Alexandre Le Fou

This short film revolves around a middle aged French man, Alexandre who suffers from schizophrenia. He lives alone and his main support appears to come from his grandmother and his father. Despite treatment, he is unemployed and continues to experience auditory hallucinations (voices). His grandmother has limited understanding of his illness and like many Asian grandparents, look forward to their grandchildren getting married. She ‘blames’ his illness on a work trip many years ago while he was on the China Sea. She hopes that faith, religion and praying would help in Alexandre’s mental health condition. Alexandre’s mother (who only appears in flashback in the film) does not accept his illness too. 

Alexandre attends an outpatient support group whereby fellow patients relate their symptoms and treatment.  Alexandre has been involved in dating sites but it was only after he moved to a new place that he knew a female neighbour for whom they started to have sexual intimacy. He appears to have some sexual side effects to his current treatment (specifically an antidepressant, Paxil) and started to reduce his medication intentionally, against advice from his treating psychiatrist. 

We get to know that Alexandre is divorced with a son. Soon, Alexandre suffers a relapse and exhibited symptoms of paranoia and ideas of reference (strangers giggling and smiling at him) and was hospitalized for treatment. Upon discharge, and presumably with compliance to his medication, he is able to reconnect with his son.

Schizophrenia is a serious mental disorder, often with a chronic and debilitating course. It is characterized by both positive and negative symptoms. Positive symptoms are hallucinations (typically auditory hallucinations although they can also be of other modalities) and delusions (false and firmly held beliefs which are usually unshared and inconsistent with the person’s educational and cultural background). Negative symptoms refer to the social withdrawal of the patients. Other domains of schizophrenia include cognitive (such as memory and poor concentration) and mood symptoms (especially depression and suicidal ideations for which antidepressant therapy is usually added).  Up to 80% of patients achieved stable remission at the end of one-year treatment but studies also revealed that 80% would suffer a relapse within the next 5 years. Medication compliance appears to have protective factor against relapse. 

In this film, we witnessed the poor understanding of the illness by the grandmother. There is no doubt that spiritual and religious support can be of help in the recovery of patients with schizophrenia – however as schizophrenia is a brain disease, medication therapy remains the main stay of treatment. The causation of schizophrenia is mainly based on the stress-vulnerability theory-  i.e. the interplay between vulnerable factors such as family history and stressors such as current life events. Chief among the brain neurotransmitters associated with schizophrenia are dopamine and serotonin. 

Some patients have no or limited insight into their illness and stop treatment because of stigmatization (including self- stigmatization). Complexity in terms of frequency, dosages and side effects of medication are also common causes of non-compliance. Alexandre has suffered a relapse because he had wanted to reduce the sexual side effects of the antidepressant medication. Patients (and caregivers) should form active partnership in the treatment strategy with the treating psychiatrist – and changes done in the treatment regime are agreed upon by all parties. Ultimately, the hope is that there is improvement in the quality of life for the patients and they are more confident in their journey to recovery to regain their normal lives.

Contributed by:

Adj Assoc Prof Lee Cheng JP

Psychiatrist and Senior Consultant, Institute of Mental Health