If Wishing Only Made it So

Early in Patch Adams the film's bête noire, a grim and impersonal doctor, delivers this wisdom to a lecture hall of first-year medical students: "It is human nature to lie. People are not worthy of trust." Therefore, he says, he and his colleagues "are going to take the human being out of you. We're going to make you into doctors." Patch Adams, a substantial hit starring Robin Williams, is a rude and hopeful gesture of protest against the idea that doctors have to exchange humanity for professionalism. It is also a fantasy, a sham, even a scam. As such, it provides an inadvertent but telling diagnosis of fantasy's place in America today.

Critics have had trouble finding a good word for Patch Adams, which follows an unorthodox medical student through three years of bedside antics (in a much-described and representative moment, he transforms an enema bulb into a bright-red clown nose) and battles with uptight doctors, concluding with his decision to found "a free hospital . . . where joy is a way of life, and love is the only aim." Writing in the New Yorker, David Denby paused half way through an excoriating review to ask, "Why bother with a movie like 'Patch Adams'?" He went on to wonder how it could be that "millions of my countrymen have put down money to see" what he described as "easily the most slovenly and whorishly sentimental work to become a big hit in this country since 'Love Story' in 1970."

The answer to Denby's puzzlement comes in the opening moments of Patch Adams, when the screen displays a promise that "The following is based on a true story." This idea—that the real Hunter ("Patch") Adams practices a blend of hilarity and medicine at a free hospital in the mountains of eastern West Virginia—has been the hook for most of the movie's publicity. CNN ran extended footage of the real Adams, a six-foot-four man with a lanky build and a Dali mustache, clowning for children. Gene Shalit of the Today Show finished a segment on Patch by intoning, "And it's true!" Online movie discussion sites have buzzed with indignation at critics' dissatisfaction with the film: a solid majority of viewers seem to agree with a young woman who pro tested against nay-sayers with a plaintive, "Patch is real, you guys!" That bedrock belief is the bottom line for Patch Adams.

It is also the problem. The movie had hardly been released when word began to emerge that no one has ever been treated at Adams's Gesund heit! Institute. The "institute" is only a piece of land with an old house, an elaborate barn, and a wood shop. As for Adams, he lives in Arlington, Virginia, just outside of Washington, D.C. According to published accounts in the Charleston Gazette and People, he gave up practicing medicine in 1983 and has since been a professional fundraiser, traveling the country with his clown nose and the shtick that inspired the movie: a plea for doctors and patients to laugh together, especially at scatological jokes. The contributions he collects nominally go to the ever-receding Ges undheit! Institute, but not much has changed on the site. As recently as a year ago, Adams boasted that he had taken in $1 million for the hospital. Now he declares that he hasn't "a clue" how much he has raised.



The movie's Adams is, like any clown, an artisan of fantasy. He brings wishes alive with simple props, staging a last safari with balloon animals for a dying big-game hunter and fulfilling an ancient patient's girlhood wish of bathing in a tub of rigatoni. This has become a familiar role for Robin Williams. Whether or not explicitly playing a clown, he has become the culture's leading alchemist of benign imagination. In Dead Poets Society, The Fisher King, Hook, Jumanji, What Dreams May Come, and elsewhere, his characters believe in magic and make other people believe, too.

Patch Adams follows this formula. The movie seriously proposes an idea usually reserved for fairy tales—that fantasy can change hearts, change institutions, change the world. The narrative draws a fair portion of its force from the widespread recognition that the world of medicine needs changing, that HMOs and insurance companies have made medicine increasingly profit-driven, mechanical, and anonymous. (In case we miss the point, the film helpfully includes an ordinary folks' gripe session about high bills and indifferent doctors that resembles nothing so much as a scripted focus group from the first Clinton campaign, as rendered in Primary Colors.) When Williams enchants the sick, collects acolytes among his classmates, and eventually wins over the State Board of Medical Examiners, he is striking back against this trend.

The broad-strokes message of Patch Adams is that laughter is not only the best medicine, but also the best politics. Clowning is the cure for disaffection, and fantasy is a good recourse for the 38 million Americans without health insurance and the tens of millions more who are badly squeezed by their HMOs' accounting decisions. This is unlikely enough, and the movie is slapdash and tawdry enough, that Patch Adams would defy credulity if not for the reassurance that "Patch is real." The fantasy survives only with the protection of a falsehood. Patch Adams is an utterly cynical defense of naivete.



The shoddiness of Patch Adams is thrown into relief by the clarity of another cinematic exercise in fantasy, Life Is Beautiful, an Italian import which has been accumulating praise for several months. Life draws its energy from Italy's answer to Robin Williams, the brilliant, sometimes excessive clown, Roberto Benigni. Like Patch, it portrays a clown's assertion of fantasy against an inhumane reality.

Here, though, the stakes are higher than in medical school. The greater part of Life Is Beautiful takes place in a Nazi death camp. There, Benigni's character convinces his young son that the camp is a strange species of resort, where vacationers participate in an elaborate competition under the administration of well-meaning guards who "play the mean guys who shout a lot." What follows is mainly a string of vignettes detailing Benigni's battle to maintain this delusion against ever-harder circumstances. In the hands of a lesser artist, the result would be unconvincing at best, self-caricature at worst. Benigni, though, succeeds in a manner that, for all its unlikeliness, never loses its credibility.

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Life is powerful precisely because it keeps the limits of fantasy clearly in view. The movie has been criticized, predictably, for obscuring the horror of the Holocaust by concentrating on a small, heroic effort in which one person is saved. Some, including Denby, have faulted Life, like Schindler's List, for ignoring the huge, ineluctable, nearly mechanical quality of the Holocaust—for making humane a time whose defining feature was its thoroughgoing inhumanity. This, though, is unfair. It misses what Benigni appears to understand: fantasy is a tragic exercise because, as W. H. Auden wrote of poetry, it makes nothing happen. Benigni does not win over his guards or attract converts among his fellow prisoners, who regard him with the indifference that the condemned reserve for madmen. Even a German doc tor whom Benigni had charmed while work ing as a waiter in Italy refuses to make an exception for the fantasist; instead, in the film's most chilling moment, the genial and sophisticated man asks his old acquaintance for help in solving a riddle that has been nagging at him, and then sends Benigni back to the barracks to await execution.

In this world, all that fantasy can possibly save is the sensibility of one person—a child—and even that precariously and at great cost. Fantasy and clowning are not the first recourse, but the last. They belong to the powerless. Fantasy is desperate, and that is the source of the beauty in its imperfect triumph.

In this fantasy, moreover, there is a curious, endearing universality. It takes something horrible, one of history's sites of most concentrated evil, and says of it: This could be anywhere. This is the opposite of the fantasy of Patch Adams, with its pretense that we can make the banal extraordinary just by wishing it so, that an enema bulb is so much more than that. This is unconvincing as art, at least in a clumsy and sanct imonious movie, and for just that reason Patch Adams has to claim to describe reality. Williams's film is thus doubly false, while Life's honest treatment of fantasy makes it at least singly true.

By banking on a "reality" that does not exist, Patch Adams also chimes with one of today's leading forms of political sanctimony. In a time when people reflexively mistrust the motives of political leaders and the competence of government, there is little appetite for national, or even systematic, responses to social problems. Among those who are inclined to despair of politics, the failures of big, private medicine are bound up with the half-remembered failure of health care reform. Govern ment, they imagine, is not an answer to the problem, but, in some vague way, part of the problem.

This attitude has inspired a programmatic localism. Politicians, policy thinkers, and journalists are all inclined to praise the local innovation over the national program, the "social entrepreneur" over the bureaucrat. This is the spirit behind much of the attempt to turn over social programs to local governments, private charities, and volunteers. It is also the source of the enthusiastic but mainly fruitless volunteer summit that the President and Colin Powell held in Phil adelphia in the summer of 1997. To be sure, an enormous amount of good happens on a small scale, and finding ways to foster and expand that work is one of today's defining challenges for public policy. Most national boosters of the local, though, fly over too fast to enjoy a clear view of the ground, and their recommendations are often opportunistic, hollow platitudes. Patch Adams, a paean to a nonexistent local effort, echoes this obtuseness. The hustle that sold this movie to Universal Pictures and Robin Williams could happen only in a time that is pious toward the local, yet also broadly ignorant of it.


Life Is Beautiful belongs to the genre of magical realism, the style identified with Gabriel García Márquez and other Latin American writers and, more distantly, with the Italian Italo Calvino. This is a style of storytelling that is on intimate and honest terms with fantasy. It does not ask us to change what we believe to be true about the world, nor does it ask us to imagine another world entirely, one to which we could have no meaningful connection. Instead, it invites us to imagine the recognizable texture of our experience drawn into a different weave, dyed with strangely brighter hues, interwoven here and there with a foreign thread. When we leave this fantasy, we carry intimations that the world is a richer place than we had suspected. In the end, we understand these intimations to be testament to the power of intellectual, moral, and artistic imagination.

The other kind of fantasy, Patch Adams's variety, tells us lies. It asks us to believe that the world is otherwise than it is. Above all, it exaggerates the power and importance of fantasy. We are very far from the terrible condition where fantasy is our only defense against unfeeling individuals and inhumane institutions—and a good thing, for fantasy is a weak, if lovely, defense. Fantasy cannot relieve us of the task of dealing politically with political problems. By relieving fantasy of that unnatural burden, we free it for its proper role—to help us believe, fleetingly, in magic, without depending on magic to save us.

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