Understanding Mental Illness for Fiction Writers: Schizophrenia Part II

Welcome back to Part II of our discussion on Schizophrenia.  In Part I, we defined the illness and how a real life person may present in a mental health clinic or hospital.  Today, the discussion will focus on how the illness is presented in film and other works of fiction.

One of the great things about writing fiction is the freedom to create a world or fit facts in any way, shape or form you choose.  If your world building is done in a credible way, readers will go along with your story without question.

However, there should be a certain level of caution when one factors in factual data.  You want to get it straight.  Particularly in the case of mental illness, why ignore the authenticity of your characters? We want to emotionally hook readers into our stories, so that they follow through to The End.  We don’t want to run the risk of alienating informed readers or adding to the negative stigma of mental illness.

Misconception #1: the use of the label schizophrenia designates all mental illness.  It also implies the crazy of crazies.  Typically when we see this label, the person is presented as dangerous, unpredictable, “mad”, deranged.  The writers, in the hunt for dramatic effect, fail to take into account that schizophrenia is a specific disorder with a special disease process.  Rarely do people who suffer with this condition, in this day and age of psychotropic medications and advanced behavior treatment strategies, do we see people roaming the streets foaming at the mouth.

But the label also gets applied to any behavior that falls outside the norm.  In the movie Benny and Joon (1993), Joon is described as schizophrenic and was reported to have a whole menu of symptoms including hallucinations, explosive outbursts, panic attacks and inability for independent living.  In the movie, we see that she has an interest in other people, she has the capacity to form intimate relationships and seeks them out.  We see evidence of the love between brother and sister throughout the movie.  She is an artist and creates beautiful paintings.  She also displays exceptional insight into the people around her.  In the real world, these factors would probably rule out schizophrenia and would lead a clinician to conclude either Asperger’s Disorder or a type of Anxiety Disorder.

Misconception #2: Hallucinations do not define schizophrenia. As mentioned in the previous article, schizophrenia is a disorder of thought, it is a debilitating brain condition; and hallucinations may or may not be apart of the presenting picture.  There are at least a half dozen other conditions in which a person also hallucinates including drug induced hallucinations, severe depression or anxiety or trauma-induced psychosis, among others.  Oh, and try not sleeping for several days, weeks or months on end and “see” what happens next, Fight Club (1999).

Misconception #3: All schizophrenics look alike.  Schizophrenia is a condition with 5 sub-categories including Paranoid, Catatonic, Residual, Disorganized and Undifferentiated.  Each sub-category includes the thought disorder however, the experience of hallucinations, illusions, delusions, anhedonia, odd or unusual behavior will vary.  The ability to function day to day also varies depending on the sub-category and the prognosis, the prediction of recovery, is also dependent on the sub-category.

These factors make it difficult or challenging to accurately portray schizophrenia in fiction.  Some writers, again for the sake of dramatic effect will toss in all the symptoms and usually end of creating an inaccurate, annoying disaster, Me, Myself and Irene (2000).

Writers have incorporated schizophrenia in their works of fiction in at least two ways.  First, the storyline is taken from the point of view of the person with schizophrenia, giving readers and movie-goers a peak into the experience, A Beautiful Mind (2001), Donnie Darko (2001).  Other writers have presented the illness from the point of view of outsiders, family, co-workers, community members, Through a Glass Darkly (1961).  More often than not, the person is perceived as deranged or dangerous, The Caveman’s Valentine, worst case scenario, or odd and socially isolated.

So, have you written stories or a novel featuring a character with mental illness?  How did this character advance your plot?  What were your challenges?

I’d love to hear your thoughts about this discussion of schizophrenia.  Please come back next week when we’ll begin a discussion about Dissociative Disorders, including Dissociative Identity Disorder (formerly Multiple Personality Disorder).

7 thoughts on “Understanding Mental Illness for Fiction Writers: Schizophrenia Part II

  1. I have a homeless guy in my story that tell the Heroine that the ghost in the building where works wants her to solve a problem. Other than talking to himself. Not too much mental illness.

  2. Mary, without knowing your story plot, the homeless guy could just be reporting what he knows, he could be delusional and there is no ghost, or he’s hallucinating, still no ghost; or he’s a sociopath and the real antagonist, who reports the ghost to the heroine for his own gain. The cool thing is the many ways you twist that one little detail.
    Thanks for stopping by.

  3. Fascinating post. Thanks for mentioning it on KOD so I found it!
    My first manuscript was a paranormal Upper YA about a girl who could see supernatural creatures that inhabit our world that others couldn’t see. I used mental illness as the reaction other people had toward her antisocial behavior.

  4. Don’t know if you’ll answer this since it has been 3 years since this was posted, but here I go.
    I got this recurring character who’s a bipolar paranoid schizo with high intelligence. She started experiencing bipolar symptoms at 14, and schizotypical symptoms at 16. Stress from her chosen criminal lifestyle didn’t help and she became full blown schizophrenic at 17, experiencing mainly visual hallucinations she can interact with, feel, and smell.
    They’re a mix of scary, pretty, and realistic. Wednesday is when they really beat down on her, and this will vary on whether she’s feeling manic, depressed, or normal. Sometimes she’ll get delusional and think her enemies are listening to her, but she’s usually able to get herself together. One hallucination she sees 24/7 is a whimsical steampunk man who is like her confidant, giver of wisdom, and lover. I feel the most “err” about the lover thing. I want them to sexual, and I that this where tactile hallucinations come in. For example, schizo hallucinates some visual fire, touches it and feels a burn. But is the whole “boyfriend hallucination” too far? And how’s the character as a schizo? Also should she be severely disturbed since she doesn’t take meds (mistrust)?

    1. Christy,

      Thanks for stopping by . . . I’m happy to answer any questions, even from content written 3 years ago.

      One of the coolest aspects of writing fiction for me it that we can create anything we want, however, we want to express, just as long as we make it believable.

      That said, let me clarify a couple things: first, if you’re going to diagnose your character and use the label in your story, there is no such thing as Bipolar Paranoid Schizophrenia. A bipolar disorder and paranoid schizophrenia are 2 distinct disease processes; you can have one or the other but not both.

      Second, schizophrenia is a degenerative disease; once the illness manifests, patients tend to deteriorate over time. The dude from “A Beautiful Mind” aside, high intellectual ability is uncommon among people with this disease and the earlier the age of first onset, the poorer the prognosis.

      Third, unlike schizophrenia, a bipolar disorder is an AFFECTIVE illness, meaning that it primarily impacts mood/emotions. Intellectual ability tends to remain intact. But like sz, the earlier the age of onset, the poorer the prognosis.

      Finally, visual hallucinations are rare and may indicate a neurological impairment of some kind, tactile hallucinations are rare too but you do find them at times with substance abuse and withdrawal symptoms. It is more common for pts with sz to report auditory hallucinations. But they are super cool to write about. I guess I need some clarification from you about whether your character’s diagnosis is part of the story or whether you, the writer, knows this is her condition but do not specify? That information might help me address your last question about the steampunk boyfriend.

      Sounds like a great story. Let me know if I can help you further.

      1. Thanks for helping me!

        I do know that bipolar and sz are two separate diseases, I just worded it wrong. And I am caught up on bipolar’s symptoms.

        The first installment of my planned quadrillogy takes place when this character is 18. Her hallucinations are slowly getting worse. She doesn’t go to the hospital because she hates doctors, but her and her brother know she has it. They have an uncle with. She was diagnosed with bipolar when she 14, though.

        This character is not the protagonist, in fact her she dislikes the protagonist. Her, her brother, and the pro are a part of this group of vigilantes trying to combat this gang and corrupt police force and mayor. Her illnesses are a burden in the mission since she goes from fine and focused to crazy and killing people to staying in bed and yelling at people who try to get her out. The hallucinations and delusions are also distractions.

        Another thing I should add is I never plan on really SHOWING what she sees in the primary series. Her brother does draw in his spare time, and will ask her to describe what she sees and will draw them out. Other than that I show her looking around at things she can only see, dodging bats flying down on her, or talking to her steampunk boyfriend when she’s alone but the protagonist can hear her.

        In the sequel (5 years later), she’s in an asylum. She’s been in there for a 3 years, and was diagnosed with sz properly. She refused to take meds, got in fights with staff, and was put in isolated rooms constantly. I played with the idea of her getting ECT, but I know that would damage her brain tremendously. She does escape the night before they plan on giving it to her though. She did learn coping skills though.

        Is that enough info? I would like to keep her visual hallucinations despite their rarity. I based her condition on this girl on YouTube who mainly only sees things and hardly hears things. I will play around with auditory things like clock ticks or music (she loves music and used to dream of singing) and just for giggles she’ll have scent hallucinations.

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