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) Schizophrenia 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, controversial 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.

40 Comments

  • I know too much about mental illness, having sick family members. My challenge isn’t getting the facts right–it’s cutting down the reality to make the stories entertaining. Too intense otherwise.

    • It is a very intense experience and translating that for the page is difficult. But you’re also in a unique position to develop truly well-rounded characters with mental health problems. You know that these are people outside of an illness – a mental health problem doesn’t define a person, though it can seem to overwhelm them at times. Maybe think about all the things that make your family outside of how the illness interacts with them – that might help you find the balance. Good luck!

  • Ros

    Thank you for this! I agree with every word. I’m a psychiatrist (in the UK) and it does my head in (that’s a technical term) when authors that I otherwise love can’t be ars*d to do their research and end up reinforcing the stigma of mental illness. Nice work.

    • Thank you! I know, right? Some of my favourite shows and books have caused me to shudder at their lazy research in this field. Any little thing I can do to help banish stigma is a good day’s work!

  • Sheri

    I like the comment on OCD. My roommate (who I have know for 40 years) has OCD. She needs things to be in order. Her room looks like a monks cell, however, anything stationary is covered in dust. She does get teary if I leave something out in her view too long. I just move it. I have ADD. We don’t like to put things away because we thing we’ll never find it. We are quite a pair. 🙂

    • Ordering is very common, as is symmetry. TV shows make a nod to it – usually, the clumsy detective knocks an ornament out of place and the irritated housewife straightens it. Which, of course, is nothing like OCD. It might take hours for that ornament to be “perfect” again and the associated distress is huge.

  • Alice Edlen

    Really great blog about the misconceptions of mental illnesses. One little thing has changed since you’ve written this; multiple personality disorder doesn’t exist anymore, they changed it back in September I think. According to the DSM-5 (diagnostic statistic manual) what was multiple personality disorder is now disasositive identity disorder (DID).

    • Thank you!

      Yes, it was already on the way out when I wrote this, but most people understand it as multiple personality disorder. DID is a really complicated condition and a controversial one – I definitely need to write a Freudian Script post on dissociative disorders soon!

      • Katie

        Multiple Personality Disorder was the name used for Dissociative Identity Disorder 20 years ago, this is not a recent change in name, but unfortunately MPD has persisted in the media. Also, DID is not the splitting off of aspects of a personality due to extreme dissociation. It is more like a failure of a personality to integrate during formative childhood years due to severe trauma. It’s neither as rare or as controversial as your article appears to make out.

        • Thank you for your comment.

          Dissociative identity disorder is one of a number of dissociative disorders, which I was attempting to capture colloquially rather than scientifically.

          However, it is rarer than most of the disorders discussed here (certainly much less common than schizophrenia) and it bears little resemblance to Hollywood’s “multiple personality disorder”.

          It is also definitely not my area of expertise. I would welcome a guest blog on the subject of I had a willing expert.

          • Katie

            I have DID and we certainly aren’t murderous maniacs, which is what media tends to suggest. Discussion of DID in a colloquial manner can be tricky as the only precedent is that set by hollywood of the dangerously unstable murderers. I hope that explains why we may come off as so pedantic when it comes to what DID is and isn’t. Any small slip in definition tends to end badly for us.
            DID affects from 0.01% to 1% of the general population depending on the studies you look at, which does take it up near schizophrenia (1.2%), it’s just often not reported for fear of backlash due to stereotyping and ignorance.

          • It is really important for the voices of people living with conditions like DID to be heard. In a brief article such as this, it is impossible to capture the complexities with any accuracy – and I apologise for any misrepresentation.

            Hollywood has a penchant for equating mental disorders with murder, unfortunately.

  • Meg

    Wait… People think that schizophrenia and slip personality are the same thing? Probably I just knew what they were because of the series I watch…
    I knew OCD wasn’t just about cleaning but about obcessions and repetitive rituals on general but it was really nice to see some good exemples! Thank you!

    • Thanks for commenting!

      Yup, they absolutely do. I’ve personally heard people say things like “she’s all over the place – she’s so schizophrenic. It’s like there’s two of her”.

      OCD is an interesting beast, because there’s so much going on beneath the surface of that disease. The outward signs are only a tiny amount of the whole problem.

  • Amanda

    Wow. I knew a lot of these facts but the one about OCD blew my mind. I always associated it with people being neat freaks and having to have things a certain way because it bothered them, and just bothered them. I am so glad I stumbled across this article because I never would have looked it up myself because I always thought that it was just that. Keep posting! Nice post!

    • That’s because the “neat freak” portrayal is the most common one in the media – we absorb these things unconsciously.

      Glad you enjoyed the post!

  • I have just discovered this article via Pinterest and would like to thank you for it. I have seen most of these before and it makes me want to pull my hair out. Same goes for depression in stories. It is not always about wanting to kill yourself or being non functional in a dark corner. It cannot be healed with “Think happy thoughts”. Though in many cases that is exactly what it is reduced to.

    I’m glad to see that you are picking up on the subject of mental illnesses in writing and hope many writers will see this before falling into the rabbit hole.

    • It also makes me want to tear my hair out – which is why I had to write it!

      I think, most of the time, authors don’t set out to cause harm with their words – they just need more info. And I am always happy to help!

  • Roxanne Coy

    Hi Rosie, First off, I want to thank you for your post and all the great and accurate info on mental illness when I stumbled upon your Pinterest Page.

  • Roxanne Coy

    Sorry about that ! My original post wasn’t finished when something went haywire.
    As I was saying. .. I have struggled with mental illness all my 53 years not only the struggle within but the struggle from my mother and her side of the family as well. I thought all that calmed down over the years but to my demise I’m still dealing with it and have been from my only child for close to 30 years. My daughter is now 34 and I many times came close to suicide because of her mental issues that I hadn’t a clue what has been the real issue until I came across an article on Narcissist Personality Disorder. ..Wow ! It describes her to the Tee !! After her father & I divorced back when she was barely year & a half years old because of his mental illness that I learned over the few years we were married. It runs in his family as well.
    I’m crying out for some direction on someone I can chat with about all this because I’m on mud slide that won’t stop rolling down this hill destroying everything within its path and that path is me.
    Can you please direct me to sometime you may know that is willing to help someone online through chat ?
    Thank you again for your time and the best of luck with all your endeavors. Looking forward to hearing from you soon.
    Sincerely,
    Roxanne Coy

    • Well done on reaching out, Roxanne. It can be very difficult to share something so painful and it’s really good that you’re looking for support.

      Are you based in the UK? The best support is available through the Samaritans – they have an email service where someone can help you work through a problem and your feelings around it. Just email jo@samaritans.org. If you feel very low, it’s better to call them so they can talk to you straight away – the number is 116 123 and is free from a landline or mobile.

      Sometimes difficulties that have been around a long time need something more than online chatting though. Your doctor can probably help you find a counselling service, or you can approach a charity like MIND directly to help you.

      I hope that is of some use to you. Thank you for getting in touch.

  • Great post! I’m writing a YA novel for NaNo right now and my character deals with depression, as I do, I didn’t want someone to just come in and tell her to get out of bed and take a shower and suddenly she was okay. I also wanted to be honest about the fact that many people don’t understand depression and say and do insensitive things.

    • Ronald Wild

      What a brilliant piece. I experienced some insight in to mental illness following a severe head trauma, which left me in my dark bubble for about two years and from which, four and a half years later, I am still recovering.
      Your article mentions many of the things people didn’t understand I was going through.
      As an experience to write about, I ‘d almost recommend it.
      Everyone with mental illness should keep a diary of a blog for future reference.

    • Ronald Wild

      Also irritating, whilst mid depression are those that tell you they ‘know exactly’ what you need. From changing medication, stopping medication, vigorous exercise, absolute rest, lively company, solitude. It is endless. In my case all my social barriers disintegrated, so I was quite comfortable, and found it marvellously liberating, to tell people to “Fuck off! You haven’t a clue what I’m going through.”
      It also made me much better at supporting friends in practical ways, such as just doing some shopping and making sure they attend appointments or getting the appointment to visit them if leaving the house is just too much.

  • April

    I love the bit about addiction it is so true a rousing speech and help of a friend or spouse might get you started on the path, but it might be the hundredth time you started and it is no where near being cured.

  • Bernie Galanko

    Great article. It will help debunk some of the myths that still stubbornly exist in the general population. As one who has lived a serious mental illness for 34 years and worked in the behavioral health profession for 29 years there is a lot for me to be happy to see her coming from a professional in the field. I live in Pittsburgh in the U.S. There are a lot of good people working in the profession here. Still there are many well meaning folks who do not have as much knowledge as they need to be most helpful in addressing the myths and fighting the stigma of mental illness. So I’m glad when I come across someone like yourself who is putting out good information. In addition to my career in the mental health profession I do a little speaking to offer insight from the lived perspective of mental illness. For most of career I’ve been like most people with these illnesses .. too afraid to come out about it even working in the field. But in the later part of my career I have become strong enough to do that and make a different kind of contribution to this field. I’m putting that out to you here in case you find situations where you need someone to contribute input from this perspective. Please feel free to contact me for more details about my background. Bernie.

    • Thank you for commenting!

      I agree that your perspective would be very helpful to writers looking for more detail. I’ll be sure to keep you in mind.

  • Another one: bipolar is just random mood swings–one second you’re happy, the next you are a raging loony, then next you are super pleasant like nothing happened. That’s not how bipolar works. These misconceptions really do make it difficult to explain your mental illness to other people. When I try to explain my bipolar, people don’t get that I might have one or two manic episodes a year with a bunch of crappy depression in between. Don’t even get me started on people romanticizing mania. Ugh. I try to educate people whenever I have the chance.

    Also, this article caught my eye on Pinterest simply for the Stargate screencap.
    I did spend a few days in a inpatient treatment center a couple years ago. No padded rooms, but very uncomfortable foam mattresses that killed my back. It was the most boring 72 hours of my life. There was nothing to do–no TV, computers, radios, phones, books, no going outside. We had crayons and paper and crossword puzzles. I literally spent hours staring at the ceiling listening to this bipolar, autistic guy ramble on about whatever came to his mind (which was a lot). I told the therapist there that if a person wasn’t crazy when they went into that place, they were sure to go crazy from boredom while there. I couldn’t wait to get out. It’s a major motivator to make sure I take my meds–don’t want to ever go back.

  • I confess that I used the arousing-speech trope, but in a different manner. My severely traumatised protagonist is impressed by the words but not converted. They settle slowly in at first, inflicting subtle changes to her attitude, and her trigger events are dormant for a while. But then, just when she thinks she has at last overcome the worst, she enters her next phase of uncontrollable violence …

  • Wonderful blog! It’s extremely helpful and well-researched.
    I have a villain who is mentally ill. He experiences violent mood swings–decent one moment, murderous the next–and is completely unpredictable. (He also thinks he’s part wolf to the point of howling at the moon.) Since he lives in the middle ages, there is no given name or treatment for his condition. What particular type of mental illness do you think this looks most like–if anything at all? Many thanks, Rosie.

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