If you are researching “sensitivity readers,” it’s likely that you have written into your novel a mentally ill character and you’re concerned about portraying that character accurately and humanely.
Regardless of your preconceptions, you won’t be able to get away with doing it wrong. You don’t want to have your reviewers pillory you and you don’t want your reputation as an author damaged, maybe forever. You don’t want your mentally ill character to cause problems for your book or to contribute to the stigma that remains. You don’t want to be savaged on social media.
When I’m talking about mental illness, I’m talking about people with conditions that make them miserable, yet they go to work every day and live the same lives you do. But they struggle. Maybe they need more time off from their jobs. I’m also talking about people who spend time in psychiatric hospitals—or should.
Your Preconceptions Will Hurt Your Book
What do you think of when you think of mental illness? Your picture is almost certainly wrong. Are mentally ill people mass shooters? Do you think that veterans with PTSD do nothing but look for ways to commit acts of violence? When you think about a psychotic person or a patient in a psychiatric facility, how do you picture them? Do you picture One Flew Over the Cuckoo’s Nest? Or maybe when you think about mentally ill people you picture the homeless people you walk past during your day—part of the landscape. Remember the TV character Monk, who has OCD so severe he needs a full-time assistant?
Do you think of your pharmacist, who struggles with depression? What about your child’s teacher, who lives with OCD? Maybe your CPA, who has bipolar disorder? Would it change your opinion of them if you knew that their conditions required them to seek periodic inpatient psychiatric care?
Or are mentally ill people to you inherently irrational? People who are dangerous, unreliable, unemployable, or contemptible? Are they in your book to scare the neighbors, terrorize your protagonist, or serve as comic relief?
And what about their families? Is the family overly concerned about what the neighbors think? Does the mentally ill person suck the life out of all family members? Is the family drained from 24/7 drama? Or is the family living in denial, pretending that life goes on as normal?
Your Preconceptions Are Probably Wrong
Mentally ill people generally get unfavorable treatment. We think of Annie Wilkes in Misery, Hedra Carlson in Single White Female, Sybil Isabel Dorsett (Shirley Ardell Mason), or Norman Bates. The other trope is that mentally ill people just see things in an unconventional way and that they are deemed mentally ill by a robotic, mechanical society.
In this worldview, mentally ill people are viewed as unrecognized geniuses. We have Vincent Van Gogh to thank for that, and Ernest Hemingway, and Sylvia Plath. The other misconception is that when someone does something horrible to people, or to an animal, they must be mentally ill.
People Will Notice When You Get It Wrong
There was a time when people didn’t know any better, and so authors could get away with writing mentally ill characters without the proper context, background, and realism. Authors could turn them into a plot device or a tool to demonstrate the heroism of the protagonist.
The people who knew better—patients or their families—encountered so much stigma that they would have been afraid to speak up. Some of you are even old enough to remember a time when mentally ill family members were kept in attics or sent away to institutions, never to return, and their relatives never talked about them. People were free to depict mentally ill people any way they liked.
That’s not true anymore. People are now willing to disclose their experiences caring for mentally ill family members and to discuss just how off-the-mark your depiction is. Mentally ill people are more likely to speak out about their own experiences—and about the authors who depict them.
Someone With My Background Can Help
I’m the parent of a mentally ill autistic child and I also have professional experience dealing with mentally ill adults.
I am in the trenches with my son as he navigates the mental health system. I have talked to a lot of parents, my son’s clinicians, special education advocates, and his peers. There is nothing like being a fly on the wall in a room with adolescents waiting to go into an intensive outpatient group therapy session. They compare hospitals, the various psychiatrists, the various staff members.
In my capacity as a state prosecutor and then a child welfare attorney, I have read hundreds of psychological and psychiatric evaluations of patients in the criminal justice and child welfare systems. I also have edited hundreds of psychological assessments of adult psychiatric patients to determine whether they need conservators/guardians or whether they can obtain their own food, clothing, and shelter. (Many of them can take care of themselves just fine. Some of them might be your neighbors.)
So when I read stories in which the mentally ill patient is either a monster or a genius, irrational and inherently incredible, a foil for the other characters, or a tortured genius, I know that more readers than you know are reacting with anything from a gasp to an eyeroll at the misconceptions, stereotypes, and lazy writing.
Here Are Some Things You Should Know
Are psychotic people unrecognized geniuses? Victims of a mechanistic society? No. When they don’t get the right treatment they may live on the street instead of with their families because they think that someone in the family is trying to kill them. They may be frightened of the people who care for them. They are hearing voices that may be saying horrible things to them. They are seeing things that aren’t there. They may be suicidal. They are vulnerable to criminal acts or financial exploitation. They are mocked or treated as lazy, blamed for their circumstances, or socially ostracized.
They may be fortunate enough to have family members who can make sure that they take their medication, have food to eat, shelter, and medical care. They may have access to the proper treatment and participate voluntarily. Some people who are psychotic take their medication and go about their days like any of us.
Some people with mood disorders function just fine. They take their medication, get therapy, and have good days and bad days.
People with OCD have intrusive thoughts, obsessive dread, compulsions that can make their days hell. If they are fortunate to have access to the right mental health treatment and medication, it might not be total hell to live inside their heads.
The System Doesn’t Work Like You Think It Does
It’s important that you know what the process of being hospitalized looks and feels like. For example, a white truck doesn’t show up with men dressed in white to put people in straitjackets and take them away. Psychiatric hospitals don’t have patients sitting around card tables all day long.
In fact, insurance companies victimize patients and their families. Insurance companies refuse to cover inpatient stays long enough for inpatients to be medically stabilized before they are discharged. Patients have limited options for residential treatment, if there are any at all.
Family Life Doesn’t Look Like You Think It Does
Because of insurance companies, patients who need and want treatment often can’t get it even when they ask for it. Parents who care for their children encounter Kafkaesque brutality from insurance companies. Patients who have no advocates are left to their own devices. The most sophisticated parents of adolescent patients—even those who are attorneys—are horribly outgunned. When you write about the parents of mentally ill people, you are likely to get it wrong unless you know how the system works and what it’s really like in a home with a mentally ill family member. A few articles—even exposés—can’t prepare you enough to portray the family member accurately.
What You Can Do To Avoid Common Mistakes
Unless you have the right background or life experience, you should seek the services of what is now called “a sensitivity reader” when you write your mentally ill characters. There is not enough research any writer can do that will take the place of real people telling you, the author, what life is really like. It’s not homogeneous. Readers will share from their experiences, but you as the author will want to blend various realities, struggles, and victories—if any—into your characters.
A sensitivity reader in this context helps you fact-check your characters to make sure that you humanize them, to make sure that your characters are realistic and credibility written, and to help your writing in general.
When I edit as a sensitivity reader, I can help make sure that your mentally ill character is sympathetic enough for your reader to care and credible enough that the things that they do or say make sense. I can help you make sure that they are not just a plot device. I can help make sure that your book is successful when it reaches your target audience.
KARIN GRAHAM is a book editor and trial lawyer in criminal law and child welfare. She offers expert editing to writers of crime fiction, thrillers, and detective novels.