Rethinking Portrayals of Mental Illness in Horror Fiction

Rethinking Portrayals of Mental Illness in Horror Fiction


“We all go a little mad sometimes” is a famous line from the 1960 Alfred Hitchcock thriller Psycho, inspired by the real-life murders of serial killer Ed Gein and the novel by Robert Bloch. 

The word “psycho” is a derogatory way to describe a mentally ill person, with connotations of violence. The killer of the film, Norman Bates, is ultimately diagnosed with “split personality,” a phrase used to describe the then-misunderstood mental condition of Dissociative Identity Disorder. As our understanding of mental disorders has evolved in reality, it is hoped that fiction will reflect this.

Ed Gein

Let’s take a real-life person with mental illness as an example. Serial killer Ed Gein inspired the novels Psycho, Silence of the Lambs and the film The Texas Chainsaw Massacre. (All of which were adapted into films.) 

Gein is called a serial killer, even though he has only been connected to two murders, and the term is usually aimed at those responsible for at least three. The macabre findings in his farmhouse (including a variety of household items made from human skin) were largely due to body snatching. 

He was diagnosed with schizophrenia (a condition long confused with Dissociative Identity Disorder) and sexual psychopathy aggravated by an abusive mother. Gein reportedly became a model prisoner when institutionalized. 

Psycho interprets his behavior as the machinations of Norman Bates’ “Mother” personality attempting to win over those in authority. In reality, institutionalization gave Gein the strict structure his disorganized mind craved. A more accurate depiction of Ed Gein’s case would’ve illustrated a need for intervention on cases of child abuse and prompt treatment of mental illness.

Stephen King’s Characters

Stephen King is one of the most celebrated writers in horror. After publishing short stories in various magazines, King published his first novel Carrie in 1974. 

Lately, King has been stepping away from supernatural horror and delving more into crime thrillers. 

Of course, King has always had the real-life horrors of mentally unbalanced and obsessive people more terrifying than any ghost or ghoul. In It, the psychopaths running loose in Derry, Maine are more terrifying than killer clown Pennywise. 

Needful Things had a demon as the antagonist (in the film adaptation it was the devil), and he looks tame compared to a cocaine fiend and two mentally unstable elderly ladies. 

A popular theory holds that the ghosts of the Overlook Hotel in The Shining were the hallucinations of a traumatized boy and a recovering alcoholic going through withdrawal symptoms.

Interestingly, in some of King’s novels, a little madness is helpful to the protagonists. The heroines of Rose Madder, Gerald’s Game and The Girl Who Loved Tom Gordon all go slightly crazy from the bad situations they’ve been thrust into. Fortunately, their hallucinations give them the strength to do what has to be done. They get out of their bad situations and sanity is gradually restored. 

Addicts in King’s novels are given some sympathy. (King has had personal experience in this area.) They are usually decent people who just need to be kept away from their vice. It’s the obsessive people who don’t get much sympathy from King. People who put their religion and/or ego above everything else are the irredeemable villains.

Current Horror Fiction and Mental Illness

My Heart is a Chainsaw by Stephen Graham Jones features a villain protagonist Jennifer “Jade” Daniels, an abused teenage girl who becomes obsessed with horror films and sees her own life as one. That obsession drives her to mentally cast another girl as the heroine of the slasher film in her mind, where she plays the role of the killer. Where They Wait by Scott Carson is a modern psychological thriller where an app drives people seeking relief from anxiety to instead commit suicide. 

The Between by Tananarive Due tells the story of Hilton James, who has post-traumatic stress disorder (PTSD) and runs a rehab clinic, and his battle with the very real threat of white supremacists. 

While Jones’s protagonist Jade is a typical “psycho killer” (who just happens to be a teenage girl) the other two novels feature people with mental illness as the targets of evil rather than perpetrators of it. Even Jade is depicted as a badly hurt girl who needs help.

What Can Be Done?

The reason mental illness is such a recurring theme in the horror genre is largely because it represents a primal fear of the unknown. Mental illness is terrifying in that it’s unpredictable. 

There’s also the common advice to writers to write what they know. Many people who write for the horror genre have struggled with addiction, grief and mental instability. But  just as it would no longer be acceptable to depict a character naming their cat after a racial slur (Looking at you, H.P. Lovecraft), it’s also not acceptable to rely on tired misconceptions about mental illness. Horror writers must take it upon themselves to research mental illness, the behaviors and symptoms. Accuracy and empathy is required.


Sources – Psycho – Film by Hitchcock (1960) – Ed Gein Inspired Horror Movies – Making of a Monster: Ed Gein – The Author –  WMG The Shining – Read it and Scream – The H Word: Mental Health, Ableism, and the Horror Genre -Texas Austin alcohol rehab

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