The film features a wealthy Angeleno when the majority of chronic pain sufferers are low-income
Describing Mary Tyler Moore's Oscar-nominated performance as a grief-stricken mother in Ordinary People, film critic Pauline Kael wrote “Moore … seems to be doing penance for having given audiences a good time” as a beloved television comedienne by choosing film roles that require “performances locked in dreariness.” It'd be easy, but not very fair, to level a similar criticism at Jennifer Aniston, another actress who came to fame playing a beautiful young woman better known for her hairstyle than her ability to confront adversity.
Claire, Aniston's character in Cake, copes with her chronic pain with pills and wine and little else, openly, hostilely refusing all efforts to help her achieve real recovery from her largely unspecified injuries—apparently because, for reasons also largely unspecified, she doesn't think she deserves it. Instead, Claire’s dangerously enamored with suicide and possibly in the middle of a psychotic break. It's the kind of role that seems ripe for onscreen masochistic martyrdom, but had Aniston, who also acted as executive producer for the film, truly wanted to make us watch her suffer she might've insisted that her character be poor, as well.
Such a choice would not only have infinitely increased the dramatic difficulties Claire—a wealthy, for-all-purposes-retired lawyer—faces as she refuses to recover, it would also reflect reality, where chronic pain disproportionately affects low-income patients. The scar treatment cream Claire avoids applying to her disfigurements, despite the concerned pleading of her housekeeper-personal-assistant-nursemaid Silvana (Adriana Barrazza), for example, might be a more meaningful signifier of inner damage if the cream's procurement had an actual cost. The explosive and ultimately degrading pharmacy scene that might've resulted from Claire having a poor person's prescription drug coverage (or lack thereof) could've provided the kind of ugly-cry clip that seems to sway Academy voters so. In the film as it is, the cream comes and goes, hardly commented on, just one more thing Claire can take for granted. Her actual uncomfortable pharmacy scene—as a “rich white lady” in a Tijuana drugstore demanding indiscreet amounts of un-prescribed schedule-one pain pills—is really more of an uncomfortable customer service experience, with Claire and the viewer cringing for entirely different reasons.
One of the worst aspects of chronic pain, other than the obvious, is the subjective nature of its severity, the lack of a satisfyingly quantifiable means of verifying its authenticity to others. That Aniston's Claire carries herself like someone who's very wincing essence is defined by the pins penetrating her legs is no accident, nor is it a symptom of overacting on Aniston's part. Claire views her pain as a license to hurt everyone around her, and those other people—especially the members of the support group she cynically attends to please her pain-management doctor—are to be tolerated only as long as it takes to get whatever she needs from them. She prefers to establish dominance early in every relationship through cash and sarcasm, and in portraying Claire, Aniston has let her humor grow significantly uglier than her still very-much-intact looks. Much of the screen time features Claire alone, suffering in silence, but that may be preferable for filmgoers without the stomach for the kind of abuse dished out by Claire, a character who can afford not to apologize.
Her wealth, however, also allows her a luxury most people in her position don't have: the option to delay her recovery indefinitely. The idea that there are no second acts in American lives is provably false across class lines, but the very rich, it seems, can linger in the lobby bar during a prolonged self-imposed intermission and nobody will have the nerve ask them to leave. For example, Claire can extend her pain-pill prescriptions by bribing her doctor with the promise of a recommendation letter. She can avoid getting busted at the border with a single strategic phone call. She can fashion her personal narrative into a long and hard-fought redemption arc complete with secret gardener humping, prescription-drug-induced hallucinations, and late-night therapeutic splash sessions in her backyard swimming pool. Most telling of the predicament facing Claire as an otherwise privileged woman in real pain is her insistence, following a tragic car accident, on lying completely flat on her back in the passenger seat as Silvana (refreshingly, the supporting role becomes less thankless as the film progresses) drives her to appointments across Los Angeles. If Claire couldn't afford a driver, she'd be forced to take the bus, where lying down is strongly discouraged and more passengers than not seem to be shouldering a disproportionate amount of pain.