Known for his old-school suspense and horror films, director Brad Anderson (The Machinist, Transsiberian) shows an uncommon sympathy toward his characters. No matter how minor or how despicable they might be, Anderson grants each of them some distinctive, humanizing trait; even the serial killer who drives the action of The Call (2013) is presented as a victim of childhood trauma. This evenhanded treatment enables Anderson to shift audience identification fluidly from one character to another, which certainly comes in handy in Stonehearst Asylum. Based on Edgar Allan Poe's "The System of Doctor Tarr and Professor Fether," this rather creeky gothic horror tale derives much of its suspense from the fact that one can't decide whom to trust.
Set in 1899, the story gets rolling when a young psychiatrist named Edward Newgate (Jim Sturgess) accepts a job at the title institution, a mental hospital isolated in a wooded, mountainous region. The eerily poised head doctor, Charles Lamb (Ben Kingsley), has instituted an experimental program in which patients interact freely with the staff. Even dangerous psychopaths are allowed to roam about the place unfettered and take part in the doctors' dinner parties. Despite this tolerant philosophy, however, Lamb reacts angrily whenever someone challenges his methods, and his thuggish chief deputy (David Thewlis) maintains order with threats of violence.
This setup all but screams that a plot twist is coming, and screenwriter Joe Gangemi, to his credit, gets it out of the way relatively early. (Spoilers follow.) A few nights after Newgate arrives, he discovers that Lamb and the other doctors are actually patients who revolted, locking up the real doctors and nurses. For the next hour of the film, Newgate conspires to free the imprisoned staff, who are slowly starving to death. But while he's devising his plan, he learns that the legitimate head doctor, Benjamin Salt (Michael Caine), was an unfeeling brute who conducted medical experiments on the inmates. One comes to sympathize simultaneously with them and the doctors, since both can now claim to be victims of abuse. As these two factions compete for the moral high ground, so too do Kingsley and Caine compete to give the hammiest performance. Anderson gives them plenty of room to duke it out, and his deliberately theatrical mise-en-scene provides a fitting backdrop for their competition.