A few comments already posted are pretty spot on...
1) It was made very clear by the reflection scene that Harry Green is a personality disorder inside George Marshall.
2) That George must've crashed the van and killed his bandmates, explaining the girlfriends comments at the end about not his fault, an accident. Movie makes mention of how tired George is. And the whole asylum riot hallucination begins when George falls asleep in the pantry. It's pointed then that George was driving the van, dead tired, fell asleep at the wheel, and killed his bandmates, and he's been racking his brain with guilt ever aince, why he's in an asylum.
3) Fingers as a symbolism running thru the film.
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