Malignant Ending Explained

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This article contains spoilers for Malignant.

In director James Wan’s first horror movie in five years, Malignant, pregnant heroine Madison (Annabelle Wallis) is traumatized early on when her abusive husband (Jake Abel) is slaughtered in their Seattle home by a vicious yet ill-defined killer lurking in the shadows. Madison is further devastated when she learns that she’s lost her baby in the attack—apparently the fourth pregnancy that she has been unable to carry to term, with the earlier ones being three miscarriages.

Her torment continues when she forms a psychic link with the killer, which allows her to watch helplessly as the murderer plows gruesomely through the members of a medical team that we met in the film’s prologue at a Gothic hilltop medical hospital. The killer is named Gabriel—a name that has connections to Madison’s past, her long-repressed memories and those doctors in that long ago chamber of medical horrors.

Who is Gabriel?

Gabriel is a little boy who lives inside my mo…uh, wait a minute, wrong horror movie.

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Gabriel is the name of an unseen patient at Simion Medical Hospital, first encountered at the beginning of the movie laying waste to doctors, operating rooms, and electrical systems. Gabriel is also the name of the “imaginary friend” that Madison had when she was a child and living with her adopted parents and sister, Sydney. And of course Gabriel is the killer who murders Madison’s husband and then begins to slaughter the members of the medical team who did something ghastly to him at that horrid hospital. But who or what is Gabriel, and what connection does he have to Madison?

It turns out that Gabriel is Madison’s parasitic twin, born along with her to a teenage girl named Serena May, who gives up her children to the researchers at Simion. At first they thought Gabriel was a massive teratoma—a malignant tumor made up of hair, muscle, tissue, and bone—attached to Madison, then named Emily. But the teratoma was, in fact, a deformed, separate child named Gabriel by his biological mother and attached to Emily via the head and spinal cord, and who could draw energy physically off Emily but could also manipulate her mind since they share a brain.

Horror is a metaphorical genre, so the brilliance of this idea is that Gabriel could be symbolic of something else—in this case, mental illness. While there have been cases of twins forming in the womb but only one making it to term (Stephen King used this idea as the basis for his novel The Dark Half),  Gabriel could also be a manifestation of bipolar disorder or dissociative personality disorder… taken to a horrific extreme.

How Did Gabriel Survive Being Cut Out?

In an act of desperation, the doctors removed as much as they physically could of Gabriel from Emily’s body and left the rest inside her skull, while “suppressing” Emily’s monstrous sibling with powerful drugs. A seemingly recovered Emily, her own memories repressed, was then taken in by her adopted family. But since Gabriel’s consciousness could not be removed completely from Emily—now renamed Madison—and part of his physical body was still inside her, he was therefore “alive” and could speak to Madison in her head. Her “imaginary friend” living rent free in her mind.

As Madison grew into adulthood and got married, she became pregnant several times—and each time Gabriel fed off the life force of the babies inside her, terminating the pregnancies while building back his own strength. It takes a beating by her abusive spouse, which includes a vicious blow to the head, to cause Gabriel to fully wake up. Emerging from within Madison (his skull-like face pokes out of the back of her head, escaping from the gash left by Madison’s husband), he literally uses her body, which he can strengthen and contort. His first act is to kill her husband, but afterward it becomes about revenge for Gabriel as he goes after the medical team that tried to destroy him. He manipulates Madison’s mind so that she sees the murders as “visions” and doesn’t realize she is committing them herself.

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Why Gabriel Kept That Woman Alive

At one point relatively early in the film, Gabriel—who we only see in a long black coat and features-obscuring hat—kidnaps a tour guide in the Seattle underground and imprisons her in a decrepit lair. The motivations and implications for these actions unclear. Later, the woman escapes her bonds and tries to flee, only to come crashing through the ceiling of Madison’s living room. That’s right, she was being held in Madison’s attic, which convinces at least one detective that Madison is an accomplice in some way to Gabriel’s crimes.

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But Madison claims no knowledge of this and doesn’t even know who the woman is. It turns out that she is Serena May, who was said by the doctors at Simion to be dead, but is very much alive and was tracked down by her son/daughter. Left comatose by her fall, Serena wakes up during the climactic confrontation between Madison, Gabriel, and Sydney in her hospital room. She asks her son to forgive her: “I should have never given you away.” But Gabriel isn’t buying it; he kills Sydney (or so he thinks) and tells Serena that he kept her alive because he wanted her to see the “monster” that he’s become.

Ideas are expressed here about abandoned children, absent parents, nurture versus nature… again, all through the metaphoric lens of horror. To see the abomination that her son has become may be the ultimate cruelty directed at Serena, which is why Gabriel wanted her alive.

Maddie Hasson and Annabelle Wallis in Malignant
Warner Bros. Pictures

Why Gabriel Wanted to Kill Sydney

Partially born but trapped inside his sister’s body, Gabriel is insanely jealous when his consciousness is repressed. When Madison is adopted into a normal, loving family, he is further enraged and uses his then-feeble strength to try and turn Madison against her family in deadly ways. And it seems that over the years, he has saved most of his animosity for Sydney.

During the final confrontation in the hospital room, he says as much, telling Sydney (Maddie Hasson) he’s “saved her for last” because Madison “chose you over me.” This is sibling rivalry taken to an extreme, especially since the angry sibling isn’t even a real child in the true sense of the word. But Gabriel’s hatred of Sydney could also be a manifestation of Madison’s own ambivalent feelings about her adopted sibling, who she may feel inferior to because Sydney is their parents’ actual biological child.

In the end, however, whatever ill feelings Madison may have harbored toward Sydney are overcome as she manipulates Gabriel into thinking he’s killed Sydney when he hasn’t and regains control of her body and mind. Madison, whose life has been defined by the feeling that she was never really part of a family,  tells her adopted sister, “All my life I’ve yearned for a blood connection with someone… yet in the end, it was right in front of me all along. Blood or not, you’ll always be my sister,” as they embrace. So maybe that’s what the movie is about?

And that’s a wrap on Malignant!

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Malignant is in theaters and streaming on HBO Max now.

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