Young Writers Society

The thing I don't like is the romanticising of mental illness- or any illness -through books and tv and movies. I'm not saying that you're doing this, Castiel, or anything like that... I'm just voicing something I think is an issue with the way mental illness is often portrayed. River, from Firefly was certainly an interesting character, but in my opinion she was portrayed in a way that made her seem somehow angelic, and waif-like because of her mental illness, supposedly. She'd have these out bursts were her brother would have to come and hug through the battle, and it ends with her sobbing in his arms.... now yeah, that does happen with some people with mental illness, but it doesn't always happen that way. It depends on the person, and the severity of the illness... often it varies drastically between genders, as well. My point is, unless you're basing you're character solely on you're own illness and tendencies, you might want to consider talking a look at some of those links Rosendorn supplied, and just think about what a mental illness would be like for someone else, regarding their style of life, family, etc.

Now, a lot of YWSers have mental illnesses, or have had someone in their life that has had one. It's not an uncommon thing, nor is it a terrible thing. Everyone has different struggles in their life that they have to face. The cool thing is, you get to learn from them... and I think mental illness shouldn't be looked at as a disability, but a challenge... a dare. I dare myself to do better, no matter what the challenge, to succeed in my goals. I dare you, as well.

I think that we shouldn't romanticise the struggles of mental illness, but instead, the challenge to do better with what we have to work with.

( that's my two cents on mental illness and portrayal )

As for mental hospitals themselves, I have no experience with them.
Though if 'trying to kill someone' is just striking out, beating some kid to a pulp... I really doubt that they'd get put into a mental hospital from a one time thing ( I knew a kid that had a mental illness, wasn't diagnosed, but would attack other kids... but they didn't get put into a mental hospital for that... they may be there now though ). When a teenager tries to kill themselves they don't get put into a mental hospital, they give them consoling first, from what I've witnessed. I would assume the same steps would apply to a teenager trying to kill a kid.

The other thing is there's different degrees, so to speak, on trying to kill people. There's someone beating someone because they're at their breaking point, and there's bringing a gun/knife to school and threatening the teachers, kids, bullies, etc. If you're character came into her school with a gun, you can bet she'd get into a mental hospital, or at the very least, it would be a prospect. If she beat a kid, she might get consoling instead. You see what I mean? It really depends... and it's good to figure out what would actually seriously get her into a mental hospital.

I'm bipolar, and prone to pretty dramatic manic episodes, so I understand where you're coming from. Some thoughts:

-I would try to avoid making your character's issues exactly the same as yours. It could be triggering for you and it runs the risk of making your character a clone of yourself. Having tried it myself (On the Edge) I know it's not easy. For that story, I exaggerated some of my real feelings while also trying to give the character her own personality and situations to react to. So I would focus on how your character would relate to her symptoms first, because it may be very different from your experience (research can help with this).

-If she seriously attempts to kill someone, she'd probably be arrested first rather than sent to a mental hospital. If she threatens to kill herself or others, she might end up in a psych ward eventually. She might also get sent to the ER--I wouldn't be surprised if school officials assumed drugs were involved.

-From my understanding, the main difference between bipolar and schizophrenia/schizoaffective disorder (which is essentially bipolar plus schizophrenia and is different from schizotypal personality disorder is how psychotic symptoms are experienced. In bipolar disorder, psychotic symptoms are tied to moods and don't occur outside of episodes, whereas with schizophrenic/schizoaffective people they do.

-Belief in paranormal things isn't necessarily a delusion/psychotic symptom, though it can be. For example, a person can believe that time travel is a possibility without it affecting how they perceive the present. If, however, they start believing their friend is a time traveler with malicious intent or that they're in a different year, that would be a symptom that may need diagnosis or treatment.

-I would look into the laws of wherever this story takes place to see what would get a minor sent to a mental hospital (vs arrested vs sent home).

I've been to two psychiatric hospitals (both in the past year and a half) so I could probably offer some insight as to what they're like. I was in short term in patient treatment, once for a week and once for four days. You can be put in a residential program where you stay for several months or more, but as far as I know that's mostly for extreme cases. I know people who have been to the hospital 15+ times and have never been put in a residential program.

Most of the time, psych hospitals are basically used to keep people from hurting themselves or others. You'll stay there until the staff think you'll act safely when you get out. 90% of the time they don't really improve the mental health of the patients anymore than regular therapy would.

In psych hospitals, everything is extremely structured. You do have some free time, but how much varies from place to place. At one hospital we got about two hours of free time with the group, and about two hours in our rooms (not counting at night). In the other we got three or four hours of group free time but we weren't allowed in our rooms at all during the day. You also typically get a few more hours of free time on weekends when things are more relaxed. A week day schedule would look something like this-

Wake up (at around seven or eight)
Morning meeting/group
Breakfast
Free time
Therapy group
Rec group
Lunch
Free time and one on one talks with therapists and staff
Therapy group
Dinner
Free time (sometimes parents are allowed to visit during this time. One place we were allowed daily visits, while at the other we were allowed one or two visits a week)
Wrap up group
Free time
Bedtime (at around ten)

During morning meetings, staff would usually ask us to set a goal for the day and ask us to rate our mobile. During the wrap up meeting we would be asked if we completed our goal and to rate our mood again.

We did a lot of different types of things in therapy groups. Usually it involved a lot of talking and, obviously, something related to therapy. (If you'd like specific examples let me know.)

In rec groups we usually did something therapy related, though with art or games or something involved. Sometimes we would just play regular games (sometimes athletic if the place had a gym, which one of them did). Other times we did art therapy.

During free times you can pretty much do what you want. The hospitals I went to had TVs, books, cards, board games, craft supplies, all kinds of stuff. We spent a lot of time coloring and playing card games. Also, tiny details, there's this card game we played in the hospital and everyone said that all of the hospitals they'd been to had played it, but they had never seen it outside a hospital. We called it Slap Happy, but other places call it different things.

For meal times some places have you go to a cafeteria and others just bring the food to the meeting rooms. It's not very good food. It's basically normal hospital food, but it's edible. Usually. (We also got a few snack times every day where we got cookies and ice cream and stuff).

Like I said, everything is really structured but in general it's really relaxed and calm. It's essentially a break from the real world and all the problems and stress that come with it. Most places don't even make you do your schoolwork while you're there.

As far as the people go, everyone gets along most of the time. The stereotypes that people in hospitals act "crazy" is just not true. Sometimes there are fights and sometimes people start throwing stuff. I've only seen that twice (both by the same girl). She kicked in a glass pane once, punched a hole in the wall, and tried to twerk on the front desk. When you start doing something like that they'll put you in isolation (we called it the quiet). She wouldn't stop and they ended up giving her a shot of sedative (nicknamed "booty juice") that goes in your butt cheek or thigh. That doesn't happen super often, though. (But apparently often enough that the chairs in the hospital weighed like 50 pounds so you couldn't pick them up and throw them). People having non violent, non raging breakdowns are a little more common. Crying and yelling and stuff like that. If you have an episode like that they'll probably put you away from the rest of the room so you can calm down.

Everyone gets really close pretty quickly in hospitals (the ones who are willing to socialize, at least; some people refuse to talk or make friends). Within a week it was like I had known everyone for a really long time, because you're basically pouring your emotions out to this group of people every day. It's hard not to get close. You're not allowed to touch each other in any way, though. (One place yelled "Boundaries!" at us any time we would try to hug).

There are two people in each room, both of the same gender. Since I'm transgender I got a room to myself. I've heard that if you're gay or bi they won't let you room with anyone either. I've even heard of a girl who was a lesbian having to room with a guy. (On a similar note, there always seems to be a lot of LGBT people in mental hospitals. At least a quarter of the people in both hospitals I was at were LGBT). Like I said earlier, some places let you into your rooms during the day and others don't. At night staff come around to check on your every fifteen minutes at night.

I think that covers most of the stuff, but there are still a few little things that might be helpful.

Some hospitals make you stay in your unit while others let the staff take the group elsewhere in the hospital, like the cafeteria, a gym, or even outside.

Everything in hospitals is meant to be really, really safe. You're not allowed to have anything sharp (including pens, only pencils we're allowed) and you're not allowed to have strings either. No shoelaces or strings in pants or anything like that. If you could possible hurt yourself with it it isn't allowed.

On the topic of clothes, they'll probably put you in scrubs when you get there (depending on how you get there) but after your parents bring clothes you can wear what you want (as long as it doesn't have strings), but most people just wear pajamas all the time.

You're allowed to being stuff with you, like books and notebooks and magazines and stuff. You have to take the staples out of magazines, though. I don't think you're allowed to being your own blanket or pillow, though, which sucks because the beds only have one thin sheet, one thin blanket, and one pillow.

Different hospitals have different rules about visitations. One of the hospitals I went to let us have visits from our parents everyday, but parents were the only people who could come. No friends or even grandparents or other family. We could also call people, but again only parents. The other place I went only allowed visits twice a week, but anyone over 18 could come and you could make phone calls to anyone your parents put on your list (including friends. If they'll answer their phones >.>) Other than that you don't get any outside contact. No cell phones or internet or anything.

Both hospitals I went to also required you to have a family meeting. Basically your parents would come in and you'd have a family therapy session.

I can't think of anything else at the moment, but if you have any questions or want anymore advice at any time let me know!

As an after thought I'll add that it really isn't hard to get hospitalized. If any mandatory reporter (basically any professionals like therapists, psychiatrists, guidance counsellors, etc) hears that you're suicidal, homicidal, or they think you're dangerous to someone/yourself, they'll likely ask you promise that you will not do anything. If you can't promise that, or they think you're lying, they'll either recommend you go to a hospital or force you to go. (I went voluntarily both times). If you've already acted on those things you don't have a choice.

I have a sister with the problems. She has many, things have been real tough lately. And Sorry Queer, hope you are OK!

Holysocks wrote: The other thing is there's different degrees, so to speak, on trying to kill people. There's someone beating someone because they're at their breaking point, and there's bringing a gun/knife to school and threatening the teachers, kids, bullies, etc. If you're character came into her school with a gun, you can bet she'd get into a mental hospital, or at the very least, it would be a prospect. If she beat a kid, she might get consoling instead. You see what I mean? It really depends... and it's good to figure out what would actually seriously get her into a mental hospital.

What if she had a breakdown at school and people were standing around her laughing while she was sitting in a corner and she was mentally shut down, and she just snapped and she lunged at them?

You still need to answer one question: What is she lunging at them with? Scissors, a stapler, a pencil, a pen, nothing but her fists and intent to kill?

You would also have to establish just how fast your character's school is at diffusing situations, and why would they let people do that in the first place? Even if it's outside of class, plenty of schools have guards that patrol the hallways, so they would see a situation like that and probably ask the kids to step away.

At this point, it sounds like you have these people doing this for no reason. Give them a reason, and give them motivation. Even if your main character doesn't know it, they have reasons—maybe they're afraid of the unknown, and your character represents someone they've never had to deal with before. Maybe they're trying to hide that they're secretly overemotional. Maybe they've been raised and trained to treat being emotional or "crazy" as purely wrong, and thus it's okay to treat other people badly because of it. Like I said, the character doesn't have to know this, but it helps your people be more than cardboard cutouts of harassers.

The punishment for this situation would vary by school, let alone by state, so I encourage you to do plenty of research as to the protocol of the places you intend on basing this in. And if you make one up completely, make sure that you have all their protocol outlined like a normal school or mental hospital would.

I'm not going to read through all these comments, so apologies if someone has already mentioned this... Try looking on Youtube! A lot of teen Youtubers have made vlogs about their experiences at mental hospitals.

Castiel wrote:

Holysocks wrote: The other thing is there's different degrees, so to speak, on trying to kill people. There's someone beating someone because they're at their breaking point, and there's bringing a gun/knife to school and threatening the teachers, kids, bullies, etc. If you're character came into her school with a gun, you can bet she'd get into a mental hospital, or at the very least, it would be a prospect. If she beat a kid, she might get consoling instead. You see what I mean? It really depends... and it's good to figure out what would actually seriously get her into a mental hospital.

What if she had a breakdown at school and people were standing around her laughing while she was sitting in a corner and she was mentally shut down, and she just snapped and she lunged at them?

Hello! I've skimmed most of the comments so far. I'm currently in a masters program for clinical psychology.

First, why would someone be hospitalized? There has to be evidence that the individual is in immediate danger of harming themselves or someone else. Even if you're fully psychotic or fully manic, you will not be in the psych ward of a hospital unless you have means, plans, and intent to harm yourself or someone else.

However, there are LOTS of other places someone could be admitted. There are lots of different inpatient treatment centers that would admit people for reasons other than risk of self-harm/harm to others. There are lots of places that focus on the "severely mentally ill" as in psychotic or manic individuals. I'm not sure if it gets that specialized for adolescents, but there are lots of inpatient options for adolescents as well.

So in this case, if all your character does is attack some people at her school, that alone would not be enough to have her admitted in a hospital. Although it could be enough to get her admitted somewhere else. What would need to happen for her to be admitted in a hospital? A mental health professional (like the school psychologist) would need to talk to her and evaluate her risk - is she planning on hurting herself or someone else? Does she have a specific plan, the means to carry out the plan, and the intent to carry out the plan? If that is not evident, the mental health professional would still talk to her/de-escalate her, etc but would not recommend hospitalization. If all of that is evident, the professional will still talk to her. Hospitalization is always a last resort. The goal would be to talk to her long enough that the plans/intent would go away because these are often impulsive decisions. If it becomes apparent that this is not going to work, the professional will recommend hospitalization. There are two routes to go: 1. she would admit herself (but would need someone to escort her to the hospital, the professional would call ahead and let them know she's on her way). 2. she would be forced (either someone would escort her or there would be a police escort).

If you want her to be admitted to the hospital, she could do everything you've said thus far. Then, after she's pulled off of the people she lunges at or the fight or whatever happens ends, she could be sent to the school counselor. The counselor would assess her risk and learn that she plans on attacking the students after school/tonight/tomorrow/whenever. OR she could be planning on killing herself that night/tomorrow/whenever because of what happened at school. As long as the things previously mentioned are all there, she would then be admitted into a hospital.

Second, what actually happens in the psychiatric ward of a hospital, I believe what queerelves said would be fairly accurate. I don't have any experience in psychiatric wards. However, I did an internship at an inpatient treatment facility for kids/adolescents. So if you're interested in going that route, I can give you more information about what a typical day looked like for the kids I was with.

Third, what she's struggling with. I know you previously said you're basing some of her stuff off of things you deal with. Someone else mentioned that you should try to avoid making the character too similar to you. I've done this with characters before and I think it makes writing really messy. Personally, I find it difficult to differentiate who the character actually is if I'm basing her too closely to me. Also, you wouldn't want to jeopardize your own mental health by making the character too close to you. (I'm not 100% sure if that would happen, but you never know). However, I think you should definitely use your own experiences for detail work. For example, if your character experiences dissociative symptoms and you've experienced dissociative symptoms, then you can use what that feels like to inspire what your character experiences.

Symptom wise, there is a TON of overlap between all of the psychotic disorders and the bipolar disorders. I don't think you need to get too caught up on what her specific diagnosis is. You could go to ten different mental health professionals and get ten different diagnoses with the same set of symptoms. It's all very complicated and to some degree, subjective. In many cases, the exact diagnosis doesn't even matter all that much because the treatments will look so similar.

I think what you should have a good idea about is if you want to go the psychotic disorder route or the bipolar route with your character. I'm more than willing to go over DSM-5 specifics about any disorder(s) if you want if that would help you decide which side she's on. I'm not sure if that would help with the specific question you originally asked, but it might help you get a better overall understanding of your character (even if it's information you never put in the book). I know I always end up doing WAY more research and knowing WAY more about my characters/locations/situations than I ever put in the book (but maybe I'm just nerdy)

Let me know if any of that is confusing or you have any other questions I may be able to help with! Personally, I think tackling mental health stuff in books is SUPER hard, but when it's done well...MAN are those books good!

-Carly

@Carlito I'm wondering why you thought you were qualified to speak on this, seeing as you have no experience? Posts above yours contradict some of the points you made, and the stories come from personal experience. I'd be far more likely to trust those who have been sent to psych wards instead of those who've never been in one.

@Rosendorn, she is in a masters program for clinical psychology, so she probably has experience examining case studies of those encountering mental illness and has been taught as to what to do when a patient should be sent to the hospital. Different personal situations demand different responses, of course, and some places go above and beyond the call to help those suffering, but this is pretty typical by-the-book procedure that many places still follow... sometimes to very tragic ends, unfortunately.

Not going to lie, this sounded fairly condescending:

I'm wondering why you thought you were qualified to speak on this, seeing as you have no experience?

Do we need hands-on experience on matters whenever we'll give out opinions here? I'd pretty much be thankful for any thoughts on whatever question I had. The quality and helpfulness of the posts will wary, but I don't see any point in calling anyone out.

I'm glad this topic has gotten a lot of response though.

I'd like to add my two cents to this again, because of something @Carlito mentioned.

So in this case, if all your character does is attack some people at her school, that alone would not be enough to have her admitted in a hospital.

Let me tell you a story.

Valentine's Day, 2012. I was 15 years old, undiagnosed, but it was fairly obvious I had some kind of mental or emotional instability due to, well, my visible instability. For the last couple of months, I had been in a Spanish 3 class—just transferred in—with a girl and her friends who despised me, and made this obvious by tormenting me nearly every day. On this day, I had already been having a hard time. I don't remember all the reasons exactly, but it was a Tuesday, I was sick, I had Driver's Ed class after school, and just the day before I had been chewed out by my choral director because it was the week of district evaluations. I was sitting in Spanish class, shrunk back into myself, not paying attention to anything until this girl spoke to me.

She asked me, "Hey, are you okay?" I didn't hear her being concerned, I just heard her usual snide voice. Already unbalanced, I collapsed, lunged at her, and hit her—three times. Was carted away to the dean's office, where I was promptly told that I was suspended for five days and if I didn't get a psych clearance from a hospital official then I was suspended indefinitely, thus effectively expelled. There was no talk about if I wanted to hurt people. There was no talk about a school psychologist—we didn't even have a school psychologist in the four county area, I doubt even in the southern half of Florida, where did you go to high school?—and there was no talk about talking me down and recommending therapy only.

I went to the psych ward. Spent four days there, was discharged once I'd calmed down (I don't have extensive experience in the ward, and most of what I know mirrors queerelves's post up at the top of the page), and got my clearance.

So I'm not sure about "protocol", but most of the kids in the psych ward got less than I did. One guy was there for throwing a brick through the window of a teacher's car—again, no school psychologist, no therapy talks—and another girl was transferred to the adult ward at age 16 because she kept running away from home. They transferred her to the adult ward to "teach her a lesson" about how nasty it really was.

I'd also like to add that working in a children's inpatient psych unit is different from working in a teenage psychiatric ward, assuming children is applied to people aged toddler to 12 or 13, as I usually see it applied. I can elaborate if you require.

Hi, Queen, here.

First off, DO YOUR RESERCH!!! it makes things more believable. I would suggust looking up and finding out all you can about the condition. Please portrayit correctaly. Is sad how people dont understand and are iggnorant. This goes with any medical condition.

first off, mental illness is very real and scary. I have schizophrenia. And I HATE it. Its very confusing and scary. I have behavioral probleams, emotional probleams. I have random mood swings that i dont reconize. I dont reconize my behavior, either. I have pobleam with relationships. I have hallucinations. I see animals often, like cats, dogs, snakes, bugs etc. I have smet stange things/food when nothing 'real' was there. I feel bugs crawling on me and inside of me. I hear voices in my head and on the outside. I get parinoid and have delousions. There are 'characters' that exist to me and no one else. Its like a whole 'world' That is real to me and no one else, eventhough it is weird and bazaar. My exspericances are very real and terifying. I live with it 24/7. And I have communication probleams and thinking probleams. I have difficulty saying and explaining things, even very simple things due to my jumbled up weird thoughts that make no sense. Sometimes I can be saying somthinh And my thoughts are 'blocked'

Wach the movie Canvas. Great movie and story. Watch the main character. Realistic portrayal of schizophrenia. If you wants more info, just adk. Sorry if I sound mean or somthing. And yes, I have been in a mental hospital.

First, why would someone be hospitalized? There has to be evidence that the individual is in immediate danger of harming themselves or someone else. Even if you're fully psychotic or fully manic, you will not be in the psych ward of a hospital unless you have means, plans, and intent to harm yourself or someone else.

However, there are LOTS of other places someone could be admitted. There are lots of different inpatient treatment centers that would admit people for reasons other than risk of self-harm/harm to others. There are lots of places that focus on the "severely mentally ill" as in psychotic or manic individuals. I'm not sure if it gets that specialized for adolescents, but there are lots of inpatient options for adolescents as well.

So in this case, if all your character does is attack some people at her school, that alone would not be enough to have her admitted in a hospital.

As far as I'm aware, attacking other people qualifies as a rather immediate danger of harming said other people, so, I'm very confused as to why it wouldn't get a person admitted to a psych ward, especially with the other aspects of the scenario...? The scenario does involve the character having a breakdown right before the attacks, which I think any first responders would learn about pretty quickly thanks to the number of witnesses.

I once had a student come to me for help because another student (in her own words) started flipping out over a torn dollar bill and attacking the furniture in the student center. It was pretty terrifying, and we had to call in medical professionals for backup after tackling the student onto the floor so he couldn't hurt himself any further because the college staff weren't capable of handling such a severe incident (and we all had no idea how to handle things despite our training). It was a really sobering experience, especially since I was one of the few people "qualified" to handle such incidents, and nothing I tried was working to help calm the student down.

I think one of the reasons why a lot of people who have been through the mental health system and a lot of stories involving portrayals of the mental health system don't show the mental health system operating the way the system is designed or supposed to operate is because it often doesn't in real life. Real life situations rarely go the way you'd expect them to go, and there's a lot of factors involved that don't get covered in textbooks or manuals or case studies.

Working with people with mental illnesses and disabilities is hard, not just on the people who have the illnesses/disabilities, but also on the people who are trying to help them. Especially when the help doesn't succeed.