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Cuckoo Nest

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Evil mesmerist and his mind-controlled somnambulist, or...
...kindly asylum director and hopelessly insane patient?

The premise of the Cuckoo Nest plot is that a character is convinced that they are in an insane asylum (a Bedlam House is a popular choice), where they are told that the events of the series are actually hallucinations.

The episode will often switch from "reality" to reality, making one wonder what's really happening. When the character tries convincing someone in the asylum that their supposed hallucinations are reality and the asylum is not, they will likely be rebuked by pointing out how fantastical and unrealistic their supposed reality is. Sometimes, even if the series canon reveals that someone was using phlebotinum to make them think they were crazy, there will be a scene in the "real world" of a psychologist giving up.

Often, if the character "accepts" the "insane asylum" reality by doing a certain thing (taking a pill, destroying the source of his "fantasy" power, et cetera), they might die, lose their power, or be submerged in the new "non-fantasy" reality forever. Occasionally the character is encouraged to kill themselves in order to wake up. The character is eventually persuaded to do said thing, and they're only stopped when incongruity reveals they're the subject of an elaborate ruse.

There's a variation on this, an ending to a movie/video game/book (they don't usually have the guts to do it to an entire series) where the final reveal is that the whole thing was just the delusion of an insane person — a combination of this trope, All Just a Dream, and Dying Dream. Don't do this unless you really, really know what you're doing, and even then you probably shouldn't: done even the slightest bit poorly, it feels like the author has played an annoying prank on the reader, and worst yet, an unoriginal one.

More ambiguously, the issue of which is "real" might never be resolved.

The Cuckoo Nest is the dark counterpart of the Lotus-Eater Machine. A more benign form of the Cuckoo Nest is the Happy Place. A more sinister one is Through the Eyes of Madness. A version without the imaginary "reality" is Go Among Mad People. The supertrope is Gaslighting. For when this is a fan theory only, see Delusion Conclusion. Sometimes occurs because the character was Mistaken for Insane.

Not to be confused with One Flew Over the Cuckoo's Nest, or with "a cuckoo in the nest". The other sort of Cuckoo's Nest is the heart of an old English ballad performed by folk-rockers Steeleye Span.


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    Anime & Manga 
  • Apollo's Song by Osamu Tezuka may well fit. For killing animals that show affection to their young, Shogo is placed in a mental hospital. EST causes him to have an out-of-body experience wherein he meets Athena, who curses him to live numerous lives of ill-fated love. Which he does, waking up each time he dies finding that it was all his imagination (or was it?) triggered by a treatment (EST, hypnotism, etc.).
  • Episode 14 of The Big O, where series protagonist Roger Smith finds himself in another world where he's a homeless bum and everyone else he knows is completely different, was one of these. Although another possible explanation is that the character involved was temporarily transported to an actual alternate world.
  • GaoGaiGar has a Monster of the Week try this on Gai. Specifically, during a battle in Earth orbit, after a flash of light from the monster's attack, Gai suddenly awakens in a hospital bed, where his father and his love interest solemnly explain that the accident that led to him becoming a cyborg only left him paralyzed and comatose for years. It lasts for about a minute.
  • Very briefly used in Perfect Blue. One of the hallucinations indicates that Mima's Detective Drama character is the real person, and her "Mima" identity was fabricated as a coping mechanism to deal with being raped in a strip club. At least, it was probably a hallucination.
  • According to Takeshi Shudō, who worked on early episodes of Pokémon' and the manga Pocket Monsters: The Animation, the series was intended to end with the revelation that an adult Ash had dreamed or hallucinated the entirety of Pokemon (Pikachu, his rivalry with Gary, the eventual Pokemon uprising, everything'') while in a mental hospital, with the takeaway being that it was a childish fantasy to move away from. Naturally this did not happen and is certainly never going to be attempted by any other writer given any access to the franchise.
  • The final season of Yu-Gi-Oh! GX culminates in the supernatural entity Darkness locking most of the supporting cast in a neverending nightmare where all their dreams are broken. When they ultimately give up on life, they are consumed by Darkness and become one with it. Judai eventually saves them.

    Audio Plays 
  • The Big Finish Doctor Who audio drama Minuet in Hell. In this case, the hospital staff genuinely believed him to be delusional and were not playing mind games. Meanwhile, another inmate is trying to convince him that he is the Doctor instead. What happened was that as the TARDIS materialized, the other inmate got zapped and formed a connection between his mind and the Doctor's, leaving the Doctor addled and the other person with clearer memories from the Doctor.

    Comic Books 
  • A 2000 AD story "Dead Signal" features a Bounty Hunter in a futuristic setting, who may be the delusion of an amputee back in the real world.
  • Batman:
    • "Mask", a two-part story in Legends of the Dark Knight, showed Batman waking up as a scrawny Bruce Wayne in an asylum. His psychiatrist explained that he had retreated into fantasy after the death of his parents. As it turned out, the psychiatrist was the vengeful son of one of Batman's enemies. However, the story ended with alternating scenes of Bruce standing tall and strong as Batman over Gotham after finally freeing himself, and of scrawny Bruce Wayne still in the hospital and being labelled brain dead.
    • One issue of Scott Snyder's All-Star Batman features Batman being put into one of these by the Mad Hatter, who uses it to try and convince Batman that, yes, he's a catatonic mental patient. Batman of course manages to break out of it, but when Mad Hatter tries to plant the suggestion that he's now in a Schrödinger's Butterfly situation Batman, very much not in the mood, soundly subverts that nonsense by pointing out — rather forcefully — that if that is indeed the case, he no longer has to worry about holding back when beating the crap out of one of his enemies in case he goes too far and kills him. An enemy such as the Mad Hatter, for instance. It only takes a few seconds preview of what that implies for the Mad Hatter to quickly clarify that nope, actually, this is reality (and also please don't hurt me).
  • Grant Morrison's final issue on Doom Patrol centers on Crazy Jane in a mental hospital, where one of the supervising doctors, convinced all of her Doom Patrol adventures have been delusions, subjects her to electroshock and discharges her to live a humdrum "normal" existence. However, in the end, teammate Cliff Steele saves her from suicide by taking her "home" to the utopian Danny the World.
  • Fallen Angel #14 directly references the Buffy episode. In this case, it seems like the character in question really is in a mental hospital, and is hallucinating the faces of the book's cast over the people there; at the end, it seems like she moves between dimensions, back to the series's universe.
  • The Moon Knight storyline "Welcome to New Egypt" opens with Marc Spector in a mental institution, and told that the only part of his past adventures that was real was the multiple personality disorder. He doesn't accept it, at least in part because the hospital being a Bedlam House made it just too obvious that this was the nightmare.
  • The Sentry Vol 2 #7 sees the Sentry trapped in an illusion that he's actually a mental patient named John Victor Williams, and actually imagined not only his adventures, but the entire Marvel Universe as well. In a bit of Painting the Medium, the recap page changes to match, recapping the story of John Victor Williams, delusional schizophrenic, rather than Robert Reynolds, the Golden Guardian of Good (who happens to also be a schizophrenic). Cleverly, the creators of the illusion implement elements of the real world into the delusion to convince "John" that he'd inserted them into his fictional world of superheroes.
    Blue Voice: You are not a hero. You are not even Robert Reynolds. A couple of years ago, you began thinking your alarm clock was speaking to you in a strange voice whenever you were near it.
  • ABC Comics' Tom Strong had one of these. It began with a standard adventure, which went into "It Was All A Dream" and he woke up to his life as an unhappily-married factory worker in a gray world with no superheroes. Then inconsistencies in his life lead him to discover that he has superpowers - but that he is a failed military experiment and his entire superhero life is just as much a delusion as his normal-schmuck life. Then he breaks out of the delusions back to his real superheroic life. The villain's plot failed because the gray world Tom Strong had been hallucinating lacked hope, and Tom couldn't give up hope.
  • Scott McCloud's Zot! has a story called "Season of Dreams" in which the main character Jenny gets trapped inside gigantic robot called Zybox, which induces her into an artificial dream in which Zot and all her adventures with him were just mere delusions caused by a severe depression after the divorce of her parents.

    Fan Works 
  • An Animorphs fanfic did this with Ax, the entire asylum scenario being a fevered dream (Or Was It a Dream?) he experiences during The Sickness.
  • Asylum (Daemon of Decay) is centered around this happening to Twilight Sparkle, with the other members of the Mane Six appearing as inmates or workers at the mental hospital as well.
  • In the Invader Zim fic Asylum of Doom, Gaz is dragged along by Dib to investigate the ruins of a supposedly haunted abandoned Bedlam House. After falling down some stairs and hitting her head, Gaz seemingly wakes up in the past as a patient in the asylum, being told that everything she knows about her life is a delusion. She's convinced that the whole thing is a concussion-induced nightmare, but the fact that it feels real and the constant stream of abuse by the asylum staff without end makes her start to doubt her sense of reality. When she's about to be lobotomized, she wakes back up in the present, convinced that she was right about it being the result of a concussion, only to glimpse the apparent ghost of a fellow patient she befriended, indicating it was a vision granted by the ghosts of the asylum.
  • Believing Stories opens with Princess Celestia waking up in an insane asylum in a human body and being told she hallucinated being a pony princess.
  • Played With in Fallout: Equestria - Project Horizons. She's in a virtual insane asylum that's part of a real insane asylum that's attempting to treat her insanity. She was not hallucinating the wasteland. They were trying to help her accept the fact that she killed an innocent.
  • Dorothy starts Patient in an asylum with no memory of the last several years. According to the doctors, Oz is a fantasy of hers. This is later subverted when it turns out she's not in an asylum. She's still in Oz with her family and friends, but she is suffering from temporary amnesia.
  • Happens in the second Season Finale of the Pony POV Series. Twilight wakes up in an insane asylum and is told she killed Trixie and has been committed. However, it turns out this is all an attempt by Trixie's Enemy Within, Loneliness to break her so she can't succeed in her mission to free Trixie from both Loneliness and Trixie's Discording. Twilight realizes this by seeing that the asylum is basically a TV version of one, not a real one.
  • Played for laughs in Tealove's Steamy Adventure. Tealove and Snowcatcher get kidnapped by a cave troll. The cave troll's prior captive, Libra Ace, can't remember her life before she was kidnapped, so she thinks that the interior of the cave is all that exists. When Libra tries to explain to the others that their memories of the outside world are just hallucinations, neither of them find it even remotely convincing. Libra comes around to their point of view when she gets all her memories back and leads the team out of the cave herself.
  • There is a Ranma ˝ fanfic called "Waking Up" in which all the characters slowly discover that all of the fantastic elements of the series (Ki Manipulation, Martial Arts and Crafts, Ranma's engagements and Jusenkyo Curses) and parts of their personalities (Akane's anger, Ranma's ego, Nabiki's love of money) were delusions caused by chemicals the legitimately crazy Kodachi was putting into the town's water supply. They spend part of the story trying to adapt.
    • There's another, "Wicked Garden," by Stefan Paul Gagne, which follows Kodachi becoming progressively more powerful through gene-spliced roses intercut with scenes of a little girl telling her that none of this made sense and that she'd fail soon. The fic ends with her finding that she's been hallucinating the events of the fanfic due to a failed formula.

    Film — Animated 

    Film — Live-Action 
  • 12 Monkeys had its protagonist confused as to whether he had really come from the future, or was just insane. This gets to the point where his former psychologist and now traveling companion believes his story even when he's convinced it's false, although his conviction may just have to do with him falling for the past, which is much more pleasant than the future until The End of the World as We Know It.
  • At the end of Brazil, when the protagonist is interrogated by the baddies, there is an action sequence in which he gets rescued by the resistance and gets to live happily ever after with his girlfriend in a house in the countryside. Then it swings back to him singing quietly to himself while strapped to a chair in the room he was being tortured in before his rescue. The torturer present remarks to the chief interrogator that he seems to be lost to them, and they leave the room, the final shot being the protagonist, tied up in a chair, singing quietly to himself, lost in insanity. A studio-mandated alternate happy ending ditched the twist.
  • The Cabinet of Dr. Caligari used this as its Twist Ending, but this was back in 1920, before it was cool. There's some evidence that this ending was inserted later by Executive Meddling. Apparently the German film making company thought that a movie about an old guy conditioning a young guy to kill on command might be in bad taste in the aftermath of WWI.
  • Inception has a variation on this trope - After entering and living in limbo for several decades, Cobb "incepted" his wife with the idea that her world wasn't real, in order to get her to come out of limbo with him. It did not end well.
  • In Open Your Eyes and its American remake, Vanilla Sky, the main character is told that he's living in a virtual reality machine and he has to kill himself to get out. In a subversion, he jumps off a building, and it's true.
  • Psycho Beach Party ends like this, with the lead character waking up in an insane asylum. The camera pulls back to show that the events have actually taken place in a drive-in movie. Characters watching remark on how lame the twist ending is, until they are stabbed by the alternate personality of the protagonist.
  • Return to Oz had fun casting doubt on whether Dorothy's adventures in Oz were real or hallucinations.
  • In Shutter Island, the entire plot was fabricated by the main character's psychologists, to get him to break his delusions and accept reality.
  • Total Recall (1990) has a scene where a doctor arrives and tries to convince the hero that he is trapped in an artificially created hallucination. He insists that the hero swallow a pill to return to reality, but the hero notices a drop of sweat falling down the doctor's face, exposing the sham. Ironically, the film teases that most of the film really does take place in the hero's head, and the doctor scene was just part of his spy thriller memory vacation. Everything the doctor warned about in his speech ("One minute, you're the savior of the rebel cause; next thing you know, you'll be Cohaagen's bosom buddy...You'll even have fantasies about alien civilizations...") happens after that scene. Before Quaid goes under the machine at the start, one of the techs says "Blue sky on Mars...", which is in fact how the movie ends. Another interpretation is that the doctor scene was NOT a part of his spy thriller, but was actually a real attempt by a real doctor (and his real wife) to snap him out of a fantasy gone wrong.
    • Subverted in the original short story (We Can Remember It For You Wholesale) when the main character has his memory altered to believe that only his existence is preventing the takeover of Earth by aliens, only for aliens to appear at the end and reveal that this is true.

  • In The Chronicles of Narnia, the Lady of the Green Kirtle tries to brainwash the heroes into thinking that Narnia was just a figment of their imagination, and that her underground caverns are the only "real" world. Puddleglum manages to stop her with a Shut Up, Hannibal!.
  • Much of the first Chronicles of Thomas Covenant trilogy focuses on the protagonist's uncertainty over whether the Land is real or not. His resolution of the problem still leaves the question open.
  • At one point in Iain M. Banks's Consider Phlebas, shape-shifter protagonist Bora Horza Gobuchul is knocked out and dreams/remembers waking from an immersive training simulation when he was much younger. The person tending to him tells him what a great job he had been doing in the training, then calls him by the wrong name, and when Horza points this out, the technician suddenly seems concerned and implies that the Horza identity is just another mask that he has forgotten he was wearing before putting him back in the machine. Horza wakes up, and it's never mentioned again until the very end when his counterpart from The Culture is looking down at this dead, true form and wonders who if she ever actually knew the real person beneath all his assumed identities.
  • The Doctor Who short story "Nothing at the End of the Lane" in the anthology Short Trips and Side Treks does this to Barbara Wright. Since the concept behind the book is to explore non-canonical concepts, it leaves the question of whether Barbara is has been attacked by a mind-parasite on an alien world, or is a schizophrenic suffering hallucinations as she tries to protect one of her students from her abusive grandfather completely open.
    • In the Tales of Terror anthology, the First Doctor story that opens the book has him defeating the Celestial Toymaker at a spooky house, but the Sixth Doctor story later on has that Doctor returning to confront the Toymaker upon being warned by his other selves, and the Toymaker claims that One never actually won in the first place and everything that's happened to the Doctors since then has been the Toymaker's gigantic illusion (which is used to explain why so many monsters he encountered looked so shabby, among other things). However, ever since One saw the TARDIS materialize outside the house just as he and his companions were leaving, the Doctor knew he'd be there again one day. Thus Six catches on to the truth as soon as he gets there, and plays dumb until the right moment.
  • The Ben "Yahtzee" Croshaw novel Fog Juice has the main character being shown by the Big Bad that he is lying in a hospital bed with a drip in his arm, and all the other characters are a drug-induced delusion. He dismisses this as the Big Bad trying to talk him into giving up... and tries not to think about the stabbing pain in his arm.
  • This is attempted on the protagonist of Glasshouse (by Charles Stross) in order to convince them that their past as a soldier and black-ops specialist was merely the fevered imaginings of an immersive game addict. When this fails, a more subtle form of brainwashing is used to turn them into a Stepford Smiler instead.
  • Much like Neverwhere, Robert A. Heinlein's Glory Road and one of Terry Brooks's Landover books have the protagonist being told at one point that all of their fantastical adventures were a hallucination and that they are crazy and/or derelicts. In all cases, these scenes are presented as kind of a "last temptation" kind of thing, but you never know...
  • In I Am the Cheese by Robert Cormier, the protagonist goes on a mental journey around his prison/interrogation center to recreate a traumatic event from his childhood, although this confusion from reality is not known until the end.
  • In an early version of John Dies at the End, Dave looks in a mirror while under the effect of Soy Sauce, and sees an overweight and insane/retarded version of himself, saying almost exactly what he says later to John.
  • Keith Laumer's Knight of Delusions (also published, confusingly, as Night of Delusions) puts its hero through an insane number of alternate realities. Every time it becomes entirely unbelievable, he gets put into yet another one and is back at square one, trying to figure out if he's completely out of it, or if he's stuck in yet another false reality. And they try everything to find one that he'll stop mucking up; PI, crazy senator, psychic defender of mankind, a scientist with a Lotus-Eater Machine, a homeless bum, God, and a good half dozen more at least. Finally the reader's told he's president and the whole deal was a test being given by aliens to see if Earth was mature enough to join the rest of the galaxy.
  • A short story in the Let the Galaxy Burn collection set in the Warhammer 40,000 universe contained this. The story begins with a powerful Tzeentchian Chaos Lord inviting a fellow Chaos Lord to his stronghold, and expounding his conquests and victories throughout his ten millennia. The visiting Lord, however, sets a trap to kill him, and the Lord awakens in the body of a lowly human Cultist, being taunted and pelted with stones by others for his failings and he realizes his "life" as a Chaos Lord was actually a false memory implanted in him as part of his punishment, the better to break his mind. But as his fellow cultists perform a ritual to mutate him into an animal-minded Chaos Spawn, he remembers one other lesson from his teachings - that sometimes Tzeentch, fitting his capricious nature, will take a champion that is on the cusp of earning his rise to daemonhood and instead take his entire life away from him, condemning him to an inglorious end. As his body is ripped apart, the only thing he can think of is which life was actually his.
  • In Neverwhere, the "test of spirit" to gain the Key weaponizes this against Richard: he has a vision that all his supernatural experiences were a hallucination, he's actually been a raving vagrant in a subway station all along, and he might as well jump in front of a train. A Fantasy Keepsake helps him rebuff the illusion.
  • In Saving The World and Other Extreme Sports, scientists try to convince Max that their escape was a dream, and that they were at the School the whole time. It's not true.
  • In Edmond Hamilton's The Star Kings duology, the second book starts with the protagonist going to a psychiatrist willingly in order to cure his memories of the first book's events (which he isn't sure are true). The therapy goes quite well until he's transported into the future to continue his adventures. The doctor believes he had a relapse and ran away.
  • In Terry Goodkind's Sword of Truth series book Chainfire, the protagonist awakes to find his wife gone, and everyone he knows convinced that she never existed and is just a character he made up during an injury. He then spends his time trying to convince people that she really exists. It turns out to have been a plot by his enemies. Duh..
  • In Robert A. Heinlein's short story They, the protagonist is a paranoid being held in a mental hospital, convinced that the purpose of the entire world is to prevent him from learning some great truth that he can only glimpse in dreams. Eventually, it is revealed that his 'paranoia' is nothing but the truth; the entire world was created just to prevent him from returning to his previous (somewhat unclear) existence entirely outside of our world.

    Live-Action TV 
  • The 7 Days (1998) episode "Déjà Vu All Over Again" has Frank Parker growing more and more Unstuck in Time, and his grip on reality growing more and more tenuous, but he manages to take control of his new powers and use them to save the day until the ending suggests that he might still be in the mental institution he was plucked from in the pilot episode, with the series only happening in his head.
  • Temporary example from Adam Ruins Everything. Emily gets sent to a (privately-owned) Prison due to being Mistaken for Junkie. She gets a certain number of infractions, and is sent to solitary confinement as punishment. Adam and Kendra explain why solitary confinement is a cruel and inhumane punishment, and that it is not reserved only for the worst criminals. Emily gets out of solitary, and is escorted back to her cell, where it's revealed that Adam and Kendra have been there the whole time...and therefore Emily hallucinated the whole segment.
  • Ash vs. Evil Dead: In "Delusion", Ash wakes up in a mental asylum where his doctor tries to convince him that all his experiences with the Deadites and the Necronomicon are delusions that "Ashy Slashy" created to cope with his brutal murder of all his friends back at the cabin. He'll see orderlies and patients around him as people he knows (such as Kelly as a female patient, Pablo as an orderly, and Ruby as a nurse) before they change back for brief flashes. It's really all an illusion created by the demon Baal to break Ash's mind.
  • The Being Erica episode "Erica, Interrupted" has Erica wake up in the hospital she went to in the series premiere, where she's told that the events of the past three seasons took place in a two-week coma caused by anaphylactic shock incurred during the pilot. She tells the image of her dead brother that whether the events really occurred or not is irrelevant; she's grown from them. It turns out that the events were a final test before Erica 'passed' group therapy and became Dr. Erica.
  • Buffy the Vampire Slayer had a perfect example of this in "Normal Again". This episode ended leaving open the possibility that the entire series was in fact the hallucination of an insane Buffy Summers.
    • Notably, instead of Buffy being encouraged to kill herself, she was encouraged to kill all her friends, and came very close to doing so. They got over it astonishingly quickly, though. Stuff like that happens in Sunnydale.
    • The description of the episode on the DVD case suggests that it was an alternate reality in which they really are hallucinations, but they're perfectly real in their reality. Word of Joss, however, seems to suggest that he finds it perfectly acceptable if fans conclude that the entire series was the fevered dream of a schizophrenic Buffy.
  • The Charmed (1998) episode "Brain Drain" has Piper being manipulated into believing that she's a mental patient instead of a witch, and she has to renounce her powers to regain her health.
  • In Community, Dr. Heidi tries to convince the study group that their past three years at Greendale Community College were all a shared delusion, taking place at the Greendale Mental Institution. Considering that everyone ended up at Greendale for life-shattering reasons and a previous episode stated that everyone but Abed had psychotic tendencies, this was depressingly realistic... until the group realized there was a flaw in Heidi's logic. A) Shirley's kids and husband, who she sees every day. B) Abed has pictures of Greendale on his phone. C) Annie is wearing a Greendale backpack the whole time. Heidi quickly admits to being a fraud hired by the psychotic Chang, who has taken over the school and replaced the dean, in order to keep the group from uncovering his actions.
  • The soap Crossroads returned a long time after being cancelled, and ended with the entire series revealed as a fantasy by an autistic woman who worked in a supermarket.
  • Doctor Who: In "Forest of the Dead", Donna abruptly finds herself in a mental hospital, where she is informed by Dr. Moon that she's been cured of her hallucinations about adventuring with the Doctor. She's actually in a Lotus-Eater Machine along with thousands of others, and the Doctor and company have to find a way to download everyone out of it, among other problems.
  • On Farscape, the Scarrans actually consider this a valid interrogation technique. Crichton only beat it because an artificially intelligent hallucination helped him counter it.
    • This was exceptionally surreal as all the non-humans John had met appeared... as non-humans. And everyone on Earth was perfectly okay with Luxans and Delvians running around. The aforementioned artificially intelligent hallucination explains this is because the intent isn't to fool the target, but drive them insane.
  • The final episodes of First Wave did this. Very effectively too, considering the whole alien plot of the first wave of invasion was to drive a few people insane as a test, and protagonist Cade grows increasingly unhinged over the course of the series.
  • House:
    • This is a recurring theme in the 5th Season. The episodes leading up to the season finale suggest to the viewer that Greg has earned a happy ending, but you soon learn that the reverse is actually true.
    • Also played with in the season 2 finale, in which House was forced to determine what was real and what wasn't after he was shot by an unknown man, which was somehow causing him to hallucinate during his recovery from the injury. He eventually figured out that everything that occurred from the moment he was shot up until then had been a hallucination, which allowed him to wake up and discover that only a few minutes had passed since the shooting, and he was still being rushed down to the ER. Kind of a combination of this trope as well as All Just a Dream .
  • JAG: In first season episode "The Prisoner", when Harm is taken father. However, on the surveillance cameras it shows that Harm is talking to no one, and the Chinese later explain that it’s all due to the drugs they’ve administered.
  • First season finale of Joan of Arcadia: Joan is for a time convinced she was hallucinating the God avatars, and the second season premiere has God coaxing her back into accepting His presence.
  • Done in Legend of the Seeker where the title character is led to believe that the entire series has been a hallucination during an illness.
  • The premise of Life on Mars (2006), particularly during the second season.
  • The Lost episode "Dave" has elements of this; it was actually written to debunk the common fan theory that everything was in someone's head.
    • Like the Buffy example above, "Dave" ended by humorously suggesting that everything was in Hurley's head: we see him back in the asylum, with his new supposed girlfriend Libby revealed as another inmate. Libby's backstory was originally intended to intertwine with Hurley's, but the character was killed off before they bothered to film the episode. She was going to be his creepy stalker, set to juxtapose Hurley's own creepy stalker tendencies in the alternate reality of the final season.
  • In The Magicians (2016), a spell called the Scarloti Web is placed on Quentin by Jules and Marina. It makes him believe he is at psychiatry, where he is told that Brakebills exists only in his mind to cover up a horrible thing that he did. He manages to contact Penny, but waking him up turns out to be difficult.
  • Moon Knight (2022): After Marc is shot and killed in episode four, he suddenly wakes up in a psychiatric ward where all of the doctors and other patients are people from the rest of the series. This continues throughout the fifth episode, with Marc and Steven's Journey to the Center of the Mind as they travel through the afterlife frequently cutting back to the "real world" where their psychiatrist is helping Marc accept his past in similar but mundane ways.
  • The Red Dwarf episode "Back to Reality" involves the crew waking up and finding out that all of their adventures aboard Red Dwarf have been a total immersion video game that they've been playing... very, very badly. As this was the fifth series finale, it was entirely plausible to viewers at the time that this was how the series was going to end. In somewhat of a twist, rather than being merely a more "normal" version of the reality, each character was the polar opposite of his normal character.
    • The Red Dwarf comic ran a strip where the episode ended differently, and focused on the Cat's supernerd alter ego Dwayne Dibbley. At the end, Dwayne decided that he was the real person and The Cat was just a hallucination.
    • The comic loved that reality; there was also a Jake Bullet strip that eventually crossed over with Duane Dibbley, and a strip about the "better" players briefly shown before our Dwarfers left the TIG building.
      • The first tie-in novel Infinity Welcomes Careful Drivers introduces the BTL (Better Than Life) gaming device, which completely immerses you in a fantasy world inside your mind. Unlike other examples, you can become aware you are inside an artificial simulation & return to reality; the catch is that most people don't have the willpower to do so.
  • The Smallville episode "Labyrinth". The culprit was an evil phantom who was trying to break Clark Kent's will so he could take over his body. Martian Manhunter intruded upon the hallucination with his telepathy to help break Clark out of it.
  • Stargate:
    • Stargate SG-1:
      • The Season 2 finale "Out of Mind" is a variation on this. The team is made to think that after a mission, they have awoken in the SGC, but far in the future, and that everyone they knew is long-dead. They are actually in a fake SGC, and in the clutches of the Goa'uld, Hathor.
      • In "The Changeling", Tel'c finds himself jumping between the SGC, and a reality where he is a human firefighter. Played with, in that neither reality is real. Except for Daniel.
    • Stargate Atlantis: In "The Real World", Weir wakes up in a mental hospital and is being told she just recovered from a coma caused by an accident. Apparently, she only imagined the Stargate program. In truth, she's infected with Replicator nanites who are trying to take over her mind and body. With some external assistance in the form of Rodney figuring out what's going on and EMPing her body to disrupt the nanites, she fights them off. The episode ends with an off-handed comment by Sheppard that they might still not be in the "true" reality, which is quickly silenced by Weir.
  • In the Star Trek: The Next Generation episode "Frame of Mind", Commander Riker is taking part in a ship's play, in which he plays a man in a mental asylum (where part of the underlying question is, in a genuinely oppressive environment, if the character is what they say he is). At the same time, he's being briefed on an undercover mission to a hostile planet. Riker starts to experience dreams and hallucinations in which he's trapped in the mental asylum. At one stage he's rescued from the asylum by the Enterprise crew who inform him he was captured during his mission. It turns out, though, he's still back in the asylum — Riker was captured on the mission, his abductors were trying to make him think the Enterprise was an illusion, and his memories of the play is how his mind is coping with the aliens' attempts to Mind Probe him. Once Riker realizes this, he's able to "break down the walls" of his fake reality, get his hands on a communicator and beam out of there. The episode ends with him trashing the set of the play, just to make sure.
  • The Star Trek: Deep Space Nine episode "Shadows and Symbols". Interestingly, the 1950s Sci-Fi writer that Sisko plays in the alternate reality was used earlier in the series ("Far Beyond the Stars"), only now he is completely insane, writing his dreams of Deep Space 9 on the walls of his cell. They considered ending the series with the sci-fi writer on a set, carrying a script for Star Trek: Deep Space Nine, but apparently decided that Trekkies would hate seeing their beloved series framed as fiction.
  • Combined with a Holodeck Malfunction in Star Trek: Voyager's "Projections". It's given the twist that the character it happens to is a hologram who is being made to believe that he is the only person who is actually real.
  • Somewhat subverted in St. Elsewhere. The series finale reveals that the entire show was just in the mind of little Tommy holding a snow globe, who was either autistic or catatonic. A subversion because it all really was in the mind of someone with mental problems, and stayed that way forever.
  • The Supernatural episode "Sam, Interrupted" has a former hunter/family friend call Sam and Dean for help from inside a mental institution, which prompts the brothers to get themselves admitted as patients to check out his claims of supernatural phenomena. When their incarceration pushes them both to the breaking point, their personal issues send them over the edge. The thing they're there to hunt doses them with crazy juice and they both have psychotic breaks while the audience watches, deeply confused. Dean's psychiatrist may have been a hallucination, which is too bad, because he actually talked to her some.
  • Terminator: The Sarah Connor Chronicles plays this perfectly straight when Sarah's disturbing dreams of being kidnapped and tortured send her to a sleep clinic, with scenes shifting between Sarah's stay in the clinic and her frightening dreams. As she begins to gain control in her "dreams" and the world of the clinic spirals into paranoia and horror, viewers may come to suspect the presence of the trope, at which the show hints from the very beginning by starting the episode in the "dream".
  • The Twilight Zone (2002) episode "Another Life" had the main character oscillating between a reality where he is a happily married and successful musician and another where he is a suspect being violently interrogated by police. During all the episode you're guided to believe that he actually is a musician that dreams he's a criminal, and then comes the obligatory Twist Ending.
  • In the Warehouse 13 episode "Don't Hate the Player", when Beatrix Potter's tea set brings the agents' worst fears to life, the worst fear of Claudia, who previously spent some time in a mental institution, is that she is still in that mental institution receiving electroshock therapy, and that her life in the Warehouse is all a lie.



    Stand-Up Comedy 
  • In his routine about gun control, Jim Jefferies says "Right now, I think I'm in Boston talking to 1200 people... but there is a good to fair chance that I'm in a mental home, standing in front of a white wall, going 'I hate guns, I hate guns, I hate guns'."

    Tabletop Games 
  • The fanmade Feng Shui supplement "Out For Blood" features an adventure called "Escape from the Asylum of the Damned" involving our heroes being captured and sent to a "psychiatric" facility run by demons, which actively suppresses supernatural schticks and basically tries its level best to gaslight and break the spirits of secret warriors sent there, trying to convince them that their lives as secret warriors is nothing but a delusion that needs to be cured.
  • John Tynes' mini-RPG Power Kill (now free on his website) is a somewhat anvilicious Author Tract which uses this device to deliver An Aesop about player-character violence and escapism in role-playing games.
  • Before the Ravenloft setting was a game-world, it was a 1st Edition D&D module and its sequel, which featured the same villain but took place in completely different regions. One way it was suggested DMs might integrate them was to use either or both of them as a Cuckoo Nest, such that the PCs would periodically collapse with Brain Fever in one module and "wake up" in the other.
  • The surreal horror and noir supplement Cthulhu City for ''Trail of Cthulhu]] gives this trope as a possible "terrible truth at the heart of the setting" option...although even if the City *is* merely a mad delusion, given the nature of the Mythos, that might not make it harmless to the investigators or the world.
  • There has been a scenario for Werewolf: The Apocalypse that worked like this, with a lot of shoutouts to One Flew Over The Cuckoo's Nest. The players are being "cured" of thinking they are werewolves. In reality, they are stuffed with rage/gnosis suppressing drugs and the plan of their captors is to repeatedly abuse them until they are ready to be transformed into fomori. The scenario ends with a mindscrew and it is quite possible the whole game session is a hallucination caused by a previous week's villain.

  • Subverted in BIONICLE. Sahmad is placed into a Lotus-Eater Machine in which he is being accepted into the new society on Spherus Magna. Since the first person he meets is being nice to him, as opposed to running away or attacking him, he assumes that she's insane and that he's trapped in some sort of asylum.

    Video Games 
  • Played arrow-straight in Alan Wake, where the protagonist awakens at an insane asylum and is told he has hallucinated everything prior. The protagonist does not believe a word of it. And he is right. Later in the DLC chapters, as he has been split in two personalities, the insane and suicidal part of him tries in a desperate bid to stop the rational and determined part in his attempt to do a Split-Personality Merge by suggesting this idea to him once again. It still doesn't work.
  • American McGee's Alice reinterprets Alice in Wonderland this way. In this case the entire game is based on the presupposition that the original books were mental aberrations, with the different characters representing various personality fragments and psychoses. The game's manual provides the detailed journal of the psychiatrist who spent years treating Alice for her psychoses and makes frequent mentions of her ramblings and drawings, all of which somehow relate to the events of Wonderland. It's subverted in the sequel Alice: Madness Returns, where Alice is completely aware that her excursions to Wonderland are delusions. That doesn't make what she does there any less important.
  • Batman: Arkham Asylum: Scarecrow does this to Batman and the player in the third hallucination. First there's a repetition of the intro scene, except it's Batman strapped to the gurney in place of Joker, with Joker and Scarecrow taking on the role of doctors and discussing Bruce Wayne's unfortunate split personality disorder. The subsequent surreal platforming section also includes such imagery, including several insane Batmen rocking back and forth, and Scarface appearing on video screens as an asylum director announcing his successes in curing Bruce Wayne.
  • In the fourth episode of the City of Heroes "Who Will Die" story arc, Malaise tries this on Sister Psyche and the Player Character. That's the hero version of things, at least - villainous characters are instead helping Malaise to do it to Sister Psyche, down to getting a character as a psychologist in the hallucination and 'explaining' why she chose particular elements.
  • In The Darkness II, several segments take place in an asylum where various characters show up in different roles (including the Big Bad as a doctor and your girlfriend as an orderly). In this case, you're outright told by a sympathetic party that the asylum is just a construct the Darkness is using to keep you from going to Hell to save your dead girlfriend. Late in the game, you're given the choice to stay in the asylum, or jump to your "death"; the latter leads to the final sequence of the game. In an interesting and amusing twist, you can find The Darkness comic books in your room, implying that you made the whole thing up after reading the comic.
  • Edna & Harvey: The Breakout and its spin-off Edna & Harvey: Harvey’s New Eyes feature an asylum as a main location. The inhabitants of the nearby village and convent school are not necessarily that much more sane.
  • The 1996 point & click adventure game Fable (not to be confused with Lionhead Studios' Fable series) infamously reveals at the end that the entire story was made up by the protagonist, who is a psychotic murderer in prison and that the narrator was his jailer. The game's re-release cuts this ending entirely.
  • The psychological horror game Fran Bow is based on the premise that you can take pills that switch between reality and your mad, gory hallucinations. These actually contain hints on how to progress.
  • Max Payne 2: The Fall of Max Payne had a Show Within a Show, Address Unknown, where the protagonist was in an insane asylum and thought everyone else there was insane. The show's events also parallel Max's own experiences to a disturbing degree, one of the many hints during the game that Max is not entirely sane. Max even lampshades this at one point.
    Max: When entertainment turns into a surreal reflection of your life, you're a lucky man if you can laugh at the joke. Luck and I weren't on speaking terms.
  • The entire premise of Sanitarium, if we discard the resolution.

  • A storyline in Fans! sees the F.I.B kidnap Shanna Cochran and - reasoning that, as the supposedly least imaginative and most 'mundane' member of the Science Fiction Club, her mind would crack under too much pressure - attempt to convince her that she is imprisoned in a mental hospital and merely hallucinating her admittedly far-fetched adventures in order to get her to turn on her friends, or at least reveal important information about them. Unfortunately for the F.I.B, however, this backfires quite spectacularly; convincing Shanna that she's crazy merely serves to break the self-imposed restraint on her imagination that she adopted after her own mother really went crazy, meaning that the now 'crazy', yet fiercely imaginative and inventive, Shanna finds it remarkably easy to outwit her captors, escape, and play a not-insignificant role in thwarting their latest plan.
    "The pain clears my head.. and reminds me of something I heard one time... It's impossible to get out of a straitjacket, because it uses the way your bones lock together. Of course, some people have escaped by dislocating their own shoulders... But to mutilate yourself, just to escape a straitjacket? While you're still in a locked cell in a holding facility? Why, to do THAT, you'd have to be...stark...raving..."

    Web Original 

    Western Animation 
  • In the Batman: The Animated Series episode "Perchance to Dream," Bruce Wayne wakes up in a world where he isn't Batman and nearly gets institutionalized by his parents and fiancee (Selina Kyle) for maintaining against all evidence that he's a superhero. He spends the episode evading the police until he gets into an altercation with Batman. It turns out it was all a dream induced by one of the Mad Hatter's gadgets.
  • Bounty Hamster: In "School's Out", Cassie is just an ordinary schoolgirl on Earth, daydreaming about space adventures with a roguish hamster — or is she?
  • Ed, Edd n Eddy has the fourth (and originally last) season finale reveal that everything shown was just three old men reminiscing about their childhood. That would at least explain how nothing took place out of their cul-de-sac, the lack of a definite time-frame, and how nobody but the main cast are ever mentioned or shown even when they are at school.

Alternative Title(s): Cuckoos Nest


Spooky Dream

Harry describes the worst nightmare he ever had.

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