Sorry for a long comment, but I think that this movie deserves my effort to write it. And I hope that it might change your bad opinion on the movie (if you've seen it already) or make you enjoy it more (if you're about to see it).
Really now, how come so many don't get this movie. It's all "Dreams inside dreams" for everybody. Goddamn Inception era... This movie is brilliant, not only an experiment on how to tell a story, it also has a message, a higher meaning and the entire movie is proof of the advice it tells you. The story is gruesome, because real life can truly suck for some people. It sucks in different proportions for each of us. In the end, regardless how miserable or happy you were, you'll die and stop existing. You fight this horrible destiny with whatever weapons you have, religion, hope. And you try to find magic in each and every thing you do. It's not fantasy, it actually borders on crazy. We choose what we want to see, what we want to know. We ignore the evil in this world, by choice. What would you rather watch today? A movie about a girl raped by her father, sent to an asylum where guards rape lobotomized girls? Or a comedy? We hide behind a mask, we assure ourselves that everything is ok and we interpret stuff we see so that it all fits in our rosy image of the world. Sure, from time to time we go see the Passion to feel sick for a few hours, but we only do that to scare ourselves deeper inside our safe heaven. And this is what the director asks you to do, find the magic, fool yourself, be as happy as you can be regardless how big a lie it is. And the entire movie is proof about how that works. He has a depressing story to show you, but he shows you in a way that's entertaining. He transforms a horror movie into a chick flick. You still know there are bad things happening somewhere, but it's still cool to watch beautiful girls and just forget the bad part, that's the whole point, no need to impress with fake tears, we know you got the story...
It's the same story for all of us, we're born, we go through good and bad stuff, we die. How I see my life is different than how others see my life and vice-versa. "Dude has beautiful wife and kids, nice home and good job and he's unhappy?! Idiot, if I had those things...". I actually have a friend that was raped and she got over it (never forget, never forgive, of course) and she's more sane and happy than a lot of people I know. And the movie is based on this perspective. You can't get inside the life of this girl, you can put yourself in her shoes. Maybe if you're a woman, but if you're a man... impossible. Why would you even try? The director knows that so he tailors the movie for you. "I have some bad news, want me to tell them in a funny way? What jokes do you like, knock knock jokes? Fine. Knock-knock, who's there?".
So he turns the asylum into a brothel, the kind I'd like to go to if I had the money. It's the same stuff underneath: no freedom, sexual abuse, violence, madness, all rolled into one. But it's something I can cope with. I'd rather watch girls dressed like hot hookers than in green hospital robes. Again, this isn't the world in which the girls escape their cruel life, it's your world, your rules, the viewer's. Everything that happens inside the brothel actually happens in the real asylum. The doctor for example, being a woman herself (the only women in the asylum's staff), is seen by the girls as one of their own, so, by extension, a prisoner herself, although with a higher status. Even though she's actually more powerful than the bad guy in the real world, they see him as the true boss. What do you see when you go by your old school? The nice principal? Or the guys from the other class who bullied you?
And then there's the dances. The doctor makes the girls relive their abuse so she can cure them. But surely that wouldn't be pleasant to watch. Screaming, throwing stuff. They almost like to to that, they can get back at the guards knowing that the guards can't hurt them. I heard movie critics say "Oh it's just a fantasy, they can't get hurt even if they get thrown through walls, how lame!". Smart, guys, real smart. For the girls (patients), the dance (acting crazy and violent) is their thing, the reason why they're there. If you don't dance, you're out. Think of it this way... if they're violent, the guards might think twice before asking them to give a blowjob. It's the only thing that protects them.
And now the dreams. While I would've loved to see Baby Doll give a sensual dance, the director said "Just a dance? How about I put her in a high school uniform and make her fight dragons with a katana?". Ok, let's see how that plays... And boy, it's awesome. Best action scenes I've ever seen, by far. I've watched a lot of action movies lately and all were a snoose fest. No matter how many cars blow up, it's boring. Actually the last good action movie I've seen was "300". If you're a girl or have homo tendencies, you might have complained about the Spartans' rock muscles. I didn't see those, what I remember are the shields, punctured by hundreds of arrows. Some might've said "Xerxes looked stupid with so many earrings". Maybe real Xerxese had just a gold bracelet, but you can bet the REAL spartans thought he was gay too for wearing THAT. And you can bet he seemed as alien to them, in his silk robes, as the 3m tall dude looked to you. You weren't supposed to like him, you were supposed to hate his guts, for whatever reasons, even just for looking weird. Same goes in this movie. You're supposed to see these crazy girls as feminine beings. You're supposed to hate the bad guy, although if it was a normal movie you'd just think "well, he did it for money, I can understand that, and she's cute, I'd rape her too if she were lobotomized". But here, you can't help hating that fu%^er. In the end, even though you were given what you wanted to see (or didn't know you did, but know you can't help watching some parts again and again and again), you were put deep inside the actual action, deep inside the minds of the girls, a more realistic and personal vision of the horror that's going on in the backstage.
It took me a while to figure out the ending (girl escapes on bus). But there was a comment on the movie that for some reason disappeared since, which was right on the money. The big sister followed her little sister to protect her, even though she didn't have problems with her parents (meaning that she wasn't crazy at all). That is why the main girl sacrifices herself to save her and tells her "it's your story anyway". But when she sees police at the bus stop, she enters a dream herself. Maybe they actually got her and took her back to the hospital. But she chose a different story. The bus driver is the guy we know from the dreams, it's insanity, a weapon she's now willing to use. This might actually be the only moment were the movie resembles Inception, because what's important is not what's real, but how you can morph reality in something that can keep you happy.