BMJ  2006;333:1127 (25 November), doi:10.1136/bmj.39041.457199.59

reViews

Rain in my Heart

This is a bleak and shocking documentary about end stage liver disease and alcoholism. In 1970s, the director Paul Watson found fame with The Family, the original "fly on the wall" documentary that was controversial for its intrusiveness and for taking a working class family as its subject. Now, with Rain in my Heart, Watson has made the documentary equivalent to The Lost Weekend (1945), the classic feature film about alcoholism, where a writer loses everything through drinking and ends up on a psychiatric ward. As with the film, this documentary presents some uncomfortable and hard to bear realities.

The documentary opens with an exasperated Watson trying to get the NHS's cooperation to make the film and he is shown on the telephone with a hospital administrator who refuses to cooperate. Finally, the director gets the go ahead and four patients, who have been admitted to a general medical ward at the Medway Hospital, Kent, under the care of the animated Dr Gray Smith-Laing, agree to participate. Dr Smith-Laing uses the opportunity to inform the public about the dangers of alcohol and says frankly of the health services that, "everything we do is too late."

Three of the patients have severe alcohol dependence and complications, and there is little to indicate any prospect of change in their drinking behaviour. Even more depressing is Nigel, the fourth patient, who claims not to have drunk for 10 years ago, but who has advanced cirrhosis from his earlier alcohol misuse. I have serious doubts that the interests of Nigel and his family were served by his inclusion in this documentary. His apparent 10 years of sobriety and his wife's struggles get lost in the incessant drinking and stuporous conversations of the other three patients. The way Dr Smith-Laing tells the family that Nigel is close to death is shocking and the camera seems to intrude, but Nigel's death on film in his partner's arms is a tender and pivotal moment of this documentary.

Out of the other patients, Toni, a 26 year old woman, dies during the filming, and Mark and Vanda both look as if they will not survive much beyond the making of the film.

Watson is so keen to find meaning and explanations for their behaviour that he pushes the patients about the cause ("their little gremlins") of their drinking. As you listen to Toni, Vanda, and Mark, they are much more reticent about simple causal explanations and in Toni's words "it just becomes a habit." This type of documentary is not the best way to explain or explore alcoholism's origins. However, Watson's humanity and compassion shines through.

The grim realities of the physical consequences of malignant alcoholism are vividly presented here, and the death of two of the four patients will shock people and cause them to pause briefly—before they then reach for their next drink.

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BBC 2, 21 November at 9 pm

Rating: ****

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