The horror of mental illness

For those of you expecting an update on the shooting of The Ditch, there’ll be an announcement soon.

In the meantime, I wanted to explore an issue which has been on my mind for some time but which has been brought into focus by recent events. As some readers may be aware, there has been controversy in the last 24 hours, because the UK supermarket chain Asda has been caught selling Halloween costumes labelled “mental patient costume”. There’s a screenshot below.


As you can see, the costume consists of a tattered, bloodstained white coat, a plastic meat cleaver, and a mask which appears to have been modelled on Leatherface of Texas Chainsaw Massacre fame. It’s a genuinely unsettling costume and one which would probably be pretty effective if you caught someone unawares on a dark Halloween night. But even if your intention was just to create an edgy, slightly troubling but fun costume which would have people doing a double-take before laughing, it would be a crude but enjoyable product to wear. After all, it’s exactly the kind of thing you expect people to wear when they go out to a Halloween party, and it saves you from finding a lab coat and tearing it up before dropping half a bottle of ketchup over it, then wrapping some bandages (or, in an emergency, some toilet paper) around your head.

But the costume has caused outrage on Twitter. Now, I know you only have to sneeze to cause outrage on Twitter, and the medium has a tendency to attract the thin-skinned and easily provoked. Nevertheless, a Twitterstorm has erupted and Asda has withdrawn the costume from sale (no word, at the time of writing, of who the manufacturer is or whether they too have withdrawn the product). If you need the reason for this spelling out, it’s because of the product description – “mental patient fancy dress costume”. (There’s some evidence, incidentally, that the product was originally intended to be called a ‘zombie’ costume.) To be brief, people have objected to the association of the words “mental patient” with a dangerous, out of control, homicidal person who appears barely human.

I, too, find this offensive, and I’m glad the product has been withdrawn (although I think I would have been content if it had merely been re-titled). Why did I find it offensive? Because, like one-quarter of the population, I have suffered from mental health problems. In my case it was suicidal depression which reached its peak about 13 or 14 years ago and came close to threatening my life. I was put on anti-depressants (largely ineffective) and given a year’s free psychotherapy on the NHS (partially effective – the therapy, that is, not the NHS which is mostly wonderful). I’m not going to go into the details of my illness, except to say that I’ve come out the other side now and I feel much, much better than I did back then. Had it not been for the professionals, however, I might not be here today.

So I’ve been a mental patient. Most of my family have been mental patients (suffering from, among other things, suicidal depression, schizophrenia, bipolar disorder and alcoholism). Not one of us has worn a leather face mask. Not one of us has had wild, unkempt hair (except maybe first thing in the morning). Not one of us has brandished a meat cleaver, or indeed any sharp object. Not one of us has worn a bloodied, tattered lab coat, straitjacket or similar item of clothing. Nor, to the best of my knowledge, have any of my friends who have suffered mental health issues (there’s a meme going round Twitter at the moment as part of the Time To Change campaign, in which mental health patients tweet pictures of themselves in their ‘mental patient costumes’, ie their normal clothes).

Why does this matter? Can’t we just take a joke? It’s obviously not meant seriously – why do we have to spoil other people’s fun? These objections are valid, up to a point. The thing is, this goes wider than one ill-considered party costume. It’s not that Asda, or the manufacturers, wanted to associate mental health patients with deranged killers. The problem is that they were tapping into a trope which runs throughout the whole of society: the image of a ‘mental patient’ being someone who has totally lost touch with reality, who hallucinates constantly, who is violent, raving and intentionally homicidal, who cannot be left on his or her own if there any sharp objects. Search for ‘mental patient’ on Google images, and you won’t be met with a page of photos of people sitting quietly in waiting rooms, wearing normal clothes, or sitting in a consulting rooms with a therapist having a gentle cry about their problems – which is the boring reality. You’ll be met with a page of wide-eyed figures crouched in corners, wearing straitjackets, chewing their hands or baying at the moon, or grinning at the camera with evil intent. This is just from googling ‘mental patient’, incidentally, not ‘mental patient in horror films’ or ‘dangerous mental patient’ or ‘mental patient looking all weird’. The association of mental patients with people who are dangerously out of control dates back centuries, millennia even, to a time when such people were assumed to be possessed by devils. Hasn’t the human race moved on since then? In developed nations (and increasingly in developing nations) there now exists a support industry designed specifically to help people in ways which are enlightened, modern, progressive and scientific. It’s frequently inadequate and underfunded, but it’s there. Science and medicine have moved on – why haven’t ‘ordinary’ people, one-quarter of whom themselves suffer from mental health issues? The pre-medieval stigma surrounding people with mental health issues persists, like some horrible bug in our DNA, and this stigma rests heavily on sufferers (as Time to Change’s section on ‘stigma and discrimination’ reveals).


The reason I’m bringing this up here is because the ‘dangerous mad person’ is not just a societal archetype – it’s a frequent device used in horror films, and has been since the genre was invented a hundred years ago. One of the most famous early examples is The Cabinet of Dr Caligari, which is actually set in a mental asylum – a film drenched in bizarre images, with a violent plot and grotesque characters, the most well-known of whom, Cesar, actually appears on the front page of the Google images search I mentioned above. Yet Cesar is not the mental patient – he is, depending how you read the story, a zombie or a sleepwalker. The mental patient in the film is Francis, ostensibly the film’s hero – the whole story is revealed to be his dream or hallucination in which his kindly (and condescending) doctor takes on the role of the evil Caligari and Cesar is no more than a figment of his disturbed imagination. Francis ends the film in a straitjacket, naturally…

There’s something about the mental health device which has made it a go-to theme for horror filmmakers. Because mental health has been historically poorly understood until recently (it’s far from perfect, even now), it’s become acceptable for horror writers to resort to ‘madness’ as a motivating factor in violent, unpredictable and frightening behaviour. In classic horror movies, scientists like Frankenstein are frequently dismissed as “mad”. Renfield, in Dracula, exhibits many of the stereotypes of the disturbed patient – gibbering, laughing at nothing, poor grooming, even eating flies (he is treated a little more sympathetically in the original novel, if I recall correctly). A serial killer is assumed to get pleasure from the simple act of killing on no grounds other than that he is ‘mad’, a fact thought unnecessary to explain – and when Joseph Stefano did try to explain it, in his script for Psycho, he made such an ugly hash of it that it that the film runs out of steam and dissipates the fine atmosphere of tension and insecurity built up by Hitchcock (although the final fault should rest with Hitchcock for not editing the sequence differently). The equation of mental patient with dangerous insanity is now rooted firmly, perhaps irremovably, in the consciousness of filmmakers – and this filters out into the public consciousness. As mental health is so rarely discussed openly, people have no other source of information, and Hollywood (and, indeed, indie filmmakers) are all too ready to step in and exploit this lack of awareness. The result is that the stigma is perpetuated.

a silence of the lambs SILENCE_LAMBS_D1-7

This is not to say that films which utilise homicidal insanity as a device are necessarily bad films, still less that they should be banned. The Silence of the Lambs, for example, is a masterful example of building and releasing tension, occasionally wrong-footing the viewer, and the performances are nearly all pitch-perfect. Yet the underlying themes and implications are deeply offensive. Jamie Gumb is portrayed as a perverted trans person (as is Norman Bates, come to that), as if his ‘confusion’ over his gender is the root of his homicidal tendencies (there’s an interesting outline of this here); while Hannibal Lecter is offered no rationale for his actions beyond a penchant for cannibalism. Meanwhile, Hannibal’s cellmates are given no better treatment – either ruthlessly offensive and violent, like Miggs, or silent and introspective. Apparently the book treats mental illness in a more sophisticated way, but of course to spend time on this when there are audiences to be entertained is thought to be commercial death for any screenwriter. But the bottom line is that this doesn’t make Silence a bad film, just an insensitive one. And there’s no point in banning it now, when it was made over twenty years ago. If we wanted to excise any negative stereotyping from our culture, we would be left with practically nothing at the end.

The only solution, in my opinion, is to look forward. It must be hoped that, as understanding of mental health issues increases and becomes more widely disseminated, as the pressure to conform, stay quiet and not speak out about one’s problems relaxes, so filmmakers will realise that they can’t justify violent behaviour with “he’s just mad” or with cod psychology skim-read from a Wikipedia article. It’s quite possible to produce compelling and disturbing horror from mental illness (Lodge Kerrigan’s films Keane and Clean, Shaven, though not technically horror films, achieve this), even without the clumsy Psycho device of trying to explain everything. There’s always a place in the horror genre for unexplained acts of violence; but I don’t see that an audience can justify any objection if this violence is carried out by something or someone supernatural or other-worldly (aliens, zombies, ‘monsters’, dream-creatures, ghosts, unexplained figures like Michael Myers). Nor can there be any reasonable objection if the old archetypes of ‘insanity’ are used (eg straitjackets, uncontrolled behaviour) provided the context is sensitive. But surely it can’t be beyond the wit of filmmakers – who are, for the most part, intelligent, creative and well-informed people – to take a bit more time and care over their depiction of mental illness, without sacrificing the visceral fear of the unknown and the uncontrollable, which is an essential element in horror?

In brief, fellow filmmakers: please don’t use mental illness as the sole justification for a character’s violent and/or anti-social behaviour unless you are prepared to take a bit of time to contextualise it. And not with some off-the-cuff one-note backstory device (“he saw his father beat up his mother”), but with something more nuanced and sophisticated. You won’t be damaging your story – you’ll be a pioneer. And the human race will be better off for it.


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