Weekend Writing: 7 steps to writing mental illness

If there’s one thing that’s ticked me off over the years, its watching novels continually fail to portray mental illness accurately, realistically, and for the sake of character not plot. So, without further ado, here are your seven steps to getting mental illness right in your next story.

  1. How did they get here?
    You better make this fucking plausible, alright? You can have it be from trauma, you can have it be from family history, but whatever you do you have to do your fucking job and explain it and EXPLAIN IT WELL. Don’t just tell me it runs in the family and leave it you asshole, tell me how. Both sides of the family? One side? DNA or brain abnormality or environmental? This is everything. This is how the illness works and affects. If you don’t do this part well, your illness is going to fall flatter than a cake with no baking powder, you got me?
  2. Do your fucking research.
    And I mean all of it. You need to know symptoms. You need to know cause and effect. You need to know treatment options. You need to know medication and the history of said goddamn medication. If this is an illness they’ve had for a long time, those meds will change as the science gets better. Meds also need to be changed due to side effects with other meds or lifestyle change. You need to know how those meds will interact with drugs and alcohol. If your character gets dosed with something, you need to know if it will have adverse side effects. If your character gets injured, you need to know if the pain meds they’re on will fuck up their treatment. You need. To know. Everything.
  3. Symptoms happen regardless of plot.
    A mental illness is not a plot device.
    *coughs*. I’m sorry, one second.
    *grabs megaphone*
    *sips water* Where were we? Ah, yes.
    Symptoms of a mental illness can crop up, even if they’re on their meds. Even if their day is going well. These symptoms will happen regardless of where you want the plot to go or how your scene is playing along. If you want to write a Real mental illness and not another Mary Sue Who Doesn’t Trust People Because Abusive Ex, then you need to do the due diligence of keeping the sub-plot conflict of their battle with mental illness present. People living with anxiety and depression can wake up feeling like crap for no reason at all. A person with schizophrenia can hear a noise that doesn’t exist in reality in the middle of a conversation at work. The illness does not vanish just for your fucking convenience. Be a smart writer, not a lazy one.
  4. Let Them LIVE.
    Not all mentally ill people sit at home all day and putz around the computer. Not all mentally ill people are afraid to leave their house. Not all mentally ill people are confined to a hospital or asylum (this shit is really really rare and usually only temporary if possible because, like hospitals, they don’t have the space/time/money to keep your ass for very long). They have lives. They work, go to school, socialize. The world goes on and they go with it. Write a character, not a caricature. The point of getting the mental illness treated is to live the life you want without it stopping you. It doesn’t mean the illness goes away, it means you work to stop it from holding you back. Just because you see someone smiling doesn’t mean they’re perfectly okay, and just because you see someone functioning perfectly and doing they’re job doesn’t mean they are entirely mentally well. The illness does not have to hold your character back.
  5. Illnesses Happen In Degrees.
    There are many different levels and types of anxiety. There are many different types and levels of depression. And there are many different types and levels of socioapthy. As with every illness, the severity comes from the type and the source of the problem. Those with a born condition, rather than one caused by trauma at an early age, will often have a far more difficult time getting treatment that’s effective rather than someone with what I politely call a “learned mental illness”, meaning the brain has learned to behave this way over time in order to protect itself from future recurring trauma.
    Mental illnesses have three major causes: DNA, neurological disorder, and environment. Some mental illnesses are genetically inherited, some are from abnormalities or birth defects, and some are from how you grew up. In very bad cases, you can have vectors in all areas, making for a very trying treatment indeed. In the same way that not all people who live with depression are suicidal, not all sociopaths are murderers. Remember this when you’re writing them.
  6. Treatment is not a straight line.
    This ties back into research, and should be common sense (but if you’re neurotypical Karen with your 14×9 pan of brownies at the school bake sale wondering why autistic kids need so much patience, maybe it’s not). No matter what treatment your characters goes on; medication, psychotherapy (which often includes directly confronting your issues in role play and groups to work over triggers and deal with phobias), or therapy, your character will experience setbacks. A medication may stop working one day when it worked for years. You could have a shit therapy day where you have a break down during a role play exercise. You could get a shitty therapist. You could be put on the wrong meds. You could be diagnosed incorrectly. It can take years for a diagnosis to actually be correct and then another two years to find the right meds, because anti-psychotics can take up to six months before the full effects kick in.
    Treating a mental illness is one of the hardest fucking things there is. It’s a not a virus that you can detect under a microscope and say “oh, its this, just give them this antibiotic and they’ll be fine in two weeks.” You’re literally working to rewire the goddamn brain into firing off the right chemicals at the right times to allow the patient to live a full life. And that’s before you add in personal accommodations for treatment and side effects. Treatment of mental illnesses is like fucking Sisyphus with the goddamn rock–you keep fighting every day, but you’re going to fall back down and have to start over A LOT. It’s not easy, not even an iota, so don’t make it out to be.
  7. They/We are just like everyone else.
    Your mentally ill character is more than just their mental illness. They experience the same shit as everyone else, every goddamn day. Their car breaks down. They get annoyed waiting in line behind Karen while she berates the poor barista with her fifteen step fucking coffee order because Karen is a goddamn suburban monster who lives to make people suffer. (Fuck you, Karen.). They have crushes on people. They fall in love. They have food allergies. And pets. And loved ones. They grumble when the bus is late and bitch when its too cold or hot. Stop treating and writing them/us as Other.
    They are not Other.
    They are just people who are sick and trying to get better and live their fucking lives and maybe even be happy. Maybe.
    I’ll settle for a laugh, and one of Paul McMahon’s Christmas cookies.

Pssst! The way the posting schedule is going to shake out is two posts per week, alternating between Lets Get Weird Wednesday and Weekend Writing, with something else to accompany it that will shift between personal posts and Monday Morning Jams. As always, comment, discuss, share, and for the love of fuck go write your damn book.


2 thoughts on “Weekend Writing: 7 steps to writing mental illness

  1. You know which media portrayal really got to me? This was super mainstream, a network drama, Michael J Fox in “The Good Wife.” He has Tardive Dyskinesia, but we never learned what medication caused the side effect or any idea what underlying illness caused him to take said medication. I mean, he could be ‘normal’ and gotten it from Reglan, a GI drug with a black box warning on it or he could have gotten TD, as I did, from Geodon! And yes, psychiatry is a messy art and science. Finding a shrink that ‘gets’ you is really hard when you have TD. The stigma is unreal, even though I’m asymptomatic.


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