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Brianna Hawks, PharmD Candidate 2016
Manchester University College of Pharmacy
Fort Wayne, Indiana

Thomas Smith, PharmD
Assistant Professor of Pharmacy Practice
Manchester University College of Pharmacy
Fort Wayne, Indiana

Student Perspective and Review

“Matchstick Men” a film directed by Ridley Scott,  stars Nicholas Cage as a long-time successful con-artist, Roy, that has obsessive compulsive disorder and self-proclaimed agoraphobia.

The film opens with scenes from within Roy’s house that takes you on a visual journey pointing out his need for an exceptionally clean, quiet, dark and orderly home to the point where even a carpet fiber out of place was quickly corrected. Symptoms of his compulsions are depicted when Roy must count while opening and closing a door three times before he can walk through it. The following scene gives insight to the ease and success of the con artistry Roy and his partner Frank pull on an unsuspecting elderly couple. This scene also shows the anxiety Roy experiences when the elderly woman unknowingly lets her dog outside without first feeding into Roy’s compulsion with doors, and the bright sunlight that hits his face thus provoking Tourette’s symptoms such as facial tics and throat clearing to ameliorate anxiety and panic.

After losing his medication down the drain, and finding out his regular doctor has left town unexpectedly, Roy quickly loses control of his symptoms and becomes completely withdrawn and focuses on cleaning his house incessantly. Frank stops by Roy’s house to check on him and brings a flurry of messiness with him suggesting Frank takes pleasure in causing disorder in an otherwise orderly home. He suggests a family known psychiatrist, Dr. Klein, to help Roy get back to daily functioning. Although Roy only wanted his medication from Dr. Klein, he finally relents and shares some of his past reveling that he may have fathered a child prior to splitting up with his ex-wife 15 years ago and has not been in a relationship since. The previous doctor had been supplying Roy’s medication illegally and Dr. Klein then too offers medication without a prescription. Roy notices they are different than what he had been taking before however; feeling desperate, he takes them anyways. As Roy’s symptoms begin to subside, he decides to find the phone number to his ex-wife but cannot bring himself to call her. He begs Dr. Klein to call his ex and after some convincing, Roy soon finds out that he has a 14 year old daughter and arranges to meet her.

As Roy sits in his car and anxiously waits to meet his daughter Angela, he is clearly wrought with anxiety and compulsively smokes and looks around nervously for her arrival. After gaining enough courage to approach Angela, they spend the day together and before he drops her off at home, they mutually decide they’d like to continue to foster a father-daughter relationship.

One night as Roy gets ready to meet Frank and plan their biggest con yet on a wealthy business man that’ll set them both into retirement, Angela shows up at Roy’s house claiming she had a fight with her mother and wanted to stay for the weekend. Roy agrees and while gone on his business meeting, the messy teenager snoops around the house looking to find out more about her father. During her stay not only does she push the limits to what Roy can tolerate with her messiness and disorder, she comes across money and a gun and confronts Roy about what type of work he really does. Not convinced that Roy is an antique dealer, Angela pressures Roy to come clean and teach her the art of scamming. Wanting to keep Angela in his life, he agrees to do so and after letting her partake in a scam, he forces Angela to return the money.

Now having learned how to con, Roy reluctantly allows Angela to partake in the final scam against the business man. After celebrating the success of the con, Angela and Roy return home to find Frank beat up and the business man out to get his money back. Unfortunately things go wrong and here is where the movie takes a few interesting and unexpected twists and turns.

Overall Matchstick Men detailed some good insight for those that suffer from obsessive compulsive disorder. As the movie portrayed, Roy’s anxiety is managed by compulsions (counting before walking through doors) and thus his behavior is maintained through this negative reinforcement cycle. Since he lived alone, his cognitive compulsions were perpetuated through avoidance and thus never getting exposed to what he was fearful of (walking through the door without having to count). Lastly, when he witnessed any deviation from these rituals, Roy’s anxiety would manifest as tics, demonstrating obvious distress and feelings of discomfort.  

Faculty Perspective and Review

“One…two…three” *walk through the front door* “one…two…three”.  This is the ritual Roy (Nicolas Cage) must perform each time he leaves his house in the 2003 film showcasing the life of a conman with a particular attention to detail. Attention to detail may be an occupational strength in his field, but in his case it interferes with the rest of his life through its manifestation as obsessive-compulsive disorder. 

Ridley Scott’s “Matchstick Men” follows the life of Nicolas Cage’s character as he schemes and deceives others as a conman (aka a matchstick man) all while suffering through the burdens of specific obsessions and the compulsions that he is driven to complete in order to relieve his stress. 

While the viewer is not privy to the specific thoughts and emotions driving Roy to his actions, we do get to witness a fairly strong account of the ostensibly unrelated acts completed to relieve his inner stress regarding his obsessions. Roy desires order, neatness, and repetition.  His meals usually consist of one item – canned tuna – which must be disposed of in a sealed plastic bag after cleaned. He answers the door in the manner described above, always needing the open and close it three times while counting before he or others can cross in or out.  Cage and the writers do a nice job of portraying the compulsions and the stress that is relieved through their completeness. 

Other aspects of the difficulty of functioning with a psychiatric illness are on display throughout the film. He has signs of other, common comorbid disorders with OCD including tics and panic attacks with agoraphobia. These are heightened during periods of stress. His illness interferes with his “work” (deceiving others) at times, he is treated with various medications and sees his psychiatrist regularly. We witness the severity of the illness including the dysfunction it causes as well as its fluctuation as Roy has higher and lower functioning days.

What Matchstick Men also gets right is the interplay between psychiatric illness and family stressors. In the film, Roy first meets his daughter at age 14. Her effect on his illness and life are obvious – at times extremely positive and at others completely aggravating. As Roy describes at one point, “I’m not very good at being a dad, I barely get by being me”. 

While most of the film does not centralize on the anxiety disorder Cage’s character suffers with and, at time, lightheartedly portrays its, it does give a peak into the mind of individuals with this illness. At one point, Roy admits to his psychiatrist that his obsessions are so severe he contemplated suicide. 

As the movie progresses, Roy’s illnesses are depicted less as the central plot materializes. Roy begins to feel more comfortable with his new circumstances as a father and includes his daughter in a large scheme to con a businessman out of millions. With his newest medication, a strong therapeutic relationship with his psychiatrist, and an adjustment period with his daughter, Roy is able to shine as the experienced and polished matchstick man that he is. However, as the film plays out, his profession is not without its risks and sometimes details are missed; even in those who value detail as a priority. 

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