The Flatliners reboot treads extremely familiar territory.

Why Do We Keep Resurrecting the Cautionary Medical Tale?

Why Do We Keep Resurrecting the Cautionary Medical Tale?

Health and medicine explained.
Oct. 3 2017 7:45 AM

Why Do We Keep Resurrecting the Cautionary Medical Tale?

In the nearly three decades since the last Flatliners film, medicine has moved forward, but our conflicted feelings about it have not.

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Kevin Bacon, Julia Roberts, and Oliver Platt in the original Flatliners.

Columbia Pictures

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When the first Flatliners movie came out in 1990, it received mixed reviews. Critics praised the novelty of its premise—a group of medical students repeatedly kill and revive themselves as a means of understanding and overcoming death—but lamented its heavy-handed delivery. The action hinges on bold scientific research giving way to menacing supernatural repercussions and, in the process, leaves no room for moral ambiguity. The movie’s slogan laid bare its intended message: “Some lines shouldn’t be crossed.” Despite those earlier concerns about the trappings of cliché, however, the film’s reboot, released Friday, recapitulates the original storyline almost exactly and with an impressively straight face. Its early reviews are likewise weak.

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There are several visible differences between the two films. In the new version, the primary cast includes three women and two people of color, as opposed to the first movie, which featured four white men and Julia Roberts. The role of ringleader, originally played by Kiefer Sutherland, has been ceded to Ellen Page, whose performance is driven by grief rather than cartoonish egomania. The technological apparatus that surrounds them all has also been updated to reflect the sexy contours of a 21st-century hospital, including glass-paneled skywalks and revolving brain scanners. But for all its stylistic renovation, this new version is propelled by the same uncomplicated logic: Bright visions of science are prone to going dark, and hubris always yields punishment.

From a practical standpoint, reboots like this one tend to rely on the commercial viability of nostalgia, so perhaps it’s obvious that the new screenplay would follow a familiar series of narrative turns. Hollywood has offered ample precedent lately for such recycled material, a trend that has anchored its own glut of critical dialogue. With regard to Flatliners and the “medical thriller” genre in general, though, one wonders what else might account for the continued production of this particular type of cautionary tale, rooted in the idea that scientific knowledge has natural limits and that pushing up against them invites catastrophe. Is it a pattern worth noting? Why do popular representations of biomedical striving still seem to conclude so logically with retribution?

The dramatic formula itself is ancient and ubiquitous. In his review of the first Flatliners for the Washington Post, Joe Brown took eye-rolling note of a painting of Prometheus situated prominently among the campus’s ubiquitous religious iconography, functioning to emphasize the hard boundary between the affairs of men and the affairs of God, as well as the consequences of that boundary’s trespass. This formula has been rehearsed enough that its continued execution has become in some measure reflexively satisfying; Icarus is made to fly specifically so that we can watch him fall.

The history of Western medicine, moreover, is riddled with examples of broad miscalculations rooted in hubris, which may also help explain the tendency of fictional medical narratives to follow these punitive arcs. A variety of obsolete therapies that were once widely promoted (leeches, lobotomies, thalidomide, etc.) invites ongoing uncertainty about medical knowledge in general. The still-dominant stereotype of a smugly paternalistic physician contrasts sharply with an oft-repeated aphorism in medical school that half of what one learns there will turn out to be wrong within 10 years of graduating. Famous ethical breaches—the withholding of treatment in the Tuskegee syphilis study, for example, or the unconsented banking of cancerous tissue from Henrietta Lacks—suggest that public mistrust of biomedicine might also be bred along moral lines. Looking forward, emerging technologies like the CRISPR/Cas9 gene-editing system are proliferating rapidly, with massively disruptive health implications but no clear guidelines as yet to prevent their misuse.

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These doubts and fears, however, are hardly the only forces structuring the popular outlook on biomedicine. At the same time, there persists a marked optimism about collective advancement in science and health. Such confidence has been distilled almost to the point of absurdity—consider for instance the “Go Boldly” ad campaign put forward by PhRMA, a corporate pharmaceutical advocacy group. Earlier this year, the campaign released a minutelong video that centralizes a different but still familiar medical drama, in which disease is the primary antagonist and everyone in the hospital is a hero. This more idealistic narrative of biomedical progress also became more prominent recently when it seemed to be directly threatened by federal proposals to restrict research funding as well as public access to care. Biomedical optimism may be a cynically predictable frame of reference for PhRMA, but its exhibition on a string of protest signs and politically charged illness narratives suggests that it holds far wider sway.

Medicine, more so than science at large, seems prone to conflicting attitudes; particularly in American medicine, this conflict has been noted before. The anthropologist Howard Stein framed the operative binary as between Hellenism and Hebraism (borrowing concepts from the 19th-century critic Matthew Arnold). In this usage, Hellenism refers to the classical Greek ideal of human perfectibility, a buoyant understanding of our own infinite potential; Hebraism, by contrast, refers to the Judeo-Christian tradition of steady fear before God, corresponding with a deep-seated sense of our smallness and fallibility. Writing in the same year as the first Flatliners film’s release, Stein viewed American medicine, with its expanding high-tech footprint, as having largely settled on the side of Hellenism. Yet our enduring taste for narratives about the foolhardiness of science in the face of the supernatural—in line with Stein’s version of Hebraism—suggests an active, ongoing tension.

The long-standing association between healing and religion might account for medicine’s distinction from science in this regard. Steady progress toward therapeutic innovation is positioned squarely alongside a veneration of tradition—the ceremonial white coat, the totemic stethoscope, the solemn and temperate Hippocratic oath. This traditionalism, in turn, can drift into a sort of piety often elicited by the vulnerability of the very sick or the resilience of the unaccountably well. The commonplace language of the hospital indicates that a bit of any clinical outcome, good or bad, can still always be apportioned to heavenly will. Whenever the mysteries of the body can’t be readily explained, medicine’s spiritual imprint encourages us to exalt them instead and at times even to suggest they should remain mysterious.

Attempting to draw conclusions from a studio blockbuster about the popular perception of modern medicine is no doubt a tenuous exercise. Yet the occasion of the Flatliners reboot, almost three decades later, seems significant as a marker of stasis with respect to that perception. Forward momentum in the medical realm remains undercut by the fear of progressing too far or too fast. Extending life too brazenly remains synonymous with cheating death, an idea that still strikes mainstream audiences as alluringly and damningly transgressive.

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Death in relation to health care has featured prominently in contemporary media, with a string of recently published books harping on the same basic point—that we ought to be better about planning for the end of life and humbling ourselves to that moment when it arrives. Atul Gawande, Haider Warraich, Jessica Nutik Zitter, and others have laid out lengthy cases for the wisdom of more deliberate dying. The response to these treatises has been overwhelmingly positive, but in practice, change has been hard to come by. Why hasn’t the needle moved further? Perhaps because ambivalence cuts both ways. The aforementioned PhRMA commercial is set to a recitation—in a low, humorless, thoroughly cinematic voice—of Dylan Thomas’ poem “Do Not Go Gentle Into That Good Night” (predating the hospice movement by more than a decade, but an anti-hospice manifesto if ever there were one). Just as overt striving leads us to anticipate a pending fall, so might an early posture of surrender make us second-guess the possibility of quitting too soon. This basic indecisiveness about our shared biomedical project feeds continued didactics from both sides.

Medical fiction could advance this dialogue by carrying either of these impulses a bit further toward its logical conclusion. Putting aside questions of plausibility, in a different film, the protagonists’ experiments might be allowed to succeed fully (as they do in, for example, Shane Carruth’s 2004 time-travel movie Primer). Tension can persist in the absence of ghosts; students coming back from the dead easily and without any paranormal baggage would still have to negotiate the public response to their reduction of death to a token amusement. Alternatively, if medicine is to fail in the face of the supernatural, it might do so more explicitly (as in Chris Adrian’s 2006 novel The Children’s Hospital), leading perhaps to a hollowed-out vision of health care, its workforce left adrift by the sudden absurdity of its mission.

Kiefer Sutherland features in the second Flatliners movie as well, as an attending physician, but with a different name and persona than his character from the first. This wink toward narrative continuity might have limited our ability to describe the new version as a simple remake, but facial recognition is about as effective as a painting of Prometheus in shifting the film’s familiar moral inertia. By rehearsing these tired narratives, the movies work to entrench an understanding that medicine, too, has no long-term memory, that hubris is hard-wired and doomed to repeat itself. Our biomedical future is certainly fraught with fresh challenges. Having seen the old spirits re-embodied to such little effect, I wonder how much better prepared we’d be to meet those challenges through the elaboration of fresh stories in the public space.

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Nitin K. Ahuja is a gastroenterology fellow at the Johns Hopkins Hospital in Baltimore.