When writing about mental health problems, I often emphasise accurate and sensitive portrayals of mental illness. But how important is accuracy in writing? Should the story come first?

Daisy Head plays Amy Stevenson  in The Syndicate - (C) Rollem Productions - Photographer: Matt Squire
Daisy Head plays Amy Stevenson in The Syndicate – (C) Rollem Productions – Photographer: Matt Squire

Last week, controversy surrounded the season finale of BBC One’s drama The Syndicate. Amy, a character with Type 1 Diabetes, complained of having low blood sugar and was later administered insulin.

The Juvenile Diabetes Research Foundation (JDRF) criticised the episode, as giving insulin to a person with low blood sugar is dangerous. Karen Addington, Chief Executive in the UK of JDRF, said:

“Television writers and producers have a responsibility to portray life with a condition such as type 1 diabetes accurately.”

However, Kay Mellor, writer of The Syndicate hit back. In her statement she made a number of points in her own defence.

I would like to examine some of those points.

Not A Medical Drama?
The Syndicate is in no way a medical drama or a serious documentary about how to treat diabetes.”

While I may have watched a lot of House at medical school, doctors do not learn medicine from television. Why, therefore, is medical accuracy more important in a medical drama than in any other TV show? What is the point of accuracy anyway?

There are two possible answers to this. One – accuracy is important because we should portray things correctly. Or two – accuracy is important because it enables a show to feel authentic. Writers want the audience to suspend disbelief and immerse themselves in the world. If it is authentic, it will feel authentic.

But with The Syndicate, medical accuracy doesn’t necessarily add to the authenticity. So, why bother?

Did Not Do The Research?
“I based the story of Amy around a young woman I spoke to who said when she’s been eating or drinking something sugary her blood level spikes [high] but then after a time her level drops dramatically. She told me she needed the insulin to stabilise her levels. Maybe it’s a case of no two people being exactly the same.

Mellor says she “researched and spoke to people who were diabetic” while writing the show. In science, the lowest form of evidence is an expert opinion. It is interesting that this is the evidence most favoured by the journalism. It is also interesting how Mellor has taken one woman’s story and extrapolated from it, to the point where she puts so much faith in this story that she thinks it contradicts the JDRF.

Taking insulin after eating or drinking something sugary is entirely sensible. It stores the glucose from the blood stream. If the glucose keeps sloshing about, however, it will eventually be peed out and the blood glucose level will drop. If it drops too low, that is a hypoglycaemia attack. That is not a good time for insulin. That is a very bad time for insulin.

Which is information Mellor would’ve received if she had asked a medical expert. Or consulted a diabetic resource. I imagine she did those things, but chose to emphasise the personal testimony of this particular woman instead.

I have often advocated looking at personal stories to help mental health accuracy. Is this foolish? Is science a better teacher than a person’s lived experience?

For The Plot?
“…like any dramatist I have to take dramatic license sometimes to make the story work.”

“…Amy is a young woman who is diabetic but also quite manipulative…We have no idea if she is lying or telling the truth at any given time.

“…Amy had been through a traumatic time with her boyfriend and clearly feels unwell and confused, she could well have made an error saying her blood sugar was low.”

“Also we have no idea what the chemist said to Spencer or what he did as a consequence… we have no idea how much time has passed.”

Mellor appears to be saying that plot trumps accuracy every time. I have seen this writing advice given time and again. Is it right that story comes first and everything else is just window dressing?

Mellor gives two possible explanations for her version of events – either Amy is lying or Amy is mistaken. She then gives a possible explanation for Spencer’s actions.

Let’s look at the on-screen events: Amy says her blood sugar is low, then later says she thinks she needs insulin. Spencer looks up diabetes on the internet, then goes to a chemist to get insulin. The chemist gives him advice. Spencer returns with insulin and administers it to Amy while she is sleeping.

It appears that Mellor may have wanted the following: Amy is vulnerable, loses consciousness and requires medical treatment. Spencer goes to get medical treatment. Spencer returns and then holds some control over Amy via the treatment.

It is possible to do this with an accurate portrayal of diabetes. It requires a couple of lines here and there, but it holds its overall shape. For example, Amy could treat her hypo with a sugary drink (as she suggests) and then send her blood sugar high. She might then remember she needs her insulin.

Sometimes Writers Screw Up
“Sometimes it can be difficult when I have one hour to tell a big dramatic story, beats are missed and hard facts can be lost.”

And this is the crux of the matter, really. Also, the closest Mellor comes to admitting she made a mistake.

What does a writer do when they’ve fucked up? When I was eagerly looking at readers’ comments on The Amy Lane Mysteries, I stumbled across a thread where I was criticised for my depiction of hackers. I am not a hacker. I am fairly computer literate, but only on the surface of things. I did research into digital forensics and cyber crime. However, I did not speak to hackers and I did not ask an IT professional to check the novel for errors.

What then could I do? I could’ve a) apologised for my mistakes b) argued that my version served the plot or c) quietly tried to improve.

The differences between Mellor and me are that I wasn’t publicly confronted and that, apart from annoying some folk, no harm comes from my mistakes.

However, the inaccurate portrayal of illness can be very harmful. In the case of diabetes treatment, it can be lethal. People believe what they see on television. It’s why there are so many campaigns for the accurate depiction of CPR, a life-saving skill that most people have only seen on TV.

In mental health, that harm comes from the perpetuation of stigma. With every mad killer, another weight is added to the overflowing pile of stereotypical portrayals. Another person is put off seeking help due to fear.

And from that standpoint, do writers always have a duty to accuracy, regardless of the plot?

Do you think writers should put story or accuracy first? Should writers apologise when a mistake is made or should they fight for their story? Let me know in the comments!

7 Comments

  • Accuracy will always suffer because no one writer can be an expert in everything.

    There’s only so much time for research and sometimes scripts are rewritten on the day they’re filmed. You can’t stop production for a week while you go and research every single detail.

    I haven’t seen The Syndicate so I can’t comment on how vital/trivial the error is (is the series over? Could there be a legitimate reason for this coming next week?), but it seems like something I would just apologise for and try not to make the same mistake again.

    But writers will always make similar mistakes anyway because there’s no way one brain can achieve the same level of knowledge/experience as however many millions watch.

    • I agree that writers will never get every detail correct – that is impossible. We can only make a reasonable effort.

      However, this plot formed a major aspect of the episode, including the issue of insulin, and this was a season regular character with diabetes. Also, the events on screen, if enacted in real life, would’ve been potentially fatal – and this wasn’t commented upon.

      I feel the writer should’ve held her hands up and said “mea culpa” and moved on. I think that arguing against the mistake is a poor step in that situation.

  • I think it’s yet another of those things that some people consider irrelevant and others consider sacred, natural laws if you prefer. I am on the irrelevant side. I have seen entire hard drives being uploaded in a matter of 5 seconds to [insert your favourite name] agency and it made me chuckle. Is it true? No. Would I prefer if the script had the agent sitting down twiddling his/her thumbs and then a “12 hours later” sign telling us that the upload failed due to the connection failing? it would be accurate and also so very boring. Do I care if Einstein said faster than light travel is impossible when reading my favourite SF books or watching Star Trek? No. Yet other people will find it sacrilege and I know authors who went to extremes in order to ensure they don’t write a non-scientific faster than light story.

    There is also another side to this. You mentioned mental illness and as someone who has suffered and has gone through her fair share of abuse, if you choose to write too close to the real thing I may get triggered and that is something I’d rather not find myself into. And yet how many books are out there with triggering warning, especially when it comes to abuse and self-harm?

    I read books to escape. I want to be lost in mythic worlds where magic and dragons and faster than light travels are real. I don’t care about accuracy not as a reader and definitely not as a writer but I do respect the people who do care about it. Neither view is a natural law. Both are subjective preferences.

    • Thank you for getting involved.

      In SF&F, my capacity for suspension of disbelief is immense. I don’t care for hard scifi – warp drive is fine by me. Sound in space? Go on then!

      Things that claim to be based in the real world bother me more. I think there’s a difference between your upload example and forensics taking five minutes in crime shows to getting a hard fact wrong e.g. Australia is in Europe, asthma inhalers are taken through the nose, etc.

      As for triggering content, I agree that writers need to consider the sensitivity and potential distress caused by their creations. But I don’t think accuracy has to be detailed. In fact, you’re better off being vague because you’re less likely to get it wrong.

  • Nicola

    Is accuracy important? Yes. Sometimes.

    If you are doing a story, that is supposed to be realistic or set in the here and now, then yes accuracy is important unless of course you are dealing with a character who is incredibly stupid who might say that 2+2 =25!

    It can’t be expected to have everything right but there is a duty to the facts. When it comes to SF&F, though it’s different. If you are in the future or a different world imo, then yeah, its fine to make things up as long as you get the basics right but if you are in a different world, you can create a whole new physics for all I care.

    I worry about the people who might be diagnosed with diabetes and watched that episode and thinks that insulin is given when you have low blood sugar, not checking with the doctor and then following it.

    That’s my problem. Writers don’t get to re-write history or re-write facts, especially if the viewer has any indication that aspects of what they are reading or watching are somewhat true.

    • I agree. SF&F needs to be internally consistent to be believable. Contemporary drama shouldn’t change reality in a substantial way, especially if the mistake could lead to dangerous behaviour.

      Thank you for commenting.

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