Magnus von Horn’s The Girl With the Needle is a harrowing exploration of a woman’s descent into a nightmarish reality, set against the grim backdrop of post-WWI Copenhagen. The film follows Karoline, a young factory worker, who finds herself abandoned and pregnant while striving to escape the clutches of poverty. As she navigates her dire circumstances, she encounters Dagmar, a charismatic woman running a hidden adoption agency within a candy store, purportedly helping poor mothers find foster homes for their unwanted children.

The Girl With the Needle is an unrelenting descent into a woman’s nightmarish hell. The film’s overwhelmingly bleak narrative is enhanced by striking black-and-white cinematography and a tension-filled soundscape, leaving the audience gasping and sweating in dreadful anticipation of where this dark tale will go next. It feels like the best and worst tendencies of Gaspar Noé and Béla Tarr have been blended together to create a work that feels both classical and modern. Victoria Carmen Sonne and Trine Dyrholm deliver utterly spellbinding performances, seamlessly integrating with the film’s escalating gothic horror elements.

In a pre-feminist age, Karoline is what entirely too many people would call a “fallen woman.” Alone, unemployed, and pregnant by a man not her husband, she is acknowledged only to be punished and invisible for all remaining purposes. Women like Karoline don’t fall of their own accord. They’re dropped, often from a great height, by a ruling patriarchy that doesn’t even care to watch them splatter. That involuntary descent, not just to a grimy gutter but to a near-Hadean underworld of human cruelty, is the chief horror in The Girl With the Needle, Magnus von Horn’s extraordinary and upsetting film an adult fairytale abundantly populated with witches and wretches, but where society is revealed as the true monster.

Von Horn’s previous feature Sweat, a selection for the scrapped 2020 edition of the Cannes Film Festival, offered a very different study of femininity bending over backwards to meet societal standards. A contemporary portrait of a young fitness influencer spiraling into disarray, it was a film of hard, glassy, neon-bright surfaces several worlds removed from the enveloping monochromatic squalor of The Girl With the Needle, set in a muddy working-class Copenhagen amid the bitter aftermath of the First World War.

DP Michał Dymek and production designer Jagna Dobesz render this depleted city as a kind of living Gothic etching, a maze of cramped, lightless rooms and narrow alleys, cross-hatched with cracks and shadows and yawning crevices in which lives can be hidden or discarded. The atmosphere may be far from the equally unforgiving stainlessness of Sweat, but the chokehold precision of von Horn’s mise-en-scène is consistent between the films: Each rigorously creates its own hostile visual prison for an isolated female protagonist. A competition berth at Cannes this year may grant Needle a higher profile than its well-distributed but underseen predecessor, but this is a sombre, commercially uncompromising work, graced by a pinhole of hope in its denouement.

In an arresting opening montage, gnarled faces morph into each other in varying contortions of agony and despair a kaleidoscope circuit of human pain. But it’s the pale, drawn visage of Karoline (Victoria Carmen Sonne, making good on her haunted promise in Holiday and Godland) on which the camera comes to linger, set in a permanent pinch of dull-eyed exhaustion that spares the script, by von Horn and Line Langebek, a good deal of backstory. We meet her on the brink of eviction from the spare, dowdy room she calls home: Her husband Peter has never returned home from war, and she barely supports herself with a soul-fraying seamstress job at a local linen factory.

When Jørgen (Joachim Fjelstrup), the well-to-do factory owner, takes pity on her, they enter into a head-on affair all-consuming enough that Karoline brusquely rejects Peter (Besir Zeciri), when he unexpectedly turns up at her door with a face brutally deformed in battle. In this pitiless post-war zone, victims victimize others to their mutual detriment. But her elevated social status is short-lived, as Jørgen’s promise of marriage proves empty once she falls pregnant. While attempting a self-abortion in a public bathhouse, she meets Dagmar (Trine Dyrholm), a kindly-faced candy-store owner who claims to secure adoptive families for unwanted infants. Despite Peter’s continued pleas to raise the child as his own, Karoline takes the offer.

It doesn’t take long to see that Dagmar isn’t all she claims to be even her claims of motherhood to Erena (Avo Knox Martin), the shy, surly young girl in her care, seem questionable but Karoline finds a strange kind of serenity in her claustrophobic back-alley home. After giving up her own newborn, she volunteers, to the aggravation of her own maternal regrets and yearnings, as a wet-nurse for the babies that pass through Dagmar’s care, unaware of her complicity in a harsh criminal enterprise. The Girl With the Needle is loosely based on a true-life case from the era, though to detail its facts would be to interfere with the brooding, slow-coiling shock of the film’s own reveal. Suffice it to say that one earthly circle of hell keeps giving way to another.

The extremity of suffering on display here makes for difficult viewing, scarcely leavened by the expressionistic beauty of its presentation. But von Horn’s film never plays as empty miserablism, in large part thanks to its grave understanding of the moral and spiritual reasoning behind unimaginable acts of violence. In a startling performance, Dyrholm plays Dagmar with cold, fearsome composure, but also raised scars of long-stifled trauma and vulnerability: A different kind of fallen woman, she sees herself as sparing others a long, slow defeat by a society with no space or concern for them.

A man’s world corrupts the women in it too; it takes a decisive act of tenderness to break the cycle, as Karoline reconsiders her wounded husband, and the possibility of family is pieced together from abandoned parts. “The world is a horrible place,” Dagmar warns Karoline, summing up the film’s baleful poetry in the process. “But we need to believe it is not so.”

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