Mental Health Monday–Telepsychiatry

You’ve perhaps heard of surgeons using robotics to perform surgery on someone in another city, state, or even country?

Well, psychiatrists can also evaluate and treat patients remotely. Called telepsychiatry, it’s a relatively new method of connecting providers with clients when distance is a limiting factor.

I’ve never done telepsychiatry, but know colleagues who have. I’d imagine it could be challenging, considering we use all our senses (including smell) to evaluate clients. On the other hand, a client usually has a therpist or case worker present with them, while the psychiatrist communicates via camera/TV.

So, writers, if you have a character in an isolated location and they need a therapist/psychiatrist, make sure they have access to the interwebz and maybe even Skype. 😉

Let me know if you have any writerly mental health questions, and I’d be happy to answer them here on Mental Health Monday. Check out Lydia’s Medical Mondays as well and Sarah Fine’s blog, The Strangest Situation for more psych related topics.

Remember, these posts are for WRITING PURPOSES ONLY and are NOT to be construed as medical advice or treatment.

Mental Health Monday

Depression hurts.

Anybody who’s seen a Cymbalta commercial knows that.

And who does it hurt?


Hmmm, makes a compelling argument for having your character suffer from it, don’t it?

Problem: People with depression don’t have a lot of motivation. They spend a lot of time inside, in pajamas or sweats, blinds drawn, covers over their head. They don’t express a lot of affect (facial expression). They don’t really like to talk and if they do, it’s slow.

Oh boy. No emotional displays. No dialogue. No action.

Can you see your plot thread unraveling as you read this?

All right, gang. So how do we make depression “exciting?” Enthralling? Something the reader would want to read?

Okay, so I must say that I by no means wish to glamorize mental illness or make it sound happy, happy, joy, joy. It’s not. Depression is a hard thing to cope with. But for those who are interested in capturing it in the written word, there are several ways to draw interest and make it compelling.

Depression can be a bit of a chameleon. It can be dynamic. It can be emotionally turbulent.

See, tension and interest already!

Agitated depression is a great option (for writing, my friends, not to have). The person suffering from it would be irritable and unable to find comfort in anything. PLUS, they’d be INCREDIBLY emotionally sensitive to even the slightest rejection. If someone–a love interest maybe?–has to cancel dinner, the person just may spiral down to disaster level proportions.

Instant drama!

Psychotic depression is also an option (for your character). That’s when someone is so severely depressed that they experience delusions and/or auditory or visual hallucinations (hear voices or see things that aren’t really there). The voices are usually mood congruent, meaning they take on the quality of how the person feels.

For example, the person could hear a voice telling them they are no good, they’re worthless, and why not just kill yourself and get it over with? Or, a person may believe their insides are literally rotting or a demon is influencing their behavior.

That could lead to some interesting twists.

Anxiety is generally a large component of depression as well. Anyone who’s anxious will have racing thoughts, they’d be in a constant state of tension, emotional turmoil, and angst.

And don’t forget substance use. Anyone who’s experiencing symptoms of mental illness could turn to alcohol and/or illicit substances (drugs) to numb their pain. By adding this feature to your character, you’ve immediately opened the door to subplots of how they get their drug, which bar they hang out in, and what sorts of legal troubles they find themselves in.

I hope this information is helpful, writerly peeps. Let me know what questions you have about lending authenticity to your characters’ mental health!

DISCLAIMER: This is NOT intended for medical advice or treatment. This is SOLELY for the purposes of writing.

Be sure to check out Lydia’s blog for Medical Monday.

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Mental Health Monday

This week’s question comes from Medical Monday guru herself, Lydia Kang. Be sure to pop over to her blog to get your writerly medical questions answered! Here’s the link:

And remember, this is meant for those who are searching for authenticity in their writing and is NOT intended as a substitution for medical advice or treatment.

Question: OCD. When is it pathological and when is it just, well, helpful? and how is it treated?

Firstly, I must say that Obsessive-Compulsive Disorder, Obsessive-Compulsive Personality Disorder, and Obsessive-Compulsive Spectrum Disorders (such as Body Dysm0rphic Disorder, certain impulse control disorders including pathologic gambling, compulsive shopping, trichotillomania/hair pulling, eating disorders, tourette’s disorder, and hypochondriasis) all represent forms of Anxiety Disorders.

Criteria defining each disorder has been outlined by the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV). This allows a clinician to determine a diagnosis as well as provide a common language between mental health professionals. (The material below is from the DSM-IV.)

Obsessive-Compulsive Disorder specifically is made up of two categories:

  • Obsessional thoughts and/or
  • Compulsive behaviors

Obsessions include:

  • Repetitive, intrusive, persistent thoughts, ideas, impulses, or images that are recognized as excessive or senseless but cannot easily be resisted, dismissed, or ignored.
  • This causes marked anxiety or distress
  • Thoughts, impulses, and images are NOT simply excessive worries about real-life problems
  • The person attempts to ignore or suppress the thoughts or tries to neutralize them with some other thought or action
  • The person recognizes the thoughts are products of their own mind
  • (Ex. Step on a crack an you’ll break your momma’s back)

Compulsions include:

  • Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession
  • The behaviors are aimed at preventing or reducing distress or dreaded event or situation
  • These behaviors are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive (Ex. Must check the stove exactly 10 times and turn the stove burner exactly 20 times to prevent the house from exploding.)
  • (Ex. Do everything you can to avoid stepping on a crack)

In order to meet diagnostic criteria, the obsessions and compulsions must take over one hour of every day (some people literally spend HOURS a day on their obsessions and compulsions!) or significantly interfere with the person’s daily funtioning, activities, or relationships.

The most common obsessions center around:

  • fear of contamination
  • fear of mistakenly harming others
  • doubt (gotta check the stove!)
  • fear of punishment for thinking evil thoughts such as obscentities and sexual thoughts
  • need for order, exactness, and symmetry

Common behaviors inlude:

  • hand washing
  • counting
  • refusal to touch an object
  • collecting unusual or worthless items
  • physical or mental ordering

Treatment usually entails a combination of medication (generally anti-depressants, like Prozac) plus Cognitive-Behavioral Therapy where the person examines their thoughts (cognitions) with their therapist and attempts behavioral changes to reduce symptoms.

Now on to what everybody’s wondering about…

Can OCD be “normal?”

Think of it this way: If the person is able to function (meaning is able to hold down a job, have meaningful  relationships, hobbies, social engagements, and does not experience overwhelming distress), then they don’t necessarily have the disorder.

Interestingly enough, people can have symptoms of many psychiatric disorders without meeting full criteria for diagnosis. You know the person who likes to keep a clean house, who lives by the adage, “a place for everything and everything in its place.” This person does not necessarily have OCD, per se. Furthermore, we ALL have wonky thoughts pop up into our minds. It does NOT mean a disorder exists.

In fact, certain activities pull for obsessive-like thinking. Demanding classes (ahem, med school-ack!) and careers can demand a mind that can think and re-think and re-think certain topics. Organizational skills are key too.

Come to think of it, these things are pretty important for writing too! And, for the most part, it does NOT mean writer’s have OCD.

Phew! 😉

Thanks, Lydia, for such a great question! Lemme know, folks, what other mental health questions you have so you can bring authenticity to your writing!

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