Haunted asylums are a Halloween staple. Does the fictional gore undermine psychiatry’s good? | GUEST COMMENTARY

Located just over an hour from Baltimore, Field of Screams in Lancaster County, Pennsylvania, has been scaring Halloween fanatics for more than 25 years. Among its atractions is its "Frightmare Asylum," which urges visitors to "feel the fear as you meet the disturbed doctors and nightmarish nurses who have taken up residence here." (Handout/Field of Screams)

As a holiday of contrasts, Halloween celebrates sweetness and superstition — trick or treat. Traditions range from pumpkin carving and candy eating to the personification of werewolves and ghosts. Yet as adults seek thrills in haunted houses and horror movies, one common and disturbing motif is the “gorification” of the seriously mentally ill.

Haunted houses across the country leverage settings, actors and props around the theme of mental illness. A New York City exhibit depicts an asylum with actors portraying psychiatric patients. Patrons can visit “the shock doc” for an interpretation of electroconvulsive therapy (ECT) and “the phobia room” for fear-induction. Advertisements show blood-soaked patients in hospital uniforms. A similar attraction in an abandoned hospital in Pennsylvania that is historically known for its mistreatment of the mentally ill is touted as the country’s “top-rated haunted house.” Dozens of horror films follow this theme, as well, with the plot twist hinging upon a psychiatric diagnosis.


As psychiatrists, we must ask: Why do people find a thrill in the details of others’ suffering?

For most laypeople, the inside of a psychiatric facility remains a mystery. The horror industry flaunts extreme versions of these institutions for profit. Perhaps we can trust consumers to recognize this. But for those of us working in these facilities, and for patients who find hope in these spaces, the risk of misrepresentation is unsettling. At their best, psychiatric institutions prioritize dignity, autonomy and healing.


Compared to Hollywood’s interpretation, ECT is refreshingly boring. We use ECT to induce a seizure that treats a range of medication-resistant illnesses. Patients receive anesthesia and muscle relaxants before their doctors deliver a short-lived electrical current. The process is brief, still and quiet.

As film consumers, we must note that the reliance upon mental illness to satisfy the thrill factor is increasingly unoriginal. Aside from the obvious dramatizations and concern about propagating a deep-seated stigma, the novelty is completely gone. Yet people keep seeking out these simulated horrific experiences.

For some, it appears thrill-seeking is an aspect of neurobiology. When exposed to a stimulus that induces a fight-or-flight response (i.e., a loud, lurking villain), individuals vary in their respective hormonal cascade. Those who detest thrill experience a spike in cortisol, the “stress” hormone. Those who instead experience a dopamine, or “pleasure,” hit will find these experiences enjoyable and continue to seek the next greatest thrill.

Evidence from other neurobiological models concludes that dopamine responses attenuate over time with the same stimulus. Therefore, when you watch the same movie, subsequent dopamine hits will not rival the original. This may explain why horror content seems eerily distant from the traditional thematic characters of Halloween like ghosts and goblins. Conceivably, the public needs a new locus of fear. One that is much more real.

Perhaps in the future, the horror genre will shift from scapegoating mental illness to something less problematic. Maybe our habituation to routine horror paves the way for something more complicated, satirical or sinister. Recent films already accomplish this. Jordan Peele’s “Get Out” offers horror-based social commentary that criticizes performative progressivism. Bong Joon-ho’s “Parasite” won acclaim for its chilling depiction of a family living secretly in a basement, in poverty. Galder Gaztelu-Urrutia’s “The Platform” is a disturbing portrayal of classism and inequity. These films harness gore and suspense to further moral imperatives.

We wonder what opportunities the haunted house as an art form is missing. Where the plot of zombified psychiatric patients is limited, the potential to expose inequity, civil unrest or climate change in a crafted narrative is boundless. The idiosyncrasies of the haunted house — immersive sets, props, animatronics, sound effects, media and actors — are ripe for a conceptual transformation. Perhaps, at its best, a haunted house can challenge us to question who we are and where we are heading.

We do not intend to ruin the simplicity of Halloween with moralizing. But we fear that sensationalist horror risks distorting public perceptions of psychiatry. And the role of horror in portraying serious mental illness as mysterious or diabolical may deter patients from seeking treatment and their families from understanding their experiences. As psychiatrists, we grapple with whether haunted houses styled as asylums are serving as distorted reminders of a past we must never forget — or of a present that is crying for change.

Dr. Emily Phelps (, Dr. Shruti Mutalik and Dr. Jacob Appel are psychiatrists at Mount Sinai Hospital.