Six outstanding performances, led by the increasingly versatile Campbell Scott, create a smart, tough, and often funny portrait of a family in decline. Even though the narrative is confined to dentist Dave’s point of view (including an excellent Denis Leary as the little devil on his shoulder), Hope Davis’ Dana is wonderfully brought to life, also. Their marital struggle is partly displaced, unfolding in the behaviors of their three daughters, and thankfully none of the ebullient young actresses falls into jarring Child Actor mode. Their believability grounds the film, especially in the lengthy (and risky) cycle of sickness that nearly destroys the family, to which they bring welcome doses of humor and energy.

Given Dave’s narrative centrality, I was pleased to see that director Alan Rudolph didn’t chain us to yet another white guy having a midlife crisis. Most other films of this kind would have shown us a hero moving from strait-jacketed WASP-ish frigidity to raw, re-libidinized, damn-the-consequences emotional boldness, the sort which our unimaginative culture celebrates as “liberated”. Think of Lester Burnham in “American Beauty”, for example. But Dave stays on his course, and in the end his method of emotional disconnection, troublesome as it is at times, hits the mark. Not as cute an answer as we found in “Far From Heaven”, but satisfyingly realistic.

Adapted from a story in Jane Smiley’s “The Age of Grief”, the film benefits from Rudolph’s elliptic narrative style, which captures Dave’s psychological state in a manner closely following the classic short story mold. Flashbacks and hallucinations are used effectively and with a novelist’s feel for shifting states of interiority. The style is similar to the adaptations of fiction we’ve seen from David Fincher or Danny Boyle, but “The Secret Lives of Dentists” might be a good illustration of how a story adaptation differs from that of a novel. Rudolph’s style isn’t far removed from “Fight Club” or “Trainspotting”, but in foregrounding the actors he seems to be aware that a short story, limited in its action, relies less on unspooling a plot than it does connecting its characters together by a web of details. One of the best films of the year.