Encountering characters who look, speak, and behave in familiar ways can help readers feel seen, heard, and, most of all, included. As writers, we want to create diverse and representative characters, and in today’s context that means including characters with mental health challenges. Here are four tips to help indie writers create a child or teen character who accurately portrays what it’s like to have a mental health challenge.
Ask yourself, Why this issue?
Why do you want to create a character with this particular mental health struggle? Do you have this diagnosis? Do you know someone with this diagnosis? Were you inspired by a character in a book or movie? Uncover any and all motivations for showcasing this particular mental health diagnosis. There’s no special formula or set of questions that will determine whether you’re “qualified” to write about a particular diagnosis. But it’s never a good idea to create a character with a specific mental health challenge simply because that diagnosis is receiving attention in the news, was recently featured in a bestselling book, or is considered “trendy.”
Decide whether to name or not to name
It’s important to decide what you will call the experience in your story. Some authors use standard medical terminology; others describe behaviors without giving the character a specific diagnosis. Crystal did both in her middle grade novel Between Two Brothers. One character is diagnosed with an anoxic brain injury, which leads to a host of mental and physical challenges. These challenges are described, along with his therapy appointments and relationships with friends and family. Another character, Uncle Jerry, has undefined mental health challenges. Crystal chose to describe his actions without giving him a specific diagnosis.
Using medical terms, such as “autism spectrum disorder” or “obsessive compulsive disorder,” can help destigmatize such labels while also ensuring that everyone is talking about the same thing. But, for better or worse, a diagnosis is still a label. And, in the real world, plenty of people meet criteria for mental health disorders without ever receiving an official diagnosis. The important thing is being consistent within your story.
Do your research
Mental health diagnoses are made by trained professionals using the current version of the Diagnostic and Statistical Manual of Mental Health Disorders or the International Classification of Diseases. This is not a perfect system, which means that, after establishing academic knowledge of a diagnosis, you need to understand how people experience the symptoms in the real world. This is important because the same mental health diagnoses can manifest in dramatically varying ways. Some cultures view mental health disorders as medical conditions that can be treated with therapy and/or medication. In other cultures, mental health issues are not discussed and are often not seen as treatable. You must understand cultural background, demographics, and spiritual beliefs to accurately represent mental health challenges in a novel.
Consider this fictional example based on Katie’s personal experience as a pediatric neuropsychologist. Imagine two children: The first child is a 10-year-old white girl. She’s an only child with two English-speaking college-educated parents who work in the technology industry in a large city. The girl attends a private school, takes horseback riding and dance lessons, and is learning Mandarin with a private tutor.
The second child is a 10-year-old Hispanic girl. She has three brothers and one sister. She recently moved from another country to a small town in the United States. Her mother speaks some English and is the primary financial provider. Her father speaks only Spanish and works long hours in the food service industry. The girl attends a public school with large classes and isn’t involved in after-school activities because she cares for her siblings every afternoon until a parent comes home.
Both of these children might ultimately meet criteria for depression (depressed mood, loss of interest in activities previously enjoyed, and so on) but the factors that contributed to their depression, what their symptoms look like, how their parents respond, and how others view their experience may be very different. Failing to understand how differently the same disorder can present in and affect two individuals can lead to myths, mistakes, and mischaracterizations.
Don’t make your character’s diagnosis their flaw
As readers, we love flawed characters because flaws are where we find hope and the possibility of healing. It may seem like giving a character a mental health diagnosis is making things hard enough for them, but your character is so much more than their diagnosis.
In order to create realistic flaws in your character, it’s important to know when their mental health challenges began. If a character is diagnosed at birth, they have time to develop life skills to manage their disorder. They may demonstrate higher levels of empathy toward other people who are dealing with mental health challenges. They may also always feel “different” or left out, and their behavior may reflect ongoing efforts to fit in. If a character hasn’t lived their entire life with a mental health disorder, they may experience denial after the diagnosis. They may pretend that nothing is wrong, refrain from asking for help, and refuse prescribed medication. They may seek to hide the truth from friends or extended family.
Everything is amplified during the tween and teen years, including the stress of friend choices, emotions, bodily changes, and likes or dislikes. When you have a mental health challenge, the amplification of these things can become an added stress, and that is where flaws should spring from.
As writers, we have a responsibility to accurately portray mental health disorders in the characters we create. Books unquestionably need more characters who depict what it’s like to live with a specific mental health diagnosis, and authors would do well to approach this aspect of their writing with the utmost care and respect.
Crystal Allen is the author of How Lamar’s Bad Prank Won a Bubba-Sized Trophy, The Laura Line, and other middle grade novels. Katie Keridan, a neuropsychologist with a doctorate in psychology and a master’s in public health, is the author of YA fantasy novels including Reign Returned and Blood Divided.
