Excision is one of those films I’ve been meaning to watch for what feels like forever. I’ve heard about it from every horror fan I know and seen it on dozens of rec lists, but somehow I never got around to it until now. Admittedly, I was a little concerned that it wouldn’t live up to the hype; that turned out not to be the case, and though I felt like I had already heard so much about it, I was still taken by surprise by how good and in-your-face gruesome it is.
The film centers around Pauline, a misfit high school senior with a tense home life and an obsession with surgery. It’s immediately evident, from the film’s opening scene onward, that her fascination is darker and more complicated than a simple interest in medical science. Pauline’s visually elaborate sexual fantasies are filled with blood and mutilation and occasionally veer into necrophiliac territory. The scenes are grotesque and stunning from a visual point of view, and they leave you repulsed and wondering when — not if — Pauline’s fantasies are finally going to spill over into real life.
In her daily life, Pauline is Daria meets Carrie White: a cynical, intelligent outcast who seems to inspire hatred in her peers. While those of us who remember being adolescent outsiders might find ourselves identifying with her to an extent, director Richard Bates Jr. isn’t interested in garnering sympathy for his anti-heroine. There are no “good” characters vs “bad” characters. Bates presents his characters as they are — flawed, often downright terrible, and disturbingly human.
The cast of flawed characters includes Pauline’s parents, played by Traci Lords and Roger Bart. One of the film’s most complex relationships is between Pauline and her controlling mother, Phyllis. It’s implied that Phyllis herself is the daughter of an abusive mother who has tried (and largely failed) to be a better parent to her children than her mother was to her. Pauline resents her mother but she also yearns for her approval, which serves as a primary catalyst for the extreme measures she takes to prove herself. Another driving force behind her actions is her seemingly genuine affection for her younger sister, Grace, who suffers from cystic fibrosis. Grace’s condition could be what originally spawned Pauline’s interest in surgery and instills her with a sense of purpose that sets her on the film’s disastrous path.
At school, Pauline is surrounded by all the typical characters you’d expect from any typical teen drama: the Mean Girl blondes, the popular boys, the annoying authority figures (made up of cameos by Malcolm McDowell, Ray Wise, and Matthew Gray Gubler as the long-suffering sex ed teacher). Wanting to bring her gory fantasies to life, Pauline decides to lose her virginity while she’s on her period and straight-forwardly proposes Adam, the boyfriend of the leader of the Mean Girl clique. During sex, Pauline indulges in a blood-drenched fantasy in which she chokes Adam — who naturally does not share her desires When she asks him to go down her on her, he promptly freaks out when he discovers she’s menstruating. For Pauline it was “everything I’d hoped it would be.”
As the film progresses, tensions come to a head when Pauline is expelled from school for attacking Adam and his former girlfriend (who vandalized Pauline’s family’s home in retaliation for her sleeping with Adam), and Grace’s condition worsens. Pauline has been meticulously researching cystic fibrosis, her interest in surgical procedures becoming even more morbid and obsessive than before, so when she learns that Grace needs a lung transplant, she sees an opportunity to save her sister’s life and make her mother proud.
The final scenes catapult the characters toward a horrifying conclusion, and when the film cuts to black we are left with its single most emotionally charged scene to linger in our minds.
While Pauline isn’t a typically sympathetic protagonist, we find ourselves hoping she will succeed — for Grace’s sake, at least — even as she is spiraling toward certain disaster. Her parents dismissed her ambition as “delusional,” but it isn’t truly clear just how far gone she is until the very end, when her former clinical, if dangerously morbid, composure gives way to full-on mad scientist, leaving her bloody and disheveled in the aftermath of the horrible things she’s done.
Excision is not for the faint of heart. It makes excellent use of visual horror and the grisly imagery of Pauline’s fantasy world will stay with you long after the credits roll. The film manages to combine horror, black comedy, and teen drama in a bleak coming of age story that isn’t quite like anything that’s come before.