age media demand that men be more personally accountable to women, and that they be injured before they can be relationally viable. And yet that demand is toothless. There’s really no downside for Mr. Man: he can fuck around until he’s sixty-three, then fall in love with one of those “neglected” fifty-something women who avoid such dunces all their lives only to come unhinged when his rakish behavior unlocks their waylaid, inner Erica Jong. It seems that a heart attack is for men a Red Dwarf birth into the Universe of Emotion whose expansion women gate and measure. Illness feminizes the man. In turn, illness asks women to bear him up while he changes – must change – so he’s hers. The uniforms are unmistakable, even from miles away: men are children, and women are their nurses and mothers, their enablers and grievers.
Second, if the man trues his heart – sexual and emotional fidelity – his disease is ameliorated, and he’s rewarded with a second act. But he must fall first; he must be punished before he opens. Thus, Tinsel Town’s “love lesson.” The immature man has heart problems. The immature man has heart problems because he’s a man. The immature man cannot take care of himself. And yet despite his medically insufficient self-regard, the immature man has a built-in conveyor to the very emotion he cannot manifest, let alone know he has. The vein needs the other (attendant woman, reason to live, answered prayer), something to kick-start him. It’s as if his true character lies ever-ready in his lack of character.
What does all this say about the psychology of men? That he must be aggressively or absent-mindedly aimless before any self-possession can enter. That his character is found via his heartlessness. That he must choose occupations whose seismic conflicts keep him teetering close to illness. That once he is made vulnerable by his heart he then becomes more than a “man” – he becomes relational and, thereby, human. That heart health is not about a man integrating his maleness but about getting rid of it because it is, by nature, always against him.
Released in 2008, The Wrestler manages a graphic portrayal of the “profession” and embeds within it a core theme of unrelenting self-abuse. The movie glorifies a man who cannot leave the culture of his maleness and, thus, must be sacrificed to it via heart disease.
Mickey Rourke, a body-building actor, is Randy, “the Ram,” a wrestler at the end of his career. He comes out of “retirement” for one last re-match with a nemesis of his glorious youth, some twenty-five years earlier in the 1980s. The film has a lambent nostalgia for the 1980s, as though it were the 1950s for Gen-X. The cult of feminism and the importance of pop culture, replacing literary culture, were still in their infancy. But what was is not what is – the Ram, though still a wrestler beloved by his audience in the 2000s, is a mess: he’s lost contact with his daughter, he’s pursing a stripper as his only confidant (who rebuffs him), and he’s become debilitated by the wear and tear of a barbaric sport.
Many a heart-attack cliché reports for duty. The grabbing at the chest, the doubling over in pain: I note the same stunts happen to Winston Churchill during the Second World War in the HBO docudrama Into the Storm. His doctor says, apparently historically true, that no one can know Churchill has had a heart attack, least of all Winston, for it will ruin his reputation. After “the Ram” clutches his chest in agony, he is taken to the hospital by his wrestling buddies and has coronary bypass surgery. With a righteous scar between his beefy pecs, he reemerges among his compatriots; recalling Churchill, no one seems to acknowledge. Also like “The Lion,” the Ram won’t keep still and continues to work out.
And then, on cue, he hopes to reunite with his daughter, whom he long ago abandoned. He quits wrestling, declaring his angst to the stripper he has befriended and to his daughter. He cries in the latter’s presence, and this opens her heart to his pain. The stripper, too, is moved by his desire for companionship.
The message, telescoped and packaged into the redemptive tabernacle of the Hollywood film, is that heart disease makes men vulnerable. Such men need tutoring because they possess scant vulnerability. It’s a core weakness. A sick culture stipulates macho identity: putting your body through the wringer – Fritos for dinner, wanton drug use, bar-hopping, keeping your condition to yourself – and you’re left with no friends and no benefits. What’s more, Ram’s putting his body through the wringer prior to his comeuppance is what movies like The Wrestler glory in. The spectacle of this physical abuse is near pornographic in its bloodlust. And it is the bloodlust, a metaphor for the damaged heart, that will kill him. This is not a story of man’s fight against heart disease. This is a story of a man’s fight against his unchangeable brutishness.
Which is how the film ends: badly, mawkishly, for audience and the Ram. He’s unable to keep a simple date with his daughter, whose final rejection pushes him back to the ring. Returning, he’s garlanded with a kind of pathetic beauty. He stages one last match for the fans, sacrificing himself to those who “love him,” basting them with spectacle. And still the stripper cares. “But what about your heart?” she says. “My heart’s still ticking,” he says, lighting the final fuse. In the time he has left, he’ll prove he can still model courage, albeit misguided, for his fans. Grappling in the ring, he’s pounded on by his opponent until the chest pain, the dizziness, the shortness of breath return and wither him. His caring foe, realizing it’s no act, keeps asking the Ram what’s wrong. Randy ignores him, and his blackened movie-ending leap into oblivion is complete.
For which I – a heart patient myself – cannot suspend my disbelief. A man with severe angina could not have smothered the pain in a series of cheer-inducing stunts. OK. It’s just drama. But isn’t that the problem with illness. Its mask. That even while dying we can’t be our weak and weakened selves. We die as men should die, self-punishing, impotent, creedal. We’re supposed to go out unaware of our disease while battling royally against the Messerschmitt that’s gunning for us. Suicide by cheeseburger. Suicide by professional loyalty. We men are to remain beguiled by our inalterable and ornery nature. Talk about a through-line: Such a character flaw seeds the illness in the first place. Why change the pattern? Isn’t it true to life: you die as you live? You would think the disease, if it has a purpose, is to awaken us. But what else would the man awaken to but the realization that he’s been deluding himself. Who wants to expire so encumbered? It’s a blessing, we say, when there’s a bullet to the brain, or he dies in his sleep: he didn’t feel a thing.
Why is the Ram, the man who will not grow up, who will not learn, owed this heroic death? What in Darwin’s name is he the hero of?
And then there’s the 1941 film of Lillian Hellman’s play, William Wyler’s The Little Foxes, the granddaddy of heart-attack movies, whose Shakespearean pedigree occupies a dramatic and psychological class all its own.
Regina Giddens is the wife of Horace Giddens, who is tormented by her and his failing heart. Regina, played by Bette Davis, wants to hasten the acquisition of his fortune so, with his money, she can finance her and her daughter’s escape from the small-town Alabama aristocracy of the early 1900s. Horace, played by Herbert Marshall, has been beaten down; he’s confined to a wheelchair, and he sulks, albeit nobly. Marshall enacts his suffering with palpable discomfort – the sick man’s labored walk and breathing, his eye-darting dread, his feverish swallow of a spoonful of medicine, perhaps liquid nitro, followed by only temporary relief. (In all scenes Marshall appears, he’s in pain, and I can’t take my eyes off him.) Davis badgers him viciously. Most appalling is how she feasts on his ailment: the closer he gets to death, the more she schemes to bring it about. Indeed, heartlessness defines them both: Marshall’s weakening heart will stop, and Davis’s heart is nonexistent. This clash speeds the drama (only the daughter and a few black servants care about him), suggesting that certain families then favored cruelty over compassion. With no bypass surgery or stenting, people avoided acknowledging a middle-aged man’s illness. Plus, succumbing to heart disease was rarely forestalled. Embracing his fate, Marshall tells his wife he’ll soon be dead. To which she replies, she hopes it’s sooner than later.
The heart-attack scene is a finely wrought contrast between her callous refusal to help him and his incapacitation. The viper Davis is reminding Marshall of her post-marriage disgust for him: “I thought you were such a soft, weak fool. You were so kind and understanding I didn’t want you near me.” Suddenly, Marshall has a breathless moment. He starts sweating. He claws at his throat. He shudders as he’s hit – the occlusion, the clot. Weakened, he wheels forward in his chair and pours a spoonful of nitro. He shakes, drops the bottle and spoon, and orders Davis to get his other bottle. She sits, a headlighted deer, and does nothing. Marshall struggles to his feet, and for the next minute, while Bette Davis stares unblinkingly, her gaze arrested on hope and terror, he stumbles past and behind her, behind her camera-facing stare, from couch to wall to foyer to staircase, and the medicine upstairs. He gets halfway up before collapsing. Only then does Davis blink and call the servants.
The death scene is much less histrionic. Tenderness takes over. We watch him hold his daughter’s hand and kiss it, we see his last breath register on her face, and we notice her expression slip from the gratitude of his kiss to the shock of his departure. The father dies of his heart condition, and the daughter’s heart is broken. And with it the story takes a twist: the daughter abandons her mother because her role in conniving Marshall’s death, which Davis cannot wipe from her face, is suddenly evident to the daughter as well.
Via Marshall’s performance (Davis won an Oscar, he did not), the scene blueprints how we think the heart patient goes. Or is supposed to go. Heart attacks provide us a dramatic exit. What’s more, those who suffer the fall – slow expiration or quick demise – do so morally. Mortality ennobles us. As we die, we expose the family’s lies.
As psychologically rich as all this is, the hyperbole is still endemic. Though we rarely reach any justice in our final hour, the culture insists we reach it in art. How righteously novels, plays, and movies spell it out. Art says we have not died untidy deaths, though most of us will. Art prepares our loved ones to make amends, arrive in time, confront the patriarch, establish succession, and achieve closure, though such ennobling seldom occurs. Art insists we make less messy that which is messier than we imagine or can handle. Indeed, we die as we think we have lived – art reshaping our incapacities as aesthetic understanding, art giving us meaning when on our deathbed meaning is seldom found, art depicting trauma and loss as more lifelike than life itself so we believe what should happen to us actually does, when it never does.
Something’s Gotta Give, The Wrestler, and The Little Foxes insist on linking heart disease to poor character and failing relationships. They do not link the condition to crummy diet and unlucky heredity, scourges just as bad. What’s more, the mulish male character stems from a culture that also goes unexamined. We do get evidence in these movies that the male culture enables his feebleness; certainly, the Ram’s working-class origin teaches him that survival equates to being tough as nails. But it’s all individual drama, never the sociology of disease. These are predictable portraits of the ineffectual man-boy. His die has been cast: he has the disease, and there’s no way out. Boxed in, he must fight, or, if a woman hovers, he must protect her from knowing how bad off he is. (Or, more commonly, he’s saved. Nicholson heeds the salvation his angelic females offer; Mickey Rourke does not – his fatal flaw.)
My point is, Hollywood heart-men are innately good, worthy of redemption, while at the same time they belabor the male’s near-sightedness as he abuts a woman’s wisdom. (In The Little Foxes, Herbert Marshall, whose weakness Bette Davis recognizes and goads, barely understands that he himself chose this monster and must pay with his life. His daughter, a female saint, comes to see what he never could.) The men’s characters are flawed because they possess no self-reflection; nor will their culture help them learn to indulge it. They are dragged along by unconscious relationships with women or careers, and their up-against-the-wall vulnerability is the only modifiable trait they have.
An ill heart, expressive of character rather than culture, guarantees three things. First, by holding the individual responsible, the largest offenders, diet and a sedentary populace, are given a pass. Second, this denial allows the medical system to treat individuals more than it treats institutions (school lunch programs, for example, or the Christmas ham), where the illness first gains traction. Third, the person who suffers a heart attack or learns in his fifties that he’s liable to have one unless he changes must disavow the social relations his family and his community have bred in him. This last notion is the toughest one to handle. In ball-cap USA, where conformity is king, a sick man paddles against the tide. He must jettison his food choices, addictive habits, and motionless lifestyle. He must be the odd-dude-out at parties when the cheesecake is passed. He must say, “No thanks. Doctor’s orders,” or, more bravely, “I don’t eat that crap and neither should you.”
In short, when a heart patient must minister to his heart condition, typically after he’s been saved by interventional cardiology, he’s either a hero – if he can change, he dumps lifetime habits for good – or a failure. And as a failure, he’s a victim, fixable, if at all, only by love, familial or romantic. My point is, the man’s character becomes a cave within which the health domain hibernates. The man has neither energy nor awareness to take on a system that has sickened him.
What’s more, the system cannot treat itself. The business of medicine, in part, relies on the ill: the sicker we become, the more its symptom-reading and symptom-fixing technologies develop. The more medicine invents treatments, the longer we live and the more necessary the products of symptomalogical medicine, especially those “life-saving” interventions, become. (Nearly thirty percent of Medicare goes to people in the last year of life; ten percent of all Medicare goes to angioplasties.) Further caustic, the national healthcare debate is so politicized (which is to say its true focus is not health but cost) that the common sense, non-pharmacological (and vastly cheaper) solutions of diet, nutrition, and walking cannot be bifurcated left-wing/right-wing and, thus, go unheard. Those who advocate, on behalf of poor and undernourished populations, for raw foods, local produce, Chinese medicine, acupuncture, massage, exercise, stress reduction, and other proven options for cardiovascular illness and other diseases are ignored, largely for one reason. They can’t compete with the likes of Nexium and Abilify who sponsor the media’s discussion of health.
But, despite the operatic presentation of pitiable characters in film, or the beautifully “sick” people taking the little purple pill in Big Pharma ads, heart disease is a, is our national disease, monolithically burdening the young, the society, and the economy, ramped up frenziedly as the healthcare system morphs into Obamacare. Put less existentially – were it more our disease, it might be less yours.
Why is it not our disease? To the extent that the actual disease can be hidden in the person and from the person it may also be hidden in and from the culture. I can illustrate this with a simple fact: Despite pink-ribbon marches for breast cancer research, that disease kills one in 37 women, while cardiovascular disease, which includes strokes, kills one in two people, two in three women. Because of a media pot that stirs breast cancer fears and because our artists represent illness predominantly through individual triumph or failure, we are blinded to the epidemic of heart disease.
Art’s duty, Chekhov said, is to ask questions. It doesn’t care about answers. OK. In that spirit, the heart-attack victim asks this of the artist: How might health be the outcome of drama? The knee-jerk charge is that if literature and film depicted health, the artist would be yoked to mere advocacy, some socialist-realism in which ameliorative outcomes, treatments “you can use,” hardly qualify as cathartic fare. But think about this. As we’ve seen, the fictional film about heart disease is obsessively one-dimensional in the drama it engages with the same story over and over – the man who’s cardiovascularly sick because of his own thick head and skin, his own poor choices.
Is it possible that our illnesses persist, in part, because of literature and film’s rebranding its audiences with the myth that only individuals are responsible for their unwell selves? Since characters have made themselves unwell, their fall is just as solipsistic. Moreover, the artist retreads this serviceable plot: he creates the heroically sanctified iceman who cometh in Eugene O’Neill’s play to delude, yet again, a bar baggy with alcoholics, telling them what they want to hear: they are sick but rescuable. The iceman himself is not beyond saving, though, in the end, even he realizes the ship of sobriety sailed long ago.
O’Neill’s plays tighten the bolt of hopelessness around the downtrodden American, celebrating, almost envying, that bitter self-regard of the sloshed. His characters’ wallowing is secure because it’s sociable. But it’s not sad. And it’s not healthy. I can hear the naysayer: If you want treatment, go to Clara Barton, not the American Theater. O’Neill provokes us to pity the deluded sufferer. And yet, for me, that’s a kind of advocacy. If you will, one that advocates Aristotelian catharsis. This bias is seldom discussed because it’s deeply ingrained in our love of the metanarrative form, namely, that the human heart is hidden and unknowable, and the artist’s job is to portray it – not to suggest a fix or palliate it with anything else than pity. How maudlin such “great art” sounds. Is there any way to challenge the character-dominated dimension of sick selves by combining medical, social, and psychological perspectives?
Consider the fall 2013 Frontline documentary about the underground, illegal world of assisted suicide, “The Suicide Plan.”
The film presents the actual people: the suicides, the families, the “exit guides,” and the prosecutors who go after all involved. We don’t see anyone die; their deaths are reported. We do see the preparation – the difficult decision to commit suicide, the best way to accomplish it, and the necessity that loved ones participate. And we do see the courage it takes to end a terminally ill life; its Pyrrhic victory is felt by everyone. To capture this from the willing (and often unwilling) on camera – that’s the health drama. Death devices (pills are cumbersome and slow; a helium bag is fast) are first played up but later deemphasized in favor of the act’s humaneness. Such is the loving, honest, hard-to-watch portrayal, yet, as I say, the health of assisted suicide. Unlike our befuddling stare at the filmic spectacle of a heart attack, here we share in the tragic dignity of the character. That grandmother with liver cancer, realizing she doesn’t want to go, but now can, is as much herself as she is you or I. The tale is universal: How will you or I respond when, inevitably, we’ll be given options for the final exit?
Documentary filmmakers and memoirists are portraying life’s actual losses with artistic intensity and narrative tack. Documentarian and author-narrator need not appeal to lovable or despicable characters as they probe our society’s myths and mores around a serious illness. These new artists isolate their personal contradictions, while they ennoble the human condition via a health-oriented outcome. Why a healthy outcome would be anti-artistic is beyond me. An honest portrayal could be just as artistic, potentially as aesthetic and impactful, as Diane Keaton saving Jack Nicholson.
Obviously, no one can dislodge Shakespeare’s or Tolstoy’s psychological insight into the corrosive self-delusions of the almighty royals and the privileged; no argument for the information-based, ethically inspired, dramatically intimate essay, memoir, and documentary film will replace King Lear or Anna Karenina. And yet I wonder whether we ever saw ourselves in those towering traumas. I hope to elevate the newer nonfictional forms to our notice against the “age-old” fictions of how we believe individual character has been drawn.
Today, we face untested ways of living and dying in a world where technology is redefining a person’s choices, once thought predetermined by God, family, traits, or the size of one’s skull. Which is why films about actual illness and dying are so critical. Technology has made suicide – one response to a terminal disease – possible, and thus, new media to express the act’s strained humanity and its medical paradoxes are vital.
In this essay, I have purposely not focused on my heart disease – my memoir tells that story. I want most for men to escape the male myths, Hollywood and beyond, by which our gender is marked and, in turn, we mark ourselves. I want us to face up to how we’ve fallen for those myths. It’s possible to live for health, for the health of those we love, for the health of a public (Americans need not succumb to cardiovascular illness so prescriptively, so fatalistically) and an economy (bankrupting itself on death-care costs), all of which needs new agents to manifest health. Since we’ve seldom linked art to healthy outcomes, one pragmatic path to manifest health will be found in forms where the artist and the ill have seldom, or not as yet, looked.