Showing posts with label Disorders. Show all posts
Showing posts with label Disorders. Show all posts

Wednesday, April 30, 2014

Narcissism: Is Your Villain in Love With Himself? Info for Writers

Oil on canvas
Oil on canvas (Photo credit: Wikipedia)
Narcissism exists in every human being along a continuum.

At the far end of this spectrum is a DSM V (the psych bible for diagnosis) mental health disorder called Narcissistic Personality Disorder. Having this full-blown personality disorder is rare. 

Video Quick Study (5:58) Narcissism on a spectrum                 normal v. pathological
Video Quick Study (2:14) Good quick over-view.

Narcissistic Traits include:

  • Grandiosity - exaggerates achievements and talents and expects others to see them as superior
  • Fantasies of unlimited success - power, brilliant intellect, beauty...
  • Belief that they are very special snowflakes and should only associate with people of their ilk
  • Requires excessive admiration - hyper-sensitive to criticism
  • Lacks empathy
  • Arrogance, haughtiness
  • Envy - of others and a belief that others envy them
  • Sense of entitlement - people should do what they asked, just because they asked/want it to be so. 
  • Takes advantage of others to achieve their personal goals. 

  • They can't be generous - strings are always attached
  • They get angry when they are criticized or disputed
  • Often artificially charming
  • Often pathological liars
  • THE KEY COMPONENT is self-absorption

Video Quick Study (3:22) Narcissist in action
Video Quick Study (11:18) Body language - excellent for
                              character development 

LOE3 (Photo credit: Wikipedia)

Narcissistic Defense

  • Narcissism is a defense. Narcissism is a defense. Narcissism is a defense.
  • All of the components in the list above are example of ways that the narcissistic personality protects  itself. 
  • You are dealing with a weak villain   trying to gain strength. 
  • They are perceived as strong - too strong - but they are not; they are emotionally weak.
  • It's okay for your heroine to support  their defenses and  not challenge them. She just needs to be aware that she is bolstering   someone who is weak and not buying into the delusions herself.
  • Projection - They believe that the heroine is the problem not them.
  • Isolation - Narcissists isolate people and do not like   individuals to interact with one another

Video Quick Study (0:55) Narcissism in action

Narcissism in a Relationship

  • Hopefully, our heroine is not in a relationship with a narcissist; she learned the signs and ran for the woods when the narcissist    started ringing her doorbell. 
    Video Quick Study (6:27) Red flags that would clue your heroine

  • No? She got sucked in? She read the insightful magazine article just a little too late? She can try to stay grounded and true to herself while in the relationship by: 
    • identifying and admitting that there is a problem.
    • not challenging the other person's delusions - which is a waste of time.
    • surrounding herself with healthy relationships who remind her about what the truth is
    • She can seek therapy, journal, do yoga, exercise, eat healthfully etc. things that keep her centered
  • Set boundaries
  • Sometimes holding one's ground - being one's truth if you will - can cause rage and abusiveness in a narcissist. This is when your heroine should SERIOUSLY consider extricating herself from the relationship. Here abuse can be physical but is more likely emotional abuse.
  • Remember that a narcissist has an agenda - your heroine cannot make them better - not through compassion, not through sacrifice, no way, no how, nothing she can do or say will make this better.
  • In order for your heroine to get her needs met when she's in a relationship with a narcissist she should never state her needs. 

She should always frame her requests in ego-stroking ways. Instead of saying I'd like for us to go to the beach with my friends, she would instead say something like, "My friends really like you and enjoy spending time with you. We want to go to the beach and it just won't be the same unless you are there with us."

  • Your heroine's vulnerability will set the narcissist off - will make them emotionally attack.
  • Narcissists need the heroine's pain to feel good themselves
  • Really the best thing for your heroine to do once she realizes that the love of her life is in the severe range of narcissism is run.
   Run far. Run fast. And make a no-contact rule. - Remember we
   ALL have narcissistic tendencies  - we are talking about severe
   cases here.

Video Quick Study (5:36) Breaking away from a narcissist
                                (emotions, thoughts)
Video Quick Study (9:11) How to break up with a narcissist. 
                                (physical behavior)

What kinds of character might have stronger narcissistic traits?

Al Murray as (left to right) Roger Dennis, Hor...
(Photo credit: Wikipedia)

  • Actors
  • Performers
  • Politicians
  • People who put themselves out in the public eye.

Why did he turn out this way?

Groopman and Cooper (2006) listed the following factors identified by various researchers as possibilities:[Groopman, Leonard C. M.D.; Cooper, Arnold M. M.D. (2006). "Narcissistic Personality Disorder". Personality Disorders – Narcissistic Personality Disorder. Armenian Medical Network. Retrieved 2007-02-14
  • An oversensitiveness temperament (personality traits) at birth.
  • Excessive admiration that is never balanced with realistic feedback.
  • Excessive praise for good behaviors or excessive criticism for bad behaviors in childhood.
  • Overindulgence and overvaluation by parents, other family members, or peers.
  • Being praised for perceived exceptional looks or abilities by adults.
  • Severe emotional abuse in childhood.
  • Unpredictable or unreliable caregiving from parents.
  • Learning manipulative behaviors from parents.
  • Valued by parents as a means to regulate their own self-esteem.

See how this article influenced my plot lines in my novella MINE and my novel CHAOS IS COME AGAIN.

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.

Tuesday, November 26, 2013

Schizophrenia for Writers - Her Problems Are All In Her Head


English: Image showing brain areas more active...
English: Image showing brain areas more active in controls than in schizophrenia patients during a working memory task during a fMRI study. Two brain slices are shown. (Photo credit: Wikipedia)
In several of the books that I have read recently, schizophrenia has played a key role in the stalking and attacking of the stories' heroines. The volatility and changeability seen in the villains mental health make for interesting plot twists.  

When I worked as an emergency interventionist for the courts, I had a few clients who were diagnosed with schizophrenia. They were all non-compliant with their medications for varying reasons. This made some of my clients very scary individuals - but not all.

Schizophrenics do not all have voices in their heads telling them to "Kill her! Stab her! Hurt her!" Indeed, people with schizophrenia are not all violent towards others or themselves. But schizophrenia is fluid and changes in symptoms should be expected. This means that one never knows if the schizophrenic with whom they are interacting is safe or not.

If you are writing a plot line in any genre that includes someone driven by mental health issues, here is some information to help you develop a character with schizophrenia.

Characteristics of schizophrenia  include: 

* Delusions
* Hallucinations
* Disorganized speech and behavior, symptoms that cause social or occupational dysfunction.

Diagnosis can only be assessed after  symptoms have been 
* Present for six month
* Include at least one month of active symptoms.
   Video Quick Study (1:48) real footage of a mental health schizophrenic breakdown
   Link Quick Study (7:04)  Aileen Wuornos killed seven men and was executed. Look at her eyes.
   You can see the sclera  (whites of her eyes) all the way around. This is a KEY SIGN of high stress.

English: A schizophrenic patient at the Glore ...
English: A schizophrenic patient at the Glore Psychiatric Museum made this piece of cloth and it gives us a peek into her mind.  (Photo credit: Wikipedia)

Schizophrenia symptoms are typically separated into 2 categories:

Positive symptoms
This photo was taken on January 15, 2010 in Ce...
(Photo credit: Wikipedia)
* Extra feelings or behaviors that are usually not present.
* Delusions - believing that what other people are 
   saying is not true  - often leading to paranoia.
   This is the person who wraps their room in aluminum
    foil so the microwaves can't effect them,
    or thinks that the government has put tracking devices
    under their skin.
* Hallucinations - Hearing, seeing, tasting, feeling, or
   smelling things that others do not experience.
   So for example, one of my clients presented with a
   friend who happened to be a dragon. This dragon
   would fly around the ceiling. She didn't like to stand up
   in her house and would often duck down and drag
   me with her because the dragon was flying around and trying to hit her with its wings. On occasion, the
   dragon would become angry and frighten her; she would take all of her medications at once to make
   the dragon leave her alone. She'd call me to tell me - then we had to have her stomach pumped. She
   was very sweet and in my experience never caused harm to anyone else, but she was tormented by the
   images - no sounds - just the very-real-to-her image of the dragon.

   Video Study (14:00) TED Talk about a woman's  experience with auditory hallucinations. She was not
   violent or suffering - but this is her story of medical intervention.
   Video Quick Study (6:36) a first person view of various hallucinations - very interesting.
   Audio Quick Study (3:38) auditory hallucination simulation
   Video Quick Study (9:53) schizophrenia simulation
Disorganized speech and behavior
   Video Quick Link (9:22) four patients experiences various symptoms of schizophrenia talking. 

Messages covering the windows of a house from ...
Messages covering the windows of a house from a patient with schizophrenia. (Photo credit: Wikipedia)

Negative symptoms: A lack of behaviors or feelings that usually are present, such as:
* Losing interest in everyday activities, like bathing, grooming, or getting dressed. Many of our homeless
   have this attribute.
* Feeling out of touch with other people, family, or friends
* Apathy - Lack of feeling or emotion.
* Having little emotion or inappropriate feelings in certain situations
* Having less ability to experience pleasure

Notice that many of the NEGATIVE symptoms mimic depression. LINK to Depression for Writers 
I was recently listening to the blogger/writer from a blog I read who was speaking on NPR. She was diagnosed with depression and was discussing her episode. She said that her anti-depressants were helping. But to my ear, boy did she sound like she was exhibiting negative signs of schizophrenia. She described her utter lack of emotion. The only piece that prevented her suicide was the idea that her husband would find her body. This was the only feeling she could conjure up. Depression and schizophrenia diagnoses often overlap. 

weird place! tries to reproduce what it's like...
weird place! tries to reproduce what it's like to have Schizophrenia. Don't stay in there too long. (Photo credit: Wikipedia)
* Schizophrenia affects different people differently and
   symptoms can vary from person to person.
* Some people may have many symptoms, while others
   may only have a few.
* Men diagnosed with schizophrenia usually start to

   show symptoms between their late teens and early
* Women usually develop symptoms during their
    mid-20s to early 30s. LINK

It used to be that schizophrenia had sub-types like paranoid schizophrenic, but in the the new DSM V (the psychiatric bible) these have been done away with because the illness is so fluid and changeable that these specifications were not helpful to the treatment. They are now noted as displayed symptoms.

Want to see this article in action?
Check out this Fiona Quinn novel Chaos Is Come Again

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.

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Sunday, September 22, 2013

Criminal Psych 101: Information for Writers


Werner Erhard and Associates v. Christopher Co...
 (Photo credit: Wikipedia)
I have a masters degree in rehabilitation counseling, which means that I worked with people who had mental health issues created by or exacerbated by physical health issues. For example, I had a family whose father was electrocuted while working in the hospital. Because he was on site, doctors were able to save his life. However, he had a complete personality change and became prone to fits of physically-abusive rage. These were aspects that could not be changed, but the family had to deal with.

When I was practicing, I was a court ordered interventionist for families at risk. My population had at least one family member who was involved in the penal system AND displayed serious mental health concerns in the family including homicidal and/or suicidal ideations, and sexually deviant behaviors, among others. 

The following are some things that I think writers might find helpful when constructing their plot lines. I will also offer, that if you have a specific question, you can leave it below, and I will do my best to help.

One of the main things that I want to point out is that clients who are seeing a mental health provider because they want to improve their lives and someone who is court ordered to work with a mental health provider are different. 


* There of their own volition
* Generally honest and working hard to make improvements
* Client's privacy is protected under the law
* End goal is to become a better/happier person

Judicial orders:

* There against their will
* Typically uncooperative and uninterested in progress
* Information gleaned in the therapeutic setting does NOT fall under the same
   patient confidentiality laws
* Client is aware that the information can/will be part of their trial or other legal
   procedure (such as parole hearing)
* Client frequently tries to manipulate the mental health worker to influence their
   testimony and outcome.

So, I dealt with a lot of deception. The two main false presentations were malingering and defensiveness.

MALINGERING - the client pretends to have a mental health issue. Usually they do this to avoid being prosecuted. Malingering runs in cycles closely copying those stories that are found in the news. Clients usually didn't make up symptoms by doing research (in my client case load). Psych disorders and medical disorders tend to be fashionable - right now bi-polar is a big diagnosis. I personally know people who have been given this designation and are medicated for it when I am very clear this is not their issue. I am not digressing - I am pointing out that even clinicians, when not paying attention, can fall into this habit as well.  But if a client presented with PTSD, I would pay very close attention to their symptoms because PTSD is so prevalent in the news right now.

How could I pick out a malingerer? 
* VERY dramatic. Really pushing the envelope on wacked-out (yes, the clinically
  correct word) behaviors. So if your character is malingering, look up the
  symptom list in the DSM V (Should be in your library) and then magnify these
* They drop the symptoms from time to time especially if they don't think anyone is
   watching. It's hard to maintain fake symptoms for long stretches of time. It's like
   constantly telling a lie; the brain is very engaged and becomes tired.

And then just to cloud things a bit, there is pseudo-malingering. That's when someone with a mental health issue pretends to have a different mental health issue because they think that will get them off the hook. Ex. Someone who is a psychopath presenting with PTSD symptoms. The mental health worker has to decide which symptoms are true and which feigned. It's a mess! But would make a GREAT PLOT TWIST!

DEFENSIVENESS - You can read this as the opposite of malingering. It's when a client, with OBVIOUS mental health issues, tries to present as stable. I had a client once who was trying to keep custody of her children. She was diagnosed schizophrenic, was non-compliant with her meds, and suicidal. When she went before the judge, she thought that the best way to keep her children in the home with her was to lie. (She was successful in keeping her six children, and the end result was catastrophic for the kids, I'm sorry to say.)

Now, while I am a counselor, typically the two titles seen in the legal system are:
Forensic Psychologists and Forensic Psychiatrists.

Forensic Psychologists 

* Have masters or PhD in psychology
* Can do psych testing
* Can offer expert testimony
* Can provide treatment and evaluation of progress  CANNOT prescribe
* Can attempt to establish a motivation in a crime
   Was it do to a substance abuse issue?
   Was it do to something that had happened to that person in the past?
   Was it do to a mental health disorder such as PTSD or Schizophrenia?

Forensic Psychiatrists

Regions of the brain affected by PTSD and stress.
Regions of the brain affected by PTSD and stress. (Photo credit: Wikipedia)
* Have medical degrees and residency in
* Can do everything that a psychologist
   can do
* Can prescribe medications
* Can decide if the client is a danger to
   self and community leading to an
   involuntary mental health hospital stay
* Can establish if the crime was based
   on a medical issue - one such issue that
   is coming up in the news lately are the
   brain injuries sustained in football,
   and tumors growing on the brain.

Counselors, Psychologists, and Psychiatrists all:

ASSESS - evaluating people using psychological tests

Mental health workers do NOT get to make a judgement. They are only offering their expert opinions. For example, I could not declare someone insane and have someone placed in a medical facility involuntarily. I would present my information and the judge would rule about the sanity/capacity of the client.

Testing is used to help the courts understand the person being assessed
Test Examples:
General personality inventories Myers-Briggs
Beck Depression Inventory 
Rorschache Test Video Link to original test (9:05)
Weschler Memory Scale
Weschler Adult Intelligence Test Video Information Link (13:38)
Robert Hare's Psychopathy Checklist Animated List - Link (2:43)
Rogers Criminal Responsibility Assessment Scales Informational Link
English: At sea aboard USNS Comfort (T-AH 20) ...
 (Photo credit: Wikipedia)

Psychiatrists can add physical exams:
Blood work
Toxicology reports
Cat Scans

TREAT - psychotherapy like talk therapy, art therapy, music therapy,
 behavior modification

* Civil - family members of custody, guardianship, JD, medical do-not resuscitate,
   disability and loss in workers comp cases and social security cases
* Criminal - 
   Ability to stand trial
   Treatment of incarcerated criminals

One of the things that Forensic Mental Health Workers are trying to decide upon is competency. Someone could have been legally insane at the time of the crime. That does NOT mean that they are insane now. So the assessment looks at what was the mental health capacity in the
* past
* present - what is their mental health standing now? 
   Can s/he give testimony? 
   Stand trial? 
   Can this client understand what is going on? 
   Can they participate in their defense?

It's during the trial that the judge would decide the level of sanity during the crime. Only about 1% of cases attempts an insanity plea. 1 in 1,000 are considered insane.

An American judge talking to a lawyer.
(Photo credit: Wikipedia)
Guilty but Insane:

If the defendant did not or could not understand what he or she was doing, or they knew it was wrong, at the time of the crime, they are considered not guilty by reason of insanity.

* Mens Rea - Guilty mind 
  You can't have a crime WITHOUT  mens rea and if you are
   criminally insane you CANNOT have mens rea and therefore you CANNOT
   be guilty

* Actus Reus volitional and conscious and/or omission to act. Ones mental
  state  can effect actus reus.
  Sleep walking disorder
  Car accident with stroke
  You don't owe the duty to go to someone's aid if they are imperil (unless by
   contract/law/or relationship)
  VIDEO QUICK STUDY (5:25) go to 1:30 to start.

Guilty but Mentally Ill:
After John Hinkley shot at Reagan the courts developed a new designation. Guilty but Mentally Ill happens when the suspect knew what he was doing was wrong BUT could not help or stop the actions because of his mental health status.

Diminished Capacity - you had the intent to commit the crime but had a mental reason for not being held completely responsible. VIDEO QUICK STUDY (:48)

See how this article influenced my plot lines in my novella MINE and my novel CHAOS IS COME AGAIN.

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.