James’s novella masterfully evokes "horrors" ranging from sexual abuse of children to suicide or botched abortion; but, typically, the effect of this text is achieved by suggestion. James’s interest in achieving a portrait of psychological more than material reality through his focus on the perspective of a single consciousness makes this novella a particularly useful counterpoint to more graphic recent memoirs of trauma or mental illness.

"Apparitionist" critics read it "straight," as a simple ghost story; they are supported by James’s preface to the novella in his 1908 New York Edition of the text, and by his familiarity with psychical research. Others see the ghosts as figments of the governess’s imagination; in particular, her obsession with the sexualized spirits may represent a hysterical response to her repressed desire for her employer. This critical question is virtually undecidable, because James so strictly limited readers’ access to the events (we have only the governess’s word for the apparitions, which the children deny and Mrs. Grose cannot see), and because his characters communicate, if at all, in maddeningly broken and nonspecific phrases.

Anti-apparitionist critics have identified specific medical antecedents for this text, including William J. Scheick, who links it with Andrew Combe’s 1834 The Principles of Psychology on the psychological problems, especially alienation, to which governesses are vulnerable ("A Medical Source for The Turn of the Screw," Studies in American Fiction,

19(2):217-20, 1991 Autumn, Boston, MA). Also, Oscar Cargill connects the novella with Freud’s case history of Lucy R. (" ’The Turn of the Screw’ and Alice James," Proc. Modern Language Assoc. 78:238-49, 1963). In addition, J. Purdon Martin argues, in his article, "Neurology in ’The turn of the screw,’ " (British Medical Journal, 894:4 [Dec. 22, 1973]: 717-21) that temporal lobe epilepsy could be responsible for the governess’s experiences.