From the fictional Smith’s Grove Sanitarium, to the very real Eastern State Hospital where John Carpenters The Ward was filmed, audiences can’t help but feel drawn into the psychiatric hospital setting, which promises both physical and psychological scares. In the realm of horror, psychiatric hospitals are referred to by their outdated, and now unused (or at least they should be) names like “mental institution” or “insane asylums,” most likely because those names are evocative of a time where psychiatric hospitals were a place of real-life horrors in the form of severe human rights abuse, major discrimination and stigma, and experimental treatments that tended to worsen mental illnesses or turn the patient into a vegetable.

Notorious psychiatric hospitals like Bethlem Royal Hospital,  once nicknamed bedlam, even functioned as a sort of zoo, where the public would come to observe the patients, or “inmates”, as they were often called. It was a terrible practice, and one that hasn’t entirely gone away. We don’t visit the hospitals anymore, but we do watch them through film. In some ways this practice has simply manifested itself into a more convenient technological form.

I’ll admit that I’m a sucker for any film set in an abandoned psychiatric hospital. Why? Because it scares me. Everything about it scares me. The film could be kind of awful and it would still scare me, mainly because it relies on actual terrible things that happened in the past, that make the word “asylum” automatically scary for people the images it conjures of padded cells and shock therapy.

But so much of the creepy atmosphere of the psychiatric hospital, abandoned or not, is because of the depiction of the patients: completely lost, drooling and spaced out or sadistic and hostile, prone to violence and rage and sexual perversion at any moment. Many horror movies and thrillers alike show scenes where patients are let out of their rooms or “cells” and wreak havoc upon the hospital, murdering orderlies and leaving a path of destruction.

It makes me question why I fall for the eerie allure. What does the horror genre obsession with psychiatric hospitals and mental illness say about the way we perceive those with mental illnesses? Does it scare us because we actually think that people with mental illnesses, especially those in psychiatric hospitals, are seriously dangerous? It’s right for us to think that psychiatric hospitals were really awful places in the past, and some still are today, but it seems like our idea of them is that they house people capable of extreme violence, people who are “sick and twisted” deviants of society.

The truth is, the patients aren’t like that. At least, not the great majority. In fact, people with mental illnesses tend to be a more of a danger to themselves than to others—think self-harm, substance abuse, and suicide. So no, the patients at a psychiatric hospital are not likely to be the next Michael Myers, and no, borderline personality disorder does not mean you have two utterly opposing good vs. evil personalities that rapidly switch back and forth between each other.

These are all misconceptions that horror movies rely on to deliver scares. The latter image, or some variation of it, is especially popular as a horror movie ending cop-out:  the main character is actually just “insane” and it’s all in their head (which, by the way, is very ableist language, so don’t use it!). In reality, people with mental illnesses like, for example, schizophrenia or dissociative identity disorder can live happy, functional lives when receiving adequate treatment—much like any physical illness.  While there definitely are cases of people with certain mental illnesses committing acts of violence, it’s important to note that this is not the dominant or driving force behind violent crime—not in the slightest.

Though I’ve questioned why I find these problematic films so appealing, I’ll admit that it hasn’t stopped me for being lured in by horror films with scenes in psychiatric hospitals—even if they aren’t entirely set there. But that’s also a part of engaging in any kind of media; we can’t always expect ourselves to banish all problematic media, because it’s an unrealistic expectation, We do, however, have to openly acknowledge what makes it problematic. In this case, while psychiatric hospitals are a certifiably scary setting sure to give anyone the creeps, viewers need to push themselves to not internalize the misconception that actual patients in these hospitals are sadistic serial killers.

Next week, I look at the problematic racist elements of horror movies that use histories of colonization and enslavement as their themes.

Financial conflicts of interest in DSM-IV and DSM-5 panelists. Courtesy of the PLoS Journal of Medicine.

The DSM-5 is the newest edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual—the book of mental illnesses. The tome has been around since the ’50s, and updated editions have reflected changing social norms— homosexuality was taken out in 1973.

Over its five editions, names have changed, symptoms have changed, and new illnesses have been added. This time around, a few things are raising eyebrows in the press and drawing lines between factions of mental health professionals and academics: the addition of a tantrum disorder in children, the amalgamation of Asperger’s and other autism spectrum disorders into one single spectrum, and premenstrual dysphoric disorder (basically extreme PMS). It’s a hard picture to piece together; conspiracy theories abound, and there’s a lot of finger pointing at good old Big Pharma.

The diagram above shows changes in financial conflict of interest in the panel members of the DSM-IV and DSM-5, and was published in the Public Library of Science Medicine journal in an essay entitled “A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists.” This sounds complicated, but trust me, once you get it, your eyes will pop.

 Lisa Cosgrove and Sheldon Krimsky’s essay and diagram, published more than a year ago in March, compares data on panelists working on the DSM-IV and the DSM-5. The DSM-IV came out in 1994 and the DSM-5 was released earlier this year, with specific changes to the panel process to increase transparency, something the APA had been criticized for in the past. This edition panelists were required to disclose their biases; pharma-related earnings were capped at $10,000 in payment and $50,000 in stock holdings per year.

There has been academic and journalistic criticism of the disclosure decision: disclosing a bias doesn’t actually erase it. Knowing what the conflict of interest is doesn’t ensure the panelist is behaving more objectively under more scrutiny. And what kind of scrutiny are they under, anyway? In the sleep/wake disorder category of panelists in the diagram above, for instance, 100 percent had known financial ties to pharmaceutical companies. Psychotic disorder panelists were at 83 percent. Granted, panelists may be very knowledgeable about their category—having worked in both treatment and development—but they are overwhelmingly tied to pharmaceutical companies as well.

We are (hopefully) moving towards the destigmatization of mental illness, and away from the mental illnessization of stigma. But these days, it’s hard to know where the actual information lies. Where in 1973 homosexuality was de-pathologized because of changing social norms, it’s hard to see that happening these days, when the people writing the book on mental illness are so intimately tied to pharmaceutical companies with very specific economic agendas. The DSM, in the past, may have reflected the evolution of the study of mental illness. Now conflict of interest makes it too murky to tell. The numbers themselves are shocking, and only the tip of the iceberg.