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Often with writing, we put our characters through hell. Some of the worst experiences are narrated in our stories leaving scars on our characters. These scars show up in the form of depression, anxiety, post-traumatic stress disorder, etc. in our characters, but unless one has first-hand experiencing these things, they can be hard to get write. And in a world where our readers actually have their own mental health struggles, it is important that we get it RIGHT.
As a registered nurse, I have a different view of mental health that shows up in my character development. I also experienced quite a bit of post-partum depression and anxiety which gave me an eye-opening view of mental health and how it is handled in the US. Long story short: I wasn’t impressed. For the next several blog posts, I’m going to be using my old nursing school textbooks and using that information to show how to write convincing characters that are suffering with mental health crisis.
This will not be a guide to be used to diagnose or treat mental illnesses. It is strictly a writer’s character development tool.
A mental disorder is “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.” (Videbeck p. 3) So basically, if a person has a moment of anxiety, it does not mean that they have an ‘anxiety disorder.’ Everyone gets anxious now and again. An anxiety disorder would be someone who deals with anxiety often enough that it is hindering something in their life. For example, they can’t go to work because of the anxiety, or they develop an eating disorder, or they can’t leave the house. The anxiety is so bad that life—or areas of life—become impossible or very hard.
I got to this point dealing with my anxiety where life was nearly impossible. I couldn’t sleep, eat, work, write, or take care of my child. It was one of the lowest points of my life. This led to depression and thoughts of suicide. It was not that I wanted to die—I just couldn’t keep living with this constant sensation of wanting to rip my hair out.
It’s been 9 months since the worst of it, and I am still recovering while under the care of a therapist. The anxiety is still there—it probably always will be—but we’ve been working very hard on using coping mechanisms. I’ve come a long way and still have a long way to go. But now I have hope, which is something I didn’t have before.
But anyways. . .
There are several different types and classifications of mental/psychiatric disorders. Keep in mind that all of these can come about for different reasons. Some are related to genetics, others physical health issues, stress, and trauma. Each impact a person to different levels and treatments are not identical. Here is a basic list of them:
Anxiety: A vague feeling of dread or apprehension; it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms. A person with an anxiety disorder demonstrates unusual behaviors such as panic without reason, unwarranted fear of objects or life conditions, uncontrollable repetitive actions, reexperiencing traumatic events, or unexplainable or overwhelming worry. They experience significant distress over time, and the disorder significantly impairs daily routines, social lives, and occupational functioning. (Videbeck p. 227)
Schizophrenia: Causes distorted and bizarre thoughts, perceptions, emotions, movements, and behavior. It cannot be defined as a single illness; rather, schizophrenia is thought of as a syndrome or as disease process with many different varieties and symptoms, much like the varieties of cancer. A person with schizophrenia is characterized by some of the following: delusions, hallucinations, and grossly disorganized thinking, speech, and behavior, flat affect (or seemingly lack of expressions during social situations), lack of volition, and social withdrawal or discomfort. (Videbeck p. 252)
Mood Disorders: Also called affective disorders are pervasive alterations in emotions that are manifested by depression, mania, or both. These interfere with a person’s life, plaguing him or her with drastic and long-term sadness, agitation, or elation. Accompanying self-doubt, guilt, and anger alter life activities, especially those that involve self-esteem, occupation, and relationships. (Videbeck, p. 281)
Personality Disorders: Diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress. (Videbeck p. 319)
Substance Abuse: A person using a drug in a way that is inconsistent with medical or social norms and despite negative consequences. (Videbeck p. 349)
Eating Disorders: Can be viewed on a continuum, with people with anorexia eating too little or starving themselves, to people with bulimia who eat chaotically, and people with obesity eating too much. (Videbeck p. 373)
Somatoform Disorders: The presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them. (Videbeck p. 393) For example: a person who has a limp but no underlying injury.
Cognitive Disorders: A disruption or impairment in the higher-level functions of the brain. They have devastating effects on the ability to function in daily life. They can cause people to forget the names of immediate family members, to be unable to perform daily household tasks, and to neglect personal hygiene. (Videbeck p. 440)
Keep in mind there can be quite a bit of overlap within each of these mental health categories. A person suffering anxiety can have a personality disorder. Or a person with depression can have a problem with substance abuse.
Obviously, this is just a very broad overview of mental/psychiatric health. The following posts are going to be breaking down each of these disorders on an understandable level and providing applications for writers on how to incorporate these things into your stories.
Psychiatric-Mental Health Nursing, by Sheila L. Videbeck, fifth ed., Wolters Kluwer/Lippincott Williams & Wilkins, 2011.
RW Hague is a registered nurse with over eight years of experience within the medical field. Using her medical expertise, she writes stories that are gritty and compelling.