One of the most polarizing horror films released in 2021 is James Wan’s Malignant. Love it or hate it, it’s unlike much of the horror fare out there. It’s almost as if Frank Henenlotter’s Basket Case was pushed through a strainer of Italian horror, then sprinkled into a blender with a modern sensibility and style. Yes, that’s a compliment and no, it’s not intended to feed into the question “Is Malignant giallo?” That’s far beyond the scope of this piece. What isn’t beyond the scope is extensive plot details for 2021’s Malignant, fewer plot details for 1982’s Basket Case, with side trips into Italian horror and mainstream releases.

After an effective, disorienting cold open in which something (whatever it is can control electricity and broadcast its thoughts over radio) attempts to escape from a clandestine medical research facility, Malignant segues into a credits sequence reminiscent of David Fincher’s 1995 release Se7en, although with a brighter color palette featuring various video feed clips as opposed to Se7en’s artful drabness. At the credit sequence’s end, we’re taken to a bucolic suburban house, into the driveway of which pulls our pregnant protagonist Madison (Annabelle Wallis). From the cheery exterior, she enters the house’s darkened interior, where her abusive husband Derek (Jake Abel) argues with her and basically blames her for her series of miscarriages. The confrontation becomes physical, and when Madison shoves Derek for touching her unborn baby, Derek pushes her by the head into the wall. She locks the door to the room once he leaves. Derek is dispatched quickly and messily by an unknown assailant, who pursues Madison through the house until she falls.

Police detectives Kekoa Shaw (George Young) and Regina Moss (Michole Briana White) arrive at Madison’s house to see the remains of Derek. From there, we shift to the hospital where Madison recovers. Madison’s sister Sydney (Maddie Hasson) informs Madison that her unborn child couldn’t be saved. The first hour of the movie seems like an especially bloody supernatural mystery, with the assailant killing two doctors who turned out to have a secret and seemingly disparate threads working themselves into the narrative, and Madison’s sharing a psychic bond with the killer, who kidnaps a tour guide and fashions a wicked murder weapon from a medical trophy awarded to one of the doctors. When Madison and Sydney present a sketch of the killer to the highly skeptical police detectives, Moss quips “Oh, OK, so I’ll put out a BOLO on Sloth from ‘The Goonies’?” The detectives enlist the help of a psychiatric hypnotherapist in an attempt to unlock Madison’s memories. She recalls that her birth name is Emily May and that her apparent imaginary friend Gabriel wanted her to kill her unborn sister, but Emily stops in time. The imprisoned woman falls through the ceiling. She’s Serena, Madison’s birth mother. Sydney visits the now-shuttered research center and discovers that Gabriel is a conjoined twin and that the doctor in charge of her case cut away enough of Gabriel so as to not damage her brain, and closes the rest of him up inside her skull. Madison’s husband awakened the dormant Gabriel when he pushed her earlier.

Madison is in a holding cell at the police station, and Gabriel releases himself in a show of carnage that begins a gloriously unhinged third act. Sydney tries to contact the detectives on her to see Serena at the hospital. The detectives try to stop Gabriel, who has hijacked Madison’s body to cut a destructive swath through the police station. Sydney arrives at the hospital just as Gabriel does, as does Detective Shaw, who puts a bullet into Gabriel/Madison, who severely wounds him and pins Sydney under a hospital bed. Sydney informs Madison that Gabriel caused her multiple miscarriages by “feeding” off her fetuses. Madison, enraged by that revelation, forces Gabriel into a mental cage and strips his abilities, taking them as her own. Gabriel says he’ll be back. Madison says she’ll be ready. Back in the hospital and in control of her new powers, Madison affirms that although she and Sydney aren’t related by blood, they were sisters all along. As they embrace, a light bulb in the corner of the room slightly flickers.

This movie is similar to Basket Case in that in both a separated mutant twin seeks revenge for a forced separation. In Basket Case, the formerly conjoined twins Duane and Belial work together in a symbiotic relationship, while Malignant’s Gabriel is a parasitic twin, an extreme version of a teratoma. Yes, science-y stuff enthusiasts, it’s impossible for conjoined twins to be fraternal or not the same sex, but it’s just about as likely for a parasitic twin to control and disrupt electricity, so all bets are off. The nightmare logic common to Italian horror is most prevalent in Malignant’s first two-thirds, effectively aided by longtime James Wan collaborator Joseph Bishara’s propulsive electronic score and Safari Riot’s mournful hypnotic cover version of Pixies’ “Where Is My Mind?” Screenwriter Akela Cooper, working from a story by herself, James Wan, and Ingrid Bisu, manages to tie the nightmare logic threads together so that when the twist happens, the groundwork laid up until then makes sense when seen in a new light. Even if Wan and company haven’t seen Basket Case, or indulged in Italian horror, it almost seems like spontaneous creation, and that can be a beautiful thing without one’s even knowing it.