Image Credit: NAMI
This article is part of the Science in Sci-fi, Fact in Fantasy blog series. Each week, we tackle one of the scientific or technological concepts pervasive in sci-fi (space travel, genetic engineering, artificial intelligence, etc.) with input from an expert.
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About the Expert
Kathleen S. Allen is a Psychiatric Nurse Practitioner (actually, a Psychiatric Clinical Nurse Specialist, similar to a NP) with five years experience as a psychiatric NP and two years experience as a psychiatric RN (registered nurse). In case you’re wondering what a Psychiatric NP does, they’re independent nurses with a four-year degree in nursing and a two-year master’s degree in nursing along with being either a nurse practitioner or clinical nurse specialist. Kathleen also has a Doctor of Nursing Practice degree which is a clinical doctorate, meaning more clinical-based rather than research-based like a PhD.
You should check out her website and Tumblr blog or connect with her on Twitter.
Mental Illness in Fiction: Get It Right, Please
A NP evaluates patients, diagnoses, orders medication if needed and does education around mental health issues. I’ve seen the gamut of mental illness, all the way from mild anxiety to full-blown psychosis in a bipolar disorder or schizophrenic or depressed patient. I’ve treated patients with suicidal tendencies, attempted suicides and patients undergoing ECT (electroshock therapy and no it’s not like it was in ONE FLEW OVER THE CUCKOO’S NEST), and medical illnesses that seemed like psychiatric ones but weren’t. Yes, that happens.
Like you, I am also a writer (see my Amazon page or my website for my books) but I’m also a mental health professional. When I read a work of fiction that either deals with mental illness in some way or the main character has a mental illness it’s usually with some degree of trepidation. More times than not they get it wrong.
Some Facts About Mental Illness
1. Having depression doesn’t mean your character can’t still have fun or laugh or be social. Your character can do all those things and still have depression. Also, one of my pet peeves is saying you’re depressed because_________. Your character isn’t depressed, they’re sad or blue or down but unless they’ve been evaluated and diagnosed with depression, your character needs to not say this.
2. A character who has bipolar disorder may have manic episodes or they may not. They might be severely depressed or only have moderate depression. Bipolar Disorder has a spectrum of symptoms.
3. No one who has Dissociative Identity Disorder (used to be called split personality) would kill someone when they are in one of their alter personality states unless the core personality would also kill. Your character would not have amnesia after killing someone. This disorder is rare (and some medical professionals don’t believe it exists at all) so be careful using it.
4. Talking about suicide does not mean your character will push the person into attempting suicide. It was already on their minds. Also, someone who cuts is not suicidal as a general rule.
5. Your characters don’t stop hearing voices when they are in a psychotic episode overnight after taking an anti-psychotic medication. Sometimes they won’t stop at all. It can take weeks to months. Know the difference between a hallucination and a delusion. They are not the same thing. And when people have hallucinations they don’t only see things that aren’t there, they may hear things or smell things that aren’t there too. And if they are in a psychotic episode, it would be difficult, if not impossible to function in their daily lives by going to school or work or maintaining a romantic relationship or really any relationship. Psychotic patients are not dangerous. Are there exceptions? Of course and those are the ones we hear about in the news. But as a general rule, they aren’t.
6. Anti-depressant medications don’t change your personality. They allow your characters to be able to function in their daily lives. Some medications have worse side effects than others but in books I’ve read when the main character is on these, either there are no side effects mentioned or the main character has them for one day. I used to tell my patients unless you develop a rash/hives or can’t breathe (same with any medication), most side effects go away within three to five days. Some have longer term side effects so it’s best to consult a medical professional about them unless you have first-hand knowledge about the medication. It usually takes 6-8 weeks for anti-depressants to work although some work in a shorter amount of time.
7. Obsessive Compulsive Disorder (OCD) is not humorous. Patients with this disorder hate that they have to check things over and over, it’s not funny or cute and one of the reasons I never walked the TV show, MONK. Can your characters have mild OCD or OCD tendencies? Yes, it doesn’t mean they have OCD. If they go back to make sure their house is locked twice, or they left the stove on, it’s not OCD.
8. Hearing voices might mean your character is schizophrenic, or it might mean they are in a bipolar episode or have severe depression. Some medications (not psychiatric ones) can cause psychosis too, also some recreational drugs. Some medical illness can also cause depression, that’s why it’s important for you, as the writer to get your facts straight.
Getting Mental Illness Right in Fiction
The bottom line is, do your research. If in doubt, call a medical professional and ask them before you write. The DSM-IV (now the V is out) used to be the book I used for diagnosis. It explains the symptoms for each disorder, including personality disorders usually there’s set number of symptoms a patient has to have before being diagnosed with a certain disorder.
Of course I’ve only touched on some brief issues I’ve seen in books, I’m sure there are others I didn’t mention. I’d be glad to answer any questions about mental illness about your characters if you hit me up on Twitter or on my website but please no medical advice for yourself.
Resources for Mental Illness
Here are some online resources for getting the facts about mental illness:
- National Alliance on Mental Illness: NAMI
- University of Michigan Depression Center
- Mental Health Myths (U.S. Department of Health and Human Services)
- 10 Facts On Mental Health from World Health Organization
Help Spread the Word
If you liked this article, please share it on Twitter! Here are some ready-made tweets:
| Click to Tweet Mental illness in fiction, by psychiatric NP @kathleea: http://bit.ly/1CVWhH6 Part of the #ScienceInSF series by @DanKoboldt #writing |
| Click to Tweet Mental illness fact: Anti-depressant meds don’t change personality. More tips from @kathleea: http://bit.ly/1CVWhH6 #ScienceInSF @DanKoboldt |
| Click to Tweet Mental illness fact: OCD is not humorous. More tips from psychiatric RN @kathleea: http://bit.ly/1CVWhH6 #ScienceInSF @DanKoboldt #writetip |
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I really appreciate this post, not only because it helps people get it right in fiction, but also because it helps people get it right in real life.
Mental illness is so common, and yet, most people are still so uninformed about it.
I totally agree, Laura. Thanks for commenting!
This is fantastic. Getting facts out there to help with the stigma of mental illness in general. So many people use these terms in derogatory ways. Others are just ignorant. And the synopsis for writers is just the best!
Well said, Kathleen. I have a similar post on my blog about fictional therapists:
http://annegoodwin.weebly.com/annecdotal/how-to-create-a-convincing-fictional-therapist
Thank you for writing this. I am a writer living with Type I Bipolar Disorder and having been hospitalized on three separate occasions, severe mania involving delusions (NOT hallucinations), ECT treatments, countless medications, talk therapy…I could go on and on. Nothing gets under my skin more than seeing mental illness poorly written. It’s so obvious when a writer hasn’t done their research! Poorly portrayed mental illnesses perpetuate the stigma surrounding mental illness.
Thank you.
As a person with mental illness, I appreciate accuracy when reading a story with a mentally ill character. Maddness between the ears is not a short story, it’s a whole life . No one survive without help and its the small acts of kindness from others that saves lives.
mary
I love that you mentioned that just because you have a disease it doesn’t mean that you can’t have happy, normal days! My ms focuses on that so much and it makes my heart happy to read it from someone else as well.
life, good and bad still happens, it’s very aggravating when a book only focuses on the bad.
Thank you. This is a great post to start from. One of my biggest pet peeves is when people use the term bipolar for someone who has rapid mood swings. That’s not what bipolar is. At All.
I never got why everyone thought The Playboy was a good movie, it was so boring I never even finished it. It made people with mental illnesses seem so one dimensional and dull (at least that’s what I thought about the characters). I have depression and anxiety disorder, but that moviews just rubbed me the wrong way.
I would counter on the medications not altering a personality. I’ll be it my personal experience with mood stabilizers and anti-psychotics in particular are about ten years removed from the current trends in medications for mental disorders. In my once upon a time with medications I was one of those cases of heavily over dosed into boarder line zombiedom. When a medication chemically caps your serotonin levels that can drastically effect someone in ways that do not pass in a few days.
Also in Monk they discuss his triggers at length, and his inability to function without assistance. The character frequently expresses massive frustration and difficulties with his condition. There are several times where you see the character break because he has to do things a specific way and hates it. Yes there are many situations where some of his smaller ticks are taken in a tongue and cheek manner, but the show doesn’t make fun of people with debilitating OCD. I’m not a fan mind you, but I’ve watched a few seasons and can see where they were going.
I completely agree with you in the vast majority of the article. Its painful to be a person with mental illnesses, and if done incorrectly in a story one can feel down right made fun of. Thank you for pointing out the places where a number of authors fall short when trying to characterize us. For those of us with serious depression, by not showing those points where we can laugh and function you aren’t truly showing the scope and horror of the disease. It makes those moments where you cannot function all the more horrible for taking your “normalcy’ away.
I agree with your opening statement about meds affecting personalities. I grew up with a mother who was diagnosed with severe depression, and when she was medicated, she was a zombie. However, the flip side was, well, severe depression and all that that entails. Either way, she wasn’t herself for most of my childhood.
Perhaps my problem is with semantics? Maybe meds affect the patient’s mood, not entire personality? I always wonder if that is what medical professionals are trying to explain with that statement.
Thanks for sharing your experiences.
This was a very informative article! Thank you! It’s clear that you have experience with a lot of these things. My fiance has depression and is on medication for it. For how common it is, it’s weird how many people don’t understand what the depression medication actually does. My fiance’s a very down-to-earth, pragmatic guy, depression or not. That didn’t change when he started taking meds either. He didn’t suddenly become happy-pappy and bubbly, but they did help him mellow out and look at life from a less hopeless point of view.
I saw that you mentioned Dissociative Identity Disorder. It’s a rare disorder and it’s hardly mentioned anywhere so I was surprised that you even mentioned it. I have a close friend who was diagnosed it. He doesn’t have blackouts or anything that’s normally associated with “Split Personality” and I would agree that his “other personalities” also wouldn’t do anything extreme that he wouldn’t normally do himself. But it’s a subtler disorder and I can also understand why some professionals might believe it’s not actually real. It would be interesting to see this disorder actually properly portrayed in fiction.