Week three of the Cinematic Representations of Mental Illness course I recently attended at Crouch End Picturehouse explored three films chosen to represent the theme of psychosis.

The topic was introduced with a brief description of how psychosis is marked by a loss of reality, with the sufferer experiencing hallucinations or delusions, plus disorganised thinking and speech. Taking a sufferer’s point of view as an unreliable narrator therefore has significant cinematic value when seeking to create plot twists and intrigue, and hence it is not uncommon to see the condition represented onscreen in one fashion or another.

Title: The Machinist
Writer: Scott Kosar
Director: Brad Anderson
Studio: Castelao Productions
Release Date: 18 January 2004

It had been a number of years since I had originally watched The Machinist, an offbeat morality play arguably most famous for—and perhaps otherwise overshadowed by—the fact that star Christian Bale lost over sixty pounds for the titular role of emaciated Trevor Reznik. The inspiration for the character came from Nine Inch Nails frontman Trent Reznor, and in particular the band’s 1994 album The Downward Spiral. As well as influencing the theme and tone, there are also multiple visual references to the work of Russian novelist Dostoyevsky: in visual references to Crime and Punishment (1866), The Idiot (1869), and—in naming the mysterious Ivan (John Sharian)—The Brothers Karazamov (1880).

Reznik is haunted by guilt and shame following an event the nature of which is hinted at throughout the movie and revealed at its climax. “If you were any thinner, you wouldn’t exist,” Reznik is told on more than one occasion. “A little guilt goes a long way,” he says himself at another. He claims (unrealistically) not to have slept in a year. Post-It notes on his fridge hint at the truth he is unable to face, one that obliquely infuses so many scenes. The trauma such as that experienced by Reznik is indeed one of a range of potential causes of psychosis, alongside its presentation as a symptom of a number of underlying mental health problems—schizophrenia, bipolar disorder, depression, and addiction among them.

In terms of quite how Reznik’s condition is realised onscreen, director Brad Anderson provides an insightful summary in an interview featured on the DVD release:

The whole movie is essentially told from the perspective of Trevor. The look of the move, the way we sapped it of colour… is almost monochromatic. That was a choice that was made… knowing that one of the symptoms of severe insomnia is that… your brain can’t process colour like it used to, and you see the world in a more black-and-white way. So, I wanted the look of the film to match the mental state of the lead character, hence… we decided to pull all the colour in the movie. Except for red, which is in some ways symbolic for Ivan’s car—that Red Firebird which is always cropping up in weird places—almost pinging Trevor’s guilty conscience and luring him closer and closer until he finally has his epiphany…

The other thing is, we didn’t want to differentiate the delusional scenes from the reality scenes. We wanted them to be seamless, more or less. We didn’t want to shoot the delusions or Trevor’s dream-like sequences in a dream-like way. The performances were a little skewed in those scenes at the airport cafe. I wanted Christian and Aitana (Sánchez-Gijón) in those scenes to almost have this heightened reality to the conversation; it doesn’t feel totally naturalistic, so it felt a little off. But visually we didn’t want those scenes to pop out from the rest of the movie that much… I wanted the image to be cleaner, and the camera movements to be elegant and simple…. We wanted the pacing to have a very languid, dreamlike quality to it, until we get more towards the end and his paranoia ratchets up and becomes more intense… We didn’t want to literally distort things, but there would be a feeling of unreality to it, even for the scenes that were really happening… We just wanted to create something that felt like some kind of nightmare dream… that this character was experiencing.

There is certainly a sense that Reznik’z psychosis in The Machinist is essentially a device around which to spin the movie’s central mystery before its escalating drama and final rug-pull—one that irritated me on first viewing—but its artful and considered presentation together with an all-too-convincing central performance by Bale make this a notable example of psychosis on film. If you don’t know the film but are interested in seeing such a representation, I recommend you seek it out.

Title: Coherence
Writer: James Ward Byrkit
Director: James Ward Byrkit
Studios: Bellanova Films / Ugly Duckling Films
Release Date: 20 June 2014

Coherence represents James Ward Byrkit’s directorial debut, shot on a micro-budget in his own home in Santa Monica over five days with a cast of eight actors. Its story is centred around the strange effects of a passing comet, which appears to create multiple intersecting realities. Its selection for the course was not due to any specific representation of psychosis, but rather for the approximation to some of its effects achieved by the unsettling narrative.

To at least some degree, it seems that this effect was a consequence of the situations in which the cast unexpectedly found themselves. Discussing his creative approach to the film, Byrkit reveals that he wrote a detailed twelve-page treatment which included all the key story beats, but that the cast received nothing but a series of notes for each night’s shoot, so were unaware of the circumstances and events that were to befall them.

Byrkit cites The Twilight Zone (1959-64) as an influence, but two of the qualities of that series that stand out for me are its economy of storytelling and a strong sense of authorship, both elements that were missing for me in Coherence. Its naturalistic tone certainly makes for an unusual watch and the unconventional approach to its production creates a boon from its scant resources, but ultimately—perhaps due to nothing more than personal taste—the banality of much of the dialogue in particular meant it didn’t really hold my interest throughout its running time.

Some elements did, however, intrigue me. The improvisational approach lends a fragmented, chaotic mood, in which suspicions towards one another abound. The notion of the coherence of reality itself breaking down both represents the sense of existential crisis that psychosis can inflict on the sufferer and the theoretical physics of quantum decoherence that is referenced onscreen. And the lure of conspiracy theories and sense of false reassurance they might offer—as when the group start discussing historical events related to comets and meteors such as the Tunguska event of 1908—is an idea that has long held my interest in a similar context.

Coherence is, ultimately, not a film that really held my attention or that offers an overt representation of psychosis, but it is nonetheless of interest in terms of its creative process and some of the ideas enshrined within it.

Title: Unsane
Writer: James Greer & Jonathan Bernstein
Director: Stephen Soderberg
Studios: Regency Enterprises / Extension 765
Release Date: 23 March 2018

Released earlier this year, Unsane was also filmed in a somewhat unconventional style in that it was shot entirely on an iPhone, lending the film a familiarity, intimacy, and an experiential tone. It tells the tale of Sawyer Valentini (Claire Foy), a young woman who has relocated to escape a stalker and now finds herself alone and vulnerable in an unfamiliar city. Her previous trauma leaves her prone to being triggered by interactions with men, “seeing” her stalker when he is not there.

Sawyer visits a counsellor at a behavioural health centre, only to unwittingly sign a release allowing her to be committed to an overnight stay that is then extended to a week. This turn of events is interesting in and of itself, suggesting an institutional manipulation of insurance cover by immoral private hospitals keen to increase their turnover, or perhaps an example of the conspiratorial thinking that is a facet of psychosis.

Foy’s performance is every bit as excellent as you might expect, grounding the film even as events spiral. There is an ambiguity to these very events once again from having an unreliable narrator as the protagonist, one that director Stephen Soderberg has explained in an interview he deliberately amplified by making changes to some of the early scenes during the editing process, seeking to deepen that sense of mystery. Ultimately, whilst a few onscreen clues point to what may be real and what may not, the narrative escalates to a preposterous degree—the kind of sensationalism that serves only to stigmatise conditions such as psychosis—and I can’t help but think that even a slightly more reigned-in final act would have led to a more effective and apposite finished product.

British newspaper The Guardian published an article published to coincide with the film’s opening under the headline “how film’s portrayal of mental illness is (slowly) improving“. In some respects, I can agree with its assertion that, as public awareness of mental health conditions has been raised, “the tone, purpose and dynamic of films about mental ill health have slowly shifted”. It still feels like there is more work to do, though, and a further heightened level of care and attention required from many screenwriters and filmmakers.

I will close once again with a recommendation that readers of this blog follow lecturer Mary Wild on Twitter and also check out the Projections podcast, co-hosted by Mary and which discusses different movies around the same six groups of mental illness covered in this course, and much more. In particular, check out the episode on psychosis, which considers two different films: Frances (1982) and The Truman Show (1999). Next: three films that exemplify addiction.