Perhaps his most ambitious, challenging, and solemn effort to date, Synecdoche, New York is the directorial debut of Charlie Kaufman, best known as the screenwriter of critically acclaimed, darkly surreal comedies like Being John Malkovich (1999), Adaptation (2002), and Eternal Sunshine of the Spotless Mind (2004). Another story of a creatively gifted, emotionally fragile male protagonist attempting to navigate his personal obsessions, longings, and regrets, this film centers upon the lifelong struggles of theatre director Caden Cotard (Philip Seymour Hoffman) to achieve familial, artistic, and physical well-being. Unfolding through the dream-like lens of his subjectivity, it is also the story of an existential dilemma undergirded by anxieties about chronic illness, and the desire to address those anxieties through acts of creation that may or may not live on beyond one's corporeal form. (That said, if this review seems excessively comprehensive, I ask you to indulge my attempt at evoking the very immensity of the project that the film depicts. Caden's vast, all-encompassing struggles to dramatize his own life make difficult the task of adequately summarizing his plight in a few broad strokes and embodied details.)

We first meet Caden in his forties as he prepares to mount Death of a Salesman, intentionally using young actors for the older roles in order to give the theatrical audience the tragic insight that these young actors, later in their lives, will experience the same end-of-life despair as the aged characters they play today. This sense of different temporal moments from one's lifespan performatively commingling during the inevitable advance toward death not only strongly informs Caden's work, but also, as we eventually discover, the structure of the film itself. From the very first scenes, Caden seems humorlessly obsessed with illness and mortality, and his world provides no shortage of daily reminders: we see him retrieve from the mailbox a grimly illustrated magazine titled Attending to Your Illness; read in the newspaper about avian flu outbreaks and obituaries of historically notable figures; and glimpse a children's TV cartoon about a virus. Although never identified as such, we are invited to perceive Caden as afflicted with some form of hypochondria through his continual suspicions about physical illness; indeed, his name is an allusion to Cotard's syndrome, a depressive neuropsychiatric disorder involving delusions that one's body has lost parts or organs, is in a state of putrification, or that one is already dead or nonexistent. While Kaufman does not directly imply that Caden is afflicted by said disorder, it is nevertheless a clue to the protagonist's morbid preoccupations and the all-encompassing project into which he later immerses himself.

Minutes after the film begins, Caden suffers a head injury caused by an exploding bathroom faucet, leading to a string of unsatisfying appointments with medical specialists as they gradually suspect symptoms of a mysterious corporeal deterioration. The clinical settings he visits throughout the film are portrayed as dark and inhospitable places, filled with shadowy corridors and gloomy examining rooms, as though lacking enough illumination to render an adequate assessment. The blank-faced doctors are impersonal, confusing, and noncommittal in their every action and word, constantly scribbling unseen notes while seemingly unable to give him a straight diagnosis before shuttling him off to another specialist. For example, initially noticing unexplained irregularities in the operation of Caden's pupils, the first doctor recommends that he see an ophthalmologist (which Caden mishears as "neurologist"), while the ophthalmologist recommends that Caden indeed visit a neurologist (which Caden mishears as "urologist"), and so on. These doctor-patient exchanges, while played for a certain grimly absurdist humor, are largely somber episodes that highlight the ominous breakdown of communication throughout his medical experience. Take this awkwardly halting display of bedside manner:

Caden: Why do I need to see a neurologist?
Ophthamologist: Just for a look-see. The eyes are part of the brain, after all.
Caden: Now, that's not true, is it?
Ophthamologist: Why would I say it if it weren't true?
Caden: It just…doesn't seem right.
Ophthamologist: Like "morally correct" or "right" as in "accurate?"
Caden: I don't know…. Accurate, I guess.
Ophthamologist: Interesting….

As viewers, we are, like Caden, unable to ascertain the "truth" of what his body may or may not be experiencing, but must puzzle at the symptomatic vagueness of his doctors' responses. Uneasily located between possible misdiagnosis and possible hypochondria, his body, by not revealing the cause of its suspected abnormalcy, complicates the simple containment that viewers often expect of illness/disability narratives. The medical establishment seeks to circuitously classify his ailment through its potentially dehumanizing system of tests and referrals, but seems merely capable of dysfunctionally expressing non-answers; the doctors do not give the impression that his condition can be logocentrically captured and somehow controlled by putting it into words. In fact, shortly after these initial examinations, there is an allusion to Kafka's The Trial, suggesting that Caden, like that novel's innocent protagonist, is struggling against a nightmarishly absurd and impenetrable bureaucracy that exercises its power through inconclusive appointments and linguistic convolutions. For example, later in the film, after Caden develops unceasing spasms in his right leg, he fearfully asks his doctor about the prognosis:

Caden: Now, you're a doctor, right? Am I dying? Can you tell me that?
Doctor: No.
Caden: "No," you can't tell me?
Doctor: I can't tell you.
Caden: "No," you can't tell me if you can't tell me?
Doctor: No.
Caden: "No," you can't tell me 'cause you're not allowed to?
Doctor: No.

This rampant miscommunication echoes the persistent communication problems that Caden faces in his family life, especially when illness is the topic at hand. When he rolls over in bed one night, mentioning that he thinks there is blood in his stool, his wife Adele (Catherine Keener) asks, "That stool in your office?" Later, he attempts to explain to his four-year-old daughter Olive (Sadie Goldstein) the spelling difference between "psychosis" and the sycosis pustules that have emerged on his face:

Caden: "P-S-Y" is like if you're crazy…like Momma. "S-Y" is like these ugly things on my face.
Olive: You could have both, though.
Caden: I could, but I don't.

His ongoing medical ordeal dampens the artistic satisfaction that should attend the critical success of his Salesman production, in conjunction with the slow dissolution of his marriage. He has been engaged in a quiet flirtation with Hazel (Samantha Morton), a young woman who works in the theater's box office, and with whom he will sporadically continue a romantic relationship throughout his life; meanwhile, Adele decides to start her life anew, taking Olive with her as she pursues her visual art career in Berlin. Caden's chronic morbidity seems to have spawned physical symptoms coincident with the blooming of Adele's artistic independence, leaving him struggling to impress her through his own future work, in hopes of perhaps winning back the lost family that represents ancestral bonds that could live on after him, through his daughter. For example, he phones Adele in Germany during a party celebrating her newfound fame, but she hangs up on him and he promptly suffers a seizure. Afterward, while sitting in a doctor's waiting room, he reads a magazine article in which Adele is quoted as being "at a point in my life where I only want to be around joyous, healthy people." Meanwhile, the latest doctor claims that there "seems to be some synaptic degradation, fungal in origin," causing Caden's autonomic functions to "go haywire." As a result, he will lose his ability to salivate, cry, and perform other simple bodily functions if not enrolled in a biofeedback program for manually retraining his body to perform these tasks. For instance, when he travels to Berlin to (unsuccessfully) locate Olive, and instead finds discarded in a rubbish pile the gift he had mailed her, he must squirt several drops of "tear substitute" into his eyes before sitting down to weep abjectly. As in the perplexing medical consultations, there is a streak of darkly comic humor in these small details of his bodily (mis)functioning, but the film's framing of these moments as absurd—perhaps even tragic—may not sit easily with some viewers with disabilities. Caden clearly has an intense fear of the bodily deterioration that seems to have finally become manifest, potentially marking him as an especially pitiable character for nondisabled viewers.

However, notwithstanding his earlier denial to Olive about having a psychosis, viewers may well ponder the extent to which Caden's illness is a mental projection of his inner anxieties onto the external world he senses, following Adele's earlier suggestion that romantic love is a projection of oneself onto the desired other. Because the film is focalized through Caden's subjectivity, the film's surreal stylizations—such as Olive's left-behind diary writing itself as Caden reads it over the years; or Hazel buying a burning house that first smolders, but is decades later filled with flames—are portrayed very matter-of-factly, not treated as extraordinary or fantastical. More disorienting is the film's highly subjective treatment of time, with months and years seeming to suddenly vanish, marked only by fleeting temporal reference points. For example, a radio announcer initially marks the morning of the faucet injury as September 22, 2005, while the newspaper retrieved from the mailbox minutes later reads October 14, and the radio broadcast on ride home from the doctor marks the date as New Year's Eve. Similarly, when Hazel invites him out on a date later in the film, Caden thinks Adele has only been away in Germany for a week, but Hazel corrects him that it has actually been a year. These slippages, aided by Kaufman's need to condense over four decades into the film's two-hour duration, can create strange effects mimicking the deceptively quick compression of time with which many people reportedly sense the passing of adult life. Yet, while the film may subtly attempt to portray some commonality of subjective experience with time in this regard, its idiosyncratic use of space positions Caden's unnamed illness within a non-realistic storytelling framework that becomes all the more apparent as the plot progresses—and, as I will explain shortly, may complicate readings of Caden as a simplistically tragic, self-loathing disabled character.

Amid the personal turmoil of his failed marriage and growing medical concerns, Caden is named a 2009 MacArthur Fellow, granting him the funding to mount a massive, autobiographical theatre piece into which he can finally pour his "real self." Moving from Schenectady to New York City, he rents a gigantic warehouse in the theater district and hires a cast and crew of hundreds—who will all immerse themselves in the "communal bath" of this production, exploring the existential crisis created by the recognition that they will all someday die. In one of the film's more surreal (or, if you like, Baudrillardian) conceits, a life-size, fully inhabitable set of New York City is built within the warehouse and peopled with actors portraying Caden and the people in his life as they dramatize the very process of mounting that same production. Consequently, these actors portraying the production's cast and crew create another life-size city set in a warehouse located within the first warehouse—in which yet other life-size sets are built within one another in a seemingly endless chain of theatrical worlds-within-worlds mirroring one another like the layers of a Russian nesting doll. Normative verisimilitude quickly erodes as Caden's day-to-day reality becomes inextricably lost within these simulacral layers filled with doppelgangers; in fact, "Simulacrum" is one of Caden's many proposed titles for the production. While Adele creates her art on a miniature scale—gallery visitors must literally wear magnifying lenses to view her work—Caden's inhabitable sets seem grotesquely large for theater, yet are cut to the measure of "real life." In this respect, the film's title "synecdoche" tellingly refers to a figure of speech in which a part stands in for a whole, or vice-versa, implying that the theatrical world contained within the warehouses is a synecdoche for Caden's whole life (and vice-versa). Because it is only Caden's immediate past that is continually dramatized, a "real life" external to the warehouses or in some way unconnected to them certainly becomes very difficult to discern as the film proceeds.

As years pass, Caden marries one of his longstanding actors, Claire (Michelle Williams), and fathers another young daughter, but their marriage is strained by Caden's single-minded dedication to the production, his ongoing closeness to Hazel (who is now his production assistant, but also has a family of her own), and his continuing preoccupation with the disintegration of his first family. In the ensuing time, Adele has remarried and become hugely famous but unreachable in Germany, while Olive has turned her body into a canvas for tattoos and begun dancing in strip shows. After seventeen years of rehearsals, Caden begins giving his actors daily notes, an array of physical and emotional troubles—e.g., "you found a lump in your breast," "you looked at your wife and saw a stranger," "you keep biting your tongue," "your wife just had a miscarriage," etc.—to motivate a sense of "the brutal truth." Including himself in this directorial strategy, he hires Sammy (Tom Noonan), a man who has been inexplicably following him for the past two decades, to play him after Sammy promises that his performance will reflect who Caden really is. Playing Caden, Sammy subsequently moves into the apartment set occupied by Claire (playing herself), filling the real Caden's role as husband and father—which eventually leads to the dissolution of Caden and Claire's marriage, especially after Sammy's on-set presence re-stokes Caden's feelings for Hazel. Meanwhile, in his research for the role, Sammy observes the changing color of Caden's feces, the handful of pills ingested daily by the latter, and the cane-assisted gait he will mimic for the part—but seems unable to personally offer any great insight into Caden's physical condition.

Chronic illness continues to serve Caden as a constant reminder of his unavoidable death, spurring his dedication to the production while straining his personal relationships with his "real" family—but the search for the source of his physical ailments has also become secondary to the film's action by this point in the narrative. Having been a central feature propelling the film's first half, the second half finds Caden's own illness increasingly diffused throughout the multi-dimensional world of the play-within-the-film; in other words, while his seemingly hypochrondriacal symptoms earlier in the film represented a sort of self-obsessed inflation of his subjectivity, the confirmation of his chronic illness leads to a gradual dissolution of subjectivity as it spurs the explicitly autobiographical turn in his artistry. Yet, rather than merely viewing Caden's relationship to his own body as "tragic," we should keep in mind that those symptoms of illness are proliferated throughout the multiple warehouses and multiple versions of himself through his creative decisions. On the one hand, the enormous production envelops his illness as the problems of "just a little person / one person in a sea / of many little people / who are not aware of me" (in the words of the film's key song); but on the other hand, Caden's bodily and emotional anxieties are broadly projected onto that autobiographical world through the multitude of daily notes he supplies each of his cast and crew members. Because his actual illness remains mysterious and unnamed throughout the film, it seems an idiosyncratic ailment, not one that might actually be shared by other, very different people than Caden; therefore, within the production he creates, his illness remains not just a state of his singular body, but becomes refracted and multiplied outward to identical versions of his self, and sublimated into other characters whose "brutal truth" is motivated by medical issues. It is as if transforming his body's actual experience into yet another sign that can be shared, and perhaps communally understood, within a hyperreal, aesthetic realm of excess signification is the best means for Caden to sense that he is not alone in the universe, that others might indeed share his ontological plight without even knowing it.

The signifiers that baffled the medical establishment are now intentionally deployed by their owner through dramatization, as if capturing his illness experience within the play's various self-contained worlds might contain and manage the illness through the constant effort of his own artistic volition. As a priest character declares late in the film: "And they say there is no fate—but there is! It's what you create." Recalling the contemporaneous process of manually retraining his bodily functions, his struggle to actively make meaning for his own life is quite literally a process of creation—but a process that hinges upon re-presenting his life as it "really" is, so as not to alter "the brutal truth." As such, this is a world only partly of Caden's creation, for the "real" life that he perpetually, almost immediately after the fact, turns into an aesthetic experience, is never fully within his control; his illness is a constant reminder of that inability to entirely command his fate, of his body's irreducibility to merely a textual sign. Because the rehearsals of his life have effectively become his life, his existence remains a sort of performance in which his seemingly comprehensive directorial power remains informed by his illness, creating an image of life in general, and all its attendant problems, as (like chronic illness) a corporeal state that can be managed with active effort but never fully commanded or "cured." In light of this desire for a shared recognition of our temporary state of being, Caden's condition is ultimately no more "tragic" than our own human condition, regardless of viewers' respective level of physical well-being. It is not just a play about death, he clarifies at one point, but a play about everything—as though the apparent individualities of the population at his disposal are readily interchangeable, with the presence of illness or disability serving as part of a collective human experience. While Caden may generalize outward from his chronic illness by considering it a potential source of misery to be lumped in with many other emotional and physical anxieties, his creative choices also point toward the fluidity of illness/disability as a source of identity potentially shared by a larger segment of the population than nondisabled viewers might often assume.

Within this deliriously Borgesian mise-en-abyme of multiple warehouses and multiple versions of Caden, years continue to pass as the rehearsals seem to overwhelm any hope of an eventual premiere. As they approach old age, the real Caden and Hazel sleep with each other's actor surrogates, spurring them to renew their affection for each other, now that their respective marriages have fallen apart. Heartbroken over Hazel's turn back toward the real Caden and accusing Caden of only ever looking at himself, Sammy leaps to his death from a building set, reenacting an unsuccessful suicide attempt by Caden years earlier. Unexplained symptoms of physical deterioration continue to heighten Caden's fears about death, but are exacerbated by other, more surreally tinged deaths of those around him: his father dies of cancer after seeing the doctor for a hurt finger, and so little is left of him that his coffin is filled with cotton balls to prevent his body from rattling around; grown-up Olive's (Robin Weigert) floral tattoos become fatally infected, withering on her body as she dies without forgiving her father for the dissolution of his first marriage; and Hazel dies from smoke inhalation in the bed of her long-burning house, shortly after consummating her renewed relationship with Caden. He resolves that the play will take place over the course of the day before Hazel died, so that he can forever replay the happiest day of his life. But life goes on within the warehouses and this romantic/narcissistic memorial gesture falls by the wayside as more years slide by without a public performance.

Caden, feeling exhausted of creative ideas—as if finally reconciled to his ultimate lack of control over his life/production, but nevertheless content to carry on—trades his directorial role with Millicent (Dianne Wiest), an actor formerly playing Adele's cleaning woman. Sammy's suicide, an act of personal volition that drastically broke from Caden's practice of dramatizing his daily life as it occurred, led Caden to realize that no one in the world is an extra, that they are "all leads in their own stories" and "have to be given their due," and this is the insight he has at last adopted for himself. Wearing an earpiece to hear stage directions from the new "Caden," the real Caden wanders through the increasingly ruined and abandoned sets, littered with corpses and rubbish, his cast and crew having died or left. Now portraying the once seemingly insignificant cleaning woman, the stage directions he receives at the end of the film explain the apparent interchangeability of his all-too-human condition: "You realize you are not special. You have struggled into existence, and are now slipping silently out of it. This is everyone's experience—every single one. The specifics hardly matter. Everyone is everyone." While this insight seemingly depoliticizes his underlying physical condition by rendering moot its specificity, it leaves open a potentially productive tension between individual and collective experiences of chronic illness and disability. Unable to creatively proceed any further, the elderly Caden is finally given the command to die—but even at this most personal and vulnerable moment, he understands that there have always been others like him. Unlike the paranoid projections of his impending demise that he had made as a younger man, his eventual death as an old man is a quiet confirmation of the self-abnegation paradoxically resulting from his ostensibly self-aggrandizing life project. Yet, even if he leaves behind no traces of his life or work, his particular illness/disability experience remains part of a shared metaphysical project of defining one's existence, of situating one's place in a world in which localized forms of physicality—here, literally projected outward into the vertiginously descending locality of the warehouse(s)—can serve as both obstacles and conduits to (inter)personal fulfillment.

Admittedly, this is only one possible reading of a literate, intelligently convoluted film that is considerably open to interpretation, a film that rewards multiple viewings as one slowly inhabits its space. Still, at once deeply sad and darkly optimistic, its Sisyphean story is driven less by a conventional illness storyline than the impending void that illness here represents. While viewers with disabilities may well regard with suspicion its recurrent correlation between illness and death, Synecdoche, New York may also prove a thoughtful and moving portrayal of living through chronic illness, rendered in surreal enough terms to complicate the viewing expectations that we might customarily hold about more conventional, verisimilar illness narratives.

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