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5 Biggest Mistakes When Writing Mental Illness

23 October 2014

From author, doctor and soon-to-be psychiatrist Rosie Claverton:

Madness in fiction, like most things in fiction, reflects and informs the popular view. If we write about terrifying, violent mad folk running about with machetes in our films, books and TV shows, the general public nod at how much that confirms their view of madness and cross the street when they see someone out of the ordinary. Or worse. Much worse.

At the bare minimum, we should get the facts right. Here are my Top 5 mental health myths in fiction that need to be kicked to the kerb.

1) Straitjackets and padded cells are not standard issue

Let’s start with straitjackets. We do not use straitjackets in mental health in the UK. They are cruel and dangerous. Short-term physical restraint is used during a psychiatric emergency and it is tightly-regulated, with training and a mountain of paperwork. If your character is spending time in a mental health unit, they will not see a straitjacket.

A bedroom in a modern mental health unit has more in common with a room in university halls than it does a padded cell.There are certain things which distinguish them – the furniture is usually heavy and secured to the walls or floor, and you won’t find hooks, nails, curtain rails or door handles, because we are safety conscious.

The Psychiatric Intensive Care Unit (PICU), where the most unwell people stay, has a step up in safety features – most notably, a seclusion or low stimulation room. This small room has furniture made of the soft squishy blocks you might see in a children’s play area. The walls, however, are just walls.

Padded rooms do still exist in some facilities. They are for short durations where a person is unwell and very rarely a permanent residence. If your character is spending a week in a mental health unit for depression, they are really unlikely to see one.

. . . .

4) OCD is not about being a neat freak

My husband has OCD. When I mention this to people, I sometimes get the response “your house must be so clean!” Wrong, on so many levels.

Obsessive-compulsive disorder involves intrusive, unpleasant, horrific thoughts (obsessions) and the felt-necessary rituals to attempt to undo, remove or counteract the thoughts (compulsions). Cleaning, ordering and symmetry can all be compulsions, but they are almost always related to an intrusive thought – for example, “if I don’t wipe the table seven times, my children will die from ebola”.

Not “I like a clean house because I hate clutter”. Or the recent nonsensical trend in dousing children in alcohol gel (hint: it does fuck-all – let them develop an immune system).

And sometimes OCD has absolutely nothing to do with cleaning. Sometimes it’s about checking the door is locked 99 times. Or repeatedly driving the same piece of road to make sure you didn’t hit anyone. Or repeating The Lord’s Prayer over and over again to protect your wife from being raped by a stranger.

It’s not about a bit of spit and polish.

Link to the rest at Swords and Lattes and thanks to Jayne for the tip.

Here’s a link to Rosie Claverton’s books

Writing Advice

4 Comments to “5 Biggest Mistakes When Writing Mental Illness”

  1. Great article for those who want to inject a level of realism into their work.

  2. Heh.

    My series protagonist has what the DSM-IV and ICD Psychiatric manuals refer to as “antisocial personality disorder” or “dissocial personality disorder.”

    There’s another, more common term often used for folks like him…

    Psychopath

    Kind of a weird choice for an idealistic, stoic, self-sacrificing hero… but it works.

    I read a ton of psychiatric nonfiction, to make sure I got him right. That was some fascinating research.

  3. I’d just suggest that each ‘institution’ and 72 hour hold [place and each rehab and each psych ward has elements and restraints that have to be checked out where one is setting the scene, rather than take anyone’s word for what is true where they set their character. Pie shaped rooms, police posted at doors, what I think of as medieval restraints –and also intrusive drug injections… I honestly cant go on…

    but, just that. To be accurate, check it out in the time and place one sets their character. Accuracy may also help others [readers] see the realities, some of which are surely beyond humane. There was much backlash for instance against ECT as a result of ‘one flew over…’

  4. “4) OCD is not about being a neat freak”

    Good to know that I’m not OCD after all. I’m a very organized person who hates clutter and likes for everything to be clean and in its place. I was the little boy whose mother never had to tell him to clean his room.

    Reading this article has made me ask if there’s some intrusive thought that makes me this way. I can honestly say no. I don’t fold my socks to ward off evil spirits. I just like a tidy sock drawer. When I’m in another person’s house that looks like a war zone, I don’t feel compelled to straigthen it up for them or feel relieved when I leave. I just shrug and think to each his own.

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