Sometimes, Hollywood gets it right. There are a few films and television shows that have nailed the patient or caregiver experience quite well. More often than not, however, Hollywood uses Cancer (in the broadest sense) whenever it needs to cue a terminal illness to create sympathy without the need for exposition, or force sentimentality when character development and theme are not enough to dredge up a true emotional response.

This problem is far from new. Hollywood has long used a heavy hand to manipulate the audience. And shorthand is often required to tell a story in the confines of two hours or less. Rarely does cancer show up in a motion picture as a fully formed subject, driving the plot on its own or acting as a subplot with any sense of realism or sincerity.  It is an issue that has bothered me since I began my own treatment and stumbled into a series of movies in which cancer was a mere tool for pushing emotional buttons, sometimes callously, frequently gratuitously. Warning: spoiler alert — I am probably going to ruin a few surprise plotlines in the coming paragraphs.

While I was sitting on the couch a few days past an early infusion, struggling with the side-effects of my chemo cocktail that left me nauseous and tired and achy and sad, I tried putting on movies that promised to engage me and distract me from my own condition. I wanted something that could suck me in and hold my attention, not mere eye candy. At the time, it had been getting a lot of positive acclaim for its performances, so I decided to give The Judge a try.

I won’t go into many details about this family drama, in which a hotshot city lawyer goes back to his small hometown to defend his estranged father, the eponymous judge, against a murder charge. It is a heck of a lot of bickering and the viewer is left with a pair of fairly unlikable characters who simply cannot get along for a huge chunk of the movie. The performances are fine and some of the story even holds up — until the time comes when the writer needed to insert a “plausible” way to gain sympathy for a guy who probably did commit murder but also needs to not quite remember doing it, while also forcing a bond to develop between the two main characters. There was no lazier way available than to give the father cancer and blame everything on that.

There have been few (if any) portrayals of cancer treatment that have seemed as disingenuous to me as what was offered in The Judge. And it was not merely because I was jaded by my own diagnosis. There was simply little thought given to the approach beyond, I imagine, trying to figure out the easiest way to make the audience members think they were feeling something. Sentimental buttons, when pressed effectively, can cause emotional responses that are not earned but still elicit the desired physical response. It is the E.T. effect, as I have called it since the first time I saw Spielberg’s pop cultural phenomenon back in the 80s. You bring the music up at the right moment, just as the camera is pushing in, making certain that the backlight is perfect and the eyes are glistening: it is almost impossible not to cry, even if, at your core, you feel nothing for what is happening on screen.

While Spielberg has always been a heavy-handed and manipulative director (and a fantastic technician in this way), he was hardly a maverick in this regard. Hollywood product, especially, but essentially all of world cinema, is rooted in the artifice of manipulation. Editors dredge sentiment from scenes just as effectively as they do suspense. It is a skill that is highly valued in Hollywood, where overly maudlin productions often garner much acclaim, as was the case with The Judge. And while that movie’s use of cancer was an obvious ploy that simply facilitated the rest of the plot, it is surprisingly commonplace for big movies to throw cancer in whenever they need a simple means of driving a piece of action or realigning the impression of a character.

After The Judge, I immediately watched a handful of other movies, trying to keep my mind occupied when I really could not venture far from the couch but also could not sleep. The days risked becoming a singular blur of malaise at that point and movies were about the only way I could pass the time other than staring at the ceiling. The next film I put on was a sci-fi epic called Elysium, in which a young girl crops up in a subplot where she is dying of cancer and the only thing that can cure her is orbiting the Earth with a bunch of rich people in their veritable paradise.

That movie is all about class disparity, with Earth dwellers living in squalor while providing all the labor and resources that make the luxurious lives of the genteel 1% possible. It was a moderately effective story, actually, and somewhat entertaining, but it lacked any real emotional core. It does not help that the characters are all one-dimensional. So, cue that cancer. Bring in the kid. But don’t bother getting too involved with the cancer experience itself — just keep her tired and mostly incapacitated until she is miraculously cured, and never mind actually addressing anything with her actual experience as a patient because, frankly, it never matters. (Also, Matt Damon’s character might also have some sort of cancer or something. I cannot remember, for the life of me. But, like I said about the girl, it never really matters.)

The next random movie or two that I watched, on the same day, mind you, also had cancer just sort of tossed in as a plot device. None of them were what I would call “cancer films” — they just needed to present an easily identifiable disease that viewers could feel bad about or characters that the audience could feel sorry for. That was really the extent of it. It irritated me how wasted these opportunities were to actually address the cancer experience and progress the real-life narrative. These were all relatively current movies, yet the cancer narrative they propelled was grossly outdated. To these movies, Cancer was just a mythological beast, a slowly moving death train chugging along on a singular track toward oblivion.

I feel that the media has a responsibility to society and that Hollywood’s portrayal of cancer could be a positive agent for change. However, these old narratives about cancer persist and new realities have a difficult time seeping their way into the pores of popular culture. It takes a strong vision and probably a lot of lucky timing to get a project out there that challenges the old narratives and avoids falling into cheap sentimentality. But it has been done, and done quite effectively.

As a kid, I remember seeing a television movie with Peter Falk and Jill Clayburgh that I found difficult to forget. Made in 1976 for ABC television, Griffin and Phoenix is a surprisingly touching romantic comedy about two terminally ill people who fall in love after meeting in a philosophy class about attitudes toward death. For years, I tried to find a copy of this movie to watch once more — it was remade in 2006 and readily panned, so I decided to avoid that version (the trailer makes it look awful, even though it clearly uses the same script).

A few days ago I finally stumbled across a bootleg copy posted to YouTube, which I will link below on the outside chance that it remains available. The video quality is pretty bad, but the story holds up. Perhaps what is interesting about it is that both characters have rather advanced cancer, one melanoma and one leukemia, but the movie is really about confronting life when there is precious little time left.

The cancers of both patients take back seat over their own search for a bit of joy and it is difficult to really call this a “cancer film” on its own, when we never are presented with any real treatment for the disease — in fact, both characters are pretty much told they are simply going to die and there is no point in treatment beyond pain medication. This was 1976, after all, and there really was not much more going on. Falk’s character, Griffin, is given the interesting option of an early attempt at immunotherapy, but he is expressly told it would only add a few potential months to the year or so he had left. Times have certainly changed. But this movie is still notable for a surprising lack of sentimentality, especially for a television movie. It never dwells upon the decline of the characters or spends much time watching them suffer. Instead, it lingers on the moments where they shift from anger or fear or sadness into bursts of joie de vivre. The sadness felt at the end of this movie is earned, in spite of the flaws in plot or execution. Even over 40 years later, few films have even attempted to open a discussion on love and death with the simple humor and humanity that Falk and Clayburgh brought to the small screen.

Only a few years later, James L. Brooks provided his over the top brew of maudlin sentimentality to the big screen with Terms of Endearment. While masterfully produced with a host of talented actors, this attempt at a film about love in the face of death (in spite of a great comic performance by Jack Nicholson) ends up pushing loads of buttons by mining the most maudlin approach possible, using terminal illness as a battering ram. I still remember sitting in the theater, resentfully wiping tears off my face because I felt forced into reacting to something that I did not really feel. Every note that Debra Winger’s dying character hits, while certainly appropriately dramatic, exists solely to press viewers into a cathartic release. The fact that it is artificial never seemed to bother most people, but it bothered me then, and it continues to set a template for how Hollywood uses Cancer props rather than genuine cancer experiences.

So I was surprised and more than a bit skeptical when my daughter asked me to watch a new series on Netflix with her called Alexa and Katie. Now, my daughter is in her tween years and the programming she is drawn to is not usually completely in line with my own taste, but she thought I might enjoy this new show. It was, she admitted, clearly in line with the humor on a lot of Nickelodeon and Disney Channel shows, and she told me that I might find some of it stupid or immature, but there was a hook: Alexa has cancer. Since she had already seen a few episodes, I figured I had better get an idea of what my daughter was being exposed to with this topic that, arguably, is close to my own heart.

But Alexa and Katie won me over fairly quickly. It is far from perfect, but it is genuine and rarely sentimental. It helps that the beats of the show are right on the money for a tween-oriented sitcom. There are gags aplenty, and the episodes are easily digestible in 20-odd minute slices. What it does extremely well, while skirting the nastiness of many cancer treatments and never getting into much technical detail about what Alexa is going through, is focusing on the humanity of relationships. Also, it is a nice snapshot of the issues kids face (or think they do) when beginning high school. It sets up some of those old Hollywood tropes and then manages to knock at least a few of them down.

Katie proves herself to be a good role model of friendship and, while the parents are typically underwritten and sometimes childlike, ultimately all of the characters end up being sympathetic for the right reasons. It manages to tackle issues that patients would actually relate to, like struggling to be treated as normal people or enjoy simple pleasures that others take for granted. Overall, it stays light and positive, but it never strays too far into stereotype unless it is trying to make a point. While I wish the cancer had been more readily defined, it was an admirable attempt to use the sitcom format to open an important discussion and shift perspectives on living with cancer. Also notable, at the end of the first season, Alexa is not cured and is still facing a potentially tough road ahead. But at least she got to the homecoming dance.

While going over my potential list of movies or television programs I felt used cancer as a cheap or lazy ploy (am I the only one who also hated The Bucket List or who feels like any time Julia Roberts movies even hint at cancer they should be avoided?), a few other positive ones also came to mind. Television dramas are notorious for tossing in cancer as a fast track toward an emotional crash, whether in the medical, legal, or police procedural formats. But when you take an irreverent and adult-oriented cartoon series like Archer, it seems like the addition of a cancer plot should be a huge misstep. Ironically, unlike the forced episodic nonsense that live-action dramas usually offer, Archer used cancer to propel the plot of an entire season and bypassed any shred of sentimentality by ensuring that the character retained his uniquely awful personality all the way through, complete with his unerring sense of sarcasm and overwhelming air of self-aggrandizement. It never makes cancer a joke and somehow the show actually manages to hit more genuine notes than television usually seems to allow.

While there are a handful of films about cancer that I still have on my watch list, like Me and Earl and the Dying Girl, or even Brian’s Song, or the documentary Just One Year that I have read really good things about, there is one film that I thought nailed the patient experience better than any other. Joseph Gordon-Levitt, who I just discovered shares my birthday, stars in 50/50 as a young writer who receives a surprise diagnosis of spinal cancer. The movie does use shorthand for a few scenes and there are a couple of missed opportunities where subplots might have been better developed, but I have yet to see a motion picture capture the visceral experience of receiving the diagnosis, or the complexities of how cancer affects relationships (for better or worse), as honestly as this one.

And somehow, 50/50 retains its comedic appeal. It helps that Seth Rogen has decent bromance chemistry with Gordon-Levitt and brings his trademark humor into the pair’s relationship. In fact, while Rogen’s character comes off as a selfish and shallow cad, he proves himself to be a steadfast and appropriate friend for what Gordon-Levitt’s character really needs. Although there is a bit of a romantic Hollywood ending tacked on, it is awkward enough to be forgiven, if not quite believable. In the end, a sporting cast and an authentic script (yes, based on the writer’s personal experience), turned this into one of my favorite movies in recent years. It showed me that in the right hands, Hollywood can still turn out movies that might actually propel the conversation about cancer forward. The real trick now, of course, is getting this to happen in a big-budget project that will be promoted on thousands of screens.

If this post resonates with you, please consider supporting my work through a monthly subscription to my feed on Patreon, or a one-time donation through PayPal. Follow me on Twitter, Facebook, Tumbler and many other fancy social sites or apps. Please share my posts to groups you are involved with on Reddit or Google+ or anywhere else that you feel it will help or enlighten or inspire another reader. (Sharing buttons are below the post!)

Thank you!