Helen starts out as a seemingly happy, successful college professor with a teenage daughter, a second marriage, and a spacious house and a car.  The onset of Helen’s major depression comes slowly, almost imperceptibly, as she sits brooding in the dark and tells her husband “it’s nothing”.  It only starts to become more obvious that she has a combination plate of depression and anxiety when she has a seemingly unprovoked panic attack when returning student essays in class.

The true depth of Helen’s problem only becomes apparent when her husband finds her curled in front of the clothes dryer in a fetal position.  When he brings her to the hospital, the doctor sends them to a neurologist, who goes through the depression inventory as Helen sits sullenly, and her husband initially answers the questions.  To his surprise, her husband discovers that she has made a previous trip there 12 years ago, several years before they married.  He expressed amazement that he had missed seeing the serious nature of her condition for so long.  The neurologist told him; “some people hide it very well.  You should see some of the clowns we have on suicide watch”.  He prescribes an antidepressant and Ativan for the anxiety.

Meanwhile, one of her music students is experiencing a similar, albeit more dramatic, downward spiral into clinical depression.  The movie intercuts to show the parallel track they take as their conditions increasingly impair their peace of mind and ability to function in society.

(I love the scene where Mathilda bangs her head against a glass partition in the hospital and cracks it.  The The image very plainly portrays the collective frustration of any number of people with the medical and mental health systems as they exist in America today.)

When Helen’s medication seemingly fails to work and she makes a suicide attempt, her husband goes to the psych ward for help, and gets a different doctor who says she will change Helen’s medication, but will not hospitalize Helen against her will.  Her husband is clearly frustrated, as Helen has made more suicide attempts, and he feels he can’t watch her constantly; to him, her need to be hospitalized seems obvious.  This is not the case for the doctors who are not living with Helen, and who cite mental health laws as being meant “to protect people like her”, in this instance, by not society having people committed at the drop of a hat.

Meanwhile Helen grows worse, and her teenage daughter eventually ends up leaving her home to move in temporarily with her biological father (who has conveniently been waiting in the wings)

It is only after Helen experiences another non-lethal mental health crisis (she has taken too many Valium and won’t wake up) that the powers-that-be allow her husband to have her committed involuntarily.

It is then that Helen wakes up in the hospital.  Helen and Mathilda meet as fellow psych ward patients and become friends and peers in a way that they probably would not have, had they remained teacher and student.

Of the two, Mathilda is the more damaged, and she is not only damaged by depression herself, but also indirectly.  Her mother committed suicide and left her a house (a nice, clean beach house with giant picture windows) all ready for her and Helen to move in.  Somehow, they seem to have enough money for groceries and utilities, even though neither of them have jobs, or were seen to file for disability benefits (I wonder how many of the mentally ill have prime beachfront real estate?).

Helen initially panicked at ECT (electroconvulsive therapy) being suggested for her, and argues when the doctor tries to talk her husband into consenting to ECT for her, but later, after her release from the hospital, chooses ECT of her own volition when she comes to the belief that by making the choice to have ECT, she is actively choosing the state of sanity.  “Modern ECT” complete with general anaesthesia, an oxygen mask, and more, is depicted.  The ECT experience is portrayed as a dream (the convulsions being muted by succinylcholine), and she is seen waking up (undoubtably with a huge headache) from a soft bed with a pillow.

This movie could be considered a modern-day morality play for the mental health system. As Helen spouts platitudes about mental health, and is presumably continuing her medication, she slowly returns to her normal activities prior to the depressive episode, and the dimmer switch in her home is turned up.

Mathilda, by contrast, deteriorates conspicuously.  She is non-compliant (whether or not her medication(s) actually work and what sort of side effects they have is not made clear to the viewers), drinks alcohol (if you are in fact taking SSRIs, you are officially advised to steer clear of both alcohol and pot), and has sexual encounters in alleys with different men.  It is not made clear whether she is engaging in the unconventional sexual activity from her own free will, or if the men involved are threatening or blackmailing her, or if she’s paying  her living expenses with prostitution.

After Helen leaves the house for the ECT (it takes at least a day to recover from the anaesthesia given in modern ECT, and she apparently has a couple of ECT sessions in a row, so the timeframe amounts to at least a couple of days) she returns to find the home environment showing evidence of neglect, disorganization, and “impulse control issues”.

The cast interviews included on the DVD were revealing.

Ashley Judd said that the scene where Helen is eating dinner with her family while undergoing major depression reminded another movie crew member of what it was like for her family when her mother had major depression.

Alexa, who played Helen’s teenage daughter Julie explained that the character she played went to live with her biological father for the sake of self-preservation even though she knew her mother “would be devastated by it”.  Alexa added that she wasn’t sure if she’d be strong enough to do what her character did if she were in a similar situation with her family.

“The people around the person that’s depressed are often affected as well, and this film does a good job of showing that”.