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What to Know Before Watching 'Unsane,' a New Thriller Set in a Psychiatric Hospital

Sometimes the news isn’t as straightforward as it’s made to seem. Sarah Schuster, The Mighty’s mental health editor, explains what to keep in mind if you see this topic or similar stories in your newsfeed. This is The Mighty Takeaway.

Horror films set in psychiatric hospitals are not new, but that’s the setting of the new psychological thriller “Unsane,” which hits theaters March 23rd. The film was directed by Steven Soderbergh and is gaining attention not only for its plot, but because it was shot entirely on an iPhone 7 Plus.

Regardless of the cinematic choices of the director, mixed feelings arrise whenever a movie tackles psychiatric hospitals and mental health. Hollywood doesn’t have a great track record for sensitively portraying individuals with mental illness and the mental health system, so it’s always a red flag when a movie uses a mental illness or a psychiatric setting as a plot device.

In the case of “Unsane,” its trailer gives us a glimpse into how the movie treats psychiatric hospitals. The trailer opens with a young woman, Sawyer Valentini (Claire Foy), scrolling through her messages. We see multiple, frantic texts from someone named “David,” who we find out is her stalker.

Valentini moved to a new city to get away from David, but she still doesn’t feel safe and sees him everywhere. She eventually goes to a mental health facility, presumably to get support.

When she visits the center, she speaks to someone and fills out forms. “It’s just routine,” someone, perhaps a counselor or a nurse, says. When she finishes, she finds out that by filling out the forms, she has (apparently, unknowingly) voluntarily checked herself into a psychiatric hospital.

Cue psychological thriller plot: Once stuck in the psychiatric hospital, she finds out her stalker works there. No one believes her, and we’re felt to wonder: “Is it real or is it a product of her delusion?” According to the movie synopsis on the “Unsane” website.

Whether you find the premise of the movie problematic itself, or if you’re a fan of psychological thrillers of all types and are psyched to see how the plot plays out, it is important to break down the possible implications a movie like this could have on the mental health community. For people who don’t have first-hand experience, a movie like this could be their only glimpse into the inner workings of the mental health system — so it’s good to go in with a critical mind, and the ability to differentiate between fact and fiction.

If you plan on seeing “Unsane,” here are some things you should know:

1. The difference between “involuntary” and “voluntary” commitment.

The trailer and the movie synopsis on the “Unsane” site actually contradict whether or not Valentini is voluntarily or involuntarily placed in the psychiatric ward. While the site states, “A young woman is involuntarily committed to a mental institution,” in the movie, a nurse explains, “By signing this [the forms], you’ve consented to voluntary commitment.”

Before we get into it, it’s important to acknowledge that, yes, perhaps in the world of the movie, the psychiatric hospital is corrupt, and the staff does go out of its way to essentially trick her into “voluntarily” committing herself, making the commitment itself involuntary.

But how can someone get involuntary committed to a psychiatric hospital in the real world? Legally, there are typically two ways it can happen: 1. The treatment is court-ordered. (For example, if the person is brought into the legal system, and a judge decides a psychiatric treatment center is more appropriate than jail.) 2. The treatment is imposed by a mental health professional when a patient is deemed a “serious risk of physical harm to themselves or others in the near future.” In both scenarios, it is supposed to be considered a “last report.”

Advocates who believe these standards don’t go far enough claim by the time you wait for someone to pose a risk of physical harm to others, it’s too late. Others have experienced mental health professionals who go too far, assuming someone is a –> or a misread sign. Even well-intended and trained mental health professions and mandated reporters commit people who shouldn’t be — the truth is,  –>suicide –> 

In their position statement on the matter, Mental Health America explains that even voluntary treatment isn’t always truly voluntary.

Coercion occurs during many so-called ‘voluntary’ admissions,” [and] persons facing involuntary commitment are routinely offered the option of becoming voluntary patients. However, in many treatment facilities, a person who has been voluntarily admitted is not free to leave when she or he chooses. Rather, it is common for mental health laws to permit the facility to detain a person for up to one week after she or he indicates a desire to leave.

In the trailer, after she is committed, Valentini calls the police, and says, “I am being held here against my will.” A nurse overhears her and says, “Do you know how many calls the cops get like that every week?”

While yes, people are put in involuntary treatment unjustly in our world, the idea that you can accidentally sign a form that gets you committed “voluntarily” when you enter a mental health center for support is widely unrealistic. In our world, a person who is not in a crisis situation will wait months before talking to a mental health professional, perhaps resorting to the ER if the situation becomes an emergency. It’s almost laughable how “efficient” the intake process in the trailer is.

While involuntary commitment has been a nightmare to some, and it’s something we should take seriously and fight against, we don’t want people to delay seeking help, scared they’ll unknowingly sign away their freedom for simply seeking support.

2. It’s important to believe victims of stalking and psychological abuse.

As Twitter user Karen Herms argues, the mystery of whether or not a woman’s concerns are serious, or if she’s just “crazy,” unfortunately reflects how many female victims of stalking and sexual assault are treated in real life. “Is anyone else bothered by the premise of essentially being, ‘Gaslighting: the movie’?” she wrote. “Like, ‘maybe she has a dangerous stalker or maybe she is just a crazy, overreacting female. YOU decide!’

According to the National Center for Victims of Crime, “15 percent of women and 6 percent of men have experienced stalking victimization at some point during their lifetime in which they felt very fearful or believed that they or someone close to them would be harmed or killed” — and the mental health effects are real. The prevalence of anxiety, insomnia, social dysfunction and severe depression is much higher among stalking victims than the general population.

Someone is not crazy for being stalked, but rather could be suffering serious psychological harm from the fear and anxiety of being stalked. While of course, the movie doesn’t make generalizations about stalking victims, it is important to remind ourselves how crucial it is to believe people who are abused — and not practice victim blaming or assume they’re exaggerating or making up what’s happening to them.

3. While a psychiatric hospital is a setting, patients are not props.

In the trailer, the patients in the hospital with Valentini are shown not as characters, but as proof the hospital is scary, and that the woman doesn’t belong there. We see one patient sitting in bed, looking at her menacingly. Another patient pops up with a piece of metal hiding in her waistband. In the trailer, besides the nurse and the woman, no one else speaks.

Of course, it’s hard to make assumptions based on a trailer. Maybe the other patients do have thriving plot lines and redeeming qualities that serve a greater purpose than making the psychiatric hospital seem creepy and unsafe.

Regardless, it’s important we humanize people who stay in psychiatric hospitals. While movies and other forms of media can and should make critiques of the mental health system, using the “scary psych patient” as a plot device further stigmatizes people who have entered psychiatric hospitals to seek help and those who have been committed against their will. People in psychiatric hospitals are people and deserve better than to be othered, or used to prove Valentini shouldn’t be there. These people look crazy, so this woman must not be. Suspense! 

Whether this movie ends up being just as stigmatizing as the trailer makes it seem, we need more accurate and passionate representations of psychiatric patients and our mental health system. Perhaps if a movie like this was an outlier, it wouldn’t be such a big deal — but if people are getting their mental health education from horror movies, we have to make sure they’re also getting knowledge elsewhere.

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