DISCUSSION: Writing Mentally Ill Characters

[canisaries]

I don't really have a reason for starting this thread other than that I suddenly got curious and I couldn't seem to find any older threads about this subject. Correct me if I'm wrong, though, I'm not too great with the forum's search feature.

So: have you written or are you planning on writing any characters with mental illnesses (depression, schizophrenia, personality disorders)? Have you done enough research? What difficulties have you run into? This sort of stuff.

 

[Persephone]

Um, so.

@Iggy most mentally ill people (even sociopaths, people with personality disorders and people with schizophrenia) are not violent. While mental differences can contribute to violence, they are not equal to morality. At worst, they just make it easier for a person who was already inclined to that direction to take action. So "inherited morality" is... not actually something that happens.

I struggle with a few. Mostly it just leads to me staying in bed too long, taking a while to get to sleep, messing up my eating schedule and staying in my apartment too much. So, if anything, I'm substantially less likely to hurt people than I would be without it lol.

All three protagonists of Iterations deal with their own mental health challenges. One has a confinement-based claustrophobia and a general anxiety problem (and PTSD), another just has normal depression (and PTSD), and the third has... probably some personality problems (and PTSD). They aren't the main parts of the characters by any means so much as reactions to their pasts and part of their defense mechanisms to avoid getting hurt again in the same ways.

It affects what they focus on in narration and how they make decisions, and their triggers can cause plot relevant downward spirals of bad decisions. And they wouldn't be the same people without them. But there'd still be a character left if they weren't there.

Those two things coexisting would be my target. From the sound of it, Iggy, I'm really wondering whether that mental illness is the character's entire reason to exist.

 

[Beth Pavell]

It's also worth mentioning that getting better from mental illness is so often a long, uphill struggle. I think this is probably why a lot of media likes to boil it down to whether the guy takes his pills or not - it's an easy analogy for someone mentally healthy to understand

 

[canisaries]

@Iggy yeah, what athena said. violent behavior and mental illness have ties, as something like hallucinations or lack of empathy can allow for violent deeds, but the former is not a direct cause of the latter. now i do write about a mentally ill man who loves to be violent, but his love of guts and blood come from his own personal interests, not his condition. his mental illness only takes away his inhibitions and lets him act upon his urges. i've been thinking of him at some point meeting a person that's like him but non-violent, which confuses him because he isn't too well-informed about psychology himself, either.

there aren't any "cures" for mental illnesses in the way that you feed a crazy person some special crystal soup and they're suddenly all fine. some illnesses are straight up incurable and can only be managed and learned to live with. some illnesses can be cured, but it takes a lot of effort and patience. medication may be used, but that's usually only to make people be able to function in their daily lives. the rest is done with therapy and the like. i myself have depression and i can tell you that if there was a one-off cure, i'd be all over that shit.

if you want to have very specific and unrealistic symptoms, why not make it a hereditary curse instead? i mean, this is pokemon we are talking about, so why not utilize the fantastical opportunities. it still doesn't have the best implications, but at least it's not directly trivializing mental illness.

 

[Misfit Angel]

I think this is probably why a lot of media likes to boil it down to whether the guy takes his pills or not - it's an easy analogy for someone mentally healthy to understand

*whistles innocently*

I'm actually a little scared to write the case I've put one of my characters into. It's only just shown itself in the latest chapter of my story, so light spoilers abound, but one of my characters uses medication to help get calm her down after a traumatizing event. I've also implied that this isn't the first time she's done it or the only reason she uses it, but it's very effective at pushing her traumatic memories aside.

What scares me is how I'll end up portraying it. I've not decided yet if the central point of it is an underlying mental illness (crippling anxiety) or a lingering drug addiction (having used it for years and needing it every now and then to focus/function). I think I can do the addiction part of it fairly well as it's something I understand and struggle with myself, but I feel the mental illness aspect would be a more compelling read... not sure what to do.

This is my first realistic attempt at approaching the subject and it's quite nerve wracking. Hopefully I can do it justice, as I don't think I do many other touchy subjects justice.

 

[diamondpearl876]

I don't have anything to add to the "mental illness doesn't equal violent" convo except I agree wholeheartedly with what @Athena and @canisaries said.

It's also worth mentioning that getting better from mental illness is so often a long, uphill struggle. I think this is probably why a lot of media likes to boil it down to whether the guy takes his pills or not - it's an easy analogy for someone mentally healthy to understand

Even medication seems wholly misunderstood.

It's not a cure all like some seem to believe. Sure, it addresses your brain chemistry and makes it a little easier to comprehend and problem solve the root of your issues, but the chances of all your suffering rushing back to you once you stop the medication is high if the root of the issues are still there. In some cases, your brain chemistry absolutely relies on medication no matter what you do (such as with severe cases of bipolar disorder). And that's okay. A lot of mental illnesses are on a spectrum, again like bipolar disorder. If you're going to hurt yourself or become non-functioning in every area of your life off of medication, then it's best to stay on. But it doesn't mean you're not prone to the suffering you feel when you're forced to deal with your issues; medication just makes it more manageable and less likely to happen often, at best.

That said, it doesn't make you weak to rely on medication like some seem to believe. Again, some people's brain chemistry just... requires it. There's no shame in that. This is an argument I see a lot, and I agree with it: why demean someone for taking medication for depression if we don't demean someone for taking medication for, say, high blood pressure? Fibromyalgia? Asthma? Allergies? Autoimmune diseases? The physical versus mental illness debate is still very much stigmatized.

*whistles innocently*

I'm actually a little scared to write the case I've put one of my characters into. It's only just shown itself in the latest chapter of my story, so light spoilers abound, but one of my characters uses medication to help get calm her down after a traumatizing event. I've also implied that this isn't the first time she's done it or the only reason she uses it, but it's very effective at pushing her traumatic memories aside.

What scares me is how I'll end up portraying it. I've not decided yet if the central point of it is an underlying mental illness (crippling anxiety) or a lingering drug addiction (having used it for years and needing it every now and then to focus/function). I think I can do the addiction part of it fairly well as it's something I understand and struggle with myself, but I feel the mental illness aspect would be a more compelling read... not sure what to do.

This is my first realistic attempt at approaching the subject and it's quite nerve wracking. Hopefully I can do it justice, as I don't think I do many other touchy subjects justice.

Arguing addiction for the sake of a more compelling read is the best sign that's not the route you should go on. I'd suggest finding a different reason and really feel inspired by it before you solidly decide to tackle it.

Anyway, the mental illness aspect seems to gear more toward PTSD than anxiety from what I read. Why are these events traumatizing for the character? Do all the traumatizing events connect somehow/have a common theme? Do they all remind the character of one single event that started a cycle of reacting the way they do? That would probably help you discern anxiety versus PTSD, if you want to look into more ideas for the mental illness route.

As for medicine, it's not unheard of to get addicted to anxiety-reducing medications like Xanax. It's actually a huge issue, to the point where some clinics are deeming anti-depressants "controlled substances" and requiring you to go to a specialist rather than a primary doctor to get anything anymore. I guess that can always be an obstacle for your character, if you want. Or have them refuse to prescribe it to the character after they suspect they're addicted. : ' )

 

[Beth Pavell]

The upside from an author's point of view is that mental illness actually gives you a lot of leeway. To take one example, depression may be an all-encompassing black numbness or it may be wanting to burst into tears for pretty much no reason. I think one piece of advice I would add without qualifier is to be wary of people who insist on one experience being universal - even if they suffer from bad mental health themselves

 

[MisheardWhisper]

Yeah, the one thing I've learned over the years is that nobody's experience is ever really the same. I tend to steer clear of mental illness in writing for the simple reason that my fics just aren't that heavy or mature for the most part. But I've struggled with depression personally, and it took me a long time to figure that out simply because what I was experiencing didn't line up with a lot of what people described (or what pop culture said depression should be). There were no suicidal thoughts, no urge to self-harm, no mood swings, etc etc. Depression (and a number of other related conditions) can often be more like ordering a Subway - just start here and pick out some symptoms from the buffet. Today there's a special on 'not enjoying things you used to love', and you can pick up to three condiments from the 'mild paranoia' range.

 

[Misfit Angel]

Arguing addiction for the sake of a more compelling read is the best sign that's not the route you should go on. I'd suggest finding a different reason and really feel inspired by it before you solidly decide to tackle it.

Anyway, the mental illness aspect seems to gear more toward PTSD than anxiety from what I read.

Unfortunately in this case, since it's introduced so recently (latest chapter), it hasn't had time to really grow yet. When I was drafting up the idea, it was to help her through the anxiety of her public appearances, as she freezes up in such circumstances without it. Normal, day to day interactions with friends and strangers on a small level don't bother her. As she's more and more in the spotlight, she relies on it more and more to get her through those public appearances until she starts to notice that she's having trouble dealing with her day to day life without it and she realizes she's become addicted to the comfort it brings.

As far as for using it to deal with a traumatic event, it was an experiment and something she'd never done before. She was looking for relief by any means necessary, and, much to her relief, it did work for her. I probably should have made it much more clear that it was a first for her and that she wasn't sure what was going to happen.

I don't know if that makes sense or if it's even realistic; I don't have experience with anti-anxiety medication, despite desperately needing it in my own life, and since everyone's experiences are a little different, research hasn't been the most helpful.

Or have them refuse to prescribe it to the character after they suspect they're addicted. : ' )

This is an interesting idea that I should look at. The subject of the healthcare system has already come up once with mixed reaction, perhaps something like that can be another effort to clear things up.

 

[diamondpearl876]

I don't know if that makes sense or if it's even realistic; I don't have experience with anti-anxiety medication, despite desperately needing it in my own life, and since everyone's experiences are a little different, research hasn't been the most helpful.

That's one nice thing about everyone's experiences being different in terms of writing. You're more likely to write something that comes off as realistic than non-realistic. At any rate, what you described to me seems perfectly realistic.

This is an interesting idea that I should look at. The subject of the healthcare system has already come up once with mixed reaction, perhaps something like that can be another effort to clear things up.

If she relies on them super often, chances are her tolerance is going to go up, and she'll need refills more often. Doctors will notice that stuff. I think I even mentioned to you once that no one will prescribe me anti-anxiety medication anymore because I need to take several pills for any of them to have any effect (5 or so compared to the recommended 1 or 2) which, to them, spelled addiction, even though my body just... wasn't reacting to small doses. So there's lots of things to mess with there if you do go down that route, I think.

 

[diamondpearl876]

Many apologies for my initial post. I removed it for it was full of nonsense and I think it gave the wrong signal to some. Please excuse me.

Hey, that's what this discussion is for. If we all knew how to write mentally ill characters off the bat or if we all knew everything about mental illness ever, I'd be pretty shocked. Feel free to ask any questions you think of for your story in the future.

 

[Natu? Natu!]

Of course it's possible to write about mental disease, as it is possible to write about anything else. There are some things that need to be kept in mind though. Some of them have already been mentioned by previous posters, others have not.
1. I would suggest considering not giving your characters an explicit diagnosis. If your character in anxious in public places, show it. Don't say "NN suffers from diagnosis X". This is partly due to show don't tell, but another factor to consider is that many readers will have experiences of mental illness, either personally or through some relative, and as has been said, two patients with the same diagnosis are not automatically that similar. The main issue will not be readers who do not know anything about the diagnosis. The main issue will be readers who know one person with the same diagnosis as your character. Not everyone realises what has already been mentioned above, that two people with the same diagnosis may have varying symptoms. If you write that "NN has depression" or "NN has PTSD" or "NN has autism spectrum disorder" or whatever, some readers will reply that "No, s/he hasn't, because I (or someone I know) have that diagnosis, so I know what it's like, and it's not like that at all". If you focus on describing how your character thinks and acts, I think that it will make it easier for many readers to identify with and feel empathy for your character, instead of being annoyed that you have misunderstood or misrepresented their diagnosis.
2. If you write about medications, do not go into too much detail. Do not say that she takes Xanax or whatever. You cannot assume that readers know about specific medication, the names of medications are typically different in different countries and you will open up for a lot of unnecessary criticism from people who are on the drugs in question.
3. I think you need to be clear for yourself what the point of the mental illness is, that is, what function it has in your story. Is it important that she has a mental illness and is that the focus of the story, or is it something she happens to have that may affect her, but the focus of the story is something else? That will influence how you could describe it.

 

[canisaries]

2. If you write about medications, do not go into too much detail. Do not say that she takes Xanax or whatever. You cannot assume that readers know about specific medication, the names of medications are typically different in different countries and you will open up for a lot of unnecessary criticism from people who are on the drugs in question.

I disagree here. It is true that with real life medications you will have to research the effects of them well, but being specific about what medication one is using is a great way of making a story feel more real. An alternate way is to come up with your own medicine and have it sound medication-y enough. But I don't really believe in blotting out real-life references just because of cultural differences - the person reading has to understand that the writer possibly comes from / the story takes place in a location other than their own. The reader might even learn about different cultures that way - prime example: a big, big part of my knowledge of American culture comes from watching the Simpsons as a kid.

 

[Natu? Natu!]

It will only feel real if you know what you're doing. Nothing can destroy a the disbelief suspension of a story like when the authors tries to be specific to make the story "real" about a subject, and it is a subject you happen to know about, and you realise that the author has misunderstood the subject him/herself, or when you think that's the case. Id say go for fake names then. I am not talking about "blotting out real life references" in general. I was specifically talking about names of medicines, and the main reson is not cultural diferences (I mentioned them only to point out that what is assumed to be general knowledge is culture specific).

 

[diamondpearl876]

For fanfic, I like to think the misunderstanding could be pointed out in a review and then the author could work to fix their mistakes or explain their side of things. Still, it's no fun to have that immersion broken from either a reader or writer standpoint.

But yeah, making up medication names and effects (in general, not specifically for mental illness) is a topic I see show up over at the NaNoWriMo forums every year, which is surprising in the "I didn't think that'd be a popular topic" kind of way. The main reason for seems to be because people have done research and don't see a medication that does absolutely everything necessary that they need for the plot or character taking the medication, which I think falls into the "I don't wanna overstep real life medications and make them seem unrealistic" category.

 

[jasonwolf]

So not to plug or anything, but my fic does have a few elements around PTSD which I got advice from some of my psychology professors just for the extra detail. In the end, my stuff veers away from it pretty fast and goes into a PTSG (post-traumatic stress growth) which is when a person is able to convert their PTSD anxiety to a driving force to improve. If you've read any of my stuff you'll see Jaklo being rather pathetic and worrisome about most everything and at the very start, he's been plagued by nightmares where he relives his past trauma or ends up creating dark ideas of what could happen next. It's even more seen in his friend who even when you see starting to recover never switches from PTSD to PTSG and is still haunted and held back by the traumas.

On the other hand I always have a tendency to have characters who, at least to me, feel like they're high functioning autistic because they get that from me being high functioning aspergers (which is now technically just autism, but its still useful to have aspergers as a term for people who don't know whats going on). Jaklo has a very deep fascination with random stuff that he finds while out, he has a brain for a hell of a lot of useless facts (which are more useful in his world TBH because pokemon are actually there), and he's got a massive preference for solitude and personal interactions rather than big groups. In the latest chapter while it's unsaid he's clearly trying to keep away from crowds as much as he can. Also one of the few positives I've ever found with my aspergers is a sense of undying loyalty. We attach to things and people and we rarely ever let that bond be broken if we can stop that. Jaklo is terrified of what may happen in the future, but he can't stop being a ranger. He's loyal to that duty more than he can be afraid.

Also anyone who was here way back when in roleplaying knows I adore Percy Jackson's world because its literally built on all the main characters being dyslexia (which I am thankful everyday I don't have) and ADHD (The other thingy I do have). My lead character Jericho may have been a far to edgy broodlord, but holyshit you could easily see the ADHD in him. i still write stuff with that cast privately because I enjoy them so much.

 

[canisaries]

Usually a positive about medication is that they have a whole bunch of side effects and not everyone gets every one of them, so there's a bit of leeway considering that.

I actually checked out what online sources have to say about the drug I'm on, and they weirdly miss my biggest symptoms, which even are the most logical ones given the drug's way of working.

Then there are also the placebo/nocebo effects, meaning you can pretty much get anything if you believe enough that you will.

 

[CrystaI]

I guess many people approach the mental illness character issue from the incorrect perspective, usually from the psychologist/doctor aka the outsider 3rd person POV, instead of from the patient's personal experience aka the concerned party 1st person POV.

I agree with @Natu? Natu! about the Show Don't Tell rule. If one may not know, a psychiatric patient is physically nothing different from a normal person. Even they may have certain critical mental weakness, they may live a normal life that is nothing different from your average daily life. It is only when they exposed to the "triggering factor" such as past memory for PTSD patient or being locked in a small tiny room for claustrophobe, stress accumulate instantly where then symptoms such as anxiety or fear or hallucination, or even physical symptoms like dizziness or dyspnea or increase in blood pressure occurs. In order to relief that symptoms, either the patient takes the medication as prescribed by psychologist, or they developed themselves a behavioral pattern or habit that helps distancing themselves away from the "triggering factor", where resulting personality disorder. E.g. A paranoia often found out having experience of betrayal before, the person's tendency to have delusion of persecution and become over-suspicious to everything could be depicted as a form of self-defense mechanism.

Hence, instead of designing a mentally ill character by labeling him/her with some disease name and then work backward in the person's past by adding specific events which causes the character to behave in symptoms as described in the disease diagnosis, it is always wiser to go constructed the character's past experience first, seeing how had the character feel during that past tragic event, and nowadays how he/she will react to the "triggering factor" if being exposed.

And also yes, research is unavoidable. However, instead of studying the general medical knowledge of those mental diseases like how a psychology student will do, I would rather suggest and that is how I did, to go case-study each single individual patients, such as by reading the life&health columns wrote by psychology or social problem journalists, or TV health programs where every week they focus on one single individual patient and report their social situation and personal feeling objectively and descriptively, or even go read the patient's personal blogs which describes how they personally feel and think on some specific days. Reading those helped me in constructing a clear inner mental image of what the patient think inside their brain, which helped me in role-play and trying to think like a psychiatric patient.

I'm writing my current fic in 1st person narrative, and one of the main character is just happened to be such mentally ill character. Hence it is utterly importantly for me to have a deep understanding of not only his tragic past and aftermath influence from that past, but also nowadays what he "normally" thinks and how he "normally" sees the outside world, and most importantly, how will his emotion and stress level fluctuates when he is exposed to the triggering factor.

But, regardless of how deep I dig into his mind, I'm a writer, not a doctor. Therefore it is not my responsibility to "diagnose" the character by listening to his past experience and create a clinical record with his current symptoms jotted down and then provide "treatment" through story-writing. TBH, I'm not even 100% sure about the mental disease he is having. It could be PTSD, autism, or even personality disorder. It is not like I didn't do my research, it is rather I tended not to bother on the diseases identification. Because as a writer, my responsibility is to depict his constantly conflicting emotions and insecure mindset where stress could easily accumulated even through small affairs, showing how he sees the outside world and himself currently, what he wished to do to become better, and portray his effort to overcome his personal problem throughout the story. And within that, the name of his illness is just trivial matter not worth to mention.

 

[diamondpearl876]

@jasonwolf I'm found that writing about a mental illness you have yourself is... a really good experience, to be honest. So no need to feel bad about plugging or whatever. What's the point of discussing writing if you can't talk about what you've written, after all?

Anyway, I've written dissociation disorders and bipolar disorder, both of which I have. While my characters' experiences with those are different from my own, it's helped me to map out dissociation episodes or mood swings in my head and get myself out of a rut a lot easier than I used to. I feel like I've said this elsewhere, but honestly, this is essentially what my cast of characters is: people that embody different traits of myself. When I write them interacting, it's basically me writing me interacting with, well, myself. And it's helped me with so much over the years.

As for research... Back in the good ol' LiveJournal days, there was a group that was literally just about helping writers with research about literally anything. Obviously, it's died over the years along with LiveJournal as a whole, but that's where I initially learned about writing psychiatric medication and bipolar disorder (before I was diagnosed myself and had my own experiences with such medication). If anyone wants to check it out for this topic or something else, it's here. otherwise, I second everything @Crystal said about researching case studies. General information is nice to know in most cases, too, but when it comes to planning for writing, the details are key.

 

[Juliko]

Wow, that LJ you pointed out is really good! I'm definitely bookmarking this!