Credited as an executive producer on the film, Natasha Richardson denied this allowed her to dictate proceedings - even when it came to the numerous sex scenes. "I'm an actress and I'm working for the director," she said. "David Mackenzie made it clear he wanted it to be as real as possible. He didn't want any restrictions whatsoever, and he asked me if I was comfortable with that. I said yes, and I was, because I knew that for this movie to work it had to be very hot and very real, and it wasn't going to be a case of doing it Hollywood all covered with a nice little sheet. So I signed up for that, and I thought it was right, but it didn't make it any easier to do. What's in the movie compared to what we shot is the tip of the iceberg."
When Paramount Pictures secured movie rights to the book in 1997, the original plan was to bring Stephen King and Jonathan Demme on board as, respectively, Screenwriter and Director.
Natasha Richardson's leading man would have been husband Liam Neeson, but for his contractual ties with Kinsey, el científico del sexo (2004).
The building used for the exterior and several interior shots as the "asylum" of the title is the former 3rd West Riding Pauper Lunatic Asylum (later re-named High Royds Hospital) at Menston, West Yorkshire. It opened in 1888, formally closed in 2003 (although many areas were disused much earlier), and was home to two thousand four hundred twenty patients at its peak.