I can add to this. I happen to work in the mental health field where I had to deal really dangerous mentally unstable individuals. To tell you that the strength and ferocity one person could possess is staggering would be an understatement. Training to ensure safety precautions were always constant because you could be with an individual who is very calculating and patient. All it takes is a brief window of opportunity and a situation could turn bad from 0 to 60 in under a minute. Four, physically unaggressive people could be sweet cake to one dangerous person if in reality, it would take ten huge guys to tackle one to the ground because he doesn't want to take his meds. That's real too!
Adding further, an ax could be plausible. It was a mental asylum and these places were self-sufficient kind of like a prison where because it was private, they had to contain their own issues until the professionals would arrive, especially if it was in operation over fifty years ago. So the character might've knew where an ax where before hand and waiting until the opportunity to grab it was the right one. If that explanation doesn't fly, remember, it's a horror movie, rationality is suspended, ;)
What's unrealistic for me is how they could have a nut bag off site without a secure escort or something? They couldn't get at least one orderly? lol.
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