I Lived Part of Unsane: Separating Fact from Fiction in Steven Soderbergh’s latest

Trigger Warning: This post contains language about depression and suicide that some may find upsetting

[Mild Spoilers About Unsane Ahead]

I never had a used tampon thrown at me, but I do remember the paper cups of shit. Not that I ever found one, but the other patients did. There was a young woman in our ward convinced she had worms in her stomach. She would steal paper cups from the cafeteria, sneak them into the bathroom and fill them with her shit. Every now and then someone would find one of the cups and raise a ruckus, but no matter how many times she was yelled at, attacked by other patients, or counseled by doctors, she never stopped collecting her shit in little paper cups. I may have forgotten most of the names and most of the faces of the patients I lived with during my ten days involuntarily committed in a prominent Manhattan hospital in the winter of 2012, but I remember her. You could find her all hours of the day walking up and down the one long corridor stretching through our hospital floor, muttering to herself in Spanish. Each time she walked by the single payphone in the hallway, she’d stop, pick up the receiver, talk into it, drop it, and continue on her way. I remember the shape of her face, her long curly hair, her perpetual grin suggesting she knew the punchline to some cosmic in-joke. I remember her. I remember those days and night of terror.

I haven’t thought about her in years, but Steven Soderbergh’s Unsane popped some kind of cork in my memory and now she and all the other patients have flooded back. The film is ostensibly a mash-up of two thriller genres: the sane patient in the mental ward (e.g. Anatole Litvak’s The Snake Pit [1948] and Samuel Fuller’s Shock Corridor [1963]) and the victim vs. deranged stalker (e.g. Martin Scorsese’s The King of Comedy [1982] and Satoshi Kon’s Perfect Blue [1997]). The film follows a woman who unknowingly commits herself to a corrupt mental institution where her stalker works as an orderly. The stalker gaslights the woman, psychologically tormenting her and dosing her with medicine that gives her violent episodes until she’s trapped in solitary confinement where he can “love her” all he wants. Said soft-spoken stalker is also a master criminal and manipulator who systematically murders everyone who gets in his way and becomes an invincible slasher villain in the last 30 minutes.

The film is pure fantasy and a perfectly serviceable piece of entertainment. If not for Soderbergh’s use of iPhone 7’s to film the entire thing, it could easily be mistaken for a direct-to-DVD thriller, the kind you can find these days in 4-pack collections for $4.99 at your local Target. But I’m not sure if Soderbergh or his screenwriters Jonathan Bernstein and James Greer had any idea they were inadvertently making one of the most authentic depictions of involuntary commitment I’ve ever seen.

I’ve never opened up about my experiences being involuntarily committed to anyone outside my immediate family and my very closest friends. These memories are intensely private, painful, and traumatic. But in-between its genre pyrotechnics, Unsane reveals a kernel of truth about America’s mental healthcare system that’s rarely elucidated as clearly and succinctly: it’s a money-making machine that sees patients as customers to be exploited instead of healed. The entire system is geared to process as many people as possible as cheaply as possible, and this capitalistic greed has a debilitating effect both on patients and healthcare professionals.

The first moment of Unsane when I started getting flashbacks of my commitment was when the protagonist Sawyer Valentini (Claire Foy) sought counseling for her traumatic experiences with David Strine (Joshua Leonard), a stalker who became obsessed with her when she worked as a hospice volunteer reading to his father following an Alzheimer’s diagnosis. His stalking became so deranged that she filed a restraining order, deleted her social media, and moved four hundred miles from her family home in Boston to a nondescript Pennsylvania city. Following a series of hallucinations of David, she scheduled an appointment with what she assumed was a support group for victims of stalking at the Highland Creek Behavioral Center.

My stomach lurched in the scene when she had unknowingly just given the institution probable cause to assume the right of parens patriae wherein the state can take responsibility over an individual to prevent them from harming themselves. It’s similar to what happened to me following an depressive episode where I had broken down weeping in a parking lot one snowy night while bringing groceries home to my university dorm room. I had suffered from intense depression since I was twelve years old as a result of undiagnosed Asperger’s and improperly treated ADHD. I had already suffered one suicidal episode when I was a teenager, so I knew I needed somebody to talk to. When I arrived at the Hospital, I only wanted a doctor I could discuss therapy options with. But what happened next was almost identical to what happened to Sawyer. A nice nurse told her to fill out some paperwork and wait in a waiting room for somebody else to come and speak to her. A second, less nice nurse came out, ushered her through a large reinforced door, and searched her belongings. Then a third, distinctly not nice nurse came and told her to strip down to her underwear so she could be searched. And don’t cause any problems, the third nurse warns. It’ll all be easier if you just do what we say. At no point was Sawyer told she was agreeing to be committed—she was in a panicked frame of mind, as was I the night I went to the hospital.

As Sawyer is jostled into the shared sleeping center for patients—a large open room with about a dozen beds equally spaced apart—she discovers to her horror that only a small percentage of her roommates are actually mentally ill. With the exception of Violet (Juno Temple), a violent psychotic who carries a homemade shiv made from a cafeteria spoon, most of her fellow patients are recovering drug addicts. The most prominent of these is Nate Hoffman (Jay Pharoah), an opioid addict in the last week of a month-long sobriety stay whose contraband iPhone gives Sawyer her only link to the outside world.

I discovered something all too similar in my stay at the Hospital. In my sleeping quarters, only one other patient was mentally ill. He was an elderly homeless man in the final stages of Alzheimer’s who needed a live-in clinic, not an emergency ward for those suffering with mental illness. Clinics mixing the mentally ill with drug addicts too commonly is standard operating procedure, with high rates of correlation between the two groups. Everyone else in my room was a drug addict. Over my stay, I got to know two of them in particular, the first being my next-bed neighbor, a morbidly obese Oxycontin addict who got admitted to the hospital after getting shot in the buttocks. The other was a rail-thin thirtysomething housewife who’d developed an appetite for Adderall. By combining patients and addicts together, many clinics—especially ones in precarious financial straits—can kill two birds with one stone. But unfortunately this leads to a mingling of otherwise mentally healthy addicts with patients in desperate need of serious psychiatric care. Everyone else in my room was a drug addict.

Before long, Sawyer allies herself with Nate, offering sexual favors in return for borrowing his iPhone to call her mother Angela (Amy Irving). Afterwards, Nate fills her in on the nature of the Center’s scam—they involuntarily commit as many people as possible under the flimsiest pretenses to milk insurance payments until their coverage dries up. Meanwhile Angela learns from her lawyer that she has no legal discourse as all the paperwork surrounding Sawyer’s admittance were technically valid. Not only that, but Sawyer and Angela both learn that the Center takes every opportunity to prolong commitments as long as possible, particularly over cases of patients “acting out.” This is exactly what happens when Sawyer understandably freaks out and attacks David when he mysteriously shows up one day as a new orderly in her ward. The administrators refuse to believe that she has a restraining order out, refuse to double-check with the authorities about his identity, and promptly stretch her 24-hour stay to ten days.

At the end of my 24-hour “voluntary commitment” period one of the doctors came to see me in my bed when I was at a particularly low point emotionally. He asked me how I was doing, and in between choked, terrified sobs I said I wanted to go home and threw my pillow against the wall. The doctor sprinted from the room like I had pulled a gun on him. The next morning, I was summoned to his office where he told me that he was oh so sorry, but due to my “outburst” they felt it oh so necessary to keep me committed for at least another week. For observation and my own good, of course. Thinking back, I wonder if he would have been so interested in keeping me for another week if I still wasn’t under my father’s comprehensive health insurance plan.

Many might balk at the idea of mental institutions deliberately detaining patients longer than necessary. But the reality is that American mental clinics are frequently bastions of corruption. Throughout the past three decades, studies and investigators discovered records of fraud when it comes to narcotic prescriptions and deliberate misdiagnosis in order “to extract every single penny possible” from vulnerable patients suffering from mental illness.

Unsane, we must remember, is a work of fiction. What happened to Sawyer was pure fantasy, and I in no way want to shame anyone involved in the film with triggering the awful memories. If anything, they’ve reminded me how deeply my stay traumatized me. The year after I graduated, I moved back down to Florida to live with my parents. It was at that time that I started meeting with a neurotherapist who properly diagnosed me with Asperger’s. In the years since then my life has completely changed for the better—I’ve moved out of my parents’ house, moved back to New York City, got a job, learned to support myself financially, and am pursuing a writing career. (Still working on those last two…) But I still bear internal scars from my commitment.

During the battery of electroencephalography (EEG) scans and counseling with which my neurotherapist pinpointed my Autism, he discovered that I was also suffering from PTSD. He asked me if I had recently experienced any traumatic episodes. And I told him the story of my time in the Hospital. I told him everything: of the shit collector; the Oxy addict; the Adderall housewife; the old man with Alzheimers; the smiling doctor who prolong my stay over a thrown pillow; the screaming patients; the withdrawing addicts; the cabin fever; the group counseling; the long boring days; the longer terrifying nights. I told him of how I didn’t know I was agreeing to be locked up, and how I cried and screamed when I realized that I might not ever get out again. My doctor sighed and said he thought we’ve found the cause.

Sawyer wasn’t as lucky. Without going into spoilers, the film makes it very clear that her time in Highland Creek Behavioral Center has left her sicker and more isolated from what’s left of her friends and family. Did she need help? Yes. She was hallucinating her stalker and ruining her life. Did I need help? Yes. I was legitimately suicidal. Recovery from mental illness and trauma is slow, difficult, and devastating. America’s healthcare system must collectively work to start seeing sufferers as people, so that the path to healing is one that is accessible and right for those who need it.

If you or anyone else you know is suffering from depression or a debilitating mental condition, seek out medical professionals you trust immediately. No matter what you might think, your life is important and there are good people in this world who want to help you get better.

If you’re feeling suicidal, you can call 1-800-273-8255.

LGBTQ+ youth and adults can call The Trevor Project at 1-866-4-U-TREVOR.

Those feeling other forms of distress or anxiety can also call the Samaritans’ 24-Hour Crisis Hotline (212) 673-3000