Films set in mental institutions have long captivated audiences; consider, for example, The Snake Pit (1948), One Flew Over the Cuckoo’s Nest (1975) and Girl, Interrupted (1999). Films that begin with a patient leaving a mental institution can be equally gripping. By “begin with” I mean that, within the first third of the movie, we either witness the patient leaving a hospital or learn about his or her recent commitment. By “leaving” I mean the patient has been released or has escaped. The 32 films compiled here, in chronological order, all build on the tension of a mental patient’s readjustment—or re-maladjustment—to society.
Eighteen of these 32 films are dramas and comedies. The rest are horror films and thrillers. Most are North American films. Otherwise, these are films that gained an audience in North America. Nearly all center on white, middle- to upper-class characters. Twenty of the 32 films present discharged or escaped patients who are male, while ten center on female patients and two on both male and female patients.
As for era, nine of the 32 films here are contemporary. Released between 1988 and 2012, they offer the subgenre’s most authentic depictions (e.g., David Cronenberg’s Spider). Eleven of these films were made between 1904 and 1966. The five earliest are all about escapees yet they span genres, laughing off mental illness via slapstick or heightening anxiety about it via melodrama and mystery.
A golden age for this subgenre, offering twelve films, lasted throughout the ‘70s and into the early ‘80s. The abundance reflects deinstitutionalization, a mental health movement that began in the US in the ‘60s and served to reduce need for permanent care. During this time, many patients with mental disorders were able to reintegrate into society thanks to advances in antipsychotics, new government programs like Supplemental Security Income (SSI), and a wider array of community mental health services.
A marker of these films as a subgenre is how often their introductions rely on either the commentary of a mental health professional or a traumatizing backstory as a plot device; elements that are combined in no less than eight films. Trauma is pivotal, if overdetermined. Narratively, cinema tends to oversimplify the onset of a character’s mental illness by rooting it tidily in a single trauma. This is called the “presumption of traumatic etiology”, a term used by Steven E. Hyler, M.D., Professor of Psychiatry at Columbia University Medical Center, in his Comprehensive Psychiatry article, “DSM-III at the Cinema”.
Another recurring myth is that of the “schizophrogenic parent”, which roots mental illness in a person’s upbringing. Most commonly it’s a mother who is blamed for creating mental illness in her child. The theory has been out of favor among therapists for decades but has endured in films and how audiences read them.
The vulnerability of a newly released mental patient is a major factor in this subgenre, as is the vulnerability of a community into which a mental patient has escaped. Ranking the vulnerability of the patient on a scale of zero to five, with five being most vulnerable and zero being least vulnerable, only one of the women ranks below three, whereas men occupy the full range evenly.
How do gender, class, and race play into this vulnerability factor? Of the female characters starting new lives, only one is of a lower class and therefore doubly vulnerable. Even she, the escapee in The Woman in White, is less central to the plot than her upper-class foil (played by the same actress). As for race, minorities in mental institutions were long vulnerable to scientific racism and biased care, facing hostile limitations upon reentering society. Despite the dramatic potential, not one of the 32 films center on the experience of a racial minority.
So it is not greater vulnerability exploited in these films, but bourgeois vulnerability and privilege lost, privilege regained, privilege at risk. This rings true as well for escapee-killer movies in which privileged households and communities come under siege.
I must own up to my own fantasy of the nervous breakdown as a fantasy of privilege, induced by cinema and reinforced by this list. Eleven of the ostensibly recovered protagonists return to spacious, well-to-do homes; four can afford adventures; and five come to live in smaller yet cozy apartments. Only four start their new lives facing insufficiency or homelessness, in Touched, Sling Blade, Spider, and Clean, Shaven.
The latter three certainly qualify as the most hard-hitting and realistic dramas on the list. They also echo what the American Psychological Association (APA) considers an enduring truth, supported by study after study over decades: lower socioeconomic status is a risk factor for, if not a cause of, mental illness and psychiatric institutionalization.
These 32 films cohere as a subgenre even in their variations. Plot remains similar from film to film while tone mutates: absurd, inspiring, campy, gritty, or brutal. Portrayal of mental anguish bends from realistic to ridiculous, provoking sympathy and fear in turn. Sensitivity and insightfulness continually fluctuate alongside stereotyping and psychobabble, revealing decade-to-decade shifts in perceptions and practices. Furthermore, the films cross several genres, or bridge them, while ranging from obscure to ubiquitous, from cult classics and drive-in fare to Oscar winners.
Going by these films, there’s not much reason to have faith in the security of mental institutions that house seriously psychotic patients, nor in the judgment of psychiatrists who release patients too easily destabilized by dysfunctional family or an aggressive society.
Indeed, in these films, newly re-stabilized characters tend to find themselves at the mercy of the unstable. They must adjust to the maladjusted. They are forced to accept being judged by others whose outwardly normal-seeming, yet in closed environments clearly toxic behaviors, have never themselves been subject to therapy, diagnosis, or stigmatization; thus, power is wielded over the mentally disenfranchised.
Whether underdog or maniac, or underdog predisposed to seeming like a maniac, a character who has emerged from a mental institution embodies dramatic tension. If an escaped patient is not returned to the institution, society may be at risk. If the released patient does not adjust to society, he or she may be at risk of return to the institution. Consequently, post-institutionalization operates in these films as a framing device that heightens the meaningfulness of every action, every dialogue. There’s everything to lose.
1. The Escaped Lunatic (dir. Wallace McCutcheon, 1904)
The success of this silent short film prompted an exact remake later the same year, Maniac Chase (dir. Edwin S. Porter), and similarly themed fare cashing in on the comedy of madness. The lunatic in this case believes himself to be Napoleon, dressing in the iconic uniform and bicorne hat. Asylum warders treat him so poorly that he jumps from his third-floor window to get away. A slapstick pursuit ensues, circling back to the asylum where the escapee returns himself to his cell. His warders find him there, reading a newspaper as if nothing’s happened.
The Napoleon costume would have been understood as comic code for generalized lunacy, if not delusions of grandeur specifically. Stan Laurel’s debut film role, in Nuts in May (1917), was also a Napoleon-dressed lunatic on the loose.
2. House of Darkness (dir. D.W. Griffith, 1913)
At the center of Griffith’s dramatic short film is the unforgettable shot of an escaped lunatic (Charles Hill Mailes) warily peering around a tree, both childlike and deranged. He crawls into the window of a doctor’s house and menaces the wife (Claire McDowell), home alone. Her piano playing saves her, soothing the psychotic man. The narrative then veers from pearls-clutching thriller into public service message about the curative powers of musical therapy, a form of therapy just beginning to gain credibility (the first national association of musical therapists was founded in 1903).
3. The Woman in White a/k/a The Unfortunate Marriage (dir. Ernest C. Warde, 1917)
Wilkie Collins’ The Woman in White from 1859, one of the very first mystery novels, spawned seven film adaptations between 1912 and 1948. This full-length silent feature begins with the woman in white (Florence La Badie) escaping from an asylum. She was never insane, however, but a half-witted victim. The backstory is that she’d witnessed the misdeeds of a nobleman and institutionalization effectively silenced her.
Once she’s escaped, she finds out the nobleman is engaged and warns his fiancée (also played by La Badie) against marriage. As one woman tries to help another undermine the male forces against them, involuntary commitment to a mental institution—or even the threat of it—is exposed as a tool that can be used against any woman.
4. A Bill of Divorcement (dir. George Cukor, 1932)
John Barrymore plays WWI veteran Hilary Fairfield, returning home “like a lost child” after 15 years in a mental institution. Discovering his wife (Billie Burke) has divorced him makes for powerful melodrama. More central to the plot is Sidney (Katherine Hepburn), on the verge of marriage, finding out that her father suffered not shellshock alone but latent insanity brought on by shellshock.
So insanity is in his blood and in hers too. Reflecting the era’s fixation on eugenics, which advocated sterilizing persons deemed genetically unfit, Sidney fears she may “inflict” on her husband either mentally ill children or her own impending breakdown. A remake of a British film from 1922, A Bill of Divorcement was remade again in 1940 with screenplay by Dalton Trumbo.
5. Road Show (dir. Hal Roach, 1941)
Drogo Gaines (John Hubbard) decides to ditch his gold-digging fiancée at the altar. When asked why, he bleats like a goat. This faking of insanity backfires, alas, as he goes from wedding chapel to booby hatch. The private hospital’s entrance sign may pun “For the Rest of Your Life” but Drogo quickly escapes, traveling off with a carnival owned by Penguin Moore (Carole Landis). There seems little difference between asylum kooks and carnival kooks, all more sincere than the respectable set attending the wedding at the start of this uneven but pleasant musical comedy.
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