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infernallegaycy · 4 years ago

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Writing Psychotic Characters

Hi! I’ve seen a few of these writing things pop up recently (and in the past), but I haven’t seen any on psychotic characters—which, judging from the current state of portrayals of psychosis in media, is something I think many people* need. And as a psychotic person who complains about how badly psychosis tends to be represented in media, I thought I’d share a bit of information and suggestions!

A lot of this isn’t necessarily specifically writing advice but information about psychosis, how it presents, and how it affects daily life. This is partially purposeful—I feel that a large part of poor psychotic representation stems from a lack of understanding about psychosis, and while I’m not usually in an educating mood, context and understanding are crucial to posts like this. A lot of this also relates to writing psychosis in a modern-day setting, simply because that’s where bad psychotic representation tends to mostly occur (and it’s the only experience I’ve had, obviously), but please don’t shy away from applying this advice to psychotic characters in sci-fi/fantasy/historical fiction/etc. Psychosis is not a wholly modern phenomenon, nor would speculative fiction feel truly escapist without being able to see yourself reflected in it.

Please also note that I am not a medical professional nor an expert in psychology. I simply speak from my personal experiences, research, and what I’ve read of others’ experiences. I also do not speak for all psychotic people, and more than welcome any alternative perspectives to my own.

*These people, in all honesty, aren’t likely to be the ones willingly reading this. But there are people who are willing to learn, so here’s your opportunity.

(Warnings: Mentions of institutionalization/hospitalization, including forced institutionalization; ableism/saneism; and brief descriptions of delusions and hallucinations. Also, it’s a pretty long post!)

Up front, some terminology notes: “Unpsychotic” refers to people who are not psychotic. This includes other mentally ill and neurodivergent people. Please try to avoid terminology like “non-[identity],” as much of it is co-opted from “nonblack.”

Also, “psychotic” and “delusional” will not be, and should not be, used to refer to anything but respectively someone who experiences psychosis and someone who experiences delusions. Remove these words as insults and negative descriptors for anyone you dislike from your vocabulary.

In addition, I generally use adjectives rather than person-first language because that is the language I, and the seeming majority of other neurodivergent and mentally ill people, prefer. Others might describe themselves differently (as “people with psychosis,” for instance). Don’t assume either way—I’d generally suggest you say “psychotic person” first, and then correct yourself if the person in question prefers different terminology.

1) Psychosis is a symptom, not a disorder.

As a term, “psychosis” describes any number of symptoms that indicate a break with reality, such as delusions and hallucinations (I’ll go into more detail about this in a bit). It commonly occurs as part of several mental and neurological disorders, including but not limited to:

Schizophrenia

Schizophreniform disorder (same symptoms as schizophrenia, but for a shorter period of time than 6 months)

Schizoaffective disorder (combined symptoms of psychosis and a mood disorder, but not enough to completely fill the diagnostic criteria for either)

Bipolar disorder (typically as part of manic episodes, but it can also occur in unipolar depression and depressive episodes)

Personality disorders, including borderline personality disorder (for which transient paranoia under stress is part of the diagnostic criteria), paranoid personality disorder, and schizoid personality disorder

Post-traumatic stress disorder

Obsessive-compulsive disorder

Dissociative disorders (though psychosis =/= dissociative identity disorder; if you want further information on the latter, which I do not have, please seek out another post!)

Psychosis can also occur with forms of epilepsy, sleep disorders, metabolic disorders, and autoimmune disorders. It tends to be a major part of neurodegenerative disorders like Parkinson’s and Alzheimer’s. In addition, it can occur when not related to a chronic health condition; things like sleep deprivation and stress can induce temporary psychosis, as can drug use and medication.

This isn’t to say you necessarily need to define a disorder for a psychotic character, as some psychotic people (including myself) primarily just describe ourselves as “psychotic,” and some aren’t diagnosed with anything specific. However, if your psychotic character is a main/perspective character, I definitely recommend it. Chances are, someone with that disorder is reading/watching, and I’m sure they’d love to see a bit of direct representation. In general, you probably should at least have something in mind, because psychotic symptoms and severity/onset can differ greatly.

Some psychotic disorders’ diagnostic criteria explicitly exclude others (someone cannot be diagnosed with both schizophrenia and schizophreniform disorder at the same time, for instance, though the latter can develop into the former), but comorbidity is possible—and often common—among certain disorders and other neurological/mental conditions. Rates vary, so definitely research this, but in short, it is very much possible for psychotic people to have multiple disorders, including disorders that don’t include psychotic symptoms. (Personally speaking: I’m autistic, ADHD, and OCD in addition to being psychotic, and I’m physically disabled as well.)

I’m not here to do all the research for you—if you want to know more about specific psychotic disorders, then by all means, look them up! Go beyond Wikipedia and Mayo Clinic articles, too. Talk to people who have them. Seek out blogs and YouTube channels run by people with them. Read books about psychosis by psychotic people**. Pay attention to how we describe ourselves and our disorders.

And if you want to write characters with those disorders, especially if you’re writing from their perspectives, then please for the love of God, hire a sensitivity reader. For authenticity, I would recommend seeking out someone with the same disorder, not just anyone psychotic.

**If you want a fiction recommendation: I don’t actually know if the author is schizophrenic like the main character, but I really enjoyed and related to The Drowning Girl by Caitlín R. Kiernan. Content warnings include, but might not be limited to—it’s been a while since I read it—unreality, self-harm, suicide, abuse, and mentions of transphobia. I haven’t personally read any autobiographies/memoirs/essays yet, so I don’t have any to offer, and quite a few that came up through a cursory search seemed only to focus on being an inspiration to neurotypical people or were from a perspective other than that of the psychotic person in question. If anyone (preferably psychotic people) has any more recommendations, fiction or nonfiction, let me know!

2) Not every psychotic person has the same symptoms.

As mentioned, psychosis consists of symptoms that involve separation with reality, which can present as positive or negative symptoms. Every person’s experiences with these are different, but some generalizations can be made. I definitely recommend reading studies and articles (especially directly by psychotic people) describing experiences and presentation!

I’ll start with positive symptoms, which refer to the presence of symptoms unpsychotic people don’t have, and can include hallucinations, delusions, and disorganized thoughts, speech, and behavior.

You probably know what hallucinations are (perceptions of sensory information that is not really present), but you might not know the specifics. Types of hallucinations include:

Auditory (which tend to be the most common, and are probably the form everyone is most familiar with, primarily as “hearing voices”)

Visual

Olfactory

Tactile/haptic

Gustatory (taste)

Somatic

Some types with regards to bodily sensations get a little muddled from here, but some forms of hallucinations you might not have heard of include thermic (hot/cold), hygric (fluids), kinesthetic (bodily movements), and visceral (inner organs).

(Note: Hypnagogic/hypnopompic hallucinations, which occur when falling asleep or waking up, are not related to psychosis and can occur in anyone.)

As mentioned, there are some forms of hallucinations that are more common, but that is not to say that everyone has the same hallucinations. A lot of us have auditory and/or visual hallucinations, but not everyone does. Some have tactile, olfactory, or gustatory hallucinations instead of or in addition to more common forms (hi! Auditory hallucinations are pretty rare for me, but I constantly feel bugs/spiders crawling on me). If you write a psychotic character that experiences hallucinations, then you should definitely do further research on these types and manifestations of them.

You’re likely also familiar with delusions (a belief that contradicts reality), though again, you might not know the specifics. Delusions can be classified as bizarre (implausible, not shared or understood by peers of the same culture) or non-bizarre (false, but technically possible). They can relate to one’s mood or not.

Some people only experience delusions and no other significant psychotic symptoms (this occurs in delusional disorder). Delusions differ between people and tend to be heavily influenced by environment, but there are some common themes, such as:

Persecution

Guilt, punishment, or sin

Mind reading

Thought insertion

Jealousy

Control

Reference (coincidences having meaning)

Grandeur

Certain types of delusions are more common in certain cultures/backgrounds or certain disorders. I can’t really go into details about specific delusions, because I try not to read many examples (for a reason I’m about to mention), but if you plan on writing a character who experiences delusions, I definitely recommend heavily researching delusions and how it feels to experience them.

I would like to note: I’m not sure how common it is, but I’ve noticed that I personally have a tendency to pick up delusions that I see other psychotic people talking about having. Just kind of, like, an “oh shit what if” feeling creeps up on me, and before I know it, that delusion has wormed its way into my life. Just in case you want some idea of how psychotic people can interact amongst ourselves!

Another quick note: Delusions, by definition, are untrue beliefs; this does not mean that anyone who has ever been delusional is inherently untrustworthy.

Disorganization of thoughts/speech and behavior is more self-explanatory. Problems with thinking and speaking tend to be one of the most common psychotic symptoms, sometimes considered even more so than delusions and hallucinations. There are a lot of ways thought processes can be disrupted, and I honestly think it would be kind of difficult to portray this if you haven’t experienced it, but some common manifestations are:

Derailment

Tangents (which you might notice me doing sometimes in this very post)

Getting distracted mid-sentence/thought

Incoherence/“word salad”

Thought blocking (sudden stops in thoughts/speech)

Repetition of words/phrases

Pressured speech (rapid, urgent speech)

Use of invented words

Poverty of speech/content of speech

(Note that thought/speech disturbances aren’t necessarily exclusive to psychotic disorders. They tend to be common in ADHD and autism as well, though symptoms can be more severe when they occur in, for example, schizophrenia.)

Behavioral abnormalities can include catatonia, which presents in a number of ways, such as mutism, echolalia, agitation, stupor, catalepsy, posturing, and more. Episodes of catatonia last for hours and sometimes longer, which usually requires hospitalization and/or medication. This tends to overlap heavily with symptoms of autism spectrum disorders, which can be comorbid with conditions like schizophrenia.

Negative symptoms, on the other hand, refer to the absence of certain experiences. It can include flat affect (lack of or limited emotional reactions), generally altered emotional responses, a decrease in speech, and low motivation. Most of these speak for themselves, and I’m not honestly sure how to describe them to someone who’s never experienced them in a way that isn’t very metaphorical and therefore kind of unhelpful. If any other psychotic people have suggestions, feel free to add on/message me!

Not every psychotic disorder involves or requires both positive and negative symptoms (to my knowledge, manic episodes of bipolar disorder mostly only include positive symptoms), but many psychotic people experience both. And, as expressed multiple times—and I really can’t stress it enough—every person’s experience with psychosis is different.

If you interview two psychotic people at random, chances are they aren’t going to have the same combination of symptoms. Chances are they won’t even have the same disorder. Therefore, if you write multiple psychotic characters, they shouldn’t be identical in terms of personality or psychosis.

There are also some qualities of psychotic disorders that may not necessarily be diagnostic criteria but are prominent in people with these conditions. These also vary between disorders, but cognitive impairments and similar traits are fairly common.

3) In a similar vein, daily experiences can vary greatly. Psychosis can be a major part of psychotic people’s lives, but it doesn’t always affect daily life.

For some people, psychosis occurs in episodes, not 24/7; you may have heard the term “psychotic break,” which tends to refer to a first episode of psychosis. This is especially true of disorders where psychotic symptoms occur under stress or during mood episodes.

For other people, psychosis is a near-constant. It can wax and wane, but it never completely goes away. These people might be more likely to invest in medication or long-term therapy and other treatment methods.

Psychosis’s impact on everyday life can also be affected by insight (how well the person can tell they’re having psychotic symptoms). There’s not a ton of accessible research—or research at all—into insight and how it affects psychotic people, and I’m not a big fan of describing people as having high/low insight because I think it has the potential to be used like functioning labels (which, for the record, are bad; plenty of other autistic people have written at length about this), but just something to keep in mind. It’s a sliding scale; at different points in time, the same person might have limited or significant awareness of their symptoms. Both greater and poorer insight have been linked to decreased quality of life, so neither one is really a positive.

Just something to be aware of: Yes, sometimes we do realize how “crazy” we seem. Yes, sometimes we don’t. No, it doesn’t really make things any better to know that what we’re seeing/thinking/etc isn’t real. No, people with low insight shouldn’t be blamed or mocked for this.

As such, the diagnostic process can vary greatly. Psychotic people aware of their symptoms or how their lives are being impacted may directly ask for a diagnosis or seek out information on their own. Other times, family or friends might notice symptoms and bring them up to a mental health professional, or someone might be forcibly institutionalized and diagnosed that way.

My professional diagnostic processes have been pretty boring: Over time, I just gradually brought up different diagnoses I thought might fit me to my therapist, whom I started seeing for anxiety (which I no longer strongly identify with, on account of my anxiety mostly stemming from me being autistic, OCD, and psychotic). I filled out checklists and talked about my symptoms. We moved on with the treatment processes I was already undergoing and incorporated more coping mechanisms and stuff like that into therapy sessions. Hardly the tearful scenes of denial you’re used to seeing or reading about.

Other people might have very different experiences, or very similar ones! It all depends! I generally don’t really like reading scenes of people being diagnosed (it’s just exposition and maybe some realization on the PoV character’s part, but it’s usually somewhat inaccurate in that regard), so you can probably steer away from that sort of thing, but you might find it useful to note how your character was identified somewhere? I don’t really have any strong opinions on this.

I’d also like to note: Everything I publicly speak about having, I’ve discussed in a professional therapy setting, just because of my personal complexes. However, I do fully support self-diagnosis. Bigotry and money are huge obstacles against getting professional diagnoses, and if someone identifies with a certain disorder and seeks out treatment mechanisms for it, there’s no real harm being done. If someone is genuinely struggling and they benefit from coping mechanisms intended for a disorder they might not have, then I think that’s better than if they shied away because they weren’t professionally diagnosed with it, and therefore didn’t get help they needed. With proper research, self-diagnosis is fully ethical and reasonable.

I do not want to debate this, and any attempts to force me into a discussion about professional versus self-diagnosis will be ignored.

Anyway! I can’t really identify any specific daily experiences with psychosis you might want to include, because as mentioned, everyone has different symptoms and ways they cope with them.

Some psychotic people might not experience symptoms outside of an episode, which can be brought on by any number of things; some might experience symptoms only under general stress; some might have consistent symptoms. The content of hallucinations and delusions can also shift over time.

Psychosis can also affect anyone—there are certain demographics certain disorders are more likely to occur in, but this could just as easily be due to biases in diagnostic criteria or professionals themselves as it could be due to an actual statistical correlation. If you want to figure out how a psychotic character behaves on a day-to-day basis, then you’re better off shaping who they are as a person beyond their psychosis first, then incorporating their psychosis into things.

(A note about this: I consider my psychosis a major part of me, and I firmly believe that I would be a very different person without it; that’s why I refer to myself as a “psychotic person” rather than “a person with psychosis.” However, there is a difference between that and unpsychotic people making psychotic characters’ only trait their psychosis.)

4) Treatment for psychosis differs from person to person. The same things don’t work for everyone.

Some people are on antipsychotics; others aren’t. Medication is a personal choice and not a necessity—no one should be judged either for being on medication or for not being on medication. There are many reasons behind either option. Please do not ask psychotic people about their medication/lack thereof unprompted.

If you want to depict a psychotic character on medication, then research different forms of antipsychotics and how they affect psychotic people. I’ve never been on medication and don’t really plan to be (though if I ever do, I’m definitely taking a note from Phasmophobia’s book and calling them “Sanity Pills.” Just to clarify, I don’t want unpsychotic people repeating this joke, but if you want some insight on how some of us regard our health…), so you’re better off looking elsewhere for this sort of information!

I’m not going to get into my personal opinions on institutionalization and the psychiatry industry in general now, but institutionalization is, while common, also not necessary, and many psychotic people—and mentally ill and neurodivergent people in general—have faced harm and trauma due to institutionalization. Again, I can’t offer direct personal experience, but I recommend steering clear of plotlines directly related to psychiatric hospitals.

I would also like to emphasis the word treatment. Psychosis has no cure. It is possible for psychosis to only last a single episode (whether because it’s only due to stress/another outside factor or because it is treated early), or for symptoms to be greatly reduced over time and with treatment, but for the most part, psychotic people are psychotic for life.

However, with proper support networks and coping skills, many psychotic people are able to lead (quote unquote) “normal” lives. What coping mechanisms work for what people differs, but some psychosis-specific coping mechanisms might be:

Taping webcams for delusions of persecution/surveillance (which is honestly also just something everyone should do with webcams that aren’t in use)

Covering/closing windows for similar reasons

Using phone cameras/audio recordings to distinguish visual and auditory hallucinations from reality (most of the time, a hallucination won’t show up on camera, though it’s possible for people to hallucinate something on a camera screen too)

Similarly, removing glasses/contact lenses to check a visual hallucination

Asking people you trust (because of stigma and delusions, this might not be a long list) to check for symptoms of an oncoming episode

Avoiding possible triggers for psychosis (for example, I don’t engage with horror media often because a lot of it -- both psychological horror and slasher-type things -- can trigger delusions and hallucinations)

I’d also like to mention that treatment isn’t a clean, one-way process; especially with certain disorders, it’s normal to go up and down over time. I’d honestly be really uncomfortable with a psychotic character whose symptoms don’t affect their life whatsoever. There are ways you can write how psychosis affects someone that are… weird, which I’ll touch on, but overall, I think it’s better to actually depict a psychotic person whose symptoms have a clear impact on their life (even if that impact is, say, they’re on medication that negates some of their symptoms).

Just to reiterate: I am not a medical professional and cannot offer real-life advice regarding treatment, especially medication. Please do not ask me too detailed questions regarding this.

5) There are a lot of stereotypes and stigma surrounding psychosis.

The way psychosis is perceived both by general society and the field of psychology has changed a lot over the years, but even now, it still remains highly stigmatized and misunderstood. Wall of text incoming, but it’s important stuff.

Typical media portrayal of psychosis tends to fall into specific categories: The scary, violent psychotic person, or the psychotic person who is so crazy you can’t help but laugh. There are other bad depictions, but these are generally the ways I see psychotic people regarded and represented the most, so I want to address them directly.

Let’s talk about psychosis in horror first. Psychosis is often stereotyped as making people aggressive and violent. You’ve all seen the “psychotic killer” trope and depictions of people who are made violent and evil by their psychosis, even if it’s not explicitly named as the case. You’ve all seen “psychotic” used as a negative adjective, used synonymously to murderous, evil, harmful, violent, manipulative, etc—maybe you’ve even used it that way in the past. There’s no denying that the way society regards psychotic people is overwhelmingly negative, and that leaks into media.

If you are considering giving a violent, irredeemable antagonist psychosis, consider this: Don’t. More or less every psychotic person hates this trope. It’s inaccurate and, needless to say, rooted in ableism.

There are racialized aspects to this as well. People of color, especially Black and Latine people, are already stereotyped as being aggressive, violent, and scary; there’s also a history of overdiagnosis (and often misdiagnosis) of schizophrenia in Black people, especially civil rights activists. White and white-passing people will only be singled out if someone notices us exhibiting psychotic symptoms, but Black and brown people are already under scrutiny. Be extra cautious about how you write psychotic characters of color.

I’m not saying you can never give a psychotic person, say, a temper; in some cases, it might even make sense. Spells of uncontrollable anger are part of the diagnostic criteria for BPD, for example, and irritability is a common trait of manic episodes. Some delusions and hallucinations can affect aggression (emphasis on can—it would be inaccurate to imply that this is always the case. Once again, each person has a different experience with their psychotic symptoms).

But when the only psychotic or psychotic-coded characters you write are angry and violent, even when the situation doesn’t call for it, then there’s a problem. When you want to write a schizophrenic character, but only in a situation where they’re going on a killing spree, there’s a problem.

Studies have shown that no substantial link exists between psychosis and violence. There is a small association, but I think it would be reasonable to say this is partially because of the stigma surrounding psychosis and various other overlapping factors; no violence or crime exists in a vacuum. In addition, though I can’t find any exact statistics on this, psychotic people are susceptible to being victims of violence (likely because of this very stereotype).

On this note, don’t use mental hospitals as a setting for horror, especially if you plan on depicting the mentally ill patients there as antagonistic and unhinged. As mentioned earlier, institutionalization is a huge trigger for many psychotic people. True, psychiatric hospitals have definitely served as a source of trauma and pain for many in the past, but mentally ill and neurodivergent people have been (and are) the victims in those situations.

Also, don’t do the “what if it was all a delusion” thing. I know this is most common in ~edgy~ theories about children’s series, but… yikes.

In the same vein that you should avoid depictions of psychotic people that are ripped straight from a bad horror movie, don’t push it too far into comedy either. You’ve heard “psych ward” jokes, you’ve seen “I put the hot in psychotic” jokes (a supposedly humorous instance of that psychotic as a negative descriptor thing), you’ve heard people say “I have anxiety/depression, but I’m not crazy!”

Even other mentally ill and neurodivergent people constantly throw us under the bus, as can be seen in that last one. We’re the butt of plenty of jokes—we see things that aren’t there, we talk to ourselves, we believe things that are just so wacky you can’t believe anyone would think that way. (Even when we don’t.)

If you have to write another character laughing at a psychotic character for their symptoms, then have it swiftly criticized in the text, and try not to imply the reader should find psychosis funny either. Treat psychotic characters’ symptoms with sympathy and understanding, not ridicule.

Psychotic people literally cannot help our delusions/hallucinations/other symptoms. If something we think/say seems “crazy” to you, chances are it does to us as well.

(We’re talking about portraying psychosis in fiction, but this applies to real-life treatment of psychotic people, too!)

Also, I’d like to note—all of this is about the way unpsychotic people view psychotic people. If you see a psychotic person laughing at themself or viewing their symptoms as scary, then that is not an invitation for you to laugh along or go beyond symptoms and think the person is scary for being psychotic. That’s the thing about gallows humor; you have to be the one on the gallows.

Moving on! In romance, there is often a presumption that love can cure psychosis. This is false. No matter how much you love (whether romantically or platonically) and want to help a psychotic person, that alone will not “heal” their psychosis. Please do not depict a psychotic person having to be cured to be happy or in love. It doesn’t work that way.

This doesn’t mean you should stray away from romance in general—I personally would definitely like to see more portrayals of psychotic people being loved and supported, especially in romantic relationships. I’d prefer it not be in spite of their psychosis, either; it would be weird if someone loved a person because of their psychosis, but I don’t think you can really love someone whom you disregard such a large part of either.

Point-blank: Psychotic people are worthy of love and affection, and I think this should show in media as well.

In relation to relationships, I’d also strongly advise steering away from writing family members and friends who see someone’s psychosis as harder on them than for the psychotic person, unless you want to explicitly disavow this behavior. Sure, it probably is difficult for other people to witness my psychotic symptoms. But it’s harder for me to have them.

I’m not sure if this is a widely-held belief, but some people also seem to think psychosis is less common than it is. Psychotic people are all around you, and if you read that as a threat or anything like that, you might need to do some self-evaluating. We exist, online and in person, and we can see and read and hear the things you say about us!

Specifically: By the NIMH’s statistics, roughly 3% of people (3 out of every 100) in the United States will experience psychosis at some point in their lives. Around 100,000 people experience their first episode a year.

This also means that it’s possible unpsychotic people reading this will end up developing a form of psychosis at some point in your life as well. Yes, even without a genetic basis; yes, even as a full-grown adult (see how common psychosis is in neurodegenerative disorders). Now this one is intended as a threat (/hj).

Also, you can’t always tell who is psychotic and who is not. I imagine there are a lot of people who wouldn’t know I’m psychotic without me explicitly saying so. Set aside any notions you might have of being able to identify psychotic people, because they will definitely influence how you might go into writing a psychotic character, and they will definitely end up pissing off a psychotic person in your life. Because… you probably know at least one!

People often regard psychosis as a worst-case scenario—which, again, is something that occurs even by people and in works that uplift mental health in general (something I’ve mentioned before is The Bright Sessions, in which a telepath is misdiagnosed as schizophrenic and has an “I’m not crazy!” outburst). I’ve talked about treatment already, but I just thought I’d say this: Psychosis is not a death sentence nor a “fate worse than death.” It may be difficult for unpsychotic people to understand and handle; it is harder to live with. But being psychotic is not an inherently bad thing, and psychotic people should not be expected to act like our lives are constantly awful and hopeless on account of stigma.

I think that’s all I have to say, so thank you so much for reading, especially if you’re not psychotic! I hope you’ve learned something from this, and once again, fellow psychotic people are more than welcome to add on more information if they’re willing.

#sparrow.txt #pseriouslypsychotic #actuallypsychotic #writeblr #writing advice #writing tips

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