CUBE (1997)

SYNOPSIS

Cube is a SciFi horror film about a group of ‘subjects’ who awaken in a room with anterograde amnesia as to how (or why) they got there. The characters discover that their new prison cell is one of 17,576 rooms that form a government-sanctioned cube with booby-traps that impede their search for an exit. The strangers must overcome significant trust issues and work together to solve the puzzle of the cube to gain their salvation.

THE PSYCHIATRY OF CUBE

The original group of 4 characters finds Kazan, an occupant of the cube who is stricken with an adult autistic disorder, likely Asperger’s syndrome. Two psychiatric comorbidities affecting people with Asperger’s syndrome include Social Anxiety Disorder (SAD) and Posttraumatic Stress Disorder (PTSD). Cube serves to review these 2 disorders through analysis of its 2 main characters. The group travels silently through a room with a sound-activated trap. After Kazan makes a sound and nearly causes Quentin’s death, Quentin threaten’s Kazan. This interaction moves the narrative forward, as these 2 characters symbolize the yin-yang of the group’s efforts to escape.

Affecting 1 in 68 children (CDC, 2014), individuals with an autism spectrum disorder have high levels of psychiatric comorbidity including SAD. The film serves as a metaphorical platform to discuss the treatments for SAD including group therapy, flooding (in vivo exposure therapy), and novel psychopharmacological therapies such as 3,4-methylenedioxy-methamphetamine (MDMA). MDMA (ecstasy) produces effects characteristic of psychedelics (hallucinogens) and amphetamines. Renewed research interest in MDMA and anxiety builds on earlier studies of lysergic acid diethylamide (LSD) and psilocybin in treating autistic minors (misdiagnosed as having childhood schizophrenia). The drug’s hallucinogenic effect may also explain Kazan’s subjective reality of being imprisoned in the cubic colossus.

Another comorbidity of Asperger’s syndrome is PTSD. This illness is likely depicted by Quentin, a police officer. NMDA inhibits the activity of the left amygdala (lessens the fear response) while increasing the activity in the prefrontal cortex (Mithoefer, 2011) thus dampening the conditioned fear response. [Spoiler Alert] Kazan and Quentin are the last men standing, with the former leaving through the hatch into the bright light, a metaphor for a breakthrough in psychotherapy.

Last week’s movie: 30 Days of Night (2007)
Next week’s movie: A Perfect Getaway (2009)

The Texas Chainsaw Massacre (1974, 2003)

SYNOPSIS

The Texas Chain Saw Massacre is a film produced by Toby Hooper that follows a group of friends who fall victim to a family of cannibals while driving through the barren back roads of Texas. The film is credited with originating several elements common in the Pre-Michael Myers slasher genre such as the characterization of the killer as a hulking faceless figure. As such, The Texas Chain Saw Massacre was inducted into the Horror Hall of Fame in 1990.

THE PSYCHIATRY OF THE TEXAS CHAINSAW MASSACRE

Edward Theodore Gein was born on August 27, 1906, to Augusta and George Gein in La Crosse, Wisconsin. Despite being a cold and domineering woman, Augusta was all that Ed had following the deaths of his father and older brother, Henry. Unfortunately, on December 29th, 1945, Augusta died. Ed Gein’s life fell apart after he “lost his only friend and one true love” (Deviant [book] by Harold Schechter). Ed remained in the house after his mother’s death and developed a morose interest in taxidermy. On November 17, 1957, police in Plainfield, Wisconsin arrived at the Gein farmhouse. The more they looked through the farmhouse, the more human trophies they found, including a suit made entirely of human skin. The serial murders of Ed Gein inspired several movies including The Texas Chainsaw Massacre, making the film a graphic depiction of Antisocial Personality Disorder.

Gunnar Hansen was selected for the role of Leatherface who he regarded as being afflicted with Intellectual Developmental Disorder (IDD). To research and develop Leatherface’s mannerisms, Hansen visited a special needs school and watched how the students moved and spoke. Another faceless (goalie-masked) killer, Jason Voorhees (posted on February, Friday the 13th), was also scripted as having IDD. Not unlike individuals with Eating & Feeding Disorders, these 2 characters have significant difficulty describing how they feel, and therefore must rely on non-verbal means to communicate their emotions and unconscious conflicts. The Texas Chainsaw Massacre poses an interesting play on words; while depicting a character that communicates non-verbally like an individual with an eating and feeding disorder, Leatherface is part of a family of cannibals.

PSYCHO-NICITY

“Synchronicity’ is a Jungian term depicting the acausal connection of two or more psycho- physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. A triple feature of Psycho, The Texas Chainsaw Massacre and The Silence of the Lambs may be the most chilling movie series given that Ed Gein inspired the creation of all 3 films.

Last week’s movie: Skeleton Key (2005)
Next week’s movie: A Perfect Getaway (2009)

Skeleton Key (2005)

SYNOPSIS

We must have had a mishap crossing the Ole Miss, the Ole Man (Vacation, 1983), because I mistakenly substituted Skeleton Key for Interview with the Vampire. Nonetheless, in the former, Caroline Ellis takes a job as a live-in nurse to care for Benjamin, an elderly man suffering from the effects of a stroke. Through Luke, an estate lawyer, Violet Devereaux hires Caroline despite appearing put off by her Hoboken-esque appearance. Despite getting off to a rocky start, Violet entrusts Caroline with Benjamin’s health, and gives her a skeleton key that unlocks every door in the plantation house but one; she’ll unlock this door with the key of her imagination (Twilight Zone, 1963).

THE PSYCHIATRY OF SKELETON KEY

Skeleton Key is a film that depicts hoodoo (root work); a culturally sanctioned belief practiced in the southeast US.

It can’t hurt you if you don’t believe” to the final plot spin when Caroline enters the conjure room in the attic. This is the only room in the house that cannot be opened with the skeleton key, and can only be unlocked with faith.

The film also serves to review Benjamin’s portrayed affliction; cerebrovascular disease, likely subcortical vascular dementia (SCVD). SCVD, also called Binswanger’s disease, involves extensive microscopic damage to the small blood vessels in the white matter of the CNS. Benjamin’s character is accurate in that symptoms tend to begin after the age of 60 in individuals with history of stroke. The characteristic features of Binswanger’s demonstrated by Benjamin include lack of facial expression and speech difficulties. The latter is captured in the curative spell conjured by Caroline, “His words have gotten lost…lost and wandering in his mind…”

Last week’s movie: The Beast Within (1982)
Next week’s movie: Texas Chainsaw Massacre (1974)

THE BEAST WITHIN (1982)

SYNOPSIS

The Beast Within is a horror film loosely based on Edward Levy’s 1981 novel of the same name. The film opens in 1964 Nioba, Mississippi with newlyweds, Caroline and Eli MacCleary, stranded on a deserted road. Caroline is knocked unconscious and raped by an unknown entity. The film then picks up 17 years later in Jackson, Mississippi, and depicts the trials of the MacCleary family as it deals with unexplained symptoms of their 17-year-old son, Michael.

THE NEUROPSYCHIATRY OF THE BEAST WITHIN

The Beast Within may be viewed as a case study to review the signs of Neurofibromatosis type 2 (NF2), a hereditary condition most commonly associated with bilateral vestibular schwannomas, also known as acoustic neuromas. These benign tumors grow on the nerves of the inner ear and commonly cause tinnitus which is experienced by Michael throughout the movie as a cicada-like ringing. In the film, Eli and Caroline decide to confront their past and return to the small town of Nioba, Mississippi to hopefully discover some information about the man (Michael’s biological father) who sexually assaulted Caroline. The timing and nature of their search underscores 2 important facts; a) signs of NF2 usually develop in the late teenage years and b) NF2 is a hereditary condition.

Interestingly, Michael may also demonstrate mucosal neuromas (fattened lips of the beast), which along with his pituitary gland “going out of control” (adenoma), is consistent with Multiple Endocrine Neoplasia (MEN) syndrome type 1.

Last week’s movie: Laid to Rest (2009)
Next week’s movie: Skeleton Key (2005)

LAID TO REST (2009)

SYNOPSIS

Laid to Rest is a 2009 slasher film depicting the “amnestic protagonist.” It follows a young woman who awakens in a casket with amnesia, and her attempts to recover her lost memories, the most disturbing of which is that she’s a victim of a serial killer who taunts the police by videotaping his victims.

THE PSYCHIATRY OF LAID TO REST

An unnamed woman awakens to find herself in a casket, without any knowledge of where she is or how she got there. In fact, she demonstrates retrograde amnesia, unable to recall any long- term memory (episodic or semantic). She complains of a headache, and appears confused as she tries to escape the mortuary and its video-taping, sadistic inhabitant, ChromeSkull.

Locked in the embalming room, she is nearly rescued by an elderly mortician with a “lazy eye” (cranial nerve palsy) before ChromeSkull impales him. We later learn upon discovery of one of the video tapes that Mr. Jones was an accomplice, Chrome Skull’s Renfield, who regained compassion for the girl before being killed in an attempt to rescue her.

Upon her escape, the woman flags down a lone passer-byer, Tucker, who refers to her as “Princess.” As the story unfolds, Princess’s psychiatric symptoms (amnesia) combine with Tucker’s physical deficit (impaired gait) to derail their multiple attempts to reach safety.

Finally, we discover that ChromeSkull is a psychotic serial killer who has been abducting young women beginning in south Florida. He posed as a “john’ to abduct Princess, a prostitute who is seen on a video tape snorting cocaine just before being assaulted with a baseball bat (and ending up in a casket). While the details of Princess’s history explain her recent experiences including the headache, an alternative interpretation (scar notwithstanding) allows for an interesting psychiatric synopsis.

It may be reasonable to assume that Princess likely abused alcohol in addition to cocaine. Taken together, Laid to Rest may be interpreted as a case study of Alcohol Withdrawal, which can be reviewed in 3 phases. The first phase, uncomplicated withdrawal, results from cessation of alcohol thats use has been heavy and prolonged. Interestingly, the one criterion from the Clinical Institute Withdrawal Assessment (CIWA is the gold standard for symptom-triggered therapy) that is not included in the DSM-5 diagnostic criteria is headache.

The second phase, complicated withdrawal, is hallmarked by either seizures or hallucinations. The latter may be due to a) Alcoholic Hallucinosis or b) Alcohol Withdrawal Delirium (Delirium Tremens, DT’s). The third phase, Wernicke-Korsakov syndrome, may begin with a triad of confusion (Princess), ataxia (Tucker), and eye findings (Mr. Jones). If left untreated, Wernicke’s encephalopathy (confusion) may evolve into Korsakov psychosis (KP). KP is a likely irreversible neurologic syndrome characterized by amnesia (while Princess demonstrates retrograde amnesia, KP more commonly presents with anterograde amnesia/difficulty with encoding new memories), confabulation (the creation of false memories), and perceptual disturbances (psychosis). While ChromeSkull may represent “a psychotic serial killer,” he may only be a figment of Princess’s imagination; a product of her delusional belief system resulting from years of alcohol abuse and subsequent Wernicke-Korsakov syndrome. While the 3 forms of alcohol withdrawal are presented here as 3 distinct phases, they need not appear in any particular order. As confabulation is not depicted in the film, so too may alcohol withdrawal not include specific symptoms..

Last week’s movie: Jeepers Creepers (2001)
Next week’s movie: The Beast Within (1982)

JEEPERS CREEPERS (2001)

SYNOPSIS

Jeepers Creepers is inspired by actual events (Unsolved Mysteries). Since this blog was started on Easter Sunday 2015, exactly 25 years ago, Ray and Marie Thornton were terrorized by a motorist while playing “the license plate game” in Cold Water, Michigan. Also, like their counterparts in the movie, they later came across the van and discovered a bloody sheet. While the Thornton’s experience remains unsolved, the 2001 horror movie it inspired depicts the fate of siblings a 2001 horror film written and directed by Victor Salva that takes its name from the 1938 song first premiered by Louis Armstrong. The film is is Trish and Darry Jenner on their travels homefrom college during spring break in the Florida countryside.

On their way home, a mysterious driver attempts to run Trish and Darry off the road with his truck. After barely escaping a second time, Darry convinces Trish to double back to investigate
what they saw earlier at the “psycho version of the Sistine Chapel.” The two find an old woman (an oracle) who tells them of “The Creeper,” a demonic keeper of a “house of pain” who hunts
every twenty-third spring for twenty-three days by striking fear into its victims in order to smell if there’s something it likes. It then feasts on the terrified victims’ body parts to reconstitute and strengthen itself.

The eponymous “Creeper” is the reincarnation of Spring-heeled Jack, a supernatural entity of English folklore of the Victorian era (sightings were especially prevalent in London). The
cyclical nature of his hunting sprees parallels that of other geographically isolated mythical characters such as the Mothman (West Virginia) and It (Maine).

THE PSYCHIATRY OF JEEPERS CREEPERS

Beyond the role urban legends play in the psychology of a culture, Jeepers Creepers is useful in reviewing the harmful effects of two drugs: alcohol and phencyclidine (PCP). In the opening scene, Darry recounts the cautionary tale of Kenny and Darla (class of ’78), a prosocial warning of the dangers of drinking and driving on prom night (Weird New Jersey’s Annie’s Grave in Totowa and The White Lady Tree in Branch Brook Park).

Later in the movie, Darry and Trish are trapped in the police station when the Creeper’s rampage is reminiscent of the scene from The Terminator. Similar to the cyborg portrayed by Arnold
Schwarzenegger, the Creeper demonstrates the behavioral (belligerence and agitation) and physiologic (diminished pain response when it’s described as wearing body armor by police)
manifestations of PCP intoxication.

It’s only right that the final thought in this blog parallels the final scene in the film. Co- occurring use of alcohol and PCP may lead to suicidal behaviors and other symptoms including (ironically) rapid eye movements (nystagmus), eyes rolled to the back of the head, and a vacant stare.

Last week’s movie: Deliverance (1982)
Next week’s movie: Laid to Rest (2009)

THE NEW DAUGHTER (2009)

SYNOPSIS

Based on a short story of the same name by John Connolly, The New Daughter tells the story of a novelist, John James, and his two children who encounter a malevolent presence when they
move into their new house. One day, while exploring the surrounding fields of their new home, the James children come across a large mound to which Louisa is strangely attracted. John soon learns that his new home is an urban legend; locally infamous for the disappearance of a woman who previously lived there.

THE PSYCHIATRY OF THE NEW DAUGHTER

The burial mound, Louisa’s strange attraction to it, and her consequent symptoms all support a case of ghost sickness; a culture bound syndrome that occurs among Native American tribes, originating from the Navajo. First, the sufferer is obsessed with death or a certain deceased person (many Native Americans with ghost sickness may actually be suffering from a complicated bereavement). While we don’t know the ancestry of the James family, ritualized mound burials link cultures across the globe, explaining why Louisa would be at risk for developing ghost sickness. Furthermore, the woman who previously lived in the home (the object of Louisa’s obsession) may have been of Native American heritage. A common belief among the Kwakiuti tribe is that a child’s soul is weaker than that of an adult. Taken together, children such as Louisa would be more vulnerable to develop ghost sickness than adults. An alternative theory is that John killed his ex-wife and buried her under the mound on his new property, thus explaining Louisa’s pathological grief process.

In any case, the sufferer begins to have nightmares and dreams, then later feels queasy when the physiological and psychological symptoms set in. Louisa has nightmares and sleepwalks the
night after she lies on the mound. The next day, John is called by the school to pick up Louisa who is nauseous. Thereafter, Louisa demonstrates additional symptoms of ghost sickness
including a change in appetite, depression, and irritability.

Last week’s movie: Pumpkinhead (1988)
Next week’s movie: Deliverance (1972)

PUMPKINHEAD (1988)

SYNOPSIS

Inspired by a poem by Ed Justin, Pumpkinhead is a cult classic horror film about Ed Harley’s inner demon manifest as one of the most Underrated Horror Killers of all time (Tyler Doupe, 2013).
The supernatural Scarecrow Folk is introduced in the movie’s opening scene, and returns about 30 years later when Harley swears revenge on a group of teenagers who mortally wound his son
while operating a motorcycle under the influence of alcohol. Upon consulting a witch in a cabin in the woods, Harley goes to Razorback Hollow to exhume the eponymous legend, revenge
incarnate.

THE PSYCHIATRY OF PUMPKINHEAD

Pumpkinhead shares the same archetypal warning (trope) with January 23’s film, A Nightmare on Elm Street; there’s a steep price to pay for exacting revenge. The film revisits the internal conflict between what “we would like to do” versus society’s prohibitions about what we should do, and applies this to a case of child murderers. With superego (frontal lobe) dysfunction, people like Harley lose the protective cortical effect and succumb to the impulsivity of the id which is driven by the pleasure principle.

When bent on revenge, one can lose oneself, as evidenced by Harley experiencing the deaths of the teenage campers through the eyes of Pumpkinhead, then ultimately taking on the image of Pumpkinhead, itself. The film, then, is analogous to the infamous Stanford prison experiment that investigated how readily people would conform to the roles of guard and prisoner in a role- playing exercise that simulated prison life (Zimbardo, 1973). A depiction of the experiment that’s less metaphorical than this week’s movie is Paul T. Scheuring’s The Experiment (2010). Similar to Zimbardo’s findings, Harley isn’t hardwired to be sadistic, but instead is influenced by environmental stress to do what he does; an action for which he pays the ultimate price.

Last week’s movie: Mama (2013)
Next week’s movie: The New Daughter (2009)

MAMA (2013)

SYNOPSIS

Mama is a supernatural horror movie by AndreI?s Muschietti that is based on his 2008 Argentine short film MamaI? about two feral children abandoned in a cabin in the woods who are fostered by a ghost that they affectionately call “Mama.” Victoria and Lilly are abandoned in Helvetia (the name of the cabin) by their father after his attempted murder-suicide is thwarted by the cabin’s supernatural resident. The film depicts the plight of the children upon their discovery, as their new family must battle Mama when it follows the children to their new home.

THE PSYCHIATRY OF MAMA

With his film, AndreI?s Muschietti has inserted himself among attachment theorists such as Klein, Bowlby, Thomas and Chess.

The D’Asange children were 3- and 1-years-old when they were abandoned. Upon getting kidnapped, the older Victoria drops her stuffed animal on the living room floor. The transitional object is a symbol of the girls’ vulnerability during the critical period of language development. Once discovered, Victoria assimilates to her new family much
easier then Lilly, whose attachment to Mama is tested right up to the movie’s cliffhanging summit.

At Rutgers Robert Wood Johnson Medical School, the first module ‘ titled Necromancy ‘ of our year-long resident Psychopathology course focuses on ghosts (wraiths) and demons. While the latter reinforce teaching points of chronic and persistent illnesses, ghost stories are told to review disorders that are episodic in nature such as Major Depressive Disorder.

“A ghost is an emotion bent out of shape…until it rights a wrong.”

Despite Dr. Dreyfuss (a psychiatrist) diagnosing Victoria with Dissociative Identity Disorder (misstated as Dissociative Personality Disorder), Mama’s true affliction is later revealed by Victoria, “It was a long time ago. A lady ran away from a hospital for sad people. She took her baby. They jumped into the water.” As such, Mama is a case study about Major Depressive Disorder, with Peripartum Onset (postpartum depression).

Last week’s movie: Mama (2013)
Next week’s movie: The New Daughter (2009)