How about an oxygen mask to go with that movie ticket and popcorn?
Usually people go to see flicks to escape the real world. But sometimes what's on screen is so realistically depicted that the visceral impact can literally make audience members ill.
The highly anticipated "127 Hours," which opens today and stars James Franco, is the latest movie to deliver that sort of punch to the gut.
Franco portrays real-life Aron Ralston, an avid outdoorsman who, seven years ago, went on a solitary hike. While in the deep recesses of a canyon in Utah, an 800 pound boulder fell on his right arm and trapped it.
The movie, based on Ralston's book "Between a Rock and a Hard Place," culminates in Ralston freeing himself – by self-amputating his trapped arm.
Franco's character's liberating deed didn't have a salutary effect on everyone who watched it. On Sunday, an article in the Los Angeles Times noted that a partial tally of film festival attendees found six people who collapsed during the movie's screening. One person who attended a guild screening commented that she felt as though she was going to throw up while watching the amputation scene. After turning dizzy, she fainted. Another attendee suffered an apparent seizure.
The Times article quoted Stephen Gilula, an executive from FoxSearchlight, which released the movie, who said, "I would prefer that people not pass out – it's not a plus." Nevertheless, Gilula said there had been at least eight other swoons at other preview screenings.
The physiological reactions are not surprising.
"It's natural to recoil when we see someone hurt or, at the next level, see someone hurt themselves," said Terrence Sheehan, a physiatrist with an expertise in amputations, and the medical director of the Amputee Coalition of America. "But when you see someone cutting through soft tissue through the bone with a crude tool, it's cringe-inducing."
"About 15 percent of people who have blood-injury phobia are predisposed to fainting," said Scott Bea, a clinical psychologist, with a specialty in anxiety and mood disorders, at the Cleveland Clinic.
But why would viewers who know they're watching a movie –entertainment that's not real – faint or become nauseous?
"Watching something this unpleasant on screen could set off a fight-or-flight response, said Steven Schlozman, a child psychiatrist and assistant professor of psychiatry at Harvard Medical School.
What follows next, he described, is the vasovagal response, in which blood doesn't make its way to the brain as fast as it should, which leads to feeling faint, lightheaded or sweaty.
"Even though, intellectually, you know you have nothing to worry about, because it's only a movie, what you see is so frightening that the body reacts," he said.
But, noted Harvard's Schlozman, there's also the important phenomenon known as the mirror neuron response theory.
"We've seen in primate studies that the brain contains specific neurons that become activated when they watch someone else go through a painful or frightening experience," said Schlozman. "The observing primate would feel what the experiencing primate felt.
"Similar brain-imaging studies have been conducted with humans using fMRIs, in which humans observing the actions of other humans can somehow participate in the experience. It's the physiological model for empathy."
What makes the amputation scene in "127 Hours" extraordinarily compelling is "the character is all alone and has no other way to free himself. The movie wants you in the shoes of the character it's portraying, and really draws you in," said Schlozman.
State-of-the-art special effects –the amputation scene in "127 Hours" involved several prosthetic arms full of fake blood, muscles, ligaments, nerves and bone, which Franco's character hacked his way through – also make the experience disturbingly graphic.
The jostling up-and-down motion can affect viewers, even if they're glued to their movie house seats, said Thomas A. Stoffregen, a motion sickness expert, and professor at the School of Kinesiology at the University of Minnesota.
"Even if you're sitting, your body is not entirely stationary," he said. "As you watch the on-screen images bobbing, your body is subtly swaying, and so you're not entirely in control of your neck and torso, which may lead you to become physically unstable in your seat." This phenomenon can lead to nausea, eyestrain and dizziness, he said. An easy fix is simply closing your eyes, which eliminates the stimulus.