There are so many horror movies set in mental institutions that it’s pretty much a sub genre at this point, and while these days we realize that the aesthetic of presenting that world in such a.. heightened and lurid manner isn’t all that enlightened, we can still appreciate a good entry on its own trashy terms I guess. William Butler’s Madhouse is a gory little diversion with a kind of messy story that it makes up for with some truly unsettling, deeply disturbing visuals that are very clearly influenced by Adrian Lyne’s Jacob’s Ladder, but such influences on other works are welcome, even if worn shamelessly on their straightjacket sleeves. Joshua Leonard, who comes across as a kind of subdued, less succinct Sam Rockwell, plays an intern taking up residency at an underfunded, spooky asylum run by a head doctor (Lance Henriksen, naturally) who has little interest or compassion for the patients and whose safety protocols and ethical groundwork are, shall we say, questionable. Most of the patients run about willy nilly and the terrifying subterranean maximum security wing is a furnace heated nightmare corridor of leering monstrosities and deliberately grotesque personalities, like the hallway of prison cells from Silence Of The Lambs went to sleep and had a bad dream. There he finds a sort of ‘patient X’, a mysterious mummified individual who tells him a long forgotten tale of a young boy decades before who was mistreated by the asylum staff (you know, more than usual anyway) and whose ghost still runs around at night, and I found it funny how the script acts as if the ghost of a little kid is the *scariest* thing left to run about the place at night when the film has this level of freaky production design and prosthetic soaked extras on hand, which are really quite impressive, even if the story can’t quite get it up. Henriksen does little more than bluster, but his presence is always welcome, the lovely Natasha Lyonne has an extended cameo as a severely distressed patient and that adorable little southern dandy hobbit Leslie Jordan (a frequent staple of American Horror Story) has a nice bit as one of the facility’s doctors who reaffirms our primal fear of being murked while we sneak out to the refrigerator for that 2am snack. Director William Butler has a solid body of DTV horror work including the Danny Trejo/Tom Sizemore vehicle Furnace and while he can’t quite land the narrative here with overall coherence and the twist is felt a mile away, Madhouse has atmosphere in spades, truly horrific gory imagery that borders on the surreal and a very effectively creepy vibe.