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Insomnia

2/11/2015

5 Comments

 
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An LA detective battles sleep deprivation while investigating a murder in a small town in Alaska where the sun never sets.

Veteran detective Will Dormer flies to Nightmute, Alaska to assist the local police force in an ongoing murder investigation. While trying to find the killer, detective Dormer battles sun filled nights that rob him of sleep. As Dormer’s mind becomes increasingly fatigued he must come to terms with a second crime as he struggles to differentiate between his waning consciousness and reality.
Neuropsychological Review
Just Let me Sleep
Steven M. Smith


As Insomnia begins we join detective Will Dormer, played by Al Pacino, early in his battle with insomnia and, possibly more importantly, anxiety. Throughout the opening credits, director Christopher Nolan uses fading and pulsating imagery to simulate the struggle of keeping one’s eyes open, effectively placing the viewer in the shoes of someone who is experiencing the side effects of extreme fatigue. 
In the United States one-quarter of the population report occasionally not getting enough sleep and about ten percent experience chronic insomnia (Center for Disease Control and Prevention [CDC], 2013), a disorder that is characterized by difficulty initiating sleep, maintaining sleep, and early morning awakening with the inability to return to sleep; and is often due to increased anxiety and an overabundance of light. (American Psychiatric Association, 2013).

Throughout Insomnia detective Dormer shows many signs of sleep deprivation. He appears drowsy, inattentive, confused, and he encounters numerous scenarios that appear to be visual hallucinations, a possible symptom of extreme sleep deprivation (West, Janszen, Lester, & Cornelisoon, 1962). But just as Dormer begins his murder investigation, a second murder occurs and the anxiety surrounding this crime begins to take an extreme toll on his sleep and overall wellbeing.

In addition to the midnight sun of Alaska, in true Christopher Nolan fashion, the director has added another element to Dormer’s decay: extreme anxiety. By creating this traumatic event in Dormer’s life, Nolan creates a scenario in which the audience sees both anxiety and lack of sleep contributing to Dormer’s decay.

Throughout Dormer’s time in Alaska, he endures one night in which he struggles to sleep before he witnesses a second crime. It should also be noted that despite having no apparent sleep this one night, the following day he does not suffer many adverse effects despite being tired. It is only after he is exposed to the trauma of second crime that the majority of his symptoms begin to manifest.

Due to this timing, from a psychological point of view, we can begin to examine differential diagnoses. One diagnosis that captures Dormer’s experience alarmingly well is Acute Stress Disorder. The symptoms of Acute Stress Disorder typically occur with 3 days to 1 month after a trauma but can manifest immediately (American Psychiatric Association, 2013). These symptoms include recurrent, intrusive and distressing memories, distressing dreams, flashbacks, an altered sense of self or surroundings, effort to avoid the memory, negative mood, and sleep disturbance (American Psychiatric Association, 2013). Keeping these symptoms in mind, it becomes increasingly clear that while Dormer does seem to be bothered by the never setting sun and his inability to sleep, his experience is better explained by Acute Stress Disorder. This would likely be his primary diagnosis because of how well his experience is captured by this disorder. It is not likely he would receive a primary diagnosis of insomnia from this snapshot of his behavior because sleep difficulty must persist for 3 months before meeting diagnostic criteria (American Psychiatric Association, 2013).    

Since sleep disturbance is a significant part of the Acute Stress Disorder diagnosis, how would his disturbed sleep be accounting for many of the symptoms we see during the movie? Detective Dormer is very sleep deprived and it appears that he has not slept once during the entire movie. Due to this extreme sleep deprivation, we would suspect that Dormer would begin to have hallucinations (Sheldon, Kryger, Ferber, & Gozal, 2014). In Insomnia though, Dormer begins to have hallucinations early on which is atypical for short durations of sleep deprivation. 

Typically, hallucinations, as experienced in Schizophrenia, are auditory in nature and are often described as hearing voices that are not present (American Psychiatric Association, 2013). However, Dormer’s hallucinations are strictly visual and he exhibits no other signs of Schizophrenia. One way to explain these apparent visual hallucinations that Dormer experiences is with a phenomenon known as micro-sleep. Micro-sleep is common in those with insomnia and is defined as a brief unintended episode of loss of attention; and often co-occurs with head snapping, a blank stare, and prolonged eye closure (Innes, Poudel, & Jones, 2013; BBC, 2014).  Because Dormer is not sleeping at night, it is likely that his brain is attempting to rest whenever possible and slips into brief micro-sleep episodes during the day. With this in mind, when analyzing Dormer’s hallucinations, while it was not likely the intent of the director,  it can be reasoned that he is in fact experiencing episodes of micro-sleep and therefore is experiencing hypnagogic hallucinations that can occur in the transition from wakefulness to sleep.

Since we have noted that Insomnia is a more accurate portrayal of Acute Stress Disorder, we should also note that some of the representations about insomnia as a disorder are indeed accurate and capture “what it feels like” to have insomnia. For example, late in the movie (time stamp: 1:44:27) detective Dormer is driving down a long stretch of straight Alaskan highway and begins to nod off while attempting to fight his body’s urge to sleep. This is not only an accurate portrayal of what insomnia's side effects could look like but it is also accurate because 37% of Americans have admitted to falling asleep behind the wheel in the past year (National Sleep Foundation, 2014). Overall, Insomnia captures the feeling of the insomnia diagnosis by utilizing a variety of imagery as demonstrated by a scene in which Dormer “spaces out” and experiences a distortion of his environment (time stamp: 1:11:38).

Insomnia is a movie I would recommend because it is not only an enjoyable film but it also does an excellent job of conveying “what it feels like” to have insomnia. Including the extreme cognitive and behavioral difficulties that may occur with insomnia. While this film can be used to demonstrate the idea of “what it feels like” to have insomnia, it should also be noted that this film is not strictly about insomnia alone. Insomnia is also about anxiety, trauma and more accurately Acute Stress Disorder. While the film does not clearly differentiate between what symptoms are due to Dormer’s anxiety versus insomnia, this effectively makes this movie very useful for teaching and discussing the topics of insomnia, anxiety, and trauma. Besides, leaving “gray areas” up to the interpretation of the viewer is a hallmark of Christopher Nolan and of good discussion.


References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

BBC. (2014, January 8). Who, what, why: What is a micro-sleep?. Retrieved from http://www.bbc.com/news/blogs-magazine-monitor-25593327

Center for Disease Control and Prevention. (2013, July 1). Sleep and Sleep Disorder. Retrieved from http://www.cdc.gov/sleep/

Innes, C. R., Poudel, G. R., & Jones, R. D. (2013). Efficient and regular patterns of nighttime sleep are related to increased vulnerability to microsleeps following a single night of sleep restriction. Chronobiology international, 30(9), 1187-1196.

National Sleep Foundation. (2014). Drowsy Driving. Retrieved from http://sleepfoundation.org/sleep-topics/drowsy-driving

Sheldon, S. H., Kryger, M. H., Ferber, R., & Gozal, D. (2014). Principles and practice of pediatric sleep medicine. Elsevier Health Sciences.

West, L. J., Janszen, H. H., Lester, B. K., & Cornelisoon, F. S. (1962). The psychosis of sleep deprivation. Annals of the New York Academy of Sciences, 96(1), 66-70.

 

5 Comments
Kelan McKibben
11/22/2015 11:15:20 am

Steven Smith does a great job of providing useful information about the many factors that are involved with a diagnosis of insomnia. The lay person might be lead to believe that insomnia is just the act of not getting enough sleep, but as Smith outlines this is not the case. The two main factors Smith contributes to Dormers insomnia are anxiety and acute stress disorder. Insomnia is usually apart of a group of diagnoses that are all interconnected. Dormers anxiety and stress directly affect his quality of sleep, then on the flip side his lack of sleep exacerbates his anxiety and stress, and thus continues the vicious circle. Most persons would probably not guess that anxiety and stress have an important impact on their quality of life (sleep included), and Smith helps educate the public through his thorough review of Christopher Nolan’s Insomnia.

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Siddhant Pathak
3/3/2016 02:08:57 pm

Steven Smith summarises and condenses the entire movie very well in this review. In my opinion, even if a person hasn’t watched this movie, reading this review can provide them with a great insight on the movie and the ideas and concepts it projects. The two psychological disorders this movie depicts are insomnia and acute stress disorder. Christopher Nolan is amazingly successful in portraying what someone experiences when they suffer from insomnia through fading and pulsating imagery.
Detective Dormer faces extreme stress and sleep deprivation in the movie and this causes his physical as well as mental health to slowly deteriorates as the movie gradually goes forward. Towards the end of the movie, the effects of this extreme stress and anxiety are clearly visible in the manner the character behaves and experiences things around him.
Overall, this movie taught me a lot about the effects that insomnia and extreme stress can have on an individual and how their lives can be impacted.

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Klaus Nuredini
3/4/2016 07:40:00 pm

The review by Steven Smith is quite detailed and comprehensive in its psychological analyzing of Insomnia. It shows clearly what caused detective Dormer’s decay, which was lack of sleep and the trauma of the second crime.
Another reason for his lack of sleep is light. As showed in the psychology 101 course notes, sleep is also affected by light, which suppresses the relaxing hormone, melatonin. For this reason, detective Dormer found it extremely hard to fall asleep during his first day in Alaska, where the sun never sets. After that, he had the trauma of shooting his partner, which, as shown in the review, became the main reason of his sleep deprivation.
Another point that can be considered is memory, which is not really analyzed in the review. As mentioned in a WebMD article named “Sleep Deprivation and Memory Loss”, sleep is necessary to consolidate a memory, so that it can be recalled in the future. This is why, when Dormer was asked why he shot the other detective at the end of the movie, Dormer appears confused and says that he just didn’t remember any more (time stamp: 1:48:30), even though we saw that he did not mean to shoot him.
Overall, there seem to be two main factors that affected his health, the trauma of the second crime and his lack of sleep. These two factors, incorporated together, cause Dormer’s health conditions to worsen and decay throughout the movie.

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Kalline Tong
3/4/2016 08:58:03 pm

This is a very informative review, and it helpfully supplements the disorders depicted in the film with accurate background knowledge. I found it fascinating that nearly the entire plot of the movie is actually a result of the disorders. After all, if Dormer had been able to get had been able to get any sleep in the disorienting 24-hour sunlight, he might not have shot Eckhart in the first place. Obviously, shooting Eckhart, whether accidentally or not, jumpstarts his mental downfall and is the cause of his acute stress disorder and increasing anxiety. Furthermore, while the reviewer notes that Dormer’s insomnia would never be a primary diagnosis in an overview of his mental state, the insomnia definitely contributed to his anxiety and acute stress disorder. Also, even though Dormer’s anxiety and acute stress disorder are not explicitly mentioned or referenced the way his insomnia is in the movie, I can see how easy it is to confuse the disorders. After all, Mayo Clinic lists the symptoms for insomnia as lack of concentration or slowness in activity and thought, while the symptoms for acute stress disorder derealization and hallucinations, and anxiety disorder ranges from mild to severe and comes with an entire range of symptoms, many of which are depicted in the movie.

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Miks
5/17/2022 01:51:02 pm

insomnia is just a metaphor to describe emotional undercurrents of America ... how to get away with murder and be happy about it

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