American Mary, a psycho-horror thriller about a financially strapped med student who finds herself immersed in the underground world of body modification, is an exploitation film with a legitimate anthropological stake in its respective milieu. It presents a twisted interpretation of a culture in which decidedly unconventional people aspire to appear as inhuman as possible. One such character, who goes by the name Ruby Realgirl (Paula Lindberg), considers the Barbie-doll body type a psychical ideal—lack of genitalia and all. A sort of Cronenbergian take on Tod Browning's Freaks, it may well be the first body-modification exploitation film—bodmodsploitation, if you will.
Without said angle, the film would be a wash. Not only is it overly reliant on blood, guts, and sadism to elicit horror, but the Criminal Minds-grade story is unimaginative, with Mary (Katharine Isabelle) drawn to her profession after an extended, Hostel-baiting torture session with her rapist professor (David Lovgren) reveals her latent talent for deforming flesh. From there, the narrative sputters from scene to scene, as Mary takes on more clients while evading the inquisitions of a detective who suspects she may have something to do with her professor's disappearance.
It's only when dealing directly with the body-mod community that American Mary rises above its trite plotline. Directors Jen and Sylvia Soska, twin sisters who appear in the film as Russian performance artists who request from Mary a particularly elaborate surgery, have a clear affinity for body-mod culture. Not only have they had some work done themselves (they sport subdermal implants and corset piercings), but they promote a tolerant stance toward this community and alternative lifestyles in general. The Soskas certainly exaggerate (i.e. exploit) their subject, but for a community that prides itself on shock value, there seems no sufficient alternative.
The twisted-surgeon story is a tried-and-true horror-movie trope, but American Mary makes the genre feel original again, primarily in the way it frames Mary not as a vicious psychopath, but a capable professional who takes pride in her job, which just so happens to involve the macabre task of bending, breaking, and deforming other people's bodies. Therein presents another spin on the genre: Her patients are, in fact, just that—people who seek out her services and are more than willing to shell out cold hard cash to let her mutilate their bodies. American Mary is the rarest sort of horror film, in which the "victims" aren't lambs to slaughter, but active, consenting participants in their own bloodshed, which is a subtle but nevertheless effective characterization that makes the argument for one's body being one's own.