Category: creative writing

Writing Post Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) is an unusual condition in that almost everyone has it to a greater or lesser degree, but few realise the impact that it has had on their lives. As the name implies, the condition describes when a person’s stress levels or reactions don’t go back to normal after a major traumatic experience. This article looks at how to write believable characters and situations involving PTSD.

PTSD is caused by exposure to a traumatic event, usually one in which a person thinks they are going to die. The classic examples are exposure to warfare, traffic accidents, sexual assault or physical assault. Experiences like these cause the brain to flood with fear, which can form long-term associations with the other stimuli present. This means that future exposure to those stimuli can trigger that deep fear again.

The classic symptom of PTSD is becoming full of adrenaline and going into combat mode when exposed to a loud noise or a touch to the head. In the former case, the loud noise might remind a character of the explosions of grenades and shellfire in combat; in the latter case, the touch to the head might remind of early childhood abuse at the hands of a parent. In either case, powerful memories of immense fear can quickly come flooding back.

The effects of PTSD are what could be expected from a close brush with gruesome physical death: adrenaline and cortisol prime the character for either combat or running. A character with the condition might easily become stirred into fight-or-flight mode as a response to the trauma. Here it can be seen that PTSD has considerable overlap with other psychiatric disorders, in particular Panic Disorder, Avoidant Personality Disorder and Generalised Anxiety Disorder.

Other effects are an increased propensity for self-harm. After all, one of the natural consequences of having a massively traumatic experience is that a person comes to realise that the world is much nastier or more dangerous than they thought it was. Some people with PTSD might decide that this world is actually pretty shit and not worth living in, given the horrors it contains.

In the case of violent crime or rape, a person might also come to lose all trust in a major societal demographic, which entails everyday difficulties. If a woman comes to distrust all men or a robbery victim comes to distrust all blacks, their life might become a lot harder and quickly, for no real fault of their own. Like children who have had bad experiences with dogs, a person with PTSD might come to dislike anything associated with their initial trauma.

Because PTSD is frequently portrayed in dramatic fiction, care must be taken not to write in cliches. The example of a nightmare leading to someone waking up in the middle of the night screaming, only to realise that the object of their terror is no longer present, is a striking one but also very heavily used. So too is the man staring into the distance, reliving a traumatic experience, not hearing someone calling to them.

A protagonist who suffers from PTSD might be aware of their condition or unaware.

If they are aware that they have PTSD, they might be a deep and sensitive character. They could be directly aware that a particular early life event has damaged them irreparably. This might be the reason for their unusual levels of compassion – the character knows what it feels like to be scared to death and commiserates with others who also do.

A story featuring such a character might be one about how they overcame their psychic damage and managed to find a way to engage joyfully with life. Often this involves healing oneself, the shamanic path. An extremely wise character may have attained their insight through having overcome an equally extreme trauma earlier in their life. Perhaps this experience caused them to understand what another character is going through.

It’s common to have PTSD and to be unaware of it. This is especially plausible on account of that people who incur severe psychological trauma might not show signs of it until many years later. A person might grow into early adulthood with a particularly surly or nasty character because of some heavy trauma incurred while a child. They might also show other signs of being strongly emotional, reckless or impulsive.

Just because a character with PTSD is not aware that they have PTSD, doesn’t mean that other characters will not be aware. In some cases it will be very obvious, because they will observe the first character go into kill mode for what seems like an insufficiently grave provocation. The character with PTSD might soon find that their condition is part of their reputation – they seem “damaged” in the eyes of others.

A combination of the two can also tell a story, such as the case of a protagonist who gradually becomes aware that they have PTSD or something like it. Perhaps they are perceptive enough to realise that a prior event has damaged their psyche – for example, they observe that they feel intense anxiety when presented with a stimulus that reminds them of a particular traumatic event.

If your protagonist encounters a character with PTSD, how that protagonist behaves might depend on their naivety and openness. A naive character might think that simply by being nice to someone with PTSD they can get them to behave normally. Although this is sometimes true up to a point, the reality is that PTSD often carries with it sinister undertones of bitterness and resentment.

It’s common for people who have PTSD for similar reasons to bond strongly over the fact. This is especially true in the case of soldiers, emergency personnel and survivors of abusive relationships. For one thing, misery loves company, but for another, severe trauma is often the kind of experience that deeply shapes a person and their conception of life and reality, so people who share the trauma often share an entire worldview that’s based on it.

C-PTSD (Complex Post Traumatic Stress Disorder) isn’t actually in the DSM-V, but it’s worth covering here for the sake of completeness. Essentially it’s a similar condition, only brought about by repeated exposure to a traumatic person or stimulus, as opposed to one single, horrifying event as is usually the case with regular PTSD.

The major difference with C-PTSD is the loss of a sense of self. One’s boundaries are violated with such consistency that it becomes hard to say where one ends and the outside world begins. This can be related to Depersonalisation Disorder and frequently coincides with a deep sense of distrust about other people.

*

This article is an excerpt from Writing With The DSM-V (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Narcolepsy

Best known as the condition that causes Grandpa Simpson to fall asleep at a moment’s notice, narcolepsy is an uncommon disorder linked to sleep patterns. This article looks at how to write believable characters with narcolepsy.

Narcolepsy is a decreased ability to regulate sleep-wake cycles. The overwhelming problem with narcolepsy, and its most characteristic feature, is that people with it can feel extremely tired during the day. The most notable symptom is recurring bouts of extreme daytime sleepiness, which can result in falling asleep in unexpected and inappropriate places.

Because being properly awake during the day is virtually a necessity for normal life function, narcolepsy can be a crippling condition for those afflicted. If it’s bad enough, driving a car will be impossible because of the risk of crashing (similar to epileptics). Taking public transport might not be possible either, which means that the life of the a narcoleptic character in your story might have to be a restricted one.

The author should pay close heed to what’s known as the “tetrad of narcolepsy”: cataplexy, sleep paralysis, hypnagogic hallucinations and being extremely tired during the day.

Cataplexy is a strange condition that involves the sudden weakening of large muscle groups. A bout of cataplexy can involve a weakening at the knees, or in the neck and head (similar to nodding off to sleep). This is one symptom that can truly wreck the life of a narcoleptic. It isn’t just that the physical debilitation is a problem, it’s that the narcolepsy sufferer learns to fear the social occasions that pose a risk of provoking one.

Sleep paralysis is the experience, often terrifying, of not being able to move one’s body when awakening or falling asleep. The experience of a character undergoing sleep paralysis might be similar to one undergoing night terrors. They may feel as if they have died.

Hypnagogic hallucinations are felt by narcoleptics when falling asleep. These are intense, vivid and dreamlike experiences that usually manifest as sights and sounds. These experiences can feel much like salvia divinorum experiences in that they are surreal and cause one to feel like one is present in another world. These hypnagogic experiences are sometimes disturbing enough to cause a person to get out of bed again.

The excessive daytime sleepiness is probably the most striking and obvious symptom. This manifests as powerful “sleepiness attacks” that overcome the narcoleptic, no matter how much sleep they have had the previous night. These attacks may be irresistible, so much so that the narcoleptic can literally fall on the ground asleep.

Narcolepsy might be more useful as a plot device than as something to afflict a character with. It could be that someone’s narcolepsy in the past led to a car accident, which then had far-reaching consequences for the protagonist of your story. Or it could be that, as a small minority of narcoleptics are “supertasters” with heightened olfactory awareness, your protagonist has a special use in forensic science or perfumery.

It might even be that a character’s narcolepsy has led to them waking up and rearranging their environment during the night. This could be combined with more interesting sleep disorders, like somnambulism.

Another curious point about narcolepsy is that it’s easy to confuse with an addiction to heroin or some other drugs. After all, it need not be immediately obvious to a close observer if a given person nodding off is doing so because of narcolepsy or heroin, drunkenness or something else. A character with narcolepsy might then feel that they are hard done by on account of being treated like something they’re not.

Unlike most of the other psychiatric conditions in this book, narcolepsy is not caused by early childhood abuse or neglect. So a character with it is unlikely to demonstrate signs of being damaged. Possibly they are an entirely normal person by most apparent measures apart from the narcolepsy.

Many stories about mental illnesses are tragedies because of the exposure to violence, neglect or abuse that caused the trauma underlying the illness. In this sense, a story about narcolepsy is probably different. The trauma might be ongoing, on account of that the coming of narcolepsy can ruin the life of an otherwise entirely normal person who had previously given no indication that they might be mentally unusual.

Alternatively, the narcoleptic could be a good choice of character to place at the centre of a comedy. A problem with suddenly falling asleep all the time could make it very hard to get things done. If a band of characters had to achieve some set goal, and one of their number was a narcoleptic, that character might constantly be letting the others down by falling asleep at inopportune times.

Likewise, a narcoleptic guard, surgeon or helicopter pilot might be considered inherently funny, on account of that their condition makes them exceptionally unsuited for that particular job, in a fish out of water sense. The author will have to take care to find the right balance between comic and ridiculous here.

*

This article is an excerpt from Writing With The DSM (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Conduct Disorder

Unlike most of the conditions in this book, Conduct Disorder (CD) is only diagnosed in children and adolescents. As the name implies, people who get diagnosed with it conduct themselves in ways that the clinician considers disorderly, in particular when it comes to respecting the rights of other people. This article looks at how to write believable and interesting characters with the condition.

The most important thing is to distinguish CD from Antisocial Personality Disorder. CD is the developmental precursor to Antisocial Personality Disorder – it can only be diagnosed in those too young to have a diagnosis of Antisocial Personality Disorder (i.e. 18 years of age). It is therefore a developmental condition.

One of the key symptoms of CD is a lower level of fear. This will express itself in a wide variety of ways.

The most notable way that a lower level of fear expresses itself in young people is when it comes to transgressions. A young person has not yet had time to internalise knowledge about the effects that their actions have on other people. They therefore have to learn to be afraid of punishment. This corresponds to Level 1 of Kohlberg’s Scale of Moral Reasoning.

A young person with CD will have a hard time internalising rules about those transgressions, in part because they don’t feel much fear, and so don’t have as much inhibition when primitive impulses towards violence and destruction start playing up on them. Because of this, they regularly violate boundaries relating to other people’s personal space and property.

Another way low levels of fear find expression is in transgressions against one’s own health. Young people already play fast and loose with their health when it comes to having a good time; young people with Conduct Disorder are nihilistically reckless. If the protagonist of your story has Conduct Disorder, chances are that they will be into the booze, weed and pills from their early teenage years.

A character with CD will likely be something of a daredevil. If they are male, they might find themselves drawn to racing motor vehicles or street fighting; if female, to shoplifting and starting trouble between men.

A story with a protagonist who has Conduct Disorder might read like J. D. Salinger’s Catcher in the Rye. Care must be taken here, therefore, not to sound cliched. Anti-hero stories mostly appeal to the same young audience, because they will most readily identify with the spirit of rebellion expressed by such a character. People with Conduct Disorder push the boundaries, for good or ill.

Punk stories, in particular cyberpunk, often feature protagonists who would appear (at least from the authorities’ perspective) to have Conduct Disorder. Young men like John Case of Neuromancer or Jonty Gillespie of The Verity Key are unrepentant criminals, usually because they have to be in order to make a living in the cracks of the edifice of respectable society.

After all, one man’s Conduct Disorder is another man’s righteous rebellion against a tyrannical oppressor. So a character with the condition might be the perfect choice of protagonist if your story involves going up against a large, faceless, totalitarian entity. After all, most of us have a point which, if pushed beyond, we will no longer behave in a co-operative manner.

If a character with CD is pitted against a malicious, evil entity (corporation or government), much of the difficulty in writing your story will come from making that entity unsympathetic enough that the reader readily comes to identify with that character. The more credibly this can be done, the less that character will look like a CD sufferer and more like a righteous hardarse.

Unsurprisingly, Conduct Disorder is highly correlated with all forms of early childhood abuse. A character with the condition might have learned by way of mimicry of their parents that violence and cruelty are perfectly acceptable ways to advance one’s interests, and that fear is for the weak and an invitation to be destroyed.

So if you are writing a character with CD they might not necessarily be a cool, daring and adventurous antihero. Realistically they are more likely to be somewhat brutal. If your protagonist encounters such a character, they might find them intimidating – the class bully, or local street thug.

If your protagonist encounters a character with CD, they could respond in a wide variety of ways, depending on how they themselves are (and their decision will be very revealing to the reader). They might consider that character a cool rebel to be befriended, they might consider them a danger to be avoided, or they might consider them a little brat to be corrected.

Conduct Disorder often occurs at the same time as Attention Deficit Disorder. It’s likely, therefore, that any character with it will have extreme difficulty at school, at work, or with either friends of family. Their life will probably be very chaotic, and will considerable Police or social worker involvement.

*

This article is an excerpt from Writing With The DSM (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

Writing Avoidant Personality Disorder

Avoidant Personality Disorder (AVPD) is characterised by extreme action taken to avoid certain feared stimuli, usually social. Social anxiety, feelings of unworthiness, timidity and sensitivity lead to a pattern of avoiding situations that involve interacting or socialising with others. This article looks at how to write engaging and realistic characters with the condition.

AVPD is a Cluster C personality disorder, which means that it’s primarily an anxious condition. The essential characteristic of it is an inability to form social bonds brought about by an extreme desire to avoid particular feared stimuli. For example, people with AVPD tend to be very sensitive to social rejection or humiliation.

It is believed to be caused by abusive or neglectful parenting patterns. In particular, rejection by one or both parents is thought to correlate highly with the condition. It can be observed in other mammals that rejection by one or both parents sharply reduces the ensuing life expectancy for that creature. No doubt the trauma from such treatment makes an impact on the behaviour of human survivors.

If your protagonist has AVDP, it might be that they experience loss and social rejection so strongly that they are simply devastated by it. They might have an internal monologue that heavily plays on fears of social encounters going wrong. A story featuring them might read very strangely as it involved a number of events that ended up not happening or not being attended by the protagonist, who felt too anxious to participate.

This can easily lead to a darker, resentful pattern of behaviour, especially if a protagonist with AVDP comes to feel a malicious desire for revenge as a consequence of their rejection. Social rejection need not lead to learned helplessness and submission in every case – it can lead to violent reprisals, especially if the rejected person feels that they have been treated unjustly.

Someone with AVDP might make a convincing villain if the author can convincingly portray a character who has become nasty as a result of their pride. It might be that the villain received some mild slight or insult and their massive ego was punctured, leading to narcissistic rage. They could be the sort of person who never forgives an insult, leading to complicated revenge schemes.

To many outside observers, AVPD looks very similar to just having low self-esteem. People with the condition tend to believe that their social presence is unwanted, and that they are unworthy of the time and attention that they are given in their social relationships. In cases of parental rejection it’s obvious how such thinking might come about, but it can be caused by other things, such as a generalised perception of social rejection.

In the mind of a character with AVPD, the everyday experience might be one plagued by self-doubt and feelings of unworthiness, in much the same way that it can be for a depressed person. Indeed, one particular strain of AVPD has a number of depressive features, in particular the casting away of, and refusing to deal with, certain traumatic memories.

A protagonist with the condition is likely to consider themselves socially inept. There might be a lot of blame directed at the self in their internal monologue. It’s possible that there is a personal quality of their own that they fixate on as an explanation for their lack of social success. As mentioned above, this can easily become projected outwards onto society.

People with AVPD can be difficult socially because they can be very needy and very resentful. There is a particular strain of the condition that is hypersensitive in a way that is not dissimilar to those with Narcissistic Personality Disorder. This type can become easily wounded by jokes or banter, to the extent that others might call them “precious”.

Feedback loops are an unfortunate common effect of this condition. Anxiety about being socially rejected often leads to a range of behaviours that themselves increase the likelihood of social rejection. Anxious eye contact often appears shifty to other people, who then come to distrust the person with AVPD. Because these people trust the person with AVPD less, they speak to them in a less friendly manner, which validates the initial feelings of anxiety and strengthens the avoidant behaviours.

A protagonist with AVPD might find their everyday experience tormenting, because people with the condition have a normal need for social interaction and intimacy – they just fear it. Because of this fear, and sometimes because of resentments, a protagonist with the condition might find their everyday experience tormenting. It might be a relentless march of anxiety, blame, missed opportunities, guilt and rejection.

AVPD sounds, and is, similar to Schizoid Personality Disorder, but there are crucial differences. For one, a character with AVPD will like be more anxious than a schizoid. For another thing, schizoids don’t generally care about other people, whereas people with AVPD will still desire positive social contact.

*

This article is an excerpt from Writing With The DSM (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.