WARNING: The following contains spoilers for Malignant, currently in theaters and on HBO Max.

Malignant has finally hit theaters and HBO Max, and with it comes an iconic horror antagonist, Gabriel, as well as several major twists. This James Wan film is more of a medical horror story than it is a possession story, which some may have been surprised by given Wan's more recent horror movies like The Conjuring and Insidious. During a press conference CBR sat in on, Wan talked about how this medical nightmare and Gabriel came to be.

"My wife, Ingrid Bisu, came to me with research that she had done," Wan said. "She's really fascinated by some medical stories and stuff like that. And so, just curiosity, she'll show me different stories, and this particular one I was like, 'Oh, my goodness, what is this?' Talking about teratoma and parasitic twins, and then we sort of delved deeper into it, and I was thinking, 'Oh, my goodness, this is so fascinating. This would actually make for a really interesting story.' It could make a really cool, messed-up movie. We started from there, and then we started doing more research and realized we could come up with a really quite unique villain that we haven't seen before, and the idea of Gabriel and medicine was born from that."

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Along with the inspiration of these medical cases, Malignant seems to pull from other fictional horror stories. Hints of David Cronenberg, Brian De Palma and others can be seen throughout the film. It's unsurprising that other films that have dealt with the same subject matter may also seem like inspiration, even when they are not -- like with Basket Case, a 1982 film about a man and his formerly conjoined twin brother's quest for vengeance.

"I wouldn't necessarily say [Basket Case] was an outright inspiration for this movie," Wan said, "but it's kinda hard to not have Basket Case come up, and when we were making this film, designing the look of Gabriel and how crazy and weird he is, because Basket Case pretty much is a story about this evil twin to some degree, and it really just stemmed from how do we create a villain that is on the back of someone's brain, and when it comes out, all that we see of the brain is just the eyeball, a little bit of mouth and teeth, but there's no way you don't make that connection with Basket Case because that's kind of what he is."

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The design of Gabriel, as Wan mentioned, is unique. His face emerges on the back of Annabelle's (Madison Mitchell) head and through her cracked open skull. Also, he hijacks her body. When he is in control, he is moving backward; however, that does not hinder Gabriel. Instead, it gives this horror villain a memorable and impressive physical performance.

"It literally is a combination of whole lots of people involved to bring Gabriel to life," Wan said. "From Annabelle's performance -- for Madison leading up to Gabriel coming out -- and then we switch to Marina [Mazepa], who is our physical body contortionist/dancer. It's pretty amazing. She's such an incredible physical performer that she played the entire -- like she played many scenes, but that precinct holding cell sequence really was incredible -- fight backward, ran backward, moved backward. It was all done in reverse. We did not cheat at all."

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"She had to blindly learn her moves and remember her moves," Wan said. "She worked weeks and days just on the choreography of that whole sequence. It was pretty impressive, and we would then put Annabelle's face -- a mask of Annabelle's face -- on Marina's face, and then we would have an animatronic Gabriel on the back of her head, and so between the puppetry and the animatronics and the live performer and visual effects on top of that, it really did take the entire filmmaking village to bring [Gabriel] to life."

To properly see Gabriel come to life, Malignant is now playing in theaters and on HBO Max.

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