STUDENT'S PERSPECTIVE:

One fact more than anything else makes this film truly memorable and deserves mention; the cachexic, unnerving individual we are looking at is in fact Batman. Christian Bale transformed himself from the almost parodically-handsome Patrick Bateman of American Psycho to his breathtaking (and not in a good way) appearance in The Machinist by losing a reported 63 pounds. Just one year later he appeared in theatres as Bruce “The Batman” Wayne in Batman Begins.

Moving on, The Machinist puts its audience in the mind of Trevor Reznik (Bale), following him throughout his work at a machine shop and personal life while trying to make sense of his extreme insomnia and various bizarre occurrences. Right from the start, he experiences numerous audio and visual hallucinations. Although many of these are made obvious, a great deal more are left as subtle or questionable, making it difficult to discern reality from delusion. To this end, the film does an excellent job of giving its viewers the same feelings of confusion that Trevor must feel. While the audience tries to pick up on inconsistencies and clues to the origin of Trevor's problems, Trevor himself handles the matter with increasing paranoia, culminating in a rather expected decline for our protagonist. The end reveal is satisfying, if a bit overly complex, and lends the movie to repeat viewings. A great deal of what we see have symbolism and purpose that may not be picked up upon without knowing the complete story. Spoilers appear in the following paragraph.

Clinically, Trevor presents as noticeably underweight with self-reported insomnia and remarkably detailed hallucinations. The film pushes the idea that his hallucinations are secondary to extreme insomnia, however there is evidence that he sleeps frequently without realizing it. Eventually it is revealed that Trevor's problems stem from likely post-traumatic stress disorder with dissociative amnesia. Indeed, his symptoms match the PTSD criteria appropriately: a traumatic event involving death with intense fear as a response, recurrent distressing perceptions and images, efforts to avoid thoughts, inability to recall important aspects, difficulty sleeping, difficulty concentrating, and significant impairment of social and occupational functioning1. His affect and level of interest in activities appear normal, however much of his interactions are with imagined people.

1American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

PSYCHIATRIC PHARMACIST PERSPECTIVE:

The Machinist, is a dark psychological thriller directed by Brad Anderson, written by Scott Kosar, and starring Christian Bale, Jennifer Jason Leigh, Aitana Sanchez-Gijon, Michael Ironside, and John Sharian. This film went mostly unnoticed by mainstream movie goers in 2004, though it is arguably one of Christian Bale's best performances as he plays Trevor Reznik, an emaciated machinist who is haunted by insomnia for reasons that both the character and audience get to discover together as the story unfolds in clues, symbols, and his mixture of hallucinations and poor reality testing.

This film requires your attention to nearly every word and image, no matter how small or seemingly insignificant. Multiple viewings are required to appreciate the symbolism in the hallucinations (dreams?) that would make Carl Jung smile knowingly. Some favorite quotes in the movie: “A little guilt goes a long way” and “If you were any thinner, you wouldn't exist” both reinforce the themes of unbearable guilt and self-punishment that Trevor Reznik imposes, unconsciously, on himself with starvation, insomnia, and even allowing himself physical harm for the purpose of filing a police report (can't say more without spoiling it). The protagonist's inability to recognize his situation at times and the symbols implying choices made, and to be made, even make the book he's reading (The Idiot – Dostoyevsky) a well placed element in the film.

SOME TEACHING POINTS OF THE MOVIE AND POTENTIAL SPOILERS:

Trevor's statement: “No one ever died of insomnia”. With still a bit of mystery behind it, it is known that we can probably survive longer without food than without sleep. Animal studies indicate death can occur even after two to three weeks without sleep. The longest documented period of a human going without sleep is eleven days. Humans may be able to survive prolonged periods without sleep, but this study shouldn't be done. Though Trevor states that he hasn't slept in a year, he has likely slept for small periods unknowingly as he switches between dream-hallucinations and his altered reality. He may have poor REM sleep given that this feature of sleep is also required and without it, a person can hallucinate and have cognitive impairment. With a disrupted circadian rhythm a person may have changes in appetite/weight as well. As we learn in the movie, a traumatic event has occurred that causes Trevor to dissociate from his reality to avoid his psychological pain and guilt, which only emerges in certain hallucinatory, paranoia, and other delusional activities and whose boundaries are weakened during the film allowing Trevor to confront himself – literally - via his alter ego “Ivan”. The diagnosis of PTSD is possible. He may also have a guilt-laden Depression with Psychotic features, though his daily affect is not overtly depressed.