Spreading the gospel of No fears, no tears

This clinical psychologist's documentaries show kids haven't got time for the pain

By Elizabeth Wasserman

While shooting her latest documentary, When Every Moment Counts, Dr Leora Kuttner witnessed the sort of moment that no filmmaker could forget. A little boy dying of a terminal disease was in his Halifax hospital room with his family, when all of a sudden in unison they broke into a soul-lifting gospel hymn. The precious scene presented Dr Kuttner with a tough dilemma. "Suddenly, I found my filmmaker self in direct opposition with my clinical self," she says in her South African lilt. "It would have been beautiful to capture the moment, but I knew it was more important to let the family share it in peace. I had to practically put my soundman in shackles to keep him back." For the 53-year-old clinical psychologist and documentary director, therapy comes first.

It was not always so. Dr Kuttner was a filmmaker before she was a clinician. The turning point in her career came in 1976, when she was working for the South African Broadcast Corporation (SABC) on a documentary about a little-known subject: the hazards of smoking. The groundbreaking program pulled no punches and included an interview with a patient with severe emphysema and footage of the severely undersized belly of a three-pack-a-day smoking pregnant woman. But before the show could air, tobacco industry executives got wind of it and put the screws on the SABC to cancel it. The heads of SABC gave in.

"It was a loss of innocence for me," Dr Kuttner recalls. "I'd always known that politics could interfere with programming, but I hadn't realized how insidious it was and it shook me so deeply." She quit her job, not knowing what to do next with a BA in psychology and a few years' experience in television. Her boss and mentor, Carol Charlewood (Dr Kuttner describes her as the "Barbara Walters of South Africa"), advised her: "Go back to school and get your doctorate. You're a clinician at heart. That's why you did such a good job on this film."

After completing a Master's in Clinical Psychology at the University of South Africa and a two-year internship at Johannesburg Hospital, the 29-year-old faced another tough decision. The late 70s were gloomy days in South Africa, she recalls. Things got more and more repressive, with little hope for an end to apartheid. Young people were leaving the country en masse; Dr Kuttner decided to join them. She chose Canada and enrolled at Simon Fraser University in Vancouver for a PhD in Clinical Psychology. At SFU she met her husband, Tom, a professor of mathematics; they still live in Vancouver, with their two children, Tamar, 18 and Daniel, 14.

A NEW DIRECTION
In the early 1980s, when Dr Kuttner began her doctoral research, the field of pediatric pain management was virtually unchanged since the 1950s. Children undergoing painful and traumatic procedures such as lumbar punctures, bone marrow aspirations and cranial taps had few anesthetic options. Though hospital staffers were trained to provide comfort, they were ill-prepared to handle the phobias and anxiety attacks that children often suffered during treatment.

Dr Kuttner saw an opportunity to make a difference. As her thesis project, she founded the Pain and Anxiety Program in the oncology department of the BC Children's Hospital. She and her colleagues introduced a range of behavioural methods for pain management, including hypnosis, the therapeutic use of mental imagery and deep breathing. Dr Kuttner came up with imaginative concepts like using bubble-blowing wands to maintain children's focus during Lamaze-type breathing and blowing therapy. The program was the first of its kind in North America and received an award from the Association for the Care of Children's Health.

CELLULOID PSYCH
In addition to her professional reputation, Dr Kuttner soon became known around the hospital for a quirky habit: she'd often do rounds with a video camera in hand and screen footage of her interactions with patients at staff meetings. One day in 1985, she got a call from the head of the oncology department. The Canadian Cancer Society was offering a $50,000 grant for educational projects � would she be interested in making a film about her work? Dr Kuttner didn't hesitate.

She was pregnant with her first child at the time, but she didn't let that deter her. Immediately after Tamar's birth, Dr Kuttner and a cameraman/sound man delved into the five-month production of No Fears, No Tears: Children with Cancer Coping with Pain. The 27-minute documentary closely followed eight of Dr Kuttner's patients through their cancer treatments and accompanying pain therapies. "It was a groundbreaking piece of documentary footage," says Dr Kuttner, who played the combined role of doctor-director throughout the shooting. The documentary was shown nationally on the CBC, translated into six languages and is still used as a teaching aid in hospitals, nursing schools and pediatric centres around the world.

Her taste for filmmaking had been rekindled, but it was more than a decade before Dr Kuttner embarked on her next film project. In 1998, she received a surprising phone call from one of the patients featured in No Fears, No Tears. Seanna, who'd been told at the age of eight that as a result of her leukemia treatment she wouldn't be able to have children, now had some great news: she'd just given birth to a healthy baby girl. In the course of their conversation, Seanna also mentioned that she had used some of Dr Kuttner's techniques to manage the pain of natural childbirth.

The wheels in the doctor's head started turning. She realized that the lives of the young subjects of her documentary in the years since their treatment was subject matter worthy of a sequel. She set out to raise the necessary funds and began work on No Tears, No Fears: Thirteen Years Later that same year.

Seven of the eight subjects of the original film were still alive in 1998, and they eagerly came to BC from all over the country to participate in the sequel. Their stories affirmed one of Dr Kuttner's strongest beliefs: that behavioural pain therapy could have a lifelong influence. One of them, a young woman named Lesley, had survived leukemia as a child and then watched her mother contract the same disease. At age 17, she was able to use Dr Kuttner's techniques to help her mother through a painful bone marrow transplant.

Another described how, after breaking his shoulder in a skiing accident, he had refused drugs at the hospital, insisting on using strictly behavioural methods instead. In fact, all seven of them expressed such an aversion to pain meds that Dr Kuttner found herself in the peculiar position of having to explain to them that some excellent drugs had come out since 1985.

Dr Kuttner's latest film is by far her most ambitious, both in terms of budget ($330,000) and scope. In it she calls attention to the work the world's best palliative care centres were doing, travelling across North America filming therapists in action. When Every Moment Counts, broadcast last March on CBC's The Nature of Things, is a celebration of what Dr Kuttner calls the "revolution in palliative care" in recent years. It's also a meditation on a subject that Dr Kuttner wishes our society would treat less squeamishly. "Whenever you talk about a dying child, people's hearts drop and they just shrink from the topic," she says. "I wanted to make a film to show that kids have enormous courage, and caregivers are able to help them in extraordinary ways, giving them hope even in the face of death."