I definitely think that he is insane. Up until the very end I thought that maybe they all really were out to get him, tricking him in to believing that he had lost his mind. But I think that the very end clarifies that for the viewers. They show him remembering everything about his wife and family, essentially watching the role play of the entire movie work on him. But then the end scene he has already lost it again, thinking it was his partner not his doctor. Really great movie though!
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