Most of us view Halloween as an opportunity to play make-believe for a day. Whether we want to be a princess, a superhero, or a terror-inducing monster, children and adults delight in dressing up and pretending to be someone else.

Origins of the Holiday

This heavily commercialized contemporary holiday is thought to have originated with an ancient Celtic celebration designed to ward off supernatural forces. Consequently, the wearing of masks and costumes to hide the identity of pranksters, honor the dead, and scare away occult threats has been a part of the holiday from the beginning. In the intervening centuries, it has morphed from bonfires and scary-faced turnips and pumpkins to a night of mean-spirited pranks to a celebration of costumes, haunted houses, pumpkin spice, and candy.

Of course, there are reasons we enjoy escaping from our daily lives through play-acting. The human ability to use our imaginations to escape into fantasy worlds has resulted in the creation of a huge body of stories, songs, plays, movies, television shows, and other forms of entertainment. As children, we use play to learn new skills and to practice social interactions. Even as adults “faking it until you make it” can enable us to develop the confidence to incorporate some of those behaviors into our daily lives.

For most people, there is a clear delineation between our fantasy selves and our real identity, but that isn’t true for everyone. A number of mental conditions including schizophrenia and bipolar disorder are characterized by difficulty separating internal and external experiences. Even depression, anxiety, and posttraumatic stress disorder (PTSD) can influence the way people behave and see the world. But when their actions seem unusual or inexplicable, they can generate uncertainty, fear, and even hostility,

Fear of Unpredictable Behavior

Throughout much of history, strange or odd behavior was attributed to supernatural forces. Many societies used punishment and torture to try to drive the spirits away. Historians suggest that many Halloween icons, including ghosts, witches, and vampires originated with attempts to explain the manifestations of mental or physical illness. While we know much more about how the brain and body work now, we still find unpredictable behavior scary and often cope by avoiding or ostracizing people who make us feel threatened. When we don’t realize that someone is exhibiting signs of mental illness, we may blame them for their behavior or overestimate their ability to temper their actions.

It doesn’t help that in an effort to make sense of the world, we often make assumptions about people who differ from us. False beliefs about the mentally ill include the assumption that they are prone to violence and that mental conditions are indicative of a character flaw and can’t be treated. Links between mental illness and the supernatural persist as well. The superstitious belief that the full moon exacerbates mental illness is common among mental health care providers and the general public although systematic examinations of emergency room visits do not support this assumption.

Demonizing Mental Illness

Nevertheless, mental illness is still a mainstay of some Halloween practices. Costumes featuring straight jackets, depictions of people described as “psycho,” and haunted houses with an asylum theme are common in the United States. The National Alliance on Mental Illness (NAMI) has argued that a haunted house based on depictions of the mentally ill should be just as taboo as one based on people with cancer would be, but the theme persists.

The consequences of demonizing mental illness are serious. The ostracization and mistreatment of people whose behavior differs from the norm can infringe on their rights and well-being. Fear of being labeled “crazy,” the lack of access to psychological care, and embarrassment are among the reasons people give for failing to seek treatment

All of this suggests that we need to make a greater effort to focus on educating people about the symptoms of mental illness; to advocate for accessible, affordable psychological care for everyone; and to promote empathy rather than stigmas about people who are suffering. This is not to say that there is no place in the modern world for celebrations such as Halloween, which acknowledge that there are aspects of life we don’t understand, that we enjoy playing make-believe, and can enjoy the thrill of being scared when we know we aren’t really in danger.

But do we really need to continue practices that perpetuate false beliefs that have the power to reduce people’s willingness to talk about mental health issues or to seek treatment? There is a great deal of evidence indicating that we benefit from traditions and rituals that mark the passage of time and create a sense of continuity in our lives. But, in a world where we know that mental illness stems from physiological disruptions in the way the 86 billion neurons in our brain function, we should be able to use those neurons to find entertaining ways to try on different identities and scare ourselves without worsening the lives of people who are already struggling to cope with the world around them.