I'd like to see a three dimensional cake that was a torso with a fondant straight jacket. On top would be a vinyl doll head like one of those make-up/hair style heads. Half of its hair would be torn out, hacked off, or shaved and the rest would be a tangled mess. It's eyes would be heavily lined or rimmed with either red or black to give a spooky, tormented look. If the doll head you found looked too smiley, I would cover the mouth with duct tape or a Hannibal type mask. Depending on the design of the doll head that you find, you may be able to either sit it on top of a platform on top of the cake, or just run a dowel straight up through the bottom of the head.
