I'm new and I hope to do this thing right, soo Hi!

I'm willing to write a short story about a girl who wakes up in a hospital and gradually discovers that the entire structure is under the influence of a "lovecraftian" being who also just awoke and drove all the people in the building insane. She has, of course, no grasp of what's going on and the more she descendes into the hospital's lower floors, the more the uneasiness, the hallucinations should be gruesome and feel real at the same time, until the final realization, which won't be a realizazion of course - this word is too... positive - but I'm still working on it.

My question is:

I'd like to create a setting that is unsettling - eh eh - due to its cleanliness. I'd like to recreate a feeling that I had reading Brave New World - I think it was - with those aseptic, lifeless halls.

The fact is... I'm unsure of the elements to insert in order to evoke fear and horror in an enviroment such as this. What hallucinations? What frightening events might shake the reader, giving him/her a sense of dread, the feeling of an ordinary reality that is crackling?

  • 8
    Welcome to the site! This is two questions, and they should be posted separately. The first one would be closed as off topic, because we don't make plot suggestions. The second question is something we're equipped to answer, though. Aug 19, 2018 at 6:22
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    Hi Mord! Welcome to Writing.SE! We're a little different than other sites -- you can take our tour to get a sense of how we work and what kind of questions work well! And Arcanist is right -- I'll edit this question, with just the second part. I hope you'll get some great answers!
    – Standback
    Aug 19, 2018 at 17:22
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    This is the kind of thing we writers learn by reading. How do your favorite horror authors unsettle you? What words and rhythms and pacing and... whatever do they use? Reading as a writer improves us as we pay attention to the techniques we see on the page. Aug 20, 2018 at 16:00
  • I'm voting to close this question as off-topic because This should go on WorldBuilding StackExchange Jan 14, 2020 at 21:31

5 Answers 5


It's all psychological. You don't necessarily need hallucinations, or even anything supernatural at all, because it's not the specific details or events that make it scary, it's how your character perceives them. You can do this in several ways:

  • Direct: "The hospital was comfortingly clean" versus "The hospital was eerily sterile"
  • Subconscious: "Light glinted off the counter like sunshine on a knife"
  • Biographical: "Hospitals always reminded her of that terrible night..."

Remember, compelling details are never neutral, they always tell a story, and that story is always about your character's internal life, even with a third person POV. The movie Signs is a good case-study: Contrast how scary the first part of the movie is, just from small, seemingly innocuous details (and a group of people living in fear), with the ending, where you actually see the monsters in all their fearsome gruesomeness (and can hardly keep from laughing).


I'm focusing on the second question, which is related to setting and metaphysics more than it is on plot.

Allow me to quote from Tzvetan Todorov's The Fantastic in length, because it is useful in order to understand the dynamics involved.

In a world which is indeed our world, the one we know, a world without devils, sylphides, or vampires, there occurs an event which cannot be explained by the laws of the same familiar world. The person who experiences the event must opt for one of two possible solutions: either he is the victim of an illusion of the senses, of a product of the imagination – and laws of the world then remain what they are; or else the event has indeed taken place, it is an integral part of reality – but then this reality is controlled by laws unknown to us …

The fantastic occupies the duration of this uncertainty. Once we choose one answer or the other, we leave the fantastic for a neighboring genre, the uncanny or the marvelous. (1973, 25)

What this means for your case, is that you need to understand the connection between genre and metaphysics involved.

  • Case A: there are demons, and the whole reality as we know it has to change (we're scared because there are demons and reality as we know it doesn't exist).
  • Case B: there are no demons, but we are losing our mind because we are seeing them in front of us (we're scared because we're going insane).
  • Case C: we don't know what's going on; there might be demons, we might be going mad (we're scared because we don't know what's going on).

If you want your story to be unambiguously supernatural in terms of affective power, then the horror elements must be presented as such. You did mention Lovecraft, but bear in mind that madness and ambiguity is a central element in at least some of his work.

Although this is a plot matter in that sense, I think that your best option would be to prolong ontological ambiguity as much as possible, balancing between opting for the one or the other Todorovian branches (supernatural explained or supernatural accepted, to use a Gothic term).

In relation to setting in particular, and if you want to focus on how clinical and aseptic it is, you should precisely try to take life out of everything. That is, remove grit (metaphorically speaking, of course) from where it would've normally been.


I expect that a large part of the problem is that you are trying to make cleanliness seem unsettling. This is difficult because it's usually the unclean that unsettles us. It would be easy to make the hospital unsettling by filling it with flies or by making the walls ever so slightly undulate like the lining of a stomach. But something overly clean and sterile is somehow less directly unsettling to us.

Some ideas:

  • Make the lead character extra uncomfortable Put her in a hospital gown. Spend plenty of time on describing her cold, bare feet. Let her pull an IV out of her arm that has been in far too long.
  • Increase the contrast with the hospital before the event It's difficult to make a hospital seem safe and and comfortable, but focus on warmth, many friendly nurses and doctors, warm light, and the safety of being taken care of by experts. Make mention of young parents picking up their newborn babies. Make sure the ailment is minor, so that the character knows she will soon be healthy again. Then after the event, draw on everything that is horrible about hospitals. The uncertainty, the loneliness, the fear and constant reminders of mortality. Muse at length on the cold maternity ward with its flickering lights and empty cribs.
  • Make other aspects of the hospital more directly unsettling Make it cold. Make it dark, or if the light must be bright (which does feel more sterile), make the light bright blue, like a staring into a spotlight when you have a migraine. Make it smell of bleach, as though the sterility is only there to hide something terrible.
  • Make the character feel sick and unclean Make her body the opposite of the overly clean hospital. Make her sweat and shiver. Make her nails split and her skin crawl. Give her small cuts on her hands and feet that burn with the antiseptic that seems to line the walls and floor. It's like the hospital considers her sick and unclean, like a foreign body that needs to be eliminated.
  • Make things sterile that shouldn't be Show brightly colored fruit and vegetables that are just slightly off. Fresh-looking broccoli that that is just a little teal in color. Apples that are juicy, but the juice hits your lungs like ammonia, and the skin sticks to the pulp like paper held on by glue.

I think the contrast between what is good and what is horrible about hospitals is an especially fruitful theme. You can delve into that for more inspiration. Put all the good before the event and all the bad after. You can even read about people's hospital experiences to give you inspiration.

  • Dude, you're a genius. I got unsettled just reading your answer. This is helping me out too
    – Tasch
    Jan 18, 2020 at 3:35

I would recommend reading this article in full: The Psychology, Geography, and Architecture of Horror: How Places Creep Us Out. It's quite interesting, but the main point is that you need to create unpleasant features and unpleasant associations.

And a word on what makes "cosmic horror" stand out from normal horror, by Lovecraft himself:

Children will always be afraid of the dark, and men with minds sensitive to hereditary impulse will always tremble at the thought of the hidden and fathomless worlds of strange life which may pulsate in the gulfs beyond the stars, or press hideously upon our own globe in unholy dimensions which only the dead and the moonstruck can glimpse.

A certain atmosphere of breathless and unexplainable dread of outer, unknown forces must be present; and there must be a hint, expressed with a seriousness and portentousness becoming its subject, of that most terrible conception of the human brain -- a malign and particular suspension or defeat of those fixed laws of Nature which are our only safeguard against the assaults of chaos -- from Supernatural horror in literature

In other words, ask yourself this: what would a malevolent God, with a sadistic wish to torture humanity, do, to make you feel dread, and make you question reality? Or, if you're not the sadistic type: recall your most vivid or disturbing nightmares, the ones that left an impression, that made you wake up in dread, and include elements from them. That's what Lovecraft did, from what I've heard.

Hostile environments that give the main character no chance to hide, and are easy to get lost in.

A hospital is perfect for this, they're often sprawling, hard to navigate, easy to get lost in, and while they offer many hiding spots for you, they offer your enemy just as many chances. And besides, Lovecraft has stated in the Cthulhu story that space/geometry makes no sense

Refuge means having a secure, protected place to hide where one can be sheltered from danger, while prospect refers to one’s clear, unobstructed view of the landscape.

We love [...] places where “you can see without being seen, and eat without being eaten

Attractive places offer us a lot of prospect and a lot of refuge [...] the worst combination is very little prospect or refuge [...] [such places] are perceived as unsafe and dangerous

Scary places may also lack what environmental psychologists refer to as “legibility.” Legibility reflects the ease with which a place can be recognized, organized into a pattern and recalled—in other words, a place that we can wander around in without getting lost

Leverage creepiness (ambiguity of a threat's presence), horror (ambiguity of a threat's nature) and fear.

Keep these notions in mind while you're describing the environment and other characters. Patients who look or act strange can make you uncomfortable, because you don't know if they are a threat or not, and it's the uncertainty that creates anxiety. Want an example? Look at Charles Manson. You can tell that you can't "expect" him to behave normally. Well, at the end he makes his intentions pretty clear...

Creepiness is a response to the ambiguity of threat [...] we get creeped out by certain people because they behave in bizarre and unpredictable ways, violating the subtle social conventions that enable us to understand their intentions [...] they present us with an ambiguity as to whether or not they are someone to fear, and this ambiguity makes us very uncomfortable.

Physical characteristics such as an unusually lean body type and unusual facial features, especially in the region of the eyes or teeth, predisposed their participants toward making a judgment of creepiness

Places can creep us out for the very same reasons that people can, by presenting us with ambiguous information that makes it unclear if the place poses a threat to us or not

Horror, on the other hand, is the growing awareness that we are indeed facing some sort of danger, although we may not yet exactly understand the nature of the threat or how best to deal with it.

Fear is the clearest of the three emotions. It occurs when we clearly recognize the nature of the danger that we face and we concoct a strategy for dealing with it.

Being alone means you creep yourself out even more easily.

Kind of obvious, but if she is in a group, or finds allies, have them split up, or have the group fall prey to the Lovecraftian monster. Losing trusted allies, or even turning those allies against her would really take a toll on anyone's psyche.

Humans are a highly social species with a strong need for interaction with others, especially during times of stress; when we go through a trying ordeal alone, a lack of emotional support and comradeship can increase our anxiety and hinder our ability to cope. We rely on others to help us resolve ambiguity, and [...] cooperative defense against threat.

However, monotonous or tedious stimulation from our surroundings may cause us to turn our attention inward—within ourselves—which most of us have much less experience handling.

This may lead us to lose confidence in our understanding of what’s going on in our surroundings; is that creaking sound upstairs just an old house pushing back against the wind, or is it something more sinister? [...] Without others with whom to share information and reactions, ambiguity becomes very hard to resolve. When this happens, our mind may quickly race to the darkest possible conclusions.

A place's history factors into its creepiness.

If a place has demonstrated a past proclivity for providing unfortunate outcomes for those who have visited it, we take that as a warning and resolve ambiguous feelings about the place by moving in the direction of caution.

signs of life suddenly interrupted and frozen in time only amplify the fear factor; remnants of a half-eaten meal on a kitchen table or clothing laid out on a bed waiting for a homeowner who has apparently vanished without warning create a frightening ambiguity about what may have taken place in the house.

Use negative associations, unpleasant/unhealthy places are inherently more creepy.

Unless you have some experience in medicine, chances are that you have no idea how you can handle tools and chemicals found in a hospital, but you know that they're pretty dangerous. There's menacing signs like "biohazard", "x-rays", "explosive", warning labels... you feel like you can't "read" the place, and that you should get out since being there is more likely to do you harm than good.

I've been admitted to an ER once, late at night. I passed out, and when I woke up, it was dark, I was in a room with a bunch of other patients, completely alone, I had a cannula stuck into my wrist... good thing I was too tired, but I seriously considered ripping that thing out and getting out of that room, just due to the uneasiness I felt in that moment.

places that isolate people without their consent such as prisons and insane asylums are often considered scary. I would take this one step further and propose that any institution that once housed any “troubled” population of people may become “contaminated” by this association [...] our brains take advantage of any information that will guide us to a conclusion about the costs or benefits associated with spending time in a place, and such places are very strongly associated with bad stuff [...] prisons, orphanages, and hospitals are ubiquitous on virtually every list of creepy places.

Death/decay/illness are extremely creepy.

Patients get progressively less sane, less responsive, less human as she sinks deeper and deeper. They are more ill, more mutilated, more deformed, with each floor. Maybe she witnesses the mutation of one of them into those monstrous beings. There's plenty of gruesome medical pictures and conditions, or sites that show pictures taken by EMTs, if you want some gruesome and realistic inspiration.

Death is inherently creepy to us because of its ambiguity, and ambiguity is the soil in which horror grows. Very few people know exactly when or how they will die, let alone what happens to them after their death


Just be ruthless with your adjectives. Look for ones that make you cringe (not in the Gen-Z type of cringe, but the actual cringe; wince, recoil, ect.). Describe things in detail and use metaphors. For me, when the character's descriptions go so far into the figurative that, as the reader, you almost don't know what is being said, it's unsettling. The novel Speak does this kind of thing and I really enjoy it.

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