To me, this movie is about how families create a scapegoat and keep that person crazy. The main character, Mabel, is married to an abusive husband. Another reviewer says his abusiveness is in response to her madness, but that just doesn't follow. People don't suddenly become abusive. They are raised to think that violence is an acceptable way to solve a problem, and there is a whole big fat set of thought processes that go with that. Mabel looks like a scapegoat to me. She is not allowed to be emotional and express her needs while those around her are also overly emotional and just as sick in the head. Nick gets a "good guy" image off of putting up with her, and he milks it by complaining about her to his co-workers, first saying "don't tell me she's crazy" as if sticking up for her and then turning around and saying, himself, that she is crazy. He really seems to be looking for some kind of praise for putting up with her. His dominating Mother has expectations he has to live up to, and that is a major factor, I think, in Nick's expectations of Mabel, his need for approval, and his methods for going about getting that approval from his mother and others. Mabel goes away for treatment, then comes back calmer and more able to articulate her needs; however, she returns to the same old family system, a system that does not ask about her needs or thoughts or feelings, but rather guesses or imposes what she should think, feel, and needs. This family system gives her conflicting messages about what it wants, double standards about what she can't do while other people do the same things. It all conspires to drive her back into her previous madness. I have my doubts about whether Nick loves her, really. I don't know if he is capable of it. He won't answer the question at the end. His co-dependent need for her to be sick is revealed in a nauseating scene where he tries to coach her back into making the old noises she used to make instead of communicating in a clear way. Mabel's new calmness highlights Nick's own instability and clearly he wants things back the way they used to be. Harrowing and revealing, I recommend this movie to people trying to understand dysfunctional family systems.