Explained, But Not Defined: How to Write Mental Health Issues Respectfully In Fiction

Show of hands: who here likes to give their characters trauma?

One of the many jokes writers like to make is the amount of trauma we give our characters. Sometimes that’s in the form of a tragic backstory where they lost their entire family to plague or their mother died when they were little. Sometimes we force them to face their deepest and darkest fears over and over again (because ChARAcTer GRoWth)

And some authors take it deeper: they explore mental health trauma, assigning their characters with all sorts of frightening inflictions to torture their psyche– PTSD, OCD, depression, and more.

Because that’s what you’re supposed to do, right? Torture and traumatize your characters to force them to piece themselves back together and grow into a better person?

Well yes… and no.

As someone who deals with trauma and mental health issues, I’ve always been interested in stories that tackle these hard topics. But sometimes, I see writers slap a label onto their characters without really thinking about what that could really mean for the character in question– or the potential future readers of the story.

Maybe you’re one of those writers. Or maybe you’re trying to write a story dealing with mental health issues, but you’re not exactly sure how to go about it respectfully.

Well, in this article I’ll be giving you five tips for writing mental health issues well, from the perspective of someone who has not only researched them extensively, but has battled them herself.

#1. Decide the Why

Any time you include mental health issues in your story, you need to ask the why. Why are you choosing to include this specific topic? Because you want to write about it? It’s convenient for flashbacks? Would youur character actually would have it in real life?

Except for a practice novel about abuse, and a novella about autism, I’ve never actually gone into a book thinking “I’m going to tackle this mental health issue”. Most of my characters gained their mental health issues as I explored backstory. For instance, in my dystopian fantasy Protectors, the main characters Jackie and Monty deal with anxiety attacks and depression. I didn’t go into the book choosing to tackle those topics– they wove themselves into the story as I developed the characters. Both my mentor characters experienced deep trauma, but only one of them– Dylan– truly has PTSD, which I realized would be a realistic disorder for him to have after researching the implications of someone’s mental health if they were forced to murder others for a living.
This leads me to my second point:

#2. Research Thoroughly, and Research Well

Despite this being the most obvious step, it’s one people sometimes forget. For instance, a lot of people give their characters PTSD, which stands for Post-Traumatic Stress Disorder. Many of our characters go through “traumatic” situations, so most people think that PTSD is flashbacks and being easily “triggered” by certain things. Flashbacks are convenient for filling in backstories, so they put the label on to explain why they are cleverly infodumping. Admittedly, even I used to do this.

But do you actually know what PTSD is? When I went to write Dylan, I wanted to research what PTSD was so I could write it accurately.

And I was kind of surprised by the definition.

When your body goes into fight or flight, fear, and stress hormones charge into the brain as a natural process to help you survive the situation. This is a healthy process because often it keeps us from doing some pretty stupid stuff!

In a normal situation, as soon as the danger is past the brain processes these chemicals and breaks them down to go back to normal levels. But when the body and brain experience a major traumatic event, such as a battle (especially a battle where the person was forced to kill someone– you’d be surprised how much the antagonism against killing people is hardwired into the human brain), abuse, an accident, or a natural disaster, the brain struggles to process what had happened. And in that struggle, some of the fear and stress hormones aren’t broken down properly and remain in the brain.

So what separates PTSD from trauma? Both forms involve the brain constantly repeating memories in trying to figure out what happened. But PTSD is different in that when those memories come up, the leftover chemicals in the brain are activated. That’s what causes vivid flashbacks and sometimes hallucinations. Because those chemicals are active, not only are you seeing what happened, but you feel like it’s happening all over again.

PTSD can be so severe for some people that they will resort to anything– even drug abuse and suicide– trying to get rid of the pain. This is a tragic end for many veterans; many of them will spend all of their money on drugs trying to forget the pain instead of getting the proper help to heal their brain. There are also stories of people with PTSD with such violent nightmares that they’ve accidentally killed their spouses in their sleep.

But many people and writers don’t know about these implications. A lot of people will make jokes like “Oh I have PTSD”. I’ll admit, even I did when I was younger and I didn’t understand the full implications of PTSD. But it’s no joke. And neither are things like OCD, depression, autism, anxiety, ADHD, or any other mental health issue. Even pyromania is a real mental health issue that should be researched carefully.

So, when you decide to give your character a mental health issue, research it well and thoroughly.

#3. The Character Is Not Just Their Mental Health

I think even people who battle mental health issues fall into this lie, that just because they face something like autism or depression, they aren’t anything but that problem. And many people tend to write their characters like this too– they don’t give them any personality beyond the trauma.

But this is simply not true. People are beyond their mental health problems because people are complex. An ADHD person isn’t always extroverted and hyper and never listening– sometimes people with ADHD can be introverted and bookish. People with PTSD aren’t always having flashbacks and being scared of everything– they try to live life beyond their trauma. Depressed people aren’t always sad and gloomy– in fact, many people who battle depression hide it behind a cheery exterior.

By only basing a character’s personality on their mental health issues, you miss an incredible opportunity to create a complex being. You also, perhaps unconsciously, perpetuate the dangerous lie that those who battle the same problems will never be anything beyond their mental health. I speak as someone who has battled autism, ADHD, and more– I am not just my mental health. They explain me, why I might not like the sound of the warning alarm on the weather radio or can’t stand touch or why I can’t stand still if I watch too many movies in one afternoon, but they don’t define me. I’m not just an introverted girl who hates being touched or loud noises. I’m not just a crazy ditz who can’t listen to anything. Do I still battle these things? Yes, and maybe I’ll battle them for the rest of my life. Maybe I won’t. But I’m not going to let them stop me from living life and you shouldn’t let it stop your characters either.

#4. Talk To People in Real Life

Talk to people who have experienced the issues you’re tackling. Learn their stories and experiences. Ask questions. Ask them what mistakes they’ve seen other writers making with mental health issues. Be respectful and polite, and don’t ask questions unless you’re willing to truly listen.

Get sensitivity readers. I know some authors who are willing to pay people to look over their books and define what they did wrong with those mental health issues. You don’t have to do that, and you don’t have to get a bunch of people, but you should at least get one.

For those of you who write ADHD and autism, here are some tips:

• Many authors only display one type of autism, nonverbal. But autism is a spectrum. I have high-functioning autism, which used to be called Asperger’s Disease. This is usually what I use in my books. 
• Autistics aren’t always showing their autism. You can have days where the autistic side doesn’t come out at all, and the days where you just need to lock yourself in a closet for a few hours to get away from the world.
• Did you know ADHD gets severely worse with dyes? I do! One orange Skittle and I’m a total mess. I’ve watched my ADHD friend go from averagely calm to a hyperactive explosion within seconds of consuming M&Ms. Red dyes have been shown to excite and inflame the brain, and for ADHD people, that means chaos.
  Now, a lot of parents still feed their kids dyes after finding out they have ADHD, so if you choose to include this it won’t be the most unrealistic thing in the world. But I’d love to see this normalized in books, where parents don’t just give their ADHD kids pills to take while still letting them eat sugar and dyes.
  (also, fun fact: coffee calms ADHD down too!)
• ADHD is not just being hyper and unattentive. A person with ADHD has a nonfiring prefrontal cortex, which is the logic section of the brain. Any time an ADHD person tries to focus, the PFC gets even more inactive. ADHD medications are designed to help the PFC fire by providing stimulants to the neurons (however, there are even some types of ADHD, such as ring of fire, that don’t respond to stimulants and can make the patient worse.). The caffeine in coffee has the same effect. Thus, many ADHD people will multitask while doing mundane tasks to keep their brain active. I like listening to music while doing school or washing dishes.
• Did you know many animals “think” in similar patterns as autistics? I learned this through reading Temple Grandin’s books, and I’ve recognized it in working with horses too. Temple Grandin is an autistic animal behaviorist who used her autism to help understand animals better. I recommend checking out her books.
  I got to see this in action when it came to two trainers at the barn that I worked under while I was being trained for my stablehand job, I noticed that my work style gelled better with a trainer who was known for being short and blunt at times, but he was also patient and very clear about what he wanted. His horses were some of the most well-behaved in the stable and I never had to second guess myself in deciphering what he wanted. The other trainer was very scatterbrained, sometimes sarcastic, and she thought in jumps and leaps, making it harder for me to know what she wanted me to do next. She wasn’t mean– in fact she was quite soft-spoken. But her way of processing in leaps made it harder for me to catch up, even with my ADHD. It was an interesting experience because it was the first time I could almost see the trainers as a horse would. It made sense why the first trainer had more well-behaved, curious horses, because he had clearly defined the boundaries without making them antagonistic to humans.

#5. Pray About It.

I know not everyone who reads this blog will be a Christian, so this section might not apply to you. But as a Christian, God is a huge part of my storytelling process. Any time I think about including a mental health issue, I talk to God about whether He thinks I should include it. Ultimately, He knows what I can handle, and if He puts it on my heart to talk about it, then I know I can continue with it in the story. Not every story I write will deal explicitly with mental health, nor should every story should. But God is your ultimate cowriter, and He needs to be included in the decision-making process.

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The world needs more writers who are willing to tackle the tough stuff. If you still want to write mental health issues after this, welcome to the battle!

But if you are starting to question whether writing about mental health issues is for you, there’s also a need for lighter stories. You don’t have to write about mental health to be a good writer. The world needs stories of all sorts, speaking truth and light in these dark days, whether they deal with depression, dealing with grief, losing friends, learning to trust, addiction, autism, accepting change or anxiety attacks.

So sharpen your pencil swords, put words to paper, and go forth in the world with your stories.