Oct 10: Event Horizon (1997)


Why not start the weekend off with a Sam Neill double feature and have Event Horizon follow In the Mouth of Madness?! Taking place in 2047, Event Horizon depicts the events surrounding the ill-fatal rescue mission embarked on by the Lewis and Clark in response to distress signals dispatched by the Event Horizon, a ship that disappeared seven years prior. The vessel had ventured into an experimental flight to test a gravity drive, which if successful, would decrease the travel time between two points in the universe. Upon reaching the Event Horizon, many sinister events take place revealing the remnants of the crew from the previous mission. Slowly, the crew of the Lewis and Clark are pulled into the hallucinogenic trances of the Event Horizon with some of the lives of the crew being claimed. Desperate measures are taken to return to earth, which unfortunately prove futile.


Among the most striking parts of Event Horizon are the hallucinations envisioned by the members of the Lewis and Clark. While hallucinations are often synonymous with psychotic disorders, general medical conditions and substance use must first be ruled out. In the film, it is possible that the hallucinations are due to delirium induced by hypoxia. Many of the hallucinations of the crew members began when they entered the Event Horizon and had less than a day of usable oxygen for the entire crew. The impact of being in stasis, perhaps complicated by electrolyte abnormalities (inadequate intake), could also have contributed to delirium. Of note, at the end of the film, Starck awakens from an over-two-month period of stasis with a delusion that Dr. Weir is impersonating one of the rescue workers. This particular type of delusion is known as the Fregoli syndrome (Weir can assume intermetamorphosis).

The hallucinations, in Dr. Weir’s case, could also be as a result of pathologic grief. While adaptive bereavement may include guilt over actions taken or not taken with the deceased while they were still alive, it is pathologic when the guilt becomes pervasive and debilitating. In Dr. Weir’s case, his pathological guilt over his wife committing suicide results in hallucinations of her insisting that he stay on the Event Horizon.

The character of Ensign Justin depicts the use of dissociation as a defense mechanism. After witnessing horrid images from the gravity core, he enters a catatonic state. When the catatonia resolves, he demonstrates Acute Stress Disorder, constantly reliving the images he saw. This leads him to attempt suicide. His means underscores the principle that men use more lethal mechanisms for suicide, as he tries to leave the ship without a space suit. It’s interesting that a crew member on a ship named Lewis and Clark would prompt a discussion of suicide, as its namesake, Meriwether Lewis, was found with two gunshot wounds at a roadside inn at Grinder’s Stand, Tennessee on this very date in 1809. He died the next morning on October 11, 206 years ago due to wounds from his suicide attempt.

Oct 9: In the Mouth of Madness (1994)


We go back-to-back today with John Carpenter’s In the Mouth of Madness. Considered by Carpenter to be the final piece of the apocalyptic trilogy preceded by The Thing and Prince of Darkness, In the Mouth of Madness is told as a patient history. Dr. Wrenn performs a psychiatric evaluation on John Trent who discloses his history of present illness (HPI) that culminates with admission to an inpatient psychiatric hospital (where the movie begins).


John Trent is an insurance investigator who was recently hired by Arcane Publishing to investigate the disappearance of Sutter Cane, an author whose novels are purported to cause acute onset of disorientation, memory loss, and paranoia in their readers. The effects fit a diagnosis of delirium, specifically disturbances in cognition (including attention, orientation, and memory) that develop over a short period of time. The disturbance is a direct physiological effect of a medical condition or a substance. Since we see through the perspective of Trent, a closer investigation may reveal the etiology of his delirium (did he give a urine drug screen upon admission to the hospital?).

Trent’s investigation leads him to Hobbs End, the fictional town in Cane’s novels. There, he finds Cane who reveals that they are all characters playing a part in a larger story, the last “chapter” of which is captured in his new novel aptly named In The Mouth of Madness. Cane also informs Trent that his fans’ belief in his stories have freed an ancient monstrous race that will overrun the earth (i.e. the end of the novel and therefore, their ultimate fate).

In viewing the film, one must consider that Trent used cocaine upon being hired while reading Cane’s novel “to research” his new client (the “altered” eyes and nosebleed of the reader killed by Trent are symbolic of cocaine’s intoxication effects). His intoxication “got him caught up” in the novel, where he was unable to differentiate fiction from reality. The cognitive deficits and perceptual disturbances that are pervasive throughout the film are the result of cocaine-induced delirium. Trent’s feelings of derealization and loss of time query the use of lysergic acid diethylamide (LSD). Along with cocaine, LSD has a sympathomimetic effect, so their concurrent use risks sudden cardiac death. Perhaps Carpenter’s theme of the apocalypse is a metaphor for the public health crisis and economic burden of drug use and heart disease in the US.



One morning in 1940, the entire population of Friar, New Hampshire disappeared. 572 people left behind all of their possessions and walked together up a winding mountain trail into the wilderness never to be heard from again. A search party dispatched by the U.S. Army eventually discovered the remains of nearly 300 of Friar’s evacuees. Many had frozen to death while others were slaughtered. Over the years, a quiet cover-up operation managed to weave the story of Friar into the stuff urban legends are made of. The town has slowly repopulated, but the vast wilderness is mostly untracked, with the northern-most stretches off limits to local hunters and loggers. In 2008, the coordinates for the “YELLOWBRICKROAD” trail head were declassified.

The first official expedition into the sick and twisted wilderness will attempt to solve the mystery of the lost citizens of Friar. The researchers’ hopes to turn a legend into an item of recorded history are jeopardized when their equipment fails; leaving them lost and at the will of what evil lurks in the woods.


In our curriculum at Rutgers-RWJMS, we relate episodic illnesses (such as Delirium and Major Depressive Disorder) to ghost stories. In their quest for discovery, the ghosts from 1940 Friar will haunt a group of researchers, allowing for YellowBrickRoad to be discussed in the context of Delirium. Serial mental status examinations by Walter (a psychologist) reveal progressive cognitive decline in the group that is abrupt in onset. One researcher, Daryl, demonstrates alterations in cognition and consciousness incident to his discovery of a hat that bears a resemblance to that of Elphaba’s, but is more appropriately comparable to the (Mad) Hatter’s in Lewis Carroll’s novel Alice’s Adventures in Wonderland. The Hatter is a principal character who is portrayed as mad, asking unanswerable riddles and reciting nonsensical poetry. His reality parallels that of the expedition in that he is trapped in a never-ending tea party; time having stopped, keeping him and the March Hare at 6:00 pm forever. While the Hatter is portrayed as mad, the phrase “Mad Hatter” doesn’t appear in Carroll’s works. Instead, it refers to a delirium caused by mercury poisoning that can be traced back to the 19th century when mercury-based compounds were used to make fine hats.

Daryl’s delirium however is not caused by mercury poisoning but is likely due to anticholinergic toxicity from deadly nightshade. Atropa belladonna (deadly nightshade) is an anticholinergic alkaloid amine (plant metabolite), and is one of the 3 subgroups of alkaloid amines which also include the hallucinogenic alkaloid amines and the stimulant alkaloid amines. The film may therefore be conceptualized as a depiction of delirium due to the direct physiologic effects of Atropa belladonna, i.e. anticholinergic toxicity.

In addition to serving as a case study of delirium “spread” through mechanisms of Shared Psychotic Disorder (versus mass poisoning), YellowBrickRoad also references Jungian theory by teaching the archetypal warning of “losing oneself in the wilderness.” This may be taken both metaphorically, as the characters stray from their own rationality, as well as literally. The original townspeople’s abandonment of Friar has less to do with what they were walking towards and more to do with what they were leaving behind and has its roots in manifest destiny. Accordingly, Yellow Brick Road should be viewed along with other rural gothic narratives such as The Shining (1980) and its own reference, the ill-fated Donner Party (1846’1847).

Last week’s movie: Carrie (1976)
Next week’s movie: Wolf (1994)