“Hamaguchi captures how invigorating and wondrous it can be to encounter another person with whom conversation is limitless”

Playing at this year’s Toronto International Film Festival in the Special Presentations section is the latest film from Japanese master Ryusuke Hamaguchi, All of a Sudden. The film marks a major departure for Hamaguchi, as it is his first feature not set primarily in Japan, instead taking place in France. Yet despite the change in location, many of his familiar interests remain, including human connection, communication, and compassion. At more than three hours, All of a Sudden is an ambitious and didactic film, filled with the remarkable direction and terrific performances that have made Hamaguchi one of the most exciting filmmakers working today.

Virginie Efira stars as Marie-Lou, the new director of an upscale Parisian nursing home called the Garden of Life. As director, her goal is to implement the “Humanitude” training protocol throughout the facility. Her biggest struggles are the administrative nightmares that come with training more than 100 employees: finding time for groups of employees to attend training without placing additional burdens on the remaining staff, convincing employees that Humanitude is necessary and will actually benefit the patients, dealing with more veteran staff members who are resistant to changing their ways, and securing a budget from higher-ups who are primarily concerned with making a profit.

Marie-Lou’s motivation is deeply personal. Her mother suffered from Alzheimer’s in her mid-sixties and experienced rapid deterioration. Watching her mother suffer in a poorly managed senior care facility inspired Marie-Lou to change careers and devote herself to providing more humane and compassionate care for people in long-term facilities. The Humanitude protocol is designed around exactly that philosophy. Its goal is to get patients up on their feet and moving, while encouraging caregivers to understand the particular conditions and needs of the people they are caring for. Alzheimer’s patients make up a large portion of the population at Garden of Life, and are often misunderstood and mishandled in traditional care facilities. Under Humanitude, patients should be spoken to within their field of view and encouraged to remain mobile and upright, with the goal of improving both their quality of life and potentially their life expectancy.

Of course, implementing this philosophy is easier said than done, particularly when it comes up against the economics of long-term care. Hamaguchi is sharply critical of this system in which financial incentives can conflict with the interests of patients. Facilities have an incentive to operate with fewer staff, which can mean less individualized care, while medications can sometimes be used as an easier solution than providing the time and attention patients actually need. There are also financial and bureaucratic incentives surrounding how care is provided, creating situations where the most efficient option for an institution is not necessarily the best option for the person being cared for. Patients who are bedridden, for example, can be easier for facilities to manage because they are less mobile and therefore less likely to fall or require additional attention. The result can be a system in which keeping someone stable and contained becomes more practical than trying to improve their condition. This is fundamentally opposed to what Marie-Lou is attempting to accomplish.

While Marie-Lou is dealing with administrative bureaucracy, trying to secure additional funding, and pushing the principles of Humanitude, by chance she meets Mari, played by Tao Okamoto. One day while traveling home on the train, Marie-Lou sees Tomoki (Kodai Kurosaki) running wildly through a park as he approaches the passing train. She realizes that Tomoki may be disabled and leaves the train to help him. Finding a GPS device in his pocket, she waits with him for his caregivers to arrive. Goro (Kyozo Nagatsuka) and Mari eventually arrive. Goro is Tomoki’s grandfather who acts in one of Mari’s plays. It is later revealed that Tomoki has been diagnosed with what is described in the film as “severe” autism. Marie-Lou and Mari immediately form a connection.

They interact almost as if they are in love, but theirs is an intellectual and deeply personal bond rather than a romantic one. They can talk for hours and remain fascinated by one another. Marie-Lou studied in Japan, while Mari studied in France, and even their names are remarkably similar. They begin discussing their similar struggles: Marie-Lou’s attempt to provide better care to those in long-term facilities, and Mari’s relationship with Tomoki and her work directing a short play in which the only character, played by Goro, decries the use of the inhumane insane asylum system. They seemingly can talk about anything. This kind of relationship is rare in life, and Hamaguchi captures how invigorating and wondrous it can be to encounter another person with whom conversation is limitless.

The film runs for more than three hours but remains constantly fascinating. There is an extended sequence in which Mari and Marie-Lou discuss capitalism, with Mari even using a whiteboard to explain her theories. It could easily become tedious, but Hamaguchi makes the conversation surprisingly compelling because it continually loops back into the film’s larger questions about the treatment of disabled people, whether they are living in long-term care facilities, suffering from Alzheimer’s, or living with other cognitive disabilities. The larger argument is that people often benefit from being outside, interacting with others, and being given opportunities to live as independently as possible, regardless of the particular disability or setback they have.

This reminds me of my own life. I often go to doctors or dentists who do not have even the basic training regarding autism or the conditions I experience. There simply is not enough education about many cognitive disabilities among medical professionals. That parallels Marie-Lou’s goal of training her entire staff, including her nurses, to better understand and care for their patients. The same kind of education could be useful across much of the medical field. Medical professionals should, for example, have a basic understanding of how different conditions can affect a person’s skin or blood pressure. Too often, that basic knowledge is severely limited.

But a lack of knowledge is not the only cause of poor care. Prejudice is another major factor. Many doctors and institutions still approach cognitive disabilities primarily as problems to be treated rather than as differences that require understanding and accommodation. Hamaguchi brings Alzheimer’s and autism together within the same film, which is not always an entirely comfortable choice. Alzheimer’s is a disease, while autism is a developmental disability and is not itself a disease but a differing neurotype. There can certainly be overlap in the kinds of care people need, but the distinction matters. Hamaguchi does not spend much time examining the prejudice and stereotypes that can shape how autistic people are treated, making this more of a minor criticism or footnote than a fundamental problem with the film.

With its extensive discussions of capitalism, disability, and institutional care, the film can at times feel more didactic than any of Hamaguchi’s previous work. Some of the scenes at the nursing home also feel inorganic and overly staged, while certain moments toward the end feel more plotted and obvious than I am accustomed to seeing from him. This is particularly noticeable because Hamaguchi has made some stone-cold masterpieces in the past, including Happy Hour, Drive My Car, and Wheel of Fortune and Fantasy. Asako I & II currently sits in my top ten films of all time; All of a Sudden does not quite reach these levels.

In some ways, the film feels like a greatest-hits compilation of Hamaguchi’s previous interests, only now set in France and centered primarily around a nursing home. It has some of the extended workshop-like conversations found in Happy Hour, the focus on acting and performance from Drive My Car, the intimacy of Asako I & II, and the political concerns of Evil Does Not Exist. Most importantly, however, it continues Hamaguchi’s long standing preoccupation with compassion and the ways people attempt to understand one another.

It is important to note, however, that a Hamaguchi film is still a Hamaguchi film, and All of a Sudden is masterfully directed. There are countless tremendous and beautiful shots, and his scenes continue to radiate with a sense of patience and humanity. A Hamaguchi film that feels lesser than his very best is still a remarkably accomplished film, and there are two tremendous performances at its center. Virginie Efira and Tao Okamoto dazzle throughout, with each actress bringing a different kind of depth to their characters. Both portray a wide range of emotions with a subtlety that borders on the sublime, and their relationship gives the film much of its power.

All of a Sudden may not reach the extraordinary heights of Hamaguchi’s best films, but there is still an enormous amount to admire. Its biggest weakness is that it can sometimes become overly didactic, with Hamaguchi presenting some of his ideas too directly. The plotting also feels obvious and staged at times rather than arising naturally. Despite this, Hamaguchi’s interest in compassion and human connection come through in some beautiful scenes anchored by sublime performances. All of a Sudden may not rank alongside Hamaguchi’s great works, but his extraordinary skill is still on full display, making it one of the better films of the year.