Fair warning, this is going to be pretty introspective, and potentially unsettling.
I recently experienced something that made me want to write this post. It was a Japanese detective visual novel, Emio – The Smiling Man: Famicom Detective Club. The ending, and a final portion detailing some of the backstory related the titular Smiling Man, is--to say the least--extremely disturbing. To dance around explicit spoilers, it's a story with a backdrop that involves familial abuse, childhood trauma, social pressure, self-mutilation, and delusional insanity.
I have a deep fear, pretty much a phobia, of things going wrong with your mind. There's an actual phobia for that, demontophobia: demento, from the Latin meaning to make crazy or deluded, and phobia meaning an unreasoning or abnormal fear. There is some in-family reason for me to have some deep-seated fears, as my late grandmother suffered from dementia during her final years. But my fear, I think, is grounded in something a little more unsettling.
It means that out of the 'horror' stories I've experienced, the ones I find truly unsettling and disturbing aren't Alien or Predator or even in principle The Thing or Event Horizon. The things that disturb me can be found in Child's Play, Se7en, Copycat, Pandorum, that bit from the Doctor Who episode "Fear Her", the Taxi Killer from CSI:NY, the Avengers episode "The Fear Merchants". Disturbed minds, abuse from those who should trust and protect you: not through conscious malice, but through unreasoning rage or outright insanity. You may be wondering why I've put Child's Play and Event Horizon so arbitrarily, since they could both be on either side of the line. But here's the distinction. In Event Horizon, the darkness and disturbed actions are triggered by an external force. In Child's Play, it is one insane killer refusing to die. And in "The Fear Merchants", it's a clique that specialises in using people's fears to trigger mental breakdowns.
There are a couple of instances that actually walk the line between those two extremes. Things like Dead Space, which feature both externally-created madness and inherent disturbed behaviour. Or several Agatha Christie, Dorothy Sayers and Ngaio Marsh stories which can feature mentally disturbed individuals, but can also feature people driven purely by malice and greed, but are otherwise legally sane. Put it this way: I don't find Lord Edgeware Dies or Unnatural Death disturbing, while I do find Sleeping Murder and Last Ditch disturbing to varying degrees.
It's why I legitimately can't watch things that involve characters in leading roles who show that kind of disturbed behaviour and madness. The worst aspects of people allowed to build into a frenzied extreme. Especially where madness meets malice, since I don't and doubt I never will believe the two are connected. Films like Speak No Evil, which I've only read a summary of out of curiosity and it's given me goose flesh. Or Joker, which I find both disturbing and highly insulting. That's why the story, and especially the background element, deeply unsettled me: it wasn't some supernatural entity doing everything, but one or more disturbed individuals.
There is another reason I feel more acute fear of this than I do of Cronenbergian body horror ala The Fly, or things like Alien or Predator. I have touched the parts of myself that might be capable of that kind of horror. The rage, the unbalanced self, the detaching from reality that makes me need to touch something to make sure it's really there, the emotional see-sawing that can make me a pain to be around. I have anxiety, and alongside that a biochemistry that seems so delicately tuned that anything can upset it drastically if I let it.
Fear is about personal experience. People who have had serious incidents happen to them at sea can develop thalassophobia, people who are trapped in tight spaces can end up with claustrophobia, there are people who suffer from thanatophobia (dread of death), arachnophobia and musophobia are so common as to be used as the butts of jokes as much as serious plot elements in stories. In my case, I think it's definitely a possibility that without my having a clear and present grasp of who I am, I might well fully experience dementophobia.
Media definitely doesn't help. It rarely shows us normal, everyday cases of mental illness that are able to be functional within everyday life and having full lives even with their conditions, but instead focuses on the either documented or theoretical worst case scenarios. Megalomaniacs, extreme and untreated PTSD or mental conditions, serial killers, unbalanced predators, and otherwise disturbed individuals who end up victimising the vulnerable. If it's taken to enough of an extreme, it stops being scary, such as the madness being augmented with theatrical effects or over-the-top demonstrations, but the current vogue is for dirt and dark filters and blood and swearing and the absolute worst opinions of humanity and society.
That leads me onto another part of mental illness in fiction that is only recently getting acknowledged. I don't need medication to manage my conditions, but I could get some (fingers crossed) if needed. The examples seen in media are people who either don't engage with the system, or are failed by it. While this is a truth, it also feeds into a myth that mental illness is some kind of on-off switch, that having some kind of delusion or compulsion means you ABSOLUTELY WILL DO SOMETHING CRIMINAL. That's just absolute bull****. From my own experience, there are good days, in my case mostly good days, but there are also bad days. Admittedly, I'm not severe, but if I were, my anxiety wouldn't be driving me to commit criminal acts. I'd just be a juddering mess barely able to do anything.
So, that was me getting my thoughts out for however long it took you to make your way through this. I know I can write someone disturbed, someone unbalanced or insane, but I know it also costs me an effort. It may seem strange, but it's easier for me to write about genuine malice or an external factor negatively influencing someone's mind than it is to write about something internal. A madness that is within, a capacity for unbalanced behaviour and cruelty that can't be pinned on anyone but yourself.
For me, just as the most moving story isn't about good-versus-evil but people who are so committed to their beliefs that they cannot find common ground, the most disturbing story is the disturbances that come purely from within and--whether through active malice or misunderstanding--turn the world against them and make them a monster.
Also, fair warning, if any of the pieces of media mentioned intrigue you, PLEASE BE CAREFUL! I wasn't joking about how disturbing they could be.