Note: This essay contains spoilers for Avatar: The Way of Water.
There’s little I love more than surprise neurology in mainstream media. One such surprise occurred recently when one of the main characters in Avatar: The Way of Water has a seizure. Seizures are the proverbial bread and butter of pediatric neurology, and while not every pediatric neurologist specializes in treating seizures, we all inevitably see hundreds of seizures during training and throughout our careers. This is because seizures are very common. About 1 in 10 people will have a seizure in their lifetime, about 1 in 26 have epilepsy (recurrent seizures) at some point in their life, and the highest incidence is in children. How wonderful it is to have this common disorder portrayed in a blockbuster film for millions of people … sort of.
Movies and TV often mischaracterize medical disorders. It’s understandable. Medicine is complicated, and writers, directors, and producers are usually not medical professionals. Ideally, the production team should hire a consultant with the appropriate expertise to guide them—but that’s not always going to happen. The accuracy of the depictions may not be very important to the creative team as long as it’s close enough to serve the narrative purpose. In fact, they may even intentionally change some aspects of a medical condition in order to make the story more accessible to a wider audience. But these inaccuracies can be problematic. People living with these disorders may be offended or feel ostracized, stigma associated with a medical condition can be exacerbated by poor representation in the media, and—much less importantly—they can leave a pediatric neurologist feeling disappointed after a 3 hour and 12 minute movie.
A little over halfway through The Way of Water, I watched anxiously as one of the young protagonists, Kiri, is found unconscious with full body convulsions while deep in the ocean. The scene begins with Kiri and the other children swimming down to the underwater Spirit Tree, which serves as a conduit to the spiritual and biological neural-like network believed to connect all living things past and present. Kiri connects to the tree and is mentally transported to a fictitious emotional encounter with her mother. As the vision dramatically escalates, the scene suddenly cuts to an outside perspective of Kiri, showing the seizure. Thankfully, her siblings and friends act quickly to bring her to the surface so she does not drown. In the next scene, we are given the medical explanation of what happened and their best guess as to why.
The visual representation of the event is decent. We see brief full body clonic movements consistent with a generalized seizure. There is a little bit of pelvic thrusting, which is not very common in epileptic seizures, but I am willing to give some leniency since it occurs underwater. She is also completely unresponsive, as you would expect during a generalized seizure. It is brief, and the shaking stops on its own (most real seizures last less than two minutes and self-resolve). Afterwards, however, she remains unresponsive for a longer period of time than we would expect—that is, unless she converted to ‘non-convulsive status epilepticus,’ meaning the seizure was still occurring in her brain without causing shaking. Usually, people gradually regain consciousness over the minutes to hours following a seizure, but Kiri abruptly wakes up and begins speaking. This is unlikely to occur after a severe seizure, but perhaps the Na’vi method of healing treats subclinical status epilepticus better than the options currently available to humans.
The explanations that follow the seizures are more problematic. First, we see two of the human scientists do a complete brain scan with something like a clear tablet—I am glad to see that imaging technology is more convenient and accessible in the future. Unfortunately, since her imaging was normal they had to guess at what happened. I could not tell whether the fancy MRI tablet was also an EEG (electroencephalogram), but this would have been the most helpful test. The Na’vi have neural links through their tails, so their EEG capabilities must be significantly better than ours: they could have plugged a computer directly into Kiri’s nervous system and analyzed her brain waves in real time. This is the kind of guidance a medical consultant could offer a production team; instead, the scientists give Kiri a clinical diagnosis of frontal lobe epilepsy without any clear evidence from their fancy tests.
“That’s the wrong diagnosis,” I quickly whispered to my husband. In a previous scene, Kiri told her father she was able to hear and feel the presence of Eywa, the spiritual mother. The scientists reference these sensations as evidence of focal seizures, ones that would not have spread to the rest of her brain like the one we witnessed. Sensory seizures like this can definitely occur, but they originate in the temporal lobe, not the frontal lobe. Furthermore, she never displays any of the typical features of frontal lobe seizures, such as drastic mood and behavior changes, inability to speak, head and eye deviation, or fencer posturing, usually occurring during sleep. (Of note, pelvic thrusting, mentioned above, can be seen with some frontal lobe seizures although it is most commonly seen with non-epileptic events.) So Kiri may have epilepsy, but if she does, it is probably temporal lobe epilepsy.
This misdiagnosis seems like a glaring mistake. Perhaps it was done intentionally in order to better fit a subtle conceptual narrative that this movie seemed to be building. The frontal or prefrontal cortex is mentioned a number of times throughout the film in relation to many complex representations of consciousness. By giving Kiri a diagnosis of frontal lobe epilepsy, her frontal lobe is now different from everyone else’s. Maybe this positions her to play an important role in Pandora’s evolving biology of thought.
But that doesn’t happen, which leads me to my biggest critique of this long-awaited sequel: the film exploits the seizure to advance the plot in a manner that is entirely unrelated to its medical or social significance. Until the seizure, Jake Sully and his family are well hidden among the Metkayina clan. When the scientists fly out to assess Kiri, Colonel Quaritch, the main antagonist, is able to track their helicopter to the reef. Quaritch then wreaks havoc until Sully is drawn out, setting up the ultimate confrontation. Kiri’s seizure is never mentioned again. Her connection to Eywa becomes more apparent in the final scenes, but the significance of her prior seizure is not explored. We never find out whether she actually has epilepsy or if it is something very different—or perhaps both—and now we won’t know for at least two more years.
I thought Avatar: The Way of Water was vaguely enjoyable as a whole, but weeks later, the seizure still bothers me. I can let the incorrect localization and other details slide, but filmmakers should never utilize medical conditions just to propel a plot forward. This movie had an opportunity to show the world what the impact of a seizure can be. It could have shown how Kiri’s new way of life would have to change, such as the need for extra precautions and adult supervision while swimming. She could have questioned whether her experience of feeling close to Eywa was real or if it was only a by-product of aberrant electrical signals in her brain. It could have demonstrated how it can be particularly tough to be diagnosed with epilepsy as a teenager by having Kiri try to grapple with how her diagnosis fits into her emerging sense of self. Most importantly, the movie had a chance to represent the millions of people living with epilepsy as the complex and wonderful people they are, but, by brushing off the seizure and moving on, the connection between what Kiri must live with and the amazing feats she later accomplishes is lost.
How seizures are represented in media matters, and Avatar: The Way of Water ultimately misses the mark. I can only hope that the next Avatar movie takes a more thoughtful approach to what is happening in Kiri’s brain.
Header Image: Jason Zhang, Ashbridge’s Bay ripples, July 2019. Wikimedia Commons.