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Cuckoo Nest

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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 often switch from "reality" to reality, making one wonder what's really happening. When the character tries convincing someone in the asylum that their supposed hallucinations are reality and the asylum is not, they will likely be rebuked by pointing out how fantastical and unrealistic their supposed reality is. 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 Go Among Mad People. The supertrope is Gaslighting. For when this is a fan theory only, see Delusion Conclusion. Sometimes occurs because the character was Mistaken for Insane.
Not to be confused with One Flew Over the Cuckoo's Nest, or with "a cuckoo in the nest". The other sort of Cuckoo's Nest is the heart of an old English ballad performed by folk-rockers Steeleye Span.
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Batman: Arkham Asylum: Scarecrow does this to Batman and the player in the third hallucination. First there's a repetition of the intro scene, except it's Batman strapped to the gurney in place of Joker, with Joker and Scarecrow taking on the role of doctors and discussing Bruce Wayne's unfortunate split personality disorder. The subsequent surreal platforming section also includes such imagery, including several insane Batmen rocking back and forth, and Scarface appearing on video screens as an asylum director announcing his successes in curing Bruce Wayne.
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The Sentry Vol 2 #7 sees the Sentry trapped in an illusion that he's actually a mental patient named John Victor Williams, and actually imagined not only his adventures, but the entire Marvel Universe as well. In a bit of Painting the Medium, the recap page changes to match, recapping the story of John Victor Williams, delusional schizophrenic, rather than Robert Reynolds, the Golden Guardian of Good (who happens to also be a schizophrenic). Cleverly, the creators of the illusion implement elements of the real world into the delusion to convince "John" that he'd inserted them into his fictional world of superheroes.
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Return to Oz had fun casting doubt on whether Dorothy's adventures in Oz were real or hallucinations.
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There is a Ranma ½ fanfic called Waking Up in which all the characters slowly discover that all of the fantastic elements of the series (Ki Manipulation, Martial Arts and Crafts, Ranma's engagements and Jusenkyo Curses) and 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.
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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.
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The Moon Knight storyline "Welcome to New Egypt" opens with Marc Spector in a mental institution, and told that the only part of his past adventures that was real was the multiple personality disorder. He doesn't accept it, at least in part because the hospital being a Bedlam House made it just too obvious that this was the nightmare.
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House:
This is a recurring theme in the 5th Season. The episodes leading up to the season finale suggest to the viewer that Greg has earned a happy ending, but you soon learn that the reverse is actually true.
Also played with in the season 2 finale, in which House was forced to determine what was real and what wasn't after he was shot by an unknown man, which was somehow causing him to hallucinate during his recovery from the injury. He eventually figured out that everything that occurred from the moment he was shot up until then had been a hallucination, which allowed him to wake up and discover that only a few minutes had passed since the shooting, and he was still being rushed down to the ER. Kind of a combination of this trope as well as All Just a Dream .
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In All Dogs Go to Heaven, the filmmakers seem to hint that Charlie's first visit to heaven 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, rather than dying because the watch got flooded and stopped working, Charlie might have drowned instead. Observant audience members are kept guessing 'til the end, when Charlie's ghost visits Anna-Marie one last time before passing on.
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The Cabinet of Dr. Caligari used this as its Twist Ending, but this was back in 1920, 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.
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In the 59th episode of Hello, from the Magic Tavern, the guest is Dr. Mark Ward, a clinical psychiatrist in Chicago who is trying to get his patient, Arnie, to accept that he is merely hallucinating all things to do with Foon; 'Usidore' is actually a fellow patient who thinks he's a wizard, and 'Chunt' is a concerned nurse; also, one of the other patients is a cheerleader who thinks she fights vampires. Many, many previous episodes are reinterpreted as Arnie's delusions. In the end, Dr. Ward turns out to be a minion of the Dark Lord, trying to mentally incapacitate Arnie, and the space station guy brings up other series that used this plot in his weekly insistence that it's all made up. Dr. Ward commiserates with Sarah, saying that after all they did, Arnie has sunk deeper into his delusion .
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The 7 Days (1998) 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 until the ending suggests that he might still be in the mental institution he was plucked from in the pilot episode, with the series only happening in his head.
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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 the image of her dead brother that whether the events really occurred or not is irrelevant; she's grown from them. It turns out that the events were a final test before Erica 'passed' group therapy and became Dr. Erica.
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In the Community episode "Curriculum Unavailable", the study group all see a therapist named Dr. Heidi, who soon reveals that none of the show up to that point actually happened, as their past three years at Greendale Community College were 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 plausible... This trope is ultimately parodied. Only a few seconds after leaving his office, the group realized tons of flaws in Heidi's logic. A) Shirley's kids and husband, who she sees every day. B) Abed has pictures of Greendale on his phone. C) Annie is wearing a Greendale backpack the whole time. Heidi quickly admits to being a fraud hired by the psychotic Chang, who has taken over the school and replaced the dean, in order to keep the group from uncovering his actions.
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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.
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Total Recall (1990) has a scene where a doctor arrives and tries to convince the hero that he 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 his spy thriller memory vacation. 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. Before Quaid goes under the machine at the start, one of the techs says "Blue sky on Mars...", which is in fact how the movie ends. 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. This is 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.
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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.
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The Supernatural episode "Sam, Interrupted" has a 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. 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.
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The surreal horror and noir supplement Cthulhu City for Trail of Cthulhu gives this trope as a possible "terrible truth at the heart of the setting" option...although even if the City *is* merely a mad delusion, given the nature of the Mythos, that might not make it harmless to the investigators or the world.
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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.
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The Twilight Zone (2002) episode "Another Life" 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 you're guided to believe that he actually is a musician that dreams he's a criminal, and then comes the obligatory Twist Ending.
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Max Payne 2: The Fall of Max Payne 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.
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GaoGaiGar has a Monster of the Week try this on Gai. Specifically, during a battle in Earth orbit, after a flash of light from the monster's attack, Gai suddenly awakens in a hospital bed, where his father and his love interest solemnly explain that the accident that led to him becoming a cyborg only left him paralyzed and comatose for years. It lasts for about a minute.
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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.
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In Neverwhere, the "test of spirit" to gain the Key weaponizes this against Richard: he has a vision that all his supernatural experiences were a hallucination, he's actually been a raving vagrant in a subway station all along, and he might as well jump in front of a train. A Fantasy Keepsake helps him rebuff the illusion.
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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/stupid version of himself, saying almost exactly what he says later to John.
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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.
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Stargate:
Stargate SG-1:
The Season 2 finale "Out of Mind" is a variation on this. The team is made to think that after a mission, they have awoken in the SGC, but far in the future, and that everyone they knew is long-dead. They are actually in a fake SGC, and in the clutches of the Goa'uld, Hathor.
In "The Changeling", Teal'c finds himself jumping between the SGC, and a reality where he is a human firefighter. Played with, in that neither reality is real. Except for Daniel.
Stargate Atlantis: In "The Real World", Weir wakes up in a mental hospital and is being told she just recovered from a coma caused by an accident. Apparently, she only imagined the Stargate program. In truth, she's infected with Replicator nanites who are trying to take over her mind and body. With some external assistance in the form of Rodney figuring out what's going on and EMPing her body to disrupt the nanites, she fights them off. 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.
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Moon Knight (2022): After Marc is shot and killed in episode four, he suddenly wakes up in a psychiatric ward where all of the doctors and other patients are people from the rest of the series. This continues throughout the fifth episode, with Marc and Steven's Journey to the Center of the Mind as they travel through the afterlife frequently cutting back to the "real world" where their psychiatrist is helping Marc accept his past in similar but mundane ways.
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Edna & Harvey: The Breakout and its spin-off Edna & Harvey: Harvey’s New Eyes feature an asylum as a main location. The inhabitants of the nearby village and convent school are not necessarily that much more sane.
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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.
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Dorothy starts Patient in an asylum with no memory of the last several years. According to the doctors, Oz is a fantasy of hers. This is later subverted when it turns out she's not in an asylum. She's still in Oz with her family and friends, but she is suffering from temporary amnesia.
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The Big Finish Doctor Who audio drama Minuet in Hell. In this case, the hospital staff genuinely believed him to be delusional and were not playing mind games. Meanwhile, another inmate is trying to convince him that he is the Doctor instead. What happened was that as the TARDIS materialized, the other inmate got zapped and formed a connection between his mind and the Doctor's, leaving the Doctor addled and the other person with clearer memories from the Doctor.
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Cuckoo Nest
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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. Except this time it was real.
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 Disturbed (Music)
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On Farscape, the Scarrans actually consider this a valid interrogation technique. Crichton only beat it because an artificially intelligent hallucination helped him counter it.
This was exceptionally 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 aforementioned artificially intelligent hallucination explains this is because the intent isn't to fool the target, but drive them insane.
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Bounty Hamster: In "School's Out", Cassie is just an ordinary schoolgirl on Earth, daydreaming about space adventures with a roguish hamster — or is she?
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Cuckoo Nest
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The Smallville episode "Labyrinth". The culprit was an evil phantom who was trying to break Clark Kent's will so he could take over his body. Martian Manhunter intruded upon the hallucination with his telepathy to help break Clark out of it.
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 Smallville
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Cuckoo Nest
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Stargate SG-1:
The Season 2 finale "Out of Mind" is a variation on this. The team is made to think that after a mission, they have awoken in the SGC, but far in the future, and that everyone they knew is long-dead. They are actually in a fake SGC, and in the clutches of the Goa'uld, Hathor.
In "The Changeling", Teal'c finds himself jumping between the SGC, and a reality where he is a human firefighter. Played with, in that neither reality is real. Except for Daniel.
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Cuckoo Nest
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The 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 Star Trek: Deep Space Nine, but apparently decided that Trekkies would hate seeing their beloved series framed as fiction.
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Cuckoo Nest
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The entire premise of Sanitarium, if we discard the resolution.
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At the end of Brazil, when the protagonist is interrogated by the baddies, there is an action sequence in which he gets rescued by the resistance and gets to live happily ever after with his girlfriend in a house in the countryside. Then it swings back to him singing quietly to himself while strapped to a chair in the room he was being tortured in before his rescue. The torturer present remarks to the chief interrogator that he seems to be lost to them, and they leave the room, the final shot being the protagonist, tied up in a chair, singing quietly to himself, lost in insanity. A studio-mandated alternate happy ending ditched the twist.
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Cuckoo Nest
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"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. As it turned out, the psychiatrist was the vengeful son of one of Batman's enemies. However, the story ended with alternating scenes of Bruce standing tall and strong as Batman over Gotham after finally freeing himself, and of scrawny Bruce Wayne still in the hospital and being labelled brain dead.
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In the Warehouse 13 episode "Don't Hate the Player", when Beatrix Potter's tea set brings the agents' worst fears to life, the worst fear of Claudia, who previously spent some time in a mental institution, is that she is still in that mental institution receiving electroshock therapy, and that her life in the Warehouse is all a lie.
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Cuckoo Nest
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Done in Legend of the Seeker where the title character is led to believe that the entire series has been a hallucination during an illness.
 Cuckoo Nest / int_8459204b
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Cuckoo Nest
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Episode 14 of The Big O, where series protagonist Roger Smith finds himself in another world where he's a homeless bum and everyone else he knows is completely different, was one of these. Although another possible explanation is that the character involved was temporarily transported to an actual alternate world.
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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 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 it is quite possible the whole game session is a hallucination caused by a previous week's villain.
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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 going to be his creepy stalker, set to juxtapose Hurley's own creepy stalker tendencies in the alternate reality of the final season.
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 Lost
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Cuckoo Nest
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In the Batman: The Animated Series episode "Perchance to Dream," Bruce Wayne wakes up in a world where he isn't Batman and nearly gets institutionalized by his parents and fiancee (Selina Kyle) for maintaining against all evidence that he's a superhero. He spends the episode evading the police until he gets into an altercation with Batman. It turns out it was all a dream induced by one of the Mad Hatter's gadgets.
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Cuckoo Nest
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An Animorphs fanfic did this with Ax, the entire asylum scenario being a fevered dream (Or Was It a Dream?) he experiences during The Sickness.
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Cuckoo Nest
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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.
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Cuckoo Nest
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In I Am the Cheese by Robert Cormier, the protagonist goes on a mental journey around his prison/interrogation center to recreate a traumatic event from his childhood, although this confusion from reality is not known until the end.
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Cuckoo Nest
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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. And he is right. Later in the DLC chapters, as he has been split in two personalities, the insane and suicidal part of him tries in a desperate bid to stop the rational and determined part in his attempt to do a Split-Personality Merge by suggesting this idea to him once again. It still doesn't work.
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In The Magicians (2016), a spell called the Scarloti Web is placed on Quentin by Jules and Marina. It makes him believe he is at psychiatry, where he is told that Brakebills exists only in his mind to cover up a horrible thing that he did. He manages to contact Penny, but waking him up turns out to be difficult.
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Cuckoo Nest
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Played for laughs in Tealove's Steamy Adventure. Tealove and Snowcatcher get kidnapped by a cave troll. The cave troll's prior captive, Libra Ace, can't remember her life before she was kidnapped, so she thinks that the interior of the cave is all that exists. When Libra tries to explain to the others that their memories of the outside world are just hallucinations, neither of them find it even remotely convincing. Libra comes around to their point of view when she gets all her memories back and leads the team out of the cave herself.
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Cuckoo Nest
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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 eventually saves them.
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Cuckoo Nest
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The psychological horror game Fran Bow is based on the premise that you can take pills that switch between reality and your mad, gory hallucinations. These actually contain hints on how to progress.
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Cuckoo Nest
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Temporary example from Adam Ruins Everything. Emily gets sent to a (privately-owned) Prison due to being Mistaken for Junkie. She gets a certain number of infractions, and is sent to solitary confinement as punishment. Adam and Kendra explain why solitary confinement is a cruel and inhumane punishment, and that it is not reserved only for the worst criminals. Emily gets out of solitary, and is escorted back to her cell, where it's revealed that Adam and Kendra have been there the whole time...and therefore Emily hallucinated the whole segment.
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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. It turns out to have been a plot by his enemies. Duh..
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Cuckoo Nest
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Believing Stories opens with Princess Celestia waking up in an insane asylum in a human body and being told she hallucinated being a pony princess.
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Cuckoo Nest
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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.
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Before the Ravenloft setting was a game-world, it was a 1st Edition D&D module and its sequel, which featured the same villain but took 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.
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The premise of Life on Mars (2006), particularly during the second season.
And the Sequel Series Ashes to Ashes (2008), with the protagonist realizing it early on.
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In the Invader Zim fic Asylum of Doom, Gaz is dragged along by Dib to investigate the ruins of a supposedly haunted abandoned Bedlam House. After falling down some stairs and hitting her head, Gaz seemingly wakes up in the past as a patient in the asylum, being told that everything she knows about her life is a delusion. She's convinced that the whole thing is a concussion-induced nightmare, but the fact that it feels real and the constant stream of abuse by the asylum staff without end makes her start to doubt her sense of reality. When she's about to be lobotomized, she wakes back up in the present, convinced that she was right about it being the result of a concussion, only to glimpse the apparent ghost of a fellow patient she befriended, indicating it was a vision granted by the ghosts of the asylum.
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Cuckoo Nest
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In Shutter Island, the entire plot was fabricated by the main character's psychologists, to get him to break his delusions and accept reality.
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Terminator: 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. As she begins to gain control in her "dreams" and the world of the clinic spirals into paranoia and horror, viewers may come to suspect the presence of the trope, at which the show hints from the very beginning by starting the episode in the "dream".
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In Edmond Hamilton's The Star Kings duology, 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.
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A short story in the Let the Galaxy Burn collection set in the Warhammer 40,000 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 millennia. 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 and he realizes his "life" as a Chaos Lord was actually a false memory implanted in him as part of his punishment, the better to break his mind. But as his fellow cultists perform a ritual to mutate him into an animal-minded Chaos Spawn, he remembers one other lesson from his teachings - that sometimes Tzeentch, fitting his capricious nature, will take a champion that is on the cusp of earning his rise to daemonhood and instead take his entire life away from him, condemning him to an inglorious end. As his body is ripped apart, the only thing he can think of is which life was actually his.
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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, until they are stabbed by the alternate personality of the protagonist.
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Doctor Who: In "Forest of the Dead", Donna abruptly finds herself in a mental hospital, where she is informed by Dr. Moon that she's been cured of her hallucinations about adventuring with the Doctor. She's actually in a Lotus-Eater Machine along with thousands of others, and the Doctor and company have to find a way to download everyone out of it, among other problems.
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Asylum (Daemon of Decay) is centered around this happening to Twilight Sparkle, with the other members of the Mane Six appearing as inmates or workers at the mental hospital as well.
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JAG: In first season episode "The Prisoner", when Harm is taken father. However, on the surveillance cameras it shows that Harm is talking to no one, and the Chinese later explain that it’s all due to the drugs they’ve administered.
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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.
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American McGee's Alice reinterprets Alice in Wonderland this way. 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. The game's manual 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. It's subverted in the sequel 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.
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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.
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In The Chronicles of Narnia, the Lady of the Green Kirtle tries to brainwash the heroes into thinking that Narnia was just a figment of their imagination, and that her underground caverns are the only "real" world. Puddleglum manages to stop her with a Shut Up, Hannibal!.
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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.).
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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 kill all her friends, 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.
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In Open Your Eyes and its American remake, Vanilla Sky, the main character is told that he's living in a virtual reality machine and he has to kill himself to get out. In a subversion, he jumps off a building, and it's true.
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Stargate Atlantis: In "The Real World", Weir wakes up in a mental hospital and is being told she just recovered from a coma caused by an accident. Apparently, she only imagined the Stargate program. In truth, she's infected with Replicator nanites who are trying to take over her mind and body. With some external assistance in the form of Rodney figuring out what's going on and EMPing her body to disrupt the nanites, she fights them off. 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.
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12 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.
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Ash vs. Evil Dead: In "Delusion", Ash wakes up in a mental asylum where his doctor tries to convince him that all his experiences with the Deadites and the Necronomicon are delusions that "Ashy Slashy" created to cope with his brutal murder of all his friends back at the cabin. He'll see orderlies and patients around him as people he knows (such as Kelly as a female patient, Pablo as an orderly, and Ruby as a nurse) before they change back for brief flashes. It's really all an illusion created by the demon Baal to break Ash's mind.
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The Charmed (1998) 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.
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The fanmade Feng Shui supplement "Out For Blood" features an adventure called "Escape from the Asylum of the Damned" involving our heroes being captured and sent to a "psychiatric" facility run by demons, which actively suppresses supernatural schticks and basically tries its level best to gaslight and break the spirits of secret warriors sent there, trying to convince them that their lives as secret warriors is nothing but a delusion that needs to be cured.
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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.
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Inception has a variation on this trope - After entering and living in limbo for several decades, Cobb "incepted" his wife with the idea that her world wasn't real, in order to get her to come out of limbo with him. It did not end well.
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In the Star Trek: The Next Generation episode "Frame of Mind", Commander Riker is taking part in a ship's play, in which he plays a man in a mental asylum (where part of the underlying question is, in a genuinely oppressive environment, if the character is what they say he is). 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, his abductors were trying to make him think the Enterprise was an illusion, and his memories of the play is how his mind is coping with the aliens' attempts to Mind Probe him. Once Riker realizes 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.
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The following is a list of statements referring to the current page from other pages.

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Madness Tropes
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Medical Horror
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Plots
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The Index Is Watching You
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This Might Be an Index
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