Young Writers Society

I have a main character with severe PTSD. Should I write that the character definitely has this, or just 'code' the character/hint at it?

If I use the former option, how should I bring it up in the narrative? Do I write a scene where the character is tested/diagnosed?


Representation is important to me--and I don't want to mess this up...

I think it kinda depends on what happened to your character to bring on the PTSD.

Personally I think less is more, so I'd suggest the hinting option. But it would be best if you just did a lot of reading on people who have ptsd for the certain thing that gave it to your character and go from there!

Hey @BeTheChange!

I don't suffer from PTSD and thus have no first-hand experience, however I have had a lot of second-hand experience in a professional capacity and thus this will be my point of reference in trying to answer your question.

It's one of the less common things I see, but one of the more interesting ones. PTSD nearly always manifests the same way, with flashbacks, nightmares, hyper vigilance. One of the things that laypeople don't know is that you can't have a diagnosis of PTSD until at least six months after the event - before that there's a range of other diagnoses - acute stress reactions, adjustment disorders... it does happen from time to time where someone is say, four months on, and you might say that they have "emerging PTSD" - but not the formal full-blown thing. The reason for this is because for up to six months after a traumatic event, those kind of symptoms can all be normal. It's like how you wouldn't diagnose someone with depression the week after their spouse dies - they're just grieving. So hence the time-lapse comes into question.

I digress.

I suppose the reason for that tangent is to feed into your story - how far out from the event are they? Have they considered getting help? Do they think they need help? How much is their PTSD affecting their life? Remember that severe PTSD can really affect your life - it makes you agoraphobic, it has you seeking safety and reassurance, it makes you avoidant. It can be completely and utterly crippling. Or, alternatively, you can still have PTSD but not as badly, and be able to function for the most part. You need to decide where on the spectrum your character lies.

I think maybe an interesting place to start could be after they've been diagnosed and while they're receiving therapy? Because you do need a character to function for a story to go ahead. They could reflect on progress they've made with a therapist, or they could use skills they've learnt to try and combat the symptoms (psychotherapy isn't my jam, unfortunately, so I can't give you much headway with that research - just ask me about pills ). So they've come out of the darkest days but are still affected, but are on the route to recovery.

If you did go with that they've been formally diagnosed, you can just bring it up that way - maybe they start having a flashback and they reflect on the day they were diagnosed, that they were told these would start getting better. Maybe they're not getting better as fast as they'd like. Or maybe they're getting more under control. You control the narrative.

If you decide not to give them a formal diagnosis, that's totally up to you! One of my pet peeves in life though is self-diagnosis and people deciding they have a mental illness without a formal assessment - often because they don't do themselves and their own resilience justice, and also often because they're wrong. It's up to you. Maybe there's no diagnosis - self or otherwise - involved, there's just symptoms. If you did want to write it maybe as an acute stress reaction or an adjustment disorder that fades with time, that can work well as a narrative arc. Or maybe the arc is accepting that PTSD is an illness and accepting help. Again, I'm doubtful of books where illnesses simply vanish into thin air through the power of friendship or whatever.

I don't think that you need to write a scene with a formal diagnosis - when I make a diagnosis, it's only an initial diagnosis at assessment and can take longer to tease out what it is in full - and that initial assessment is between forty-five minutes and an hour long. Your book doesn't need a forty-five minute doctor appointment in it - though you could reference it in passing, I just don't think you need to write the whole thing.

My last thing is remember that psychiatrists love coding. As a European, I am partial to the ICD 10 criteria, but if you hail from 'Murica, you might prefer DSM-V. Have a read through the criteria for both (in the links) - even if you decide not to go down the formal diagnosis route, having an idea of the diagnostic criteria can help inform you on how to write the character - as well as reading first-hand accounts, and attempts by authors who have gone before you

Hope that helps, bing me if you'd like me to help any further

-Stella x

For me it depends on 2 things:

- Does "PTSD" exist as a diagnosis in the world? (because in fantasy, or historical, or even sci fi, it might not)

- Would the character themselves consider that they have it? (this will impact whether or not they even try for the diagnosis)

If the answers to the two are yes, then say it outright. If the answer to either is no, don't say it but do code it and own the representation should anybody ask later. There are many ways of doing representation, and a solid piece of coding is acceptable so long as the symptoms themselves are accurate and plot-consistent.

PTSD is complicated, with literally thousands of possible variations (for example, you could not experience flashbacks or nightmares at all, or very infrequently). I have an article about it that broadly describes the different symptoms of PTSD and how they could apply to an individual character.

My absolute favourite PTSD representation is Fullmetal Alchemist. In that series, the PTSD is coded but very character relevant— it impacts the plot in multiple places, and taints a lot of the character interactions. That type of behaviour is critical.

Because in the end, the word itself doesn't matter; it's the quality of the symptoms. If you paint on a caricature of what PTSD is, then it doesn't matter if it's coded or outright started. What matters is how much it's woven into the very fabric.

Research a lot (The Body Keeps the Score is an amazing book). Get sensitivity readers. Follow blogs that deal heavily with trauma, preferably writing ones such as script trauma survivors. Those resources are safe to gather inspiration from because they're specifically designed for people to use them to research; if you're going inter-community, then some things you might not be allowed to spread out beyond the confines.