X for Methotrexate: Groundedness Filmed from the Rheumatic Body

DOI: https://doi.org/10.33008/IJCMR.2020.33 | Issue 6 | May 2021

Anna Ulrikke Andersen (University of Oxford, UK)


Abstract

This film and statement looks at the different sites involved in the research, development, production and use of the medication Methotrexate. Initially used to treat childhood leukaemia in Boston in the late 1940s, this chemotherapy proved successful in treating autoimmune illnesses such as rheumatoid arthritis. After a series of trials conducted by Michael Weinblatt (MD), Methotrexate became the most commonly used medication for treatment of rheumatoid arthritis from 1990s and onward, replacing or substituting alternative treatment forms such as climatic or hydrotherapy. Whereas most countries have ventured away from these alternative therapies, Norway still has a governmental funded programme offering climatic therapy, where patients are sent for rehabilitation in warm climates. Aiming at engaging with the sites that relates to this medication, my research uncovered a series of places from Norway to Boston and Puerto Rico. Based on archival research, oral history, site-visits and film production, my film X for Methotrexate (Andersen, 2019, 16mm, 05:59, produced at the Harvard Film Study Center) addresses the theme Grounded Place by juxtaposing the chronically ill and disabled body’s embodied connection to place, with a global network of pharmaceutical production, experienced and seen from the disabled body.


Research Statement



A prefilled, disposable injection device contains a yellow liquid: Methotrexate. The next shot: the abdomen of a woman injecting herself with the drug. Holding the needle still as the liquid slowly seeps into her body, she looks out the window of her tower block. Here, at the window, drug-consumption takes place.

Arif Dirlik argues ‘Place as a metaphor suggests groundedness from below, and a flexible and porous boundary around it, without closing out the extra local, all the way to the global.’ (2011: 57). He sees place in the context of our contemporary, globalised economy (48). And although exploited for capitalist gain, the notion of place is both grounded with topography and produced by social relations (57). A focus on place could enhance a politics that moves from the bottom and up, re-grounding economic life (54). In his work, Dirlik explores how the notions of indigenism and social movements relate to place, to bring forth new critical perspectives and propose a more sustainable future. I wonder how Dirlik’s notion of place and groundedness corresponds or contracts with groundedness experiences from the disabled body. What kind of sustainable futures could be imagined, if the disabled body is our point of departure?


We begin with the rheumatic body: a disabled body.


Jos Boys argues that the disabled body itself has critical potential, in the way it offers alternative, unstable and complex perspectives on the body in space (2017). Her take on architecture springs from the field of disability studies, challenging the assumption that a disabled body is broken, and must be fixed by medicine, rehabilitation and education (Titchkosky and Michalko 2012). Instead, Boys and others with her use the disabled body as a starting point to uncover new nuances related to our built and natural environment. The disabled body is used to finding alternatives and to navigating a system that does not really fit.


The film X for Methotrexate (2019, 16mm, 5:59) begins with the disabled body, followed by a view from a window. Then, a shot of a grey stone building, easily recognisable as Harvard Medical School, and a male voice reveals a fragmented history of pharmaceutical research and production. This voice-over is edited out of a 50 minute long interview with Michael E. Weinblatt, Rheumatologist at Brigham and Women’s Hospital, professor at Harvard Medical School, and author of the article ‘Methotrexate in Rheumatoid Arthritis: A Quarter Century of Development’ (2013). Weinblatt traces the history of the drug back to 1948 and the Boston based research of Sidney Farber. From its initial use to treat childhood leukaemia, this chemotherapy eventually proved successful in treating other illnesses, and currently is considered as ‘the standard of care in the treatment of adult rheumatoid arthritis.’ (2013)

From the cold, grey walls of Harvard Medical School, a series of shots takes the viewer into the depths of the libraries, encountering the journals, texts and images published in the past, before returning the woman’s flat as the sun sets. Where is Methotrexate produced? He does not know. Puerto Rico used to be the big site for Methotrexate, but because of tax laws, they’re no longer there.

When comparing Weinblatt’s article to the film, the film is less interested in chronology and established facts. Instead, the moving images take the viewer on a journey through an institution, including a performative and fake chemistry experiment showing research and production of Methotrexate as imagined by the unskilled patient. The 50 minute interview with Weinblatt is reduced to short sentences in editing, chosen to underscore the filmmaker’s interest and perspective as different from that of Weinblatt. He is not interested in the sites of production. ‘They are so many’, he explains. To him, going to Puerto Rico would not be useful.


The disabled body, however, has multiple reasons for leaving the cold, winter weather in New England, to go south. Warm climates can benefit patients with rheumatism. In a different but equally cold part of the world, the Norwegian government has since 1976 been sending patients with rheumatic illness to southern Europe. Run by Oslo University Hospital, this four-week treatment programme is based on the assertion that ‘rehabilitation in a warm climate has shown to be superior when it comes to easing the burden of symptoms like pain and fatigue.’ (2011: 125) As the patients inhabit warm climates, their wellbeing improves. Many Norwegians travel south for treatment, and the Norwegian Association of Rheumatism has since 2000 owned their own rehabilitation facility, Reumasol, in Spain. For people living with rheumatic illness, being in warm water helps.


Strong colours, bright light and white beaches, this is the tropical Puerto Rican landscape. These vibrant visual images are juxtaposed with sounds captured indoors: recorded at the hydrotherapy pool at Reumasol in southern Spain. This bubbling soundtrack from the pool intensifies as the visual imagery shows clear, Caribbean water filmed up close. Water glittering in the sunshine, the sea invites bodies to delve in, soak and float.

The footage is shot on 16mm film using a Bolex h16 camera. The camera is heavy, using a spring-wound clockwork power system that must be cranked by hand. The rolls of film must be loaded into the camera, each 100ft roll large enough to capture about 2:30minutes of footage. The work is physical, which resonates with filmmaker Werner Herzog’s claim that filmmaking is an athletic rather than intellectual endeavour (see Nagib 2012: 58). According to Lucia Nagib, these physical aspects of Herzog’s filmmaking is evident in his attention to disability and the physicality of difference as evident in films such as Land of Silence and Darkness (1971), and the strenuous process of making films such as Aguirre, The Wrath of God (1972), where the crew infamously had to struggle through the Amazonian jungle to make the film. To Nagib, Herzog’s physicality is a response to ‘irretrievable loss of identity, a rupture between the human element and its environment through which the materiality of the former comes to the fore.’ (2012: 58) A case could be made for choosing ‘difficult’ equipment, such as a Bolex h16. Filming in cold weathers, hands and fingers stiffens. In the heat, the skin can burn, and the body gets dehydrated after long periods spent in the sun. The physical aspects of filmmaking make identity a matter of materiality, following Herzog.


The film ends with shots of wild horses: a symbol of power, strength, and freedom. ‘In Europe, they send people to the Baths, to the Spas, but we don’t do that anymore’ Weinblatt explains.


In his discussion of the notions of place Dirlik argues that attention to place, understood by looking at social movement and indigenism, can be a way to highlight difference and challenge universalist assumptions of social categories (2011: 59). He argues how ‘its specifics must come from the dialectics of the movement itself as it articulates needs and visions not of off-ground global capitalism but of the many worlds we inhabit that are grounded in places.’ (2011: 89) In his account of place, he acknowledges the importance of understanding gender, race and ethnicity, but does not mention disabilities. I draw upon Dirlik’s understanding of place and its critical potential in the film X for Methotrexate (2019). Through the film and the filmmaking, a series of embodied experiences of place is revealed, through a particular focus on the different sites involved in the research, development, production and use of the drug Methotrexate. The nausea felt after injecting Methotrexate from home, movements experienced through university buildings and libraries, or imagined scenes of the chemist’s laboratory, show the patient’s perspective and experiences of place. Here, a body of literature read and conveyed by experts is interpreted by a living body of a non-expert, and they do not always correspond. A different sense of groundedness is involved as the filmmaker travels to Puerto Rico, and her version of Methotrexate’s history are marked by detours compared with the history presented by Weinblatt. Water and warmth are soothing.


An alternative set of global connections comes forth. These connections include the much-travelled itinerary between North and South, or the journey the medication itself makes from laboratory to production, pharmacy and eventually the body. But complicating this network of connections is the perspective of the disabled body, which include places that are imagined, mis-interpreted, unexpectedly marked by bodily pain or pleasure, and in the case of X for Methotrexate (2019), these sites are filmed. Exploring place from this perspective creates different connections that can be felt, experienced, imagined, and embodied. This body lives with pain and pleasure, the known and the unknown, the imagined and the physical.


Acknowledgements

A special thanks to Kathryn Abarbanel, Alen Agaronov, Jonas Kure Buer, Lucien Castaing-Taylor, Harvard Film Study Center, Peter Galison, Abi Palmer, Scott Podolsky and Michael E. Weinblatt.


References

  • Boys, J, ed. (2017). Disability, Space, Architecture: A Reader. London: Routledge.

  • Dirlik, A. (2011). ‘Globalization, Idigenism, Social Movements, and the Politics of Place.’ Localities (1): 47-90.

  • Nagib, L. (2012). ‘Physicality, Difference, and the Challenge of Representation: Werner Herzog in the light of the New Waves.’ In A Companion to Werner Herzog. Chichester: Blackwell Publishing. 58-79.

  • Strumse, Y. A. S.. (2011). ‘The Efficacy of Rehabilitation in Warm and Cold Climates for Patients with Rheumatic and Neurological Diseases: Three Randomised Controlled Studies’, PhD Thesis, University of Oslo.

  • Titchkosky, T. and Michalko, R. (2012). ‘The Body as a Problem of Individuality: A Phenomenological Disability Studies.’ In Disability and Social Theory. Edited by Dan Goodley, Bill Hughes, and Lennard Davis. Basingstoke: Palgrave MacMillan. 127-142.

  • Weinblatt, M. E. (2013). ‘Methotrexate in rheumatoid arthritis: a quarter century of development.’ In Transactions of the American Clinical and Climatological Association (24): 16-25. Accessed 01.11.2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715949/