The Belly of an Architect (1987)

The American architect Stourley Kracklite arrives in Rome with his younger wife, Louisa. He is there to mount an exhibition devoted to Etienne-Louis Boullee, an eighteenth-century architect whose buildings were mostly never built.

From the first scene the film watches Kracklite's body. He eats. He photographs the stomachs of classical statues. And he keeps getting abdominal pain that comes back.

His Italian collaborators quietly strip him of authority and siphon off the money. He becomes fixated on the story that the emperor Augustus was poisoned by his wife, and starts to suspect Louisa of the same. She tells him she is pregnant. She also begins an affair with the exhibition's co-organiser. Then she leaves.

Doctors tell him he has stomach cancer and months to live. At the opening ceremony, replaced as director, he watches from a high window as Louisa cuts the ribbon and goes into labour. He jumps.

Spoilers throughout. Kracklite's diagnosis and his final scene are both discussed here.

Greenaway made an allegory, not a case study, and yet he got one clinical fact exactly right.

Abdominal cancer does not usually announce itself. It shows up as months of vague, dismissible pain that a middle-aged man puts down to rich food, stress or age. Kracklite has an extra explanation available to him, poison, and he takes it. Plenty of real people take the ordinary ones.

That long gap between first symptom and diagnosis is the single reason stomach cancer is so often found late.

NCI puts it plainly. Early on, stomach cancer usually has no symptoms, which makes it hard to detect, and symptoms often begin only after the cancer has spread.

When early symptoms do occur, NCI lists these:

• Indigestion and stomach discomfort.
• A bloated feeling after eating.
• Mild nausea.
• Loss of appetite.
• Heartburn.

Read that list again and notice what it is: a description of an ordinary week. Every item has a dozen harmless causes, and most of the time one of those is the answer.

More advanced disease adds signs that are harder to explain away. Blood in the stool. Vomiting. Weight loss for no known reason. Stomach pain. Jaundice, meaning yellowing of the eyes and skin. Fluid building in the abdomen. Trouble swallowing.

In the United States there are no standard or routine screening tests for stomach cancer in people at average risk. NCI says so directly.

But NCI also names groups who may benefit from screening with upper endoscopy, which is a thin camera passed through the mouth into the stomach:

• Older people with chronic gastric atrophy, meaning a thinned stomach lining, or with pernicious anaemia.
• People who have had part of the stomach removed, or who have a family history of stomach cancer.
• People with certain genetic syndromes.
• People from countries where stomach cancer is more common.

That last line explains something the film cannot. Japan and South Korea run national gastric cancer screening programmes, because the disease is far more common there. The same cancer is caught earlier in those countries partly for that reason.

Endoscopy is not free of risk. NCI lists false results, and rare but serious complications including a puncture of the oesophagus or stomach, bleeding, and reactions to the sedation. That is why it is offered to people with a raised risk rather than to everyone.

There is no endoscopy. No staging. No conversation about surgery, chemotherapy or palliative care. The diagnosis arrives as a single verdict, delivered once, and then the film moves on.

Kracklite also stays physically imposing and mentally sharp. He shows none of the weight loss, vomiting, difficulty eating or exhaustion that advanced gastric cancer brings.

His belief that he is being poisoned is dramatically rich and clinically dangerous as a message. It edges towards the idea that symptoms like his are a state of mind. And the ending swaps suicide for death from disease, so the film never has to show dying at all.

It is very good on what an unexplained illness does to a person. The obsessive self-monitoring. The paranoia. The humiliation of losing physical and professional authority at the same time.

It is also honest that serious illness speeds up the collapse of a marriage and a career that were already unsteady. And that a diagnosis, when it finally lands, changes nothing about the momentum of a life falling apart. That is bleak and true.

Nothing on this page is advertising and nothing is for sale. If the list of easily dismissed stomach symptoms was useful, you can help keep it free to read. Support our work.

The Belly of an Architect is a film about a man losing everything, with a cancer used as the clock. As a medical account it is nearly empty.

Its one accurate insight is worth keeping. Stomach cancer hides behind indigestion. For most people there is no test to catch it in advance, so the thing that matters is whether indigestion, early fullness, difficulty swallowing or unplanned weight loss get investigated when they persist instead of being explained away.

• https://www.cancer.gov/types/stomach/symptoms
• https://www.cancer.gov/types/stomach/screening

This page discusses The Belly of an Architect for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.