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Through the Eyes of Madness

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"Yesterday upon the stair
I met a man who wasn't there.
He wasn't there again today
Oh how I wish he'd go away."
Hughes Mearns

The creepy, foul-smelling uncle of the Cuckoo Nest, this trope makes a point of obscuring the objective truth of the tale in order to screw with the audience's minds. Sure, we see the grotesque tendril moving under the neighbor's skin just like the protagonist does, but who says the camera is telling the truth? Then again, there's never any conclusive proof that he's not a monster either. By their very nature, these stories end without any definite decision as to what was really going on.

Compare to Only Sane Man; in it the Only Sane Man, along with the audience, is sure that the strange thing is real and everyone else just turns a blind eye on it, while this leaves it ambiguous. Another key difference is that trope is often used for comedic effect while this trope is horrific if done properly.

Unlike the Cuckoo Nest, there isn't an "either/or" pair of realities that can be switched between, or a truthful reality waiting to be accessed — just a long, horrible descent into the darkness of the human mind.

Compare Unreliable Narrator, for instances in which this character is telling the story. Is often Paranoia Fuel at its purest, if done well. Contrast Maybe Magic, Maybe Mundane and Mistaken for Bad Vision. If madness gives a person the ability to see real things that others can't, that's a variety of Power Born of Madness.

Very often overlaps with Mundane Horror, which is basically Truth in Television, since many mental disorders, including schizophrenia, add horrifying hallucinatory details to everyday life.

If it's clear that it's not all in the protagonist's mind and the danger is real, then the main character is Properly Paranoid. If someone is deliberately messing with someone in such a way that resembles this trope, that's Gaslighting. If the madness conceals the fact that the protagonist is a murderer, that's The Killer in Me. If the work chooses to show the underlying truth, it may do so by Cutting Back to Reality.

See also Delusion Conclusion, when the audience dismisses the plot of a work as this trope. Can overlap with Your Mind Makes It Real.

Expect some spoilers here. In many works, the fact that the viewpoint character is crazy is a major Twist Ending.


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    Anime & Manga 
  • Fate/stay night: Heaven's Feel: In the second film, Lost Butterfly, Sakura Matou finds herself in a lovely fairy tale world, wearing a lovely princess dress and surrounded by cute creatures and food, and happily starts playing and feasting. In reality, she is wandering through the city barefoot and only wearing a nightgown, killing everyone in her path with a shadow monster.
  • Ghost in the Shell: Stand Alone Complex:
    • In one episode, an assassin is interrupted by the protagonists, but blows himself up to take out his target. Well, actually not. That minute of footage was all from his viewpoint, so he only thought he pulled it off.
    • There was another episode focusing on a pilot fantasizing about assassinating his politician boss. It opens with a shot of him succeeding, then cuts to reveal that they hadn't gotten to the destination that it took place in. The main characters are randomly different people, apparently running a brothel. At the end, they agree that he's not a real threat to anyone's life, as he would never really go through with his assassination plot.
  • The Horror Mansion: In "The Magic Ball", despite previously seeing the hand of Atsuko's baby, indicating that it was a normal human child, we now see it as a monster, just like Mayako's babies, while Atsuko seems to see all the babies as normal. As Atsuko never seemed to have been affected by whatever the Magic Ball had done, this calls the audience's vision of the babies as monsters into doubt. And if the audience can't trust itself to perceive the truth here, how can it know that any of the apparent strange happenings throughout the story were real? The monsters in the well, Isamu's transformation, the bizarre change in attitude of Mayako's and Atsuko's parents... it's possible none of it was real.
  • Kaguya-sama: Love Is War: Most chapters consist of serious, mind-wracking battles that Shirogane and Kaguya go through and their extreme efforts to deny their feelings to themselves and each other. Chapter 50 is the first to reveal that, to an outside party like Kashiwagi, all of the mind games mostly come across as blatant and awkward flirting. No wonder Everyone Can See It.
  • Neon Genesis Evangelion: Are the events of the last two episodes real, or are they all merely taking place in Shinji's shattered psyche? Some trivial details, they could potentially fit in during the closing moments of the Movie.
  • Odd Taxi: The final episode confirms that the characters are not actually animals, but they are portrayed that way because the main character is suffering from a brain injury that causes him to see people as animals.
  • Paranoia Agent: It starts with the questionable existence of Lil' Slugger and the unassured sanity of the witnesses and/or victims. When incontrovertible proof is presented that Lil' Slugger is real - but not a real person - and he is most definitely supernatural, that's the signal for things to really go off the rails.
  • Perfect Blue: Towards the end, the audience is seeing things through the eyes of two different characters' madness, at the same time.
  • The Rising of the Shield Hero:
    • When Naofumi Iwatani is betrayed by Malty and then suffers some immense trauma, not only does he lose his sense of taste, but he becomes incapable of seeing that Raphtalia has turned into a beautiful woman. This leads him to think that everyone around him is a pedophile for complimenting her beauty. When Raphtalia is taken away by guards, he perceives it as her abandoning him. When she is returned and his vision returns to normal, he doesn't recognize her at first because he had always seen her as a little girl.
    • When Motoyasu Kitamura is betrayed and abandoned by Malty and his other companions and Filo is the only one to cheer him up, he goes somewhat insane. He sees all women except for Filo and other human form Filolials as pigs. He only sees Raphtalia as normal when Naofumi tells him that she is Filo's sister.
  • School-Live!:
    • Part of the manga is depicted through Yuki's eyes. The series is set in a Zombie Apocalypse but Yuki, who is in serious denial and is delusional, has created a defense mechanism where she sees her desolate, horrific life as a fun Schoolgirl Series.
    • Later Yurii starts suffering similar symptoms to Yuki and is implied to be hallucinating a teddy bear is her presumably dead kid sister.
  • Soul Eater: The effects of the Kishin and the Black Blood are an erosion of sanity. Since the good guys failed to stop the Kishin from reviving, the effect is slowly spreading over the entire world. For examples, there's the kids hallucinations when they come face-to-face with Asura, Eruka and Free having the skin pulled off their faces plus the one where Black Star appears to succeed in stopping Eruka. Maka's hallucination in the Clown chapters twists a cute flashback into the abrupt 'deaths' of her father and friends. One of the last battles in the series turns this around, with Stein hallucinating that his bloody killing of the enemy forces is, in fact, him 'unwrapping presents' to see what's inside.
  • Yu-Gi-Oh! GX:
    • After Judai Yuki loses to Edo Phoenix and the Light of Destruction tries to mess with his mind, he goes through a period of being unable to duel because he sees all his cards as blank, while to everyone else, his cards are normal. He regains the ability to see his cards when he acquires the Neo Spacian cards.
    • Princess Rose is obsessed with the story The Frog Prince and sees her Frog cards as handsome princes, while everyone else sees them as giant frogs. After Judai beats her in a duel and she angrily walks off, he suddenly sees the spirit of an actual frog prince (as in a tiny humanoid frog resembling Kermit wearing a prince costume) watching over her. He admits her prince was real, but she ironically cannot see the spirit.
    • In Season 4, after Judai has his rematch with Saiou, he gets infected with darkness and hallucinates Johan as Trueman. Johan manages to snap him out of it with a duel.

    Comic Books 
  • The Auteur: Darwin sees blood, bones and gore everywhere and everyone as talking, skinless corpses.
  • Cindy and Biscuit: It is just about possible to read the whole strip naturalistically as the story of a lonely and disturbed little girl with a disturbingly violent imagination, although the strips from Biscuit's point of view suggest otherwise.
  • Deadpool: When Wade is the main character or narrator. His main series that debuted in Secret Invasion is a great example, mainly the first issue showing him seeing the people trying to kill him as admiring fans wanting an autograph. He snaps out of it, but it makes you wonder just how reliable his point of view actually is. I mean, he thinks Nick Fury is a talking baby.
  • The Filth: It's ambiguous how many of the events are real and how many of them are Greg Feely's encroaching madness.
  • Harley Quinn: The first solo comic depicted her as seeing the world around her as a slapstick cartoon universe in which none of the the violence she commits has serious consequences, while in fact she really is killing and maiming people.
  • How Loathsome: Nick — a drug dealer — tells a story of how three German men followed him around, using mind-control powers to mess with his perception until he shot them dead. How much of this was a hallucination caused by drugs, how much is the truth, and how much is a lie is never explained.
  • The Killing Joke: Are the Joker's flashbacks what actually happened or simply a fabrication of his twisted mind?
    They throw me out, and I had a wife and an unborn child... or it was two cows and a goat? Sometimes it's so confusing...
  • In "Men in Black" in Uncanny Tales from the Grave #4note  Jim Norton starts a KKK-Expy which dresses in black cloaks and pillowcase masks. During their first hate crime he escapes from the police and runs home. When he removes his mask he finds another one underneath — and another, and another — to the point where he frantically tears off an apparently infinite number of masks. In the final panel the cops find him dead on the floor with his face ripped to shreds.
    Narrator: Like your wife said, Jim, you were an awfully sick man! But what bigot isn't?
  • Mister Miracle (2017): Mister Miracle slits his wrists as part of his latest adventure and escape routine, trying to see if he can escape death itself. He spends a few days in the hospital, then goes home. From that point on, it becomes increasingly unclear what's actually happening and what's delusion. At one point Miracle has a conversation with Oberon, despite the fact that the latter died from cancer months ago. When Miracle is reminded of this tidbit, "Oberon" immediately disappears. It's not even clear what the cause of the delusions could be; Mister Miracle could just be mentally ill... or he might be infected by the Anti-Life Equation.
  • The original Plastic Man run by Jack Cole had exaggerated, cartoony art and storylines to match, often making Plas himself the Only Sane Man. In Phil Foglio's 1980s Plastic Man, this was established as just being the way he saw the world.
  • Scott Pilgrim and Gideon Graves both subconsciously create false memories so they don't have to live with their mistakes. The false memories they come up with are kind of... weird, usually reducing the women around them to vapid, smiling fangirls who hang on their every word. Scott gets better. Gideon does not.
  • Sundowners from Tim Seeley is about a support group for superheroes, or rather, people who think they're superheroes. They each have individual mental and physical disorders which seems to affect their view of the world and causes hallucinations. However, the comic leaves it up for interpretation if they're just ill or if they are indeed fighting against demons and monsters. Even when a scene of them fighting a group of shadowy villains is seen through the eyes of an outsider, where they don't seem to be fighting anything at all, is presented, it's partly implied that the reason they can see these things is because they're mentally ill. There's also the fact that they're all seeing the same things, and some of their so-called hallucinations are given moments of interacting with other people when none of them are present.
  • Ultimate Spider-Man: An issue shows the conversation between Spider-Man and Green Goblin from the previous issue, only from the latter's point of view. Among other things, he sees blood-red skies, Spider-Man as some horrifying human/spider hybrid and dozens of ghost-like "plasmids" floating around and whispering to him.
  • JLA (1997): The Queen of Fables believes that Wonder Woman is Snow White and that Superman is Prince Charming. From her point of view, Wonder Woman wears Snow White's traditional dress instead of her usual swimsuit-like armor.
  • X-Men: One issue shows the final "Everyone against Cyclops" battle from Avengers vs. X-Men from Scott's point of view, while he's Drunk on the Dark Side of the Phoenix Force. He can't keep track of what's happening now as opposed to his memories (admittedly, at least partly because "a man with claws is attacking me" is a recurring theme), or whether he thought about doing something and decided not to, or did it and then used his Reality Warper powers to undo it again.

    Comic Strips 
  • Candorville generally implies either "everything supernatural is real" or "everything supernatural is a hallucination", but it keeps going back and forth on which it's implying. Saxon's crazy — he thinks he's a Dhampyr. No, wait, he just showed off his Game Face. No, only Lemont saw it, and Lemont sees bizarre things all the time that nobody else ever sees, so perhaps . . . Wait, Susan saw something too! But no, she was only dreaming. It seems the final conclusion will be it's real — Lemont's lawyer is shackled to a wall next to the skeleton of one of his friends, and his captor quite clearly has fangs.

    Fan Works 
  • Always Visible: It is implied that Galbraith clearly does not see the incident in a normal state and that he is close to a breakdown - especially towards the end of the third act.
  • Afterglow (Unfaithful): Walker's still having hallucinations about dead people. The narration implies that the sandstorm is sentient and actively trying to hunt him down. And when Falcon-1 shows up at the end, Walker initially assumes that they are yet another hallucinaton.
  • All Guardsmen Party: After Sarge becomes an Interrogator, we see Twitch's point of view as he goes through one of his episodes. He hears orks through the walls of a septic pipe and occasionally shoots the wall in a vain attempt to kill them. Of course, the audience knows that there are no orks.
  • Asylum (Daemon of Decay) has Twilight going to bed after another day with her friends, only to wake up in the titular asylum, where the the nurses and her doctor inform her the life she remembers was just a side-effect of her new experimental treatment regiment. Instead of becoming the personal apprentice of Princess Celestia, Twilight apparently had a mental breakdown, and has been hallucinating her many misadventures. On the one hand, most of her friends and the other characters from the show are still real in some way or another, but her prized assistant and adopted brother is not. Though sad, this all seems legit... until Twilight hears Celestia telling her that the Asylum isn't real and Equestria is in grave danger of dark forces that have created the asylum to trick her and Twilight starts noticing signs of a conspiracy among the staff and seeing things that may or may not be real, but whether she really is crazy, in some kind of Lotus-Eater Machine, or both is yet to be made clear.
  • At The Food Court: The first part of the epilogue is from Ash's perspective, who has mentally regressed to the maturity of a spoiled five-year-old. While he is aware that Pikachu has been silent for years, he doesn't understand that this is because his Pikachu is a stuffed toy.
  • BURN THE WITCH: Tikki's POV segments demonstrate how her way of thinking is being influenced just enough by Witch Hunter's powers to make her support their plans to burn Lila at the stake. Despite having witnessed far too many innocents meeting such gruesome fates, including former holder Jeanne d'Arc. But Lila is far from innocent, after all...
  • Cain: Katsuki is a Villain Protagonist with an extremely Self-Serving Memory. While he outright refuses to see just how awful most of his actions are, one incident in particular stands out: his attempt to paint Toshinori as a predator. As part of this scheme, he narrates that he ambushes Izuku in the locker room, forces him to strip, and fakes 'hickies' by having other students pinch and hurt him. invoked Word of God affirmed that Katsuki is deliberately downplaying what actually happened, but offers no further insight or clarification.
  • A Canterlot Wedding: Aftermath: Twilight is so traumatized by the events of Shining Armor and Cadance's wedding that she suffers from PSTD attacks. Including, at one point, hallucinating that all of her friends were actually changelings.
  • Getting Back on Your Hooves: The side story 'Another Happy Mother's Day' is told from the perspective of the original story's Big Bad, Checker Monarch, who went completely insane during her Villainous Breakdown at the end. She is completely out of touch with reality to the point that she's created False Memories.
  • Jessica: This is a strong possibility, especially in the scene in which Cameron realizes who Jessica is, and ultimately reconciles with her. Cameron's friends cannot see the creepy things that he sees Jessica say and do during the game, Cameron is known to have Multiple Personality Disorder, and both of Cameron's alternate personalities are quiet when he is engaging with Jessica during the game.
  • My Little Pony: Totally Legit Recap: Downplayed in one episode, where it's briefly implied the elegant harp motif that often plays while Rarity's talking is actually an auditory hallucination she has.
  • The New Retcons: Shortly after Elizabeth and Anthony get married, Elly has a mental breakdown that causes the lines between the past and present to blur for her. This leads to things like her mistaking Edgar for his father Farley, refusing to accept April as her daughter because she only remembers Michael and Elizabeth, and generally getting worse and worse over time... all while writing letters that reveal more and more of her skewed persepctive.
  • Return to Krocodile Isle: The last scene before the credits reveals that the climactic attack on DK Isle was all just an Imagine Spot... but, given K. Rool's insanity, it then calls into question how much (if any) of his musical number really happened. In particular, a blink-and-you'll-miss-it shot of Kremling dummies in the tavern, which otherwise only appear in K. Rool's lair, is often seen as evidence that his grand reveal to his Krew was also just in his head.
  • The Rugrats Theory: This is the premise of works based on the story, such as the Vocaloid song. The concept is that Rugrats is from the view point of a delusional and lonely Angelica. All the babies died before she could meet them.
  • Ultra Fast Pony:
    • In Season 1, Applebloom's only friend at the beginning of the episode, Twist, is revealed to be a figment of her imagination. And not a benevolent one either.
    • In episode 64, after mistaking a random tourist for the Pony Games inspector, the tourist claims to be just a delusion.
    • In episode 81:
      • Fluttershy has a run in with fairies with bad Scottish accents who mistake her for their god which only she can see...
      • We get to see how Rainbow Dash sees the world... insane doesn't began to describe it.
      • At the very end of the episode, we get to see a talking flower from Rainbow's delusion return, with the rest of the cast seemingly all reacting to it, but don't seem to be surprised, implying they might all be delusional to some extent. Really puts some things in perspective...

    Films — Live-Action 
  • American Psycho seems plausible as a conventional serial killer movie — until the Villain Protagonist goes to withdraw money from an ATM and it displays a message that he finds perfectly reasonable: "FEED ME A STRAY CAT."
  • The Amityville Horror (1979) and the remake: The protagonist becomes possessed by the haunted house, seeing his own children and wife as demons and eventually killing his own dog with an axe. Later on he goes after the family too, but after being knocked out and dragged away from the house, he becomes sane again.
  • At various points in Anon (2018), Sal's Augmented Reality implant is hacked to change his perception of the world in real time, causing him to hallucinate various things, such as a different flight of stairs in front of him, or the hallway outside his apartment being on fire. Because we're frequently seeing these events through his eyes, the viewer shares in his confusion.
  • Roman Polański's "Apartment Trilogy", consisting of Repulsion, Rosemary's Baby, and The Tenant.
    • The Tenant: The protagonist learns that the previous tenant of his apartment had committed suicide by throwing herself from the apartment window; he becomes convinced that his neighbors are trying to force him to re-enact her suicide. By the end of the film, it is unclear how much of what we have seen has been the product of his descent into madness.
  • Asylum (1972 Horror): The factuality of all three of the patients' stories told — Bonnie's, Bruno's and Barbara's — are suspect due to their clear insanity in the present. Of the three, "Lucy Comes to Stay" is the most overt, as it's implied from the start that Barbara is only hallucinating Lucy's presence — in fact, Lucy first appears casually sitting on a chair when Barbara turns around, apparently having appeared out of nowhere. At the end of Barbara's story, we see something from her perspective that is definitely unreal: when Barbara looks into her mirror, she sees Lucy in place of her reflection.
  • The Attic: Emma is a bit unstable and agoraphobic, so the audience suspects that her perception is unreliable once she starts seeing a mysterious double of herself wandering around the house, among other strange occurrences. But her family's behavior around her starts seeming increasingly suspicious, and a detective she meets, who is willing to believe her, sees the double too, and uncovers proof that her family was hiding the existence of a dead twin sister... The Reveal is that she was imagining both her sister and the detective, and when she witnesses her sister murdering her brother, she was really killing him herself. But then it turns out that there was something supernatural going on after all: The house they lived in was a Genius Loci that kills off families that move there by picking a potentially vulnerable family member and giving them paranoid hallucinations.
  • The Beast with Five Fingers: The disembodied hand is seen by, and attacks Hilary, who tries desperately to convince others of the thing's existence. However, at the end of the film, it is revealed that Hilary was using the severed hand to stage a "Scooby-Doo" Hoax, but his Sanity Slippage caused him to believe that the hand was real and haunting him.
  • A Beautiful Mind: John Nash is a noted mathematician who is hired by the Pentagon as a code breaker to look for magazine and newspaper articles apparently linked to a Soviet atomic bomb plot. After he is spotted by enemy agents during an attempted info drop-off, he is blackmailed into staying on the assignment, only for the film to later reveal that these black-op missions, the attacks and conspiracies are chiefly resulting from Nash's paranoid schizophrenia.
  • A Christmas Horror Story: One of the segments involves Santa Claus fighting a zombie outbreak among his elves in the North Pole... It turns out "Santa" is a volunteer at a charity food drive at the mall, who suffered a nervous breakdown, went Axe-Crazy, and started attacking volunteers and mall employees he was imagining to be zombie elves. There are a few early hints that something is "off" about this story line — it's the only segment that (seemingly) doesn't take place in the same fictional suburb as the others, the wraparound segments keep mentioning a disturbance at a local mall, and early on Santa and his elves have an oddly technical, in-depth discussion about weather phenomena, hinting at "Santa's" true identity as a local radio weatherman who briefly appeared in the wraparound.
  • Big Eyes: When Walter begins commercializing her work, Margaret starts to see people in the grocery store with giant eyes like in her paintings. This is never brought up again.
  • In the original version of Cat People, whether the wife was really turning into a vicious beast or was just plain nuts was left heavily ambiguous, until the final scene.
  • The American remake of Dark Water. While the mother's neuroses and unreliable point of view exist in both versions, the finale of the original cements the ghost horror story interpretation while the remake prefers to leave it ambiguous.
    • The original Koji Suzuki short story counts as this trope, too. Yoshimi experiences several minor paranormal occurrences, and at the end is unsure whether it was real or the product of her over-stressed mind.
  • Since The Descent's main character was hallucinating without a doubt at several separate points, there is a popular theory that the cave monsters were all in her mind and it was her that killed all her friends. The director originally put a crawler silhouette into the first hallucination sequence (which took place outside the cave) but had it edited out because he wanted to leave it more ambiguous. The Descent Part 2 ignores this completely.
  • In Don't Look Back (2009), the viewer sees things from the point of view of main character Jeanne, who increasingly comes to doubt her own sanity as the film progresses.
  • One popular interpretation of Drag Me to Hell is that the effects of the curse are all in the protagonist's head, possibly out of guilt for not helping the old women who cursed her.
  • Enemy: One popular interpretation of the film is that it takes place mostly in Adam's head, with Anthony being a symptom of his delusions.
  • Fight Club deals with a nameless protagonist befriending a man named Tyler Durden and creating an underground fighting ring for men. As it turns out, Tyler is merely a split-personality that represents the kind of person the narrator wants to be, which means for the majority of the film he's talking to himself. And once it's revealed, there's a flashback to several earlier scenes, this time without Tyler and with the protagonist in his place, saying his dialogue verbatim, just to drive the point home.
  • The film Griff the Invisible deals with a character who likes to imagine himself as a superhero late a night, with a high tech computer system, fancy superhero suit, and a fire ladder in his pantry. Later we are shown that the supercomputer is just a series of old, out dated computers stacked on top of each other with a fake cardboard one as well, the superhero suit is more just cobbled together sports equipment, and the pantry is normal.
  • The Hand wherein the protagonist's severed hand goes around killing people. Turns out it was him all along doing it, because the trauma of losing his hand and finding out his marriage is very unstable drove him insane.
  • Hellraiser:
    • Hellraiser: Inferno: Joseph keeps seeing momentary visions of the Cenobites as people's faces randomly morph into nightmarish shapes. When Joseph confronts them they are perfectly normal however. The world around Joseph gradually becomes increasingly bizarre and nightmarish and it becomes unclear what is even happening for real. He's revealed at the end to not actually have been insane, but being tortured in hell for most of the movie.
    • Hellraiser: Hellseeker: Trevor keeps seeing flashes of the Cenobites and other creepy stuff that probably isn't really happening. He eventually finds out that he's been Dead All Along.
  • Horse Girl: Sarah is seemingly suffering from delusions and hallucinations throughout the film. However, it's left ambiguous what is real or not.
  • Il Profumo Della Signora In Nero chronicles the descent into complete insanity of a woman due to the childhood trauma of having driven her mother to kill herself out of shame.
  • The film from which this trope previously took its title, In the Mouth of Madness, was heavily inspired by the Cosmic Horror Story of H. P. Lovecraft and featured Sam Neill going mental with an axe. To make it even better, the question isn't just limited to whether Sam Neill's character is sane or not, but also whether he actually exists or is just a figment of the in-story horror writer's imagination (or for that matter, a figment of the screenwriter's mind). The man's not just in the mouth of madness, but being digested.
  • Inland Empire, like most of the movies of David Lynch, starts in a somewhat "realistic" way, but after the first hour, is practically impossible to know what thing is real, a dream, or hallucinations.
  • Jacob's Ladder, where the main character can't tell whether he's really switching back and forth between realities, or if the hellish experiences and the crazy Government Conspiracy he thinks he went through are just the products of his feverish mind. It turns out he's dying and/or in purgatory, and all the awful things he goes through are helping him let go of his life.
  • In Joker (2019), the eponymous character becomes increasingly psychotic throughout the film and also probably suffers from brain damage, and the movie is from his point of view. Needless to say, a lot of the events of the film are suspect, in that they may only be taking place in Arthur Fleck/Joker's head. The clearest example is Arthur's entire relationship with Sophie Dumond. He hallucinates or vividly imagines interactions with her, and seems to believe that they are in a relationship, when in reality, he only talked to her once in the hallway of their apartment building, and he also followed her around the city for an entire day. The viewer doesn't know for certain that his relationship with her has been entirely in his head until she finds him in her apartment uninvited, and asks him, "Your name is Arthur, right?" It is also unclear if some of the events of the last part of the movie actually happened, though that is left a little more ambiguous.
  • La Moustache, a minor French film, uses this to a smaller degree. First the protagonist shaves off his moustache, and his wife doesn't remember he ever had one. He finds photos of a vacation they took, and in the photos he had a moustache, but the photos disappear, and his wife doesn't remember ever taking the trip. Then he tries to call his mother and finds out she's been dead for a year, and his wife tries to have him institutionalized and forcibly medicated. He escapes and flees to another country, gets a hotel room and wanders around for a while—then returns to the hotel room and discovers his wife's there, and thinks they're on vacation together. She doesn't remember any of his previous confusion, and the viewer is confused in turn.
  • The Machinist is an almost surrealist example of this trope. However, the ending revelation rationalizes everything. The protagonist has gone so mad from guilt for a past sin that he repressed that his mind has invented an Enemy Without to punish him, as well as befriending the people whose lives he accidentally destroyed.
  • In Madhouse (2004), we see the film through the eyes of Clark who is mentally unstable until he loses it at the end.
  • The Man Who Killed Don Quixote: The film plays with this, often leaving initially ambiguous if Javier and Toby's increasingly wacky finds are somehow real or just random but absurdly appropriated happenings.
  • Mandy (2018): It is extremely unlikely that Mandy could be burned into ashes that blow away in the wind just from being wrapped in a tarpaulin and doused in gasoline, and Red seeing this happen is more likely to be a reaction to extreme trauma than witnessing objective reality, and this in turn casts doubt on the reality of all the weird stuff that happens afterwards. And then he takes some drugs.
  • Marebito is, on its face, a kind of dark Urban Fantasy movie about a man who travels into the underworld and finds a vampire chained to a rock. However, all the movie's fantasy elements are taken from real conspiracy theories and well-documented paranoiac fantasies (there's a lot of stuff about Richard Sharpe Shaver in particular), and the main character's starts doing increasingly questionable and insane things. Then a woman shows up, claiming to be his wife, and demanding to know where their daughter is...
  • The Messenger: The Story of Joan of Arc: The film toys with the audience over whether Jeanne really has visions from God, or is just deluded.
  • Ms. 45: Much of the film has dream like quality, and it is not clear how many of the events after the rape scenes are real, and how many are the result of Thana's Sanity Slippage.
  • Naked Lunch is a very loose adaptation of a book that was fairly freeform to begin with by a man who was doing a lot of drugs at the time. Different layers of the movie's reality bleed together, combining sequences and characters from the book with scenes of the book itself being written... while doing a lot of drugs. The end result is one of the stranger biopics ever made.
  • The war of wills between the title character and the housewife in Peter Weir's The Plumber has some elements of this. Certainly, the plumber does behave in ways that are completely inappropriate and occasionally illegal, but the film keeps it deliberately vague as to whether he's a genuine psycho who is menacing this poor woman, or she's a neurotic who is projecting her anxiety onto a harmless oddball.
  • Psych-Out:
    • During Warren's bad STP trip, he sees other people as zombies and his arm as rotten and infested with maggots, leading him to try to kill his friends and cut his arm off.
    • When Elwood uses a bat to fight off Jenny's attempted rapists, he sees himself as a swordsman fighting knights and later a dragon.
    • When Jenny takes STP, she sees everything around her burst into flame.
  • Many of the scenes shown through Molly's POV in Ripper: Letter from Hell are suspect as her sanity is slowly slipping as the film progresses. For example, late in the movie, she sees her younger self guiding her through the forest. By the end of the film she is completely insane and confined to an asylum, where she sees the world around her as 1888 London.
  • In Romasanta: The Werewolf Hunt, it is impossible to tell which parts of Antonio's story are true and which have been warped by his madness. For example, did he see a wolf tearing at the body of the woman in the forest, or was it the human Romasanta?
  • Scott Pilgrim vs. The World. Though fans are divided on how to interpret it, Word of God from the director says that most of the weirder stuff that happens in the movie is all in Scott's head, and none of it actually happened. A popular fan theory is that Scott is actually a deranged serial killer. The movie also frequently has weird scene transitions (and weird scenes in general) that make it very hard to tell which parts are really happening and which parts are Scott's daydreams/actual dreams. For example, there's one scene where he excuses himself to go to the bathroom. After doing his business as normal, he exits the bathroom, only to find himself in a corridor resembling a school corridor. He follows it to the end to see his own front door, with snow in front of it, and Ramona standing in front of it ringing the doorbell. The doorbell ringing gets louder and louder, until the scene fades into Scott waking up in bed with the doorbell ringing for real. Just what happened between the bathroom scene and the dream?
  • Stanley Kubrick noted with the film The Shining that it was his objective to create this impression instead of supernatural powers being at work (for instance, it's suggested that the locked storage room's door accidentally went open, not due to any ghosts). There were still some details that couldn't be explained by assuming the protagonist(s) are crazy, especially "the shining" psychic powers used by Danny to call Hallorann for help even though he's hundreds of of miles away.
    • One mechanism used in the film to discomfort the audience was that of impossible spaces, which would normally be a sign of either severe mental trauma or something supernatural... but then, how often does anyone memorize the layout of a hotel?
  • A lot of Shrooms is seen through the eyes of characters who are tripping on magic mushrooms, making very hard to know what is real and what is not.
  • Society: Throughout the movie Bill keeps seeing horrific visions of people distorting their bodies in impossible ways, but a second later everything is back to normal. Subverted in the end when it turns out it was all real, leading to one of the most nauseating climaxes in the history of film.
  • Spider (2002) is told from the point of view of its protagonist, a man with schizophrenia who is reliving the traumatic events of his childhood. It was definitely not directed by David Cronenberg.
  • Spider-Man Trilogy:
    • Spider-Man: Norman Osborne hallucinates first the Green Goblin mask and then his own reflection talking to him, symptomatic of his split personality brought on by the serum he injected.
    • Spider-Man 2: At the end, Harry hallucinates his father in the mirror, telling him to avenge his death. Harry breaks the mirror and finds a room full of serum...
    • Spider-Man 3 has Harry suffering two hallucinations; a further hallucination of his father (though judging by the voice it's more like the Green Goblin than Norman) representing his evil side, and Bernard, his butler, who Word of God says is a hallucination that represents Harry's good side.
  • A subtle example in Spider-Man: Far From Home: The villain, Quentin Beck, recalls people laughing during Tony Stark's presentation of his invention; this and what follows is characterized as his Start of Darkness. Except the same moment was seen in Captain America: Civil War, and there was absolutely no laughter or derision by anyone present. This puts everything else about the villain's perception of events into question. It's unclear if the villain actually believed people were laughing, or was just saying so to paint Tony as a bad guy, but if the former, it may explain the real reason why Tony had decided the guy was unstable.
  • Spiral (2007), which leaves several questions up in the air at the end. Did he kill all of these women? Did most of them actually exist? What's the final sketch?
  • Horror Anthology Film Strange Events has the short "Descent", where a woman finds herself trapped in an elevator with a man she recognizes as her best friend's killer. The ensuing conversation gets very tense, and the man seems to be dropping hints that he knows she's a witness - when he tries to come closer to her, she stabs him repeatedly with a pen in self-defense, killing him... Then the elevator comes back on and she steps out, only to be confronted by a security officer who also looks exactly like the killer. The previous scene is shown again Once More, with Clarity, but now the man in the elevator is played by an entirely different actor, with his bald head being the only real physical similarity to the killer - the main character, possibly suffering from undiagnosed PTSD, had a breakdown and killed an innocent person.
  • The Suicide Squad: There are shots where the audience sees from Polka-Dot Man's point of view and how he literally sees everyone as his abusive Mad Scientist mom. And Harley envisions flowers blossoming out of thin air and cartoon birdies as she slaughters the soldiers holding her captive.
  • In Summer of Sam, there's a scene of David Berkowitz being ordered to go out and kill people by his neighbor's demon-possessed dog. (Also historically wrong, as the real Berkowitz eventually admitted he'd made up the demon-dog story when he was bucking for an Insanity Defense.)
  • Super: It's left unclear if Frank actually heard God's voice and received visions from him, or is just mentally ill. The latter is quite possible given his unhinged behavior, and even he's unsure at one point if he's really hearing God's voice or it's just in his mind.
  • In Total Recall (1990), the main character is either a secret agent in deep undercover on Mars (which is what he paid Rekall to experience), or he is going insane due to brain damage from side effects of the memory implant.
  • The Uninvited (2009), though it's executed with very little ambiguity.
  • The ending of Vampires vs. Zombies implies that the events of the film may have been a psychotic delusion of Jenna's while she is incarcerated in the asylum.
  • Vanilla Sky (2001), directed by Cameron Crowe and starring Tom Cruise. Remake of 1997 Spanish film Abre los Ojos, a.k.a. Open Your Eyes. After a car accident that kills his girlfriend and disfigures his face, the protagonist is haunted by increasingly bizarre occurrences. The ending explains that everything that has occurred after the car accident has been a dream. In real life, after the car accident, he signed a contract with a company that preserves its clients' bodies after death and keeps their brain waves active in lifelike virtual reality dreams, and then committed suicide. The bizarre occurrences are explained as glitches in the program. In the end, he decides to wake up from the dream program.
  • Videodrome by David Cronenberg is shown from the perspective of the protagonist, Max Renn, who has certainly gone batty at some point. Everything up to the first Brian O'Blivion tape he watches can be assumed to be real as he's still only slightly affected by the signal. But when Bianca tells him that his life could become "100% video hallucination", suddenly it looks more and more likely that the bizarre plot twists (i.e. an evil conspiracy operating out of an opticians', his best friend being part of this conspiracy, murdering people with flesh/metal hybrid weaponry) is all part of a massive psychotic break triggered by the Videodrome signal. Maybe.
  • The Voices major theme is this. The protagonist is explicitly mentioned to not have taken his medication for a long time and hallucinates voices in his head (usually those of his pets, then those of three accountants of the firm he works for, whom he has beheaded while keeping their heads in his fridge). He also sees his home as a nice and cozy nest, while it is actually disgustingly filthy and littered with trash. When he eventually takes his pills, he is brutally awoken in the night by nightmares about his past, then freaks out after noticing that his home is so trashed and that his pets don't talk.

  • Along The Winding Road: The protagonist may be perfectly normal, but the love interest certainly claims insanity to the point that we can't be sure if he caused the zombie apocalypse or not.
  • American Psycho. Patrick Bateman, the narrator, is clearly insane, and has bizarre hallucinations (such as a Cheerio interviewed on a talk show, or himself stalked by a park bench) which he believes to be true. It's also ambiguous whether he committed the brutal (and somewhat unlikely) murders that he describes in graphic detail. There's also the fact that, if you pay attention to the detailed pop culture references, the novel clearly takes place during the stock market crash of 1987, and yet Bateman -- an investment banker -- never mentions it.
  • This is explored in The Return, the final book of Blood Knight Rachel from the Animorphs series. Rachel is a character who has spent the past forty-seven books devolving from an Action Girl to a Blood Knight Sociopathic Soldier. Consequently, a good chunk of this book focuses on the hallucinations she's experiencing. Though, to be fair, a good deal of these hallucinations are induced by Crayak. The books deals with the return of David as well, and she continuously relives conversations she had with David internally. These conversations are shown in a font used nowhere else in the series, perhaps to underscore how badly Rachel is cracking up.
  • The Aunt's Story by Patrick White, which has three sections. In the middle one, the protagonist goes mad, and the reader gets seriously Mind Screwed.
  • Chasing Shadows: Holly's chapters delve into her increasingly fragile mental state as her visions and mental health worsen, culminating in bringing Savitri close to death in the hopes she can bring Corey out with her.
  • Elizabeth Woods' novel Choker tells the story of 16-year-old loner Cara Lange, who reconnects with her Childhood Friend Zoe after years of being apart, with Zoe claiming to be "on the run" from trouble back home. Zoe helps get Cara get her social life back on track, and even helps her get the attention of her crush. However, things take a turn for the suspicious when girls in town start going missing and turning up dead, and Zoe's behavior becomes increasingly strange. To add to that, no one else besides Cara seems to notice Zoe's existence at all. Following a confrontation in an abandoned barn, it's revealed that "Zoe" was merely an imaginary friend Cara had made up during her childhood to cope with her loneliness, and that Cara herself murdered the girls, in the midst of a long stint of not taking her schizophrenia medication. Cara's parents also reveal that Cara had a habit as a child of blaming Zoe for her own disturbing actions, including poisoning a neighbor's dog that had bitten her.
  • In the book The Devil's Advocate, this is much more present than in the film, to the point of getting seriously disturbed as the protagonist kills his boss.
  • Nikolai Gogol's appropriately titled short story, "Diary of a Madman", chronicles the descent into madness of a petty Russian bureaucrat who eventually comes to the conclusion that he is the heir to the throne of Spain.
  • Possibly one of Charles Dickens' most chilling ghost stories is titled "A Madman's Manuscript" (from The Pickwick Papers). There are a lot of exclamation marks.
  • Discworld
    • Wyrd Sisters has several scenes from the perspective of Duke Felmet, and his conviction that the witches are making the king's blood reappear on his hands, however hard he scrubs them with wire-wool and sandpaper...
    • Scenes from the perspective of Cosmo Lavish in Making Money start off fairly rational, apart from his conviction that the pain of wearing a ring several sizes too small is Lord Vetinari's power entering him. Later on, his portrait of Lord V is turning to him and saying "Soon you will be a beautiful butterfly." Cosmo is delighted, because Vetinari must be going insane if he's saying things like that. In the end, he fully believes he is Vetinari and is admitted into a hospital, specifically into the "Vetinari Ward", with others like him suffering from similar delusions.
    • In Thud!, when Vimes goes on a Roaring Rampage of Revenge after finally succumbing to the Summoning Dark, it's mentioned he's seeing farm animals as it's six o'clock, and he's supposed to be reading Where Is My Cow? to his son. What he's actually doing is tearing his way through numerous heavily armed dwarfs.
  • The Doctor Who Eighth Doctor Adventures novel The Blue Angel is a less-disturbing variant than most: the Alternate Universe human Doctor has already been diagnosed as mentally ill, generally doesn't take his delusions too seriously, and generally stays on his meds, so it seems that he's unlikely to become too terribly confused. However, it does render the story very confusing, especially as some of the things he has delusions of certainly seem to be actually happening in one of the story's other plotlines, and the reader really can't tell if the story contains Magical Realism or the Doctor simply hallucinates that his mother is a mermaid, one of his friends has a talking dog which tells his other friend that all realities and stories are equally real, and other strange things. It also creates the impression that perhaps the TV series is All Just a Dream — the Doctor just has delusions about Daleks and Cybermen and weird phallic monsters made of cellophane and such.
  • "The Double: A Petersburg Poem" by Fyodor Dostoevsky fits this trope.
  • Dracula: Jonathan's diary entries get like this, especially if read taking into consideration exactly how his sense of time passing has been screwed up.
  • Earthlings: In the first section of the book, Natsuki is a naive and increasingly-traumatized child, and as an adult, she's a Broken Bird who it gradually becomes clear is genuinely insane. Natsuki truly believes she and her cousin Yuu are aliens stranded on Earth, that her toy hedgehog speaks to her, and that she killed a "wicked witch" that first corrupted her teacher and made him molest her, and then killed him, when it is apparent to the reader that there was no witch, just an abusive man, and Natsuki killed him. We see the murder from her perspective, where she hears her toy's voice in her ear and sees "gold liquid" spilling all over the room and staining her clothes rather than blood. It's decades before she pieces together what really happened that night, and by then, her mind has totally snapped anyway.
  • The title character in Eden Green is a self-described rationalist and scientist, but her narrative goes further and further off the rails as the book goes on, implying that she's losing her mind to her needle-symbiote.
  • A version of Hans Christian Andersen's "The Emperor's New Clothes" featured in one of the Datlow/Windling Whole-Plot Reference collections plays a relatively lighthearted version of this. Due to a twist involving the boy who reveals that the Emperor has no clothes, both the narrator (The brother of the Emperor, who is a manipulative, treacherous would-be usurper who's far more incompetent than he realizes) and the reader are left wondering whether the clothes didn't exist, or they really did exist, and the narrator couldn't perceive them because he was wholly unfit for his position.
  • The Reveal in Evil Genius starts out sounding like Cadel is simply paranoid, but then the evidence starts stacking up...
  • Fight Club deals with a nameless protagonist befriending a man named Tyler Durden and creating an underground fighting ring for men. As it turns out, Tyler is merely a split-personality that represents the kind of person the narrator wants to be, which means for the majority of the book he's talking to himself.
  • Stanisław Lem's character Ijon Tichy is subject to this in The Futurological Congress after being dosed with powerful hallucinogenic drugs.
  • Germain, from Eric Nylund's A Game of Universe, has multiple personalities. However, he knows he has them (and can usually keep them in control) and there's a valid source for them: a magical ritual to copy knowledge from someone. However, when he learned the ritual, no one mentioned the voices-in-your-head side effect, and coincidentally he doesn't start hearing them until after some incredibly traumatic experiences. By the end of the story, two characters have suggested that he didn't actually copy their personalities into his head, he simply made them up in order to justify doing certain unpleasant things (however one of the characters advancing this idea lives in his head, and the other is a Mind Screwing telepath).
  • In Ghost Radio, local DJ Joaquin hosts the titular radio station, where listeners call in to share ghost stories on the air. After his dead friend Gabriel calls them, Joaquin slowly slides into this, hallucinating his callers' stories, time rapidly changing before his eyes, and more, accelerating non-stop while Joaquin struggles to maintain his grip on reality. When he finds evidence of the anomalies in his life, Joaquin's girlfriend Alondra almost dies, and Joaquin has to perform a Toltec ritual and sacrifice himself to save her.
  • Stephen King's The Girl Who Loved Tom Gordon plays this trope with one aspect. The creature that stalks Trisha, and eventually confronts her at the book's climax: is it just a black bear, distorted by her fear and her fever-induced hallucinations? Or is it really the supernatural horror, the "God of the Lost" she imagined it to be as it stalked her, and during her mental duel with it? Just to toy with you, the novel has someone else witness it who seems to provide the objective truth of it being a black bear... then it turns out he thought it was something else for a moment, too, but he's a drunk, and thus no more reliable.
    • This comes up again in his short story "The Moving Finger", in which a man believes that he sees a finger sticking up out of his bathroom sink's drain. Things get increasingly weird (and the main character gets increasingly unhinged), until the reader isn't sure what's really going on. The ending suggests one possible 'mundane' explanation, but leaves it ambiguous.
      • This story can also be read without doubting the narrator, and either way the very end seems to be designed to suggest that it was all real.
    • Stephen King explores and discusses the trope more extensively in his short story "The Ballad of the Flexible Bullet". A writer is told a story by his publisher about another writer, struggling with writer's block, who became obsessed with the idea that his typewriter was inhabited by beings who were truly responsible for his writing ability, beings who needed to be appeased with offerings for his continued success. The protagonist indulges what seems like a harmless superstition by leaving an offering for the "Fornits", and gradually spirals into the same delusions. The climax in particular implies either that the writer was actually right, OR had managed to thoroughly delude his wife who had, up until that point, seemed to be a non-believer.
    • King said that the appeal of The Shining, for him, was the way that it "blurred the line between the supernatural and the psychotic" — although it seems less blurry than in Kubrick's film version.
    • Implied in some adaptations of King's novel Carrie. After Carrie is humiliated by having pig's blood dumped on her, she thinks the students are all laughing at her, when they've really been shocked into silence. In some adaptations, Nice Guy Tommy was even calling them out on the prank while this was going on in Carrie's head.
    • King also does this in his short story "Suffer the Little Children", in which neither the teacher nor the readers are sure if her students are "something else" or not. They seem to confirm their identity to her, but who knows if the words the teacher hears are what was really said?
  • This trope is the only possible explanation for the Mind Screwy Goosebumps book I Live in Your Basement, about a boy named Marco who defies his overprotective mother and goes out to play softball, only to get hit in the head. While recuperating, he receives strange calls from a boy named Keith, who lives in his basement, and is said to be a blob monster disguised as a human. The rest of the story shows how Marco's reality is slowly slipping away and how everything he experienced is either a dream or a vivid hallucination — until it's revealed at the end that Keith is the one having the weird dreams and that he's the one who lives in fear of the human who lives upstairs.
  • Stefan Grabiński was a fan of Edgar Allan Poe and it shows in his sheer propensity for insane narrators.
  • The premise of Joseph Sheridan Le Fanu's short story "Green Tea". Is Rev. Jennings really being visited by a demonic monkey that no one else can see? Or is the green tea he drinks habitually slowly poisoning him, causing visual and auditory hallucinations? The story's narrator insists it's the latter, and is confident he can cure Jennings, but before he gets a chance to try, Jennings kills himself under the monkey's orders. It's made doubly tricky via its use of the Direct Line to the Author ploy: the story's "editor" freely admits to having changed the names of all the characters save for the protagonist, and tweaking and omitting bits of information here and there - but nevertheless insists he is completely impartial.
  • The Hollow City features a protagonist who is, unambiguously, schizophrenic and hallucinating, and his struggle to find out what is and isn't real... especially once he sees one of the monsters chasing him while medication is suppressing his other hallucinations.
  • "The Horla" by Guy de Maupassant is exactly that. As is almost any fantastic short story written by de Maupassant. And the author himself ended his life in a psychiatric hospital.
    "Relating the advent in France of an invisible being who lives on water and milk, sways the minds of others, and seems to be the vanguard of a horde of extra-terrestrial organisms arrived on earth to subjugate and overwhelm mankind, this tense narrative is perhaps without peer in its particular department."
  • In House of Leaves, Johnny describes in detail how the Minotaur attacks and rips into him, or how he vomits at its stench, only it didn't happen and the creature was never there in the first place. Or was it? The book is irritatingly vague about whether the creature exists or Johnny is hallucinating. For certain, Johnny descends further and further into insanity as the book progresses.
  • The terrifying "The Repairer of Reputations" in Robert W. Chambers' The King in Yellow is so saturated in this trope that it's hard to even tell what the setting is; everything we hear about its 20 Minutes into the Future (from the perspective of its author in 1895, anyway) dystopia comes from the narrator, and the narrator definitely does not seem to have borne the Brown Note of reading The King in Yellow quite as well as he thinks he has...
  • In the Known Space story "The Ethics of Madness", the protagonist unknowingly goes off his meds because his autodoc's "refill me" light burns out just as the drug supply is exhausted. Once, he uses another autodoc and gets re-medicated... and when it wears off, he "realizes" that the other autodoc had been tampered with by his "enemy". Not surprisingly, things go downhill from there.
  • Life Is But A Dream revolves around a girl with schizophrenia and the vivid dreams and nightmarish delusions she has, especially when she stops taking her medications and believes the world is going to end soon.
  • The apparently boring narrator of Sarah Waters's The Little Stranger, who may or may not be responsible for all the horrible things that happen — including the suspicious death of his ex-fiancée.
    • Waters's earlier novel Affinity also featured a first-person narrator sliding into insanity, though there it's made quite clear at the end what's actually going on.
  • H. P. Lovecraft's stories:
    • In "The Rats in the Walls", it is never quite clear whether what's happening to the character is actually happening, actually happened, or whether the character just went insane. The fact that he starts off clearly not that well adjusted in the first place and winds up in an insane asylum or living deep in Paranoia Fuel Territory really doesn't help things.
    • Played with in The Temple, where the narrator is trying to tell his story while constantly pointing out that much of what he is writing is probably just delusions brought on by madness.
    • Hypnos leaves it extremely open whether the narrator's nameless "friend" ever really existed or was simply a marble statue he may have found and taken home someday all along.
  • Lunar Park: The narrator is a writer named after the author of the novel: Bret Easton Ellis who is an unreliable narrator, because he describes things the other characters don't see or feel. The main character is abusing drugs, some of the hallucinations might be to some extent related to that. Also, there is an intertextual reference to Ellis' novel, American Psycho. Ellis' character has apparently also written a novel titled American Psycho and he says: "Patrick Bateman is an unreliable narrator."
  • "Miriam" tells the story of a little girl taking over a middle-aged woman's life — except that the little girl exists only in the woman's head.
  • Rachel Klein's The Moth Diaries... You never figure out how much was hallucination, or whether it was indeed hallucination at all.
  • In Dean Koontz's Odd Thomas, this is partially used in the fact that it's made to seem that Stormy lives through the mass murder at the mall, when instead it's just Odd's ability to see dead people fooling the reader into thinking she's alive. Odd even says, "For a while I had gone mad."
  • One Flew Over the Cuckoo's Nest is narrated by "Chief" Bromden, a paranoid schizophrenic who hears machinery clanking in the walls, sees his fellow patients controlled like marionettes by Nurse Ratched, and repeatedly claims the entire ward is enveloped in a thick white fog that makes it impossible to see or move. At the beginning he claims that everything he describes "Is true even if it didn't happen."
    • His narration doubles both as a terrifyingly astute metaphor, and a description of his own view of a reality that was long ago fucked over.
  • Edgar Allan Poe is a master of this, especially in "The Tell-Tale Heart". *shudder*
  • The short story "A Pursuit" by Brian Evenson. The narrator describes how for days he's been pursued by his third ex-wife, or maybe it's his second ex-wife, while sometimes interrupting himself to give a Suspiciously Specific Denial about the death of his first ex-wife or to criticize himself for Breaking the Fourth Wall. While the ending is very open to interpretation, it implies that he had already murdered all three of his ex-wives before the story began.
  • A Scanner Darkly by Philip K. Dick. The protagonist has increasing trouble in making the distinction between reality and fantasy, due to his addiction to a drug that causes a split between the two hemispheres of his brain.
    • This is a favorite trope of Philip K. Dick and variations appear in most of his works.
    • PKD lives on this trope (this and Paranoia Fuel). VALIS, anyone? "Flow, my tears," the policeman said, Game players of Titan, Ubik... hell. Pick any of his novels or short stories and you will find a protagonist spiraling into either the terrifying deconstruction of his own mind, or the painful deconstruction of reality. Either way, said protagonist is going to be royally screwed.
      • A Maze of Death isn't as well-known (understandably, due to its inconsistent publication history), but it's a pretty good rehearsal of the themes PKD would soon explore in more detail in Ubik.
  • In 17 and Gone, Lauren's increasingly elaborate visions and dreams are seen from her perspective, and it's eventually revealed that it was all schizophrenic symptoms.
  • In Shutter Island, the protagonist's viewpoint becomes increasingly inconsistent until the halfway point, where we are first forced to consider the possibility that he is the one who is truly mad. At the very end, it's ambiguous whether he's truly insane, or truly rational for the first time in the entire film and choosing lobotomy over living with his crime.
  • Every character in The Sister Verse and the Talons of Ruin is trapped in an endless hallucination that mirrors their thoughts and fears. John has become particularly unhinged and paranoid as a result of this.
  • In The Terror by Dan Simmons it's not clear if the monster slaughtering the explorers is just a combination of sleep deprivation, denial, stupidity and a bear or if it is actually the spirit Arctic.
  • The book The Turn of the Screw and its film adaptation, The Innocents; whether or not the children are really being haunted is never addressed.
  • Barry N. Malzberg's short story "What I Did to Blunt the Alien Invasion". This story has two tracks, one in which aliens reveal themselves to a man and warn of a coming invasion, after which he does everything within his limited means to warn people, including offering to betray humanity. The other is implied to be a man who becomes unstable, eventually causing his wife to leave and he to be arrested.
  • Alexandre Dumas's "The Woman with the Velvet Necklace" establishes early on that its viewpoint character comes from a family with a history of mental illness, and that he himself hasn't always got the stablest relationship with reality. Later, even the viewpoint character is tortured by the questions: Is he going insane? Is he a recent escapee from a mental hospital? Or is the story that he's a recent escapee from a mental hospital merely a coverup for a story that is far more bizarre and horrifying?
  • A World Without You revolves around a boy who believes he is a time-traveling superhero at an academy for people with powers instead of his reality of mental illness. Much of the book is spent under the belief he can reverse time and save his "missing" girlfriend, who died by suicide in reality.
  • "The Yellow Wallpaper" describes of a woman who's locked in a room with only the yellow wallpaper to look at, growing more obsessed and insane about it as time goes on. It's semi-autobiographical.
  • "Young Goodman Brown", by Nathaniel Hawthorne, uses this. Goodman Brown is walking into a forest with the devil to a witch's meeting, at which he sees all the good and prominent people of his Puritan township in unholy worship. He ultimately rejects the devil and the whole thing disappears, leaving the reader and the character unsure of whether or not what he had seen was real. The lack of surety and the constant doubt poison Goodman Brown until he finally dies as a twisted, suspicious, lonely old man.

    Live-Action TV 
  • Accused: Stephen is clearly a paranoid schizophrenic, which makes him think his stepmother killed his mother, the family dog, and is now trying to kill his father and brother as well. Eventually this leads to him stabbing her in what he believes to be a defense of them and himself. He refuses to admit he's mentally ill though, or allow a psychiatric examination. This means he's convicted and gets six years in prison when most likely he wasn't responsible at all.
  • The Affair: Throughout much of Season 3, after doing a 3-year stint in prison during the Time Skip between seasons, Noah is being stalked by a psychotic prison guard named John Gunther who even stabs him during a home invasion. When he visits Gunther in his hometown, he (initially) doesn't even recognize Noah and turns out to just be a normal guy. It's likely that most of their interactions in prison were imaginary, and Noah stabbed himself.
  • Agents of S.H.I.E.L.D.:
    • A heartbreaking example: In the first season finale, Agent Fitz nearly drowns trying to save Agent Simmons and ends up comatose as a result. Season 2 opens up several months later; Fitz is out of his coma and while he does suffer lingering brain damage, Simmons is by his side assisting his recovery as he builds a cloaking device for the team's airplane. Sounds well and fine until the end of the episode, when we learn that Simmons left SHIELD months ago when she felt she was hindering Fitz's recovery, and he has been hallucinating her presence ever sincenote . From here on, we see him delusionally talking to himself and his "cloaking device" is nothing but a pile of scrap metal. One can conclude that Coulson only keeps Fitz around to protect him from HYDRA, since he'd be an easy target at a nursing facility. Fortunately, Fitz makes a full recovery, and it turned out Simmons was working undercover at Hydra and returned to SHIELD when her mission was over.
    • In the second half of Season 5, the team are based over a rift to a "fear dimension" which occasionally sends forth their worst fears. Since Fitz's greatest fear is that he's more like his Framework persona, the ruthless head of HYDRA known as the Doctor, than he likes to think, it's unsurprising when the Doctor emerges from the rift, has an argument where he calls Fitz weak, and then operates on Daisy to restore her powers against her will, since it's the only way to close the rift and regualar!Fitz is too weak to do it. Only when Gemma bursts in in the middle of the operation do we learn that the Doctor did not emerge from the rift. When he interacts with Fitz, this is happening in Fitz's head the way it has been ever since he left the Framework. When he interacts with others, it's just Fitz, who has let the Doctor persona take over to do "what needs to be done".
  • In the Babylon 5 episode "Passing Through Gethsemane", Brother Edward seems to be falling victim to this. At one point, Brother Edward walks through a station corridor. He hears voices, sees a message written in blood on the wall ("DEATH WALKS AMONG YOU"), and "flashes back" to an unfamiliar memory where he's running through water from someone. When he brings station security to the same corridor, as fits this trope, the bloody message is gone. This ends up being a subversion; further investigation reveals there are hidden speakers all through the corridor, there are traces of a "disappearing ink" substance that was likely used to write the bloody message, and the "flashback" was triggered by a Centauri telepath that Brother Edward had encountered just before entering the corridor.
  • Buffy the Vampire Slayer: In the Season 6 episode "Normal Again", a demon stabs Buffy with a weapon that is a part of it. Said weapon is also poisonous and causes vivid hallucination. Buffy believes she is in an asylum being treated for her delusion that she is the Slayer. After 6 years of watching the show, we the Audience automatically assume that the Sunnydale scenes are real and the asylum scenes are delusion until the final reveal, which has one final "hallucination" that she's gone catatonic.
  • A seventh-season episode of CSI danced around this trope, when the team gets to deal with a cult that believes in an Ancient Conspiracy of shapeshifting snake aliens. One of the cultists is under interrogation, and at one point we see the detective raise his water glass and, without warning, dip a snake-like tongue into it. We later get to see some of the police as the reptilians from the perspective of a couple cult members, in flashback. Of course, this being CSI and not The X-Files, this was only a hallucination of the cultist. Probably.
  • Community:
    • In the episode "Beginner Pottery", Jeff can't accept the fact he is unable to succeed in a pottery class, and ends up stalking and assaulting one of his fellow classmates.
    • A more humorous version is "Abed's Uncontrollable Christmas".
  • In the show Crazy Ex-Girlfriend, Rebecca randomly breaks out into musical numbers, sometimes involving other people (sometimes a lot of other people). It's implied (although never confirmed) that this is all taking place in Rebecca's head. However, in later episodes, other characters have musical numbers without Rebecca being anywhere near, implying either that the musical numbers are real or that Rebecca's "madness" has spread to them.
  • Criminal Minds:
    • The episode "Normal". A man takes out his fantasies of killing his family by killing other people. This leads up to a climactic chase scene where he's trying to get his family out of the city when his wife jerks the wheel and makes them crash. When he's pulled from the rubble, it's revealed he had been hallucinating them the whole episode and killed them pretty early on, which is hinted at constantly, in retrospect. It's one of those things you've got to watch twice.
    • The episode "With Friends Like These" has a young man being pressured by his "friends" into killing innocent people, and they won't leave him alone until he does it. Then it's revealed that he was alone the whole time.
  • The Crowded Room: Much of the events in the series it turns out really didn't happen as we're first shown, as several characters are Danny's alternate personalities, with this only shown to be the case after going over them again.
  • Empire: Andre, whose mental instability is a major plot point throughout the series, starts seeing a new psychiatrist in the fourth season and also finds a new girlfriend, a detective named Pamela. Just as the relationship becomes strong, Andre admits to her that he killed a man, and she reveals that she's been working undercover and seduced him just to nail him as a suspect. She starts to arrest him, but a fight ensues and he accidentally kills her. He calls Lucious and Cookie to help him deal with this mess... only for them to tell him there's nobody on the floor. He yells at them that she is right there, but her body blips in and out of view. His parents repeat that there's nobody in the room except the three of them. We then see flashbacks of Andre and Pamela's scenes together throughout the season. When they were on a date, Pamela told him to not to talk so loudly because people were starting to stare; in reality, they were staring because he was talking to himself in the middle of the restaurant. We see another scene where he was dealing with others in her presence but she only interacted with him, because she was never there in the first place. And when they made get the idea. Needless to say, the realization caused him to utterly break down. It turned out his "psychiatrist" was in league with the Big Bad and the medication he prescribed caused Andre to hallucinate Pamela into existence.
  • Guillermo del Toro's Cabinet of Curiosities: In "The Murmuring", Nancy is the only one who can hear and see the ghosts in the house, while Edgar is completely oblivious. This makes it ambiguous whether the ghosts actually existed as entities, or if they were the product of Nancy's grieving, depressed and sleep deprived mind.
  • House:
    • In the episode "No Reason", House is shot and is placed into a drug-induced coma. When he wakes up, his debilitating limp is cured, but he soon starts experiencing short-term memory loss and hallucinations while working on a particularly bizarre and seemingly unsolvable case. The other doctors suspect he's suffering side-effects from the drug they put him on, but he becomes convinced that he's actually still comatose. He resolves to break out of his coma by killing his own patient. It turns out that he's right and it works, but there's a moment there where it looks like he was wrong and he's just murdered a man in a particularly gruesome way.
    • The episodes where he hallucinates of Amber's and Kutner's ghosts count as well.
  • The The Lonely Island song/SNL Digital Short "Like a Boss". The "boss" is clearly unstable, and it's possible the hallucinations start after he fails suicide, but after he blacks out in the sewer, it falls into Talkative Loon territory.
  • This provides the twist ending for the Masters of Horror episode "Imprint". After all the horrible events that the disfigured prostitute tells Christopher and the revelation of a Siamese Evil Twin, he shoots the prostitute, and it turns out to be Komomo all along — the Hooker with a Heart of Gold he was trying to find. Christopher was actually driven completely insane from what's implied to be guilt for raping and killing his sister and the entire story was part of his hallucinations.
  • Millennium (1996):
    • In the episode "The Thin White Line", the audience sees through the eyes of a young Serial Killer who hears his victims giving explicit permission for him to kill them. His former cellmate talks about people begging to be murdered, but in his case it's ambiguous whether he's speaking literally or metaphorically.
    • In the episode "...Thirteen Years Later", the story is framed with Frank Black relating to a roomful of FBI agents about a strange series of murders he once investigated on the set of a horror movie. Then comes the Twist Ending, which reveals that the killer, who was one of the actors, became so immersed in his role that he started imagining himself as Frank and was actually speaking to a room of patients in the asylum.
  • In the last couple episodes of the first season of Mr. Robot, it's revealed that Mr. Robot is actually Elliot's subconscious representation of his father, who died years ago. Since Elliot didn't know, the audience didn't either, so all of the scenes with Mr. Robot in them didn't happen the way we saw them, and it's up for debate how much of the previous season was actually real and how much was entirely in his head. Darlene is also Elliot's sister, and when she sees that he doesn't remember her, she asks if he forgot her “again”, implying this has happened before.
  • The Mystery Science Theater 3000 episode Future War has Pearl test LSD on Servo and Crow and hook them up so everyone can see what they're seeing. When they look at Servo's POV, everything turns all warped with a nightmarish green filter and a monstrous Mike and Crow making distorted noises. Mike is horrified, while Servo just laughs it off and explains that that's what he always sees.
  • The OA: The entire series follows Prairie's point of view. In the last episode, it's suggested that she's been making her story up using inspiration from books she's read. Ultimately it's not resolved whether she's insane or not.
  • The Outer Limits (1995): In the episode "The Voyage Home", this is played with. The three-man crew of a spaceship are slowly going mad after returning from a mission on Mars. At one point the pilot suddenly transforms into an alien creature in front of the engineer, who jettisons him into outer space. Except when the third guy (the doctor) shows up when this is going on, the 'alien' one looks completely normal and begs him to stop their insane colleague. It turns out that they were both aliens who had assumed their shapes, and the engineer was the last real human on board.
  • Perception revolved around a schizophrenic college professor/neuroscientist who moonlights as a consultant for the FBI, helping them solve murders. Several times the audience is shown a character interacting with him, only to learn that they were never there.
  • Stargate-verse:
    • Stargate Atlantis: The episode 3x06 "The Real World" had Weir wake up in an asylum and be told that she had hallucinated the entirety of her time on Atlantis as a way of coping with her fiance's death. The doctors urge her to let go of her delusions to become sane again. In reality she has been infected with replicator nanites that are causing her to hallucinate the asylum.
    • Stargate SG-1:
      • A particularly creepy episode of, 3x04 "Legacy", has Daniel Jackson slowly going insane from delusions and terrifying hallucinations caused by a piece of Applied Phlebotinum. Much of the episode is seen from his perspective, resulting in this trope. At the halfway point, however, it turns into a Cuckoos Nest trope when the other characters find proof that Daniel was never actually insane as such. The episode would have been more effective if we, the audience, hadn't been shown some thing infecting Daniel's body right in the first act of the episode.
      • "Shadow Play" uses it when Jonas Quinn's mentor scientist visits the insurgents' headquarters, bristling with activity, to hide the fact that the entire thing is The Schizophrenia Conspiracy and the place is actually an empty warehouse.
  • Star Trek:
    • Star Trek: Deep Space Nine: Subverted in the episode "Whispers", where everybody Miles O'Brien knows slowly turns against him. The subversion is that it is Miles O'Brien himself who has been replaced, and the story is told from the clone's point of view. He doesn't know this, but everybody else does (or learns). Both he and the audience only find out at the end.
    • Star Trek: Voyager: In the episode "Persistence of Vision", Janeway is starting to see parts from her holodeck program in different parts of the ship. They go from little things, like being served the same meal as the one she saw in the program, to characters talking to her. It finally culminates into one of them attacking her in her quarters. She wrestles the attacker down and calls for security. Just as you're wondering what's taking security so long to get there, the camera shifts and it turns out she's in sickbay, having never left after her initial exam in the first place.
    • Star Trek: The Next Generation: In the episode "Frame of Mind", where something like this happens... well, it's safe to say the episode is about Riker. Maybe.
  • Subverted in The Tick (2016), where in the first couple episodes, Arthur, who always wanted to be a superhero, and has had a history of paranoia and hallucinations, keeps seeing a super-hero named The Tick — but conveniently, silent and invisible whenever anyone but Arthur is around. Thus, we, the genre-audience, start to believe that Arthur has invented The Tick and we're seeing another of Arthur's hallucinations — and by the second episode, Arthur comes to that realization himself, too... incorrectly. It was just a hilarious coincidence that nobody saw or heard him.
  • Warehouse 13:
    • Pete in "Around the Bend", who is exposed to a telegraph that makes him hallucinate a scenario in which Valda has gone power mad and is trying to take over the Warehouse.
    • Played with in "An Evil Within", where the artifact is a key that belonged to H. P. Lovecraft, which makes whoever touches it be viewed by others as an Eldritch Abomination.
    • "The Ones You Love" reveals that this has been happening to Artie ever since he used the astrolabe; all his interactions with Brother Adrian since then have been manifestations of his Enemy Within as it grows strong enough to perform a Split-Personality Takeover.
  • The Wheel of Time (2021):
    • At the start of Episode 1, Red Aes Sedai are chasing a male channeler and his older friend. When cornered, the friend suggests fighting the pursuers with the One Power. Then he disappears. An Aes Sedai then tells him that the madness must have started manifesting, if the channeler started seeing and hearing things.
    • In his first scene Logain is approached by two humanoid figures woven out of Saidin, who keep nagging that everybody is going to betray him. Later he insists he's hearing all the Dragons that failed before him.
  • Wilfred: The protagonist Ryan sees Wilfred not as a dog, but a man in a dog costume. Often, even though Ryan generally looks after Wilfred for a neighbor, the viewer can't always be sure if Wilfred's really there or not. And Ryan once spent an entire episode hallucinating in his basement, during which Wilfred and a passing stranger (who isn't really there at all) put him through various games. In another, Wilfred allegedly sneaks hallucinogenic drugs into his tea. This becomes a bit of fridge horror when one considers that Wilfred really is just a dog, meaning Ryan likely drugged it himself without even knowing. During the resulting drug trip, Wilfred murders Ryan's "spirit guide" to prevent Ryan discovering the truth about who/what/why Wilfred is. And in a recent episode, it's suggested Ryan somehow set himself up to be framed for mass money fraud without being aware and blaming it on Wilfred (it turns out Ryan's girlfriend was out of her mind and did it herself at the instruction of her own Wilfred hallucination — this one French). Couple all of this with the series' many dips into Ryan's past, revealing many dark and traumatic aspects of his life and psyche, and it can be very difficult to figure out which parts of episodes are real and which parts are just in Ryan's mind.
  • The X-Files: In "Field Trip", Mulder and Scully are trapped underground in a giant fungus mycelium, hallucinating that they were trying to solve a case (the case that brought them into the forest, in fact), while in reality the mycelium was secreting a hallucinogenic narcotic compound onto their skin to keep them passive while it slowly digested them. To further fit this trope, both Mulder and Scully seem to have had the exact same "plot" to their hallucinations, which is pointed out as impossible in the actual episode.

  • Everything, everything, everything by Napoleon XIV.
  • "The Ballad Of Dwight Fry" by Alice Cooper. Also From the Inside, a later concept album.
  • Pearl Jam's Ten describes the lives of various disturbed and troubled people, including a girl in a psychiatric hospital, a boy who suffers from an Oedipal Complex, and a homeless man. The songs seem to characterize these emotions with sympathy.
  • "My Mind Playin' Tricks On Me" by the Geto Boys.
  • As the title suggests, the Coheed and Cambria album "Good Apollo, I'm Burning Star IV, vol. 1: From Fear, Through the Eyes of Madness" contains a lot of this. Maybe. In a nutshell, The Writer has been writing the story contained within the first two albums. His girlfriend, who he was going to propose to, cheats on him, because he's been spending too much time on the story, and not enough with her. He's angry, contemplates killing her or the character based on her in the story, and starts imagining his run-down old ten-speed bicycle is talking to him, operating as his "Son of Sam" dog of sorts. He ends up Breaking the Fourth Wall of his story, communicating with his protagonist, Claudio Kilgannon...
  • Coldplay of all bands, did this in A Rush of Blood to the Head.
  • The Killers have their "Murder Trilogy." While the "Jenny Was A Friend Of Mine" and "Leave the Bourbon on the Shelf" don't qualify, "Midnight Show" fits pretty well.
    The crashing tide can't hide a guilty girl
    With jealous hearts that start with gloss and curls.
    I took my baby's breath beneath the chandelier
    Of stars and atmosphere
    And watched her disappear
    Into the midnight show.
  • The "Weird Al" Yankovic songs "Albuquerque" and "Everything You Know is Wrong".
  • The music video of "Asylum" by Disturbed has the patient/protagonist attempts throughout to escape from the eponymous asylum depicted this way. The events within are always surreal and usually overly violent and brutal (such as his being killed or beaten by the doctors and staff multiple times) while deranged and schizophrenic camera editing always follow the patient's POV (scenes without him are completely clean). The kicker is that after every one of his "deaths", he ends up back in his padded cell, implying it was a delusion.During the last event, he tosses himself into a furnace to escape the doctors pursuing him, thinking he'll just be sent back to his cell. This one wasn't a hallucination.
  • The Violent Femmes' Country Death Song is sung from the point of view of a man slowly losing his mind, culminating in pushing his daughter into a bottomless pit, and eventually hanging himself.
  • Evillious Chronicles:
    • In the song "Moonlit bear", Eve Moonlit, played by Hatsune Miku, found two apples deep in the wood and got chased by a bear. As it turned out, the apples are two infants and the bear their mother, whom Eve ended up killing.
    • Megurine Luka as Sudou Kayo in "The Tailor Shop on Enbizaka" is an Unreliable Narrator in this way. In the song, she tells the story in a way which leads the audience to believe that her lover has been cheating on her with three other women who she ends up killing one after another. While her behavior alone makes her out to be pretty crazy, at the end of the song, it's revealed that her supposed "lover" doesn't even know her, and the women she killed were his wife, sister, and daughter. When he fails to identify her, she kills him, too.
  • One could argue that the events described in The Lonely Island's Like a Boss are a product of Andy's delusions after being rejected by Debra. In fact the entire performance review could be an interview with his psychiatrist.
  • "What's He Building In There?" from Mule Variations by Tom Waits uses this trope in a non-supernatural sense. While nothing supernatural is implied, it's never revealed whether the narrator of the song is psychotically paranoid and obsessively fixating on an innocent (albeit eccentric and reclusive) neighbor as he harmlessly works in his shed, or whether the neighbor actually is up to something sinister in the shed and only the narrator is aware of it.
  • According to Word of God, Of Monsters and Men's "Little Talks".
    It's about a couple and the husband passed away and it's from the conversation between the two of them. We don't know if she's going crazy or if someone's actually there.
  • The Iron Maiden song "Still Life." It's ostensibly told from the perspective of a man who's being driven slowly insane by ghosts he sees in a swimming pool, but since we don't get any outsiders' side of the story, we don't know if the ghosts are really there or if he's just imagining them.
  • David Bowie's "The Man Who Sold the World", though only by dint of unashamedly swiping the lyrics from the Hugh Mearns poem quoted at the top of this page.
  • Poets of the Fall tackles this more than once
    • In the video for "Lift." its a given that Mad Dreamer Mark is actively having Hallucinations of flying moths, but a final reveal that an Inkblot Test which he also saw as a moth shape is actually totally dissimilar throws even the less fantastic imagery he was shown at his psych hearing into doubt.
    • Zig-Zagged in "Psychosis," the chorus makes a point of confessing the singer's psychosis, even as other verses that initially sound like Word Salad Philosophy resolve into relatively coherent expressions of rage and frustration at the superficial nature of fame, before the singer eventually decides to exploit it and start a Cult of Personality.
      Revelation leading to my psychosis and inspiration
      Digest another hallucination, psychosis by recreation
      Happy till the next deterioration, psychosis
  • Used in the music video for the Daft Punk song "Prime Time of Your Life". A normal-looking girl passes several pictures of herself alongside various skeletons, steps into her bathroom, and peels her skin off with a razor. When she collapses dead of blood loss and her parents rush in, the camera pans back over the pictures, revealing they're all of ordinary people. It's implied the girl was anorexic.
  • The Men That Will Not Be Blamed for Nothing: "This House Is Not Haunted" ultimately remains ambiguous because the sceptical narrator is thoroughly convinced that the supernatural isn't real, so madness is the only possible explanation.
    Repeat to myself, everything's all right

    Myths & Religion 
  • According to Orthodox Christianity, this is what hellfire actually is. It's God's love, burning your soul as you haven't allowed God to heal you from sin.

  • It's gradually revealed that Season 1 of Palimpsest could be this. Maybe. While it seems like it's a ghost story, with Anneliese gradually becoming more and more aware of the ghosts of Ms. Aikmann and Thomas, it's made clear that Anneliese isn't entirely stable, and there's enough parallels between Anneliese's experiences and a possible mental break in her past that she very well could be losing her mind.

    Tabletop Games 
  • Changeling: The Lost: Players have a stat called "Clarity" which indicates how tenuous a hold the player's character has on his or her perception of reality. At low levels of Clarity, the core book encourages the Storyteller to provide subtly different information to that player in comparison to the rest, so as to simulate a reaction to something only that character is seeing.
  • Don't Rest Your Head: A low-level madness induced by chronic severe insomnia allows the characters to enter a Neverwhere / Dark City style Dark World. Depending on the GM, the setting can be treated as fully real, as existing only in the players' sleep-deprivation-addled heads, or as some combination of the two.
  • JAGS Wonderland: So you've started hallucinating and hearing voices — perhaps you're schizophrenic. No, wait, you're not schizophrenic — you've got this disease called Cyclic Psychoaffective Disorder. None of the medical professionals like to talk about it, because you can physically interact with the hallucinations... and it's contagious. No, wait, those aren't hallucinations — they're the things that operate on the lower levels of reality. You're not losing your grip on reality; reality is losing its grip on you.
  • The central conceit of the 1996 RPG Psychosis; all the PCs suffer from a different delusion, and their grasp of reality (ie, how the Gamemaster describes things to them) is shaped by that. They have to work together to figure out what's actually going on.
  • In Vampire: The Masquerade, Malkavian vampires are all like this. They definitely are vampires and they really do have a piece of a mad undead god in their minds, but other than that they shouldn't completely trust anything they see or hear.
  • Warhammer: Age of Sigmar: The Flesh-Eater courts are beautiful kingdoms of stately castles and prosperous villages, where regal kings on the backs of tamed dragons lead armies of noble soldiers and heroic knights to defend their borders against barbarians hordes and monstrous invaders — in their minds anyway. They remain oblivious — in some cases willfully so — to the fact that they're deformed raving cannibals and undead dragons squatting in ruined, crumbling castles, ruled over by deluded, devolved vampires who unwittingly project their own Delusions of Grandeur onto their mortal thralls, slaughtering and devouring any normal humans who unwittingly wander into their territory.

  • 35MM: A Musical Exhibition: In most animatics of "The Ballad of Sara Berry", this is the usual portrayal of Sara putting on the Prom Queen's crown, sash and scepter after murdering the other girls competing for the title. From her point of view, she looks beautiful, is smiling joyously, her dress is pristine and the other students are happily cheering for her. In reality, they're staring at her in horror and Stunned Silence, while she's covered in blood and is wearing a crazed Broken Smile as she's handcuffed and dragged away by the police.
  • Shakespeare's Hamlet is perfect for this as the entire play is driven by Hamlet seeing a ghost of his dead father telling Hamlet that his uncle, the king's brother, is a murderer. The play then goes on to make Hamlet seem as insane as possible while still keeping everything the ghost said plausible, yet never confirmed.
    • The guards see the ghost before Hamlet does, although it never speaks to them and never confirms its existence to anyone but Hamlet. Hamlet, at the urging of Horatio (essentially the sanest person in the play), goes out to meet the ghost alone, and only then does it speak. Indeed, later in the play the ghost appears to Hamlet while his mother is with him and only Hamlet can see the ghost. The only person in the play who has solid evidence that there is a ghost is Hamlet, and he very well could be mad as a hatter.
    • It probably doesn't help that the oldest version we have of the story is from a time where, really, it was perfectly acceptable to believe in ghosts, and Hamlet (or, rather, the character Hamlet is an Expy of) was a fine cocktail of Obfuscating Mental Illness and badass in a Viking shell, who survives his Roaring Rampage of Revenge.
    • And of course, whether Hamlet really is mad and/or is just "putting an antic disposition on" has been the subject of massive debate for a couple hundred years. A convincing textual argument can really be made for either, or both. His supposed madness is even lampshaded. Hamlet wonders if the ghost he saw was a hallucination, or a demon sent to him to trick him. He tests this theory out by attempting to make his uncle feel guilty for the murder the ghost described to him. How does he do it? He talks some actors, who are hired to put on a play for the royalty, to modify the murder scene so that it more closely resembled his father's supposed death. His uncle tested positive, making it harder for audiences to argue that Hamlet was simply mad.
  • A better example might be the Scottish play, where Banquo's ghost torments MacBeth. Some directors leave the ghost out of scene, leaving us to wonder whether the ghost exists or he's just going mad. As nobody else can see it when it is there, he probably is anyway (the hallucinatory dagger was probably the first sign). On the other hand, the man definitely does have witches screwing with his life; he can't have hallucinated them, since Banquo saw them too (although it is sometimes suggested that they were only real the first time he saw them, and that the other encounters were madness-induced hallucinations).
  • The 2012 French play Le Père* (translated into English in 2014) is told from the point of view of an elderly man succumbing to dementia. The set is constantly changing and characters are played by more than one actor, capturing the man's confusion as he loses touch with his memories and life.

    Video Games 
  • Afraid of Monsters reveals itself to have been this through its normal endings. After the whole game of exploring a dark and deserted city, having to kill all sorts of monstrous entities of unclear origin just to survive, and a final stretch through some entirely different reality... the endings sequentially reveal that all of that was just your character, while high on the pills he's been taking, going on a psychotic rampage and killing 27 people. The endings respectively show his arrest after the rampage, his questioning at the station where he reveals he can't remember any of what happened, and ultimately, him hanging himself in his cell out of guilt. The last ending you can get after getting all three of those, though, instead goes for the All Just a Dream route: rather than getting high on the pills and going on a rampage, you simply overdosed on them in the hospital's bathroom and imagined everything after that.
  • Alan Wake toys with this a few times, but ultimately, things reach the point where an actual malevolent supernatural force is the only reasonable explanation.
  • The manual to American McGee's Alice has the case notes of Alice's psychiatrist, which match the action in Wonderland very nicely. Is Wonderland some sort of objectively real dimension Alice is traveling in? Is it nothing but Alice's insanity? Is it somewhere in between and that nasty "psychiatrist" is helping crack poor Alice? You're never really sure, especially since the opening cinematic implied that the denizens of Wonderland woke Alice to save her life during a house fire.
    • Taken further in the sequel, when we actually see Alice blending Wonderland and the real world. Maybe. Word Of God says it's for real. She regained her health, she pulled her confidence from the depths of her mind to the real world, and now, everybody in this Crapsack World will see Through the Eyes of HER Madness.
  • Anatomy's final tape greatly implies that the entire game was all imagined by the Sapient House, and that the player was merely a figment of its imagination in order to keep itself company as it sits abandoned forever.
  • In Assassin's Creed: Valhalla Eivor can drink a potion that makes him/her have dreams where s/he is Odin in Asgard fighting against jötnar alongside the other gods, with giant deer, wolves and fantasy-architecture all around. However as the missions' progress, it becomes clear (and this is straight-up confirmed in the secret ending) that what Eivor is witnessing is in fact heavily warped memories of the Isu civilization at its final hour just before the First catastrophe.
  • Baldur's Gate flirts with this. You're told, late in the game, that your foster-father, Gorion, was actually poisoned, not killed, and that the doppelgangers you've just been massacring really were the childhood friends they at first appeared to be. Then the characters who told you this — Elminster, Gorion and Tethoril — turn out to be disguised doppelgangers, not themselves.
  • In Batman: Arkham Asylum, you progress through multiple surreal segments in which Batman is exposed to the Scarecrow's fear gas, and he is forced to witness his worst fears becoming real and to re-live the most horrifying and psychologically scarring moments of his life.
    • The sequel, Batman: Arkham City, also has a segment where Batman is given the "Blood of the Demon" from Ra's Al Ghul and hallucinates surreal terrain and phantasmal enemies. In another he must shrug off the Mad Hatter's mind control in a battle that looks (to him) like it's taking place on the face of a giant watch floating in a bizarre environment. Batman also spends a good chunk of the game slowly dying from blood poisoning and at one point is fighting Mr. Freeze and sees his face turn into that of the Joker.
    • Batman: Arkham Origins invites you to take a walk down memory lane with the Joker, and has a side mission in which you get to wander through a crack-trip Wonderland with electrified floors courtesy of the Mad Hatter.
    • The Harley Quinn DLC from Batman: Arkham Knight. When in Harley's Detective Vision you see the walls covered in crazy writing.
  • In The Binding of Isaac, there are many; many hints that the whole of the game is this for Isaac. In fact, according to this analysis, which Edmund McMillen himself called "By far the most mind blowingly accurate break down of the over arching meaning behind the game's ending", the whole central theme of the game is Isaac deciding whether he will stay and die in his own self-created delusion or return to reality.
  • BioShock 2. At the particular moment of the game, you got to see the world through the eyes of a Little Sister for a while, which is true cognitive dissonance. The grimy Hellhole Prison Persephone appears as a drape-filled museum-like place and the deformed splicers become extravagantly-dressed men and women wearing masks.
  • Toyed with via the insight mechanic in Bloodborne. The more insight you amass throughout the game, the more you see things that you normally wouldn't, including certain enemies, new attacks, and Eldritch Abominations clinging to Yharnam's buildings. Though most of these things aren't hallucinations.
  • Call of Cthulhu: Dark Corners of the Earth, a game that comes complete with Sanity meter and hallucinations, is based on the works of H. P. Lovecraft. Thus, while it's easy to believe the events chronicled are real, the beginning (which is also the ending, where the main character hangs himself in an insane asylum) coupled with repeated hallucinations of still being in the asylum during the game cause one to wonder if he is mad because of the events or the events came from his madness.
  • Catherine: Catherine herself exists only to Vincent and the other men she is seducing (as versions of their ideal sex-pot); she's a succubus. This causes Vincent some grief towards the end of the game.
    • Of couse, this title being a Spin-Off from Shin Megami Tenseinote , it comes with the territory that all the supernatural phenomena happening during the plot is definitely real. But of course, given who are in charge of this, two demons who weaponize illusions and insanity, leaving everyone involved in doubt of what's real or not, players included, is how they make it all happen nice and smoothly.
  • The Dark Seed duology, particularly Dark Seed II. The main character is undergoing therapy, and the psychiatrist just doesn't believe that the Dark World really exists. Given the ending, whether Dark World exists really or is just a hallucination of Michael Dawson is an open question.
  • In the Dead Space universe, there's quite a bit of this due to the influence of the mysterious Markers.
    • In Dead Space, Isaac goes aboard the Ishimura to find his girlfriend who has been dead this entire time, and it was a combination of guilt, denial, and the Marker that made him believe she's still alive. The Mole reveals the truth to him before she's crushed into paste by the Hive Mind.
    • In Dead Space 2 Isaac is fully aware that his mind can't be trusted and that Nicole is a hallucination, but he eventually begins to trust it which makes the vision's betrayal all the more awful at the end. Also, Stross is in the throes of this throughout the game.
    • In Dead Space: Extraction the first chapter is this, Sam Caldwell believes that dozens of maniacs are attacking him all the while being assaulted by mysterious symbols and the voices of his dead friends, but it turns out that he's just been shooting innocent people this entire time. He comes to this realization after being gunned down by the police.
    • In Dead Space 3, Isaac has dealt with his personal demons since the last game, so he doesn't have many psychotic episodes. But the slack is picked up by the second protagonist, John Carver, in Co-op mode. Meanwhile the Awakened epilogue DLC is half hallucinated by both characters, with a fair chunk of the enemies not even, technically, existing.
  • The Deer God opens with the protagonist shooting a baby deer, an act for which he "must redeem [him]self." What he doesn't realize (until the "Human" ending) is that it wasn't a deer.
  • Dinosaur Forest reveals the adventures of the Space Opera protagonist had been a hallucination from a prison inmate undergoing severe mental health treatments.
  • Doom³ has the marine hallucinating all alone with visions of hell while incoming enemies spawn in front of him.
  • Dying Light allows the player to see through the Eyes of a Runner when Krane nearly succumbs to his infection. Cue Alien Geometries and mistaking a civilian for a monster.
  • Strongly implied in the first two Endless Nightmare. Your character, James, suffers a Sanity Slippage after the deaths of his wife and daughter in the hands of a Serial Killer, before waking up in his abandoned house (first game), now haunted by his family. The first game ends with James failing to escape and finding his Glock, deciding to just blow his face off; only for the second game to have James returning in an Abandoned Hospital Awakening with zombies and undead everywhere. After killing loads of undead, James unexpectedly sees a fiery Fire Demon, which he defeats, only to suddenly reappear in a cell... being a man driven borderline insane with grief and agony after losing his family, it makes sense that nothing actually makes sense in-game.
  • Eternal Darkness: Sanity's Requiem takes place in this trope.
    • A lot of the creepiness comes from the fact that there ARE actually monsters, zombies and demons around... but is that sound of earth-shaking footsteps right behind you one of them, or just a sign that your reality-check has finally bounced? When a healing spell misfires and blows off your torso, it could just be because the magic you use comes from an accursed tome of darkness, or it could just be a hallucination... also, the fact that most of the characters you play end up going mad, dying, or both, helps to drive home the point.
    • Of particular note is Dr. Maximilian Roivas. When playing as him, several of his servants suddenly attack him, and after killing them are revealed to have been possessed by Bonethieves. Listening to the comments of his Bonethief autopsies, as well as a later cutscene, strongly imply that not every servant killed had been the victim of a Bonethief... If Max talks to one of the female servants before he picks up the Tome of Eternal Darkness, she makes (relatively) normal conversation. After picking up the tome and incurring a bit of sanity loss, she giggles and tosses "something that looks like a human organ" into the cooking pot note . However, if you kill her, you take a massive loss of Sanity, just as if you had killed someone innocent... and no Bonethief pops out of her.
  • Fallout:
    • Fallout 3: If you explore Vault 106, an underground shelter full of insane dwellers who will attack you on sight, your vision will occasionally turn blue and you'll start to see visions of people you knew while living in Vault 101, including your father and best friend Amata. In one area, you'll fight a survivor cloaking himself with a stealth boy, while having visions of the Tunnel Snakes, a small gang of bullies from 101 that will come to his aid in the fight. After exploring the Vault for a bit, you'll learn that this is caused by psychoactive drugs that were released into the Vault's air filtration system 10 days after the main door was sealed, which is also what drove the Vault's inhabitants insane.
      • The Point Lookout DLC has the quest Walking With Spirits, where as a rite of passage to enter a tribe's cathedral, you are sent to The Mother Punga, a huge Punga Fruit, to collect its seeds... which have very powerful hallucinogenic side effects, causing The Lone Wanderer to have a very long and vivid hallucination as they walk back to the cathedral. Highlights include a large red translucent bonesaw and a silver needles sewing stitches into the ground, dolls on poles that appear to be waving or perhaps pointing the way ahead, ghost ghouls will attack (which won't cause damage, and which may or may not even be visible), your mother's skeleton, labeled "Mom," upon an operating table surrounded by party balloons, displaying the cruel point that it was giving birth to you that caused her death, various people from the Capital Wasteland that disintegrate when searched, including Lucas Sims, Moira Brown, Amata, Elder Lyons, and an unnamed settler, and last but not least, a larger version of the Megaton bomb with a character similar to Mister Burke named "Mister Break" standing in front of it, in Tobar's voice he says, "Congratulations, my boy (or "my dear" for a female character), you are going to pull through and everything will be right as rain." When spoken to, he will say, "No, no. Don't try to get up yet. You'll only hurt yourself.", before the bomb then explodes.
    • Fallout: New Vegas: This is the only real explanation for how the "Wild Wasteland" trait works, a trait you can give your character that will throw a bunch of odd Easter Eggs and replaces a few relatively normal minor encounters with less mundane ones, including adding an encounter with a gang of rolling-pin armed old women and replacing a mercenary camp with an alien recon team,note . The only way this is possible is if the trait makes the Player Character delusional. Which considering the game opens with them miraculously surviving a double-head-shot, wouldn't really be that surprising.
      • This is, however, Inverted with No-Bark Noonan, in Novac. He's the resident loon, having been stung several times in the head by Radscorpions (which are bigger than humans) with venom. During a quest to investigate who abducted Boone's wife, Carla, No-Bark provides the most accurate and astute account of what happened to Carla; not only does he note that the most normal-seeming people have the most to hide, but he bore witness to what was happening, though he interpreted it as someone other than the Legion abducting Carla into slavery after briefly stopping by the motel's front office. Some espionage work in there reveals that Jeannie May, the somewhat-normal owner of the motel, signed a contract with the Legion to sell Carla into slavery and gave them a free pass to waltz into town to extract her.
      • There is a side-quest in the Honest Hearts DLC, where The Courier has to drink a special tea made by the Sorrows shaman White Bird, that causes their vision to go blurry, before fighting the "Ghost of She", a mythical and large yao guai said to have fused with the soul of a nameless little girl, after having killed her. When The Courier confronts said yao guai, you find that it's somehow on fire when it attacks you and after doing enough damage to it, it duplicates and you're forced to fight four flaming yau guai at once. After killing the original, the Courier's vision returns to normal and the duplicates disappear. While it is likely that this was just the affects of the "tea" and you just killed a regular yao guai, considering the Fallout franchise has played with adding otherworldly elements before...
    • Fallout 4 continues this tradition with the quest "Visions in the Fog" from the Far Harbor DLC. In it the Sole Survivor must drink from an allegedly sacred spring. Upon doing so you are given a MASSIVE dose of rads and then things take a turn for the odd: Shadowy versions of the native wildlife begin appearing in your vision and a ghostly woman leads you across the island to your goal.
  • Final Fantasy VII: Sephiroth plays with Cloud Strife's sanity for most of the game, although he gets better.
  • Five Nights at Freddy's 4: A young child tries to survive a group of nightmarish animatronics, which are just that: his nightmares. Having his head crushed by a real animatronic really did eat away at his mental health, and also transported him to Coma Land.
  • Gadget: Past as Future takes on shades of this midway through the game. You're assigned by a government agent to find a group of scientists who claim that a comet will strike the Earth. But along the way, you end up repeatedly exposed to the Sensorama device, which brainwashes you into working for the scientists instead. Visions of a mysterious boy and a strange post-apocalyptic swampland show up from time to time, multiple people give conflicting statements as to what's really happening, and by the end of the game, it's never made clear just how much of the game actually happened.
  • Hotline Miami revels in this, with increasing amounts of hallucinations and Interface Screw as Jacket's mental health slowly deteriorates, and some odd scenes like a brutal murder scene suddenly skipping forward several times to show how impersonal Jacket's brutality has become. The sequel also has Martin Brown, an actor starring in a movie based on Jacket's exploits. He admits at one point that he's an utter psychopath who relishes being able to play out his violent fantasies on film, and thus the levels where he's filming scenes for the movie play out just like your average ultra-violent Hotline Miami level, with no indication that none of it's real until the very end. Another level features the Son tripping out on drugs and going through the whole level imagining all the enemies he's facing as hideous monsters.
  • Hungry Lamu: Lamu sees the dog and the player's friends as being sentient fruit he assumes wants to be eaten. The scribblings of "They Are Fruit" in Lamu's favourite book suggest this to be a self-defense mechanism for what's left of his sanity.
  • Killer7. You start out fighting alongside aspects of your Split Personality, and still... it gets weird. Well, that's one interpretation. Of course, Suda51 himself probably doesn't know what's actually going on.
  • Kingdom Hearts 3D [Dream Drop Distance]: Most of the bad guys spend the game Mind raping Sora, so the game becomes this by the time the player reaches The World That Never Was.
  • In LISA, there are several occasions where the protagonists suffer from intense hallucinatons, caused by their severe trauma-induced Sanity Slippage.
  • In Mad Rat Dead, it turns out that the first half of the game was this, with the Rat God causing Mad Rat to hallucinate the various things he did, such as killing the scientist and the Mob Rats. Once Heart tries to slap Mad Rat out of it, he begins to see the world as it truly is.
  • In Mark of the Ninja, it's said that whoever bears the "mark" will be granted supernatural gifts, but will also eventually be driven insane by it; the player character is marked, and toward the end of the game, he's asked if the hallucinations are getting worse. As it turns out, the player has been seeing through the eyes of varying degrees of madness for the whole game. Ora doesn't exist.
  • In the Overlord DLC for Mass Effect 2, Shepard has their cybernetic implants briefly hacked by a rogue AI, causing them to see the entire world in Matrix Raining Code, as well as video feed depicting an autistic man named David Archer who can communicate with the Geth. It turns out that David Archer is the rogue AI, having driven half-mad after being hooked into computer mainframe by his amoral brother and he was causing things to go haywire whilst trying to scream for help!
  • Certain missions in Max Payne are examples of this, as is the show-within-the-game Address Unknown.
  • Oracle of Tao: Ambrosia is a girl supposedly called by God to save the world. The problem is that it's unclear to her whether or not her quest is even real, much less her traveling companions. A possible interpretation of what's going on is that aside from meeting her party, the entire quest is a giant delusion of a girl hoping to feel important because her birth parents abandoned her.
  • Pata Noir: P.I. Douglas Reilly is off of his (unspecified) medication - because he "works better" without it - and therefore has a somewhat more literal view of metaphors than most people. If the text says that a cigarette butt is smoking like the embers of a dying fire, Reilly can (apparently) pick up one of the embers and use it to warm up a potential client who's been acting coldly toward him.
  • This trope is the main source of horror in Phantasmagoria: A Puzzle of Flesh. The main character was recently released from a mental institution, and throughout the game sees and hears horrific things that no one else seems to notice.
  • Postal:
    • Postal casts the player as a stressed employee turned paranoid delusional who goes on a horrific rampage. And why does he do this, you may ask? While it's probably all about revenge subconsciously, he's deluded himself into believing that the town he lives in must be terminated because its inhabitants are insane. Talk about projection.
    • Postal 2: Apocalypse Weekend: Some time after the Postal Dude has suffered a gunshot wound to the head at the end of Postal 2, he often finds himself transported to a Silent Hill-like "alternate reality" version of his current location, where the walls are made of blood and Gary Coleman-like demons appear and attack him. It's probably just a head-trauma-induced hallucination, though. Probably. Postal Dude even remarks "With my luck, that's really a nun. Or someone's grandmother." after blowing away one of the demons with his firearms; being the guy he is, though, he follows this up with "but there's no sense in taking chances".
  • In the indie walking simulator Sagebrush, about exploring an abandoned cult compound years after the former cult leader led a mass suicide, parts of the compound are oddly intact for something that's been abandoned for years, and you keep running into inexplicably fresh blood splatter. Then you get into the church and start reliving the horrific last moments of the cultists, and the environment turns hostile and sinister, with documents berating you for still being alive and the lighting and movement controls going increasingly wonky as you loop through the same series of rooms again and again. It becomes clear that Lilian, the player character, is hallucinating out of a combination of trauma and Survivor Guilt.
  • Sanitarium: Early on, it's not clear which parts are real, which parts are the main character's demented hallucinations and which parts may be someone else's deranged hallucinations.
  • Silent Hill:
    • Silent Hill 2 runs on this trope, with it becoming increasingly clear that the town is showing the characters things only they can see. The game ends with the revelation that Mary didn’t die three years ago; James killed her recently and has been trying to convince himself otherwise. The letter he received slowly disappears throughout the game, implying that it was just another part of James’s delusions. Maria is likewise revealed to be created from James’s conflicted feelings about seeing Mary again. It is also made clear that Angela and Eddie are seeing a different town than James, and that Laura, being a child, doesn’t see anything supernatural. Finally, this trope is implied with even more horrific implications when returning to the area where James killed his first monster. You will find it blocked off by police tape, raising the question of just what exactly James bludgeoned to death with a wooden plank.
    • Silent Hill 3 raises the possibility that it's an example of the trope, with a character first angrily decrying ("You come here and enjoy spilling their blood and listening to them cry out. You feel excited when you step on them and snuff out their lives."), then shockedly asking the game's protagonist, regarding the creatures she's fought and killed for the whole game, "Monsters...? They looked like monsters to you?" He claims to have just been kidding... but he may have been just saying that to calm her down and the monsters were just her mysticism-addled visions of innocent bystanders... but then again, maybe he really was just kidding.
    • The Bad Ending of Silent Hill: Origins shows a drugged and restrained Travis strapped to a table, apparently suffering a psychotic episode, with snatches of dialogue playing that strongly indicate that The Butcher was actually Travis himself, and that Travis was just going around slaughtering innocent people for the whole game. Since the Good Ending leads directly into Silent Hill, however, the Bad Ending is probably not canon.
    • Silent Hill: Shattered Memories starts out as a game about Harry trying to find his daughter Cheryl. Except it's really about an adult Cheryl clinging to her delusions of her father's ghost. The therapy sessions are played from Cheryls point of view in the real world, while Harry's sections take place in Cheryl's mind. Whether she succeeds in moving on or not depends on the ending.
  • Spec Ops: The Line uses this to deconstruct the military-shooter genre. The protagonist is eventually overwhelmed by the horrors of Dubai, up to and including forty-seven civilians he took it upon himself to try to rescue burning to death because of a white phosphorus attack that he was responsible for launching; after this point, he starts imagining things, and the player isn't privy to what's real and what's in his head. At least twice, the game blatantly telegraphs that this is going on, mostly by having him work on his own and pull out a Desert Eagle from his holster rather than the more standard and sensible sidearm he had before, but the clues leave out just how far gone he is until the ending. Really, really far.
  • The Suffering: On the one hand, there's definitely monsters tearin' shit up. On the other hand, the main character, Torque, is definitely out of his damn mind. On top of the constant hallucinations, he can transform into a hideous monster that does excellent melee damage to foes, but suffers from health damage if used for too long. It's eventually revealed that Torque only imagines his transformation and the weird attacks he uses while in the form of the monster: it's all just him slaughtering people with his bare hands. This becomes very obvious when other characters react with surprise at how many enemies Torque killed while transformed, but never seem to notice any physical change.
  • In Team Fortress 2's "Meet the Pyro", the world is shown through the Pyro's lenses. In actuality, the Pyro is brutally massacring the BLU team with fire, while, according to the Pyro's lenses, they're bringing candy, sunshine, and joy to a collection of baby-like cherubs while "Do You Believe In Magic?" by The Lovin' Spoonful plays.
    • In-game you can give yourself eyes of madness by wearing the "Pyrovision Goggles"; eyewear that make (supported) maps bright pastel in color, replace shouts of pain with laughing, makes everyone voice's high-pitched, and replaces messages of one player dominating the other with ones saying they're becoming friends.
    • In the comics, it's shown that Pyro views anything that isn't on fire or otherwise being subjected to violence and mayhem as being dreadfully dull, boring, and colorless. It's only once they start burning things, or see things being burnt, that any joy or happiness can be perceived.
  • They Hunger played with this in the third chapter. The intro cutscene shows a hospital, with a doctor mentioning a delirious patient who keeps screaming about the living dead, as a baby from the maternity ward cries in the background. Then the game starts, and you jump out of your hospital bed and start killing the zombies who have taken over the hospital. But as you fight through the city, you keep hearing a baby crying...
  • Twisted Metal: Black: Preacher's story begins when he was possessed during an exorcism gone wrong, and forced to commit mass murder; he joins the competition so he can clear his name and put down the demon for good. Calypso reveals the terrible truth: There never was a demon - Preacher is just a delusional schizophrenic. The exorcism was just an ordinary baptism, and he murdered everyone in the church in a sudden psychotic fit, entirely on his own. Preacher does not take it well.
  • Until Dawn has one segment while the player controls Josh, who's gone off his meds and is hallucinating badly in the abandoned mines. Josh is assailed by visions of Hannah and Beth as corpses blaming him for their deaths, his psychiatrist, a giant severed pig's head, and ultimately a Wendigo.
  • Vampire: The Masquerade - Bloodlines: Vampires of the Malkavian clan are always mentally unwell. If the player character is Malkavian, they experience different dialogue all through the game compared to vampires from other playable clans. Among others, the player can have thoughtful discussions with TV sets and road signs and realize in unholy terror that the cabbie that has been driving you around LA is actually Caine the Original Freaking Vampire! Or is he?
  • In We Happy Few, the world looks brighter and more colorful when you're on Joy, but particularly drab and dreadful things are twisted into something cheerful. We see the effects first-hand in the prologue: Arthur (who has gone off his meds and is becoming a "Downer") and his friends pummel a piñata at a birthday party, and then Arthur realizes, to his horror, they've just beaten an enormous rat to death, and his co-workers are devouring its flesh with every sign of enjoyment.
  • The Works of Mercy: The game gets very trippy at points, such as displaying odd, changing colors or having eyes mysteriously appear around the house. Then it turns out the protagonist was actually the psychopath on the phone, making it clear just how crazy they really are.
  • Some encounters with the Lovecraftian Old Gods in World of Warcraft including unsettling whispers directly to the player. A both very creepy and amusingly literal take on the "in the mouth of madness" phrase occurs if you die in the "brain" area of the fight with Yogg-Saron: your body appears in the middle of the boss itself, with your camera gazing out through its immense, gnashing teeth.

    Visual Novels 
  • Chaos;Head features a main character who is a self-described disgusting, delusional, otaku, hikikomori who is approached by several beautiful girls all with a mysterious connection to a series of murders going on in Shibuya. This makes it extremely hard to tell where the events of the series lie on the line between paranoid hallucination and supernatural strangeness — if there is in fact any separation between the two at all.
    • As it turns out, the main character himself is the equivalent of someone's Imaginary Friend taking a life of his own and turning into a Not-So-Imaginary Friend. The "real" Takumi is a wheelchair bound old man with a terminal illness. The teenaged, otaku Takumi is the result of the "original" Takumi's near Reality Warper level ability to project "illusions". The delusions that Takumi experiences are likely linked to his nature as a Tomato in the Mirror, and not because he's suffering from a lack of sanity.
  • A significant portion of Higurashi: When They Cry. It doesn't help that sometimes it's a first-person narrative at the time. Although some objective explanations are given. Eventually. However, a good chunk of the explanations are only in the visual novels.
    • Masterfully done in Tatarigoroshi-hen. In order to protect Satoko, Keiichi kills her Evil Uncle. But the next day, Satoko insists that her uncle abused her later that night and his other friends say Keiichi was at the festival at the time. But wait! The uncle's missing and the body isn't where Keiichi buried it. Satoko still insists that her uncle is abusing her. Keiichi did kill Teppei and everyone's providing a cover story. Why does Satoko insist Teppei is still alive? Well... Just because Keiichi is the Unreliable POV Character doesn't mean he's the only one going crazy, does it?
  • Saya no Uta... Through the eyes of Fuminori, whose senses had been inversed, every human being is as disgusting as a pile of organs and putrid flesh pouring pus. Not only do humans look this way to him, but every single shape (his house, the sky, the cars) looks like it's covered in guts and gore. Everything smells foul, sounds foul and feels foul to him. The actual Eldritch Abomination looks like an angel to him. And then he finds some meat that smells nice...
  • Tsukihime is told in the first person perspective of the protagonist, and due various drugs, enemies within, an attempted Demonic Possession and a Psychic Link with the Big Bad, who is an Ax-Crazy Serial Killer vampire, Shiki's grip on sanity gets pretty strained at times.
  • Tokyo Dark: Ayami is a detective investigating the death of Kazuki, her partner, and the supernatural circumstances surrounding it. However, in one ending, she has a sudden flashback which shows that she is actually Kazuki's stalker, who killed him when he 'betrayed' her by seeing another girl. Ayami's clothing then changes to a straitjacket, the woman you thought was her neighbour is revealed to be a nurse, and the background fades out to be replaced with a padded cell. It's left unclear whether Azumi went insane and was imagining herself to be in an asylum, or was really insane from the start.
  • Umineko: When They Cry: No witnesses survive the murders, but the audience is shown the spectacularly magic action sequences. In this case, the "madness" is actually invoked; the idea is that the Game Master claims that all the murders are done by magic, and the object of the game is to break "the illusion of the witch" and figure out how they could have been done by human hands.

    Web Animation 
  • Rooster Teeth released a special Red vs. Blue video that was shot from Caboose's perspective. Highlights include Sarge talking like a pirate and random images appearing on the walls. The video if here, but fair warning; It's a 360 video, so you need to view it on a Google Chrome for the proper experience.
  • Winston, a short film on the YouTube channel Alter, runs on this trope. It’s basically The Tell Tale Heart in a snowy place and the main character is convinced his neighbor Gary is stalking him…from beyond the grave.

  • Under the influence of blue mushrooms, the cast of College Roomies from Hell!!! have hallucinated multiple times, yet there are hints of truth slipping through the haze. In the most recent case, they fully realized they were hallucinating and went with it anyway just in case they learned something important.
  • In Lucid Spring, a bear with the power to alter one's perception of reality comes after Pacem and Viktor. As they run for their lives from it, the world begins to distort more and more around them and the only thing they're sure "belongs" is the other.
  • Ennui GO!: Max's perception of the world is very unusual. In "Cross-Eyed", he sees some kind of monster behind Cricket, and in "Cooling Off", he sees Calixta as a demon-like creature. However, in both cases Max seems to think this is perfectly normal. In part 2, this is shown again; Max still sees Calixta as the same creature (albeit with her current height and proportions), while he sees Robin as a mix of her Galiath and Scarab costumes. "Eyes" reveals they're not hallucinations; Max actually has the ability to see magic, including people's astral forms, much to Len's astonishment and Max's relief.
  • The Port Sherry "Asylum" posits that Batman has been insane all along, and his Rogues Gallery are concerned medical professionals and scientists analyzing his condition, with a psychiatrist named Jack being the most dedicated.
  • Romantically Apocalyptic: There are several logs and comics told from Pilot's point-of-view that show his delusional view of the world and various hallucinations as fact. Given how surreal the world already is, it's at times difficult to parse what is and isn't something Pilot is imagining.

    Web Original 
  • Several well-known Creepypastas, such as "Grocery List", employ this trope. The Creepypasta Wiki also has a category labelled "Mental Illness".
  • SCP Foundation: SCP-1499 is a gas mask that is at first described as sending the wearer to an Eldritch Location populated by Humanoid Abominations. The addendum to the exploration log reveals that it really just sends them to another part of the world and alters their view to think they're in such a place.

    Web Videos 
  • Atop the Fourth Wall: Linkara described Marville as "a gaze into the eyes of madness" to how its author, Bill Jemas, thinks the world works.
  • Board James has been going in this direction ever since James started going Sanity Slippage. And by the end of "Full House / Do the Urkel", there's the implication that he's been insane the entire series, which was confirmed in the next episode which revealed that James was merely a Split Personality of The Angry Video Game Nerd all along but was unaware of it.
  • The Nostalgia Critic:
    • A recurring theme in the post-revival episodes. The Les Miserables review hinted that Rachel and Malcolm might only exist in his head, and The Christmas Tree had us directly see his hallucinations before cutting back to other people confused.
    • It's not just him either, as Hyper Fangirl's vlogs are full of the line between fiction and reality getting blurred, and her considering it normal.
  • Search for Sandvich: The Medic's videos occasionally have inanimate objects (like rocks and grass) suddenly start speaking in a low demonic voice. Given that this is the Medic, who is a Mad Scientist with little grasp on sanity, it's likely that we're seeing things from his crazy perspective.
  • Sky Does Minecraft is the only member of Team Crafted who can actually understand squids. This make the mod showcases in which a squid has the spotlight fall under Mind Screw.

    Western Animation 
  • Adventure Time:
    • In "Mortal Recoil", we get to see what the world looks like to the Ice King for a few seconds. It's less than pleasant.
    • A very mild example occurs in "Red Starved". Finn is looking for something red for Marceline to feed off and finds a large ruby, but a monster Finn talks to keeps insisting it's an emerald. Once Finn brings it up to Jake and Marceline, it turns out it actually is an emerald (the shown color changes from red to green), and Finn is red-green colorblind.
  • The Amazing World of Gumball:
  • American Dad!:
    • In "The American Dad After School Special", Steve revealing that his new girlfriend is chubby makes Stan horribly self-conscious about his own weight and begins excessively dieting, with help from an enthusiastic coach named Zach. However, despite Stan's best efforts he keeps gaining weight, and it appears as though his family is sabotaging his diet by injecting his vegetables with fat so as to make him feel bad and apologize to Steve. However, after being sent home from work after passing out during a physical, the family confronts him about his weight issue and state that he is really anorexic. At that point, it's revealed Stan wasn't getting fatter, he was suffering from a delusional state of mind and lost so much weight he was practically a walking skeleton. His personal trainer also turned out to be a hallucination, and Francine and Hayley's "sabotage" was really an attempt to make Stan better.
    • "100 A.D." has Roger being high on Turkish amphetamines, hallucinating that he's driving on a weird planet with Steve as a Nazi walrus and Klaus as Garfield.
  • Arcane: Whenever a scene switches to Jinx's perspective in Act 2 onwards, her hallucinations begin to affect the show itself, there are constant quick cuts, flashbacks have crude and distorted faces drawn over them, inaudible whispers can be occasionally heard in the background, and Mylo and Claggor’s ghosts appear to haunt Jinx.
  • Big City Greens: In "Pizza Deliverance", Tina, a girl who works for Mama Roni's Pizza, is to make a delivery to the Green family now living in Smalton, but brushes off her co-workers' fears after seeing a horror movie. Once she gets to the country, she gets lost and feels nervous; eventually, everything through Tina's eyes appears as a horror movie with a sick green filter, and she begins seeing the Greens as evil marauding zombies out to eat her, prompting her to avoid them as much as possible. In reality, the Greens are mildly confused that she keeps running away from them and not even giving them their pizza, and in the end, Tina realizes that the Greens are really nice and learns not to believe what she sees in movies.
  • Bojack Horseman: The episode "Time's Arrow" is a Whole Episode Flashback showing the life of Beatrice as seen through her dementia-addled mind. Because she has trouble remembering things now, all the faces of people in the background are featureless, details of scenes pop in as they go on (for example, she only remembers Butterscotch was holding a hat after he says it, and the hat materializes in his hand), and some memories are warped and distorted (such as a family portrait in the background phasing between the one in her childhood home and the one in her adult home, words on signs distorting, and after her mother's lobotomy, Beatrice only sees her as a literal shadow to symbolize how she became an Empty Shell).
  • Courage the Cowardly Dog: This is one of the biggest reasons that Freaky Fred's episode ends up as one of the most disturbing ones, despite Fred being the epitome of a Harmless Villain in action.
  • In the Ed, Edd n Eddy Halloween Episode, Ed watches so many B-grade monster movies that he starts hallucinating and seeing everyone that he meets as monsters, such as the Kankers as witches and Kevin as the Headless Horseman. At the end of the episode, he then sees Eddy and Edd frolicking in flowers, when in reality the kids are beating them up (despite Ed being the one who attacked all of them).
  • Harley Quinn (2019): Per Word of God, much like her character in the animated series and the comics as explained above, in this series, what the audience is shown about Gotham and its super-criminals is all through the perception of Harley. To her, they are eccentric, affable people who are living their lives whereas most everyone knows them as fearsome, terrible villains causing catastrophe on a daily basis. That said, it doesn't really explain how the former interpretation is still shown even in scenes that Harley is not involved or even present in.
  • The Loud House: In "Really Loud Music", Luna wants to enter a songwriting contest for a TV show, America's Next Hitmaker, but she is pensive before she sends her initial song because she worries it's not a song the whole world will love. She then visits her siblings and parents doing their usual mundane things in reality, but from Luna's perspective, they suddenly burst into song out of nowhere with different genres based on whoever she is visiting (Lola singing a showtune, Lana doing a toilet jam, Lisa spitting rhymes about the periodic table, and so forth). When Luna comments about such, the family says they weren't singing; according to Lisa, Luna was hallucinating the musical numbers because of her indecisiveness and uncertainty over trying to find the right sound for her song.
  • In the My Life as a Teenage Robot episode "Daydream Believer", Jenny is given a chip to allow her to simulate dreaming. When she tries to activate it during the day, it breaks, causing reality in her eyes to resemble the world of Dr. Seuss crossed with Roman mythology. In particular, she sees Tuck and later Brad as goat men.
  • My Little Pony: Friendship Is Magic:
  • In the Regular Show episode "More Smarter", Mordecai and Rigby make themselves progressively smarter until they see everyone around them as unintelligible neanderthals. On the opposite end, the others see them arguing in Gratuitous Latin.
  • The Venture Bros.: In Season 4, Henchman 21 deals with the death of his best friend, Henchman 24, who died at the end of Season 3. The audience sees 21 at first having one-sided conversations with 24's skull, then two-sided conversations with 24's ghost. There are teases that maybe the skull can move or the ghost can interact with the world, and that maybe the ghost knows things that 21 couldn't, but ambiguity is maintained. Even 21 himself is not always sure he's sane as he searches for 24's killer. The truth is revealed at the end of the season. The ghost is not real.

    Real Life 
  • Outsider art is, for better or worse, generally considered to be this, since it is usually created by individuals with various mental illnesses, the most common one being paranoid schizophrenia. Drawings and paintings created by individuals with schizophrenia are often interpreted as being representative of their own distorted perception of reality, although historically it's only the most severe cases that are reflected. One outsider artist, August Natterer, had a severe case of paranoid schizophrenia that started with a debilitating hallucination he suffered where he reportedly saw thousands of allegedly prophetic images of Revelations in an hour. All of his paintings after that point were of his various hallucinations.
  • Francis E. Dec, author of many infamously crazy rants, might be an example. His fans speculate that he suffered from a particular form of schizophrenia known as Schizofreniform Influencing Machine Delusion. The world as seen through his rants is filled with Frankenstein slaves, deadly computer devil gods, infrared crusaders, assassins behind every corner, sodomite politicians and many, many more.

"… you think this is too horrible to have really happened, this is too awful to be the truth! But, please. It’s still hard for me to have a clear mind thinking on it. But it’s the truth even if it didn’t happen."


Video Example(s):

Alternative Title(s): The Mouth Of Madness


K. Rool's Triumphant Return

The last scene before the credits reveals that the climactic attack on DK Isle was all just an Imagine Spot... but given K. Rool's insanity, it then calls into question how much (if any) of his musical number really happened. In particular, a blink-and-you'll-miss-it shot of Kremling dummies in the tavern, which otherwise only appear in K. Rool's lair, is often seen as evidence that his grand reveal to his Krew was also just in his head.

How well does it match the trope?

5 (12 votes)

Example of:

Main / ImagineSpot

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