Three Ways Writers Screw Up Mental Health

I mentioned this at a Gen Con panel, and Mike Shel made some great additional comments that prompted this post. There are three big ways that writers fuck up when it comes to mental illnesses (and media in general, thus people in general).

Schizophrenia doesn’t mean Dissociative Identity Disorder

This is schizophrenia. This is dissociative identity disorder (also known as multiple personality disorder). They are not the same thing, regardless of how often media uses them interchangeably.

Not only do people use them interchangeably, but some also use schizophrenia as a synonym for hallucinations (which is a part of, but not the whole of, this condition). And folks use dissociative identity disorder to mean full-blown “fully realized identities who aren’t aware of each other” conditions, which is the rarer form of this.

If you’re a writer on one of my projects, and you pull one of these out, you’ve better goddamn well know what you’re talking about. And even then, I’m going to give your usage a hairy eyeball because so many people don’t actually know what these conditions mean — a casual use of the word “schizophrenia” will conjure completely contrary thoughts in the head of far too many readers.

Asocial doesn’t mean Antisocial

Many people use “antisocial” to mean “this person doesn’t like hanging around with people/is a recluse/is an introvert.” Everyone who does sounds like a moron, because antisocial personality disorder is a condition that is closer to being a sociopath than it is to being someone who doesn’t like leaving the house.

Here’s more about asociality. And while I’m generally loathe to quote Wikipedia, in this case it’s spot on:

Asocial is distinct from antisocial as the latter implies an active misanthropy or antagonism toward other people or the general social order.

Post-Traumatic Stress Disorder

Unless you seriously do your research, don’t even go here. Why? Because many people with PTSD play our games. Many of them are soldiers. How about not trivializing the shit they go through. And this isn’t just being politically correct — do you really want to anger armed individuals who have been trained in combat?


In general, if you’re going to throw around mental illnesses and disorders, do your damn homework and make sure you can portray it in a way that will properly get past any erroneous preconceived notions that various readers will have. And it’s very easy to look like a moron to those who do know about the subject matter. Let’s make characters, not caricatures.

What other ways have you seen?

– Ryan


9 Responses to Three Ways Writers Screw Up Mental Health

  1. First off, I’ve a Bachelors of Science in Applied Psychology and I’ve done work as a Qualified Mental Health Associate. While my degree had course work in counseling techniques, as well as conflict resolution and negotiation, the bulk of my upper division work was in research methods and abnormal psychology (both in adolescents and adults). That is the more contemporary context for how I often see, or react to mental health issues in our entertainment.

    I think that a lot of writers tend to ‘screw up’ mental health is that they often seem to play disorders off for laughs, regardless of if they’ve gotten them correct or not.

    Instead of commiserating with folks, laughing with them about issues, some writers tend to go for the cheap laugh, which is directed at the person. It’s mocking aimed at the wrong target, unless you’re aiming yourself for a sympathetic revenge-based antagonist it’s just misapplied.

    I hate the cheap laugh, not only because I think it’s unfair to suffers of various disorders but also because I think that we (as audiences and contributors) are worthy of a deeper, more well-constructed laugh.

    • Ryan Macklin says:

      The other way I’ve seen it is to create someone alien (often as a reason for being a villain), which is divorced from the human element of this conditions — written as “that thing that happens to other people, and the POV character doesn’t care about the humanity of the person.”

      – Ryan

  2. McNutcase says:

    One of the ones that bugs me too often is inaccurate depictions of depression. I struggle with depression, and it’s not about being sad. It’s a loss of emotional range. Kind of like the loudness war with music, the difference between “loud” and “soft” is eroded. There have been times when I’ve wished I could feel sad. Or happy. Or ANYTHING.

    Another one that touches on mental health which I don’t think I’ve seen dealt with well: chronic pain. Like it or not, physical pain, particularly ongoing physical pain, affects mental state. On my worse days, I have a significantly shorter fuse; those are the days when I’m not fit company for other humans, because it turns me into a snappish, short-tempered cockbite.

    • Ryan Macklin says:

      Regarding chronic pain, that was the way in which I really admired the writers on House (regardless of how utterly formulaic the episodes were). But then I had to stop watching it, because I had similar chronic pain, and I found his reactions to people starting to seem justified.

      – Ryan

  3. John says:

    As a mental health professional, I concur completely. Writers also screw up bipolar disorder, which is characterized by intense, abnormal moods of SIGNIFICANT duration (weeks), not “being happy one minute and sad the next.”

  4. Travis says:

    Another way that people tend to mess up PTSD is presenting it as something that only or primarily happens to soldiers as a result of being in a war. More often, it arises from rape, sexual assault, or abuse.

    Something else that games and writers seem to miss often is the high rate of co-morbidity of mental health issues – PTSD and depression commonly go together, and PTSD from long-term abuse is often co-morbid with DID symptoms.

  5. Marc says:

    Another thing I’ve seen is Generic Crazy. Because crazy people are just CRAZY! They could do anything! CRAZY! Which is both wildly inaccurate, and boring/lazy to boot. Every disorder is unique, with fascinating specifics, and everyone has their own individual implementations of those mental bugs, which are equally fascinating. (And horrible/exasperating/tragic/tedious/grinding/etc.)

    • Martin says:

      The Generic Crazy-symptom was especially widespread with the Malkavians in Vampire:The Masquerade. Some of the source material was horrible and inspired a lot of inexperienced players to equally horrible characters.
      I like the idea of the Malkavian clan, but it is hard to pull of in a mature and interessting way. For many people, Malkavian just became an excuse for ‘dress funny and act random’.