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

Matchstick Men


Matchstick Men, directed by Ridley Scott, was released in 2003 and is based on the book by Eric Garcia called Matchstick Men: A novel about Grifters with Issues. It is a film about confidence tricksters in which the main protagonist, a con artist called Roy, is convincingly played by Nicolas Cage as a man who suffers from Tourette’s syndrome and obsessive-compulsive disorder. There are two themes in this film that run alongside each other: a clever story of conmen, filled with the expected twists and an impressive final ‘sting’, and a deeply personal tale of a man struggling to cope with serious mental illness who is challenged by the appearance of a teenage daughter he didn’t know existed.


Matchstick Men

Matchstick Men also presents us with an interesting portrait of a psychiatrist, Dr Klein, whom Roy visits for help with his condition. This is a film about deception and disclosure in various settings and relationships and offers much for the viewer interested in how we assess the truth about what we are told. 

The Film

For anyone who hasn’t yet seen the film and doesn’t want the plot revealed, please do not read on until viewing it.

Matchstick Men opens with Roy, at home, suffering with his numerous obsessive compulsive symptoms, which take the form of a need for order and cleanliness and a compulsion to open and close doors three times, whilst counting aloud, before he can walk through them. His Tourette’s syndrome consists of a facial tic involving mostly his left eye and audible grunting. In the following scenes, we watch Roy and his partner in crime, Frank, play out a ‘short con’ on an unsuspecting housewife. Roy is exposed to bright sunlight, when a door is opened to her garden, which triggers an increase in his facial tics, grunts and then the onset of a panic attack.

Roy takes regular medication for his symptoms, but despite this treatment he lives a lonely life and seems unable to act on a clear attraction, apparently reciprocated, toward a cashier at his local supermarket. Although Frank is seen to be generally supportive and tolerant of Roy’s symptoms, he occasionally finds pleasure in upsetting him by deliberately defying his need for cleanliness. Matchstick Men creates a tremendous tone of anxiety for the viewer in the scenes in which Roy struggles to control his world. His smoking, an attempt to self medicate, increases as he becomes more stressed and anxious and is at times almost unbearable to watch, especially in the confined space of his car.

When Roy accidentally loses the remaining supply of his psychiatric medication down the waste disposal unit of his sink, a comic element is briefly added to the film, soon followed by Roy’s horror and despair when he finds that the doctor, who was supplying them illegally, has moved away. Without medication, his symptoms worsen, such that Frank arranges for him to see a psychiatrist he knows called Dr Klein. In the first meeting with Dr Klein, Roy begs for just a few tablets. Dr Klein refuses and insists on a proper assessment, during which Roy reveals that he has been without an intimate partner since leaving his wife almost 15 years before and that his wife had been pregnant when they parted. Roy, uncertain as to whether he had been the father of the baby, becomes curious to know whether he now has a 14 year-old child. Dr Klein supplies Roy with some different pills, that he believes will help him to feel much better, and says he will contact his ex-wife on his behalf. The new pills appear to help improve all of Roy’s symptoms. After learning that has a daughter, called Angela, who would really like to meet him, Roy is challenged by his newfound role as her father and his obsessive-compulsive disorder is tested to its limits by her visits to his house. As he struggles to cope with a messy teenager in his life he also becomes aware of the positive emotional effect that she is having in his sterile life. Faced with the dilemma of whether he should tell her the reality about his work, she makes some discoveries in his home, which force him into telling her the truth.

As Angela learns about her father’s real profession and the amount of money that he has made from it, she asks to learn the trade from him. Wanting to keep her presence in his life, he reluctantly agrees. Caught up in the wish to please Angela, he reluctantly teaches her how to carry out a simple ‘con’, but forces her to return the money to the victim after it has been successfully completed.  Frank, by this stage, has persuaded Roy to carry out a ‘long con’ with him, that promises to extort a much larger sum of money from a businessman that Frank has met. Contrary to Roy’s wishes, Angela becomes involved in the final part of the operation, which goes very wrong. On returning home, Roy and Angela find the business man holding Frank hostage and he requests all of the money that Roy has in the house. When Angela goes to get the money, she returns with a gun and shoots the businessman. Frank and Angela drive away at Roy’s request before he receives an unexpected blow to the head from the businessman. As Roy wakes up in a hospital bed, he is questioned by police officers, but refuses to answer anything until he can see his psychiatrist. When Dr Klein arrives at his bedside he whispers the pass code for his bank vault box and asks that it be given to his daughter. It is only when Dr Klein has left and no one else returns that Roy gets up and opens his hospital room to reveal that he is on the roof top of a tall building and is himself the victim of an audacious sting carried out by Frank, with the help of a fake daughter, psychiatrist and businessman. However, one year later, after having lost all of his money, Roy has found love and marriage with the cashier, who is now pregnant with their first child. He is also honestly employed as a carpet salesman and suffers far fewer symptoms. 

Relevance to the field of Mental Health

The subject of OCD has been covered in my previous Minds on Film blog about The Aviator and I would refer readers, wanting more information about OCD, to that post. In the character of Roy, there is ample opportunity to examine the day-to-day effect that obsessive-compulsive disorder might have on an individual and their relationships. However, Matchstick Men also introduces viewers to one of the conditions commonly associated with OCD, Tourette’s syndrome. This is a neurological condition characterised by involuntary, random sounds and movements, known as tics, which usually begins in childhood. It is thought that up to 60% of children with Tourette’s syndrome develop OCD. The tics are often used to relieve uncomfortable feelings or sensations and many people are unaware of their tics. In Roy’s case his tics and grunts are seen to be closely linked to his level of anxiety, something that is well recognised in sufferers generally. His vulnerability at the hands of others reminds us of the predicament that many people with mental illness live with. It is only when Roy has abandoned his stressful life of crime and finds a meaningful loving relationship, that he is able to overcome the most distressing symptoms of both of his disorders.

There is excellent information about all aspects of Tourette’s syndrome at the NHS Choices website, including a discussion about the co-morbidity with OCD and ADHD, and further advice is available at the website of the charity Tourettes Action. Medication does have a role in treating some of the symptoms of Tourette’s syndrome and there are three types of drugs that may be used: alpha2-adrenergic agonists; muscle relaxants and neuroleptics. Behaviour therapy is the widely used non-pharmacological treatment of choice, which can be used alone or with drugs depending on the severity of the symptoms. Through using relaxation and a technique called habit reversal many people with Tourette’s syndrome are enabled to manage their symptoms better.

I would highly recommend Matchstick Men to anyone interested in working in Adult Mental Health, whether in psychiatry, psychiatric nursing, psychology or in any of the branches of psychotherapy.

•  Minds on Film is written by Consultant Psychiatrist, Dr Joyce Almeida.

•  More information about Matchstick Men is available at IMDB, as well as a short trailer.

•  The film can be purchased at


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Re: Matchstick Men
Dear Dr Almeida,

Thank you very much for introducing me to your interesting and useful blog. From now on you will have us as regular visitors. We have just watched this film which proved my belief that a clean conscience can boost a person's "immune system". Thank you
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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.