Hello. Is there a list of anything that you want to see more in mute/non-speaking fictional characters? Are there any tropes/stereotypes that i need to be wary of? Thanks!
Hi!
We would love to see:
All sorts of AAC methods (high tech, low tech, and no tech)
Disabilities other than "functionally abled but magically just can't speak", like cerebral palsy, autism, intellectual disability, language processing disorders, situational mutism, apraxia, etc.
On that note, if your character can't speak because their tongue got cut out, which seems to be the major reason to have a nonspeaking character in fiction, that will affect their quality of life in a lot of ways other than being unable to speak. Commit to actually portraying that, please. Or just pick another reason they don't speak!
Fewer characters who are hearing and use sign language. Not that it never happens, but it makes up the vast majority of sign language representation in fiction and pop culture, despite being a very small percentage of actual signers in real life.
If you want a signing character, please consider making a Deaf character! (Think about how easy it is if you already have a character translating what your signing character is saying: just have them interpret spoken language too. You're now like 3/4 of the way to having solid Deaf representation.)
Nonverbal characters who are physically capable of making noise, like grunting, laughing, squealing, etc. even though they can't actually speak. These sounds can be communicative or non-communicative.
Or using echolalia, accidental mouth words, or other non-communicative speech in the case of autistic or intellectually disabled characters!
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Writing Schizophrenia and Psychosis: Hallucinations and Delusions
[Plain text: Writing Schizophrenia and Psychosis: Hallucinations and Delusions]
So you've read our lovely guide on parts of schizophrenia and psychosis unrelated to hallucinations and delusions, you've skimmed our tag, but it's finally time to tackle the most commonly known part of schizophrenia: hallucinations and delusions.
So, hearing voices or seeing shadow people and thinking everyone is after you, right? I'm done?
Nope!
This is a guide to the many many kinds of hallucinations and delusions that exist, written with experience by people with psychosis.
A note obviously that psychosis is highly personal and your mileage may vary. This is not meant to be an all-encompassing post.
Conditions that can cause psychosis (not exhaustive):
Schizophrenia,
Schizoaffective Disorder,
Schizophreniform Disorder,
Delusional Disorder,
Brief Psychotic Disorder,
Major Depressive Disorder with Psychotic Features,
Bipolar Disorder,
Psychotic Disorder Due to Another Medical Condition (yes that's the real name and the Another Medical Condition usually refers to things like Alzheimer's, Parkinson's, brain tumors, etc.),
Substance/Medication-Induced Psychotic Disorder.
The first three are also known as the "schizo-spec" (schizophrenia spectrum) disorders, with delusional disorder and brief psychotic disorder sometimes also being included in that definition.
Hallucinations
[Plain text: Hallucinations]
There are many kinds of hallucinations, the most commonly discussed being auditory and visual. However, they are not the only ones! There are also tactile, olfactory, gustatory, and somatic ones (the latter are often categorized under tactile or vice-versa).
The most frequent kind of hallucination experienced changes depending on the exact disorder. Overall, the most common ones are either auditory or visual (e.g. auditory are the most common in schizophrenia, and visual in neurological disorders), then the other one of the aforementioned two, then tactile/somatic, then olfactory, and then gustatory.
A person can experience any number of those, and multimodality (involving multiple senses) is more common than unimodality (involving just one sense) in people who have a primarily-psychiatric condition. In other words, having hallucinations that involve multiple senses is common for those on the schizo-spec, but very rare for those with ocular conditions, for example.
Types of hallucinations:
[Plain text: Types of hallucinations:]
Auditory hallucinations: There are many things a person can hear, the most common and most discussed being voices. However, other common auditory hallucinations are whispering, hearing your name being called, music, and hearing people walking around.
Command hallucinations: a subset of auditory hallucinations. My absolute enemy. A hallucination, usually external voice but sometimes an "implanted voice" that commands the listener to do things, from something simple like standing up to hurting themselves or others. The listener can resist, but I personally find the longer I have command hallucinations the harder they become to resist or ignore. Often the thing that gets me sent to inpatient. The most important distinction for command hallucinations are that they are not intrusive thoughts - the person is insistent they are external from them.
Visual hallucinations: Less common than auditory hallucinations but still incredibly common. Not always shadow people or recognizable people - I see strangers and have never had the same visual hallucination twice, although some people do see returning "characters". I do see shadow people occasionally, but they aren't the only thing people see and can be a somewhat exaggerated depiction. I know a lot of people who see cats, for some reason. If you can think it, someone can see it!
Obviously hallucinations can but don't have to be scary, it simply depends on the person and experience.
A person can see almost anything as a hallucination. Some people experience what are known as "simple" visual hallucinations (as opposed to "complex" ones)âbasic patterns, spots, geometric shapes, lights, lines. They are not lifelike or clear, and are visibly out of place. Simple hallucinations are less common on the schizo-spec, but anyone can have them.
Tactile hallucinations: my absolute enemy (hey, different mod here). Tactile hallucinations are less common than visual or auditory ones, and often come with other kinds of hallucinations as a bonusâespecially somatic ones, since there's no clear distinction between those two a lot of the time. They encompass touch, feeling, and spatial sense in the broadest sense you can possibly imagine. They can be annoying in their own manner as there is often no way to check their validity; you usually can't just record or take a picture of them to verify them.
Tactile hallucinations can be, as most hallucinations, basically anything. One of the most common types is the feeling of parasites, bugs, or other animals, like snakes, moving across or under the person's skin.
Parasitic/formication hallucination is the main example of tactile hallucinations to the point that there are sometimes used as synonyms. It's also very often associated with delusional parasitosis, where the person actually believes that they are in fact infested, which will be mentioned in the "delusions" section.
For many people tactile and somatic hallucinations will be one and the same, or otherwise inseparable, like the feeling of blood or urine dripping down their body, being burned, feeling their organs or bones "move around", or having their skin stretched.
In my personal experienceâYMMVâtactile hallucinations are the most difficult to acknowledge as fake (for me, this is in comparison to visual and olfactory ones). Even if you are aware of the possibility of being in psychosis, since they can't be reliably verified for the most part, are often at least theoretically possible, and frequently co-appear with delusions of the same theme.
Olfactory hallucinations: smelling things that aren't there. Those can be pleasant, gross, or completely neutral, as most hallucinations in general. Smell hallucinations can be (unofficially; this is just a distinction I've used myself) categorized into external (smells "outside" the person having the hallucination, like a fire) and internal ("in/on" the person having the hallucination, i.e. a smell that's coming from their own body). In my anecdotal experience, people tend to have more of only one of these types rather than both.
One of the most common ones is the perception of having extremely offensive body odor or bad breath, but it can also do with urine, blood, even decomposition, etc. The hallucinations generally revolve around mundane things (there's nothing "OMG I must be in psychosis!" about thinking you smell bad), which might make them difficult to spot as fake, even if someone is aware that they are overall psychotic.
Many kinds of olfactory hallucinations might make the person feel insecure (body related smells), paranoid (chemical related smells; e.g. I had a recurrent hallucination of smelling spilled gasoline), or cause problems with things like eating (smelling non-edible things in food; rot, mold...).
Gustatory hallucinations [disclaimer: none of the mods have first-hand experience with this one; this is entirely based on external sources]: tasting things that aren't there. The rarest kind of hallucinations statistically, though it shows up in some non-shizo-spec conditions more often (e.g. epilepsy).
Gustatory hallucinations are mostly realistically plausible (for example, feeling a bitter or sour taste) or realistic but unusual (e.g. metallic taste). They often coexist with other kinds of hallucinations and delusions, often exacerbating the problem (e.g. a person with delusions of being poisoned might experience a hallucination of dangerous chemicals in their food, solidifying the delusion).
Hallucinations FAQ
[Plain text: Hallucinations FAQ]
Q: How to describe hallucinations in a sensitive manner?
A: Sensitivity and hallucinations is less about being sensitive about the hallucinations and more about the person having them. Hallucinations can be anything, and I mean it. For every "stereotypical" hallucination, there's a thousand real people who will have it. Unless you're considering doing something extremely out there, I wouldn't worry about the content of hallucinations being sensitive or not; anything that's common enough to be listed as an example of a hallucination is more than safe. Some hallucinations are scary, a lot are deeply unpleasant. That's okay to show.
So, how do you describe the person having the hallucinations?
First of all, don't make them violent towards others. This is a very harmful stereotype that writers love to use. Psychotic people can be violent since they are people, but they're much more likely to be victims of violence as well as committing violence towards themselves (both in the self-harm context, as well as in attempts of dealing with psychosis that ultimately result in unintentional self-injuries). Don't make someone into a murderer because they are hearing voices or smelling blood in their food.
Second, show them as a full person and that psychosis is part of them as that person. Why* are they psychotic? How do they experience it? When did it start, and how often do they have episodes? Do they go to therapy? Do they take medication? How do they feel about it? Make them seem human while integrating psychosis into their character, not just a "normal" person with a "scary gimmick" slapped on top without considering what it actually means for them.
*ânot as in "there needs to be a reason for a character to be disabled", but as in "what condition is causing them to hallucinate".
Third, don't push people with low insight under the bus. Someone who can't tell their hallucinations apart from reality isn't stupid or "worse" than someone who has higher awareness. It also doesn't translate to morals; someone who fully can't tell what's real isn't more likely to be evil. It also doesn't make them blissfully unaware angels that should be treated like children. Don't moralize a mental illness in either direction.
To go back to the actual hallucinationsâtreat them as what they are: hallucinations. They aren't future-telling, prophecies, visions from an alternate dimension, sources of magic, whatever else, they aren't those things. A delusional person (or character) might believe that what they're experiencing is something "greater", but that'd be a part of a delusion; it's not something you should put as part of your objective worldbuilding. Even just implying that psychosis has some "deeper meaning" can mess some people up.
This is my least favorite form of psychosis representation in media. Honestly, personally, I'd rather be portrayed as violent than like I have some secret gift, but don't do either.
Q: How to integrate hallucinations into a story without the story becoming about them?
A: Depends greatly on whose POV you're writing from, how much insight the character has, and what emotions do they experience while hallucinating.
If it's a non-POV character who is aware they are in psychosis and are relatively unbothered by it, you can just describe them glancing around, or otherwise checking where the hallucination is. In most cases someone with high insight won't be interacting with a hallucination (an exception could be a pleasurable hallucination that the person enjoys).
They might ask another character if they also see/hear/feel the hallucinationâeven if someone is fully aware they are currently in psychosis, it might be difficult to verify which things are fake and which aren't. Maybe the character is sure that the person they're "seeing" is fake, but aren't sure about the dog that's with them.
You can describe the character being clearly distracted by something; looking into a specific place, moving weirdly, or not being able to stay on topic.
If you're trying to write about the character experiencing hallucinations and having low insight, it might be much more difficult to not make the story (or the scene) about itâif you don't go out of your way to acknowledge them as hallucinations then it will look like there is no hallucinations present, since the character will just consider them to be real. It'd just be another part of the settingâyou can obviously throw in something that would be clearly out of place for the reader, but it will raise questions that you should probably address, thus making the scene about the hallucinations.
A similar thing can happen if your character is experiencing an unpleasant hallucination: you kinda have to make the scene about it. if the character is scared, it'd be weird to ignore that. You can of course go "they saw a peculiar creature in the yard, one so weird that they knew right away it wasn't really there, so they decided to ignore it," since you can be aware of a hallucination being fake while still being disturbed. In that situation you can have the character purposefully trying to distract themself, show them being under stress, or having another kind of reaction (e.g., using some sort of grounding technique, having a panic attack, etc).
Q: What are some common ways to tell what is and isn't a hallucination?
A: Visual: taking pictures/videos, taking off your glasses (hallucinations will sometimes stay in-focus when the real world blurs accordingly), asking another person if they also see it.
Auditory: recording the sound, asking another person.
Blind people having visual hallucinations and deaf people having auditory ones usually just assume that the hallucination is fake, especially if it's the only thing they are able to see/hear.
Olfactory: asking another person.
Tactile/somatic: no consistent way as far as I'm aware. In some circumstances you can tell by just looking (e.g. you feel like you're having a nosebleed, you can just look in the mirror to check) or asking another person (e.g. you feel like you're levitating), but for most hallucinations there is no way of telling (e.g. how would you check if there's something happening to your internal organs? Get a body scan of some sort maybe?).
Gustatory: if it's about a real food you can ask another person if they also feel the same taste, otherwise no way of telling as far as I'm aware.
Q: Does being able to logically differentiate between reality/hallucinations stop emotional responses?
A: It can, but it's not a guarantee by any means. Imagine you're on a rollercoaster or watching a horror movie: logically speaking, you know that you are safeâbut still, you get scared, it's a natural response. If the insight helps someone emotionally, it's usually partial.
That said, being able to recognize something as a hallucination might (key word here) help someone stop having a psychotic episode, which could end the emotional response. But just because you know that something is fake doesn't mean you'll stop believing it. In fact knowing that you're believing something that is fake can be even more distressing than not knowing it's fake.
For some people, a hallucination could be traumatic or plain upsetting and continue to disturb them even after it's gone and they are no longer having an episode.
Not everyone will be particularly emotional though. Some people hallucinate 24/7 and just treat their hallucinations as another part of their day, even if they're fully conscious of them being fake.
Q: Can blind people have visual hallucinations/deaf people have auditory hallucinations?
A: Yes. For those where the two are connected, the former is called Charles Bonnet syndrome, the latter Musical Ear syndrome. The major distinction is that in both of those, the person experiencing the hallucinations usually has high insight (i.e., is aware that they are hallucinations) and they don't generally co-occur with delusions.
Blind and deaf people with residual vision/hearing can also experience "regular" visual/auditory hallucinations as well (and obviously other kinds tooânothing is stopping a deaf person from having olfactory hallucinations).
The one important caveat is that people with congenital (!) cortical (!) blindness do not, for unknown reasons, ever develop schizophrenia.
Delusions
[Plain text: Delusions]
Delusion is a fixed belief in something that is considered false, even after seeing evidence for the thing being untrue. The delusional belief isn't a part of the person's culture or religion, and isn't accepted as true among other members of their community. The belief is generally disturbing to the person and causes them distress.
The delusions that one can have are basically endless in terms of options, but they can be broadly put into two categories:
Bizarre: delusions that are impossible to occur in real life.
Examples:
being abducted by aliens,
having your thoughts broadcast over the radio,
being a supernatural entity.
Non-bizarre: delusions that are possible to occur, even if highly unlikely.
Examples:
being poisoned,
having a partner cheat on you,
being watched by the government.
Of course, in terms of fiction, what's considered "possible to occur in real life" might differ from these examples.
Delusions can also be categorized in "themes", such as:
Persecutory: the theme surrounds believing that one is being harassed, attacked, stalked, or conspired against, often by powerful entities. Frequently reported as the most common type of delusion, especially in schizo-spec disorders.
Grandiose: surrounds believing that one has special powers, status, knowledge, skills, has relationships with famous, powerful, and otherwise important people, or is such a person themself.
Jealousy: surrounds believing that one's partner is unfaithful.
Erotomanic: surrounds believing that another personâoften of higher status, such as a celebrityâis in love with them.
Somatic: surrounds believing that there is something wrong with one's physical body, such as being infested with parasites, having blood replaced with a different liquid, or missing internal organs.
Religious: surrounds believing that one is a god or another religious figure, like a prophet or a saint, and/or is receiving directions/commands from those. A person doesn't have to actually be religious to experience religious delusions, nor has to be of the same religion that the delusion is about.
Thought manipulation: surrounds believing that one's thoughts are being manipulated in some way. Common examples include believing that one's thoughts are being broadcast, or that foreign thoughts are being purposefully inserted into their brain.
Mixed: delusions that match multiple of the aforementioned types. E.g. a character who thinks the government wants to kidnap them for their magical powers (persecutory+grandiose); a character who thinks that they are married to a famous pop star and that she's cheating on them (erotomanic+jealousy), etc.
Unspecified: literally everything else.
There are also specific delusions which are often referred to as their own syndromes/disorders. They are generally considered very rare but they are frequently referenced in media. Some of them are:
Clinical lycanthropy: a delusion that one is turning into a werewolf. Often clinical lycanthropy is a catch all term now for clinical zooanthropy, which is the belief you are transforming into any sort of animal. It's very rare and can be part of a disorder such as schizophrenia or exist as a delusion on its own. Often people with it will start to behave alongside the disorder, such as eating raw meat or feeling somatic transformation, or hiding so as not to hurt others in their beastly state.
Delusional parasitosis/Ekbom's syndrome: a somatic delusion where you believe there are bugs/bacteria/parasites inside your body, generally under the skin. Commonly co-occurs with tactile/somatic hallucinations, adding realism to the delusion.
It very frequently results in self-harming behaviors in an attempt to "get them [parasites] out". That can be anything from skin scratching to auto-amputation or disembowelment. The less extreme ways can result in infections and painful skin conditions, sometimes solidifying the person in the delusion that their body is in fact infested. The more extreme ways can and probably will result in death for obvious reasons.
A common phenomenon associated with it is the "matchbox sign" where the person finds "evidence" of the "parasites" (usually dead skin, fabric, small pieces of food, etc.) and shows it to someone, often a doctor, as proof of the infestation (matchbox coming from it being the go-to container for the "specimen", but honestly it can be anything. Who even has matchboxes anymore). A person with this disorder can also obsess over parasites/other animals that can in fact infest humans, potentially forcing them to avoid certain activities as much as possible (not eating meat, not going into forests, obsessively washing themself, etc).
To my knowledge this is the most common syndromic delusion, though it could be related to the fact that people with delusional parasitosis are also the most likely to see a doctor about it (though the doctor of choice would practically always be a dermatologist, not a psychiatrist) and thus get counted in statistics.
[Disclaimer: the next three are entirely based on external sources since no mods have first-hand experience with them.]
Capgras syndrome: a delusional misidentification syndrome where the person believes that someone else has been replaced by a clone/double/impostor. Most commonly the person who was "replaced" is a close family member or a spouse. Rarely, a person can also think that multiple people or a group were "replaced". Very rarely, the person with the delusion might think that they themself have been "replaced".
The delusion might be persecutory in nature, where the person believes the "clone" is there to spy on them or hurt them. This can sometimes lead to attempts of "unmasking" or confronting the "impostor" in an attempt to get their loved one "back".
Fregoli syndrome: a delusional misidentification syndrome where the person believes that strangers or acquaintances are someone they know in disguise. While generally it centers around people, it can also happen with animals or objects. It usually has a persecutory aspect to it, where the person thinks the "disguised" person is trying to follow or harm them in some way.
Cotard syndrome: also sometimes known as "walking corpse syndrome". It's a wide-spectrum delusion where the person believes that they already are dead, are currently dying, are immortal (and thus unable to die), have died but were reborn in some way, or just don't exist. People who have it might also believe that their organs are gone, rotting, or dying. Some can also abandon their basic human needs (such as eating) since they think it's no longer necessary.
Cotard syndrome is very rare in real life, especially in young people.
This is not an exhaustive list, just some examples.
Delusions FAQ
[Plain text: Delusions FAQ]
Q: What do delusions feel like?
A: So, it primarily depends on "insight"âwhether the person has no, low, or high insight into their own delusion. The vast majority of people who experience delusions will have very little to no insight during their psychotic episodes.
Delusions feel like every other thing that's real, except they aren't, well, real. During a psychotic episode, delusions are facts as much as everything else around you. You don't question them since they feel obvious.
In delusions, there's lack of proofâwhich can be filled in by hallucinations (person believes they have a lethal disease, and starts hallucinating symptoms), explained by the delusion itself (person believes that someone else is in love with them, and interprets regular behaviors as "signs"), or simply ignored (the average person also doesn't know how [random everyday technology] actually works, but knows that it's a real thing that existsâpeople don't tend to question things they simply consider to be true, even if they don't really understand them).
Q: How to describe delusions in a sensitive manner?
A: To quote myself from earlier: sensitivity and delusions is less about being sensitive about the delusions, and more about the person having them. Delusions can be of anything, about anything, they can sound stupid and seem absurd to outsiders. I'm not saying "write the most ridiculous delusion you can think of for fun", more so "yes, some people do have unusual beliefs due to having the Unusual Belief Disorder".
Delusions are frustrating for everyone involved almost by definition. They aren't true and they directly affect what you believe, so they make you believe nonsense. And you can't "just explain lol" to the person that what they're saying/thinking is untrue because, well, it's a delusion. By definition, the belief being verifiably false really doesn't matter.
What's important to remember is that the delusional person isn't doing it on purpose. It's not a case of someone Purposefully Spreading Misinformation or rejecting factual data to further their agenda, it's a mental illness. Portraying it as a choice or some moral failure is simply incorrect. You can't just "opt-out" and magically stop being delusional.
So, what to actually do?
Recognize that delusions generally aren't fun. Obviously, everyone's experience is different, but delusions tend to be distressing. Persecutory ones will almost always be very negative, while a religious or grandiose one could even feel positive for someone if they think they are an angel or have some amazing talent.
Try to show the character's feelings in a sympathetic way, not a mocking one. What they believe isn't true, but their feelings are as real as anyone else's.
It's also important to remember that a delusion is something you genuinely believe. Try to put yourself in that position: you simply know some things. What your name is, how your pet looks like, where you live, whatever. If someone tried to convince you that you are wrong about these things, you'd think they're crazy. Imagine your coworker talking to you like they know your home life better than you do. Depending on the exact circumstances, you would probably have some sort of reactionâwhether that be anger, being baffled, or just kinda weirded out.
It's the same when someone is delusional, and the "things you simply know" just happen to not actually be true.
This kinda leads to considering the ways in which a delusional character interacts with others. Some delusions are ignorableâthe other character can kinda just nod and change the topic and move on. Others are a bit more in your face (e.g. the character thinks they are some higher being, or they think the character they're directly talking to wants to hurt them). Again, just telling someone "that's not true lol" doesn't really do much, if anything it can make the delusion worse (again: imagine you confront someone who you think is poisoning you, and they just say "um but I'm not?? what are you talking about lol you sound crazyy"). Try to consider what the relationship between the characters is, and what their personalities areâare they considerate, are they impatient, do they understand how the delusions affect the other character? Does the other character realize/know that the psychotic character is in psychosis at all?
Q: How do I incorporate delusions into a character's voice realistically?
A: TLDR: It's can be hard to make dialogue that sounds realistic for a character who has the disconnect-with-reality disorder.
First, try to consider how your character experiences their delusions in general. Are they extremely disturbed and can't stop thinking about their delusion when they're having an episode, or is it more of a background noise?
If it's disturbing them, then it probably won't sound realistic. When the delusion is all-consuming, the person having it might talk about it in circles and relate everything to it. Depending on how the psychotic character actually behaves, other characters might feel like they're being pranked because it just seems like "too much". It might be "like in the movies". The character can be going in circles trying to figure out how to stop NASA from broadcasting their thoughts around the globe; this happens.
At the same time, sometimes the delusion is much more covert. Sometimes on purpose (e.g. character with persecutory delusions believes that they are being observed, and doesn't want the observer to realize that they are aware of the observing, so they actively choose not mention anything about it), sometimes as a by-product of the way the delusion affects them (e.g. character with an erotomanic delusion isn't distressed by it, and they just vaguely mention their 'partner' in a way that doesn't really even tip anyone off).
If it's the first, you might be dealing with a character who is simply nervous/hiding something (because, well, they are). They might avoid certain topics or visibly get more stressed if the conversation goes into uncomfortable territory.
If it's the second, it will probably be more subtle. Perhaps you-wouldn't-be-able-to-tell-it's-a-delusion subtle. It depends on the character's exact delusion. Some would just be considered non-events (they say they have a partner who's famous, or that they are accomplished in some way), relatively normal/common events (partner is cheating on them, they have some serious illness), and some would be clearly bizarre (they say that their parents have been replaced by robotic clones, or that they are some mythical creature). If it's the first or the second, there might be no "tell", or maybe there will be some logical errors that other characters can catch on to, maybe there will be some inconsistencies when the character asks about it further, or maybe there will be nonsensical changes that happen between different retellings of the story that let others know something is off.
If it's the third clearly-bizarre option, then the "delusion reveal" might feel like it's coming out of nowhere, or create a sudden tone shift. It will be explained further in the post more, but psychosis isn't always obvious. Sometimes you learn that someone is psychotic because they say one thing that makes absolutely no sense. Again: it might feel abrupt, unexpected, other characters might think that they are being pranked at first. Just don't make the narrative make fun or mock the delusional character.
As to what you shouldn't do: no matter how delusional someone is, people still have other traits. Delusions aren't a replacement for backstory, relationships, preferences, or personality. They can and do affect them (and vice-versa), but if all the character talks about is their delusions, it will come off as either boring and flat, or a parody.
Psychosis FAQ
[Plain text: Psychosis FAQ]
Q: Can psychosis go undetected by the people around the person experiencing it, or is it very obvious?
A: Depends (sorry). But yes, sometimes it can absolutely go undetected, especially in case of a person experiencing mundane non-bizarre delusions and/or hallucinations.
It can also depend on the actual cause of the psychosisâfor example, schizophrenia often comes with disorganized speech (among other things) which is definitely noticeable.
On the other hand, delusional disorder is often referred to as a "high functioning" disorder where it can be very hard for others to notice anything is wrong. It's generally characterized by non-bizarre delusions, unremarkable behavior ("not odd"), relatively non-impaired functioning, and any hallucinations that come with it are relatively minor and most importantly, fit the theme of the (probable) delusion.
My own absolutely worst psychotic episode went undetected by everyone I was living with at the time (in a tiny apartment at that). For someone else, a stranger could notice that they are experiencing psychosis from the other side of the road. It's a very wide spectrum, and a person can be on different ends of it at different times of their life.
It's basically: could you tell that your coworker who is ranting about their wife cheating on them is having a psychotic episode? Because they could be, and you probably wouldn't even consider it as an option since it's a very mundane delusion. On the other hand, if the coworker told you that their wife has been replaced by an identical evil clone overnight, you will know there's something going on because that's not a thing that happens.
Q: What impacts what hallucinations and delusions come up? Are they random?
A: As far as I'm aware, there's no actual research on this. We know that certain types of hallucinations and delusions are more common in specific disorders (e.g. in schizophrenia, auditory hallucinations and persecutory delusions are more common than other types), but that's about it. We don't know why certain people hallucinate cats meowing, and other ones hear demonic screaming.
Anecdotally speaking, people tend to stick to their delusions rather than have a completely new kind every time they have a new psychotic episode. It could be literally the same delusion following them ("the government is watching me"), it could branch out over time ("the government is spying on me and stealing my thoughts"), or incorporate other delusions that still somewhat connect, either in theme (in this case persecutory) or in subject (in this case government-related). In my experience, it would be very unusual for a person to have a psychotic episode where their delusions center around one thing with a specific theme, go into remission, and then have their next episode center something completely different with a fully unrelated theme (excluding "major event happening between the two episodes" type stuff).
Having unrelated hallucinations is more frequent since multimodality is very common.
The content of delusions or hallucinations is essentially "anything". It can be related to trauma, but doesn't have to. It can be related to the person's daily life, but doesn't have to. It can make sense from the outside, but doesn't have to.
Q: What do antipsychotics do from a more first-person perspective? How do they affect the symptoms of psychosis?
A: Make you sleepy... no, the biggest thing my antipsychotics have done when dosed correctly and on the right mix is they have helped give me a tool to more easily establish what is real or true and not. Even "in remission", a person with psychosis may experience hallucinations or mild delusions. It's less the symptoms that stop and more that they stop being as disturbing and disruptive, in my (mod bert again!) experience. They do not affect speech or negative symptoms for me, however.
Other mod here! When on the wrong antipsychotic, my delusions and hallucinations got meaner. They were more persecutory and I also experienced "old" hallucinations that I had not seen in a while returning. However, on my best dosage, my antipsychotics made my hallucinations nicer and quieter. Not as in like literally less loud, but they became easier to ignore. Like above, I have never seen an improvement in my speech or cognitive symptoms from medication.
Q: What kind of things can trigger a psychotic episode?
A: Technically speaking, anything can. It depends a lot on the actual disorder causing the psychosis (no points for guessing what triggers an episode in someone who has Medication-Induced Psychotic Disorder), but the most common triggers would be:
high stress,
recent traumatic event,
substance use,
sleep deprivation,
and social isolation.
My symptoms can be triggered by talking about them or seeing content similar to my hallucinations and delusions. For example, hearing a bible story triggered a religious hallucination, etc.
Sometimes the trigger is also "nothing" as far as the person experiencing the episode knows.
Things to Avoid
[Plain text: Things to Avoid]
Violent psychotic characters, especially ones that kill others because of "the voices"/"the visions". Psychotic people are much more likely to be violent towards themselves than anyone else.
Magical psychotic characters where the psychiatric disorder is some sort of magic system mechanic. A mentally ill character can have powers or whatever, but don't make symptoms into something they aren't.
Delusions/hallucinations that predict the future or have some other kind of omniscient quality to them. Again, this is a real medical condition, not a writing prompt.
Rule of thumb: would you still make the character psychotic even if their symptoms served no purpose in terms of worldbuilding and/or establishing something supernatural? Because if the answer is no, you have to rethink some things.
Psychotic characters who always have to be one of the like, four possible character archetypes (evil cannibalistic serial killer/mad scientist/Victorian era child in a horror movie/side character whose delusions are played for a joke and/or to show how 'dumb' they are).
Things We Want to See
[Plain text: Things We Want to See]
Regular people who just happen to be psychotic because of a mental health condition.
Psychotic characters who also experience other symptoms of their condition. Schizophrenia, the most commonly portrayed psychotic disorder, has many more symptoms than just that.
Psychotic characters who aren't young. Elderly people are actually the most likely to develop psychosis, childhood onset is extremely rare in comparison.
Psychotic characters who aren't white, physically abled men. Your character can be of literally any background, anyone can develop psychosis. In media it's almost exclusively either white men with poorly "researched" schizophrenia to portray them as crazy and dangerous, or sometimes women with delusions (usually erotomanic/jealousy type for obvious reasons) to portray them as crazy and unbearable to be around.
Characters who experience other kinds of hallucinations than just auditory and visual ones.
Characters who experience cognitive and speech symptoms.
Characters with other disabilities.
Characters who need a lot of support as a direct result from their psychosis. This should be portrayed as a neutral thing.
Psychotic characters who still have a social life! And hobbies!
Characters with MDD [major depressive disorder] that experience hallucinations/psychosis as a result. This was something I experienced during one of my worse periods and I have quite literally never seen anyone talk about MDD with psychosis outside of a medical context.
I hate when a character becoming disabled is treated overall like a tragedy. What I am confused about is that losing an ability does cause a struggle to adapt and some mourning which, in my personal experience, really sucks. The frustration of relearning how to eat without the use of a thumb is real, but someone who canât use their thumb shouldnât be assumed to have a worse life. A character starting to need a mobility aid isnât something to be pitied, but someone who has always loved to run no longer being able to participate in that hobby is usually distressing. What are tips / ways to show the negative emotions that come with losing an ability without making the reader think becoming disabled / more disabled is overall a bad thing
Thank you for any advice! This blog is really helpful
- @writeintrees
Hello,
I think it's just the regular idea that sometimes things can be objectively harder, and it doesn't mean it's hopeless or tragic.
Immigration is hard. Going through a break-up and back to the dating scene is hard. Being poor is hard. Being an ER doctor is hard. Seeking asylum is hard. Having your parents divorce is hard. We don't need to pretend there are no difficulties, or that everyone is uwu awesome all the time.
There are symptoms that are horrible. You experience ableism. Structural barriers. Everything is expensive. You lose the ability to do certain things, and you have to spend a lot of time or money on others. Those things are, for the most part, included in the "becoming disabled" package and they are overall bad. Acknowledging that is just being honest about the situation, disability by definition results in limitations in various life activities.
There is also the community. You meet new people, many that you'd have never met otherwise. Gain a new perspective on things. You might discover new hobbies or sports. Maybe you learn a new culture. A new language, if you become Deaf. Some people even find religion, spirituality, or some other deeper meaning in their experience.
As time passes, you get used to some of the bad things from the previous paragraph, you learn how to work around the others, and you simply keep living with the ones that still piss you off. There might not be a time when a cervical spine injury stops causing you physical pain, but there might be a time when you manage your opioids as just another part of your day before picking up your son from school.
The key is to find balance. We don't need "pushing through chronic pain" to show that it's not that bad, we need a community that will help and be there when the chronic pain is, in fact, too bad to deal with. Does it suck that maybe you won't be able to go out because you have to stay in bed -- yes. It literally just does. But maybe your friends love you, and will come hang out with you rather than leaving you alone.
Similarly, it does suck if your entire life was soccer and you lose your leg. You first go through shock. Then the 5 stages of grief, in a randomized order, like three to ten times. It's all meaningless and over and all that. But human beings generally try to find solutions and adapt, grieving forever is not exactly helpful. So maybe you try to go back to playing, but on crutches. It either does or doesn't work. Maybe your prosthetist gives you a flyer from a local amputee soccer team that's looking for players. Will it be the same -- no. It could be worse, just too different, or it could be better, because you are now around people who you know for a fact understand you. And if it doesn't work out? You try other stuff. Maybe you end up playing water polo, because it's the one sport where you feel "like before". Or get into video games about sports, or start doing videos about soccer and talk about it with others online. Maybe you never fully find your "thing", and just hop from hyperfixation to hyperfixation looking for what hits right, ending up exposed to hobbies you never even considered doing before. At least you're no longer just playing a stage of grief slot machine.
I just don't think disability is fundamentally different from any other makes-your-life-harder event. It's like if you had a partner, but ended up breaking up or divorcing. You cycle through stages of grief, tell yourself it's over and horrible forever, all that ad nauseam. But eventually you'll probably meet someone new. Now, it won't be the same person. Maybe they're worse in some things, or do some differently, and you're not used to them. But they have their own charm too, and you eventually learn how to function together. At no point do you develop amnesia about your past relationship, but you're satisfied with where you are now regardless. I don't think this ending would be a bad thing.
There doesn't have to be a moment where the character 100% accepts their disability with everything that comes with it. I don't think most people do. I don't like the way my eyes work or hurt from such rare events as "sunlight", but I simply try to adapt to the way they are. There's really not much choice.
The disability experience simply has parts that are bad. There is no way of genuinely showing pissing yourself or having a migraine as a positive thing, I don't think there's literally any point in pretending these are pleasant. But they're just one part of life of that disabled person. If the positive parts are shown too, it won't be solely bad.
The face equality post made me realize that in addition to being horrible in so many ways, laws that use biometric scanning to age ID people for mature content are almost definitely also extremely ableist.
is there a difference between the terms non verbal, non speaking and mute? I've seen them all used for seemingly the same conditions/to describe the same thing but by different people.
Hello,
Non-verbal vs non-speaking is mostly a matter of preference, as well as some intra-community differences. You can see this post talk about it, or this one. You will sometimes see it used interchangeably.
Generally the most common type of difference these are used for is that someone non-verbal experiences language problems, and might not be able to communicate with language (including AAC) either fluently or in general. It often implies intellectual disability, autism, or brain damage with cognitive symptoms (rather than purely motor ones).
On the other hand, someone non-speaking can have a mechanical problem, like inability to move or coordinate their mouth, or have had their voice box removed, or some other, usually physical, condition. It often implies something like paralysis (ALS for example), dysarthria, having a tracheostomy, or surviving a head-and-neck cancer.
Some people might use non-speaking over non-verbal to emphasize that they have linguistic abilities, just not the ability to physically produce speech.
Non-speaking might sometimes be suggested as the "better" option because "not everyone can speak, but everyone has language!", which is not always true for those who are non-verbal. Some people don't have any meaningful linguistic capability, and communicate exclusively without language. There are valid and important communication methods that don't rely on it.
These are specifications that aren't used much, but are something I noticed regardless. Most of the time, they're either exact synonyms or pure matter of preference. Non-speaking is also a newer term to my understanding, so someone older might be more likely to use non-verbal.
Many people who have language disabilities, because of their disability, will not differentiate these words. The difference, when it's there, is rather minor in the grand scheme of things.
As a bonus, there is also (rarely) oral vs non-oral. Someone could be oral, i.e. produce sound, but not speaking or verbal, because the sounds do not form speech or maybe aren't communicative or even purposeful. Think of someone who can only groan or laugh.
You can also sometimes see it to emphasize that someone communicating with sign language is both using language (thus, verbal) and is speaking (thus, speaking), but does not do so orally specifically. Other people would consider that non-speaking because signing is signing, speaking is oral speaking. And so on...
Mute is more complicated. At least in my view it's rather outdated when it comes to describing people who don't ever talk. The only places I still see it used is situational (also called selective) mutism, which is a real medical condition, and "deaf-mute", which is a pejorative term.
I don't really see many either non-verbal or non-speaking people also identify as mute, but out of the two it's probably closer to the "non-speaking" implication. But it generally strikes me as a term someone else would describe a person who can't talk, rather than for that person to describe themself with (with the exception of situational mutism). But it could be simply a matter of a social circle.
If any followers have additional insight feel free to share in the notes.
mod Sasza
(addition by Mod Rock: deaf-mute is generally considered outdated terminology to refer to a Deaf person who doesn't speak, but there are some Deaf people who reclaim the term stylized as DeafMute to emphasize their decision not to vocalize as part of their Deaf identity.)
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Hello! Iâm writing a story that involves a schizophrenic character with delusions, as well as another character whoâs very set in his ways and tends to dismiss evidence against his troubled view of the world. The latter is not intended to be psychotic, justâŠdeeply, stubbornly wrong.
Do you have any suggestions for how I should go about differentiating the two? Mostly for making it clear that the latter is not experiencing delusions?
2/2 Should probably be a little clearer about my ask actually. The second character is a conspiracy theorist basically and a lot of the stereotypical tinfoil hat type stuff kind of looks like delusions which is what could cause issues, I want him to have that tinfoil hat vibe but also separate him from the character experiencing actual delusionsâitâs not because of psychosis for him, itâs because of basic mistrust and logic leaps. Itâs late so Iâm probably not explaining all this perfectly but Iâm thinking about it now so this is when I write it
Hello!
This is an interesting problem, especially considering that these two categories of people can definitely look the same (and rarely also are the same people). But I think there's a few things that you could do to separate them to the viewers.
The easiest is to show the schizophrenic character as having intermittent psychosis, rather than continuous. Conspiracy theorists don't really have "episodes" where they suddenly stop believing the thing they're conspiring about.
Another is to involve non-delusion symptoms, which are also necessary for diagnosis of schizophrenia. A conspiracy theorist, no matter how dedicated, won't experience hallucinations, catalepsy, or speech problems. A character with schizophrenia will.
A characteristic of delusions is also that it is not possible to convince the person otherwise. They will continue believing into whatever they're delusional about, generally without feeling like they need to explain it. Many conspiracy theorists actually change their beliefs (for example, starting to blame a different demographic for why XYZ is bad) based on what's going on socially or politically, even if the conspiracy itself continues.
Another method is the target of the delusion vs of the conspiracy theory. Persecutory "Big Government" type delusions can and are often similar, or mimic conspiracy theories. Erotomanic ones, generally speaking, don't. Etc. "Parasites under my skin" also doesn't sound particularly conspiratorial.
Alternatively, even if the character does have persecutory delusions, you can make them seem too extreme to be possibly considered genuine beliefs by the readers. A conspiracy theorist might think that the government is putting chemicals in the water, but probably not that they're literally inserting thoughts into their head, or that their loved ones have been replaced by identical clones.
Depending on the actual delusion and circumstances, a schizophrenic person can (and very often will) be heavily distressed either by the content of the delusion, or potentially by the awareness of being delusional. They can't really "tune out" if the subject annoys them too much. A conspiracy theorist wouldn't be afraid of the fact that they believe their theories.
Saw a recent post and wanted to ask something similar!
Is there a list of anything that you want to see more in characters with a G or J tube? Are there any tropes/stereotypes that i need to be wary of? Thanks!
Characters Iâm thinking of:
- character who loses top 2/3 of stomach from a traumatic incident- has pylorus still and is able to eat a little by mouth but isnât able to eat enough by mouth to sustain because remains of stomach is small- dependent on J tube
- autistic character who got a G tube as a child for various reasons including ARFID, and still has it and depends on it as an adult
Hello!
I'd like to see:
Any character that has a j-tube, since I'm not familiar with literally any. I don't know if there are any stereotypes, as I don't think enough people are aware of this (or the jejunum being a body part they have in general).
Characters that have a specified reason why they have the feeding tube (even if it's just "they can't absorb enough nutrients" or "they cannot safely swallow") rather than just being Unable To Eat.
Some causes could include: gastroparesis (stomach paralysis), Crohn's, gastrointestinal and head-and-neck cancers/physical trauma, ulcerative colitis, dysphagia, eating disorders, intestinal failure... For temporary reasons, it could be as simple as "surgery".
Characters who have a feeding tube because of cerebral palsy. The lowest estimate of how many people with CP use one that I found was ~6%, which is not that low to be honest, but I can't say I've ever seen it represented. Though it's also limited by the fact that characters with cerebral palsy that severe aren't represented as a whole.
This isn't really a stereotype since the opposite is accurate for many people, but I'd like to see characters with feeding tubes that visibly improve after getting it. For example, a character that was malnourished regaining their energy after getting a tube placed.
Characters shown caring for their feeding tube by themselves.
Characters that have literally any other "aesthetic" than "hospital". A character that does spend a lot of time in a hospital/medical setting is not necessarily a Hospital Character as long as they have literally anything else going on. But if in every depiction they're just standing there with that IV drip on an infusion stand in that hospital gown...
Depending on the condition, some people with a feeding tube can still eat by mouth. They might just not be able to eat enough or to absorb it correctly.
Characters who can't eat by mouth, at all, and maybe do miss food but don't make it their entire personality.
A variety of characters with feeding tubes! Some that have always used it, ones that are new to it, ones that use it permanently/very long-term, ones that use it because of a temporary illness or surgery, etc.!
How to Support People with Facial Differences - the Face Equality Week 2024 Special
[large text: How to Support People with Facial Differences - the Face Equality Week 2024 Special]
Today is the 13th of May, which means that the Face Equality Week has just started. This year's theme is âMy Face is a Masterpieceâ which is probably my favorite sentence ever said about having a facial difference. Huge fan, should be used way more often in my opinion.
Because of this occasion, I would like to share some thoughts about Face Equality that I think are rather entry-level, i.e. you don't need to know much to execute these, but you can still support us.
Stop the stare.
I know it's fun to stare - or so I guess, at least - but maybe you shouldn't. Next time you see someone who has a scar or who's face does not move the same way as yours, just mind your business. We can tell when you're âdiscreetlyâ looking.
Don't call us deformed.Â
Knowing how the people you're trying to support actually call themselves should be an absolute first step, but most people still fail here. Most of us don't appreciate being called âdeformedâ. I certainly don't. Say âfacial differenceâ, or âdisfigurementâ if you must. It's 2024. Leave âdeformedâ to medical reports from the 70s.
No more âWhat happened?!âs.
If you aren't a doctor, there's a high-to-100% chance that it's none of your business. It's cool that you're curious - keep it to yourself.
Stop insinuating that we are ugly.
âSupport people who are ugly!â isn't very supportive. I would say, not in the slightest. Say âpeople who don't fit the current beauty standardsâ if that's what you mean.Â
Or, to go with this year's theme, âpeople whose faces are masterpiecesâ : )
Use critical thinking online.
Is the reaction photo actually funny, or is it just a person with a craniofacial condition? Is the meme actually a meme, or is it just making fun of a person with a facial disfigurement? Is body-shaming suddenly hilarious to you when the person shamed has strabismus?Â
If the entire punchline is âlol they have a disability xdâ, it's ableism. Plain and simple.
To go with the point above - your joke is probably not funny.
We get it! You can't help telling us how "you're going to hell for laughing" (which yeah, probably) and how we remind you of the ugliest character you have ever seen. I guarantee you that we heard it, and that you are behaving like an edgy middle schooler who hasn't "found out" yet. It's boring and annoying. Also ableist, but you're aware of that already if you're saying that you're going to hell.
Stop with the goddamn trigger warnings.Â
We aren't âbody horrorâ, we aren't âgoreâ, we aren't something that you need to advise your viewers to use their discretion over. Every âgraphic footage: child with neurofibromatosisâ and â#tw burn scarâ is a sign of ableism and disfiguremisia. People with facial differences deserve to be seen. Ableds can survive seeing a person without a nose.
Do a basic reading on what disfiguremisia is.
New word! And an important one. It's a brand of ableism that intersects with more or less everything, and it means discrimination and hatred of people with facial differences/disfigurements. The bullying, harassment, endless name-calling, and microaggressions are all results of disfiguremisia. The ways in which everything is harder for us isn't some unchangeable rule of how the world works, it's just an extremely prevalent type of discrimination.
Understand that we are people.
I know, revolutionary - and yet impossible for so many people to get. We can be a visual representation of evil when it's necessary, we can be a feel-good inspirational story on a morning talk-show, but not much else, it seems. In reality, we are complex, we have our own lives, we can be happy and sad and have the same exact joys and worries that you have.
Hey, artists - facial differences don't make you evil.
Title stolen from a great essay by Lise Deguire (link). When's the last time you saw a positive character with a facial difference that wasn't inspiration porn? I mean a character that's not edgy, full of angst, a murderer, or a villain. Based on what you see in the media, you'd think that having a scar renders you evil on the spot, but in reality it just makes you loathe how artists apparently think you are like. It's boring, it's overdone, it's ableism. Stop doing this, and start noticing when it's being done. Point it out if your friend is writing their new villain to be an evil burn survivor. This kind of portrayal needed to stop ages ago, but tomorrow will be a great time as well.
Before you reply with âI've never seen thisâ - Darth Vader, Lion Kingâs Scar (subtle name, great thing to teach kids!), Freddy Krueger, Voldemort, we could be here forever. You're just not paying attention.
Pay attention to where we are not included.
As discussed, there are some places where you see us all the time. But where do you not see us?
Advertisements (unless it's for a scar-removal cream, of course). Fashion shows. Magazine covers. Romance movies where we are the main character.
We deserve to see ourselves in what's around us in the same way able-bodied people do. Trying to make it seem like we don't exist - that's deliberate.Â
Interact with our art.
We draw, write, sing, act in movies, we do everything. Support us in the most tangible way - leave us a nice comment, read our books, listen to our songs. Watch movies where actual people with facial differences star, not pseudoinspirational stories about how âbeing disfigured is okâ where they shove an able-bodied actor into a full face prosthetic just to not have an actor with a disfigurement on set.
Include us.
As this year's Face Equality Week calls for, include us. In art, in movies, in books, in your life. Show us as positive people who are valuable, who are a part of your community - I guarantee that we are in every one that's out there. The world is hostile and unwelcoming to people with facial differences - be the change, wherever you are.
I know that it is different from the usual posts I make, but I hope it was somewhat educational. I just like to use every occasion that I can to force Face Equality into people's heads. To make this at least a bit about writing to keep the blog's theme, I will say that if you want to write about us, you need to care about us in real life as well. Otherwise, it's pointless and, as representation, genuinely worthless.
Below the readmore are some links/resources that you can click to educate yourself further. A lot of them lead to Face Equality International because they have just about everything you should know. If you want to be a better ally to people with facial differences, I heavily recommend them.
