Long associated with horror and mystery, the “asylum” (once the proper name for mental institutions and the one still referenced in film and fiction) has long been a ready-made locale for evil happenings in our stories — perfect for Halloween.

The asylum has always been a setting for a variety of fictional horrors because the reality of these institutions was bleak and controversial when states and voluntary associations began to establish them in the 18th and 19th centuries. This lent itself to fictionalized horror, and the result has been that horror books and films set in such institutions are a routine part of our culture and often capture broader social concerns of our times.

But the persistent use of the trope of asylums — which has outlasted the use of these types of institutions — may be doing harm. Research indicates that such fiction stigmatizes mental health treatment and discourages Americans with mental illness from seeking the help they need.

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Today’s mental health treatments bear little resemblance to the asylums of yore. Despite touting fantastic “cure” rates, mental hospitals raised concern from the start. Former patients warned the public that these were oppressive places, where inmates lost all of their freedoms and became subject to confinement, purging, stultifying drugs and cruel attendants. Isaac Hunt captured the horrors of these institutions in a description of the Maine Insane Hospital in 1851. It was a “most iniquitous, villainous system of inhumanity, that would more than match the bloodiest, darkest days of the Inquisition or the tragedies of the Bastille.” It did not help that by the end of the 19th century, asylums became hopelessly overcrowded and the patients subject to increasingly drastic treatments.

This harsh, foreboding landscape made the asylum perfect for authors — including Mary Wollstonecraft in “Maria” to Edgar Allan Poe in “The System of Dr. Tarr and Prof. Fether” — who wanted to comment about some aspect of society or the social order. For Wollstonecraft in 1798, it was male domination — her protagonist is locked up after trying to flee an abusive husband — and Poe aimed to call into question the reformist fervor taking hold in the United States in the 1840s. His villain, a deranged doctor named Monsieur Maillard, wreaks havoc and seemed to be a parody of a reformer.

In addition to social commentary, the bleak nature of asylums lent themselves to more traditional sinister villains. While George Lippard’s 1845 novel “The Quaker City; Or, The Monks of Monk Hall” is forgotten today, it sold more copies than any other novel until Harriet Beecher Stowe’s epic “Uncle Tom’s Cabin” came along seven years later.

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Lippard’s villain, a vicious asylum superintendent named Ravoni, was a demented, possibly supernatural mind doctor who strutted about in French heels wearing a “lustrous coat of dark satin” covered in “rich embroidery of golden lace,” with diamonds for buttons. Ravoni could apparently raise the dead and had conquered death himself, being centuries old by his own account. “Quaker City” was a classic 19th-century melodrama.

As these examples demonstrate, in literature, asylums became the setting for all sorts of monsters, designed to send a chill up readers’ spines. These included famous creations like Dracula and Frankenstein, along with less-famous examples like Lon Chaney’s “The Monster.”

As they had for Wollstonecraft and Poe, fictional asylums and their monsters often not only reflected the bleakness of the setting but also other social concerns. During the Progressive era, the monsters in fictional asylums often reflected Anglo American worries about “dangerous” immigrants and racially unsound evolutionary throwbacks.

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The tradition of the fictional asylum translated to film after movies burst onto the scene in the 1920s.

Maybe the most famous horror film involving a mental hospital jolted audiences in 1978 when filmmaker John Carpenter introduced Americans to a mental hospital escapee named Michael Myers.

Carpenter was inspired by a field trip to a “mental institution” he had taken as a student at Western Kentucky University. “The kid I saw the day I went,” he recalled, “had the Devil’s eyes, and he stared at me with a look of evil and it terrified me.” This fear led to the creation of Myers, who undertook a wave of terror on Halloween night. “Halloween” cemented both the modern trope of the mechanical, superhuman psychopath and the indelible link of the asylum to our scariest holiday.

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When “Halloween” premiered, America’s mental hospitals were in the throes of deinstitutionalization. Cheap antipsychotic drugs, dwindling federal and state funds and a full-tilt effort by critics to demonstrate the harmfulness of psychiatry all spelled the downfall of the state hospital. With the closings, former patients often found themselves uncared for and on the streets. New public panic arose regarding their supposed “violent” natures.

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Carpenter’s villain reflected this fear of dangerous mentally ill people and the failings of the social safety net. Ultimately, Myers’s psychiatrist, Dr. Loomis, has to fill him with bullets. This, it is suggested, is the only real “cure” for monsters like him.

More recent films like “Scary Stories to Tell in the Dark,” “It Chapter Two” and “Joker” continue the tradition of depicting mental hospitals as frightful, desperate places full of monsters of one sort or another. The hospitals are shot featuring leering corridors, washed-out cells, bad treatments and ineffective (or worse) staffs.

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As Halloween has expanded and become big business, the idea of asylums as spooky places housing sinister forces has moved beyond the silver screen.

Newly closed asylums with rotting, mansion-like settings attract “ruin porn” aficionados. Some, like the Trans-Allegheny Lunatic Asylum in West Virginia, offer ghost tours for the adventurous. Until recently, big-money theme parks have also used asylums to scare patrons. For a while, for instance, Six Flags New England had a Halloween attraction, Psycho-Path Haunted Asylum. It closed in 2016 following an online petition, which circulated because of a growing recognition that while asylums might be the ideal locale for frightful tales, this use has a downside in real life.

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While the standard asylum plots of tyranny and malevolence have remained common, we’ve also experienced a rising understanding of the prevalence of mental illness in society and the stigmatization of those suffering from it. Painting institutional psychiatry as a home for evil has done a disservice to the much more complex story of medical transformation, reformist vicissitudes, public stigmatizing and funding problems that plague mental health care in America.

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There is an even greater reason, however, to retire the scary asylum from our experience of Halloween: Associating such facilities with horror risks hurting those with mental illness by making them reluctant to seek care.

One 2014 study found that institutions “are often depicted as unhygienic, dilapidated buildings where restraints, seclusion rooms, ECT [electroconvulsive therapy] and psychosurgery are frequently used … this may be related to the fact that the general public gets a great deal of information from the media and film, and in the case of modern horror, MHCEs [Mental Health Care Environments] and mental health practitioners are presented in a negative and stigmatizing light.” As result, “people will refuse to seek treatment."

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Even individual works of fiction can have this effect: Studies have shown that people suffering from mental illness are less likely to seek ECT after watching movies like “One Flew Over the Cuckoo’s Nest."

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In a society with a mental health crisis, in which the portion of young Americans whose insurance does not cover mental-health care has doubled even as depression rates have risen, and another 10 million adults report untreated needs associated with their mental health care, we must look carefully behind the message of what entertains us. We do a disservice to the reality of mental illness if we do not pause and consider the more complex realities, and failings, of our health-care system and social perceptions.

Instead of stigmatizing mental health care as a land of horrors, we need to destigmatize seeking treatment. The horror book or film set in an asylum is a storied part of our lure dating back centuries, but it’s time to rethink this tradition.

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