If you freeze the frames at the beginning of the film, and read the newspaper clips, you see that the real murders took place not at a motel, but at an apartment complex and that Malcolm lived in a basement apartment at the complex. The newspaper clip says that there were six murders, all by stabbing. You also see that Malcolm's mother was born in 1940, arrested about 1960; that the murders took place in the late 1990's and that the "present day" is 2002. The psychiatrist seemed to be using a technique to treat Malcolm's MPD by helping him kill off his personality fragments, but, unfornately for the psychiatrist, they didn't kill off Paris or Timmy, leaving Malcolm to finish off Paris is his mind and the psychiatrist in reality.
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