A Clinical Psychologist Goes to the Movies, Part 4

Films can be an incredibly powerful way to learn about mental illness and psychopathology – watching films relevant to mental health can help professionals to become more productive as therapists, and help students become more adept at recognizing and understanding symptoms and behaviors. To supplement the recent publication of the fifth edition of Movies and Mental Illness, in which I explore more than 1,500 movies and the characters involved, I am pleased to present a series of “Spotlight” articles that will critically examine the psychological content of new movies as they are released. 

This article reviews the film The Substance (2024).

The Substance

Last month Demi Moore won a Golden Globe award for Best Performance by an Actress in a Motion Picture, Musical or Comedy for her role in The Substance, a film written, directed and produced by Coralie Fargeat. The Substance also has been nominated for a Best Picture and Best Director Academy Award, and Moore has also been nominated in the Best Actress category.

The Substance is an example of body horror, and, although I typically dislike this genre, The Substance is a compelling film. The movie opens with the placement of a Hollywood “Walk of Fame” star that we see disintegrate and decay in slow motion at the end of the film – it is a compelling metaphor for the inevitable disintegration and decay that accompany aging. 

Moore plays the role of Elisabeth Sparkle, a once famous but now fading actress who has been reduced to leading early morning television exercise programs. Elisabeth gets fired on her 50^th birthday because she is too old to host an exercise show, and she is no longer beautiful. The parallels to Jane Fonda’s history are striking, as is the allusion to a movie executive named “Harvey,” presumably an oblique reference to Harvey Weinstein, the misogynistic and disgraced film producer and founder of Miramax Films, whose conviction led to the Me-Too Movement.

Harvey is played by Dennis Quaid, vividly and disgustingly shown devouring a plate of shrimp, remarking, “pretty girls should always smile.” His sexism and misogyny are palpable, especially in scenes like the one in which Elisabeth hears him comment on his need to replace her with a more desirable actress: “We need her young, we need her hot, we need her now.” 

After a car crash, Elisabeth gets treated and learns about a surreptitious, underground pharmacy that sells a black-market drug that promises to give her “a better version of yourself.” However, the treatment comes with a catch: the new you has to alternate with the old you, one week in each body. The benefit of switching is that the new you is beautiful, sexy and glamorous – exactly what one wants to see with a male gaze. Early in the film, a disembodied voice asks:

“Have you ever dreamt of a better version of yourself? Younger, more beautiful, more perfect. One single injection unlocks your DNA, starting a new cellular division, that will release another version of yourself. This is the Substance. You are the matrix. Everything comes from you. Everything is you. This is simply a better version of yourself. You just have to share. One week for one and one week for the other. A perfect balance of seven days each. The one and only thing not to forget: You. Are. One. You can't escape from yourself.”

Elisabeth’s “better version” of herself is played by Margaret Qualley as “Sue,” a beautiful woman who delights in audience adulation and her power over men. Sue represents all Elisabeth once was – and all Elisabeth aspires to be in the future as she turns into her better, younger self.

Several critics have noted that director Coralie Fargeat is able to direct a movie like this precisely because she is a woman – no man could have made this movie. Fargeat also deliberately sought out Demi Moore because she fit the role so perfectly: Moore had several hit films in the 20^th century, including A Few Good Men, GI Jane, and Striptease (a film Moore made in 1996 when she was 33 years old); however, she had never won a major award for acting, and she was not offered leading roles. Fargeat read Moore’s biography before casting her, and, among other things, she was impressed by Moore’s decision to pose nude for an Annie Leibovitz cover of Vanity Fair when Moore was seven months pregnant.

Golden Globe host Nikki Glasser commented on this grim reality for Moore and fellow nominee Pamela Anderson, 57 years old: “If you’re a woman over 50 in a lead role, they call it a comeback. If you’re a guy over 50 in a lead role, congratulations, you’re about to play Sydney Sweeney’s boyfriend.” (Sydney Sweeney, best known for her roles in The White Lotus, Euphoria and The Handmaid’s Tale, is considerably younger than her fiancé, Jonathan Davino.).

Body Image, Cosmetic Surgery and Aging

The Substance is a film about body image, and specifically body image in women, and the way society reacts to different bodies. It is well-established that woman have more difficulties with body image than men; although many men are concerned about image issues like baldness, height, and weight, all of these concerns are far more pronounced for women (Bucchianeri et al, 2013; Quittkat et al., 2019). 

The film asks a fundamental and profound question; Can you make yourself better than you already are? One can’t watch The Substance without thinking about the multiple ways we strive to improve our bodies as we age – Botox, breast enlargement, face lifts, and cosmetic surgery – not to mention Ozempic, Wegovy, and other similar miracle drugs that promise dramatic weight loss with minimal exercise and dieting. These drugs have significant side effects (Suran, 2023), and they are controversial. Writing in the journal Fat Studies, Oswald (2024) noted:

“The fat loss effects of Wegovy, Ozempic, and similar semaglutides are being hailed as miracles, allowing for the elimination of fatness—a goal severely aligned with anti-fatness and severely misaligned with the lives and politics of many fat people and their allies.”

Many people have confronted the seemingly inevitable deterioration that accompanies aging, seeking out surgical solutions that are less dramatic than Elisabeth’s, but still significant and potentially dangerous. Kam et al. (2022) noted that cosmetic surgery typically improves body image, but they point out that “other crucial aspects of psychological well-being may or may not similarly benefit¼. Overall, researchers have concluded that cosmetic surgery improves body image but [disagree about] its effects on self-esteem, anxiety, and depression.” 

In another study, Shelley Eriksen (2012) surveyed women to assess how cosmetic surgery affected their body image, self-esteem, and aging attitudes. She found:

“Part of the developmental trajectory of middle and late life presumes adjustment to physical aging, an adjustment that is complicated for women for whom the prioritization of beauty is central to their social value in Western societies¼. [D]espite having undertaken action to improve their appearance through surgical means at some point in their adult lives, cosmetic surgery recipients did not inevitably feel younger than their years, or better about themselves, compared to those who have not pursued surgery.”

As shown dramatically in the film, almost all aging adults have to cope with the demoralizing changes that accompany aging, and awareness of these changes tends to be exacerbated by social media (Bazile, 2024). Aharoni Lir and Ayalon (2024) showed film clips to older women aged 54–76 and used latent thematic analysis to develop a five-attitude model of women’s responses to aging. The factors they identified include:

Grief—over the loss of youth and attractiveness
Resentment—over gendered media representations and cultural norms
Avoidance—distancing from one’s aged appearance
Care—maintaining grooming routines
Acceptance—coming to terms with the changes in appearance

These authors found that locus of control mediated the responses of women to aging, noting “Those with an external locus of control internalized the judgmental gaze of others, thus, reporting a greater sense of loss. Those with an internal locus of control were better able to accept themselves and focus on grooming rather than conforming to an imagined ideal.” Demi Moore’s character Elisabeth Sparkle clearly has an external locus of control.

Similar Films

Critics have posted significantly mixed reviews, with some reviewers seeing the film as brilliant, while others simply call the film body image porn. I fall somewhere in the middle. What is clear is that Coralie Fargeat deliberately and cleverly pays homage to numerous other films in the horror genre. Examples include long hallways and patterned carpets, evoking memories of The Shining, and the massive amounts of blood lost in the final scene, reminiscent of the prom scene in Brian De Palma’s Carrie. Other scenes pay homage to David Cronenberg’s Videodrome and The Fly, David Lynch’s Elephant Man, Alfred Hitchcock’s Vertigo, and Aronofsky’s Black Swan. There are passing allusions to Alien, The Stepford Wives, and King Kong. I also found the film similar in many ways to M. Night Shyamalan’s Old, a film in which a vacationing family finds themselves on a secluded beach that somehow causes them to age quickly and dramatically, living their entire lives in a single day. Finally, the film’s theme seems to overlap considerably with another new film, A Different Man, in which an actor’s appearance is dramatically transformed after a medical procedure.

While I can’t recommend The Substance for every viewer, I can say that it is a film that will leave you thinking about the inevitable decay and decrepitude that seems to be the way of all flesh, as well as the sad and inhumane way we sometimes treat people as they age.

References

Aharoni Lir, S., & Ayalon, L. (2024). Beauty work or beauty care? Women’s perceptions of appearance in the second half of life. Journal of Women & Aging, 36(3), 256–271. doi.org/10.1080/08952841.2024.2321668

Bazile, K. E. (2024). Social media use and body image concerns for midlife and older women. Psychology of Popular Media, 13(4), 741-747. https://doi.org/10.1037/ppm0000532 

Bucchianeri, M. M., Arikian, A. J., Hannan, P. J., Eisenberg, M. E., & Neumark-Sztainer, D. (2013). Body dissatisfaction from adolescence to young adulthood: Findings from a 10-year longitudinal study. Body image, 10(1), 1-7.

Eriksen, S. J. (2012). To cut or not to cut: Cosmetic surgery usage and women's age-related experiences. The International Journal of Aging & Human Development, 74(1), 1–24.  https://doi.org/10.2190/AG.74.1.a 

Kam, O., Na, S., La Sala, M., Tejeda, C. I., & Koola, M. M. (2022). The psychological benefits of cosmetic surgery. Journal of Nervous and Mental Disease, 210(7), 479–485.  https://doi.org/10.1097/NMD.0000000000001477 

Oswald, F. (2024). Anti-fatness in the Ozempic era: State of the landscape and considerations for future research. Fat Studies: An Interdisciplinary Journal of Body Weight and Society, 13(2), 128–134. doi.org/10.1080/21604851.2024.2307674

Quittkat, H. L., Hartmann, A. S., Düsing, R., Buhlmann, U., & Vocks, S. (2019). Body Dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Frontiers in psychiatry, 10, 864. https://doi.org/10.3389/fpsyt.2019.00864 

Suran M. (2023). As Ozempic's popularity soars, here's what to know about semaglutide and weight loss. JAMA, 329(19), 1627–1629. https://doi.org/10.1001/jama.2023.2438