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Spoiler warnings generally aren't my style, because I believe that when reading a review, there should generally be an assumption that parts of the work being reviewed will be revealed. It's impossible to write a thoughtful review otherwise. However, since this movie is still in theatres at the time of writing, and this review will reveal large, crucial chunks of the plot, I recommend seeing the movie before reading this in full. The concise version is that it's a well-made film that's thought-provoking, an intense psychological thriller, but not particularly happy, and that doesn't paint the pharmaceutical industry or psychiatric medicine in a good light.

I saw this movie on a whim, and as someone with a strong distrust of psychiatric medicine, the premise was very intriguing: A suicidally-depressed woman is prescribed an anti-depressant that causes her to kill her husband while sleepwalking. There's more to the synopsis, but that's pretty much all I knew going into it. So there were a lot of surprises.

As a bit of backstory to this review, my circle of friends includes a large number of people who have been prescribed psychiatric medication in the past, or are currently on such medication. A few of them are success stories; with the help of their pills, they have happier, more fulfilling lives, with little to no side effects. Unfortunately, it's my observation that they're in the minority. For everyone else, results are widely varied. Some are emotionless zombies now, including one person who discontinued her meds because she got tired of not feeling anything. Most report (or exhibit) side effects which are present to such a strong degree that I can't help questioning whether they're actually seeing an improvement in their lives. I'm not going to tell someone "you shouldn't be taking this", because I'm not a doctor, and it's not my decision to make, but personally, if I had to choose between continuing to be easily distracted, or being able to focus at the cost of being angry and unstable when the pills wore off, I'd take the former. But that's just me.

As for my own personal experience, I've never used psychiatric medication, but not because I've never needed it, I simply didn't trust it and didn't want to turn to it unless I had exhausted all other options. I've been suicidally depressed at a number of points in my adult life (something I'm only just now becoming comfortable talking about, given how recent some of those thoughts were), and at one point following a semi-serious attempt (vehicle related), I saw a counselor for it. Within the first session, before I had even gotten through what my issues were, he wanted to prescribe anti-depressants. It seemed like it didn't even occur to him that I had very concrete factors contributing to my depression. I saw him regularly for several months, but he didn't understand a lot of what was going on, and seemed to only be half-heartedly trying to help me, and I didn't trust him much, so I stopped going.

So, this movie hit home very strongly for me. Early on, the main female character, Emily, attempted to commit suicide by driving her car head-on into a concrete wall. She survived the impact, and in the hospital, the psychiatrist, Dr. Banks, comes in to talk to her. In a seeming breach of protocol, he doesn't hospitalize her, but after just a few minutes of conversation, he releases her, along with a prescription for an anti-depressant. Right away, this movie was uncomfortable to watch, but I kept going.

From there, things were downright weird. In an amplification of the real world, everyone the characters come into contact with is taking some sort of psychiatric drug. The doctors hand them out like candy, everyone else has their favorite pill, and the whole environment is downright creepy. The real world doesn't work quite like this, obviously, but there's some familiarity to it; I've seen plenty of friends have entire conversations based on their past and present psych meds.

After trying a number of different drugs, Emily is prescribed a fictional one, portrayed in the movie as a new, experimental antidepressant. Seemingly, it's the perfect one for Emily; her symptoms are resolved, without crippling side effects. Except for one, she develops a fairly elaborate sleepwalking problem. As in, she'll get up in the middle of the night, start some music, and make breakfast, all in her sleep.

Overall, she has a significant quality of life improvement, without suicide attempts, but one evening, everything goes wrong. She starts making dinner while sleepwalking, and her husband comes home. He tries to wake her while she's chopping vegetables (common sense: never interrupt a sleepwalker with a weapon), and she turns on him, repeatedly stabbing him in the torso, completely without emotion. She then returns to bed, later waking up and hysterically calling 911, at which point the police quickly determine that she was responsible for the crime.

At this point, the movie starts to get truly disturbing to someone who distrusts almost all psychiatric medicine. Emily is found not guilty by reasons of insanity, and institutionalized.

The remainder of the movie gets very twisted and complex, but it illustrates how completely helpless an institutionalized person is, and how much power a psychiatric doctor yields over such a person, in a truly horrifying way. And yes, the system works this way for the benefit of all involved, but the idea that a person can legally hold such power over another, with zero recourse whatsoever for the patient, is a concept that gives me nightmares. I'll try not to reveal too many of the twists, because that's part of the fun, but the movie illustrates an edge case where a doctor abuses that power. I don't really care that it generally doesn't happen, the fact that it can happen is profoundly disturbing. They even show electro-shock therapy in the movie, which is a bit hyperbolic; it has legitimate uses, but much like an enema, it's not a medical procedure that needs to be shown on screen. Psychiatric medicine is already depicted in a way that fuels the fears of those of us who already fear it, they really didn't need to throw that in on top of it.

Toward the end, there's a point where things seem like they're resolving pleasantly. Emily's wrongful institutionalization ends, the true villain is brought to justice, and Dr. Banks is cleared of accusations of wrong-doing. All is peachy. But in a final twist (which I'm going to spoil), Dr. Banks uses his position as a doctor to have Emily re-committed, even though she clearly doesn't have the psychological issues she's presumed to have (she certainly has issues, but psych hospitals generally can't do much for a manipulative, cold-blooded murderer, as far as I'm aware). Specifically, when she shows up for her court-mandated appointment with him, he prescribes a battery of drugs that would have the combined effect of turning her into a vegetable, including Thorazine and a mood stabilizer (supposedly so she'll be happy about the Thorazine). When she understandably panics and tries to leave, she's immediately arrested, and her panic increases into a hysterical, desperate struggle to break free of her captors. The film then ends with the doctor resuming his happy life, ostensibly the hero of the film, and Emily in the mental hospital, presumably under the influence of the aforementioned Thorazine, staring vacant-eyed out the window.

I described this movie as well-made, and until those final three scenes, it's cinematically brilliant. But the ending is just plain awful, on multiple levels. For one thing, it creates a major plot hole; in order for Dr. Banks to bring the true villian to justice, he needs Emily's cooperation, which she provides. But the entire case rests on Emily having faked the murder of her husband, which would result in her being cleared of both her original institutionalization and the subsequent terms of release. Failing that, Emily would at least need to be lucid in order to testify in court on the new case, to get the charges to stick. Neither of these would be possible if she were re-institutionalized as part of her original terms of release and put on something like Thorazine.

But my bigger problem with this movie is that it rewards a doctor who clearly doesn't know what being a doctor is about. Of the three main characters, all of them are pretty awful; the true villian is a manipulative extortionist, Emily is a manipulative murderer, and Dr. Banks is a doctor who violates almost every ethical standard in modern medicine. The villian is arrested, Emily is wrongly institutionalized for life and prescribed drugs that carry permanent side effects, but Dr. Banks gets a happy ending; in fact, aside from his office being in a somewhat less ritzy part of midtown Manhattan, he suffers no consequences whatsoever in the end. And, in essence, Dr. Banks is rewarded for being everything that's wrong with modern psychiatry. Excluding the ethics violations later in the movie, which he performs with arguably understandable justification (sort of), this is a doctor who is far more interested in medicating problems than working on them with his patients. He writes a prescription for every patient in his care, consults with pharmaceutical companies to funnel more patients into new drugs, and even describes his philosophy on psych drugs in a way that makes them a permanent part of a person's life. That is awful.

Mental health care is a crucial part of modern life, but brain-altering drugs should always, always be a last resort in treating problems. It's indisputable that mental disorders exist that are caused solely or heavily by brain chemistry, and that can only be treated chemically, but this is not justification to shotgun pills at patients. Mental health care should be about curing the patient so they can live a functional, happy life, and part of that is finding the source of a person's disorders, which are not always chemical. Someone with anxiety issues might have a chemical anxiety disorder, or they might be grossly overworking because they're trying to fill a void in their life that can only be spotted by an outside observer. And someone who's suicidally depressed might have chemical depression, or they might have just gone from what they thought was the road to a successful career, into a dead-end miserable life. Maybe that person needs someone to help with their crippling self-confidence issues.

I won't claim to speak for every person who's struggled with depression, because every case is different. But mine is a case where an overzealous doctor wanted to prescribe psych drugs for something that wasn't rooted in chemical issues. I chose not to take the pills, and I struggled for a long time. But during that struggle, I found the help I truly needed from my friends. There was no one person who helped with all of it, but many of them helped with many different things. Many people helped me develop self-confidence in my various skills. One person helped me see hope in a particularly hopeless moment. Several people helped me out of a bad relationship, and several others helped me recover from one that ended badly. Almost everyone helped me see that my issues were related to concrete factors in my life, and helped me develop the hypothesis that fixing those specific factors would eliminate the depression I struggled with. And, one special person gave me the resources and the stepping stone I needed to test that hypothesis, which ended up being correct. I can't say that things would've been worse if I had taken the pills, but I can say for sure that I wouldn't be in the position I'm in today. My depression was severe, and was a major obstacle in itself in many case, but had it been removed, I'd probably still be in rural Virginia, and I definitely would not have taken the risks that led to where I am today. Why would I? The driving force that got me out of rural Virginia, and inspired me to risk complete financial collapse, was the crippling, hopeless depression I felt while living there. It was a literal matter of life and death, for me, and at times when that wasn't the case, I was content to stay there, infinitely throwing money at debt that wasn't shrinking, waiting for the timing to be perfect, something that would never happen.

Again, my way is not the right way, I got lucky. But my case illustrates the larger point that in order to help every person fulfill their potential, mental health care needs to reserve medication for a last resort. Pills don't automatically solve problems, but a skilled human who can be trusted to listen and provide clarity can make a world of difference in a person's life. And that's what I expect in a mental health professional; someone who truly wants to help me, not a walking prescription pad.