Review of Unsane

Unsane (2018)
3/10
As a psychiatrist and a film lover, I was highly disappointed.
1 April 2018
Warning: Spoilers
As someone who works in the mental health field, the first act of this movie excited me. The set up seemed to suggest a film that would attempt to capture the experience of a psychotic individual who finds herself involuntarily committed; to convey the confusion and desperation of such an experience for the patient, and perhaps the callousness of the staff who have become so jaded to such a presentation that they fail to meet the emotional needs of that patient. I felt genuinely uncomfortable through the first 20-30 minutes of the film as this scenario was explored, so much so that it forced me to reflect on my own experiences with psychotic patients and how important it is not to lose that level of empathy regardless of how routine the work may become. Furthermore, I was tantalized by the possibilities of the film in blurring the line between delusion and reality, expecting it to keep me questioning what was real and what wasn't.

And then the film throws all of that into a wood chipper. And burns the wood chips. Unfortunately, from here I'm really going to have to get into specifics, ie spoilers, so,

***SPOILERS***

First, I just have to mention the numerous inaccuracies here in the depiction of an inpatient psychiatric ward. The physical setup of the facility is quite odd with its communal bedroom shared by all of the patients which is locked every night without any staff member being physically present inside. Even more unlikely is that during the day the patients are allowed to wander around the rest of the facility without seemingly any security. I'll concede that I obviously haven't seen every possible inpatient setting design, but this is quite removed from anything I'm familiar with.

More problematic though are the way restraints and seclusions are portrayed in the film. Restraints and forced medication can happen if an agitated patient is unable to be calmed by any other measure and is at imminent risk of harm to themselves or others, but patients are never restrained in a communal room and then left alone for extended periods of time, unmonitored by staff, and no less surrounded by other inpatients who are often psychotic and potentially dangerous. Medication injections are also always given in a muscle rather than in a vein as depicted here, and certainly never in a neck vein. Patients placed in a seclusion room are highly monitored and there are extremely strict regulations on how long a seclusion can last. It can not be used punitively and for indefinite periods of time as portrayed here. Opiate addiction on its own is never an indication for an involuntary psychiatric hospitalization and would never be covered by insurance. Staff members would never be able to secretly move patients to remote areas in a facility and hold them hostage there - everything is video monitored and it is standard for every patient to be physically checked on by nursing staff every 15 minutes.

I could keep going, but I won't. Afterall, this is a movie. Films often can take liberties with reality, though for a film like this that is examining the mental health system and offering commentary on it, the gross inaccuracies are more problematic. Still, I did my best to see these as artistic liberties taken in the service of telling a story, entertaining an audience, and conveying a message. The problem is that the film fails on all of these levels as well.

I mentioned earlier that I was tantalized at the possibilities that the film set up in blurring the line between delusion and reality, and I was completely let down. There is absolutely no ambiguity here, no intrigue, no possible interpretation where the stalker isn't real. And while that's far less interesting to me, it at least could've worked as an entertaining B-movie. But the plot is so offensively absurd that it crumbles even with the most cursory critical analysis. How did this stalker manage to get a job as a nurse at this facility within 24 hours of our protagonist showing up there? Did he kill the real nurse and pose as him? No - because then the nursing staff obviously would recognize him as an imposter in that case. Furthermore, a co-worker specifically comments that he is one of the most dependable nurses they have which obviously indicates he has some history at the job. So then is it a coincidence that our protagonist chose this facility from her random google search and her stalker just happened to have taken a job there prior? Did I miss some explanation for this? Even if I did, it's just incredibly improbable to the point of pure contrivance.

And then our stalker is able to kidnap patients, hold them hostage, torture and kill them, all within a secured and staffed facility where patients would be monitored continuously as I previously mentioned. I had to stifle laughter when he explains to the protagonist, whom he is now indefinitely holding hostage in a seclusion room on a seemingly deserted, unstaffed floor of the hospital (which in itself is ludicrous), that the other staff members just "assumed" that she had been discharged and her insurance coverage had expired. A patient cannot be discharged from a hospital like this without clearance and direct orders from a psychiatrist, who then prepares all of the necessary paperwork, prescriptions, referrals to outpatient providers etc. It is a multidisciplinary process that involves the psychiatrist, nurses, and social workers. It's utterly laughable that the film asks you to believe that a patient would just be "assumed" discharged from a facility like these when none of this process had taken place.

***END OF SPOILERS***

Again, I could keep going but I'd be beating a dead horse. Highly disappointed with this film, and sadly it will likely perpetuate so many of the negative stigmas surrounding psychiatric hospitals. It does have some striking visuals here and there, the lead performance is quite good, and I did enjoy the raw quality of the filmmaking, but this is nowhere near enough to make up for its issues. I couldn't even recommend it to someone who has no knowledge of the mental health world as it totally fails as campy B horror/thriller too with its absurd plot and utter failure to capitalize on the potential for intrigue/ambiguity in the setup. Skip it.

1.5/5
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