A severely injured man and woman awake in an abandoned sanitarium only to discover that a sadistic caretaker holds the keys to their freedom and the horrific answers as to their real identity.
The premise is simple, the cast small: a young man (Thomas Cocquerel) and young woman (Camille Stopps), both nameless, wake up next to each other on hospital gurneys in an abandoned facility. They have no memories of themselves or each other, and no understanding of why they’re there. Large parts of their bodies are swathed in dressings and pressure bandages, blood soaking through onto skin, clothes, and sheets.
I’m not great at guessing twists, and when I thought, a few minutes into squelchy horror Alive, that I’d worked out the shocking explanation, it sounded so crazy I assumed I’d been out in the sun too long after several weeks in gloomy Lockdown.
It turns out I was right (middle-aged women like me live to say that) so I can only say if you’re flummoxed by Alive, just spend your day trying to homeschool a recalcitrant 8 year old on the hottest day of the year and just when your brain is spinning it’ll come to you in a flash.
You won’t get confirmation until the last few scenes, but trust me when it comes it’ll feel sweeter than Alan Partridge getting one over on Des Lynam, Steve Rider and Clare Balding, all in one go.

Their scrubs-wearing captor, known only as The Man (Angus Macfadyen), is a terrifying mix of avuncular NHS doctor and sadistic butcher. You can’t fault his soothing yet slightly infantilising bedside manner, apart from when he’s sticking needles into gaping wounds and cranking arms beyond the point of discomfort into agony. “Pain means you’re alive” he tells them, like a ’70s mum who refuses to buy brand-name Calpol (okay, me).
He potters about his grotesque, twisted version of a hospital recovery room with a vase of pretty white flowers for the young woman and “rehabilitation exercises” so harsh the young man is nearly killed. Sometimes he seems paternal (though his male victim is always the least favoured child); at other times like a jealous lover. He’s creepy and unpredictable, a terrifying mixture.
Repeated escape attempts by the pair are soundtracked with mocking warnings via the intercom system, though it does give them an opportunity to investigate endless rooms and broom cupboards stacked with torture instruments and sticky with blood. Attempts at killing The Man are repeated too – but like nits on a primary schooler, he keeps coming back just when they think they’ve done enough.
Rob Grant, who directed and edited Alive, later wrote and directed the excellent Harpoon, a bleakly hilarious tale of three quite unpleasant people stuck on a drifting boat with no food, water, or way of getting back to shore. Harpoon is a film that has a lot of fun with questions of cannibalism (mainly could you eat someone in a crisis), and expertly leverages the way distrust grows during a disaster – how well do you really know someone? Most importantly Grant maintains its sense of detached amusement right to the end.
Alive doesn’t quite succeed at that, though it seems to be aiming in that direction; mainly because the big reveal, which comes at the very end, dominates the previous 90 minutes to such a degree.
Without that huge “who are they?” question hanging over us, this would threaten to be just another torture porn knock-off (though if you prefer your horrors more torture than porn, rest assured everyone is too bandaged up to strip off).

The first half hour is incredibly tense, as we struggle to second-guess The Man’s intentions and motivations, watching through half-closed eyes as he decides between psychological or physical torture.
The final 25 minutes impressively ratchets up the fear and confusion.
The central section struggles to maintain the initial tension, and at times feels like a blood-soaked episode of Through The Keyhole. I half-expected Loyd Grossman to pop up, wondering “which psychopath lives in a house like this”. What the two unwilling patients find in the sanatorium as they search for a way out isn’t very surprising for a horror, even if the reasons for it being there are; and to be honest more disgusting is the homemade porridge-like mush The Man forces them to eat. I honestly wanted to be sick watching it (my loathing of porridge is well-known though).
There are also loose ends that remain untied – why he tortures them isn’t really explained, for a start.
That’s not to downplay Alive‘s visceral, messy horrors, as The Man literally picks at an open wound. I avoid Saw-type psychological slasher films as a rule (it was the Rob Grant connection that led me to request a screener for this) – I have enough trouble locating my keys in my handbag not to want to watch someone dig one out from behind their own eyeball. But if you love a slowly-opening door, the music holding us frozen as we await a horrific, bloody jump scare, this is for you. (And Grant really does enjoy pushing those moments to their limits; he’s clearly a director who’s going places, including but not limited to the darkest recesses of our minds.)

Stopps and Cocquerel are impressive – their characters bound together in terror, both of not knowing who The Man is and not knowing who they are. Their disorientation at having no known personality or strengths to fall back on, or anchor their humanity, is palpable; blurry flashbacks to their old lives add to their confusion. The woman’s attempts to placate The Man and play her more stubborn ward-mate off against him are entirely realistic.
Dazed and drugged, their attempts to escape are almost animalistic, initially staggering and loping as if not sure how their own limbs work.
Macfadyen is the standout star here though, so good he becomes an antihero. I can quite see people rooting for him, as The Man’s soft-spoken bedside manner is so persuasive. (His accent is hard to place. He sounds English sometimes, and there’s a Scottish burr at others. He reminded me of John Hammond in Jurassic Park, a character I always felt got away with far too much. A twinkle in your eye can take you a long way.)
There are few places creepier than abandoned hospitals, their institutional peeling paint, echoey corridors and utilitarian colour schemes adding to an atmosphere of mournful misery. Grant makes great use of his dark and dirty location, the glimpses outside revealing just how stuck they are; horror films often turn on its head the idea that home is the haven, and here that is pushed to effective and terrifying extremes.
It often feels like wakeful dreaming, where you can’t get out and you’re running through treacle (or in this case congealing blood).
Alive isn’t overtly funny though there is humour in The Man’s pretend frustration. “I can blind him, yes? What do you think.” he says to the woman, momentarily treating her as his queen to be appeased. “Castration? I can also… kill him? Tell me what you want!” All this is said while her co-captive lies strapped to a bed, their tormentor wielding a drill, a saw, and even a pair of garden shears.
Note: there is a mid-credit scene and a post-credit scene.
Alive is available in the UK on various platforms including iTunes and Sky. Read my Q&A with actor Angus Macfadyen.
I have an ever-growing list of questions about Alive, and have written about them here – be warned this is VERY spoilery.
Watch a clip from Alive and scroll down for images from the film:
Alive (2020) – Clip from SC Films International on Vimeo.