'The Patient' and the Beginning of a Larger Conversation in the Horror Genre

Warning: This article contains spoilers for 'The Patient' which began airing on Hulu on August 30. 

Hulu's 'The Patient' is a different kind of horror, defined by its lighthearted style and lack of melodrama. It stars Steve Carell, a comedy superstar famous for his roles in 'The Office' and the '40-Year-Old Virgin.' Carell plays a successful psychologist, Dr. Alan Strauss, who's abducted by his patient, Sam Fortner (Domnhall Gleason). He wakes up and finds himself lying in a strange bed with a shackle around his ankle. 

During their initial conversation, it's revealed that Sam is a serial killer who kidnaps the doctor in an attempt to get help with his homicidal urges. If Sam was truthful about the things he'd done in a normal office setting, he'd have to worry about the doctor reporting him, and he couldn't have that. Instead, he found a doctor that he could hold hostage in his downstairs den. It's a simple environment. There's green shag carpeting, board games stacked up against the banister, and double doors leading outside. It's a stark departure from the dungeons and makeshift torture chambers we can usually expect from the genre. 

From the beginning, Carell, who colors the character with a sense irony and cynicism, takes a hushed approach to things. There's no clawing at the walls, no banging around, and no begging. Instead, he tries to manipulate his captor, faking treatment options, advising him against this kind of care, and trying to convince Sam that he wouldn't have to report him at all. He could simply forget this ever happened and treat Sam like any normal patient. He says they could even make an appointment for the following week. It's all a ruse to get free, and none of it works. Ultimately, he's forced to create a shank out of his foot cream tube, which he uses to hold Sam's mother up at knifepoint. He gives Sam the choice to either turn himself in or watch his mother die. It doesn't work. Sam tackles him to the ground and strangles him just like he does with his other victims. There was no struggle--or very little, at least--no fireworks, no gunshot, no suspense. Everything felt futile, or at least doubtful, and strangulation is not a dramatic death. It's silent and quick. Strauss is killed in the same muted style that characterized the entire series.

When we think of killers, we think of Buffalo Bill lowering a bucket of lotion, or the way Hannibal Lecter would lick his lips, ready for another tasty morsel. That's entertaining, and those things do exist in real life. The annals of history are filled with eccentrics--some crazier than fiction--but they're not relatable, and they don't feel real. They're shocking, otherworldly monsters who do things we can barely comprehend. 

Sam was relatable. He lived in a normal house with a normal mother, and he had everyday issues. His father would beat him. He left a failed marriage, and he was staying at home. We could see him as a young man who was battling a basic mental illness--not a psychotic killer that wore human skin. 

He wasn't a cannibal or a necrophiliac. He wasn't all that creative with his M.O. He was a strangler who collected wallets and watches--souvenirs that he could keep from his victims. His backstory made sense. There was nothing wild or strange about him, other than his urges. This allowed us to connect with him, take a dive, and really understand what was going on inside his head. It was the perfect dynamic for a story about treatment. It got us wondering whether or not he could change. We know men like Buffalo Bill and Jeffrey Dahmer are likely irredeemable, but someone as simple and easy to understand as Sam, who knows? It didn't seem like too much of a stretch. It had us wondering, and the show really did seem poised to tell us whether or not treatment was possible.

From the beginning, Dr. Strauss was not interested in helping Sam. He just wanted to leave. When he was asked to form a treatment plan, he gave a series of excuses as to why it wouldn't work in a hostage scenario. They varied. Part of it was the power dynamic between them, Sam's control over Strauss, and the stress of being held prisoner. It was an attempt to get Sam to let him go, and Sam wasn't convinced. When Strauss heard Sam's mother walking around upstairs, he decided to try another tactic. He asked Sam to bring her into their so-called sessions. It looked as though Strauss wanted to convince Sam's mother to let him go, but that was never confirmed. Instead, he challenged Sam to think of his mother every time he had an urge to kill. It was cliche and poorly thought out and though Sam did try to follow Strauss's advice, it didn't help at all.

Sam told Strauss about a man who worked at a Greek restaurant, Elias. Sam was a food inspector, and the restaurant wasn't up to code. He didn't like the way Elias talked to him--like he was stupid--and he was struggling with homicidal ideation against him. He wanted to go back there and kidnap Elias.

This is where 'The Patient' started to shine as an outlier in the horror genre. For more than 70 years, the American public has been obsessed with serial killers on film. Every child knows the soundtrack to Psycho. We've all heard the big names. We all crowded theaters ready to watch characters get slaughtered by masked madmen, but rarely--if ever--have we seen honest depictions of their urges or real doctors trying to treat those urges. It doesn't come up. The genre never asks us whether or not they can be treated. It's all about whether or not we can catch them or get away from them before they kill us. That's the genius of the series. They gave us a man--someone we can relate to or even sympathize with, simply because of what he was going through--and they showed us what it's like to walk a day in his shoes.

They drew a stark contrast between the bloodthirsty sadism of Hollywood's killers and Sam's urges. When he would talk about his target, he would pace around. He'd tense up. He'd insist that he was going to do it. He wanted to do it. He said Elias deserved it. It was similar to what you would expect from a meth or heroin addict. Cut the words 'murder' and 'kill' from the script, put him in a psychologist's office, and he could easily have been talking about a drug. It made his struggle more relatable and easier to understand. Many of us have seen people act that way--from addiction, anger, an eating disorder, or anxiety--and we could almost feel what he was feeling. It had us actually asking whether or not it would be possible to treat him. 

He'd be on the cusp, jumping out of his chair, ready to run out the door and kill Elias, but he wouldn't. There was a controlled effort--not much, but the kind of thing you'd expect from someone dealing with an addiction or a compulsion. He'd sit back, talk about how much he wanted to do it, and he'd say that he wanted to change, but he wasn't sure if he could. There was potential there--an answer waiting for us, like the perfect comeback on the tip of our tongues, and instead, we got Dr. Strauss. 

This is a man with an entire toolkit tailor-made for helping people control their behavior. He wasn't just a psychologist. He was a famous author, a leader in the field, and the best he could come up with were simple diversionary tactics. He'd tell Sam to talk, sit down, and try to do something else. At one point, Sam called him from work, because he didn't think he could finish out the day without going after the man. At random, Strauss thought that maybe Sam should visit his ex-wife so he would have someone to distract him. It helped, but Strauss didn't think any of it through. He just said the first thing that came to mind.

Strauss was the ultimate letdown. He lied and bullsh*tted his way through everything. He never put any effort into Sam's treatment. What little he did do was an attempt to either escape or a half-hearted attempt to save Elias' life. It made sense. The man was scared out of his mind, certain that Sam would kill him. So he did what he had to do. But the audience deserved more. We were so close to answering a question that the genre rarely asks, and the person that was supposed to answer it for us could barely think straight. Sam eventually caught on that Strauss wasn't the man for the job and killed him, and he was right. They wouldn't have gotten anywhere. 

It's possible that Strauss was meant to represent a field that stigmatized and ignored people like Sam. He was incompetent, just like his peers have been incompetent when it comes to treating homicidal ideation. They don't take it seriously. They'll dismiss the Sams as incurable, and advocate for incarceration rather than treatment--not because that's the most realistic outlook, but because they don't have the tools to help them--which is often the case. It's unfortunate that the series didn't pursue this even further.

In the end, we were left with a compelling conundrum and a story that failed the audience as much as it failed Sam. They dangled an interesting carrot over our heads and pulled it back, replacing it with a lackluster anticlimax and the untimely death of the doctor.

The field of psychology has long struggled with social stigma and biases when it comes to homicidal ideation. The general belief is that most serial killers are psychopaths and can't be treated. But the truth is much more complex, of course. Homicidal ideation and behavior can stem from any number of problems, ranging from psychotic disorders, mood disorders, and personality disorders, to chemical imbalances, and even things like toxic metal poisoning. 

Treatment is very complex and best left to professionals, but if someone has too much of a metal in their system, that needs to be treated--just like someone with untreated psychosis or a mood disorder needs to be treated, and if that is the underlying cause of their homicidal ideation, then logic dictates that it will lessen or go away. 

Some conditions are more difficult to treat than others. This is the case with personality disorders, which are often blamed for many of the traits we would consider to be common in your garden variety serial killer. This includes a lack of empathy, callousness, and often narcissism. Psychopathy typically--though not always--refers to antisocial personality disorder, which can be treated--though not always effectively, just like anything else. Psychologists are even making headway with symptoms like a lack of empathy, which was long considered to be incurable. One of the biggest reasons for the myths surrounding these disorders is because the public has been told for so long that people like this cannot be cured. That bias has carried over into the mental health field, and it's one that we should be fighting. If we can enter prisons, start studying and providing treatment to killers--and people with antisocial personality disorder, which make up a significant portion of inmates--then we can avoid further killings down the road and start to deal with many of the issues that plague the justice system. Far too often, we throw them in, let them rot, then let them out, only to commit the same crimes again. The prison system needs to be a place for treatment--something many facilities reject--or we won't be able to address our recidivism rate or keep petty criminals safe when they enter the system.