Syringes, crucifixes and (un)therapeutic whirlpools:
The social and medical horror of
Joe Howsin explores the ‘social horror’ of Rose Glass’ excellent British horror debut film, 2019’s Saint Maud…
Like many great works of art, the power of religious horror lies in the irresistible tension it portrays: a tension between, as Timothy Beal argues in Religion and its Monsters, ‘order and chaos, orientation and disorientation, self and other, foundation and abyss’ . This tension is everywhere in Saint Maud (2019, Rose Glass): between the spiritual Maud and the secular Amanda, between zealous fanaticism and nihilistic despair, Maud’s dual role as victim and villain, the social tension between community and individuality, and the tension created when a desire to do good is marred and warped by neglect and hardship. Soaked in images of crucifixes and angels, overlaid with Maud’s prayers, dreams of sainthood and (eventually) unforgettable martyrdom, religion unsurprisingly looms large in Saint Maud.
But while religion serves Rose Glass’ phenomenal debut well visually and thematically, if we (the horror-loving public) focus purely on the crucifixes, the iconography of faith, the art of Blake, we risk missing some of the film’s more prescient concerns. For while Glass’ contemporary classic can rightly be considered a religious horror, we must also contend with the fact that Saint Maud is a social horror, in which the pain of loneliness is omnipresent, and a medical horror, in which the grim realities of care, the emotionally and physically demanding work of nursing and the tragedies of an underfunded public service loom equally large.
The opening scene of the film makes this everyday horror immediately apparent: the muted colour signifies that what we are witnessing is, though horrific, absolute reality, in contrast with Maud’s moments of religious revelation, which are alive with colour (the levitation scene being the most obvious example of this, taking place against a background of brightly flashing fireworks, (0:54:00) as well as the oversized luminous blue moon (1:09:03), and glowing red cyclones in the sky (1:17:01), among others). While Maud’s gesture—her arms outstretched, looking up to the ceiling (0:01:45)—has obvious religious connotations, what she actually sees is far from divine: the cockroach’s alien physicality foreshadows the abjection Maud is about to experience from society as a result of the elderly patient’s death. But the flash of recognition on her face (0:01:57) suggests that she identifies with the creature, and so casts it, and consequently herself, in a more pleasing (holy) light. The corner in which the roach appears (0:01:55), however, communicates that this coping mechanism will prove claustrophobic: it will entrap Maud, and the longer she spends within this delusion, the more twisted it will become, and the further from herself she will stray.
Part 1: A religion in images
As religion takes on a more prominent role in Maud’s life, it becomes apparent that her faith is a veneer, scar tissue from her traumatic experiences in the hospital, both a symptom and an unhealthy coping mechanism shielding her from the pain of isolation and loneliness. Tragically, the more heavily Maud relies on her nebulous faith to protect her, the more distortive and hollow it proves itself to be. Maud’s identity as a nurse, on the other hand, remains authentic no matter how far it is thrust into the periphery; whenever Maud’s past as a nurse appears, even in the midst of her deepest delusions, it shatters her constructed identity as a twisted saint and reinstates, if only for a short time, her truer self.
Maud’s ever-increasing loss of rational self-identification is shown subtly in her flat, a space emblematic of her internal state throughout the film. The flat is not, other than her makeshift shrine, codified as an overtly religious space. Quite the opposite: where churches are built to emphasise height and open space in order to shift one’s thinking upwards, towards God and heaven, the low ceiling of Maud’s flat is instead cramped and claustrophobic, while its position below street level further implies that she is separate from God and all forms of community—both religious and secular. Likewise, where places of worship are wide and open to accommodate a bustling congregation, Maud enters her flat through a dark, narrow alley, emphasising her isolation. The only part of the church her flat resembles is the crypt, which neatly articulates the macabre nature of her warped faith. The ultra-close image of boiling soup (0:02:40), meanwhile, transforms a traditionally comforting meal into something obscene – reminiscent of boiling blood or mucus – thereby evoking the abject in relation to Maud’s living space. The abject, as defined by Julia Kristeva in ‘Powers of Horror’ , refers to things that we discard or separate from ourselves: as individual humans, this takes the form of bodily waste and excretions, while socially, the abject refers to rogue elements that do not fit within normative boundaries of what is traditionally considered ‘acceptable’. The reappearance of the abject, therefore, signals a breakdown in the distinction between what is us and what is not, what belongs in society and what does not. In this way, the flat is coded as a place outside of society, and consequently, it is a symbol of society’s failure to care for its most vulnerable members, instead making them outcasts, like Maud herself.
The possessions on display in Maud’s flat, meanwhile, reflect the superficial place religion holds in contrast to her identity as a nurse. While Maud’s prayer beads are prominent, they are dwarfed by her nurses’ uniform and medical equipment (0:03:11); only, where the former is positioned within the illuminating light of the lamp, Maud’s medical paraphernalia is left in shadow, thereby visualising the ‘light’ of divinity juxtaposed against the ‘shadow’ of the mundane. Due to her experience in the film’s opening scene, the harsh reality of medical care is something Maud would rather not see in the full light of day. The set design and lighting depict nursing as something essential to Maud’s personality but also as a source of trauma she cannot entirely face, hence the use of religious imagery to partially obscure it. Despite this need to mask the trauma associated with her profession, Maud’s prayer is dominated by the mundane realities of her new posting: she goes over her schedule, says ‘think I’ll have to get up at about six tomorrow’, and laments ‘the pain in [her] stomach […] now further hampered by menstruation’, for which she prescribes herself ‘two ibuprofen and milk of magnesia’ (0:03:21). The clinical way in which Maud describes her symptoms and treatment demonstrates how integral nursing is to her identity. In contrast, religion bookends Maud’s monologue without characterising it, as there is little of the spiritual introspection one usually associates with prayer in this speech.
Medical procedures continue to dominate the first forty minutes of Saint Maud—we experience Amanda’s barrage of injections and medications in unflinching detail, so much so that, after a while, much of the squeamishness one may have associated with it, in the beginning, devolves into dull routine (0:07:30). This desensitisation is an effective way of eliciting empathy for Maud and Amanda: for the former, we begin to understand how the harsh world of Maud’s religion may become tantalising once one’s everyday life is characterised by a repulsive mixture of trauma and monotony; for the latter, one begins to understand Amanda when she says, ‘you have no idea how dull it is to be dying’ (1:13:38). Despite being pushed into the cognitive background, the medical world is inescapable in Maud’s uniform and the closely filmed scenes of care, including Amanda’s therapeutic exercise routine. Consequently, when the subject of religion comes up, both Maud, Amanda and the audience are understandably drawn to it as a novelty. When Maud’s necklace slips out of her uniform during Amanda’s physiotherapy, the ex-dancer cannot resist playfully exclaiming ‘hello’, and asking ‘who’s your saint?’ (0:08:40) It’s here that the inauthenticity of Maud’s religion first becomes apparent, as she testily answers ‘Mary Magdalene’. When Amanda implies that necklaces of this particular figure aren’t made, Maud answers, with embarrassment, ‘I ordered it online’ (0:08:51). This small moment foreshadows much of the horror in Saint Maud; by taking the unorthodox figure of Mary Magdalene as her personal saint, Maud immediately sets herself apart from mainstream religion, reflecting her position as an outsider in both social and religious circles. Furthermore, the detail that she obtained the necklace through the impersonal, detached world of online consumer capitalism frames her faith as insubstantial and somewhat hollow: it is perhaps a belief system Maud has not given as much consideration as she should have. Finally, Amanda’s mocking tone and coy smile are indicative of her derision of Maud’s faith, an attitude that breeds increasingly extreme modes of conflict between the two.
The banalities of Amanda’s treatment continue in this fashion until the dramatic scene in which Maud, after being ridiculed and mockingly dressed as a ‘little saint’ in a napkin, slaps Amanda and is subsequently fired (0:40:24–0:41:40). We are given no indication prior to this that Maud is a bad nurse, far from it; behind her soul-saving zeal lies a genuine concern for her patient. This is demonstrated by the scene in which Maud confronts Carol, Amanda’s girlfriend, and attempts to chase her away, Carol’s chief sin being, rather than any religion-fuelled bigotry on Maud’s part, that Carol cares for Amanda ‘not enough’ (0:30:15), something demonstrated earlier when Carol harshly remarks that the champagne is ‘mostly for me’ (0:26:47), an indication of callousness towards the ill Amanda. This flippancy is what raises Maud’s ire as a nurse, rather than a ‘saint’. Her sincere care for her patient, coupled with her obvious competency, makes the fact that it is Maud’s faith (a coping mechanism for dealing with the stress and trauma she associates with nursing) that causes her to become alienated from her career all the more tragic.
As one might imagine, Maud’s dismissal affects her deeply: while treating the burn mark on her hand, Maud’s belief in God gives way entirely to the harsh reality of medical care (0:44:07), perhaps a final attempt on her part to reassert her lost identity as a nurse. This time, however, the procedure is self-administered care for a self-inflicted injury, emphasising her isolation. She then begins to pick aggressively at the wound, making this a twisted form of care that reflects the anguish she associates with the profession.
Loneliness is a horror that many people in Britain experience and many more dread: according to The Campaign to End Loneliness website, ‘45% of adults feel occasionally, sometimes or often lonely in England. This equates to twenty-five million people’ . It is worth noting that other studies of loneliness in the UK found that the proportion of those who reported feeling lonely ‘often’ or ‘always’ (about 2.6 million adults) was about the same proportion as pre-lockdown , indicating that this epidemic of loneliness has deeper, more historical roots in British society than COVID-19 and is not likely to simply disappear now that lockdown has mostly been lifted. The scene in which Maud tries (and fails) to connect with other young people in the pub is indicative of a wider experience of loneliness affecting young people in the U.K.; significant risk factors of loneliness include being of a younger age group and having a mental illness , making Maud particularly at risk. The prevalence of loneliness in young people is an often overlooked and troubling phenomenon: an online survey of 55,000 people found that ‘40% of 16–24-year olds reported often feeling lonely’ , making Maud a figure who represents a possible dark future for Britain in more ways than one.
The most striking images in Saint Maud’s pub sequence are the whirlpools that miraculously appear in patrons’ pint glasses (0:49:08), which are likely a reference to The Bible’s book of Job, 13:11-21 line 11, which reads: ‘shall not his whirlpool sweep you round, and terror from him fall upon you?’ . In the story, Job loses faith in God but is terrified back into the fold more fervent and pious than ever. The relevance of this biblical tale is obvious: it is only after this brief stint of disbelief that Maud becomes truly zealous in her pursuit of sainthood. However, Maud’s relapse into the depths of warped religious dogma can also be seen as an escalation of her unhealthy coping mechanism towards trauma, loneliness and loss. The whirlpools act as an evocative visualisation of the downward spiral lonely young people, especially those with mental illnesses, find difficult to escape. Studies show that individuals suffering from depression engage in withdrawal behaviours, which leads to an increasingly worse mood, and this in turn widens the ‘insurmountable distance between [themselves] and others’ . This is further compounded by the behaviour of non-lonely people towards the lonely: studies conducted by pairing lonely individuals with non-lonely individuals found that ‘the partners of lonely participants rated them as less involved and likable’ and expressed ‘less desire for future interactions’, thereby deepening the person’s cycle of loneliness . This is caused in part by lonely individual’s tendency to take on ‘passive interpersonal roles which disrupt social performance’ . This passivity can be heard in Maud’s conversation with her ex-colleague, Joy, when she meekly offers an unnecessary apology simply because Maud (quite literally) calls her for help (0:47:41). Maud’s strained identity as a servant of God can similarly be read as her taking on a wider role of passivity within her life. Her fall into religious delusion can likewise be seen as an escalation of the denial that many young lonely people exhibit, alongside ‘alternative gratifications such as sexual promiscuity, drugs […] alcohol, or rebellion’ —in this case, rebellion from normative religious and social structures. This cycle of loneliness is evocatively and heartbreakingly depicted in the pub sequence, where we see Maud fail to forge meaningful connections and ultimately fall victim to sexual assault, degradation and rejection on all sides (048:18–0:51:07). Is it any wonder that she would desperately seek a sense of community (however flawed) when faced with such internal and external factors pulling her deeper and deeper into a life of loneliness?
Pushed to the brink of despair by her dismissal, Maud sinks deeper into religious delusion for escape and relief. However, as I have alluded to previously, Maud’s particular brand of religious dogma is a hollow imitation of the communal life she seeks. After the levitation scene, Maud joyfully exclaims: ‘revelation, and just in time’ (0:54:30) while energetically cleansing her flat. This resurgence of religious fervour is interrupted briefly when Maud comes across her nurses’ uniform: she pauses, mid-motion, a painful expression of nostalgia settling across her face before quickly stuffing the garment away in a bin bag (0:54:06). This resurfacing of Maud’s old life juxtaposes the DIY nature of her religious clothing in comparison to the authenticity of her nurses’ uniform. In the height of her delirium, in which a failed baptism/exorcism leaves Amanda murdered with a pair of scissors, Maud dons a bedsheet in place of a nun’s habit or other such religious garment (1:03:43); the clear similarities between this bedsheet robe and the mocking napkin used to ridicule Maud earlier in the film (0:40:28) highlight that her religious beliefs are still merely a thin veneer meant to obscure the reality of her tragic life. The fact that Amanda is able to shatter Maud’s belief simply by telling her, ‘he isn’t real, you know,’ (1:13:13), demonstrates the frailty of Maud’s spiritual framework; however, Maud immediately hallucinates Amanda as a demon (1:14:11), demonstrating the extreme lengths Maud’s warped psyche will go in order to protect itself. This murder scene stands out as perhaps the only moment in the film where we might lose sympathy for Maud; however, it is important to keep in mind that, while Maud’s actions are inexcusable, they are motivated by hallucinations, not malice. It is also unclear how much of Amanda’s speech we should attribute to Maud’s delusions: while one reading might argue that nothing we hear from Amanda is objective, another perspective might suggest that Amanda truly does say these things to Maud, even going so far as to pretend to be demonic, in order to goad Maud into killing her as a method of assisted suicide. This is foreshadowed by an earlier scene in which Amanda watches a televised news report about the subject before abruptly turning it off (0:22:26): ‘no one sees what they don’t want to’ (0:13:14). In either case, the murder is a tragic end for the vivacious Amanda, and an equally tragic demonstration of just how far from herself Maud has strayed.
Part 2: Care under strain
While the personal horror of Maud and Amanda’s stories form the core of the narrative, Rose Glass’ peerless debut, like many of horror’s most enduring texts, makes allusions beyond the scope of character and theme to comment upon its contemporary moment; in this case, Saint Maud reflects upon contemporary Britain’s healthcare anxieties and warns of an impending crisis in the mental health of health care staff.
While still employed as Amanda’s live-in nurse, Maud encounters Joy (0:31:36), a colleague from her previous (presumably NHS) posting in a hospital. True to her name, Joy is bright and smiling, with an easy-going attitude that sits in stark contrast to the shy, guarded Maud (called Katie by Joy, clearly drawing lines of distinction between Maud’s previous identity as a nurse and her new persona as a saint). Yet, Joy’s casual and jovial demeanour masks the dark state of affairs she relays to Maud: ‘got patients sleeping in corridors, surgeries double-booked’; in short, the hospital is described as ‘a total madhouse’ (0:31:55). The uncomfortable silence the two nurses share after this report implies a shared knowledge and experience of these conditions, and while Joy’s stiff-upper-lip attitude is commendable, it belies a certain resignation that has fallen over British culture: that one of our treasured institutions is in trouble, and it has been for some time.
A large factor in this decline is, of course, lack of funding. However, the details of this are complex and somewhat obscure; NHS funding for the last twelve years is a story of contradiction and misleading appearances. On the surface, things seem to be looking up: the budget for the NHS has risen by 1.4% per year on average (adjusted for inflation) in the years between 2009 and 2019. However, this is in contrast to the average rise of 3.7% since the NHS was established . A growing and longer-living population mean that this budgetary increase should have at least been maintained, not lessened. Similarly, in 2020/2021 ‘planned spending for the Department of Health and Social Care in England was £201.7 billion […] up from £148.8 billion in 2019/20’. This, again, looks at first like a step in the right direction, but in reality, this increase includes the £50 billion of extra funding granted in response to COVID-19 . The problem here is, firstly, this increase is the product of an unforeseen crisis forcing the government’s hand, not a sign of a long-term commitment to improving NHS funding; secondly, there are very real concerns surrounding how efficiently (not to mention how ethically) this £50 billion was spent as the health secretary has been evasive on where exactly the money has gone and why with many high-profile contracts being awarded to Conservative party donors (something Matt Hancock has very reassuringly called ‘a coincidence’ ). The big picture is that NHS funding has decreased significantly compared with pre-2009 levels, and exacerbating and obscuring the issue is the fact that many of the government’s pledges to rectify the situation are either ill-planned (in 2020, the Commons Public Accounts Committee were ‘not convinced that [the Department of Health and Social Care] has plans for how the NHS will secure 50,000 more nurses’  as Boris Johnson promised) or come with severe caveats, such as the new five-year funding deal announced in 2018, which rose NHS funding by £33.9 billion (not adjusted for inflation) but, crucially, excluded vitally important areas of development—the most relevant of which, for this paper, is the budgetary exclusion of the education and training of NHS staff . This abandonment of staff is dramatized by Saint Maud in stark and shocking detail.
There are repeated references to Maud suffering a breakdown due to overwork: Amanda describes Maud’s former hospital as a ‘horrible place’, a place where Maud says she was ‘stretched too thin’ (0:14:19–0:14:43). We learn more about this in a later scene, in which Joy visits Maud in her flat; she consoles Maud, telling her that what happened to her elderly patient wasn’t her fault and admits that ‘we could see you were struggling for a while and no one did anything’ (1:06:45). This lack of support is reflected in the real-world findings of studies conducted by UNISON, the nation’s largest union for public service workers. They found that among mental health practitioners, ‘45% of respondents […] have said they are thinking of leaving their jobs,’ as a direct result of lack of funding and lack of managerial support .
Joy goes onto lament that ‘there’s no time […] it feels like everyone’s in their own little bubble’ (0:06:58). Another study conducted by UNISON revealed that, during the COVID-19 pandemic, almost half (48%) of the employees questioned admitted they were struggling to cope with the increased workload. Of that group, the majority of those who sought support did so through their colleagues (58%) . In this sense, Joy’s attempt to support Maud through her crisis is indicative of how staff are supported mentally, i.e., by each other. Yet, Joy is too late to help Maud. Where earlier this conversation would perhaps be the turning point for Maud and the true answer to her prayers, Joy instead finds her completely consumed by delusion. This, also, is sadly reflective of the experience of many nurses; a study conducted by Fund our NHS, an independent group advocating for an increase in NHS support, found that ‘52% of respondents said they were too busy to provide the care they would like’ . While this statistic primarily references being unable to provide care for patients, it also implies that staff do not have the time to care for each other.
The reason for this overwork, and the subsequent decline in the mental health of staff, is simple: there are not enough nurses on staff to meet the growing healthcare demands of the country. ‘[S]tatistics from the Royal College of Nursing in 2020 reveal there are 40,000 nursing vacancies in health and care settings in England’ , and compounding this problem is the fact that the ‘number of nurses and health visitors in England leaving their jobs in hospital and community settings within the first three years has risen nearly 50% since 2013-14, standing at 28%’ . The strain put upon the remaining staff is evident: ‘anxiety, stress and other psychiatric illness accounted for 28.3% of all sick leave in May 2020’ . Once again, we find ourselves back in the heart of the whirlpool: a tragic (and preventable) cycle of underfunding, leading to a lack of support, understaffing, overwork, mental health problems and finally, more NHS staff leaving the service; this, in turn, leads to even worse staff shortages, even more overwork, more mental health problems, and so on. The shoes with nails in the soles that Maud wears in an act of penance (0:55:08) are a tragically fitting image for the overwork, and subsequent emotional, mental and physical trauma, burdening NHS staff.
Conclusion: Why religion?
Perhaps religion is such a useful tool for depicting contemporary anxieties because it encompasses every aspect of human existence; it is spiritual and psychological, it interacts with society and the body, and it is a phenomenon that exists in the modern world while evoking the distant past. Where some horror texts comment upon this anachronistic tendency to survive in a predominantly secular age, thereby critiquing both the secular and the religious via contrast, Saint Maud appears more interested in religion’s capacity (and sometimes demand) to overtake an entire, singular life. This is not necessarily a criticism of religion, however, as Glass depicts healthcare professions as being similarly capable of becoming one’s sole concern, demanding more and more until isolation and illness become inevitable. But the film never depicts either circumstance as essential: a haven of moderation is possible. It only takes support from one’s peers, from governments and from institutions. Truly effective religious horror always depicts its divine subjects in this nebulous way. By doing so, texts reflect on the fact that where God was once a certainty, now it is a question; so too are institutions, governments, and even our own minds, up for debate – and perhaps, destruction.
 Kristava, Julia (DATE) Powers of Horror. (PUB).
 The Book of Job Bible verses