Five Mistakes about Painkiller Addiction in the Movie "Cake"

Warning -- this article contains spoilers

"Cake" tells the story of Claire's struggle with chronic pain as a consequence of a
horrific motor vehicle accident in which she lost her little boy. Addicted to the painkiller Percocet in an attempt to manage her ongoing emotional and physical distress, Claire is faced with the choice to end or move on with her life.

Although Cake contains several truths about painkiller addiction, it also reflects an unrealistic perspective both on those who are coping with chronic pain and medication overuse, and on those who care for them.

Here are five mistakes that stood out.

No-one Understands Painkiller Addiction

While it is true that both the loved ones of people with painkiller addiction, and the healthcare professionals who treat them, can sometimes feel frustrated and have a hard time relating to people who over-use pain medication, it is inaccurate to assume that no-one understands. Family and friends are often all too aware that their loved one is hurting, and while chronic pain can certainly put a strain on the relationship, the way that so many people in Claire's life wrote her off as a "bitch" -- with the exception of her long-suffering paid assistant, Silvana -- did not ring true.

In a situation where a mother had narrowly escaped death while her small child died in the same car, most people would feel immense compassion and be very forgiving of Claire's moodiness. To portray her as rejected by those around her de-values the reality of the many family members who support and care for disabled and addicted relatives, as well as friends and volunteers who provide a support network. It also sends a message of hopelessness to viewers who suffer from chronic pain and painkiller addiction, that is unnecessarily harsh and potentially harmful.

Healthcare Professionals Are Consistently Incompetent

It is true that many people who develop painkiller addiction find ways of obtaining more medication than their doctor prescribes. This can include double doctoring, and even smuggling medication in extreme circumstances. But it is unlikely that a wealthy, articulate lawyer like Claire would have exhausted all legitimate sources of medication and would resort to drug smuggling only six months after her accident.

While doctors can become frustrated with patients who over-use medication, a patient like Claire would probably be under the care of a specialist who would be overseeing her pain management, and a psychiatrist or psychologist for the mental health problems that would be expected from such a profound trauma. Even if her insurance did not provide these services, her wealth would enable her to go to a private psychologist or pain clinic. Yet her only other professional supports appeared to be a badly run support group, which she was expelled from due to her anger -- highly implausible, given that anger is extremely common among people with chronic pain, and Claire's emotional expression was mild sarcasm rather than rage -- facilitated by a woman of unspecified professional status with an alcohol problem, a disorganized physician who seemed more interested in talking about her personal life than Claire's, and inadvertently fell for Claire's ruse to obtain additional Percocet, and a physiotherapist who seemed to have completely unrealistic expectations of someone so early in recovery.

Healthcare professionals are much more switched on to both chronic pain management skills, and to monitoring and managing the risks of painkiller addiction. If Claire had systematically worked her way through all the physicians in LA, she would have found a good one. And rather than a support group, her doctor would have referred her to a psychologist to provide her with appropriate therapy for trauma and grief.

Recovery from a Traumatic Accident Can be Expected in Six Months

Although we can't be certain exactly how long ago the accident occurred, Claire's physiotherapist complained that she has shown no improvement in 6 months. Given Claire's extensive surgery and obvious whiplash injury, expecting improvement in this timeframe is unrealistic. Claire is reminded that the pins in her legs are going to hurt, but her physiotherapist does not seem to be providing her with any guidance on how to manage the pain, even while doing her therapy in the pool.

Recovery from the physical trauma of an accident can take much longer than 6 months, and recovery from a devastating emotional trauma involving the loss of a child could take years, particularly when exacerbated by relationship breakdown, and an absence of emotional support from a therapist or others. It seems as if Claire's character is a mashup of a variety of chronic pain patient "types," including those who have been in recovery for a much longer period of time.

People with Chronic Pain Feel 100% Hurt 100% of the Time

The pain experienced by people with chronic pain, especially while dealing with the fluctuations of painkiller effects, is real. But it is not 100% painful, every second of the day. Monitoring fluctuations in pain levels, leading to greater understanding of what helps and what worsens pain is an important aspect of pain management. Yet Claire appeared to be continuously in 100% pain, with the possible exception of the moment she swallowed a Percocet.

People with Chronic Pain Don't Care About, or Appreciate Others

Perhaps the cruellest misconception of people with chronic pain, as characterized by Claire's character, was that she was portrayed as a callous, hard-hearted "bitch." Unappreciative of the efforts of her assistant, Silvana, or her estranged husband, Claire appeared to feel nothing as she seduced the gardener, who was married with small children, or as she satisfied her curiosity about the family life of a member of her support group who had died by suicide, by intimidating her group leader into divulging confidential information by first threats then bribery.

People with chronic pain are often caring people who suffer guilt and distress about not being able to do things for others due to their disability. Many continue to care for others, such as children and other dependents, even while struggling with their own pain and painkiller addiction. While they may feel disconnected and dissociated as a consequence of trauma and the effects of painkillers, pain and drugs do not remove their hearts.

While this is drama, not reality, for Claire to be completely callous and indifferent to others for most of the movie, then to suddenly feel inspired to bring a cake to the birthday celebration of a recently orphaned boy she barely knows, presents an unfair and unrealistic image of people with chronic pain and medication addiction issues.

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