Mental health facilities, colloquially known as asylums, have long been a trope in horror, whether people are sneaking into closed facilities after dark, living in them, or interacting with them in some other way. It is not just the asylum itself that is horrifying, but also its inmates, those who stalk the halls and once haunted the beds; there is something deep, dark, and disturbing about such facilities in the psyche of pop culture creators and consumers alike. The asylum represents something terrifying and unknown.
This ties into larger themes of mental illness as horror metaphor, of course. The crazed killer, the obsessive-compulsive torturer, the psychopathic foster parent, even the evil stepmother with overtones of implied mental illness all have their place in pop culture, portraying mentally ill people as inherently dangerous, frightening, and, above all, evil. Thus, under this framework, it makes sense to see psychiatric facilities framed as places of horror, because they represent a distillation of the most evil at work, a concentration of all those found so crazy that they can’t be allowed out into society.
Since it is nondisabled people who tend to tell the stories, most depictions of mental health facilities in pop culture do not stray from an underlying narrative about mental illness: it is a bad thing, mental health facilities are valuable for ‘fixing’ craziness, and permanent institutionalisation is an acceptable fact of life for some mentally ill people. Counters to this narrative, stories told by disabled people, are less commonly part of the narrative: we do not see resistance to psychiatric abuse, for example, we do not see mentally ill people opposed to institutionalisation and fighting for autonomy, we do not see mentally ill people confronting the idea that mental illness is bad.
Under the accepted pop culture framework about mental illness, of course the asylum is a terrifying place. More than that, though, it is terrifying for those who do not belong there. In many depictions of mental health facilities in pop culture and drama where the facility is framed in a negative light, it’s negatively portrayed because it is imprisoning sane people. Because the hero or heroine is trapped by conniving doctors, lying family members, or an entire culture. It is up to the protagonist of the piece to figure out how to escape the asylum in the face of gaslighting, abuse, and other tactics.
The institution is not a bad place because it is an institution where all residents may be deprived of autonomy, but because it contains ‘innocents,’ i.e., those who are not mentally ill. The narrative lacks a deeper examination of the institution as, well, institution. If the narrative depicts torture and abuse of patients, including the protagonist, this may be used to suggest that the authorities are going too far and the facility needs to be reassessed, but it still doesn’t explore the larger framework of how inpatient mental health is handled, the history of institutions, and what they are like today.
Inpatient treatment can be incredibly valuable for patients who opt to pursue it, have the structural support they need, and are able to fully participate in their care plans. For some people with severe mental illnesses and treatment-resistant conditions, the opportunity to retreat from society and focus on getting well can create a chance to develop coping skills and strategies for managing mental illness. Inpatient treatment is not a bad thing, in and of itself. But abuses of inpatient therapy programs are, including those which torture patients, compel people into treatment without considering their rights as individuals, use outdated and inappropriate treatment methods, and lock people into the system without providing them with any tools for getting out.
Historically, mental health facilities were used as rubbish tips for the unwanted of society, including not just people with genuine mental illnesses but also people with cognitive impairments and those who didn’t satisfy their families; mental illness was highly gendered and women who didn’t behave could find themselves institutionalised until they ‘saw sense.’ Needless to say, none of these three groups got what they needed from their stays in institutions, and the widespread habit of institutionalising the inconvenient lasted well into the 1980s.
Today, some mental health facilities and institutions provide excellent care, offering very high standards to patients and focusing on fighting the legacy of institutional treatment. Others are cesspits, including some that have been forced to close in the wake of lawsuits and other legal actions because of civil rights violations and human rights violations. Pop culture often seems unable to distinguish between the two, and it seems unable to grasp the idea that being an ‘innocent’ person in an institution is a more complex problem that they’re making it out to be. It’s not just that a brave sane protagonist is trapped in with all the crazy people, unable to get out, but that institutional abuses of mentally ill people continue to this day.
People who haven’t received inpatient treatment or interacted directly with those who have may not understand the role mental health facilities play in society. They certainly don’t get a fair assessment from pop culture: the reason mental health facilities, closed institutions, and psychiatric wings in hospitals are scary isn’t the crazy people, but the terrible history, and in some cases the horrific present, in those facilities. Because no one deserves to become a subject of experimentation, torture, and abuse, sane or not. And everyone deserves access to compassionate, appropriate health care.
Changing the framework of the narrative on institutions, of course, requires rethinking the view of mental illness. If mental illness is viewed as a socially neutral thing rather than a negative trait, suddenly, the understanding of institutions and their role in society changes radically.