Novocaine: Nathan Caine’s CIPA Explained

This article contains mild spoilers for “Novacaine.” 

Cinema has always been a great source for a semblance of truth rather than truth itself. That’s partially because truth is a hard thing to define in the best of cases; everything from the legal system to reporting the news has shown us that even something as supposedly cold and hard as the facts will be debated ad nauseam. All this is to say that, of course, fiction films have never been and will never be appropriate to use as a primary source of factual information. There’s typically nothing nefarious about this, but is a byproduct of the ultimate aim of telling a story, which is to best enhance the drama and the experience of the audience, often at the expense of reality.

With that understood, there are also examples of films which manage to thread the needle between fiction and reality well enough that, although they’re not 100% accurate, still treat their chosen subject with respect and understanding. Given the now well-established practice for most films to hire a technical advisor or equivalent role on a production, most movies at least attempt to present everything from military maneuvers to medical practices as accurately as possible on-screen, and that tends to extend to other real-life experiences.

One area that has a spottier track record than most is the portrayal of medical conditions, where it’s sometimes the case that depictions are erroneously or insultingly represented. Fortunately, that doesn’t seem to be the case with “Novocaine,” which opens in theaters this weekend. In the film, Nathan Caine (Jack Quaid) is said to be living with the condition known as CIP (Congenital Insensitivity to Pain) since birth, which is a congenital issue that doesn’t allow him to feel pain. While the invocation of this condition is ostensibly an excuse to throw an Everyman character into a series of gnarly fight sequences where he takes a licking and keeps on ticking, its treatment and depiction in the film (including Nathan’s character as a whole) is highly respectful, and a great example of a genre movie having its based-in-reality cake and eating it, too.

The concept of gawking, gasping, or even laughing at those different in the world is one that unfortunately has deep roots in culture and entertainment. After all, such things as a carnival sideshow, places that typically put people with physical differences on display, used to exist well into the end of the 20th century. Although modern society has generally moved on from such othering (well, at least that version of it, anyway), it’s still not all that uncommon to have a film utilize a real-life condition for dramatic purposes that misrepresents that condition. For example, even though 2016’s “Split” was using the real-life condition of Dissociative Identity Disorder as a springboard for its genre thrills (and, given the movie’s twists, also for slight-of-hand), it came under fire for playing too fast-and-loose with the reality of DID. In a similar manner, 2016’s “The Accountant” uses the lead character’s autism as ostensibly a realistic way of giving him a “superpower” in his ability to rapidly analyze and sanitize accounting records, yet its depiction rubbed some the wrong way.

In both of those examples, the conditions depicted are used ostensibly as narrative shortcuts, a way to explain each character’s heightened abilities while attempting to keep the films grounded in a realistic world. One of the ways that “Novocaine” screenwriter Lars Jacobson and directors Dan Berk & Robert Olsen avoid this pitfall is by continually keeping Nathan and his struggles as a character alive, rather than using CIP as a mere springboard excuse to go wild with lots of inconsequential stabbings and shootings. CIP is rare enough of a condition — it’s thus far only appeared in approximately every 1 in 25,000 births worldwide — that the film can get around a few questions of plausibility here and there, but it never goes too far in its depiction that it feels like it’s ignoring the condition altogether.

As Nathan describes to Sherry (Amber Midthunder), his love interest in the film, CIP (also known as congenital analgesia) is a condition where a person cannot feel and has never felt pain. This means that life is more difficult for them, not less, as the sensation of physical pain helps with larger issues, such as programming our brains with regard to survival instincts, and smaller ones, such as keeping us from accidentally harming ourselves (including, as Nathan is particularly troubled about, the possibility of chewing off his own tongue while eating solid foods). As with most rare conditions of this type, medical professionals aren’t clear on the exact cause of CIP, citing everything from a genetic mutation to an increased production of endorphins in the brain as a possible cause. There are also two main types of CIP, one where the person can’t even feel the stimulus of the thing causing them physical pain, and another where the stimulus can be recognized by them, but their response is non-existent or inappropriate (for the record, “Novocaine” generally depicts the former type).

While most people living with CIP lead a careful existence, there is as of yet no surefire cure, and the life expectancy of those with the condition isn’t long (all of which is explained by Nathan early in the film). “Novocaine” utilizes Nathan’s condition in a way that makes it exciting and even aspirational rather than implausible and wince-inducing. Given that Nathan isn’t a trained fighter, his pursuit of the bank robbers that kidnap Sherry involves his ability to use his condition to give him enough endurance to utilize the objects around him to deal out some hurt to his enemies. So, instead of the umpteenth fight sequence involving lots of expert fighting technique, “Novocaine” lets Nathan fight with his heart and head more than his hands, doing things like purposely shoving his fists into shards of broken glass in order to make a DIY version of brass knuckles. Even though the gags in the film are inspired, the script keeps Nathan’s condition alive in the way his many injuries still impede him since they don’t heal up. As Nathan’s online friend Roscoe (Jacob Batalon) reminds him, he’s not Wolverine.

Of course, “Novocaine” is primarily an action movie, and as such is mostly concerned with the entertainment value of CIP rather than delving into the nitty gritty of the condition. Yet the most commendable aspect of the film is how it treats its characters with a surprising amount of depth and respect. This doesn’t just apply to its treatment of Nathan, but also the way Nathan and Sherry’s budding romance is allowed to breathe before the proverbial s—t hits the fan, a quality which tons of other action movies often overlook and/or take for granted. This approach likely stems from how the film attempts to be as well-rounded as possible, blending together elements of action, horror, film noir, and romantic comedy, thus causing the filmmakers to consider more than just a setpiece here or a quip there.

This respectful approach to characterization makes Nathan a fascinating and relatable protagonist, especially because he’s never treated with kid gloves. He’s allowed to be awkward, naive, overeager, and especially uninformed when it comes to the movie’s big twist. Yet it never feels like we the audience are being invited to laugh at him, as we’re with him all the way from the beginning. One of the most valuable and personally relatable aspects of his depiction is how Nathan is someone living with a condition that cannot be detected by the naked eye. In essence, he’s someone able to “pass” in social situations as just an average straight white dude, affording him an assumed level of privilege and the like, yet he sometimes finds himself having to explain to a cute girl he likes that he has certain unusual dietary restrictions. As someone who’s lived with several autoimmune disorders since my early 20s, I was delighted to see that Nathan wasn’t being treated as someone to pity or make fun of. Instead, the movie accurately depicts him as living his life despite the myriad differences from the experience of average folks, everything from having to set a watch alarm to use the bathroom to making smoothies for himself every morning.

That’s the real secret to utilizing a real-life condition in a movie: presenting it as matter-of-fact rather than abnormal or even “special.” We’ve been trained by thousands of films to see a character’s quirks and oddities as additive rather than subtractive, so by presenting a condition in this way, the use of a condition goes into more of a character development space rather than having an awkward box drawn around it. As Sherry explains during her love scene with Nathan (another example of positive depiction in and of itself — he can have sex!), everyone’s got their scars, their issues, their something that makes them feel like they stand apart. “Novocaine” and its treatment of CIP is a great reminder that our differences and conditions don’t have to make us feel broken, or rejected, or alone. For a movie all about various forms of pain, that feels pretty damn good.