In 1960, audiences watch in enraptured terror as Norman Bates, donned in his mother’s dress and a disheveled wig, looms over Lila Crane with a menacing knife and a manic expression. The puzzle pieces click and, as the audience makes the connection between Norman’s visually-absent mother, the corpse in his basement, and the bizarre costume and identity he had taken up, the title of the film becomes the diagnoses of Norman Bates: Psycho (Hitchcock, 1960). How else might a relatively attractive young man have assumed another identity, that of his long-dead, once-overbearing mother? How else might Norman have convinced himself that his mother is not only alive but very much so in control of his actions to the point of murder? The answer, that he is a psycho, draws dangerous equations between mental illness and horror, violence, and murder; equations that still exist in the horror genre today.

Mental illness and mental hospitals encompass a horror movie trope that horror fans will undoubtedly recognize within seconds -- the young, giggling couple looking for somewhere to find privacy, or the nervous young boy trying to prove he’s not “chicken” to his friends, or the teenagers looking for adrenaline-filled adventure despite legends of escaped psycho-killers -- all of these and more illustrate the popularity of the setting of a psychiatric ward and mentally-ill patients in horror films. We can understand a lot about how psychiatric disability is viewed through the utilization of the abandoned psychiatric ward or the old mental hospital as a setting. Furthermore, the way that psychiatric patients and those with psychiatric disability are villainized in horror movies says a lot about how mental disability is treated within our society today. 

In order to understand the implications of the ways mental illness is portrayed in horror movies, it is helpful to trace the history of psychiatric wards and the individuals who inhabited them. Psychiatric wards and mental institutions have evolved significantly throughout the course of their existence. In the past, the mentally ill would generally be taken care of by their families. That being said, in the cases of violent or uncontrollable individuals, more structure was necessary. Originally, individuals with severe and violent cases of mental illness would be jailed. However, as mental illness became a more widely known issue, there was an increase in the need for care of the mentally ill community. Initially, psychiatric patients were housed in hospitals, but eventually, the psychiatric facilities became their own separate wards (“Early Psychiatric Hospitals & Asylums”). However, the general idea behind these psychiatric facilities focused less on treatment and more on the removal of the mentally ill from the public. Even in the 19th and 20th century, mental illness was feared. The evolution of treatment over time reflected this initial fear.     

The word asylum stems from the Greek word “asulos” and the Latin word” asulon”, meaning refuge (“Definition of Asylum”).  The asylum approached the treatment of mental illness from a moral perspective. The Friends Asylum in Philadelphia was the first independent psychiatric institution but led the way for many more institutions to be built. Rather than being unfairly treated and restrained, patients were treated kindly and restrained as little as possible. The emphasis was on humanitarian values. 

The more sinister image of psychiatric wards, the image that is so prevalent in the horror genre, stems from the effects of the economic crisis of the 1890s. With the plummet of the economy, so too did the quality of care in psychiatric treatment.  Psychiatric institutions became overcrowded and, in comparison, understaffed (D’Antonio). Dorothea Dix became famous for her work in reforming mental asylums. She observed a lack of humanity in treating the mentally ill. Dorothea Dix traveled across North America and Europe in the 19th century, where she observed horrible conditions. She saw patients “in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience!”. Dorothea Dix described patients, isolated and forgotten by staffs, patients kept in cages and not allowed to leave, patients strapped to beds for days at a time, patients chained, patients confined for so long that they lost use of their limbs (Dix, 2006).  

The cruel and inhumane images of mental illness and psychiatric wards that are seen in the horror genre stem from the aforementioned horrific conditions and treatments implemented in psychiatric facilities to patients. However, while these images continue to be seen in horror, the conditions of psychiatric treatment facilities improved significantly. Eric Goffman wrote the book Asylums which was a field study on his work of St. Elizabeth’s hospital, the same hospital where Dorothea Day worked. Like Day, Goffman found flaws in the overall efficacy of mental asylums, and coined the idea of “institutionalization” or “total institution”; these terms refer to how patients had to learn to adjust to life within psychiatric hospitals. Likewise, the concept of “deinstitutionalization” described the movement away from large psychiatric hospitals and permanent impatient residency s towards a more general, communally-accessible mental health care (Chow, Winnie, & Stefan, 2013). 

The concept of deinstitutionalization (or de-hospitalization) was tied tightly to the civil rights movement, and during the 1960s and 1970s, psychiatric institutions underwent significant reform. Activists were determined to undo the cruel and inhumane conditions that psychiatric patients had undergone for decades, and conditions improved alongside the implementation of new therapies and treatments. Policy makers considered mental illness more seriously and implemented acts such as the Community Mental Health Act, which funded community-based care and treatment, and the Mental Health Systems Act, which improved community-based treatment facilities and services for the mentally disabled (Yohanna, 2013). 

While the trend of deinstitutionalization and the call for better healthcare reformed the once-cruel and insufficient mental asylums, the image of evil psychiatric hospitals and dangerous patients still exists within mass media; particularly, these images exist in horror movies. While the images of demented doctors and bloody straitjackets may allow for a quick Hollywood scare, the portrayal of psychiatric wards and psychiatric disability as terrifying and dangerous contributes to the negative view of psychological disability and further validates damaging stigmas surrounding mental disability. 

Horror movies employ psychiatric hospitals and psychiatric patients to evoke fear and terror. Often, in horror movies, “normal” protagonists become trapped or lost in the desolate, crumbling halls of an abandoned mental hospital and must escape the horrific building and the ghosts of the violent patients who once lived there. The patients’ demonic behavior is sometimes associated with the horrible conditions under which they lived but is almost always attributed to the psychiatric disability itself. 

The images seen in psychiatric facilities in horror movies are often incorrect stereotypes. While conditions in psychiatric facilities were in the past inhumane and cruel at times, the mentally ill today do not live in cages; they are not bound in straight jackets or restraints, nor are they subject to painful treatments or involuntary lobotomies. These stereotypes have become recurring tropes in the horror genres; particularly popular tropes include treatment as punishment (ie. electroshock therapy, restraints), “Dr. Evils”, an inability to leave (and thus being kept against their will), and “deranged psycho killer-patients”. 

In its second season, aptly titled “Asylum” (Murphy, et. al. 2013), American Horror Story followed doctors and patients alike at the fictional mental institution Briarcliff Manor. The acclaimed horror television series featured many of the aforementioned tropes, but particularly torturous treatments performed by sadistic doctors on patients who were not only mentally healthy but trapped against their will. The season is set in 1964, and this time period is most notable when journalist Lana Winters goes to investigate the conditions of Briarcliff but finds herself trapped in the asylum due to her mental illness of homosexuality. In a particularly terrifying scene, Winters is forced to undergo electroshock therapy at the hands of Sister Jude, who clearly enjoys inflicting the “treatment” more than she should. One of the other staff members at Briarcliffe, Dr. Thredson, uses patients to perform grotesque experiments, at one point amputating the legs of a patient. American Horror Story: Asylum uses the images Dorothea Dix describes and escalates these images to the extreme. The patients shown are violent, and the doctors are sadistic. 

The Canadian film, Grave Encounters (Angelski, Shawn, & Karlin, 2011), is a prime example of the setting of the psychiatric hospital. Grave Encounters was a low budget film directed and written by The Vicious Brothers. Despite the low budget, The Vicious Brothers deliver some truly terrifying moments through the use of “found footage” shots and striking special effects, but at the same time utilized every single trope previously mentioned. In the film, a production crew of a ghost-hunting reality show, in an effort to gain popularity, locks themselves inside an abandoned mental hospital that was known for being cruel, overcrowded, dirty, and, for the patients there, torturous. Once they are locked in, armed with EMF detectors, night vision cameras, and walkie-talkies, strange noises become demonic, straightjacket-clad mental patients and evil doctors. The crew is picked off one by one, only to return in hospital gowns with bloody holes in the sides of their skulls. As the movie comes to a close, the audience learns that the ghosts of the violent psychiatric patients and the sadistic, lobotomy-obsessed doctors, are out to get them (“Grave Encounters”).  The film is impressively terrifying for a low budget movie with minimal resources; but the scares and terror are very much so at the hands of the mentally ill, who are portrayed as crazy, incredibly violent, and monstrous. 

The Silence of the Lambs (Demme et. al.), the 1991 psychological horror classic, was groundbreaking, not only in its reception worldwide but in its critical acclaim. The film won Academy Awards in all top five categories and is still the first Best Picture winner film of the horror genre. Indeed, the movie is terrifying, smart, dark, and thrilling. Yet, one can still see the tropes of mental illness in the film. Dr. Hannibal Lecter, who is a psychiatrist, is first seen behind a pane glass in a prison cell by the FBI agent Clarice Starling, who has been warned that Lecter is beyond dangerous and psychologically unstable. Later in the film, when Lecter being transferred to a different facility, he appears on an upright, rolling stretcher, restrained head to toe by straps and donned in not only a straight jacket but a bite mask. Even though Lecter’s behavior is not the wild behavior of other axe murderers, the images of the straightjacket and bite mask inherently convey a mental instability. Lecter appears normal, talks properly, and as a result the image of him completely bound for the safety of others is startling and only enhances the idea that he is truly psychologically dangerous. The use of straight jackets and restraints only emphasizes that he must be dangerous because he is a psychopath. Additionally, because Dr. Lecter is, in fact, a doctor of psychiatry but also a cannibalistic serial killer, the “Dr. Evil” trope is only further validated. 

The negative portrayal of mental illness and psychiatric hospitals continues to exist in horror films today. The psychological horror film A Cure for Wellness (Haythe, 2016) is the perfect example of how treatment facilities are made out to be sinister prisons. In the film, the protagonist, Lockhart, is sent to a health spa to speak to a fellow company board member. As the seemingly relaxing treatments transform from tranquil to terrifying, Lockhart finds himself trapped, unable to escape, restrained by sadistic doctors. What makes this film so terrifying to audiences is that a “normal” person is locked up against his will. Lockhart is forced to endure treatments like shock therapy and is forced to take medicine that affects his sanity. The film paints a clear distinction between what it means to be mentally “normal” and mentally ill. As Lockhart remains imprisoned in the treatment facility, he becomes insane. The film perpetuates the fear of treatment facilities and the idea that once one enters such a place one will never be able to get out. 

 All of these movies, and so many more, utilize the settings of psychiatric facilities and the characters of mentally ill patients to invoke fear and terror in the audience. Horror movies that perpetuate such violent and abusive images may elicit effective scares but at the cost of inaccurate and damaging stereotypes. The public perception of mental hospitals is undoubtedly influenced by the negative views offered in horror movies (Posech, 2007). Recurring tropes, used to invoke terror on the big screen, may too discourage those with mental illness from seeking treatment; in actuality, many of the horror film scare tactics are nonexistent in modern-day psychiatric facilities. For example, lobotomies are no longer used and are considered inhumane. Electroshock, so often portrayed as a painful treatment given against the patient's’ will, is now extremely rare and, if implemented, safe. Electroshock (or Electroconvulsive therapy) is a treatment that is only used after significant consideration by medical professionals and, of course, the desire of the patient (“Electroconvulsive Therapy (ECT). The trope that patients in psychiatric facilities are placed against their will and unable to leave is only true in the rarest of circumstances when individuals are clearly at risk of hurting themselves or others. In actuality, most people voluntarily check themselves into psychiatric facilities and often leave within a matter of days (Morris, 2017).

Additionally, while horror movies portray mentally ill individuals as violent, dangerous, and unpredictable, research has shown that not only are mentally ill individuals no more violent than those without mental illness, but they actually have an increased likelihood of being the victims of violence (“Fact vs Myth: Mental Illness & Violence”). In many horror movies, villains are described as “crazy psycho killers” -- characters like Michael Myers from the classic slasher film Halloween, who is an escaped psychiatric patient. The very language that surrounds our description of classic villains in inherently stigmatizing towards mental illness: a “mad” scientist, a “deranged” ax murderers. In order to make humans monsters in mass media, they need simply be labeled as mentally disabled for the monstrous behavior to be explained (Kambam, 2013). 

Inaccurate images of mental illness not only perpetuates a fear of the mentally ill but also emphasizes a fear of psychiatric facilities. These images may dissuade individuals with mental illness from seeking health, both from fear of the treatment facilities and from fear but being judged by others. As movies perpetuate negative stereotypes about the mentally ill, individuals with mental illness feel shame and do not seek the care that they deserve (Posech, 2007). 

When I was fourteen, depressed and anxious before I even know what depression or anxiety meant, I found an old Stephen King novel (Bag of Bones) in my basement. I’d always been scared of being scared, but the horror genre quickly became my obsession. I watched all the classics, read as much King and Koontz as possible, researched Serial Killers in my spare time, and, most importantly, was first in line at the movie theatre for every new horror flick that came out, no matter how cheesy the previews looked. By late high school, I was aware that I was mentally ill, aware that my behaviors were anything but healthy or safe or sane. There was a treatment facility center near my house where my best friend had gone for two weeks of inpatient. I wanted to go, I wanted to get help. But every time I thought about asking my parents, I would be overcome with images of restraints and forced pills, of painful therapies and lobotomies and straitjackets. I rationally knew that these were not things I would find in a modern-day psychiatric facility, but the possibility was enough to keep me from seeking treatment. 

I set foot in a psychiatric ward two months into my freshman year of college after a mental breakdown left me teetering on the edge of holding-it-together and downing-a-bottle-of-pills. Mount Sinai’s Psychiatric Facility looked a few shades lighter than the halls I’d seen in horror movies, and the doctors were ten times as nice. I wore a hospital gown, but never was a strapped onto a bed or locked in a padded room. The treatments were one-on-one time with a counselor and art therapy with glitter glue. The patients ranged from those on 72-hour emergency observation like myself and severely schizophrenic, but everyone was either friendly or nonresponsive. 

Horror was the source from which I learned about mental illness and, in turn, learned that I fell into the same category. As a result, I felt shame, fear that I would become the next Michael Myers or that if I told my parents or teachers about what I was experiencing I would be carted away to the nightmarish places I’d seen in so many movies. I know now, through therapy and treatment, that I am not a villain, not the next victim of some evil psychiatrist, but had I known these truths sooner, I might have saved myself years of suffering. 

The movies mentioned in this analysis are only a handful of horror films and books that depict mental illness and treatment as just that: horror. At the heart of these movies is one overwhelming conclusion: mental illness is horror, the source of violence, and treatment is only torture. The movies I’ve mentioned are still movies that I love to watch, but before I knew the truth about mental disability and psychiatric hospitals, I only know that these movies showed me. 

    In her essay on disease versus disability, Diane Herndl writes that “disability is not something that a person possesses but something one encounters when dealing with other people or with physical spaces that are inaccessible” (2005). Using this definition, we can see that mental illness ironically enough fits within the mold of disability quite nicely. For so many individuals with a psychological disability, everyday activities and “normal” behaviors are difficult or impossible. Mental illness is so stigmatized in our society today that often psychologically disabled individuals must make up different excuses to explain their own inability to complete “normal” activities. 

Mental illness or mental disability is unique in that it does not fit into either category well, and is rejected by both. There is such a significant stigma placed on mental disability; because it is not necessarily “physical”, individuals with mental disability often hear various iterations of “it’s just in your head”. However, mental illness is not physically disabling in the way that a missing limb is. Mental disability is hard to understand -- we cannot see it, we cannot fix it like we might a broken arm or a bad case of the flu. We cannot tell who is disabled from it, nor to what extent they are disabled. Of course characters like Norman Bates from Psycho and the cast of American Horror Story: Asylum are prototypes of mental disability and psychiatric institutions for so many: they are what the masses are shown about mental disability, and the depictions of the mentally ill as main characters in horror films do not exactly encourage those suffering from mental disability to speak out about their own experiences. Ultimately, as horror movies and other mediums continue to stigmatize mental disability, so too will that stigma grow in society around us.