5 Biggest Mistakes When Writing Mental Illness

Madness in fiction, like most things in fiction, reflects and informs the popular view. If we write about terrifying, violent mad folk running about with machetes in our films, books and TV shows, the general public nod at how much that confirms their view of madness and cross the street when they see someone out of the ordinary. Or worse. Much worse.

At the bare minimum, we should get the facts right. Here are my Top 5 mental health myths in fiction that need to be kicked to the kerb.

1) Straitjackets and padded cells are not standard issue

Daniel Jackson in a padded cell (Stargate SG-1)

Let’s start with straitjackets. We do not use straitjackets in mental health in the UK. They are cruel and dangerous. Short-term physical restraint is used during a psychiatric emergency and it is tightly-regulated, with training and a mountain of paperwork. If your character is spending time in a mental health unit, they will not see a straitjacket.

A bedroom in a modern mental health unit has more in common with a room in university halls than it does a padded cell. There are certain things which distinguish them – the furniture is usually heavy and secured to the walls or floor, and you won’t find hooks, nails, curtain rails or door handles, because we are safety conscious.

The Psychiatric Intensive Care Unit (PICU), where the most unwell people stay, has a step up in safety features – most notably, a seclusion or low stimulation room. This small room has furniture made of the soft squishy blocks you might see in a children’s play area. The walls, however, are just walls.

Padded rooms do still exist in some facilities. They are for short durations where a person is unwell and very rarely a permanent residence. If your character is spending a week in a mental health unit for depression, they are really unlikely to see one.

2) Scizophrenia is not split personality (which does not really exist)

I thought this myth was busted a long time ago, but a recent survey by the Time to Change mental health campaign found that 68% of the British public think schizophrenia is split personality.

Okay, let’s start at the beginning. The word schizophrenia does literally mean “split mind”. But it was the 19th century and they went through a lot of words back then, including dementia praecox – which is a very strange term that applied to everything and nothing in psychiatry over about fifty years.

Schizophrenia, as we now know it, is a disorder of psychosis – a breakdown of the ability to differentiate reality from fiction. When people talk about split personality, they are thinking of the rare, questionable multiple personality disorder.

In fiction, multiple personality disorder usually involves several distinct personalities operating out of one body and with differing levels of conscious awareness of each other. In modern psychiatry, this could be a very severe form of dissociative state – where people unconsciously break off from reality pieces of themselves and hide them away, or undertake journeys without any memory of them.

However, this is rare and the split between the personalities is usually less well divided. A person may retreat to a child-like presentation during a therapy session, but that personality does not take over the body and commit murders without the “innocent” dominant personality knowing. 

3) Psychiatrists and psychotherapists are not the same thing

Psychiatrist – expert in diagnosing mental health problems and prescribing medication, with some knowledge of giving talking therapies to patients (e.g. CBT, psychotherapy)

Psychotherapist – expert in deliverying a specific type of talking therapy – usually psychoanalysis, psychoanalytic psychotherapy or psychodynamic psychotherapy.

Clinical psychologist – expert in one or many talking therapies, but usually not psychotherapy (because we have a different word for that!).

This point comes with a health warning – because the state of play is different in the USA than it is in the UK. US-trained psychiatrists are predominately medics first BUT are also all trained in psychotherapy. UK “medical psychotherapists” are psychiatrists who are specially trained in psychotherapy. You can read more here

4) OCD is not about being a neat freak

My husband has OCD. When I mention this to people, I sometimes get the response “your house must be so clean!” Wrong, on so many levels.

Obsessive-compulsive disorder involves intrusive, unpleasant, horrific thoughts (obsessions) and the felt-necessary rituals to attempt to undo, remove or counteract the thoughts (compulsions). Cleaning, ordering and symmetry can all be compulsions, but they are almost always related to an intrusive thought – for example, “if I don’t wipe the table seven times, my children will die from ebola”.

Not “I like a clean house because I hate clutter”. Or the recent nonsensical trend in dousing children in alcohol gel (hint: it does fuck-all – let them develop an immune system).

And sometimes OCD has absolutely nothing to do with cleaning. Sometimes it’s about checking the door is locked 99 times. Or repeatedly driving the same piece of road to make sure you didn’t hit anyone. Or repeating The Lord’s Prayer over and over again to protect your wife from being raped by a stranger.

It’s not about a bit of spit and polish. 

5) Addiction is not cured by a rousing speech

Like the rallying cry that ends Hollywood depression (i.e. misery), you can rely on a motivating thirty-second speech to suddenly snap a person out of their crippling addiction, whether it be to alcohol, prescription medication or gambling.

Because it’s just that simple. He just needed to believe in himself! She just needed that special man to come into her life! Bullshit.

Charles Xavier in X-Men: Days of Future Past

Let’s take Charles Xavier in X-Men: Days of Future Past. One minute, he’s mired in an alcohol, drug-fuelled stupor. The next, after one big event, he’s suddenly back to his First Class self. With no explanation of how he shook off this supposedly highly-addictive substance. 

These miraculous transformations reinforces the rhetoric that people with addictions are merely not trying hard enough or have flaws in their characters, rather than acknowledging that this is severe brain disease with potentially fatal consequences.

Do you have questions about mental health for your plot or characters? Join Vicky Newham and me for #psywrite, a monthly Twitter chat helping writers enhance the accuracy and sensitivity of their mental health portrayals and improve their psychological understanding of interactions between characters, situations and arcs.

Our first chat is Tuesday 21st October at 8pm BST on the Twitter hashtag #psywrite.

Code Runner launch

Code Runner, Book 2 of The Amy Lane Mysteries, launches today!

You can purchase a copy of your very own by visiting any reputable ebook retailer, like the following:

Carina Press | Amazon | Barnes & Noble | Google Play | iBooks | Kobo

Not heard of Code Runner? Let me fill you in:

Book two of The Amy Lane Mysteries
coderunner-cover

Ex-con Jason Carr has faced down the toughest thugs in Cardiff, but being assistant to a brilliant, eccentric hacker who hasn’t been outdoors in ten years has its own challenges. Still, he and Amy Lane can solve cases even the cops can’t crack. And when a corpse washes up on a beach, Jason can’t resist chasing the clues—or defying Amy by infiltrating the very gangs he once escaped.

Amy is distraught when Jason’s pursuit gets him framed for murder. He’s thrown back in prison where he’s vulnerable to people who want him dead. He needs Amy to prove his innocence. Fast.

But Amy hasn’t been honest with him—her panic attacks aren’t getting better. And now, with everything that makes her feel safe ripped away, she must stand alone, using her technological skills to expose a baffling conspiracy and a new kind of online crime. Can she clear Jason’s name before danger closes in?

Praise for Code Runner

“Be prepared for a thrilling ride through the countryside of Cardiff, South Wales, and its environs as Amy Lane embarks on another wild adventure.” – RT Magazine, 4* review

“I recommend this series to anyone who likes a fast paced thriller but one that also makes you think.” – Tracey Walsh @ Crime Reader Blog

jason-wanted

To celebrate the Code Runner launch, there are several awesome online happenings for you to participate in, like the #FindJason book selfies, #Carina Mystery blog blitz and Twitter chat, and the Code Runner blog tour. You can find out more about all those things here.

You can follow all the news and updates about The Amy Lane Mysteries by following the blog, liking the Facebook Page and signing up for The Amy Lane Mysteries newsletter.

Amy Lane’s Guide to Password Security

With ONE WEEK to go until the Code Runner launch, my agoraphobic hacker Amy Lane lays down the law on password security. Ignore her at your peril!

password-bonjovi

If you’re looking for my advice, I’m assuming we’ve filtered out the first layer of morons. I’m talking about the kind of people who think “password” is a great password or use one of the most common and worst passwords of the year. Or that swapping out letters for numbers in the name of their favourite band is the height of security. (Yes, Jason, I’m looking at you.)

I also assume you have something worth guarding. Facebook is a leaking sieve for privacy – your best password is wasted on it. Of course, the best hackers will always bypass your defences, but you don’t have to make it easy for them.

Memorable data
password-firstpet
Unless you have a good head for random letter-number strings, you will likely base your password on words in common usage. This improves the chances of your password being guessed by a hacker. If that word is publicly associated with you, those chances increase at a steep incline. Therefore, if you use something as moronic as your child or dog’s name as your password, the probability of a first-time guess approaches 1.

However, our memory functions better when we have something to hang it on. We are increasingly asked to answer information about our school teachers and first cars because it is assumed that this information is only available to us and our closest friends and friendly, who we presumably trust. This, in my view, is a dangerous assumption. However, it is better than writing it down, which is a capital crime and should be punishable by firing squad. Do not do this.

password-numbers-xkcd
Letters, numbers, symbols
Services are demanding more and more conditions for your passwords. Uppercase letters, special characters, 8-16 characters – by imposing these rules, they hope to make your password more secure. In fact, they are driving more people to write down their passwords in an effort to remember. This is, of course, very stupid (See above: firing squad).

Numbers prove difficult to remember for most people. However, under specific circumstances, they prove easier to remember. Pairing numbers or grouping them into familiar patterns can help. For this reason, dates can be useful – though not your wedding anniversary, please (See above: moronic). You can also recycle numbers you learned in the past, like your best friend’s phone number or the postcode of your first house.

Group your passwords
As we have already established, most people cannot remember random data. Ideally, we would have different passwords for every single one of our access points. I live in the real world, however, and I know that this is not the case.

password-unicornvnarwhal

A way to get around this problem is to group passwords – perhaps based on function or subject matter, and sometimes based on level of security. Your bank security should be higher than your phone passcode, though both should be as secure as possible. Perhaps you use the same password for every account your setup in 2014, or perhaps you have a set of passwords for work and a set for home. Maybe all your social media accounts share variations of one password – and variations are very important. We do not want one guessed password to fell an empire.

Use it or lose it
password-snoopy
Password-saving browsers and applications are a blessing and curse. On the one hand, they prevent the sin of writing down a password. On the other, they mean that all someone needs to do is open your browser and they can access every account you own. At minimum, your browser passwords should have an access lock – a master password.

However, the best way to remember a piece of data is to use it continuously. This will maintain it in short, medium and long-term memory. Therefore, resist the urge to tick “remember me” after setting a new password. Constantly typing the password will help you to remember it.

better-passwords
The best passwords are personal
Your password should be memorable to you and only you. The crush in primary school that you did not tell a single soul about. Your favourite character on the TV show you watched after your parents were in bed. The book you read that changed your life but everyone else dismissed as trash. These are memory gold, the data mine from which all your passwords should be gathered.

If you speak a non-English language, use it in your password. If you have a favourite phrase or saying, consider using the initials. Surnames and exotic place names that have no connection to you except that you once read about them on Twitter but did not press “favourite”.

Pair two completely separate parts of your life in one password. The name of your school house and your favourite blend of coffee. The day you passed your driving test and the first single you every owned on CD (or mp3 or tape or record). The details of your first kiss, even if it’s still in your future.

These are the dreams passwords are made of. Go forth and make better passwords.


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.

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.

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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?