Steven Soderbergh’s latest thriller Unsane follows Sawyer Valentini (Claire Foy) as she grapples with reality in a battle with her own mind. The film follows her as she relocates to Boston, seemingly to allude a stalker, David Shrine (Joshua Leonard). In an effort to seek help from the stress of being stalked she visits a mental health facility that ends up admitting her against her will. This is where she finds out that the very stalker she was seeking help for has a job at the facility that she is being held. A dramatic sequence of events ensues as she struggles to convince others (including the audience) that one of the nurses at the facility is her violent stalker.

Mental illness has many names; “insanity,” “lunancy,” and just plain old “nuts”, all of which carry a negative connotations conveying instability, weakness and invoking dismissal by others. Some films exploit this automatic mental process of dismissing weak-appearing characters to provide ‘twist’ ending (The Usual Suspects comes to mind). Others like The Lookout utilize these biases to draw in empathy for the protagonist. In the case of Unsane, we are left to question whether Sawyer has a mental illness or not, pressing ‘pause’ on the usual 1-2-3 of cognitive biases that roll into the mind.

Throughout the film the audience teeters between believing her claims and thinking she has a mental illness. They accomplished this by incorporating factual diagnostic criteria for delusional disorder into the events of the film, but also recognized that symptoms of persecutory delusions do not occur in isolation, but recognizing that in clinical practice it is often comorbid with post-traumatic stress and mood disorders. Such as a mood disorder that arises from the intense emotional load of being a stalking victim.

Despite its positives, the film isn’t without its shortcomings with respect to accuracy. For example, psychiatric inpatient rooms are generally separated by gender so female and male patients who not be sleeping in a room together. Additionally, medications are dispensed only by nurses and non-nursing staff like orderlies do not have direct access to medications, let alone controlled substances. Finally, you would generally not find Fentanyl in a standalone psychiatric facility due to the fact that it is an extremely potent opioid that has no psychiatric indication.

Regardless of the degree of realism and accuracy your project requires, drop me a line at heydoc@reelmd.com

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