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The H Word: Mental Health, Ableism, and the Horror Genre

Our genre isn’t known for its warm and compassionate embrace of disability. From physical disfigurement to mental illness, those with disabilities are an all-too-convenient Other to demonize. The current battle for greater inclusion in the genres continues to shed light on those stories and voices that have been excluded. As we look beyond race, gender, and sexuality for inclusion and representation, ability is vital for us to reexamine. With the epidemic of mass shooters and the opioid crisis showing no end in sight, American culture is starting to rethink our approach to mental illness. Nick Jonas is doing mental health PSAs for Cigna—that’s a watershed moment. We have an opportunity here and now to take the horror genre into fresh territory. That’s going to mean rethinking and dropping our clichés about mental illness.

This is not an essay of politically correct bluster and offense. This is about worn-out clichés and their effects on the quality of the writing itself, let alone on the readers. As a person with no physical disabilities, I won’t be tackling that area of ableism in the genre. As someone with a personal and family history of mental illness, I’ll do my best. First, let’s get a handle on the terms “crazy” and “mental illness.”

Many of our villains, and some protagonists, are “crazy.” This is a catchall term for anyone whose personal reality doesn’t match the traditional or popular definition of reality, and they’re usually extreme. Maybe they hallucinate (Videodrome). Maybe they’re delusional and at times believe themselves to be another person entirely (Psycho, Friday the 13th). Maybe they just think murder is fun.

Mental illness, on the other hand, currently includes everything from depression and anxiety to drug and alcohol addiction to schizophrenia. It’s clear that most (indeed, most) of twentieth century horror film and fiction had no idea what schizophrenia actually is, often confusing it with dissociative identity disorder (DID, also/formerly known as multiple personality disorder). Schizophrenic people are rarely a mortal threat to anyone but themselves, if even. Those with DID are no more likely to kill than anyone else. The idea of a bloodthirsty killer tucked into the fragmented psyche of a mild-mannered neighbor is at least as old as The Strange Case of Dr. Jekyll and Mr. Hyde (1886). It’s much older if you include legends of werewolves and other predatory shape-shifters.

From a professional, artistic, and critical perspective, this is just lazy writing. It was fresh when Stevenson did it over a hundred years ago, but as creators we would do well to get past these overused plot points. Let’s not call them a “crutch” in the current context. Sure, the fear of the unknown is the oldest and most potent fear, etc., and mental illness is scary and unpredictable. But mental illness is especially scary for the people who are mentally ill. Poe, Shelley, Lovecraft, Dick (Philip K.)—all lived lives shaped by mental illness, and each drew from this experience to create great works of storytelling. Consider how each uses their creative talents to portray mental illness, neurosis, paranoia, addiction, and other conditions in a more personal way than the stab-happy murder machines that ruled the eighties. That decade came to an end thirty years ago.

The lack of research by writers into sanity and neurosis is clearly a problem. We live in a time in which psychological conditions such as OCD, antisocial behavior, and PTSD triggers have been robbed of their significance in our common conversation. Hating clutter doesn’t make you obsessive-compulsive. Trigger warnings are for trauma survivors who cannot avoid reacting in panic to depictions of rape or violence; they aren’t for angsty young people who don’t want to encounter uncomfortable material in the classroom. And, if I may really get up on this soapbox, stop saying “antisocial” when you mean “introverted.” Antisocial personalities are “characterized by a long-term pattern of disregard for, or violation of, the rights of others. A low . . . conscience is often apparent, as well as a history of crime . . .” This quote is from Wikipedia for heaven’s sake. Google it.

To reduce such inaccuracies, start by doing your homework like a professional. By all means, write about mental illness, but do it with an accuracy (and, if you don’t mind, some empathy) that stands up to real world experiences of disease and disability. Extremes are our sandbox in the horror genre, but consider how commonly your peers are presenting the rarest cases. Has someone written murder and torture in ways that you probably can’t top? Then don’t; find your own angle and create something new.

It’s challenging, though. Some mental illnesses may be unavoidable in our genre—are we really going to promote the idea that spree killers are “differently sane,” even healthy? Don’t be PC about it, but be socially just: someone who rapes and kills repeatedly, or who walks into a house of worship and guns down dozens, is almost certainly mentally ill, but they’re very unlikely to be schizophrenic. Psychopaths and people enduring psychotic breaks very likely make up the majority of serial, spree, and mass murderers. I’m not a psychologist or a scientist, and I’m not sure where to look for that data (I, too, need to do my homework). I do know from research that many psychopaths and sociopaths don’t commit acts of personal violence, but they do tend to excel in business and politics, and that’s no joke.

Some tropes are still fruitful, and all they need is a little reinvention or updating. Although gaslighting has been a trope for a century or more, it’s still fresh and scary as hell. Gaslighting, for those unfamiliar, is a form of abuse in which the perpetrator manipulates the abused by making them doubt their reality, memory, and sanity. This happens far more frequently in the real world than spree killers. Many readers know what I’m talking about. It’s especially scary when the target of the manipulation has a history of mental illness, mistrusting their own senses already. While an unreliable, mentally ill narrator or protagonist is nothing new, we’re still finding ways to make them fresh, and gaslighting is tried, true, and scarier to many of us than a masked madman with a knife.

Complicating this trope are examples such as Angela/Peter in Sleepaway Camp, whose manipulative and clearly mentally ill aunt misgendered and gaslighted the character into a new identity. This child’s bloody rampage seems to be a direct reaction to years of mental abuse, but that nuance was lost for decades on audiences. Most viewers only think of the film’s closing shots of the femme Angela, naked and presenting male genitalia, while wild-eyed, hissing, bloody, and holding a knife. Countless other films and stories lay the blame of the killer’s derangement on an abusive mother figure, especially if she was promiscuous and neglectful. This is pure misogynist fantasy, utter slut-shaming bullshit. Plenty of people had neglectful moms; some had mothers who did sex work to get by. We don’t see the killer’s rampage inspired by his mother’s boyfriends or johns nearly as often as the blame is laid on Mom herself. As a creator, you can do better than this.

Does a murderer need to be batshit crazy in order to kill multiple people? Why can’t Pamela Voorhees simply murder all those horny camp counselors out of grief and obsessive revenge? This would still be a form of mental illness, but on top of this grief, Mrs. Voorhees speaks in her own son’s voice—“Kill her, mommy!”—in a kind of inverted Norman Bates delusion. Personally, I want to see some (fictional) mothers kill a bunch of horny teens because they want to, not because their dead son has possessed their psyche. Maybe I’ll go write that story.

Other crazy slasher tropes have died out due to social and medical progress. For instance, we seem to have left behind the cliché and repeated portrayal of trans characters as villains, perverts, and clowns. For decades in the horror genre, gender identity was sewn to DID, schizophrenia, and murder. The trope of the insane, murderous crossdresser was prevalent. No distinctions were made between transvestites (those who dress as the opposite sex for thrill or escape), people with schizophrenia (the possible illness of Norman Bates, who thought he was literally his own mother), people with DID (likely the villain in Dressed to Kill, who adopts a separate female persona when killing), and transgender people, whose gender identity simply doesn’t match the one enforced on them since birth. Penny Dreadful introduced an intriguing and dignified trans character a few years back with Angelique, but she was quickly reduced to a plot device to support the arc of a more prominent character. Then she was murdered. The Silence of the Lambs attempted to tear down the cliché of the crazy trans person, but the exposition adds up merely to “he’s not trans, he’s just insane.” This effort to reduce prejudice against trans folks rests on the ableism of demonizing the mentally ill, and it still connects the two.

For more and better alternatives, look around. Read widely and beyond your comfort zone. I love the various versions of the Chinese-Buddhist Journey to the West, in which demons and monsters can be rehabilitated, often with their own consent. To merely kill them would be a waste of a good monster. For something Western and modern, Shirley Jackson routinely explored mental illness in ways that articulate the experience in compelling and succinct ways. Mary Katherine Blackwood, the narrator of We Have Always Lived in the Castle, is one of the most interesting in English-language literature precisely because of her sympathetic mentally ill perspective.

Loving the horror genre doesn’t mean there’s anything wrong with you. You know this. Loving slasher movies and gore doesn’t make you a pervert or less sophisticated than an opera fan. Opera is a genre brimming full of murder, for what it’s worth. Likewise, loving a good old-fashioned crazed killer doesn’t make you a bad person, but continuing to add to outdated and prejudiced tropes does make you a less interesting artist. Do not doubt: no matter who you are—and I’m talking especially to the traditional majority here—you have a unique story to tell. I’m white, male, and from a middle class upbringing, but believe me, I’ve seen some shit, especially growing up in Florida.

So I ask you, dear writerly reader: do you want to churn out endless discount Buffalo Bills, or will you reach into your own abyss and see what fresh perspectives you can dredge up? Do your homework, and don’t forget to delve into your own experience. Norman Bates got one thing right: we all go a little mad sometimes.

Evan J. Peterson

Evan J. Peterson is an essayist, journalist, fiction author, poet, professor, and editor living in Seattle. He’s the author of Skin Job and The Midnight Channel and editor of Lambda Award finalist Ghosts in Gaslight, Monsters in Steam: Gay City 5. His writing can also be found in The Myriad Carnival, Nightmare Magazine’s “Queers Destroy Horror!” issue, Weird Tales, The Stranger, The Queer South anthology, Arcana: The Tarot Poetry Anthology, and Drawn to Marvel: Poems from the Comic Books. His first nonfiction book was published by Lethe Press in 2017, and he also reads tarot for international clients. Check out for more.