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James Wan Breaks Down The Inspiration For That Malignant Twist

At first blush, "Malignant" seems like it's just like the last ten years' worth of James Wan horror movies. A house that seems haunted? Check. A person who is actually haunted? Double check. A family working together to overcome a terrifying evil? Yes, all these aspects are present in "Insidious," "The Conjuring," and now "Malignant." However, once you get beyond the surface comparisons, "Malignant" is unlike either of the franchises which brought Wan so much success in the 2010s.

"Malignant" tells the story of Madison Mitchell (Annabelle Wallis), a woman who, after a mysterious, dark past, is adopted into a loving home. However, while trying to start a family of her own, she's plagued by miscarriage after miscarriage, a nightmare only made worse when people around her are suddenly and brutally murdered. As the murders ramp up, Madison begins seeing them through horrific visions and becomes aware that someone from her past named Gabriel is responsible.

If you've seen "Malignant" then you know that Gabriel isn't just someone from Madison's past — he's her sentient tumor/conjoined twin who was mostly excised from her as a child but whose mind (and face) still lingers in the literal back of her mind. The entire third act of "Malignant" features Gabriel taking control of Madison's body and walking backwards while slaying everyone in sight.

The ending of "Malignant" is absolutely bonkers leading many to wonder where James Wan came up with the idea — and now we have our answer.

Could you have a Gabriel of your very own?

Before we begin: No, there's no way you have a malignant, psychic twin hiding in your skull that can take over your body and do crimes. Please keep the impossibility of "Malignant's" plot in your head as we discuss the next part, which is the reality of the teratoma.

A teratoma is a very real type of tumor, which, while often benign, is still exceptionally gross as it can be made up of things like, hair, muscle tissue, or teeth. And, yes, there is something specifically called a fetus in fetu, which is basically a growth inside the body that resembles (but is not) a fetus. This is where Wan and his spouse Ingrid Bisu came up with the conceit for "Malignant".

"My wife, Ingrid, she does a lot of research into medical anomalies," explained Wan in an interview with Entertainment Weekly. "She goes, 'There are people that are afflicted by this thing, that were born like this.' I just thought, wow. So obviously my horror movie-f—ed mind went immediately to the most messed-up story I could come up with. Her and I, we just started spit-balling ideas and eventually snowballed into a concept."

In conclusion, while you absolutely cannot be possessed by the spirit of a psychic teratoma, your body could technically grow a benign version of Gabriel at any time — just some horrific food for thought brought to you by James Wan.

"Malignant" is in theaters and streaming on HBO Max now.