Listen, you could probably do an entire thesis on this; even with my limited means, I'd like to go back to the beginning of the game and walk us to town for about half an hour and talk about this. I wrote a post about Liminal Christmas Eve on my main blog a couple of years ago, and it's my best attempt at explaining liminality, I think:
– You know what “the liminal” is, right? It’s not just the Backrooms and the “liminal internet aesthetic”?
– It can refer to thresholds (Latin: līmen) of both time (the sun rising or setting; midnight on New Year’s Eve; birthdays, graduations, even death itself) and space (doorways, crossroads, intersections, international borders; the wardrobe to Narnia, the rabbit hole to Wonderland–you see a lot of these in fantasy media).
– And not just specific threshold points but more general times (adolescence/coming of age; long journeys; periods of social instability) and spaces (hallways, lobbies, waiting rooms, airports, bus stations, parking lots, streets, abandoned buildings, ruins). Travel itself, a state of being between one place and another, is liminal. Anything temporary has a liminal quality. A parking lot is liminal in a way that a garage is not, you get me? The liminal is a place you’re not staying permanently, and the time you’re Not Staying in it.
– The “internet aesthetic” version also highlights the emptiness of things that may or may not have already been liminal (office hallways, closed buildings, abandoned malls), where an additional aspect is the the explicit unease, the uncanny quality, that the emptiness creates. Emptiness is not requisite, however, and an airport is liminal whether it’s full of people or not.
– So we have both specific points of crossing and broader states of between-ness.
As such, let me hit you with a few screenshots of The Liminal in Silent Hill 2. Which is basically the entire game, but here's what I've got at hand:
I'm not even showing y'all The Longest Staircase in the World, or all the holes James has to jump down in order to get to Toluca Prison at, apparently, the center of the earth. I haven't even mentioned the long walk through the forest to town; elevators and stairwells and looping hallways that always lead you back to where you started; an entire level that's just multi-floor labyrinths; the way that the backyards of South Vale are a throughway to Heaven's Night, which is a throughway to Moonlight Grove, which is a throughway, etc.; the way that James is always fighting his way through one location to get to the next, just an endless chain of forward in real time, never resting.
And the word "rest" Is why I wanted to describe all of that. Late in the Otherworld Brookhaven section, we find a document from the increasingly troubled Director of the hospital, who is (as far as I can tell) a dreamlike projection of James himself:
I won't rest until they are solved
I won't rest
I can't rest
I don't know how
anymore
In Angela's final scene, she will say, "Maybe now I can rest." We first met her in the town cemetery--which is a liminal place for anyone who's alive, but graveyards are also where the dead are laid to their "final rest." It's up to interpretation as to whether James, Eddie, and/or Angela (and Laura, for that matter) are actually alive or perhaps already dead, in a plane of existence that's closer to purgatory, or even hell. Or maybe they're still able to leave their personal Silent Hill(s) and rejoin the real world, if only they can face what they've done first. It's intentionally ambiguous, and it's up to you. But I think the word "rest" carries a lot of weight in this game, and I tend to believe that these characters, amidst the liminality of this story, are not unlike "the restless dead."
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Otherworld Brookhaven: Patient 0050 and electroshock therapy
I actually did know in advance of commentary 9 that electroconvulsive therapy (ECT) is still used today, in contrast to my surprise that some people actually benefited from lobotomies. In fact, I'd read a long time ago that Carrie Fisher had spoken positively of it, and I thought, that'd be a cool fact to bring up, but maybe that's her business and I shouldn't--
Carrie Fisher regales listeners with her thoughts on self-destruction, death, and delirium in this follow-up to Postcards from t...
Oh. Yeah, the late Carrie Fisher was entirely open about her mental health treatments, to the point where her urn was shaped like a Prozac pill. She did say that she had some memory loss due to ECT, but nowadays, you can decide for yourself if that's a decent trade-off and consent to the treatment. What I discovered is that the reason electroshock therapy was originally so dangerous, though, was because the convulsions could break arm and leg bones. Only later was the therapy "modified" with anesthetics and muscle relaxants. So when I quote Jonathan Sadowsky aloud on the video--
I am a historian of psychiatry, and I have published a book on the history of ECT. I had, like many people, been exposed only to the frightening images of ECT, and I grew interested in the history of the treatment after learning how many clinicians and patients consider it a valuable treatment. My book asks the question: Why has this treatment been so controversial?
Well, the broken bones were part of it, certainly.
ECT was invented in Italy in the late 1930s. Psychiatrists had already discovered that inducing seizures could relieve symptoms of mental illness. Before ECT, this was done with the use of chemicals, usually one called Metrazol. By many reports, patients experienced a feeling of terror after taking Metrazol, just before the seizure started. A Cleveland psychiatrist who was active then once told me that the doctors and nurses used to chase the patients around the room to get them to take Metrazol.
That wasn't great either.
(My offhand claim that Benjamin Franklin "cured a woman of hysterical fits" is not sourced as clearly as I would like, although he did have an electrostatic machine, and this subscription-only book chapter, "Benjamin Franklin and the Electrical Cure for Disorders of the Nervous System," may have more info.)
So modern ECT is very different, the current is much milder, and muscle relaxers are given. I don't know that I would choose to have it (today or ever), but I did have to sit there and ask, I'm bipolar. If I were at this hospital back in the day, what treatment would they have given me? I do think I would have been given electroshock therapy, for better or worse. And that's something I want you to think about, especially if you've been listening to me play Silent Hill tour guide for several hours: patients who were given these dangerous and painful treatments were just like me, just like you. You know, actual people.
(I also mention an anti-seizure drug I take, as it's been repurposed to stabilize bipolar mood cycling. I don't specify in the video, but I've been pretty open about my own mental health treatment over the last couple of decades. It's Lamotrigine, also known as Lamictal, and it's one of the most effective medications I've taken.)
So. In terms of Patient 0050's "puzzle," you have to stumble across a generator and turn it on; I don't think there's actually a clue or hint to do so, except an electrical cord that you might follow out of sheer curiosity. Follow it back to the ECT room--where a table? stretcher?) is standing on end like it's ready to shock Frankenstein's monster back to life--and turn on the machine. Four numbers will appear burned into the stretcher, and that's the code you need for the lock on the right side of the box.
This is one of those Silent Hill Moments™ that's intellectually disturbing, but visually, it's cool as hell. Honestly, it's one of my favorite images in the entire game, especially the way the stretcher looks like it's at the center of a spiderweb. I think, also, that this scene looking so unrealistic and fantastical, especially compared to the historical photos we actually saw, takes a bit of the edge off. It's artistically disturbing, like, something James might imagine in a nightmare, rather than a medical tragedy. I mentioned references to Thomas Harris' works and the show Hannibal in commentary 7, and that TV series got away with a lot of really, really horrific imagery by pitching it at the level of a fever dream. That's the approach in Otherworld Brookhaven, I think.
But we also learn something else, which is: Patient 0050 somehow gave ECT to himself. Unlike the control exerted over Patients 0090 and 0130, Patient 0050 sought it out against the staff's will:
Front, handwritten:
I found 0050 in the ECT room again.
This time I checked, he was not appointed for the treatment.
How is it possible he got there all by himself?
And how would he know how to turn the thing on?
Somebody's going to answer for this.
Back, typed:
So close.
It will happen.
Has to
My feeling is that a staff member wrote the note on the front by hand, obviously, but the typing on the back is more of a psychic imprint or dream image, rather than "Patient 0050 actually ran this sheet of paper through a typewriter." My other inference is that he's trying to electroshock himself into some alternate reality--he might potentially be the same patient who blames himself for his daughter's death, and he might want to be in a world where she's still alive. There's a journal we'll see at the end of the video where the doctor discusses the ethics of perhaps letting "him" (unspecified) be happy in his false reality. And all of this, of course, parallels James and the iteration of Silent Hill he's in, where Mary may (or may not) be real and alive.
Now, how Patient 0050 managed to sneak into the ECT room, put himself on the stretcher, and then also reach the machine to turn it on... I don't know. James himself has at least one imaginary friend; one wonders.
Otherworld Brookhaven: Patient 0090 and lobotomy procedures
I endured much suffering to bring you this research on transorbital (aka "icepick") lobotomies, because I have A Thing about eye injury--I can't even put in contact lenses--and I do not care for any of this. So underneath the cut, I'm going to have the procedure setup as shown in the game (there's a dummy, not a person), the tools involved (there's some blood), and some article links with information. Again: I'm not happy about this, but this is the attention to detail you can expect from Cleolinda Industries. The video version of this discussion starts around 19:40; and I've set it to that timestamp.
As I mentioned in the previous commentary, we're shown a preview of the Otherworld Brookhaven puzzles, and this is the one corresponding to Patient 0090. So here's the article excerpt I read in the video commentary:
It's 75 years since the first lobotomy was performed in the US, but the procedure has an international history.
Surgeons would drill a pair of holes into the skull, either at the side or top, and push a sharp instrument - a leucotome - into the brain.
The surgeon would sweep this from side to side, to cut the connections between the frontal lobes and the rest of the brain.
[Portuguese neurologist Egas] Moniz reported dramatic improvements for his first 20 patients. The operation was seized on with enthusiasm by the American neurologist Walter Freeman who became an evangelist for the procedure, performing the first lobotomy in the US in 1936, then spreading it across the globe.
From the early 1940s, it began to be seen as a miracle cure here in the UK, where surgeons performed proportionately more lobotomies than even in the US.
Despite opposition from some doctors - especially psychoanalysts - it became a mainstream part of psychiatry with more than 1,000 operations a year in the UK at its peak. It was used to treat a range of illnesses, from schizophrenia to depression and compulsive disorders.
The reason for its popularity was simple - the alternative was worse.
"When I visited mental hospitals… you saw straitjackets, padded cells, and it was patently apparent that some of the patients were, I'm sorry to say, subjected to physical violence," recalls retired neurosurgeon Jason Brice.
The chance of a cure through lobotomy seemed preferable to the life sentence of incarceration in an institution.
"We hoped it would offer a way out," says Mr Brice. "We hoped it would help."
"We hoped it would help" was the idea I wanted to bring us to, because it really, really surprised me that lobotomies actually helped some people. In that article, Hugh Levinson also writes, "Psychiatrist Dr John Pippard followed up several hundred of [neurosurgeon Sir Wylie] McKissock's patients. He found that around a third benefited, a third were unaffected and a third were worse off afterwards." Like, that is wild as hell to me. I had always thought it was a procedure doctors "did to" people, purely as a way of neutralizing "unruly" patients that stopped just short of murder. In the scrapped first take of this commentary, I said that "certainly no one consented to this," but perhaps some of those patients did, hoping for that benefit.
(A quick break for the two famous patients I mention in the video: Rosemary Kennedy and Rose Williams, sister of Tennessee Williams.)
Now, I'm going to quote from Wikipedia here because the "Lobotomy" article has some well-cited information that's not available online:
For medical historian Roy Porter, the often violent and invasive psychiatric interventions developed during the 1930s and 1940s are indicative of both the well-intentioned desire of psychiatrists to find some medical means of alleviating the suffering of the vast number of patients then in psychiatric hospitals and also the relative lack of social power of those same patients to resist the increasingly radical and even reckless interventions of asylum doctors.
So Porter describes both the Brice perspective here, as well as our Director of Brookhaven Hospital, who was mistreating the "three crucial patients" we investigate.
Many doctors, patients, and family members of the period believed that despite potentially catastrophic consequences, the results of lobotomy were seemingly positive in many instances or were at least deemed as such when measured next to the apparent alternative of long-term institutionalisation. Lobotomy has always been controversial, but for a period of the medical mainstream, it was regarded as a legitimate last-resort remedy for categories of patients who were otherwise regarded as hopeless. Today, lobotomy has become a disparaged procedure, a byword for medical barbarism and an exemplary instance of the medical trampling of patients' rights.
And that latter idea is the perspective we get in Brookhaven Hospital. Both Patient 0090 (who is not Eddie, but seems to resonate with him) and Patient 0130 (similarly, "Angela") receive treatments they apparently don't want. Patient 0050 ("James") is a... remarkable exception to that, but we'll get to that in the electroshock therapy post (yeah, we get that too).
So here's what we see in Otherworld Brookhaven:
Note: "The Procedure." Transcript:
oh, how we danced
arms flailing, our bodies
in perfect synchrony
and the music played
but in any dance
there comes a time
one must take the lead
and the music got louder
and louder
pounding
piercing
and then
silence
I believe that the "dance" is between the surgeon and patient. Possibly the patient struggling, "arms flailing," with the staff trying to get him into the chair? This chair, in the next room:
The one who takes the lead would be the doctor; the pounding is the mallet, the "Instrument of Force" that we pick up.
The "piercing" is the orbitoclast: the "icepick" used in the orbital (eye socket) lobotomy, the "Key of Bliss." The "silence" is what happened to the unlucky third of McKissock's patients. As the Wikipedia article phrases it, "many lobotomy patients suffered devastating postoperative complications, including intracranial hemorrhage, epilepsy, alterations in affect and personality, brain abscess, dementia, and death."
Basically, the Patient 0090 "puzzle" is a fetch quest to fight your way past several monsters and find the orbitoclast; once you've obtained it, you go back to that (actual) mannequin in the chair. The one that's shielding its face with its hands, as if saying, Don't do this to me.
I'll bring over what I said in the Patient 0090 post:
I do think that the phrase "Key of Bliss" is meant to connect with the "Bliss" ending, in which James enters the world of a happy vacation video where Mary never gets sick. And that ending does involve, as this lobotomy setup does, a chair. That being said, the last shot of the "Bliss" ending is an empty armchair, suggesting that James has physically left the real world—rather than, say, being left in that chair like the corpse in Wood Side apartment 213, or the lobotomized patient here. I don't want to spoil Shutter Island for you, even after all these years, but that book/movie raises similar questions as to whether it's better to remember what you did or escape to ignorance. I think that's the kind of choice James is making in the "Bliss" ending. The orbitoclast as the "Key of Bliss" adds some subtext to that, in the sense that all the patients may correlate to James in addition to a specific character—but as far as I can tell, Patient 0090 primarily corresponds to Eddie.
It was only recently that I realized why I can't smoothly jog around backwards like all the competent gamers do: I'm using the WASD keys on PC, not a controller. So I want us to all appreciate that I am God's bravest little toaster for figuring out how to maneuver with W + mouse as well as I do (but also, this is why you get some odd movements from me at times).
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(Edited to add video discussion from commentary 8. The text below is more in-depth, but there's some additional discussion of an "anger management" theme in the video.)
So I was doing research into medical practices of the early 20th century, because apparently I wanted to be deeply upset on a Tuesday night, and I discovered that
Lobotomies fell out of use once antipsychotic medications were developed, as a much less invasive treatment (to say the least).
Here's an ad for Thorazine that is hilariously alarming, with a tiny man squaring up against a giant eyeball
which is honestly the most JAMES LOOK AT THIS EYE GRAFFITI. HERE'S ANOTHER ONE. DO YOU SEEEEEE thing that I've ever seen.
The in-game Araxium ad that we see everywhere features two sets of (normally proportioned) eyes and nothing else, so the design isn't anywhere close to the Thorazine ad. But it does have the eye theme going, and it's not going to prompt anyone to burst into laughter. But I do think Bloober Team came up with the word "Araxium" from ataraxic, and Thorazine was the first. (They did some similar word-scrambling with the medication names on the Green Pharmacy receipt.)
The poster mentions both "anger" and "fear" (I think I'd misread that tiny "anger" as "anxiety" this whole time? There's also a different drug advertised for that); I think that's why there's an Araxium poster near one of Patient's 0130's tents. It can represent both James/0050 and Angela/0130, in keeping with the idea that the three (imaginary) patients relate to each of the three main characters, while also symbolizing James collectively in different ways.
I also think that 0130 has been assigned "pills" as her treatment because it turns out that the three Otherworld treatments are listed on the cork board in order of their invention: electroshock first, starting in the late 1930s (with earlier concepts going back to the 1700s!); lobotomies, first used in the 1880s and then coming into wide use in the 1940s and '50s; and then, Thorazine in use by the early 1950s. Angela, being the youngest, gets her corresponding patient assigned to the newest treatment.
The word "control" also leans more towards Patient 0130, potentially. Back in Jacks Inn, I was saying that a modern ad would sound more like (smooth, chipper TV ad impression:) "Get control of YOUR life, YOUR way, with Araxium." But if you think about it, the intimidating Araxium ad actually raises the question: who is in control? I was reading about experimental treatments being well-intended, but also reckless and invasive, as medical historian Roy Porter points out (WARNING: that's the lobotomy article on Wikipedia). At the same time, he observed, patients often had a lack of social power to refuse these treatments. I've been saying that (IMO) James needed some kind of treatment for his spiral during Mary's illness and didn't get it; Patient 0130 had medication forced on her, and the Director was one of those reckless doctors "in control."
While I discuss all of this in the commentaries for videos 7 and 8, I wanted to sort all the scattered documents and hints and implications by subject to get some clarity. James is the only person in Brookhaven Hospital that we know for sure is real (you might or might not count Laura, depending on which theories you believe); the patients and Director may represent himself and/or other people he's encountered in the game. Also, while we're here, let's talk about the nurses:
Patient 0050, symbolizing James
Patient 0090, symbolizing Eddie
Patient 0130, symbolizing Angela
"A Page from a Diary": Mary?
The Director of Brookhaven Hospital
Bubblehead Nurses: The Jacob's Ladder head shake
Bubblehead Nurses: The full discussion
Not to use weasel words, but it's widely believed that the three "hopeless cases" parallel James, Eddie, and Angela in various ways, and so Ian and I are working off that assumption. In the original game, per the fan wiki,
All three of these patients have striking similarities to three of the main characters in the game: Jack Davis is very similar to Angela Orosco, Joshua Lewis is reminiscent to Eddie Dombrowski, and Joseph Barkin shares traits alike to James Sunderland. However, another theory says that all three notes refer solely to James, since all the names begin with the letter "J". Jack represents the part of James who is normally a model person, yet also has suicidal feelings; Joseph displays the part of James who feels guilt and regret for [SPOILER] and the delusions James is immersed in; and Joshua portrays the part of James who feels he needs to be persecuted and also represents his violent self ([SPOILER]).
The three patients in the remake aren't named, removing the "J" theory, and one of the patients is specifically referred to as "she," making the 3:3 parallel stronger. I do still think that all three patients can resonate with James on some level, particularly the use of the word "bliss" with the "Eddie" patient, given that there's a "Bliss" ending, but the remake has put more focus on the patients as three individuals. Ian really spearheaded our efforts to figure this out (I helped!), particularly the idea that the "him" the patients are so afraid of is actually the Director himself.
