There is certainly peril for those who like horror films and simultaneously practice psychiatry. There is even greater peril for those who like horror films and who are also staunch advocates for decreasing the still pervasive prejudice towards psychiatry and psychiatric illness. For many horror films, after all, the go-to villain, the particularly devious and evil monster, takes its cues from psychiatry. This poses certain philosophical challenges.

Do you recall the famous scene with the psychiatrist in John Carpenter’s Halloween? The doctor details with a kind of dumbstruck awe the total absence of conscience and empathy in the suspected killer. This scene demonstrates the recurring horror trope of the automaton who kills for no reason. It is an irresistibly easy horror narrative, but it is also potentially highly stigmatizing. 

Horror is, after all, about self and other. Michael Meyers in Halloween is the other. The people he attacks are you and me. In this way, horror has a dangerous tendency to slide into a demonization and even a de-humanization of the villain. This stops us from looking more closely at our uncomfortably mirrored responses to the threats that these antagonists bring to our lives.

At the end of the day, horror movies can be terribly stigmatizing to both psychiatry and psychiatric disease.

Except some horror movies are just the opposite.

As a horror fan, I’ve found myself constantly in search of my special version of the horror genre’s holy grail. These are movies that use as their playground the complexities of the mind and all of the nuanced tricks it can play. We experience fascination as well as a not-a-little dread as we confront the unsettling lack of certainty that the protagonists experience. In these films, and it is an oversimplification to call them simply psychological horror movies, we feel uncomfortable, the characters in the movies feel uncomfortable, and we never quite resolve our uneasy emotions. Empathy, even with that which frightens us, is coaxed from the dark pit of not-knowing.

This is also uncomfortably a metaphor for the essential paradox of psychiatry. A pneumonia is a pneumonia because there are symptoms of pneumonia. There is also an elevated white blood cell count, and, most importantly, a corresponding chest x-ray showing inflammation in the lungs.

But psychosis

The patient says he hears a voice. We don’t hear the voice. No one else hears the voice. So how do we really know there’s no voice? Some have noted that the presence of activity in the auditory cortex of patients with auditory hallucinations proves that the hallucinations are coming from the brain. But if sound only exists because the auditory “cortex” hears it, how can we say with certainty that someone who hears a hallucinatory voice isn’t just hearing something no one else can hear?  We decide, by convention, that the voice isn’t there, but we never really know.

I’m of course being a bit cheeky. I don't think there’s a voice other than the one that a person unlucky enough to suffer a psychotic disorder thinks he or she hears. But I know that the same argument could be made of migraines, and yet no one stigmatizes migraines. Let’s face it. Migraines don’t add much to a narrative, psychosis does.

For me, the Holy Grail of horror are the movies where we never really know whether the protagonist experiences what he says he experiences. With that in mind, may I suggest a few of these gems, almost always from independent movie houses, where this theme of uncertainty roams freely? If you choose to watch these during Halloween tomorrow, perhaps camped out at the front door with your bowl of candy for the kids, know this:

These are not gory films. These are unsettling films. These films will make you think. These films will make you question reality. 

If you have some of your own, please feel free to chime in with your suggestions. After all, I need some movies to watch on Halloween as well.

1. They Look Like People (2015): This indie gem is a bare-knuckled look at two buddies as they negotiate their friendship in the setting of what appears to be burgeoning psychosis. This movie also gets my prize for best title of the year.)

2. Resolution (2012): Another buddy film, with one friend trying to save the other from the throws of addiction and trauma despite the fact that there may (or may not) be much more sinister things in the woods where they’re holed up.

3. Martin (1978): I know George Romero made terrific zombie films, and I had the good fortune to talk to George many times about his creations. But if you wanted to see George’s eyes twinkle, all you had to do was to ask him about Martin. Is Martin a vampire? Or does he just think he’s a vampire? Have others just told him so often that he’s a vampire that he has to go along with it? This is one of favorite vampire movies, and though it is hard to find (you’ll probably have to hit up the library), it is so worth the trouble. 

4. The Invitation (2015): I can’t even discuss this without spoiling it, but know that the last 15 minutes are as thought-provokingly unsettling as anything I’ve ever seen on the screen.

5. Habit (1995): The mystery in Larry Fessenden’s evocative vampire movie isn’t whether there’s a vampire in the movie. It’s hardly a spoiler when I tell you that there’s a vampire in the movie. The mystery—in fact, the very source of the unease—is brought about by the rebirth of life and purpose that the human protagonist experiences as he increasingly communes with the bloodthirsty but nevertheless powerfully enticing female ghoul. What’s worse, we are forced to ask. To be aimless and disconnected, or to be connected with the singular and yet devoted purpose of a beautiful vampire companion?

6. The Alchemist’s Cookbook (2016): An apparently lonely and psychotic man camps in an old mobile home in the woods, attempting to conjure a demon. You decide whether he’s successful. It's really hard to tell.

Please me know your suggestions. I've got a lot of time tomorrow night to watch stuff while I hand out candy to the neighbors. 

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