#ask the prose

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[vmkhoneyy]

“People are inherently terrible” no!!! Have you ever seen a child wait for their friend while they tie their shoelaces? Have you ever known someone who would bring hurt squirrels and rabbits and mice to the nearest vet just so it doesn’t suffer? Have you seen someone grieve? Have you ever read something that hit your heart like a freight train? Have you looked at the stars and felt an unexplainable joy? Have you ever baked bread? Have you shared a meal with a friend? Have you not seen it? All the love? All the good? I know it’s hard to see sometimes, I know there’s pain everywhere. But look, there’s a child helping another up after a hard fall. Look, there’s someone giving their umbrella to a stranger. Look, there’s someone admiring the spring flowers. Look, there’s good, there’s good, there’s good. Look!!!!

[lucidloving]

@inanotherunivrse // You're On Your Own, Kid— Taylor Swift // @inkskinned // Richard Siken, Crush // @lilcowgirl7-deactivated20210223 // Heather Havrilesky, How to Be a Person in the World // Zoe Heller, "Everything You Know" // Atticus

[wyyvoren]

you find the opposite must be true, too. if you put evil into the world, you receive it as well. you hold your mother’s now cold hand. you think you must’ve done something truly wicked.

[ID: Scum Villain fanart of young Luo Binghe kneeling and sobbing as he holds his mother's limp, skinny hand. The washerwoman is almost completely offscreen, and the angle is low and tilted up to look at Luo Binghe's face. End ID]

[comicaurora]

...What happens if I put a full twenty dollars into the urban fantasy vending machine?

it's been on the backburner for over a year, so nothing fresh, but for twenty dollars in the urban fantasy vending machine, here is a short vignette I haven't touched in a year and a half

The room was crisp and bright, all sharp edges and polished monochrome. The sun shone in through the floor-to-ceiling windows, refracting off the sparkling glass and steel spires that carved out the skyline and focusing with almost suspicious precision directly into my eyeballs. I slumped down further in my chair and squinted across at the empty desk. Everything was too damn bright.

“Can I get you anything, detective?”

The voice that rang out from behind me was innocent and musical. The woman it belonged to was not.

I scowled. “Absolutely not.”

“Suit yourself.” I could hear the indulgent smile. “The coffee’s very good, you know. I don’t settle for anything less than the best.”

“I’m sure.”

“And with a nose like yours, I’m sure you already knew.”

Water boiled, and a rich, bitter scent coiled through the air. It was good. Probably that Blue Mountain stuff, or - no. It had to be Turkish. Of course she’d do Turkish.

I squeezed my eyes shut and exhaled harshly. There was no way around it - I was exhausted. I’d hit the 48-hour sleep dep limit back on Saturday and had been burning through raw determination ever since. It was damn stupid of me, frankly. I probably couldn’t even handle arithmetic right now, let alone solve a mystery.

But it’d be real stupid of me to accept a drink from the most notorious poisoner in history, so I was just going to have to deal with it.

I reluctantly opened my eyes and the world blurred back into focus as a tall figure briefly eclipsed the dazzling display of sun-sparkled skyscrapers. A coffee cup settled on the desk with a soft clink. There was a rustle as she settled into the high-backed chair and leaned forward. The sun caught in her golden braided bun and played across the shoulders of her elegant black suit. Pale, slender hands clasped the coffee cup with practiced precision.

“So,” Medea said. “How can I help you today?”

Her eyes were honey-gold. Granddaughter of Helios, the myths had said, and the sun certainly seemed to be in the habit of favoring her. Her corporate empire dealt in energy. Geothermal, hydroelectric, solar, even nuclear - all those shiny, clean alternatives that were slowly outcompeting the old oil-burning models. Her power stations were already keeping the lights on for half of the eastern united states. It was a hell of a niche she’d carved out for herself, and like everything else she’d ever done, she was stunningly good at it. Then again, for a demigod princess and compulsive social climber, the world of corporate politics must’ve felt like a home away from home.

Her gaze was steady and level, like I wasn’t cutting into her busy workday. Like she had all the time in the world.

Well. She did, didn’t she?

I sighed. “There’s a new drug on the streets.”

“Is it Tuesday already?”

“This one’s different.” I rubbed my eyes. “Right now, they just think it’s a hallucinogen.”

“And?”

“It’s not. It shows what’s really there.”

The coffee cup froze halfway to her lips. “How much?”

“Can’t tell for sure. Sounds like they’re seeing fairies, sprites, goblins, standard hidden world stuff… but I’m pretty sure it cuts through glamour. Might even go deeper, start showing shifter’s true forms.” I leaned back. “The secret world won’t stay secret for long if the users and abusers start comparing notes. I was half-tempted to take some of the stuff myself just to find out how much they know, but I’m not exactly a neutral test subject.”

“Yes, between your physiology and your temperament, that would be very unwise.” The clink of her cup cut off my half-hearted retort. “Do you have any mortal friends who might be willing to take the plunge?”

I barked a bitter laugh. “All my mortal friends are wizards or cops.”

“Unfortunate. I see why you came to me.” She leaned back, lacing her fingers together. “I’m sorry to disappoint you, but this is the first I’ve heard of it.”

Damn. Damn. Why was I surprised?

“That kind of potion isn’t really my style anyway,” she said. “Illusions and the breaking thereof are rather… outside my typical wheelhouse.”

“I know, I know.” I rubbed my eyes again. “I didn’t think you were making the stuff. I just hoped maybe you knew something. Nobody knows where it’s coming from.”

“The Goblin Market?”

“Obviously some people are dealing it through there, but I don’t have a supplier.”

“Tricky.” She leaned back. “What’s the delivery method?”

“That’s the weird part. It’s topical.”

She quirked an eyebrow. “Unusual. No ingestion or injection?”

“No.” I dug into my jacket pocket and pulled out the scuffed stainless steel tin, then dropped it on her desk. “Kid up in Wicker Park saw me, dropped this and ran. Broad daylight. I wasn’t even changed.”

“You do cut an intimidating figure regardless.”

I scowled. “I don’t know what he saw.”

She nodded once, then gestured at the tin. “Do you mind?”

“Be my guest.” I sank deeper into the chair.

She delicately picked up the tin and traced a nail around the lid. “The container is mundane.”

“Yep.”

She turned it in her hands, the battered metal catching the light. Then she cracked the lid.

I braced myself and squeezed my eyes shut. The smell was overwhelming and utterly unidentifiable - syrupy, sickly, wormwood and petrichor and rot. The headache I’d been nursing intensified.

I heard her sniff. Lucky woman. She had to try to smell the stuff.

“Otherworldly ingredients.” There was a click and the smell dissipated. I risked cracking an eye open. She’d replaced the lid and was staring at the container pensively.

“What do you think?”

She arched an eyebrow. “Maybe I should be asking you. If I want to identify the makeup of an unknown mixture, I need a full lab and the favor of Hekate. You just need your nose.”

I groaned. “All I know is it’s weird and I hate it.”

“Weird?”

“Weird! I can’t pin it down. It almost smells like something, but” - I waved my hands vaguely - “it’s all wrong.”

Medea stared for a moment, then set down the tin. “Detective, have you ever been to fairyland?”

“I assume you’re not being euphemistic,” I said, rubbing my eyes.

“No. I’m referring to the realm of fairy. Built on the ruins of Tír na nÓg, ruled by the Fairy Queen, land of glamour and illusion, home of the people of the hills. You must be familiar.”

“Of course I am.”

“But you’ve never been there?”

“I don’t do otherworld travel if I can help it.” I sat up. “Why?”

Medea idly traced a finger over the tin. “The bones of the fairy realm are very real, but for the most part, the realm is a beautiful illusion starving for reality. Your senses are entranced by a perfect, glamorous experience, but your body and soul waste away. Surely you’re familiar with the harmful effects of fairy food?”

“On paper.” I glanced at the tin. “You think this is some kind of illusion?”

“Just the opposite.” She tapped the lid sharply. “Fairyland is nothing more than the eternal dream of the Fairy Queen, but Tír na nÓg is as real as you or I. A land of promise and plenty, lost to ruin when its link to this world withered away. Its denizens fading to shades, its fruits and flowers rotting and decaying where they grew.”

I frowned. “This… this isn’t your area. Why do you know so much about this?”

She sighed. “Really, detective. Did you really think, over three thousand years, I stayed entirely in the mediterranean?”

“No, of course not-“

“After my flight from Athens I broadened my horizons significantly. I have visited the realm of Fairy several times.” She wrinkled her nose. “Of course, after the Tír fell to ruin, the quality of ingredients I could acquire plummeted rather dramatically. Gossamer illusions make for poor potions.”

I tried to cut through the fog in my head. Things were coming together. “You… think this was made in fairyland?”

“I think it was, at minimum, made from fairyland.”

“The smell… is odd. Like a floral perfume gone wrong. Rot making everything sweeter.” I scowled. “Not an illusion. Illusions don’t smell that bad.”

“Good,” she said. “Then some industrious denizen appears to have scoured the far edges of Fairyland to acquire ingredients from the ruins of the Tír.”

[threewordusername]

you

d.b.a

[thoughtkick]

Being positive isn’t pretending that everything is good. It’s seeing the good in everything.

Ask-Angels.com

[professorcalculusstanaccount]

hi i just came accross your st benezet's basement and i love it a lot, this is a really cool idea !!! is it just like, a concept or will you ever write a full story ?

Thank you very much! Every story idea I post is fully plotted out, I just don't have the time to draw out the stories entirely as comics. I do draw out the odd story beat in my sketchbooks - here's Chang and Tintin's reunion at the start of the story I cleaned up.

Perhaps one day I'll draw out one of my stories entirely. I don't want my work to be stolen and sold by pastiche pirates...

Story post for St Benezet's Basement is here

[tooquirkytolose]

This Is Not My Story

[perfectquote]

Being positive isn’t pretending that everything is good. It’s seeing the good in everything.

Ask-Angels.com

[ask-the-prose]

I need a word for horny but not in a sexual way more just like wanting kisses and hugs and affection or something

Hi! Thanks for the ask! A word used for what you are describing could be "needy" as in "needy for affection" or "needing reassurance" or simply just "affectionate"!

Some great resources to help you: thesaurus.com, tip of my tongue, and word hippo.

-- Indy

[queer-ragnelle]

Hi, I’m just curious. I know that the star/pentacle on a red background symbol for Gawain comes from the green knight but where does the double eagle on the purple background come from?

Hello!

This proved more difficult to find sources for than I anticipated. I didn't want to just say "French texts" and leave it at that. And good thing I didn't! I couldn't find a single textual description of Gawain's eagle device anywhere. Vulgate yielded nothing, no mention of an eagle shield in the stories of Chretien de Troyes. Not even in Le Morte d'Arthur does Gawain's device get a mention! Galahad's red cross on white is always described, Palomides's black armor and insignia is well-documented, but never Gawain's heraldry. Now I was determined to figure this out.

According to The Heraldry Society, many of the coats of arms we associate with the knights of the Round Table are believed to originate from illuminations made around Sir Thomas Malory's time and curated by Jacques d’Armagnac. From there, I was able to track down a book called The Manuscripts and Patronage of Jacques d'Armagnac which catalogues his vast collection. I edited the PDF to enable word-search as it's an 800 page volume and that will make using it much easier. Here's what I found:

Evidently, in an illustrated copy of the Prose Tristan, Gauvain is depicted with "rose arms with gold double-headed eagle." Later in the same text, Mordret's heraldry is described the same but with "a white horizontal bar through it," and Agravain's is once again identical to Gauvain's except with "a white diagonal stick over the eagle." There's no corresponding images present in the book, and what illuminations were included are completely illegible, the scan is atrocious. However each illumination is labeled with a corresponding folio and source text so whenever the British Library's Digitized Manuscripts are fully restored, maybe we can check that out.

And there you have it! As a bonus, here's yet another coat of arms for our friend Calvano, as he's known in Italian, inherited from his pops and described in La Tavola Ritonda.

Hope that helps, it's the best I can do with what I have. Take care!

[surqrised]

Being positive isn’t pretending that everything is good. It’s seeing the good in everything.

Ask-Angels.com

[thehopefulquotes]

Being positive isn’t pretending that everything is good. It’s seeing the good in everything.

Ask-Angels.com

[resqectable]

Being positive isn’t pretending that everything is good. It’s seeing the good in everything.

Ask-Angels.com

[perfectfeelings]

Being positive isn’t pretending that everything is good. It’s seeing the good in everything.

Ask-Angels.com