This past Halloween I stayed at home with my wife and watched old horror films. One of them was the psychological suspense thriller, What Ever Happened to Baby Jane, released in 1962. This is the story of two aging sisters, one of whom is paraplegic and confined to a wheelchair on the second floor of their Hollywood home. The movie featured stunning performances by paraplegic Blanche (Joan Crawford) and her abusive, psychologically imbalanced and alcoholic sister Jane (Bette Davis).
In the course of the film, Blanche is horrifically abused by Jane. As I watched this film, I realized that it presents a chilling but not-so-unrealistic portrayal of elder abuse. As a geriatrician who has worked with elders for over two decades and written on this topic, it struck very close to home and shared similarities with cases I had encountered over the years. Blanche suffers several types of abuse at the hands of her sister, which can be classified as follows:
* Verbal abuse. Blanche is called names and verbally demeaned by Jane.
* Physical abuse. Blanche is struck several times in the movie, including one chilling scene where she is kicked several times as she lay on the floor.
* Deprivation of services. Blanche desperately tries to call a physician and Jane interrupts, making sure the doctor does not arrive.
* Psychological abuse. Blanche is kept isolated and the phone is taken away.
* Starvation and willful neglect. Blanch is deprived of food, and given several meals that discourage her from eating (I won’t spoil the movie for those who want to watch).
* Physical restraint. Blanche is eventually tied to the trapeze bar while in her bed.
* Financial exploitation. Jane practices Blanche’s signature and signs checks in her sister’s name.
The unfortunate victim recognizes her sister’s disturbed mind and tries to survive by appealing to the more sane aspects of her personality. Joan Crawford presents us with an accurate portrayal of a person embarrassed, frustrated, and overwhelmed by her isolated, abusive situation. She desperately tries to get help while Jane descends into a world of fantasy, self-delusion, and violence. In doing so, Jane reveals several hallmarks of an abusive personality, not the least of which is the defense mechanism of denial. On several occasions Jane puts her hands over her ears when the topic of discussion turns to her own behavior.
The events featured in this film are unfortunately common in day-to-day medical practice, but frequently go unreported and unnoticed. In this case, the abuser was the victim’s sister, but abusers can have many roles including spouse, adult child, or unrelated caregiver. Although primary care providers are sometimes in the best position to diagnose and intervene, they may not be trained in warning signs or reporting mechanisms. I discuss this topic in more detail in my publication, Elder neglect and abuse: A primer for primary care physicians. I would recommend anyone who is interested in this topic to start by reading my article, then to view this film.
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