Steven Soderbergh’s Unsane explores systemic sexism by comparing and pairing stalker David Strine with a corrupt medical facility.
Beyond Empowertainment contains an entire case study on Steven Soderbergh’s Unsane, including interviews with the costume designer and production designer and an analysis of Claire Foy’s performance. Get your copy here.
Without the systemic power imbalances inherent in our society, the stalker in Unsane, David Strine, is no match for his victim, Sawyer Valentini. David is a pathetic and lonely character who latches onto Sawyer when she gives him minimal attention; Sawyer is a steadfast and determined woman with more than enough smarts to out-manoeuvre her captor. But in the Highland Creek medical facility, where Sawyer is unwillingly admitted and where David has scammed his way into a job, nothing is equal. The structural inequalities present in a medical institution (and almost any type of institution) enable David and render Sawyer powerless.
In Unsane, Soderbergh analogizes these institutional hierarchies of oppression with those of the outside world under patriarchy. Highland Creek itself is an oppressive institution: the bulk of its orderlies are men; the patients Soderbergh shows us are women and people of colour (the lone white male patient we meet goes undisciplined after he gropes Sawyer). Highland Creek exists not to help these people, but to exploit them. Many, including Sawyer, were tricked into being involuntarily committed to the institution, which will continue to hold them regardless of their actual sanity until their private insurance stops paying, at which point they will be discharged.
Lining up the toxicity of David’s male dominance alongside Highland Creek’s exploitation of its patients lays bare the power men hold over women. Under patriarchy, women have gone unheard, dismissed as crazy and emotional the way Sawyer herself is dismissed when she insists on her sanity. Men are seen as rational and trustworthy, which David uses to his advantage in his abuse of Sawyer. Soderbergh gives the realities of everyday sexism, often subtle and insidious, a tangible form by making David and Sawyer’s relationship exist within the power disparity of orderly and patient.
Instances of patriarchal dominance punctuate Unsane, even before the explicit horror begins. Before she is institutionalised, Sawyer’s boss behaves inappropriately toward her, inviting her to a conference (“Two nights at a hotel”) despite having just started in her new role. The subtext is clear — to him, to her, to us — but all she can do is politely excuse herself, and his behaviour is allowed to pass unchecked. This happens in the film’s opening 10 minutes, placing this type of sexual entitlement in the everyday. It is separate from what is to come, but no less terrifying. Both Highland Creek and the boss’s office have a sickly yellow lighting, linking the two locations and the abuses that take place within them.
Sawyer knows how to navigate this kind of patriarchal entitlement. She deescalates the conversation, saying she needs more experience before being sent to a conference. To excuse herself, she says she should get back to work. There’s no aggression in her manner. That her boss is able to behave this way is down to the characteristics of the institutions that protect him. This clearly isn’t the first time her boss has propositioned an employee; his self-satisfied air stems from a place of patriarchal comfort, and Sawyer’s reaction implies she’s dealt with this kind of behaviour before.
Note that this takes place in circumstances where Sawyer can’t impose consequences. The employer/employee dynamic compels Sawyer to keep her boss happy, another instance of a gendered interpersonal power imbalance that’s open to abuse. In this instance, Sawyer isn’t in danger, so a fuss would do more harm than good. Sawyer still retains basic control over her life at this point, enabling her to stay calm and navigate the conversation diplomatically. It’s once Sawyer loses control entirely that she is no longer able to rely on this kind of de-escalation to manoeuvre herself out of harm’s way.
Before she’s taken in by Highland Creek, the film makes sure we understand Sawyer to be a capable and strong-willed woman. This makes us more aware of how powerful the systemic forces against her are: the corrupt health care system, and a male stalker aided by both the hospital and patriarchal assumptions. On a date, she is absent-mindedly entertaining a man for the purposes of sex. She has control over her decisions and her body in this period— both in the bar when she’s so disinterested in anything other than taking him home that she forgets his name, and back at her apartment where she panics and removes herself from the encounter. Though Sawyer experiences trauma and paranoia, these symptoms do not make her a passive person, and her momentary anxiety is manageable so long as she retains essential control over her own life. That she ultimately survives David is down to this ownership over her own agency, where she knows her own worth and that her reactions are always valid.
Soderbergh’s Unsane is such an effective horror film — a modern day #MeToo horror — because it reveals how unfair systems assist abusers in damaging their victims. Taking place in a prison-like hospital, where there are universally understood dynamics between doctors and patients, and wardens and prisoners, the setting becomes a microcosm for the real world’s social imbalances. David’s ability to act as an abuser is magnified within this confined setting, where he is an oppressive male figure abusing the vulnerable Sawyer. Both the patriarchy and the institution of care combine to empower David, as a man and as a doctor, equipping him with privilege. Every time Sawyer is not taken seriously in the hospital, it resembles the way women are stripped of agency everywhere from their personal lives to their place of work.
The institutional power of the hospital in Steven Soderbergh’s Unsane
In Unsane, the psychiatric hospital exploits its patients’ trust in it as an institution of care, locks them up for their insurance without them realising this is what they are agreeing to, and then gaslights them by convincing them they belong there. Sawyer is admitted against her will, and whenever it seems she is about to be freed, a Highland Creek employee finds a reason to extend her stay. The character of Nate, a journalist undercover as a fellow patient, informs Sawyer of this dodgy practice: “They got beds; you got insurance.” He suggests that the moment she mentioned suicide during her consensual check-up was when the facility found a justification to stop her from leaving.
Sawyer is just as shocked as we, the audience, are by the corrupt hospital because we have unwavering trust for institutions of care. Sawyer starts the film sharing that trust: part of why she can’t fight past the facility’s gaslighting is because she genuinely expects people to listen to her. Her repeated protests are dismissed, but it takes her a while to figure out this method of resistance will get her nowhere. Effectively, her trust in hospitals makes her initially play by the rules, before she realises the rules, in this case, are designed to keep her imprisoned. The hospital, with its corridors that Soderbergh renders labyrinthine by his shot choice, disorients us in the same way it disorientates its patients. Similarly, security cameras are framed less as a comforting security feature and more a tool of observance, their purpose more akin to how prison guards monitor inmates.
Sawyer’s incarceration is methodical, not aggressive, by hospital employees twisting typical conventions of care into something abusive and exploitative. Nurse Boles tells Sawyer, “I need to look through your bag. I look through everyone’s bag. You’re not being singled out. It’s procedure.” Boles is using authoritative language within a medical context. These ‘rules’ are supposed to reassure Sawyer that what is happening is completely normal. Sawyer could argue with the nurse on an individual level, but it is far more difficult to argue with an entire ethos which says that this is how things are done here. She is powerless against the methodologies of Highland Creek, literally stripped of her possessions and clothes, reducing her to just a walking bank account for the facility to leech money out of.
The hospital’s gaslighting is so effective that it even sews doubt about Sawyer’s sanity in the mind of the viewer. After calling the police to come help her get out of Highland Creek, Nurse Boles asks her: “Do you know how many calls the cops get like that every week?” It is one of the most overt instances in the film of Sawyer’s judgement being challenged. It calls into question her version of events, attempting to place doubt in her mind as well as ours. “Those are from crazy people,” Sawyer responds, but there’s a hesitation in her voice that suggests that even she is questioning her own sanity.
That the police take this phone call as seriously as Boles predicted shows the influence of trusted institutions. All it takes is being shown Sawyer’s paperwork – signed under false pretences during her check-up – for them to be satisfied that she does indeed belong there. The police have no reason to doubt the doctors and every reason to doubt the supposedly mentally unsound patients who want out, so her legitimate cries fall on deaf ears. The horror is in knowing the cops acted as most of us would, putting faith in a hospital meant to be for good, and deciding that an investigation would be a waste of resources. This refusal to follow through on Sawyer’s cry for help further strengthens the hospital’s hand, building their argument that she should be locked up.
The patriarchal power of David Strine in Steven Soderbergh’s Unsane
The film’s tangible antagonist, known stalker David Strine, is only as scary as he is because of everything that enables him. A corrupt medical facility where he assumes a position of power is the ideal place for him to isolate Sawyer. For much of the film, Sawyer is helpless against David not because of his physical strength or his abusive words, but because he is backed by institutions that embolden him and which he can hide behind. The film draws a connection between what the doctor-patient relationship is capable of and how David wants his female victim: dependent on him and hanging on his every word for a chance at a better life.
David is emboldened by the influence he wields both as a man under patriarchy and as a nurse in an institution of care. He assumes the role of a nurse under the name George Shaw, a man he murdered and whose identity he stole. As David is known under a different name to the Highland Creek staff, Sawyer only appears more crazy when she cries out his real name. Calmly, he refutes her, reasserting that her mental state is causing her to lose her judgement. His workmates are satisfied. They are complicit in and victim to his words, trusting him blindly because of his role as a person of power — a nurse and a man.
There is no accountability at Highland Creek because everyone working there is taking part in some kind of abuse. When David spikes Sawyer’s drugs, nobody questions him directly. There are no consequences; his competence is assumed. Brushed off as a mistake, David plays the fool, pretending to be crestfallen and remorseful at his “error”. He speaks softly and with compassion, and he is complimented by Nurse Boles: “We could use more like you.” He is considered an upstanding example of a good nurse who follows procedure and understands how to handle patients. He has worked his way into the hospital’s routines, such as daily distributions of drugs to patients. Despite the mundanity of the task, its regularity and importance give him a significant amount of power, fully integrated into the staff’s dynamic while in control of the meds people are taking. This mix of mundanity, power, and no accountability is perfect for David: Sawyer is never even informed that her psychotic symptoms resulted from a drug.
In a roundabout way, David actually serves the hospital’s agenda by drugging Sawyer into a psychotic episode. Since Highland Creek has a monetary incentive to convince its patients they are crazy, Sawyer’s extreme disorientation, along with her assault of a staff member she confuses for David, gives the hospital reason to keep her there longer and causes Sawyer to doubt her own mind. As Sawyer becomes less certain of her own stability, she resists her confinement less and fits the profile of a mental patient better. That, and if Highland Creek ever admitted David was able to swap meds so easily, it would doubtless instantly be sued.
Throughout Soderbergh’s Unsane, David benefits from being a man in a patriarchal society and a nurse within a medical setting. But take these power imbalances away and level the playing field, and Sawyer regains control. When he and Sawyer go head to head in a bare padded cell, the room symbolically represents the removal of the oppressive forces of the institution. The hospital beds, the wards, the doctors, and the cameras are all gone, and all that is left is an empty cube of a room, with no props or connotations to be exploited. Sawyer is able to hold her own because David has placed her somewhere where his race, gender, and assumed credentials no longer benefit him.
David sets in motion his own downfall because he was convinced he could physically and mentally overpower Sawyer when unaided by anything else. With no doctors around, no professional faćade, Sawyer is capable of taking him on. She is the stronger and smarter person, able to get inside his head when there are no structural imbalances aiding him and making her more vulnerable. She has regained some control, and he has confirmed she is not crazy. She cannot be gaslit when the institutional influences are gone and his abuse is laid bare.
The patriarchal dynamic remains in the room, but Sawyer knows how to navigate it. Her survival instincts show a social savvy where she uses the fact that she is a woman either to her advantage or, at the very least, to make it out of a horrible situation alive. It is how she escaped the meeting with her boss at the beginning of the film, passively making excuses instead of confronting the abuse. It is how she got her phone call, by aggressively complimenting Nurse Boles — “You’ve been so considerate of my feelings and my well-being… You’re so nice, oh my God, it’s like you read my mind!” — when all she wants to do is kick and scream her way out of there. In the padded cell, it is her survival instinct that helps her outsmart David.
David has isolated her in this room, which makes it seem like Sawyer has lost all possibility of refuge. Yet it turns out that David has unwittingly made a mistake and actually liberates Sawyer by putting in her this setting. Here, she is no longer under the illusion that the hospital will help her. Away from the watchful eyes of security cameras, she is able to rely solely on herself to survive what is in front of her, no longer weakened by deceptive symbols of safety. She regains her power because Strine has unwittingly removed what has been keeping her at bay.
Nothing she does can be used against her like it had been up until now, so she is free to use everything at her disposal to survive this patriarchal encounter just as she did outside of the hospital. She counterattacks David with a kind of psychological torture, telling him (true) things he is unhappy to hear and unable to handle. She meekly thanks him for breakfast, tells him she is not used to people being so considerate, before questioning his sex life and whether he has ever been with anyone. Commanding him to fetch another patient and “fuck her in front of me,” Sawyer has turned the tables and now controls him.
For David to obey this command shows a seismic shift in who has control in Unsane. Sawyer’s blunt honesty convinces David to trust her, even though she’s dropped some ugly truths. That he brings Violet to the cell shows a naivety on his part, unquestioning of Sawyer’s request. He seems to think it is sincere and believes he is winning her over. He doesn’t know what Sawyer and the audience know: that Violet has a shiv and that the sexual component was to appeal to David’s perverse nature, ensuring he would actually follow through with retrieving her. It shows his lack of control, in that he isn’t able to think that many moves ahead, and he doesn’t know Violet carries a weapon. Sawyer’s foresight allows her to control David’s movements and to bring a weapon into the cell. Her plan is successful. She escapes the room, but only after throwing Violet under the bus. As Sawyer watches through the window, David murders Violet by snapping her neck.
Even though Sawyer ultimately escapes from Highland Creek and David and kills David, it isn’t an entirely happy ending. Six months after this ordeal, Sawyer thinks she sees David sitting in a restaurant. Heightened, she approaches him from behind with a knife, before realising, at the very last moment, that it isn’t him; she flees. Despite knowing he’s dead, the effects of her ordeal have only exacerbated her PTSD. The effects of her imprisonment have left her on the constant verge of a fight or flight response. The lasting impact of his stalking has stripped away at her sense of control, which she now prepares to violently defend at a moment’s notice.
Unsane is about abusive men and abused women. Sawyer is left vulnerable for so much of the film because so much is stacked against her, whether that is her stalker, a corrupt medical facility, or patriarchy itself. For a time, the audience is encouraged to question her sanity and become suspicious of her mental state, which leaves her isolated on a meta level too. As a #MeToo horror, Unsane acknowledges the unseen forces in society that continue to oppress people, aware that systemic change is necessary for how we tackle the abuse of women. Without those forces, the victims can fight back.