It isn’t often that chronic pain patients find themselves in the national spotlight, much less splashed on a movie screen, but on April 21st the movie Cake was released on Blu-ray and DVD.

An estimated 100 million people in the U.S. suffer from chronic pain, contributing to a global total of 1.5 billion people. That it has taken so long to see a major motion picture with a chronic pain patient in a starring role further affirms chronic pain’s status as an invisible illness. The film has been met with mixed reviews, ranging from a critique of the lead actress to an analysis of the storyline, but one thing is certain: chronic pain patients will identify with the portrayal of chronic pain’s daily struggle

Starring Jennifer Aniston, Cake is the story of Claire Simmons, a woman living with chronic pain after a car accident that took the life of her young son. The film opens with Claire in a chronic pain support group. Claire is called to speak about the recent suicide of Nina, one of the group’s members. Her bitter eulogy that applauds Nina’s successful suicide gets her kicked out of the support group and sets the stage for her character’s quest to find relief from her mental and emotional pain.

As the film progresses, Claire’s story develops as we learn about the crash that killed her son, meet the husband she has pushed away, watch her befriend Nina’s widower, and follow her as she travels to Mexico to buy illegal pain prescription drugs with Silvana, her housekeeper and the only person Claire hasn’t managed to push away.

That Claire is deemed unlikeable by so many viewers and reviewers of this movie is one of the most curious things about the film. In Hollywood, actresses who accept roles as ugly or unlikeable characters are generally acknowledged to be going for an Academy award. Reviews of the movie have focused on Claire’s lack of make-up, scars, and abrasive personality rather than focusing on the harsh realities of life with chronic pain that are portrayed in the film. This does a disservice to the already-rare, mainstream look into daily chronic pain. A few things that the film misses are important points to remember.

Chronic pain is often accompanied by mental disorders

Claire is grieving the loss of her son, but when grief continues past six months in a way that interferes with daily life, it is then generally re-classified as a depressive disorder. Chronic pain patients suffer from depression at a rate nearly four times that of the general population, and half of them will attempt suicide. Claire clearly exhibits symptoms of depression, including excessive sleeping, loss of interest in previous occupations (she is a lawyer), and anger and irritability.

One reviewer assigns these behaviors to Aniston rather than Claire and follows that up by saying, “Aniston reaches for anguish and comes across as pissy. Tragic? No, just irritating.” He even goes so far as to say that if she ended up killing herself by lying down in train tracks that he would feel sorry for the engineer and the paperwork that he would have to fill out. This sort of thinking may be extreme, but it is one example of just how misunderstood and maligned chronic pain patients, and depression sufferers, can be.

Chronic pain patients can be as confused and complex as any other person

Other reviewers have called Cake a character study of a “character not worth studying.” Which part of the character is not worth studying? A broken, grieving mother? A chronic pain patient? A depressed person who has no idea how to put herself and her life back together?

For both patients and their loved ones, chronic pain can sometimes feel like that is all there is to a person. For Claire, even sitting up in a car is too painful. As Claire’s story unfolds in Cake, we learn more about the person she is underneath the pain. We also learn how long the journey back to that person will be. Every person suffering from chronic pain is more than their pain. Their story is deeper than their treatment plan. Chronic pain patients may see themselves in Claire’s physical suffering, but they may also find themselves looking deeper.

Opioid dependence is real, and opioid use is complex

Opioids are a controversial feature of chronic pain treatment, and with good reason. Since oxycodone was approved for use in the early 1990s, opioid dependence and overdose has risen. Although stricter controls and prescription monitoring seems to have gotten this increase under control, Claire’s abuse of opioids, especially when combined with alcohol, is a complex issue for chronic pain patients.

For acute injury opioids can be an excellent, short-term pain management strategy, but for long-term, chronic pain, there exists a very real danger of dependence. After extended use, neurological changes occur that make the brain need more opioids to obtain relief. This can happen in a matter of days or weeks. Each person’s neurochemistry is very different. For some chronic pain patients, this risk is a trade-off they are willing to make for a few moments of relief. Those who would judge this willingness to submit to dependence in order to feel a moment’s relief from pain may never have experienced chronic pain or known someone who does.

It is difficult to truly understand chronic pain unless you experience it

There is real anger from some in the chronic pain community for what they feel is a lack of understanding about just how bad chronic pain is. Aniston’s character is very clear that she is looking for relief from physical, mental, and emotional pain, and she is willing to do anything to find it, dragging Silvana to Mexico for opioids, befriending Nina’s widower, and contemplating suicide. Claire is isolating herself from the rest of the world because the rest of the world so clearly does not get it.

In some ways, it seems that reviewers of this movie are the same way. They have been focusing on Aniston’s lack of make-up and snippy attitude instead of really diving deeply into why she is that way. There are indications that life was not always so for Claire. That chronic pain has stolen her life seems secondary to those who disliked the film. For people without intimate knowledge of chronic pain, this is an honest assessment. For those who do suffer, this assessment is even more painful.

Cake does have some challenges. That Claire is difficult to like is ameliorated by the fact that those who are closest to her still like her, even as she pushes them away. The movie unfolds slowly, and that can be challenging to be fed the plot bit by bit, especially when most movies pride themselves on their quick and clever pacing. But the film also moves a bit in the way a chronic pain patient might: slowly, deliberately, and unsure of what the next moment might bring. For chronic pain patients, seeing their struggles onscreen may just be the first step to bringing more awareness to their condition. And that might just be worth all of the criticism it took to get there.

Have you seen Cake? What did you think?

Image by Owen Winkler via Flickr


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