Mental Health Monday–Featuring Transcend by Christine Fonseca

Accurately capturing and portraying psychosis is extremely difficult. In cinema, you can use special effects, sound effects, even CGI graphics to crate hallucinations and altered perceptions.

But how does one do it via writing?

I think a fantastic example of a character’s descent into madness is TRANSCEND by Christine Fonseca. Described as Phantom of the Opera meets Black Swan, this dark, YA, (and I’d add historical) novel takes the reader on a roller coaster ride of emotion, intrigue, betrayal, paranoia, delusion, love, horror, tragedy, and rage.

It’s an intense, quick read, just by its nature–Christine doesn’t let you take a breath! 😉

A unique twist is the alternating point of view–FOR ONE CHARACTER! It’s a bit jarring, but I suspect that’s the author’s intention to keep the reader guessing.

What’s most captivating about it to me is that even after I finished reading it, I still had more questions.

Check out Christine Fonseca’s blog HERE.

What books have you read that capture mental illness particularly well?

If you have a character that needs “shrink-wrapping,” don’t hesitate to ask me a question, here in the comments, on Twitter (see sidebar), Facebook (see sidebar), or email me @

Remember, these posts are for writing purposes only and are NOT intended for medical advice or treatment.

Mental Health Monday–Character Analysis: I Hear Voices…No, Really

Stina Lindenblatt asked me to give a run down of treatment for her character. He hears voices, but they are real (in a paranormal way). They end up driving him to cut his wrists. And Stina wants to know what would happen next.

In the state of New York (where I live), someone can be admitted to a psychiatric facility on an Emergency Admission. Also known as an Involuntary admission, people who are a danger to themselves or others can be admitted for treatment, even if they don’t want to be. (We also admit people voluntarily, of course.) I bring this up because not all states have this law.

So, if Stina’s character showed up in my ER, let’s say, and has cut his wrists and reports hearing voices, I’d recommend inpatient hospitalization for his safety and stabilization. Treatment would include keeping him in a safe environment (in the hospital), offering him medication, individualized therapy, and group programming.

Medication varies by diagnosis and symptoms, but someone experiencing auditory hallucinations (voices) would be given an anti-psychotic. “First-generation anti-psychotics” (so called because they were identified and produced first) include Haldol, Thorazine, and Prolixin. They are fast and effective, and though Stina’s character would likely be sleepy for the first few days he’s on them, he’d also note resolution of symptoms within a few days to a couple of weeks. “Second=generation anti-psychotics” (so called because they were developed after the first generation ones and were touted to have less side effects (despite causing other side effects like metabolic changes)) include Risperdal, Seroquel, Zyprexa, and Abilify. Also quick-acting, these agents would resolve Stina’s character’s symptoms within a few days.

One may assume cutting of wrists indicates a suicide attempt and therefore means the person is depressed. (This isn’t always the case, but let’s go with that assumption here, okay?) So, in addition to the antipsychotic, Stina’s character would be offered an anti-depressant like Zoloft, Prozac, Celexa, Wellbutrin, or Effexor. These medications take several weeks to kick in. A person doesn’t have to stay in the hospital for that length of time, by any means. We just need to see their mood begin to stabilize out.

Before leaving the hospital, it would be important for Stina’s character to have follow up treatment with a psychiatrist and counselor scheduled. This would allow for outpatient monitoring of his medications and symptoms. Antipsychotics (if symptoms are resolved and thought to be part of a depressive episode) can be discontinued within a few weeks or months. Anti-depressants should be taken for at least a year to fully treat the current episode and prevent future ones.

If someone has chronic symptoms and history of depressive episodes, they’d more than likely need to stay on medications long-term. If someone has chronic psychosis, they’d need to stay on the medications long-term as well.

Stina’s character is 17, which may alter his management a bit…however, in this case, he’d likely be given the same medications as an adult.

Based on Stina’s description of her character’s clinical presentation, I’d diagnose him with Psychotic Disorder Not Otherwise Specified (he doesn’t necessarily meet criteria for DSM-IV diagnosis) and perhaps Depressive Disorder Not Otherwise Specified.

Other potential diagnoses include: Brief Psychotic Episode, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder, and Major Depressive Disorder with Psychotic Features. Any medical conditions or drug use would have to be considered as well.

I hope this is helpful, Stina!

I’d be happy to answer any follow up questions as well. There’s a lot of information in this post and I could certainly go on, but I won’t cause your eyes will start crossing soon. 😉

Be sure to check out Lydia’s Medical Monday post about what plant in your garden could kill you.

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

Mental Health Monday–Did You Hear That?

It started about two weeks ago. First, a buzzing sound, nothing serious, like I’d listened to my headphones too long and my hearing was fried. Then the whispers started, unintelligible dronings that were more annoying than anything else. At first, I’d ask my roommate what he said. After like a thousand times, he said to knock it off, the joke wasn’t funny anymore.

Last week, the voice spoke. And I understood it.

“We’re watching you,” it said.

I ignored it. The first twelve times. Then I got pissed off. Someone had to be doing this to me. Some sick bastard who hated me.

I checked the entire apartment, rushing from room to room, checking the central air vents, behind the bookshelves, all the electronic equipment. Maybe someone had bugged the place. Yes, that’s it. They bugged the place and they were harassing me. What else could it be? My roommate was at work. The TV wasn’t on. My phone was shut off. “Who’s there?”

“We’re watching you.” The voice sounded just like my uncle Jim. But he died two years ago.

“Why?” I had to shout over the pounding of my heart.

“You’re a horrible person and you should just die.”

“Leave me alone!” I argued back, standing in the living room, flailing my arms like a lunatic.

“You should kill yourself. Rid the world of your filth.” The sound came from my bedroom.

I ran into my room. No one was there.

My roommate called the cops the day before yesterday. Just because I barricaded myself in my room. It was the only safe place. The police broke down the door and cuffed me when I refused to let them in. My roommate told them I was crazy. That landed me in the psych ward.

The nurse–if she really was a nurse, I don’t know, she could have been a part of it–tried to give me some pills. I refused to take them. The voice said they were poison.

They gave me an injection after I tried to break out of the unit.

When I woke up, they told me to keep taking the medicine. I took it, figuring it would get me out faster. At least the voice has stopped. The doctor said the medicine was helping that. She wants me to keep taking it…

The above excerpt represents what someone may endure when they experience auditory hallucinations. Every case is different and hallucinations can occur in a variety of settings, but suffice it to say, the symptom is terrifying. This could be a first psychotic break of a young man heading toward schizophrenia. It could be the result of using drugs. Maybe the guy has some sort of neurologic or medical condition that has affected his brain. Maybe he’s so depressed (or manic) that he’s developing psychotic symptoms.

I hope this illustration provides some insight into what people suffer through when they have this type of mental illness.

Remember, this post is for writing purposes only. It is NOT intended to be medical advice or treatment.

Check out Lydia’s post for Medical Monday!

(link to photo)