Well-Being Mental Health

Fear of insane asylums runs deep in our culture. Here’s why.

An empty wheelchair
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Story at a glance

  • Troy Rondinone watched hundreds of movies to catalog how asylums have been depicted in pop culture.
  • He found that fear of asylums runs deep and has roots in the first years of the U.S.
  • Negative depictions of mental health care can deter people from seeking help.

Maybe every year the horror film industry should have to retire one cliche. This year I would like to nominate the person-pulled-backwards-by-unseen-bad-thing, like they’ve reached the bungee cord’s end. One plot device used a lot in scary movies that may never stop being scary is the insane asylum.

Troy Rondinone can probably rattle off all the books and movies that use it and throw in a “Starsky and Hutch” and “Loony Tunes” episode for good measure. Rondinone watched between 200 and 300 asylum movies for his book “Nightmare Factories: The Asylum in the American Imagination” (2019, Johns Hopkins University Press), the first pop culture history of mental hospitals, and it’s a doozy.

In each chapter, Rondinone takes readers through a different moment in the history of American mental health care and the public reflection of it in media. The scholarship is so thorough and Rondinone’s writing so rich and confident that the book is like a rip current — good luck getting out of it. Just go with it.

Rondinone is a historian at Southern Connecticut State University, and mental hospitals fell on his radar quite unexpectedly.

“In a fit of insomnia, I found myself watching one of these ghost hunter shows,” Rondinone says. “They were exploring what they said was the most haunted place in America, which was the Trans-Allegheny Lunatic Asylum,” in Weston, West Virginia. Rondinone wondered why asylums are so scary and if they always were.

Roots of fear

Yes, indeed they were, and from our country’s origins. Having just won a war in which we fought for our own freedom, we weren’t comfortable with locking people up.

“Rondinone said that asking itself “How do you have order in an individualistic society?” was a puzzle that America, a newborn country, had yet to solve. Can you have complete freedom and safety at the same time? If you start trading in some freedoms for safety, “do you open the door to tyranny?”

“On a primal level, Americans fear confinement. It’s been drummed into our heads for 200 years — liberty, freedom,” says Phil Nobile, Jr., director, producer and editor of the recently relaunched Fangoria magazine via email.

“Our history of enslaving other humans has also probably baked in some guilt about such independence being taken away.”

The answer to the problem of the mentally ill was, well, to paraphrase Norman Bates, to put them in someplace. Mental hospitals embody “the kind of out-of-sight, out-of-mind nature of how we sometimes stigmatize people suffering from mental illness,” Rondinone says.

“We create in our imagination a monstrous prison house where they are confined and we project our own fears dating back to the revolutionary period, of tyranny and control and racialized revolt.”

It’s not surprising that the first artist Rondinone reports to give us an asylum narrative is Edgar Allan Poe, according to Rondinone, is the first artist to use an asylum narrative, which he employs in his short story “The System of Dr. Tarr and Professor Fether,” published in 1845. It’s a black comedy in which a young man traveling in the south of France decides to visit the local mental asylum.

“The narrator is a buffoon, and he doesn’t realize the lunatics have taken over despite all of the very loud hints,” Rondinone says. They’ve locked up the brutish attendants and tortured them and “in the end they break out.”

The first asylum exposé came when undercover reporter Nelly Bly unmasked New York’s Blackwell’s Island as a “human rat-trap” in 1887, revealing horrible conditions, brutal staff and physical and mental abuse, which would become staples of asylum narratives well into the 21st century. We also learn of the terrifying ease with which people, particularly unwanted wives, could be committed to asylums, which Rondinone calls “prisons for inconvenient women.”

Early in the 20th century, a new medium brought us an enduring asylum character. The insane physician shines in the 1920 surrealist masterpiece “The Cabinet of Dr. Caligari.” Nobile points out that it also gives us film’s first unreliable narrator when the person revealed to be our storyteller is actually an asylum inmate.

Shocking treatments

Electroconvulsive therapy is featured in all hoorifying asylum narratives, including the 1948 classic “The Snake Pit,” with its depiction of patients practically seizing with pain. It’s enough to scare anyone out of wanting to go near a mental hospital. But if there is anything worse, it was the lobotomy and Randall Patrick McMurphy of “One Flew Over the Cuckoo’s Nest.” In the cool, orderly world of Nurse Ratched, troublemakers like McMurphy are handled with ECT, and if that doesn’t work, surgery that will create compliance. There’s a reason the movie won Best Everything at the 1975 Oscars.

McMurphy, for whom it was better to die under a pillow than live under Nurse Ratched, had been sent to the asylum from prison, thinking it would be just as easy. The American fear of confinement never made the prison story the cinematic bogeyman that asylums were. This could be because prisons are fairly well-understood, but asylums are mysterious, leaving filmmakers to take license with the institutions and mental health itself, to mold it to whatever themes they’re exploring.

“This habit has resulted in mental hospitals being portrayed pretty unfairly and has maybe even contributed to a stigma of mental health care that leads to so many folks self-medicating, which possibly feeds our country’s addiction problem and homelessness problem,” Nobile says.

Conversely, cinema has at times been a watchdog for standards of care in mental hospitals. “Cuckoo’s Nest,” Rondinone writes, ignited demands for patient’s rights and other reforms.

By the 1960s, the asylum was comfortable “but there’s something off,” Rondinone says. The people in them realize “they’ve been duped, and their haven is a prison,” a perfectly timed vibe for the Women’s Liberation Movement and asylum stories including “The Bell Jar” and “Diary of a Mad Housewife.

Trust and money are dwindling for state mental health facilities by the 1970s. The disaster of deinstitutionalization begins, as does the cinematic advent of the Escaped Maniac. The most famous and lucrative one of all is Michael Myers in the “Halloween” franchise, with the tagline “The night HE came home.”

A telling recommendation for a modern horror film is Nobile’s pick of 2018’s “Unsane.” By Stephen Soderburgh and starring the insurance industry, it was shot on an iPhone. “It will in time be remembered as both the first important movie of the MeToo/Believe Women era, and a thoroughly plausible condemnation of the abuse occurring between insurance companies and the health care system,” says Nobile.

Bringing us up to date, you may find yourself at a theatrical haunted house with a mental hospital vignette, crazed doctors, homicidal patients. It’s a practice, Rondinone writes, that mental health advocates are trying to stop.

Like many other asylum narratives, these depictions stigmatize the mentally ill and mental health care, making people afraid to seek treatment.

Rondinone says maybe it’s time for the gothic asylum tale to retire a cliche or two.

Nightmare Factories will give you a mind-bogglingly long reading/watch list and Rondinone says there were hundreds of pages edited out for length.

“I don’t want to say I went crazy on it,” he says. You can tell he did. Don’t tell the nurse.

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