Exploring Disease Representation in Movies

The Academy Awards, also known as Oscars, are given annually by the Academy of Motion Picture Arts and Sciences. To celebrate the 90 years of this prestigious prize, and to highlight the relationship between cinematography and medicine, we analyzed the report of 554 films, which received nominations to “Oscar for Best Picture” since the first edition in 1929.¹

To perform an accurate analysis, three authors independently evaluated the movies’ plots to searching references to illnesses or other aspects related to the medicine. The cases of disagreement have been discussed with a group of further three authors.

War wounds excluded, we found that among the nominated films, medicine references are reported in the plot of 105 (18.9%) (Table 1). Medicine references are present in twenty (21.9%) of ninety-one awarded films. The distribution of films referring to medicine is reported in Figure 1.

Table 1 Films with Medical References Received Nomination for “Oscar for Best Picture”

Figure 1

Percentage of films with reference to medicine during the different decades. The figure shows the percentage of films referring to medicine, calculated as: (number films with medicine references ∕ number films which received nomination to “Oscar for Best Picture”) × 100.

Our analysis shows that the most represented diseases are the psychiatric (21.9%) ones followed by neurological ones (13.3%), alcohol addiction (13.3%), and infectious diseases (13.3%).

Psychiatric diseases continue to have significant emotional and social impact but the methods of their treatments have always been a topic of ethical debate. It is interesting to note the references to passive-aggressive behavior, anxiety, delirium, and the use of questionably ethical treatment such as electro-shock therapy and lobotomy in “One Flew Over the Cuckoo’s Nest.”

Interesting are also the depictions of psychiatric diseases, such as schizophrenia, depression, post-traumatic stress, obsessive-compulsive, and bipolar disorders. Significant mental disabilities were brought to public attention by the movie “Rain Man,” in which the protagonist suffered from Savant syndrome.

A strong medical and social impact have also alcohol and drug addictions; the last are prevalent in films from the 2000s onwards.

Frequently reported illnesses are neurological diseases, which affect considerably the quality of life of the patients and their relatives. There have been references to ischemic stroke, senile dementia, cerebral hemorrhage, epidemic encephalitis, cerebral palsy, post-traumatic paraparesis, and amyotrophic lateral sclerosis as reported in biopics on Lou Gehrig and Stephen Hawking.

References to infectious diseases (scarlet, yellow, typhoid fevers, bubonic plague, measles, pneumonia) occur mostly in the movies of the 1930s and 1940s, when they were the most common causes of mortality. Moreover, five films set at the beginning of the twentieth century refer to tuberculosis, whereas HIV infection is reported mostly in movies set in the 1980s, when the disease was at its peak and highly stigmatized.

Surprisingly, two of the most widespread diseases of twentieth and twenty-first centuries are under-represented: we found nine references to oncological diseases, and only three references to heart diseases (respectively only 8.5% and 2.8% of the films referring to medicine).

We further report references to mutism and deaf-mutism, amnesia, insomnia, hemophilia, carbon monoxide poisoning, and two rare diseases such as the Proteus syndrome and the picnodysostosis, in “The Elephant Man” and in “Moulin Rouge,” respectively. Only few references can be found to metabolic diseases such as gout and diabetes mellitus.

From the 1990s onwards, some movies deal with important themes, such as euthanasia, clandestine abortion, medical malpractices, and relationship between environmental pollution and cancer.

Lastly, we wish to underline the plots of some films dealing with medicine and ethics in medicine; the biopic “The Story of Louis Pasteur” describes Pasteur’s discoveries; “The Citadel,” a film, in which the protagonist, a Scottish doctor, initially dedicated to cure miners affected by tuberculosis changes his mind after a meeting with a colleague and decides to solely serve the rich hypochondriacs.

Our analysis confirms that medicine and disease are an intrinsic part of humanity and, hence, serve as quasi-infinite source of inspiration for film-makers of past and present alike.