by Lisa Hall-Wilson
Trauma and mental health issues can be uncomfortable to discuss, but there’s no denying the internal conflict these storylines intrinsically create. We live in a society that prioritizes politeness, civility, predictability, and generally keeping a lid on things. Disclosures of trauma and evidence of mental health issues upend the cart—so to speak. But fiction shines a light on the inner workings of a character. Understanding and portraying mental health and trauma with authenticity, compassion, and realism is super important.
Everyone probably knows someone, works with someone, is related to someone, was in a relationship with someone who struggles with trauma and/or mental health issues. And in this pandemic/post-pandemic season, the public awareness of mental health and trauma makes these issues, including these types of scenarios, in fiction not only more attractive, but more realistic.
As someone who daily manages my mental health (with varying degrees of success), here are 9 things writers should be aware of, or learn more about, when writing about mental health and trauma.
I can’t give you a roadmap or a set of do’s and don’ts on writing about these issues. The severity of mental health issues and symptoms varies widely, and symptoms and coping mechanisms can change. The events and scenarios that cause these issues are very individual, as is each person’s ability to cope with the symptoms or changes.
Spend time crafting your character’s mental strength and emotional intelligence. These guideposts will help you navigate the emotional ups and downs the story journey will bring to your character. For example, do they mask their symptoms day to day, seek professional help, self-medicate, self-harm, self-destruct, etc.?
It's unfair to assume that everyone with mental health issues or past trauma is a danger to themselves or insane. When you consider the number of people living with these issues, the percentage who make the news is very small.
What must be clear to the reader is the WHY. Why does the character makes the decisions they do? Why are certain things hard? Why do emotions get the best of them at the worst times? The writer must show the emotional context behind everything.
Writing about mental health and trauma requires that you, as the writer, are intentional. Know why your character is saying and doing everything.
Trauma and mental health issues are exhausting. Every situation, encounter, action and reaction, comes at a price: emotional, mental, and physical. The theory of spoons is something worth exploring. Spoon Theory equates spoons to units of energy. Experts originally used Spoon Theory for those who have chronic illness, but it’s helpful in understanding and communicating the toll of daily life on energy resources for those living with trauma and mental health issues. Fiction rarely conveys this well.
To an outsider not privy to the inner workings of the mind, the actions and emotions of those with past trauma or mental health issues appear to be irrational or disproportionate. These reactions can be loud, disruptive, and involve physicality that can be dangerous.
But as a writer, it’s your job to show that this reaction is not irrational, based on what is going on inside your character. They may have survived their trauma by fighting back, or by compliance. When they feel threatened, that reaction makes sense because that’s what saved them last time. Choose the emotional tools, vocabulary, or trust in a relationship to help readers understand why a character stays silent or can’t keep a polite lid on their emotions anymore. And then show the consequences!
Those with past trauma and mental health do not, generally, share what’s going on inside. There’s too much risk, too much vulnerability, too much stigma, for that to happen most of the time (see section on stigma and bad reactions). However, your reader gets to see into thoughts and feelings the character doesn’t show anyone else.
Showing the juxtaposition of what’s going on inside vs what’s visible outwardly is crucial to showing mental health and trauma realistically. Don't just show what’s spoken aloud to other characters. Your character needs to FEEL things, not just think about they feel.
How is your character perceived while they’re simply doing their best to survive or regain control of overwhelming emotions? The emotional outbursts are not irrational. But they are most likely inconvenient and embarrassing, avoided at all costs, and may leave a path of destruction internally and externally.
Anger is just a fact for every human, but for those who struggle to contain overwhelming emotions it can be very destructive. At the expense of personal relationships and self worth, anger is used to regain a sense of control. Anger can be part of the fight response when we feel threatened. And for the person who is constantly alert and vigilant for danger, this response will often simmer just under the surface, ready to be called up at a moment’s notice.
Additionally, anger can be a real sign of healing. Those who had no voice, no autonomy, no escape, had to comply or become perfect. They needed this response to survive. Anger wasn't allowed. Anger is a demonstration of healing in that they acknowledge long ignored and suppressed emotions. Now these emotions have a voice.
Most people must go to work every day. They must go to the grocery store, get in the car or hop on a bus. They must continue to interact with society in various ways. Most of us need that interaction with society (as the pandemic taught us). Everyone manages their mental health and trauma symptoms. That may look like lying in bed til noon, it may look like always keeping their hands busy, it may mean never being without something creating noise—a tv, headphones, music, it may mean vodka for breakfast—whatever helps them silence or distract from the emotions that just. Won’t. Shut. Up.
It may look like zealously guarding their peace and staying inside their window of tolerance, even if it makes them appear flaky or distant. Managing symptoms may look like substance abuse, excessive exercise, therapy, isolation, or avoidance. Your character will strive to manage the symptoms they find intolerant or inconvenient (at least situationally), and the key is for the reader to understand WHY they seek this behaviour, and how it helps. Why is this behaviour worth the social or personal cost to the character?
Everyone has good days and bad days and it’s important to be honest about that. Some task or situation that may be fun or tolerable one day, is avoided at all costs the next. People usually carry the weight of mental health issues silently, which creates a strength that’s impressive and often generates immense compassion for others.
Now, you’re going to say relationships in general are hard. And that’s fair. But those with trauma and mental health issues often keep thoughts and feelings and urges locked down and hidden until they can’t keep a lid on things anymore and explode. For instance, sharing that you spent six hours researching the best/most effective OTC medication to kill yourself with will get you formed and incarcerated in a hospital. Not many are willing to live with the consequences of sharing that.
How many times is it said of someone who committed suicide: no one knew they were struggling?
But this is info the reader needs to have.
There are thoughts and feelings that if shared would have too high a social cost, etc. But that constant guardedness, vigilance, and secrecy is not conducive to close intimate relationships. In addition, those closest to us are often the very ones who bear the brunt of the emotions we’re no longer able to keep a lid on.
PTSD and Bipolar forums are full of people sharing about marriages that have disintegrated, jobs lost, time in jail/court, and relationships destroyed. Those with depression and anxiety are simply difficult to spend a lot of time with and may push you away (even if connection is what they most desperately seek), especially if we strive to maintain our own peace (through politeness, civility, etc.).
Mental health and trauma issues permeate into every aspect of life. Don't isolate PTSD flashbacks without other accompanying symptoms and disruption, for instance.
I recently tried to write a romance with a female protag with PTSD, and my crit partners found her difficult to relate to and a bit neurotic. And they were right. I could tone down the severity of the PTSD, or change up the symptoms this character lives with—both valid options. Or I may plough through and see how it goes. I’m not saying it can’t be done, but to do it well adds enormous complexity and will/should force you to explore your emotions in a way that’s uncomfortable.
Most people with mental health issues and trauma understand that their behaviour (at times) isn’t logical to the situation at hand. The reaction is often disproportionate. It’s often not really about what’s going on in that moment, but about something else (past trauma, exhaustion, frustration, vulnerability, fear) that was triggered. There’s this internal acknowledgement that how you feel doesn’t match what’s going on around you, and the accompanying reality that at times you have no control over how you’re reacting. (Which is why those with panic disorder, for instance, go to extreme lengths to avoid any situation that may cause the panic to take over.)
People who are Bipolar may be aware they’re on the high swing, or a low swing, but that may not mitigate their ability to react to that internal situation. You rarely will yourself out of depression. You may explode over something really trivial, but your reaction wasn’t about what was happening, but about the emotion overwhelming you inside.
Capturing this battle authentically, in a way that creates emotional connection and sympathy with the reader, is vital.
I do not know many struggling to manage and heal from trauma and mental health issues, who haven’t encountered professional counselor or lay-person that caused harm. Sometimes it’s simply a matter of a bad fit personality wise, sometimes a layperson doesn’t refer to a professional when they should. Sometimes professionals misdiagnose or lack specialized knowledge for complex mental health issues. Sometimes people aren’t up front or fully disclose what’s going on and receive counseling that consequently isn't appropriate.
Most have experienced poor reactions from others upon disclosing trauma or mental health issues. People look at you differently. They treat you differently. Friends stop inviting you places or exclude you. Finally, they kick you out of families or marriages. Most have been told at some point to “just get over it”, “just snap out of it”, or “move on”. Some counselors recommend not taking medication that would make symptoms easier/bearable. Some patients refuse, for a variety of reasons, to take medication. Many don’t require any medication to manage their symptoms in a healthy way.
The bad reactions, very often, outnumber the good. So keep this in mind when writing these characters. This mistrust of society, of doctors, of family, friends or coworkers, is often well-earned. How would that change things for your character? How would that make their life more difficult?
If you’re writing about another time or place, how mental health issues and trauma manifest themselves may change. The prevalence of various mental health issues can vary by time and place. Those struggling with PTSD after WW1 showed many different symptoms than those who struggle to manage PTSD after combat in Vietnam or Afghanistan, for instance. Hysteria was a catch-all term for decades. It prompted a variety of different responses from family and professionals in various time periods. I often look to novels written in the period I’m writing about.
Do you/will you include some aspect of trauma or mental health issue in your writing? What do you struggle with most in writing it?
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Lisa Hall-Wilson is a writing teacher and award-winning writer and author. She’s the author of Method Acting For Writers: Learn Deep Point Of View Using Emotional Layers. Her blog, Beyond Basics For Writers, explores all facets of the popular writing style deep point of view and offers practical tips for writers.
She runs the free Facebook group Going Deeper With Emotions where she shares tips and videos on writing in deep point of view.
Top image by Deleyna via Midjourney.
Angry woman image by Robin Higgins from Pixabay
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This is an incredible post. Thank you so much for sharing. Your advice was perfect. And for someone who is both a writer and has their own struggles and past experiences, your post was insightful and understanding. As a writer specifically, you provide excellent points on how to write a character who's experienced trauma.
Thanks, Cindy. Glad you found it helpful. It's meant to be a starting point for research.
Good topic - I don't think I've seen it explored much, but fiction is the ideal place to 'try out' solutions.
It is a lot to ask a novel to deal with more than a couple of these, because the action would come to a grinding halt, and all the space would need to be spent on coping.
My mainstream novel trilogy-in-progress deals with one self-centered damaged woman whose motto is 'Why NOT me?' and one woman handling the many complexities of chronic illness with very little energy.
The remaining main character thinks he doesn't deserve personal success in a relationship because he is on the track of mega-stardom, and that must take precedence in his life: he has a limited window, so career must come first.
In other words, three people with common ordinary problems, a little exaggerated.
Everyone deals with something; some of the things are life-altering; all choices have consequences.
Yes, giving a character mental health issues or past trauma can slow the pace, though not always. Lots of suspense/crime novels feature protags with various mental health issues who don't navel gaze, but spend a lot of time drinking, or in risky behaviour outside or work, etc. But, often those novels fail to explore the internal conflict and focus on external conflict (solving the murder for instance).
So true - because some PEOPLE ignore their inner conflicts - characters, too, and either don't want to know why they're doing things, or know and drink, etc., to forget or block.
All grist for the mills. And yes, it does slow things down some, but I'm not interested in the action shoot-em-ups anyway, and it suits me. As long as it doesn't get plodding, which varies by the reader's subjective expectations.
This was an excellent post. Thank you for sharing. I could hear how personal it was in the words while understanding how important the topic is for people to grasp. I know because I've been there.
I suffer from PTSD and more and have had a handful of counselors who were awful to the point of harmful. I've had one who was exceptional in the extreme. In the six years I saw him, he not only treated me, but taught me how to seek and apply self-help with a discerning eye. That included demanding the best from any counselors in the future. In short, he saved me and continues to save me even though I moved and haven't seen him in a decade.
Mental health issues, sometimes stemming from trauma, are often a part of who my MCs are. I reveal their nature like the mystery they appear to be to those on the outside. I also — this is vital — show them respect in their good and bad moments. I also have balance around them. There are those who sympathize and support (sometimes only one person), those who are indifferent and/or demonstrate avoidance, and those who are actively hostile. In short, and even though I write fantasy, I hold up a mirror to reflect society and expose why the sufferer fears exposure.
In short, we all have value, something to contribute. When members of society are more accepting, everyone benefits. When society rejects, it, not the person suffering, becomes the poison.
I'm sorry you've had bad experiences. I've had a few myself and they make seeking help extra hard. When you're already struggling with mental health and trauma issues, adding rejection, betrayal and other BIG emotional hurts, it just adds more rocks to the sack on your back (so to speak). I like the way you choose to juxtapose the reactions -- that's helpful for readers to understand if your character is an unreliable narrator or not.
Thank you for sharing this, Lisa. It is extremely helpful in writing and in life.
Thanks for all your help in posting 😀 And I'm glad it was helpful, even if just from a high level perspective.
Whether it was by coincidence or divine intervention the caption of your guest blog popped up in my inbox, along with other writing-related emails. I am so glad that I clicked on yours.
I recently completed my memoir manuscript, currently titled "Faith, Hope and Brass Bawls." I can attest to the fact that your blog is consistent with real life...mine... after my 19-year-old college student daughter was involved in a terrible car crash that left her with traumatic brain injury, legally blind, many permanent physical injuries as well as total amnesia of her life prior to the crash, and short term memory deficit.
My vivacious, beautiful, talented daughter awoke from a 38-day coma, and I learned that she was a 19 year old toddler who knew no one or nothing, so toilet training was on the near future agenda. Having no professional answers, I created the scenario that at any moment she would again be the daughter I had for almost 2 decades. I didn't know her, she didn't know her family or anything else, The family imploded in the wake of the trauma, leaving every negative emotion in its wake.
And so, your words reached me, and I thank you for them. Regards, Jean
I certainly didn't intend to refer my daughter as vacuous! I hate spell check sometimes! She was vivacious! Jean
I'll change it, Jean. And this sounds horrifically hard. I'm so glad you dug deep and wrote your memoir!
That sounds really hard, Jean. ((hugs))
I think it's important to share the reality of living with these issues - help fight the stigma. And really, if you're looking for a David and Goliath type story, fighting mental health and past trauma hits home for a lot of people unfortunately. Take care of yourself.
This post is amazing, Lisa! It's high-level, but still completely accessible and and super comprehensive.
Plus, I got to laugh during that opening over: "We live in a society that prioritizes politeness, civility, predictability, and generally keeping a lid on things." Canada sounds lovely. Most of that has gone by the way side in America these days and I miss it.
hahaha - perhaps you're right. I just had in mind all the cases of rape, etc that happen because someone doesn't "look" like a rapist, or a threat - so we ignore red flags and warning signals out of a fear of appearing rude or irrational. Maybe shouldn't watch Nordic Noir before writing blog posts lol