My thoughts on the movie are quite simply that it was pretty good, but could have been better.
See, I think Moviebob is sort of lost in his admiration for the movie's director that he tends to forget the entire point of this kind of movie. I don't see the point of a "twist" that is that heavily foreshadowed and obvious. Truthfully I think that makes the movie something of a failure, especially seeing as I can think of things they could have done like having a double twist (which I half expected) that could have redeemed the whole thing on that level.
What's more I will be honest in saying that while the bits at the Asylum itself were positively awesome, with good effects and visuals all around, I almost walked out of the movie at the very beginning.
Why you might ask? It has nothing to do with the twist, but there is this scene of Leonardo Dicaprio and his partner coming into the island on the ferry, having a conversation. I'm no expert on visual effects, but to me it looked painfully like a soundstage with the "boat platform" placed in front of a moving backround/backdrop. Maybe I'm wrong, but that is how it actually looked. In today's world of visual effects, I don't expect to see something that looks like it could have actually been in an old 1950s detective movie. I don't know... maybe that was intentional, but I was half expecting rubber bats on strings, fake blood capsules, and other FX that are only entertaining in intentionally bad movies (or very, very old ones).
Opinions vary, but that first scene was really, really disappointing. If it was actually shot on a real boat (which I doubt) then someone really needs to have a word with a Camera crew that can make reality look like a badly executed soundstage scene.
That said, I won't spoil the "twist" (and I actually came back to Moviebob's review to avoid even an indirect spoiler) but really... it will overwhelm you. Sadly this is a style over substance movie.