ask-the-prose

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[ask-the-prose]

I'm so very happy to see you've found some comfort in this guide! A lot of people don't understand what exactly happens at the hospital so it's hard to depict it with compassion and respect to the patients. It's easy to make it a place of roses and daffodils your character can't see, or a place where the staff abuse patients for no reason at all.

The truth is that the hospital is a humiliating experience. Stripped down to have a nurse observe skin lesions, not allowed shoes, people telling the character how they should be grateful they even have the ability to be there (assuming they have any sort of insurance to cover their stay). One time, the hospital decided to serve our unit chicken fried steak. It was mostly culturally appropriate because it's comfort food in the southern US where we were, but we were only allowed plastic spoons to eat it with. People are not allowed dignity at the hospital, and it weighs on the patients.

That said, most nurses and techs want to help, they just don't know how. I know people who have worked inpatient psychiatric units for decades. The way they talk about their former patients is horrifying. It's not because they don't care or didn't want to help them, but they'd been so jaded by how hard that job is, that they'd dehumanized the patients in order to maintain a compartmentalized mental health. This was to protect their own health, after all, patients will throw bodily fluids at them, will call them names and slurs and anything they can think of to hurt them. They'll sometimes see improvement, only for that patient to return in a few weeks. Sometimes they'll have a darling patient that wants to get better and tries and tries so hard. They will never know most of the time if that patient gets better or goes home and completes. It's a damn hard job, and it's one with a lot of power that is so easy to abuse. Nurses and techs very rarely act out to hurt the patient with the intent of hurting the patient, its usually because they have dehumanized the patient in their head enough to justify it to themselves. Abuse at the hospital rarely happens for the joy of it, it's because the system itself is flawed.

So no, in writing it's frustrating to see the characters get either the scariest treatment on earth (let's stigmatize and scare people from an important resource they may need) or to have the most joyful fun and whacky experience (the normal person enters the hospital to gawk at the weirdos who actually need the support) when in reality it's the place I needed at the time I needed it. I'm here to talk about this experience BECAUSE I went to the hospital. But also, I never, ever, ever want to go back because there's a certain level of trauma that happens at the hospital that is deeply difficult to talk about openly.

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

#ymmv wrt experiences at the hospital #as ive said in the guide ive seen both sides and both ends of the spectrum #its not hard to abuse the power hospitals give to their staff #and patients are frequently dehumanized not because we're sick or secretly evil #but because the nurses and techs and doctors are also not given support they need to remain healthy #cw mentions of suicide

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[ask-the-prose]

Something else you may see as someone who has to read a lot of ai generated drivel from employees who use it to generate emails: large, professional sounding words either used incorrectly or barely correctly. Where a simpler turn of phrase can be used, ai generated text will use the most "professional" or smart sounding words.

Real example from a text message generated by ai: Hello [me], I'm currently experiencing delays in my estimated time of arrival. I'm driving at a reduced speed due to my impaired vision without wearing my glasses.

A person would say: Hi/hey/hello/good morning, I'm running late. I left my glasses at work and I'm trying to drive safely.

If you catch yourself rolling your eyes or feeling like you are wasting time trying to interpret the complicated language that can easily be rephrased to use simple clear language, it was probably an ai directed to sound professional or expert.

This is especially relevant to bots giving writing advice because they are trying very hard to sound expert. In reality, they sound stilted and tedious to read.

How to Tell If That Post of Advice Is AI Bullshit

Right, I wasn't going to write more on this, but every time I block an obvious AI-driven blog, five more clutter up the tags. So this is my current (April 2024) advice on how to spot AI posts passing themselves off as useful writing advice.

No Personality - Look up a long-running writing blog, you'll notice most people try to make their posts engaging and coming from a personal perspective. We do this because we're writers and, well, we want to convey a sense of ourselves to our readers. A lot of AI posts are straight-forward - no sense of an actual person writing them, no variation in tone or text.

No Examples - No attempts to show how pieces of advice would work in a story, or cite a work where you could see it in action. An AI post might tell you to describe a person by highlighting two or three features, and that's great, but it's hard to figure out how that works without an example.

Short, Unhelpful Definitions - A lot of what I've seen amount to two or three-sentence listicles. 'When you want to write foreshadowing, include a hint of what you want foreshadowed in an earlier chapter.' Cool beans, could've figured that out myself.

SEO/AI Prompt Language Included - I've seen way too many posts start with "this post is about..." or "now we will discuss..." or "in this post we will..." in every single blog. This language is meant to catch a search engine or is ChatGPT reframing the prompt question. It's not a natural way of writing a post for the average tumblr user.

Oddly Clinical Language - Right, I'm calling out that post that tried to give advice on writing gay characters that called us "homosexuals" the entire time. That's a generative machine trying to stay within certain parameters, not an actual person who knows that's not a word you'd use unless you were trying to be insulting or dunking on your own gay ass in the funniest way possible.

Too Perfect - Most generative AI does not make mistakes (this is how many a student gets caught trying to use it to cheat). You can find ways to make it sound more natural and have it make mistakes, but that takes time and effort, and neither of those are really a factor in these posts. They also tend to have really polished graphics and use the same format every time.

Maximized Tags (That Are Pointless) - Anyone who uses more than 10 one-word tags is a cop. Okay, fine, I'm joking, but there's a minimal amount of tags that are actually useful when promoting a post. More tags are not going to get a post noticed by the algorithm, there is no algorithm. Not everyone has to use their tags to make snarky comments, but if your tags look like a spambot, I'm gonna assume you're a spambot.

No Reblogs From The Rest of Writblr - I'm always finding new Writblr folks who have been around for awhile, but every real person I've seen reblogs posts from other people. We've all got other stuff to do, I'm writing this blog to help others and so are they, the whole point of tumblr is to pass along something you think is great.

While you'll probably see some variation in the future - as people get wise to obviously generated text, they'll try to make it look less generated - but overall, there's still going to be tells to when something is fake.

I don't have any real advice for what to do about this (other than block those blogs, which is what I do). Like most AI bullshit, I suspect most of these blogs are just another grift, attempting to build large follower counts to leverage or sell something to in the future. They may progress past these tattletale features, but I'm still going to block them when I see them. I don't see any value in writing advice compiled from the work of better writers who put the effort in when I can just go find those writers myself.

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[ask-the-prose]

Hello!

So, I'm writing a literal nightmare for story, I'm still not sure of what will be the exact plot, I'm just vibing and writing it all based off a nightmare I had myself one month ago. In that story, everyone disappears besides the protagonist and her two younger brothers who don't really speak (6 and 2 yo) while she's alone at home with them. I want it to be subtle that it is actually a dream, but not very unexpected, you know? I'm making an open ending too, I'm not so worried because I don't plan of posting/publishing, I'm writing more for myself, but I still felt like asking this to see if I can have any advice, since I'm not very experienced and a teenager. How do I make it sound/look like a nightmare without making it too obvious? Thank you. I hope this makes sense...

Hey there! Thanks for the ask :)

This seems like an interesting concept and like something that can give you all sorts of great practice and a chance to experiment with your style and process. I'll do my best to give you advice you can use, but like you said, this is for you so you're welcome to take or leave anything I say.

I always find that when it comes to making your writing feel some type of way, the devil is in the details. Think back to the nightmare that inspired you. Were there any hints that it was a dream? I'll admit, I lucid dream most of the time, so I know when things are dreams immediately. (Think, oh this zombie is about to bite me, luckily this is a dream and I'm going to fly away. That's my personal dream logic.)

The thing about dreams is that they are a salad of your subconscious thoughts and ideas. Things don't tend to mesh well together, nor is there really a comprehensible plot line, which makes it difficult to turn them into a story. That being said, stories don't have to be true to life. This nightmare story has an open ending right? So perhaps it's a dream, perhaps not. That's for the reader to decide.

But as for your part, you can add details that don't add up. Things moving around on a table, concepts not adding up, all of that goes hand in hand with the horror genre, and are also common aspects of dreams that people don't pick up on until they've woken up. ("Of course that dream wasn't real, it took place in a bedroom I haven't slept in since I was a child!") Dreams are hazy and difficult to logic your way through, but when everything is clear when you wake up, it's obvious right?

It's difficult to recreate this in writing without being confusing to the reader. Objects moving around on tables when a character doesn't notice or make note of the strangeness seems like an error on the author's end. Something common in writing especially in movies and TV shows is to have the character remark that something is unbelievable or strange in order to push the audience to further suspend their disbelief beyond what they already have, to accept events that seem outlandish or beyond expectation. You can use this tool in your writing as well.

Something like this: Protagonist set the glass down upon the table before her youngest brother. With a shriek, he swiped his hand across the table, knocking the plastic bowl to the ground. Protagonist stopped. The bowl was a glass a moment ago, right? Brother shrieked again, this time in bubbling belly laughs that brought a smile to Protagonist's face despite the mess.

Acknowledge the strange, but move on as if the strange was exactly what the reader should have expected. You can use this strategy often to great effect in the horror genre. Think about every slasher movie ever made, they use this tool a lot!

Another method you could use would resemble books or other stories with time skips and flash backs and forwards. These can be utilized in a lot of genres, but you see them a lot also in horror and mystery. Modify it to suit your needs. Something can be framed as a flashback or forward, when textually, it's more like one of those moments people have in the middle of the night where they wake up briefly and return to sleep without recognizing they'd ever been asleep. When I do this, it's usually to gulp down as much water as I can handle without accidentally drowning myself, but ymmv, everyone's different.

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

[ask-the-prose]

Writing Mental Health With Compassion

I've gotten a few questions regarding depicting characters with mental health challenges and conditions and I wanted to expand a little more on how to depict these characters with compassion for the real communities represented by these characters.

A little about this guide: this is, as always, coming from a place of love and respect for the writing community and the groups affected by this topic at large. I'm also not coming at this from the outside, I have certain mental illnesses that affect my daily life. With that, I'll say that my perspective may be biased, and as with all writing advice, you should think critically about what is being told to you and how.

So let's get started!

Research

I'm sure we're all tired of hearing the phrase "do your research," but unfortunately it is incredibly important advice. I have a guide that touches on how to do research here, if you need a place to get started.

When researching a mental health condition that we do not experience, we need to do so critically, and most importantly, compassionately. While your characters are not people, they are assigned traits that real people do have, and so your depiction of these traits can have an impact on people who face these conditions themselves.

I've found that reddit is a decent resource for finding threads of people talking about their personal experiences with certain illnesses. For example, bipolar disorder has several subreddits that have very open and candid discussions about bipolar, how it impacts lives, and small things that people who don't have bipolar don't tend to think about.

It's important to note that these spaces are not for you. They are spaces for people to talk about their experiences in a place without judgment or fear or stigma. These are not places for people to give out writing advice. Do NOT flood subreddits for people seeking support with questions that may make others feel like an object to be studied. It's not cool or fair to them for writers to enter their space and start asking questions when they're focused on getting support. Be courteous of the people around you.

Diagnosis

I have the belief that for most stories, a diagnosis for your characters is unnecessary. I have a few reasons for thinking this way.

Firstly, mental health diagnoses are important for treatment, but they're also a giant sign written across your medical documents that says, “I'm crazy!” Doctors may try to remain unbiased when they see mental health diagnoses, but anybody with a diagnosis can say that doctors rarely succeed. This translates to a lot of people never getting diagnoses, never seeking treatment, or refusing to talk about their diagnosis if they do have one.

Secondly, I've seen posts discuss “therapy speak” in fiction, and this is one of those instances where a diagnosis and extensive research may make you vulnerable to it. People don't tend to discuss their diagnoses freely and they certainly don't tend to attribute their behaviors as symptoms.

Finally, this puts you, the writer, into a position where you treat your characters less like people and story devices and more like a list of symptoms and behavioral quirks. First and foremost, your characters serve your story. If they don't feel like people then your characters may fall flat. When it comes to mental illness in characters, the people aspect is the most important part. Mentally ill people are people, not symptoms.

Those are my top three reasons for believing that most characters will never need a specific diagnosis. You will likely never need to depict the difference between bipolar and borderline because the story itself does not need that distinction or to reveal a diagnosis at all. I feel that having a diagnosis in mind for a character has more pitfalls than advantages.

How does treatment work?

Treating mental health conditions may appear in your story. There are a number of ways treatments affect daily life and understanding the levels of care and what those levels treat will help you depict the appropriate settings for your characters.

The levels of care range from minimally restrictive and minimal care to intensive in-patient care in a secure hospital setting.

Regular or semi-regular therapy is considered outpatient care. This is generally the least restrictive. Your characters may or may not also take medications, in which case they may also see a psychiatrist to prescribe those medications. There is a difference between therapists, psychiatrists, and psychologists. Therapists do not prescribe medications, psychiatrists prescribe medications after an evaluation, and psychologists will (sometimes) do both. (I'm US, so this may work differently depending where you are. You should always research the specific setting of your story.) Generally, a person with a mental illness or mental health condition will see both an outpatient therapist and an outpatient psychiatrist for their general continuing care.

Therapists will see their patients anywhere from once in a while as-needed to twice weekly. Psychiatrists will see new patients every few weeks until they report stabilizing results, and then they will move to maintenance check-ins every 90-ish days.

If the patient reports severe symptoms, or worsening symptoms, they will be moved up to more intensive care, also known as IOP (Intensive Outpatient Program). This is usually a group-therapy setting for between 3-7 hours per day between 3-5 days a week. The group-therapy is led by a Licensed Professional Counselor (LPC) or Licensed Professional Social Worker (LPSW). Groups are structured sessions with multiple patients teaching coping mechanisms and focusing on treatment adjustment. IOP’s tend to expect patients to see their own outpatient psychiatrist, but I've encountered programs that have their own in-house psychiatrists.

If the patient still worsens, or is otherwise needing more intensive care, they'll move up to PHP (Partial Hospitalization Program). This can look different per facility, but I've seen them to be more intensive in hours and content than IOP. They also usually have in-house psychiatrists doing diagnostic psychological evaluations. It's very possible for characters with “mild” symptoms to go long periods of time, even most of their lives, without having had a diagnosis. PHP’s tend to need a diagnosis so that they can address specific concerns and help educate the patient on their condition and how it may manifest.

Next step up is residential care. Residential care is a boarding hospital setting. Patients live in the hospital and focus entirely on treatment. Individual programs may differ in what's allowed in, how much contact the patients are allowed to have, and what the treatment focus is. Residential programs are often utilized for addiction recovery. Good residential programs will care about the basis for the addiction, such as underlying mental health issues that the patient may be self-medicating for. Your character may come away with a diagnosis, or they may not. Residential programs aren't exclusively for addictions though, and can be useful for severe behavioral concerns in teenagers or any number of other concerns a patient may have that manifest chronically but do not require intensive inpatient restriction.

Inpatient hospital stays are the highest level of care, and this tends to be what people are talking about when they tell jokes about “grippy socks.” These programs are inside the hospital and patients are highly restricted on what they can and cannot have, they cannot leave unless approved by the hospital staff (the hospital's psychiatrist tends to have the final say), and contact with the outside world is highly regulated. During the days, there are group therapy sessions and activities structured very carefully to maintain routine. Staff will regulate patient hygiene, food and sleep routines, and alone time.

Inpatient hospital programs are controversial among people with mental illness and mental health concerns. I find that they have use, but they are also not an easy or first step to take when dealing with a mental health condition. Patients are not allowed sharp objects, metal objects, shoelaces, cutlery, and pens or pencils. Visitors are not allowed to bring these items in, staff are not allowed these items either. This is for the safety of the patients. Typically, if someone is involuntarily admitted into the inpatient hospital program, it is due to an authority (the hospital staff) deeming the patient as a danger to themselves or others. Whether they came in of their own will (voluntary) or not does not matter in how the program operates. Everyone is treated the same. If someone is an active danger to themselves, then they may be on 24-hour suicide watch. They are not allowed to have any time alone. No, not even for the bathroom, or while sleeping, or during group sessions.

Inpatient Hospital Programs

This is a place of high curiosity for those who have never been admitted into inpatient care, so I'd like to explain a little more in detail how these programs work, why they're controversial, but how they can be useful in certain situations. I do have personal experience in this area, but as always, your mileage may vary.

When admitting, hospital staff are the final say. Not the police. The police hold some sway, but most often, if someone is brought in by the police, they are likely to be admitted. They are only involuntarily admitted when the situation demands: the staff have determined the person to be an imminent danger to themselves or others. This is obviously subjective, and can easily be abused. A good program with decent staff will do everything they can to convince the patient to admit voluntarily if they feel it is necessary, but ultimately if the patient declines and the staff don't feel they can make the clinical argument that admittance is necessary, the patient is free to leave. It should be noted that doctors and clinicians have to worry about possibly losing their licenses to practice. They don't want to fuck around with involuntary admittance if they don't have to, and they don't want potentially dangerous people to walk away.

Once admitted, the patient will have to remove their clothing and put on a set of hospital scrubs. These are mostly made of paper, and most often do not have pockets, but I have seen sets that do have pockets (very handy, tbh). They are not allowed to take anything into the hospital wing except disability-required devices such as glasses, hearing aids, mobility aids, etc. Most programs will require removing piercings, but not all of them, in my experience.

The nurses will also do a physical examination, where they will make note of any open wounds, major scars, tattoos, and other skin abrasions that may be relevant.

The patient will then be led to their bed, where they will receive any approved clothing items from outside, a copy of their patient rights, and a copy of the floor code of conduct and rules, a schedule, and any other administrative information necessary for the program to run efficiently and legally.

Group sessions include group-therapy, activities, coping skills, anger management, anxiety management, and for some reason, karaoke. There is a lot of coloring involved, but only with crayons. A good program will focus heavily on skills and therapeutic activities. Bad programs will phone it in and focus on karaoke and activities. Most hospitals will have a chaplain, and some will include a religious group session. I've never attended these, so I can't speak for them.

Unspoken rules are the hidden pieces of the inpatient programs that patients tend to find out during their first visit. There is no leaving the program until the doctor agrees to it. The doctor will only agree to it if they deem you ready to leave, and you are only ready to leave if you have been compliant to treatment and have seen positive results in the most dangerous symptoms (homicidal or suicidal ideations). Noncompliance can look like: refusing your prescribed medications (which you have the right to do at any time for any reason. That does not mean that there won't be consequences. This is a particularly controversial point.), refusing to attend groups (chapel is not included in this point, but that doesn't mean it's actually discounted. Another controversial point.), violent or disruptive outbursts such as yelling or throwing things, and refusing to sleep or eat at the approved and appointed times. All of this may sound like the hospital is restricting your rights beyond reason, but I've seen the use, and I've seen the abuse. Medications are sometimes necessary, and often patients seriously prefer having medication. Groups are important to a person's treatment, and refusing to go can be a sign of noncompliance or worsening symptoms. If someone is too depressed or anxious to go to group, then they're probably not ready to leave the hospital where the structure is gone and they must self-regulate their treatment. Violent or disruptive outbursts tend to be a sign of worsening symptoms in general, but even the best of us lose our tempers from time to time when put into a highly stressful situation like an inpatient hospital stay. The hospital is supposed to be a place of healing, for many it is. But for many more, it is a place of systematic abuse and restriction.

Discharge processes can be long and arduous and INCREDIBLY stressful for the patient. Oftentimes, they won't know their discharge date until the day of, or perhaps the day before. Though the date can change at any time. The discharge process requires the supervising psychiatrist to meet with the treatment team and then the patient to determine if the patient had progressed enough to be safely discharged. Discharge also requires a set outpatient plan in place, such as a therapy appointment within a week, a psychiatrist visit, or admittance into a lower level of care. This is where social workers are involved. Patients are not allowed access to cell phones or the internet. They cannot make their own appointments with their outpatient care providers without a phone number and phone access. Some floors will have phone access for this reason, others will insist the social worker arrange appointments and discharge plans. Social workers are often incredibly overworked, with several patients on their caseload.

The patient cannot be discharged until the social worker has coordinated the discharge plan to the doctor's approval. Most often, unfortunately, the patient rarely receives regular communication regarding the progress of their discharge. I've been discharged with as much as a day's notice to two hours notice.

Part 2 Coming Soon

This guide got longer than expected! Out of respect for my followers dashboard, I will be cutting it here and adding a Part 2 later on.

If you find that there are more specific questions you'd like answered, or topics you'd like covered, send an ask or reply to this post with what you'd like to see in Part 2.

– Indy

#writing advice #writing tips #writing resources #writeblr #amwriting #asktheprose #ask the prose #writing mental health #mental health #writing with compassion #writing mental illness #writing compassionately

[ask-the-prose]

So that was a lie... editing now and posting today!

Hey writers! Sorry for the extended absence from this blog, but keep an eye out for a new guide coming out in a few days! Just need to edit it up and it will be ready for posting.

- Indy

[ask-the-prose]

Hey writers! Sorry for the extended absence from this blog, but keep an eye out for a new guide coming out in a few days! Just need to edit it up and it will be ready for posting.

- Indy

[ask-the-prose]

Here's a summary:

MILIEU: A milieu story concerns the world surrounding the characters you create.

IDEA: An idea story concerns the information you intend the reader to uncover or learn as they read your story.

CHARACTER: A character story concerns the nature of at least one of the characters in your story. Specifically, what this character does and why they do it.

EVENT: An event story concerns what happens and why it happens.

Let's examine each of these in turn.

[ask-the-prose]

Do Your Research

This phrase is regularly thrown around writeblr and for good reason. It's important to research what you are writing about to know what to include, what can be fudged, and how to depict whatever you're writing. I see "do your research" most thrown around by well-meaning and highly traditionally educated writers. It's solid advice, after all!

But how do you research?

For those writers who don't already have the research skills necessary to write something comfortably already downloaded into your brain, I put this guide together for you.

Where do I even start?

It's a daunting task, research. But the best place to start is with the most basic, stupidest question you can think of. I'm going to talk about something that I already know a lot about: fighting.

When researching fight scenes, a great way to start is to look up what different weapons are. There are tons out there! So ask the stupid questions. What is a sword? What is a gun? How heavy are they?

Google and Wikipedia can help you a lot with these basic-level questions. They aren't great sources for academic articles, but remember, this is fiction. It doesn't need to be perfect, and it doesn't need to be 100% accurate if you don't want it to be. But knowing what is true to life will help you write well. Just like knowing the rules of writing will help you break them.

You may find in your basic research sweep that you have a lot more specific questions. Write them all down. It doesn't matter if they seem obvious. Write them down because they will be useful later.

How To Use Wikipedia Correctly

Wikipedia is a testament to cooperative human knowledge. It's also easy to edit by anonymous users, which means there is a lot of room for inaccuracies and misleading information. Wikipedia is usually pretty good about flagging when a source is needed or when misleading language is obvious, but Wikipedia itself isn't always the most accurate or in-depth source.

Wikipedia is, however, an excellent collection of sources. When I'm researching a subject that I know nothing about, say Norse mythology, a good starting point is the Wikipedia page for Odin. You'll get a little background on Odin's name and Germanic roots, a little backstory on some of the stories, where they appear, and how they are told.

When you read one of the sentences, and it sparks a new question, write the question down, and then click on the superscript number. This will take you directly to the linked source for the stated fact. Click through to that source. Now you have the source where the claim was made. This source may not be a primary source, but a secondary source can still lead you to new discoveries and details that will help you.

By "source-hopping," you can find your way across the internet to different pieces of information more reliably. This information may repeat itself, but you will also find new sources and new avenues of information that can be just as useful.

You mean I don't need a library?

Use your library. Libraries in many parts of the US are free to join, and they have a wealth of information that can be easily downloaded online or accessed via hardcopy books.

You don't, however, need to read every source in the library for any given topic, and you certainly don't need to read the whole book. Academic books are different from fiction. Often their chapters are divided by topic and concept and not by chronological events like a history textbook.

For example, one of my favorite academic books about legislative policy and how policy is passed in the US, by John Kingdon, discusses multiple concepts. These concepts build off one another, but ultimately if you want to know about one specific concept, you can skip to that chapter. This is common in sociological academic books as well.

Going off of my Norse Mythology example in the last section, a book detailing the Norse deities and the stories connected to them will include chapters on each member of the major pantheon. But if I only care about Odin, I can focus on just the chapters about Odin.

Academic Articles and How To Read Them

I know you all know how to read. But learning how to read academic articles and books is a skill unto itself. It's one I didn't quite fully grasp until grad school. Learn to skim. When looking at articles published in journals that include original research, they tend to follow a set structure, and the order in which you read them is not obvious. At all.

Start with the abstract. This is a summary of the paper that will include, in about half a page to a page, the research question, hypothesis, methods/analysis, and conclusions. This abstract will help you determine if the answer to your question is even in this article. Are they asking the right question?

Next, read the research question and hypothesis. The hypothesis will include details about the theory and why the researcher thinks what they think. The literature review will go into much more depth about theories, what other people have done and said, and how that ties into the research of the present article. You don't need to read that just yet.

Skim the methods and analysis section. Look at every data table and graph included and try to find patterns yourself. You don't need to read every word of this section, especially if you don't understand a lot of the words and jargon used. Some key points to consider are: qualitative vs. quantitative data, sample size, confounding factors, and results.

(Some definitions for those of you who are unfamiliar with these terms. Qualitative data is data that cannot be quantified into a number. These are usually stories and anecdotes. Quantitative data is data that can be transferred into a numerical representation. You can't graph qualitative data (directly), but you can graph quantitative data. Sample size is the number of people or things counted (n when used in academic articles). Your sample size can indicate how generalizable your conclusions are. So pay attention. Did the author interview 300 subjects? Or 30? There will be a difference. A confounding factor is a factor that may affect the working theory. An example of a theory would be "increasing LGBTQ resources in a neighborhood would decrease LGBTQ hate crimes in that area." A confounding factor would be "increased reporting of hate crimes in the area." The theory, including the confounding factor, would look like "increasing LGBTQ resources in a neighborhood would increase the reporting of hate crimes in the area, which increases the number of hate crimes measured in that area." The confounding factor changes the outcome because it is a factor not considered in the original theory. When looking at research, see if you can think of anything that may change the theory based on how that factor interacts with the broader concept. Finally, the results are different from the conclusions. The results tell you what the methods spit out. Analysis tells you what the results say, and conclusions tell you what generalizations can be made based on the analysis.)

Next, read the conclusion section. This section will tell you what general conclusions can be made from the information found in the paper. This will tell you what the author found in their research.

Finally, once you've done all that, go back to the literature review section. You don't have to read it necessarily, but reading it will give you an idea of what is in each sourced paper. Take note of the authors and papers sourced in the literature review and repeat the process on those papers. You will get a wide variety of expert opinions on whatever concept or niche you're researching.

Starting to notice a pattern?

My research methods may not necessarily work for everybody, but they are pretty standard practice. You may notice that throughout this guide, I've told you to "source-hop" or follow the sources cited in whatever source you find first. This is incredibly important. You need to know who people are citing when they make claims.

This guide focused on secondary sources for most of the guide. Primary sources are slightly different. Primary sources require understanding the person who created the source, who they were, and their motivations. You also may need to do a little digging into what certain words or phrases meant at the time it was written based on what you are researching. The Prose Edda, for example, is a telling of the Norse mythology stories written by an Icelandic historian in the 13th century. If you do not speak the language spoken in Iceland in 1232, you probably won't be able to read anything close to the original document. In fact, the document was lost for about 300 years. Now there are translations, and those translations are as close to the primary source you can get on Norse Mythology. But even then, you are reading through several veils of translation. Take these things into account when analyzing primary documents.

Research Takes Practice

You won't get everything you need to know immediately. And researching subjects you have no background knowledge of can be daunting, confusing, and frustrating. It takes practice. I learned how to research through higher formal education. But you don't need a degree to write, so why should you need a degree to collect information? I genuinely hope this guide helps others peel away some of the confusion and frustration so they can collect knowledge as voraciously as I do.

– Indy

[ask-the-prose]

Conducting a War

So, your story takes place during a war. Maybe your characters are experiencing war or maybe they're waging war against other characters or groups. Likely, you are not a general or expert in warfare. How do you write a story that is set during a war?

Who's fighting who?

The first, most obvious, step is to know who is fighting whom and why. Wars are between groups of people. They can be a small clan, a massive nation, or even an entire planet or galaxy. Two characters fighting it out are not considered "at war" because they are representing themselves and settling an individual dispute, even if it is a high-stakes dispute.

Why are the parties in your story fighting? There are a lot of different reasons why two groups of people would go to war against each other, but most wars are over resources at their center. Disputes over land and borders, over who gets what crops and for what price, and even religious wars are usually about the resources available and scarcity. So when you're talking about war, you need to know what either side wants. Just like a character, your war parties need to have desires and stakes.

"Resources" can mean just about anything that society needs. Food, fresh water, opportunities for trade, minerals, metals, building materials, and wealth are all examples of resources your war parties can fight over.

What does it take to wage war?

Wars require resources too. It's not just about getting resources but spending resources as well. When nations go to war in the real world, there are opportunities for people to make exorbitant amounts of money and wealth by taking advantage of a wartime economy.

The parties waging war need people to fight their battles. They need to pay those people, arm them, feed and clothe them, and transport them to where they need to be. Where does the government or person in charge get the food, armor, weapons, and transportation? Where do they allocate those scarce resources? Oftentimes in war, those in charge must make sacrifices. Is there a portion of land that the person in charge gives up to protect another portion with their limited resources?

There are unlimited stories hidden in these questions, and a large base of world-building will help to answer these questions in depth. There are many opportunities for tension and rising stakes for your war parties in the event that the opposing side makes acquiring war resources difficult or impossible.

Types of Armies

Your armies tell you a lot about the resources available to your characters and how you can build your story and plot line around the war. So I'll discuss the differences between four types of armies that exist in the real world and throughout history. These are examples; you can change or twist these examples however best suits your story.

The first is a professional army. These guys are paid and trained by the state; being in the army is their entire job. The army can fill a number of different roles other than fighting, but their purpose is to provide martial protection to the people of their nation and carry out martial orders from the government or sovereign entity in charge. Important aspects of a professional army to consider: these soldiers are paid for their work, they are trained by professionals, and oftentimes they follow a hierarchy or chain of command. Most governments provide medical care to their professional armies, but this isn't required. The soldiers can be conscripted or voluntary.

Next up is a mercenary army. This army is also paid for their services, but they are not trained by the state, and they ultimately take their orders from the organization, not the government. The government commissions the mercenary army for their services. The government does not provide most of the resources required to maintain an army. They pay for the army but don't necessarily feed, arm, or clothe them.

A fyrd is a historical term that refers specifically to the Anglo-Saxon armies raised by different Lords and Thegns to protect their lands and shires. These armies consisted of civilians and able-bodied free men from the local settlements and farms gathered by the ealdorman. They were conscripted into the service, and they lacked formal martial training. Also, importantly, their provisions and weapons were provided by the soldiers themselves. Meaning you will see fewer long swords and forged weapons for the purposes of fighting and more axes and improvised weaponry. The purposes of the improvised weaponry are primarily as other tools, such as axes for chopping wood and knives for butchery. Any horses or mules brought along for work or fighting are the property of the lords or farm owners who provided them.

A militia is very similar to a fyrd; this army consists of civilians who are paid or conscripted into service by the government but are not professional soldiers. These militias may sometimes have training from professional soldiers among their ranks, but mostly they are civilians training themselves. The soldiers provide their provisions, weaponry, and armor, meaning that the wealth has to come from the soldiers and their professional jobs and not from their martial services. The militia is a more modern term, but it is marginally different in that most militias we think of today are voluntary and not conscripted.

Battle Strategy

This is where a little research may help you. Battles behave differently depending on different factors. What technology and weaponry is available to your war parties? Are we talking about bladed weapons or guns or lasers? Is your army a professional or mercenary army, or is it more like a fyrd or militia?

When setting up a battle in your story, focus on the differences between the two armies and how that may affect their strategy toward fighting or engaging the enemy. If your fyrd faces a professional army, they may encounter some problems regarding weaponry and armor. Your fyrd will struggle to match a professional army in defending against well-made weapons and professional training. How do they work to compensate for those weaknesses?

When looking at two equally armed and trained armies, a general or battle strategist will look to the terrain to plan a battle. Generally, controlling the high ground helps in battles. If one army has a heavy cavalry presence, your opposing army may want anti-cavalry measures in place. Do they have the space to do so? Urban areas will lend themselves well to guerilla-style and urban warfare tactics. Jungles and forests will look different to hills and plains, and deserts bring unique problems to a battle that a mountainous terrain might not.

What is the battle for? Battles have a purpose; otherwise, there would be no value to the loss of troops. What is worth the risk of losing lives? Does the battle have stakes? Some stakes that might be worth conducting a battle over include taking control of a river pass, allowing naval trade and travel, cutting off control of a trade route to the enemy, or invading an important town or city to process and refine necessary materials.

Ending the War

The war will eventually end if your characters are lucky. But what ends a war? Wars usually end with agreements between the two opposing parties following surrender or extension of peaceful negotiations. Negotiating what each party needs or wants is an art in and of itself. Each party must come to the agreement that waging war further is more expensive and less rewarding than ending violent opposition with concessions made by either side.

Conclusion

Wars and battles are like characters; they have needs, desires, and stakes. Writing your characters in a war or battle will hinge on the needs and stakes of the greater war and story. Important questions to ask are: what are we fighting for? Who are we fighting? And what happens if we don't fight?

–Indy