Oct 26: Thirteen Ghosts (Thir13en Ghosts) (2001)


Thirteen Ghosts (Thir13en Ghosts) is a remake of the 1960 horror film, 13 Ghosts, written by Robb White. When the original film premiered, scenes involving ghosts were shown in Illusion-O: audiences received viewers with red and blue cellophane filters, giving them a choice to see the ghosts (look through the red filter) or not (blue filter “removed” the ghosts).


One by one, the 12 ghosts of the black zodiac are released, each of which has a biography rich in mental illness. The film allows for the discussion of Antisocial Personality Disorder from 12 converging perspectives, each explained by the biographies of the 12 ghosts of the black zodiac (Table. 1).

1. The First Born Son

Biography: The First Born Son is the ghost of Billy Michaels, a boy who died when his neighbor shot an arrow through the back of his head while playing “Cowboys and Indians.” In death, Billy is in his cowboy suit and holding a tomahawk, with the arrow protruding from his head. His ghost whispers “play with me.”

Links to psychiatry: Jigsaw (Saw, 2004, “let’s play a game”); Grady twins (The Shining, 1980, “play with us, Danny”)
Billy Michaels allows for the discussion on Conduct Disorder (CD), as both Saw (John Kramer) and The Shining (Jack Torrance) are movies with main characters depicting Antisocial Personality Disorder (APD). Since APD can only be diagnosed in patients 18 years of age or older and requires the onset of CD prior to the age of 15, the boy-ghost illustrates its cardinal sign: a repetitive and persistent pattern of behavior in which major age-appropriate societal norms are violated.

2. The Torso

Biography: The Torso is the ghost of Jimmy “The Gambler” Gambino. One day, Jimmy bet heavily on a boxing match, and tried to slip out of town when he lost. The mob caught up with Gambino and dumped his corpse into the ocean. His ghost is just his torso, trying to walk around on its hands, while his head lies nearby screaming within the cellophane he was buried in. When his eccentric uncle dies, Arthur Kriticos moves his family into a bequeathed mansion haunted by malevolent ghosts. There is literally danger around every corner, as the spells that keep the ghosts at bay are broken, unleashing the 12 tortured souls onto their new landlord and his family.

Links to psychiatry:
The differential diagnosis of clinically significant gambling includes professional gambling, impulse dysregulation elsewhere classified (e.g. Antisocial Personality Disorder), and Gambling Disorder. Individuals with Antisocial Personality Disorder and Gambling Disorder are at risk for incurring debts (e.g. “chasing” one’s losses) as portrayed by Butch Coolidge.

3. The Bound Woman

Biography: The Bound Woman is the ghost of Susan LeGrow, a privileged girl who cheated on the star football player, Chet Walters, at the prom. The next morning, her body was found buried at the 50-yard line. Her ghost dons a prom dress, hanging suspended by Chet’s tie around her neck.

Links to psychiatry: Carrie (1976)
Given the drama at the prom, The Bound Woman is an allusion to Stephen King’s Carrie. While Antisocial Personality Disorder may once again be in the differential diagnosis, King’s 1976 horror film is symbolic of Anorexia Nervosa.

Anorexia Nervosa may be conceptualized in psychodynamic terms as a reaction to the demand that adolescents behave more independently and increase their sexual functioning. Patients then replace preoccupations about eating for other age-specific pursuits. A character analysis of Carrie reveals an adolescent who is unable to separate psychologically from her mother. Her body is perceived as though it is possessed by an introject of an intrusive, domineering and unempathic mother. Starvation serves as an unconscious means of starving and destroying the internalized mother-object.

4. The Withered Lover

Biography: The Withered Lover is Jean Kriticos, the wife of Arthur, the movie’s protagonist. Jean was burned severely while trying to save her family from a devastating house fire, and later died of her wounds. Unlike the other ghosts, she is not a vengeful spirit.

Links to psychiatry: The Hatfields & McCoys
On January 1, 1888, Randolph (Ran’l) McCoy’s house was burned to the ground and numerous family members slain by the Hatfields. Rand’l’s wife, Sally, was badly injured in the fire, and eventually died in a mental hospital (in a hospital gown). The blood feud between the Hatfields and McCoys is one marked by – you guessed it – Antisocial Personality Disorder. However, what’s more striking is the role alcohol played in inducing and perpetuating the families’ personality traits.

5. The Torn Prince

Biography: The Torn Prince is the ghost of Royce Clayton, a gifted high school baseball player with a superiority complex. In 1957, he was challenged by a greaser to a drag race, but was killed when his car spun out of control and flipped over; the cause of the accident was a cut brake line. His ghost carries a baseball bat, and parts of his face and body are torn from when he was dragged under the car.

Links to psychiatry: The Warriors
The Torn Prince is an allusion to the Baseball Furies of the 1979 cult classic, The Warriors. In his thriller, Walter Hill merges Antisocial Personality Disorder with the gang mentality, and sprinkles in some empathy (the Warriors) to create audience ambivalence.

6. The Angry Princess

Biography: The Angry Princess is the ghost of Dana Newman, “someone so ugly on the inside, she couldn’t bear to go on living if she couldn’t be beautiful on the outside” (Se7en, 1995). Her preoccupation with perfection leads her to find employment with a plastic surgeon, where her wage was paid in cosmetic surgeries. When a self-inflicted procedure goes horribly wrong, she commits suicide. Her naked ghost is holding the very knife she killed herself with.

Links to psychiatry: American Mary (2012)
American Mary is a Canadian horror film directed by the “twisted” Soska sisters that, like The Angry Princess, merges themes of Antisocial Personality Disorder and Body Dysmorphic Disorder.

7. The Pilgrimess

Biography: The Pilgrimess is the ghost of Isabella Smith, a young woman who sailed across the Atlantic in 1675 to start a new life in a New England colony. Upon her arrival, the town’s livestock began to mysteriously die. A local preacher accused her of witchcraft. She was sentenced to a slow death in the stocks where children stoned her, women cursed her, and men spat on her. Her ghost is walking around with her hands still locked in the stocks.

Links to psychiatry: VHS (2012)
In the video tape titled “10/31/98,” a group of friends attempt to rescue a woman undergoing an exorcism. In both cases, young women “who are different” are condemned to death reminiscent of the Salem Witch Trials. While the evil at the heart of a witch may inspire a nature-versus- nurture debate on the etiology of Antisocial Personality Disorder, a substance-induced personality disorder must first be ruled-out. Numerous hypotheses have been formulated to explain the occurrence of the Salem Witch Trials in 1692 (17 years after Isabella was killed). One theory is that of substance-induction, specifically; personality change due to the ingestion of grain contaminated with ergot, a group of fungi of the genus Claviceps that grows on rye and related plants.

8 & 9. The Great Child & The Dire Mother

Biography: The Dire Mother is the ghost of Margaret Shelburne who was a woman who stood at a mere three feet tall. A showman (a la Sam Torr) convinced Margaret that he should exhibit her. Upon agreeing, she was raped by the Tall Man and gave birth to Harold, “The Great Child,” who weighed over 300 pounds. One day, some circus workers decided to play a cruel joke on Harold by kidnapping Margaret. Upon finding his mother dead in the sack she was kept in, Harold violently chopped the workers to death with an axe and placed their remains on display. Later, an angry mob tore Harold apart. Their ghosts are always together and The Great Child still holds the axe he used to kill the circus workers with.

Links to psychiatry: American Horror Story: Freak Show (2014)
Whereas The Bound (underweight) Woman is an allusion to Carrie and her omnipresent mother (the film is a metaphor for Anorexia Nervosa), The Great (Overweight) Child & The Dire Mother are enmeshed, the etiology of Bulimia Nervosa.

Carnivals and “freak shows” serve as rich venues to study the group dynamic that may contribute to antisocial traits. For example, under the guise of being a talent scout, Stanley (American Horror Story: Freak Show) attempts to murder or capture some of the performers to sell them to the Museum of Morbid Curiosities.

10. The Hammer

Biography: The Hammer is the ghost of George Markley, a blacksmith who was wrongfully accused of stealing. A gang led by his accuser hanged his wife and children and burned their bodies. George killed his accuser with his sledgehammer. He was then subjected to a cruel form of “frontier justice,” being chained to a tree and executed by having railroad spikes driven into his body. The mob then cut off his hand and attached the sledgehammer to the wrist. His ghost is seen with the railroad spikes protruding from his body and a sledgehammer for a left hand.

Links to psychiatry: Candyman (1992)
Both “The Hammer” and Candyman myths are about African Americans wrongfully accused, persecuted by a mob, killed, with their hands cut off and replaced by weapons. Hence, both are cultural warnings about revenge (taken by those wrongfully accused), and as urban legends, help a culture lend explanation to random events of violence.

11. The Jackal

Biography: The Jackal is the ghost of Ryan Kuhn. Born to a prostitute in 1887, Ryan began attacking prostitutes by his early adult years. He was committed to Borinwood Asylum where he perished in a suspicious fire. His ghost is in his undone strait-jacket with his head locked in a broken cage.

Links to psychiatry: Charles Manson
Ryan Kuhn is The Jackal, the Manson spirit, aptly named given his shared developmental history with Charles Manson. Hence, the 11th ghost represents severe Antisocial Personality Disorder and sociopathy.

12. The Juggernaut

Biography: The Juggernaut is the ghost of a serial killer named Horace “Breaker” Mahoney. Standing seven feet tall, Mahoney “went mad” following the death of his parents, picking up female hitchhikers and tearing them apart with his bare hands. One day, he picked up an undercover female police officer, who called for backup, bringing in a SWAT team that took Horace down in a hail of bullets. His ghost shows bullet holes all over his clothing, and the round that finished him, in the center of his forehead.

Links to psychiatry: Edmund Kemper
As imposing serial killers go, Breaker Mahoney is the spirit of the “Co-ed Butcher,” Ed Kemper. Standing 6 ft 9 in and weighed about 280 pounds, Kemper killed 10 people, 1 less than his fictional counterpart. Much like the 11th ghost, Mahoney depicts severe Antisocial Personality Disorder and sociopathy.

Table 1. Thirteen Ghosts (Thir13en Ghosts) &
13 Teaching Points about Antisocial Personality Disorder (APD)
# Ghost of the Black Zodiac Name Links Antisocial Personality Disorder
1 The First Born Son Billy Michaels Saw (2004); The Shining (1980) Since Billy is just a boy, his story reminds that for diagnosis of APD, one must have evidence of Conduct Disorder prior to the age 15
2 The Torso Jimmy "The Gambler" Gambino Pulp Fiction (1994) Along with Gambling Disorder, APD is in the differential diagnosis of compulsive gambling
3 The Bound Woman Susan LeGrow Carrie (1976) Etiology (nurture): Absent father and cold, domineering mother contribute to APD and other mental disorders (see Nos. 8 & 9)
4 The Withered Lover Jean Kriticos The Hatfields & McCoys The role of alcohol in antisocial traits (see #7)
5 The Torn Prince Royce Clayton The Warriors (1979) The "gang mentality" ' males adopting APD traits (see #7)
6 The Angry Princess Dana Newman American Annie (2012) Etiology (psychodynamic): APD and "acting out" as a form of non-verbal communication similar to somatic symptom disorder
7 The Pilgrimess Isabella Smith VHS (2012) The "gang mentality" ' females adopting APD traits (see #5); substance-induced personality disorder (see #4)
8 The Great Child Margaret Shelburne American Horror Story: Freak Show (2014) Etiology (nurture): The enmeshed family contributes to APD and other mental disorders (see #3)
9 The Dire Mother Harold Shelburne American Horror Story: Freak Show (2014) Etiology (nurture): The enmeshed family contributes to APD and other mental disorders (see #3)
10 The Hammer George Markley Candyman (1992) The role urban legends play in explaining random events of violence
11 The Jackal Ryan Kuhn Charles Manson APD and sociopathy
12 The Juggernaut Horace "Breaker" Mahoney Edmund Kemper APD and sociopathy
13 The Broken Heart Arthur Kriticos The Grinch; Elphaba (Wicked, 2003) There are several examples of people whose hearts grow cold; the 2 listed are favorites who are "green" with envy.

Oct 14: The Amityville Horror (1979; 2005)


The Amityville Horror is a 2005 remake of the 1979 horror film which itself was based on a novel of the same name by Jay Anson. The film chronicles the life of George and Kathy Lutz and their family after they move into a haunted house on Long Island. The house at 412 Ocean Ave. was previously the grizzly scene of a mass homicide committed by Ronald (Ronnie) DeFeo, Jr. who murdered six members of his family on November 19, 1974.

Despite the 1979 film being a traditional “haunted house story,” we learn that The Amityville Horror is about demonic possession when Kathy researches microfiche and discovers “voices told him (Ronnie Defeo) to do it.” After moving into the basement, he “killed them all” just 28 days later (a timeframe also forecasted in Richard Kelly’s 2001 film, Donnie Darko). The movie also references The Shining and Hellraiser (1987) when Kathy discovers that Native Americans were tortured (there are pictures of Clive Barker-esque torture) in a secret room in the basement. The torturer suicided by slitting his throat so that his presence would live forever, thus explaining the spirit possession of George’s body.


At Rutgers Robert Wood Johnson Medical School, the first module, Necromancy, of our year- long resident Psychopathology course incorporates ghosts (wraiths) and demons. Tales of demonic possession serve to reinforce teaching points of chronic and persistent illnesses. Movies about demonic possession may therefore be metaphorically interpreted as case studies of psychosis. In The Conjuring, the Warrens ended the movie with the discovery of a new haunted house; one we now also investigate from an educational perspective.

The scene of “the DeFeo murders” in Amityville is haunted by the ghosts of the victims. We learn that Chelsea, the youngest daughter of the Lutzes, has an imaginary friend, Jodie. Similar to Stephen King’s The Shining, our provisional thought is that this is developmentally appropriate. However, like Danny Torrence, Chelsea’s behavior becomes maladaptive, and her perceptual disturbances are ultimately deemed not to be age-appropriate. In one scene, we visit the archetypal warning of inappropriate conduct when supervising children; the “bad babysitter.” This archetype – which we will revisit in Scream, Halloween, and Friday the 13th ‘ is a prosocial warning that is violated by Lisa, who is attacked by Jodie and rendered catatonic.

As a tale of demonic possession, George Lutz begins to demonstrate delusions of passivity. He suffers from thought insertion when he succumbs to the delusion that he’s not in control of his own behavior. “All that is psychotic is not schizophrenia” however. In George’s case, schizophrenia is unlikely, given the atypical characteristics of his presentation. Delusions of
passivity are no longer considered first-rank quality (DSM-5), thus allowing for a broader differential diagnosis. The differential exemplifies the biopsychosocial formulation:

In the 2005 film, a review of systems (ROS) reveals George to be experiencing coughing, nausea, and vomiting. Anytime an individual manifests respiratory and GI symptoms, alpha-1 anti-trypsin deficiency must be considered in the differential diagnosis. Since it’s new-onset, George’s alpha-1 anti-trypsin deficiency is likely acquired. Might The Amityville Horror be about psychosis secondary to alpha-1 anti-trypsin deficiency? One potential etiology of acquired alpha-1 anti-trypsin deficiency is hypergammaglobulinemia. George’s psychotic behavior may have resulted from being exposed to mold (seen throughout the house) with an impaired immune system (due to hypergammaglobulinemia).
An additional biological theory of George’s psychotic symptoms is sarcoidosis. This autoimmune disease is characterized by lung granulomas, giving rise to pulmonary symptoms, as well as hypercalcemia which would explain his GI and psychiatric symptoms.

In the original (1979) film, emphasis is placed on George’s struggle with his faith, perhaps a predisposing factor of his psychosis. In a stress-diathesis model, his psychotic break results from the precipitant of his move to a house that is the scene of the infamous DeFeo murders.

Oct 8: The Thing (1982)


At the Amundsen’Scott South Pole Station, most personnel leave by the middle of February, leaving a few dozen “winter-overs” (mostly support staff plus a few scientists) who keep the station functional through the months of Antarctic night. The winter personnel are isolated between mid-February and late October. After the last flight has left for the winter, an annual tradition is a double feature viewing of The Thing and The Shining.

So, following yesterday’s blog on The Shining, its only right to examine John Carpenter’s The Thing next. Based on John W. Campbell, Jr.’s novella, Who Goes There?, the movie is about a parasitic , extraterrestrial lifeform that assimilates organisms at the molecular level, thus allowing it to mimic the host phenotypically.

Set in Antarctica, The Thing begins with a Norwegian helicopter pursuing an Alaskan malamute to an American research station. When the last surviving Norwegian is shot and killed, the Americans go to the Norwegian base only to find it burned to the ground. MacReady and the crew learn that the Malamute was alien, and before they could kill it, the thing begins to assimilate the other dogs and members of the research team.

Considered by Carpenter to be the first part of an apocalyptic trilogy along with Prince of Darkness and In the Mouth of Madness, The Thing pays homage to Dracula, depicting the trials of MacReady (modern day Van Helsing), who leads the team as they try to capture and kill the inhuman scourge before it can hibernate and move beyond the continent.


We discover that the thing was trying to freeze itself and hibernate, thus introducing the notion of dyssomnias; sleep abnormalities in the amount, quality, or timing of sleep involving abnormalities in mechanisms generating sleep-wake states (as opposed to parasomnias which are abnormal behaviors occurring in association with/around the time of sleep such as sleep walking). One dyssomnia, Non-24 Hour Sleep-Wake Type (a Circadian Rhythm Sleep-Wake Disorder), is characterized by abnormal synchronization between the 24-h light-dark cycle and the endogenous circadian rhythm. Given that a) the setting of the film is the Antarctic night, b) the alien’s circadian rhythm is longer than 24 hours, c) the alien needs to hibernate, The Thing may be viewed as an exercise in the Sleep-Wake Disorders.

The Thing can also be interpreted as a case study of “mass paranoia;” with imminent danger behind every familiar face, the film oscillates between hypervigilance and Shared Psychotic Disorder. For example, Blair becomes increasingly paranoid, calculating that if the alien escapes Antarctica, all life on earth will be assimilated within a few years.
In the final scene, MacReady and Childs watch the camp burn and acknowledge the futility of their distrust and share a bottle of scotch. The ambiguous ending is clarified 30 years later by Joss Whedon; in The Cabin in the Woods, the scene revealing the “Fail” in Sweden most likely reveals the cataclysmic outcome of The Thing.