Reflection's Edge

Characters on the Couch: Introduction

by AJ Grant

Given that the characters we write about are not, in fact, real people, it can seem strange to want to devote time and attention to their psychological needs. After all, we're the ones at the keyboard, are we not? If we want our characters to laugh, cry, or stress out, it is entirely up to us to determine when, why, and how that happens - isn't it?

The answer is: yes, and no.

Certainly the emotions of our characters can go at, as Babylon 5 creator J. Michael Straczynski put it, "the speed of the plot." If we need our protagonist to feel depressed, for instance, we can certainly make her feel depressed. But just as it would be unrealistic for a human character who had been shot in the chest to be totally healthy and fighting bad guys within a few hours (Jack Bauer on 24 notwithstanding), it's likewise unrealistic for a character who has anorexia to order a second helping of dessert with her dinner.

Moreover, as Marion Zimmer Bradley used to say, stories aren't about ideas; they're about people. What your character thinks and feels is a vital component of why she does whatever it is he's chosen to do. Understanding human psychology gives a writer valuable tools for moving a story along both on an internal and external level. Internally, a character starting out with a psychological problem provides a motivation for how he's propelled through the story. Externally, events could happen to him which create problems and thus provide a reason for his behavior to change during the tale.

Psychological elements can give depth to characters and necessary conflict to plotlines. It's one thing to say your character is a hero because she was destined to be - another for her to act like a hero because she has a death wish. Or to perform heroic acts in spite of a crippling phobia. Understanding psychology allows authors to answer the question "Why is my character doing this?" in a way that helps create three-dimensional characters, even if an official diagnosis of illness never makes it to the page.

Contrary to what certain actors would have us believe, mental illness is illness. The science of psychology, soft though it may be, tracks the workings of the brain in what are recognizable patterns. Authors who wish to use psychological elements in their stories need to pay close attention to known psychological details in the same way that authors with pregnant characters need to familiarize themselves with nine months' worth of human development, and authors with characters who get wounded out in the wild need to familiarize themselves with first aid - or with what happens to a person who is wounded when no first aid can be had.

Fortunately there are many ways that an author can become familiar with psychology without spending the time and money to get a doctorate. The key is understanding psychology as a whole, and learning how to discover more about the illness that your story needs. This article is the first in a series called "Characters on the Couch," which attempts to explain mental disorders in a way that will be helpful to authors. In subsequent articles, we'll get more in-depth with some of the illnesses that commonly pop up in stories, such as bipolar disorder, depression, eating disorders, post-traumatic stress disorder, and borderline personality disorder. In this article, we'll start by covering psychology as a concept. What is it? How are illnesses classified? What are some common misconceptions? What websites are good for research?

What The Heck Is This Thing?

Simply put, psychology is the study of what we feel, think, and do. If a lung specialist wants to make sure that we can breathe without problems, a psychologist wants to make sure that we can interact in the world without problems.

It is for this reason that psychology is considered a "soft" science. If a patient shows up at the doctor's office with a broken bone, the actual broken bone is easy to prove. The doctors can take x-rays and see the fracture for themselves. On the other hand, if a patient shows up at the doctor's office and complains of feeling sad, a diagnosis is harder to make. To begin with, how can anyone quantify sad? Even if they could, sadness from depression is not necessarily the same as sadness due to recent frustrations on the job, which isn't necessarily the same as sadness brought on from a dysfunctional thyroid gland. (Suddenly that broken bone is looking like the more attractive problem, isn't it?)

However, psychology is not fighting blind. Years of research have allowed psychologists to observe and research patients and determine that certain illnesses can, in fact, be categorized and classified in the same way that physical illnesses can be.

Everybody Thinks They're Napoleon, Right?

Common misconceptions about mental illness abound. The most common is that mental illness isn't actually illness. Surely people with agoraphobia could leave the house if they kept a stiff upper lip, right? Sure. And parapeligics could walk if they wanted to strongly enough.

Though it can't be denied that not all doctors are created equal, and that some are far too happy to prescribe Prozac or Ritalin for those who might not need it, this does not mean that mental illness is all in the patient's head (so to speak). One of the problems is that people use terms like "depression" when they don't necessarily mean that they are clinically depressed. This can cause a misconception that anyone who's feeling a little bit down in the dumps will have Paxil shoved down their throats if they go anywhere near a doctor - or that people who are clinically depressed just need to have a good cry and then get on with life.

Another common misconception is that having a mental illness means that you're crazy. Certainly some mental illnesses can cause symptoms such as delusions, hallucinations, or other behaviors that most people think of as "crazy," but not all mental illnesses do this. Just as a cold is not the same as the flu is not the same as life-threatening pneumonia, someone who needs a brief bout of group therapy to deal with his bereavement at the death of a loved one is not the same as someone whose Schizophrenia makes him believe that the government has planted recording devices in his teeth.

Another misconception is that people with mental illness don't have problems - they're just fun, quirky folks who can teach us all a wacky yet valuable lesson about marching to the beat of our own drummers. (For a good example, see Johnny Depp's character in Benny & Joon.) This stereotype does a great disservice both to those who struggle with mental illness personally, and to the friends and family members who spend a great deal of time and energy taking care of them.

Dogs Saving Mannequins - or maybe DSM stands for something else

The Diagnostic and Statistical Manual, or DSM, is the guidebook that the American Psychological Association (APA) uses to determine what illnesses patients have. (Outside of America, the International Statistical Classification of Diseases and Related Health Problems, or ICD, is typically used instead. It is similar to the DSM in that it breaks illnesses down into quantifiable categories, though it doesn't always use identical critiera to the DSM. This article series will mainly reference the DSM.) The DSM is an attempt to break mental illnesses down as objectively as possible to aid in patient treatment and psychological research. Thanks to the DSM, when a researcher at UCLA refers to patients with Delusional Disorder, a researcher at Harvard knows exactly what that means.

The DSM is also used to explain why patients are at the doctor's office in the first place. This can cause some confusion when people become upset at certain conditions' inclusion in the DSM, mistakenly assuming that the APA thinks people with those conditions are "crazy." For example, there was a great deal of controversy about the inclusion of Premenstrual Dysphoric Disorder because some felt that the APA was trying to equate the female reproductive cycle with insanity. This was not the case. Instead the goal was to provide a way for women to get treatment if the mood swings associated with their menstrual cycle made it impossible for them to function.

A helpful comparison would be to think of physical illness. Just because a dermatologist has a code to classify treatment of skin blemishes that are cancerous doesn't mean that the dermatologist believes that everyone with freckles has cancer. Likewise, just because the APA has a way to classify Seasonal Mood Disorder doesn't mean that they believe everyone who feels a little stressed during the holidays needs to be committed (although some of us may feel that about ourselves while trapped in a mall on Christmas Eve).

The strength of the DSM is that it makes sure that those who are being treated for mental illness actually need that treatment. Just as a heart surgeon wouldn't operate on a patient who actually had a ruptured appendix, a psychiatrist wouldn't want to prescribe anti-depressants to someone who was actually suffering from bipolar disorder - or who wasn't properly depressed at all.

This is not to say that the DSM or APA is perfect. Unfortunately, while everyone can agree that a broken bone needs to be healed, not everyone can agree on what a so-called "normal" thought or emotion is. When psychology was in its infancy, it was considered abnormal if a woman showed interest in sex. Now it's considered strange if she doesn't. Likewise, there is the infamous example of how homosexuality was once considered a mental illness and now is not.

But every science is constantly evolving. After all, we used to think that the best way to heal people was to bleed the illnesses out of them. Plus I've heard rumors that the earth actually revolves around the sun and not the other way around. Talk about crazy, huh?

Is Bipolar Contagious?

There is no single cause for mental illness, but if you want your character to be mentally ill there are various ways to get her there. Note that although some disorders may be transitive and grounded in recent events, many illnesses have a strong chemical or physical component, and will never be "cured" so much as "adapted to."

Who's Shrinking Heads and How Do They Do It?

You've determined your character is mentally ill, you've used the DSM to figure out what it is they have, you've painted an accurate picture of mental illness, and now you want your character to get some help. What form is that help going to take?

Therapy takes different approaches, but on the whole all therapy shares the goal of identifying the patient's problem and helping the patient deal with it in some fashion. In order to achieve those goals, therapists may follow one of three basic approaches:

  1. Cognitive: The patient's problems stem from irrational or faulty thinking.

  2. Behavioral: The patient's problems stem from reinforcement of dysfunctional actions.

  3. Psychodynamic: The patient's problems stem from childhood.

A patient who is depressed will probably do well with cognitive therapy. A patient who is terrified of going on airplanes will probably do well with behavioral. A patient who wants to sleep with his mother and kill his father is a psychodynamic's wet dream. However, on the whole, most therapists will treat a patient with a little bit of everything and tailor the treatment to the patient's needs.

Therapy can take place one-on-one for someone who needs individual attention (a person seeking treatment for depression); with a group for those who can benefit from learning that they are not alone (an addiction recovery support group); or with a few select people who share a common problem (a married couple trying to avoid divorce).

Those who provide professional help can take many forms as well. Psychiatrists are medical doctors and thus can prescribe medicine for those whose mental illnesses require it. Psychologists have doctoral degrees in the field of psychology, but cannot write prescriptions. There are also Social Workers who may not do therapy per se, but who can help work with those whose mental illness has made it hard for them to hold a job or live on their own.

Psychology on the Web

Now that you know enough about psychology to start playing Sigmund Freud with your characters, here are some handy links to help you get started:

A basic overview of clinical psychology and its practice: http://www.guidetopsychology.com/intro.htm

The encyclopedia of psychology: http://www.psychology.org/

The American Psychological Association's homepage: http://www.apa.org/

Online DSM-IVTR information: http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm

The DSM-IV Made Easy: http://mysite.verizon.net/res7oqx1/index.html

International Statistical Classification of Diseases and Related Health Problems: http://en.wikipedia.org/wiki/ICD-10

Online ICD codes: http://www3.who.int/icd/vol1htm2003/fr-icd.htm


©AJ Grant

AJ Grant has a BA in psychology from Columbia University, which may go to prove the argument that a little knowledge is a dangerous thing. A full listing of AJ's articles and stories can be found on AJ's website. AJ is a staff writer for Reflection's Edge.






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