Gaslight­ing, coer­cion, and the men­tal health indus­try in Unsane

This piece con­tains dis­cus­sion of sex­u­al assault and abuse in a health­care setting.

“Coer­cion” and ​“Gaslight­ing” are cur­rent­ly pop­u­lar buzz­words used to describe abu­sive per­son­al rela­tion­ships. We have become hyper aware of these con­cepts in the wake of #MeToo; both are symp­toms of the sys­tem of misog­y­ny, rear­ing its ugly head in our per­son­al lives. ​“Gaslight­ing” is a term root­ed in the 1944 film Gaslight, and is a process of manip­u­lat­ing some­one into doubt­ing their own san­i­ty. ​“Coer­cion” is also a form of manip­u­la­tion, where peo­ple are made to do some­thing either through force, or threats. For me, as a mad-iden­ti­fy­ing per­son, coer­cion and gaslight­ing loom largest in my life when I am around the very peo­ple who are sup­posed to sup­port me with my ill­ness­es: Men­tal Health Services.

Just like in abu­sive per­son­al rela­tion­ships, the coer­cion and gaslight­ing I have repeat­ed­ly encoun­tered at the hands of clin­i­cians is part of the larg­er struc­ture of misog­y­ny. Instead of sup­port­ing and val­i­dat­ing the expe­ri­ences of a sur­vivor of ear­ly child­hood abuse and repeat­ed sex­u­al assault, they use diag­noses as labels to blame me for the way I am, rather than the soci­ety that has hurt me over and over.

In a world where one in three women have sur­vived sex­u­al assault, it is con­ve­nient to blame indi­vid­u­als – in par­tic­u­lar to diag­nose them with dis­or­ders that focus on an issue with their ​“per­son­al­i­ty” – than to admit that mas­sive sys­temic issues have to be fixed. I have repeat­ed­ly fall­en vic­tim to this sex­ist bias in how psy­chi­a­try responds to women; so does Sawyer Valen­ti­ni (Claire Foy) in Steven Soderbergh’s Unsane.

In hor­ror films, women like Sawyer (and like me) who have been through trau­ma are often depict­ed as hys­ter­i­cal, vio­lent; in need of med­icat­ing and being strapped to a bed. We are often reduced to being vil­lains. The most famous exam­ple of this is Glenn Close’s char­ac­ter in Fatal Attrac­tion, but the trend has been a wide­spread phe­nom­e­non that has exist­ed since the begin­ning of the hor­ror genre. We like to watch ​“mad” peo­ple unrav­el. We like to watch ​“mad­women” unrav­el even more.

The way Sawyer’s jour­ney is depict­ed, is part of a series of images that are repeat­ed over and over, not only in hor­ror films, but in oth­er images of men­tal dis­tress. There is a hunger for images of ​“mad­women” in our soci­ety, specif­i­cal­ly of ​“mad­women” dur­ing the process of descend­ing into men­tal ill-health, and there has been for a long time. When we look at Charcot’s famous pho­tographs of hys­te­ria from the 1800s, it is the pho­tos of hys­ter­i­cal women, in var­i­ous states of decline, that have been remem­bered and repro­duced, and not the pho­tos he also took of male patients.

In hor­ror films, char­ac­ters like Sawyer, Alex in Fatal Attrac­tion, Su-mi in A Tale of Two Sis­ters and Madi­son in Malig­nant are depict­ed with greater rel­ish and atten­tion to their decline, than ​“mad­men”. Whilst we ques­tion what is going on with Sawyer’s men­tal health in Unsane, and vivid­ly see her unrav­el through the use of fish-eye lens­es, and Claire Foy’s pow­er­ful per­for­mance; there is no ques­tion­ing of Micheal Myers’ san­i­ty in Hal­loween, or in most oth­er depic­tions of ​“mad­men”.

We don’t watch in twist­ed fas­ci­na­tion as Myers descends into men­tal dis­tress, in the way that we watch Claire Foy put every­thing she has into the sane/​unsane dichoto­my, because his men­tal ill-health is a per­ma­nent fea­ture. This gen­er­al­ly isn’t the case when hor­ror films focus on the san­i­ty of women. Instead audi­ences want to see Sawyer scream, and fight, and spit, all whilst being uncer­tain about her moti­va­tions and state of mind. Claire Foy does it all.

In Unsane Sawyer is admit­ted to a psy­chi­atric hos­pi­tal after sign­ing paper­work that she assumed was to get out­pa­tient help with her trau­ma-relat­ed anx­i­ety. Sawyer has just moved to a new city to escape a stalk­er who made it impos­si­ble to con­tin­ue with her life as it was. As in a lot of hor­ror films, the is-she/isn’t‑she mad dynam­ic plays out, with the audi­ence unsure if Sawyer is hal­lu­ci­nat­ing that a mem­ber of staff is in fact her stalk­er and also ques­tion­ing whether Sawyer should be in hos­pi­tal or not.

For a direc­tor mak­ing a hor­ror film, Soder­bergh is actu­al­ly very real­is­tic in his depic­tion of this. Women are reg­u­lar­ly doubt­ed when they express how they have been abused by men; and women who are per­ceived to have a men­tal ill­ness even more so. When I have talked about sex­u­al assault to psy­chi­atric staff, they have fre­quent­ly dis­missed me by instant­ly chang­ing the sub­ject, or mak­ing it oth­er­wise clear that they don’t believe me. This then affects the care I get from them, just like it does for Sawyer.

What is clear, how­ev­er, is that mem­bers of staff repeat­ed­ly gaslight, coerce, drug and restrain Sawyer, start­ing with con­vinc­ing her to sign papers to com­mit her­self, and con­tin­u­ing by gaslight­ing her when she insists that she doesn’t need to take up an inpa­tient bed, and then lat­er when she is in dan­ger. If the staff had tak­en Sawyer’s con­cerns seri­ous­ly they could have avoid­ed the vio­lence that makes up most of the third act of the film, but in some ways that is beside the point.

Ignor­ing and drug­ging patients doesn’t help them. Even if some­one is hal­lu­ci­nat­ing, even if some­one has zero grip on real­i­ty, they still need to be lis­tened to in order for them to be treat­ed prop­er­ly. Some­times I am con­vinced that peo­ple have poi­soned my food. In real­i­ty no-one has ever poi­soned my food but there is a spe­cif­ic rea­son why I have had this delu­sion: I feel unsafe in a world where so many peo­ple have phys­i­cal­ly hurt me in the past.

There is always some­thing ratio­nal behind the irra­tional, and gaslight­ing, coerc­ing and drug­ging patients into ​“behav­ing” rather than lis­ten­ing to their con­cerns, just makes the sit­u­a­tion worse. And yet this is the pri­ma­ry focus of most men­tal health care facil­i­ties both in hor­ror films like Unsane, and in many of the real-life hos­pi­tals and out­pa­tient units I have found myself in.

In this way, hor­ror films – often crit­i­cised for poor por­tray­als of men­tal health – can actu­al­ly prove use­ful. Their cin­e­mat­ic exag­ger­a­tion of the coer­cion, gaslight­ing, and oth­er forms of misog­y­ny present in the psy­chi­atric care sys­tem can high­light and illu­mi­nate the real-life roots of these prac­tices. Maybe psy­chi­a­trists who watch Unsane will think twice before ignor­ing the con­cerns of their patients. Maybe the gen­er­al pop­u­la­tion will be able to see that char­ac­ters like Sawyer are put in posi­tions where it is impos­si­ble to prove that you are ​“sane”. That Sawyer’s reac­tions, escape attempts and vio­lence against her stalk­er and oth­er patients when pro­voked might look ​“Unsane”, but are actu­al­ly pro­por­tion­al respons­es to the way she is being treat­ed and viewed by men­tal health professionals.

I can no longer access men­tal health ser­vices; I have been inval­i­dat­ed and psy­cho­log­i­cal­ly harmed by their assump­tions one too many times. Yet I still have Bipo­lar Dis­or­der and I will always be ill. This reg­u­lar­ly puts my life at risk, and has end­ed up in a sit­u­a­tion where I am very heav­i­ly med­icat­ed, by per­son­al choice. I would rather take a hand­ful of meds sev­er­al times a day, than risk hav­ing to see men­tal health ser­vices again.

Watch­ing Unsane makes me won­der if some­thing sim­i­lar would hap­pen to Sawyer, if she were a real per­son. The film estab­lish­es that she doesn’t need to be in hos­pi­tal, but she does still expe­ri­ence men­tal dis­tress as a result of trau­ma, which the events of the film will have only com­pound­ed. I doubt Sawyer, like me, would ever be able to trust psy­chi­atric staff again, no mat­ter how much she need­ed help. That is not how it should be.