'Unsane' Gives a Real-World Medical Conspiracy a Big Final Twist

Fingerprint Releasing / Bleecker Street
Fingerprint Releasing / Bleecker Street

The following contains major spoilers for the film Unsane. To read on and then get in a tiff about this story ruining the movie would be considered by most mental health professionals to be "nuts."

There's a big twist in Unsane, the latest swiftly produced indie from the one-man film virtuoso Steven Soderbergh. The movie starts like a thriller based in reality, one with a little bit of commentary about the state of American health care, until it takes a hard left. Then -- jump scare! -- it's actually just another dumb horror movie.

And when I mean dumb, I mean A Nightmare on Elm Street 3: Dream Warriors-level dumb.

But hold on a minute. Maybe that's the intention? Steven Soderbergh, the man behind Traffic and Ocean's 11 and The Knick and Magic Mike is widely regarded as something of a genius. The Oscar-winning director can film projects in secret (and on an iPhone, to boot), work around traditional distribution models and achieve picture lock on the same day he wraps production, and gives the impression that "the creator has a master plan." Surely any sort of foray into schlock is going to be an exercise in genre expectations, right? Right?

The answer: sure, but that doesn't make Unsane any less dumb.

Fingerprint Releasing / Bleecker Street

Soderbergh's movie kicks off with a hyper-realistic tone, thanks in part to the look of his iPhone photography, as well as the gripping lead performance from Claire Foy. Foy's Sawyer Valentini is a tough-as-nails bank analyst, but her aptitude at a new job is just the excuse her gross boss needs to make an inappropriate pass (though one just subtle enough for plausible deniability.)

Sawyer clearly has some "issues," brushing off comments from her FaceTiming mom (Amy Irving) about why she's moved to Pennsylvania. When she hooks up with a Tinder date, she brings him back to her apartment, only to melt down and lock herself in the bathroom. "You initiated!" the freaked-out dude exclaims, clearly terrified of accusations of misconduct.

The eruptions convince Sawyer to goe in for a psychological consultation. There she mentions an ex-stalker back in Boston and, even though she knows it's crazy, confesses that she "sees" him everywhere. The clock-punching counselor asks some leading questions, receives a vague affirmative on "suicidal ideation," gets Sawyer to sign some papers that she thinks are merely for further visits and, voila: Sawyer is now locked up in a "wrong [wo]man"-style Hitchcockian hell.

Sawyer meets Nate (Jay Pharoah), another inmate cut off from the world and under "observation," who explains that the private, for-profit facility has a pattern. They maintain empty beds just for wide-eyed, stressed-out people with good insurance policies. They trick them into saying the wrong thing, suck the insurance companies dry for as long as they can, then throw the patients back to the world.

Since this is all played extremely straight and terrifyingly it leads to the question: Does this sort of thing actually happen?

Fingerprint Releasing / Bleecker Street

There have been stories (recent ones at that) about Universal Health Services ($124.22 on the NYSE), which oversees the largest chain of psychiatric hospitals in the USA. A federal inquiry is underway to determine if UHS has held patients longer than medically necessary in order to squeeze insurance companies for each additional day. Naturally, the third party most affected is a company called Tricare, whose primary policyholders are active military families. (In other words, you, the taxpayer, would be the one getting screwed if the accusation against UHS turns out to be true.)

A BuzzFeed report about UHS from 2016 is basically a roadmap for the first half of Unsane. A woman seeking help cracks a few jokes during an initial interview, signs what she thinks are standard papers, and next thing you know, she's doped up, wearing a gown, and "under observation." It's big business. "[People] think we’re going to diagnose them for anxiety or depression. Our goal is to admit them to the hospital," a former intake worker for a UHS facility says in the report.

So Unsane deals with a serious issue, and one that ought to be more widely known. Which is why it is so frustrating when the movie nosedives into B-picture foolishness.

An interesting spin during the first half is not quite knowing if Sawyer is merely a victim of corporate vampirism or is actually cuckoo. She frequently has visions of her stalker and is quick to get very violent. She might have to stay longer than her initial seven day observation period (and maybe lose her job?) if it keeps up. This makes for intriguing cinema! And then [big, BIG spoiler] it turns out to be something else entirely.

Fingerprint Releasing / Bleecker Street

Her Boston stalker really is the guy distributing her zonk-out pills. We're asked to believe that he's been stalking her so hard that when she went for her consultation and got socked away in the nuthouse for a period of time, he went and murdered one of the nurses, assumed his identity, no one who worked there noticed it and he was able (in just a matter of days) to find all the keys and dangerous stuff he'd need to kill anyone who gets between him and the woman he desires.

In the grand scheme of terrible grindhouse movies, we've all seen (and maybe even liked) far worse. But by the time the throat-slashing and poisonous injections start, the balloon has popped, and there's no reason to take Unsane seriously. The picture ends with typical final girl jazz. Few will think twice about the legitimacy of the film's earlier claims. It's a shame.

I admit that I, too, figured that since the rest of Unsane was so silly the serious part had to have been made up. I even spoke with a friend who is a mental health professional (in Pennsylvania, just like Unsane.) He tells me he's heard nothing of "traps" during consultations for insurance dough under false pretenses. He further says that the more common collusion is amongst doctors and patients against insurance companies. Meaning, in order to work around red tape toward the goal of wellness, a doctor will feed a patient a line with a wink, get them to say something that can trigger a course of action that would otherwise require lengthy tests or additional visits.

Call me crazy, but all this gray area sounds like a much more intellectually stimulating arena for a director like Steven Soderbergh than another goon chasing a woman with a sharp object. I get that the exercise of reorienting your expectations -- in other words, thinking you are seeing a so-called "real" movie, discovering you are in a schlock corridor, then reevaluating what you have seen -- is an unusual experiment. But as Unsane shows, most of the time you'd rather get what you think you've signed up for.

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Jordan Hoffman is a film critic and writer whose work appears in The Guardian, Vanity Fair, and The Times of Israel. He likes rock songs that are over 10 minutes. Follow him on Twitter @jhoffman.