New horror Smile sees a doctor’s mind begins to turn on her after she witnesses a traumatic event involving a patient. This dark, bloody scary horror left a big grin on Daniel Rutledge’s face.

A sinister smile is often put to effective use in movies. It can be really disturbing to see someone smiling before or during doing something horrific. But rarely does a film lean into using creepy smiles as much as this one. Some of those smiles I continued to see hours after the film finished as I lay in bed with my eyes closed trying to sleep. Remembering that the next day, I smiled to myself, for having my sleep disrupted like that means the film was a success.

A word of warning: there is a lot of suicide in this film, much of it presented in a way that would be very confronting for some viewers. For others, of course, this will be part of the appeal, giving it an intensity and nasty edge that makes it feel potent. The violence is almost all grisly and graphic, and depicted in unflinching long takes that will cause a lot of wincing. Couple this with a very heavily grim tone and you’ve got the sort of thing horror fans should definitely pay attention to. There are also a lot of jump scares, but most feel earned rather than cheap. As the first feature film from director Parker Finn, this is a very impressively constructed horror.

Finn as a writer is less impressive, with many of his plot points predictable. Smile is the latest in a list of several modern horror movies in which the central horror serves as a metaphor for trauma itself. Although it says a lot more than most about how mental illness is treated in America, its ideas around trauma do feel like we’ve seen them all done before. There’s actually quite a lot of Smile that could have been inspired by the likes of It Follows, The Ring and Hereditary, among others. It’s original enough that I didn’t mind those similarities, but for some viewers could be grating.

Perhaps I was just distracted by the brilliant elements in the filmmaking. As the protagonist becomes more and more unhinged, the camerawork becomes more unusual and unnerving. Much more dramatically unsettling is the sometimes abrasive sound design and dread-inducing score. But a few other little missteps keep Smile from reaching greater heights than it does. During a fairly crucial scene, the lead’s performance is quite unconvincing in a way I found distracting. She’s generally great, but there’s one bit of her being really distressed about halfway through I wish they’d gotten a better take of. Then in the third act, things elevate to a level of campiness not even hinted at earlier in a way that’s a bit jarring.

It’s a shame it’s not a total home run, but none of the problems are even close to dealbreakers. I think we’re extra critical of modern horror movies because there have been so many great examples of it. Smile won’t take a place up there with the best of them, but it does what it needs to as a dark, bloody scary horror that has left a big grin on my face.