Characters with mental illness

Ale H. Miller · Apr 21, 2014

Hello, all. For the current tale I'm working on, one of my characters will gradually suffer mental issues. Schizophrenia and another type as well possibly and I REALLY want to handle this topic with care, I have no plans to make light of it or jab at the illness in anyway. More accurately, it's more of a corrosion of sanity kind of thing. The character progressively worsens through the story.

I know it's good (at times) to write in or around topics that make you uncomfortable and boy does this make me uncomfortable for some reason, but I know it needs to be done. How should I treat visual and auditory hallucinations, behavior, mannerisms etc? Even more importantly though, I'm lost on HOW to write these problems. Do I write them? Third person, first person? For some reason this is troubling me.

Thank you so very much.

cornflake · Apr 21, 2014

Ale H. Miller said:
Hello, all. For the current tale I'm working on, one of my characters will gradually suffer mental issues. Schizophrenia and another type as well possibly and I REALLY want to handle this topic with care, I have no plans to make light of it or jab at the illness in anyway. More accurately, it's more of a corrosion of sanity kind of thing. The character progressively worsens through the story.

I know it's good (at times) to write in or around topics that make you uncomfortable and boy does this make me uncomfortable for some reason, but I know it needs to be done. How should I treat visual and auditory hallucinations, behavior, mannerisms etc? Even more importantly though, I'm lost on HOW to write these problems. Do I write them? Third person, first person? For some reason this is troubling me.

Thank you so very much.

First, you do a LOT of research.

For instance, I'm not sure which type of schizophrenia you're talking about, but none of what you mention is monolithic. Visual hallucinations are very rare, behaviour is very vague and personal, etc.

How you write those things depends on how you're writing the book?

Jo Zebedee · Apr 21, 2014

I'm in the middle of writing a book about a girl with an undefined mental illness. I've gone down the showing route, which sometimes leaves the reader at sea - as the character is - but, as the other characters are pragmatic sorts, it makes her scenes stand out. I write her in close third, but any narrative style would be possible - I think the story drives that more than the character's illness.

I'm lucky - one of my betas is a mental health professional and is very patient at letting me know when I'm off the mark. But the research is down to me and, like with all these subjects, took a long time.

shadowwalker · Apr 21, 2014

I would contact your local NAAMI and explain what you're doing and what help you'd like.

I'd shy away from first person, because just getting it right is hard enough without trying to personalize it that deeply.

And for heaven's sake, define what set of illnesses your characters have. One, most illnesses are not one clearly defined one, but a main player with co-stars; Two, you won't get your behaviors/thoughts right; Three, you'll end up with stereotypes if you don't.

Iamfenian · Apr 21, 2014

Ale H. Miller, from someone who suffered from a disorder called ICU Delirium (Yep, acknowledged by the AMA), I wrote a short story about it. Basically it is a psychosis that afflicts patients who have traumatic illnesses or injuries and are cared for in ICU. I recall my visual hallucinations vividly (for two weeks...I call them my 'journeys'.), and sadly it has long term effects such as cognitive impairments (yes) and horrible PTSD (yes). If you want to read the story, just pm me and I will send it to you, BUT I would take the advice of cornflake and do a lot of research.

GingerGunlock · Apr 21, 2014

Research. Definitely research. The DSM-V is probably available at your local library to read the entries you feel best apply to the character you're trying to write.

I read a book a few years ago called Divided Minds: Twin sisters and their journey through schizophrenia which I felt, at the time, gave me a good handle on that individual's case and also treatment options which seemed as though they may be typical (at least at the time). My Mother's Keeper was another fairly good one.

shadowwalker said:
I would contact your local NAAMI and explain what you're doing and what help you'd like.

I'd shy away from first person, because just getting it right is hard enough without trying to personalize it that deeply.

And for heaven's sake, define what set of illnesses your characters have. One, most illnesses are not one clearly defined one, but a main player with co-stars; Two, you won't get your behaviors/thoughts right; Three, you'll end up with stereotypes if you don't.

Excellent advice in general, but what I bolded specifically. While many "real" people have comorbid conditions, trying to do so in fiction with that you are not familiar with can present those difficulties.

Deleted member 42 · Apr 21, 2014

I'm going to move this thread to Story Research, where I think it will wider exposure.

jeseymour · Apr 21, 2014

It's not exactly the same thing - but you should read "Flowers for Algernon."

http://www.amazon.com/dp/0156030306/?tag=absowrit-20

The author does a fabulous job with first person narration of a mentally disabled man.

My main character suffers from PTSD and depression, and I do write about these issues, but not in first person. I have a relative who is a psychiatrist specializing in PTSD, which helps.

King Neptune · Apr 21, 2014

I think the way that you would write it would depend on what you want readers to take from it. A first person account would be interesting, but it might not be comprehensible. A third person account would give readers what someone would see, hear, etc. of the mentally ill person.

There are a fair number of fictional characters that have some sort of mental illness. How it works in the story varies widely. One of the best such characters is Sherlock Holmes, who seems to have had Asperger's Syndrome; although Michael Dibden's "The Last Sherlock Holmes Story" makes it into something more serious.

StephanieZie · Apr 21, 2014

It's good I found this thread, because I've been grappling with the same thing lately. My MC is going to have treatment-resistant schizophrenia that gradually worsens throughout the novel. I've never known anyone with schizophrenia, so it's going to be a challenge. It's a back-burner idea, so I've got alot of time to research it, but I'm already thinking about playing around with POV in a way that suggests an eroding sense of self and continuity of experience. For instance, maybe starting with a close third when she's relatively mentally stable, then switching around between third and second, and finally getting into first person to show isolation. Of course this would be hard to pull off, and I'm not sure if I'm a skilled enough writer to do it well, but it's an interesting idea.

Sarashay · Apr 21, 2014

Keep in mind that schizophrenia, as upsetting as it is, is much more boring than media depictions would have you presume. Visual hallucinations are extremely rare. Auditory hallucinations are more common than visual ones. Delusions are perhaps the most difficult symptom, because the brain itself is the source of both the delusion and the certainty of the deluded belief. The delusions themselves don't always make for interesting stories, such as the lady I heard of who came to get her meds and explained that she could read the minds of the people on TV when she didn't take it.

Having done my time in both hospitalization and outpatient treatment, my interest in mental-illness-as-spoooooooky-thing has plummeted to nil. It would be novel to see a work where a character has mental illness but the plot is about something other than the mental illness itself.

kuwisdelu · Apr 21, 2014

It's important to read firsthand accounts and not just clinical accounts.

No mental illness is textbook, and if you write to a textbook definition, it's going not going to feel realistic.

At least, not to anyone with or anyone close to someone with mental illness.

AHunter3 · Apr 21, 2014

I was diagnosed paranoid schizophrenic (once) and, before that, manic-depressive (which is now called bipolar disorder) (once also).

No one appointed me Lunatic-in-Chief or anything, so I don't get to speak for all other diagnosed schizzies (or bipolarites), but I'd be happy to read any snippets or segments and give you feedback from my particular perspective.

Which (incidentally) is a patients'-rights / pro-civil-liberties for psychiatric patients perspective of the sort generally abbreviated as "CSXer", also called "mental patients' liberation movement", sometimes also as the "anti-psychiatric movement"

Anna Spargo-Ryan · Apr 21, 2014

One of my WIPs has two characters with mental illnesses: the MC (first person POV) and her mother. The mother's illness is bipolar disorder, where the daughter develops a kind of undiagnosed, grief-induced psychosis (mostly delusions) after her baby is stillborn.

For me, part of my motivation for writing these characters was the cliched misrepresentation of mental illness in the arts. Especially where bipolar is concerned. I wanted to write a truthful account of what it means to have these disorders. For the first-person "episodes", I really wanted to get inside the mind of the deluded character and show what it's like to believe the truths the brain spouts, even when they are clearly impossible.

I mostly drew on personal experience, but I also spoke to friends and family members who have mental health concerns. Some are dx, some are not. Each offered a different way of looking at things. I read first-hand accounts by different types of sufferers. I read a couple of books that I thought gave good representation of the experience - one I really like is STEEPLECHASE, by an Australian author called Krissy Kneen.

I totally agree that the most important thing about incorporating mental illness into your story is that it is truthful. Don't rely on other literature, movies, etc. Get as many first-hand accounts as you can. I feel that every bit of writing about mental illness should contribute to its awareness in an honest and real way, and that's how I approach it in my own writing.

Mr Flibble · Apr 21, 2014

I feel a tad more comfortable writing mental illness (being mentally ill myself) but I would advise getting someone with an approximation of the particular illness as a first reader

Because no matter how much research you do. there will be things that you will get wrong (at least partly from "oh I never thought of that!"). And this is not a problem, provided you get some expert feedback.

Ale H. Miller · Apr 21, 2014

Sarashay said:
It would be novel to see a work where a character has mental illness but the plot is about something other than the mental illness itself.

Sorry for the late response.

Well that's what mine is basically, the MC's starting to fall apart but it's only one ingredient in the entire stew. This is only a sub-plot at best, the main plot is something much larger in scale.

And also, thank you very much to everyone else for your advice and for sharing with personal factoids. I've made note of pretty much all of it. And I've looked up different types of Schizophrenia and so far I've been mixing a few together, more so behaviors and symptoms that come with different types like auditory hallucinations ,a few visual ones, "olfactory" hallucinations, "tactile", formal thought disorder, and something called "knight's move thinking". So, it's been sort of a hodgepodge so far. Is this correct for the most part?

Also, if it helps at all. The MC's been on medication, dealing with the problem for years and had been getting better and really leveling out, up until something happens and the MC stops taking it and the old problems arise once more, only intensified now give the current situation the MC is in.

Thanks again

cornflake · Apr 21, 2014

Ale H. Miller said:
Sorry for the late response.

Well that's what mine is basically, the MC's starting to fall apart but it's only one ingredient in the entire stew. This is only a sub-plot at best, the main plot is something much larger in scale.

And also, thank you very much to everyone else for your advice and for sharing with personal factoids. I've made note of pretty much all of it. And I've looked up different types of Schizophrenia and so far I've been mixing a few together, more so behaviors and symptoms that come with different types like auditory hallucinations ,a few visual ones, "olfactory" hallucinations, "tactile", formal thought disorder, and something called "knight's move thinking". So, it's been sort of a hodgepodge so far. Is this correct for the most part?

Also, if it helps at all. The MC's been on medication, dealing with the problem for years and had been getting better and really leveling out, up until something happens and the MC stops taking it and the old problems arise once more, only intensified now give the current situation the MC is in.

Thanks again

NO. Sorry, but this is what I meant by research. No, you can't just throw a hodgepodge of random symptomology from various disorders, subtypes of disorders, etc., and whatever else seems dramatic, or what have you, into the mix.

Anna Spargo-Ryan · Apr 21, 2014

cornflake said:
NO. Sorry, but this is what I meant by research. No, you can't just throw a hodgepodge of random symptomology from various disorders, subtypes of disorders, etc., and whatever else seems dramatic, or what have you, into the mix.

Agreed.

"Mixing together" isn't the same as co-morbidity. Many mental illnesses present together (depression and anxiety disorders often come in pairs) but they are distinct illnesses, not mashups from lots of different ones.

Ale H. Miller · Apr 22, 2014

Ah, I see. I guess I'm definitely going to have to rework quite a bit of what I've done on the matter so far. Please keep in mind this is my first attempt at a novel, so even though I'm stockpiling information I'm very much learning along the way. Thank you for pointing me in the right direction, this is a real complicated issue and really trying to absorb as much as I can. Absolutely going to hit the research harder, thanks

Bolero · Apr 22, 2014

There were two autobiographies I read a number of years ago written by a woman who had been a nun and then left. The first one was about leaving being a nun, the second, written many years later, was about how she had discovered she had a mental illness - and had been ill while a nun without realising it. So part of it was her some years later, re-visiting her experiences that she'd recorded in her first book and saying "ah, now I know what was going on". From the library, and I cannot remember what they were called - if anyone else can I'd recommend them as they seemed to me (without first hand experience) to be very detailed and vivid.

AHunter3 · Apr 22, 2014

You should also not write about the experiences of a person with a psychiatric diagnosis after reading one, two, or even fourteen quinquagintillion treatises written by psychiatric professionals. Reading materials written by psychiatric professionals will not get you inside the head of a psych patient; they'll get you inside the head of a mental health professional or perhaps a statistical epidemiologist.

You need to read things written by current or former patients about their own experiences, not the exclusion of all other materials but definitely as primary source materials.

Also, it is important to understand that psychiatric diagnoses are not directly analogous to a diagnosis of (let's say) a ruptured appendix or a diagnosis of staphylococcus infection. In the latter examples the existing medical science has a highly precise understanding of the conditions' etiology (i.e., we know at least in a broad sense the type of circumstances and events that lead up to the current diagnosed condition) and the immediate pathology (exactly how the current condition is disabling or threatening very precisely understood normative functions) and the prognosis if left untreated (exactly what the ailment will progress towards if left to follow its own trajectory), and the treatment is tailored to intervene in, again, a time-tested and highly precise manner.

Psychiatric diagnoses are, instead, in an arena of knowledge where we just don't possess that kind of solid understanding. A psychiatric diagnosis is more analogous to (let's say) a diagnosis of allergic rhinitis, or encephalalgia: "We have seen this pattern before". A solid understanding of etiology does not exist (We don't really know what causes it, although we have some theories), nor of exactly what is going on currently to cause the problem, and the available interventions are mostly of the symptom-amelioration variety.

cornflake · Apr 22, 2014

AHunter3 said:
You should also not write about the experiences of a person with a psychiatric diagnosis after reading one, two, or even fourteen quinquagintillion treatises written by psychiatric professionals. Reading materials written by psychiatric professionals will not get you inside the head of a psych patient; they'll get you inside the head of a mental health professional or perhaps a statistical epidemiologist.

You need to read things written by current or former patients about their own experiences, not the exclusion of all other materials but definitely as primary source materials.

Also, it is important to understand that psychiatric diagnoses are not directly analogous to a diagnosis of (let's say) a ruptured appendix or a diagnosis of staphylococcus infection. In the latter examples the existing medical science has a highly precise understanding of the conditions' etiology (i.e., we know at least in a broad sense the type of circumstances and events that lead up to the current diagnosed condition) and the immediate pathology (exactly how the current condition is disabling or threatening very precisely understood normative functions) and the prognosis if left untreated (exactly what the ailment will progress towards if left to follow its own trajectory), and the treatment is tailored to intervene in, again, a time-tested and highly precise manner.

Psychiatric diagnoses are, instead, in an arena of knowledge where we just don't possess that kind of solid understanding. A psychiatric diagnosis is more analogous to (let's say) a diagnosis of allergic rhinitis, or encephalalgia: "We have seen this pattern before". A solid understanding of etiology does not exist (We don't really know what causes it, although we have some theories), nor of exactly what is going on currently to cause the problem, and the available interventions are mostly of the symptom-amelioration variety.

I don't at all disagree that it's important to read people's own experiences of mental illness, but I think this comes off as way too dismissive of psychologists and psychiatrists, their sciences, their work, and the idea of any other perspective besides that of a mentally-ill person's.

If nothing else, how the OP is writing his or her book should help determine what perspectives should be sought. If there are other characters' points of view included, it'd certainly be helpful to read clinical impressions, descriptions, etc. People of all sorts aren't necessarily aware of how they appear to others, and that's magnified when someone has issues with perception.

In a general sense, this reads as if everything written by psychologists and psychiatrists is just dry, statistical or clinical lists of symptomology and guesswork, and that's not in any way the case. Doctors can get to know their patients, can spend years working through illnesses and disorders with them, listening and talking and actually understanding what goes on. Even those involved in research and not clinical work can spend seriously significant time with individual patients, and with in-depth reporting made by clinicians, and by patients. To just dismiss writing by professionals as mostly useless, though they're the ones who have spent years studying and working with people with these disorders, as opposed to being a single person with a singular experience, seems to me short-sighted.

kuwisdelu · Apr 22, 2014

Anna Spargo-Ryan said:
"Mixing together" isn't the same as co-morbidity. Many mental illnesses present together (depression and anxiety disorders often come in pairs) but they are distinct illnesses, not mashups from lots of different ones.

But on the other hand, that distinctness is not always clear, and people can sometimes go through multiple diagnoses that aren't "correct".

It's not really a mashup, but neither are mental illnesses additive.

Eh, when it comes to writing about it, defining it in purely clinical terms is never quite adequate.

Anna Spargo-Ryan · Apr 22, 2014

kuwisdelu said:
But on the other hand, that distinctness is not always clear, and people can sometimes go through multiple diagnoses that aren't "correct".

It's not really a mashup, but neither are mental illnesses additive.

Eh, when it comes to writing about it, defining it in purely clinical terms is never quite adequate.

Definitely. I've been through 10? diagnoses and still don't have a definitive outcome.

But there are clear distinctions between different presentations, and clinical symptoms, and I think that if you're going to give it a name ("Schizophrenia") willingly smashing them together is not the way to go about it.

Canotila · Apr 23, 2014

Just a thought, as someone who works with adults with disabilities.

Is your character aware they are ill? From what I have seen first hand, there is a world of difference working with someone with schizophrenia that is hallucinating and believes their hallucinations are real, vs. someone that is hallucinating and knows it is a hallucination.

Either way hallucinations can be extremely distressing, even for someone that knows it's not real. This is also probably not universal, but I've never known someone with schizophrenia to hear voices that say nice things.

Definitely do lots of research. First hand accounts from people is strongly preferred to clinical accounts.

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