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
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.
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.