Welcome to a new series of Freudian Script, where I delve into psychology and psychiatry for writers.

My focus over the next few weeks will be on common mental health disorders, including basic facts, common portrayals in fiction, and how writers can accurately and sensitively tackle these diseases in their work.

DISCLAIMER: This blog post is designed for writers of fiction. If you are concerned that you or someone you know has symptoms of mental health problems, please see your doctor.


My first topic is PSYCHOSIS. Frequently misunderstood and misrepresented by writers and journalists alike, psychosis covers myriad diseases and comes in many varieties. Psychosis is NOT psychopathy – the terms “psychotic” and “psychopathic” are not the same thing, though these terms are frequently (and inaccurately) used interchangeably. While I will discuss psychopathy and sociopathy at a later date, we will concentrate on psychosis for now.

What is psychosis? In the broadest sense, psychosis is the inability to distinguish what is real and what is not. It is found in diseases such as schizophrenia and bipolar affective disorder, and can also be triggered by use of psychoactive chemicals (e.g. cannabis, LSD, etc.). Organic psychosis can originate due a neurological condition, such as dementia or a brain tumour.

In this post, I will concentrate on the favourite form of psychosis in fiction: schizophrenia.

Schizophrenia covers a hodge-podge of diseases that have psychotic features, the most common form of which is paranoid schizophrenia. During the nineteenth and early twentieth century, when folks were still figuring out mental health disorders, the diagnosis of these conditions was a bit haphazard.

Kurt Schneider, a smart German bloke, developed a set of “first rank” symptoms of schizophrenia, which suggested that schizophrenia was the likely culprit.

They included:
> Voice hallucinations – external, talking about the person, providing a running commentary on what the person is doing or the person’s own thoughts heard aloud
> Thought interference – the feeling that thoughts are being inserted, removed, blocked or broadcast to the world
> Delusions of control – that someone or something is controlling the body, including movement and changing feelings
> Delusional perception – where an ordinary perception takes on extraordinary meaning (e.g. “The traffic lights changed and I knew I was an angel”).

Of course, the experience of psychosis is not limited to these facets, but they are more aligned with schizophrenia. Note the absence of the Hollywood favourite: visual hallucinations. Of course, film is a visual medium and therefore visual hallucinations are more dramatic and convincing.

See: A Beautiful Mind.

The real John Nash primary experienced his psychosis as delusional beliefs of organisations working against him and, later, auditory hallucinations. Note also how the hallucination talks directly to Nash, which is again atypical.

People with schizophrenia who experience auditory hallucinations often have delusional explanations for these voices. For example, “the neighbours are spying on me” or “the government has bugged my house”. It is difficult to convince people these delusions are false, but particularly if they come from countries with a history of political oppression (e.g. Iran, Sri Lanka, etc.).

A particularly good example of schizophrenia portrayal is Sarah’s brother Michael in “Love Actually”. The delusional content, while bizarre, is not played for laughs and the scene in the hospital is fairly accurate (though the nurses are a bit odd). But Michael is a plot point, not a character.

So, why might a writer include a character with psychosis? The most obvious reason is The Twist. Perhaps one of the main characters is an hallucination? Maybe the government conspiracy thriller is actually someone’s mental breakdown? Maybe we’re all still inside the dream? Psychosis takes the Unreliable Narrator to the extreme. Also, conversely, the diagnosis of a mental illness in the context of a plot where aliens really are invading adds another obstacle to your protagonist.

A psychotic experience, whether part of a chronic mental illness or as a one-off episode, possibly related to drug use, is the epitome of terrifying. Voices from people you cannot see, persecution by unseen agents, the feeling of being controlled. The experiences of people with schizophrenia may make interesting reading for any horror writer looking for new ways to provoke fear.

With all chronic conditions, it is important to think twice before giving a character schizophrenia. It is well-documented that Aaron Sorkin didn’t know what he was letting himself in for when he gave President Bartlet multiple sclerosis, and that dominated a large portion of series plot in “The West Wing”. Schizophrenia can be well-managed, yes, but there are consequences to having the disease and the treatment, as well as the associated stigma.

NEXT TIME: In two weeks, Freudian Script will look at a common but potentially fatal disease which is often snubbed – Depression.

If you need advice or guidance on writing a character with a mental illness, please contact me by e-mail or in the comments below – I am always happy to help out!


  • Nice article and a great idea for a post series. Schizophrenia is often mistaken for psychopathic behaviour by writers, including those writers actually suffering from schizophrenia as I discovered a few weeks ago when a Bang2writer came gunning for me over our apparent “misrepresentation” of schizophrenia in DEVIATION … Apparently if it wasn’t for films like ours, this guy would be able to get a job, etc. Actually, the character that caused the controversy is a psychopath and even referred to as one in the screenplay.

    • It’s partly a sign of internalised stigma, a lot like what you’ve been talking about with teen mums. People with schizophrenia read about the “psychotic psychopath” in the media and think all those things are true for them. It leads to oversensitivity, assuming all depictions are faulty, and it means folks don’t seek help for fear of being judged.

      Accurate depictions of mental health issues, including psychosis and psychopathy, makes for better movies and healthier societies.

      *steps off soapbox* 😉

  • Gracie

    Rosie, I really enjoyed your post and will look forward to reading the rest of the series.

    I am tackling a number of mental health issues in my MS ( my first novel )and would love to have a chat about it a little further if you have the time.

    The whole thing is a little convoluted to explain in a wee post, but the protagonist is taking AED’s. It’s based on the mental deterioration she experiences while taking these drugs, complications in pregnancy, guilt, depression, obsession,postnatal issues, and much much more.
    I feel I may have bitten off a little more than I can chew, but If you would be willing to have a chat I would appreciate it.

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