The final 10 minutes are where, as Darren Aronofsky states, all hell breaks loose. He wanted the culmination of all four stories to be as insane as possible. For the scene where Sara gets shock treatment, the director had everyone set up for the shot. He then brought Hubert Selby Jr. in and had him read that chapter of his novel to Ellen Burstyn as a way to prepare her. During the "ass-to-ass" scene, Aronofsky mentions (kind of casually) that it's based on something he experienced first-hand.

Film

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