Cuckoo Nest

The premise of the Cuckoo Nest plot is that a character is convinced that they are in an insane asylum (a Bedlam House is a popular choice), where they are told that the events of the series are actually hallucinations.

The episode will switch from "reality" to reality, making one wonder what's really happening. Sometimes, even if the series canon reveals that someone was using Phlebotinum to make them think they were crazy, there will be a scene in the "real world" of a psychologist giving up.

Often, if the character "accepts" the "insane asylum" reality by doing a certain thing (taking a pill, destroying the source of his "fantasy" power, et cetera), they might die, lose their power, or be submerged in the new non-fantasy reality forever. Occasionally the character is encouraged to kill themselves in order to wake up. The character is eventually persuaded to do said thing, and they're only stopped when incongruity reveals they're the subject of an elaborate ruse.

There's a variation on this, an ending to a movie/video game/book (they don't usually have the guts to do it to an entire series) where the final reveal is that the whole thing was just the delusion of an insane person -- a combination of this trope, All Just a Dream, and Dying Dream. Don't do this unless you really, really know what you're doing, and even then you probably shouldn't: done even the slightest bit poorly, it feels like the author has played an annoying prank on the reader, and worst yet, an unoriginal one.

More ambiguously, the issue of which is "real" might never be resolved.

The Cuckoo Nest is the dark counterpart of the Lotus Eater Machine. A more benign form of the Cuckoo Nest is the Happy Place. A more sinister one is Through the Eyes of Madness. A version without the imaginary "reality" is going among mad people.

Not to be confused with One Flew Over the Cuckoos Nest, or with "a cuckoo in the nest".

Anime

 * Episode 14 of The Big O was one of these, although another possible explanation is that the character involved was temporarily transported to an actual alternate world.
 * Gao Gai Gar has a Monster of the Week try this on Gai. It lasts for about a minute.
 * The final season of Yu-Gi-Oh! GX culminates in the supernatural entity Darkness locking most of the supporting cast in a neverending nightmare where all their dreams are broken. When they ultimately give up on life, they are consumed by Darkness and become one with it. Judai saves them with some crap about cards.
 * Very briefly used in Perfect Blue. One of the hallucinations indicates that Mima's Detective Drama character is the real person, and her "Mima" identity was fabricated as a coping mechanism to deal with being raped in a strip club. At least, it was probably a hallucination.

Comic Books

 * Fallen Angel #14 directly references the Buffy episode. In this case, it seems like the character in question really is in a mental hospital, and is hallucinating the faces of the book's cast over the people there; at the end, it seems like she moves between dimensions, back to the series's universe.
 * Grant Morrison's final issue on Doom Patrol centres on Crazy Jane in a mental hospital, where one of the supervising doctors, convinced all of her Doom Patrol adventures have been delusions, subjects her to electroshock and discharges her to live a humdrum "normal" existence. However,
 * A 2000 AD story "Dead Signal" features a Bounty Hunter in a futuristic setting, who may be the delusion of an amputee back in the real world.
 * ABC Comics' Tom Strong had one of these. It began with a standard adventure, which went into "It Was All A Dream" and he woke up to his life as an unhappily-married factory worker in a gray world with no superheroes. Then inconsistencies in his life lead him to discover that he has superpowers - but that he is a failed military experiment and his entire superhero life is just as much a delusion as his normal-schmuck life. Then he breaks out of the delusions back to his real superheroic life. The villain's plot failed because the gray world Tom Strong had been hallucinating lacked hope, and Tom couldn't give up hope.
 * "Mask", a two-part story in Legends of the Dark Knight, showed Batman waking up as a scrawny Bruce Wayne in an asylum. His psychiatrist explained that he had retreated into fantasy after the death of his parents.
 * Scott McCloud's Zot has a story called "Season of Dreams" in which the main character Jenny gets trapped inside gigantic robot called Zybox, which induces her into an artificial dream in which Zot and all her adventures with him were just mere delusions caused by a severe depression after the divorce of her parents.
 * "Apollo's Song" by Osamu Tezuka may well fit. For killing animals that show affection to their young, Shogo is placed in a mental hospital. EST causes him to have an out-of-body experience wherein he meets Athena, who curses him to live numerous lives of ill-fated love. Which he does, waking up each time he dies finding that it was all his imagination (or was it?) triggered by a treatment (EST, hypnotism, etc)
 * "Apollo's Song" by Osamu Tezuka may well fit. For killing animals that show affection to their young, Shogo is placed in a mental hospital. EST causes him to have an out-of-body experience wherein he meets Athena, who curses him to live numerous lives of ill-fated love. Which he does, waking up each time he dies finding that it was all his imagination (or was it?) triggered by a treatment (EST, hypnotism, etc)

Fanfic

 * There is a Ranma One Half fanfic called "Waking Up" in which all the characters slowly discover that all of the fantastic elements of the series (Ki Attacks, Martial Arts and Crafts, Ranma's engagements and Jusenkyo Curses) and even parts of their personalities (Akane's anger, Ranma's ego, Nabiki's love of money) were delusions caused by chemicals the legitimately crazy Kodachi was putting into the town's water supply. They spend part of the story trying to adapt.
 * There's another, "Wicked Garden", by Stefan Paul Gagne, which follows Kodachi becoming progressively more powerful through gene-spliced roses intercut with scenes of a little girl telling her that none of this made sense and that she'd fail soon. The fic ends with her finding that she's been hallucinating the events of the fanfic due to a failed formula.

Film

 * The Cabinet of Dr. Caligari used this as its Twist Ending, but this was back in 1919, before it was cool.
 * There's some evidence that this ending was inserted later by Executive Meddling. Apparently the German film making company thought that a movie about an old guy conditioning a young guy to kill on command might be in bad taste in the aftermath of WWI.
 * Total Recall has a scene where a doctor arrives and tries to convince the hero that his is trapped in an artificially created hallucination. He insists that the hero swallow a pill to return to reality, but the hero notices a drop of sweat falling down the doctor's face, exposing the sham. Ironically, the film teases that most of the film really does take place in the hero's head, and the doctor scene was just part of it his spy thriller memory vacation.
 * Another interpretation is that the doctor scene was NOT a part of his spy thriller, but was actually a real attempt by a real doctor (and his real wife) to snap him out of a fantasy gone wrong. Note that before he goes under the machine, one of the techs says "Blue sky on Mars...", which is in fact how the movie ends.
 * It goes beyond on that. Everything the doctor warned about in his speech ("One minute, you're the savior of the rebel cause; next thing you know, you'll be Cohaagen's bosom buddy...You'll even have fantasies about alien civilizations...") happens after that scene.
 * Which makes sense if the movie was all true and the doctor was sent by Cohaagen, if he was just part of the program, or if he was telling the truth.
 * Subverted in the original short story (We Can Remember It For You Wholesale) when the main character has his memory altered to believe that only his existence is preventing the takeover of Earth by aliens, only for aliens to appear at the end and reveal that this is true.
 * At the end of Brazil, when the protagonist is interrogated by the baddies, there is an action sequence in which . Then we get to see him  A studio-mandated alternate happy ending ditched the twist.
 * Return to Oz had fun casting doubt on whether Dorothy's adventures in Oz were real or hallucinations.
 * Gothika
 * In Abre Los Ojos and its American remake, Vanilla Sky, the main character is told that he's
 * Psycho Beach Party ends like this, with the lead character waking up in an insane asylum. The camera pulls back to show that the events have actually taken place in a drive-in movie. Characters watching remark on how lame the twist ending is,
 * Twelve Monkeys had its protagonist confused as to whether he had really come from the future, or was just insane. This gets to the point where his former psychologist and now traveling companion believes his story even when he's convinced it's false, although his conviction may just have to do with him falling for the past, which is much more pleasant than the future until The End of the World As We Know It.
 * In Shutter Island
 * Inception has a variation on this trope -

Literature

 * Keith Laumer's Knight of Delusions (also published, confusingly, as Night of Delusions) puts its hero through an insane number of alternate realities. Every time it becomes entirely unbelievable, he gets put into yet another one and is back at square one, trying to figure out if he's completely out or if he's stuck in yet another false reality. And they try everything, and I do mean everything, to find one that he'll stop mucking up; PI, crazy senator, psychic defender of mankind, a scientist with a Lotus Eater Machine, a homeless bum, God, and a good half dozen more at least.
 * A short story in the Let The Galaxy Burn collection set in the Warhammer 40000 universe contained this. The story begins with a powerful Tzeentchian Chaos Lord inviting a fellow Chaos Lord to his stronghold, and expounding his conquests and victories throughout his ten millenia. The visiting Lord, however, sets a trap to kill him, and the Lord awakens in the body of a lowly human Cultist, being taunted and pelted with stones by others for his failings. They perform a ritual to mutate him into an animal-minded Chaos Spawn, and as his body is ripped apart the only thing he can think of is which life was his.
 * At one point in Iain M Banks' Consider Phlebas, shape-shifter protagonist Bora Horza Gobuchul is knocked out and dreams/remembers waking from an immersive training simulation when he was much younger. The person tending to him tells him what a great job he had been doing in the training, then calls him by the wrong name, and when Horza points this out, the technician suddenly seems concerned and implies that the Horza identity is just another mask that he has forgotten he was wearing before putting him back in the machine. Horza wakes up, and it's never mentioned again until the very end when.
 * That's not in the version I read and love! Who are you? What have you done to my timeline? You're really a psychologist masquerading as an idle internet poster, aren't you?
 * The Ben "Yahtzee" Croshaw novel Fog Juice has the main character being shown by the Big Bad that.
 * In an early version of John Dies At the End, Dave looks in a mirror while under the effect of Soy Sauce, and sees an overweight and insane/retarded version of himself, saying almost exactly what he says later to John.
 * Much like Neverwhere, Heinlein's Glory Road and one of Terry Brooks' Landover books have the protagonist being told at one point that all of their fantastical adventures were a hallucination and that they are crazy and/or derelicts. In all cases, these scenes are presented as kind of a "last temptation" kind of thing, but you never know...
 * Much of the first Chronicles of Thomas Covenant trilogy focuses on the protagonist's uncertainty over whether the Land is real or not. His resolution of the problem still leaves the question open.
 * The Doctor Who short story "Nothing At The End of the Lane" in the anthology Short Trips and Side Treks does this to Barbara Wright. Since the concept behind the book is to explore non-canonical concepts, it leaves the question of whether Barbara is has been attacked by a mind-parasite on an alien world, or is a schizophrenic suffering hallucinations as she tries to protect one of her students from her abusive grandfather completely open.
 * This is attempted on the protagonist of Glasshouse (by Charles Stross) in order to convince them that their past as a soldier and black-ops specialist was merely the fevered imaginings of an immersive game addict. When this fails, a more subtle form of brainwashing is used to turn them into a Stepford Smiler instead.
 * Inverted, subverted, and played with - a lot: Bulgakov's The Master and Margarita.
 * In Terry Goodkind's Sword of Truth series book Chainfire, the protagonist awakes to find his wife gone, and everyone he knows convinced that she never existed and is just a character he made up during an injury. He then spends his time trying to convince people that she really exists..
 * In I Am the Cheese by Robert Cormier, although this confusion from reality is not known until the end.
 * In Edmond Hamilton's Star Kings dilogy, the second book starts with the protagonist going to a psychiatrist willingly in order to cure his memories of the first book's events (which he isn't sure are true). The therapy goes quite well until he's transported into the future to continue his adventures. The doctor believes he had a relapse and ran away.
 * In The Chronicles of Narnia,
 * Similarly to the Narnia example above, in the third Maximum Ride book, scientists try to convince Max that their escape was a dream, and that they were at the School the whole time.

Live Action TV

 * Buffy the Vampire Slayer had a perfect example of this in "Normal Again". This episode ended leaving open the possibility that the entire series was in fact the hallucination of an insane Buffy Summers.
 * Notably, instead of Buffy being encouraged to kill herself, she was encouraged to, and came very close to doing so. They got over it astonishingly quickly, though. Stuff like that happens in Sunnydale.
 * The description of the episode on the DVD case suggests that it was an alternate reality in which they really are hallucinations, but they're perfectly real in their reality. Word of Joss, however, seems to suggest that he finds it perfectly acceptable if fans conclude that the entire series was the fevered dream of a schizophrenic Buffy.
 * Smallville, episode "Labyrinth".
 * Star Trek the Next Generation, episode "Frame Of Mind". Commander Riker is taking part in a ship's play, in which he plays an innocent man thrown into a mental asylum (presumably for political reasons). At the same time he's being briefed on an undercover mission to a hostile planet. Riker starts to experience dreams and hallucinations in which he's trapped in the mental asylum. At one stage he's rescued from the asylum by the Enterprise crew who inform him he was captured during his mission. It turns out though he's still back in the asylum -- Riker was captured on the mission and his memories of the play is how his mind is coping with the aliens' attempts to Mind Probe him. Once Riker realises this he's able to "break down the walls" of his fake reality, get his hands on a communicator and beam out of there. The episode ends with him trashing the set of the play, just to make sure.
 * Star Trek Deep Space Nine, episode "Shadows and Symbols". Interestingly, the 1950s Sci-Fi writer that Sisko plays in the alternate reality was used earlier in the series ("Far Beyond the Stars"), only now he is completely insane, writing his dreams of Deep Space 9 on the walls of his cell.
 * They considered ending the series with the sci-fi writer on a set, carrying a script for DS 9, but apparently decided that Trekkies would hate seeing their beloved series framed as fiction.
 * Combined with a holodeck malfunction in Star Trek Voyager's "Projections". It's given the twist that the character it happens to is a hologram who is being made to believe that he is the only person who is actually real.
 * The final episodes of First Wave did this.
 * Very effectively too, considering the whole alien plot of the first wave of invasion was to drive a few people insane as a test, and protagonist Cade grows increasingly unhinged over the course of the series.
 * Stargate SG-1, episode "The Changeling".
 * Played with in that neither reality is real.
 * The Season 2 finale is a variation on this. The team is never made to think that they are in mental institutions, but that they are in the future and everyone they knew is long-dead.
 * Stargate Atlantis, episode "The Real World": Weir wakes up in a mental hospital and is being told she just recovered from coma caused by an accident. Apparently, she only imagined the Stargate program. The episode ends with an off-handed comment by Sheppard that they might still not be in the "true" reality, which is quickly silenced by Weir.
 * The Medium episode "Time Out of Mind" started off with this plot.
 * The Lost episode "Dave" has elements of this; it was actually written to debunk the common fan theory that everything was in someone's head.
 * Like the Buffy example above, "Dave" ended by humorously suggesting that everything was in Hurley's head: we see him back in the asylum, with his new supposed girlfriend Libby revealed as another inmate. Libby's backstory was originally intended to intertwine with Hurley's, but the character was killed off before they bothered to film the episode. She was literally going to be his creepy stalker, set to juxtapose Hurley's own creepy stalker tendencies in the alternate reality of the final season.
 * The Red Dwarf episode "Back to Reality" involves the crew waking up and finding out that all of their adventures aboard Red Dwarf have been a total immersion video game that they've been playing... very, very badly. As this was the fifth series finale, it was entirely plausible to viewers at the time that this was how the series was going to end. In somewhat of a twist, rather than being merely a more "normal" version of the reality, each character was basically the polar opposite of his normal character.
 * The Red Dwarf comic ran a strip where the episode ended differently, and focused on the Cat's supernerd alter ego Dwayne Dibbley. At the end, Dwayne decided that he was the real person and The Cat was just a hallucination.
 * The comic loved that reality; there was also a Jake Bullet strip that eventually crossed over with Duane Dibbley, and a strip about the "better" players we got a brief glimpse of before our Dwarfers left the TIG building.
 * The Supernatural episode "Sam, Interrupted" had former hunter/family friend call Sam and Dean for help from inside a mental institution, which prompts the brothers to get themselves admitted as patients to check out his claims of supernatural phenomena. When their incarceration pushes them both to the breaking point their personal issues send them over the edge.
 * Wow, that's blurby. The thing they're there to hunt doses them with crazy juice and they both have psychotic breaks while the audience watches, deeply confused. Dean's psychiatrist may have been a hallucination, which is too bad, because he actually talked to her some.
 * The Charmed episode "Brain Drain" has Piper being manipulated into believing that she's a mental patient instead of a witch, and she has to renounce her powers to regain her health.
 * First season finale of Joan of Arcadia: Joan is for a time convinced she was hallucinating the God avatars, and the second season premiere has God coaxing her back into accepting His presence.
 * Used to rather creepy effect in Neverwhere and in the book of the same name it spawned. Richard, partway through his bizarre adventure in the sewers and other places, had his 'spirit tested', by essentially weaponizing this trope.
 * The entire story has elements of this sprinkled throughout, as well.
 * Pretty much the entire premise of Life On Mars (UK version), particularly during the second season.
 * And the Spiritual Successor Ashes to Ashes, with the protagonist realizing it early on.
 * One Twilight Zone episode had the main character oscillating between a reality where he is a happily married and successful musician and another where he is a suspect being violently interrogated by police. During all the episode, and then comes the obligatory Twist Ending.
 * Somewhat subverted in St Elsewhere. The series finale reveals that the entire show was just in the mind of little Tommy holding a snow globe, who was either autistic or catatonic. A subversion because it all really was in the mind of someone with mental problems, and stayed that way forever.
 * In a similar case, the soap Crossroads returned a long time after being cancelled, and ended with the entire series revealed as a fantasy by an autistic woman who worked in a supermarket.
 * On Farscape, the Scarrans actually consider this a valid interrogation technique. Crichton only beat it because
 * This was exceptional surreal as all the non-humans John had met appeared...as non-humans. And everyone on Earth was perfectly okay with Luxans and Delvians running around.
 * The Sarah Connor Chronicles plays this perfectly straight when Sarah's disturbing dreams of being kidnapped and tortured send her to a sleep clinic, with scenes shifting between Sarah's stay in the clinic and her frightening dreams. Of course,
 * Done in Legend of Seeker where the title character is led to believe that the entire series has been a hallucination during an illness.
 * This is a recurring theme in the 5th Season of House. The episodes leading up to the season finale suggest to the viewer that Greg has earned a happy ending, but
 * Also played with in the season 2 finale, in which House was forced to determine what was real and what wasn't after . He eventually figured out that , which allowed him to  . Kind of a combination of this trope as well as.
 * The Seven Days episode "Déjà Vu All Over Again" has Frank Parker growing more and more Unstuck in Time, and his grip on reality growing more and more tenuous, but he manages to take control of his new powers and use them to save the day.
 * The Being Erica episode "Erica, Interrupted" has Erica wake up in the hospital she went to in the series premiere, where she's told that the events of the past three seasons took place in a two-week coma caused by anaphylactic shock incurred during the pilot. She tells her  brother that whether the events really occurred or not is irrelevant; she's grown from them.
 * In Community, Dr. Heidi tries to convince the study group that their past three years at Greendale Community College were all a shared delusion, taking place at the Greendale Mental Institution. Considering that everyone ended up at Greendale for life-shattering reasons and a previous episode stated that everyone but Abed had psychotic tendencies, this was depressingly realistic...

Music

 * The music video to "Asylum" by Disturbed has the patient/protagonist going through a series of events while escaping from the asylum that most likely aren't happening. These include being beaten and killed multiple times by the doctors and staff, and later force-fed his own (apparent) body parts (camera tricks are used to differentiate between his delusions and reality). Each of these events after his death lead to a Reset Button in which he's back in his padded cell, and by the final event he's gotten wise to this, and tries to kill himself in a furnace..

Radio

 * The Big Finish Doctor Who audio drama Minuet in Hell.

Tabletop Games

 * Before the Ravenloft setting was a game-world, it was a 1st Edition D&D module and its sequel, which feature the same villain but take place in completely different regions. One way it was suggested DMs might integrate them was to use either or both of them as a Cuckoo Nest, such that the PCs would periodically collapse with Brain Fever in one module and "wake up" in the other.
 * There has been a scenario for Werewolf: The Apocalypse that worked like this, with a lot of shoutouts to One Flew Over The Cuckoo's Nest. The players are of course being "cured" of thinking they are werewolves. In reality, they are stuffed with rage/gnosis suppressing drugs and the plan of their captors is to repeatedly abuse them until they are ready to be transformed into fomori. The scenario ends with a mindscrew and

Theater

 * Calderón's Life is a dream

Toys

 * Subverted in Bionicle. Sahmad is placed into a Lotus Eater Machine in which he is being accepted into the new society on Spherus Magna. Since the first person he meets is being nice to him, as opposed to running away or attacking him, he assumes that she's insane and that he's trapped in some sort of asylum.

Video Games
"Max: When entertainment turns into a surreal reflection of your life, you're a lucky man if you can laugh at the joke. Luck and I weren't on speaking terms."
 * American McGee's Alice does a similar thing with Alice in Wonderland; in this case the entire game is based on the presupposition that the original books were mental aberrations, with the different characters representing various personality fragments and psychoses.
 * You wouldn't really know this if you hadn't read the game's manual, though, which provides the detailed journal of the psychiatrist who spent years treating Alice for her psychoses and makes frequent mentions of her ramblings and drawings, all of which somehow relate to the events of Wonderland.
 * A bit different from most examples since, canonically, Wonderland was All Just a Dream anyway.
 * So was Through The Looking Glass. The question is: Whose dream was it?
 * It's subverted in Alice Madness Returns, where Alice is completely aware that her excursions to Wonderland are delusions. That doesn't make what she does there any less important.
 * Batman Arkham Asylum: Scarecrow does this to Batman and the player in his first appearance.
 * Max Payne 2 had a Show Within a Show, Address Unknown, where the protagonist was in an insane asylum and thought everyone else there was insane.
 * The show's events also parallel Max's own experiences to a disturbing degree, one of the many hints during the game that Max is not entirely sane. Max even lampshades this at one point.


 * The entire premise of Sanitarium, if we discard the resolution.
 * Played arrow-straight in Alan Wake, where the protagonist awakens at an insane asylum and is told he has hallucinated everything prior. The protagonist does not believe a word of it.
 * Later in the DLC chapters,.
 * In the fourth episode of the City of Heroes "Who Will Die" story arc, Malaise tries this on Sister Psyche and the Player Character.
 * That's the hero version of things, at least - villainous characters are instead helping Malaise to do it to Sister Psyche, down to getting a character as a psychologist in the hallucination and 'explaining' why she chose particular elements.
 * In The Darkness II, several segments take place in an asylum where various characters show up in different roles (including the Big Bad as a doctor and your girlfriend as an orderly). In this case, you're outright told by a sympathetic party that the asylum is just a construct the Darkness is using to keep you from going to Hell to save your dead girlfriend. Late in the game, you're given the choice to stay in the asylum, or jump to your "death"; the latter leads to the final sequence of the game.
 * In an interesting and amusing twist, you can find ''Darkness' comic books in your room, implying that you made the whole thing up after reading the comic.

Webcomics
""The pain clears my head.. and reminds me of something I heard one time... It's impossible to get out of a straitjacket, because it uses the way your bones lock together. Of course, some people have escaped by dislocating their own shoulders... But to mutilate yourself, just to escape a straitjacket? While you're still in a locked cell in a holding facility? Why, to do THAT, you'd have to be...stark...raving...""
 * A storyline in Fans! sees the F.I.B kidnap Shanna Cochran and - reasoning that, as the supposedly least imaginative and most 'mundane' member of the Science Fiction Club, her mind would crack under too much pressure - attempt to convince her that she is imprisoned in a mental hospital and merely hallucinating her admittedly far-fetched adventures in order to get her to turn on her friends, or at least reveal important information about them. Unfortunately for the F.I.B, however, this backfires quite spectacularly; convincing Shanna that she's crazy merely serves to break the self-imposed restraint on her imagination that she adopted after her own mother really went crazy, meaning that the now 'crazy', yet fiercely imaginative and inventive, Shanna finds it remarkably easy to outwit her captors, escape, and play a not-insignificant role in thwarting their latest plan.


 * Invoked/parodied in Sinfest.

Web Original

 * AH Dot Com the Series, two-part episode "The Gates of Dawn".
 * Done extremely well with the trailer for The Batman Complex, a fake film where the Christian Bale Batman movies are revealed to be a hallucination by Christian Bale's character from The Machinist, who is being treated for schizophrenia by Cobb and his team from Inception.
 * On the SCP Foundation, in one of the realities visited by SCP-507, an involuntary inter-dimensional traveler, he was kept in a mental hospital for the duration of his shift when they mistook him for an inmate suffering from dementia.

Western Animation

 * Ed, Edd n Eddy has the fourth (and originally last) season finale reveal that everything shown was just three old men reminiscing about their childhood. That would at least explain how nothing took place out of their cul-de-sac, the lack of a definite time-frame, and how nobody but the main cast are ever mentioned or shown even when they are at school.
 * In All Dogs Go to Heaven, the filmmakers seem to hint that Charlie's first visit to heaven after after his Near-Death Experience might have just been a hallucination, that it's just a coincidence the watch that represents his life on Earth resembles the one Carface gave him, and that at the end, . Observant audience members are kept guessing 'til then end, when

Other

 * This is the premise behind the roleplaying meta-game Power Kill, which is played in conjunction with a regular RPG with the events of that other game treated as the hallucinations of the Power Kill characters.