Do’s and Don’ts of Including Mental Illness in Your Fiction

In addition to the joy of being an author, I have also had the privilege of being a clinical psychologist for the last fifteen years. In fact, I practice in mental health full-time as a Pediatric and Perinatal Psychologist and I write in my spare time.

My Psychologist job has greatly influenced my writing as all my published books focus on writing about characters with a form of mental illness and on their recovery from mental illness. 

In the last few years, I have been thrilled to see that many authors are writing books with characters who struggle with mental illness. All mental health professionals are strongly dedicated to promotion of normalization of mental illness and understanding of it, as well as decreasing the stigma associated with being mentally ill. 

I would encourage any author to consider including mental illness in their books as a challenge for their character, the same way we often include divorce, job loss, death, and medical illness as a challenge for the characters. Having said that, there are a few important points to consider when writing about mental illness.

How Does Mental Illness Fit Into Your Story

Write about mental illness because it makes sense for your story, for your character. In my upcoming thriller, my character has PTSD, because I have been desperate to tell a story of a sexual assault victim with PTSD for years. It’s an important statement for me. Ask yourself why you are choosing a mental illness and why it’s important to your story, to your character’s growth and change. 

Creating Unreliable Narrators by Giving Them Mental Illness

Don’t use mental illness as simply “a device” or “a tool”. You will offend many of your readers who may have the illness and you will do a disservice to your character. If you want to have an unreliable narrator, giving this narrator a mental illness is not the best choice. To be accurate, there are only a few types of mental illness that result in misperceiving reality (for example, Schizophrenia or Substance Abuse). However, I often see authors use mild anxiety or depression to create their character into an unreliable narrator. That’s offensive to people who suffer from these conditions. Struggling with anxiety and depression does not make you confused about reality.

Giving Your Characters a Wrong Mental Illness 

Research your different types of mental illness. Don’t choose a severe mental illness for your main character. A character with a severe mental illness will not be able to function well in your book. There will not be much of a change or growth. It will not be realistic for this character to recover unless your book covers years. Choose a mild to moderate mental illness; for example, social anxiety or fear of flying or panic attacks. 

Consult a mental health professional to help you select an illness. DSM-5 is the manual that describes all the mental illnesses, but, it is not a substitute for asking a mental health professional to help you understand what your character may be struggling with. When an author calls me with a question, I can usually come up with a perfect mental illness for their character in a few minutes, saving them hours of research. 

Choosing Treatment for Your Characters 

Research who the mental health professionals are who will treat your character if you choose to portray them in your story. I often see mistakes in books regarding this issue. Don’t use cliché physical portrayals. I wear a suit to work most days to work. Most of us don’t have couches in our offices. I would never use a candle during a therapy session. I treat every person in a completely different way, depending on the person and their needs. 

Mental illness is a medical illness, it is not a choice, don’t portray it as something that’s easy for a character to overcome. It’s often a lifetime struggle. Treat the subject with respect, kindness, and sensitivity. Do your research. Find out what treatments are effective for the illness your character has and what treatments are not. I often read a book that portrays a character in treatment that has been shown over and over not to work. Yet, the character magically recovers from this treatment. 

Research Mental Health Laws

This differs by state. I see mistakes made in bestselling novels all the time regarding laws on hospitalizing patients with mental illness. Some key points across all states exist.

For example, mental hospitals can’t keep your character against her will for more than 24 hours or about; she would only be kept against her will if she were a danger to herself (actively caught committing suicide) or others (caught trying to kill someone).

Generally, she will voluntarily enter a mental health hospital if she and doctor or family believe she is at risk for suicide or hurting someone. How long your character stays depends on how long her insurance will allow or how long the mental health hospital will recommend.

Common length of stay is only 5-7 days. In the U.S., mental health hospitals are not allowed to keep patients for a long time.

A Few Don’ts:

Don’t portray suicide in detail. Mental health research has shown over and over that portrayal of suicide in literature and in the media (TV or print) leads to the increase of suicide rates in the vulnerable population. It’s fine to write, “X committed suicide” and describe the effect this has had on others. Please don’t describe the suicide in graphic detail for pages. It will harm people. Don’t fool yourself thinking that you will save someone’s life. You won’t. You will hurt people. I have seen it happen. I have research data to prove it. The same goes for self-harm and cutting. 

Don’t make people with mental illness villains. Only 3% of mentally ill commit violent crimes. However, people with Personality Disorders or people we typically name as Psychopaths commit many. These crimes are not always violent, but they usually quite deviant and evil. For example, sex offenders, domestic violence perpetrators, white supremacists fall into that category. These people don’t have a mental illness that can be treated. While their problems are listed in the manual of mental disorders, it’s only because they are different from “norm” and not because we believe they have an illness that’s treatable. 

Don’t use derogatory language. Even if you are not writing about a character with mental illness, please beware of your language. About a third of your readers struggle with mental illness. Search your manuscripts for words, such as “crazy,” “psycho,” “looney.” These are derogatory words which refer to mentally ill. See if you can find a better substitute. 

As a final point, please seek sensitivity readers for your manuscripts about mental illness. There are many of us available, whether we are mental health professionals or people with mental illness. We are happy to help. 

—

Elena Mikalsen is published author of two novels and a member of the Women’s Fiction Writers Association, the Author’s Guild, the International Thriller Writers Association, and the RWA. She enjoys writing stories about smart women in extraordinary circumstances. Her third novel will be released in December of 2019. Her debut novel, WRAPPED IN THE STARS, won First Place at the Chanticleer Romantic Fiction Awards in 2018. She is somewhat obsessive about travel, but, when she is at home, in San Antonio, she can be found browsing through bookstores or antique shops with her husband and two children.

When not writing stories, she is a Pediatric Psychologist and Assistant Professor at Baylor College of Medicine, helping children with chronic medical illness. She blogs on issues of mental health for teens and adults.

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Category: Contemporary Women Writers, How To and Tips, On Writing