Malcolm Rivers is a mental patient who has apparently committed murder. An informal hearing among doctors and a judge who are trying to decide whether he should go to jail or a mental hospital is the framing device used throughout the movie. His main advocate, Dr. Malick, is played by Alfred Molina. Also in this framing scene is Matt Letscher from Good Morning Miami. We only see Malcolm, though, and what he looks like--overweight and balding, and not played by anyone famous--toward the end of the movie.
We then discover that Edward (John Cusack) doesn't exist. He's simply one of Malcom's multiple personalities. When Edward asserts himself, we see Malcolm as Cusack, but to all intents and purposes, John Cusack's character doesn't exist, except as a fragmented personality. We then learn that all of the other characters at the desert motel setting are other personalities, and the motel setting itself a fictitious setting within Malcolm's mind. This is why they all have the same birthday: Malcolm created different personalities, and since they're all extensions of himself, naturally, they share traits with him, such as his birthday. This is also why they all have the same name as that of a place: Maine, Washington, Caroline, Rhodes, Paris, York, etc. What we see as the character's die throughout the movie is one of the personalities killing the rest. (This is not the first story involving a character with MPD, in which the dominant personality kills the others--Andrew Robinson played such a character on an episode of L.A. Law)
The very last portion of the movie depicts Paris, having apparently escaped from the motel, gardening in front of her house, when Timothy shows up. As it turns out, Timothy is the killer personality . He's the one that was in control when Malcolm committed the murders he did (in the real world). He kills her, just as he killed all the others, and as the movie ends, only Timothy the murderer personality, is in charge of Malcolm.
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