Showing posts with label Bipolar disorder. Show all posts
Showing posts with label Bipolar disorder. Show all posts

Sunday, July 10, 2016

Is Your Character Considering Suicide? Info for Writers

Detail of The Death of Socrates. A disciple is...
Detail of The Death of Socrates. A disciple is handing Socrates a goblet of hemlock (Photo credit: Wikipedia)
TRIGGER ALERT - While this article is a combination interview and basic review of psychology, if you have had any contact with someone who has attempted suicide or suicided, or you have contemplated suicide, this might engage you in thoughts along those lines. Please read safely and with my best wishes.

Fiona - 
I would like to introduce you to The Bergh (how cool is that for a pen name?), a fellow Kindle Scout winner and writer friend. He writes horror - the kind that submerges crazy voices in your head that a year later, when you're lying in your bed listening to the house creak, bouys thoughts of terror to the surface.

The Bergh recently wrote a short story that struck me in a new way - one that is equally frightening but in a different way. Apparently on Twitter there was a discussion about books with "The Girl" in the title - the one on the train, the one that was gone, the  . . . Well, it seems popular books have to have a girl in the title. And thus a challenge was born.

The Bergh - 
I’ve never penned a story or novel based off of an idea for a title before. Usually it’s the story’s idea that captures me and holds me hostage, demanding to be written; so this was a first for me. Yet as much as I thought the title was wickedly clever, I didn’t want this to be just a cheesy satire or an attempt to milk the very teet I was poking fun of. I wanted this to be a story that could stand on its own.

The only idea I started with was that the Girl would be searching for a title to something she had written. But, and I can say this in all honesty, what came out as I continued writing frightened me. It wasn’t the light-hearted story I was attempting to write. Instead, this story dove deep, sinking into a dark place that I have shared with very few people in my life. It’s not an autobiography; it’d have to be called “The Boy Who …” and, quite frankly, books with “Boy” in the title don’t sell as well as those with “Girl.”


There are times when I feel creative ideas, especially exceptional ones, aren’t so much created by their auteurs, but discovered. Like finding treasure buried in sand -- you can’t claim to have created what you find, you just swept away the dirt and grime in order to reveal what was always there but just kept hidden. This story, for me, fell into that category. I don’t think I could have come up with it if I had tried to. Instead, I opened up a vein and let the story bleed onto the page, almost literally.

Depression. Suicide. These are subjects that are difficult to approach. I had no intention of including even the thought of these themes in the story, and yet it’s where the narrative demanded to go. And so, rather than the Girl searching for a title to her story, we discover she’s searching for the title to her suicide note.

Fiona - 
If you are writing suicide or suicidal ideations into your plot, here is some information you might find helpful:

The following information was presented at a suicide intervention talk for the Medical Reserve Corps and is incormporated with the permission of the instructor.

  • Talking about wanting to die or kill oneself
  • Looking for ways to kill oneself such as searching on line or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or unbearable pain
  • Talking about being a burden to others
  • Increased use of alcohol or drugs
  • Acting anxious or agitated, unusually confused
  • Reckless behavior
  • Sleeping too little or too much 
  • Withdrawing from society
  • Showing rage or seeking revenge
  • Extreme mood swings
  • Low or no energy, unable to perform daily tasks like taking care of self or kids
  • Feeling numb or nothingness
  • Fighting with family and friends
  • Thinking of hurting self or someone else
  • Unable to get rid of troubling thoughts or memories
NOW, be careful to only pick a few of these characteristics for your character - your character would not exhibit them all. And perhaps would exhibit them only to certain people and put up a front for others.

You'll see that many of the above signs are also part of mental health conditions. Not everyone with a mental health disorder knows they have a mental health disorder. Most go undiagnosed. Many people who are undiagnosed self medicate with alcohol and/or drugs. You'll see drugs and alcohol on the list below - but frequently it is the overt/obvious-to-others expression of an underlying mental health issue  -- what others might notice. Conditions that are health factors in suicide:
  • Depression (full article)
    • Please note that while this is the diagnosis that most people associate with suicidal ideation, it's important to understand that Most people with depression do NOT attempt suicide BUT most people who attempt suicide are depressed.
    • Depression affects (according to the CDC) 20-25% of Americans over the age of 18 in any year.
  • Substance use disorder
  • Bipolar disorder (full article)
  • Schizophrenia and psychosis (full article)
  • Personality traits of aggression, mood changes, and poor relationships
  • Conduct disorder
  • Anxiety disorder
  • PTSD (full article)
  • TBI (traumatic brain injury)
  • Smoking
  • Serious cronic helath issue and/or pain
Environmental Factors:
  • Access to a lethal means (example guns in the house)
  • Prolonged stress
    • harassment
    • bullying
    • unemployment
    • relationship problems
  • Life events
    • divorce
    • death
    • job loss
  • Exposure to someone else's suicide
Historical Factors:
  • Previous suicide attempts
  • Family history
  • Child abuse

Is your character going to be helpful?
  • Acknowledge
    • Take suicidal talk seriously. 
    • Be willing to listen
  • Care
    • Talk to the person about what's troubling them and how they feel. It will probably take some effort to overcome reluctance to having this conversation on the part of the helper. It's a hard thing to hear/talk about for both parties.
  • Treatment
    • Get professional help immediately
      • Call a hot line. You can make one up but the real one to find help in your area is 1800-273-TALK
      • Go to the local emergency department or community health center
      • Contact their primary health provider or mental health provider 
      • If all else fails 911
Is your character going to do the wrong thing?
  • Cheer the person up or tell them to snap out of it.
  • Assume the situation will take care of itself
  • Let them swear you to secrecy
  • Argue or debate moral issues
  • Risk their personal safety. (if they're doing it right they'd leave and call the police) - this might be a planned murder suicide in your plot, and you can get your character out and possibly save multiple lives - or not, how do you want your plot to play out?

Some stats to inform your writing from the CDC&P:
  • Approximately 38k people suicide each year (suicide is the end result so differentiate attempted suicide and suicided) Compare that to the 14,196 in 2013 according to the FBI who were murdered
  • 70% of people who commit suicide  give some kind of warning to their friends or family. 
  • 50% have a positive blood alcohol level (for an alcohol level article go HERE)
  • Suicide is the 2nd leading cause of death for adolescents aged 12-18
  • Females are 3x more likely to attempt suicide, but males are much more likely to suicide.
  • Between 20 - 40% of people who suicide have attempted suicide in the past.
Perhaps your plot line indicates that someone in your character's life has committed suicide. All characters will follow a bereavement journey in their own way. In some this might have them recall a death (especially of a beloved pet which is an immensely traumatic event that isn't recognized enough in mental health and in general) or might uncover a characters own underlying issues. But there are some commonly experienced feelings:
  • Alone
  • Sad
  • Deveasted
  • Angry 
  • Afraid
  • Ashamed
  • Guilty
  • Abandoned
Struggles after a suicide that you can lace into your plot line might include:
  • Disbelief that it was indeed a suicide.
  • Ambivalnece - glad that they are now at peace though they wish the other character had worked out a way to be happy and alive,
  • Coping - coming to terms moving on
  • Review - going over the event sifting through events and conversations
  • Searching - making sense of the loss
  • Renewal - seeing a path to carry on. Reprioritizing  and reviewing values
The Behrg - 
About three or four years ago I was diagnosed with MDD (Major Depressive Disorder). I won’t go into the details of what triggered my disease, but it has been – and continues to be – the most difficult thing I’ve ever experienced.

If you’re one of those who have never experienced depression or suicidal thoughts, count your blessings, but know that someone within your sphere of influence is most likely suffering right now. We can all do better at reaching out to those who are down, lifting instead of kicking. 

And to those of you who find every day is a battle, know that you’re not alone. There is help. Seek a professional – believe me, it can be life changing. As difficult as it can be, reach out to a friend, a prevention hotline, ANYONE who can help you in those moments when the darkness seems to surround you from all sides. And know that without the darkness, we’d never appreciate the light.”

Fiona - 
Suicidal ideation (thinking about) is not uncommon. If you read this article, and it has triggered you please talk with someone. A number to call is:
1-888-628-9454 (Spanish)

A big thank you to The Behrgh for sharing. 

As always, a big thank you ThrillWriters and readers for stopping by. Thank you, too, for your support. When you buy my books, you make it possible for me to continue to bring you 

helpful articles and keep ThrillWriting free and accessible to all.

Sunday, June 22, 2014

Bipolar Disorder for Writers: Does Your Character's Mood Swing From One Extreme to the Next?

English: Roller coaster in Xetululu, Guatemala
 (Photo credit: Wikipedia)
Your character is on a wild ride. Instead of the normal hills and bumps in the road, she is instead on a roller coaster and is seeking help from a physician and a mental health provider. I would like to go over some of the diagnostics that you might be describing in your character if she has bipolar disorder

There are two components to bipolar disorder. The lows and the highs. The difference between schizophrenia and bipolar disorder can be difficult to distinguish especially in adolescents since, according to the DSM, they share many of the same criteria including: irritability, agitation, grandiosity, persecution delusions.
To learn more about schizophrenia go HERE 

The two criteria for Bipolar Disorder include periods of depression and periods of expressed manic episodes.


* Find a complete blog article HERE

Manic Episode.

The criteria for a manic episodes require:
Manic (Photo credit: Wikipedia)
1. A distinct period where the persons mood is
    elevated, expansive, or irritable
    and lasts for at least a week. 
    (or if it is so acute, that hospitalization
    is required, this time frame is not required.)
2. During the period of time that the individual is
    experiencing a mood disturbance, there has to 
    also be at least three items from the following list
    (remember you character would not have them all. Just pick
   * inflated esteem or grandiosity
   * decreased need for sleep (3hrs)
   * uncharacteristically talkative
   * racing thoughts
   * distractability
   * increased goal-directed behavior
   * excessive pleasure seeking (sex, buying sprees, etc.)
3. This is not mixed episode - a mixed episode is when an
     individual cycles very quickly from manic state to
    depressive state nearly every day.
4. The mood change is severe enough as to interrupt the subjects
     life - their work, relationships, and social
     interactions. OR their behavior requires hospitalization to
     prevent harm to self or others
5. The symptoms aren't caused by substances such as drugs and/or
    alcohol, medicine or a medical condition
    such as hypothyroidism. *** This is why a complete physical
    with blood workup should be conducted PRIOR to a mental
    health diagnosis
(This information comes from the DSM IV which was not significantly revised with the new DM V. The DSM - Diagnostic and Statistical Manual - is the bible for mental health workers evaluations)

Painted Lady (Cynthia cardui)
Painted Lady (Cynthia cardui) (Photo credit: bbusschots)

In order to help you understand how this chemical imbalance effects a person, I chatted with Cynthia Forget. 

I am including both the official questions and some of the aside back and forth so you get a good picture. 

Many people with psychological disorders are very private and self-protective about sharing their experiences. I am very grateful that Cynthia was so open about her experience. There is a lot of stigma that comes with a psych disorder diagnosis - I think you
will see and agree with me that
Cynthia is a lovely person who
is in a daunting position.

Fiona - 
Hey sweetie. How are you today?

Cynthia - 

I'm "phine" as opposed to "fine" - it's the word used when you say "fine" but don't mean it.

Are you on a low swing?

Cynthia - 
Very much so - but life goes on.

Fiona - 
Are your meds taking the edge off?

Cynthia - 
Not as much as I'd like, but I'm sure they're helping.

Fiona - 
I'm so sorry - is it okay for us to talk today or would you rather wait?

Cynthia - 
No today is okay - I've actually been looking forward to it, and there's not much I look forward to.

Fiona - 
Okay, good, so we'll start: Hi Cynthia, thanks for being here today. Today, we are talking about the psychological disorder called Bipolar Disorder. Can you tell me about your connection with this diagnosis and your advocacy?

Cynthia -
I was diagnosed with bipolar disorder in 2005. I have bp1. Fiona - my mind is running quite slow so I'm afraid you're going to have to pull the info out of me.

Fiona - 
Not a problem. And if you need to do this in several interviews, that's okay too.

Cynthia - 
You're so kind.

Fiona - 
Not at all - I truly appreciate your helping me. So here is a question: You said to me your mind is working slowly - is that a function of your meds?

Cynthia - 
I believe it is due to my meds and just the actual state of depression.

Fiona - 
You've been living with a diagnosis for 9 years. What are some of the difficulties that this has created for you?

Cynthia - 
The main difficulty I have encountered is that I am unable to work. I am currently on a disability pension. My job required extreme executive functioning - memory - decision making etc - they are impaired by the bp. 

This is a link to a blog article that Cynthia and I did on Criminal Trial Coordination, her position prior to her disability pension. Link

Fiona - 
Your diagnosis is BP1 can you tell us about the difference between BP1 and BP2?

Cynthia - 
Bipolar disorder is basically a brain disorder where the neurotransmitters - serotonin, dopamine and noradrenaline - create episodes of mania and depression effecting mood, emotions and behavior. BP1 is when there are extremes of mania and depression BP2 is when you have hypomania rather than mania - a milder form.

Fiona - 
And the swing between the polar events - is there a predictable cycle?

Cynthia - 
There is for some people, but generally no - it tends to be an unpredictable illness - but with mood charting patterns can be identified.

Fiona - 
What might a typical cycle from low to high to low look like in terms of time span?

Cynthia - 
That's too difficult to say - everyone is so different - if a person cycles 4 or more times in a year, they are considered as rapid cycling - from days to weeks is called ultra rapid cycling and within a day/hours is called ultradian cycling

Fiona - 
How long would a peak or trough last? You are experiencing a depression, can you tell yourself - just 2 weeks, and I'll pull out of this...

Cynthia - 
Unfortunately not - sometimes it's a few days or weeks, but I personally had a 2 year episode some time ago.

Fiona - 
Of depression? Do you experience manic episodes that last as long?

Cynthia - 
BP is so individualized, I did have one manic episode that was 2 years as well - that was before I was diagnosed and before I was medicated.

Fiona - 
Are there times when you feel like you are stabilized at what you would consider to be a normal affect?

Cynthia - 
Yes - but not nearly as long as I would like - I have good days and bad days.

Fiona - 
How does your mania express itself?

Cynthia - 
Well, I become the smartest person I know - I believe I can do anything -  get pressured speech / stuttering - my thoughts go off on tangents constantly and my mind races - I have great needs to shop and spend money - I drive recklessly - I am enthusiastic and generally feel terrific, confident and invincible - very wired - very creative - a general feeling of euphoria - restless and unable to concentrate - sleeping very little - promiscuous.

Fiona - 
Is that something you feel like you want to medicate to have stop or does that feel like a high you'd really like to ride?

Cynthia - 
A high that I love to ride. Only thing is, it tends to get me in trouble. "I wish I were manic," that's a mantra you'd hear many people with bp say.

Fiona - 
That's very interesting. I'm sure it feels much better than the troughs. Tell me about some of the trouble it can get you into (and others you know have experienced).

Cynthia - 
You can get into trouble with poor judgment, irritability and aggression, also promiscuity can wreak havoc on a marriage, work problems...

Fiona - 
Do you (and others) skip medications to prolong the manic periods? If not, how do you get yourself to take pills that might make you feel less good?

Cynthia - 
I am medication compliant - I take my meds as directed - some people, as you say, may try to control their moods by skipping meds - this usually leads to problems - as time goes on, I think most people realize they need their meds.

Fiona - 
"Promiscuity can wreak havoc on a marriage" Tell me about consequences - will the law understand if you drive too fast, commit petty crimes, buy drugs etc.? Do the people in your life understand that you are not in control of your brain and give you a get out of jail free card in the relationship?

Cynthia - 
The answer to all of that is no. No get out of jail free cards.

Fiona - 
So how does that impact people's ability to stay in long term relationships?

Cynthia - 
It's challenging - the divorce rate for a marriage with one party has bp is 90% (compared to 40%)

Fiona -
You run a blog about bipolar disorder - what is your goal?

It started as an outlet for myself - something to write about - but it has evolved into providing information to people about bipolar and as a support for people with bipolar

Fiona - 
And I'm sure those who love them are looking for answers as well. What is the most common misunderstanding you run into?

Cynthia - 
I guess that if you take your meds, you'll be better - like there's a cure - there's not - it can only be managed, not cured.

Fiona - 
When you read books that include characters with bipolar disorder, or on TV and in movies, etc., do you feel that this condition is fairly represented? What would you have writers change?

Cynthia - 
I think they try to portray the condition properly - some shows do better than others - people have different opinions of what is a good portrayal - I like the "Black Box," but it's getting a lot of negative feedback on Twitter - I personally think they're doing a good job.

Fiona - 
I'm not familiar - what is Black Box?

Cynthia - 
It's a show where the lead character is a neurologist with bipolar disorder - New this season.

Fiona - 
And who is panning it? People in the bipolar community? Or those outside?

In the community, I believe.

Fiona - 
In the responses you are reading - do people in the BP community not like it because it stereotypes, or does not educate, what are their concerns?

Cynthia - 
If I remember (memory is an issue), I think it is because it stereotypes.


Are there any books that you've read that you thought, "Wow! This author nailed it - that's exactly what I experience."

Cynthia - 
Yes - An UnQuiet Mind - by Kay Redfield Jamison - she has bipolar disorder and is also a psychiatrist at Johns Hopkins University - an expert in her field

Fiona - 
Here is an absurdly broad question - What do you want writers to understand when they are construction characters with bipolar disorder?

Cynthia - 
That each person is different and unique - to avoid the stereotypes - it is unpredictable and exhausting - there is a lot of self care involved.

Fiona - 
Tell me about a self-care routine.

Cynthia - 
Mood charts, routine, sleep, nutrition, walking, meds, pscychiatrist, therapy, support system, light box, avoiding drugs/alcohol, avoiding personal triggers, monitoring symptoms biggest one: avoid stress. And education.

Fiona - 
Cynthia distinguishes between her psychiatrist and her therapy. A psychiatrist is someone who has a medical degree and has a psychology background. They monitor the physiologic state of a patient. While psychiatrists can provide therapy, typically this is done (for cost containment reasons) by a trained psychologist, social worker, or counselor. The therapist can then inform the psychiatrist of changes that might necessitate a review of the medication regiment.

Cynthia, are people with BP disorder generally considered to be at high risk for self-harm?

Cynthia - 

Fiona - 
The light box is to avoid depression with a lack of vitamin D from the sun?

Cynthia - 

Fiona - 
Do people with BP disorder trigger like a person experiencing PTSD? Can you give me an example of a trigger?

Cynthia - 
Triggers are very personal and different - my biggest trigger is death - any involvement in death spirals me into depression

Fiona - 
What kinds of psychotherapy is the most common/most effective with BP disorder?

Cynthia - 
CBT - cognitive behavioral therapy

Fiona - 
Do you run into a lot of snake oil salesmen? People who can "cure" you if only you would follow this diet take these supplements etc.?

Cynthia -
I've read about it, but personally I have not come in contact with it.

Fiona - 
Our hour is coming to a close, my last question:

What do you wish I had asked you?

Cynthia - 
What's the best part about having bipolar? Creativity.

Fiona - 
Oh, good one! I lied. I have another question - is there any scientific research that gives you hope that your chemistry can one day be corrected?

Cynthia - 
Good question. I guess all the neurological studies they're doing are hopeful, but truthfully, I'm not sure I'd take it away if I could. It's me.

Fiona - 
What a self-loving, wonderful answer.

Again, a huge thank you to Cynthia for sharing her life experience with BP1.

Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.