A State of Madness (Mis 500 Locos) is based on an episode in the life of Dr. Antonio Zaglul, who is considered the father of psychiatry in the Dominican Republic. In 1955, when he was 35 years old, Zaglul was appointed director of the Padre Billini Psychiatric Hospital, an experience he detailed in his memoir Mis 500 Locos.

In A State of Madness, Zaglul is faced with the difficult responsibility of dealing with 500 mentally disturbed people and a staff and system that is not prepared to try to heal them by treating them as human beings. Indeed, Zaglul’s most important achievement, as portrayed in the film, is transforming the attitudes of the hospital staff, who lose their cynicism and regain their own self-respect.

As if helping the patients and the staff is not enough of a challenge, Zaglul becomes aware that mixed in with the regular patients are political dissidents who oppose the brutal dictatorship of President Rafael Trujillo. This, Zaglul discovers, is much harder to overcome. In real life, Zaglul was forced into exile, but returned to the Dominican Republic after the assassination of Trujillo and the collapse of his family’s attempt to retain power.

This is the third time one of director Leticia Tonos’ films has been chosen to represent the Dominican Republic for the Academy Awards. The others were Love Child in 2011 and Cristo Rey in 2014.