Dedicated to the work of Michael Powell and Emeric Pressburger and all the other people, both actors and technicians who helped them make those wonderful films.
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Film and book
Michael Powell's neurological cinema
Last November I received a letter from Diane Broadbent Friedman, enclosing a copy of her book, A Matter of Life and Death: The Brain Revealed by the Mind of Michael Powell. Friedman wrote that when she was a nurse practitioner on a neurological unit, she had seen this old film and had immediately wondered whether some of the seemingly fantastic scenes and events in it had a neurological basis. I had seen A Matter of Life and Death as a boy - it came out just after World War II, and I remembered being haunted by the power and strangeness of the film with its large escalator running up to heaven and the weird six-note musical motif that ran through it. Now, 60 years later, alerted by Friedman's letter, I watched A Matter of Life and Death again with my colleague Orrin Devinsky, a specialist in seizure disorders.
The film, which was called Stairway to Heaven in the USA, opens with the hero (David Niven, as an RAF pilot) flying a doomed bomber. The plane is in flames, but Niven has given his parachute away to a crewman, and he intends to jump to his death rather than be burnt alive in the plane. He has a final conversation with a radio operator - an American girl stationed in wartime England - and then jumps into the thick Channel fog to his certain death. Mysteriously, however, he survives, and by happy accident immediately meets the girl he had had his "final" conversation with. He is bewildered to find that he is still alive, but apart from a headache and feeling a little strange, he is unharmed.
The next day he has a strange vision: a foppish figure in 18th-century dress appears and identifies himself as an angel of death, a conductor to the afterlife, sent to meet Niven at the moment he jumped from the plane. The angel had been unable to locate him in the dense fog - would he now, please, accompany him to heaven?
This is the first of many supernatural visitations, and an intricate heaven and- earth drama unfolds on screen.
As neurologists, we could see how many of the film's seeming irrelevancies - details that had eluded me as a boy - could be understood as hallucinatory auras announcing a temporal lobe seizure. Before each mystical vision, for example, the pilot cocks his head as he "hears" music,
"Friedman shows that A Matter of Life and Death is not only the surreal and romantic fable it was taken to be by most viewers, but a carefully worked out neurological case history as well."
and sniffs as he "smells" something - it is always the same music, always the same smell. Alarmed by Niven's behaviour, his girl seeks the advice of a physician friend. The doctor takes a history, observes Niven's attacks, and makes careful note of his hallucinations and altered behaviour. He is also able to show, after one attack, a dilated pupil, an upgoing toe, and a massive field-cut in half of Niven's visual field. The physician diagnoses "adhesive arachnoiditis", apparently a consequence of a previous head injury, and advises immediate surgery. During this surgery, Niven pleads his case in heaven for remaining in this life.
As neurologists, Orrin Devinsky and I have seen many patients who have temporal lobe seizures - such seizures may include mystical visions and a post-ictal conviction of their "truth" (although never visions and delusions as detailed and logical as Niven's). Yet when the film came out in 1946, reviewers were strangely silent about these medical details - no one, indeed, seems to have noticed.
That all of these tantalising neurological details had been missed, or
seen as irrelevant, by filmgoers and reviewers alike astonished Friedman when she first saw the film in 1990. Fascinated, she embarked on what was to become a painstaking project to reconstruct the researching of the film. Michael Powell, who directed the film, had died, but his widow was still alive. On the basis of interviews with her and many others who had known Powell, Friedman discovered that he had read widely in medical journals and had interviewed neurologists and watched them examine patients. (A nice touch in the film is when the neurologist pulls a key out of his pocket to test the plantar reflexes - typical on-the-spot behaviour for a physician who has to make an instant examination with whatever he has on him.)
Feeling she had hit paydirt, Friedman published an article in Seizure, in 1992, hoping for a response from its readers, but there was no reaction. Undaunted, she expanded her research, and now, 16 years later, provides us with all the evidence in her meticulously researched book (one sees from the bibliography alone that she has read more neurology, and specifically more about temporal lobe epilepsy, than most neurology residents).
Friedman shows that A Matter of Life and Death is not only the surreal and romantic fable it was taken to be by most viewers, but it is also a carefully worked out neurological case history. By a happy coincidence, the original 1946 film has just been re-released with restored footage in The Collector's Choice: The Films of Michael Powell. One hopes that everyone, but especially physicians and neurologists, will visit or revisit this unique double treat, a first class piece of film, full of human drama with, if one has eyes to see it, a minutely worked-out neurological basis.
Oliver Sacks OS2177@columbia.edu
A Matter of Life and Death: the Brain Revealed by the Mind of Michael Powell Diane Broadbent Friedman. AuthorHouse, 2008. Pp 292. US$19·95. ISBN 1-438-90945-4. The Collector's Choice: The Films of Michael Powell A Matter of Life and Death (Stairway to Heaven) Directed by Michael Powell, Emerich Pressburger. Age of Consent Directed by Michael Powell Sony Pictures, 2009. US$24·00. ASIN B001IZNIV4.
Vol 373, Issue 9668
March 21, 2009
See also the author's pages
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