Freudian Script: Gangs and Drugs

gangs-drugs

Gangs and drugs – in the eyes of the public, inextricably intertwined. But what is the impact of gang lifestyle on mental health? And how do alcohol and drugs fit the picture?

What is a gang?
My protagonist Jason often protests that he wasn’t in a gang. He ran with a group of lads who liked petty theft and doing drugs on the weekend. So, what exactly is a gang?

In its 2009 report “Dying to Belong”, The Centre for Social Justice identified that part of the problem of researching and tackling the negative effects of gang culture is the lack of universal definition. Therefore, they proposed a definition, which we will use for the purpose of this post:

“A relatively durable, predominantly street-based group of young people who
(1) see themselves (and are seen by others) as a discernible group
(2) engage in a range of criminal activity and violence
(3) identify with or lay claim over territory
(4) have some form of identifying structural feature
(5) are in conflict with other, similar, gangs.”

So, do all gangs do drugs?
As you can see, gangs and drugs don’t always go hand in hand by definition – though drug use could fit into the “criminal activity” catch-all of lawbreaking. However, some researchers in the field consider substance misuse as a “defining characteristic” of gang membership.

One such research group is headed by Professor Jeremy Coid, whose research into mental health and gangs is very accessible and well worth a read. In a UK research survey of gang members, 67% were alcohol dependent and 57% were drug dependent (you can read the full article here).

This research groups describes a “syndemic” in UK gang culture – two or more diseases that co-exist in a given group and make each other worse. For gangs, that’s substance misuse, violence and AIDS (SAVA). In short, drugs are a big problem for gang members but they aren’t the whole story.

Gangs and Mental Health
What about other mental health problems associated with gang membership? Gang members have much higher rates of mental illness than both violent and non-violent men. High rates of psychosis and anxiety are reported in gang populations. However, there are some problems in working out exactly how much more they are affected.

For example, paranoia is often a feature of psychosis. But is it paranoia if they’re really out to get you? Hypervigilance can be part of Post Traumatic Stress Disorder – but is that a normal response to an environment where anyone might attack you at any time?

Different rates of mental health problems will also occur at different levels of a gang. Higher level gang members are no longer involved in violence – they are now businessmen and power brokers. However, they may carry the historical risk of previous violence. Think: The Wire.

gangs-drugs-lighter
Mental Health and Drugs
I am not talking about addiction and dependence today, except to say these are diseases not character flaws or lifestyle choices. Instead, let’s talk about the mental health problems that co-exist with alcohol and drug use. I could go on and on about the specifics of individual drugs and their link to mental health problems, but let’s just touch on common problems and their common causes.

Psychosis
Hallucinations are a recognised part of drug trips, such as with LSD. They can also be part of acute alcohol intoxication and withdrawal (delirium tremens or DTs). These tend to be visual hallucinations, which is mainly what differentiates them from schizophrenia, et al. (contrary to what Hollywood would have you believe). However, certain drugs can tend towards other types of hallucinations – cocaine is specifically associated with formication, the feeling that insects are crawling under your skin. Cannabis use is commonly associated with paranoia.

Drug-induced psychosis is when a psychotic episode is triggered by using drugs. The most common drugs for causing this are cannabis and cocaine, though I’ve seen it with other stimulants.

Why do some people who smoke tonnes of weed never experience psychosis and some smoke one joint and land in full-blown nightmareland? Well, why does anyone get any disease? It’s likely that those people are particularly vulnerable to drugs and that this is a warning to take better care of their brains. However, there is a dose-related link between cannabis and psychosis – heavy smoking (meaning >50 joints in your lifetime!) double psychosis risk.

We also have a bit of chicken and egg problem. Some people with psychosis turn to drugs and alcohol as a way to cope with their strange and terrifying experiences, often termed “self-medicating”. When a person presents with a psychotic illness and drug use, it can sometimes we difficult to tease out which came first.

Depression and anxiety
The relationship between alcohol and depression is complex one. Alcohol is a depressant, and heavy alcohol use is linked to depression. But folks also use alcohol to cope with depression. Unfortunately, the effects are short-lived and alcohol maintains the depression. Anxiety has a similar picture – drinking calms the nerves, but only temporarily. The rebound makes the anxiety worse, which fuels the need for more alcohol. Cannabis and benzodiazepines share a similar picture.

Cocaine is slightly different. After the initial high, the crash of cocaine can be devastating and is associated with higher suicide risk. Its usage also fuels anxiety.

Linking gangs and drugs to mental health problems
So, having looked at the mental health risks of merely being in a gang and then the effects of drugs on mental health, you can see how we’d get an additive effect. That’s why gang members use mental health services much more than the general population.

There are also people who are both attracted to gang lifestyle and to drug use. I am thinking specifically of those with dissocial personality disorder and psychopathy.

Writing gangs, drugs and mental health
We’ve seen casual drug use, violence and psychopaths in a gang context. We’ve also see addiction, dependence and withdrawal told vividly on screen (Trainspotting, anyone?). The untold stories are the ones about vulnerabilities – psychosis, anxiety, PTSD – and the difficulties in accessing help, in admitting anything which may be seen as a weakness when strength is survival.

In Code Runner, I play with the idea of mental illness as a weakness. One gang leader has the moniker “Madhouse Mickey”, creating a persona which feeds off others’ perceptions that he is unpredictable, a ticking time bomb. But that ruse only works if he is 100% in control of the situation. Mickey actually uses mental health stigma to his advantage to maintain a position of authority.

I also mess with Jason’s head (because I really love to do that). His experience with drugs in Code Runner leads him to doubt the one thing he thought he knew about himself – whether he is capable of murder. As laid out in the Code Runner book trailer, the aftermath of his very bad trip forces him to confront the possibility.


If you have a question about mental health and writing, leave a comment here, find me on Twitter or ask me a question on Goodreads.

Code Runner is available to order for delivery to your e-reader on 29th September 2014. Share the trailer on social media to enter the giveaway.

Jason Carr’s Guide to Surviving On The Run

Bad day at work? Rent due and short of cash? Framed for murder? My streetwise ex-con Jason Carr, half of the crime-solving team in The Amy Lane Mysteries, shares his practical tips for successfully surviving on the run…

I’ve known my fair share of trouble. More than my share, being honest, but that’s my own fault. I mucked about in the past, got nicked by the cops – and rightly so, let’s admit it – before being sent down. But this time, it weren’t my fault. I got framed for a crime I didn’t commit and, despite my boss’ best efforts and with some bad guys trying to finish me off, I ended up running from my problems.

I don’t really recommend it, but if you find yourself in this kind of jam, here are my tips for staying alive and keeping a low profile.

Mobile phones are not your friend
ontherun-phone
You know those smartphones we carry about everywhere? My boss is a tech whizz and she tells me that anybody can track you down if it’s in your pocket. And I’ve seen her in action, tracking suspects all over Cardiff just using their phones. If you’re serious about going on the run, ditch your phone asap. That goes for your fancy iPads and laptops and anything else that half-thinks for itself.

ontherun-country
Stay off the beaten track
Given the choice of towns, cities and main roads or open fields and dirt tracks, you gotta go country every time. I’m a city boy, born and bred in Cardiff, so I haven’t the first clue what to do in a field full of sheep. But there aren’t many cameras out in the Welsh valleys and not many folks to spot you. That said, there are fewer strangers about too, so don’t just march into the local and order a pint. They’ll know you don’t fit in, especially if you’re wearing a monkey suit for your court date.




Hello darkness, my old friend
ontherun-afterdark

While we’re being careful of those stranger-danger, Neighbourhood Watch types, it’s always better to move after dark. Find somewhere to hole up during the daytime, preferably warm and dry but at least out of the way, and then get going again under the stars. Not that we get many stars out in Wales – too many clouds, dishing out that rain we’re famous for. Also, barns might not be your best idea. Not many people are packing in Wales, but farmers and their mums probably are and you don’t want them to get twitchy with a shotgun in hand.

Safe for you and safe for your mates
ontherun-frontdoor
If you’re a selfish git, you might just be thinking of your own skin. But if you’ve got family you love and mates you respect, you’re gonna want to keep them out of harm’s way as well as you. So making straight for your mam’s front door isn’t smart – it might draw down all kinds of hell on her, from the law to the lawless. But if you’ve got a techy friend who stays off the radar and has a few nooks and crannies to hide you away, it might be worth paying her a visit.

Someone to watch over you
ontherun-someone
Last and no way least, you need someone to look out for you. Someone on your side, who really believes you aren’t a complete waste of space who probably did what everyone’s saying he did. It helps if that person also knows how to go about proving you’re innocent, has friends who are honest cops, and maybe planted a tracking device on you to make sure she knows where you are 24/7. It’s creepy at first, but it’s good to know that someone’s genuinely got your back. And wants you to come home.


When streetwise ex-con Jason Carr is framed for murder, agoraphobic hacker Amy Lane must prove his innocence before he is hunted down by vengeful gangs, the police and the mastermind behind it all. Code Runner, Book 2 in The Amy Lane Mysteries, is released on 29th September 2014 and you can order it here.

If you haven’t met Amy and Jason yet, Binary Witness is currently on sale for 61¢/37p on Amazon and 99¢/60p everywhere else. Buy it now!

Code Runner Book Trailer: The Making-Of

With four weeks until CODE RUNNER hits virtual bookshelves, it’s time to share the book trailer!

(You can find out more about Code Runner and the associated giveaway here)

But over here at Swords and Lattes, I know y’all expect a little more. So let me talk you through how this trailer came into being – consider this the DVD commentary of the Code Runner book trailer.

What is a book trailer?
It is a trailer for a book.

I admit, I was a little sceptical. Because my previous experience with book trailers was James Patterson’s latest novel turning up on my TV and me thinking “WTF this is the worst telemovie ever – oh no, wait, it’s a book”.

But I know from my short film efforts that folks love a good YouTube video. Short, sharp, to the point. Folks love visuals, and a shortcut to the main event. While I am not a natural viewer of video articles, I do now click Twitter pictures over reading articles to see if it’s worth my time.

With a novel, a good synopsis and an excerpt can work well. But a great cover can seal the deal and, if a video extra can entice an audience, I’m game. For Binary Witness, the lovely folks at Realm Pictures filmed me reading Chapter One. (You can see it here.) For Code Runner, I wanted to try something a little different.

Research
So, I started watching book trailers.

Some were great. Some were awful. So it is with all content everywhere.

Three trailers particularly struck me. The first was for Lauren Beukes’ The Shining Girls. It is very like a film trailer and fits the book’s plot and atmosphere very well. However, I don’t have the resources to film a one-minute short film for my book. I’m also not keen on giving my characters definite faces – characters are open to the readers’ imaginations and I don’t want to limit that.

The second was for JF Penn’s Pentecost. Advice from The Creative Penn is invaluable for any author interested in marketing, so I was obviously keen to take in her trailer wisdom. I tried to use some footage collected in the woods for the Code Runner teaser trailer but I wasn’t particularly happy with how it turned out.

The third trailer I loved was for Chuck Wendig’s Blackbirds and Mockingbird. I love this trailer. It’s a great introduction to the character and premise of the series, and Wendig’s writing style. However, I took note of his comments in that post and the feedback – it runs a little long and, again, it was professional produced with $$$. But I loved the simple combination of words and voiceover, and I thought it could form a good basis for a Code Runner book trailer.

Test – one, two, three: the voiceover
Those who have met me IRL may notice its my voice on the trailer. However, it took my own husband thirty seconds to recognise me!

Honestly, I don’t know what happened. I sat down, pressed record on my iPhone and read the excerpt from Chapter 9: Lost Boy. My breathing was a little obvious in places and I tried to re-record the worst bits, but I’m afraid I couldn’t find that tone again – the creepy voice had departed forever. Instead, I cleaned it up in Audacity and imported it into good, old Windows Movie Maker.

A picture’s worth a thousand words: the images
I wanted the words to convey the atmosphere of the novel, not just “say what you see”, Catchphrase-style. But I also didn’t want each image to be too “busy” – I figured we were working with old Powerpoint wisdom here, so I limited my fonts.

I chose a typewriter-style for the main text, with other simple images and font changes for emphasis. For the change in the middle of the text, I used a more handwriting-based font to encourage the flow of reading – again, an atmosphere choice.

trailer-example-text

I planned each “full image” with multiple layers using Paint.net and then saved out each individual image. I then adjusted the timing to follow the narration. The whole thing probably took me a whole day of work, over three sessions or so. And I’ll admit that I’m pretty pleased with how it turned out.

So, what do you think? Let me know your thoughts on my trailer and books trailers in general in the comments!

Freudian Script: Bipolar Affective Disorder

Bipolar Affective Disorder: The Fight For The Middle Ground

mask-bipolar-affective-disorder

After the revelation that Robin Williams suffered with bipolar affective disorder, a rush of articles about creatives and mental health problems sprung up all over the shop. Last week – not for the first time – a young man sat in an assessment with me and said he didn’t want medication to take away his “creativity”.

So, now seemed like a good time to talk about what bipolar affective disorder is and what it isn’t, and how Hollywood and the media often get it wrong.

What is bipolar affective disorder?
Also know as manic depression, bipolar affective disorder is a mental health problem consisting of cycles of two opposite moods: manic/high phases and depressive/low phases. In between episodes, people sit somewhere in a mood state that is “normal” for them – which may run slightly high or low, depending on the person. A person with “rapid cycling” disease has four or more episodes per year.

Bipolar depressive episodes look a lot like depression – aka unipolar depression. The main difference is that bipolar depression does not respond as well to antidepressants, and people more frequently experience psychosis.

Manic episodes are what set bipolar affective disorder apart from other mental health problems. Mania is a state of “high” mood, associated with disinhibition and living really, really fast. This is often portrayed as living in one very exciting party 24/7. Some people do experience their manic episodes in this way – which is one reason why some people really hate taking medication for them. Highs can be a lot of fun.

But they can also be really ugly. Some people don’t experience manic episodes as happy highs but irritable, restless periods, which is increasingly likely as folks get older with the disease. People also make huge errors of judgement – sleeping with many different partners when they’re usually monogamous, spending money they don’t have, and crashing their cars. Mania can also come with psychosis – believing they have special powers, hearing the voice of God, thinking they can fly.

Suicide risk is high in people with bipolar affective disorder, but actually moreso in a high phase. The combination of inescapable agitation and lowered barriers leads to more likely suicide attempts.

The Stephen Fry Effect
First off, before I go further, I will saw this: I greatly admire Stephen Fry as an artist, as a man and as a person struggling with a mental health problem. This is in no way an attack on the man or how he chooses to lead his life. But it is important to recognise the impact of celebrity on mental health stigma.

Bipolar affective disorder, of all mental health problems, carries a certain level of desirability. In private healthcare, it is often given to patients who would be better served with a different diagnosis or no diagnosis at all. There is something attractive about this disease.

This may be down to the “party time” reputation of high episodes. However, I feel it’s also due to the creativity myth – i.e. bipolar affective disorder is the disease of creatives, funny men and artists. With your brain running faster than the rest, you’ll be faster with a witty retort. On a deadline? You can pull several all-nighters in a row to finish that novel and then go out for drinks.

Stephen Fry is the poster child for this attitude. Even though he now takes medication, he is renowned for not taking medication since 1995 until this recent change. This is the most-frequently cited argument I have heard against medication for mental health problems – “it will ruin my life/personality/creativity. Look at Stephen Fry.”

This is, of course, bollocks. No medication changes your personality. Medication of various kinds can be sedating and can affect concentration. If your brain runs at a slightly-high normal, medication can bring it down to a lower baseline, which some people experience as slowing. However, all the evidence suggests that people with stable bipolar affective disorder are more productive than those off treatment. This is because they are more consistent, and not constantly disrupted with too-high or too-low swings in their mood.

Writing Bipolar Affective Disorder
Bipolar is not sexy. It is not fun. It is not a party. And it’s not Jekyll and Hyde, or Two-Face, or any other “split personality”.

I’d like to see more realistic depictions of bipolar affective disorder. I’d like to see mania not portrayed as a party, but as a brutal experience with real-life consequences beyond a hangover. I’d like to see characters with bipolar who predominately experience depression. And I would like to see more smart, well-adjusted characters who are like “yeah, I have bipolar, and?”. Because a person with stable bipolar affective disorder can be a high-functioning professional with no external signs of illness, like a person with well-controlled asthma need only carry an inhaler.

Stigma is fought be showing good mental health as well as mental illness. Bipolar affective disorder is no different.

Writers’ Block: Keep The Car Running

Writers’ Block: figment of an anxious writer’s imagination or a terrifying urban legend that could swallow your writing career whole?

old-car-writers-block

So, if writers’ block is real – and many writers swear that particular bogeyman is lurking in their closet – how do we identify the causes and manage them so that this ghost in the machine doesn’t stall our writing engines?

This post is brought to you by a very large to-write pile and an overextended car metaphor. You’re welcome.

Hunger strikes! Fuel your writing
If the car has no fuel, it ain’t going nowhere. This is my personal number one cause of writers’ block. Are your basic human needs met? Are you well-rested, with a full stomach, quenched thirst and an empty bladder? I need a cup of tea by my elbow if I’m going to be writing, or strong, sugary coffee if my brain won’t kick into gear. Learn your body’s signs that you need to refuel.

Life charges the battery
Writers are solitary, indoor creatures. If you fortunate enough to spend solid days writing, what else are you doing with your life? Nothing comes from nothing. If you’re not out experiencing life, what the hell are you going to write about? This is how we end up with endless stories about writers. Don’t be that guy.

Keep experiencing, keep living. And I am not talking about Twitter.

Books and films are water and oil
Like life, you also need to experience other creatives doing their thing. Be a consumer of fine literature and excellent films. True, there are lessons to learn from bad stuff, but writers feed on good fiction, like tennis pros play better opponents to improve their game. Make sure you keep reading and keep watching stellar works to take your work to the next level.

Know your destination
Some drivers meticulously plan out a route with three different route planners and an old, battered A-Z before setting off. Some plug a postcode into the satnav and press “go”, just seeing what comes up. Others have a vague idea where the place is and just jump in the car and hope for the best. These are all valid ways to drive to a place, as long as you actually get there.

Know what kind of writer you are. If you need a plan, make a plan. If you like to wing it, straighten up and fly right. But a lot of folks get writers’ block because they’re forgotten where they’re going and how they were gonna get there. Take out the map again and figure it out. Otherwise, you’ll just end up driving in circles or parked up on the verge.

If all else fails, get a new car
Sometimes, it just ain’t happening. The car is a twenty-year-old rustbucket and it don’t drive no more. You’ve prodded it and patched it and changed every bit of it so that there’s an original part left, and it still ain’t going.

That’s the time to get a new car. Ditch the stuck project, perhaps only temporarily, but put it down and walk away. And get excited about something new.

Because writing is discovery and we’re all on a journey someplace exciting, if only we can keep that writers’ car running!

What’s your #1 cause of writers’ block? How do you overcome it?

Myths about Depression and Suicide

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Given the recent tragic death of Robin Williams and the resulting surge in media attention, I thought I would bust a few myths about depression and suicide.

EDIT 13/08/14: Amended to capture some of the ugliness that the UK media vomited out this morning

1) “What did he have to be depressed about? He had everything!” / “Oh, that particular problem is why he had depression and killed himself, is it? That explains everything!”

Money does not buy good health. Close, loving relationships do not cure depression. The adoration of millions is not a NICE-approved treatment for any mental health problem, including addiction and mood disorders. 

Wealthy, loved and famous people still get ill. They have heart attacks, break their limbs and die of cancer. Why is it so shocking that they should also have mental health problems?

Conversely, debt does not cause depression. Addiction does not lead to violence. These things can contribute to someone’s illness, but depression is a disease. It is not a disease that has a linear relationship with a stressor: debt -> depression is not like smoking -> lung cancer. Because, if that was the case, having lots of money would cure depression. And we are now running in agonised circles like exhausted hamsters.

There is a public perception that mental health problems are somehow under a person’s control. Which leads me to…

2) “But everyone feels sad! He should’ve cheered himself up.”

Depression is a disease. It is not feeling a bit sad. Depression is to sadness what lung cancer is to the common cold. Depression and sadness may both have low mood as a feature, but that does not mean they are the same thing. Both lung cancer and asthma have cough as a symptom and they are nowhere near the same thing.

Telling people with depression to “cheer up” is the equivalent of telling someone with Parkinson’s Disease to just quit shaking. It is beyond rude and insensitive and into downright dangerous. The “pull yourself together” attitude contributes to public stigma, self-stigma and discrimination.

3) “Why didn’t he just get help?”

First off, we don’t know what help Robin Williams in particular did or didn’t have. I am not going to comment further on that.

However, as a wider issue, there are really two myths here: why didn’t he SEEK help and/or why didn’t that help stop his suicide? 

Seeking help is difficult. Stigma means that people with depression and other mental health problems are constantly told they do not have a problem, they’re making it up, they should “be strong” like everyone else and that medications are a crutch. This is bullshit. 

And, if people do reach out, what happens next? There is no magic wand in mental health. You do not seek help and transform into a healthy person overnight. Medication, therapy and support take time.

Depression is a potentially fatal disease. I believe the vast majority of people with depression can be helped to protect their lives from their illness, but it would be pure arrogance of professionals, relatives and concerned citizens to assume they can save everybody. Sometimes all the help in the world is not enough. And, like a cure for cancer, this is our mental health dream. Except we don’t get nearly as much money as cancer fighters.

4) “Comedians all have a dark side”

This is a version of the “creative people are all mad” bollocks that I frequently see quoted, often around Stephen Fry or the permananently wasted poets of the nineteenth century.

People with stable mental health are more productive than those with untreated illnesses. Mental health problems are neither a requisite nor an obstable to pursuing a career in the arts. If you are holding out on getting your disease treated because you’re worried about your art, think about the risk you’re taking with your life and weigh it up against the potential loss of creativity.

Because you can’t make great art if you’re dead.

5) “He should’ve been stronger! He should’ve fought harder!”

Like people with asthma should chuck out their inhalers and just learn to breathe like the rest of us?

Like people with diabetes should liberate themselves of their insulin and just will their blood sugars to normal levels?

Like people with cancer should just pull themselves together, think happy thoughts and eradicate those pesky cells from their body?

I know I keep going on about cancer but this is the level we need to think on if we’re going to talk about mental health problems. I want days, even weeks dedicated to mental health. I want national races given over to mental health research. I want an annual national televised programme to raise money for Mind and Rethink and the Samaritans.

Because that is how we combat myths about depression and suicide. That is how people stop suffering in silence.
That is how we give people the opportunity to survive depression instead of dying from it.

If you need help, please contact the Samaritans, your GP or someone you trust.

Freudian Script: Psychiatrist v Therapist

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“I’m going to see a shrink for therapy” – what does that actually mean? Who are you going to see and for what? What is the difference between a psychiatrist, a psychologist and a therapist? Who would win in a Psychiatrist v Therapist fight?

Freudian Script is going to demystify the difference between a psychiatrist v therapist and what exactly folks mean by “therapy”.

What is a psychiatrist?
A psychiatrist is a medical doctor who specialises in mental health. In the UK, this means going to medical school, doing at least a couple of years in different medical and surgical jobs, then specialising in psychiatry. Psychiatrists are members of the Royal College of Psychiatrists.

You would visit a psychiatrist particularly for diagnosis, medication and monitoring. You may also visit them for therapy, but I will get into that later.

What is a psychologist?
A clinical psychologist is someone who has trained in psychology, usually to the PhD level (which means they are also called doctor!), and specialise in different psychological therapies. They can specialise in a particular therapy – for example, cognitive-behavioural therapy. These professionals take the lead on psychological therapy, or talking therapy.

You would visit a psychologist for a specific type of talking therapy, usually for a time-limited period. This is equivalent to taking a course of medication or undergoing a surgical procedure as a treatment for what ails you.

What is a therapist?
A therapist is anyone who feels like calling themselves a therapist. No, really. Some therapists are registered with professional bodies, which means you know what you’re getting, but otherwise it’s a free-for-all.

Therapists do not need to be psychiatrists or psychologists. They can also be “counsellors” – which also doesn’t really tell you what qualifications or therapy they are actually peddling.

Don’t get me wrong – therapists can be highly-trained and effective practitioners, but the term can be used and abused by anyone with an office.

But when you say “I’m seeing a therapist”…
However, common things are common. When someone is “in therapy” or “seeing a therapist”, they are usually talking about psychodynamic psychotherapy, psychoanalytical psychotherapy or psychoanalysis – i.e. adapted from the Freudian model.

So, it’s all about fancying your mother…?
While Sigmund Freud had some very interesting ideas about young children and their impressions of their parents, a lot of his work is nothing to do with that (though both childhood and sex feature frequently in his work).

The theoretical background focusses on how a person’s internal world relates to the external world, particularly how we re-enact patterns we learned as children in our adult lives and how these are a source of conflict to us. It is a deep and fascinating set of theories, but I won’t go into the details – suffice it to say, this is the underpinning of what is commonly called “therapy” or “psychotherapy”.

And psychiatrists do this?
This is where I start busting some Hollywood myths. Not all psychiatrists practice psychotherapy. In fact, in the UK, most psychiatrists do not regularly practice psychotherapy at all. It is a sub-speciality of psychiatry, like cardiology is a sub-speciality of medicine and orthopaedics is a sub-speciality of surgery.

But not all psychotherapists are psychiatrists. You do not need a medical degree to be a psychotherapist. However, to be a licensed psychoanalyst, you have to be trained in the modality.

Psychotherapy v psychological therapy
Let me re-emphasise here the difference between psychotherapy and psychological therapy. Psychotherapy is an exploration of the subconscious with the general aim of bringing it to conscious awareness, so it can be used in the present. Psychological therapy is a goal-orientated talking therapy for a specific problem – i.e. depression, spider phobia, failing relationship. It is usually time-limited to a few weeks, whereas psychotherapy and psychoanalysis can go on for years. “Brief psychotherapy” can last for a year!

Who visits a psychotherapist?
Anyone can visit a psychotherapist. In the National Health Service, it is reserved for people with long-standing emotional difficulties, particularly severe enough to be considered a personality disorder. In the private sector, however, anyone can sign themselves up for a bit of analysis. And this is the version we often see in Hollywood – anyone and everyone has a therapist.

What’s it like in a psychotherapy session?
Psychotherapy sessions last 50 minutes, no more, no less. They take place at the same time and in the same place at regular, precise intervals. This is part of the therapy – a consistent space that contains. They take place at a minimum of once per week, but in very intense therapy, they can happen every day.

freud-couch-psychiatrist-therapist
Sigmund Freud’s original couch

Some therapists use a couch, in the classical Freudian style. Not being able to see the therapist’s face is meant to create a more intense experience and progress therapy faster. Most now use a chair, a more natural setting that more people warm to easily.

In the first meeting – the so-called “business meeting” – the therapist takes the lead and explains the rules of consistency. At every session after, the client takes the lead. They speak first and they speak last. They talk about whatever they want, like Freud’s original free association. The role of the therapist is to ask curiously and point out any patterns they see, drawing the client’s attention to the unconscious.

Anyone who has ever watched a film in which a therapist appears will no doubt be surprised by this description. Hollywood psychotherapy is very therapist-led, though the ubiquitous “how do you feel about that?” is fairly common!

harleen-quinzel-psychiatrist-therapist

Also, though I cringe that I should have to point this out, therapists do not sleep with their clients. That is how therapists lose their job and their accreditation. You cannot be impartial with someone if you are swapping bodily fluids. Also, therapists do not generally “go insane” from being therapists. Else we would have no therapists. I’m looking at you, Harleen Quinzel.

What is Hollywood’s obsession with therapists?
My theory: cheap exposition. You want to know how your arsehole character really feels? Have him open up to his therapist. Your strong, tough guy shares some painful childhood experience that made him the loner he is today – you get vulnerability, you get an explanation for his behaviour, and he gets a “get out of jail free” card for his next arsehole action. See: Christian Grey.

Real therapy does not work that way. Sure, there are “eureka” moments but most of it is slow, gradual awakening over months and years. However, that does not fit into a 90-minute film or the episode-of-the-week where a burned-out cop is ordered to see a therapist before he returns to active duty.

Write Better Therapy
So, what do I want to see? How about folks that are in therapy just-because? What about more complex explanations for why folks have difficulties? How about some therapists who actually practice a recognisable form of psychotherapy and don’t sleep with their clients? My demands are modest, I assure you.

How do you feel about that?

Writers’ Tools: Expert Opinions

Expert opinions are the gilding of the lily in writing fiction. They turn a piece of entertainment into an accurate piece of entertainment, less likely to make irate professionals scream at the TV and ruin the emotional death scene for everyone else in the living room.

(Yes, I have done this. Many times. We don’t watch hospital dramas in my house anymore.)

While I hesitate to call experts “tools” – because I want them to still speak to me – they fit into this character because this knowledge is an optional extra that makes a writer’s life easier – or turns it into a total bloody nightmare.

What is an expert opinion?
An expert opinion is research involving a living, breathing person, as opposed to a book, documentary, website, journal article, etc. That person may be a universally-recognised expert (e.g. an academic specialising in forensics) or may have gained knowledge through personal or professional experience (e.g. a police officer working a rural beat).

Why use an expert opinion?
First things first – why research at all? I am stickler for accuracy in fiction. Not necessarily for the particular ribbon colours used in service medals, but for the sensitive portrayal of people – their lives, jobs, towns and culture. I feel that it’s disrespectful to ignore that basic level of detail, to make stuff up that actually affects people’s lives. I know that other writers have different perspectives on this issue – from “research gets in the way of creativity” to “I must check historical records for that day to check if it was raining”. If you fall into the accuracy-seeking camp, I think that an expert opinion should form a vital part of a writer’s research strategy.

When I research, I like to start with broad brush strokes. I read books around the subject, look at photo galleries of locations or read a Wikipedia article. For example, for my feature film script about a gossip journalist, I bought a bunch of magazines and followed gossip journalists on Twitter. This stage generally occurs before I start a first draft. However, if an unfamiliar subject is the main focus of the work, it may help to have an expert to turn to for a background guide as well as questions.

If specific questions come up during writing, I first turn to Google. But while that easily answers questions like “who will Cardiff play on the last day of the 2013/2014 football season?”, it is less helpful for “where is the best place on Anglesey for smuggling?” That is where the expert opinion comes in.

A caution against Death By Research
A writer can spend hours, days, months and years conducting research and never actually write a word. Spending five years shadowing a zoo keeper to make sure your family adventure is pitch-perfect may be overkill. An expert opinion can lend an air of authenticity.

The other warning is against shoehorning every little fact you may have learned into your work, by hook or by crook. Exposition can easily kill a narrative. If folks wanted to be drowned in facts, they would watch a documentary. A balance needs to be struck between accuracy and regurgitating an encyclopaedia.

Using expert opinions
For The Amy Lane Mysteries, I needed both extensive background knowledge in subjects and to answer specific questions that arose as and when. I’ve been assisted in raising a dead body out of the ocean by Dr Laura Walton-Williams and Dr Claire Gwinnett of Staffordshire University. I’ve learned about the sand of North Walean beaches from Professor Ken Pye. And I’ve discovered that nowhere serves food in Aberystwyth after midnight on a Sunday from my fellow writers who live in dear old Aber.

Here are a couple of specific examples where I’ve turned to an expert opinion for research:

Digital forensics
Amy Lane is a hacker who fights crime. Therefore, she needs to be well versed in digital forensics, cyber criminals and how to track them. I reached out to several universities who taught courses of this nature and a couple of people replied. Only one, however, went on to answer my extensive list of questions – Dr Burkhard Schafer of the University of Edinburgh.

computer-forensics-expert-opinion

He was also invaluable in directing me to other resources, such as textbooks, blogs and articles. He was my guide through the murky waters of research.

Barry Island Tides
For Code Runner, I needed one of my team to make a deduction based on the location of a dinghy off the coast of South Wales. Basically, I made life extremely difficult for myself because I wanted to have fun with a dinghy.

Enter Barry Yacht Club. With the help of Nick Phillips and Ray Brown, I charted the waters off Barry Island and sent my dinghy on a plausible adventure. The draft scene was checked over by Nick to make sure I hadn’t ballsed it up when I added the quirks of dialogue and deductions of my sleuths.

barry-island-expert-opinion

Don’t be shy!
What I’ve learned through researching these topics is that folks love to talk about their expertise. I have had a few non-respondents, but I’ve never been met with anything less than enthusiasm by those from whom I’ve sought an expert opinion.

Have you used expert opinions in your research? What is you advice for finding experts who can help with research?

Sticks and Stones: Mental Health Stigma and Crime Fiction

stigma-crime-wordle

Crime fiction is entertainment. Writers’ primary goal is to entertain. But what is the impact of the written word on the most vulnerable people in society? Does crime fiction contribute to mental health stigma?

What is stigma?
The term stigma refers to the negative stereotypes, prejudice and discrimination directed towards a group – in this case, people with mental health problems. For example, the stereotype “schizophrenics are psycho killers” may lead to attitudes like “all mental patients should be locked up” and “I don’t want a nutter around my children” and actions like avoiding people with mental health problems, opposing mental health facilities in their neighbourhoods, and beating a man to death.

Stigma is not just about public attitudes to mental health. People with mental health problems can direct these negative attitudes towards themselves – self-stigma: “It’s my fault I’m depressed – I’m not strong enough to cope.” There is also institutional or structural stigma, where organisations discriminate against individuals, such as quietly cutting 1,711 psychiatric beds.

Stigma and Crime Fiction
People with mental health problems have a long history of portrayal in fiction. In Sophocles’ Greek tragedy Ajax, the titular character is tricked by Athena into believing animals are the Greek leaders. He is deeply ashamed that he was fooled by the goddess, convinced the Greeks are laughing at him, and literally falls on his sword. Here we have a classic example of self-stigma ending in violent death.

The Samaritans have issued guidance to all individuals involved in the media about portrayals of suicide, due to the evidence that suicide reporting influences suicidal people. Over 60% of broadcast media portrayals of people with mental health problems are “pejorative, flippant or unsympathetic”.

I hate reaching the end of a crime novel and, when the detective reveals the killer, the only explanation for his crimes is “oh, he’s mad”. Not only this lazy and deeply unsatisfying for the reader, it also contributes to the wealth of mental health stigma contributing to the lie that “killers are crazy, so crazies are killers”.

The stigmatising doesn’t end with the perpetrators of crime. Detectives and crime solvers are also suffering from poor mental health, although their issues may be treated more as quirks or “character flaws” rather than serious health problems. The functional alcoholic detective has existed for decades, belying the serious consequences of alcohol dependence. While Adrian Monk’s OCD may be well-realised at times, his colleagues reference to him being “very persnickety” falls short of describing this debilitating condition. And the rise of Autistic Spectrum Disorders, particularly Aspergers, in detectives such as Sarah Lund, Saga Norén and the BBC’s Sherlock fails to take in the breath of ASD while shamelessly enjoying a character who “speaks their mind” as if this is the only hallmark of the disorders.

Stigma and Crime Writers
Writers have long understood the significance of words. Edward Bulwer-Lytton cemented a sentiment over two thousand years old when he wrote “The pen is mightier than the sword.”

When I asked panellists at CrimeFest 2014 about the impact of crime fiction on mental health stigma, answers ranged from striving for accuracy to be respectful to not doing research because entertainment is the most important thing.

The words at the top of this page were all used by crime writers at Theakstons Crime Writing Festival last weekend. These are individuals whose work I enjoy and opinions I generally respect.

However, even as influencers of culture, they are also products of it – their language is the language of their community. As George Orwell wrote in 1984 “if thought corrupts language, language can also corrupt thought.”

Words can kill can kill with far great efficiency than sticks and stones. Perhaps some crime writers need to reconsider how they use theirs.

Are My Book Sales Good? Data for Novelists

book-sales

Every debut novelist asks “what are good sales figures?” and every seasoned novelist/agent/publisher replies with “it depends”.

While this is undoubtedly true, it’s not very useful to the novelist trying to work out where they fit in the world of books. We know who’s at the top – bestsellers are determined by The Sunday Times, The New York Times, USA Today and more recently Amazon. These folks are selling 2000+ copies per day, depending on the season.

Newsflash: most novelists do not sell thousands of books per day.

Reports on author earnings can be useful, but they are difficult to apply on an individual level. Also, earnings =/= sales.

Traditional publishers pay in two main ways – advances, where you get money before you sell anything, and royalties. Some publishers, like my publisher Carina Press, don’t give advances but give higher royalty rates. However, royalties are only paid once you’ve “earned out” your advance (i.e. accumulated royalties are more than what was paid upfront) and they’re paid on a schedule, when the publisher receives money for sales.

For example, Carina Press pays royalties four times per year. The next royalties are due in September, but the accounting period for those ended May 2014. As my debut novel Binary Witness was released 5th May 2014, I will be paid for the first month of sales in September. Except Amazon usually operates around a three month delay, so I probably won’t see those payments until December. Confused yet?

My second book Code Runner is released in September. Therefore, finding out how well Binary Witness sold in December is a little late to know if my various marketing strategies worked. I’m fortunate in that Harlequin, the publisher that the Carina Press imprint sits under, gives me sales data on a weekly basis – however, this only represents 80% of North American sales. As I’m a UK-based author, this is again of limited use.

Which returns us to the original question: how do I find out my sales and how do I know if they’re any good?

Enter NovelRank.

example-book-sales-rank

NovelRank uses Amazon Sales Rank to calculate book sales. It’s main limitations are that it only accounts for Amazon and it is by its very nature not particularly accurate, but for our purposes it is good enough. Theresa Rangan has helpfully made a chart that allows folk to estimate actual sales from Amazon’s rank, if you don’t want to add your book to NovelRank.

Not only does NovelRank help you estimate your own sales, it allows you to look at other people’s. For me, this is the most useful part of the exercise and helps to answer the second part of the question. Because when we ask “are my book sales good?”, what we’re really asking is “how do they compare to other novelists’?”.

Comparing yourself to every other novelist is pointless. I am not going to sell like Stephen King, because a) he writes in a different genre and b) he has a few more decades of writing and motion picture deals on me. I’m also not going to sell like top self-publishers, because certain marketing options are limited by my publisher – e.g offering free/cut-price books to encourage growth of my fanbase.

Therefore, the best comparison is other novelists in my genre and with my publisher. Luckily for me, several Carina Press mystery authors are also signed up for NovelRank, so I can peruse their sales figures for the past few years.

This was a very interesting exercise. I looked at authors who wrote series and I went back to their debut novel sales. I then looked at the sales of subsequent books in the series, and how the sales of that book increased relative to the first book AND how the previous books also experienced a bump. Which makes sense, as marketing for Book Two will probably make new readers look for Book One.

What I found was very encouraging. Authors starting with tens of sales per month have now reached hundreds of sales per month, including an increase in pre-orders and backlist sales. I also found my debut novel sales to be comparable to my peers. This gave me increased confidence when approaching acquisitions, knowing I wasn’t starting at a significant disadvantage.

Do you track your book sales? Do you compare yourself to other authors or do you set personal targets? What tools do you use?