The film is a parody of suspense films, most obviously the films directed by Alfred Hitchcock: Spellbound, Vertigo and The Birds. The film was dedicated to Hitchcock, who worked with Brooks on the screenplay and later sent Brooks a case containing six magnums of 1961 Château Haut-Brion wine to show his appreciation.
Arriving at Los Angeles International Airport, Dr. Richard Thorndyke (Mel Brooks) has several odd encounters (such as a flasher impersonating a police officer, and a passing bus with a full orchestra playing inside it). He is taken by his driver, Brophy (Ron Carey) to the Psycho-Neurotic Institute for the Very, Very Nervous, where he has been hired as a replacement for Dr. Ashley, who died mysteriously. Brophy has a condition of nervousness, and he takes pictures when he gets nervous. Upon his arrival, Thorndyke is greeted by the staff, Dr. Charles Montague (Harvey Korman), Dr. Philip Wentworth (Dick Van Patten), and Nurse Charlotte Diesel (Cloris Leachman). When he goes to his room, a large rock is thrown through the window, with a message of welcome from the violent ward.
Thorndyke hears strange noises coming from Nurse Diesel's room and he and Brophy go to investigate. Diesel claims it was the TV, but it was actually a passionate session of BDSM with Dr. Montague. The next morning, Thorndyke is alerted by a light shining through his window. It is coming from the violent ward. Dr. Montague takes Thorndyke to the light's source, the room of patient Arthur Brisbane (Charlie Callas), who thinks he is a Cocker Spaniel.
Wentworth and Diesel argue about whether he can leave the institute. After she lets him go, he drives home, but the car has been rigged to blast rock music loudly through the radio. Wentworth is trapped in his car, his ears hemorrhage, and he dies from a stroke, aggravated by the loud music.
Thorndyke and Brophy travel to San Francisco, where Thorndyke is to speak at a psychiatric convention. He checks into the atriumed, vertigo-inducing Hyatt Regency San Francisco, where much to his dismay he is assigned a room on the top floor, due to a reservation change by a "Mr. MacGuffin". He pesters the bellboy (Barry Levinson) with repeated requests for a newspaper, wanting to look in the obituaries for information concerning Dr. Wentworth's demise. He then takes a shower, during which the bellboy comes and in a frenzy mimics stabbing Thorndyke with the paper while screaming "Here's your paper! Happy now?! Happy?" The paper's ink runs down the drain.
After his shower, Victoria Brisbane (Madeline Kahn), the daughter of Arthur Brisbane, bursts through the door. She wants help in removing her father from the institute. She says that Nurse Diesel and Dr. Montague are exaggerating the illnesses of wealthy patients so the institute can milk rich families of millions of dollars. Thorndyke agrees to help after discovering that the patient he met was not the real Arthur Brisbane.
To stop Thorndyke, Diesel and Montague hire "Braces" (Rudy De Luca), the silver-braced man who organized Dr. Ashley's and Wentworth's murders, to impersonate Thorndyke and shoot a man in the lobby. Now with the police after him, Thorndyke must prove his innocence. After he is attacked by pigeons, he contacts Brophy, and realizes Brophy took a picture of the shooting. The real Thorndyke was in the elevator at the time, so he should be in the picture.
He orders Brophy to enlarge the picture. When he goes to call, "Braces" tries to strangle him; however, Thorndyke is able to kill him. Brophy enlarges the photo, and Thorndyke is indeed visible in the picture. Nurse Diesel and Montague capture Brophy and take him to the North Wing. They also take the real Arthur Brisbane (Albert Whitlock) to a tower to kill him.
Thorndyke suffers from "high anxiety", which prevents him from climbing the tower's steep stairs and helping Brisbane. But with the help of his friends, he overcomes his phobia. Thorndyke knocks Diesel's orderly (Lee Delano) out a tower window, saving Brisbane. Nurse Diesel leaps out from the shadows and attacks Thorndyke with a broom, but falls out the tower window. She falls to her death, laughing hysterically and riding the broom. Dr. Montague appears from the shadows and gives up before being accidentally knocked unconscious by Brophy. Victoria is reunited with her father, gets married to Thorndyke, and they go on their honeymoon.Richard H. Thorndyke references Roger O. Thornhill from North by Northwest: each is photographed, holding the murder weapon in a crowded lobby, each photograph makes the front page news, and the two travel in order to clear themselves while avoiding the police. The two movies each end with a cut to their leads' respective honeymoons.
The fear of heights, the climbing of the tower to save Victoria's father and scene beneath the Golden Gate Bridge, reference Vertigo.
The shower scene references Psycho.
The two scenes where the viewpoint camera approaches a window (and crashes) parody the opening scene in Psycho, where the point-of-view camera seemingly enters through a window.
The scene of Dr. Wentworth driving in the rain is reminiscent of Janet Leigh's scene in Psycho.
The death of Dr. Wentworth references Family Plot.
The scene between Dr. Montague and Nurse Diesel (from under the coffee table) is a reference to Rope.
The pigeons on the jungle gym reference The Birds.
The attempted murder in the phone booth references Dial M for Murder.
Victoria's entrance into Thorndyke's hotel room references The 39 Steps.
The "fake face" worn by the murderer may reference the Dutch diplomat in Foreign Correspondent.
Brophy's camera references Rear Window.
While on the phone with Victoria, Thorndyke tells her to meet him by the "north by north west corner", referencing the Hitchcock movie North by Northwest.
Nurse Diesel, portrayed by Cloris Leachman, is a caricature of Mrs. Danvers in Rebecca.
Thorndyke's childhood trauma is in reference to Marnie.
Thorndyke and Professor Lilloman's fight references The Ring.
Dr. Richard Harpo Thorndyke - Mel Brooks
Victoria Brisbane - Madeline Kahn
Brophy - Ron Carey
Nurse Charlotte Diesel - Cloris Leachman
Dr. Charles Montague - Harvey Korman
Professor Lilloman - Howard Morris
Arthur Brisbane - Albert Whitlock and Charlie Callas
Braces - Rudy De Luca
Dr. Philip Wentworth - Dick Van Patten
Norton the orderly - Lee Delano
Desk Clerk - Jack Riley
Dennis - Barry Levinson
Maid - Beatrice Colen
Handsome Bystander - Michael Shannon
Three of the film's writers appear in comical supporting roles: Ron Clark as the (non)deranged patient Zachary Cartwright, Rudy De Luca as the killer "Braces", and Rain Man director Barry Levinson as the tightly-wound bellhop, Dennis.
High Anxiety was well received by the majority of critics and currently holds a 75% "Fresh" rating on Rotten Tomatoes. After viewing the film, Hitchcock sent Brooks a case of expensive wine with a note that read, "A small token of my pleasure, have no anxiety about this." At the 35th Golden Globe Awards, the film received nominations for Best Motion Picture - Musical/Comedy and Best Motion Picture Actor - Musical/Comedy for Mel Brooks,