When filmmaker Oren Moverman returned to Givatayim, near Tel Aviv, on leave from his paratrooper unit during the first Lebanon War, he often shut himself in his room and repeatedly watched the Vietnam War saga “Apocalypse Now.”
“My head was still in the combat zone,” the 43-year-old said from his Manhattan home. “When you immerse a man into a world of violence and death, then bring him back to ‘normal’ life, he feels like he’s from another planet. And, now, everything’s supposed to be fine, everyone’s moved on, but he is still back there, in a way.”
Moverman has brought his first-hand knowledge of what he calls the emotional landscape of war to his directorial debut, “The Messenger,” now in theaters. It is the first of the recent spate of American films about the Iraq War, including “The Hurt Locker” and “In the Valley of Elah,” by to be penned by a former soldier.
In the quietly searing drama—which has earned excellent reviews and Oscar buzz – a wounded Iraq War veteran and a jaded Army captain pair up to work one of the most dreaded jobs in the military: as casualty notification officers who must inform “next-of-kin” that a loved one has died. Amidst the death calls, the tightly wound men reveal their respective psychic wounds. Beneath his bluster and chattiness, Captain Tony Stone (Woody Harrelson), is an alcoholic, relationship-resistant, lonely mess. And the returning veteran, Sgt. Will Montgomery (Ben Foster), seldom speaks publicly but virtually convulses with anger while isolated in his room.
Moverman identifies most with Foster’s character, specifically the disorientation the fictional Ben feels upon returning to civilian life. “There is a ‘theater’ of the Army—macho posturing where guys learn to bury their emotions and to act in expected ways,” the director said. “All this adds up and becomes harrowing. Some soldiers find themselves locked up inside, which is what Ben Foster’s character is going through. He’s had hellish experiences; he’s come out of them alive, so there’s survivor’s guilt, and also hero’s guilt, because he perceives that he has done nothing extraordinary. And he’s drinking a lot, he’s trying to numb himself, he’s not sleeping well, he goes to the supermarket in the middle of the night, he’s listening to music as loud as he can to drown out the [psychic] noise.”
The soft-spoken Moverman is quick to add that he did not include any of his actual military experiences to the script, only the emotional ones—above all his desire to ease his way back into civilian life, in his case by moving to New York to become a filmmaker. “Much of ‘The Messenger’ is about someone who has been traumatized but who is actively trying to get back to a place where he can connect and function – ironically through casualty notification.”
The idea for the film emerged several years ago, as Moverman and “The Messenger’s” co-writer, Alessandro Camon discussed a newspaper story about a casualty notifications officer and realized the process could provide a dramatic way into a story about the unseen consequences of war. Unseen to Americans, that is.
“Because the Israel Defense Forces is a people’s army, you grow up with images of your father putting on his uniform for reserve duty, and, in my case, my dad leaving to fight in the Yom Kippur War,” Moverman said. “I also grew up grow up seeing and hearing about the flip side of that: the casualty notification team who would knock on your door when a loved one had died.”
Moverman seems loathe to discuss details of his own military service, which occurred from 1984 to 1988 and included the first Intifada. He alternately dismisses his experiences by saying they were not that interesting while hinting that they were, in fact, deeply disturbing and life-altering.
Yet it was while patrolling in Hebron one day in 1985 that Moverman received what would turn out to be his big break into the American film business. Because he had lived in the United States with his family as a teenager, the young Israeli spoke good English, and so was asked by his sergeant to stop a tourist who had emerged from a taxi carrying a video camera. When Moverman told the visitor he could not shoot in the military zone, the enraged tourist, a documentarian, began screaming and denouncing the occupation.
“I told him I agreed with many of his views, but I was a soldier, and this was what I was sent to do – even though I would have loved to help him, because I was interested in film,” the director recalled. “I think that disarmed him; we began talking, and he gave me his business card.” When Moverman moved to New York to study cinema at Brooklyn College in the fall of 1988, the documentarian helped him get a job working with direct cinema legend Al Maysles.
Moverman went on to make a name for himself as a writer or co-writer on films such as Todd Haynes’s “I’m Not There,” “Jesus’ Son” and “Married Life.”
While scripting “The Messenger,” he researched the United States’s casualty notification process, which was quite different from the one he remembered from Israel. The IDF team, he said, consists of four service men, a psychiatrist and a physician: “People do faint or have heart attacks,” he explained of the need for a medical doctor. The U.S. process, he learned, is sparer: Just two officers, a scripted speech from the secretary of the Army, the facts of death, and word that another officer will follow up with the family. “Some people perceive this to be rather cold, but I think the intention is to break the news in an honorable way.”
During production on “The Messenger,” Moverman shot each of the six casualty notification scenes with a hand-held camera in one long take. To enhance the intensity he did not allow his stars to see the actors portraying the next of kin until they actually opened the door in the sequence.
During the 28-day shoot at Fort Dix, Moverman said, military personnel showed him extra respect because he was an Israeli veteran; Foster, meanwhile, urged him to tell his own war stories.
“[Oren] didn’t want to say he was in war, he was in an occupation,” Foster told IFC.com. “He’s a really humble guy, but he understands the mindset of a warrior. It’s pretty basic. You’re horny all the time, you’re worrying about who’s f———your girlfriend, you want to shoot something, you’re bored, you’re terrified. Getting back to life with people who don’t share the same experiential vocabulary can be very isolating.”
The conversations proved illuminating for Moverman.
“For some reason I had been able to separate the fact that I’ve served in the military from the fact that I was making this kind of film, which probably says a lot about my lack of self-awareness” he said. “But Ben asked me a lot of questions and the more I spoke the more I found connections to the character, which moved this project to a place where I was even more personally invested.”
‘The Messenger opens Friday, November 20, 2009
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Venezuelan playwright Moisés Kaufman brings the historical drama surrounding fallen English playwright Oscar Wilde to the stage in “Gross Indecency: The Three Trials of Oscar Wilde.” Using transcripts and real quotes from Wilde’s infamous trials, as well as newspaper articles and the personal accounts of those involved, Kaufman chronicles how the darling of Victorian England was shunned for “committing acts of gross indecency with other male persons.” An L.A. Theatre Works audio performance, recorded live without sets or costumes, to be broadcast on public and satellite radio nationwide. Sat. 2:30 p.m. Also, Sun. at 4 p.m. $40-$48. Skirball Cultural Center, 2701 N. Sepulveda Blvd., Los Angeles. (310) 827-0889. <a href=){kind=spacer}
” title=”latw.org”>latw.org. is a very helpful review of the pooled data from all the randomized trials for mammography in different age groups. The table shows how many women are needed to be invited to undergo mammograms in each age group to prevent 1 death from breast cancer. The numbers for women in their 60s are terrific. 377 women in their 60s need to be offered mammography to save 1 life from breast cancer. (The lower the number of women who must undergo mammograms to save one life, the more beneficial the intervention.) In their 50s 1,339 women must be screened to save a life, and in their 40s 1,904 must be screened. <strong>So mammography is still life-saving for women in their 40s it just saves fewer lives than for women in their 50s and 60s.</strong> In fact, the abstract of the article concludes</p>
<p style=){kind=link}
 summarizes the potential harms by age per 1,000 women screened. We would expect the harms in women in their 40s to outbalance the benefits and lead to the recommendation against mammograms at that age. The left column in the table deals with women in their 40s. Recall that it takes 1,904 women to be screened to save one life from breast cancer in that age group. Since the table shows the harms per 1,000 women screened, if we multiply each number by 1,904/1,000 we discover the harms that result from saving one life in this age group. <strong>So to save one life from breast cancer by screening women in their 40s with mammograms we would have to inflict 186 women with false positive mammogram results (abnormal mammograms without any cancer present), </strong><strong>161 women would have to undergo additional imaging and </strong><strong>18 women would have to undergo biopsies.</strong></p>
<p>Now, I don’t want to minimize the misery involved in an unnecessary breast biopsy (unnecessary only in hindsight, of course). The procedure itself is uncomfortable and waiting for results is torture. Still, 18 biopsies to save one life strikes me as a wonderful trade-off, especially given that saving a life in the 40s yields many years of additional living. How can the USPSTF possibly judge that these harms outweigh the benefits? They hedge their recommendation by saying that the decision should be individualized for each patient, but that’s true for all medical decisions. Why then recommend against it?</p>
<p>Because it’s sometimes difficult to understand the numbers involved, I ask you to do the following thought experiment. You are a physician addressing an auditorium of 1,904 women in their 40s. You tell them “If you all have mammograms before you turn 50 one of your lives will be saved from breast cancer compared to just waiting until you all turn 50. Some of you will get breast cancer and die of it whether you get mammograms or not, and most of you won’t get breast cancer. If you start mammograms now, 18 of you will get biopsies, and a lot of you will get incorrect initial mammogram results requiring more mammograms or ultrasounds or MRIs. But only one of you will have her life saved from breast cancer.” Each woman can and should decide for herself but they’d like a recommendation from you.</p>
<p>I can’t imagine not recommending mammograms under this circumstance. Of course some women may choose against mammography, but to me the harms seem minor compared to the benefits.</p>
<p><strong>How frequently should women have mammograms?</strong></p>
<p>The decision to recommend biennial mammograms is based on a study published in an article at link 3, below. The study uses various models to compare the harms and benefits from different mammogram frequencies. But this article does something that has generally been outside the purview of the USPSTF. It considers cost.</p>
<p>The results state that having a mammogram every two years had 81% of the benefit of annual mammograms with far fewer false-positive results, unnecessary biopsies and additional imaging. <strong>And they state explicitly that annual mammograms consume more resources than mammograms every other year.</strong></p>
<p>There are two important objections to this. First of all, getting only 81% of the life-saving benefits of annual mammograms may not strike many women as a victory. Why not capture all the benefits by having the test annually? The answer might be the additional harms, but as we’ve seen in the previous section, the harms are quite modest and most women would not be deterred by them. The second objection is that previously the <strong>unique value of the USPSTF was that it advised physicians about the value of tests regardless of costs</strong>. That allowed us to give patients the best advice we could, and allowed patients to decide if the cost was worth the benefit. Now, the USPSTF is deciding for us that annual mammograms are too expensive.</p>
<p><strong>Conclusion</strong></p>
<p>So, I and many other physicians will <strong>advise women to have annual mammograms starting at age 40</strong>. And in my opinion they should continue to do so until they are ill or frail enough that a new diagnosis of breast cancer would be unlikely to shorten their lives. For some women this might be in their 70s, for others, in their 80s.</p>
<p>But the broader outrage is that a group that I used to turn to without hesitation for objective review of the scientific data, a group that informed my daily advice to patients, has provided recommendations inconsistent with their own data and motivated by economics. Patients and physicians have neither the skills nor the time to scour the world literature on important topics. Who will fill the role that the USPSTF abandoned?</p>
<p><strong>Learn more:</strong></p>
<p>Scientific articles:</p>
<p>(1) <a href=){kind=link}