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Mental Illness Primer for Speculative Fiction Writers 6: Suicide and the Sandman

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.

The assessment of mental illness should draw information from as many sources as possible (self, others, mental health workers), and should consider a change from the baseline.

Examination of Buffy s6ep17 shows superficial attendance to reality of mental illness. 

Electro-convulsive Therapy (ECT) has a troubled history, but is both safe and effective.

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).

Scope: 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 6: Suicide and the Sandman

sandman 1

Neil Gaiman and an army of artists wrote ‘Sandman’ for 75 issues between 1989 and 1996. It is one of the high points of the sequential arts medium and has won a string of awards. If you have not read it stop now, because I will talk about the end. Seriously, do not proceed beyond this point.

The series ends in what is essentially the suicide of the eponymous Sandman (aka Morpheus aka Dream, of the Endless). There are many wonderful things about the series but the suicide of Morpheus was elegantly nuanced.

Family History

sandman2

 

Morpheus is one of the endless (pictured above): Dream, Destruction, Desire, Delirium (formerly Delight), Despair, Death and Destiny. They are godlike beings who represent some fundamental aspect of sentient life as their names suggest. We are never told who their parents are, but there is a birth order.

If you remember the previous parts we mentioned that in assessment of mental illness one has to check the family history. Is there evidence of mental illness in the Endless? Well, yes. We’ll leave out the absent parents (which we know can screw up any child) and go straight to the siblings.

  1. Destruction walked away from both his duties and the family.
  2. Despair constantly self-harms by cutting herself.
  3. Delirium is psychotic, and her change from Delight shows a definite onset of psychosis.
  4. Desire is not necessarily mentally ill, but S/he is homicidal and vindictive. The vindictiveness is a trait shared by Morpheus.

This shows a definite problem in the family.

What about Morpheus himself?

sandman3

The Sandman is rigid and inflexible. He is narcissistic and vindictive, prone to excessive vengeance.

He is prone to depression as is demonstrated many times throughout the series. He bears the guilt of killing his own son (long story) and imprisoning a woman who spurned him for over a thousand years in Hell.

Morpheus dies in the end. In my opinion he committed suicide.

“The only reason you’ve got yourself into this mess is because this is where you wanted to be”

-Death

The circumstances that lead to Sandman’s death were engineered in part by Desire, but we are clearly informed that Morpheus could have avoided it, but chose not to.

In my opinion his suicide was made realistic by the absent parents, the family history and his personal experience of depression combined with an inflexible personality.

Some points about suicide

Suicide is extremely tragic and has been depicted in dramatic form and fiction since man could form sentences. It appears to have been with us throughout recorded history. I’ve heard it said that one suicide can affect up to sixty people.

Because suicide is rather dramatic and eye-catching we often lose sight of one thing: it is uncommon. In most countries it is in the order of 11-16 per 100,000 per year. It is never casually done.

There are three components to suicide: 1. The person is dead. 2. The person died by their own hand. 3. They intended to die by their own hand.

These three components (but 3 in particular) make suicide difficult to prove, and for historical reasons it is defined differently in different countries (For example, England and Wales have a different way of determining suicide when compared with Scotland). This makes research difficult and comparison of statistics tricky.

Most but not all victims suffer from a mental illness at the time of suicide. Mood disorders increase risk. 60-70% have depression, people with schizophrenia are at risk, especially around the time of diagnosis and during recovery; substance abuse is a risk factor; anxiety and panic disorders can be risk factors. Note that people who have experienced non-lethal self-harm or suicide attempts are at increased risk of completed suicide (and can we just put that whole ‘cry for help’ malarkey to rest please?).  Even though two thirds of those who kill themselves have never tried to harm themselves about one tenth of those who harm themselves may go on to kill themselves. A chronic medical condition can be a risk factor, especially if associated with chronic pain.

Twin studies demonstrate that there is a genetic component to suicide, but it isn’t Mendelian.  The captain of the HMS Beagle (yes, the one with Darwin) was a man called Robert FitzRoy. He was noted to be odd and almost certainly suffered from Bipolar disorder. FitzRoy killed himself by slitting his own throat in 1865. FitzRoy’s uncle had killed himself by similar means about a decade earlier. According to Bryson, 2003, “FitzRoy came from a family well known for a depressive instinct.”

To Nuance Suicide in Fiction Consider:

  • Past history of suicide attempts
  • A history of impulsive behaviour
  • A family history of depression or suicide attempts
  • Living alone
  • Being widowed/divorced
  • Sometimes seen in white elderly males more commonly
  • There should be access to the means
  • There may be a childhood adverse experience
  • There may be previous suicidal ideation
  • There may have been planning
  • Substance misuse is very common
  • Recent loss is common
  • A personal history of depression/panic disorder

Remember: Be sensitive. Suicide should not be a punchline or plot device. Remember that what you write affects real people with real lives.

Next: Mini Case Study: ‘Hush’

 

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Mental Illness Primer for Speculative Fiction Writers 5: Electro-convulsive Therapy

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.

The assessment of mental illness should draw information from as many sources as possible (self, others, mental health workers), and should consider a change from the baseline.

Examination of Buffy s6ep17 shows superficial attendance to reality of 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).

Scope: 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 4: Electro-convulsive Therapy

One Flew Over the Cuckoo's Nest

One Flew Over the Cuckoo’s Nest

I’m going to go ahead and say this from the start: Electro-convulsive Therapy (ECT) is both safe and effective. ECT is a controversial topic, but not a controversial treatment. The problems with public acceptance of modern ECT are understandable, but historical and subjective. As a writer/filmmaker, you need to know how ECT was performed in the historical era you are writing in.

The essential feature of ECT is the induction of seizures by way of electric current.   Electricity gets a bad rap in psychiatry, yet it is used all the time in medical treatment e.g. Defibrillators, TENS (Transcutaneous Electrical Nerve Stimulation) machines, diathermy in surgery to name a few. Nobody gets upset about all this, so it is not electricity that is the problem.

History 

Convulsive treatment started in the late 1930s out of an erroneous belief that people with epilepsy did not suffer from schizophrenia. The scientists of the day decided that induced seizures might cure schizophrenia. They used electricity, but also chemicals like cardiazol. With time electricity became the only method of inducing seizures.

We do, however, need to place the use of ECT in historical context. There have been, unfortunately, many abuses of psychiatry. Some of these have been nefarious, others well-meaning though paternalistic, but all led to some degree of suffering. This is not a talk on history, but a few key points should be noted. Psychiatrists in Nazi Germany subscribed to Lebensunwertes leben (‘lives unworthy of life’) and allowed or encouraged thousands of patients to be killed in ‘Action T4’ which is  believed to have been a dress-rehearsal for the extermination of Jews and Roma. The Soviets also gave us something called ‘Sluggish Schizophrenia’ which was a euphemism for dissident behaviour and the use of psychiatry for social control.

Asylums were seen by some as places to keep the mentally ill apart and (with hints of eugenics) to stop them from breeding. Interesting side note: being gay was considered a mental illness at this time.  The plight of patients on the Greek Island of Leros discovered in 1989 should remind us that such abuses are still possible in modern times. All kinds of purported ‘treatments’ emerged including insulin coma therapy, water dousing, centrifuging, mechanical restraints, psychosurgery, shock treatment, etc. By the end of WWII only ECT, psycho-surgery and Insulin Coma therapy survived as effective physical treatments for serious mental illness.

In the 1950s psychotropic drugs were discovered (by mistake while we were trying to make antihistamines). The simultaneous massive social change at the time along with the work of Goffman, Laing and Foucault as well as a financial incentive for governments led to the progressive closure of asylums. I am aware that I have simplified and collapsed a number of events and interpretations, but you can look these up. They are a matter of public record.

What’s important with respect to ECT is that it still drags around the historical and socio-cultural baggage of the asylums, inhuman treatment, coercion, paternalism, experimentation, eugenics and the immense human suffering that preceded modern mental health treatment.

When is ECT given today?

 ·        Severe depression ·        Catatonia·        Prolonged or severe mania·        Especially if there is refusal of food or drink 

What Does Modern ECT Involve?

In simple terms the psychiatrist explains the procedure and reasons for choosing that treatment option. They should seek consent in writing. The individual should undergo a physical assessment to ensure that there are no physical ailments that might make ECT risky. There should be a baseline memory test. Ideally, there should be a chat with an anaesthetist. After double-checking the consent, anaesthesia and muscle relaxation is induced. The pulse of electricity is applied with electrodes and seizure activity is monitored. The patient then goes on to recovery.

So, in summary:   Consent, anaesthesia, muscle relaxation, seizure, recovery.

It is usually about as dangerous as a dental procedure. You can read more about it from the Royal College of Psychiatry page

The events in the Jack Nicholson film may have happened once, but not any longer. ‘One Flew Over the Cuckoo’s Nest’ was already dated at the time of its release in 1975. It was based on a book published in 1962 (during the wave of asylum closures mentioned above).

Smallville s3e9 ‘Asylum’: Lex Luthor gets ECT

Lex Luthor gets science fictional ECT

Lex Luthor gets science fictional ECT

 ECT is a plot device in this TV programme about the early years of Superman. Short term memory loss is a side-effect of ECT. Lex Luthor’s father wishes for his son to forget something so he engineers a dose of ECT to perform a memory wipe. It would have been more useful to get Clark Kent to kiss Luthor. This episode is an incredibly negative portrayal of the mentally ill and displays ignorance of how ECT works. It describes ECT as “draconian” and risking irreparable brain damage and successful in 50%. ECT cannot be used to wipe memories. The patient will not remember the treatment or scream. ECT in the episode is done without anaesthesia.

Similarly in Batman # 471 where Killer Croc is given ECT, there are visible sparks, there is no anaesthesia, and the doctors wear surgical masks.

This is the second time Killer Croc appears in this talk. Co-incidence?

This is the second time Killer Croc appears in this talk. Co-incidence?

Some criticism has been levelled at ‘Homeland’ Season one’s portrayal of ECT because the recipient winces when the treatment is applied. I’ve seen what looks like a wince in some patients, although it could be seizure-related.

Please read this 2012 Guardian article from someone who has experienced ECT.

Summary: ECT is both effective and safe. Try to avoid mass media as source material.

Next: Suicide and the Sandman 

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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).

Scope:

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

 

croc

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

 

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Movie Mini-review: X-men: Days of Future Past

After watching this I needed some time to gather my thoughts , and now I think I can put them down.

 

XDFP is a decent summer movie and probably rewatchable. I’m going to assume you are familiar with the X-men. If you aren’t, educate yourself here or here. Long time fans, do not think it is an adaptation of the comic of the same name. It is not, although it has borrowed some plot elements. This is a good thing.

 

Like other X-men films the narrative follows Wolverine around as our main go-to point-of-view character. Which is fine, but not-so-fine when you think of all you’re missing. XDFP does not show Cyclops or Jean Grey any love. Storm, Colossus, Ice Man, Kitty Pryde, Bishop and Blink are basically bruisers and not really part of the narrative at all.

 

The film opens in the far future and a bunch of adaptable, mutant-hunting robots are about to wipe out the last of the X-men. They hatch a plan to send Wolverine’s mind back in time to stop the pivotal event that led to the creation of the robots. Yes, it’s time-travel, but I like the idea that they are not sending any actual physical mass. His future mind would “possess” his past body and make the necessary changes. It’s all so “Let’s go back in time and shoot Hitler” but it’s a comic fantasy. Whatchogonna do?

 

In the past he is expected to basically get the band back together. The challenge is brokering a truce between main bad guy Magneto (Michael Fassbender) and Professor Xavier (James Macavoy) while also trying to find Mystique (Jennifer Lawrence), who, like in the first movies, essentially blue-nakeds her way though the movie like a Smurfette on steroids.

 

I’m gonna swing right past the wonky understanding of quantum physics and the nature of time. Nah, no, I’m not. They spoke of time as if it is this linear thing that stretches from the Big Bang through a definite future. To be honest Doctor Who’s “timey-wimey, wibbley-wobly” explanation was better. Future screenplay writers should read “A Brief History of TIme” before writing the first scene. Or, hell, just read Wikipedia.

 

So how does this movie fare as a summer draw? If you don’t examine it closely, it’s pretty decent. The special effects were worthy. The action sequences are the best of any X-men film. It shows actual teamwork, which, in the comics, is the best part of their fight scenes. The pacing is fine, with no real dull moments. There were even some touching bits. The dialogue was sufficiently snappy and there were no groan moments. Quicksilver’s scenes were the best and in my opinion he was gone too soon. More Quicksilver please. Solo movie, even. In the short time he was on screen we learned a lot about him, which is good storytelling. He was the most interesting character in the film.

 

The characterisation and character development was pretty weak. Wolverine is Wolverine. We already know from the start that Prof X is a bit of a dick in the past, and that he will turn into the future awesome incarnation. Therefore, no tension. Ditto Magneto. There were bits of emotional tension here and there which comic fans will understand (Iceman and Kitty sharing a look during a fight scene, Kitty and Colossus teaching together in Xavier’s school), but largely there were no surprises here.

 

The whole movie continued to channel the sixties and seventies, particularly the paranoia. There were deft touches here and there, and a shout-out to Watergate (we see the tapes), Abraham Zapruder, and JFK amongst others.

 

There are no strong female characters in this film. Front and centre like a fanboy’s wet dream, is the ever-naked Mystique. She has no agency of her own, borrowing motivation which was programmed in her by Magneto and inadvertently by Prof X (who inexplicably holds himself to a promise he made to her when he was like 9 years-old). Zero character development since the last film (X-men: The Last Stand, which, somehow wasn’t the last stand. Oh, well). Storm was redundant. Kitty Pryde served the plot. Her heroic action was to use her power to send Wolverine back in time. She then spends the rest of the movie holding on to his fricking head. Seriously. This is what she does.

 

Colossus et al were just pawns to be moved around by the plot, not their own agendas. Cyclops…oh, you get the picture.

 

Watch it with your brain at low gear and you’ll be fine. Lots of eye-candy set pieces and it just about avoided the disaster-porn label while still being action packed with superhero mayhem.

 

3/5

 

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THUG, Sorry, GEEK LIFE

THUG GEEK LIFE

 

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Review: Delirium: Going Inside by Neil Gaiman and Bill Sienkiewicz

This short tale is part of the collection ‘The Sandman: Endless Nights’

For the uninitiated, between 1988 and 1996 Neil Gaiman earned his chops writing a comic series called ‘The Sandman’. If you read that sentence as it stands you’re bound to have a dismissive reaction. After all, what the hell is a Sandman? The whole situation is not helped by the cheesy character in a suit, fedora, gas mask and cape that Kirby used to draw.

Gaiman’s Sandman is a sprawling yarn than incorporates mythology, history, sociology and a whole lot of other concepts that I am not smart enough to recognise. What  you need to understand for the purposes of this review is that Sandman is the embodiment of dreams. He is one of the Endless, beings who all embody (and are named) Destiny, Death, Dream, Destruction, Despair, Desire and Delirium.

‘Going Inside’ is a tale of Delirium.

Reading the story is a lot like being delirious. I’ll get to the art in a minute. The tale opens on a girl who is catatonic as a result of sexual assault, and her attentive mother. The scene changes and we meet a homeless man who clearly suffers from schizophrenia as illustrated by his fragmented, paranoid thoughts.

“If you paint this message over 1334 Seventh Street will suffer physical damage from who was behind it? The Catholics? The Templars? The A.M.A again?”

This is the start of a curious quest narrative. The five heroes have in common disorders of the mind but seem to be led on by a dog and a raven, familiars of Destruction, Delirium and Dream and the rational anchors of the story. Without the animals ‘Going Inside’ would spin out of control, flung out into boring territory by the authenticity of the streams of consciousness. Being a short story there is little I can say without revealing the plot.  The beauty of the writing is in chronicling the fractured reality of the questers while maintaining forward momentum at the same time avoiding the ‘freakshow’ element. This is not as easy as it seems. How do you make people with mental illness protagonists without a. making fun of their disorder or b. using the disorder as entertainment. One way to do that is to avoid using the mentally ill in fiction, but that is absurd and discriminatory. The laziest kind of story uses invented madness rather than researching actual illnesses.

Dream is behind the story, of course, pulling the strings and saying little. This is a rescue mission into territory that even Dream would not dare enter. Negotiating their various psychoses is not easy, but the thread that runs through is the idea that a girl is hurt and they must help.

If you are unfamiliar with Sienkiewicz’s work shame on you. In this story he is in his element with explosions of colour, surreal juxtapositions, black-and-white sections and panel distortions in a mixed-media phantasmagoria. He uses a motif of fishes to lead the reader through what could be a potentially confusing series of images.

I can’t tell you what this story means. In the introduction Gaiman does not say, although he mentions a different story he had planned to do with Sienkiewicz also based on madness. You could attempt a loose interpretation by saying it takes the mentally ill to help the mentally ill. The worst thing that can happen to you reading this tale is you’ll learn what a carcharodon carcharias is.

I would buy ‘Endless Nights’ for this story alone.

No star scoring here; just go read the damn story.

 

 

Originally posted on 01/12/2012 in ‘Random Headshots’

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