Whatever your opinion of this movie, there is one universal truth... Insanity. None of the movie is real, there is no magik, no murders, no book, no Faith. This is simply a tumultuous journey through the mind of an insane man. Stop trying to figure it out and look at it exactly as it is. The only constant is insanity obviously fabricated by the mind of a mental patient. At the very end of the movie they show two nurses in what can only be a mental hospital, No Doctor Ek. The nurses are not guessing, but sure that the patient will not wake up, not to say that he cannot wake up, but he is obviously sedated or heavily drugged, which rules out any possibility of a coma as there is no visible life support. There are no scars on his head thus no brain surgery. Think Identity only the personalities do not die when they are killed, all these people are in his head with the exception of the nurses who are indeed real(paranoid schizophrenia), one personality Doctor Eck knows it enough to diagnose it, but the personality called Dr. Ek has an ulterior motive, aka the book of magik, therefore Trevor has no reason to believe that any of the people are not real. Overall this movie was entertaining and well done if you ask me, you can certainly say it has some very good discussion about it, which I am sure was intended.