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The Horror of the Mind: How Mental Illness is Depicted in Psychological Horror

Writer's picture: Bryan AlaspaBryan Alaspa

A girl with numerous scary faces around her to depict mental illness in horror

Psychological horror taps into the deepest fears we hold—those that don’t rely on jump scares, gore, or monsters lurking in the shadows but rather stem from the mind itself. It’s the genre that makes us question reality, sanity, and how far the human mind can unravel. At its core, psychological horror often revolves around mental illness, exploring the frailty of the mind and blurring the line between what's real and imagined. For horror fans, this genre provides a unique experience: one that terrifies because it feels all too real.


In this blog post, we’re diving into the portrayal of mental illness in psychological horror—how it’s used to unsettle audiences, reflect societal fears, and craft some of the most disturbing stories in the horror fiction genre. Let’s explore the eerie landscape where horror and psychology intersect.


The Frightening World Inside Our Heads


What makes psychological horror so chilling is its focus on the human psyche. Unlike supernatural horror, which often allows the audience to distance themselves from the horror by saying, "Well, ghosts aren't real," psychological horror brings the terror to a place we can all relate to: our minds. It forces us to confront the fragility of our mental state, making us wonder how close we might be to experiencing the same breakdowns as the characters we see in these stories.


Movies like Black Swan and The Babadook do this masterfully. These films focus on characters struggling with deep-rooted psychological issues—grief, depression, and even schizophrenia—using these conditions to create a suffocating atmosphere. The horrors in these stories aren't from outside forces but from internal battles, where the real terror is the fear of losing control.


Mental Illness as a Gateway to Horror


In many psychological horror stories, mental illness serves as a catalyst for the horror. It drives the plot forward and heightens the tension by making us unsure whether the terrifying events are happening in reality or are simply in the character’s mind.


Take The Shining, for instance. Jack Torrance’s descent into madness is one of the most iconic examples of mental illness in horror. As the Overlook Hotel slowly takes hold of him, it’s hard to distinguish where Jack’s pre-existing psychological fragility ends and the hotel’s supernatural influence begins. This ambiguity is central to psychological horror: are we watching someone succumb to external forces or watching their own mind unravel?


Similarly, in American Psycho, Patrick Bateman’s sociopathic tendencies are amplified in ways that make the audience question whether his murderous fantasies are real or just delusions. The horror in American Psycho is not just in the violence but in the terrifying possibility that the human mind can create such chilling, detached perspectives.


Sympathetic Monsters or Misrepresentation?


While psychological horror can be compelling, there’s always the risk of misrepresenting mental illness. Some argue that horror often demonizes mental illness, turning characters with psychological disorders into the “monsters” of the story. Films like Psycho and Split have faced criticism for portraying people with dissociative identity disorder (DID) as dangerous killers, perpetuating negative stereotypes.


However, there are also more nuanced portrayals, where mental illness is treated with depth and empathy. The Babadook, for example, explores grief and depression through the metaphor of a monstrous entity, but it’s not the character’s mental illness that makes her a threat—it’s how she suppresses and avoids dealing with it that gives rise to the horror. Hereditary does something similar, focusing on family trauma and mental illness as generational curses, making the horror a deeply personal and emotional experience.


These kinds of stories show that mental illness can be explored in psychological horror without reducing characters to mere stereotypes. Instead of demonizing them, these works show how untreated or misunderstood mental illness can create tension and fear—both for the character and those around them.


The Unreliable Narrator: A Staple of Psychological Horror


One of the most popular tools in psychological horror is the unreliable narrator, a character whose perception of reality is distorted by their mental state. This device keeps audiences on their toes, making us question whether the events unfolding are real or imagined.


In Fight Club, we follow the narrator’s chaotic journey through insomnia and dissociative identity disorder, only to realize that his split personality, Tyler Durden, is a figment of his imagination. Similarly, Shutter Island keeps viewers in the dark about Teddy Daniels’ true mental state until the gut-wrenching twist at the end.


These stories play with the idea that the mind is inherently unreliable, and by aligning the audience with an unstable character, the horror feels more personal. You’re not just watching someone’s mind break—you’re experiencing it through their eyes.


Mental Illness as Reflection of Society's Fears


Psychological horror, particularly in its portrayal of mental illness, often reflects societal fears about mental health. In the past, mental illness was largely misunderstood and stigmatized, and horror stories from earlier eras (such as Dr. Jekyll and Mr. Hyde) played into those fears. Characters with mental disorders were often depicted as villains or “others” to be feared.


Today, while there is more understanding and empathy toward mental health issues, psychological horror continues to play on our anxieties about losing control. The fear of breakdowns, isolation, or being perceived as “crazy” remains a potent source of horror because, even in modern society, mental illness can feel isolating and overwhelming.


Why Psychological Horror Stays With Us


What makes psychological horror so effective—and terrifying—is its ability to linger long after the story ends. Whereas a jump scare may only last for a moment, the themes explored in psychological horror can stick with you for days, weeks, or even years. It raises unsettling questions: What if I lose control? What if I can’t trust my own mind?


For horror fans, this genre offers a unique kind of thrill. It’s not just about being scared—it’s about facing the complex, often terrifying realities of the human mind. Mental illness, in all its forms, makes psychological horror feel personal, intimate, and disturbingly close to home.

So, next time you find yourself drawn into a psychological horror story, remember: the scariest thing might not be the monster under the bed, but the one hiding in your head.


My latest novel is a psychological horror tale called Newcomers. You can pre-order it here.


Also - if you'd like to check out all my works of horror, visit my Amazon store!

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