On Writing Mental Illness in Speculative Fiction

I’m not sure if write what you know is the most common piece of writing advice out there, but it’s got to be in the top three. And taking that advice, one of the themes I usually include in my work is mental illness and wellness. I struggle with it. I have an anxiety disorder, and I am no stranger to depression either. And a lot of people in my life deal with depression, anxiety, bipolar, and a smattering of other more arcane diagnoses.

So you’d think mental illness and wellness would be a natural pairing with my interest in creative writing. Especially since writing is one of my favorite coping mechanisms. And yet, I have found it to be an incredibly difficult theme to handle. It takes a deft touch to handle a suicidal or deeply anxious major character without the reader losing interest, or disliking that character.

I think that’s the nature of mental illness. It’s a stopping force, and a story (and the characters in it) need to go go go. Especially in speculative fiction. Maybe Holden Caulfield can mope around in his depression for a hundred pages, but Harry Potter sure can’t. Which is probably why Potter doesn’t seem to have PTSD despite nine years of abuse and neglect at the hands of the Dursleys.

That said, mental illness is something I’m going to keep including in my stories. I want to write about it, and I need to write about it. The trick I’m working on now is keeping a plot moving even when my depressed or anxious characters would rather just hide in their rooms all day. Through trial and error, it seems like the key is to not let a character’s state be static. If a character is struggling with mental illness, they need to be either getting better, or getting worse.

Which isn’t how mental illness works in real life. It’s a never-ending slog of medication, therapy, and maintaining healthy habits (like exercise, writing, and knitting) while avoiding unhealthy behaviors (like overwhelming myself with my own expectations). “Better” or “worse” is something that can happen quickly, but more it can take months. Or years. So it becomes a balance of mentioning the slog, but keeping it “off page”, and then forcing the depressed or anxious character into action through events out of their control.

The young necromancer spent years repressing his unsettling, unwanted powers. But outlaws just kidnapped his little sister. So who cares about upsetting people any more? It’s zombie time! He’ll just have to deal with his issues later, once things settle down and several months fly by in a brief passage.

It’s not easy to get that to work over the course of a novel. But I like how it’s turned out in a couple of short stories I’ve written (links below). Check them out if you’re interested in finished examples of my writing theories in action, or if you just enjoy short speculative fiction and have a few minutes.

“Saint Peter” — an artificial intelligence reaches out to a suicidal young man in an attempt to save his life. I posted this one not too long ago, but here it is again anyway.

“She Swallowed a God” — a family’s dysfunction and mental illness reframed as a fairy tale. This one is a flash fiction contest entry that didn’t win, but I really like how it turned out anyway. So there.


Screw You, Ken Kesey

I’m loud and proud about pretty much any aspect of my life, but when it comes to the lives of those close to me I’m hesitant to spill their secrets publicly. Hence my few, vague allusions to “family stuff” keeping me busy.

But hey, I have permission to spill! And I’ve got something important to say while I’m at it.

Just what was the “family stuff” going on? Well, my husband has been very ill. His depression and anxiety got much worse earlier this year, much worse than my own has ever been. After trying everything else to save him from his inner demons we decided he should try electroconvulsive therapy, formerly known as electroshock therapy, and also known as ECT.

(Spoilers: My husband is doing great right now. He’s even started in on the 3rd draft of an excellent sci-fi novel, the first in what will likely be a long series — goddamn he writes fast!)

This seemed risky, because ECT has a checkered history. It was invented at a time when hysteria was still thought to be a real disease, and much of what was done to “help” the mentally ill amounted to torture.

But unlike hydrotherapy or lobotomies, ECT actually works, and after centuries of refinement has become quite safe.

It began with an observation: epileptics don’t get depressed, despite their plight being rather depressing. This led to the use of chemicals to trigger seizures in “hysterical” patients back in the 1700s, and later to the use of electricity for the same effect.

It worked, but there were risks. Most notably broken bones from thrashing about, and memory loss. So the process was modified. Drugs were added to prevent physical convulsions; muscle relaxants were used first, and then later increasing amounts of anesthesia until general anesthesia became the normal practice. Smaller and smaller amounts  of electricity were used, and in different ways, until confusion and memory loss were minimized.

Nowadays, it can be an outpatient procedure. It’s totally safe; the patient is only cautioned not to drive at all if they are getting multiple treatments per week. My husband got some severe headaches and nausea after his treatments, and he’s had some memory loss — nothing important, just little things like what groceries we bought, or that he has a doctor’s appointment. But that’s it. The only risks are those posed by general anesthesia, which are quite low. And long term, his memory should return mostly, if not wholly, to normal.

There doesn’t seem to be a consensus about just how effective ECT is. Wikipedia says 50% of patients receive some benefit, and of those half become severely depressed again and go in for another round of shocks a year later. The hospital’s informational video said “more than 70%” of patients receive some benefit, and “some” relapse. Of the patients we have spoken to, whether they have depression or bi-polar disorder, 100% benefited.

And my husband has benefited immensely, which is the important part.

So, why didn’t he try this miracle treatment sooner?

Well, it’s unpleasant, expensive*, and disorienting, so it’s a last resort. And I’ve heard from a few sources that as recent as the ‘80s ECT was a whole different beast. The memory loss was worse, the recovery times were longer, they weren’t using enough anesthetic yet to prevent all that scary thrashing. It frightened some of the health professionals (my sources) who administered it.

Oh yeah, and there’s this little book out there by one Ken Kesey. You might have heard of it, it’s only the most famous novel about mental health facilities.

One Flew Over the Cuckoo’s Nest.

Hey, a book! Literature! Now I can tie this back into the theme of my blog. So here’s that something important I wanted to say.

Literature is powerful, and screw you, Ken Kesey.

If it weren’t for that stupid book, my husband might have gotten the treatment he needed months earlier. See, our healthcare system works a lot better if someone is birddogging the doctors on your behalf. And I didn’t birddog for ECT early on because I was still correlating it with crucifixion and submission to the man, thanks to Kesey’s potent imagery.

To be fair, Kesey isn’t the only one who has made mental health facilities look like evil, awful places. American Horror Story’s second season insisted that asylums were full of rape and demonic possession. You almost forget how helpful the hospital and its staff are for Girl, Interrupted once she stops fighting the system. And for a long time, maybe even in the ‘60s, mental hospitals were evil, awful places. Some of them (county health**, cough cough) still are evil, awful places.

But that’s due to under funding and the general stigma we have about mental health in this country. And putting One Flew Over the Cuckoo’s Nest on high school reading lists doesn’t help.

I’m not advocating a book ban. That’s not how I roll. But it needs to be taught in historical context, not just handed to kids. And in general, writers need to stop using scary looking mental health treatments as a symbol for the struggles of normal people against fate or the government. I don’t know how this became a thing, but it sure is. Twelve Monkeys, Penny Dreadful, the whole concept of Arkham Asylum in the DC Universe. None of it paints a favorable picture of mental health care. All of it makes it look like something we don’t really need any more.

But we need it. It saved my husband’s life. So this is an open call to all writers, directors, and media creators. I get it that the asylum of horrors is a fantastically fun trope. But please consider painting a more authentic and modern picture of mental health treatment from time to time.

Who knows? You just might save a life.


*This blog post brought to you by Obamacare. Obamacare: helping Millennials with pre-existing conditions get affordable insurance so they don’t have to move back in with their parents if they get sick.

**County Health does not mean to be evil and awful. But they are deeply underfunded, so they can’t provide many actual services. Mostly they are short-term jail for the poor and delusional.