On Writing Mentally Ill & Insane Characters

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Know what it means to be psychotic, insane, and mentally ill.

First, the term "psychotic" refers to someone who has a severely warped perception of reality due to an underlying disorder. It is not to be confused with the term "psychopathic," which means something else entirely. Someone who is psychotic may experience delusional beliefs (eg, that the government has bugged xir house, or that xe has a special mental connection to a celebrity, or that aliens are plotting to kidnap xir), or may experience hallucinations. Being psychotic does not necessarily mean a person will commit violent action - someone who is a pacifist, for example, isn’t likely to go shooting people just because a voice in xir head told xir to.

"Insane" is a legal term today. To quote Law.com, "insanity" is:
n. mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis, or is subject to uncontrollable impulsive behavior.

Let's examine what it means to be "mentally ill," or what it means to have a mental disorder. Different places give slightly different descriptions, but most agree that it has little to do with simply having some eccentric tastes or some unusual personal beliefs about the nature of reality. For a few examples, let's take the Merriam-Webster definition, the Mayo Clinic definition, the National Alliance on Mental Illness's definition, and the DSM5's definition. To sum up the last one, a mental disorder typically causes disability or distress in one's life, and cannot be accounted for as a normal reaction to a difficult event or as a behavior considered normal in the person's culture. Furthermore, one is not mentally ill merely for having opinions or engaging in behavior that runs contrary to society's expectations and values.

Now, society is full of people who will label people insane or crazy at the drop of a hat. Mutter under your breath to memorize something? SCHIZO! A little too energetic and enthusiastic? CRAY-CRAY! Rock yourself or twiddle your hands to calm yourself down? PSYCHO! A little too interested in a specific subject? NUTCASE! See the world in a somewhat different light from everyone else and have opinions that aren't quite mainstream? INSANE!

Sure, these issues can potentially indicate an underlying illness, but are not proof in and of themselves. If people who exhibit them otherwise have no trouble getting along with their lives, let alone show any further symptoms that could indicate a genuine mental illness, then people are wrong (and cruel, if they use the terms in a derogatory or dismissive sense) in labeling them thus. If they don't actually have any other issues, then they can probably be accurately described as quirky, eccentric, strange, offbeat, or odd. Insane, mad, crazy, and all those are would most likely be misnomers. And while we're at it, characters who act "random" aren't insane or "crazy," either - being "random" is simply a form of goofing off.

As an example of a character who might be considered insane by the average but probably actually isn't, let's look at Dr. Finkelstein in The Nightmare Before Christmas. Fans occasionally refer to him as "the mad scientist." However, there's no in-universe justification to assume he is "mad." He is narcissistic and controlling, yes. But given that he is respected by other members of his community - including the kind-hearted Jack Skellington - we can infer that Dr. Finkelstein doesn't do anything too far out of his culture's boundaries and norms. For all appearances, Dr. Finkelstein is not insane.

Some common myths and misconceptions addressed.

MOST MENTALLY ILL PEOPLE ARE NOT VIOLENT. Mental illness does not magically remove someone's more compass nor erase their ability to feel empathy. The scant few people who harm others due to mental illness usually do so because of a strong underlying delusion, a compulsion, and/or a lack of self-control. Potentially, a person who believed that xir child was possessed by demons due to psychosis might kill that child if xe believed it was the only way to get rid of the demons. But again, remember: most mentally ill people are no more violent than anyone else.

Also, a person does not simply snap and go into a state of permanent insanity or psychosis after a single traumatic event. Otherwise mentally-healthy people are sometimes known to develop temporary psychosis after a traumatic or stressful event, but recovery will occur within a month. Trauma and stress can also potentially exacerbate the symptoms of a pre-existing mental illness, or trigger an episode associated with it, or make it difficult for the person to cope with its symptoms. Long-term stress and abuse are also associated with certain mental disorders. And of course, certain drugs and medications can trigger psychotic episodes.

This isn't to say that sudden trauma never causes mental issues of any kind. Sudden trauma can result in developing a phobia or PTSD. Because the minds of people with PTSD are constantly on high alert for danger, they are more likely to perceive a threat where there is none, and they may react accordingly. Additionally, they will have a harder time in general regulating their emotions, which can cause them to lash out in harmful ways. But even so, the vast majority of people with PTSD are not violent, and PTSD does not turn people into aggressive predatory killers. If anything, they're more likely to harm themselves - those with PTSD are far more likely to commit self-harm or suicide than others.

Also, contrary to what some people think, not all unprovable or outlandish beliefs mean mental illness, psychosis, or insanity, and neither will a competent psychotherapist immediately assume they do. In psychology, a delusional belief is a belief that one clings to regardless of facts shown to the contrary, and cannot be explained through things that this person has learned. Colloquially, a delusion is any false belief a person holds. While psychosis can create delusional beliefs, not all false or outlandish beliefs come from psychosis. If John taught from birth that the world was a giant cabbage, that humanity was descended from aphids, and that anyone who said otherwise was part of an evil conspiracy to lead people away from the truth, he could hardly be considered psychotic for believing thus. People in general are often reluctant and find it difficult to let go of beliefs that they find soothing, or that give them a sense of place in the world, or have held for a long time, or have deep personal investments in; if they resist convincing otherwise due to this, they cannot be described as psychotic, insane, or mentally ill for it.

Things that need to be avoided.

The pretty little "mad" waif. You know, the characters who sit around in pretty frilly dresses, sip tea (or blood), and make pretty little babble at people (or stuffed animals). These characters inevitably make mental illness look pretty and romantic.

The "mad" prophet/prophetess. The characters who through nigh-incomprehensible babble deliver prophecies and wisdom. This perpetuates the myth that there is something magical or mystical about mental illness.

The perfect innocent who snaps, goes "insane," and goes on a murder rampage. For reasons mentioned earlier, this is bollocks. Plus, it reinforces the misconception that mental illness or insanity automatically means violent behavior.

Characters who do bad things simply because they’re mentally ill. Mental illness isn’t a magic switch that flips a person’s morality topsy-turvy or turns it off entirely. While mental illness can in some cases contribute to a person’s harmful or destructive behaviors, there is still always an underlying motivation behind the person’s actions.

Characters whose coolness, awesomeness, or badassery is supposed to derive from their "insanity" or "madness." This is a form of romanticizing mental illness, so please avoid doing this. It's fine if your character's awesomeness or coolness comes from being an offbeat eccentric, but to link it to actual insanity or mental illness is not okay.

Characters for whom being "insane" or "crazy" is pretty much all the character is about. People with mental illnesses are people with hopes, dreams, fears, ambitions, hobbies, passions, etc. Characters who are supposed to have severe mental issues need to be three-dimensional people as much as any other type of character does.

Using "insanity" or "craziness" as an excuse for a character behaving in an incoherent, inconsistent way. Mentally ill people who do strange-seeming things usually have an actual rationale for it that just isn't obvious or intuitive to the average person. Let's say we have a psychotic individual who puts a radio into a freezer. This person isn't doing it because mentally ill people are just so lolrandom, but is more likely doing it out of a genuine belief that the radio ought to be put there for some reason - perhaps this individual believes that putting the radio in the freezer will destroy the government spying devices in it, or stop it from emitting harmful radiation.

Equating mental illness with childishness. It sometimes happens that mentally ill teens and adults are treated as or are even outright stated to be "sad/lonely/hurting little children inside." Sometimes they're shown to be naive about things that most people know, ("why do you make so much noise when I poke you with this knife?") or talk with a "childish" vocabulary ("you've been naughty, and now you must be punished!"). Sometimes caring for them is depicted as being much like caring for a sick or injured child. All of this is inaccurate. Mental illness typically doesn't make people think, act, or talk like children, and even when they do need care they absolutely should not be treated like children by their caretakers. This trope is actually harmful, as it helps perpetuate the myth that mentally ill people have childish mentalities and need to be treated like children.

Anything that implies that being "insane" is something that people do simply to be irritating, difficult, different, or rebellious. Because it's not. It's the result of a mental illness. It's not something that one can simply up and decide to be or not to be.

Anything that implies that anyone with with strange or unconventional ideas, opinions, or habits must be "insane." As explored above, a person can believe or do things that would be considered pretty strange by the majority of the populace without actually being mentally ill.

(Note that for the last two, it's one thing if characters in the story believe thus. But if the rest of the story agrees with these characters and shows their views to be absolutely true... then you've got an issue.)

Let your mentally ill characters take care of themselves more.

Although mental illness can and often will make life pretty difficult in many ways, this doesn't mean that your mentally ill characters should all be completely helpless and reliant on others. In fact, this is a pretty insulting way to depict the mentally ill. There's often a lot that mentally ill people can do for themselves. For one thing, many mentally ill people have jobs just like everyone else.

Research, research, RESEARCH!

What you see in TV and books is often wrong, and what the population at large believes is often wrong. For example, many people think of schizophrenia as a mental illness that causes multiple personalities, when in fact it causes psychosis and can dampen a person’s ability to feel emotion. Bipolar disorder doesn’t cause an instant shift in mood, but rather its effects happen over a period of time.

Likewise, the terminology to refer to the mentally ill has changed over the years - while using "mad" or "crazy" would have been considered perfectly professional in times past, today the terms are considered by many to be insensitive and hurtful due to their long history of being used in derogatory and dismissive fashions. So it's important that you know which terms would be appropriate to use in your work depending on the time period and setting you're writing.

Whatever mental condition you’re planning to write, do the research. Read books, medical websites, blogs, etc. - anything you can find. But remember - the map is not the territory. If you go to a website that lists symptoms and behavioral criteria and base a character's condition solely on that, you will get it wrong. Make sure you look into sources where people who have the condition are writing. Don’t limit yourself to one source, either - read as much as you can.