Okay!

Say hello to my little friend!

- They said hello to his little friend.

That's actually a line that's kinda funny

because cocaine can also cause erectile dysfunction.

That's something to just keep in mind

while this is going on too.

Hey, GQ!

I'm Dr. Eric Bender.

I'm a psychiatrist who specializes in child,

adolescent, adult,

and forensic psychiatry.

And this is "The Breakdown."

[upbeat music]

- First up, "Fight Club."

- [The Narrator] For six months, I couldn't sleep.

I couldn't sleep.

I couldn't sleep.

I couldn't sleep.

With insomnia, nothing's real.

- Right away, the narrator talks about being sleep-deprived.

Insomnia for six months.

When you are sleep-deprived, you do not think clearly.

In fact, it's considered unethical to sleep-deprive someone

more than 48 hours.

In some places,

sleep deprivation is considered a form of torture.

- [The Narrator] Everything's far away.

Everything's a copy of a copy of a copy.

- You can see that quick flash of Tyler Durden coming up.

And he's saying everything's a copy of a copy of a copy.

And you see him kinda sleeping.

"Fight Club" is, I'm guessing, purposefully, unclear

as to what is going on with The Narrator.

Here, you see him have this hallucination.

This is very common with sleep deprivation.

When you have sleep deprivation,

you can first start to get very confused,

and then, after time, you can have some delusions

and some hallucinations.

And the hallucinations in sleep deprivation can be complex.

You can actually have auditory and visual hallucinations.

You can actually have distortions even of your own body.

Sensing that your body is changing.

And, as we know,

The Narrator looks quite different from Tyler Durden.

So there's quite a change in how he appears.

You can also believe you are someone else.

In fact, in studies of sleep-deprived individuals,

some of them said, "I felt like I was another person."

A lot of themes in "Fight Club" have to do with

consumerism and belonging.

The idea that a club, a place to belong,

here you have this group of men fighting each other

and beating each other to a pulp,

you have to wonder if they're getting in

some nice shots to the head,

and does that actually make people have more delusions

or more hallucinations.

In the beginning of the movie, after he goes to the group,

there is a moment when he cries and then he sleeps.

There can be a very cathartic experience.

Meaning this release of something

that helps you move on with it in your life.

There can be a release of emotions when you cry,

and it doesn't surprise me that he would sleep.

The data show you actually need to sleep

about 50% of the time you've been deprived

in order to get back to a baseline functioning cognitively

and behaviorally, the way you were before.

He clearly didn't do that,

and maybe that's why we actually see Tyler Durden

more and more present,

because he's more and more sleep-deprived.

There was a study that was done

showing how people that were sleep-deprived

responded to certain texts, just reading texts.

Those that were sleep-deprived for about 35 hours,

looked at the texts,

and they actually did a scan in the brain.

They showed that the connections between the amygdala,

where your emotions are kinda centered in your brain,

and the frontal cortex, where you can actually organize them

and keep stable,

it doesn't connect the way it should

when you're sleep state is actually good.

When you're sleep-deprived, there's not a connection.

And, instead, you go into this fight or flight reaction

and "Fight Club" or flight, I guess,

is more appropriate in this case.

Next up, "Scarface."

[multiple things clattering]

[feet pattering]

[men shouting in foreign language]

- This is Tony Montana,

who's become this cocaine emperor, essentially.

He is so high, that he has missed on the screens earlier

that all these people are invading his home.

He's also becoming more and more paranoid

throughout the movie

- You wait here, okay?

I'll be with you.

I'll be back.

- When Tony's talking to his sister here,

it's possible that

that's some of the psychosis he's experiencing,

that everything's gonna be fine,

as he's talking to his dead sister.

He's now got this incredible drive

to kill everybody around him.

This is cocaine-induced psychosis, quite possibly,

or at least the effects of using cocaine.

Cocaine's a drug that can make someone feel

like they have more energy.

It increases the dopamine in the system

by blocking dopamine from being taken up by the brain.

Dopamine is the pleasure chemical that your brain makes.

It also can make you feel more confident.

It can make you feel paranoid and delusional.

So, throughout the film, we've seen Tony get more paranoid.

Here, he's pretty delusional.

He's gonna take down all of these agents

while they're coming into his house.

Before this, you've seen a mountain of coke on his desk

and he's just snorting it,

or even, like, dropping his head into it.

So, there's definitely some cocaine on board.

- You wanna play rough?

Okay!

Say hello to my little friend!

- Pause here.

There is the delusion

that he's gonna just take everybody out himself.

They said hello to his little friend.

That's actually a line that's kinda funny

because cocaine can also cause erectile dysfunction.

That's something to just keep in mind

while this is going on too.

Again, violence is not inherent

for people who have mental illness.

There are certain situations where violence can occur.

We've talked about when somebody might have a delusion

and they wanna protect themselves.

And it's an acute psychosis issue.

Then another place where you might have more violence

is actually with substances,

and cocaine is one of those.

You can get more aggressive.

So, grabbing a grenade launcher

certainly is a sign of aggression.

Tony's reaction here, the cocaine is working in his system.

He's not feeling like he's doing anything wrong

or out of the ordinary.

He's also defending his house.

Cocaine was used as an anesthetic, originally.

When he gets shot, many times,

it's interesting that he doesn't necessarily

fall down right away, but stays upright.

Was it that much of an anesthetic?

I doubt it, but, that was likely more Hollywood.

It does actually have some anesthetic purposes.

We don't use it for that anymore, obviously.

"Black Swan."

[feet pattering]

Here, we see Nina, who's working really hard,

and she's not feeling quite herself.

Suddenly, in the mirror,

it seems like her movements are not happening in real time.

That can illustrate an illusion.

She might see something go,

but it looks like it's larger than it is,

or it looks like somebody that she doesn't know.

Hallucination would be if it weren't there to begin with.

It's not clear exactly what's happening.

There's so many factors contributing

to why she might be experiencing this.

She has this overbearing, overprotective mother,

this competitive frenemy,

there's some stress levels that are going up.

There's also some hints that she has an eating disorder.

And when your brain is not fed or nourished,

you don't think clearly.

So, it's possible that all this is contributing

to how she's seeing the world around her.

That Nina's seeing her reflection differently,

that could be more of an illusion

that she's seeing her reflection which is there,

but it appears distorted.

I don't know that there's any particular significance

to the fact that she's seeing herself,

other than she's now been really, really focused,

and obsessive about things.

And there does seem to be a level of obsession

that can be almost psychotic.

It's delusional that you need to do this

or else this is gonna happen.

You're gonna lose your part.

You're gonna not have friends, whatever it is.

So there can be a level of anxiety

that almost seems delusional.

And maybe she's experiencing that

along with seeing these other things.

When someone has body dysmorphic disorder,

they see their body differently than it actually is.

Someone might focus on their ear

and think their ear is not formed correctly,

and see plastic surgeons and wanna change it,

and they just don't see how their body's shaped

the way it actually is.

If she has some form of this,

it would make sense that she's not seeing

how her body looks in the mirror properly.

But this looks more to be, like,

a hallucination or an illusion,

because it's doing things differently.

It's actually moving differently.

If Nina is sleep-deprived too, from all the work

and times she's putting into her dancing,

that can also generate some of these possible hallucinations

and worries, and the way she sees herself.

"Shutter Island."

- Let's put them at the table, Andrew.

We'll dry them off.

We'll change their clothes.

They'll be our living dolls.

- Here, we see Dolores,

having just committed this horrible crime.

She's talking about her kids who are deceased,

as if they can be living dolls.

She has had a history in the movie of bipolar disorder.

That's what they're at least suggesting.

In bipolar disorder, you can have psychotic symptoms too.

You can have hallucinations.

And it sounds like she either had hallucinations

or some delusional beliefs about killing her children.

It's not clear exactly what was going on.

Was there a command auditory hallucination

that told her to do this?

Was it delusional thinking?

She is really delusional.

And you can see how Andrew's responding here, really upset.

A colleague of mine had a 14-year-old boy who was psychotic

and the boy actually asked him,

"So, am I gonna become a serial killer now?"

That's not what we need to teach people.

That because there's mental illness, there's violence.

There are some states during which

someone with mental illness could be prone to violence,

but it's not because they're prone to being violent,

they might be trying to defend themselves

because of a delusional belief.

That kind of violence

is actually often most occurring at home.

The likelihood of being hurt by someone

who's got a mental illness

is way less than getting struck by lightning.