The “Cake” of the title refers to the homemade birthday cake a chronic pain sufferer named Nina wanted to make for her young son, representing her wish for a normal life and the physical abilities she used to have. A member of her support group, Claire, scoffed at her idea as being overly sentimental, but when Nina commits suicide by jumping off a highway overpass, Claire can’t stop thinking about it and visualizing her own suicide. Nina begins visiting Claire’s heavily medicated dreams as an almost demonic figure, tempting and criticizing her by turns.
But the cake is a lie; it does not accurately depict the financial straits most people with chronic pain encounter when they’re no longer able to work. As a former lawyer, Claire can seemingly afford to pay for a housekeeper to keep her place clean, prepare food, and occasionally drive her to Tijuana for illicit pain medication smuggled back into the U.S. in a hollow statue of St. Jude. Though she gets stopped at the border once, a quick phone call to her lawyer ex-husband takes care of it. She doesn’t seem to require public benefits and never seems to fight with her insurance company, though her doctor and physical therapists are starting to tire of her lack of progress.
At the ending, Cake appears to draw the conclusion that a chronic pain sufferer merely needs to deal with their grief and trauma to have their physical condition improve, but that’s demonstrably false. Many chronic pain conditions have their root in auto-immune and other diseases which have no emotional cause. It’s irresponsible to lead the public to believe that all that needs to be done is “get over it”.