Mental Illness Primer for Speculative Fiction Writers 3: How to Assess Mental Illness

Key Learning Points So Far:

The portrayal of mental illness by writers/creators affects stigma. Stigma leads to negative treatment once individual is identified (‘marked’) as mentally unwell.

Mental illness is difficult to define but is socio-culturally determined. Cultural context is important when depicting a character as mentally ill. There should be no drug/alcohol intoxication or organic illness. Behaviour/experience also needs to be sustained in order to attribute it to mental illness.

Trigger Warning

Up to 1 in 4 people can be affected by mental illness so if any of the topics discussed here affect you contact your health professional (General Practitioner in the UK).


This is for creators of speculative fiction. The idea is to improve depiction of the mentally ill in narratives like film, books, music videos etc. It is just a primer, therefore it will not go into too much detail.

Spoiler Alert:Here there be spoilers. Deal with it. I will try not to reference anything currently showing in cinemas, but I make no promises.

Part 3:  How to Assess Mental Illness



The Batman School of Diagnosis Swamp Thing #66, Nov 1987 DC / Vertigo

Here we see Batman delivering a villain called Killer Croc to Arkham Asylum for the Criminally Insane.

Batman’s reason? Croc killed thirty people with a firebomb. The doctor’s response? “Of course! I-I’ll admit him into a treatment program immediately.”

Killing does not equal mental illness. Not even mass murder can be used as criterion for mental illness. This is incredibly stigmatising.  What tends to happen is that people start to draw erroneous inferences: if killing = mental illness then mental illness = killing. The myth of the psycho-killer is sustained this way. The capacity of mentally well people to commit murder is beyond the scope of this discussion, but just bear in mind that people all over the spectrum of sanity/insanity can commit any kind of atrocity.

There are three key elements to assessing mental illness in any culture. Attendance to these will help nuance your portrayal.

1. I am not feeling myself:  reports by the individual involved stating that something is not right.

2. This person is not okay: reports from other people about the individual, stating that something is not right

3. My assessment shows abnormality: opinion of mental health professional having assessed the situation taking 1. And 2. Into consideration.


It its simplest form, these three factors will establish if a person is mentally unwell or not. Let’s take each in turn.

I am not feeling myself

The individual suffering from mental illness knows something is not right. Compared with the baseline functioning of their self something has deviated. This could be anything from a vague sense of unease to a low mood for weeks to sleep loss to auditory hallucinations. The key thing is that something is different. Precisely what is amiss is a different matter, and can be quite contentious. For example, a person who heard voices in his head presented to a dentist in order to have his teeth removed because he thought they were picking up radio transmissions. 

The fact that the person isn’t feeling well does not mean they will disclose this to anybody. This is often a problem. In the easiest scenario a person would take this problem to their family doctor and seek help. It seldom works out that way (see also, Stigma). The person knows that they are not at their basline functioning. Whether they seek help or not depends on the level of insight and/or perceived stigma. Insight is dimensional, not categorical. It can range from complete disbelief that there is anything wrong to appropriate help-seeking behaviour with full awareness. A lack of insight is common in psychotic illnesses, and this is encoded in culture with the idea that if you think you’re mad you probably aren’t. This is not true, by the way.

This person is not okay

Here we mean an observation by people around the sufferer that something is not right. In this day and age, of course, seeing someone walking down the street talking to themselves may mean nothing more than a smart phone with earpiece. It could mean the person is responding to auditory hallucinations. It may also mean bad continuity editing in a Hollywood movie:

"There's no time to add earpieces! Let's get the movie out. Nobody will notice."

“There’s no time to add earpieces! Let’s get the movie out. Nobody will notice.”

Observations by loved ones, frenemies and random bystanders may help inform us about mental illness. A deviation from normal routine, prolonged absences from work, strange behaviour, poor self-care (where there has been previous good self-care), self-harming behaviour can all point to mental illness. Friends and family are particularly important because one assumes that they’ve known the person for a long time and can tell that there’s a problem.

My Assessment Shows Abnormality

Assessments by mental health professionals is the next part. A good assessment will take into account #1 and #2. The person would be asked a number of questions including

  • Prior contact with mental health professionals
  • Family History of mental illness (because many illnesses run in families. Note this for when you are designing the character)
  • Drug and alcohol use (note also that in addition to having substance misuse problems people can self-medicate with drugs and alcohol)
  • Physical Health (People with mental health problems tend to have poorer physical health than the general population for various reasons)
  • Forensic History (contact with the Law)

I will not go into every aspect of mental illness assessment, but the more you take into account diverse sources of information the more likely you are to get an accurate picture. This may take time.

Next: Mini Case Study: Buffy The Vampire Slayer, season 6, episode 17



1 Comment

Filed under graphic_novel, mental_illness, movie, psychiatry, psychology, writer, writing

One response to “Mental Illness Primer for Speculative Fiction Writers 3: How to Assess Mental Illness

  1. Pingback: Mental Illness Primer for Speculative Fiction Creators: Contents page | Long Time After Midnight

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