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The Royal College of Psychiatrists Improving the lives of people with mental illness

The Machinist


Released in the UK in 2005, The Machinist was directed by Brad Anderson and stars Christian Bale in one of the most committed performances to be seen in cinema. Bale loses so much weight for the part of Trevor Reznik, more than 4 stones in a matter of months, that his skeletal form is almost too difficult to watch at times. The film opens with the main protagonist, Reznik, in an extremely disturbed state of mind, seemingly disposing of a body rolled in carpet. What follows is the back-story to this scene, as we learn that Reznik has suffered from a year of crushing insomnia and dramatic weight loss. The film ends with us understanding the cause of his initial insomnia and the subsequent development of his paranoid psychosis.

The Machinist

With a tagline to the film that states ‘A little guilt goes a long way...’ we find ourselves firmly in the realm of psychiatric illness for the whole of the 98 minutes and it gives the viewer an opportunity to experience the confusing and frightening world of paranoia at close quarters. The screenplay was written by Scott Kosar, who states that he was influenced by Dostoyevsky’s The Double: A Petersburg Poem, a short novel that describes the inner struggle of its protagonist, who starts seeing his double everywhere, as his mental state deteriorates. It is worth mentioning that some scenes in The Machinist are disturbing, despite it being rating as a 15. 

The Film

I do not intend to reveal the entire plot of The Machinist, but wish to consider the way in which the film provides us with suggestions about Reznik’s mental state. This begins with the choice made by the director, throughout most of the film, to use a cinematic atmosphere of low light and grimy surroundings, which contribute to an overall tone of hopelessness and despair. The musical score also reinforces what we see of Reznik’s fearful, persecutory state of mind for much of the film. But it is the gaunt, haunted skeletal appearance of Bale himself who manages to convey the complexity of his character, racked with guilt, denial and increasing persecutory anxieties, that makes this an extraordinary visual account of a mental illness unfolding before our very eyes.

After the initial opening scene described above, we learn that Trevor Reznik is single and works as a machine operator at the local factory. We discover that he visits a prostitute, called Stevie, regularly and that he is a friend to her as much as a client. Early in the film, she is clearly concerned about both his weight loss and his distracted mental state and suggests that he see a doctor. However, he refuses to seek help of any kind. The management at his workplace also express concern about his weight loss and mental state, asking him if he is ‘doing drugs’. To them he states that he has got a lot on his mind, but he’s dealing with it.


His distracted mental state then leads to an awful accident at his work in which a colleague loses a limb, resulting in the other workers turning against Reznik for his ‘weird’ state of mind. His paranoia in this context appears real and justified. In the investigation of the incident, Reznik confesses to having been distracted by another worker, called Ivan, leading him to discover that there is no such person employed by the factory. However, Ivan continues to pursue Reznik, who begins to feel increasingly persecuted. He begins to neglect his day-to-day responsibilities and personal care and in a downward spiral of despair also loses his job. But he continues to turn to Stevie as someone he can trust until, finally, she too becomes a part of his persecutory world and she throws him out of her flat. A parallel storyline, with particular significance to the film, concerns Reznik’s late night trips to the airport coffee bar where he has become well known to the waitress there who works the night shift. Interestingly, these scenes are bathed in light and seem to offer some temporary way out of the darkness for Reznik.


As the film progresses the boundary between truth and delusion becomes completely blurred for Reznik and the viewer. Certain everyday objects, like the cigarette lighter in his truck, appear to take on a special significance only understandable after the final scenes of the film. We are not sure what to believe until we are given several clues that Ivan is in fact a part of Reznik himself, hounding him until he finally makes the right choice about something he has done. Only when he takes full responsibility for his earlier action does he get any resolution of his guilt and can at last fall into a deep sleep.  The film provides us with the final piece of the psychological puzzle at its very end but some viewers may have managed to collect enough clues before then to reach the correct conclusion for themselves.


Relevance to the field of Mental Health

For any professional engaged in carrying out mental state assessments, this film offers the opportunity to enter the persecutory world of an individual and to experience the blurring of boundaries between truth and delusion that so disturbs people suffering from a paranoid psychosis. An excellent article on paranoia, entitled Helping patients with paranoid and suspicious thoughts: a cognitive–behavioural approach by Daniel Freeman and Philippa Garety (Advances in Psychiatric Treatment (2006) 12: 404-415) could be read alongside a viewing of this film for enriched learning.


The Machinist offers not only a brilliant springboard to teach about the experience of paranoia but also presents the opportunity to consider the differential diagnosis in someone who presents with such symptoms and to examine the predisposing, precipitating and perpetuating factors that might be used in constructing a psychodynamic formulation. Further discussion about psychodynamic formulations is available in a two-part article published in Advances in Psychiatric Treatment entitled Teaching of psychodynamic formulation to psychiatric trainees (2005) 11: 416-423 and (2006) 12: 92-99 both by Chris Mace and Sharon Binyon.


With regards to Reznik, one could suggest that his premorbid personality, shaped perhaps by the absence of his father from a young age, coupled with his single status and lack of intimacy, has predisposed him to develop a depressive episode, in which he suffers from extreme anorexia and chronically impaired sleep, which in turn further impair his cognitive functions. We come to understand that the trigger for his illness was his spur of the moment decision to flee from a traumatic event generating huge guilt. His depression steadily worsened over a year without any professional help, until he develops a severe psychotic depressive episode with mood congruent paranoid delusions, visual hallucinations and second person auditory hallucinations. I suggest that Ivan represents a projection; the mental mechanism described by psychoanalysts whereby a person attempts to get rid of unacceptable impulses or parts of the self by externalising them.


The Machinist could also offer a platform for discussion about the topic of insomnia and chronic sleep deprivation. A very good and broad introduction to the topic of insomnia and its causes can be found on the NHS choices website. It is important to note that although Reznik states that he hasn’t slept for a year, we actually watch him having a brief lapse into sleep that lasts a few seconds one night. In reality, the sleep deprivation record is thought to stand at 266 hours (a little over 11 days) achieved on live webcam in 2007 by a 43 year old Cornishman called Tony Wright, as this BBC report describes. The Guinness Book of Records stopped acknowledging attempts at sleep deprivation prior to his achievement because of the negative consequences for health.

The Machinist could definitely be used to teach students from various backgrounds about persecutory delusions and abnormal perceptions and it illustrates the importance of obtaining an independent history from an informant, whenever possible, when interviewing someone suffering from paranoid symptoms. I would recommend this film for anyone seeking to work in adult mental health.


Finally, after mentioning the first national medical film festival, Medfest 2011, in my last post, I was fortunate to attend the St George’s event as a panellist. The three contrasting films shown made for a very interesting evening of viewing and discussion, one of which, called Shadow Scan, tells the harrowing story of an over stressed, drug addicted and depressed, self-harming junior doctor. Written and directed by doctor turned filmmaker, Tinge Krishnan, Shadow Scan won a BAFTA in 2001. Lasting ten minutes, it is available to watch on YouTube and could definitely be considered alongside The Machinist in a discussion about the filmic techniques used to create an atmosphere of despair and depression in a character. Shadow Scan can be viewed in its entirety here and for anyone interested in hearing more about the festival, there is an excellent review at the Lancet online, May 18, 2011.


•   More information about The Machinist can be found at IMDB as can a short trailer.

•   The DVD can be purchased at

•   Minds on Film is written by Dr Joyce Almeida


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About this blog


Minds on Film is a monthly blog that explores psychiatric conditions and mental health issues as portrayed in a selection of readily available films.

Please note that this blog may contain plot spoilers. Any views expressed are purely my own.

Dr Joyce Almeida
Dr Almeida is a consultant
psychiatrist working in the private sector in the UK.