Guest Post: How Much Should You Emphasize Your Character's Mental Illness?

I'm pleased to welcome Dr. Carolyn Kaufman, author of The Writer's Guide to Psychology, back to the blog! I interviewed her last year for Psychtember (you can read Part 1 here and Part 2 here) and this time she's participating with a guest post in response to a question I sent her. Take it away, Carolyn!

One thing I've noticed with many YA books is that when a character has a mental illness, the whole story becomes focused around that aspect and it turns into an "issue book." Do you think this is helpful, or would it be beneficial to have more stories that feature teens that just happen to have mental illnesses? Why?

I think “issue books” often do a nice job of showing what it’s like to deal with a psychological problem, which benefits teens who are dealing with a mental health issue in their own lives, or in the life of a friend or family member. As our ability to recognize and talk about psychological issues has expanded (and as diagnostic criteria have expanded), we’ve become more aware of psychological problems that used to get misdiagnosed or swept under the proverbial carpet. Even people who have not been directly impacted by a psychological disorder can benefit, because we all are bombarded with TV shows, movies, and even cartoons that make assumptions (many of them wrong) about what someone with such a disorder is like. Getting an insider’s point of view makes us more empathetic.

I do like stories that address psychological problems without making said problems the axis on which the story turns, however. Though many people with undiagnosed or newly diagnosed problems are consumed by the disorder that’s bogging them down, many, many people learn to manage their diagnoses. The diagnosis then becomes an ongoing part of their lives, but not by any means the thing that defines them.

In other words, when someone is first diagnosed with something like ADHD or bipolar disorder (manic depression) or panic attacks, they may go through a stage of using the diagnosis as part of their identity.  For example, they may say to people, “I’m bipolar,” or “One of my prominent characteristics is my ADHD,” or “I really have to think about my panic attacks before I can do anything else.”  But just like teens with epilepsy or diabetes learn to adapt and make dealing with the problem part of their daily routine, so too do many people with psychological problems.  And I’m not sure that’s portrayed often enough in fiction—people coping with their problems.

Granted, stories are more exciting when there’s drama and conflict, but the period when someone is first diagnosed isn’t the only time that things can be shaken up! For example, someone who has learned to manage a disorder must also learn if, when, and how they are going to tell others. For example, when and how does a 17-year-old girl who’s trying to impress her new boyfriend tell him she has a problem with bipolar disorder? There’s still a great deal of stigma toward mental illness, and it is usually much harder to say “I have manic depression” than it is to say “I get migraines” or “I have diabetes.” She will probably worry about how her boyfriend is going to take it, whether he’s going to think she’s “crazy” for having to take meds and visit a psychiatrist, whether he’ll tell other people. And even if he handles it well, what if his parents disapprove? And what’s he going to do the first time he sees actual symptoms? Will he be supportive, demeaning, afraid, angry?

In addition to that, her lifestyle may not mesh with her peers’ expectations. She may not be able to stay up all night, sleep irregular hours, eat like her body is a garbage disposal, let her blood sugar drop too low, use popular remedies (like appetite suppressants, high-caffeine drinks, or over-the-counter-cold medicine), or drink alcohol. (Yes, 17 is under the legal drinking age, but we know that many teens experiment before that.) Things like this can trigger bipolar episodes or exacerbate symptoms.

Also remember that stressors can aggravate many psychological conditions, so even a character who normally deals well can be thrown off track by a breakup, changing schools, or a parental divorce.

Finally, I think a lot of authors do extensive research to try to understand a disorder they want to portray, and we all know how tempting it is to use everything we’ve learned! But sometimes a light touch is best.  You can, like I said above, remind yourself that the disorder is a part of the person’s life, something that needs to be managed, not something that defines him or her.

I have a character who has panic attacks in social situations that involve pressure. This isn’t a huge part of the novel, and I never even name the problem (i.e. panic attacks). Instead, I just show him doing his best to deal with each attack as it comes. In a good novel, a vulnerability like this really should flare up and cause problems at a crucial moment, but again, it doesn’t need to define the character or the novel.

Carolyn Kaufman, PsyD's book, THE WRITER'S GUIDE TO PSYCHOLOGY: How to Write Accurately About Psychological Disorders, Clinical Treatment, and Human Behavior helps writers avoid common misconceptions and inaccuracies and "get the psych right" in their stories. You can learn more about The Writer's Guide to Psychology, check out Dr. K's blog on Psychology Today, or follow her on Facebook!

Thanks very much, Carolyn, for this insightful look at how to write a character with mental illness without turning the story into an "issue book"!

Readers — do you like it when a book zeroes in on a particular mental health issue, or do you prefer to see stories where it's there, but not the main focal point? Can you recommend some YA books that aren't "issue books" but still accurately portray a character with a mental illness?

Guest Post: Hoarding and OCD in The Butterfly Clues

I'm happy to welcome Rebecca Taylor back to the blog for another Psychtember guest post! You can read her guest post for last year's event here.

I wanted to start by thanking Danya for inviting me to guest blog on her site, I love connecting with other bloggers and having the opportunity to reach a wider audience. So to all you fellow bloggers who are reading this (hint, hint) feel free to hit me up about a multitude of topics (psychology, writing, reading, working, kids…you name it!)

So I wanted to write about hoarding for several different reasons. One, I have had my copy of THE BUTTERFLY CLUES by Kate Ellison sitting on my bedside table for months waiting patiently for my attentions. For those of you who are not familiar with this book, the main character, Lo, is a hoarder AND has OCD (counting, word repetitions, and complex rituals.) Two, I have recently become completely addicted to watching HOARDING: BURIED ALIVE on TLC. And three, it was the first topic that sprang to mind that wasn’t already being covered by another guest blogger.

I like to start by saying that unlike many other “topic” YA books, THE BUTTERFLY CLUES is not actually about hoarding or OCD. It is actually a mystery about a murdered exotic dancer named Sapphire and Lo’s drive to solve that murder. For you writers out there, the hoarding and OCD are really used more as interesting character flaws and also serve (quite nicely I might add) to create conflict and serve certain plot elements where needed. Having said this, I would say that the hoarding and OCD come up so frequently throughout the book, that they are almost like another character in and of themselves or a C storyline if you will. Which, given the nature of these disorders, seems appropriate because both hoarding and OCD can be so disruptive to typical life functions that they become entities to contend complicating even the most simple of daily functions. So why the book is not about hoarding directly, I think Kate Ellison did a really wonderful job of showing how the disorder impacts Lo’s ability to solve this mystery much the same as how real people need to manage their real life under the constraints of a debilitating disorder.

I really did enjoy this book.

As far as hoarding goes, oh lord, what a challenging mental health condition that impacts every area of a person’s life. Hoarding is a new disorder being considered for addition to the DSM V (now set for publication in May of 2013) and the criteria under Obsessive Compulsive and Related disorder are looking something like this:

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.  

B. This difficulty is due to a perceived need to save the items and distress associated with discarding them.

C. The symptoms result in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities).

D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi Syndrome).

F. The hoarding is not better accounted for by the symptoms of another DSM-5 disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, decreased energy in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder).

Specify if:

With Excessive Acquisition: If symptoms are accompanied by excessive collecting or buying or stealing of items that are not needed or for which there is no available space.

It goes on to address to what degree the person has insight into their disorder and this appears to be the key to whether or not they are successful in diminishing the hoard through therapy because the people who have poor insight into their hoarding tendencies seem to go round and round in a frustrating and confusing cognitive loop of justification for their hoarding. Practically every item has great necessity and value to the individual and their anxiety about parting with their belongings is so intense, when challenged to even make decisions about letting a singular item go to either the dump or donation, those with poor insight become masters at avoidance, deflections, and circular logic. When pressed, they sometimes become very angry and aggressive probably as a learned behavior that is often successful in driving others away. If hoarding continues unabated, living conditions can become so dilapidated that routine maintenance and cleaning become impossible. Kitchens and bathrooms become unusable as toilets and sinks overflow, pipes break, walls and roofs deteriorate, bugs and animals move in and food, garbage and feces pile up and into the preexisting piles.

In THE BUTTERFLY CLUES, Lo’s hoard is contained in her bedroom and is not noticed by grief stricken parents: a drug dependent and depressive mother and a workaholic father. I would say that Lo’s insight into her hoard is very poor and, while it is not addressed directly in the book, it does not seem like she would, at this stage of her life, be very receptive to therapy. But, as I said before, this is not really the point of the book in the first place so I’ll just keep my armchair quarter back opinions to myself, ahem.

In short, yes I recommend reading THE BUTTERFLY CLUES. I do not recommend hoarding.  And now, I’m going to go clean out my closet.

Rebecca Taylor is a school psychologist and author of YA fiction. ASCENDANT, the first book in her ASCENDANT series, releases in June 2013 from Crescent Moon Press. She is represented by Emma Patterson at The Wendy Weil Agency Inc.

Follow her at:

Twitter: @RTaylorBooks

Facebook: http://facebook.com/RebeccaTaylorBooks

Blog: http://rebeccataylorbooks.blogspot.com

If you would like Rebecca to be a guest blogger on your site, email her at Rebecca@rrtaylor.com

     

ASCENDANT by Rebecca Taylor
(Crescent Moon Press, June 2013)

When I was twelve, my mother disappeared. I was the first person to never find her.

I’m sixteen now and she has never been found, alive or dead.

I’m not the girl I should have been.

When Charlotte Stevens, bright but failing, is sent to stay at her mother’s childhood home in Somerset England her life is changed forever. While exploring the lavish family manor, Gaersum Aern, Charlotte discovers a stone puzzle box that contains a pentagram necklace and a note from her mother—clues to her family’s strange past and her mother’s disappearance. Charlotte must try to solve the puzzle box, decipher her mother’s old journals, and figure out who is working to derail her efforts—and why. The family manor contains many secrets and hidden histories, keys to the elegant mystery Charlotte called mom and hopefully, a trail to finding her.

Thanks very much, Rebecca, for this thoughtful and informative discussion of the OCD/hoarding portrayal in The Butterfly Clues!

For those of you who have read The Butterfly Clues, what did you think of the presentation of Lo's mental health issues?

Guest Post: Best Friends Forever...Whatever

I'm happy to welcome Jeannie Campbell from The Character Therapist back to the blog for another Psychtember guest post! You can read Jeannie's guest post for last year's event here.

Best Friends Forever….Whatever

By

Jeannie Campbell, LMFT

There seems to be a growing trend in YA novels to feature a heroine with low self-esteem who has to endure the malevolent ministrations of her so-called best friend.

The heroine is usually too timid to speak up for herself at the beginning of the book. Her “best friend” gives her backhanded compliments and teases her in the one area that emotionally cripples the heroine.

One book with the scenario above is Jennifer Echol’s The One That I Want. Gemma’s frenemy, Addison, wants the guy Gemma does. She makes things intolerable for Gemma with cutting remarks about Gemma’s weight or fashion sense.

Claire LaZebnik’s Epic Fail features an uprooted young heroine, planted in a hip Los Angeles prep school. She gets in with the “in” crowd, who only turn on her with cruelty to ruin her life.

I began to reflect whether this accurately reflects the pulse of young adult female friendships and did a little research.

Apparently, it does.

In 2010, Dr. Michelle Anthony and Dr. Reyna Lindert wrote Little Girls Can Be Mean,  a book that addresses this very issue.  They focused on elementary-aged girls (K-6) and the friend-slash-bully their own daughters had faced.

It seems that boys don’t typically have this type of covert bullying. They are much more physical in how they intimidate and manipulate each other. Girls, on the other hand, rarely do overt bullying, and tend to favor the old saying, “Keep your friends close and your enemies closer.”

Bullying best friends only gets worse as time passes. The stakes are higher, as are the social consequences. Many of these girls have been mistreated for so long that by high school, they succumb to the feelings of hopelessness and helplessness and never imagine they could change their social situation.

As a mental health professional, I am concerned about the lack of a role model these heroines would be for my own daughter, were she old enough to read these stories. And while I’m secretly glad that the evil best friend gets her comeuppance by the end of the book, she does so only after the heroine either humiliates her publically or tells her off privately.

I’m not a fan of these inappropriate portrayals of how to solve interpersonal conflicts. Teens should be able to communicate in an assertive manner what their needs are, whether those needs are emotional, social, or physical. If a friend stands you up in favor of hanging out with someone else, no girl should just “let this slide,” or make up excuses for the friend’s behavior.

I realize that fictional books have to take the heroine through a journey. The internal character arc of being fearful at first and then growing courageous enough to speak up for yourself is attractive to many authors. It’s an easy sell, but there can be so much more to fiction!

I’m appreciative of the YA books bringing this issue to light, but we have to be careful about what message we are sending out to teens. We want to reach them where they are at, and many a teen girl will relate to being bullied by her best friend.

Great, that means she’ll pick up the book off the shelf.

So let’s make sure that when she does so, what she reads is like a road map to show her how she can better her social life through assertive communication, not aggression, revenge, or passive-aggressiveness. 

Jeannie Campbell is a Licensed Marriage and Family Therapist in the state of California. She is Head of Clinical Services for a large non-profit, but has worked in a variety of venues, from a psychiatric hospital to private practice. She is the owner and operator of The Character Therapist, an online therapy service for fictional characters where writers can receive her professional insight to improve characterization with psychology. 

Thanks very much, Jeannie, for drawing attention to this unsettling trend in teenage girl "friendships" (and YA)!

Readers, what books have you read that portray these types of relationships? Have you ever had a "best friend" of this variety?

Guest Post: Where Real Meets Unreal

I'm happy to welcome Dr. Sarah Fine, author of the upcoming YA novel Sanctum, back to the blog for another Psychtember guest post! (You can read Sarah's guest post from last year here.)

Where Real Meets Unreal: Characters’ Reactions to Trauma in YA Speculative Fiction

When I was in the early stages of writing SANCTUM (which comes out only a few weeks from now! October 16^th! Yipes!), I made a decision: The protagonist, Lela, had to be a tough, scrappy fighter, someone who could believably sneak her way into hell and battle whatever she came up against. Out of that decision blossomed Lela’s past, which is marked by abuse and loss. But … as a psychologist who’s worked with kids who’ve been through some pretty tough stuff, I couldn’t give Lela that kind of history without consequences for her as a character. It left her wounded. Vulnerable. In need of some healing even though she couldn’t yet ask for it.

Basically, I created a character who exhibits many symptoms of post-traumatic stress disorder (PTSD), though in the contemporary urban fantasy world of SANCTUM, it is never called exactly that. But if we consider the formal diagnostic criteria in the DSM-IV, Lela’s experience definitely meets Criterion A (a trauma which involved a threat to her “physical integrity” and her own helpless reaction to it), Criterion B (re-experiencing of the trauma; I’m trying not to spoil things so I won’t get specific), Criterion C (at least three symptoms of avoidance/numbing of responsiveness), and Criterion D (at least two symptoms of hyperarousal, things like exaggerated startle response and hypervigilance to threats) for PTSD. The trauma occurs two years prior to the start of the story, and the symptoms have dogged her ever since. How they impact her actions and relationships—and how she evolves as a result of what she goes through in the dark city beyond the Suicide Gates—is a significant part of her development as a character throughout the series.

In fantasy, there’s often not a lot of room for formal diagnostic talk or labels, which is something you see more often in contemporary YAs like Wintergirls, Hold Still, Willow, and Life Is But A Dream. A few contemps, such as Compulsion, are specifically about a mental illness but don’t necessarily label it. A notable exception is Jackie Morse Kessler’s fascinating fantasy series about the Riders of the Apocalypse, in which several of the characters have diagnosable disorders, including anorexia and self-harm (which is a nonspecific symptom of several different disorders, actually).

But usually, in speculative fiction, we don’t see this so much. Considering the occurrence of mental illness in adolescents (1 in 5!), you might think we would, but the sci-fi/fantasy genres tend to have a different focus. The big exception here, however, is reactions to trauma. Which makes sense, because the characters regularly go through terrifying, life-threatening things. In fact, I might argue that we don’t see truly impairing reactions to traumatic events in YA sci-fi/fantasy/dystopians as often as you might expect, given what authors (including myself …) put their characters through. I mean, there aren’t a ton of studies on how frequently PTSD occurs after a traumatic event, but in a study of folks in Manhattan after 9/11, it turned out well over 50% had at least one identifiable symptom of PTSD in the 5-8 weeks afterward. In other words, it’s pretty common to experience some lingering effects after something that scary.

The Marbury Lens is all about what could be considered an acute stress reaction (ASR) but is not at all a clinical examination of it (because it’s A LOT more complex and wild than that). And in Insurgent, Tris exhibits several clearly identifiable symptoms of Acute Stress Disorder, the only thing she could really be diagnosed with so shortly after a trauma (PTSD can only be diagnosed a minimum of one month after the trauma). She has some re-experiencing of the event, avoidance of things that remind her of it, and symptoms of increased emotional arousal. HOWEVER … she doesn’t exhibit any dissociative symptoms (that I could detect), so she doesn’t actually meet formal criteria for the disorder. That doesn’t mean she isn’t deeply affected by what happens at the end of Divergent, though.

In Catching Fire and Mockingjay, Katniss experiences debilitating symptoms of PTSD (so do a few of the other characters). In reading those books, I really felt like Suzanne Collins captured how persistent and crippling those symptoms could be. I appreciated how, in books that portray incredible brutality and violence, she did not shrink from showing the severe and lasting effects of those things on the characters. It wasn’t like they got out unscathed—quite the contrary. They (most of them, at least) were not destroyed by their experiences, but they were changed by them, and not in a good, healthy way. Despite that, they persisted, and in my opinion, there’s true heroism and bravery in that alone.

What are some other fantasy or sci-fi books you’ve read that cover the characters’ reactions to traumatic events? Are there any that strike you as being particularly well done? Have you read books where you wonder how the character manages to endure intense trauma and come away seemingly unscathed? Where do you think this type of thing—true PTSD or any other mental disorder—fits within the scope, plots, etc. of non-realistic/contemporary YA fiction?

Sarah Fine got her doctorate in clinical psychology and specializes in working with children and their families. Her YA urban fantasy debut, SANCTUM, will be published on October 16th (Marshall Cavendish Children's Books/Amazon Children's Publishing). She is represented by Kathleen Ortiz at New Leaf Literary. Her blog, The Strangest Situation, is about the (messy, awesome, blurred, thrilling) intersection of those two endeavors.

Thanks so much, Sarah, for this insightful analysis of trauma portrayals in YA fantasy and sci-fi! Readers, what are your thoughts on this topic? How would you respond to the questions Sarah raises?

Psychtember Question Box!

Psychtember is back this coming fall (mark your calendars!), and along with it, Dr. Carolyn Kaufman! She's a clinical psychologist, author of the book The Writer's Guide to Psychology, and writing coach. You can read last year's interviews with her here and here. 

Last year I gave my blog readers the chance to offer up their own questions for Dr. Kaufman, and I'd like to do the same again this year! This time around, though, I'm going to make it an anonymous "Question Box" so that people feel more comfortable voicing their ideas. For instance...

• Are you a writer, wondering how to best portray a character with a particular mental illness? 
• Are you a reader, trying to figure out if therapy in real life actually works like it does in the YA novel you're reading? 
• Are you a mental health professional looking for books to recommend for teens who are struggling with mental health issues?  

 

Whatever the case may be, I welcome your questions! I'll choose some and pass them on to Dr. Kaufman, who will answer them during the event.

To suggest a question or topic for Dr. Kaufman to discuss, please use the form below (or if it's not working for you, this link here).

Guest Post: Parentification in YA (and eBook giveaway!)

Today I'm happy to welcome Jeannie Campbell from The Character Therapist to the blog for a Psychtember guest post!
 

Jeannie Campbell is a Licensed Marriage and Family Therapist in the state of California. She is Head of Clinical Services for a large non-profit, but has worked in a variety of venues, from a psychiatric hospital to private practice. She graduated summa cum laude from New Orleans Baptist Theological Seminary with a Masters in Psychology and Counseling and magna cum laude from the University of Mississippi with a double major in psychology and journalism.

I’m so honored to be included in Psychtember. YA books are some of the most fun to read for me because I deal with a lot of teens and early twenties in my own practice as a Licensed Marriage and Family Therapist.

Today I’m blogging about parentified teens, which is something I’ve seen a lot in real life, so therefore should see a lot of in fictional books. All of you YA writers out there would be the best place for me to start. 

WHAT IT IS

Parentification is a role reversal between parent and child. The child's needs of comfort, guidance and attention are sacrificed to meet the parent's physical and emotional needs.

There are two types of parentification: 

1) Emotional 

A child is robbed of a childhood when they have to meet the emotional or psychological needs their parent. Parents sometimes talk to their children as if they are therapists, best friends, or even worse, as a surrogate spouse or significant other. Sometimes this is called emotional incest, and it happens with the child who is the opposite sex of the parent. 

2) Physical 

Sometimes called instrumental parentification, this is when the child takes up the role of meeting the physical needs of the parent or family. This could include cooking, cleaning, grocery shopping, paying bills, getting younger siblings ready for school, helping with homework, giving out medications, and much more. It's not the same as giving a child assigned chores to complete. It's dysfunctional in that the duties are beyond the age-appropriate level for that child, leaving them little/no time to engage in normal childhood activities like playing, going to school, doing sports, developing peer friendships, and even sleeping. 

WHAT'S WRONG WITH IT 

Children and teens learn about their world through experience. They go through developmental milestones each year, which allow them to be self-sufficient adults. When they are in a home with responsible parents, they are free to explore their environment and not worry about making mistakes because they have their parents as safety nets.

A parentified child has no such freedom. They are stifled, unable to explore for fear of making mistakes, and they can't afford to make mistakes! They become isolated from their peers and may associate with individuals who are older, putting them at risk of being manipulated or used by older people. They carry an enormous burden, which is unhealthy and overwhelming. It's emotional abuse with damaging effects. 

PARENTAL FACTORS 

What type of parents do parentified children likely have? Usually if there is any kind of drug or alcohol abuse, the children try to take care of their parent. Stealing their keys so the parent doesn't drive drunk, hiding alcohol or pills so they can't be found...that type thing. If a parent is absent and there are multiple children, the oldest will generally be parentified, stepping in to take care of the younger by doing laundry, learning to cook, making school lunches, etc. Parents with personality disorders or severe mental illness are also prone to parentifying their children. It varies from situation to situation, but rarely (if ever) would you find a parentified child with a "normal" parent. 

LONG-TERM EFFECTS 

There are many. I'll stick to a few main ones below. 

1) Rocky relationships as adults - in general, a parentified child has difficulties forming relationships as an adult. Many marriages and friendships fail as adults. Sometimes when a child isn't allowed to act like a child when he/she is a child, they start to act like a child when they grow up. Their partner might think them irresponsible or immature, as if they are sowing wild oats not sown before. 

2) Anger - can be explosive or passive. They may not know why they are angry, but find themselves lashing out at people they care about. They can harbor lingering resentment at their parent, long after the parent has died or been incarcerated or institutionalized. Eventually the child will grow up and realize they had no childhood, and they'll never get that time back. 

3) Perfectionism - mentioned above, but a parentified child had to live up to high expectations, not only of their incompetent parent, but also of themselves. What child doesn't want to please their parent, to take care of them if need be? As children they believed that their power was unlimited. Rescuing their mom or dad required doing everything just right, and if they failed, they berate themselves and think it's their fault. They do this into adulthood. 

4) Control freak - being robbed of any other way of living except being in control, a parentified child might automatically default to being in control (if they don't swing in the other direction), and might react badly when a situation goes beyond their control or they feel their control is being threatened.

Young adults everywhere can relate to parentification, I promise. Either they will have experienced it firsthand or know of a friend who did. I hope that this post gets your wheels turning about how to incorporate this information into your own works in progress!

I hope that you’ll take the time to visit my website, The Character Therapist, and sign up for my newsletter. You’ll automatically receive my Writer’s Guide to Character Motivation for free. While you’re there, sign up to be a “follower” of my blog…just ‘cause you’re nice.

I’m also giving away a copy of my Writer’s Guide to Creating Rich Back Stories to one lucky commenter on this post! To be entered, just leave your email address below.

Thanks very much, Jeannie, for such an interesting discussion, and for offering up your e-book for giveaway! The winner will be drawn on Sunday, Sept. 18, after 8 pm EDT.

Psychtember Interview with Dr. Carolyn Kaufman: Part 2

I'm very pleased to have Dr. Carolyn Kaufman back on the blog today for the second part of her interview! She's the author of the excellent The Writer's Guide to Psychology, and she stopped by last week for Part 1. (If you haven't read that post yet, definitely check it out!) 

First, a bit about her: 

Carolyn Kaufman is a clinical psychologist, an Associate Professor of Psychology, and a writing coach.  Her book, THE WRITER'S GUIDE TO PSYCHOLOGY: How to Write Accurately About Psychological Disorders, Clinical Treatment, and Human Behavior is a fun, easy-to-understand guide that helps writers avoid common misconceptions and inaccuracies and "get the psych right" in their stories. She blogs about writing for the QueryTracker.net Blog and Psychology Today. You can also learn more about The Writer's Guide to Psychology or follow her on Facebook or Google+! 

Note: These interviews are a combination of my own questions and a few submitted by anonymous others.

- What is your process for creating a character with mental illness? 

I like creating characters with psychological problems, because a lot of real people have psychological problems, and I think real problems bring veracity to a story. Off the top of my head, I’ve had several characters with PTSD (Post Traumatic Stress Disorder…the villain in that story was really sadistic!), a character with social anxiety disorder, and a character who was suicidally depressed.

Some tips for creating a character with a psychological problem:

1.     Pick one psychological problem, not multiple problems.  Comorbid disorders (two or more disorders that impact one another) always complicate the clinical picture, and if your character has multiple disorders, you’re going to have more trouble portraying any of them accurately.  Even with my psychologist background, I only choose one disorder at a time for a character, because more than that is too much to juggle well.

2.     Research the disorder using reliable sources, and double-check the things you think you know.  For example, many people mistakenly think schizophrenia and multiple personalities are the same thing (as noted above, they’re totally different, and the official name for multiple personalities is now “dissociative identity disorder”).

 There are general message boards online for writers to ask questions about areas they’re researching, and I’m sure they’re great with objective information, but they can be minefields when it comes to psychology.  Everybody thinks they understand psychology (especially if they’ve had problems of their own), and so a lot of urban legends get tossed around.  You’re better off visiting some medical or psychiatric websites that describe the disorder, maybe visiting some message boards where people who have the disorder talk about it amongst themselves, reading a self-help book or two on the disorder, getting a copy of The Writer’s Guide to Psychology (sorry, couldn’t resist! [http://amzn.to/jIz0m8]), or even writing an email to one of the psychologists online who work with writers.  I do that via my Archetype Writing website (there’s a Q&A form at http://archetypewriting.com/qa/qaform.htm), but I know there are others out there, too. For example, if you’re writing about a disorder in a younger child, Sarah E. Fine, a practicing child psychologist, is a great resource, and she welcomes questions on her blog, The Strangest Situation (http://thestrangestsituation.blogspot.com/).

3.     Remember that someone who’s dealing with a psychological disorder is dealing with it across settings – at school, at work, at home, and with friends.  The disorder shouldn’t randomly appear and disappear when it’s convenient for the story.  In many ways, the disorder can be likened to the character’s shadow – it’s always there, though perhaps more noticeable some times than others, and it darkens the character’s life.

- When telling a story with a mentally ill character, how do you make sure you're accurately portraying the disorder without overloading the reader with psychology facts? 

The trick, I think, is to show the disorder in the character’s life, rather than telling the reader about it.  While stories can help readers understand mental illness, a storyteller’s job is first and foremost to tell a good story!  If you really feel compelled to educate readers on a disorder – maybe because you’ve dealt with it yourself -- you can always provide some “back matter” for the book or story that recommends a good book or website with more information.

In my story that has two characters with PTSD, nobody even calls the disorder PTSD, because it’s set in a post-apocalyptic world without fancy diagnostic manuals. Everybody calls it “war sickness.”  So don’t feel like you’re obligated to name and describe the disorder. Just show how it impacts your character’s life (and the lives of those around her).

- In your experience, does the stigma associated with mental illness extend to reading books involving these disorders? If so, how would you suggest members of the book community (writers, librarians, booksellers, etc.) try to combat this?

I’m not aware of a stigma against reading books about people who have psychological problems; in fact, I think people are fascinated by mental illness and may sometimes even go out of their way to read about characters who have it.

I think what’s harder is not treating people who have psychological problems like train wrecks with no feelings.  There’s a myth that people with psychological problems—whether we’re talking about something like schizophrenia or something more common like ADHD--don’t realize that others are looking at them, whispering about them, and judging them.  Believe me, most of them know, and it’s hurtful.

What I find upsetting is when a psychological problem is handled by an author who has clearly never given a single thought as to how difficult it is to live with the burden of a disorder.  These types of authors tend to use psychological problems in a gimmicky way; they trot out mentally ill characters as if they were “freaks” in a carnival.  Nobody would treat someone with cancer that way in a book; they shouldn’t do it with psychological disorders.

With regards to members of the book community, I do think it’s cool when authors who deal with serious psychological issues point readers in the direction of more information, whether that information is on a website or in a well-written self-help book.  I know that librarians and booksellers often have strict rules about what can be placed where, but if a book really takes on a serious psychological issue, it would be great to display one or two other books on dealing with those problems in real life.

Thanks so much, Carolyn, for providing some great insights into writing about mental health issues!

Readers, have any of these discussion topics sparked some more questions? If so, ask away in the comments, and Carolyn will stop by to answer them! :) 

 

Guest Post: Writing Mental Health Well

I'm delighted to welcome Dr. Sarah Fine from The Strangest Situation to the blog! First, a bit about her:

Sarah Fine got her doctorate in clinical psychology and specializes in working with children and their families. She also writes young adult fiction and is represented by Kathleen Ortiz at Nancy Coffey Literary. Her blog, The Strangest Situation, is about the (messy, awesome, blurred, thrilling) intersection of those two endeavors.

And here's Sarah's guest post for Psychtember:

I frequent the forums at AbsoluteWrite, and fairly regularly, I see folks asking about how to write characters with certain mental illnesses. And sometimes, in the query forums, I see queries referring to characters who are “schizo” (which always makes me cringe) or who have obsessive compulsive disorder, bipolar disorder, or anxiety. I also get plenty of questions in my inbox from writers wanting to make sure their plots and characterizations are accurate. Mental illness is a hot topic!

Some people might ask: Why are people so keen to write this type of “darkness” into their stories and characters (Hi, Meghan Cox Gurdon! Yes, I AM talking to you!)?

Let’s start with this:

About 20% of children and adolescents in the United States have an emotional or mental disorder.

That’s … a lot. Many of us have loved ones and friends who have been diagnosed with a mental illness. Many of us have ourselves been diagnosed with a mental illness. I know of few people whose lives have been untouched by depression or anxiety or some other emotional or mental disorder. And so, many of us want to write stories that include these elements. The question is—how do you do it well?

A few humble suggestions:

1. Go for individuality. Not every person with a certain diagnosis has the same symptoms or behaves in the exact same way. FAR FROM IT. Just because you know one person with bipolar disorder doesn’t mean you understand all people with bipolar disorder, right? Because children and adolescents (and adults) with emotional and mental disorders are an incredibly diverse bunch, don’t go for the obvious stereotype. Examples of books that include highly individualized portrayals of characters with diagnosed mental illnesses: Cryer’s Cross, by Lisa McMann, and The Curious Incident of the Dog in the Night-Time, by Mark Haddon.

2. Go for depth. No matter what the diagnosis, each person IS A PERSON with likes, dislikes, fears, quirks, preferences, strengths, and talents, right? It’s the details that make them 3-D: mannerisms, speech patterns, passions, pet peeves. A good character, regardless of a diagnosis, will have all of these. And without them, all you’ve got is cardboard. Examples of books that have accomplished this kind of depth: Harmonic Feedback, by Tara Kelly and Hold Still, by Nina LaCour.

3. Go for reality. If you’re writing a person who’s been diagnosed with a disorder, there has to be impairment. Some aspect of daily functioning must be problematic as a result. That’s what makes it a disorder. Mental illness is not pretty, or delicate, or elegant, or convenient, or attractive. Mental and emotional disorders bring enormous costs—in lost opportunities and broken relationships, stumbles and tragedies, not to mention incredible suffering. I'm totally not saying it has to be all-painful-all-the-time, because people live and cope and thrive despite having these disorders every day. I'm just saying don’t trivialize it. Use individuality to make your character sympathetic. Use talents and quirks to make the character attractive. Use strengths and resilience to help the character triumph. But don’t gloss over the illness. Awesome examples: Cracked Up To Be, by Courtney Summers, and Willow, by Julia Hoban.

4. Go for accuracy. What are the basic diagnostic criteria for the disorder you’re writing about? Do you understand them? Do you know what they actually mean, how they actually look? Do you know much about the disorder itself? If you’re in the research stage for your book, I suggest you start here or here. (I also suggest you be careful of the internet, because, man, there’s a lot of wild, unfounded information out there.) But don't just read the facts. Read a few personal stories. And of course, if you know someone with that diagnosis who's willing to give you a perspective, listen and take a lot of notes, because that will give you a lot more depth and warmth--and intensity, especially if you’re writing about a teen.

Oh, and if you happen to have the diagnosis yourself, I STILL suggest you get other perspectives. Writing a character who is a thinly veiled version of you can be a trap--what's it going to feel like if one of your betas says your MC is unsympathetic? It's gonna feel personal! So be careful with that (and that goes for every character, not just ones with mental illnesses). Examples of blisteringly accurate portrayals of mental illness: Wintergirls by Laurie Halse Anderson and Compulsion, by Heidi Ayarbe.

5. Go for perspective. Just because your character has a mental illness, that doesn’t mean you have an issue book (unless you want to). It doesn’t mean that your book is about mental illness. Your book is about a character (and probably more than one), right? The mental illness does not define that character. Great examples of this: Will Grayson, Will Grayson, by John Green and David Levithan, and The Things a Brother Knows, by Dana Reinhardt.

There you have it, my quick guide for writing characters with mental or emotional disorders. Any questions? Do you have some additional points to add to this list? What about good books to suggest or that demonstrate one of these points? There are so many excellent ones out there (and, of course, a few that aren’t so excellent, but we don’t have to name those). Are you writing a book that includes a character with a mental illness? How have you gone about it?


Thanks very much, Sarah, for these helpful suggestions!

Guest Post: A Possible Role for Books in Teen Mental Health

I'm very happy to welcome Dr. Alicia Hendley to the blog today, for a Psychtember guest post! First, a bit about her:

"Alicia Hendley is a clinical psychologist (currently works at a university counselling centre), mom of four, and writer of fiction and poetry. She obtained her Ph.D. in Clinical Psychology from the University of Windsor (Ontario). Her first novel (A Subtle Thing) was published in 2010 (Five Rivers Chapmanry) and depicts a young woman's experiences with depression, beginning in adolescence. She has also written a novel for adults about bullying as well as a middle grade novel geared for girls (both unpublished). Alicia can be found at aliciahendley.blogspot.com."

And now her post!

 

When it comes to mental health, adolescence is not necessarily a carefree time of sunny skies and calm seas. According to results from a recent survey of over 10,000 teens across the USAⁱ, over 30% of participants had met criteria for an anxiety disorder in their lifetime, with about 14% having experienced a mood disorder and about 11% having experienced a substance use disorder. The average age for an anxiety disorder to begin was six-years-old (I will say this again—six-years-old!), with age thirteen as the average age of onset for a mood disorder and age fifteen for a substance use disorder. Elsewhere, in a study that followed over 1400 children for several years ⁱⁱ, it was noted that by age sixteen, over 35% of participants had been diagnosed with at least one mental disorder. Such rates should raise the hackles on the necks of any concerned adult.

What should raise the hackles even more is this sobering fact: a significant proportion of teens who are struggling with mental health difficulties do not seek out help, even when such help is available.

Why would this be? I would argue that for many teens, there is a sense of shame and isolation associated with what they are experiencing, be it thoughts of suicide, binge-eating, or self-mutilation. It’s hard to give a voice to your psychological pain when you worry that others may label you as different, unacceptable, or even worse, crazy.

Another factor to consider is whether or not the teen feels truly ready to make the changes that may be involved in recovery. When I speak of change here, I refer to both general change, such as deciding to start going regularly to psychotherapy, as well as more specific change, such as learning how to cope with intense pain without cutting or purging.

When thinking about such changes, many health professionals use the Stages of Change framework ⁱⁱⁱ. This framework views change as a process involving several phases, including pre-contemplation, contemplation, preparation, action, and maintenance. While this model is commonly used with substance use problems, I see it as a helpful general framework to use when considering how ready someone is for active work in therapy.

As a psychologist, most clients enter my office in the contemplation or preparation stages. They are likely struggling with certain concerns and may be thinking seriously about trying to make a change. When in those stages, information about one’s difficulties, whether found in magazine articles, news items, or even in novels, can play a positive role in terms of whether or not the process of change actually continues.

Speaking from my own clinical experiences working with hundreds of young people, I have repeatedly had clients tell me that a book they have read impacted their decision to seek help. Some of these books have been novels, some memoirs, some have been directly geared to the young adult reader, some not. Regardless, I have witnessed this phenomenon enough times to know that there is something to it. On more than one occasion, I’ve had a teen client confide in me that they had believed what they were going through was so “crazy”, so “disgusting”, and so “abnormal” that they were too ashamed to tell anyone, until they read about others who were going through the same thing and realized that maybe they weren’t quite so different, after all. It seems that these books did what I try to do with my clients—they helped to give words to emotional pain and to normalize what can feel so terribly, horribly wrong.

Does this mean that anything goes in terms of YA literature written about psychological difficulties? Of course not—and to me that it where the role of a good, professional editor comes in, to ensure that the content of the manuscript in front of them is worthy of its most vulnerable readers. But keeping in mind the rates of mental disorders amongst adolescents, I would argue that even if YA books written about psychological concerns ultimately play only a small role in helping more teens decide to seek help, they are worth their weight in gold.


Thanks very much, Alicia, for sharing your perspective on this topic!


Readers, what do you think about the role of books for teens struggling with mental health issues?

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ⁱ Merikangas, K.R., He, J.P., Burstein, M., Swanson, S.A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Commorbidity Survey Replication—Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10),  980-989. 

ⁱⁱ Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837-844. 

ⁱⁱⁱ Prochaska , J.O., & DiClemente, C.C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.