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Mental Illness and the Horror Genre

An exploratory essay by Emma L. Gilbert

The relationship between horror media and mental illness is messy, and on many occasions outright screwed up. Today, I’m going to take you through various examples of horror films that utilize mental illnesses and disabilities, often as a central theme, and examine how exactly mental illness is used to benefit the tone of each film, and how some of them may or may not use it in a distasteful fashion.

Without further ado, here we go!

“Psycho” is the earliest film I know of at the moment that utilizes mental illness explicitly as a sort of evil or “villain”. The big reveal is that the character Norman Bates’s late mother developed as another personality inside his head which, very clearly, resembles Dissociative Identity Disorder (we will actually be talking about DID more than once today, as it appears to be the most common mental condition used in horror movies next to psychosis or schizophrenia).

I can only assume in the time of “Psycho’s” release, this portrayal was considered anything but realistic to general audiences (The term “psycho” is even considered a slur nowadays by a fair few mental health experts and activists). Mentally ill individuals were but a disturbed fantasy in the minds of the public, and in many ways they still are.

In more modern times, mental illnesses on the “scarier” side (like DID) are seldom understood or spoken about, and this makes them a very easy target to use as driving scare factors in horror films. We fear what we don’t understand, we know this, we’re talking about it a lot nowadays, but movies similar to “Psycho” that use such things as plot material for their stories still get made so carelessly.

Let’s dive into another example more thoroughly:

“Midsommar” is a 2019 horror film directed by Ari Aster, the man behind “Hereditary” (which we will also be discussing). I know a lot of people love this movie, just like people love “Psycho”. It won just about every award from Fangoria’s 2020 “Chainsaw Awards”, which are completely fan influenced. But it completely missed the mark for me because of a couple instances involving disabilities. And while these instances are miniscule, it’s the fact that they are so miniscule, so “tossed in”, that bothers me.

My first problem begins at the start of the movie. We open with our lead fretting over an ominous email sent to her by her mentally ill sister, which is all well and good. But the ultimate result of this situation is that she was right to be worried, as her sister had hooked herself up to a car exhaust pipe which she used to poison herself and their parents, resulting in the death of all three.

This is… extreme. And while it’s absolutely okay to be extreme (I’m one of those horror fans that enjoys a little extremity), it’s peculiar, and yet not so peculiar, to have it alongside the aspect of the opening I’m about to explain.

The illness of the sister character is specifically labeled as bipolar disorder. Why is this specifically a problem for me? Mentally ill people can be dangerous, that’s an indisputable fact. But I’m gonna pause “Midsommar” here, because it’s a good time to shift over to a movie that I believe suffers the same problem.

“Split”, both in the title movie and in the ensemble “Glass”, refers to anti-hero Kevin Crumb’s disorder as Dissociative Identity Disorder (there it is again!). This was a problem since the very conception of the first film, because it’s doing that thing where a mental disorder is used explicitly to make the villain of a horror film scarier. And while the character of Kevin isn’t ultimately seen as evil, the film still misconstrues many things about DID in order to keep its creep factor (like, people don’t wind up with evil alter egos who kidnap and kill people in a cult-like fashion, and people with DID do not go through extreme physical altercations when different personalities take the front).

This was many folks’ first introduction to the very concept of DID, just like back in the 60s with “Psycho”, and the movie does little to deter the audience from taking what they are seeing as factual. It really drives home the fact that Kevin has this disorder that is real, using that perceived realism to enforce the horror of its story. It uses a lot of typical “professional” imagery and dialogue, such as namedropping the disorder and having the character attend a therapist regularly on-screen. These things in film tend to equate in the general ignorant public’s mind to something bordering on or outright factual. While I choose to believe most people recognize the easy potential for illegitimacy in fictional movies, I still notice, even in myself, how further research is seldom enacted, and the information granted by that movie remains present in the back of our minds.

I’m not trying to say this is entirely the fault of the team behind “Split”, because I believe people should be responsible for recognizing that not everything they see is true, no matter how legit it looks. But the fact is that people are stupid and do take stuff like this as fact whether they realize it or not, and I think that filmmakers and storytellers should hold a little responsibility for making sure their highly fictionalized portrayals of real things (especially real people) don’t get taken as hard fact. Easy resources for understanding complex mental conditions are not popular enough or offered enough to garner the public’s attention; I’m sure someone would rather watch “Split” instead of reading a textbook on DID studies.

All that being said, let’s go back to “Midsommar”. The mention of bipolar disorder is a one-time occurrence, but it still sticks out to me; both because I noticed a trend in Aster’s films of using mental illness explicitly (like I said, “Hereditary” comes later), and that this diagnosis is used at the ultimate expense of the sister.

Throughout the movie, Terri (the sister) is seen as a scary, taunting ghost through Dani (the lead)’s eyes. She is only ever depicted as that terrifying last picture of her, with tubes taped to her mouth and their parents beside her. She also seems to be looking right at Dani in these sequences, too, if I’m remembering correctly. It’s a fearful memory; her sister is a villain.

Using a disorder described as a “mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and ability to carry out daily tasks” to tie to a character that was unhinged enough to plug herself into a car exhaust pipe to kill herself and her family seems… like a reach, to me, at least. She would’ve had to plan that out- it takes serious dedication, supplies, thought, and time to pull that off. Bipolar people can be prone to sudden outbursts, not necessarily to planning and executing an intricate double homicide/suicide.

What I’m trying to say is that there’s no way bipolar disorder was the sole cause here. There were clearly more “things” she had going on, but the only thing they say is that she’s bipolar, therefore suggesting that is the reason behind what she did, and then treat her like a vengeful ghost the rest of the movie.

There is perfectly good reason for Dani to see her sister as something sinister, though. Literally the only aspect of this plot point that messes it up for me is that we have a “diagnosis”. It doesn’t feel right to me to use such a common and non-extreme illness for the sake of being like “ooh check this out, this is a real mental illness and mentally ill people do bad stuff sometimes, look at that! Look!” It’s lame, and unkind, and, like “Split”, borders on irresponsible. It’s times like this where a character’s mental condition could use a little more ambiguity, especially when it’s literally never brought up again. It’s so nonchalant, so careless, and that’s what bothers me.

Now, I’m gonna move away from mental illness alone for a hot second and explore how “Midsommar” treats its other disabled character.

“Midsommar” depicts an explicitly inbred character with a facial deformity named Ruben who lives with the Swedish cult and is treated like a sort of “higher being”. They are clearly treated with care, but through the gaze of the American characters, we see them as off-putting. And, again, this framing makes sense, as Ruben was purposefully conceived through incest because of some misguided religious belief that disabled people are closer to clarity.

But, stop; what is this portrayal doing, again? It is doing that thing where it uses a disabled character to give us the creeps. And this is made worse when Ruben goes on to kill and skin one of the American characters, and then wear his face as a mask.

Okay, listen. It’s wrong of the cult to purposefully bring a very physically and mentally challenged individual into the world for religious reasons, but that’s not relevant to my point. Yeah, it’s weird, but people like that character are real- and, no matter how they came to be, they’re here now. Why are we always looking at these people with pity or fear, and normalizing that reaction? It can be jarring to see someone who looks like that, sure, but they’re a person, and should be treated like one.

Oh, and not to mention having Ruben wear the skinned face of a “normal” person is absolutely representative of wanting to “look like everybody else”, which is a screwed-up narrative especially when you’re using the disabled person as a straight-up monster. I get the whole “skin the fool” thing, that was funny, but did we have to do that? This is Ruben’s “normal”, and that’s not an awful thing.

Before we reach “Hereditary”, I’d like to say that the utilization of deformed people as killers and monsters in horror is, I think, arguably more prevalent and inescapable than the use of mental illness by itself. It’s present to a point where we just have to deal with it and the amount of irreplaceably iconic villains with facial deformities, but I’d like to believe that we can do better and move past that. Make a monster, not a person.

Let’s get cracking on “Hereditary” now, which I think uses mental illness as a much more core aspect to its story than “Midsommar”. Again, Aster makes it clear out the gate that our evil character (the grandmother) was indeed mentally ill, and this is, again, used at the character’s expense.

Now, I wanna keep this short, because with how much I went off talking about “Split” and “Midsommar”, I think that what I find troublesome about a movie called “Hereditary” about a mentally ill cultist grandmother passing on her “lifestyle” to her family is rather obvious.

I mostly want to discuss the character of Charlie, because her portrayal is what bugs me the most. My gripe with her is that she is very obviously autistic, or something along those lines, which is framed as a creepy thing about her. She’s supposed to be some kind of “chosen one” that her grandmother wanted, and I guess this was grounds to have her be the “creepy one”. But this can be done without making the character blatantly mentally compromised (and before anyone comes for me, I’m autistic, and despite the many wonderful things about it, it also does hinder me from some basic things in life, so, yeah, it’s compromising). It’s just so tacky, uninspired, and tired.

In regards to other characters, we see Annie speak of how her grandmother suffered from mental conditions (I can’t recall whether or not one was specifically named), and then watch her exhibit various “scary” symptoms herself (trying to set her son on fire, etc.), which grow worse post-Charlie’s death as she is wracked with grief. Annie’s case isn’t quite as terrible as things such as “Split”, as she never actually does anything, only attempts and then snaps herself out of it (before the end of the movie where everything goes to hell, of course). My main problems, as mentioned, are with Charlie and the grandmother, mostly Charlie. I just wanted to attempt to cover all “Hereditary’s” portrayals at least briefly before moving on to my next subject.

Now that I’m done being mad, let’s explore another recent horror film that uses mental illness as a core aspect.

“Daniel Isn’t Real” is a 2019 film by Adam Egypt Mortimer about a boy (Luke) who experiences a traumatic event as a young child, which he copes with by manifesting an imaginary friend named Daniel. Daniel doesn’t stick around, though, as he tricks Luke into poisoning his mother, almost killing her, and resulting in the two locking Daniel away.

It’s incredibly easy to decipher the, once again, use of DID symptoms. One could easily push this movie aside due to this fact, as clearly, the mental illness is used as the spooky horror thing again. But I’m of the belief that this film handles itself a little better than the likes of “Split”, and here’s why.

It’s a bad thing to use mental illness as your villain, unless you do it right, and there is a way to do that. Luke (the mentally ill person) isn’t the villain, Daniel (the mental illness symptom) is, just like Kevin isn’t “Split’s” villain, but the important difference is that, in “Daniel Isn’t Real”, the audience sympathizes realistically with Luke, doesn’t turn his illness into something extremely outlandish. In “Split”, the audience is following the heroine, who is terrified of the outside force that is Kevin and his personalities. “Split’s” DID is otherworldly and threatening. “Daniel Isn’t Real’s” DID is threatening, but something the audience and Luke hold hands through and fight together.

Aside from some muddy metaphorical aspects (assuming I’m reading it right) and the use of some racial stereotypes common in horror films, “Daniel Isn’t Real” is on the upper end of horror featuring mental illness.

It is also worth noting that there is actually a specific mental illness brought to attention in the film, schizophrenia, as Luke is seen reading a book about it once he starts realizing he’s losing control of Daniel. But this is merely a suggestion, as he doesn’t actually know what is going on in his head and we never get an official declaration of his condition. This brief clip pretty much only helped in solidifying my perception of the story as about mental illness first, and a demonic imaginary friend second. If you ask me, I think dissociative identity disorder fits more with the film than schizophrenia, but my knowledge on both of these disorders is relatively “bare basics”, so take that with a grain of salt. And besides, from this point on I’m going to be looking at the portrayal mainly as an undefined trauma induced condition.

I view Daniel as a visual representation of Luke’s mental condition. He is rude, and childish, and malicious, nothing like who Luke is, who wants nothing more than to get rid of him. Mental illness can feel like there is some evil thing in your brain telling you awful things and threatening your existence, and Daniel represents this feeling perfectly.

Going even deeper, the movie opens with a shooter entering a small café and massacring multiple patrons and themself. One of the things that causes Daniel to manifest is Luke, having left his home where his parents are shouting at one another non-stop, coming face to face with the dead shooter. It is later revealed that Daniel, an ancient demonic “imaginary friend”, was inhabiting the shooter at the time, thus making him the cause of the massacre. And he chose Luke as his next host on that fateful day.

Pause now. We’ve got a blatant mental illness metaphor, and it’s the direct cause of a murder. Why am I more lenient on this and hard on things like “Midsommar”? It’s because this detail plays into what I view as a very interesting interpretation of mental conditions and their preceding trauma.

Looking past Daniel being a demon, I see this as the shooter struggling with the same or a similar type of mental condition caused by a past trauma. This person was sick, as all terrorists of this breed are. Again, this narrative is helped by the fact that we are following Luke and not someone on the outside of his problem, and therefor understand the real lack of control had by anyone Daniel (A.K.A. mental illness) has touched, and, more importantly, the helplessness they feel.

Am I saying people who enact gun violence are partially innocent and have no free will? No, that’s stupid. The real point of me bringing this up is simply that I find it interesting how the film looks at trauma as sort of a contagion. Hurt people can hurt people, and traumatized people can traumatize people. Whatever “demons” that killer hosted were passed on to Luke- and, if the film wanted to go for a broader subject and ditch the singular evil imaginary friend concept, passed onto many others, too. But, it didn’t, and I think that works best, as symptoms like Daniel typically only manifest in young children, assuming you wanna go with the DID/schizophrenia reading, which is what the film offers to us.

We see experiences and fears felt by everyone who has mental illnesses portrayed visually in “Daniel Isn’t Real”, sometimes feeling like a mixed bag of different symptoms from different mental conditions. I see myself and my own experiences in Luke, and it feels good to see the mentally ill person as the hero, and the mental illness being at least mainly a threat to the mentally ill person rather than the outside world, which is how it is more often than not.

And while the movie ends on a sad note, actually quite similar to Kevin’s end in “Glass”, what it does with its runtime is, for the most part, what I want to see more of in terms of mental illness in horror.

Like I said at the beginning, we’re an easy target. Autistic, obsessive compulsive, anxious, depressed people like me are scary when you have no idea what you’re looking at. Yes, we can be dangerous sometimes, but to nobody more than ourselves. But much more than dangerous, we’re scary to ourselves.

I’ve lived in terror for long periods of time before due to my mental illnesses, and I’ve had this thought; “why doesn’t someone make a horror movie where the mentally ill person is the protagonist, and the mental illness is the monster?” “Daniel Isn’t Real” executed this idea almost perfectly, if not for the fact that Daniel was out to hurt other people, because what’s scarier than a person with a realistic mental condition hurting other people? Ooooo.

Living with mental illness can feel like a horror movie all on its own. The horror is in my head, and I can’t kill it, only keep it at bay, control it. And I think that is scarier than any Norman Bates, than any Kevin Crumb, than any Ruben. To live with a force in your head that wants nothing more than you for to be in misery is a horrific reality worse than any killer.

And before I close, I want to comment on one more little detail. I’m much more critical on recent movies that work with this subject matter than I am on older movies; that’s why I had so much to say about the Aster films and “Split” and so little about “Psycho”. This is because I understand how invisible the very concept of mental illness was in everyday society in “Psycho’s” time. It wasn’t just an easy target, it was a given, and nobody writing these films had any idea of what they were doing or the seedling of thought to look into it. It was that alien.

Today, we are talking about mental illness so much, and yet we are still so careless with what we use it for in our media. It is blasphemous to me that directors and writers still insist on using mentally ill people as villains and creepy characters. Mental illness is such a complex experience that deserves to be explored from the viewpoint of those of us who live with it, not as a toy for the bigshot horror director of the hour to toss around like a hot potato.

There was an excuse in the 1960s. There is no excuse now. We can do better.

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