Wednesday, September 28, 2016

Portrayal of Alcohol Use Disorder in Days of Wine and Roses

Days of Wine and Roses, while indeed a work of fiction intended to entertain, also serves as an excellent portrayal of the development of Alcohol Use Disorder (hereafter AUD or alcoholism), and, in the case of one character, recovery from it. This essay will serve as an evaluation of the movie’s presentation of the symptoms of AUD from this Psychology student’s perspective. The symptoms of AUD will serve as the framework for the evaluation, each symptom being evaluated for what is presented accurately, what is presented inaccurately, and how the film could have improved its portrayal of the illness. The conclusion will provide additional thoughts on the movie’s depiction of AUD, the film itself, and how it may alter the audience’s understanding of the disorder.
The portrayals of Joe Clay and Kirsten Arnesen Clay by Jack Lemmon and Lee Remick, respectively, and their descent into alcoholism, individually and as a couple, is both quite accurate and heartbreaking. While Joe starts the movie with what could be argued is mild AUD, Kirsten doesn’t drink at all before she meets Joe. Over the course of the film every one of the eleven symptoms associated with AUD is evidenced by one or both characters, including: using alcohol in greater amounts and/or for a greater length of time than intended, a desire to cut down or stop using alcohol but lacking the ability to do so, spending a great deal of time getting, using, or recovering from drinking, experiencing cravings and/or urges to drink, failing to perform one’s duties at work, home, and/or school due to alcohol use, continuing to drink when it results in relationship difficulties, giving up important social, work related, or recreational activities due to alcohol use, continuing to drink alcohol despite it putting one in danger, continued drinking despite knowing it could be contributing to the cause and/or worsening of a physical or psychological problem, requiring more alcohol to achieve the same effect (also known as tolerance), and the development of withdrawal symptoms, which can be alleviated by more alcohol. Some of these symptoms blend together, and some examples of one symptom will also exemplify others. Also part of the diagnosis of AUD is severity. In Days of Wine and Roses, this writer would argue that both characters go through all three levels of severity over the course of the movie. This writer will discuss terms associated with treatment towards the end of this essay. As can often be the case with the evolution of alcoholism, the initial development of symptoms can appear benign, even desirable. Initially, Joe and Kirsten’s life seems fun, spontaneous, with alcohol functioning as an enhancer of their enjoyment. However, as they continue to drink, and as their symptoms continue to develop, dramatically affecting their lives, it quickly becomes apparent that their relationship to alcohol is not beneficial, but rather a disease.
Probably the first, and most easily spotted, symptom in the movie is the amount of time Joe spends getting, using, and recovering from alcohol. The opening scene finds him with a drink in his hand, and, short of when he is at the office, he is almost always drinking. On his first date with Kirsten he brings a bottle that he drinks from on their walk after dinner, finishing it off while they watch the bay. In the following scene Joe tells his boss he can’t deal with someone who has been trying to reach him, implying it’s because he is hungover. Subsequent examples of this symptom for Joe include his efforts to find a drink Kirsten likes and then getting supplies to make it for her, his nearly constant drinking at work events, while out, and at home, his lateness to work after his daughter’s birthday when he loses his seniority with the company, his relapse on Kirsten’s father’s farm with the hidden bottles, and finally his last dalliance with alcohol after finding Kirsten in the motel. For Kirsten’s part, there are fewer scenes exemplifying this symptom, but they are perhaps even more powerful for it. Once she starts drinking, the first scene that really exemplifies the extent of her use is when she drinking and ignoring their daughter, eventually lighting their apartment on fire. In the aftermath, Joe discovers that she’s been spending much of her time at home drinking. Subsequently, she joins Joe in his relapse at the farm, continues to drink once Joe is out of the hospital and in AA, eventually disappearing on a bender, winding up at a motel. She continues to drink after leaving Joe and their daughter, and, even at the end of the movie, refuses to completely give up drinking, telling Joe that it makes the world look “less dirty” to her. The portrayal of this symptom was well done, and while the movie could, perhaps, have shown more of the recovery time Joe and Kirsten needed from their drinking, overall it conveyed the important elements.
Quickly following the time spent on their addiction, the movie introduced the symptoms of failing to perform one’s duties at work, home, and/or school, as well as giving up important social, work related, or recreational activities, due to alcohol use. Although these are two separate symptoms in the DSM V, this writer found them closely tied together in the movie, not to mention thematically, so they will be addressed together for the purposes of this review. As previously mentioned, early on in the movie the view sees Joe begin to lose his ability to function fully at work, coming in hungover, then late, getting demoted, and eventually sent to Texas to work on a lesser account. Additionally, once Joe and Kirsten are together, Joe still spends much of his time after work drinking, ostensibly for work, coming home late and drunk, at one point even to the point of being unable to keep himself from waking their baby. The consequences of both characters’ drinking results in Joe getting fired. As time progresses the viewer finds out that Joe has gone through five jobs in four years. They are living in substantially reduced conditions. Joe even states the point, saying “I’m a drunk, and I don’t do my job.” After an attempt at sobriety on Kirsten’s father’s farm, Joe decides they deserve a reward and smuggles in multiple pints. This ultimately results in the destruction of some of the farm property, loses them their jobs and housing there, and lands Joe in the hospital. For Kirsten’s part, much of her exhibition of these symptoms revolve around her daughter. While the viewer sees Kirsten’s escalating drinking earlier, the first display of these symptoms comes in the previously discussed scene showing her ignoring her child to drink and watch cartoons, culminating with her ignition of their apartment. After the disastrous binge at her father’s farm, which also sees her yelling at her daughter and trying to kiss her father, her prioritization of alcohol over her family leads her to disappear on the bender that ends in the motel, and, finally, sees her leave her family, unable to give up drinking. One expression of this symptom that is alluded to, but never quite shown explicitly, is Joe and Kirsten’s prioritization of drinking together over going out and socializing with others, filling out the depiction of the latter symptom. Overall, Days of Wine and Roses does a good job of showing how these symptoms develop over time, becoming more serious as the addiction becomes worse. Again, perhaps they could have shown more explicit instances of the two giving up important social, work related, or recreational activities, but they make nods to it, and they very clearly display both characters’ increasing failures when it comes to work/life duties.
As the plot develops, one of the most impactful symptoms of AUD displayed in the movie is continued use despite the relationship problems it creates. From the early problem with Kirsten’s neighbors created by Joe’s inebriated spraying for cockroaches, to his drunken argument with her that eventually wakes their baby, to the drunken destruction of Kirsten’s father’s farm, Joe’s examples of this behavior are fairly clear cut. If anything, Kirsten’s are presented with even greater clarity. Though it begins later in the movie, Kirsten’s addiction eventually creates tensions with Joe, her father, and her child. From ignoring her child and burning their apartment, to drunkenly trying to kiss her father and yelling at her child, to eventually leaving Joe and her child because she needed to drink, but couldn’t handle doing so around a sober Joe, her increasingly more serious addiction has cost her greatly by the end of the film. This symptom was well presented throughout the film, and is, perhaps, the most heartbreaking element of Joe and Kirsten’s shared addiction. In the end it costs them their family.
Closely linked to the previous symptom is the continued use of alcohol, even when it puts the individual in physical danger. There are a few particularly explicit moments where the movie depicts this symptom, as well as several instances where it is presented somewhat more subtly. The explicit moments include Kirsten setting their apartment on fire with both her and their child inside, as well as Joe’s multiple hospitalizations following his two serious binges, later in the movie. The more subtly portrayed instances of this symptom include the somewhat humorous moment when Joe comes home drunk and slams into the glass wall of their apartment lobby, his scaling of a wet tree in a rainstorm to search for another hidden bottle of booze, and Kirsten’s disappearances late in the movie, including dalliances with men she doesn’t know well. Once again, Days of Wine and Roses does a good job presenting this symptom of AUD to the viewer. This writer would be hard pressed to improve on their portrayal within the confines of the plot.
The symptom of experiencing cravings for, and urges to drink, alcohol is another symptom that is depicted both explicitly and implicitly. The implicit depiction occurs every time the characters are seen drinking at what most people would consider inappropriate times or to clear excess. This behavior is in full effect for Joe at the beginning of the movie, and is evidenced by both characters throughout. Explicitly, the viewer sees this when Kirsten says she wants to get a drink after the awkward introduction of Joe to her father, again when Joe grabs a drink in the middle of their late night argument, when a very clearly drunk Kirsten pouring herself another drink after essentially ignoring their child, in the scene where Joe smuggles pints into Kirsten’s father’s house, and later when he goes to find the third, hidden bottle, when Joe gives in and they both drink in the motel room, and finally when he stumbles out of the motel looking for more booze and tries to break into a liquor shop. Additionally, Kirsten’s choice at the end of the movie to not give up drinking, despite the cost, could be seen as an example of this symptom. So too could Joe’s encouragement of her drinking at the beginning of the movie, looking for a ‘drinking buddy’. In total, Days of Wine and Roses does a good job of presenting a range of behaviors that depict this symptom.
There are several scenes in the movie that illustrate the symptoms of tolerance and of drinking more alcohol and/or drinking longer than intended. These symptoms would seem, to this writer, to interact with each other, and in the movie they are mostly exemplified by the same scenes. One of the first indications that their tolerance has increased, and that they are drinking more than intended comes after Joe’s demotion when he and Kirsten are drinking at home and he discovers that they have fewer bottles than he thought, the implication being that they are drinking more than they realize. The next depiction comes when they drink at her father’s farm, intending only to drink a little, but becoming tremendously inebriated, and requiring a third pint to continue their fun, which, of course, leads to the dramatic conclusion of the scene. Finally, the scene towards the end of the movie, where Joe finds Kirsten in a motel room, ends with Joe giving in and the two consuming a tremendous amount of alcohol. While the movie could have presented tolerance development in the two more explicitly, the symptom of drinking more and longer than intended is well depicted throughout the movie.
Another set of closely linked symptoms in Days of Wine and Roses are those of continuing to drink despite knowing it is causing the individual physical and/or psychological problems, and the development of withdrawal symptoms, alleviated by more drinking. These mainly show up late in the movie, although Joe’s hangovers could be seen to constitute evidence of the former. The explicit depictions of the latter are largely found in Joe’s hospitalizations where he experiences hallucinations and delirium tremens. The former is illustrated by Joe’s final bender with Kirsten after his first hospitalization and initial period of sobriety, as well as by Kirsten’s behavior and decision making at the end of the film, despite her awareness of her degraded physical and mental health. The one element of these symptoms that is not depicted in the film, and indeed one of its only true oversights as an example of AUD, is the use of alcohol to relieve withdrawal symptoms. Including a scene portraying that, while not integral to the plot, would have rounded out their depiction of alcoholism.
The last symptom this paper will discuss is that of wanting to cut down and/or stop, but being unable to. This writer saved this symptom for last due to its integrality to both the disease and to the movie. From the point of Joe’s initial realization of how far they had fallen, the desire to drink less and, finally, to stop drinking served to define the differences each character’s path. As someone interested in the field of clinical psychology, this symptom of the disease holds particular interest, as it seems key to any treatment, and a dichotomy that must be of particular psychic pain for an individual experiencing it. In Days of Wine and Roses the viewer sees this first in Joe and Kirsten’s binge at the farm. Following Joe’s hospitalization and AA treatment, their paths begin to diverge. While Joe finds some success in his assisted sobriety, Kirsten refuses help and tries to stay sober through sheer force of will. When she fails, she disappears on a bender, the culmination of which finds Joe experiencing his final relapse with Kirsten. She, however, can’t bring herself to stop, and consequently loses both her husband and her daughter. This writer has only one criticism of the portrayal, but it is more a philosophical one and will be discussed in the concluding paragraph. Ultimately, this movie presents the inability to stop drinking quite poignantly and realistically.
Without question, Days of Wine and Roses is one of the best fictional portraits of Alcohol Use Disorder that this writer has seen. There are few, if any, missing elements from a diagnostic perspective. Lemmon and Remick do an excellent job portraying their characters’ struggles with alcoholism, and the consequences. For a movie with the primary purpose of entertainment, the accuracy of the depiction was impressive. The one area where this writer had any real qualms was with the black and white aspect of Joe’s decision at the end of the movie. While this is entirely within the scope of realism, AA is a very black and white recovery program, this writer would have been interested to see a depiction of harm reduction as a recovery model. It may have also made for an interesting window into the struggles inherent in two recovering alcoholics following fairly divergent recovery models. That personal quibble aside, this was an excellent movie, and a thorough representation of a debilitating disorder.

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